ResearchPad - socioeconomic-aspects-of-health https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Financial health as a measurable social determinant of health]]> https://www.researchpad.co/article/elastic_article_15758 Financial health, understood as one’s ability to manage expenses, prepare for and recover from financial shocks, have minimal debt, and ability to build wealth, underlies all facets of daily living such as securing food and paying for housing, yet there is inconsistency in measurement and definition of this critical concept. Most social determinants research and interventions focus on siloed solutions (housing, food, utilities) rather than on a root solution such as financial health. In light of the paucity of public health research on financial health, particularly among low-income populations, this study seeks to: 1) introduce the construct of financial health into the domain of public health as a useful root term that underlies other individual measures of economic hardship and 2) demonstrate through outcomes on financial, physical and mental health among low-income caregivers of young children that the construct of financial health belongs in the canon of social determinants of health.Materials and methodsIn order to extract features of financial health relevant to overall well-being, principal components analysis were used to assess survey data on banking and personal finances among caregivers of young children who participate in public assistance. Then, a series of logistic regressions were utilized to examine the relationship between components of financial health, depression and self-rated health.ResultsComponents aligned with other measures of financial health in the literature, and there were strong associations between financial health and health outcomes.Practice implicationsFinancial health can be conceived of and measured as a key social determinant of health. ]]> <![CDATA[<i>Toxocara</i> species environmental contamination of public spaces in New York City]]> https://www.researchpad.co/article/elastic_article_14754 Toxocara canis and Toxocara cati are helminth worms that infect dogs and cats, respectively. Infected dogs and cats will defecate thousands of Toxocara eggs into the environment. Humans are incidental hosts and are exposed when consuming contaminated soils via the fecal-oral route. After leaving the gastrointestinal tract, the Toxocara larvae will enter the vasculature and can migrate to any major organ system, including lungs, ocular, and central nervous system. Symptoms can range from mild muscle aches to severe asthma, blindness, and encephalitis. Humans are not definitive hosts of the parasite and cannot transmit Toxocara eggs to the environment or other humans. There is a need for research on the sanitary impact of Toxocara for both humans and animals, especially in large urban cities such as New York City. Poverty is also associated with higher rates of toxocariasis, with more contamination in poorer neighborhoods where animal control, deworming of pets, and less sanitary conditions exist. This study aims to understand further the disparity of lower socioeconomic areas having higher rates of contaminated parks and playgrounds, comparing the five boroughs of New York City.

