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IntroductionIntensified poverty arising from economic decline and crisis may have contributed to reductions in HIV prevalence in Zimbabwe.ObjectivesTo assess the impact of the economic decline on household wealth and prevalent HIV infection using data from a population‐based open cohort.MethodsHousehold wealth was estimated using data from a prospective household census in Manicaland Province (1998 to 2011). Temporal trends in summed asset ownership indices for sellable, non‐sellable and all assets combined were compared for households in four socio‐economic strata (small towns, agricultural estates, roadside settlements and subsistence farming areas). Multivariate logistic random‐effects models were used to measure differences in individual‐level associations between prevalent HIV infection and place of residence, absolute wealth group and occupation.ResultsHousehold mean asset scores remained similar at around 0.37 (on a scale of 0 to 1) up to 2007 but decreased to below 0.35 thereafter. Sellable assets fell substantially from 2004 while non‐sellable assets continued increasing until 2008. Small‐town households had the highest wealth scores but the gap to other locations decreased over time, especially for sellable assets. Concurrently, adult HIV prevalence fell from 22.3 to 14.3%. HIV prevalence was highest in better‐off locations (small towns) but differed little by household wealth or occupation. Initially, HIV prevalence was elevated in women from poorer households and lower in men in professional occupations. However, most recently (2009 to 2011), men and women in the poorest households had lower HIV prevalence and men in professional occupations had similar prevalence to unemployed men.ConclusionsThe economic crisis drove more households into extreme poverty. However, HIV prevalence fell in all socio‐economic locations and sub‐groups, and there was limited evidence that increased poverty contributed to HIV prevalence decline.

In this paper, we analyze whether work values differ between three dimensions of time (age, birth cohort, period). Using data of five waves of the World Values Survey and the European Values Study from more than forty countries and hierarchical age-period-cohort regression models, we did not find relevant gaps between birth cohorts with respect to the relative importance of work or with respect to work values. Thus, we claim that, in European and Euro-Atlantic countries, birth cohorts, on average, do not differ significantly with regard to their work values. Our results suggest, however, that the relative importance of work is significantly higher in the middle-age groups than among the younger or older groups. Regarding work values, we found that the importance of having an interesting job, good pay, and good hours decreases with age, and that job security is equally important at every age, whereas the importance of having a useful job increases with age.

SummaryIn the last 50 years Thailand has achieved advanced demographic and health transitions. Many infectious diseases are controlled and infant and maternal mortality rates are among the lowest in the region. Within such a low mortality setting, however, substantial variations in health persist, with education being a major driver. This paper assesses the ongoing mortality transition in Thailand, examining relationships between risk factors and mortality outcomes among a large nationwide cohort of distance-learning Open University students, as well as examining the differential mortality benefit enjoyed by this educated group when compared with the general Thai population. The cohort comprised 87,151 participants, who in 2005 completed a questionnaire collecting detailed information on socio-demographics, health behaviours and health outcomes. Participants were aged 15–87 at baseline and lived in all regions of the country. Cohort members' citizen identification numbers were matched with official death registration records to identify mortality among participants. A total of 1401 deaths were identified up to November 2016. Results show cohort study participants experiencing mortality at approximately one-third of the rate of the general population in the same age and sex groups. The gap between the mortality rates in the two groups widened with increased age. Differential risk factor prevalence among the two populations, particularly lower overweight and obesity prevalence and lower cigarette smoking rates in the cohort, can explain some of this variation. The largely unmeasurable effect of aspiration for life improvement through distance education while embedded in their communities is shown by this study to have a powerful effect on mortality risk. With overall education levels, including higher education, rising in Thailand this growing group of educated aspirational Thais may represent future trends in Thai mortality. Identifying the drivers and characteristics of this mortality variation can help inform policies to provide health services and to help reduce mortality in the whole population.

"This paper deals with the fertility transition, one of the two essential components of the demographic transition. The analysis demonstrates that by applying the cohort perspective new insights are obtained about how the fertility transition unfolded. Within the overall framework of the fertility transition there were four distinct pathways of fertility trends. Combining these findings with those of other scholars shows that the demographic transition has not yet led to an equilibrium of relatively stable low mortality and stable low fertility. The four fertility transition pathways are the following: (1) The Western fertility transition pathway characterized by major cohort total fertility rate (CTFR) fluctuations; (2) the South European fertility transition pathway characterized by an almost uninterrupted CTFR decline; (3) the Central and East European fertility transition pathway characterized by stable CTFRs in the 1920s to 1950s cohorts and a decline in the 1960s and 1970s cohorts; (4) the East and South-East Asia fertility transition pathway characterized by a late start in the mid-20th century with rapidly declining CTFRs. The exploration of societal conditions shaping fertility trends in the 19th and 20th centuries confirms Notestein's conclusions that the causes are a complex combination of 'technological, social, economic, and political developments' as well as cultural and ideational effects, and that it is 'impossible to be precise about the various causal factors'. At times the primary factors were economic, as in the Great Depression of the 1930s and the 1960s post-war prosperity in Western countries. However, these economic factors also had many political, cultural, social, policy and other important facets. In Central and Eastern Europe the primary factors during the era of state socialism were the political system and social policies. The patriarchal nature of societies was the prime factor shaping fertility trends in Southern Europe and in East and South-East Asia." (author's abstract). This article contains supplementary material in the form of an online appendix: http://dx.doi.org/10.12765/CPoS-2017-10en

