Insular pathways to health care in the city: a multilevel analysis of access to hospital care in urban Kerala, India

OBJECTIVES: To identify individual and urban unit characteristics associated with access to inpatient care in public and private sectors in urban Kerala, and to discuss policy implications of inequalities in access. METHODS: We analysed the NSSO survey (1995-1996) for urban Kerala with regard to source and trajectories of hospitalization. Multinomial multilevel regression models were built for 695 cases nested in 24 urban units. RESULTS: Private sector accounts for 62% of hospitalizations. Only 31% of hospitalizations are in free wards and 20% of public hospitalizations involve payment. Hospitalization pathways suggest a segmentation of public and private health markets. Members of poor and casual worker households have lower propensity of hospitalization in paying public wards or private hospitals. There were important variations between cities, with higher odds of private hospitalization in towns with fewer hospital beds overall and in districts with high private-public bed ratios. Cities from districts with better economic indicators and dominance of private services have higher proportion of private hospitalizations. CONCLUSIONS: The private sector is the predominant source of inpatient care in urban Kerala. The public sector has an important role in providing access to care for the poor. Investing in the quality of public services is essential to ensure equity in access.     

An update on physical health and economic consequences of overweight and obesity

Overweight and obesity (OW and OB) have been on the increase globally and posed health risks to the world’s population of all ages, including pre-born babies, children, adolescents, adults and elderly people, via their comorbid conditions. Excellent examples of comorbidities associated with obesity include cancer, cardiovascular diseases (CVD) and type 2 diabetes mellitus (T2DM). In this article, we aimed to review and update scientific evidence regarding the relationships between obesity and its common physical health consequences, including CVD, T2DM, hypertension, ischemic stroke, cancer, dyslipidemia and reproductive disorders. In addition, the economic burden of OW and OB will be discussed. Abundant evidence is found to support the associations between obesity and other diseases. In general, the odd ratios, risk ratios or hazard ratios are often higher in OW and OB people than in the normal-weight ones. However, the molecular mechanism of how OW and OB induce the development of other diseases has not been fully understood. Figures also showed that obesity and its-related disorders exert enormous pressure on the economy which is projected to increase. This review highlights the fact that obesity can lead to numerous lethal health problems; therefore, it requires a lot of economic resources to fight against this epidemic.     

First Nations Health: Supporting health equity for First Nations,Inuit and Métis peoples

The National Collaborating Centre for Indigenous Health (NCCIH) is unique among the National Collaborating Centres as the only centre focused on the health of a population. In this fifth article of the Canada Communicable Disease Report’s series on the National Collaborating Centres and their contribution to Canada’s public health response to the coronavirus disease 2019 (COVID-19) pandemic, we describe the work of the NCCIH. We begin with a brief overview of the NCCIH’s mandate and priority areas, describing how it works, who it serves and how it has remained flexible and responsive to evolving Indigenous public health needs. Key knowledge translation and exchange activities undertaken by the NCCIH to address COVID-19 misinformation and to support the timely use of Indigenous-informed evidence and knowledge in public health decision-making during the pandemic are also discussed, with a focus on acting on lessons learned moving forward.     

Religious involvement,social support,and health among African-American women on the east side of detroit

BACKGROUND: A significant body of research suggests that religious involvement is related to better mental and physical health. Religion or spirituality was identified as an important health protective factor by women participating in the East Side Village Health Worker Partnership (ESVHWP), a community-based participatory research initiative on Detroit's east side. However, relatively little research to date has examined the mechanisms through which religion may exert a positive effect on health. OBJECTIVE: The research presented here examines the direct effects of different forms of religious involvement on health, and the mediating effects of social support received in the church as a potential mechanism that may account for observed relationships between church attendance and health. DESIGN: This study involved a random sample household survey of 679 African-American women living on the east side of Detroit, conducted as part of the ESVHWP. MAIN RESULTS: Results of multivariate analyses show that respondents who pray less often report a greater number of depressive symptoms, and that faith, as an important source of strength in one's daily life, is positively associated with chronic conditions such as asthma or arthritis. Tests of the mediating effect of social support in the church indicated that social support received from church members mediates the positive relationship between church attendance and specific indicators of health. CONCLUSIONS: These findings are consistent with the hypothesis that one of the major ways religious involvement benefits health is through expanding an individual's social connections. The implications of these findings for research and practice are discussed.     

