Results In all the three countries, this study finds health expenditure to be the predominant out of pocket cost incurred by women experiencing violence. Women who experience violence also have statistically significant higher depression, disability and acute illness scores, and thus indicate the broader health impacts of VAWG. These health impacts affect the overall productivity of women experiencing violence. Approximately 80 million productivity work days in Pakistan, 65 million productivity work days in Ghana, and 8.5 million productivity work days in scaled population of South Sudan are lost due to women experiencing any violence. The productivity loss indicates the significant impact VAWG has on the overall economy. ConclusionThe results of this study on the socioeconomic cost of VAWG highlight the need for crucial action by a wide range of actors, from local authorities and community leaders to national government. Moreover, the results suggest the potential burden that VAWG places on the health sector in the countries studied. The health and economic impacts outlined in this study together build a strong economic case for investment by government and donors in the prevention of VAWG.

Results Social and cultural engagement were both independently associated with a lower risk of developing dementia in older age in fully-adjusted models. Using time-to-event analyses, socialising once a week was associated with a 29% lower risk OR=0.71 95%CI 0.52-0.97 and cultural engagement every few months or more was associated with a 42% lower risk OR=0.58 95%CI 0.41-0.80. Using competing risk models, socialising OR=0.80 95%CI 0.59-1.08 and cultural engagement OR=0.65 95%CI 0.47-0.90. Using modified Fine and Gray Subdistribution hazards models, socialising OR=0.66 95%CI 0.53-0.82 and cultural engagement OR=0.42 95%CI 0.32-0.56. Community group activities were only associated with dementia in minimally-adjusted models. Results were robust to sensitivity analyses considering moderators, reverse causality, over-adjustment, and baseline cognitive function. ConclusionThe results presented here suggest that social and cultural engagement are independent risk-reducing factor for the development of dementia in older age. Even for those who lack contact with friends and family or who socialise infrequently, engagement with cultural venues, even on a less frequent basis, could be protective against the incidence of dementia. These findings align with broader findings relating to cognitive reserve and support the development of multimodal community-based interventions to promote healthy cognitive ageing amongst older adults.

BackgroundHeart failure (HF) is one of the leading causes of mortality, morbidity and hospitalisation in older adults. Although short stature has been associated with increased risk of coronary heart disease previous studies have consistently shown tall stature to be associated with increased risk of atrial fibrillation (AF) a known major risk factor for the development of HF. Relatively few studies have investigated the association between height and incident HF. We have therefore examined prospectively the association between adult height and incident AF and incident HF in a population based cohort of older men.MethodsProspective study of 3530 men aged 60–79 years with no diagnosed HF, myocardial infarction or stroke at baseline (1998–2000) followed up for a mean period of 15 years, in which there were 212 incident HF cases. Incident AF was based on a subgroup of men (n=1348) who attended re-examination in 2010–2012. Men were divided into 5 height groups: <168.2, 168.2–172.9, 173.0–176.9, 177.0–183.0 and >183.0 cms based on the quartile distribution of height with the top 5 percent separated out.ResultsCVD risk factors tended to decrease with increasing height but a positive association was seen between height and prevalent AF. Tall stature was prospectively associated with increased risk of incident AF. Both short stature (<168.2 cms) and tall stature (>183.0 cms) were associated with significantly increased risk of HF in age-adjusted analysis compared to those in the second height quartile [HR (95% CI) 1.58 (1.07,3.02) and 1.90 (1.04,3.50) respectively]. The increased risk seen in short men was attenuated after adjustment for lifestyle characteristics, established CHD risk factors, inflammation (CRP) and prevalent AF [adjusted HR=1.37 (0.92,2.02) ]. Since tall men had the most favourable CHD risk factors, adjustment increased the risk further (adjusted HR (95% CI) 1.97 (1.05,3.68). However further adjustment for incident AF attenuated the increased risk seen in tall men (HR=1.76 (0.93,3.31)].ConclusionBoth short stature and tall stature are associated with increased HF risk but the pathways underlying these associations are different. The increased risk of HF in short adults appear to be largely explained by adverse CVD risk factors associated with short stature; in tall men the association was partially explained by their increased risk of developing AF. Average body height has increased worldwide over the decades and if this trend continues, the prevalence of tall older adults is likely to increase which may contribute to an increasing burden of AF and HF.