Low Socioeconomic Individuals Research Articles

Impact on Fecal Microbiota and Health-Related Markers of an Intervention Focused on Improving Eating Behavior in People at Risk of Food Insecurity.

Non-communicable diseases are particularly prevalent among low-income individuals and are associated with the consumption of processed foods, fat, and sugars. This work aims to evaluate the impacts of a nutrition education intervention for low socio-economic individuals on sensory perception, health-related parameters and gut microbiota. Twenty low-income adults underwent a 4-week intervention. Dietary information (three 24 h recalls), detection thresholds and discrimination scores (salty and sweet), and severity of depressive symptoms (Beck Depression Inventory-II (BDI-II)) were collected. Fecal microbial composition and short chain fatty acids were determined by 16S ribosomal RNA-gene sequencing and gas chromatography, respectively. After the intervention, 35% of subjects presented higher compliance with dietary recommendations, increased consumption of vegetables and lignans and reduced consumption of processed meats and nitrosamines, together with depleted levels of Actinomycetota. Higher discrimination for salty and sweet and lower BDI-II scores were also obtained. This nutrition education intervention entailed changes in dietary intake towards healthier food options, reduced potentially carcinogenic compounds and improved scores for discrimination and severity of depressive symptoms. The confirmation of these results in future studies would enable the design of strategic policies contributing to the optimal nutrition of materially deprived families through affordable healthy plant-based interventions.

Cross-sectional Use Patterns and Characteristics of Premium Versus Non-Premium Cigar Smokers in the United States, 2010-2019.

Few studies have addressed the use patterns and characteristics of the past 30 days of premium versus non-premium cigar smokers. We pooled 10 years of data from the National Survey on Drug Use and Health (NSDUH; 2010-2019) to evaluate use patterns and demographic and tobacco use characteristics of premium and non-premium cigar smokers ages 12 years and older in the U.S. cigar-type was manually coded as premium or non-premium according to the brand used most often. Between 2010 and 2019, 4.7% (95% CI = 4.6-4.8) of individuals aged 12 and older currently smoked cigars (past-30-day use). Smoking premium cigars (0.9% [95% CI = 0.8-0.9]) was less prevalent than smoking non-premium cigars (3.0% [95% CI = 2.9-3.1]). Although current non-premium cigar smoking prevalence steadily declined over the years, current premium cigar smoking prevalence remained stable. Premium cigar smokers were more likely to be older (≥25 years), male, non-Hispanic white, heterosexual, college educated, living in a large metro area, and to have income above 200% of the poverty threshold compared to non-premium users (p < .05). Additionally, past-30-day premium cigar smokers were less likely than non-premium users to initiate cigar smoking before the age of 18 years, smoke cigars frequently or daily, smoke cigarettes, or use marijuana (p < .05). Overall, premium cigar smoking is less prevalent than non-premium cigar smoking, especially among populations such as youth, racial/ethnic and sexual minorities, and low socioeconomic individuals. Premium cigar smokers tend to smoke infrequently and initiate cigars later in life compared with non-premium smokers. Study results can inform recommendations for regulating premium cigars. This study found that between 2010 and 2019, there are meaningful differences in the use patterns and characteristics of past-30-day premium versus non-premium cigar smokers in the United States. Premium cigars comprise a small share of the market compared to other cigar types and are less likely to be used by youth and other tobacco control priority groups (eg, racial/ethnic minorities and individuals with low socioeconomic statuses) that bear a disproportionate burden of risk and harm from using tobacco products. Additionally, most premium cigar users smoke them only occasionally. However, it is important to continue to monitor premium cigar use, as these patterns could shift because of factors like changes in marketing practices, consumer awareness, and product prices. Tobacco policy changes may also alter the patterns and trends of premium cigar use over time. A greater, more comprehensive understanding of premium cigars' physical characteristics, patterns of use, user perceptions, tobacco industry marketing strategies, and health effects will together help to inform cigar-related regulations.

