Differences In Health Indicators Research Articles

Comparative Health Behaviour of Young People with Disabilities in Hungary: A Cross-Sectional Study.

The health status of Hungary's population is unfavorable, with significant differences in health indicators not only compared to the EU15 but also to the Visegrad countries. Unfavorable health indicators can be disproportionate and particularly affect vulnerable groups, such as people with disabilities. In this study, we set out to compare the health behavior of disabled youth and youth with typical development in Hungary. We also aimed to compare the health behavior of adolescents in the Visegrad countries. The eating habits of both groups of young people we examined are unfavorable. Adolescents with disabilities experience a significantly higher rate of school stress than children with typical development in Hungary. The prevalence of somatic complaints and parameters of poor mental well-being are significantly higher in Hungary than in the other Visegrad countries. The results indicate that additional interventions are needed in Hungary and that differentiated, professional health promotion is needed for young people with disabilities. The researchers recommend extending the study to disabled adolescents living in Visegrad countries, on the basis of which an injury-specific health promotion methodology could be developed with international interprofessional cooperation.

PROFILE OF CAREGIVING ACTIVITIES AND ASSOCIATION WITH PHYSICAL HEALTH AMONG DEMENTIA SPOUSAL CAREGIVERS

Abstract The daily care of a person living with Alzheimer’s disease and related dementia (ADRD) is associated with threats to the health and well-being of family caregivers. Although more is known about the relationship between caregiving and psychosocial distress, far less is known about the relationship between caregiving and physical health and health behaviors. This study aims to identify intensity of caregiving experience profiles and compare the profiles to multidimensional physical health indicators and health behaviors among spousal caregivers for persons with ADRD. Using data from 152 spousal caregivers aged 65 and over, the intensity of caregiving experience (ICE) was measured as the number and frequency of health- and medical-related helping activities for his/her care recipient. Multidimensional health indicators included fatigue, sleep disturbance, physical functioning, pain interference, and general health from self-reports, and the number of chronic conditions from the electronic health records. Health promotion behaviors were assessed as: health responsibility, physical activity, nutrition, interpersonal relations, and stress management. Cluster analysis was performed to determine the number of ICE profiles. T-tests and chi2 tests were to assess differences in health indicators and behaviors between clusters. We identified two distinct caregiving experience patterns: high-intensity (37.5%) and low-intensity (62.5%) caregiving. Caregivers from the high-intensity caregiving cluster reported feeling more tired (t=2.254, p< .05), perceiving more sleep disturbance (t=3.06, p< .001), and performing less physical activity (t=2.05, p< .05). Future studies are needed to develop effective interventions to reduce sleep disturbance and fatigue among family caregivers who are heavily involved in caregiving activities.

Quality of Life of Patients Who Have Suffered from Acute Cerebrovascular Accident (Investigation Based on EQ-5D-5L).

Acute cerebrovascular accident is known to be one of the main causes of morbidity, mortality, long-term disability, and disability in society. To investigate the quality of life of patients who have suffered from acute cerebrovascular accident (hereinafter ACVA) in stratified groups by age, gender, diagnosis, type (primary or secondary), and severity of a stroke, as well as undergoing rehabilitation. This research is a cross-sectional descriptive-analytical study. The main research method is a survey. Data collection was carried out in 2020 in Almaty of the Republic of Kazakhstan by inpatient doctors (City Clinical Hospital No. 5 of the Public Health Department of Almaty), engaged in the rehabilitation treatment of patients with acute cerebrovascular accident. The standardized questionnaire EQ-5D-5L was used to assess the quality of life due to health conditions. Data on the state of "mobility", "self-care", "daily activities", "pain", "anxiety", as well as data on self-assessment of health status (according to the EQ VAS scale) were analyzed using the Level Sum Scores (hereinafter LSS). The study involved 258 respondents who had a stroke. The survey was conducted 2 months after the respondents were discharged from the hospital. The average LSS index of patients who underwent ACVA was 10.2 (9.7±10.7). Significant differences in LSS levels ( P ≤ 0.001) were revealed by the severity of stroke and by the fact of rehabilitation. Differences in LSS levels by age, gender, diagnosis, and type of ACVA are insignificant (P > 0.05). The difference in health indicators of patients with primary and repeated strokes indicates the fact of deterioration in the quality of life with each subsequent stroke. The quality of life of patients with ACVA is associated with the fact of rehabilitation: low values of EQ VAS in the group of patients who did not undergo rehabilitation and high values of EQ VAS in those who underwent rehabilitation. After a stroke, the majority of patients tend to have a negative quality of life, mostly due to violations of the component "daily activities". The identified significant disparities in LSS and EQ VAS indicators further show that the quality of life varies among stratified groups. The kind (primary or secondary) and severity of the stroke, as well as the existence of rehabilitation, are indicators that impact the quality of life of patients who have had ACVA.

