Changes in health indicators related to health promotion and microcredit programs in the Dominican Republic.

OBJECTIVE: To assess the impact of health promotion programs and microcredit programs on three communities in the Dominican Republic. One community had only the health promotion program, one community had only the microcredit program, and one community had both a health promotion program and a microcredit program. This pilot project examined the hypothesis that the largest changes in 11 health indicators that were studied would be in the community with both a health promotion program and a microcredit program, that there would be intermediate changes in the community with only a health promotion program, and that the smallest changes would be in the community with only a microcredit program. METHODS: The health promotion programs used community volunteers to address two major concerns: (1) the prevalent causes of mortality among children under 5 years of age and (2) women's health (specifically breast and cervical cancer screening). The microcredit program made small loans to individuals to start or expand small businesses. Outcome measures were based on comparisons for 11 health indicators from baseline community surveys (27 households surveyed in each of the three communities, done in December 2000 and January 2001) and from follow-up surveys (also 27 households surveyed in each of the three communities, in June and July 2002, after the health promotion program had been operating for about 13 months). Households were randomly chosen during both the baseline and follow-up surveys, without regard to their involvement in the microcredit or health promotion programs. RESULTS: The health indicators improved in all three communities. However, the degree of change was different among the communities (P < 0.001). The community with parallel microcredit and health promotion programs had the largest changes for 10 of the 11 health indicators. CONCLUSIONS: Multisector development is known to be important on a macroeconomic scale. The results of this pilot project support the view that multisector development is also important on a microeconomic level, given that the parallel microcredit and health promotion programs resulted in greater change in the measured health indicators than either program alone. As far as we authors know, this is the first published study to quantify changes in health indicators related to parallel health promotion and microcredit programs as compared to control communities with only a health promotion program or a microcredit program.     

Challenging household dynamics: Impact of orphanhood,parental absence,and children's living arrangements on education in South Africa

Abstract

Public health and social-historical changes have had multiple effects on South African children and families. This study examines the association between challenging family dynamics, such as child orphan status, and educational delay, as defined by being below proper grade-for-age. Analysing the 2003/2004 South Africa Demographic and Health Surveys (DHS) dataset, we estimate orphan prevalence, maternal and paternal household presence, other household characteristics, and schooling variables in a nationally representative household sample. Among 5592 children ages 8–14 in South Africa, 21% had experienced parental death, 33% did not have their mother present in the household, and 63% of the children were not living with their father. Twenty per cent were behind proper grade-for-age. A bivariate analysis shows that orphaned children experienced 35% greater odds of being behind in school (p<0.001). After adjusting for parental presence, household characteristics, and socio-demographic factors, orphan status does not remain significantly associated with being behind in school. However, maternal presence, relationship to the household head, number of children in a household, and socio-demographic characteristics each independently affect a child's likelihood of educational delay. Findings offer a more nuanced understanding of household dynamics that may protect against or exacerbate educational delays among vulnerable youth.     

Challenges of Reproductive Health Management in the Camps of Internally Displaced Persons: A Systematic Review

BackgroundInternally Displaced Persons (IDPs) in the camps face many reproductive health challenges. They should meet their needs timely to save their lives. This paper outlines a systematic review to discuss the challenges of reproductive health management in the camps of internally displaced persons.MethodsFor this research, electronic databases including PubMed, Science Direct, Scopus, Pro Quest, Google Scholar and Cochrane Library till January 1, 2020 were searched. A threestage screening process was used for the selection of literature due to PRISMA checklist. Finally, a thematic synthesis approach was applied to analyze the data.ResultsIn total, 133 articles were identified; 11 articles met the inclusion criteria for entering the process of final analysis. The findings were demonstrated in six main categories of availability and accessibility of reproductive health services, sexual and gender-based issues, human rights, social and cultural issues, coordination and collaboration, and mental health issues. The remarkable result of this study highlighted that the main challenges are lack of access to health services, violence against women and lack of household education.ConclusionResults of this systematic review present valuable advice for policy makers and managers to prepare and respond effectively and timely to reproductive health challenges of internally displaces persons. Disaster preparedness plans and contingency plans for maintaining and developing reproductive health in IDPs camps are recommended.     

