Quality Of Later Life Research Articles

Health Inequality Among the Elderly in Rural China and Influencing Factors: Evidence from the Chinese Longitudinal Healthy Longevity Survey.

Based on data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), this paper calculates the health distribution of the elderly using the Quality of Well-Being Scale (QWB) score, and then estimates health inequality among the elderly in rural China using the Wagstaff index (WI) and Erreygers index (EI). Following this, it compares health inequalities among the elderly in different age groups, and finally, uses the Shapley and recentered influence function-index-ordinary least squares (RIF-I-OLS) model to decompose the effect of four factors on health inequality among the elderly in rural China. The QWB score distribution shows that the health of the elderly in rural China improved with social economic development and medical reform from 2002 to 2014. However, at the same time, we were surprised to find that the health level of the 65–74 years old group has been declining steadily since 2008. This phenomenon implies that the incidence of chronic diseases is moving towards the younger elderly. The WI and EI show that there is indeed pro-rich health inequality among the rural elderly, the health inequality of the younger age groups is more serious than that of the older age groups, and the former incidence of health inequality is higher. Health inequality in the age group of 65–74 years old is higher than that in other groups, and the trend of change fluctuated downward from 2002 to 2014. Health inequality in the age group of 75–84 years old is lower than that in the group of 65–74 years old, but higher than that in the other age groups. The results of Shapley decomposition show that demographic characteristics, socioeconomic status (SES), health care access, and quality of later life contributed 0.0054, 0.0130, 0.0442, and 0.0218 to the health inequality index of the elderly, which accounted for 6.40%, 15.39%, 52.41%, and 25.80% of health inequality index. From the results of RIF-I-OLS decomposition, this paper has analyzed detailed factors’ marginal effects on health inequality from four dimensions, which indicates that the health inequality among the elderly in rural China was mainly caused by the disparity of income, medical expenses, and living arrangement.

The Effects of Health Promotion Program on Health belief, Health promoting Behavior and Quality of Life for Middle-aged Women: Based on Health Belief Model

Purpose: The purpose of this study was to examine the effects of health promotion program, which was based on the Health Belief Model, on the health belief, health promoting behavior and quality of life for middle-aged women. Methods: The study focused nonequivalent control group pretest-posttest design. Data were collected among 40 middle-aged women (20 were experimental group and 20 were control group) on 1st November 2014 and 25th April 2015. The experimental group received 12 sessions of health promotion program for aging preparation once a week for 12 weeks. Data were analyzed by χ2 and t-test and paired t-test using the PASW 21.0 program. Results: The study results shown that, health belief (t=-2.94, p=.006), health promoting behavior (t=-4.76, p<.001) and higher quality of life (t=-7.65, p<.001) scores of experimental group were higher than the control group. Conclusion: The health promotion program based on the Health Belief Model was effective and increased the health belief and health promoting behavior and quality of life among middleaged women. It seems health promotion program is necessary to improve middle age women's health and quality of later life.

High fat diet alters gut microbiota but not spatial working memory in early middle-aged Sprague Dawley rats.

As the global population ages, and rates of dementia rise, understanding lifestyle factors that play a role in the development and acceleration of cognitive decline is vital to creating therapies and recommendations to improve quality of later life. Obesity has been shown to increase risk for dementia. However, the specific mechanisms for obesity-induced cognitive decline remain unclear. One potential contributor to diet-induced cognitive changes is neuroinflammation. Furthermore, a source of diet-induced inflammation to potentially increase neuroinflammation is via gut dysbiosis. We hypothesized that a high fat diet would cause gut microbe dysbiosis, and subsequently: neuroinflammation and cognitive decline. Using 7-month old male Sprague Dawley rats, this study examined whether 8 weeks on a high fat diet could impact performance on the water radial arm maze, gut microbe diversity and abundance, and microgliosis. We found that a high fat diet altered gut microbe populations compared to a low fat, control diet. However, we did not observe any significant differences between dietary groups on maze performance (a measure of spatial working memory) or microgliosis. Our data reveal a significant change to the gut microbiome without subsequent effects to neuroinflammation (as measured by microglia characterization and counts in the cortex, hippocampus, and hypothalamus) or cognitive performance under the parameters of our study. However, future studies that explore duration of the diet, composition of the diet, age of animal model, and strain of animal model, must be explored.