Reflection of Types of Prosocial Behavior During COVID-19 in Collectivistic Asian Countries-India and Indonesia.

COVID-19 is an infectious disease that has widened the gap between victims and non-victims in society. Understanding how individuals support and assist COVID-19 sufferers in a pandemic crisis is critical. Thus, this study aims to qualitatively evaluate the prosocial intention and types of prosocial behavior toward COVID-19 victims by low socioeconomic individuals from India and Indonesia’s collectivistic societies. We conducted semi-structured and in-depth interviews during the lockdown from March to May 2020, via phone and in-person, using a purposive selection of respondents (total n = 50). The data were analyzed using the qualitative synthesis method. Five themes were discovered: 1) too scared to help, 2) love to help but scared: moral dilemma, 3) informing authority who knows how to handle, 4) caring, sharing, and supporting, but with a distance, and 5) helping at one’s personal health risk. This study highlights that prosocial intentions range from minor acts of kindness to self-harm and out-of-bounds acts of kindness for COVID-19 victims.

Understanding health problems in people with extremely low health-related quality of life in Korea

Little is known about patients reporting extremely poor health-related quality of life (HRQoL). This study targeted population with inferior HRQoL and examined their problems experienced with HRQoL dimensions, and impacts of different morbidities on these problems. Data were obtained from a population-based survey in Korea. HRQoL was measured by EQ-5D questionnaire and low-HRQoL population was defined as individuals whose EQ-5D utility score was among the lowest 5% of total survey population. Logistic regression models were used to evaluate the impact of fifteen morbidities on HRQoL dimensions. Of 2976 low-HRQoL participants, females and low socioeconomic individuals were predominant. They experienced significantly more problems in all dimensions, with pain/discomfort, and mobility as the most frequently reported problems. Problems in HRQoL dimensions diverged according to diseases. Individuals with arthritis experienced more difficulties with mobility (aOR 2.62, 95% CI 1.77–3.87) and pain/discomfort (aOR 2.86, 95% CI 1.78–4.60). Stroke patients experienced more problems in self-care (aOR 2.24, 95% CI 1.59–3.15) and usual activities (aOR 1.87, 95% CI 1.11–3.14). Having two or more diseases was associated with worse outcomes in usual activities and increased risk of depression. Thus, efforts to improve status of low-HRQoL should be customized to fulfil unmet needs corresponding to various diseases, and depression prevention is needed for those with multimorbidity status.

Abstract 13346: Sociobehavioral and Clinical Risk Factors Associated With Severe Asymptomatic Hypertension: A 1999-2018 National Health and Nutrition Examination Survey Analysis

Introduction: Individuals with severe asymptomatic hypertension (SAH) are at high risk of CVD. It is unclear which risk factors are associated with SAH and whether they are different in patients with &amp; without awareness of hypertension (HTN). We hypothesized self-reported HTN status would significantly modify the effect of factors associated with SAH. Methods: We included adults ≥20 years from the 1999-2018 National Health and Nutrition Examination Surveys. Mean BP was calculated as the average of 3 consecutive BP readings 30 seconds apart. SAH was defined as mean SBP≥180 or DBP≥120. We used survey design-adjusted multivariable logistic regression to identify demographic, behavioral, comorbid, and medication-related factors for SAH. We then determined the modifying effect of self-reported HTN on the independent associations between covariates and SAH. Results: Among the 44,622 participants (mean age 47, 51% female, 69% White, and 30% HTN), 0.9% had SAH. Nearly 26% with SAH did not report HTN diagnosis and 62% were taking ≤1 BP medication. SAH individuals were more likely to be older, female, non-Hispanic Black, of lower socioeconomic status, have CVD, and report lower alcohol and salt intake than those without SAH (Table). The significant associations between Black race, female sex, lower income, &amp; BMI and SAH were not different by self-reported HTN (Table). Self-reported HTN significantly modified the effect of older age (OR [95% CI]; HTN: 1.07 [1.06, 1.08], No HTN: 1.10 [1.08, 1.13]), lower education (HTN: 1.04 [0.77, 1.42], No HTN: 2.26 [1.15, 4.44]), lack of insurance (HTN: 2.82 [1.86, 4.28], No HTN: 1.01 [0.52, 1.96]), and CKD (HTN: 1.49 [1.12, 1.98], No HTN: 2.24 [1.25, 4.03]) on SAH. Conclusions: Regardless of self-reported HTN status, non-Hispanic Blacks, females, and lower socioeconomic individuals were independently associated with SAH in the U.S. Older age, low education level, and CKD may confer greater risk of SAH in patients lacking HTN awareness.

