‘I feel safer in the streets than at home’: Rethinking harm reduction for women in the urban margins

ABSTRACT

Through qualitative data collected with women affected by drug use and drug-related violence in Bogotá, this article explores the convergence of harm reduction rationales and violence prevention programming in the urban margins to advocate for women’s health empowerment and health rights as victims of intergenerational trauma and violence. We propose a methodological shift of public health praxis from street-based outreach models to intimate spaces of intervention for health outcomes embodiment ¹ 1 Drawing from Krieger’s (2004) conceptualisation, we define embodiment as the stories our bodies hold and how they interact with the urban environment. as we continue to develop our community health model to work with marginalised communities in the urban global South. Through this work committed to social justice in marginalised urban communities, we seek to support women’s health needs through harm reduction in historically marginalised communities in urban settings. Our results expose how multi-level gender-based violence affects women’s health in their living spaces in the urban margins. Drawing from women’s voices and narratives of urban violence, we call for a feminist alternative to traditionally masculinist and public-space oriented harm reduction practice for health empowerment in the urban margins.     

Age at natural menopause in Beirut,Lebanon: the role of reproductive and lifestyle factors

Summary. Primary objective: To determine the median age of natural menopause and factors associated with the timing of menopause in Beirut, Lebanon. Research design: A population-based sample of 298 women were interviewed using a semistructured questionnaire. Methods and procedures: Logit analysis and logistic regression were used to estimate the median age and identify correlates of menopausal status. Main outcomes and results: The median age of natural menopause in Beirut, Lebanon is estimated to be 49.3 years. Not being currently married (odds ratio (OR)=4.19, 95% CI: 1.53, 11.51) and smoking (OR=1.02 for each year of smoking, 95% CI: 1.00, 1.05) are significantly associated with an earlier age at menopause. Women with menstrual bleeding longer than 5 days have later ages at menopause (OR=0.50, 95% CI: 0.26, 0.97). Age at menarche, parity, education and socio-economic status are not statistically associated with the age at menopause. Conclusions: The age at natural menopause in Lebanon is comparable to median ages reported for women in industrialized countries (49.3-51.4). Our results emphasize the role of smoking in determining an earlier age at menopause and indicate that reproductive characteristics affect the timing of menopause.     

Quality of Life in Rural and Urban Adults 65 Years and Older: Findings From the National Health and Nutrition Examination Survey

Purpose: The proportion of people over 65 years of age is higher in rural areas than in urban areas, and their numbers are expected to increase in the next decade. This study used Andersen's behavioral model to examine quality of life (QOL) in a nationally representative sample of community‐dwelling adults 65 years and older according to geographic location. Specifically, associations between 3 dimensions of QOL (health‐related QOL [HQOL], social functioning, and emotional well‐being) and needs and health behaviors were examined. Methods: The 2005‐2006 National Health and Nutrition Examination survey was linked with the 2007 Area Resources File via the National Center for Health Statistics’ remote access system. Frequencies and distribution patterns were assessed according to rural, adjacent, and urban locations. Findings: Older adults reported high levels of QOL; however, rural older adults had lower social functioning than their urban counterparts. Older blacks and Hispanics had lower scores than whites on 2 dimensions of QOL. Associations between QOL and needs and health behaviors varied. Although activities of daily living were associated with all 3 dimensions, others were associated with 1 or 2 dimensions. Conclusions: The lower scores on social functioning in rural areas suggest that rural older adults may be socially isolated. Older rural adults may need interventions to maintain physical and mental health, strengthen social relationships and support, and increase their participation in the community to promote QOL. In addition, older blacks and Hispanics seem more vulnerable than whites and may need more assistance.     

Health Insurance and Chronic Conditions in Low-Income Urban Whites

Little is known about how health insurance contributes to the prevalence of chronic disease in the overlooked population of low-income urban whites. This study uses cross-sectional data on 491 low-income urban non-elderly non-Hispanic whites from the Exploring Health Disparities in Integrated Communities—Southwest Baltimore (EHDIC-SWB) study to examine the relationship between insurance status and chronic conditions (defined as participant report of ever being told by a doctor they had hypertension, diabetes, stroke, heart attack, anxiety or depression, asthma or emphysema, or cancer). In this sample, 45.8 % were uninsured, 28.3 % were publicly insured, and 25.9 % had private insurance. Insured participants had similar odds of having any chronic condition (odds ratios (OR) 1.06; 95 % confidence intervals (CI) 0.70–1.62) compared to uninsured participants. However, those who had public insurance had a higher odds of reporting any chronic condition compared to the privately insured (OR 2.29; 95 % CI 1.21–4.35). In low-income urban areas, the health of whites is not often considered. However, this is a significant population whose reported prevalence of chronic conditions has implications for the Medicaid expansion and the implementation of health insurance exchanges.     

