The Changing Perspective of Livelihood in Rural Society and the Role of NGOs in Livelihood Diversification: A Case Study of Chamoli’s Agrarian Communities

This study aimed to develop a model for predicting the cardio-cerebrovascular disease of the South Korean elderly using the random forests technique. This study analyzed 2,111 respondents (879 males and 1,232 females), who were age 60 or older, out of total 7,761 respondents, who completed the Seoul Welfare Panel Study. The result variable was defined as the cardio-cerebrovascular disease (e.g., hypertension, cerebral infarction, hyperlipidemia, cardiac infarction, and angina). As a result of developing a random forest-based model, the major determinants of the cardio-cerebrovascular diseases of the South Korean elderly were mean monthly household income, the highest level of education, subjective health condition, subjective friendship, subjective family relationship, smoking, regular exercise, age, marital status, gender, depression experience, economic activity, and high-risk drinking. Among them, mean monthly household income was the most important predictor of the cardio-cerebrovascular disease. Based on the developed prediction model, it is needed to develop a systematic program for preventing the cardio-cerebrovascular disease of the Korean elderly.

An adequate food intake, in terms of quantity and quality, is a key to healthy life. Malnutrition is the most serious consequence of food insecurity and has a multitude of health and economic implications. India has the world's largest population living in slums, and these have largely been underserved areas. The State of Food Insecurity in the World (2012) estimates that India is home to more than 217 million undernourished people. Various studies have been conducted to assess food insecurity at the global level; however, the literature is limited as far as India is concerned. The present study was conducted with the objective of documenting the prevalence of food insecurity at the household level and the factors determining its existence in an urban slum population of northern India. This cross-sectional study was conducted in an urban resettlement colony of South Delhi, India. A pre-designed, pre-tested, semi-structured questionnaire was used for collecting socioeconomic details and information regarding dietary practices. Food insecurity was assessed using Household Food Insecurity Access Scale (HFIAS). Logistic regression analysis was performed to determine the factors associated with food insecurity. A total of 250 women were interviewed through house-to-house survey. Majority of the households were having a nuclear family (61.6%), with mean family-size being 5.5 (SD +/- 2.5) and the mean monthly household income being INR 9,784 (SD +/- 631). Nearly half (53.3%) of the mean monthly household income was spent on food. The study found that a total of 77.2% households were food-insecure, with 49.2% households being mildly food-insecure, 18.8% of the households being moderately food-insecure, and 9.2% of the households being severely food-insecure. Higher education of the women handling food (OR 0.37, 95% CI 0.15-0.92; p < or = 0.03) and number of earning members in the household (OR 0.68, 95% CI 0.48-0.98; p < or = 0.04) were associated with lesser chance/odds of being food-insecure. The study demonstrated a high prevalence of food insecurity in the marginalized section of the urban society. The Government of India needs to adopt urgent measures to combat this problem.

The objective of this cross-sectional study was to determine relationships between socioeconomic status and organ damage in Mexican systemic lupus erythematosus (SLE) patients. Demographic and clinical variables were assessed. Socioeconomic status was evaluated using the Graffar method and monthly household income. Lupus activity and organ damage were measured using the SLE disease activity scale, validated for the Mexican population (Mex-SLEDAI), and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) scale. The 143 Mexican female SLE patients included (mean age 40.1 ± 8.9 years, mean disease duration 8.9 ± 6.3 years) had a mean monthly household income of $ 407.2 ± 326.5. According to the Graffar index, 18.9%, 52.5%, and 28.7% had high/medium-high, medium, and medium-low/low socioeconomic status, respectively. Organ damage was observed in 61 patients (42.7%). Patients with organ damage had lower monthly household incomes ($241.4 ± 152.4 vs. $354.8 ± 288.3) and were more frequently unemployed (57.3% vs. 35.3%; p = 0.01) than those without. Low monthly income was not associated with lupus activity or self-reported health status. In the adjusted multivariate analysis, low monthly income ( < $300) was associated with organ damage. In conclusion, low income may be associated with organ damage in Mexican SLE patients.

