High Socioeconomic Areas Research Articles

The Demographic Representativeness and Health Outcomes of Digital Health Station Users: Longitudinal Study.

BackgroundDigital health stations offer an affordable and accessible platform for people to monitor their health; however, there is limited information regarding the demographic profile of users and the health benefits of this technology.ObjectiveThis study aimed to assess the demographic representativeness of health station users, identify the factors associated with repeat utilization of stations, and determine if the health status of repeat users changed between baseline and final health check.MethodsData from 180,442 health station users in Australia, including 8441 repeat users, were compared with 2014-2015 Australian National Health Survey (NHS) participants on key demographic and health characteristics. Binary logistic regression analyses were used to compare demographic and health characteristics of repeat and one-time users. Baseline and final health checks of repeat users were compared using McNemar tests and Wilcoxon signed rank tests. The relationship between the number of checks and final health scores was investigated using generalized linear models.ResultsThe demographic profile of SiSU health station users differs from that of the general population. A larger proportion of SiSU users were female (100,814/180,442, 55.87% vs 7807/15,393, 50.72%), younger (86,387/180,442, 47.88% vs 5309/15,393, 34.49% aged less than 35 years), and socioeconomically advantaged (64,388/180,442, 35.68% vs 3117/15,393, 20.25%). Compared with NHS participants, a smaller proportion of SiSU health station users were overweight or obese, were smokers, had high blood pressure (BP), or had diabetes. When data were weighted for demographic differences, only rates of high BP were found to be lower for SiSU users compared with the NHS participants (odds ratio [OR] 1.26; P<.001). Repeat users were more likely to be female (OR 1.37; P<.001), younger (OR 0.99; P<.001), and from high socioeconomic status areas—those residing in socioeconomic index for areas quintiles 4 and 5 were significantly more likely to be repeat users compared with those residing in quintile 1 (OR 1.243; P<.001 and OR 1.151; P<.001, respectively). Repeat users were more likely to have a higher BMI (OR 1.02; P<.001), high BP (OR 1.15; P<.001), and less likely to be smokers (OR 0.77; P<.001). Significant improvements in health status were observed for repeat users. Mean BMI decreased by 0.97 kg/m2 from baseline to final check (z=−14.24; P<.001), whereas the proportion of people with high BP decreased from 15.77% (1080/6848) to 12.90% (885/6860; χ21=38.2; P<.001). The proportion of smokers decreased from 11.91% (1005/8438) to 10.13% (853/8421; χ21=48.4; P<.001). Number of repeat health checks was significantly associated with smoking status (OR 0.96; P<.048) but not with higher BP (P=.14) or BMI (P=.23).ConclusionsThese findings provide valuable insight into the benefits of health stations for self-monitoring and partially support previous research regarding the effect of demographics and health status on self-management of health.

Exploring children’s participation in commercial swimming lessons through the social determinants of health

Drowning is a public health challenge, disproportionately impacting children. Social determinants of health (SDH) such as socio-economic disadvantage and geographic isolation increase drowning risk. Swimming and water safety lessons, in part, have reduced drowning in children, while also enabling healthy aquatic participation. Research suggests that some Australian children receive insufficient swimming and water safety education and are not achieving essential skills. A cross-sectional retrospective analysis of swimming and water safety skills achieved by a cohort of children (5-12years) attending commercial swimming lessons in three Australian states was undertaken. Variables included participant demographics (age, gender, and the SDH of socio-economic status [SES], and geographical remoteness) and skills being taught and achieved. Skills achieved were analysed against the National Swimming & Water Safety Framework and the National Benchmark. Swim schools were more likely to teach freestyle (87%) and backstroke (83%); and less likely to teach water safety skills like treading water (53%), and survival backstroke (46%). Overall, 40% of 12-year-old children failed to achieve the National Benchmark of 50 metres freestyle, fewer were achieving minimum water safety skills. Children from low socio-economic areas and regional locations were less likely to be achieving 50 metres freestyle. Children in this study were commonly from major cities (94%) and of high socio-economic areas (53%). Swimming lessons must incorporate a broad range of swimming and water safety competencies to ensure children have the skills required to reduce drowning, especially for those deemed at increased risk. Stakeholders must prioritise holistic drowning prevention education strategies, ensuring all children can access swimming and water safety programs regardless of their socio-economic status or geographical location.