自制社区居民健康档案封面标签的应用

目的：探讨社区卫生服务中心应用自制封面标签对社区居民健康档案进行标识管理。方法：采用购买的彩色蜡光可粘贴型标签纸按一定的规格裁剪成型后，分别按照卫生服务中心的规定进行粘贴标识。结果：自2008年应用自制封面标签对社区居民健康档案进行分类标识管理以来，提高了社区居民健康档案的管理质量，也提高了医护人员的工作效率。结论：自制社区居民健康档案封面标签不仅费用低、易于制作，应用效果也好。     

北京地区居民健康门户使用情况调查与分析

目的:通过调查分析北京地区居民对健康门户使用情况的认知和功能需求,为统筹规划、科学设定北京地区居民健康门户奠定基础。方法:利用问卷星设计电子调查问卷对居民进行匿名式网络抽样调查,以北京居民为调查对象,进行功能需求调查研究,共调查对象246名。调查内容包括居民的基本信息;居民对健康门户的使用习惯、推送方式、使用内容等;居民从健康门户上最希望获得服务内容的意愿;居民对健康门户的意见和建议。结果:获得快捷的便民服务成为健康门户使用的第一大需求,选择便捷的沟通渠道、及时的服务咨询和最新的政策信息人数过半,预约挂号、检查检验报告查询和支付缴费仍是首选功能需求,政府从业人员选择居民健康门户最优先考虑的因素是安全性与隐私保护。结论:此次调查为统筹考虑北京地区居民健康门户明确了建设模式和发展方向,以围绕居民需求,推进便捷服务,提升用户体验为宗旨,加强顶层设计,打造集中共享、便民惠民、安全规范的居民健康门户。     

Differences of height and body mass index of youths in urban vs rural areas in Hunan province of China

Background: Economic reforms in China were implemented approximately 30 years ago. Since then, people's nutrition, living conditions and overall health have continually improved, but there has been an imbalance between the progresses in urban vs rural areas. Height and body mass index (BMI) are regarded as two important indicators of nutritional status and overall health.

Aim: The aim of this study was to investigate differences in height and BMI between Chinese youths of rural vs urban areas and further, to determine whether these differences have changed over time (1990s vs 2000s).

Subject and methods: 24 194 urban youths and 7130 rural youths were recruited in Hunan province of China. In each gender group, the subjects were divided into eight subsets according to age, geographic area residence, and decade when the youths were measured. Independent t-tests were used to test the differences of height and BMI between the studied groups.

Results: Both male and female youths from urban areas were significantly taller than youths from rural areas in both the 1990s and 2000s (all p<0.001), with the exception of the 1990s female 15–18 years subset (p=0.21). The height of youths was significantly greater in the 2000s compared to the corresponding gender and geographic subset in the 1990s (p<0.001), except for the female 15–18 years subset from rural areas (p=0.10). Similar results were obtained for BMI.

Conclusion: There are significant differences in height and BMI between youths raised in urban vs rural areas, and positive growth trends of height and BMI over time (1990s vs 2000s) in youths in Hunan Province of China.     

金平区居民防癌知识及获取途径的调查

目的 了解汕头市金平区居民对防癌知识的认知情况以及获取途径,为有针对性开展健康教育提供依据.方法 采用自制的居民癌症预防知、信、行调查问卷对3678 名居民进行调查.结果 居民对癌症病因、诱因知晓率最高的是工业产生的废气、废水（88.4%）,癌症常见的早期症状知晓率最高的是身体任何部位出现无痛性肿块并逐渐增大（75.7%）,癌症预防行为认知率最高的是保持良好的卫生习惯（81.6%）.居民认为较好的健康教育途径是社区卫生服务中心（ 或） 站防癌讲座（53.3%）、向医务人员咨询（51.5%）.结论 金平区居民对癌症知识的认知不够,应开展多种形式健康教育,提高居民防癌意识.     

Transitioning Residents from Nursing Facilities to Community Living: Who Wants to Leave?

OBJECTIVES: To examine nursing facility residents' or their legal proxies' perspectives on transitioning out of nursing facilities by assessing residents' perceptions of their ability to live more independently, their preferences regarding leaving the facility, and the feasibility of transitioning with community support.
DESIGN: Analysis of survey findings from the California Nursing Facility Transition Screen (CNFTS).
SETTING: Eight nursing facilities in southern California.
PARTICIPANTS: All chronic maintenance, long-stay residents receiving Medi-Cal (California's Medicaid program) were eligible for the study (n=218). Of these, 121 (56%) self-consenting residents or legal proxies were interviewed. No presumptions were made as to which residents were appropriate candidates for transition based on health or functional capacity.
MEASUREMENTS: CNFTS contains 27 open- and closed-ended questions on preference, ability, and feasibility of transitioning.
RESULTS: Twenty-three percent of residents and proxies believed that the resident had the ability to transition; 46% indicated a preference to transition; and after discussing potential living arrangements and services, 33% thought that transitioning would be feasible. Of those who consented to allow access to their Minimum Data Set 2.0 (MDS) information (n=41; 34% of the sample), agreement in the assessment of preference was found in 39% of cases.
CONCLUSION: Transition decisions are complex and include preference, as well as perceptions of the resident's ability to live in a more independent setting and the feasibility of transitioning. Compared with the MDS, the screen identified a higher proportion of residents who want to transition, suggesting that a systematic approach to assessing the complex decision to transition is needed.