An integrative and multi-indicator approach for wildlife health applied to an endangered caribou herd

Assessing wildlife health in remote regions requires a multi-faceted approach, which commonly involves convenient samplings and the need of identifying and targeting relevant and informative indicators. We applied a novel wildlife health framework and critically assessed the value of different indicators for understanding the health status and trends of an endangered tundra caribou population. Samples and data from the Dolphin and Union caribou herd were obtained between 2015 and 2021, from community-based surveillance programs and from captured animals. We documented and categorized indicators into health determinants (infectious diseases and trace elements), processes (cortisol, pathology), and health outcomes (pregnancy and body condition). During a recent period of steep population decline, our results indicated a relatively good body condition and pregnancy rates, and decreasing levels of stress, along with a low adult cow survival. We detected multiple factors as potential contributors to the reduced survival, including Brucella suis biovar 4, Erysipelothrix rhusiopathiae and lower hair trace minerals. These results remark the need of targeted studies to improve detection and investigations on caribou mortalities. We also identified differences in health indicators between captured and hunter sampled caribou, highlighting the importance of accounting for sampling biases. This integrative approach that drew on multiple data sources has provided unprecedented knowledge on the health in this herd and highlights the value of documenting individual animal health to understand causes of wildlife declines.

Graded chronic pain scale revised: validation in a Veteran sample.

The Graded Chronic Pain Scale (GCPS) is frequently used in pain research and treatment to classify mild, bothersome, and high impact chronic pain. This study's objective was to validate the revised version of the GCPS (GCPS-R) in a US Veterans Affairs (VA) healthcare sample to support its use in this high-risk population. Data were collected from Veterans (n = 794) via self-report (GCPS-R and relevant health questionnaires) and electronic health record extraction (demographics and opioid prescriptions). Logistic regression, adjusting for age and gender, was used to test for differences in health indicators by pain grade. Adjusted odds ratio (AOR) with 95% confidence intervals (CIs) were reported with CIs not including an AOR of 1 indicating that the difference exceeded chance. In this population, the prevalence of chronic pain (pain present most or every day, prior 3 months) was 49.3%: 7.1% with mild chronic pain (mild pain intensity and lower interference with activities); 23.3% bothersome chronic pain (moderate to severe pain intensity with lower interference); and 21.1% high impact chronic pain (higher interference). Results of this study mirrored findings in the non-VA validation study; differences between bothersome and high impact were consistent for activity limitations and present but not fully consistent for psychological variables. Those with bothersome chronic pain or high impact chronic pain were more likely to receive long-term opioid therapy compared to those with no/mild chronic pain. Findings highlight categorical differences captured with the GCPS-R, and convergent validity supports use of the GCPS-R in US Veterans.

The gut microbiota as a target to improve health conditions in a confined environment.

