What Happened to the American 'Middle Class'? Class and Consumption in America

This study was conducted to understand the infant (0-12 month) feeding practices among different classes' mothers in Dhaka city. The study was carried out among the 183 mother-infant pair of the upper, middle and lower socio-economic classes in Dhaka city and purposive sampling method was applied. The study was conducted at following areas in Dhaka city which were selected purposively. The mean age of upper class, middle class and lower class were 35±4, 25±3 and 21±7 in years. Regarding first feeding it was observed that upper (75%), middle (85%) and lower class (48%) first gave colostrum. It also observed that 18% of upper class mother first gave powder milk, while in case of middle class it was 5%. In lower class preference of giving honey and sugar water were 21% and 12% respectively. The starting time of breast feeding indicated that in upper classes (74%) breast feeding initiated within one hour, while in middle (75%) and lower classes (84%) it was given within 12 hours. It was highlighted that 44% upper and 36% lower class mothers started complementary feeding at 3 month of the baby respectively, while in middle class 61% mother started complementary foods at 5 month of their baby. In case of duration of breast feeding practices, middle and lower classes breast-feed continued longer time than upper class. Majorities of the upper class prefered egg, soup, fruit juice while middle class liked meat-fish, egg, khichuri, fruits. On complementary feeding the lower class choiced mainly rice-potato, dal, khichuri or vegetables. The study result should not be generalise and need further large scale research. DOI: http://dx.doi.org/10.3329/akmmcj.v5i2.21124 Anwer Khan Modern Medical College Journal Vol. 5, No. 2: July 2014, Pages 5-8

Introduction: Exclusive breastfeeding (EBF) for the first six months of life improves health and increases infant survival. In Asia, Pakistan ranks second in child mortality. Socioeconomic status (SES) is an important predictor of healthy behaviors. The study aims to understand the barriers to exclusive breastfeeding faced by mothers from different socioeconomic classes in Pakistan.
 Method: The cross-sectional study was done in the Pediatric outpatient department (OPD) of Shifa International hospital and community health center from November 2020 to 1 March 2021. Mothers and their children 1 to 3 years of age were included in the study.
 Results: A total of 175 mothers and their children were included. EBF for the first six months was done by 120 (68.6%). However, by one year of age, only 99 (56%) continued breastfeeding. Out of these 175 mothers, 79 (45%) were from the lower class, 69 (39.4%) were from the middle class, and 27 (15.4%) were from upper SES. Among the lower, middle, and high socioeconomic classes frequency of EBF practiced by mothers was 51, 54, and 15 (p 0.03), respectively. Pre-lacteals were given to 102 (58.2%). This practice was more frequent in lower SES families (0.03). The majority of working women belonged to upper SES (0.04). Mothers in the upper class are least likely to EBF their children (OR 0.5 CI 0.2-1.3). The adjusted odds ratio for EBF is highest for lower SES mothers, followed by the middle class.
 Conclusion: Support from family, place and mode of delivery, working mothers, and high socioeconomic class are important factors affecting exclusive breastfeeding in Pakistan.

The biggest consumers of dairy products for children aged 1–3 years, which are referred to as growing-up milk (GUM), come from the middle and lower socioeconomic classes. More than 90% of Indonesians belong to this segment. In 2020, the proportion of the population living in rural and urban areas will be almost equal, namely 43.3% and 56.7%, respectively. Understanding brand switching behavior is essential to enabling GUM manufacturers to stay in business and thrive by retaining loyal customers. The aims of this study are (i) to assess the level of brand switching; (ii) to examine the determinant factors of brand switching behavior; and (iii) to compare the brand switching behavior of GUM consumers in rural and urban areas of middle and lower socioeconomic classes in Java. The research was conducted in 4 sub-districts in 2 provinces (East Java and D.I. Yogyakarta) using a guided interview method with a questionnaire. Research respondents were 419 consumers of GUM, and they were selected using the purposive sampling method. Data analysis used partial least squares - structural equation modeling (PLS-SEM) and multigroup analysis (MGA). The study found that the level of brand switching among GUM consumers in Java is 57%, which is considered high. The most important factor that influences the brand switching behavior of GUM consumers in Java's middle and lower socioeconomic classes is bad prior experiences, followed by variety seeking, bad product attributes, and customer dissatisfaction. A defective product is the most reflective indicator of a bad prior experience. There is no difference in brand switching behavior between rural and urban consumers in Java from the middle to lower socioeconomic classes. Therefore, GUM manufacturers are allowed to adopt the same marketing strategy to increase efficiency.

