Critical Determinant Of Health Research Articles

The influence of an agricultural intervention on social capital and water insecurity coping strategies: Qualitative evidence from female smallholder farmers living with HIV in western Kenya

BackgroundGreater social capital is associated with positive health outcomes and better HIV management. The ways by which social capital may influence household water insecurity (HHWI), a critical determinant of health among persons living with HIV, remain underexplored. Further, despite the importance of reliable water access and use for health and agricultural productivity, few studies have described the strategies smallholder farmers living with HIV use to manage water insecurity. ObjectiveWe qualitatively explored how an agricultural intervention (provision of a treadle pump for irrigation) influenced HHWI coping strategies through its impacts on social capital among smallholder farmers living with HIV in western Kenya. MethodIn 2018, we purposively recruited participants from the Shamba Maisha study, a randomized agricultural intervention (NCT02815579) that provided irrigation pumps to improve treatment outcomes and food security among smallholder farmers living with HIV in western Kenya (n = 42). Participants shared their experiences with water insecurity through go-along and photo-elicitation interviews. Data were thematically analyzed using inductively developed codes. ResultsParticipants described diverse strategies for coping with agricultural water insecurity. Dimensions of social capital such as feelings of belonging, connectedness, and trust influenced the use of the treadle water pump and other water access behaviors. For instance, participants reported borrowing or sharing water pumps with friends and neighbors if they felt they had a good rapport. In addition, participants indicated a willingness to engage in collective activities, such as supporting the operation of the irrigation pump during planting, when they felt sufficiently connected to a larger group. Overall, individuals in the intervention arm described greater social cohesion, reciprocity, and community connectedness than those in the control arm. ConclusionThe impact of an agricultural intervention on water access and use was described as being modified by social capital among female smallholder farmers living with HIV. Findings suggest that social capital may create an enabling environment for implementing strategies that improve the management and reduce the burden of HIV. Measuring these strategies and their associations with HIV outcomes may strengthen our understanding of resilience among female smallholder farmers living with HIV. The development of a coping strategies index and its use in a longitudinal study could help to identify pathways through which social capital influences health and the effectiveness of livelihood interventions.

Quality of antenatal care and outcomes of Hypertensive Disorders in Pregnancy among antenatal attendees: A comparison of urban and periurban health facilities in Ghana.

Rural-urban-peri urban disparity assessments on health outcomes have been considered as critical determinants of health and health service outcomes. It is policy relevant in terms of the burden of disease and also provides focus on target interventions. This study aimed to assess the differences in the quality of Ante-natal Care (ANC) and the outcomes of Hypertensive Disorders in Pregnancy (HDPs) from selected health facilities in Ghana. This was a questionnaire-based cross-sectional study. Data on demographics, proportions of HDPs, quality of ANC and the outcomes of HDPs were collected. Logistic regression models were used to examine the association of the independent variables with the location of the health of facility. A total of 500 pregnant women were included in this study. There were 270 (54%) urban and 230 (46%) peri-urban dwellers. The proportion of HDPs varied with the location of the health facility. Women attending urban health facilities were more likely to be hypertensive (μ2 = 126.4; p<0.001), have chronic hypertension with superimposed pre-eclampsia (p< 0.001), have good quality ANC (μ2 = 41.28; p< 0.001), deliver full term (μ2 = 4.83; p = 0.028), and have excellent knowledge on HDPs (μ2 = 227.65; p< 0.001) compared to women receiving care in peri-urban health facilities. The method of delivery and outcome of birth did not statistically vary amongst the periurban and urban health facilities. There was an increase in the proportion in preterm in urban compared to periurban. The burden of HDPs was high in urban health facilities with high proportion of its mothers receiving quality ANC as well as having excellent knowledge on HDPs compared to mothers receiving care at the periurban health facilities. There is a need to target maternal care interventions to the periurban health facilities to improve obstetric health outcomes.

