Low Economic Income Research Articles

Reduced serum zinc levels while improving growth of underweight school children in trial of zinc-fortified milk in Indonesia

Background Most children in low-income countries haveinadequate dietary zinc. The study was aimed to demonstrate theeffect of iron-zinc fortified milk in improving zinc status amongunderweight school children in Indonesia.Objective To evaluate the effects of milk fortification with zinc onserum zinc levels in underweight Indonesian school children.Methods A double-blind, randomized, controlled, communitybasedstudy was conducted on 426 underweight children aged 7to 9 years in several low economic income level elementary schoolsin Jakarta and Solo. Subjects were randomly allocated to receiveeither zinc-fortified milk (n= 217) or standard milk (n=209) for6 months. The fortified milk provided an 2.38 mg zinc per dayand the standard milk provided 0.88 mg zinc per day.Results Among underweight children, the prevalence of stuntingwith a height-for-age z-score < - 2.0 SD was 39.7%. Almost allsubjects (98%) had zinc intake ofless than 60% of the Indonesianrecommended daily allowance (RDA) for that particular agegroup. After receiving the milk intervention, mean serum zincconcentration declined significantly in both groups (from 13 .50±3.05 μmol/Lat baseline to 10.59±1.93 μmol/L, P< 0.05), butgrowth parameters (weight and height) improved.Conclusion Reduced mean serum zinc levels were observed inchildren who received standard milk, as well as those who receivedzinc-fortified milk. These reduction in serum zinc levels may be apart of homeostatic control mechanim for improving the negativezinc balance in zinc pools, as a negative effect on linear growthwas not observed. Larger clinical trials of adequate sample sizeneed to be conducted in order to provide better understandingon zinc regulation among underweight school children. [Paediatrlndones. 2012;52:118-24).

Basic Needs and Wealth as Independent Determinants of Happiness: An Illustration from Thailand

Thailand has been a global economic success story, transforming from one of the poorest countries in Southeast Asia in the 1960s, to a modern and dynamic nation, and all within the lifetime of the current generation. However, growth has been accompanied by marked increases in economic inequality both at the regional and individual levels. In this context studying how relatively poor people appraise their situation (‘subjective wellbeing’) and how this relates to traditional ‘objective’ measures of wellbeing such as wealth and basic needs is particularly relevant. This paper investigates the relationship between basic needs as defined by the Theory of Human needs (THN, Doyal and Gough 1991), material wealth and happiness. Specifically, we intend to answer the following research question: Are wealth and basic needs indicators always interchangeable when analyzing happiness determinants in low income settings? The paper focuses on seven communities in the South and North-east of Thailand with contrasting levels of access to markets and services. It challenges the common assumption that at low economic levels, wealth or income matter for people’s happiness because they increase satisfaction of basic needs, arguing instead that wealth might contribute to happiness for personal or symbolic reasons, which are not related to the use of goods as basic needs satisfiers. Thus, it suggests that indicators of wealth and basic needs should not be used interchangeably when studying happiness determinants in low income settings.

Chemotherapy in gallbladder cancer: Improving survival

15140 Background: Since 1999 we had been studying the effect of chemotherapy in gallbladder cancer, a disease frequent in low economical income area of the world, orphan of research, traditionally considered chemotherapy-resistant. Previous studies included 5- FU regimen and communicated response rate of 10–26 %, and no changes on survival. We first conducted a phase II study with gemcitabine (Gem), and later, another study (with support of GOCCHI) using Gem and cisplatin (C). Since 2001 we had treated patients out of clinical trial. We compare median survival observed in all series. Methods: Patients file of both 2 phase II studies and clinical record of all patients treated out of clinical trial were retrieved and median survival was calculated. The both phase two trials had a similar population, and inclusion criteria, both were multicenters. The third cohort is a one center experience. The regimens used were: Gem 1,000 mg/m2 on days 1,8 and 15 every 28 days (first trial), Gem 1,250 mg/m2+C 35 mg/m2 on the 1 and 8 days every 21 days (second trial), only maximum 6 courses were planned. The third group, most frequently, received Gem 1.000 mg/m2 (10mg/m2/min)+C 40 mg/m2 days 1 and 8 every 21 days, until disease progression and/or toxicity; second line chemotherapy was allowed. Among whole group 7 pts, who had significant response, underwent a surgical resection. Survival was also calculated and comparison is included. The toxicity was evaluated every 2 weeks and response was assessed every two cycles using CT scan. Overall survival was calculated from beginning of chemotherapy until death or last follow up. Survival analysis was also done using Kaplan Meier’s tables Results: For Gem monotherapy (26 pts) median survival was 30 weeks, for Gem+C (44 pts) median survival was 28 weeks. For third group (29 pts) median survival was 56 weeks. Until now, for the 7 pts who underwent a surgical resection median survival is 92 weeks, with one pt alive, without evidence of disease, at 112 weeks of follow up Conclusions: Both regimens showed better efficacy than 5-FU based chemotherapy, the combination did not show better survival. The third group has better median survival, probable due to the use of second line therapies. Combining chemotherapy + surgical resection may be a better treatment for some few, well selected patients. No significant financial relationships to disclose.

