Low Socioeconomic Factors Research Articles

Salmonella infections modelling in Mississippi using neural network and geographical information system (GIS)

ObjectivesMississippi (MS) is one of the southern states with high rates of foodborne infections. The objectives of this paper are to determine the extent of Salmonella and Escherichia coli infections...

Family income per capita, age, and smoking status are predictors of low fiber intake in residents of São Paulo, Brazil

We hypothesized that dietary total fiber intake may be less than recommendations and that the intake of total, soluble, and insoluble fiber may be associated with demographic, lifestyle, and socioeconomic factors. Data were drawn from the Health Survey of São Paulo, a cross-sectional population-based study. Adolescents, adults, and elderly persons living in São Paulo city were included. Demographic, lifestyle, and anthropometric data were collected from households. Dietary intake was measured using two 24-hour dietary recalls. All analyses were conducted based on the sample design of the study. The proportion of individuals who met the adequate intake (AI) for total fiber intake was examined, and foods that contributed to the intake of fiber and fractions were evaluated. The relationship of total, soluble, and insoluble fiber intake with demographic, socioeconomic, and lifestyle characteristics was determined using multiple linear regression models. A low proportion of individuals met the AI for dietary fiber. The foods that most contributed to total fiber intake were beans, French bread, and rice. Total fiber intake was negatively associated with former and current smokers and positively associated with family income per capita and age. Soluble fiber intake was negatively associated with current smokers and positively associated with female sex, age, and family income per capita. Insoluble fiber intake was negatively associated with former or current smokers and positively associated with age. In summary, residents in the city of São Paulo had a low fiber intake, and demographic, socioeconomic, and lifestyle factors were associated with dietary fiber and intake of its fractions.

Anemia Among Children Exposed to Polyparasitism in Coastal Kenya.

Anemia represents a substantial problem for children living in areas with limited resources and significant parasite burden. We performed a cross-sectional study of 254 Kenyan preschool- and early school-age children in a setting endemic for multiple chronic parasitic infections to explore mechanisms of their anemia. Complete venous blood cell counts revealed a high prevalence of local childhood anemia (79%). Evaluating the potential links between low hemoglobin and socioeconomic factors, nutritional status, hemoglobinopathy, and/or parasite infection, we identified age < 9 years (odds ratio [OR]: 12.0, 95% confidence interval [CI]: 4.4, 33) and the presence of asymptomatic malaria infection (OR: 6.8, 95% CI: 2.1, 22) as the strongest independent correlates of having anemia. A total of 130/155 (84%) of anemic children with iron studies had evidence of iron-deficiency anemia (IDA), 16% had non-IDA; 50/52 of additionally tested anemic children met soluble transferrin-receptor (sTfR) criteria for combined anemia of inflammation (AI) with IDA. Children in the youngest age group had the greatest odds of iron deficiency (OR: 10.0, 95% CI: 3.9, 26). Although older children aged 9-11 years had less anemia, they had more detectable malaria, Schistosoma infection, hookworm, and proportionately more non-IDA. Anemia in this setting appears multifactorial such that chronic inflammation and iron deficiency need to be addressed together as part of integrated management of childhood anemia.

Ecological correlation between diabetes hospitalizations and fine particulate matter in Italian provinces.

BackgroundExposure to particulate matter has been associated with increased risk of cardiovascular and respiratory diseases. We evaluated the ecological correlation between standardized hospital discharges with diabetes in Italian provinces and fine particulate matter (PM2.5) adjusting for common risk factors, socioeconomic factors and differences in hospitalization appropriateness.MethodsWe used cross sectional data aggregated at the province level and available from official institutional databases for years 2008–2010. Covariates included prevalence of adult overweight, obese, smokers, physically inactive, education and income (as average gross domestic product per person, GDP). We reduced the number of covariates to a smaller number of factors for the subsequent statistical model by extracting meaningful components using principal component analysis (PCA). Log-linear multiple regression analysis was used to model diabetes hospital discharges with PCA components and PM2.5 levels and hospitalization appropriateness for men and women.ResultsThe first PCA components for both men and women were characterized by larger loadings of risk factors (obesity, overweight, physical inactivity, cigarette smoking) and lower socioeconomic factors (educational level and mean GDP). Diabetes hospitalization increases with the first PCA component and decreases with the index of hospitalization appropriateness. In fully adjusted models, diabetes hospitalizations increase with increasing annual PM2.5 concentrations, with a rise of 3.5 % (1.3 %–5.6 %) for men and of 4.0 % (1.5 %-6.4 %) for women per unit of PM2.5 increase.ConclusionsWe found a significant ecological relationship between sex and age standardised hospital discharge with diabetes as principle diagnosis and mean annual PM2.5 concentrations in Italian provinces, once that covariates have been accounted for. The relationship was robust to different means of estimating PM2.5 exposure. A large portion of the variance of diabetes hospitalizations was linked to differences of hospital care appropriateness between Italian regions and this variable should routinely be included in ecological analyses of hospitalizations.