The Impact of Psychotropic Drug Costs on the Brazilian Family Budget: An Analysis of the Family Budget Surveys of 2003 and 2009

Sweeteners, jointly demanded with food and beverages, have been proven to be good sources of energy, vitamins, minerals and amino acids. This study examined urban households’ demand for sweeteners in Ogun State, Nigeria. Primary data were obtained using a pre-tested questionnaire in a cross sectional survey of 160 households through a multi-stage sampling technique. Data were analysed using descriptive statistics and the Linear Approximate Almost Ideal Demand System (LA-AIDS) model. Results revealed that 51.2% of the households were headed by females with an average age of 37 years and an average household size of five persons. Majority (62.3%) of the household heads had tertiary education. The average monthly household demand for honey, sugar and other sweeteners were 1.31liters, 1.06kg and 0.30kg respectively. About forty-one percent of the household heads had salaried occupation and 6.3% were unemployed. The mean monthly household income was N93,347.90 with the average monthly food expenditure as N12,289.98 of which N1,445.70 was expended on honey and N392.35 on sugar. Own-price and income had an increasing effect on demand for honey (p<0.01) while own-price had an increasing effect on demand for sugar (p<0.01). The age of household head had incremental influence on honey demand (p<0.01) while it had a decreasing influence on sugar demand (p<0.05). Also, marital status had incremental influence on honey demand (p<0.10) while it had a decreasing influence on sugar demand (p<0.05). The study concluded that the demand level for honey was higher than sugar and other sweeteners in all of the households. The study recommended that increased household income should be enhanced to boost household demand for honey.

Catastrophic health expenses and impoverishment of households of patients with rheumatoid arthritis

Osteoporosis is characterized by low bone mass, deterioration of the microarchitecture of the bone tissue and increase susceptibility to fractures. Clinical manifestations are fractures and their complications. The most common fractures are hip,spine and wrist, although any bone is susceptible. To assess the resource utilization and the annual costs incurred by patients with postmenopausal osteoporosis One hundred consecutive patients were studied in the Universidade Federal de São Paulo. The inclusion criteria were: postmenopausal osteoporosis (WHO 1994) for at least one year b) at least one year attending the outpatient clinic, minimal comprehensive and speaking conditions. The socioeconomic and clinical characteristics, the resource utilization and costs in the last year were assessed using 2 questionnaires. The unitary costs were based in the Public Healthcare System Index (1998). The mean age was 66 years and the monthly family income was R$ 534.14 (US$ 456 - in 1998). There was a mean of 7 visits/patient/ year. 77% of the patients used calcium and 38% used estrogens. The mean total annual costs for osteoporosis treatment, considering societal perspective, were R$ 908.18 (US$ 776-in 1998) per patient per year. The costs related to osteoporosis treatment represented 11% of the mean monthly household income from the patients' perspective (R$ 534=US$ 456). As the population is ageing and the osteoporosis incidence is increasing, health policy should be implemented to rationally allocate the scarce resources available, based on economic analysis.

Emergency care systems are critical to improving care for time-sensitive emergency conditions. The growth and development of these systems in Sub-Saharan Africa is becoming a priority. Layperson knowledge and recognition of emergency symptoms and subsequent care-seeking behavior are key to achieving timely access to care and appropriate treatment. This study aimed to assess community knowledge of emergency conditions as well as barriers to accessing the emergency care system in Northern Tanzania. This was a cross-sectional study of households in three districts in Kilimanjaro, Tanzania from June to September 2021. The primary outcome was an inappropriate response to any of five hypothetical emergency conditions. Secondary outcomes were the incidence of household emergencies and delay in care access for those with emergency conditions. Data were analyzed using descriptive statistics. Associations between the outcome of interest and select household characteristics were analyzed using Fisher's Exact tests for categorical measures and Wilcoxon rank-sum tests for continuous measures. A total of 539 households were interviewed with 2,274 participants. The majority (46.8%) were from Moshi District Council. 73.7% used cash and/or had no insurance. The mean monthly household income was 226,107.6 Tanzanian Shillings. 76 (14.1%) households reported experiencing an emergency condition in the past year and 225 (41.7%) of respondents had an inappropriate response to at least one hypothetical emergency condition. A higher proportion of those with delayed access to healthcare paid with personal cash and a lower proportion had national health insurance. A higher proportion of those with inappropriate responses to hypothetical emergency conditions lived in rural districts, were uninsured, and had a lower mean income. Community-dwelling adults in Northern Tanzania have significant gaps in understanding of emergency care conditions and delayed access to care for these conditions. Distance to the healthcare facilities, cost, and lack of insurance may contribute to care delays. Increasing insurance coverage and developing emergency medical services may improve access to care.

