High Socioeconomic Population Research Articles

Abstract P285: Relationship Between Body Mass Index, Waist Measurement, Six-Minute Walk Performance and Whole-Body Strength in Adults With Cardiovascular Disease: Findings From the Lifestyle Heart Health Study

Introduction: Cardiovascular disease (CVD) is the leading cause of death, killing 17.9 million people annually worldwide. Key risk factors include physical inactivity, overweight/obesity, high blood pressure, high cholesterol which worsen with age, and smoking and excessive alcohol intake. Six-minute walk (6MW) performance and whole-body muscle strength are both related to cardiovascular mortality and also worsen with age, particularly in the absence of physical activity. The aims of this study were to understand levels of cardiovascular risk and compliance to usual medical treatment (medication, lifestyle modifications) in a high socioeconomic Australian population, and to identify relationships between key risk factors, 6MW and muscle strength. A secondary aim was to help inform development of the Lifestyle Heart Health Education Program. Methods: This was a cross-sectional study of 473 people with CVD in Sydney. Class was classified based on the Australian socioeconomic index for areas. Conditions were defined according to Australian national guidelines. Medical history, body mass index (BMI), waist measurement, whole-body muscle strength and 6MW measurements were assessed. Simple linear and stepwise regressions were used to assess potential relationships. Results: Mean age of the cohort was 66.8±11.6; range 21-94 yrs; 68.5% female; socioeconomic index was deemed high. All participants had CVD, of which 25% were on aspirin. Hypertension was prevalent in 65% (38% on anti-hypertensives); 65% had dyslipidaemia (40% on a statin); 91% had a BMI over 26.0; and 85% of males and 80% of females had a waist measurement over gender-specific heart health recommendations. Less than 3% of the cohort smoked, and less than 10% consumed alcohol at a level deemed high-risk. Almost 20% of the cohort were at risk of CV mortality according to 6MW performance with scores less than 350 metres. Waist measurement, BMI, and blood pressure were the greatest risk factors across the cohort. Muscle strength (r=-0.34; r 2 =0.17; p<0.001) and 6MW performance (r=-0.37; r 2 =0.17; p<0.001) both decreased with age. BMI and age were the most significant predictors of 6MW (r=-0.45; r 2 =0.20; p=0.004) and whole-body strength (r=0.49; r 2 =0.24; p<0.001) in females; waist and age were the most significant predictors of 6MW (r=-0.38; r 2 =0.14; p=0.11) and whole-body strength (r=0.41; r 2 =0.17; p=0.04) in males. Conclusion: Whilst alcohol and smoking campaigns are working to reduce consumption of these harmful substances, low cardiorespiratory and muscular fitness and overweight/obesity remain highly prevalent. Population-level interventions such as the Lifestyle Heart Health Program that aim to reduce weight and waist and improve physical activity, walking ability and muscle strength are urgently needed to reduce cardiovascular risk and mortality.

Low-income San Franciscans' Access to Basic Needs during COVID Shelter-in-Place: A Focus on People Who Use Drugs

Abstract: We conducted a cross-sectional study of low-income San Franciscans to assess the impact of COVID-19 on their life and well-being during the period of the COVID-19 pandemic when the focus was on higher socioeconomic populations. Stratified analyses compared people who used drugs with those who did not and open-ended response data were sorted into themes. Of the 145 participants, most (70%) changed their behavior by practicing social distancing and reducing the number of their contacts. Of people who used drugs (98, 68%), 40% reported increased difficulty accessing/using drugs, 33% reduced access to drug treatment, and 41% increased concern about drug overdose for themselves or others. Compared with those who did not, people who used drugs experienced improvements in access to food, feeling supported by friends and family, and access to medical care. Our findings indicate the shift in services during COVID-19 had mixed impacts on people who use drugs.