Confined environments increase psychological stress and lead to health problems such as abnormal mood and rhythm disruption. However, the mechanism by which confined environments impact health has remained unclear. Significant correlations have been reported between psychological stress and changes in gut microbiota. Therefore, we investigated the effect of a confined environment on the composition of the gut microbiota by 16s rDNA high-throughput sequencing, and analyzed the correlation between gut microbiota and health indicators such as uric acid (UA), sleep, and mood. We found that the gut microbiota of the subjects clustered into two enterotypes (Bi and Bla), and that the groups differed significantly. There were notable differences in the abundances of genera such as Bifidobacterium, Dorea, Ruminococcus_torques_group, Ruminococcus_gnavus_group, Klebsiella, and UCG-002 (p < 0.05). A confined environment significantly impacted the subjects' health indicators. We also observed differences in how the subjects of the two enterotypes adapted to the confined environment. The Bi group showed no significant differences in health indicators before and after confinement; however, the Bla group experienced several health problems after confinement, such as increased UA, anxiety, and constipation, and lack of sleep. Redundancy analysis (RDA) showed that UA, RBC, mood, and other health problems were significantly correlated with the structure of the gut microbiota. We concluded that genera such as UCG-002, Ruminococcus, CAG352, and Ruminococcus_torques_group increased vulnerability to confined environments, resulting in abnormal health conditions. We found that the differences in the adaptability of individuals to confined environments were closely related to the composition of their gut microbiota.

Functional outcomes of Tai Chi exercise prescription in women with knee osteoarthritis

Knee Osteoarthritis (KOA) is the most common type of knee joint injury and also a risk factor for multiple health consequences and is prevalent among older women. The updated clinical guidelines for KOA treatment by the American Rheumatism Association recommend Tai Chi exercise. However, a literature review outlined limitations in Tai Chi intervention implementations. This study aimed to address some of the gaps. This study selected thirty female patients to participate in Tai Chi exercises and undergo relevant tests. The subjects were randomly assigned to Tai Chi or education groups. Independent sample t-tests were conducted to compare the difference in health indicators between the two groups after the intervention. The difference-in-differences (DID) regression was performed to assess the difference in the health outcomes between the two groups at baseline and follow-up and the difference in the differences. After the completion of the intervention, the Tai Chi group reported significantly improved KOA symptoms, physical fitness, and health status indicators than the control group. Specifically, the group differences were significantly larger at the baseline than at the follow-up. Our findings provide compelling evidence of the effects of the innovative Tai Chi exercise prescription specifically designed for KOA patients. The empirical evidence on its effectiveness in alleviating KOA symptoms and improving the overall health of middle-aged and elderly women with KOA suggested that Tai Chi intervention exercise has huge prospects for integration in KOA rehabilitation therapy.

School and non-school day screen time profiles and their differences in health and educational indicators in adolescents.

Sedentary behavior and screen-based devices in particular have been negatively associated with a wide range of health and educational indicators. However, few have examined these relationships separately for school days and non-school days, and none have used a person-centered approach. This study aimed to identify school and non-school day screen time profiles, as well as examine possible differences in health indicators (physical fitness, fatness, physical activity, sleep duration, and Mediterranean diet) and academic performance. This study involved the participation of 1573 Spanish adolescents aged 12-16 years (54.73% girls). Academic performance was measured through grades in Mathematics, Language, English, and Physical Education. Physical fitness was measured through a battery of tests (cardiorespiratory fitness was measured using the 20 m shuttle run test, and muscular strength with both handgrip and standing long jump tests), while fatness (skinfold thicknesses) was assessed with calipers. Finally, physical activity, screen time, sleep duration, and adherence to the Mediterranean diet were measured using self-reported questionnaires. Hierarchical cluster analyses based on square Euclidian distances and Ward's method were performed based on daily minutes of screen time recorded on school and non-school days. We identified four clusters labeled and described as: (1) "High-high": highest screen time on school and non-school days; (2) "High-low": high screen time on school days and low screen time on non-school days; (3) "Low-high": low screen time on school days and high screen time on non-school days; (4) "Low-low": lowest screen time on school and non-school days. Adolescents who belonged to the "High-high" profile had worse health-related behaviors (i.e., physical activity, sleep duration, and adherence to Mediterranean diet) and academic performance than most other profiles, while adolescents who belonged to "Low-low" profile showed the opposite pattern. Adolescents in the "Low-high" profile had a higher sleep duration on school days and better academic performance than those in the "High-low" profile. No differences in body fat, cardiorespiratory fitness, and muscular strength were found between the four different profiles. The results suggest that adolescents who accumulated a large amount of screen time on school and non-school days reported worse health-related behaviors and academic performance. Moreover, adolescents who had high screen time on school days reported only a short sleep duration on school days and worse academic performance than on non-school days. Conducting interventions to reduce screen time in these four profiles, particularly in the groups of students with more screen time on school days, becomes essential to improving adolescents' healthy lifestyles and academic performance.