Background and Objectives: This study developed a support vector machine (SVM) algorithm-based prediction model with considering influence factors associated with the swallowing quality-of-life as the predictor variables and provided baseline information for enhancing the swallowing quality of elderly people’s lives in the future. Methods and Material: This study sampled 142 elderly people equal to or older than 65 years old who were using a senior welfare center. The swallowing problem associated quality of life was defined by the swallowing quality-of-life (SWAL-QOL). In order to verify the predictive power of the model, this study compared the predictive power of the Gaussian function with that of a linear algorithm, polynomial algorithm, and a sigmoid algorithm. Results: A total of 33.9% of the subjects decreased in swallowing quality-of-life. The swallowing quality-of-life prediction model for the elderly, based on the SVM, showed both preventive factors and risk factors. Risk factors were denture use, experience of using aspiration in the past one month, being economically inactive, having a mean monthly household income <2 million KRW, being an elementary school graduate or below, female, 75 years old or older, living alone, requiring time for finishing one meal on average ≤15 min or ≥40 min, having depression, stress, and cognitive impairment. Conclusions: It is necessary to monitor the high-risk group constantly in order to maintain the swallowing quality-of-life in the elderly based on the prevention and risk factors associated with the swallowing quality-of-life derived from this prediction model.

OBJECTIVE To estimate out-of-pocket medical expenses to women and families for maternity care at all levels of the health system in Burkina Faso, Kenya and Tanzania. METHODS In a population-based survey in 2003, 6345 women who had given birth in the previous 24 months were interviewed about the costs incurred during childbirth. Three years later, in 2006, an additional 8302 women with recent deliveries were interviewed in the same districts to explore their maternity care-seeking experiences and associated costs. The majority of women interviewed reported paying out-of-pocket costs for facility-based deliveries. Out-of-pocket costs were highest in Kenya (a mean of US$18.4 for normal and complicated deliveries), where 98% of women who delivered in a health facility had to pay some fees. In Burkina Faso, 92% of women reported paying some fees (mean of US$7.9). Costs were lowest in Tanzania, where 91% of women reported paying some fees (mean of US$5.1). In all three countries, women in the poorest wealth quintile did not pay significantly less for maternity costs than the wealthiest women. Costs for complicated delivery were double those for normal delivery in Burkina Faso and Kenya, and represented more than 16% of mean monthly household income in Burkina Faso, and 35% in Kenya. In Tanzania and Burkina Faso most institutional births were at mid-level government health facilities (health centres or dispensaries). In contrast, in Kenya, 42% of births were at government hospitals, and 28% were at private or mission facilities, contributing to the overall higher costs in this country compared with Burkina Faso and Tanzania. However, among women delivering in government health facilities in Kenya, reported out-of-pocket costs were significantly lower in 2006 than in 2003, indicating that a 2004 national policy eliminating user fees at mid- and lower-level government health facilities was having some impact.

It is important in otolaryngology to accurately understand the etiology of a laryngeal disorder, diagnose it early, and provide appropriate treatment accordingly. The objectives of this study were to develop models for predicting benign laryngeal mucosal disorders based on deep learning, naive Bayes model, generalized linear model, a Classification and Regression Tree (CART), and random forest using laryngeal mucosal disorder data obtained from a national survey and confirm the best classifier for predicting benign laryngeal mucosal disorders by comparing the prediction performance and runtime of the developed models. This study analyzed 626 subjects (313 people with a laryngeal disorder and 313 people without a laryngeal disorder). In this study, deep learning was the best model with the highest accuracy (0.84). However, the runtime of deep learning was 39min 41sec, which was a 10 times longer development time than CART (3min 7sec). This model confirmed that subjective voice problem recognition, pain and discomfort in the last two weeks, education level, occupation, mean monthly household income, high-risk drinker, and current smoker were major variables with high weight for the benign laryngeal mucosal disorders of Korean adults. Among them, subjective voice problem recognition was the most important factor with the highest weight. The results of this study implied that the prediction performance of deep learning could be better than that of machine learning for structured data, such as health behavior and demographic factors as well as video and image data.

Child feeding practices, food habits, anthropometric indicators and cognitive performance among preschoolers in Peninsular Malaysia

We read with great interest the recently published article by Ilesanmi and colleagues in your journal [1]. The authors’ observation that patient’s mean monthly cost of treatment for hypertension was ₦1440±560 ($9.6±3.7), equivalent to 11% of their mean monthly household income was very interesting. It made an interesting piece to read that patient illness costs due to care seeking for hypertension are largely undocumented in Africa just like has been observed for infectious diseases like tuberculosis [2].

Catastrophic health expenses and impoverishment of households of patients with rheumatoid arthritis

Forest dependency, co-management and improvement of peoples’ livelihood capital: Evidence from Chunati Wildlife Sanctuary, Bangladesh