Association between Dietary Nutrient Intake and Depressive Symptoms among Japanese Postpartum Women: An Observational Cross-sectional Study

Background: Low dietary nutrient intake may be associated with depressive symptoms. However, few such studies have been conducted among postpartum women and results have been controversial. Purpose: To investigate the association between dietary nutrient intake and depressive symptoms among Japanese one-month postpartum women. Methods: This cross-sectional study was conducted at a university hospital in Tokyo from June 2015 to September 2016. We recruited healthy women with healthy babies at their postpartum check-up. Dietary nutrient intake was assessed using a validated, brief-type, self-administered diet history questionnaire. Depressive symptoms were defined as a score of ? 9 on the Edinburgh Postnatal Depression Scale. Multiple logistic regression analysis was performed to identify if dietary nutrient intake was associated with depressive symptoms. Variables with P-values < 0.10 in the bivariate analysis and factors identified as important, based on the literature review, were included. P < 0.05 was considered significant. Results: Data from 246 participants were analyzed. Depressive symptom prevalence was 19.5%. Participants with an educational level above university level comprised 69.1%, and 68.3% of participants had a household income of ? 7 million Japanese yen. In the multivariate analysis, dietary nutrient intake was not significantly associated with depressive symptoms. However, higher educational level and need for emotional support as assessed by midwives or nurses were significantly associated with an increased risk of depressive symptoms. Conclusion: Dietary nutrient intake was not significantly associated with depressive symptoms in this high socioeconomic status population. Further research is needed to identify the relationship between dietary intake and depressive symptoms among more socioeconomically diverse postpartum women. Additionally, it may be important for postpartum depression support systems to pay attention to highly-educated women and to undertake continued follow-up for women who are assessed by midwives or nurses as needing emotional support either during pregnancy or while in the hospital.

Obesogenic eating behaviour and dietary intake in German children and adolescents: results from the GINIplus and LISA birth cohort studies

Background/objectivesThe transition to adolescence is characterised by considerable behavioural changes, including diet. This study describes the level of obesogenic eating behaviours in 10- and 15-year-olds, and their association with dietary intake.Subjects/methodsParticipants of the 10- and 15-year follow-ups of the German GINIplus and LISA birth cohort studies were included (N10 = 2257; N15 = 1880). Eating behaviours and dietary intake were assessed via self-report questionnaires. Sex-stratified, cross-sectional associations of “external eating”, “emotional eating” and “dietary restraint” (the latter at age 15 years only) with dietary intake (17 food groups—categorised into tertiles, macronutrients, and total energy) were assessed using multinomial logistic or multiple linear regression as required, adjusting for covariates and correcting for multiple testing.ResultsReported levels of eating behaviours were low in both age-groups. External eating was higher in 10-year-old males than females, while all eating behaviours were most pronounced in 15-year-old females. At 10 years, emotional eating was associated with medium vegetable intake in females (Relative Risk Ratio (RRR) = 1.84, p = 0.0017). At 15 years, external eating was associated with total energy (kJ) in females (β = 718, p = 0.0002) and high butter intake in males (RRR = 1.96, p = 0.0019). Dietary restraint in females was inversely associated with total energy (β = −967, p < 0.0001) and omega-3 fatty acids (Means Ratio (MR) = 0.94, p = 0.0017), and positively associated with high fruit (RRR = 2.20, p = 0.0003) and whole grains (RRR = 1.94, p = 0.0013).ConclusionObesogenic eating behaviour scores are low among children and adolescents of a predominantly high socioeconomic status population and present only few associations with specific aspects of diet, mainly among adolescent females.

Hematological Characteristics During the Third Trimester of Pregnancy in a Population of Low and High Socio-Economic Levels in Lubumbashi