BALNEOLOGIC, BALNEOMUD AND CLIMATIC RECREATIONAL RESOURCES NORTH-WESTERN BLACK SEA COAST IN RESORT FUNCTION OF REGION

Balneology and climate balneomud recreational resources are an important component of recovery, treatment and rehabilitation of all population groups. The most modern and equipped resorts North-Western Black Sea can potentially significantly increase its contribution to improving the quality of life of the population and the resort functions of region. This article discusses some of the profiling of the Black Sea and recreation systems balneomud climatetype, and the use of their resources. Objective of this paper is to study mineral and mud resources of the most important territorial recreation systems of the three regions of the North-Western Black Sea region of Ukraine: Odessa, Mykolayiv and Kherson in terms of their recreational and tourist use, aswell as to diversify the socio-economic features of the region. We used the methods of content analysis of the literature and reporting information, statistical processing of data, estimates Bonitation factors functioning and development of recreation systems. Having studied in this research balneotherapy, mud-bath and climatic resources in the most perspective recreational systems Northwestern Black Sea resorts on the example ofOdessa, Nikolaev, Kherson region, we have identified the characteristics of their recreational and tourist use, socio-economic functions of these regions. By systematizing and analyzing the data, a table Bonitation rated resorts Kuyalnik, Lebedevka, Sergeevka, Ochakov Rybakovka, Gopri, skadovsk that defines recreational potential areas on the main indicators. The highest score (29) received resorts Kuyalnik and Skadovsk mainly due to tourism infrastructure and a well-developed social and economic spheres. Fewer points (27) observein resorts Sergeevka, Ochakov, Gopri the territories which received low marks cultural-historical and socio-economic factors. The lowest score (22 and 25) counted resorts Lebedevka and Rybakovka in terms of natural, cultural-historical, infrastructural and socio-economic factors. For further use of the recreational areas considered necessary to create individual programsto improve the tourist potential of resorts that would include data on the degree of development of various factors affecting the increase or decrease of capacity to function of resorts and the region as a whole.

Spatial and non-spatial determinants of successful tuberculosis treatment outcomes: An implication of Geographical Information Systems in health policy-making in a developing country

This retrospective study aimed to address whether or to what extent spatial and non-spatial factors with a focus on a healthcare delivery system would influence successful tuberculosis (TB) treatment outcomes in Urmia, Iran. In this cross-sectional study, data of 452 new TB cases were extracted from Urmia TB Management Center during a 5-year period. Using the Geographical Information System (GIS), health centers and study subjects’ locations were geocoded on digital maps. To identify the statistically significant geographical clusters, Average Nearest Neighbor (ANN) index was used. Logistic regression analysis was employed to determine the association of spatial and non-spatial variables on the occurrence of adverse treatment outcomes. The spatial clusters of TB cases were concentrated in older, impoverished and outskirts areas. Although there was a tendency toward higher odds of adverse treatment outcomes among urban TB cases, this finding after adjusting for distance from a given TB healthcare center did not reach statistically significant. This article highlights effects of spatial and non-spatial determinants on the TB adverse treatment outcomes, particularly in what way the policies of healthcare services are made. Accordingly, non-spatial determinants in terms of low socio-economic factors need more attention by public health policy makers, and then more focus should be placed on the health delivery system, in particular men’s health.