Does Acculturation Matter? End-of-Life Care Planning and Preference of Foreign-born Older Immigrants in the United States.

Background and ObjectivesAdvance care planning (ACP) is a critical component of health care affecting the quality of later life. Responding to the increase in the older immigrant population in the United States, this empirical study explored the racial/ethnic gaps in ACP behaviors among older immigrants and examined the end-of-life (EOL) care planning and preferences of foreign-born immigrant older adults focusing on race/ethnicity, acculturation, health need factors, and enabling social factors (financial capability, public assistance, and informal supports) after controlling predisposing factors (sociodemographic characteristics).Research Design and MethodsUsing a subsample from the National Health and Aging Trends Study 2011 and 2012, hierarchical logistic regression models of the EOL plan and preferences were examined with 50 multiple imputation data sets (n = 232).ResultsDescriptive statistics reveal lower ACP engagement of immigrants from racial/ethnic minority groups. In logistic models, however, only Black immigrants were less likely than Whites to have EOL conversations. Among acculturation factors, age at immigration was only negatively associated with having a durable power of attorney for health, but not significantly associated with other ACP behaviors. Instead, health and social factors, primarily need in health and informal support (i.e., number of coresidents and receiving financial help from family members), were associated with different types of ACP components. Receiving public assistance (i.e., receiving Medicaid and SSI) were positively associated with EOL treatment preferences.Discussion and ImplicationsOlder foreign-born immigrants, in general, showed lower ACP engagement than the overall older population. Moreover, minority immigrants were lower on ACP engagement than both White immigrants. This study highlights the need for formal and informal assistance for enhancing EOL planning for older immigrants. Adding to the culturally competent approach, policy efforts should address social and health factors that accrued throughout individuals’ life spans and affect older immigrants’ EOL preparation and care.

Pszichoszomatikus tünetek gyakoriságát befolyásoló tényezők 18–90 éves nők körében

Psychosomatic health complaints are common in children and adults as well, and affect the quality of later life. Age tendency of psychosomatic complaints are influenced by regional, socioeconomic, environmental and lifestyle factors. Our aims were to reveal the age pattern of the psychosomatic health complaints in Hungarian women aged 18–90 years and to identify those components of lifestyle, body structure and environmental factors that affect the pattern of psychosomatic complaints among 18–90 year-old women.&#x0D; Healthy premenopausal and postmenopausal women were enrolled to the present analysis (n=483). Three groups of the psychosomatic health complaints were used: somatic (abdominal pain, headache, dizziness), psychic (irritability, nervousness, grumpiness) and sleep disorders (awakenings during the night, falling asleep difficulties, waking up tired). Frequency distributions of women experiencing somatic, psychic complaints and sleep disorders often (daily or several times a week) were analysed by comparing the results derived from our previous auxological study. Logistic regression analysis was applied to reveal the relationship between the groups of psychosomatic health complaints and the hypothesized predictive factors.&#x0D; The frequency of the most psycho-somatic complaints reached maximum values in the age-group of 21–25 years and another increase was identified in women aged 56–60. Irritability, waking up tired and awakenings during the night were the most frequently reported symptoms. The frequency of symptom of awakenings during the night increased up to the age group of 61–65 years. The results of the regression analysis revealed that the frequency of the psychic complaints and the level of physical activity affected the frequency of somatic complaints. Age, sleep disorders and somatic complaints were determinants of the psychic complaints. Postmenopausal status and the frequency of the psychic complaints influenced the frequency of sleep disorders.&#x0D; Numerous factors of lifestyle and body structure were tested in the analysis. Special life events (school, work, birth of children, menopause) are suspected in the background of the highlighted periods. More factors (socioeconomic status, nutrition, health condition, disabilities) should be considered in future studies.