The Effects of Blended Learning on STEM Achievement of Elementary School Students

Science, technology, engineering, and mathematics (STEM) programs serving students from low socioeconomic areas are understudied in the literature. More research studies need to be conducted to make informed instructional decisions for students who may be at a disadvantage compared to their peers from higher socioeconomic areas. The purpose of this research study was to determine the effects of traditional science instruction and blended learning on STEM achievement of elementary school students from low socioeconomic areas. Third, fourth and fifth grade students (N = 129) from a low-socioeconomic school were randomly assigned to receive traditional science instruction or a blended learning science curriculum approach. The science, technology, engineering, and mathematics (STEM) achievement scores were analyzed by conducting a one-way two-group Multiple Analysis of Variance (MANOVA) implemented in R statistical computing platform (R Core Team, 2018). The results indicated that the teaching method had a statistically significant effect on the linear combination of the science, technology, mathematics and engineering scores (F(4,124) = 80.27, p &lt; .0001, Pillai’s Trace = .721, partial η2 = .721), in favor of the blended learning approach.

Trends of Postoperative Radiotherapy for Completely Resected Non-small Cell Lung Cancer in China: A Hospital-Based Multicenter 10–Year (2005–2014) Retrospective Clinical Epidemiological Study

Objectives: The role of postoperative radiotherapy (PORT) in the treatment of patients with completely resected non-small cell lung cancer (NSCLC) is not clear. Few study explored the trends of the PORT use. In this study, we examine the status of PORT use of completely resected NSCLC in mainland China.Methods: From 2005 to 2014, patients with primary lung cancer from eight hospitals across seven geographic regions of mainland China were selected. Then patients with staged I–IIIA NSCLC receiving radical surgery were enrolled in this study. The chi-square test was used to compare differences in the use of PORT among the groups of different age, regions and stages. The Cochran-Armitage trend test was used to identify the trend in the PORT use from 2005 to 2014.Results: Totally, 2,253 out of 7,184 patients were with staged I–IIIA NSCLC receiving completely resection. Only 122 patients (5.42%) received PORT. During this decade, the use of PORT declined significantly (p = 0.0002). In high socio-economic areas, the percentage of PORT use was 7.43%, which was significantly higher than 1.34% in the low socio-economic areas (p < 0.0001). Age was also associated with PORT use (p = 0.0747). For N0-1 and N2 NSCLC, the proportions of PORT use were 4.01 and 10.22%, respectively (p < 0.0001). And in N0-1 or N2 NSCLC, the proportions both decreased significantly during this decade (p = 0.009 and 0.026, respectively). For stage I, IIA, IIB and IIIA, the proportions who received PORT were 2.59, 4.65, 5.49, and 10.29%, respectively (p < 0.0001). Modern radiation techniques were widely used, but the volumes and doses varied widely. The proportions of using IMRT and EPID/IGRT increased after 2012.Conclusions: In China, the use of PORT was less than developed countries and had a declined trend. The use of PORT was related to disease stages, patients' age and geographic location. Both in N0-1 and N2 diseases, the use of PORT declined. Proper education of radiation doctors was urgently needed.

Applicability of two commonly used bone age assessment methods to twenty-first century UK children