Background: During pregnancy, many hematologic changes occur to meet the demands of the developing fetus. The objective of this study was to describe the hematological characteristics in the third trimester in a population of low and high socioeconomic levels in Lubumbashi, in relation to the WHO and China reference values. Methodology: A descriptive cross-sectional observational study was carried out in Lubumbashi, among pregnant women received during the third trimester antenatal consultations in apparent good health. A total of 128 pregnant women with a monofetal pregnancy of at least 27 weeks of amenorrhea in apparent good health were selected and divided into two groups of low and high socioeconomic levels. Blood was drawn and analyzed on the CYANHEMATO machine. Results: Hemoglobin (HB) averages were 9.63 ± 1.52 and 11.19 ± 1.07 g / dl respectively in the low and high socioeconomic levels population. The majority of patients in the two populations were in the reference range for red blood cell (RBC) count from 2.75 to 4.64 1012 / l. The average values of hematocrit (HCT), mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) in Lubumbashi were lower than in the China population : 28.39 ± 4.21 versus 32.47 ± 3.46% ; 67.34 ± 9.50 versus 74.38 ± 8.15 fl and 22.96 ± 3.56 versus 25.71 ± 3.23 pg for reference values of 36% ; 90.8 fl and 30.5 pg, respectively. As for the red blood cell distribution width (RDW), it was higher in the low socio-economic level population (16.86 ± 3.40%) than in the high socio-economic level population (14.90 ± 2.25%) with a difference highly significant (p &lt;0.0001). Conclusion: The RBC and RDW were significantly increased in Lubumbashi, while HB. HCT, MCV and MCH were decreased. The mean corpuscular hemoglobin concentration (MCHC) did not present any particularity

The association of smoking and socioeconomic status on cutaneous melanoma: a population-based, data-linkage, case-control study.

SummaryBackgroundPrevious studies have identified an inverse association between melanoma and smoking; however, data from population‐based studies are scarce.ObjectivesTo determine the association between smoking and socioeconomic (SES) on the risk of development of melanoma. Furthermore, we sought to determine the implications of smoking and SES on survival.MethodsWe conducted a population‐based case–control study. Cases were identified from the Welsh Cancer Intelligence and Surveillance Unit (WCISU) during 2000–2015 and controls from the general population. Smoking and SES were obtained from data linkage with other national databases. The association of smoking status and SES on the incidence of melanoma were assessed using binary logistic regression. Multivariate survival analysis was performed on a melanoma cohort using a Cox proportional hazard model using survival as the outcome.ResultsDuring 2000–2015, 9636 patients developed melanoma. Smoking data were obtained for 7124 (73·9%) of these patients. There were 26 408 controls identified from the general population. Smoking was inversely associated with melanoma incidence [odds ratio (OR) 0·70, 95% confidence interval (CI) 0·65–0·76]. Smoking was associated with an increased overall mortality [hazard ratio (HR) 1·30, 95% CI 1·09–1·55], but not associated with melanoma‐specific mortality. Patients with higher SES had an increased association with melanoma incidence (OR 1·58, 95% CI 1·44–1·73). Higher SES was associated with an increased chance of both overall (HR 0·67, 95% CI 0·56–0·81) and disease‐specific survival (HR 0·69, 95% CI 0·53–0·90).ConclusionsOur study has demonstrated that smoking appeared to be associated with reduced incidence of melanoma. Although smoking increases overall mortality, no association was observed with melanoma‐specific mortality. Further work is required to determine if there is a biological mechanism underlying this relationship or an alternative explanation, such as survival bias. What's already known about this topic? Previous studies have been contradictory with both negative and positive associations between smoking and the incidence of melanoma reported.Previous studies have either been limited by publication bias because of selective reporting or underpowered. What does this study add? Our large study identified an inverse association between smoking status and melanoma incidence.Although smoking status was negatively associated with overall disease survival, no significant association was noted in melanoma‐specific survival.Socioeconomic status remains closely associated with melanoma. Although higher socioeconomic populations are more likely to develop the disease, patients with lower socioeconomic status continue to have a worse prognosis.

Beyond the Calories-Is the Problem in the Processing?