Positive and negative social support and HPA-axis hyperactivity: Evidence from glucocorticoids in human hair

IntroductionWhile positive social support is associated with lower prevalence of disease and better treatment outcomes, negative social relationships can instead have unfavourable consequences for several physical and mental health conditions. However, the specific mechanisms by which this nexus might operate remain poorly understood. Hypothalamic–pituitary–adrenal (HPA) axis hyperactivity owing to psychosocial stress has been proposed as a potential pathway underlying the link between social support and health. Hair glucocorticoids such as cortisol and cortisone are emerging as promising biomarkers of long-term retrospective HPA activation. Therefore, the aim of this investigation was to examine the effects of positive and negative experiences of social support within key relationships (i.e. spouse/partner, children, other family members, and friends) on cortisol and cortisone. MethodsThese associations were tested in a sample of 2520 older adults (mean age 68.1) from the English Longitudinal Study of Ageing. Hair samples were collected in wave 6 (2012/13). To understand the impact of cumulative exposure to poor social support, the analysis used self-reported data from waves 4 (2008/09) and 6. Covariates included demographic, socioeconomic, lifestyle, and hair characteristics. ResultsIn cross sectional analyses, lower positive support from all sources and specifically from children were associated with higher cortisol. Additionally, lower positive support from children was positively associated with cortisone. Similarly, higher overall negative support was related to higher cortisol, and greater negative support from children was also positively associated with cortisone. In longitudinal analyses, there was evidence for positive associations between hair glucocorticoids and cumulative exposure to poorer social support. ConclusionsExperiences of low positive and high negative social support, particularly from children, were both related to higher hair glucocorticoids. Hence, social relationships of poorer quality in later life may have adverse effects on the HPA axis thereby increasing the individual’s susceptibility to poor health.

Theories of Successful Aging: A Systematic Literature Review

This study is significant in increasing interest in living a successful life among the older population. Implications are directed to social work researchers and practitioners to help educate older adults in the community on the social and behavioral importance of the positive aspects of aging such as successful aging and healthy aging to increase a chance of longevity. The major contribution of the study will be constructing and providing specific types of strategies to older adults and practitioners in the gerontological social work field who assist to improve the population's quality of later life. Rowe and Kahn's longitudinal study of successful aging contributed to the development of the theory of successful aging, which has been considered one of the most salient theories among the studies on aging. However, there have been controversies on the theory for a few reasons including the restricted subjectivity on the perceptions toward successful aging and the limited sample population for the study participants has been a critical issue. A systematic literature review was conducted to explain how Rowe and Kahn's successful aging theory was generated and to discuss about the theory in multidimensional way. In-depth discussions of Rowe and Kahn's successful aging theory has been provided, and it has been compared with other successful aging theories. In addition, detailed descriptions of other relevant theories of aging has been presented and other relevant studies using the successful aging theory among older populations have been provided in order to study about the applicability of the theory.

Religious Heterogamy and Partnership Quality in Later Life.

Prior research points to the importance of couple-level religious similarity for multiple dimensions of partnership quality and stability but few studies have investigated whether this association holds for older couples. The current article uses dyadic data from the National Social Life, Health, and Aging Project (NSHAP), a representative sample of 953 individuals age 62-91 plus their marital or cohabiting partners. We use modified actor-partner interdependence models. Religious service heterogamy predicted lower relationship happiness and satisfaction. Both associations were partially explained by the fact that religiously dissimilar partners report relatively little free time in joint activity. Further, religiously heterogamous couples had less frequent sex and engaged in less nonsexual touch than their more similar counterparts. Taken together, results attest to the ongoing importance of religious similarity-service attendance, in particular-for partnership quality in late life. Future research is needed to more fully examine which mechanisms account for these patterns.

