Disadvantaged Socioeconomic Circumstances Research Articles

Management and Outcomes of Esophageal Atresia With or Without Tracheo-Esophageal Fistula Over 15 Years in South Africa

IntroductionTo determine the incidence, management and outcomes of esophageal atresia/tracheo-esophageal fistula (EA/TEF) over a 15-y period in South Africa. MethodsA retrospective chart review of neonates with EA/TEF presenting at the main tertiary referral hospital in the KwaZulu-Natal province between 2002 and 2017 was conducted. Data collection comprised patient and maternal demographics, clinical presentations, laboratory and radiologic investigations, surgical procedures, and outcomes. A multivariate logistic regression determined the risk factors associated with mortality. ResultsAmong 180 neonates, mean (SD) age of diagnosis was four (three) days postnatal with Gross Type C (n = 165, 92%) being the most common and the incidence was one per 10,000 live births. Majority were born term (n = 95, 53%) at peripheral hospitals (n = 167, 93%) with a mean birth weight of 2369 (736) grams. Overall HIV exposure rate was 27% (n = 48). Most (n = 138, 77%) patients presented with established pneumonia, 44% (n = 61) of whom required prolonged (>7 d) ventilator support. The median (IQR) hospital stay was 11 (8-20) d. Overall survival rate was 70% (n = 126). Birth weight <1500 g, life threatening anomalies, ventilation >30 d and postoperative sepsis contributed to mortality. ConclusionsIncidence, disease types and presentations were similar to developed countries. Despite advances in technology and neonatal care in Africa, EA/TEF surgical outcomes remain suboptimal likely due to caregivers’ inability to care for these infants in disadvantaged socioeconomic circumstances with poor sanitation, etc. Research is needed to identify strategies tailored for disadvantaged communities which may contribute to improved outcomes in the perioperative and postoperative period.

Socioeconomic circumstances and lung function growth from early adolescence to early adulthood.

A reduced lung function in early adulthood is associated with respiratory and non-respiratory diseases and is a long-term predictor of mortality. This study investigated the association between early socioeconomic circumstances (SEC) and lung function growth trajectories from early adolescence until early adulthood. We analysed data from the EPITeen population-based study, including adolescents born in 1990. Study waves occurred at 13, 17 and 21 yearsof age. Information on sociodemographic, behavioural and health factors, anthropometry and spirometry was collected. Early-life SEC were assessed using maternal education and paternal occupational position. The forced expiratory volume in the first second (FEV1) growth trajectories were drawn considering sex-and-height interactions over an 8-year period. Our sample included 2022 participants with complete informationfor the relevant variables. Participants from most disadvantaged SEC presented lower FEV1 at early adolescence compared to high-SEC counterparts, but differences seem to diminish with height growth. The effect of paternal occupational position in lung function growth trajectories was moderated by height, thus individuals from fathers with less advantaged occupational position had lower FEV1 at early adolescence, but they had a faster FEV1 growth over time. Individuals from most disadvantaged SEC presented lower lung function at early adolescence compared to high-SEC counterparts; nevertheless, a catch-up growth was observed. Lower socioeconomic circumstances were previously associated with reduced lung function and a higher risk of respiratory diseases in adults. Fewer studies analysed the effects of early-life socioeconomic circumstances in lung function growth during adolescence. Disadvantaged socioeconomic circumstances were associated with lower lung function in early adolescence. However, social differences diminished over adolescence, suggesting a catch-up growth of lung function among those from lower socioeconomic circumstances. An improved understanding of the mechanism underlying lung function catch-up (or the absence of catch-up) might support interventions to narrow social inequalities in respiratory health and should be further investigated.

Socioeconomic circumstances and respiratory function from childhood to early adulthood: a systematic review and meta-analysis

ObjectiveDisadvantaged socioeconomic circumstances in early life have the potential to impact lung function. Thus, this study aimed to summarise evidence on the association between socioeconomic circumstances and respiratory function from...

Doing science in difficult socioeconomic circumstances.