Producing vulnerability: A qualitative analysis of health equity impacts of budget cuts to intercity public transportation - evidence from saskatchewan, Canada

IntroductionTransportation is a critical determinant of health particularly for chronically ill patients yet Canadian evidence on intercity transportation barriers for healthcare access remains scant. In 2017 the Saskatchewan Government eliminated a 70-year-old bus company, the Saskatchewan Transportation Company (STC), as part of austerity measures aimed at saving $85 million. No health equity impact analysis was conducted by the government, yet the bus served 253 communities and provided medical passes for chronically ill patients and families prior to the closure. We explored health equity impacts of the decision and how this decision produces vulnerability for those in marginalized social positions. MethodsDrawing on intersectionality theory and the politics of health, we interviewed 100 former bus riders seeking healthcare and other services and conducted six focus groups with 24 stakeholders including physicians, nurses and Indigenous health system organizations’ staff. We used qualitative case study methodology to inform analysis and ensured rigour through a synthesized member checking. ResultsMany patients were female (68%) and self-reported living with disabilities (27%). The closure has limited access to specialized care especially for those with chronic conditions such as HIV/AIDS, Diabetes etc. Reduced healthcare access is experienced unequally depending on people's social and geographical locations (gender, age, (dis)ability, geography and ethnicity). The closure produces unique vulnerabilities for patients and community members through five key pathways: the ability to drive, vulnerable geographies, poverty, safety (especially for Indigenous women) and lost freedom (for those with disabilities), and these vulnerabilities are worse for those experiencing intersecting oppressions. ConclusionAusterity, disinvestment and budget cuts to public transportation create unique vulnerabilities and health inequities. Countries such as Canada, need integrated public transportation systems to promote healthcare access. Transportation-related austerity decisions ought to be assessed through a health in all policies (HiAP) framework to protect vulnerable populations from pathogenic public policies.

Racism, Power, And Health Equity: The Case Of Tenant Organizing.

Racial disparities in health are among the most disconcerting forms of inequity in the United States. Divergent health outcomes between Americans racialized as White and those racialized as Black, Latinx, and Indigenous do not stem from biological or genetic differences. To the contrary, "race" comes to have concrete consequences through social, economic, and political systems. Yet the political contours of health equity remain especially understudied. This article places the politics of health equity in the foreground through the lens of housing, a critical determinant of health. Drawing on in-depth qualitative evidence rooted in the experiences of tenants who confront health-threatening housing conditions, I examine how people within racially and economically marginalized communities organize to build political power in response to those conditions. By charting how tenants navigate state and local political processes, I demonstrate the possibilities for organized tenants to wield power in ways that help advance health equity in the face of structural racism.

Sex differences in neurologic presentation and outcome of SARS-CoV-2, especially cerebrovascular manifestations

Neurological manifestations of COVID-19 and their impact have not been well characterized. Neurological involvement may be caused directly by the effects of the virus infecting the brain or indirectly by the local and systemic immune responses against the virus. Acute cerebrovascular disease, particularly ischemic stroke, has emerged as a serious complication of infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The arrival of COVID-19 represented a unique occasion to study sex difference, and accentuated the need for further study to elucidate the mechanisms that differentiate clinical outcomes among male and female patients. Recent pandemics has a clear sex disparity in clinical outcomes, and morbidity and mortality from COVID-19 are higher among men. Interestingly, the previous decade, there was sparse literature evaluating the impact of sex differences on outcomes in infectious diseases, especially on neurologic complications. Ongoing advances in scientific research have demonstrated sex differences in the neurological complications of neuroinfectious diseases, and sex and disparities in health care are frequently encountered. The evidence for potential sex differences and gender inequalities, including socioeconomic status and occupational exposure in the COVID-19 pandemic is continuing to emerge. In summary, sex is increasingly recognized as a critical determinant of health and disease, particularly relevant to the topical COVID-19 pandemic. Morbidity and mortality from COVID-19 are greater for males, however, the mechanisms for this difference are unclear. Understanding the differences in outcomes between males and females improve the effectiveness of health interventions. However, outcomes of the neurologic complications of infectious disease may be partially explained by sex differences in immune responses. With this narrative, we intend to provide the reader with a comprehensive coverage of where we currently stand regarding sex differences specific, especially on outcomes critical neurologic manifestations of the SARS-CoV-2 infection.

