Improvement In Socioeconomic Conditions Research Articles

Stagnation of maternal mortality decline in Bangladesh between 2010 and 2016 in spite of an increase in health services utilisation: Examining data from three large cross-sectional surveys.

After a 40% reduction in maternal mortality ratio (MMR) during 2001-2010 in Bangladesh, the MMR level stagnated between 2010 and 2016 despite a steady increase in maternal health services use and improvements in overall socioeconomic status. We revisited the factors that contributed to MMR decline during 2001-2010 and examined the changes in these factors between 2010 and 2016 to explain the MMR stagnation in Bangladesh. We used data from the 2001, 2010, and 2016 Bangladesh Maternal Mortality Surveys, which sampled 566 115 households in total, to estimate the changes in the risk of dying of maternal causes associated with a pregnancy or birth between 2001-2010 and 2010-2016. We carried out Poisson regression analyses with random effects at the sub-district level to explore the relationship between the change in risk of maternal death from 2001 to 2016 and a range of demographic, socioeconomic, and health care factors. Between 2001 and 2016, the proportion of high-risk pregnancies decreased, except for teenage pregnancies. Meanwhile, there were notable improvements in socioeconomic status, access to health services, and the utilisation of maternal health services. A comparison of factors affecting the risk of maternal death between 2001-2010 and 2010-2016 indicated that first pregnancies continued to offer significant protection against maternal deaths. However, subsequent pregnancies among girls under 20 years became a significant risk factor during 2010-2016, increasing the risk of maternal deaths by nearly 3-fold. Among the key maternal health services, only skilled birth attendants (SBA) were identified as a key contributor to MMR reduction during 2001-2010. However, SBA is no longer significantly associated with reducing mortality risk during 2010-2016. Despite continued improvements in the overall socioeconomic status and access to maternal health services in Bangladesh, the stagnation of MMR decline between 2010 and 2016 is associated with multiple teenage pregnancies and the lack of capacity in health facilities to provide quality delivery services, as SBA has been primarily driven by facility delivery. The findings provide a strong rationale for targeting at-risk mothers and strengthening reproductive health services, including family planning, to further reduce maternal mortality in Bangladesh.

Bilateral hand dactylitis: An unusual presentation of the great imitator: Tuberculosis.

The incidence of tuberculosis in developed countries has decreased over the years due to the use of effective tuberculosis drugs and improvements in socio-economic conditions. However, with the ease of global transport and increased travel to countries with high tuberculosis prevalence, the reduction in extrapulmonary tuberculosis cases has been less significant compared with the overall decrease in tuberculosis cases. Extrapulmonary tuberculosis can manifest in a variety of ways. Tuberculous dactylitis, a rare form of tuberculous osteomyelitis, was first described by Rankin in 1886. It mainly affects the short tubular bones in the hands and feet of children and is sometimes called 'spina ventosa'. A 42-year-old male patient initially presented to an external centre reporting swelling and pain in the hand joints of one year's duration. Despite one year of treatment with leflunomide and methylprednisolone (16 mg) and a history of methotrexate use during this period, he experienced no improvement. The patient's condition worsened after the start of sulfasalazine. Dermatological examination was performed due to the presence of haemorrhagic crusted papules and plaques on the ventral surface of both hands. A wound culture was taken, but no bacterial growth was observed. One week after the initial evaluation, the patient complained of persistent foul-smelling nasal discharge, which led to an evaluation by the infectious disease department. At this time, the Quantiferon test was positive. Mycobacterial culture on Days 1 and 3 showed growth of the Mycobacterium tuberculosis complex.

Anemia Prevalence and Socioeconomic Status among Adolescent Girls in Rural Western India: A Cross-Sectional Study.