Doing scientific research can be a challenging, but creative and rewarding career. However, the challenge of doing research is orders of magnitude more difficult for scientists lacking access to the necessary resources. Resource-scarce environments are quite common worldwide and are highly contingent on the financial and social climate of one’s location. Through the experiences of four scientists, this Perspective explores the challenges associated with doing research in disadvantaged socioeconomic circumstances. By reflecting on the humble beginnings of these scientists, we examine the motivation to stay in or leave one’s home country, and how hardships can be leveraged to cultivate passionate and productive researchers.

Early life socioeconomic status associates with interleukin-6 responses to acute laboratory stress in adulthood

It is proposed that environmental exposures in early life influence immune programming. Specifically, socioeconomic disadvantage is thought to program an immune phenotype that is prone to inflammation and associated with increased risk for inflammatory disease later in life. Existing literature shows an inverse association of early childhood socioeconomic status (SES) with adult levels of systemic inflammation. Here, we extend that literature to examine whether early childhood SES also relates to the magnitude of inflammatory response to acute psychological stress in adulthood. Healthy volunteers (N = 110; 40–58 years; 59% female; 90% white) performed a laboratory stress protocol, with blood samples drawn at the end of a 30-min baseline, a 5-min speech task, and a 30-min recovery to assess interleukin (IL)-6 stress responses. An early childhood SES index was derived from reports of parental home and vehicle ownership, and number of bedrooms per child in the home across ages 1–2, 3–4, and 5–6. Regressions adjusted for current age, sex, race, and BMI showed that lower SES at age 1–2 was associated with larger IL-6 stress responses in adulthood (ΔR2 = 0.05, β = −0.24, p = .03). This association was independent of adult SES and task-evoked affective responses. No association was found between SES at ages 3–4 or 5–6 and IL-6 responses. These results provide initial evidence for a link between disadvantage in the first 2 years of life and heightened inflammatory response to stress in adulthood; this link may contribute to the increased disease risk that accompanies being raised in disadvantaged socioeconomic circumstances.

Children's Language Ability and Psychosocial Development: A 29-Year Follow-up Study

Little is known on the psychosocial adult outcomes of children's early language skills or intervening circumstances. The aim of this study was to assess the longitudinal trajectory linking childhood receptive language skills to psychosocial outcomes in later life. The study comprised 6941 men and women who participated in a nationally representative Birth Cohort Study. Direct assessment of language skills were made at age 5. The sample was studied again at age 34 to assess psychosocial outcomes and levels of adult mental health. Characteristics of the family environment, individual adjustment, and social adaptation in the transition to adulthood were assessed as potential moderating factors linking early language skills to adult mental health. In early childhood, cohort members with poor receptive language experienced more disadvantaged socioeconomic circumstances than cohort members with normal language skills and showed more behavior and psychosocial adjustment problems in the transition to adulthood. At age 34, cohort members with poor early language skills reported lower levels of mental health than cohort members with normal language. After adjustment for family background and experiences of social adaptation, early language skills maintained a significant and independent impact in predicting adult mental health. Early receptive language skills are significantly associated with adult mental health as well as psychosocial adjustment during early childhood and in later life. The needs of children with language problems are complex and call for early and continuing provision of educational support and services.

Adaptations to changing times: Agency in context

British society has changed greatly over the past half century. Increasing uncertainty about economic and social developments is becoming a distinctive feature of modern industrialized countries, affecting the life chances and opportunities of young people making the transition from dependent childhood into independent adulthood. Summarizing recent findings from data collected from about 30,000 individuals born 12 years apart, in 1958 and 1970 respectively, this paper examines the role of individual agency in shaping educational and occupational transitions as well as the assumption of family‐related roles in times of social change. The data suggest that societal change and the associated increasing uncertainty does not impact on all individuals in the same way, and that there has been an increasing polarization between those who are able to benefit from the economic and social transformations and the ones who are excluded, largely because of their relatively disadvantaged socioeconomic circumstances and lack of access to opportunities in education and employment. It is concluded that human agency processes cannot be studied in isolation from the sociohistorical context in which they are embedded.