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<![CDATA[The association between cervical cancer screening participation and the deprivation index of the location of the family doctor’s office]]> https://www.researchpad.co/article/elastic_article_14737 Cervical cancer screening rates are known to be strongly associated with socioeconomic status. Our objective was to assess whether the rate is also associated with an aggregated deprivation marker, defined by the location of family doctors’ offices.MethodsTo access this association, we 1) collected data from the claim database of the French Health Insurance Fund about the registered family doctors and their enlisted female patients eligible for cervical screening; 2) carried out a telephone survey with all registered doctors to establish if they were carrying out Pap-smears in their practices; 3) geotracked all the doctors’ offices in the smallest existing blocks of socioeconomic homogenous populations (IRIS census units) that were assigned a census derived marker of deprivation, the European Deprivation Index (EDI), and a binary variable of urbanization; and 4) we used a multivariable linear mixed model with IRIS as a random effect.ResultsOf 348 eligible doctors, 343 responded to the telephone survey (98.6%) and were included in the analysis, encompassing 88,152 female enlisted patients aged 25–65 years old. In the multivariable analysis (adjusted by the gender of the family doctor, the practice of Pap-smears by the doctor and the urbanization of the office location), the EDI of the doctor’s office was strongly associated with the cervical cancer screening participation rate of eligible patients (p<0.001).ConclusionThe EDI linked to the location of the family doctor’s office seems to be a robust marker to predict female patients’ participation in cervical cancer screening. ]]> <![CDATA[Correlates of childhood morbidity in Nigeria: Evidence from ordinal analysis of cross-sectional data]]> https://www.researchpad.co/article/elastic_article_14636 Child mortality records show that 1 in every 13 children dies before age five in sub-Saharan Africa with diseases such as pneumonia, diarrhoea and malaria considered to be the leading causes of such deaths. In Nigeria where 50% of all under-five deaths are attributed to morbidity, much attention has been directed to single health conditions. This study aims at examining the factors that are associated with single health conditions and comorbidity among children in Nigeria.Materials and methodsThis study was based on data from 2013 Nigeria Demographic and Health Survey (DHS) which involved 27,571 under-five children who suffered from acute respiratory infection, diarrhoea or fever within two weeks of data collection exercise. Descriptive statistics and generalized ordinal logistic regression model were used for the analysis.ResultsAbout 14% of children suffered from a single health condition and 9% suffered from comorbidity. The likelihood of suffering from a single health condition and comorbidity is higher for children who are of third order birth or more (OR = 1.24, 95% CI = 1.11–1.39 & OR = 1.31, 95% CI = 1.12–1.55) compared to those who are of first order birth. The likelihood also increased for children whose mothers live in Northeast (OR = 3.19, 95% CI = 2.86–3.55 & OR = 3.88, 95% CI = 3.30–4.57) compared to children whose mothers live in North Central. The odds of suffering from a single health condition and comorbidity reduced for children who are from richest households, aged 3 years and above and were of average size at birth. Children of women who obtained water from improved source are less likely to experience any morbidity (OR = 0.93, 95% CI = 0.87–0.99) compared to children whose mothers obtained water from non-improved source.ConclusionsThe study has demonstrated that children in Nigeria are not only exposed to the risk of single health conditions but they are also exposed to the risk of comorbidity. Efforts should be made to design appropriate health care models that would facilitate a considerable reduction in childhood morbidity in the country. ]]> <![CDATA[How much is enough? Exploring the dose-response relationship between cash transfers and surgical utilization in a resource-poor setting]]> https://www.researchpad.co/article/elastic_article_14571 Cash transfers are a common intervention to incentivize salutary behavior in resource-constrained settings. Many cash transfer studies do not, however, account for the effect of the size of the cash transfer in design or analysis. A randomized, controlled trial of a cash-transfer intervention is planned to incentivize appropriate surgical utilization in Guinea. The aim of the current study is to determine the size of that cash transfer so as to maximize compliance while minimizing cost.MethodsData were collected from nine coastal Guinean hospitals on their surgical capabilities and the cost of receiving surgery. These data were combined with publicly available data about the general Guinean population to create an agent-based model predicting surgical utilization. The model was validated to the available literature on surgical utilization. Cash transfer sizes from 0 to 1,000,000 Guinean francs were evaluated, with surgical compliance as the primary outcome.ResultsCompliance with scheduled surgery increases as the size of a cash transfer increases. This increase is asymptotic, with a leveling in utilization occurring when the cash transfer pays for all the costs associated with surgical care. Below that cash transfer size, no other optima are found. Once a cash transfer completely covers the costs of surgery, other barriers to care such as distance and hospital quality dominateConclusionCash transfers to incentivize health-promoting behavior appear to be dose-dependent. Maximal impact is likely only to occur when full patient costs are eliminated. These findings should be incorporated in the design of future cash transfer studies. ]]> <![CDATA[The association between national income and adult obesity prevalence: Empirical insights into temporal patterns and moderators of the association using 40 years of data across 147 countries]]> https://www.researchpad.co/article/elastic_article_13857 At a country level, population obesity prevalence is often associated with economic affluence, reflecting a potential adverse outcome concomitant with economic growth. We estimated the pattern and strength of the empirically observed relationship between national income and adult obesity prevalence, and the moderating role of countries’ macro-environments on this relationship.MethodsWe assembled data on national obesity prevalence, income and a range of variables that characterize macro-environments related to 147 countries from multiple international organizations and databases. We used a Bayesian hierarchical model to estimate the relationship (elasticities) between national income (using Gross Domestic Product Per Capita, GDPPC) and adult obesity prevalence, and the moderating effects of five different dimensions (globalization orientation, demographic characteristics, economic environment, labor market characteristics, and strength of health policies) of countries’ macro-environments on the income elasticities. Using the latest (2019–2024) available national income growth projections from the International Monetary Fund, we forecast future global trends in obesity prevalence.FindingsOver the 40-years 1975–2014, adult obesity prevalence increased at a declining rate with GDPPC across the 147 countries. The mean income elasticity estimates were 1.23 (95% credible interval 1.04–1.42) for males and 1.01 (0.82–1.18) for females. The elasticities were positively associated with the extent of political globalization and negatively associated with urbanization and share of agriculture in the national GDP. Income based projections indicate that obesity prevalence would continue to grow at an average annual rate of 2.47% across the studied countries during 2019–2024.ConclusionsPopulation obesity prevalence exhibits a positive relationship with national income and there is no evidence that the relationship, while weakening, actually turns negative at higher income levels (“obesity Kuznets curve”). Based on current trends, global obesity prevalence will continue to increase during 2019–2024, with the rate of growth higher in low- and middle-income countries. As most people currently live in low- and middle-income countries with rising incomes, our findings underscore the urgent societal imperatives for effective policy initiatives, especially those that target the concomitant “nutrition transition” process with economic affluence, to break or at least further weaken the positive relationship of population obesity prevalence with national income. ]]> <![CDATA[The emergence of social gaps in mental health: A longitudinal population study in Sweden, 1900-1959]]> https://www.researchpad.co/article/elastic_article_11234 During the recent decades, social inequalities in mental health have increased and are now one of the most persistent features of contemporary society. There is limited knowledge about when this pattern emerged or whether it has been a historically fixed feature. The objective of this study was to assess whether socioeconomic and gender gaps in mental health changed during the period 1900–1959 in Sweden. We used historical micro data which report all necessary information on individuals' demographic characteristics, occupational attainment and mental disorders (N = 2,450) in a Swedish population of 193,893. Changes over time was tested using multilevel Cox proportional hazard models. We tested how gender-specific risks of mental disorder changed and how gender-specific socioeconomic status was related to risks of mental disorder later in life. We found a reversal in gender gaps in mental health during the study period. Women had a lower risk than men in 1900 and higher risks in 1959. For men, we found a negative gradient in SES risks in 1900 and a positive gradient in 1959. For women, we found no clear SES gradient in the risk of mental disorder. These findings suggest that the contemporary patterns in socioeconomic and gender gaps in mental disorder emerged during the 1940s and 1950s and have since then persisted.