ObjectivesTo assess the effect of secular change on skeletal maturation and thus on the applicability of the Greulich and Pyle (G&P) and Tanner and Whitehouse (TW3) methods.MethodsBoneXpert was used to assess bone age from 392 hand trauma radiographs (206 males, 257 left). The paired sample t test was performed to assess the difference between mean bone age (BA) and mean chronological age (CA). ANOVA was used to assess the differences between groups based on socioeconomic status (taken from the Index of Multiple Deprivation).ResultsCA ranged from 2 to 15 years for females and 2.5 to 15 years for males. Numbers of children living in low, average and high socioeconomic areas were 216 (55%), 74 (19%) and 102 (26%) respectively. We found no statistically significant difference between BA and CA when using G&P. However, using TW3, CA was underestimated in females beyond the age of 3 years, with significant differences between BA and CA (− 0.43 years, SD 1.05, p = < 0.001) but not in males (0.01 years, SD 0.97, p = 0.76). Of the difference in females, 17.8% was accounted for by socioeconomic status.ConclusionNo significant difference exists between BoneXpert-derived BA and CA when using the G&P atlas in our study population. There was a statistically significant underestimation of BoneXpert-derived BA compared with CA in females when using TW3, particularly in those from low and average socioeconomic backgrounds. Secular change has not led to significant advancement in skeletal maturation within our study population.Key Points• The Greulich and Pyle method can be applied to the present-day United Kingdom (UK) population.• The Tanner and Whitehouse (TW3) method consistently underestimates the age of twenty-first century UK females by an average of 5 months.• Secular change has not advanced skeletal maturity of present-day UK children compared with those of the mid-twentieth century.

Here one year, gone the next? Investigating persistence of frequent emergency department attendance: a retrospective study in Australia

ObjectivesPatients are presenting to emergency departments (EDs) with increasing complexity at rates beyond population growth and ageing. Intervention studies target patients with 12 months or less of frequent attendance. However,...

Influenza-like illness and antimicrobial prescribing in Australian general practice from 2015 to 2017: a national longitudinal study using the MedicineInsight dataset

ObjectivesTo investigate the epidemiology of influenza-like illness (ILI) by general practice and patient characteristics, and explore whether sociodemographic variables or comorbidities affect antiviral or antibiotic prescribing.DesignOpen cohort study.SettingA representative sample...

Reasons why insured consumers co-pay for medicines at retail pharmacies in Pretoria, South Africa.

BackgroundCostly prescription medicines with existing cheaper alternatives tend to be purchased by medically insured consumers of healthcare. In South Africa medical scheme members pay higher out-of-pocket payments for medicines than those without insurance.AimThis study explored reasons for co-payments among insured Pretoria medical scheme members purchasing prescription medicines at private retail pharmacies, despite being insured and protected against such payments.SettingThe study took place in retail pharmacies in Pretoria, Gauteng Province, South Africa.MethodsAn exploratory qualitative study was performed. Semi-structured interviews were conducted among purposefully sampled medical scheme members (12) and nine key informants (six pharmacists and three regulators – one for the pharmaceutical industry, one for medical schemes and one for pharmacists). Three pharmacies (two corporate and one independent) each were identified from high and low socio-economic areas. Scheme members were interviewed immediately after having made a co-payment (eight) or no co-payment (four) from the selected pharmacies. Interviews were recorded, coded and organised into themes.ResultsCo-payments were deemed confusing, unpredictable and inconsistent between and within pharmacies. Members blamed schemes for causing co-payments. Six sampled pharmacies rarely stocked the lowest-priced medicines; instead, they dispensed medicines from manufacturers with whom they had a relationship. Corporate pharmacies were favoured compared to independents and brand loyalty superseded cost considerations. Medical scheme members did not understand how medical schemes’ function.ConclusionUnavailability of lowest-priced medicines at pharmacies contributes to co-payments. Consumer education about generics and expedited implementation of National Health Insurance could significantly reduce co-payments.Keywordsco-payments; high socio-economic; low socio-economic; medical scheme; medicines pricing policy; National Health Insurance; pharmacist; prescribed minimum benefit; retail pharmacy; regulator.

Relative Validity of the Eat and Track (EaT) Smartphone App for Collection of Dietary Intake Data in 18-to-30-Year Olds.

(1) Background: Smartphone dietary assessment apps can be acceptable and valid data collection methods but have predominantly been validated in highly educated women, and none specifically measured eating-out habits in young adults. (2) Methods: Participants recorded their food and beverage consumption for three days using the Eat and Track (EaT) app, and intakes were compared with three dietitian-administered 24-h recall interviews matched to the same days as the reference method. Wilcoxon signed-rank or t-tests, correlation coefficients and Bland–Altman plots assessed agreement between the two methods for energy and percentage energy from nutrients (%E). (3) Results: One hundred and eighty nine of 216 participants (54% females, 60% resided in higher socioeconomic areas, 49% university-educated) completed the study. There were significant differences in median energy intake between methods (p < 0.001), but the EaT app had acceptable agreement for most nutrient densities at the group level. Correlation coefficients ranged from r = 0.56 (%E fat) to 0.82 (%E sugars), and between 85% and 94% of participants were cross-classified into the same or adjacent quartiles. Bland–Altman plots showed wide limits of agreement but no obvious biases for nutrient densities except carbohydrate in males. (4) Conclusions: The EaT app can be used to assess group nutrient densities in a general population of 18-to-30-year olds.

