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The aim of the paper is to critically review the notion of social capital and review empirical literature on the association between social capital and health across countries. The methodology used for the review includes a systematic search on electronic databases for peer-reviewed published literature. We categorize studies according to level of analysis (single and multilevel) and examine whether studies reveal a significant health impact of individual and area level social capital. We compare the study conclusions according to the country's degrees of economic egalitarianism. Regardless of study design, our findings indicate that a positive association (fixed effect) exists between social capital and better health irrespective of countries degree of egalitarianism. However, we find that the between-area variance (random effect) in health tends to be lower in more egalitarian countries than in less egalitarian countries. Our tentative conclusion is that an association between social capital and health at the individual level is robust with respect to the degree of egalitarianism within a country. Area level or contextual social capital may be less salient in egalitarian countries in explaining health differences across places.

BackgroundEvaluation of integrated care programmes for individuals with multi-morbidity requires a broader evaluation framework and a broader definition of added value than is common in cost-utility analysis. This is possible through the use of Multi-Criteria Decision Analysis (MCDA).Methods and resultsThis paper presents the seven steps of an MCDA to evaluate 17 different integrated care programmes for individuals with multi-morbidity in 8 European countries participating in the 4-year, EU-funded SELFIE project. In step one, qualitative research was undertaken to better understand the decision-context of these programmes. The programmes faced decisions related to their sustainability in terms of reimbursement, continuation, extension, and/or wider implementation. In step two, a uniform set of decision criteria was defined in terms of outcomes measured across the 17 programmes: physical functioning, psychological well-being, social relationships and participation, enjoyment of life, resilience, person-centeredness, continuity of care, and total health and social care costs. These were supplemented by programme-type specific outcomes. Step three presents the quasi-experimental studies designed to measure the performance of the programmes on the decision criteria. Step four gives details of the methods (Discrete Choice Experiment, Swing Weighting) to determine the relative importance of the decision criteria among five stakeholder groups per country. An example in step five illustrates the value-based method of MCDA by which the performance of the programmes on each decision criterion is combined with the weight of the respective criterion to derive an overall value score. Step six describes how we deal with uncertainty and introduces the Conditional Multi-Attribute Acceptability Curve. Step seven addresses the interpretation of results in stakeholder workshops.DiscussionBy discussing our solutions to the challenges involved in creating a uniform MCDA approach for the evaluation of different programmes, this paper provides guidance to future evaluations and stimulates debate on how to evaluate integrated care for multi-morbidity.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3367-4) contains supplementary material, which is available to authorized users.

Details of service receipt by 132 people diagnosed with dementia and their carers were collected in South London (boroughs of Lewisham, Camberwell, Southwark and Croydon), a geographical area served by several health and social care providers. The data collected included the Caregiver Activity Survey, which details the informal care given. This paper reports the formal and informal services received by the people with dementia at entry to the study. The amount of time spent on specific caring tasks by all informal carers of people with dementia averaged seven hours per week, but was significantly higher for co-resident carers, even when controlling for the level of dependency of the person cared-for. The odds ratios of receipt of formal services are given, according to where people were living: in the community or residential care, with co-resident carers or alone.

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We test whether individual health status is related to area-level social capital measured by rates of voting participation in municipal political elections, controlling for personal characteristics, where health status is measured by mapping responses to interview survey questions into the generic health-related quality of life measure (HRQoL) the EQ-5D in order to derive the health state scores. The analysis is based on unbalanced panel data from Statistic Sweden's Survey of Living Conditions (the ULF survey) and a 3-level multilevel regression analysis, where level 1 consists of a total of 31,585 observations for 24,419 individuals at level 2 nested within 275 Swedish municipalities at level 3. We find that the health state scores increase significantly with municipality election rates. This result is robust to a number of measurement and specification issues explored in a sensitivity analysis. However, almost all variation in health status exists across individuals (more than 98%), which demonstrates that even if social capital (and other contextual variables) may be significant it is of less importance, at least at the municipality level in Sweden.

In Norway, as in many countries, the national insurance system is under economic stress from demographic change impacting on the pensions versus contributions balance, and an increasing number of disability and sickness benefit claimants. The general practitioner (GP) is responsible for assessing work capacity and issuing certificates for sick leave based on an evaluation of the patient. Although many studies have analyzed certified sickness absence and predictive factors, no studies assess its variation between patients, GPs or geographical areas within a multilevel framework. Using a rich Norwegian matched patient-GP data set and employing a multilevel random intercept model, the study attempts to disentangle patient, GP and municipality-level variation in the certified sickness absence length for Norwegian workers in 2003. We find that most observed patient and GP characteristics are significantly associated with the length of sick leave (LSL) and medical diagnosis is an important observed factor explaining certified sickness durations. However, 98% of the unexplained variation in the LSL is attributed to patient factors rather than influenced by variation in GP practice or differences in municipality-level characteristics. Our findings indicate that GPs practice variation does not matter much for the patients' LSL. Our results are compatible with a high degree of patient involvement in current general practice. Based on this understanding one may infer that GPs play an advocate role for their patients in Norway, where the patients' own wishes are important when decisions are made.

The study was carried out to know the effects of probiotics (Protexin® Boost) supplementation on growth performances and haemato-biochemical parameters of "Shaver Star Bro" broiler chickens during the period from September to October 2003. A total of 20, day-old broiler chickens were randomly assigned into four equal groups (n = 5) as A, B, C and D. Group A was considered as control fed with commercial ration while group B, C and D were fed with commercial ration with the addition of 1 g, 2 g and 3 g probiotics / 10 litres drinking water respectively up to 35 days of age. The results showed that the body weight gains corresponding to the different treatments were differed significantly (p < 0.01) at the 1st, 2nd, 3rd, 4th and 5th weeks of age. The meat yield characteristics corresponding to the different treatments did not differ significantly (p > 0.05) whereas bursa weight differed significantly (p < 0.05) among the different groups. The mean values of Hb, PCV and ESR corresponding to the different treatments were significantly (p < 0.01) differ. Triglycerides, HDL, LDL, SGPT and SGOT values corresponding to the different treatments were also differed significantly (p < 0.01). The findings suggest that supplementation of probiotics has significant effects on live weight gain and haemato-biochemical parameters of broiler chickens. Key words: Probiotics; effects; growth; haemato-biochemical parameters; broiler chickens doi: 10.3329/bjvm.v2i1.1933 Bangl. J. Vet. Med. (2004). 2 (1) : 39-43