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<![CDATA[Identification of cholera hotspots in Zambia: A spatiotemporal analysis of cholera data from 2008 to 2017]]> https://www.researchpad.co/article/Nb4ea4681-5c5d-42bd-a1ce-642b56a34f03

The global burden of cholera is increasing, with the majority (60%) of the cases occurring in sub-Saharan Africa. In Zambia, widespread cholera outbreaks have occurred since 1977, predominantly in the capital city of Lusaka. During both the 2016 and 2018 outbreaks, the Ministry of Health implemented cholera vaccination in addition to other preventative and control measures, to stop the spread and control the outbreak. Given the limitations in vaccine availability and the logistical support required for vaccination, oral cholera vaccine (OCV) is now recommended for use in the high risk areas (“hotspots”) for cholera. Hence, the aim of this study was to identify areas with an increased risk of cholera in Zambia. Retrospective cholera case data from 2008 to 2017 was obtained from the Ministry of Health, Department of Public Health and Disease Surveillance. The Zambian Central Statistical Office provided district-level population data, socioeconomic and water, sanitation and hygiene (WaSH) indicators. To identify districts at high risk, we performed a discrete Poisson-based space-time scan statistic to account for variations in cholera risk across both space and time over a 10-year study period. A zero-inflated negative binomial regression model was employed to identify the district level risk factors for cholera. The risk map was generated by classifying the relative risk of cholera in each district, as obtained from the space-scan test statistic. In total, 34,950 cases of cholera were reported in Zambia between 2008 and 2017. Cholera cases varied spatially by year. During the study period, Lusaka District had the highest burden of cholera, with 29,080 reported cases. The space-time scan statistic identified 16 districts to be at a significantly higher risk of having cholera. The relative risk of having cholera in these districts was significantly higher and ranged from 1.25 to 78.87 times higher when compared to elsewhere in the country. Proximity to waterbodies was the only factor associated with the increased risk for cholera (P<0.05). This study provides a basis for the cholera elimination program in Zambia. Outside Lusaka, the majority of high risk districts identified were near the border with the DRC, Tanzania, Mozambique, and Zimbabwe. This suggests that cholera in Zambia may be linked to movement of people from neighboring areas of cholera endemicity. A collaborative intervention program implemented in concert with neighboring countries could be an effective strategy for elimination of cholera in Zambia, while also reducing rates at a regional level.