Hemispheric Specialization for Speech Perception in Four-Year-Old Children from Low and Middle Socio-Economic Classes

The purpose of this study was to determine if intelligence quotient mean test scores of middle school students of different races, sexes, and socioeconomic classes could be significantly increased through the use of tangible and intangible rewards of money and praise. One hundred and thirty-five students from lower and middle socioeconomic classes were randomly assigned to three groups. The stratified groups, two experimental and one control, contained approximately the same number of male and female students. The students were identified as lower and middle socioeconomic class whites and lower socioeconomic blacks. Ten hypothesis were tested and the results supported the following:). Significant increases in the intelligence quotient test scores of lower class blacks were dependent upon monetary reward. 2. Significant increases in the intelligence quotient test scores of middle and lower class whites occurred when spoken verbal praise was administered. 3. The sequencing of money first and praise second led to significant increases in the scores of lower and middle class white females and middle class males.

Underactive thyroid is an endocrine system disorder defined by inadequate thyroid hormone synthesis by the thyroid gland. Hypothyroidism affects lipid profiles is via thyroid hormone and thyroid hormone receptor, which is mostly expressed in the liver, may bind to thyroid hormone to control the expression of downstream target genes. The objectives of this study aimed to determine lipid parameters and liver function in hypothyroid patients and correlate dyslipidemia and deranged Liver functions with the thyroid profile. Methodology: This Descriptive Cross-Sectional study was conducted in the Medical department at PMC Hospital and NORIN Hospital Nawabshah, SBA for the period of 06 months from July 2023 to Dec 2023. After taking approval from Ethical review committee of the Institute, 200 males and females diagnosed patients of hypothyroidism fulfilling the inclusion Criteria were selected. Non probability purposive sampling technique was used. A written consent was taken and required laboratory reports were collected for information. Demographic information, history of the patient and physical examination were collected using a structured questionnaire. To analyze the pattern of dyslipidemia, a lipid profile and routine tests were performed. Results: Mean age of the participants was 38.46 ± 2.68 years and majority of the participants were belonging to lower and middle socioeconomic class. There was statistical significant association (p-value <0.05) between poor class and middle class. There was significant association between obesity and deranged liver function (p-value 0.037) and with deranged lipid parameters (p-value 0.010). Pearson correlation (2 tailed) test was applied to measure the correlation between deranged lipid profiles and deranged liver enzyme. There was positive correlation (0.169) between deranged lipids profile and deranged liver enzyme. Conclusion: Results of this study reveal that hypothyroidism is directly linked with deranged liver enzymes and lipid parameters because in hypothyroidism there is low metabolism especially in liver. Dyslipidemia and abnormal liver enzymes make the condition worse and have an impact on the prognosis and course of the disease. To lessen the severity, it is advised that dyslipidemia should also be treated in these patients.

Amoebiasis, caused by Entamoeba histolytica , has a worldwide distribution and is of public health significance in many developing countries. It has a fecal-oral transmission cycle and is most prevalent in developing countries in regions where substandard sanitary conditions exist due to poverty. Little is known about the epidemiology of E. histolytica infection and its presence in different socioeconomic communities in developing countries. We undertook the present study in the city of Lahore, Pakistan, and our prediction was that the prevalence of E. histolytica -like cysts and E. histolytica stool antigen would be lower in patients from upper socioeconomic levels than in individuals from middle or lower socioeconomic levels. We investigated the prevalence of E. histolytica in humans from 3 socioeconomic communities in territories of Lahore, Pakistan. Six hundred fecal samples were collected and examined using both microscopy (triple fecal test) to detect cysts of E. histolytica -like amoeba and ELISA (stool antigen ELISA) to demonstrate diagnostic stool antigens of E. histolytica . Samples were from individuals living under conditions deemed to be upper socioeconomic class (n = 287), middle socioeconomic class (n = 172), and lower socioeconomic class (n = 141). The total prevalence of positive samples was 22.5% (135/600) by triple test and 16.8% (101/600) by stool antigen ELISA in the 600 fecal samples. Statistically, significant (P < 0.05) differences in prevalence were seen between the 3 socioeconomic class groups. Forty-four (15.3%) and 32 (11.1%) of 287 in the fecal samples from the upper socioeconomic class were positive by triple test and by antigen ELISA, respectively. Thirty-nine (22.6%) and 29 (16.8%) of 172 in the fecal samples from the middle socioeconomic class were positive by the triple test and by antigen ELISA, respectively. Fifty-two (36.8%) and 40 (28.3%) of 141 in the fecal samples from the lower socioeconomic class were positive by the triple test and by antigen ELISA, respectively. We accept our hypothesis based on these findings. We also demonstrated that fecal samples collected from the youngest age group (1 mo-5 yr) were more likely to be positive for E. histolytica antigens than were samples from the other 3 age groups, and that prevalence was significantly higher (P < 0.05) in the summer than in the other 3 seasons. These results highlight the importance of surveillance of this relatively ignored pathogen in this developing metropolitan city in Pakistan.