Anemia poses a significant challenge among Indian adolescent girls due to their heightened vulnerability, resulting from increased micronutrient requirements, rapid physical growth, menstrual blood loss, inadequate nutrition, and socioeconomic disparities. This study sought to evaluate the prevalence of anemia, along with socioeconomic and nutritional statuses among adolescent girls attending rural public schools in Pune, India. A sample of 400 girls was selected from 22 villages through Symbiosis International University. Hemoglobin levels were assessed using the HemoCue 201 system, while standardized protocols were employed for height, weight, and BMI-for-age measurements. Socioeconomic status was determined using the Kuppuswamy scale. The findings revealed an overall anemia prevalence of (42.75%), comprising severe (2.5%), moderate (21%) and mild (20.25%) cases. Additionally, a substantial proportion (74.6%) of girls were classified as underweight. Socioeconomic analysis disclosed that 64.25% of families belonged to the lower middle class, and 27% in the upper lower class. Anemia was more prevalent in young adolescent girls (10-14 years) and in the families of adolescents who had low income, were illiterate, unemployed, and belonged to the lower-middle class and upper-lower-class socio-economic status (SES) and did not have a bank account. Anemia was prevalent in adolescent girls and associated with low SES. This study underscores the limitations of relying solely on the distribution of iron and folic acid tablets to combat anemia. A holistic strategy is imperative, encompassing improvements in SES of families (literacy, employment and income), as well as initiatives aimed at enhancing the nutritional status of adolescent girls.

Why do Zakah Institutions in Sri Lanka Underperform?

Zakah as a compulsory worship obligation of Muslims has been practiced for several decades in an institutionalized form in Sri Lanka. Although the institutionalized mechanism contributes to some improvements in socioeconomic conditions, recent research highlighted that the impact of such a model is yet below the expected level. The institutional zakah practice in Sri Lanka has remained essentially informal lacking any state recognition or zakah specific regulation. This paper examined the contemporary challenges and root causes of the zakah institutions’ underperformance in Sri Lanka. This paper took a qualitative methodology and collected primary and secondary data through official documents, interviews, and published literature. The empirical findings of the paper reveal a threefold challenge that contributes to the inefficient institutional zakah performance, namely low collection, ineffective disbursement, and external hurdles. The paper suggests that the prolonged dominant informal and individualist zakah culture of Sri Lankan Muslims fails to actualize the designated goals of zakah and this in turn has contributed to the contemporary challenges. The paper highlights the need for developing an alternative jurisprudential methodology that has the potential to offer sensible remedies to the contemporary identified challenges. The paper suggests that zakah institutions must thoroughly re-evaluate existing zakah applications to improve the effectiveness and efficiency of their zakah management systems. It is also suggested that it would be helpful to establish a National Zakah Consultative Body that can advise the government on adopting effective regulations or guidance relevant to zakah management for the Sri Lankan Muslim minority.

Hepatitis A Chronic Immunity in Iran: A Geographic Information System-Based Study

Background: Chronic immunity to hepatitis A (HA) is largely influenced by environmental factors, such as socioeconomic indicators, public health conditions, and access to safe water. In the past two decades, Iran has witnessed improvements in socioeconomic status, increased urbanization, enhanced health education, improved access to safe drinking water sources, and better public health conditions. However, these changes have not been uniform across all regions of Iran, and varying epidemiological situations are expected. Objectives: This study aimed to delineate the pattern of HA chronic immunity across different regions of Iran using geographical information system (GIS) mapping. Methods: The study included a total of 3255 individuals who tested positive for anti-hepatitis A virus (anti-HAV) immunoglobulin G (IgG). This study analyzed factors such as place of residence, marital status, age, and gender to explore possible relationships. Univariate and multivariable analyses were conducted to identify independently associated factors for HA. A locally weighted scatterplot smoothing (LOWESS) multivariate model was developed using a backward stepwise approach. Geographical variations in the prevalence of HA chronic immunity in the general population of Iran were assessed to understand spatial effects and risk factors. A Bayesian spatial model was employed to identify the spatial pattern of HA chronic immunity prevalence, using OpenBUGS version 3.2.3. Results: The prevalence of HAV immunity was higher in regions with mild semi-dry climates (aPR = 2.37, 95% confidence interval [CI] = 2.30 - 3.33, P< 0.001), medium semi-dry climates (aPR = 1.37, 95% CI = 1.14 - 1.63, P< 0.001), dry climates (aPR = 1.13, 95% CI = 0.9 - 1.4), and ultra-dry climates (aPR = 1.79, 95% CI = 1.05 - 2.98, P = 0.033), compared to semi-humid climates. Other variables did not exhibit a significant relationship with HA chronic immunity. The GIS analysis map revealed that immunity to HA was generally lower in the capital cities of Iran’s provinces. However, most central regions of Iran exhibit medium endemicity; nevertheless, higher immunity to HA was observed in border areas and coastal regions, particularly in the northern part of the country. Conclusions: Different regions of Iran display distinct patterns of HAV endemicity, influenced by the country’s climatic diversity.