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<![CDATA[Health promotion with physiolytics: What is driving people to subscribe in a data-driven health plan]]> https://www.researchpad.co/article/N67264028-7608-43f5-811f-a7ed2c904b8b

Data-driven health promotion programs and health plans try to harness the new possibilities of ubiquitous and pervasive physiolytics devices. In this paper we seek to explore what drives people to subscribe to such a data-driven health plan. Our study reveals that the decision to subscribe to a data-driven health plan is strongly influenced by the beliefs of seeing physiolytics as enabler for positive health behavior change and of perceiving health insurances as trustworthy organizations that are capable of securely and righteously manage the data collected by physiolytics.

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<![CDATA[Cutaneous leishmaniasis and co-morbid major depressive disorder: A systematic review with burden estimates]]> https://www.researchpad.co/article/5c7d95d9d5eed0c484734dd0

Background

Major depressive disorder (MDD) associated with chronic neglected tropical diseases (NTDs) has been identified as a significant and overlooked contributor to overall disease burden. Cutaneous leishmaniasis (CL) is one of the most prevalent and stigmatising NTDs, with an incidence of around 1 million new cases of active CL infection annually. However, the characteristic residual scarring (inactive CL) following almost all cases of active CL has only recently been recognised as part of the CL disease spectrum due to its lasting psychosocial impact.

Methods and findings

We performed a multi-language systematic review of the psychosocial impact of active and inactive CL. We estimated inactive CL (iCL) prevalence for the first time using reported WHO active CL (aCL) incidence data that were adjusted for life expectancy and underreporting. We then quantified the disability (YLD) burden of co-morbid MDD in CL using MDD disability weights at three severity levels. Overall, we identified 29 studies of CL psychological impact from 5 WHO regions, representing 11 of the 50 highest burden countries for CL. We conservatively calculated the disability burden of co-morbid MDD in CL to be 1.9 million YLDs, which equalled the overall (DALY) disease burden (assuming no excess mortality in depressed CL patients). Thus, upon inclusion of co-morbid MDD alone in both active and inactive CL, the DALY burden was seven times higher than the latest 2016 Global Burden of Disease study estimates, which notably omitted both psychological impact and inactive CL.

Conclusions

Failure to include co-morbid MDD and the lasting sequelae of chronic NTDs, as exemplified by CL, leads to large underestimates of overall disease burden.

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<![CDATA[The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana and the path to universal health coverage in India: Overcoming the challenges of stewardship and governance]]> https://www.researchpad.co/article/5c8acc3bd5eed0c48498f23f

In an Essay, Blake Angell and colleagues discuss ambitious reforms planned to expand coverage of the health system in India.

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<![CDATA[Delays in arrival and treatment in emergency departments: Women, children and non-trauma consultations the most at risk in humanitarian settings]]> https://www.researchpad.co/article/5c8823bcd5eed0c484638f1b

Introduction

Delays in arrival and treatment at health facilities lead to negative health outcomes. Individual and external factors could be associated with these delays. This study aimed to assess common factors associated with arrival and treatment delays in the emergency departments (ED) of three hospitals in humanitarian settings.

Methodology

This was a cross-sectional study based on routine data collected from three MSF-supported hospitals in Afghanistan, Haiti and Sierra Leone. We calculated the proportion of consultations with delay in arrival (>24 hours) and in treatment (based on target time according to triage categories). We used a multinomial logistic regression model (MLR) to analyse the association between age, sex, hospital and diagnosis (trauma and non-trauma) with these delays.

Results

We included 95,025 consultations. Males represented 65.2%, Delay in arrival was present in 27.8% of cases and delay in treatment in 27.2%. The MLR showed higher risk of delay in arrival for females (OR 1.2, 95% CI 1.2–1.3), children <5 (OR 1.4, 95% CI 1.4–1.5), patients attending to Gondama (OR 30.0, 95% CI 25.6–35.3) and non-trauma cases (OR 4.7, 95% CI 4.4–4.8). A higher risk of delay in treatment was observed for females (OR 1.1, 95% CI 1.0–1.1), children <5 (OR 2.0, 95% CI 1.9–2.1), patients attending to Martissant (OR 14.6, 95% CI 13.9–15.4) and non-trauma cases (OR 1.6, 95% CI 1.5–1.7).

Conclusions

Women, children <5 and non-trauma cases suffered most from delays. These delays could relate to educational and cultural barriers, and severity perception of the disease. Treatment delay could be due to insufficient resources with consequent overcrowding, and severity perception from medical staff for non-trauma patients. Extended community outreach, health promotion and support to community health workers could improve emergency care in humanitarian settings.