Background: In addition to physical welfare, reproductive health is also vital for psychological well-being. All stages of reproduction can take place safely if reproductive health is well cared for, and it ultimately leads to the formation of healthy new offspring. The aim of this study is to know about reproductive health-related knowledge and practices in women of reproductive age in an underdeveloped area in Pakistan and to identify the associated factors that give a meaningful impact on reproductive health.Methods: A cross-sectional study was carried out among women of childbearing age in underdeveloped areas in the province of Punjab, Pakistan. A sample of 400 was taken on a random basis. All the relevant data were collected from February 1, 2022, to August 30, 2022, with the help of a structured questionnaire, designed specifically for the study, informed consent was taken from all of the participants before data collection. Questions were asked about their menstrual cycles, use of contraceptives, knowledge about sexually transmitted diseases, screening of cervical cancer, pap test, human papillomavirus vaccine, and related to home or hospital deliveries. Socioeconomic classes were defined by different income ranges per month as lower class, upper lower class, middle class, upper middle class, and upper class.Results: Ten percent of participants with education up to fifth grade have never used any method of contraception while 70% of participants who studied up to eighth grade never used the same. In lower class and upper lower class, the prevalence is 33.3% and 41.7%, respectively. The prevalence of screening for cervical cancer is 50% in married women and 60% in the upper middle class. Of women with education up to eighth grade, 65% answered with No, and the prevalence is 50% for lower-class women. Regarding the human papillomavirus vaccine, 41.7% of married women, 33.3% of women in upper class, and 50% of women in the middle class mentioned that they know about it, while 68.4% of women have education up to eighth grade and 47.4% of lower-class women answered with No. Of women with education up to eighth grade, 92.5% had one to two deliveries at home, and 68.8% of women with education up to fifth grade had three to four deliveries at home. Fifty percent of women from both lower and upper lower classes had one to two deliveries at home. Twelve women from the upper middle class had all of their deliveries at home and 20 had five to six deliveries at home. Of women with education up to fifth grade and eighth grade, 64.3% and 28.6%, respectively, had their all deliveries at a hospital; 22.9% of women from the upper class and 20% of the upper middle class also had all deliveries at the hospital, Thirty-three women who graduated from college had one to two deliveries in the hospital. All of these results are found to be significant with a p-value <0.05.Conclusion: Knowledge about reproductive health is less prevalent in women with low education and the same is for lower and lower middle socioeconomic class. The education level of women and their socioeconomic class is one of the major factors that have a meaningful impact on their reproductive health and practices.

Hemispheric Specialization for Speech Perception in Six-Year-Old Black and White Children from Low and Middle Socioeconomic Classes

Context:In India, Vitamin D deficiency is a major public health problem, associated with lack of sunlight exposure in spite of abundant sunshine usually accompanied by reduced dietary intake. In women of reproductive age, Vitamin D deficiency in pregnancy has been associated with an increased risk of gestational diabetes mellitus, preeclampsia, maternal and perinatal morbidity and mortality.Aims:The aim of the present cross-sectional study was to evaluate the levels of serum Vitamin D 25(OH) D and calcium in women of reproductive age from India.Settings and Design:A cross-sectional study was carried on a total of 224 healthy nonpregnant and nonlactating women in the reproductive age group of 20–49 years.Materials and Methods:Demographic, socioeconomic class, and biochemical parameters for the estimation of serum 25(OH)D and calcium levels in women of reproductive age were studied.Statistical Analysis:Statistical Package for Social Sciences version 20.0 was utilized for conducting the statistical analysis of the data.Results:Vitamin D deficiency (<20 ng/ml) was present in 88% of women. Women from middle socioeconomic class had the lowest mean serum 25(OH) D levels (9.6 ± 6 ng/ml) as compared to women from upper middle (11.4 ± 8 ng/ml), lower (11.2 ± 8 ng/ml), and upper (10 ± 8.6 ng/ml) socioeconomic class. Serum calcium levels were found in the normal range of 8.5–10.5 mg/dl for all the study subjects.Conclusions:There is a high prevalence of hypovitaminosis D among women of reproductive age. These women may possibly have a higher risk of development of osteoporosis and pregnancy-related complications in future life.