The effects of maternal and child HIV infection on health equity in Tigray Region,Ethiopia, and the implications for the health system: a case–control study

ABSTRACT

Services that aim to prevent mother-to-child HIV transmission (PMTCT) can simultaneously reduce the overall impact of HIV infection in a population while also improving maternal and child health outcomes. By taking a health equity perspective, this retrospective case control study aimed to compare the health status of under-5 children born to HIV-positive and HIV-negative mothers in Tigray Region, Ethiopia. Two hundred and thirteen HIV-positive women (cases), and 214 HIV-negative women (controls) participated through interviews regarding their oldest children. Of the children born to HIV-positive mothers, 24% had not been tested, and 17% of those who had been tested were HIV-positive themselves. Only 29% of the HIV-positive children were linked to an ART programme. Unexpectedly, exposed HIV-negative children had fewer reports of perceived poor health as compared to unexposed children. Over 90% of all the children, regardless of maternal HIV status, were breastfed and up-to-date with the recommended immunizations. The high rate of HIV infection among the babies of HIV-positive women along with their low rates of antiretroviral treatment raises serious concerns about the quality of outreach to pregnant women in Tigray Region, and of the follow-up for children who have been exposed to HIV via their mothers.     

Integrating gerontological competencies in Canadian health and social service education: An overview of trends,enablers, and challenges

ABSTRACT

As the number of older adults increases, it is imperative that gerontological competencies are imbedded in health and social service education reviews of Canadian published and grey literature presents trends, barriers, and enablers of sustained movement toward graduating professionals with gerontology competencies. Overall, gerontological education remains insufficient. Main barriers include resources for faculty and teaching. This review also identified discipline-specific competency frameworks that could inform curriculum enhancement and education accreditations; however, most educators were unaware of these. Further limiting workforce development is the lack of gerontology competency statements within regulatory documents. This review concludes with recommendations for federal and provincial policies to establish educational accreditation programs in geriatrics, develop core competencies, and integrate these into regulatory frameworks. Failure to do so will continue the trend of insufficient preparation of health and social service professionals to care for older adults.     

The effect of physical activity on dose-relationship between serum 25-hydroxyvitamin D and cardiovascular health events in older adults

Background and aimsReverse J- or U-shaped associations between serum 25-hydroxyvitamin D (25[OH]D) concentrations and cardiovascular outcomes have been reported, which need clarifications in older adults. Physical activity, correlating with both serum 25[OH]D concentration and cardiovascular health, may have an effect on the dose-relationships.Methods and ResultsAt baseline, 2790 participants aged 65 years and over, free of vitamin D supplementation use, had assays for serum 25[OH]D concentrations and health related characteristics and measurements, were followed up for cardiovascular events and death by up to 7 and 15 years, respectively. The dose–response associations of serum 25[OH]D concentrations with cardiovascular events and mortality risk were examined using Cox regression models.After adjusting for physical activity and other covariates, serum 25[OH]D concentration was non-linearly associated with cardiovascular mortality risk (U-shaped, P = 0.009). According to the Institute of Medicine categories, the HR(95% CI) of cardiovascular mortality risk separately in deficient (<25 nmol/L), inadequate (25 to < 50 nmol/L) and potentially harmful (≥125 nmol/L) level was 1.67 (0.23, 12.01), 1.66 (1.25, 2.20) and 2.21 (0.30, 16.37), respectively. The risk of 25[OH]D inadequacy for cardiovascular mortality was significantly attenuated by increased physical activity, especially leisure activity (P for trend = 0.008 and 0.021, respectively). No significant finding was observed for incident cardiovascular events.ConclusionBoth lower and higher serum 25[OH]D concentrations were associated with risk of cardiovascular mortality in Chinese community-dwelling older adults. Physical activity may attenuate the cardiovascular mortality risk of vitamin D inadequacy, but its role in individuals with higher 25[OH]D concentrations remains unclear.     

Effects of vitamin D supplementation on strength, physical function, and health perception in older, community-dwelling men

OBJECTIVES: To study the effects of vitamin D supplementation in healthier populations of men. DESIGN: : Randomized, controlled trial. SETTING: General clinical research center. PARTICIPANTS: Sixty-five healthy, community-dwelling men (mean age+/-standard deviation=76+/-4, range 65-87). INTERVENTION: Cholecalciferol (1,000 IU/d) or placebo supplementation for 6 months; all received 500 mg supplemental calcium. MEASUREMENTS: Upper and lower extremity muscle strength and power, physical performance and activity, health perception, calcium and vitamin D intake, and biochemical assessment, including 25-hydroxyvitamin D (25OHD), parathyroid hormone (PTH), and ionized calcium levels. RESULTS: The levels of 25OHD increased and PTH decreased in the cholecalciferol group, whereas there were no significant changes in the control group (P<.001). Baseline 25OHD levels correlated with baseline single-leg stance time and physical activity score. Baseline PTH levels correlated with baseline 8-foot walk time and physical activity score. No significant difference in strength, power, physical performance, or health perception was found between groups. CONCLUSION: The 25OHD or PTH levels correlated with physical activity and physical performance in older, community-dwelling men with normal 25OHD status. Vitamin D supplementation increased 25OHD levels and decreased PTH levels but did not increase muscle strength or improve physical performance or health perception in this group of healthy, older men. Further investigations of the effects of vitamin D supplementation should focus on individuals with low levels of vitamin D.     