Changes to the frequency and appropriateness of vitamin D testing after the introduction of new Medicare criteria for rebates in Australian general practice: evidence from 1.5 million patients in the NPS MedicineInsight database

ObjectivesTo assess changes in the frequency of vitamin D testing and detection of moderate/severe vitamin D deficiency (<30 nmol/L) among adults after the introduction of new Medicare Benefits Schedule (MBS)...

A shameful affair? A figurational study of the change room and showering culture connected to physical education in Danish upper secondary schools

ABSTRACTThe purpose of this article is to explore the clothes changing and showering situation related to PE in upper secondary schools in Denmark. We strive to understand why many young Danish people choose not to shower in relation to PE. Traditionally, Denmark has had a quite liberal attitude towards the naked body, which has affected the clothes changing and showering culture related to sport and leisure. However, young people in the Danish schools today are very reluctant about changing clothes and showering in the same room as their fellow students, and many choose to skip the shower all together. This paper draws on a research study of young Danish upper secondary school students’ (1st year, age 15–17) experiences of the clothes changing and showering situation related to PE. The data material comprises a six-month observation study of gender integrated PE lessons in two different schools in the Copenhagen area (high and low socio-economic areas) and 8 focus group interviews (N = 64) with male and female students from these schools. Theoretically, the research draws on figurational sociology as introduced by Norbert Elias We argue that the critical attitude towards the youth generation’s body cultural practices is perhaps misplaced. This is a development in accordance with the civilizing processes of the Western world. An approach to this issue should perhaps be a change in the structure around PE in schools, finding solutions that meet contemporary youth culture.

Oral Hygiene Practices and Prevalence of Dental Caries Among School Children in Niger State, Nigeria

The study investigated the oral hygiene practices and prevalence of dental carries among school children (6 – 12 years) in Niger State, Nigeria. A total of 477 pupils constituting 246 boys and 231 girls were used in the study. Stratified randomly sampling was used in selecting pupils from 9 public primary schools based on high, middle and low socio –economic levels. Data obtained from this study was analysed using percentages and Chi-Square statistic at 0.05 level of significance. Results of the study revealed that, the practice of toothbrushing was not statisfactory among pupils for the reason that a large numbers of pupils 202 (42.3%) did not brush their teeth at all. Also the prevalence and the number of dental caries were greater in the pupils of low socio-economic areas (66.5%) than the others. The high and middle socio-economic areas had a similar overall prevalence of dental caries of 59.4% and 60.1% respectively. Toothbrushing behavior among the pupils was strongly related to the parental education and their socio economic statuses however, there was no statistical significance in the prevalence of dental caries among the socio-economic groups. Health education programmes such as, brushing of teeth twice daily, especially at night before going to bed to improve oral hygiene practices was therefore recommended.

Assessing Spatial Equity and Accessibility of Public Green Spaces in Aleppo City, Syria

This paper examines the accessibility of urban green spaces within the Syrian city of Aleppo before the civil war using an environmental justice approach by indicating the current state of the parameters proximity and quantity in relation to the socioeconomic status of the inhabitants. Therefore, we conducted the average nearest neighbour analysis, facilities over and under coverage analysis, network analysis and a one-way analysis of variance (ANOVA) test followed by a post-hoc Tukey honestly significant difference (HSD) test. The findings clearly indicate that the spatial pattern of the distribution of public parks facilities was significantly clustered (p-value &lt; 0.0001), with a z-score of −16.4. Several neighbourhoods within the western and central parts of the city were identified to have a higher density of facilities, while the majority of the neighbourhoods located in the marginal parts in eastern Aleppo (low income) lack access to urban green spaces. The hierarchy-wise analysis reveals a strong deficit of urban green spaces at lower hierarchies, for example pocket parks and neighbourhood parks, while access to quarter parks and district parks is high. The urban green spaces at higher hierarchies are located in high and middle socioeconomic status areas. Regarding social segregation in park distribution and their accessibility, the data showed that high income neighbourhoods enjoy a significantly higher percentage of park facilities. The approach presented in this paper offers a generic method for the future development of public green spaces for balanced and sustainable planning.