Food Security in a Regional Area of Australia: A Socio-economic Perspective

While Australia is considered to be a highly food-secure nation, some populations are more vulnerable to food insecurity than others and this applies to Tasmania, an island state of Australia. The aim of this study was to highlight food security issues in the two local government areas of Dorset and Clarence in Tasmania, Australia. This paper reports on the key quantitative findings of the project with a focus on food access and food utilisation, and their association with socio-economic factors. Quantitative data were collected from a total of 835 survey participants using a questionnaire developed in close consultation with service provider organizations as well as public health and nutrition experts. The study revealed 53 (6.6%) residents were at the low food security and 18 (2.1%) who literally went without food. The significant correlations between low food security and socio-economic factors evidenced in the study further suggested that the low-food security residents were more likely to come from the more vulnerable groups of low income families (χ2= 42.528, df = 6, p < 0.05), the younger and older population groups (χ2= 12.361, df = 5, p < 0.05) or those living in socio-economically disadvantaged rural areas (χ2= 165.9, df =7, p < 0.05). A link between physical and financial access was clearly indicated due to high fuel cost (44.4%) which was the most common barrier reported among those who used personal vehicles for travelling to and from food shops. The study findings help to direct strategic policies to food security for the future of such as the for all Tasmanians strategy by the Tasmanian Food Security Council which focuses on ensuring social food equity for all Tasmanians. These strategies include promoting publicly funded community cars, promoting local produce and food access initiatives such as increased farm gate sales, farmer markets, food cooperatives, community gardens and growing and swapping produce within communities.

Low Socioeconomic Factors: Not a Limiting Factor for African American Men

A study on the lived experiences of 14 adult African American men, who grew up in low socioeconomic status (SES)households, was undertaken to determine factors that helped them overcome disadvantage and ultimately achievepositive life outcomes. Theoretically, the odds would seem to be stacked against them. Low SES is an especiallydifficult condition for many African Americans to overcome and may be a catalyst for under achievement ineducation, while fomenting antisocial behavior, and oppositional thinking. The reasons are manifold and complex;the literature graphically details social and economic inequities that occur in low SES environments. Throughpersonal demographic data and verbal reflections, the participants provided insights of events that led to positive lifeoutcomes. Keys to success were found in education attainment, athletic and extracurricular activities, and having atleast one adult mentor/role model whose nurturing, guidance, and love kept them on a straight line trajectory towardadulthood. Their life stories were dotted with influences owing to adult norms whose example helped them overcomelow SES quality of life issues including racially based contextual stressors.

The Prevalence and Pattern of Superficial Fungal Infections among School Children in Ile-Ife, South-Western Nigeria

Fungal infections of the skin and nails are common global problems with attendant morbidity among affected individuals. Children are mostly affected due to predisposing factors such as overcrowding and low socioeconomic factors. The aim of this study was to determine the prevalence and the clinical patterns of superficial fungal infections among primary school children in Ile-Ife. A multistage sampling was conducted to select eight hundred pupils from ten primary schools in Ile-Ife. Data on epidemiological characteristics and clinical history was collected using a semistructured questionnaire and skin scrapings were done. The prevalence of superficial fungal infections among the 800 respondents was 35.0%. Male pupils constituted 51.0% of respondents while the females were 49.0%. The mean age for all the respondents was 9.42 ± 2.00. Tinea capitis was the commonest infection with a prevalence of 26.9% and tinea unguium, tinea corporis, and tinea faciei had a prevalence of 0.8%, 0.6%, and 0.5%, respectively. Tinea manuum had the least prevalence of 0.1%. Pityriasis versicolor had a prevalence of 4.4%. Microsporum audouinii was the leading organism isolated. The study shows that the prevalence of superficial fungal infection (SFI) among primary school children in Ile-Ife is high with tinea capitis as the commonest SFI.