Social support from the closest person and sleep quality in later life: Evidence from a British birth cohort study

ObjectivesSupportive social relationships have been found to be related to fewer sleep problems and better sleep quality. We examined associations between positive and negative support from the nominated close person across 15years of follow-up with sleep quality in older age. MethodsMRC National Survey of Health and Development study members reported sleep quality at age 68 (n=2446). Cumulative exposure to and changes in positive and negative support were derived from data at age 53, 60–64 and 68years. Pittsburgh Sleep Quality Index scores were regressed on social support measures adjusted for i) gender only then additionally ii) education, marital status, number in household, limiting illness, body mass index, caregiving, iii) and affective symptoms. ResultsGreater exposure to positive support and lower exposure to negative support over 15years were independently associated with better sleep quality at age 68. Sleep quality was poorer for those who experienced declining positive support or increasing negative support. Those who nominated their spouse/partner as their closest person at age 53 but not at age 68 had poorer sleep quality than those who nominated their spouse on both occasions. These associations were not explained by the covariates, including affective symptoms. ConclusionsBased on repeat data on support from the closest person, this study finds a link between declining social relationship quality and poor sleep quality. Whilst acknowledging that the association may be bi-directional, the study suggests that interventions to improve older people's social relationships may have benefits for sleep.

Factors associated with older people\u2019s long-term care needs: a case study adopting the expanded version of the Anderson Model in China

BackgroundAlongside changes in society and the economy, the family’s function of taking care of older people is weakening and the formal care mode is becoming more accepted. Older Chinese people are facing diverse choices of long-term care (LTC) modes. Acknowledging this situation, to optimize older people’s arrangements for LTC services and improve quality of later life, this study sets out to explore and make theoretical sense of older people’s LTC needs and to identify the factors influencing their LTC needs.MethodsQuestionnaire data were collected from 1090 participants in four Chinese cities in 2014. A conceptual framework was established based on the Anderson Model (i.e., predisposing factors, enabling factors, and need factors), and further strengthened by adding several psychosocial factors (i.e. intergenerational relationships, unmet care service needs, and self-image). Multinomial logistic regression was adopted to explore the influencing factors of LTC needs. Participants choosing home-and-community-based care were regarded as the reference group.ResultsAfter controlling for predisposing, enabling, and need factors, those with better self-image (OR = 1.027, p = 0.021) and fewer unmet care service needs (OR = 0.936, p = 0.009) were identified as being more likely to choose family care; those with less close intergenerational relationships (OR = 0.676, p = 0.019), fewer unmet care service needs (OR = 0.912, p = 0.027), and better self-image (OR = 1.044, p = 0.026) were more likely to choose institutional care. Gender- and age-related differences in the determinants of LTC needs were observed.ConclusionsThe findings of this study suggest that professionals and service providers should pay more attention to the important role of psychosocial factors in affecting older people’s LTC needs and be more sensitive to gender- and age-related differences. Effective efforts to improve intergenerational relationships, to further develop care services for older people, and to foster a more positive image of aging should be emphasized.

Antiplatelet therapy strategies for ischemic stroke

The paper considers the key areas of antithrombotic platelet therapy for ischemic stroke (IS). Antithrombotic therapy is shown to be a multistep and multidisciplinary strategy of treatment for patients with IS that begins with the first symptoms of the disease and continues throughout life. Each stage, including fibrinolytic therapy, early administration of antiplatelet and anticoagulant drugs, and personalized antithrombotic prevention of recurrent cerebral disorders, is important in itself and serves a single goal. Untimately, all efforts should be aimed at reducing mortality rates in the acute phase of stroke and the functional dependence of a patient and at preventing venous thromboses, recurrent stroke, and all cardiovascular events to increase the duration and quality of life. Fibrinolytic therapy increases the patient's chances for a full neurological recovery and improves the quality of later life. Antiplatelet drugs reduce the risk of cardiovascular death, early recurrences of stroke, and recurrent noncardioembolic stroke. Parenteral anticoagulants in acute stroke decrease the risk of venous thrombosis/thromboembolism, oral anticoagulants reduce that of recurrent cardioembolic stroke.