Assessment of Burnout Syndrome and Physical Activity of the University Teachers – A cross-sectional Observational Study

Background: Burnout and physical activity (PA) are two critical determinants of health. The burnout and PA of the university teachers in Pakistan are not well, established. The main objective of the present study is to determine the prevalence of burnout syndrome and the level of physical activity in university teachers.&#x0D; Methodology: The sample of university teachers (n=505) was drawn from 14 public/private universities in Peshawar using a partly convenient, non-probabilistic method based on an exhaustive and up-to-date database of all universities in Peshawar. Data were collected on these parameters: socio-demographics, anthropometrics (body weight, height, and body mass index: BMI), Burnout using Maslach Burnout Inventory (MBI-ES), and PA level. The global Physical Activity Questionnaire developed by WHO (GPAQ-WHO) was used. &#x0D; Results: The sample consisted predominantly of males (78%) with a mean (SD) age of 37.5 ± 7.9 (Range: 28 – 60). The results demonstrated that 19% of university teachers suffered from burnout syndrome, with most of those with job experience &lt;10 years. The mean PA for all the respondents was 955.1 MET minutes/week, with significant differences in PA levels of male and female teachers from public vs. private universities (p, for all trends &lt; 0.05). The proportion of physically active university teachers was 63.6% (95%CI 56.6 to 68.2), with a higher proportion of university teachers without Burnout Syndrome being physically active than those with Burnout Syndrome (73.5% (95%CI 68.1 to 79.3) vs. 21.6% (95%CI 16.5 to 24.6). Only a small number of university teachers could achieve the recommended levels of PA with differences between genders and university types.&#x0D; Conclusion: Work-related burnout is seen in teachers with poor physical activity, and females are mostly affected. Public sector universities showed a greater burnout rate. The public sector needs to revitalize the staff and train them to manage their workload efficiently.

A case for connecting school-based health education in Aotearoa New Zealand to critical health literacy

ABSTRACT Critical health literacy (CHL) and more specifically the development of young people's CHL in school-based health education is an under-explored area in research. This is despite health literacy being viewed as a critical determinant of health in contemporary times (World Health Organization. (2016a). The mandate for health literacy. https://www.who.int/healthpromotion/conferences/9gchp/health-literacy/en/) and the ever-growing recognition of the need for people to be critical consumers and producers of knowledge in the twenty-first century. In this paper, we present findings from a qualitative study which explored the learning experiences and outcomes of senior secondary school-based health education in Aotearoa New Zealand. We conducted a deductive thematic analysis based upon a range of authors' descriptions of the components of CHL. Our findings indicate multiple ways in which health education has the potential to connect to the development of CHL, with these organized into four themes: Taking individual and collective action to promote health, interpersonal awareness and skills, knowledge of community and political structures and social determinants of health, critical thinking and appraisal of health-related information. We conclude the paper with implications for policy and practice relating to CHL in our complex times, as well as avenues for future inquiry in this under-researched area.

Study of Health Promotion Lifestyle and Psychological Well-being in Women Attending the Health Centers of Arak City in 2019

Background and Aim: Women are the central pillar of social development and the main axis of family health. Success, survival, and promotion of society depend on the health of women in society. Since Health Promotion lifestyle and psychological well-being are important determinants of health, this study was conducted to determine the Health Promotion lifestyle and psychological well-being in women attending the health centers of Arak City in 2019. Methods &amp; Materials: In this cross-sectional study, among women who attended health centers in Arak City, 221 women who met the inclusion criteria were included in the study by continuous sampling and the form of demographic information, health promoting lifestyle profile-Ii (HPLP-II), and Ryff Psychological well-being Questionnaire was completed. Data were described using descriptive statistics of frequency, frequency percentage, mean, standard deviation, and data analysis by analysis of variance, independent t-test, and regression using SPSS software v. 19. Ethical Considerations: This study was approved by the Ethics Committee of Research Deputy of Iran University of Medical Sciences (Code: IR.IUMS.REC.1398.609). Results: The mean health-promoting lifestyle in the study units was 135.96; the mean physical activity components were 16.31; The mean nutrition was 26.41, with the lowest and highest scores, respectively. The mean psychological well-being in the study units was 72.29. The mean components of purpose in life were 10.76, and the mean personal growth was 13.19, with the lowest and highest scores, respectively. Age, chronic diseases, employment, number of children, and alcohol consumption had a significant negative relationship with a health-promoting lifestyle, and a woman’s and her husband’s education had a significant positive relationship with a health-promoting lifestyle (P&lt;0.05). Overall demographic variables predict as much as 13% of health-promoting lifestyles. Age, number of children, and chronic physical and psychological diseases had a significant negative relationship with psychological well-being and economic status. A woman’s and her husband’s education had a significant positive relationship with psychological well-being. Overall, demographic variables predict as much as 10% of psychological well-being. Conclusion: Considering that health-promoting lifestyle and psychological well-being are two critical determinants of health, studying these two indicators and the factors affecting them can help Intervention planning to promote women’s physical and mental health.