A cross sectional survey of internet use among a highly socially disadvantaged population of tobacco smokers

BackgroundTobacco smoking is highest among population groups which are the most socially disadvantaged. Internet-based smoking cessation programs have been found to be effective, though rates of internet access are not well known in these groups. This study describes the rates of internet use and types of technology used to access the internet by a population of socially disadvantaged smokers. The study also examined relationships between sociodemographic and smoking behaviours with amount of internet use and type of device used.MethodsA cross-sectional survey of 369 clients (response rate 77%) from two non-government community service organisations in metropolitan New South Wales, Australia was conducted using touchscreen computers. Descriptive statistics and logistic regressions were used to examine results.ResultsEligible participants ranged from 19 to 88 years old current tobacco users. Over half (58%) of the participants reported weekly or more frequent use of the internet with less than a third (28%) not having any access. The odds of using the internet at least weekly decreased with age and as heaviness of smoking increased (OR = 0.94, p < 0.001; OR = 0.81, p = 0.022, respectively). Odds of internet use were higher as income increased (OR = 2.74, p < 0.001 for individuals earning $201–$400 per week; OR = 2.83, p = 0.006 for individuals earning > $400 per week). Device use differed for age and income.ConclusionsInternet-based interventions appear to reach the majority of socially disadvantaged populations. It is expected that this reach will continue to grow, making internet-based interventions a potential platform for providing care to low socioeconomic individuals who smoke, however inequalities may be exacerbated for those individual without internet access.ImplicationsInternet use among socially disadvantaged tobacco users is moderate (58%). An internet-based smoking cessation intervention for socially disadvantaged tobacco users may be an effective intervention however, older, heavier tobacco users may not benefit as easily due to limited internet access and therefore acknowledging these limitations when developing an intervention can help to acknowledge limitation of intervention reach.

Practical and ethical issues for delivery of advanced ENT services in the Indian subcontinent: efforts to 'Bridge the Gap'.

The Indian healthcare industry, one of the largest in the world, caters for 1.3 billion people. The modern middle class addresses its needs by visiting private hospitals, which provide comprehensive services but at a high cost. The low socioeconomic individuals visit government hospitals where all basic services are available, but there is a struggle to provide advanced healthcare. In order to rectify this dichotomous approach, new initiatives are being implemented to provide uniform healthcare across the society. Technological advancements have been rapid and modern methods have reached the shores of India at the same pace as in the western world. In otolaryngology, advanced services especially for restoration of hearing loss and multimodality treatments for head and neck cancers have been two areas where practical and ethical dilemmas have existed to provide the most optimal treatment at subsidized costs. This article explores these two areas as examples to understand the specific problems encountered in delivering advanced ENT care in a low-resource setting in a large populous country. Introduction of government health insurance schemes have helped the poor to make use of advanced healthcare. The highlight of this scheme has been the inclusion of expensive interventions like cochlear and auditory brainstem implantation, whereby cost of the device, surgery and habilitation have all been delivered cost free for eligible children.