African American and Latino Men's Recommendations for an Improved Campus Environment

The purpose of this study was to share findings from semistructured qualitative interviews with 9 African American and 12 Latino men about their ideas on how university personnel could better support their needs. Stressing the need for African American men to learn self-reliance to counter microaggressions, African American participants offered recommendations to students rather than personnel. Latino participants discussed the need for personnel to provide critical information about college resources. Keywords: African Americans, Latinos, microaggressions ********** Despite increased representation in the United States, African American and Latino young men struggle in many important areas of their lives. For the past 4 decades, they have maintained the highest school dropout and incarceration rates of all ethnic groups in the United States (Reyes & Nakagawa, 2010), and although most youth transition front adolescence to adulthood to lead healthy, sustainable lives, some young people, a disproportionate number of whom are Black and Latino males, are trapped in a cycle of prison, poverty, and disadvantage (Reyes & Nakagawa, 2010, p. 37). With respect to college completion, the number of African American and Latino men attaining a bachelor's degree is much lower than the number of White and Asian and Pacific Islander men (Aud et al., 2012). It is known that degree attainment contributes to greater economic stability (U.S. Department of Labor, 2015), which is positively associated with mental health (Eaton & Muntaner, 1999). Thus, diminished educational attainment has significant consequences for African American and Latino men, who already contend with gendered racism in the workplace, housing, and many other important areas of their lives (Edley & Ruiz de Velasco, 2010). The academic achievement of African American and Latino men is an important issue for counselors in educational settings. As outlined by Lewis, Arnold, House, and Toporek (2003), advocacy-oriented counselors recognize the impact of social, political, economic, and cultural factors on human development (p. 1) and, in the case of African American and Latino men, understand both the challenges they face in their pursuit of higher education and the importance of degree completion for men's later quality of life. Unfortunately, research has found that as Latino men advance in college, they become less likely to rely on others for support (Gloria, Castellanos, Scull, & Villegas, 2009). Munoz (1986) found that Latino students reported higher levels of personal stress than did their White peers when they sought out support for academic and/ or personal needs for fear that they were confirming others' perceptions that they were not college material. Therefore, more research is needed to explore the barriers faced by African American and Latino college men with accessing critical campus resources, such as mental health support, as well as the important role counselors can play in improving men's overall educational experiences. Conceptual Framework This study was greatly informed by critical race theory (CRT), a paradigm based in critical legal studies (Delgado & Stefancic, 2001; Ladson-Billings, 1998) that emerged in the 1970s to critique the treatment of race and racism in American legal ideology and practice. Critical legal studies was rooted in the assumption that legal doctrine within the United States, having developed amid the backdrop of the nation's historically oppressive treatment of people of color, could not function as a race-neutral system. Rather, the American legal system, much like other major institutions, was an extension of the racist underpinnings of the country and thereby inadvertently served to maintain the status quo (i.e., the mistreatment of people of color). Within education, CRT has been adopted as a conceptual framework that places a historical and cultural lens on educational policies and policy making and thereby encourages an analysis of racial exclusion and other forms of discrimination against students (Ladson-Billings, 1998; Villalpando, 2004). …

Quality of life amongst older Brazilians: a cross-cultural validation of the CASP-19 into Brazilian-Portuguese.

IntroductionAs population ageing becomes a global phenomenon the need to understand the quality of life of older people around the world has become increasingly salient. The CASP-19 is a well established measure of quality of later life. The scale is composed of 19 items which map onto the four domains of control (C), Autonomy (A), Self-Realisation (S) and Pleasure (P). It has already been translated to 12 languages and has been used in a number of national and international studies. However use of the scale outside of Europe has been very limited. The objective of this study was to translate and evaluate the use of the CASP-19 amongst older Brazilians.MethodsThe CASP-19 was translated from English to Portuguese, back-translated and submitted to an analysis of equivalence by a committee of judges. The scale was then administered to a sample of community dwelling older people in Recife, Brazil (n = 87), and tested for psychometric properties. The Control and Pleasure domains exhibited good internal consistency. By removing one item from each of the Autonomy and Self Realisation domains their internal consistency was improved.ResultsThe mean age of the sample was 75.6±0.7 years, subjects were mainly female (52.9%), white (52.9%), who lived without a partner (54%), and had a monthly income varying from USD 340.00 to USD 850.00. Translation and cross-cultural adaptation permitted good understanding and applicability of final version. Psychometric analyses revealed that the removal of two items improved the internal consistency of the Autonomy and Pleasure domains. Confirmatory factor analyses suggest that a 16 item, four factor, model best fits the data.ConclusionIn this small exploratory study the CASP-19 Brazil demonstrated good psychometric properties. It was easy to use for both participants and researchers. Hopefully future studies in Brazil will employ the scale so that more direct cross national comparisons can be made with older people in Europe and the US.