The purpose of this review is to describe the trends in dietary patterns and food quality over time along with the possible role of ultra-processed foods in obesity, chronic diseases, and all-cause mortality in the US population. There is a rising obesity epidemic, corresponding chronic diseases, and increases in ultra-processed food consumption. In mice and in vitro trials, emulsifiers, found in processed foods, have been found to alter microbiome compositions, elevate fasting blood glucose, cause hyperphagia, increase weight gain and adiposity, and induce hepatic steatosis. Recent human trials have found ultra-processed foods as a contributor to decreased satiety, increased meal eating rates, worsening biochemical markers, and more weight gain. In contrast, Blue Zone, indigenous South American, and Mediterranean populations with low meat intake, high fiber, and minimally processed foods have far less chronic diseases, obesity rates, and live longer disease-free. As the USA continues to industrialize, food has become more processed and cheaper and more convenient along with the coexistent rise in obesity prevalence. This review highlights the overall trends in food: mild improvements in dietary quality in higher socioeconomic populations, but no significant increases in whole fruit, vegetables, legumes, or nuts. Consumption of ultra-processed food is associated with weight gain and may contribute to metabolic syndrome and chronic disease. To combat this epidemic, we must create and disseminate detailed recommendations to improve diet quality and overall nutrition.

Socioeconomic impact of the current management of severe biliary acute pancreatitis: comparative study

Acute pancreatitis of biliary origin is a common gastrointestinal pathology, in which timely management still is the most important. The aims of this research is establish the socioeconomic impact in the current management of severe acute pancreatitis of biliary origin comparing two centers of the third level, one of high socioeconomic population and another of low in Bogotá, Colombia. A retrospective, cross-sectional comparative study was conducted between January 2012 and December 2017, in two hospitals of Bogotá DC. We evaluated their socioeconomic characteristics, gender, time of evolution at the time of consultation, Marshall score, ICU stay, hospital stay, complications, surgical management and mortality. 101 patients from two different socioeconomic strata (high and low) were analyzed, where a 10 times higher risk of requiring a surgical procedure in the group of patients with low stratum was found, as well as a higher mortality compared with those of high stratum. (11.3% Vs 4.2%). There were also more complications in the low socioeconomic group with respect to the high, as in the exocrine failure (81.1% vs 31.3%) and the compartment syndrome (35.8% vs 4.2%). There is greater morbidity and mortality in patients of low socioeconomic status in the context of this pathology. This study can guide new research that increases the clarity of the socioeconomic impact on the outcomes of severe acute pancreatitis.

Hospitalizations for primary care sensitive conditions: association with socioeconomic status and quality of family health teams in Belo Horizonte, Brazil.

Hospitalizations for primary care sensitive conditions (HPCSC) have been used as a measure of the effectiveness of primary care. Few studies, however, have measured the quality of primary health care (PHC) and how it impacts HPCSC trends. We employed previously calculated quality scores of PHC attributes (access, continuous/ongoing care, coordinated care and comprehensive care) assigned to health centres and investigated the correlation between these quality scores and HPCSC time trends in public hospitals in the city of Belo Horizonte, Brazil, adjusted by demographic and socioeconomic factors between 2010 and 2013. Socioeconomic risk was determined using the Health Vulnerability Index, a composite indicator including sanitation, habitation, education, income and health variables. Between 2010 and 2013, 447 500 hospitalizations, excluding births, were recorded in Belo Horizonte. Of these, 85 211 were HPCSC (19% of total admissions). Of 145 health centres, 133 were analysed in this study, with 75 059 HPCSC in the 4-year period. In the initial univariate model, only the PCH attribute 'access' and 'social vulnerability' had an effect on hospitalization rates. In the multilevel analysis, socioeconomic vulnerability became the only predictor of HPCSC rates. A 10% increase in high socioeconomic risk population meant an increase of 5 HPCSC/10 000 in women and 4/10 000 in men for each individual primary care unit, while a 10% increase in low-risk population meant a reduction in HPCSC of 6/10 000 in women and 5/10 000 in men. The results support the importance of using HPCSC as a measure of PHC effectiveness, considering individual, health service-related and socioeconomic characteristics; however, additional measures of effectiveness of care provided by family health teams seem necessary to assess PHC performance.