Hypertension, socioeconomic status and depressive symptoms in Chinese middle-aged and older adults: Findings from the China health and retirement longitudinal study

BackgroundThis study aimed to examine the effect of diagnosed hypertension on depressive symptoms and socioeconomic status (SES) as moderator in the effect in middle-aged and older adults in China. MethodsWe used data from the nationally representative survey of China Health and Retirement Longitudinal Study, including 6273 participants free from depressive symptoms at baseline in 2011–12. We assessed the depressive symptoms based on the 10-item Center for Epidemiological Studies Depression scale. We conducted Cox proportional hazards regression models to examine the effect of baseline diagnosed hypertension status on the subsequent depressive symptoms in 2011–15 with the report of Hazards ratios (HRs). ResultsThe diagnosed hypertensive participants were more likely to have depressive symptoms than non-hypertensive peers (HR = 1.12, 95% CI: 1.02–1.23) after adjusted for controlled variables. The effect only occurred in the group of low SES, with rural residency (HR = 1.13, 95% CI: 1.02–1.26), below-average household income (HR = 1.14, 95% CI: 1.02–1.26) and primary school or below educational attainment (HR = 1.12, 95% CI: 1.00–1.25). LimitationsMeasures of the onset or duration of hypertension were not included, which may modify the estimated effects on depressive symptoms. ConclusionsDiagnosed hypertension is a chronic stressor leading to depressive disorders, and the responses to this stressor merely occurred among the low socioeconomic individuals. Our findings underscored the importance of examining the connection between mental and physical health in the context of aging and shed lights on the action to developing strategies for detection and management of hypertension that could cause psychological stress, which may contribute to fighting against depressive symptoms, especially in the low SES population.

A Qualitative Study to Understand the Potential Efficacy of an Information-Based Sugar Reduction Intervention among Low Socioeconomic Individuals in the UK.

Sugar consumption in the UK consistently exceeds recommendations, despite the association it has with poor health outcomes. Low socioeconomic groups are most likely to over-consume sugar, which could exacerbate existing health disparities. Various interventions attempt to reduce the amount of sugar consumed, but their effectiveness is still unclear. This study qualitatively explored the sugar consumption behaviours of individuals experiencing food poverty, and examined how an information-based sugar reduction intervention might influence these behaviours. Eight clients and six volunteers from a food bank in Bristol (UK) completed semi-structured, one-to-one interviews that were thematically analysed. Food bank clients appeared to heavily consume sugar, with little understanding of the associated health effects and limited awareness of the intervention. Consumption behaviours were particularly influenced by personal and psychological factors, such as mental health; in addition to social factors, like familial behaviours and food access issues. It emerged that food bank clients’ often-challenging personal circumstances were likely to promote their sugar consumption. Making intervention materials visually appealing and easily comprehendible were found to be important for improving an intervention’s reception. Recommendations were developed to improve the efficacy of similar information-based sugar reduction interventions among socioeconomically deprived groups.

Ancillary Benefit of Increased HPV Immunization Rates Following a CBPR Approach to Address Immunization Disparities in Younger Siblings.

Increasing HPV vaccination rates may decrease the disproportionately high HPV-associated disease incidence and mortality in African Americans (AA) and lower socioeconomic individuals. Data from a community-based participatory research (CBPR) study addressing immunization disparities among 19-35month old children was analyzed to identify ancillary benefits in HPV immunization rates for adolescent siblings. Sub-study analysis inclusion criteria: AA (N = 118), 13-17years old, younger sibling enrolled in parent study, and enrolled ≥ 9months. Parent/caregiver interventions included: a web-based immunization toolkit with information on age-appropriate vaccines; a multimedia community outreach campaign; and reminder mailings. HPV up-to-date (UTD) status was defined as Wisconsin Immunization Registry (WIR) documentation of at least three HPV vaccines. McNemar's test compared pre/post intervention HPV status. Two dependent proportions testing compared the proportion of adolescents that became UTD in the study cohort, City of Milwaukee, and State of Wisconsin. Parents/caregivers perceived that 92% of adolescents were HPV-UTD, while only 24% had a WIR-verified HPV-UTD status. Baseline UTD status of the younger siblings 19-35month old 4:3:1:3:3:1:4 antigen series was 63%, which increased to 86% at study completion. Adolescent's HPV-UTD immunization status increased from 30 (25%) at enrollment to 54 (46%) at study completion [p = 0.004]. A statistically significant larger proportion of adolescents became HPV-UTD in the study cohort (20%) compared to the City of Milwaukee [14%, p = 0.042] and the State of Wisconsin [14%, p = 0.046]. A culturally-tailored CBPR approach targeting parents/caregivers of younger AA children can have significant ancillary benefit to increase HPV immunization rates in adolescent siblings.