The association of low socioeconomic status and the risk of having a child with Down syndrome: a report from the National Down Syndrome Project

Advanced maternal age and altered recombination are known risk factors for Down syndrome cases due to maternal nondisjunction of chromosome 21, whereas the impact of other environmental and genetic factors is unclear. The aim of this study was to investigate an association between low maternal socioeconomic status and chromosome 21 nondisjunction. Data from 714 case and 977 control families were used to assess chromosome 21 meiosis I and meiosis II nondisjunction errors in the presence of three low socioeconomic status factors: (i) both parents had not completed high school, (ii) both maternal grandparents had not completed high school, and (iii) an annual household income of <$25,000. We applied logistic regression models and adjusted for covariates, including maternal age and race/ethnicity. As compared with mothers of controls (n = 977), mothers with meiosis II chromosome 21 nondisjunction (n = 182) were more likely to have a history of one low socioeconomic status factor (odds ratio = 1.81; 95% confidence interval = 1.07-3.05) and ≥2 low socioeconomic status factors (odds ratio = 2.17; 95% confidence interval = 1.02-4.63). This association was driven primarily by having a low household income (odds ratio = 1.79; 95% confidence interval = 1.14-2.73). The same statistically significant association was not detected among maternal meiosis I errors (odds ratio = 1.31; 95% confidence interval = 0.81-2.10), in spite of having a larger sample size (n = 532). We detected a significant association between low maternal socioeconomic status and meiosis II chromosome 21 nondisjunction. Further studies are warranted to explore which aspects of low maternal socioeconomic status, such as environmental exposures or poor nutrition, may account for these results.

Hepatitis E virus and hepatitis A virus exposures in an apparently healthy high-risk population in Italy

The prevalence of anti-hepatitis E virus (HEV) and anti-hepatitis A virus (HAV), as well as the possible links with socio-demographic and other viral risks factors, were evaluated in an inmates population. The study population consisted of 973 consecutively recruited inmates of eight Italian prisons. The anti-HEV prevalence was 11.6 % (113/973). It increased significantly by age (χ(2) for linear trend: p = 0.001) and was significantly higher among non-Italian compared to Italian inmates (15.3 vs. 10.7 %, respectively). Age >40 years [odds ratio (OR) 2.1; 95 % confidence interval (CI) 1.4-3.1], non-Italian citizenship (OR 1.8; 95 % CI 1.1-2.9) and anti-HIV seropositivity (OR 2.2; 95 % CI 1.2-4.2) were the only factors independently associated to anti-HEV positivity by logistic regression analysis. The overall anti-HAV prevalence was 86.4 %, and was significantly higher in non-Italian compared to Italian prisoners (92.6 vs. 84.9 %, respectively; p = 0.02). Age older than 40 years (OR 3.6; 95 % CI 2.2-5.9), <5 years formal education (OR 2.1; 95 % CI 1.3-3.2) and non-Italian nationality (OR 2.7; 95 % CI 1.5-4.8) were factors independently associated to anti-HAV positivity by the logistic regression analysis. Compared to the general population, significantly higher anti-HEV and anti-HAV prevalences were observed in an inmates population in Italy. Old age and non-Italian nationality were factors independently related to both HEV and HAV exposures. This data suggest the important role of low socio-economic factors in the transmission of both infections in high-risk populations. The possible epidemiological and/or pathogenetic links between HEV and HIV exposures need to be studied further.

Stress urinary incontinence in climacteric women in a northeastern Brazilian municipality: a household survey

Low socioeconomic factors may influence the development of stress urinary incontinence (SUI). Thus far, there is little research available on SUI in developing countries. We aimed to determine whether the prevalence of SUI in a northeastern Brazilian municipality was higher or lower than in the general female population. Cross-sectional household cluster study of 1,180 climacteric women in the São Luís municipality (Maranhão state, Brazil) was conducted using a standardized questionnaire that was previously tested in a pilot study and administered by interviewers to obtain socioeconomic and cultural information, climacteric aspects, and life habits related to SUI. From this population, 15.34% (n = 181) had SUI; this prevalence did not change with age. More than half (57.92%) of the patients replied that they had not consulted a physician for their SUI. The presence of SUI was not associated with any socioeconomic or gynecological variables after multivariate analysis. The prevalence of SUI in São Luís was similar to the rates observed in the general global female population. Socioeconomic and gynecological variables were not associated with SUI.

