Severity of juvenile onset recurrent respiratory papillomatosis is not associated with socioeconomic status in a setting of universal health care

BACKGROUND: Juvenile onset recurrent respiratory papillomatosis (JORRP) results from HPV transmission. Cervical cancer, also transmitted via HPV, is known to be correlated with socioeconomic status (SES). This study aims to determine if an association exists between SES and severity of JORRP. METHODS: Cross-sectional study of all active JORRP patients at the Hospital for Sick Children in Toronto in 2005. SES information from Hollingshead surveys, Postal walk Census data, and Low Income Cutoff Data were compared with Derkay-Wiatrak disease severity scores, peak annual surgical frequency, and age of diagnosis. Statistical analysis was performed using Spearman, Mann-Whitney, and linear regression analyses. RESULTS: Twenty-one patients were surveyed. Hollingshead results were as follows: two patients (10%) were class I (major business and professional); 11 patients (52%) were class II (medium business, minor professional, technical); 4 patients (19%) were class III (skilled craftsmen, clerical, sales workers); 4 patients (19%) were class IV (machine operators, semiskilled workers); 0% were from class V (unskilled laborers, menial service workers). Interestingly, based on postal code data nine patients (45%) were below the low income cutoff as compared to the Toronto (metropolitan) and Ontario (provincial) rates of low income (17% and 14%, respectively). There was significant correlation between each of the SES measures and between disease severity measures. However, analysis of the SES measures versus disease severity measures did not demonstrate any significant relationship. CONCLUSIONS: Though almost half the patients lived below the low income cutoff, this study did not demonstrate a significant correlation between socioeconomic status and severity of disease in JORRP. One possible explanation is that universal access to the Canadian health care system is able to provide support despite a large proportion of patients being socioeconomically vulnerable. A national level study is underway to further detect any relationship between SES and JORRP severity in the general population.     

Prevalence and factors affecting underweight,overweight and obesity using Asian and World Health Organization cutoffs among adults in Nepal: Analysis of the Demographic and Health Survey 2016

ObjectiveThere is a little published data on prevalence and determinants of underweight, overweight and obesity among adults in Nepal. This study analysed the cross-sectional Nepal Demographic and Health Survey (NDHS) 2016 to obtain these using the World Health Organization (WHO) and Asian-specific cutoffs of body mass index (BMI).MethodsThe 2016 NDHS used a multistage cluster-sampling design to obtain data on major health indicators in Nepal. The BMI cutoffs for underweight was <18.5 kg/m². The BMI cutoffs for overweight/obesity as per the Asian and WHO classifications were ≥23, and ≥25 kg/m², respectively. After reporting the prevalence according to sex and background characteristics, multilevel logistic regression was conducted to estimate odds ratios.SubjectsThis analysis included 12,652 adults (5283 males and 7369 females) with a median age of 40 years (interquartile range [IQR]: 28–54).ResultsThe overall median BMI was 21.5 kg/m² (IQR:19.3–24.3). The overall prevalence of underweight was 16.7% (15.1% among males and 17.1% among females). The Asian-specific BMI cutoffs found the prevalence of overweight and obesity as 26.4% (27.4% among males and 25.6% among females) and 11.0% (7.7% among males and 13.3% among females), respectively. The WHO-recommended BMI cutoffs found 18.2% people overweight (16.7% among males and 19.3% among females) and 4.3% (2.5% among males and 5.6% among females) people obese. The prevalence and odds of extreme body weight categories (i.e., underweight, overweight and obesity) varied according to age, sex, education level, household wealth status, place, ecological zone and provinces of residence as per both recommended cutoffs. Overall, higher education level and wealth status were positively associated with overweight/obesity and inversely associated with underweight as per both cutoffs.ConclusionA large proportion Nepalese adults have either underweight, overweight or obesity, and could be at a greater risk of mortality and morbidity due to these extreme body weight categories. It is essential to address the factors or characteristics that are associated with the higher prevalence and likelihood of these extreme body weight categories to reduce the overall burden of underweight and overweight/obesity in Nepal.     