Identify the Critical Success Factors of Business Management in Taiwanese Veterans Home

According to a survey conducted by the Council for Economic Planning and Development of Taiwan, the population of adults aged 65 years or above will increase from 11.2% in 2012 to 20% in 2025. The Veterans Affairs Commission (VAC) Taiwan also revealed that until April of 2011, there are 456,866 veterans living in Taiwan (one in fifty Taiwanese residents is a veteran). Their average age is 68.1 years old and the majority of veterans (56%) are aged 65 and older. The increase in life expectancy and ongoing growth of aging population has led to new models of aging that empower older people to fulfill their quality of later life. In order to take care of the veterans who have contributed to the country and spent half of their life defending the country, the Veterans Affairs Commission Taiwan is assigned with responsibilities to assist in medical care, home care and other general services. These services were designed to facilitate the transition of military personnel from the armed forces to civilian life. The aim of this paper is to identify the critical successful factors of business management in Taiwanese Veterans Home by Analytic Hierarchy Process (AHP). The author’s survey results revealed that the top three critical successful factors of business management in Taiwanese Veterans Home are; service quality of the professional team, long-term care planning and accidents audit plan.

Sexual activity and psychological health as mediators of the relationship between physical health and marital quality.

The pathways linking spousal health to marital quality in later life have been little examined at the population level. We develop a conceptual model that links married older adults' physical health and that of their spouse to positive and negative dimensions of marital quality via psychological well-being of both partners and their sexual activity. We use data from 1,464 older adults in 732 marital dyads in the 2010-2011 wave of the National Social Life Health and Aging Project. We find that own fair or poor physical health is linked to lower positive and higher negative marital quality, spouse's health to positive quality, and that own and spouse's mental health and more frequent sex are associated with higher positive and lower negative marital quality. Further, we find that (a) sexual activity mediates the association between own and partner's physical health and positive marital quality, (b) own mental health mediates the association between one's own physical health and both positive and negative marital quality, and (c) partner's mental health mediates the associations of spouse's physical health with positive marital quality. These results are robust to alternative specifications of the model. The results suggest ways to protect marital quality among older adults who are struggling with physical illness in themselves or their partners.

Sidney Katz, MD: A New Paradigm for Chronic Illness and Long-Term Care

Dr. Sidney Katz's legacy to the field of gerontology is internationally recognized as his success at developing standardized measures and processes, beginning with the activities of daily living index, for the functional assessment of older adults with chronic conditions necessitating long-term services and supports. That work served as the bedrock for his subsequent major accomplishments, which improved rehabilitation services through interdisciplinary team work and attention to the patient-family constellation; reformed the regulation of nursing homes, refocusing it on resident outcomes and quality of life; and promulgated the concept of active life expectancy as a new approach to measuring the quality of later life. Few other scholars and researchers in the history of the field of aging can claim one, much less multiple monumental contributions leading to major advances in the treatment of chronic illness and the quality of long-term care.

Revisiting Gerontology's Scrapbook: From Metchnikoff to the Spectrum Model of Aging

The historical roots of gerontology date to a time when old age was characterized as physical and mental decline. Nonetheless, Metchnikoff questioned the inevitability of this decline, believing that quality of life could be improved by broadening our understanding of the science of aging, a multifaceted concept that extends well beyond the biological science interpretation so prevalent in gerontology's history. This article examines foundational gerontological theories in an effort to unravel complex interactions that constitute physiological aging processes, the psychological manifestations of individual adaptation, and the importance of social and spiritual relationships in aging successfully. Evaluating these theories through an interdisciplinary lens will benefit scholars, researchers, and aging services professionals because it offers opportunities to extend gerontological concepts from theory to development of models that can ultimately be applied in common practice to promote successful aging, regardless of one's physical or cognitive health status. To that end, we propose the Spectrum Model of Aging. Utilizing components of game theory, we believe it offers a synergistic approach to improving quality of later life and thus promises to move the field of gerontology beyond disciplinary boundaries.