Abstract 2365: Impact of Socioeconomic Level on Cardiovascular Risk in Ischemic Stroke Patients: The OPTIC Registry

Background : The impact of socioeconomic factors (SEF) on the risk of future vascular events in stroke patients has been understudied. The Outcomes in Patients with TIA and Cerebrovascular disease (OPTIC) registry included patients in secondary prevention of stroke. Objective : to stratify the risk of vascular event recurrence in patients with cerebral infarction according to presence of PAD, ankle-brachial index (ABI), known coronary artery disease (CAD), involvement of several arterial beds, geographic variations and SEF. Method : Between January 2007 and December 2008, 3635 patients aged 45 years or older were enrolled in the OPTIC registry from 245 sites in 17 countries in the following regions: Latin America (1543 patients), Middle East (1041 patients), North Africa (834 patients), and South Africa (217 patients). PAD was present in 7.8%, ABI in 22%, CAD in 12.8%, and 31.1% were unemployed, 26.2% had less than 2 school years, 23% of patients had no health insurance, 12.8% lived in rural area, 8.4% lived alone, 7.5% did not live in a house/flat. Primary endpoint included vascular death (VD), myocardial infarction (MI) and stroke. Results : During median follow-up of 731 days, 524 patients had at least 1 primary event; 190 patients had VD, 88 nonfatal MI, and 296 nonfatal stroke. The estimated risk of primary endpoint was 15.6% (95%CI, 14.4-17.0%) at 2-year. The risk increased with the number of vascular beds involved from 13.1% to 30.7% (p for trend&lt;0.001). Using patients from Latin America as reference, age-sex-adjusted HR was 1.29 (95%CI, 1.04-1.60) for Middle East, 1.31 (95%CI, 0.90-1.89) for South Africa, and 1.64 (95%CI, 1.32-2.04) for North Africa. The absolute additional risk of having a primary endpoint ranged between, 4.7% for unemployed patients to 17.5% for patients not living in a house/flat. In multivariate analysis, living in rural area, not living in a house/flat, unemployment status, no health insurance cover, and less than 2-years school were associated with an increased cardiovascular risk (all adjusted p&lt;0.004). There was a stepwise increase in the primary endpoint with the number of low SEF ranging from 13% to 62% (adjusted p-value for trend&lt;0.001). Conclusions : vascular risk in stroke patients in North and South Africa, Middle East and Latin America varies not only with the number of arterial beds involved but also with socio-economic variables, particularly poor health insurance cover, not living in a house/flat and low education level

La promotion de la protection solaire est-elle une urgence pour prévenir le cancer de la peau au Maroc ?

The effects of ultraviolet (UV) radiation on life on Earth have continuously been the subject of research. Over-exposure to UV radiation is harmful, but small amounts of exposure are required for good health. It is, therefore, crucial for humans to optimise their own UV exposure and not exceed UV levels that are sufficient for essential biological functions. Exceeding those levels may increase risk of developing health problems including skin cancer and cataracts. Smartphones have been previously investigated for their ability to detect UV radiation with or without additional devices that monitor personal UV exposure, in order to maintain safe exposure times by individuals. This review presents a comprehensive overview of the current state of smartphones' use in UV radiation monitoring and prediction. There are four main methods for UV radiation detection or prediction involving the use smartphones, depending on the requirements of the user: devoted software applications developed for smartphones to predict UV Index (UVI), wearable and non-wearable devices that can be used with smartphones to provide real-time UVI, and the use of smartphone image sensors to detect UV radiation. The latter method has been a growing area of research over the last decade. Built-in smartphone image sensors have been investigated for UV radiation detection and the quantification of related atmospheric factors (including aerosols, ozone, clouds and volcanic plumes). The overall practicalities, limitations and challenges are reviewed, specifically in regard to public education. The ubiquitous nature of smartphones can provide an interactive tool when considering public education on the effects and individual monitoring of UV radiation exposure, although social and geographic areas with low socio-economic factors could challenge the usefulness of smartphones. Overall, the review shows that smartphones provide multiple opportunities in different forms to educate users on personal health with respect to UV radiation.