Ethnicity,household composition and COVID-19 mortality: a national linked data study

ObjectiveTo estimate the proportion of ethnic inequalities explained by living in a multi-generational household.DesignCausal mediation analysis.SettingRetrospective data from the 2011 Census linked to Hospital Episode Statistics (2017-2019) and death registration data (up to 30 November 2020).ParticipantsAdults aged 65 years or over living in private households in England from 2 March 2020 until 30 November 2020 (n=10,078,568).Main outcome measuresHazard ratios were estimated for COVID-19 death for people living in a multi-generational household compared with people living with another older adult, adjusting for geographic factors, socioeconomic characteristics and pre-pandemic health.ResultsLiving in a multi-generational household was associated with an increased risk of COVID-19 death. After adjusting for confounding factors, the hazard ratios for living in a multi-generational household with dependent children were 1.17 (95% confidence interval [CI] 1.06–1.30) and 1.21 (95% CI 1.06–1.38) for elderly men and women. The hazard ratios for living in a multi-generational household without dependent children were 1.07 (95% CI 1.01–1.13) for elderly men and 1.17 (95% CI 1.07–1.25) for elderly women. Living in a multi-generational household explained about 11% of the elevated risk of COVID-19 death among elderly women from South Asian background, but very little for South Asian men or people in other ethnic minority groups.Conclusion Elderly adults living with younger people are at increased risk of COVID-19 mortality, and this is a contributing factor to the excess risk experienced by older South Asian women compared to White women. Relevant public health interventions should be directed at communities where such multi-generational households are highly prevalent.     

Sociocultural factors in depression in Asian Indian women

Peru is undergoing many deleterious economic and social changes, and the health consequences for families headed by single women is of special concern. However, not all single mothers’ families may be at similar risk of morbidity. My purpose in the present study was to determine whether variation in illness prevalence was associated with ostensibly small differences in socioeconomic resources and physical living conditions in areas like Peru. I used both qualitative and quantitative methods in this study. The sample included single‐women‐headed households from the rural Nuñoa District, located in the southern Peruvian Andes (N = 22 families with 90 individuals). Quantitative cross‐sectional survey results suggested that the mother's formal education, the availability of a latrine, drinking water contamination, the gender ratio of the household, and the quality of the social support network were key risk factors. They statistically predicted 35–91% of the morbidity variance between families (p ≤ .03‐.0001). I illustrate these findings in three ethnographic case studies. The case studies show how the degree of illness among single‐women‐headed families was affected by small differences in their social and physical living conditions.     

中国50岁及以上人群衰弱轨迹的研究

目的 识别中国≥50岁人群的衰弱轨迹，并探索相关影响因素。方法 采用WHO“全球老龄化与成人健康研究”（SAGE）中国项目第一至第三轮纵向数据，由32种变量计算衰弱指数得分，并在此基础上在组基轨迹模型中采用删失正态模型确定随时间变化的衰弱轨迹模式，采用多项式logistic回归模型研究社会经济地位和行为影响因素对衰弱轨迹的影响。结果 共纳入4 303名≥50岁且拥有3轮完整数据的调查对象进入分析，本研究识别出3条衰弱轨迹：低水平稳定轨迹（LT）、中度增加轨迹（MT）和高度增加轨迹（HT），分别占所有调查对象的75.9%，19.1%和5.0%。多项式logistic回归分析的结果显示，与LT组相比，HT组更倾向是女性（OR=1.88，95%CI：1.22~2.92）和农村居民（OR=1.87，95%CI：1.29~2.70）。在家庭人均财富方面，OR值有一个明显的梯度，较低的家庭财富更有可能归为HT组。结论 本研究识别出了3种我国≥50岁人群衰弱轨迹的进展模式，并强调了干预措施应尽可能地以那些衰弱进展快速的脆弱人群为目标。     

Social gradients in health for Pakistani and White British women and infants in two UK birth cohorts

Objectives. This study aims to examine social gradients in low birth weight (LBW), preterm birth, smoking during pregnancy and maternal health for women and infants of Pakistani origin and White British women and infants in the UK.