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<![CDATA[Food insecurity and violence in a prospective cohort of women at risk for or living with HIV in the U.S.]]> https://www.researchpad.co/article/5c89779fd5eed0c4847d31be

Background

Food insecurity and violence are two major public health issues facing U.S. women. The link between food insecurity and violence has received little attention, particularly regarding the temporal ordering of events. The present study used data from the Women’s Interagency Human Immunodeficiency Virus Study to investigate the longitudinal association of food insecurity and violence in a cohort of women at risk for or living with HIV.

Methods

Study participants completed six assessments from 2013–16 on food insecurity (operationalized as marginal, low, and very low food security) and violence (sexual or physical, and psychological). We used multi-level logistic regression, controlling for visits (level 1) nested within individuals (level 2), to estimate the association of experiencing violence.

Results

Among 2,343 women (8,528 visits), we found that victims of sexual or physical violence (odds ratio = 3.10; 95% confidence interval: 1.88, 5.19) and psychological violence (odds ratio = 3.00; 95% confidence interval: 1.67, 5.50) were more likely to report very low food security. The odds of experiencing violence were higher for women with very low food security at both the current and previous visit as compared to only the current visit. HIV status did not modify these associations.

Conclusions

Food insecurity was strongly associated with violence, and women exposed to persistent food insecurity were even more likely to experience violence. Food programs and policy must consider persistent exposure to food insecurity, and interpersonal harms faced by food insecure women, such as violence.

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<![CDATA[Adult body weight trends in 27 urban populations of Brazil from 2006 to 2016: A population-based study]]> https://www.researchpad.co/article/5c897752d5eed0c4847d29e8

Objective

We aimed to estimate trends in population-level adult body weight indicators in the 26 state capitals and the Federal District of Brazil.

Methods

Self-reported weight and height data of 572,437 adults were used to estimate the mean body mass index (BMI), and the prevalence of BMI categories ranging from underweight to morbid obesity, in Brazil’s state capitals and Federal District, from 2006 to 2016, by sex. All estimates were standardized by age.

Results

From 2006 to 2016, the main findings showed that: (i) the overall mean BMI increased from 25.4 kg/m2 to 26.3 kg/m2 in men, and from 24.5 kg/m2 to 25.8 kg/m2 in women; (ii) the overall prevalence of overweight increased from 48.1% to 57.5% in men, and from 37.8% to 48.2% in women; (iii) the overall prevalence of obesity increased from 11.7% to 18.1% in men, and from 12.1% to 18.8% in women; (iv) in general, the largest increases in overweight and obesity prevalence were found in state capitals located in the north, northeast, and central-west regions of Brazil; (v) the prevalence of severe obesity surpassed the prevalence of underweight in 22 and 9 state capitals among men and women, respectively; and (vi) the mean BMI trend was stable only in Vitória state capital in men.

Conclusions

The policies for preventing and treating obesity in Brazil over the past years were not able to halt the increase in obesity prevalence either in the state capitals or the Federal District. Thus, a revision of policies is warranted. Furthermore, although policies are necessary in all state capitals, our results suggest that policies are especially necessary in the north, northeast, and central-west regions’ state capitals, where, in general, the largest increases in overweight and obesity prevalence were experienced.

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<![CDATA[Utilization patterns of insulin for patients with type 2 diabetes from national health insurance claims data in South Korea]]> https://www.researchpad.co/article/5c89775bd5eed0c4847d2ad6

Type 2 diabetes mellitus (T2DM) is a chronic disease that requires long-term therapy and regular check-ups to prevent complications. In this study, insurance claim data from the National Health Insurance Service (NHIS) of Korea were used to investigate insulin use in T2DM patients according to the economic status of patients and their access to primary physicians, operationally defined as the frequently used medical care providers at the time of T2DM diagnosis. A total of 91,810 participants were included from the NHIS claims database for the period between 2002 and 2013. The utilization pattern of insulin was set as the dependent variable and classified as one of the following: non-use of antidiabetic drugs, use of oral antidiabetic drugs only, or use of insulin with or without oral antidiabetic drugs. The main independent variables of interest were level of income and access to a frequently-visited physician. Multivariate Cox proportional hazards analysis was performed. Insulin was used by 9,281 patients during the study period, while use was 2.874 times more frequent in the Medical-aid group than in the highest premium group [hazard ratio (HR): 2.874, 95% confidence interval (CI): 2.588–3.192]. Insulin was also used ~50% more often in the patients managed by a frequently-visited physician than in those managed by other healthcare professionals (HR: 1.549, 95% CI: 1.434–1.624). The lag time to starting insulin was shorter when the patients had a low income and no frequently-visited physicians. Patients with a low level of income were more likely to use insulin and to have a shorter lag time from diagnosis to starting insulin. The likelihood of insulin being used was higher when the patients had a frequently-visited physician, particularly if they also had a low level of income. Therefore, the economic statuses of patients should be considered to ensure effective management of T2DM. Utilizing frequently-visited physicians might improve the management of T2DM, particularly for patients with a low income.