An innovative approach to address homelessness in regional Australia: Participant evaluation of a co-payment model

ObjectivesHomelessness is not only about lack of secure housing, it is sometimes caused by simple reasons such as lack of money to travel home. The purpose of this study was to investigate whether the participant co-funded assistance program (‘Return to Country’ [R2C]), when offered to low socio-economic individuals experiencing homelessness, represented an effective use of scarce resources. Study designIn northern Australia, a remote and sparsely populated area, Indigenous persons who travel to regional centres cannot always afford airfares home; they therefore become stranded away from their ‘country’ leading to rapidly deteriorating health, isolation and separation from family and kin. The R2C program was designed to facilitate travel for persons who were temporarily stranded and were voluntarily seeking to return home. The program provided operational support and funding (participants co-funded AU$99) to participants to return home. MethodsUsing a descriptive, case series research design, university researchers independently evaluated the R2C program using semi-structured interviews with 37 participants. ResultsAn investment of AU$970 per participant in the program with partial co-payment was associated with high participant acceptability and satisfaction in-line with harms reduction around substance and criminal abuse, which is suggestive of long-term success for the model. ConclusionsFindings from this study can contribute to the development of best practice guidelines and policies that specifically address the needs of this unique population of stranded persons, who are seeking to return home. The acceptance of the co-payment model can be adopted by policy makers involved in homelessness prevention in other locations in Australia or internationally as an add-on service provision to mainstream housing support.

Patient Navigators as Essential Members of the Healthcare Team: A Review of the Literature

In the U.S. an estimated 2.5 trillion dollars was spent on the management of chronic diseases. Today, a major problem being experienced is soaring healthcare costs. In addition, disparities among the underserved and low socioeconomic individuals exist because many have access needs, which contributed to non-compliance issues. Barriers that contribute to non-compliance may include, but not be limited to: transportation needs; finances; health literacy; cultural beliefs; and lack of education. These barriers can be eradicated with the use of a patient navigator. Patient navigators are health professionals such as a nurse, social worker, or lay person trained to help patients navigate the complex healthcare systems of today. Patient navigators assist patients with managing follow-up appointments, medications, transportation needs, and coordination of care. The use of a patient navigator is also one strategy that can help mitigate the effects of healthcare disparities. The purpose of the review of the literature was to identify the benefits of patient navigators as essential members of the healthcare team. The roles and positive outcomes to patients, as well as to healthcare systems, is described. The improvement in access to healthcare for the poor and underserved has improved patient outcomes which have contributed to lower healthcare costs. The positive outcomes of patient satisfaction and lower healthcare costs are an advantage to healthcare systems. These benefits support the need for patient navigators.

Beliefs about smoking-related lung cancer risk among low socioeconomic individuals: the role of smoking experience and interpersonal communication.