Life-course socioeconomic status and its impact on functional health of Portuguese older adults

Abstract Background Functional health is arguably one of the most important health indicators for older adults, because it assesses physical, cognitive, and social functions in combination. However, life-course circumstances may impact this multidimensional construct. The aim of the present study was to assess the relationship between life-course socioeconomic status (SES) and different dimensions of functional health in older adults. Methods Data on 821 Portuguese adults aged 50 and over in 2013-2015 were analyzed. Life-course SES was computed using participants’ paternal occupation (non-manual (nm); manual (m)) and own occupation (nm; m), resulting in four patterns: stable high (nm+nm), upward (m+nm), downward (nm+m), stable low (m+m). Functional health included physical and mental functioning, cognitive function, handgrip strength, and walking speed. Linear (beta coefficients) and logistic regressions (odds ratios) were used to estimate the association between life-course SES and functional health. Results Overall, those who accumulated social disadvantage during life-course presented worse functional health than those with stable high SES (stable low - SF-36 physical functioning: β=−9.75; 95%CI: -14.34;-5.15; SF-36 mental health: β=−7.33; 95%CI: -11.55;-3.11; handgrip strength: β=−1.60; 95%CI: -2.86;-0.35; walking time, highest tertile: OR = 5.28; 95%CI: 3.07;9.09). Those with an upward SES were not statistically different from those in the stable high SES for most of the health outcomes however, those with an upward SES trajectory tended to have higher odds of cognitive impairment (OR = 1.75; 95%CI: 0.96;3.19). A downward SES trajectory increased the odds of slower walking speed (OR = 4.62; 95%CI: 1.78;11.95). Conclusions A disadvantaged life-course SES impacts older adults’ physical and mental functioning. For some outcomes, this was attenuated by a favourable adulthood SES but those with a stable low SES consistently presented worse functional health. Key messages • Overall, stable high SES leads to better functional health, but for mental health functioning, handgrip strength and walking speed, it is possible to overcome the initial social disadvantage. • These results reinforce that even though health disparities may start early in life, they are mutable and capable of changing through the improvement of socioeconomic conditions.

Patterns of Social Determinants of Health and Child Mental Health, Cognition, and Physical Health

Social determinants of health (SDOH) influence child health. However, most previous studies have used individual, small-set, or cherry-picked SDOH variables without examining unbiased computed SDOH patterns from high-dimensional SDOH factors to investigate associations with child mental health, cognition, and physical health. To identify SDOH patterns and estimate their associations with children's mental, cognitive, and physical developmental outcomes. This population-based cohort study included children aged 9 to 10 years at baseline and their caregivers enrolled in the Adolescent Brain Cognitive Development (ABCD) Study between 2016 and 2021. The ABCD Study includes 21 sites across 17 states. Eighty-four neighborhood-level, geocoded variables spanning 7 domains of SDOH, including bias, education, physical and health infrastructure, natural environment, socioeconomic status, social context, and crime and drugs, were studied. Hierarchical agglomerative clustering was used to identify SDOH patterns. Associations of SDOH and child mental health (internalizing and externalizing behaviors) and suicidal behaviors, cognitive function (performance, reading skills), and physical health (body mass index, exercise, sleep disorder) were estimated using mixed-effects linear and logistic regression models. Among 10 504 children (baseline median [SD] age, 9.9 [0.6] years; 5510 boys [52.5%] and 4994 girls [47.5%]; 229 Asian [2.2%], 1468 Black [14.0%], 2128 Hispanic [20.3%], 5565 White [53.0%], and 1108 multiracial [10.5%]), 4 SDOH patterns were identified: pattern 1, affluence (4078 children [38.8%]); pattern 2, high-stigma environment (2661 children [25.3%]); pattern 3, high socioeconomic deprivation (2653 children [25.3%]); and pattern 4, high crime and drug sales, low education, and high population density (1112 children [10.6%]). The SDOH patterns were distinctly associated with child health outcomes. Children exposed to socioeconomic deprivation (SDOH pattern 3) showed the worst health profiles, manifesting more internalizing (β = 0.75; 95% CI, 0.14-1.37) and externalizing (β = 1.43; 95% CI, 0.83-2.02) mental health problems, lower cognitive performance, and adverse physical health. This study shows that an unbiased quantitative analysis of multidimensional SDOH can permit the determination of how SDOH patterns are associated with child developmental outcomes. Children exposed to socioeconomic deprivation showed the worst outcomes relative to other SDOH categories. These findings suggest the need to determine whether improvement in socioeconomic conditions can enhance child developmental outcomes.