Informed consent for clinical trials: a review

To identify and highlight challenges related to informed consent process for clinical trials in sub-Saharan Africa. Published original research findings and reviews in the English literature, together with anecdotal information from our current professional experiences with clinical trials. Review of peer-reviewed articles. Online searches were done and requests for reprints from corresponding authors and institutional subscription. Information categorised accordingly. Informed consent for clinical trials conducted in sub-Saharan Africa (SSA) is not always "truly informed" or "truly voluntary". Guidelines for obtaining informed consent are often difficult to implement because of low literacy levels, socio-economic and cultural factors. The local ethics committees, whose role is critical in informed consent, are weak, ill-equipped or non-existent in some countries. Many participants may have incomplete understanding of the various aspects of the clinical trials due to language barriers, the way information is disclosed or terms used for informed consent documents. In some settings, clinical trials are the only access to health care services for the local population. Further, participants may enroll with perceived notion of cure of their conditions, for monetary or material benefits. There is need for national guidelines on clinical research including ethics review, compensation of subjects, requirements for research investigators, facilities and ethics committees as well as budgetary allocation. These guidelines must not only address specific and unique local circumstances but also meet minimum international clinical research standards. Local bioethics and research capacity should be developed and strengthened with research sponsors contributing towards this. Local research is needed on the validity and reliability of informed consent for clinical trials and factors influencing that in different socio-cultural settings in SSA.

Rubella seroprevalence among primary and pre- primary school pupils at Moi's Bridge location, Uasin Gishu District, Kenya.

BackgroundRubella is an infectious and generally mild childhood viral disease. The disease is of public health importance because infection acquired during early pregnancy often results in foetal abnormalities that are classified as congenital rubella syndrome (CRS). The burden of rubella infection in most developing countries in not well documented because of limited epidemiological data. However, availability of an effective vaccine has made it necessary to have all the countries with no routine vaccination schedule to evaluate the burden of disease in order to make informed decisions on rubella vaccination and strategy. To address this gap we conducted a study to determine age-specific rubella seroprevalence rates and related risk factors among primary and pre-primary school children in Uasin Gishu district, Moi's Bridge location of Kenya.MethodsSubjects of the study were 498 pupils from seven primary schools aged 4–20 years. Questionnaire surveys with blood sampling were conducted between January to July 2005. Samples were tested for rubella specific IgG antibody using ELISA test kit (Enzygnost® Behring, Germany).ResultsOverall, rubella seropositivity rate was 80% and it increased with age from 59% (among ages 4–6 years) to 94% (ages 14–20 years). Multivariate logistic regression analysis model, showed that age of child and ownership of a television set which is a proxy measure of socio-economic status of family were significantly associated with rubella seropositivity. The odds of rubella seropositivity in a child older than 13 years was more than that in children younger than 7 years (OR = 3.8 95% CI 2.56–5.78). The odds of rubella seropositivity in a child whose family did not own a television set was 3 times higher than that of child whose family owned a set (OR 3.06, 95% CI 1.17–7.97).ConclusionThe study provides important and highly useful information on rubella age specific seroprevalence rates in Kenya. Advancing age was found to be associated with increased risk of rubella. Low socio-economic factors suggest an increased risk of infection in certain categories of society, and control measures need to target this. Overall, the findings can also be used by policy makers to model introduction of routine rubella vaccination in the country and also other developing countries facing similar challenges. More than half of the children got infected in pre-primary and efforts to control rubella should target pre-school children. These data provides pre-vaccination information that can be used to guide immunization strategy as well as to determine success of an immunization programme.

Risk factors for pre-term birth in Iraq: a case-control study

BackgroundPreterm birth (PTB)is a major clinical problem associated with perinatal mortality and morbidity. The aim of the present study is to identify risk factors associated with PTB in Mosul, Iraq.MethodsA case-control study was conducted in Mosul, Iraq, from 1st September, 2003 to 28th February, 2004.ResultsA total of 200 cases of PTB and 200 controls of full-term births were screened and enrolled in the study. Forward logistic regression analysis was used in the analysis. Several significant risk associations between PTB and the following risk factors were identified: poor diet (OR = 4.33), heavy manual work (OR = 1.70), caring for domestic animals (OR = 5.06), urinary tract infection (OR = 2.85), anxiety (OR = 2.16), cervical incompetence (OR = 4.74), multiple pregnancies (OR = 7.51), direct trauma to abdomen (OR = 3.76) and abortion (OR = 6.36).ConclusionThe main determinants of PTB in Iraq were low socio-economic status and factors associated with it, such as heavy manual work and caring for domestic animals, in addition to urinary tract infections and poor obstetric history.