Previous research has documented that smoking prevalence is generally high among low socioeconomic groups and that tobacco industries continue to target these population groups. However, little research has investigated the beliefs of individuals with low socioeconomic position (SEP) about the association between smoking and cancer risks. In this study, we examined beliefs about smoking-related lung cancer risk and the role of smoking experience, mass media exposure and health-related interpersonal communication among a sample of low SEP population. Data were gathered from 324 urban poor recruited from adult education centers in the greater Boston area, Massachusetts, USA as part of a larger project called Click to Connect. While we collected a variety of data at baseline and follow-up, the data for this study come from the baseline survey alone. We found that individuals with smoking experience tend to be better than those without in perceiving the lung cancer risks of smoking. Moreover, we found that health-related interpersonal communication with friends and family members is positively associated with beliefs about the link between smoking and lung cancer. Our findings suggest that low SEP individuals with smoking experience might be more exposed to anti-tobacco messages than are low SEP individuals without smoking experience. This could suggest that anti-tobacco interventions thus far may have done very little in raising the awareness of low SEP nonsmokers about the dangers of smoking and that they may have little potential to avert the initiation of smoking in this population.

Determinants of tuberculosis transmission and treatment abandonment in Fortaleza, Brazil

BackgroundTuberculosis (TB) remains a public health problem, despite recent achievements in reducing incidence and mortality rates. In Brazil, these achievements were above the worldwide average, but marked by large regional heterogeneities. In Fortaleza (5th largest city in Brazil), the tuberculosis cure rate has been declining and treatment abandonment has been increasing in the past decade, despite a reduction in incidence and an increase in directly observed therapy (DOT). These trends put efforts to eliminate tuberculosis at risk. We therefore sought to determine social and programmatic determinants of tuberculosis incidence and treatment abandonment in Fortaleza.MethodsWe analyzed sociodemographic and clinical data for all new tuberculosis cases notified in the Notifiable Diseases Information System (SINAN) from Fortaleza between 2007 and 2014. We calculated incidence rates for 117 neighborhoods in Fortaleza, assessed their spatial clustering, and used spatial regression models to quantify associations between neighborhood-level covariates and incidence rates. We used hierarchical logistic regression models to evaluate how individual- and neighborhood-level covariates predicted tuberculosis treatment abandonment.ResultsThere were 12,338 new cases reported during the study period. Case rates across neighborhoods were significantly positively clustered in two low-income areas close to the city center. In an adjusted model, tuberculosis rates were significantly higher in neighborhoods with lower literacy, higher sewerage access and homicide rates, and a greater proportion of self-reported black residents. Treatment was abandoned in 1901 cases (15.4%), a rate that rose by 71% between 2007 and 2014. Abandonment was significantly associated with many individual sociodemographic and clinical factors. Notably, being recommended for DOT was protective for those who completed DOT, but associated with abandonment for those who did not.ConclusionLow socioeconomic status areas have higher tuberculosis rates, and low socioeconomic individuals have higher risk of treatment abandonment, in Fortaleza. Treatment abandonment rates are growing despite the advent of universal DOT recommendations in Brazil. Proactive social policies, and active contact tracing to find missed cases, may help reduce the tuberculosis burden in this setting.

Which Inequality Makes People Dissatisfied with Their Lives? Evidence of the Link Between Life Satisfaction and Inequalities

This paper aims at establishing a clear link between different types of inequality and life satisfaction in Europe. We analyse the relationship between life satisfaction and both income inequality and inequality of opportunity using seven waves of the European Social Survey. The results show that in Europe both income inequality and inequality of opportunity reduce people’s life satisfaction. Our main results suggest that all socio-economic groups are dissatisfied with income inequality, whereas primarily low socio-economic individuals worry about inequality of opportunity. We find that expected mobility is very important in explaining the link between inequality and life satisfaction for all socio-economic groups in Europe. We advance the hypothesis that life satisfaction is conditioned by a mix of normative arguments against inequality and by the fear/possibility to lose/gain a good social position. This result complements findings on the mediating role of social mobility in the relationship with subjective well-being.