Developing an Antiracist Lens: Using Photography to Facilitate Public Health Critical Race Praxis in a Foundational MPH Course

Racism is a critical determinant of health that affects outcomes; shapes practice, policy, research, and interventions; and disproportionately burdens nondominant racial populations. The racial justice challenges of today, combined with persistent health inequities exacerbated by the COVID-19 pandemic, have intensified the need for racial equity–minded public health professionals. Because training programs play a key role in developing professionals, they must center teaching about racism and promoting antiracism within their curricula. The critical race theory–grounded strategy Public Health Critical Race Praxis (PHCRP) provides a useful framework, calling for examination of how racism operates within individuals and the systems, such as public health, in which they work. Foundational public health courses provide a vital opportunity to launch such an examination and lay the groundwork for antiracism praxis. This article offers a curricular model that integrates PCHRP with a creative approach to facilitate exploration of racial identity among public health students. Students in our course use photography and written reflections to create dual portraits, one depicting how they see themselves and the other imagining how they might be seen by others in our racialized society. Our pedagogical process prompts critical self-reflection about racial identity, a crucial foundation for addressing the health consequences of structural racism. Spurred by creative inquiry, students of all racial and ethnic backgrounds tell us that our course boosts their racial consciousness, enhances their understanding and ability to engage diverse communities, equips them to see and name racism in the public health context, and galvanizes them to work toward dismantling it.

The relationship between health literacy, health status and health outcomes among German 4th-graders

Abstract Background The WHO describes Health literacy (HL) as a critical determinant of health, and a number of studies among adults link low HL to adverse health outcomes. However, little research has been conducted on HL and health outcomes in younger populations. Thus, this study describes the relationship between HL, health behaviors, and health status among children in primary schools. Methods A cross-sectional pen-and-paper survey was conducted in a convenience sample of 4th-graders in the federal state of North Rhine-Westphalia, Germany. Self-report measures were used for subjective HL, health behaviors (freq. of brushing teeth, eating fruit, exercising, screen time), and health status (subj. health, chronic condition, freq. of doctor visits, feeling ill). Correlations and binary logistic regression for the outcome “at least one adverse health behavior” (e.g. brushing teeth &amp;lt;2x a day; not eating fruit every day) are reported. Sex, age, family affluence, background of migration, numeracy, literacy, and health knowledge are included in the regression model. Results In our sample of n = 899 children (mean age 9,56 years), HL is significantly correlated with subj. health (ρ=.262**) doctor visits (ρ=.086*), feeling ill (ρ=-.078*), brushing teeth (ρ=.116**), eating fruit (ρ=.191**) exercising (ρ=.124**) and screen time (ρ=-.096**). Logistic regression (X2=29.237; p=.001, n = 648) shows that the relative risk for ≥1 adverse health behaviour is higher for boys (OR: 1.4; 95%-CI [1.016-1.927]) and children with lowest family affluence (1.7 [1.097-2.694]). Also, for one unit increase in HL (range 1-4), risk decreases by about 50% (0.472 [.298-.748]). Conclusions Already at a young age (9-10 years), HL is linked to a number of health outcomes. Further, HL has been found to be a potential predictor of adverse health behaviors after controlling for confounders.Thus, the promotion of HL might play an important role in mitigating adverse health behaviors early in the life course.

Effect of yeast and essential oil-enriched diets on critical determinants of health and immune function in Africanized Apis mellifera.

Nutrition is vital for health and immune function in honey bees (Apis mellifera). The effect of diets enriched with bee-associated yeasts and essential oils of Mexican oregano (Lippia graveolens) was tested on survival, food intake, accumulated fat body tissue, and gene expression of vitellogenin (Vg), prophenoloxidase (proPO) and glucose oxidase (GOx) in newly emerged worker bees. The enriched diets were provided to bees under the premise that supplementation with yeasts or essential oils can enhance health variables and the expression of genes related to immune function in worker bees. Based on a standard pollen substitute, used as a control diet, enriched diets were formulated, five with added bee-associated yeasts (Starmerella bombicola, Starmerella etchellsii, Starmerella bombicola 2, Zygosaccharomyces mellis, and the brewers’ yeast Saccharomyces cerevisiae) and three with added essential oils from L. graveolens (carvacrol, thymol, and sesquiterpenes). Groups of bees were fed one of the diets for 9 or 12 days. Survival probability was similar in the yeast and essential oils treatments in relation to the control, but median survival was lower in the carvacrol and sesquiterpenes treatments. Food intake was higher in all the yeast treatments than in the control. Fat body percentage in individual bees was slightly lower in all treatments than in the control, with significant decreases in the thymol and carvacrol treatments. Expression of the genes Vg, proPO, and GOx was minimally affected by the yeast treatments but was adversely affected by the carvacrol and thymol treatments.