Factors influencing health-related quality of life in chronic liver disease

To investigate the factors contributing to health-related quality of life (HRQL) in chronic liver disease (CLD). Patients with CLD and age- and sex-matched normal subjects performed the validated Thai versions of the short-form 36 (SF-36) by health survey and chronic liver disease questionnaire (CLDQ). Stepwise multiple regression analysis was used to assess the impact of disease severity, demography, causes of CLD, socioeconomic factors, and self-rating health perception on HRQL. Two-hundred and fifty patients with CLD and fifty normal subjects were enrolled into the study. Mean age and the numbers of low educated, unemployed, blue-collar career and poor health perception increased significantly from chronic hepatitis to Child's Classes A to B to C. Advanced stage of CLD was related to deterioration of HRQL. Increasing age and female reduced physical health area. Low socioeconomic factors and financial burden affected multiple areas of HRQL. In overall, the positive impact of self-rating health perception on HRQL was consistently showed. Advanced stages of chronic liver disease, old age, female sex, low socioeconomic status and financial burden are important factors reducing HRQL. Good health perception improves HRQL regardless of stages of liver disease.

Antenatal care in the capital city of Cambodia: Current situation and impact on obstetric outcome

To analyze the situation of antenatal care (ANC) attendance in the capital of Cambodia, Phnom Penh, and the effect of ANC attendance on delivery and newborn outcome, in order to establish a strategy for ANC in the national reproductive health program in Cambodia. This was a health facility-based retrospective cohort study. Background factors (education, household income, and parity) were obtained through interview, and obstetric information (cesarean section, low birth-weight, and maternal complications) were collected from the medical records of women who delivered during 1 month at all the public and private health facilities in Phnom Penh. Relations were analyzed between the number of ANC visits, background factors, and obstetric outcome. A total of 1204 responses were received from Phnom Penh residents, representing 84% of the estimated number of deliveries in the city. Of these, 89% were from public health facilities. Low educational level, low household income, and multiparity were risk factors for ANC attendance. There was no association between the number of ANC attendances and obstetric outcome. Our study has shown that Phnom Penh residents have good access to ANC and delivery care. Low socioeconomic factors are risk factors to ANC. The number of ANC visits had no association with poor perinatal outcome, but further study on quality of ANC and its impact on obstetric outcome is needed. Within the limited resources, safe motherhood strategies need to be targeted to the rural area and to the poor in order to increase access to ANC and delivery care.

Gender and alcohol moderate caregiver reported child behavior after prenatal cocaine

Objective The concurrence of prenatal alcohol exposure with other drug exposure, low socioeconomic status and environmental risk factors may obscure associations, if any, between prenatal cocaine exposure and child outcomes. This study evaluates the effects of prenatal cocaine exposure on child behavior in analyses stratified by gender and prenatal alcohol exposure status. Methods Maternal alcohol, cigarette, and illicit drug use were prospectively assessed by interview during pregnancy and postnatally. Maternal and neonatal urine were tested for drug exposure as clinically indicated. Caregiver report of child behavior was assessed with the Achenbach Child Behavior Checklist (CBCL). Dichotomous cocaine exposure was characterized as no (negative history and biologic markers), and any (positive history and/or biologic markers during pregnancy and/or positive urine screen at delivery from either mother or infant). Results Prenatal cocaine exposure was associated with adverse effects on offspring behavior that were moderated by the gender of the offspring as well as prenatal alcohol exposure. For girls without prenatal alcohol exposure, 6.5% of the unique variance in behavior was related to prenatal cocaine exposure. For these girls, the odds of scoring in the abnormal range for Aggression was 17 times control levels (95% confidence limits 1.4 to 203). These findings, though significant, have wide confidence intervals and need to be replicated in larger cohorts and on longitudinal follow-up.