Prevalence of soil-transmitted helminths and associated risk factors among primary school children in Kandahar, Afghanistan: A cross-sectional analytical study.

Soil-transmitted helminth (STH) infections are global health problem, especially in low-income countries. Main objectives of this study were to estimate the prevalence and intensity of STH and its risk factors among school children in Kandahar city of Afghanistan. This was a school-based cross-sectional analytical study, with data collected during eight-month-period (May-December, 2022) from 6- and 12-years old school children in Kandahar city, Afghanistan. All the stool samples were examined by saline wet mount method and Kato-Katz technique. Data were analyzed by using descriptive statistics, Chi square test, and multivariate logistic regression. A total of 1275 children from eight schools of Kandahar city were included in this study. Mean age of these children was 8.3 years with 53.3% boys. The overall prevalence of any intestinal parasitic infection was 68.4%. The overall prevalence of STH infection was 39.1%, with Ascaris lumbricoides (29.4%) as the most prevalent STH species. Mean intensity of overall STH infection was 97.8. Multivariate logistic regression revealed playing barefoot (AOR 1.6, 95% CI 1.1-2.2), not washing hands after defecating and before eating (AOR 1.3, 95% CI 1.0-1.7), having untrimmed nails (AOR 1.4, 95% CI 1.1-1.8), and belonging to poor families (AOR 1.3, 95% CI 1.0-1.7) as the risk factors associated with the predisposition of school children for getting STH in Kandahar city of Afghanistan. There is high prevalence of STH among school children of Kandahar city in Afghanistan. Most of the risk factors are related to poverty, decreased sanitation, and improper hygiene. Improvement of socioeconomic status, sanitation, and health education to promote public awareness about health and hygiene together with periodic mass deworming programs are better strategies for the control of STH infections in Afghanistan.

Pattern and Socio-demographic characteristics of Drug Users at the National Drug Law Enforcement Agency (NDLEA) Rehabilitation Facility, Port Harcourt

Background: Substance abuse particularly among young people has become a large phenomenon globally affecting all segments of society. The abuse of alcohol, tobacco, cannabis and other psychoactive drugs among young people has become an issue of public health concern with untold negative consequences on human existence. Aim: This study sought to examine the sociodemographic profiles and patterns of drug use among drug users at the NDLEA Rehabilitation Facility, Port Harcourt. Materials and Methods: This was a descriptive cross-sectional study conducted among inmates of the National Drug Law Enforcement Agency (NDLEA), Port Harcourt. A structured questionnaire covering socio-demographic characteristics and other factors were self-administered to inmates of the facility, who have been brought by their relative for addiction care over a period of 3 years (2017 to 2020). Ethical approval was obtained from the ethical committee of the University of Port Harcourt Teaching Hospital and approval was obtained from the NDLEA Authority. All other ethical provisions were followed. Descriptive statistics was used to analyzed the data. Data were analyzed with number count, percentage, and then Chi-square of independence. Results: Majority of the drug users were male (98,8%), single (72.5%), unemployed (27.5%) and apprentice (40.0%), between the ages of 15 and 35 (67.5%) and with tertiary education. Cannabis was the most consumed drug (75.7%), followed by nicotine (30.8%) alcohol (28.3%), cocaine (27.4%) and heroine (25.8%). Majority of the users were introduced to drug by friends and family members and referred to the feeling they got on the first day of use as high and happy. Majority had 15 to 25 years as age of onset of drug use and there were no family history of psychoactive substance use or mental illness. Conclusion: Substance use is common among young people between the ages of 26 and 30, single, with higher level of education and low-income earners. Majority use illicit drugs, which they started at early age of 15 to 25 and introduced to by friends and family members. Improvement in socio-economic status of adolescents and sustained public health enlightenment will help to reduce the rising prevalence of drug use.