Influence of drying methods on health indicators of brewers spent grain for potential upcycling into food products

Brewer's spent grain (BSG) was dried via infra-red drying (IRD) or hot-air drying (HAD) and milled into fine powders. Proximate analysis (moisture, protein, fat, ash, carbohydrates by difference), water activity, dietary fiber, total soluble phenolics, and antioxidant capacity analyses were performed to characterize and compare both types of BSG powders. Mice feeding of the two types of dried BSG, each at three different concentrations, was conducted to compare the effects of the two types of dried BSG on health indicators and to determine evidence of dose response. Weights of body, feed intake, adipose tissue, kidney, and liver were recorded; blood plasma, cholesterol, liver fat, and fecal fat and protein were also measured.Significant differences were observed for liver and adipose tissue, cholesterol, and fecal protein between mice fed diets with different concentrations of BSG compared to the control diet. The analysis of hormones related to type II diabetes and metabolic syndrome did not show differences between the hormones examined, except for ghrelin and leptin, which are directly correlated with increased white adipose tissue in mice consuming high fat diets. No differences in health indicators were found in mice fed with the two different types of BSG. Mice fed with HAD and IRD BSG diets increased the relative abundance of Firmicutes and Bacteroidetes phylum microbiota compared to control diet, with no differences due to the type and concentrations of BSG in mice diets. The present results suggest that increasing levels of BSG incorporated into human foods may impart health benefits.

Cardiorespiratory responses in healthy young adults with exposure to indoor airborne PAEs: A randomized, crossover trial of air purification.

Phthalic acid esters (PAEs) are widely used as plasticizers in industrial process and consumer products. Nowadays, PAEs are ubiquitous in the environment and are reported to be associated with cardiorespiratory diseases. However, studies about the association between indoor airborne PAEs exposure and cardiorespiratory health were limited, and the potential biological mechanism remains under-recognized. A randomized crossover trial was conducted on 57 healthy young adults in Beijing. Repeated health measurements were performed under real and sham indoor air purification with a washout interval of at least 2weeks. The concentration of indoor airborne PAEs were determined by gas chromatography-orbit ion trap mass spectrometry. Health indicators including blood pressure, lung function, airway inflammation, and circulating biomarkers reflecting blood coagulation and systematic oxidative stress were measured. Linear mixed-effect model was used to examine the between-treatment differences in health indicators, and three models including single-constituent, constituent-fine particulate matter (PM2.5) joint, and single-constituent residual model were used to estimate the association between indoor airborne PAEs and health indicators. The indoor airborne PAEs were reduced effectively under real air purification. The total indoor airborne di-2-ethylhexyl phthalate (DEHP), bis (4-Methyl-2-pentyl) phthalate (DMPP), diphenyl phthalate (DPP), and diethyl phthalate (DEP) were identified to be most significantly associated with the increase of blood pressure and airway inflammation, and decrease of lung function. A doubling increase in DEHP, DMPP, DPP, DEP was associated with the increase of 17.2% (95% CI: 3.9%, 32.2%), 11.7% (95% CI: 3.5%, 20.6%), 7.0% (95% CI: 2.4%, 11.8%), 6.0% (95% CI: 1.8%, 10.4%) in FeNO, respectively, in single-constituent residual model. Significant associations between specific total indoor airborne PAEs and increased levels of health biomarkers including oxidized low-density lipoprotein (ox-LDL), 8-isoprostane (8-isoPGF2α), and soluble P-selectin (sP-selectin) were observed. Indoor airborne PAEs may cause adverse cardiorespiratory health effects in young healthy adults, and indoor air purification could ameliorate the adverse cardiorespiratory effects.