Trade agreements and drug access: assessment of the impact of the 2009 Peruvian new drug policy on anti-infectives registration and availability

BackgroundThe United States-Peru Free Trade Agreement required changes in the Peruvian pharmaceutical legislation that resulted in the National Drug Policy (NDP) of 2009. This study evaluated the registration of brand and generic anti-infectives before and after the agreement and implementation of the NDP and assessed the availability of anti-infectives in community pharmacies located in Arequipa-Peru.MethodsAnti-infectives registration database, provided by DIGEMID (Peruvian Drug Regulatory Authority), was evaluated from January 2005 to August 2014. Registration status included: new registrations, re-registrations, awaiting registration; or expired, denied, suspended, canceled and disregarded registrations. In addition, ten retail pharmacies located in different socio-economic areas in Arequipa were sampled in August 2014. Descriptive statistics and chi-square test were used for the analysis.ResultsA total of 6112 anti-infectives registrations were categorized (5007 = antibacterials, 340 = antimycotics, 143 = antimycobacterials, and 622 = antiviral drugs). New registrations for brand and generic anti-infectives decreased from 2005 to 2013 (311 to 60 and 164 to 20 respectively). Re-registrations were from 121 (brand) and 115 (generics) in 2005 to 6 (brand) and 5 (generics) in 2013. Anti-infectives awaiting registration increased from 0 in 2005 to 351 (brand) and 137 (generics) in 2013.The retail pharmacy survey included 1105 anti-infectives. These pharmacies carried 647 (58.6%) products awaiting registration, 74 (6.7%) expired (mostly combination of sulfonamides and trimethoprim followed by penicillin with extended spectrum, and fluoroquinolones), 4 (0.4%) suspended, and 2 (0.2%) denied registrations. Pharmacies in the low socio-economic area of the city had the highest proportion of generics (59.0% vs. 16.1%) from foreign origin (mainly India), and brand anti-infectives from Peruvian manufacturers (68.8% vs. 48.1%). High socio-economic areas had highest proportion of branded anti-infectives (83.9% vs. 41.0%).ConclusionsThe new NDP reduced the number of brand and generic registrations; generics had the largest decline in registrations. Anti-infectives found in pharmacies located in low-income areas were more likely to be generics, and less likely to be currently registered by DIGEMID. The potential reduction in generic registrations resulting from the implementation of the NDP as a consequence of the bilateral trade agreement could result in lower availability of low cost medicines, but may increase the safety, efficacy and quality of marketed medicines.

A resource reallocation model for school dental screening: taking advantage of teledentistry in low-risk areas

To estimate the scale of resource transfer that could be achieved by screening low-risk schoolchildren using teledentistry rather than using traditional visual dental examination. This study was based on a previous cost-minimisation study that compared the costs of two dental-screening approaches (visual and teledentistry). The data for the population of children 5-14 years of age was obtained from the Australian Bureau of Statistics and was divided across Australia according to statistical local area (SA2). The cost models (for teledentistry and visual screening) for each SA2 relative to the state, Remoteness Area (RA) and Socio-Economic Index for Area (SEIFA) indexes were estimated. The geographical information system was used to superimpose modelled cost data on the geographical map to provide a visual presentation of the data. Resource transfer scenarios, based on risk minimisation, were then developed and analysed. This study demonstrated a suboptimal allocation of dental-care resources, such that children living in high socio-economic areas (major cities) with low disease burdens consuming half of the estimated resources of a universal visual dental screening system. The findings suggest that utilising teledentistry screening for low-risk children has the potential to free up $40 million per annum. Such resources can be reallocated to increase care access and improve the quality of dental services for vulnerable children. To reduce inequalities in dental health within a community, scarce health-care resources should be targeted at the population at most risk. These findings can be used to inform policymakers, guide the appropriate distribution of scarce resources and target dental services to benefit high-need children.