Hysterectomy for gynecological indication at the General Hospital of Kasenga, in the city of Uviran, in the Province of South-Kivu in the Est of the Democratic Republic of Congo

We conducted a retrospective and cross-sectional study. We collected the data over a period of one year. It took place over a period of time from January 25, 2021 to January 25, 2022 in the obstetrics gynecology departments of the General Hospital (GH) of KASENGA in the city of Uvira in the province of South Kivu in the East of the Democratic Republic of Congo (DRC). The main objective is to determine the frequency of hysterectomy in this part of DRC and to determine what would be the gynecological indications. Only patients who underwent hysterectomy for gynecological indication were included in our study. We found that the frequency of hysterectomies for gynecological indications compared to all surgical activity was 12.5%. The average age of our patients was 54.2 years. The indications were dominated by hysteroceles (44%) and uterine myomas (20%). The approach was vaginal in 52% and abdominal in 48%. The hysterectomies were total in 92% of cases and radical in 8% of cases. We did not note any major complications except parietal infections which were in 16% of cases. All patients received postoperative antibiotic prophylaxis. No anticoagulant treatment was prescribed. After this work we found that hysterectomy is frequent at the Reference Hospital (HR) of KASENGA with the main indication, hysterocele according to the different degrees. We did not have many complications and this would be due to the early antibiotic prophylaxis. The improvement of socio-economic conditions, awareness and early detection should improve the conditions of care.

Radiolabeling with Technetium 99m for the Diagnosis of Coronary Heart Disease in Senegal

Coronary heart disease is the leading cause of death in industrialized countries. In Africa, its prevalence is increasing in line with the westernization of lifestyles, the improvement of socio-economic conditions and the increase in life expectancy. Therefore, myocardial perfusion scintigraphy presents itself as an effective imaging technique allowing improved prevention, diagnosis and therapeutic management and monitoring of patients at risk. Our present work has exclusively focused on the early diagnosis of patients at risk in the nuclear medicine department of the Grand Yoff General Hospital (HOGIP). Our work consisted of administering a radiopharmaceutical to a patient and monitoring its fate in the body by external detection of gamma radiation using a Mediso Nucline TM gamma camera. We used vectors like sestamibi and tetrofosmin. These vectors have the particularity of having an affinity and a tropism for the myocardial tissue. These two vectors were labeled with technetium 99m (radiotracer). Indeed, these radioactive tracers attach themselves to the organ to be studied from where they emit gamma radiation captured by a gamma camera which detects the signal from this organ and reconstructs a computerized static or dynamic image. This made it possible to make a diagnosis of ischemia or myocardial necrosis in 57% of cases in women and 82.5% of cases in men in a sample of 45 patients. Thanks to the qualitative visual interpretation of the distribution of the tracer, a diagnostic aid was provided by the semi-quantitative analysis provided by the study of the polar maps (bull's eyes). This myocardial perfusion scintigraphy can be a valuable diagnostic aid, especially in our countries where income is limited.