Health outcomes in young adulthood among former child refugees in Denmark, Norway and Sweden: A cross-country comparative study.

This study aimed at comparing several health outcomes in young adulthood among child refugees who settled in the different immigration and integration policy contexts of Denmark, Norway and Sweden. The study population included refugees born between 1972 and 1997 who immigrated before the age of 18 and settled in the three Nordic countries during 1986-2005. This population was followed up in national registers during 2006-2015 at ages 18-43 years and was compared with native-born majority populations in the same birth cohorts using sex-stratified and age-adjusted regression analyses. Refugee men in Denmark stood out with a consistent pattern of higher risks for mortality, disability/illness pension, psychiatric care and substance misuse relative to native-born majority Danish men, with risk estimates being higher than comparable estimates observed among refugee men in Norway and Sweden. Refugee men in Sweden and Norway also demonstrated increased risks relative to native-born majority population men for inpatient psychiatric care, and in Sweden also for disability/illness pension. With the exception of increased risk for psychotic disorders, outcomes among refugee women were largely similar to or better than those of native-born majority women in all countries. The observed cross-country differences in health indicators among refugees, and the poorer health outcomes of refugee men in Denmark in particular, may be understood in terms of marked differences in Nordic integration policies. However, female refugees in all three countries had better relative health outcomes than refugee men did, suggesting possible sex differentials that warrant further investigation.

Choose Where You Live Carefully: Built Environment Differences in Children’s Cardiorespiratory Fitness and Cardiometabolic Risk

Information regarding urban-rural differences in health indicators are scarce in Brazil. This study sought to identify rural-urban differences in cardiorespiratory fitness (CRF) and cardiometabolic risk (CMR) in Brazilian children and adolescents whilst controlling for the important confounding variables including social economic status (SES). This is a cross-sectional study developed with children and adolescents (n = 2250, age 11.54 ± 2.76) selected from a city in the south of Brazil. CRF was estimated using a 6-minute run/walk test. CMR scores were calculated by summing different cardiometabolic risk indicators. CRF was analysed assuming a multiplicative model with allometric body-size components. CMR differences in residential locations was assessed using Analysis of caovariance (ANCOVA) adopting SES, Body Mass Index (BMI), waist circumference (WC), age and fitness as covariates. Results indicated a main effect of location (p < 0.001) with children living a rural environment having the highest CRF, and children living in the periphery of towns having the lowest. Analysis also revealed significant main effects of location (p < 0.001) with children living a rural environment having the lowest CMR and children living in the centre of towns having the highest. Therefore, Brazilian children living in a rural environment appear to have superior health benefits.

Variation in Health Among Unstably Housed Youth From Cities, Suburbs, Towns, and Rural Areas

PurposeYouth face similar rates of homelessness across rural and urban areas, yet little is known about how the health of unstably housed youth varies by location. We assessed differences in health by location (city, suburb, town, and rural) and housing status among youth facing a range of unstable housing experiences. MethodsThis secondary data analysis from 8th, 9th, and 11th graders completing the 2019 Minnesota Student Survey examined youth who had experienced housing instability in the prior year (n = 10,757), including running away (48%) or experiencing homelessness (staying in shelter, couch-surfing, or rough sleeping) with (42%) or without (10%) an adult family member. We conducted multifactor analysis of variance to assess differences by location (urban, suburban, town, and rural) and housing experience for each of five health indicators: suboptimal health, depressive symptoms, suicide attempts, ≥2 sexual partners, and e-cigarette use. ResultsIn main effects models, all health indicators varied based on housing status; suboptimal health, ≥2 sexual partners, and e-cigarette use also varied by location. Interaction models showed that unaccompanied homeless youth in suburbs reported poorer health compared with those in cities. Compared with suburbs, youth in towns were more likely to report ≥2 sexual partners (19.9%, 24.1%) and e-cigarette use (39.5%, 43.3%). ConclusionsOur findings suggest that unstably housed youth face a similar burden of poor health across locations, with only subtle differences in health indicators, yet most research focuses on urban youth. Future research is needed to identify how to best meet the health needs of unstably housed youth across locations.

