Youth Adversities Amplify the Association between Adult Stressors and Chronic Inflammation in a Domain Specific Manner: Nuancing the Early Life Sensitivity Model

There is strong evidence that chronic, systemic inflammation hastens onset of the diseases of old age that ultimately lead to death. Importantly, several studies suggest that childhood adversity predicts chronic inflammation. Unfortunately, this research has been plagued by retrospective reports of childhood adversity, an absence of controls for adult stressors, and a failure to investigate various competing models of the link between childhood adversity and chronic inflammation. The present study was designed to address these limitations. Using 18 years of data collected from 413 African Americans (58% female) included in the Family and Community Health Study, hierarchical regression analyses provided support for a nuanced early life sensitivity explanation for the link between early adversity and adult chronic inflammation. Controlling for health risk behaviors and adult SES, late childhood (ages 10–12) adversity amplified the association between adult adversity (age 29) and chronic inflammation. This interaction operated in a domain-specific fashion. Harsh parenting amplified the relation between intimate partner hostility and inflammation, whereas early discrimination amplified the relation between adult discrimination and inflammation. These findings suggest that individuals may be primed to respond physiologically to adverse adult circumstances that resemble those experienced earlier in life.

     

Gender differences in perpetuating factors,experience and management of chronic insomnia

The higher prevalence of insomnia in women has been attributed to biological factors, which are less likely than cognitive and behavioural factors to play a role in perpetuating insomnia. Gender differences in perpetuating factors have not been extensively examined. This study compared men’s and women’s self-reports of factors that perpetuate insomnia; experience of symptoms, perceived severity and impact on daytime functioning; and use of strategies to manage insomnia. Data were collected at baseline, using reliable and valid measures, in a project that evaluated behavioural therapies for insomnia. The sample (N = 739) consisted of women (62.4%) and men (37.6%). Gender differences were found in: (1) perpetuating factors: men took more naps and held more unhelpful beliefs about insomnia, whereas women experienced higher pre-sleep arousal; (2) perception of insomnia severity: higher among women; (3) perceived impact of insomnia: higher fatigue among women; and (4) use of strategies (higher in women) to manage insomnia. Gender differences were of a small size but could be associated with women’s stress, expression of somatic symptoms, and interest in maintaining their own health to meet multiple role demands.     

Signaling virtue: voluntary accountability programs among nonprofit organizations

This article examines the structure of nonprofit voluntary accountability and standard-setting programs, arguing that these programs can be understood as collective action institutions designed to address information asymmetries between nonprofits and their stakeholders. Club theory and the economics of certification suggest that such programs have the potential to provide a signal of quality by setting high standards and fees and rigorously verifying compliance. Such mechanisms can signal quality because higher participation costs may allow only high-quality organizations to join. The article examines the implications of signaling theory using an original dataset on the structure of 32 nonprofit accountability programs across the globe. While many programs set high standards for compliance, the key distinction between strong and weak programs is the use of disclosure or verification mechanisms to enforce compliance. Contrary to theoretical expectations, compliance standards and verification do not appear to be substitutes in creating stronger voluntary programs.

Co-Production and Health System Reform – From Re-Imagining To Re-Making

There is growing interest in the application of citizen participation within all areas of public sector service development, where it is increasingly promoted as a significant strand of post-neoliberal policy concerned with re-imagining citizenship and more participatory forms of citizen/consumer engagement. The application of such a perspective within health services, via co-production, has both beneficial, but also problematic implications for the organisation of such services, for professional practice and education. Given the disappointing results in increasing consumer involvement in health services via 'choice' and 'voice' participation strategies, the question of how the more challenging approach of co-production will fare needs to be addressed. The article discusses the possibilities and challenges of system-wide co-production for health. It identifies the discourse and practice contours of co-production, differentiating co-production from other health consumer-led approaches. Finally, it identifies issues critically related to the successful implementation of co-production where additional theorisation and research are required.