STUDY OF MATERNAL AND FETAL OUTCOME IN PATIENTS OF ECLAMPSIA

Background: Eclampsia is still a major cause of maternal morbidity and mortality in India and across the globe. Material & Methods: This was a descriptive cross-sectional study conducted at Government Medical College, LaturMaharashtra in 240 eclamptic patients admitted from 1st January 2019 to 30th June 2020, included after permission from the Institutional Ethics Committee & were evaluated regarding eclampsia, its sociodemographic presentation, risk factors, and fetomaternal complications. Epi- info 7.2.5 & SPSS version 2.0 was used for statistical analysis. The incidence Results: of eclampsia in the study was 1.64%. The mean age of eclampsia cases was 21.25 ± 2.47 years. 71.66% of cases were primiparous, 61.25% of cases of eclampsia had no education at all, and 13.33% of cases had a family history of preeclampsia.70% of patients were unbooked, 68.33% of cases were from rural residence while 78.34% cases were referred from different hospitals. 87.50% cases had antepartum eclampsia, 66.98% presented at gestational age less than 37 weeks, and 65.84% presented with severe hypertension with blood pressure >160/110 mm Hg on admission. 63.75% of cases had 2-4 convulsions before the start of anticonvulsant therapy. 67.91% of cases were delivered by lower segment cesarean section while 32.09% of cases had delivered vaginally. 9.17% of cases had HELLP syndrome, 7.5% cases had PRES, 5% cases required ventilatory support, and 2.92% cases developed pulmonary edema. Maternal death occurred in 9 cases. Pulmonary edema was the commonest cause of death in 44.44% of cases of eclampsia. 56.67% of cases of eclampsia had LBW babies, 85% of babies were born alive and there were 15% perinatal deaths. Eclampsia is still major Conclusion: contributor for maternal and perinatal mortality and morbidity. The incidence of eclampsia and maternal deaths are higher in developing countries due to lack of education and lack of antenatal care. Proper antenatal care, early detection of pre-eclampsia, health education about imminent symptoms to patients, and proper management of pre-eclampsia are essential steps for the prevention of eclampsia. The maternal and fetal outcomes can be improved by the better provision of health care facilities, antenatal care, and improvement of socioeconomic conditions.

Does women's empowerment and socio-economic status predict adequacy of antenatal care in sub-Saharan Africa?

Quality and adequate antenatal care (ANC) are key strategies necessary to achieve Sustainable Development Goal 3.1. However, in sub-Saharan Africa (SSA), there is a paucity of evidence on the role women's empowerment and socio-economic status play in ANC attendance. This study aimed to examine whether women's empowerment and socio-economic status predict the adequacy of ANC in SSA. Data from the recent Demographic and Health Surveys (DHSs) of 10 countries in SSA were used for the study. We included countries with a survey dataset compiled between 2018 and 2020. We included 57 265 women with complete observations on variables of interest in the study. Frequencies and percentages were used to summarize the results of the coverage of adequate ANC services across the 10 countries. A multivariable binary multilevel regression analysis was employed to examine the association between women's empowerment and socio-economic status indicators and the adequacy of ANC. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were used to present the findings of the regression analysis. The average prevalence of adequate ANC in SSA was 10.4%. This ranged from 0.2% in Rwanda to 24.5% in Liberia. Women with medium (aOR 1.24 [CI 1.10 to 1.40]) and high (aOR 1.24 [CI 1.07 to 1.43]) decision-making power had higher odds of adequate ANC compared to those with low decision-making power. Women with higher levels of education (aOR 1.63 [CI 1.36 to 1.95]) as well as partners with higher education levels (aOR 1.34 [CI 1.14 to 1.56]) had the highest odds of adequate ANC compared to those with no formal education. Additionally, those working (aOR 1.35 [95% CI 1.23 to 1.49]) and those in the richest wealth category (aOR 2.29 [CI 1.90 to 2.76]) had higher odds of adequate ANC compared to those who are not working and those in the poorest wealth category. Those with high justification of violence against women (aOR 0.84 [CI 0.73 to 0.97]) had lower odds of adequate ANC compared to those with low justification of violence against women. Adequacy of ANC was low across all 10 countries we included in this study. It is evident from the study that women's empowerment and socio-economic status significantly predicted the adequacy of ANC. As such, promoting women's empowerment programs without intensive improvements in women's socio-economic status would yield ineffective results. However, when women's empowerment programs are combined with active improvements in socio-economic status, then women will be encouraged to seek adequate ANC.

Taenia solium: Socioeconomic changes and prevalence evolution in four endemic communities in northwestern Mexico.