Examination of differences in health indicators between efficient and inefficient countries.

Objective:This study determined whether there is a statistically significant difference between efficient and inefficient Organization for Economic Co-operation and Development (OECD) countries in terms of health indicators using fuzzy data envelopment analysis (FDEA).Methods:In the study, FDEA was performed with three input variables directly affecting health, four environmental factors considered to indirectly affect health, and two output variables. Literature research was used to determine appropriate variables. In FDEA, three different α-cut levels were used. The hypotheses regarding whether there was a statistically significant difference between efficient and inefficient countries in input and output variables were tested for all α-cut levels of upper bound efficiency values.Results:In terms of health indicators, 17 countries were efficient at α-cut 0 and 0.5. At α-cut 1, 18 countries were efficient. There was only a statistically significant difference between the efficient and inefficient countries in “the number of physicians.”Conclusion:This study shows the number of physicians was the most important determinant affecting the efficiency of a country’s healthcare system. Inefficient countries had a greater mean for number of physicians. Thus, inefficient countries consume more resources than efficient ones.

Using geographical analysis to identify child health inequality in sub-Saharan Africa.

One challenge to achieving Millennium Development Goals was inequitable access to quality health services. In order to achieve the Sustainable Development Goals, interventions need to reach underserved populations. Analyzing health indicators in small geographic units aids the identification of hotspots where coverage lags behind neighboring areas. The purpose of these analyses is to identify areas of low coverage or high need in order to inform effective resource allocation to reduce child health inequity between and within countries. Using data from The Demographic and Health Survey Program surveys conducted in 27 selected African countries between 2010 and 2014, we computed estimates for six child health indicators for subnational regions. We calculated Global Moran’s I statistics and used Local Indicator of Spatial Association analysis to produce a spatial layer showing spatial associations. We created maps to visualize sub-national autocorrelation and spatial clusters. The Global Moran’s I statistic was positive for each indicator (range: 0.41 to 0.68), and statistically significant (p <0.05), suggesting spatial autocorrelation across national borders, and highlighting the need to examine health indicators both across countries and within them. Patterns of substantial differences among contiguous subareas were apparent; the average intra-country difference for each indicator exceeded 20 percentage points. Clusters of cross-border associations were also apparent, facilitating the identification of hotspots and informing the allocation of resources to reduce child health inequity between and within countries. This study exposes differences in health indicators in contiguous geographic areas, indicating that specific regional and subnational, in addition to national, strategies to improve health and reduce health inequalities are warranted.

Mixing modes in a population-based interview survey: comparison of a sequential and a concurrent mixed-mode design for public health research