A Lifecourse Perspective on Socio-economic Inequalities in Health: The Influence of Childhood Socio-economic Conditions and Selection Processes

In this article a lifecourse perspective on socio-economic inequalities in health is presented. In a lifecourse perspective, cumulation of adverse socio-economic circumstances and selection are important mechanisms, which successively may cause a downward spiral. A conceptual model is examined with empirical data. Three processes in the explanation of socio-economic health inequalities are emphasised: the contribution of childhood socio-economic conditions, the contribution of childhood health and the contribution of health selection. Data were used from the longitudinal Study of Socio-Economic Health Differences (LS-SEHD) in the Netherlands.
It was found that the relation between adult socio-economic status and adult health is influenced by childhood socio-economic conditions. An independent effect of childhood socio-economic conditions on adult health was partly explained by unhealthy behaviour and personality characteristics and cultural factors. Also, childhood health was found to play a role in the explanation of socio-economic health differences in early adult life. Health selection in childhood seems the most important mechanism in this process. With respect to health selection in adult life no effect of health problems on downward social mobility was apparent. Our results indicate that the occurrence of a downward spiral is likely to be significant during the period of childhood and youth.     

The effect of being informed on receiving immediate breast reconstruction in breast cancer patients

Introduction

In previous research from the NABON breast cancer audit, observed hospital variation in immediate breast reconstruction (IBR) rates in the Netherlands could not be fully explained by tumour, patient, and hospital factors. The process of information provision and decision-making may also contribute to the observed variation; the objective of the current study was to give insight in the underlying decision-making process for IBR and to determine the effect of being informed about IBR on receiving IBR.

中药食疗配合延续性护理对中老年糖尿病患者SAS、SDS、SES评分及血糖水平的影响

目的探讨中药食疗配合延续性护理对中老年糖尿病患者SAS、SDS、SES评分及血糖水平的影响。方法选取我院中老年糖尿病患者80例,依据护理方法将这些患者分为延续性护理组和常规护理组。对两组患者的SAS、SDS、SES评分、血糖水平进行统计分析。结果延续性护理组患者的SAS、SDS评分均显著低于常规护理组(P0.05),SES评分显著高于常规护理组(P0.05),空腹血糖、餐后2h血糖、糖化血红蛋白水平均显著低于常规护理组(P0.05)。结论延续性护理较常规护理更能有效降低中老年糖尿病患者的SAS、SDS评分及血糖水平,提升患者的SES评分。     

Forecasting Disparities With Early Substance-Use Milestones

Substance use contributes to health disparities across race/ethnicity, gender, and socioeconomic status (SES). Although adolescent research indicates group-based differences in regular use, few studies have examined patterns when initiation is just beginning. Using a sample of 917 Rhode Island middle schools students (54% female, 26% non-Hispanic White), we collected demographic information at baseline (M age 12.2); we then examined ever-puff (cigarettes), ever-sip (alcohol), and ever-use (marijuana) behaviors three years later. For cigarette use, we found differences based on SES and race/ethnicity (prevalence was particularly high among Native American youths). Marijuana use was associated with lower SES, and alcohol use was higher among females than males. Overall, findings indicate racial/ethnic-, gender- and SES-based differences in early substance-use milestones. From a prevention standpoint, it is important to evaluate differences not only in heavy substance use, but in early milestones, as they may set the course for health disparities across the life span.     

Perceived social position and health: Is there a reciprocal relationship?

Recent work exploring the relationship between socioeconomic status and health has employed a psychosocial concept called perceived social position as a predictor of health. Perceived social position is likely the “cognitive averaging” (Singh-Manoux, Marmot, & Adler, 2005) of socioeconomic characteristics over time and, like other socioeconomic factors, is subject to interplay with health over the life course. Based on the hypothesis that health can also affect perceived social position, in this paper we used structural equation modeling to examine whether perceived social position and three different health outcomes were reciprocally related in the Wisconsin Longitudinal Study, a longitudinal cohort study of older adults in the United States. The relationship between perceived social position and health differed across health outcomes—self-reported health, the Health Utilities Index, and depressive symptoms—as well as across operationalizations of perceived social position—compared to the population of the United States, compared to one's community, and a latent variable of which the two items are indicators. We found that perceived social position affected self-reported health when operationalized as latent and US perceived social position, yet there was a reciprocal relationship between self-reported health and community perceived social position. There was a reciprocal relationship between perceived social position and the Health Utilities Index, and depressive symptoms affected perceived social position for all operationalizations of perceived social position. The findings suggest that the causal relationship hypothesized in prior studies—that perceived social position affects health—does not necessarily hold in empirical models of reciprocal relationships. Future research should interrogate the relationship between perceived social position and health rather than assume the direction of causality in their relationship.