Systematic review on the financial return of worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity

This systematic review summarizes the current evidence on the financial return of worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity. Data on study characteristics and results were extracted from 18 studies published up to 14 January 2011. Two reviewers independently assessed the risk of bias of included studies. Three metrics were (re-)calculated per study: the net benefits, benefit cost ratio (BCR) and return on investment (ROI). Metrics were averaged, and a post hoc subgroup analysis was performed to compare financial return estimates between study designs. Four randomized controlled trials (RCTs), 13 non-randomized studies (NRSs) and one modelling study were included. Average financial return estimates in terms of absenteeism benefits (NRS: ROI 325%, BCR 4.25; RCT: ROI -49%, BCR 0.51), medical benefits (NRS: ROI 95%, BCR 1.95; RCT: ROI -112%, BCR -0.12) or both (NRS: ROI 387%, BCR 4.87; RCT: ROI -92%, BCR 0.08) were positive in NRSs, but negative in RCTs. Worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity generate financial savings in terms of reduced absenteeism costs, medical costs or both according to NRSs, whereas they do not according to RCTs. Since these programmes are associated with additional types of benefits, conclusions about their overall profitability cannot be made.     

Role of physical activity,physical fitness,and chronic health conditions on the physical independence of community-dwelling older adults over a 5-year period

The variability in the individual characteristics and habits could help determine how older adults maintain independence. The impact of the variability in physical activity, physical fitness, body composition, and chronic health conditions (co-morbidities) on the independence of older adults, especially over time, is seldom examined. This study aims to analyze quantitatively the impact of baseline values and changes in physical activity, physical fitness, body composition, and co-morbidities on the physical independence of community-dwelling, older adults over a 5-year period. Data from 106 and 85 community-dwelling adults (≥60 years) were collected at baseline and after five years, respectively. Linear regression selected the main predictors of changes in physical independence as follows: the baseline physical independence (β = 0.032, R² = 9.9%) and co-morbidities (β = −0.191, R² = 6.3%) and the changes in co-morbidities (β = −0.244, R² = 10.8%), agility (β = −0.288, R² = 6.7%), aerobic endurance (β = 0.007, R² = 3.2%), and walking expenditure (β = 0.001, R² = 5.1%) (p < 0.05). In conclusion, baseline physical independence, baseline co-morbidities, and changes in co-morbidities, walking, agility, and aerobic endurance predicted physical independence over five years regardless of age and gender. Gains of up to 8.3% in physical independence were associated with improvements in these variables, which corresponds to regaining independence for performing one or two activities of daily living.     

Bancroftian filariasis on Pemba Island, Zanzibar, Tanzania: An update on the status in urban and semi-urban communities

Cross-sectional clinical, parasitological and entomological surveys for bancroftian filariasis were conducted in Konde, Chake Chake and Kengeja, three urban and semiurban communities on Pemba Island, and the results were compared with similar surveys done 15 years earlier. The overall prevalences of clinical manifestations among males aged 15 years or more (n = 614) was remarkably similar to those recorded 15 years earlier: elephantiasis 1.4% in 1975 and 1.1% in 1990; hydrocele, 22.4% and 21.8%, respectively. However, when the communities were compared individually, there was a reduction in the hydrocele prevalence in Konde from 22.4% to 11.5% and an increase in Kengeja from 27.0% to 35.5%. The overall microfilarial prevalence found during night blood surveys of all individuals aged 1 year or more (n = 2687) was 9.7%, compared to 14.2% recorded in 1975. The reduction was most pronounced in Konde. Of 1052 female mosquitoes caught with CDC light traps, 95% were Culex quinquefasciatus and 5% Anopheles gambiae s.l. Infective larvae of Wuchereria bancrofti were found only in the former. The filariasis situation in urban and semiurban communities on Pemba Island appears not to have changed considerably over the last 15 years.