Design. The sample included women and singleton infants from the Born in Bradford (BiB) study (n?=?8181) and the first sweep of the Millennium Cohort Study (MCS) (n?=?8980). Social gradients in health for four measures of socioeconomic status (SES): maternal education, means-tested benefits, financial situation, and occupation of the father were analysed in multivariate regression models adjusting for maternal age and parity.

Results. For White British mothers and infants in the MCS sample, social gradients in health were observed for at least three out of four measures of SES for each health outcome (p for trend <.01). Similar trends were found for White British mothers and infants in the BiB sample, although these were less likely to be significant. There were few associations between measures of SES and outcomes in the Pakistani samples. The strongest evidence of a social gradient in health for Pakistani women was demonstrated with the self-reported measure of financial situation, in relation to mental health (p for trend <.001 in both cohorts).

Conclusion. This study describes a lack of social gradients in health for Pakistani women and infants and discusses potential explanations for this finding.     

Perceived discrimination and depressive symptoms: a study of Vietnamese women who migrated to South Korea due to marriage

ABSTRACT

International migrants are one group that is vulnerable to discrimination and mental health problems. This study examined the experience of perceived discrimination and its impact on depressive symptoms among women who migrated in the specific context of marriage. Using social constructionism and the stress appraisal model, this study conceptualized perceived discrimination as a potential source of stress and hypothesized that it would negatively impact the mental health of migrant women. A survey sample of 212 Vietnamese marriage migrant women in South Korea was used for the final analysis. Perceived discrimination was measured using the adapted Everyday Discrimination Scale (EDS). Overall, approximately 62% of the sample reported having at least one discriminatory encounter based on the nine items of the EDS. The results of the multivariate analyses indicated that perceived discrimination posed a significant risk to mental health (β = 0.43, p < .001). The experience of perceived discrimination increased the amount of explained variance of depressive symptoms by 17%. Findings highlighted the adverse mental health consequences of daily unfair treatment and disrespect in interpersonal contexts and the importance of social policies and programs that promote respect for cultural diversity.     

The Group-lending Model and Social Closure: Microcredit, Exclusion, and Health in Bangladesh

According to social exclusion theory, health risks are positively associated with involuntary social, economic, political and cultural exclusion from society. In this paper, a social exclusion framework has been used, and available literature on microcredit in Bangladesh has been reviewed to explore the available evidence on associations among microcredit, exclusion, and health outcomes. The paper addresses the question of whether participation in group-lending reduces health inequities through promoting social inclusion. The group-lending model of microcredit is a development intervention in which small-scale credit for income-generation activities is provided to groups of individuals who do not have material collateral. The paper outlines four pathways through which microcredit can affect health status: financing care in the event of health emergencies; financing health inputs such as improved nutrition; as a platform for health education; and by increasing social capital through group meetings and mutual support. For many participants, the group-lending model of microcredit can mitigate exclusionary processes and lead to improvements in health for some; for others, it can worsen exclusionary processes which contribute to health disadvantage.Key words: Exclusion, Economic assistance, Health status, Group-lending model, Health equity, Microcredit, Social exclusion, Bangladesh     

Willingness to Pay for Health-Related Quality of Life Gains in Relation to Disease Severity and the Age of Patients

ObjectivesDecision-making frameworks that draw on economic evaluations increasingly use equity weights to facilitate a more equitable and fair allocation of healthcare resources. These weights can be attached to health gains or reflected in the monetary threshold against which the incremental cost-effectiveness ratios of (new) health technologies are evaluated. Currently applied weights are based on different definitions of disease severity and do not account for age-related preferences in society. However, age has been shown to be an important equity-relevant characteristic. This study examines the willingness to pay (WTP) for health-related quality of life (QOL) gains in relation to the disease severity and age of patients, and the outcome of the disease.MethodsWe obtained WTP estimates by applying contingent-valuation tasks in a representative sample of the public in The Netherlands (n = 2023). We applied random-effects generalized least squares regression models to estimate the effect of patients’ disease severity and age, size of QOL gains, disease outcome (full recovery/death 1 year after falling ill), and respondent characteristics on the WTP.ResultsRespondents’ WTP was higher for more severely ill and younger patients and for larger-sized QOL gains, but lower for patients who died. However, the relations were nonlinear and context dependent. Respondents with a lower age, who were male, had a higher household income, and a higher QOL stated a higher WTP for QOL gains.ConclusionsOur results suggest that—if the aim is to align resource-allocation decisions in healthcare with societal preferences—currently applied equity weights do not suffice.     