BackgroundPopulation-based surveys currently face the problem of decreasing response rates. Mixed-mode designs are now being implemented more often to account for this, to improve sample composition and to reduce overall costs. This study examines whether a concurrent or sequential mixed-mode design achieves better results on a number of indicators of survey quality.MethodsData were obtained from a population-based health interview survey of adults in Germany that was conducted as a methodological pilot study as part of the German Health Update (GEDA). Participants were randomly allocated to one of two surveys; each of the surveys had a different design. In the concurrent mixed-mode design (n = 617) two types of self-administered questionnaires (SAQ-Web and SAQ-Paper) and computer-assisted telephone interviewing were offered simultaneously to the respondents along with the invitation to participate. In the sequential mixed-mode design (n = 561), SAQ-Web was initially provided, followed by SAQ-Paper, with an option for a telephone interview being sent out together with the reminders at a later date. Finally, this study compared the response rates, sample composition, health indicators, item non-response, the scope of fieldwork and the costs of both designs.ResultsNo systematic differences were identified between the two mixed-mode designs in terms of response rates, the socio-demographic characteristics of the achieved samples, or the prevalence rates of the health indicators under study. The sequential design gained a higher rate of online respondents. Very few telephone interviews were conducted for either design. With regard to data quality, the sequential design (which had more online respondents) showed less item non-response. There were minor differences between the designs in terms of their costs. Postage and printing costs were lower in the concurrent design, but labour costs were lower in the sequential design. No differences in health indicators were found between the two designs. Modelling these results for higher response rates and larger net sample sizes indicated that the sequential design was more cost and time-effective.ConclusionsThis study contributes to the research available on implementing mixed-mode designs as part of public health surveys. Our findings show that SAQ-Paper and SAQ-Web questionnaires can be combined effectively. Sequential mixed-mode designs with higher rates of online respondents may be of greater benefit to studies with larger net sample sizes than concurrent mixed-mode designs.

Health and health-related indicators in slum, rural, and urban communities: a comparative analysis

BackgroundIt is generally assumed that urban slum residents have worse health status when compared with other urban populations, but better health status than their rural counterparts. This belief/assumption is often because of their physical proximity and assumed better access to health care services in urban areas. However, a few recent studies have cast doubt on this belief. Whether slum dwellers are better off, similar to, or worse off as compared with rural and other urban populations remain poorly understood as indicators for slum dwellers are generally hidden in urban averages.ObjectiveThe aim of this study was to compare health and health-related indicators among slum, rural, and other urban populations in four countries where specific efforts have been made to generate health indicators specific to slum populations.DesignWe conducted a comparative analysis of health indicators among slums, non-slums, and all urban and rural populations as well as national averages in Bangladesh, Kenya, Egypt, and India. We triangulated data from demographic and health surveys, urban health surveys, and special cross-sectional slum surveys in these countries to assess differences in health indicators across the residential domains. We focused the comparisons on child health, maternal health, reproductive health, access to health services, and HIV/AIDS indicators. Within each country, we compared indicators for slums with non-slum, city/urban averages, rural, and national indicators. Between-country differences were also highlighted.ResultsIn all the countries, except India, slum children had much poorer health outcomes than children in all other residential domains, including those in rural areas. Childhood illnesses and malnutrition were higher among children living in slum communities compared to those living elsewhere. Although treatment seeking was better among slum children as compared with those in rural areas, this did not translate to better mortality outcomes. They bear a disproportionately much higher mortality burden than those living elsewhere. Slum communities had higher coverage of maternal health services than rural communities but it was not possible to compare maternal mortality rates across these residential domains. Compared to rural areas, slum communities had lower fertility and higher contraceptive use rates but these differences were reversed when slums were compared to other urban populations. Slum–rural differences in infant mortality were found to be larger in Bangladesh compared to Kenya.ConclusionMortality and morbidity indicators were worse in slums than elsewhere. However, indicators of access to care and health service coverage were found to be better in slums than in rural communities.

A picture is worth a thousand words: maps of HIV indicators to inform research, programs, and policy from NA-ACCORD and CCASAnet clinical cohorts.