Effects of county-level attributes on geographic variation in female breast cancer mortality rates across counties in United States.

e13093 Background: Though studies have examined geographic disparities in breast cancer mortality among United States (U.S.) counties, county-level risk factors were not accounted for. The aim of this study is to efficiently map the spatial association between female breast cancer mortality rates &amp; socioeconomic attributes across U.S. counties for identifying high risk geographical clusters in terms of socioeconomic attributes. Methods: County-specific age standardized breast cancer mortality rates for women ≥20 years in the U.S. were obtained for 3,109 counties in 48 contiguous states from Surveillance Epidemiology and End Results program from 1990-2012. County-level attributes such as percentages of Hispanic white, Non-Hispanic white, Non-Hispanic black, &lt; high school education, below 200% poverty, urban, foreign born, language isolation, women aged ≥ 40 years with mammography within last 2 years, and median household income were gathered from U.S. decennial census. Factor analysis condensed county attributes into three factor covariates namely Hispanic immigrants, health care access among urban high socioeconomic population, and non-Hispanic black unemployment. Spatiotemporal analysis was carried out by structured additive regression model to incorporate spatial functions &amp; Markov chain Monte Carlo simulation techniques. Results: Moran’s index suggested existence of spatial dependence for breast cancer mortality among U.S. counties. As mammography screening, %urban population, % with high socioeconomic status and non-Hispanic black unemployment increased in counties of the Southwest region, Rocky mountain region and those in the western border of Midwest region of U.S, risk of breast cancer mortality increased significantly above the national average. As the Hispanic immigrant culture increased, counties of Midwest region of U.S had significantly higher mortality rates compared to national average. Conclusions: These initial results describe socio-economic, cultural, and healthcare access factors for observed geographic variations in female breast cancer mortality, and in turn, could support a stronger theoretical basis for public health policy.

Prevalence of metabolic syndrome in higher socioeconomic class of Ahmedabad, Gujarat, India

Background: The metabolic syndrome (MetS) is a highly complex multifactorial endocrine disorder, which includes ectopic fat accumulation, impaired insulin sensitivity, and increased systemic inflammation. Globally, a rapid increase in the prevalence of MetS is observed as a result of persistent obesity. The MetS includes the features such as insulin resistance, dyslipidemia, hypertension, and a male, visceral distribution of adipose tissue; it is related to the high incidences of morbidity and mortality, which result from various commonly occurring diseases such as diabetes, cancers, myocardial infarction, and stroke. Objective: To determine the prevalence of MetS, its components, and risk factors among a higher socioeconomic population in Ahmedabad, and to estimate the prevalence of MetS using the International Diabetes Federation (IDF) definition to compare it with the prevalence estimated using the definition of the National Cholesterol Education Program (NCEP). Materials and Methods: This cross-sectional survey of a higher socioeconomic population was carried out in Ahmedabad, Gujarat, India, from April to December 2014. The subjects included were between the age group of 25 and 65 years. A total of 500 subjects were selected for this study. But, 22 subjects were discarded owing to insufficient blood samples. Result: In this study, of the total 478 subjects, 213 (44.6%) male subjects and 265 (55.4%) female subjects were analyzed. About 264 (55.2%) of them were between 25 and 45 years, and 214 (44.8%) of them were between 46 and 65 years of age. About 95% of all the subjects were married. About 373 (78.0%) were nonsmokers and 105 (22.0%) were smokers; 372 (77.8%) were nonalcoholics and 106 (22.2%) were alcoholics; 154 (32.2%) showed normal weight, 218 (45.6%) overweight, and 106 (22.2%) obese. The female subjects were younger and showed higher values of BMI and WC and, thus, were more prone to overweight and obesity. Conclusion: The global prevalence of the MetS was 26.2% and 42.6% by the NCEP adult treatment panel III (ATP III) and IDF criteria, respectively. Central obesity was the most prevalent determinant of MetS, followed by low levels of high-density lipoprotein (HDL), and then high blood pressure (BP). The triad of low HDL, high BP, and central obesity were largely responsible for MetS in this community.