Long-term effects of job loss on male health: BMI and health behaviors

Employment is one of the most critical determinants of health and health behaviors for adults. This study focuses on Ukraine and measures how an involuntary job loss – defined as job loss due to business closures, reorganizations, bankruptcies, or privatization – affects BMI, being overweight or obese, smoking, alcohol consumption, and physical activity. There are three reasons to study Ukraine in the aftermath of an enormous economic transition that resulted in employment contraction as high as 40 % compared to 1990. First, nearly all published studies on the relationship between job loss and health and health behaviors have been on developed countries, meaning that our study fills the gap in the literature on transition economies. Second, the job losses that we study are plausibly exogenous and affected a significant share of the population. Third, the longitudinal survey follows individuals for up to 10 years starting from 2003, allowing us to capture the long-term effects of past job loss on outcomes at a specific point in time and their trajectories across the life cycle. Applying growth-curve models, we show that past involuntary job loss significantly alters the age trajectories of all considered outcomes at both extensive and intensive margins.

Is the Right to Housing Being Realized in Canada? Learning from the Experiences of Tenants in Affordable Housing Units in a Large Canadian City

Background: Housing is a critical determinant of health and a basic human right. Historically, Canada’s housing policies have not been grounded in a human rights-based approach. In the 1990s, a policy shift prioritized efficiency in government spending and deficit reductions over the provision of many social programs including affordable housing. With various levels of government now acknowledging and recognizing the need for more affordable housing, it is important to understand tenant experiences, perspectives, and needs to ensure policies and practices are supporting individuals appropriately. Methods: In total, 161 individuals participated in this study by completing online or in-person questionnaires. Results: Exploratory analysis of results revealed that although there were some positive benefits to affordable housing, many tenants continued to struggle financially, physically, mentally, and emotionally without adequate supports in place. Conclusions: These findings highlight the need for affordable housing to be part of a system of care that provides supports along a continuum. The results further reiterate that placing a person or family in affordable housing does not guarantee that their lives have improved. Without robust affordable housing models that prioritize the empowerment of individuals and families, housing policies may fail to fulfil the right to safe and affordable housing for Canadians, especially when considering historically marginalized populations.

Law and Policy as Tools in Healthy People 2030.

Laws and policies are critical determinants of health and well-being. They can encourage positive behaviors and discourage harmful behaviors, and they can enhance or worsen health, health equity, health disparities, and health literacy. Recognizing their contribution to conditions in the environments in which people are born, live, learn, work, play, worship, and age, and people's experiences of these conditions, the US Department of Health and Human Services considered the roles of law and policy throughout its development of Healthy People 2030. Laws and policies often interrelate, but they have different purposes. A law is an established procedure, standard, or system of rules that members of a society must follow. A policy is a decision or set of decisions meant to address a long-term purpose or problem. Healthy People 2030 offers an opportunity for users in diverse sectors and at all levels to use laws and policies to support or inform the initiative's implementation, address health disparities and health inequities, and improve health and well-being in this decade. Introducing new laws and policies or rescinding existing ones to achieve Healthy People 2030 goals offers a chance to rigorously assess outcomes and weigh the balance of good outcomes against unintended consequences.

Sex-specific associations of circulating testosterone levels with all-cause and cause-specific mortality.