IntroductionMaps are powerful tools for visualization of differences in health indicators by geographical region, but multi-country maps of HIV indicators do not exist, perhaps due to lack of consistent data across countries. Our objective was to create maps of four HIV indicators in North, Central, and South American countries.MethodsUsing data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) and the Caribbean, Central, and South America network for HIV epidemiology (CCASAnet), we mapped median CD4 at presentation for HIV clinical care, proportion retained in HIV primary care, proportion prescribed antiretroviral therapy (ART), and the proportion with suppressed plasma HIV viral load (VL) from 2010 to 2012 for North, Central, and South America. The 15 Canadian and US clinical cohorts and 7 clinical cohorts in Argentina, Brazil, Chile, Haiti, Honduras, Mexico, and Peru represented approximately 2–7% of persons known to be living with HIV in these countries.ResultsStudy populations were selected for each indicator: median CD4 at presentation for care was estimated among 14,811 adults; retention was estimated among 87,979 adults; ART use was estimated among 84,757 adults; and suppressed VL was estimated among 51,118 adults. Only three US states and the District of Columbia had a median CD4 at presentation >350 cells/mm3. Haiti, Mexico, and several states had >85% retention in care; lower (50–74%) retention in care was observed in the US West, South, and Mid-Atlantic, and in Argentina, Brazil, and Peru. ART use was highest (90%) in Mexico. The percentages of patients with suppressed VL in the US South and Northeast were lower than in most of Central and South America.ConclusionsThese maps provide visualization of gaps in the quality of HIV care and allow for comparison between and within countries as well as monitoring policy and programme goals within geographical boundaries.

Gay Acres: Sexual Orientation Differences in Health Indicators Among Rural and Nonrural Individuals.

Geographic location is a significant factor that influences health status and health disparities. Yet, little is known about the relationship between geographic location and health and health disparities among lesbian, gay, and bisexual (LGB) persons. This study used a US population-based sample to evaluate the associations of sexual orientation with health indicators by rural/nonrural residence. Data were pooled from the 10 states that collected sexual orientation in the 2010 Behavioral Risk Factor Surveillance System surveys. Rural status was defined using metropolitan statistical area, and group differences by sexual orientation were stratified by gender and rural/nonrural status. Chi-square tests for categorical variables were used to assess bivariate relationships. Multivariable logistic regression models stratified by gender and rural/nonrural status were used to assess the association of sexual orientation to health indicators, while adjusting for age, race/ethnicity, education, and partnership status. All analyses were weighted to adjust for the complex sampling design. Significant differences between LGB and heterosexual participants emerged for several health indicators, with bisexuals having a greater number of differences than gay men/lesbians. There were fewer differences in health indicators for rural LGB participants compared to heterosexuals than nonrural participants. Rural residence appears to influence the pattern of LGB health disparities. Future work is needed to confirm and identify the exact etiology or rural/nonrural differences in LGB health.

Associations of sexual and gender minority status with health indicators, health risk factors, and social stressors in a national sample of young adults with military experience

PurposeTo assess the associations of self-identified lesbian, gay, bisexual, and questioning sexual orientation or transgender status (LGBTQ) and military experience with health indicators. MethodsWe used data from the Fall 2012 National College Health Assessment. The survey included self-identified sociodemographic characteristics, mental (e.g., depression) and physical (e.g., human immunodeficiency virus) conditions, health risk behaviors (e.g., smoking), and social stressors (e.g., victimization). We used modified Poisson regression models, stratified by self-reported military service, to examine LGBTQ-related differences in health indicators, whereas adjusting for sociodemographic characteristics. ResultsOf 27,176 in the sample, among the military-experienced group, LGBTQ individuals had increased adjusted risks of reporting a past-year suicide attempt (adjusted risk ratio [aRR] = 4.37; 95% confidence interval [CI] = 1.39–13.67), human immunodeficiency virus (aRR = 9.90; 95% CI = 1.04–79.67), and discrimination (aRR = 4.67; 95% CI = 2.05–10.66) than their non-LGBTQ peers. Among LGBTQ individuals, military experience was associated with a nearly four-fold increased risk of reporting a past-year suicide attempt (aRR = 3.61; 95% CI = 1.46–8.91) adjusting for age, sex, race and ethnicity, marital status, depression, and other psychiatric diagnoses. ConclusionsMilitary experience may moderate health indicators among LGBTQ populations, and likewise, LGBTQ status likely modifies health conditions among military-experienced populations. Results suggest that agencies serving military populations should assess how and if the health needs of LGBTQ individuals are met.