Parental responsibility beliefs: associations with parental anxiety and behaviours in the context of childhood anxiety disorders

BackgroundHigh levels of parental anxiety are associated with poor treatment outcomes for children with anxiety disorders. Associated parental cognitions and behaviours have been implicated as impediments to successful treatment. We examined the association between parental responsibility beliefs, maternal anxiety and parenting behaviours in the context of childhood anxiety disorders. MethodsAnxious and non-anxious mothers of 7–12 year old children with a current anxiety disorder reported their parental responsibility beliefs using a questionnaire measure. Parental behaviours towards their child during a stressor task were measured. ResultsParents with a current anxiety disorder reported a greater sense of responsibility for their child's actions and wellbeing than parents who scored within the normal range for anxiety. Furthermore, higher parental responsibility was associated with more intrusive and less warm behaviours in parent–child interactions and there was an indirect effect between maternal anxiety and maternal intrusive behaviours via parental responsibility beliefs. LimitationsThe sample was limited to a treatment-seeking, relatively high socio-economic population and only mothers were included so replication with more diverse groups is needed. The use of a range of stressor tasks may have allowed for a more comprehensive assessment of parental behaviours. ConclusionsThe findings suggest that parental anxiety disorder is associated with an elevated sense of parental responsibility and may promote parental behaviours likely to inhibit optimum child treatment outcomes. Parental responsibility beliefs may therefore be important to target in child anxiety treatments in the context of parental anxiety disorders.

Prevalence of Hepatitis A virus (HAV) and Hepatitis E virus (HEV) in the patients presenting with acute viral hepatitis

Background: Hepatitis A virus (HAV) and Hepatitis E virus (HEV) are both enterically transmitted, resulting in acute viral hepatitis (AVH) in developing countries. They pose major health problems in our country. This study was done to determine prevalence of HAV and HEV in patients presenting with AVH and the co-infection of HAV and HEV in these patients. Materials and Methods: A cross-sectional study of 2-years duration was conducted in the Department of Microbiology, KMC, Mangalore. A non-random sampling of 958 patients presenting with AVH was considered in the study. On the basis of history, serum samples were analysed for IgM anti-HAV and IgM anti-HEV for the detection of HAV and HEV, respectively using commercially available ELISA kits. Data collected was analysed by using Statistical Package for the Social Sciences (SPSS) version 11.5. Results: The seroprevalence of HAV- and HEV-positive patients were 19.31% and 10.54%, respectively. The seroprevalence of both HAV and HEV in patients with acute viral hepatitis was 11.5%. The prevalence of HAV and HEV among males (68% and 31%) was higher than in females (31% and 20%) and was predominantly seen among young adults. These infections were predominantly seen during end of monsoons and beginning of winter. Conclusion: Though the prevalence of HAV is much higher than that of HEV, co-infection rate of 11.5% mandates the screening for HEV which will be of immense importance in pregnant women and improving levels of personal hygiene among higher socio-economic population. These data will be essential for planning of future vaccination strategies and for better sanitation programme in this part of the country.