Aims: To determine the factors associated with the occurrence of skin diseases among children attending the Children’s Outpatient Clinic of the University of Port Harcourt Teaching Hospital (UPTH). Study Design: A Cross sectional study design was used. It was both descriptive and analytical. Place and Duration of Study: The study was carried out in the Children’s Outpatient Clinic of the Department of Paediatrics, UPTH from June to August 2020 (3 months). Methodology: We studied 370 children aged less than 18 years. A semi structured interviewer-administered questionnaire was used to obtain all relevant data. This was followed by dermatological examination of the children to make diagnosis of skin diseases. Relevant samples for laboratory confirmation were also obtained where necessary. Results: Among the 88 children (23.7%) who had skin diseases, our study showed that the socio-demographic factors associated with the occurrence of skin diseases includes: male gender (p=0.001) and low socio-economic class (p&lt;0.001). Hygiene-related factors associated with occurrence of skin diseases includes: lack of water within the home (p=0.001), bath frequency &lt; twice per day (p=0.001) and sharing of personal items (p&lt;0.001). On multiple logistic regression analysis of these factors, the factors predictive of skin diseases were: male gender (p=0.000), low and middle socioeconomic class (p=0.004) and lack of water within the home (p=0.013). Conclusion: Several socio-demographic and hygiene-related factors were identified to be associated with the occurrence of skin diseases among children in our study. These factors provide an important window for interventions to prevent and control the burden of skin diseases among children in our setting.

The objective of the present study is to describe the comparative occupational experience of adults from 23-27 years of age and from 28-32 years according to whether they belong to the middle, comfortable or disfavoured socio-economic class. To accomplish this, we interviewed 161 subjects from 23-32 years in the number 03 administrative region (Quebec). Subjects were randomly chosen and divided according to variables of socio-economic class, sex and work sector. Results indicate that the 23-27 years old adults is busy with a "landing" on the job market. Depending on the class, this "landing" is primarily attentive (middle class), discreet (disfavoured class) or manifest (confortable class). The 28-32 years old adult is searching for a promising path. Depending on the case, this search is worthy optional (middle class), oriented towards the viable conditions of the milieu (disfavoured class) or very ambitious (comfortable class).

To study the profile and various risk factors associated with unintentional injuries in children. The study is a cross sectional analysis of data collected from 351 children presenting with unintentional injury to a tertiary care hospital in Navi Mumbai, India. Data were collected about variables based on Haddon Phase Factor Matrix - host, environment and agent factors. Proportions for categorical variables across various groups were compared using Chi square test or Fisher's exact test. Logistic regression model was used to evaluate the factors. Falls (36%) were the most common injuries followed by bites (23%). Majority of children were school going children (38%) followed by preschool children (29%). Forty-seven percent were from lower socioeconomic class. Commonest place of injury was home (48%) and the commonest time was evening (49%). Though there was male predominance in injuries, the difference across gender did not vary significantly (p=0.15). Poisonings were significantly more common in infants and toddlers and in rural population (p<0.001); kerosene being the commonest agent. Rural population is at more risk of bites compared to urban (p<0.001); dog bites being the commonest followed by scorpion bites. Foreign bodies were significantly more common in upper and middle socioeconomic class and bites, in lower socioeconomic class (p<0.005). Injuries from rural area and lower socioeconomic class were more serious, requiring hospitalization; they were also more likely to present late to the hospital (p<0.05). Profile of injuries varies widely as per the variations in agent, host and environmental factors. Socio-environmental, economic conditions and infancy-toddler age groups are predisposing risk factors for bites and poisoning. Although rural areas and lower socioeconomic class population are more vulnerable to serious types of injuries, they still lack essential basic medical care.

Implications of an inappropriate rise in estradiol with initiation of antagonists

We expect a lot from the middle classes. At least three distinct arguments about the special economic role of the middle class are traditionally made. In one, new entrepreneurs armed with a capacity and a tolerance for delayed gratification emerge from the middle class and create employment and productivity growth for the rest of society. In a second, perhaps more conventional view, the middle class is primarily a source of vital inputs for the entrepreneurial class: it is their “middle class values”—their emphasis on the accumulation of human capital and savings—that makes them central to the process of capitalist accumulation. The third view, a staple of the business press, emphasizes the middle class consumer, whose demand for quality consumer goods feeds investment in production and marketing, which in turn raises income levels for everyone. This essay asks what we should make of these arguments in the context of today's developing countries. We focus on two groups of households: those whose daily per capita expenditures are between $2 and $4, and those with expenditures between $6 and $10. These are the groups that we will call the middle class. Starting from survey data on patterns of consumption and investment by the middle class in thirteen developing countries, we look for what is distinct about the global middle class, especially when compared to the global poor (defined as those whose per capita daily consumption is below $2 a day). In particular, is there anything special about the way middle class people per spend their money, earn their incomes, or bring up their children?