Does Time Spent on Household Activities or Housework Stress Complicate Recovery Following Coronary Artery Bypass Surgery?

ABSTRACT

Objectives: The purpose of the present study was to examine the role of household activities and housework stress as factors contributing to gender differences in recovery following coronary artery bypass graft (CABG) surgery. Therefore, the impact of time spent on household activities and housework stress on physical functioning (PF) was explored.

Methods: Psychosocial data were measured two months and again one year after CABG in a sample of 351 patients (23% women) recruited within one week before surgery. Self-report questionnaires included assessment of household responsibilities, depression (PHQ–9), and PF (SF-36 subscale).

Results: The results revealed that, following CABG, women spent more time on household activities and experienced markedly more stress due to these activities than men. Surprisingly, only housework stress was associated with poorer PF, whereas the time spent on household activities did not explain differences in PF in men and women. Finally, household responsibilities were not associated with the poorer recovery of the female CABG patient.

Discussion: In conclusion, our results do not support the advice that women should not resume household activities two months after surgery. More research is needed to establish valid guidelines.     

Reading fiction during sick leave,a multidimensional occupation

Background: In bibliotherapy, the therapeutic gains of reading fiction are ascribed to the literature. Viewing reading fiction as an occupation may give other explanations of its therapeutic function. Aim: The aim of this qualitative study was to explore the experiences of reading fiction among women during a period of sick leave. Material and methods: A qualitative approach was applied. Eight women who had been reading fiction during sick leave were interviewed. Results: An overarching theme: Supporting one’s active self, comprised five categories of experiences: a prospect of ordinary life, a place of refuge, a life together with others, a source of power, and as supporting an active life. Conclusion and significance: Based on the categories, reading fiction is seen to comprise intentional, functional, mental, relational, and personal dimensions. A tentative model of supporting one’s active self is proposed, which may be helpful in clarifying the mechanisms of the process of change. The health-related dimensions of reading fiction suggest that reading fiction should be regarded as a significant occupation comparable with other, more highlighted ones. Understood in this way, it is argued that the results add to the knowledge base in occupational therapy focusing on how meaningful occupations connect to occupational life trajectories.     

The double burden of overweight or obesity and anemia among women married as children in India: A case of the Simpson’s paradox

BackgroundChild marriage, defined as marriage before age 18 years, could impact women’s nutritional status through biological as well as environmental and socioeconomic attributes affecting diet and lifestyle behaviors. This study aims to examine whether women married as children have a differential risk of individual level double burden of overweight/obesity and anemia at adult age compared to women married as adults.MethodsUsing nationally representative data from India we estimated multinomial logistic regressions to obtain relative risk ratios (RRR) in favor of mutually exclusive anemia and overweight/ obesity conditions among women aged 20–49 years. We estimated the model for full sample and for sub-samples by household wealth groups.ResultsWe find that women who were married as children had a lower relative risk (RRR=0.941) of the double burden of anemia and overweight/obesity in the full sample. However, when sociodemographic correlates were accounted for and assessed in sub-groups by wealth groups, they had a higher relative risk (ARRR ranging from 1.079 to 1.204) of the double burden compared to women married as adults.ConclusionOur results thus portray a classic case of the Simpson’s paradox by documenting a reversal of association between child marriage and occurrence of the double burden of malnutrition in the subgroup level than that in the general population. This finding provides a critical policy insight for effective public health interventions to improve women’s health and wellbeing, particularly in low resource settings.     