2378 - Bikes in Schools and Biking to School: Can One Support the Other?

Highest Scoring Abstract: Researcher Background In the last 20 years there has been a dramatic decrease in the proportion of New Zealand children who ride a bike to school, from 12% to 2%. Over this period, New Zealand has also seen record levels of childhood obesity, increased hours of ‘screen time’, and more children being transported in cars – trends that have wider health, social, and environmental impacts. ‘Bikes in Schools’, now in approximately 90 schools in New Zealand, consists of schools building bike tracks in their grounds, and providing bikes and helmets for students to use during lessons and free time. The aim is to increase access to regular bike riding. This study investigated the impact of Bikes in Schools on biking participation and biking to school, and school perceptions of the initiative. Methods A mixed-method, quasi-experimental evaluation, involving 16 schools in New Zealand was conducted. Student survey data and school bike rack counts from 12 schools with Bikes in Schools (intervention), and four schools without (comparison), were compared at baseline and one year later. Key informant interviews were conducted with representatives from intervention schools, followed by thematic analysis to understand perceptions of the initiative. Results The sample included 2,014 students in intervention schools (mean age, 8.93 years), and 542 students in comparison schools (mean age, 8.85 years). Ten school representatives were interviewed. At the one-year follow-up, more students had ridden a bike in the last seven-days in intervention schools than comparison schools (78% vs. 48%). Average bike rack counts indicated limited changes in biking to school across both intervention and comparison schools. However, moderate increases in bike rack counts, were seen at two intervention schools in higher socio-economic areas (indicating that 5.4% and 9.7% more students rode to school). Bikes in Schools were highly valued by schools. Perceived benefits were: improvements in students’ bike skills; increases in physical activity; and, families using the bike tracks for physical activity after school. Conclusions Bikes in Schools creates a safe, social space for students and families to be active on bikes. In the short-term, Bikes in Schools results in students biking more; however, it does not appear to translate to increases in biking to school in most contexts – although longer-term changes may occur. The combination of safe routes to school, Bikes in Schools, and improving access to bikes at home, is worthy of further investigation as a multi-faceted intervention to increase biking to school. Acknowledgements: Bike On NZ Charitable Trust

2378 - Bikes in Schools and Biking to School: Can One Support the Other?

Highest Scoring Abstract: Researcher Background In the last 20 years there has been a dramatic decrease in the proportion of New Zealand children who ride a bike to school, from 12% to 2%. Over this period, New Zealand has also seen record levels of childhood obesity, increased hours of ‘screen time’, and more children being transported in cars – trends that have wider health, social, and environmental impacts. ‘Bikes in Schools’, now in approximately 90 schools in New Zealand, consists of schools building bike tracks in their grounds, and providing bikes and helmets for students to use during lessons and free time. The aim is to increase access to regular bike riding. This study investigated the impact of Bikes in Schools on biking participation and biking to school, and school perceptions of the initiative. Method A mixed-method, quasi-experimental evaluation, involving 16 schools in New Zealand. Student survey data and school bike rack counts from 12 schools with Bikes in Schools (intervention), and four schools without (comparison), were compared at baseline and one year later. Key informant interviews were conducted with representatives from intervention schools, followed by thematic analysis to understand perceptions of the initiative. Results The sample included 2,014 students in intervention schools (mean age, 8.93 years), and 542 students in comparison schools (mean age, 8.85 years). Ten school representatives were interviewed. At the one-year follow-up, more students had ridden a bike in the last seven-days in intervention schools than comparison schools (78% vs 48%). Average bike rack counts indicated limited changes in biking to school across both intervention and comparison schools. However, moderate increases in bike rack counts, were seen at two intervention schools in higher socio-economic areas (indicating that 5.4% and 9.7% more students rode to school). Bikes in Schools was highly valued by schools. Perceived benefits were: improvements in students’ bike skills; increases in physical activity; and, families using the bike tracks for physical activity after school. Conclusion Bikes in Schools creates a safe, social space for students and families to be active on bikes. In the short-term, Bikes in Schools results in students biking more; however, it does not appear to translate to increases in biking to school in most contexts – although longer-term changes may occur. The combination of safe routes to school, Bikes in Schools, and improving access to bikes at home, is worthy of further investigation as a multi-faceted intervention to increase biking to school. Acknowledgements: Bike On NZ Charitable Trust