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<![CDATA[Assessment of factors affecting diabetes management in the City Changing Diabetes (CCD) study in Tianjin]]> https://www.researchpad.co/article/5c6c758cd5eed0c4843cfe89

Objective

This study aimed to identify the local levels of vulnerability among patients with Type-II diabetes (T2DM) in Tianjin. The study was aimed at curbing the rise of T2DM in cities.

Methods

229 participants living with T2DM were purposively sampled from hospitals in Tianjin. Collected data were coded and analysed following well-established thematic analysis principles.

Results

Twelve themes involving 29 factors were associated with diabetes patients’ vulnerability: 1. Financial constraints (Low Income, Unemployment, No Medical Insurance/Low ratio reimbursement); 2. Severity of disease (Appearance of symptoms, complications, co-morbidities, high BMI, poor disease control); 3. Health literacy (No/Low/Wrong knowledge of health literacy); 4. Health beliefs (Perceived diabetes indifferently, Passively Acquire Health Knowledge, Distrust of primary health services); 5. Medical environment (Needs not met by Medical Services); 6. Life restrictions (Daily Life, Occupational Restriction); 7. Lifestyle change (Adhering to traditional or unhealthy diet, Lack of exercise, Low-quality sleep); 8. Time poverty (Healthcare-seeking behaviours were limited by work, Healthcare-seeking behaviours were limited by family issues); 9. Mental Condition (Negative emotions towards diabetes, Negative emotions towards life); 10. Levels of Support (Lack of community support, Lack of support from Friends and Family, Lack of Social Support); 11. Social integration (Low Degree of Integration, Belief in Suffering Alone); 12. Experience of transitions (Diet, Dwelling Environment).

Conclusion

Based on our findings, specific interventions targeting individual patients, family, community and society are needed to improve diabetes control, as well as patients’ mental health care and general living conditions.

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<![CDATA[Socioeconomic vulnerability associated to Toxoplasma gondii exposure in southern Brazil]]> https://www.researchpad.co/article/5c6f14bed5eed0c48467a799

Human toxoplasmosis, a protozoonosis caused by Toxoplasma gondii, has been described as a worldwide foodborne disease with important public health impact. Despite infection has reportedly varied due to differences in alimentary, cultural and hygienic habits and geographic region, social vulnerability influence on toxoplasmosis distribution remains to be fully established. Accordingly, the present study has aimed to assess T. gondii seroprevalence and factors associated to social vulnerability for infection in households of Ivaiporã, southern Brazil, with 33.6% population making half minimum wage or less, ranked 1,055th in population (31,816 habitants), 1,406th in per capita income (U$ 211.80 per month) and 1,021st in HDI (0.764) out of 5,570 Brazilian cities. Serum samples and epidemiological questionnaires were obtained from citizen volunteers with official City Secretary of Health assistance in 2015 and 2016. In overall, serosurvey has revealed 526/715 (73.57%) positive samples for anti-T. gondii antibodies by Indirect Fluorescent Antibody Test. Logistic regression has shown a significant increase associated to adults (p = 0.021) and elderly (p = 0.014) people, illiterates (p = 0.025), unemployment (p <0.001) and lack of household water tank (p = 0.039). On the other hand, sex (male or female), living area (urban or rural), yard hygiene, meat ingestion, sand or land contact, owning pets (dog, cat or both) were not significant variables of positivity for anti-T. gondii antibodies in the surveyed population. Although no significant spatial cluster was found, high intensity areas of seropositive individuals were located in the Kernel map where the suburban neighborhoods are located. In conclusion, socioeconomic vulnerability determinants may be associated to Toxoplasma gondii exposure. The increased risk due to illiteracy, adult or elderly age, unemployment and lack of household water tank were confirmed by multivariate analysis and the influence of low family income for seropositivity by the spatial analysis.