精准帮扶视域下灾难性卫生支出的脆弱群体分析*

目的：识别脆弱群体,降低灾难性卫生支出发生风险。方法：采用2018年《中国健康与养老追踪调查》数据。 用卡方检验比较不同组别之间灾难性卫生支出发生率,用logistic回归分析识别灾难性卫生支出的影响因素。结果：2018年, 家庭灾难性卫生支出总体的发生率为27.37%。logistic回归分析结果显示,已婚、自评健康差、家庭规模小、家庭经济情况差、有家庭成员利用门诊或住院卫生服务、家庭有慢性病患者、家庭有60岁以上成员的家庭为灾难性卫生支出的脆弱群体。 结论：鉴于灾难性卫生支出发生率较高,需采用更加精准有效的策略来降低居民的灾难性卫生支出发生风险。     

Eight-Year Longitudinal Changes in Body Composition in Healthy Swiss Adults

Objective: Significant changes in body composition occur during lifetime. This longitudinal study (8.0 ± 0.8 yrs) in a cohort of healthy sedentary and physically active men (n = 78) and women (n = 53), aged 20 to 74 yr describes: 1) the longitudinal changes in weight and body composition and 2) their associations with age and physical activity.

Method: Fat-free mass (FFM) and body fat (BF) were assessed by bioelectrical impedance analysis (BIA). Subjects who regularly performed >3 hours per week of endurance type physical activity were classified as “Active”. Others were classified as “Sedentary”. Subjects were also separated by age (<45 yr vs ≥45 yr).

Results: FFM increased by 1.7 ± 2.8 kg in men <45 yr who gained 4.0 ± 5.0 kg of body weight and was maintained (0.5 ± 1.6 kg) in women <45 y who gained 1.6 ± 3.0 kg of weight. A weight gain of 1.2 ± 3.3 kg in men ≥45 yr was accompanied by stable FFM (?0.1 ± 2.3 kg), and of 1.0 ± 3.2 kg was accompanied by a loss of FFM in women ≥45 yr. In active men ≥45 yr, maintenance of FFM was associated with smaller weight gains than in sedentary; sedentary men ≥45 yr decreased FFM with larger weight gains than active subjects. Sedentary women <45 yr were able to gain FFM; the active women maintained, but did not gain FFM with smaller weight gains than in sedentary women. FFM decreased in ≥45 yr women despite of small weight gains.

Conclusion: Weight change is clearly associated with a change in FFM. Weight gain is necessary to offset age-related FFM loss between 20 and 74 yrs. In active men, a FFM increase was associated with less weight gain than sedentary men. Future studies should evaluate the threshold of weight change and the level of physical activity necessary to prevent age-related losses of FFM.     

Are partner's features important to understand health at older ages? The Spanish case

ObjectiveTo analyse health differences among partnered individuals in Spain aged 65-81 considering their combined (education of both partners and age gap) and household (economic capacity of the household) characteristics.MethodA cross-sectional study of the 2015 Spanish sample of the European Union Statistics on Income and Living Conditions survey (EU-SILC) on partnered individuals aged 65-81 years (N = 1787). Using logistic regression models separately for women and men we obtained odds and predicted probabilities of having less than good health (95% confidence intervals) according to combined information from both partners on education and age, the household's economic capacity and partner's health status.ResultsProbabilities of not having good health are significantly less among lower educated women whose partners are more highly educated (compared to both partners being lower educated) and among women whose partner is younger or has good health status. The latter also applies to men. Living in a household without economic difficulties also favours health (both sexes).ConclusionsFor both sexes a partner's health status is the variable that shows the largest effect on elderly partnered Spanish people's health but women's health appears to be more sensitive to their partner's educational attainment and the household's economic situation.     

Urban and Rural Differences in Pregnancy Weight Gain in Guilan,Northern Iran

Objectives This study aimed to compare pregnancy weight gain and weight gain patterns in a group of Iranian women who attended urban and rural public health centers for prenatal care in Guilan, Iran. Design A secondary data analysis using routinely collected health centers data. Setting 12 randomly selected health centers in urban and rural areas in Guilan. Participants A total of 2,047 pregnant women (1,097 in urban areas and 950 in rural areas) who regularly attended health centers for prenatal care and delivered between June 2003 and August 2006. Measurements Data on prepregnancy weight, height, pregnancy weight gain, mother’s age, parity, education and infant birth weight were extracted from the health records. The women were categorized based on their prepregnancy body mass index as underweight, normal weight and overweight. Findings These results showed that among normal weight women, 41.1% of urban and 56.6% of rural women had weight gains below the Institute of Medicine (IOM) recommendation (P < 0.0001). Among underweight women, 48.1% of urban and 65.8% of rural women had weight gains below the IOM recommendation (P < 0.0001). Rural women with normal prepregnancy weight gained less weight than the urban women in the second trimester of their pregnancy (5.7 ± 2.9 kg vs. 4.6 ± 2.5 kg, P < 0.0001). The underweight rural women gained less weight in both the second and the third trimesters of their pregnancy than the urban women. While the overall prevalence of having low birth weight (LBW) infants for underweight women were 5.2% only 1.9 % of those who gained adequate pregnancy weight gain had LBW infants. Conclusion This study indicated that a considerable proportion of the women both in urban and rural areas in Guilan, Iran had inadequate pregnancy weight gain. These results showed that prenatal care in terms of pregnancy weight gain in the present health system is not satisfactory.     