Multilevel, cross‐sectional study on social capital with psychogeriatric health among olderJapanese people dwelling in rural areas

There has been increasing interest in the effect of social capital (SC) on health over the last decade both in Japan and internationally. This study elucidated whether components of SC are linked to the psychogeriatric health of older Japanese individuals. Data for 169 eligible older people living in three rural areas were collected. Multilevel analyses were performed to examine associations between general trust, informal social interaction and formal group participation with self-rated health, mini-mental state examination (MMSE), self-rated depression scale (SDS) and general self-efficacy scale (GSES). Our study revealed that MMSE, SDS and GSES were significantly associated with informal social interaction and formal group participation after adjusting for area-level SC. However, we observed no relationship between general trust and health outcomes. The findings suggest that the strategic enhancement of social cohesion and social networks for older people may promote their health and quality of later life.

Life course socio-economic position and quality of life in adulthood: a systematic review of life course models.

BackgroundA relationship between current socio-economic position and subjective quality of life has been demonstrated, using wellbeing, life and needs satisfaction approaches. Less is known regarding the influence of different life course socio-economic trajectories on later quality of life. Several conceptual models have been proposed to help explain potential life course effects on health, including accumulation, latent, pathway and social mobility models. This systematic review aimed to assess whether evidence supported an overall relationship between life course socio-economic position and quality of life during adulthood and if so, whether there was support for one or more life course models.MethodsA review protocol was developed detailing explicit inclusion and exclusion criteria, search terms, data extraction items and quality appraisal procedures. Literature searches were performed in 12 electronic databases during January 2012 and the references and citations of included articles were checked for additional relevant articles. Narrative synthesis was used to analyze extracted data and studies were categorized based on the life course model analyzed.ResultsTwelve studies met the eligibility criteria and used data from 10 datasets and five countries. Study quality varied and heterogeneity between studies was high. Seven studies assessed social mobility models, five assessed the latent model, two assessed the pathway model and three tested the accumulation model. Evidence indicated an overall relationship, but mixed results were found for each life course model. Some evidence was found to support the latent model among women, but not men. Social mobility models were supported in some studies, but overall evidence suggested little to no effect. Few studies addressed accumulation and pathway effects and study heterogeneity limited synthesis.ConclusionsTo improve potential for synthesis in this area, future research should aim to increase study comparability. Recommendations include testing all life course models within individual studies and the use of multiple measures of socio-economic position and quality of life. Comparable cross-national data would be beneficial to enable investigation of between-country differences.

Effect of vitamin D deficiency during pregnancy on offspring bone structure, composition and quality in later life.

During foetal development, calcium requirements are met as a consequence of maternal adaptations independent of vitamin D status. In contrast, after birth, dependency on vitamin D appears necessary for calcium metabolism and skeletal health. We used a rodent model (Sprague-Dawley rats), to determine if maternal vitamin D deficiency during pregnancy had a deleterious effect on bone structure at birth. Vitamin D deplete females were maintained under deplete conditions until birth of the pups, whereupon all dams were fed a vitamin D replete diet. Offspring were harvested at birth, and 140 days of age. Bones were analyzed using micro-computed tomography and strength tested to study differences in bone structure, density and strength and subjected to elemental analysis using plasma mass spectrometry to determine strontium, barium and calcium contents. Offspring from deplete mothers displayed altered trabecular parameters in the femur at birth and 140 days of age. In addition, at 140 days of age there was evidence of premature mineralization of the secondary ossification centre of the femoral head. Elemental analysis showed increased strontium uptake in the femur of the developmentally vitamin D-deficient offspring. Vitamin D depletion during development in the offspring may have a long-lasting effect, despite repletion of vitamin D from birth. This may have consequences for human health given the low vitamin D levels seen during pregnancy and current lifestyle of sun avoidance due to the risk of skin cancer.