In Mexico, for the past 30 years, a continuous decrease in the incidence of clinical taeniosis/cysticercosis has been documented. This work aimed to determine the influence of improvement in socioeconomic conditions on the prevalence of Taenia solium in four endemic communities in northwestern Mexico. This study was carried out in two phases. First, documentary information (1989-2018) was collected about the prevalence of Theridion solium in the federal entity of Sinaloa State. Second, a pilot study was performed in four communities of Sinaloa, which had an endemic history of Taenia transmission. In each community, a risk factor questionnaire was applied, and serum and stool samples were collected for convenience in a non-probabilistic way. Anti-cysticercus antibodies and adult worm coproantigen were determined. The documentary analysis showed the incidence of taeniosis and cysticercosis to have decreased by 98 and 53%, respectively, while the human development index increased by 5% (1992-2017). Our data suggest that the risk of parasitic transmission is low, although female sex was a risk factor for reporting tremors or seizures (prevalence rate 2.1336, CI: 1.1821-3.8508) and background of tapeworm infection (prevalence rate 1.2893, CI: 0.9795-1.6972). No tapeworms or eggs were found while examining stool samples, but protozoa cysts were observed in four samples. Unexpectedly, only one of the 79 stool samples was positive for coproantigens. This positive result was confirmed in a second sample. However, the evaluation of a third sample was negative. No antibodies were found in human (n=377) or pig (n=69) samples. These data suggest parasite transmission has been interrupted and could be possibly associated with improving socioeconomic conditions. Further studies are needed to determine the real prevalence of zoonoses in Mexico.

Helicobacter pylori World Gastroenterology Organization Global Guideline

Helicobacter pylori remains a major health problem worldwide, causing considerable morbidity and mortality due to peptic ulcer disease and gastric cancer. The burden of disease falls disproportionally on less well-resourced populations. As with most infectious diseases, the largest impact on reducing this burden comes from improvement in socioeconomic status, which interrupts transmission. This has been observed in many regions of the world, but the prevalence of infection remains high in many regions where improvements in living standards are slow to occur. Meanwhile, the optimal clinical management and treatment pathways remain unsettled and are evolving with changing antimicrobial resistance patterns. Despite decades of research and clinical practice, major challenges remain. The quest for the most effective, safe, and simple therapy remains the major issue for clinicians. The search for an effective vaccine appears to be elusive still. Clinical guidelines do not infrequently proffer discordant advice. A major challenge for guidelines is for relevance across a variety of populations with a varying spectrum of disease, antimicrobial resistance rates, and vastly different resources. As local factors are central to determining the impact and management strategies for H. pylori infection, it is important that pathways are based on the best available local knowledge rather than solely extrapolating from guidelines formulated in other regions, which may be less applicable. To this end, this revision of the World Gastroenterology Organisation (WGO) H. pylori guideline uses a "Cascades" approach that seeks to summarize the principles of management and offer advice for pragmatic, relevant and achievable diagnostic and treatment pathways based on established key treatment principles and using local knowledge and available resources to guide regional practice.

The burden of somatic diseases among people with alcohol- and drug use disorders are influenced by mental illness and low socioeconomic status. A registry-based cohort study in Norway

ObjectivesPersons with alcohol use disorder (AUD) and drug use disorder (DUD) have a lower life expectancy than the general population. We examined the burden of somatic diseases among persons with AUD or DUD and investigated impact of socioeconomic status (SES) and mental health disorders on the co-occurrence of somatic diseases in these groups. MethodsWe performed a retrospective, register-based cohort study with a 6-year follow-up of persons (aged ≥18 y) with AUD (13,478) or DUD (16,659). Cox regression analyses were used to estimate hazard ratios (HRs) of somatic diseases. ResultsPatients with DUD were, on average, 10 years younger at the point of diagnosis than patients with AUD. Mental illnesses were prominent in both groups (AUD: 40.5%, and DUD: 46.9% vs 3.5% in controls). Adjusting for mental disorders, the risk of all somatic diseases among the AUD and DUD groups was reduced by 30%. Some of the elevated risk of somatic diseases among persons with AUD and DUD is explained by low SES, though less than that explained by the presence of mental disorders. The diseases with highest risk among AUD patients were metabolic disorders (16.9-fold) and hypertension (14.8-fold), and among AUD patients, viral hepatitis (23.3-fold), after adjusting for low SES and mental disorders. ConclusionsPersons with AUD had a higher risk of most somatic diseases, while those with DUD had specific risks for infections and viral hepatitis. Mental health disorders and SES adjusted the associations regarding most somatic diseases. In general, improvement of socio-economic conditions, preferably in combination with professional support to self-manage mental health problems, will reduce the risk of somatic illness in both groups. For DUD patients, available sterile user equipment will reduce the risk of viral hepatis.