Gender differences in physical activity patterns among older adults who fall

ObjectiveThis study describes gender differences in the level and pattern of physical activity in groups of older adults who were frequent fallers, intermittent fallers, or non-fallers.MethodsInterviews were conducted with adults aged 50 years and older (N = 1834) at senior centers across Pennsylvania from 2010 to 2011. Self-reported falls and validated measures of physical activity were collected at baseline and at 6- and 12-month follow-up assessments.ResultsComplete follow-up data were available for 1487 participants. Men who fell frequently decreased in recreational/leisure activity and household/yard work compared to the intermittent fallers and non-fallers. This association remained even when controlling for baseline health status. All women—regardless of fall group—engaged in similar levels of recreational/leisure activity and household/yard work over time. For both men and women, frequent fallers also showed a greater decrease in walking activities compared to intermittent fallers and non-fallers.DiscussionFrequent falling among older adults is associated with declines in common leisure, household, and walking activities. The effect of falling frequency on physical activity appears to affect men and women differently, generating the hypothesis that interventions to promote physical activity among fallers need to be gender specific.     

Hospitalisation among the elderly in urban China

ObjectivesThe aim of this study was to examine the trend of hospitalisation amongst the elderly in urban China and analyse the main socio-economic factors which are affecting the use of inpatient care.MethodsData from the Chinese national household health interview surveys conducted in 1993, 1998 and 2003 were analysed. The following variables were selected: gender, health insurance coverage and household income.ResultsElderly people with insurance are more likely to use inpatient services than those who were not insured. Elderly people in the low income group are less likely than ones in the high income group to use inpatient services. Non-hospitalisation is more common amongst elderly women than elderly men and amongst the non-insured. The likelihood of elderly people in the low income groups not using inpatient services has increased dramatically from 12% in 1993 to 134% in 2003. Financial difficulty appeared to be the most common reason for not accessing inpatient care, particularly for elderly people without health insurance.ConclusionsElderly people with low income, without health insurance, and women appear to be more vulnerable in their access to inpatient care. Appropriate policies could be developed to protect these groups of people from high health care expenses.     

孕早期体力活动与妊娠期糖尿病关系的队列研究

目的 前瞻性地探究北京地区孕妇总体力活动和不同类型体力活动与妊娠期糖尿病（gestational diabetes mellitus,GDM）的关系。方法 以中国孕产妇队列研究·协和项目中的909名孕妇为研究对象,采用孕期身体活动问卷（pregnancy physical activity questionnaire,PPAQ）调查孕早期家务照顾、职业活动、运动锻炼和交通活动,并随访收集研究对象GDM诊断情况。采用非条件多因素logistic回归进行关联性分析。结果 共206名孕妇（22.7%）诊断为GDM,调整年龄、孕前BMI、糖尿病家族史和其他类别体力活动等因素后,logistic回归结果显示,相比于孕早期家务照顾较低水平的孕妇,中等水平的孕妇GDM发生风险较低（OR=0.654, 95% CI：0.436～0.980）;相比于不参加运动锻炼的孕妇,运动锻炼达标的孕妇GDM发生风险较低（OR=0.518, 95% CI：0.287～0.934）;总体力活动、职业活动和交通活动与GDM的发生无关。结论 孕早期运动锻炼和家务照顾是GDM的影响因素,鼓励孕妇提高孕早期运动锻炼水平、从事适度家务照顾可能有助于预防GDM。