SOCIO-ECONOMIC PREDICTORS OF IPM TRAINING PARTICIPATION AND IMPLEMENTATION IN ILLINOIS CHILDCARE CENTERS

SOCIO-ECONOMIC PREDICTORS OF IPM TRAINING PARTICIPATION AND IMPLEMENTATION IN ILLINOIS CHILDCARE CENTERS AbstractBackground and AimsA comprehensive program for childcare providers and supervisors to reduce pesticide use and promote integrated pest management (IPM) in Illinois childcares is analyzed, in order to determine its impact on different populations. Since populations are non-uniform in their perception and response to environmental challenges, researchers are looking for criteria to identify at-risk populations and opportunities for promoting environmental behavior.Infants and young children are particularly vulnerable to pesticide impacts because of their physiology, metabolism and behavior. Critical neurodevelopment processes are especially at risk from toxins. The majority of childcares report using pesticides, where approximately 53 million US children spend up to ten hours daily.While regulated school IPM programs have proliferated, childcares are more difficult to influence as they vary in location, size, and government oversight; while socio-economic factors help explain access.MethodA listing of licensed trained and untrained childcares from the post-survey was analyzed for pest incidences, IPM training participation and implementation and the results compared to census 2000 socio-economic data.ResultsChildcares in underprivileged populations were significantly more likely to participate in training than middle socio-economic populations; and mostly large centers participated. Understanding IPM benefits correlated positively with lower socio-economic and negatively with middle to high status, while IPM actions only coordinated with spending a high percentage of income on rental. Training resulted in selective adoption of IPM practices, especially pest prevention.ConclusionsThe training program raised awareness leading to IPM implementation in large licensed childcare centers in underprivileged, but not higher socio-economic populations; homes or license exempt childcares where children may be at even greater risk. This may reflect the formal organization and resources of government subsidized centers serving weaker populations and the strong motivation of childcare providers to protect children.

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Risk Factors For Postpartum Depression In A Well-Child Clinic: Maternal And Infant Characteristics Bir Sağlıklı Çocuk Polikliniğinde Doğum Sonrası Depresyonda Risk Faktörleri: Anneye ve Bebeğe Ait Öze

Aim: The aim of this study was to identify possible risk factors for postpartum depression development in mothers of infants who were brought to fi rst-month well-child visits. Material and methods: Self-reports were obtained from 103 mothers. The interviews collected data on mothers’ sociodemographic and health characteristics, and infants’ characteristics. The Edinburgh Postpartum Depression Scale (EPDS) was used to assess maternal depressive symptoms. Results: In this high socioeconomic population, twenty-eight mothers (27.1%) scored in the clinical range of the EPDS. Mothers’ unemployment, maternal health problems during present pregnancy, depression history during previous and present pregnancies, delivery complications, infant health problems, and infant cry/fuss problems were associated with postpartum depression. Conclusion: Postpartum depression was common at one-month well-baby visits. Nonworking mothers, those with health problems during pregnancy and with a problematic infant were often depressed. Well-child visits provide a convenient setting for evaluating postpartum depression and related risk factors.

Sero-prevalence of Hepatitis B virus among middle to high socio-economic antenatal population in Sierra Leone

This study was designed in order to find out the prevalence of HBV markers amongst pregnant women of middle and high socio-economic class in Sierra Leone. The aim was to determine the necessity and likely benefits of a scheme aimed at the vaccination of children of seropositive mothers who can afford the cost until mass immunisation is possible. A total of 302 women were studied. The seroprevalence rate formed in this study population was 6.2%. The proposed intervention would markedly reduce the HBV status in Sierra Leone, taking into account the high prevalent rate amongst this group. The low anti-HBs found in this population was suprisingly (5.1%); considering the high degree of antigenemia, this should be a subject for future research.

Financing dental care in the US: A contest of means not thought

The marketplace has determined the financing of dental services in the US for both philosophical and historical reasons. However, professional dental policy has been influenced by the financial solutions proposed by medicine and the advocates of socialized health care. Market-based dental financial policy has been more successful for middle to higher socioeconomic populations by controlling costs while maintaining a high standard of dental care, preserving choice of provider, and stimulating competition between dental care providers for individuals and dental benefit programs for insured individual. Yet, this financial approach has been less successful for middle to lower socioeconomic populations including the aging population. For these service populations, governmental financing of dental services has provided a “safety-net.” However, neither financial policy has been able to develop their own financial system for providing a high standard of dental services to all socioeconomic peoples who choose to access dental services. This result has given rise to a mixed bag of approach constituted on various different political, economic, and social agendas. Debate continues between public and private sectors regarding financing dental services. Thus, financially vulnerable consumers must be aware of private charitable and governmental programs from which to obtain dental services.