Testosterone is a critical determinant of health in both genders. However, the relationship between circulating levels of testosterone and mortality remains undetermined. We examined the associations of serum total testosterone (TT) and free testosterone (FT) with all-cause and cause-specific mortality in 154 965 men and 93 314 postmenopausal women from UK Biobank. Cox regression models were used to calculate the hazard ratios (HR) and 95% CIs. Given multiple testing, P < 0.005 was considered statistically significant. Over a median follow-up of 8.9 (inter-quartile range: 8.3-9.5) years, we documented 5754 deaths in men, including 1243 (21.6%) from CVD and 2987 (51.9%) from cancer. In postmenopausal women, 2435 deaths occurred, including 346 (14.2%) from CVD and 1583 (65.0%) from cancer. TT and FT concentrations were inversely associated with all-cause mortality in men, with the multivariable HR of 0.82 (95% CI: 0.75-0.91) and 0.80 (95% CI: 0.73-0.87) for the highest (Q5) vs the lowest quintile (Q1), respectively. In postmenopausal women, TT concentrations showed a positive association with all-cause mortality (HR for Q5 vs Q1 = 1.20, 95% CI: 1.06-1.37). Furthermore, higher TT and FT concentrations were associated with a lower risk of cancer mortality in men (both P for trend = 0.001), whereas TT concentrations were suggestively associated with a higher risk of cancer mortality in postmenopausal women (P for trend = 0.03). Our findings suggest that high levels of circulating testosterone may be beneficial for all-cause and cancer mortality in men but detrimental in postmenopausal women.

The Association Between Health Literacy and Self-rated Health Among Residents of China Aged 15–69 Years

Health literacy is a critical determinant of health. However, the association between health literacy and outcomes among Chinese residents has not been studied using nationally representative data. This study examines the association between health literacy and self-rated health among Chinese residents based on the 2017 China Health Literacy Survey. The 2017 China Health Literacy Survey was conducted among non-institutionalized residents aged 15-69 years from 31 provinces in China. Self-rated health was measured using a single question with a 1-5 scale. Health literacy was assessed using the Chinese Health Literacy Scale. Multilevel linear regression models examined the association between health literacy and self-rated health. Data were collected in 2017 and analyzed between 2018 and 2019. The final sample size was 85,384. The overall weighted mean of the self-rated health score was 4.02 (95% CI=4.00, 4.03). After adjusting for individual-, county-, and province-level covariates, Chinese residents with higher levels of health literacy were more likely to have better self-rated health (β=0.0007, SE=0.0002, p<0.001). Of 6 dimensions of health literacy, 4 (i.e., infectious diseases literacy, chronic diseases literacy, medical care literacy, and health information literacy) were associated with self-rated health. Additionally, self-rated health was associated with gender, age, education, occupation, annual household income, and chronic conditions. Using nationally representative data collected in 2017, this study found that self-rated health is associated with health literacy among Chinese residents aged 15-69 years. The promotion of health literacy should be an important component of health education, patient management, and health promotion.

Sex differences in COVID-19: candidate pathways, genetics of ACE2, and sex hormones.

Biological sex is increasingly recognized as a critical determinant of health and disease, particularly relevant to the topical COVID-19 pandemic caused by the SARS-CoV-2 coronavirus. Epidemiological data and observational reports from both the original SARS epidemic and the most recent COVID-19 pandemic have a common feature: males are more likely to exhibit enhanced disease severity and mortality than females. Sex differences in cardiovascular disease and COVID-19 share mechanistic foundations, namely, the involvement of both the innate immune system and the canonical renin-angiotensin system (RAS). Immunological differences suggest that females mount a rapid and aggressive innate immune response, and the attenuated antiviral response in males may confer enhanced susceptibility to severe disease. Furthermore, the angiotensin-converting enzyme 2 (ACE2) is involved in disease pathogenesis in cardiovascular disease and COVID-19, either to serve as a protective mechanism by deactivating the RAS or as the receptor for viral entry, respectively. Loss of membrane ACE2 and a corresponding increase in plasma ACE2 are associated with worsened cardiovascular disease outcomes, a mechanism attributed to a disintegrin and metalloproteinase (ADAM17). SARS-CoV-2 infection also leads to ADAM17 activation, a positive feedback cycle that exacerbates ACE2 loss. Therefore, the relationship between cardiovascular disease and COVID-19 is critically dependent on the loss of membrane ACE2 by ADAM17-mediated proteolytic cleavage. This article explores potential mechanisms involved in COVID-19 that may contribute to sex-specific susceptibility focusing on the innate immune system and the RAS, namely, genetics and sex hormones. Finally, we highlight here the added challenges of gender in the COVID-19 pandemic.