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<![CDATA[Socioeconomic gap between neighborhoods of Budapest: Striking impact on stroke and possible explanations]]> https://www.researchpad.co/article/5c76fe19d5eed0c484e5b4a4

Introduction

Hungary has a single payer health insurance system offering free healthcare for acute cerebrovascular disorders. Within the capital, Budapest, however there are considerable microregional socioeconomic differences. We hypothesized that socioeconomic deprivation reflects in less favorable stroke characteristics despite universal access to care.

Methods

From the database of the National Health Insurance Fund, we identified 4779 patients hospitalized between 2002 and 2007 for acute cerebrovascular disease (hereafter ACV, i.e. ischemic stroke, intracerebral hemorrhage, or transient ischemia), among residents of the poorest (District 8, n = 2618) and the wealthiest (District 12, n = 2161) neighborhoods of Budapest. Follow-up was until March 2013.

Results

Mean age at onset of ACV was 70±12 and 74±12 years for District 8 and 12 (p<0.01). Age-standardized incidence was higher in District 8 than in District 12 (680/100,000/year versus 518/100,000/year for ACV and 486/100,000/year versus 259/100,000/year for ischemic stroke). Age-standardized mortality of ACV overall and of ischemic stroke specifically was 157/100,000/year versus 100/100,000/year and 122/100,000/year versus 75/100,000/year for District 8 and 12. Long-term case fatality (at 1,5, and 10 years) for ACV and for ischemic stroke was higher in younger District 8 residents (41–70 years of age at the index event) compared to D12 residents of the same age. This gap between the districts increased with the length of follow-up. Of the risk diseases the prevalence of hypertension and diabetes was higher in District 8 than in District 12 (75% versus 66%, p<0.001; and 26% versus 16%, p<0.001).

Discussion

Despite universal healthcare coverage, the disadvantaged district has higher ACV incidence and mortality than the wealthier neighborhood. This difference affects primarily the younger age groups. Long-term follow-up data suggest that inequity in institutional rehabilitation and home-care should be investigated and improved in disadvantaged neighborhoods.

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<![CDATA[Perceptions of chest pain and healthcare seeking behavior for chest pain in northern Tanzania: A community-based survey]]> https://www.researchpad.co/article/5c6c7595d5eed0c4843cfecf

Background

Little is known about community perceptions of chest pain and healthcare seeking behavior for chest pain in sub-Saharan Africa.

Methods

A two-stage randomized population-based cluster survey with selection proportional to population size was performed in northern Tanzania. Self-identified household healthcare decision-makers from randomly selected households were asked to list all possible causes of chest pain in an adult and asked where they would go if an adult household member had chest pain.

Results

Of 718 respondents, 485 (67.5%) were females. The most commonly cited causes of chest pain were weather and exercise, identified by 342 (47.6%) and 318 (44.3%) respondents. Two (0.3%) respondents identified ‘heart attack’ as a possible cause of chest pain. A hospital was selected as the preferred healthcare facility for an adult with chest pain by 277 (38.6%) respondents. Females were less likely to prefer a hospital than males (OR 0.65, 95% CI 0.47–0.90, p = 0.008).

Conclusions

There is little community awareness of cardiac causes of chest pain in northern Tanzania, and most adults reported that they would not present to a hospital for this symptom. There is an urgent need for educational interventions to address this knowledge deficit and guide appropriate care-seeking behavior.

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<![CDATA[Is there an association between working conditions and health? An analysis of the Sixth European Working Conditions Survey data]]> https://www.researchpad.co/article/5c6c75c9d5eed0c4843d01a5

This paper analyses the association between working conditions and physical health using data from the Sixth European Working Conditions Survey (EWCS6) released in 2017. The econometric analysis uses two indicators to describe health status: self-assessed health (SAH), which is a subjective indicator of health; and an objective indicator of health (SICK), which is based on the occurrence of any illness or health problem that has lasted or is expected to last for more than 6 months. The theoretical hypotheses concerning the association between working conditions and SAH and the association between working conditions and SICK are tested using a standard ordered probit model and a standard probit model, respectively. The results show that encouraging working conditions, work environment, and job support are associated with both better self-assessed health and better objective health.

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