THE IMPACT OF EARLY CONDITIONS ON THE PREVALENCE OF DIABETES ACROSS THREE COHORTS OF OLDER ADULTS IN MEXICO

Abstract In low-and-middle-income countries like Mexico the impact of disadvantaged early childhood conditions (ECC) on later-life health in not well known and may be changing across birth cohorts. Our objective is to examine the impact of ECC on the propensity to have diabetes in three different cohorts of older adults aged 60-69 (born in 1930-1939, 1940-1949, 1950-1959). We examine to what extent differences in ECC, sociodemographic characteristics, and lifetime obesity explain the differences in the prevalence of diabetes across the cohorts. We use five waves of data from the Mexican Health and Aging Study (n=10,313). We estimate a series of logistic regression models and use counterfactual analyses to identify the roles of ECC and lifetime obesity on cohort-specific diabetes prevalence and on differences in diabetes prevalence across cohorts. Our results suggest that improvements in ECC would decrease prevalence of diabetes by 12.5% in the 1930-1939 cohort and 10% in the 1950-1959 cohort. However, the rise of obesity at age 50 counters this effect and leads to higher prevalence of diabetes in both cohorts. Our models show that if everyone had a normal weight at age 50, the prevalence of diabetes would decrease by 31.3% for the 1930-1939 cohort, 27.3% for the 1940-1949, and 26.7% for the 1950-1959 cohort. Despite improvements in socio-economic conditions during childhood in Mexico, the increase in lifetime obesity appear to offset the benefits derived from better ECC resulting in higher rates of diabetes.

Short-term socioeconomic status shift and long-term cardiovascular outcomes in China: a population-based cohort study

IntroductionLimited studies have discussed the effect of socioeconomic status (SES) shift on cardiovascular outcomes, especially in less developed regions and countries. We; therefore, explored the association between short-term SES shift...

The management of Helicobacter pylori infection and prevention and control of gastric cancer in China.

Helicobacter pylori (H. pylori) infection, a type-1 carcinogen, was closely associated with gastric cancer (GC). Successfully eradicating H. pylori infection could reduce the incidence of GC. China was a country with high incidence of GC and high prevalence of H. pylori infection. Nearly half of worldwide GC new cases and deaths attributed to H. pylori infection occurred in China. H. pylori prevalence varied over time with the improvement of socioeconomic status and sanitary conditions. The knowledge of antibiotic resistance rate in time was important to guide the clinical choice of antibiotics use in the regimens. With the publication of five Chinese consensus reports on the management of H. pylori infection and the effort of public preach of H. pylori-related knowledge, the standardization of H. pylori diagnosis and treatment by clinicians was improved. Bismuth-containing quadruple therapy was widely applied in clinical practice of H. pylori eradication because of high efficacy and safety. High-dose Proton Pump Inhibitor-amoxicillin dual therapy or vonoprazan-amoxicillin dual therapy showed comparable efficacy and lower side effects than bismuth-containing quadruple therapy, which were the alternative choice. The diagnosis rate of early GC was low and distinguishing Chinese GC risk population for the further endoscopy screening was important. Efforts have been done to establish prediction models to stratify GC risk in the Chinese GC risk population. We reviewed the current situation of the management of H. pylori infection and prevention and control of GC in China here.

Association between Maternal Age and Complications of Pregnancy in Primipara

Objectives: The purpose of this study was to analyze the association between maternal age and pregnancy outcome in primipara. Methods: We evaluated retrospectively the clinical characteristics and pregnancy outcomes in primiparous mothers who delivered a fetus after more than 22 weeks of gestation in I hospital from January 2017 to December 2018. Statistical analysis was performed using chi-square tests and multivariable logistic regression. The education, occupation, abortion history, assisted reproductive technology (ART) and multiple pregnancy all showed significantly higher incidence, depending on maternal age (<i>p</i><0.000). Results: The odds ratio in maternal complications was 2.327 times higher in mothers 40 years and above than mothers 29 years and below, and 1.912 times higher in mothers 35-39 years than mothers 29 years and below. The odds ratio in gestational diabetes was 3.337 times higher in mothers 40 years and above than mothers 29 years and below, and 2.698 times higher in mothers 35-39 years than mothers 29 years and below. Conclusions: Consequently, this study showed a significant association between maternal age and pregnancy outcome in primipara. However, as the maternal age increases, the improvement of socioeconomic status and health level are expected to have a greater impact on outcome of pregnancy despite the physical defects of biological aging.