Effects of vitamin A deficiency during pregnancy on maternal and child health

Objective To examine the association between biochemical vitamin A deficiency in pregnancy and maternal and fetal health. Design A cross sectional clinical study. Setting Antenatal clinic of nutrition unit of Niloufer Hospital catering for a low socio-economic population, and a private nursing home (Swapna nursing home) catering for a high socio-economic population. Population 736 pregnant women in their third trimester of pregnancy belonging to low ( n = 522) and high socio-economic groups ( n = 214). Methods All the women were subjected to a detailed clinical, anthropometric and obstetric examination. Night blindness was assessed by administering the standard WHO questionnaire. Birthweight and gestational age of the infants, maternal anaemia and development of pregnancy-induced hypertension in the mother were recorded. Haemoglobin and serum retinol were estimated at the time of recruitment to the study. Main outcome measures Serum retinol levels, anaemia, pregnancy-induced hypertension, birthweight and gestational age of the infant. Results Night blindness was observed in 2.9% of the women and subclincal vitamin A deficiency (serum retinol <20 μg/dL with no clinical signs) in 27% of the women. Moderate to severe anaemia was observed in 41.2% of the women, and 15.8% of the women developed pregnancy-induced hypertension. Sixty-one (9.4%) women delivered preterm. Univariate analysis identified a significant association between serum retinol <20 μg/dL and preterm delivery (OR = 1.74, 95% CI 1.03–2.96), maternal anaemia (OR = 1.82, 95% CI 1.28–2.60) and pregnancy-induced hypertension (OR = 1.56, 95% CI 1.02–2.83). After adjusting for the confounding variables (body mass index, parity, age and socio-economic status) in a multivariate analysis, the significant associations between serum retinol <20 μg/dL and preterm delivery ( P = 0.02) and anaemia ( P = 0.003) persisted, while that for pregnancy-induced hypertension disappeared ( P = 0.71). Conclusion The study suggests that subclinical vitamin A deficiency is a problem during the third trimester of pregnancy. Serum concentration of retinol <20 μg/dL appears to indicate a deficient status, and is associated with an increased risk of preterm delivery and maternal anaemia.

Effects of vitamin A deficiency during pregnancy on maternal and child health.

To examine the association between biochemical vitamin A deficiency in pregnancy and maternal and fetal health. A cross sectional clinical study. Antenatal clinic of nutrition unit of Niloufer Hospital catering for a low socio-economic population, and a private nursing home (Swapna nursing home) catering for a high socio-economic population. 736 pregnant women in their third trimester of pregnancy belonging to low (n = 522) and high socio-economic groups (n = 214). All the women were subjected to a detailed clinical, anthropometric and obstetric examination. Night blindness was assessed by administering the standard WHO questionnaire. Birthweight and gestational age of the infants, maternal anaemia and development of pregnancy-induced hypertension in the mother were recorded. Haemoglobin and serum retinol were estimated at the time of recruitment to the study. Serum retinol levels, anaemia, pregnancy-induced hypertension, birthweight and gestational age of the infant. Night blindness was observed in 2.9% of the women and subclincal vitamin A deficiency (serum retinol <20 microg/dL with no clinical signs) in 27% of the women. Moderate to severe anaemia was observed in 41.2% of the women, and 15.8% of the women developed pregnancy-induced hypertension. Sixty-one (9.4%) women delivered preterm. Univariate analysis identified a significant association between serum retinol <20 microg/dL and preterm delivery (OR = 1.74, 95% CI 1.03-2.96), maternal anaemia (OR = 1.82, 95% CI 1.28-2.60) and pregnancy-induced hypertension (OR = 1.56, 95% CI 1.02-2.83). After adjusting for the confounding variables (body mass index, parity, age and socio-economic status) in a multivariate analysis, the significant associations between serum retinol <20 microg/dL and preterm delivery (P = 0.02) and anaemia (P = 0.003) persisted, while that for pregnancy-induced hypertension disappeared (P = 0.71). The study suggests that subclinical vitamin A deficiency is a problem during the third trimester of pregnancy. Serum concentration of retinol <20 microg/dL appears to indicate a deficient status, and is associated with an increased risk of preterm delivery and maternal anaemia.