There are limited data on the frequency of foregone health service use in defined populations. Here we describe Thai patterns of health service use, types of health insurance used and reports of foregone health services according to geo-demographic and socioeconomic characteristics. Data on those who considered they had needed but not received health care over the previous year were obtained from a national cohort of 87,134 students from the Sukhothai Thammathirat Open University (STOU). The cohort was enrolled in 2005 and was largely made up of young and middleage adults living throughout Thailand. Among respondents, 21.0% reported use of health services during the past year. Provincial/governmental hospitals (33.4%) were the most attended health facilities in general, followed by private clinics (24.1%) and private hospitals (20.1%). Health centers and community hospitals were sought after in rural areas. The recently available government operated Universal Coverage Scheme (UCS) was popular among the lower income groups (13.6%), especially in rural areas. When asked, 42.1% reported having foregone health service use in the past year. Professionals and office workers frequently reported 'long waiting time' (17.1%) and 'could not get time off work' (13.7%) as reasons, whereas manual workers frequently noted it was 'difficult to travel' (11.6%). This information points to non-financial opportunity cost barriers common to a wide array of Thai adults who need to use health services. This issue is relevant for health and workplace policymakers and managers concerned about equitable access to health services.

There are limited data on the frequency of foregone health service use in defined populations. Here we describe Thai patterns of health service use, types of health insurance used and reports of foregone health services according to geo-demographic and socioeconomic characteristics. Data on those who considered they had needed but not received health care over the previous year were obtained from a national cohort of 87,134 students from the Sukhothai Thammathirat Open University (STOU). The cohort was enrolled in 2005 and was largely made up of young and middleage adults living throughout Thailand. Among respondents, 21.0% reported use of health services during the past year. Provincial/governmental hospitals (33.4%) were the most attended health facilities in general, followed by private clinics (24.1%) and private hospitals (20.1%). Health centers and community hospitals were sought after in rural areas. The recently available government operated Universal Coverage Scheme (UCS) was popular among the lower income groups (13.6%), especially in rural areas. When asked, 42.1% reported having foregone health service use in the past year. Professionals and office workers frequently reported 'long waiting time' (17.1%) and 'could not get time off work' (13.7%) as reasons, whereas manual workers frequently noted it was 'difficult to travel' (11.6%). This information points to non-financial opportunity cost barriers common to a wide array of Thai adults who need to use health services. This issue is relevant for health and workplace policymakers and managers concerned about equitable access to health services.

"Within this analysis of demographic and economic dependency ratios for 45 countries around the world, we reiterate the importance of age- and gender-specific employment levels as well as their determinants when discussing the economic challenges associated with population ageing. Building upon existing research on economic dependency, we portray and discuss cohort variation in employment and its possible effect on the challenges of population ageing, focusing on the implications of high youth unemployment, the role of changes in female employment and the evolution of retirement patterns across cohorts. The insights from our analysis reaffirm findings elsewhere that younger populations may not be as well off in the light of demographic change as an analysis of their demographic structure alone would suggest and stress the importance of considering the cohort dimension of employment in this discussion." (author's abstract)

BackgroundIn longitudinal health research, combining the richness of cohort data to the extensiveness of routine data opens up new possibilities, providing information not available from one data source alone. In this study, we set out to extend information from a longitudinal birth cohort study by linking to the cohort child's routine primary and secondary health care data. The resulting linked datasets will be used to examine health outcomes and patterns of health service utilisation for a set of common childhood health problems. We describe the experiences and challenges of acquiring and linking electronic health records for participants in a national longitudinal study, the UK Millennium Cohort Study (MCS).
MethodWritten parental consent to link routine health data to survey responses of the MCS cohort member, mother and her partner was obtained for 90.7% of respondents when interviews took place at age seven years in the MCS. Probabilistic and deterministic linkage was used to link MCS cohort members to multiple routinely-collected health data sources in Wales and Scotland.
ResultsOverall linkage rates for the consented population using country-specific health service data sources were 97.6% for Scotland and 99.9% for Wales. Linkage rates between different health data sources ranged from 65.3% to 99.6%. Issues relating to acquisition and linkage of data sources are discussed.
ConclusionsLinking longitudinal cohort participants with routine data sources is becoming increasingly popular in population data research. Our results suggest that this is a valid method to enhance information held in both sources of data.

Background Minimally invasive pedicle screw placement may have a higher incidence of violation of the superior cephalad unfused facet joint.
Study Aims We investigated the incidence and risk factors of upper facet joint violation in percutaneous robot-assisted instrumentation versus percutaneous fluoroscopy-guided and open transpedicular instrumentation.
Methods A retrospective study including all consecutive patients who underwent lumbar instrumentation, fusion, and decompression for spondylolisthetic stenosis and degenerative disk disease was conducted between January 2012 and January 2016. All operations were performed by the same surgeon; the patients were divided into three groups according to the method of instrumentation. Group 1 involved the robot-assisted instrumentation in 58 patients, group 2 consisted of 64 patients treated with a percutaneous transpedicular instrumentation using fluoroscopic guidance, and 72 patients in group 3 received an open midline approach for pedicle screw insertion.
Results Superior segment facet joint violation occurred in 2 patients in the robot-assisted group 1 (7%), in 22 of the percutaneous fluoroscopy-guided group 2 (34%), and in 6 cases of the open group (8%). The incidence of facet joint violation was present in 5% (3) of the screws in group 1, 22% (28) of the screws in group 2, and 3% (4) of the screws in group 3.
Conclusion Meticulous surgical planning of the appropriate entry site (Weinstein's method), trajectory planning, and proper robot-assisted instrumentation of pedicle screws reduced the risk of superior segment facet joint violation.