Geoprocessing in health area

The map's usage and the concerns about geographic distribution related with diseases are not a recent issue. A classical example is the John Snow survey -maps were used to locate cholera's cases and related them with the water supplying. The spatial representation techniques are fewer used in health sectors due to troubles in managing such information. So, the aim of this survey was to establish the disease spatial distribution in Ribeirão Preto, 2002. Secondary data were used to elaborate this study. The spatial distribution of cases was realized by using the MapInfo 7.8 software. Although many cases were concentrated in the northeast region in the city, which consists the quarters of low economical income. The results contribute to show the Tb spatial distribution in Ribeirao Preto, they also reinforce the space category as a methodological alternative to manage, to monitor and to evaluate the health actions by directing interventions to decrease the iniquities.

Inequidad de ingreso y autopercepción de salud: un análisis desde la perspectiva contextual en las comunas chilenas

The correlation between income inequality and life expectancy was demonstrated 10 years ago, but later, several studies suggested that the negative impact of a low economic income on the health status was disappearing. To assess the independent effects of community income inequality on self rated health in Chile. Multilevel analysis of the 2000 National Socio Economic Characterization Survey (CASEN) data from Chile. Individual level information included self rated health, age, sex, ethnicity, marital status, education, income, type of health insurance and residential setting (urban/rural). Community level variables included the Gini coefficient and median income. The main outcome measure was dichotomized self rated health (0 if excellent, very good or good; 1 if fair or poor). 101,374 individuals (at level 1) aged 18 and above, nested within 285 communities (at level 2) and 13 regions (at level 3) were studied. Controlling for a range of individual level predictors, a significant gradient was observed between income and poor self rated health, with very poor most likely to report poor health (10.5%) followed by poor (9.5%) low (9%) middle (7%), high (6%) and very high (4.5%) income earners. Controlling for individual and community effects of income, a significant non linear effect of community income inequality was observed, with the most unequal communities being associated with approximately 5% higher likelihood of reporting poor health compared to the most equal communities. Individual income does not explain any of the between community differences and neither does it wash the significant effects of income inequality on poor self rated health. The contextual effect of inequality is almost as large as the differential observed in poor health comparing the very poor to the very rich individual income categories.

Ascaris-Trichuris association and malnutrition in Brazilian children.

This work was designed to evaluate the role of intestinal parasites on nutritional status in three rural areas of Brazil. A total of 520 children aged 1-12 years were studied through a questionnaire concerning housing, socio-economic conditions and a 24-h food intake recall. Measurements of weight and height were also performed, and three stool samples were collected on consecutive days for parasitological analysis. Scores of the standard deviation (z-scores) for the weight-for-height and height-for-age were used to characterise the growth profile. A high prevalence of intestinal parasites was detected, with Giardia lamblia (44%), Endolimax nana (43%), Ascaris lumbricoides (41%) and Trichuris trichiura (40%) being the most prevalent. Eleven per cent of the children were classified as showing stunting. Inadequate daily caloric intake was observed in 78% of the population and the proportion of those with inadequate protein intake was 34%. Logistic regression analysis was employed for the multivariate study. Stunting was significantly associated with estimators of low economic income, inadequate protein intake and polyparasitism, especially the association between Ascaris lumbricoides and Trichuris trichiura.

Some important factors in perinatal mortality statistics in a rural state

The aid of a biostatistician in the planning of a combined study of perinatal mortality and in evaluating the data is evident.In North Carolina the socioeconomic and environmental factors are significant but the variables indicate that the racial factor becomes less significant.The poorly educated female in the low economic income group is subject to greater hazards from antepartum, intrapartum, and postpartum complications. These complications contribute to the increase in perinatal mortality.The increased incidence of spontaneous premature rupture of the membranes warrants special mention in this group of patients.In a related study of premature infants who lived at least 5 years there was a definite increase in minor and major defects; in social studies they tested at a lower level.It is again evident that maternal and perinatal morbidity and mortality cannot be “cured” by medical care, alone.