Direct interactions with commensal streptococci modify intercellular communication behaviors of Streptococcus mutans

The formation of dental caries is a complex process that ultimately leads to damage of the tooth enamel from acids produced by microbes in attached biofilms. The bacterial interactions occurring within these biofilms between cariogenic bacteria, such as the mutans streptococci, and health-associated commensal streptococci, are thought to be critical determinants of health and disease. To better understand these interactions, a Streptococcus mutans reporter strain that actively monitors cell–cell communication via peptide signaling was cocultured with different commensal streptococci. Signaling by S. mutans, normally highly active in monoculture, was completely inhibited by several species of commensals, but only when the bacteria were in direct contact with S. mutans. We identified a novel gene expression pattern that occurred in S. mutans when cultured directly with these commensals. Finally, mutant derivatives of commensals lacking previously shown antagonistic gene products displayed wild-type levels of signal inhibition in cocultures. Collectively, these results reveal a novel pathway(s) in multiple health-associated commensal streptococci that blocks peptide signaling and induces a common contact-dependent pattern of differential gene expression in S. mutans. Understanding the molecular basis for this inhibition will assist in the rational design of new risk assessments, diagnostics, and treatments for the most pervasive oral infectious diseases.

Exploring associated factors of subjective health literacy in school-aged children

Abstract Background Health literacy (HL) has been acknowledged as a critical determinant of health. While HL and its potential determinants have been studied in adults, little research has been conducted with children. Therefore, this study investigates factors associated with children's subjective HL to explore potential entry points for the promotion of HL in childhood. Methods Cross-sectional data was collected from 4th-graders at German schools with a self-report questionnaire. Age, sex, family affluence, functional HL, self-efficacy, motivation to learn about health, and perceived parental health orientation were included as potential determinants, while the dependent variable subjective HL was assessed with a newly developed scale. We used hierarchical linear regression to explain variance in HL with different sets of predictors. Results n = 907 4th-graders (53.4% female) were surveyed. Subjective HL was high, with 82.2% reporting that it was “rather easy” or “very easy” for them to deal with health-related information. Age, sex, home language, and family affluence together were able to explain 2% of variance in subjective HL. In contrast, 19.3% of variance could be explained by all independent variables together, whereby family affluence, functional HL, self-efficacy, motivation, and perceived parental health orientation were significant predictors (p &amp;lt; .01). Motivation was the most potent predictor (β = .24), followed by parental health orientation (β = .18) and self-efficacy (β = .11). Conclusions This study was able to identify potential predictors of HL among children. Our data indicate that the promotion of health-related motivation and self-efficacy, but also of certain parental attitudes might be particularly fruitful in order to support the development of HL early in the life course. However, intervention research will need to provide further evidence on the extent to which these factors can be modified and actually lead to increased HL. Key messages This study was able to identify potential predictors of children’s HL which might be used to inform interventions. Further longitudinal research is necessary to verify our findings.

Social determinants of health among urban homeless in Delhi, India

Abstract Introduction Housing is a critical determinant of health that operates synergistically with other social determinants of health (SDH), like food and nutrition. The urban homeless count among the most neglected and marginalized groups; they live and work in conditions that make them prone to disease. We conducted a study to understand the role and interplay of various SDH among the urban homeless in India. Methods A qualitative study was undertaken to understand the social determinants of health among homeless people in Delhi, India. Organizations working with the population were initially consulted. Criterion sampling was used to draw a convenience sample of participants for 24 in-depth interviews and five focus group discussions. Field observations were also done. Data were analysed using a grounded theory approach using Atlas.TI 8 software. Results The homeless lived in proximity in shelters making them susceptible to infectious disease such as Tuberculosis, or on the roadside making them prone to road-traffic accidents owing to intake of drugs and alcohol. Injuries caused by violence were common and homeless people lined up each morning for first aid services. Single homeless women were vulnerable to being stalked and raped. At a homeless recovery shelter, where a large number of homeless people had Tuberculosis or HIV, poor nutrition was reported as a leading factor that lowered immunity and affected chances of recovery. Lack of coordination between the different departments of the government for taking effective measures for ensuring better health of the urban poor was also reported. Conclusions The conditions of living clearly affected the lives of homeless people. The settings - the quality of housing and social environment in addition to the ineffective role of the state played a prominent role in impacting the health of the urban poor. There clearly is a need for policy measures that can address factors that shape the health of poor people. Key messages Homelessness is a crucial determinant of health: it severely affects the health and well-being of homeless people. The lack of a political will to address SDH is a leading challenge.