Prevalence of dental caries in relation to residential factor among (6-9) years old children in Baghdad

dental caries survey was conducted concerning 6-9 years old children in two different social areas in the city of Baghdad.The total sample composed of 180 (90 males and 90 females). Purpose of this study included the estimation of the prevalence of dental caries and its association with the socioeconomic background of children.Results showed that for the primary dentition dmfs and dmft values were higher for males aged 6-7 and 7-8 years in high socioeconomic class (7.8 &amp; 4.2 , 9.7 &amp; 4.7) than in low socioeconomic class (6.7 &amp; 3.9 ,7.2 &amp; 3.2) with statistically no significant differences ( p&gt; 0.05). For children aged 8-9 years in low socioeconomic area the values were higher compared with those in high socioeconomic area for both sexes.For the permanent dentition the high social class showed higher prevalence of dental caries compared with their lower social class counter parts except females aged 8-9 years with low socioeconomic status recorded higher DMFS and DMFT values ( 2.66 &amp; 2.6) compared to those in high socioeconomic (2.6 &amp; 1.8), while the relation was not significant ( p&gt;0.05).Generally the present study showed that the prevalence of dental caries for primary teeth was higher among children with low social class (dmfs &amp; dmft) than those with high social class, while the results were reversed for the permanent teeth.

Intra-urban patterns of domestic solid waste recycling in sub-Saharan Africa: towards an exploratory search for insights in Gaborone, Botswana

Botswana is among those developing countries that are rapidly transitioning from predominantly rural to urban societies. Gaborone, its capital city, is seriously confronted by formidable challenges of sustainable metropolitan management, including the proper handling of solid domestic waste. Although the international convention of the 3-Rs, namely, Recycle, Reduce, Reuse is generally accepted; its implementation remains elusive. It is therefore of utmost importance to unravel significant determinants of the gap between nominal acceptance and praxis in order to influence policy. This preliminary case study, consequently, sought to identify the underlying factors that differentiate waste recycling practices from high, medium, and low socio-economic areas Gaborone. Key informants, including municipal officials and company representatives, in charge of city solid waste management, were interviewed. A probit model was used to analyze those factors that could influence recycling and waste separation practices. Results showed that tenure, gender, income, affluence, location of house increase the likelihood of recycling while age, education level, household size and source of waste management information did not influence the likelihood of recycling. Stakeholders should place greater emphasis on positive environmental awareness, and appropriate reward systems for recycling domestic solid waste and recycling should be tailored according to the locational needs.

Does wealth make health? Cherchez la renal replacement therapy.

In this issue of CKJ, McQuarrie et al. have explored the relationship between socioeconomic status and outcomes among Scottish patients with a renal biopsy diagnosis of primary glomerulonephritis. Patients in the lower socioeconomic category had a twofold higher risk of death. No significant differences were observed on progression to end-stage renal disease (ESRD) requiring renal replacement therapy (RRT), suggesting that overall medical management was appropriate for all socioeconomic categories. The findings are significant since they come from an ethnically homogeneous population with free access to healthcare; they also relate to a specific aetiology of chronic kidney disease (CKD) expected to be less dependent on unhealthy lifestyles than other more frequent aetiologies that dominate studies of CKD in general, such as diabetic or hypertensive nephropathy. A closer look at the data suggests that living in a high socioeconomic area is associated with lower mortality, rather than the other way round. Furthermore, the differences in mortality were most pronounced during the RRT stage of CKD, providing clues for further research. In this regard, Wilmink et al. and Nee et al. point to access to pre-ESRD nephrology care and to the best kidney transplantation options as modifiable factors to be studied in the realm of T3 translational research to improve CKD patient outcomes.