Improving access to community‐based food systems: Comparing perspectives of low socioeconomic individuals and food system representatives

AbstractAimThe present study compares perspectives of low socioeconomic individuals and food system representatives to identify ways of increasing access to community‐based food systems.MethodsFocus groups with low socioeconomic individuals and semistructured interviews with representatives of farmers' markets, community‐supported agriculture schemes, and a commercial fruit and vegetable box scheme explored enablers and barriers to accessing community‐based food systems for those of low socioeconomic status and potential solutions to improve participation. Data were analysed using grounded theory and thematic analysis, respectively.ResultsAffordability, convenience and knowledge were barriers for low socioeconomic individuals. Food system representatives acknowledged these same barriers, but showed different understandings of their importance. Some strategies to improve access suggested by low socioeconomic individuals were amenable to representatives; however, for other strategies, views between the two groups were divided, particularly for strategies addressing affordability.ConclusionsA disconnect exists between views of low socioeconomic individuals and food system representatives in regard to improving disadvantaged groups' access to community‐based food systems. Several strategies amenable to both stakeholder groups are identified; however, further communication and collaboration is required to identify additional innovative solutions.

Determinantes do valor da proteína C-reativa em indivíduos de nível sócio-econômico muito baixo

FUNDAMENTO: Inflamação sistêmica exacerbada tem sido descrita em indivíduos de baixo nível sócio-econômico, porém estudos sobre determinantes dos valores de proteína C-reativa foram realizados apenas em países desenvolvidos. OBJETIVO: Identificar preditores de PCR em indivíduos de baixo nível SE em um país em desenvolvimento e avaliar se a PCR está relacionada ao nível SE nesse cenário. MÉTODOS: Oitenta e oito indivíduos de nível SE muito baixo foram recrutados de uma comunidade pobre, semi-rural no Brasil; 32 indivíduos de nível SE alto foram utilizados como amostra de comparação. A PCR de alta sensibilidade foi medida por nefelometria. RESULTADOS: Entre os indivíduos de baixo nível SE, os preditores independentes de PCR foram índice de massa corporal > 25 kg/m² (P<0,001), hábito de fumar (P=0,005) e condições infecciosas agudas (P=0,049). O grupo com baixo nível SE (mediana=2,02 mg/l; variação interquartil: 0,92 - 4,95 mg/dl) apresentou níveis mais altos de PCR quando comparado com o grupo de alto nível SE (1,16 mg/l, variação interquartil: 0,55 - 2,50 mg/dl, P=0,03). O índice de massa corporal foi mais alto (27 ± 4,9 kg/m² vs 25,5 ± 3,2 kg/m²; P=0,07) e a prevalência de infecção aguda foi maior (32% vs 3%, P=0,002) no grupo com baixo nível SE. Após exclusão de indivíduos com sobrepeso ou condições infecciosas, os valores de PCR foram similares entre os grupos com baixo e alto nível SE (0,93 mg/l vs 1,08 mg/l, P=0,28). CONCLUSÃO: Adiposidade, condições infecciosas e fumo são preditores de PCR em indivíduos com nível SE muito baixo. Os primeiros dois fatores são os determinantes da exacerbação da inflamação em indivíduos de muito baixo nível SE.

Seroprevalence of Hepatitis B virus infection among an Afro-descendant community in Brazil.

Furnas dos Dionísios is an Afro-Brazilian black community whose descendants were mainly fugitive slaves that established themselves in the State of Mato Grosso do Sul (MS), Brazil. The population is comprised mainly of low socioeconomic individuals who are engaged in agricultural activities. The objective of this study was to investigate the prevalence of hepatitis B (HB) and its correlation with epidemiological data obtained from the community. The studied population totaled 260 individuals with ages varying from 1 to 79 years (median 20). One hundred thirty-three (51.2%) were females and 127 (48.8%) were males. A high prevalence for anti-HBc was observed (42.7%), with present infection detected in 9.2% of the subjects who were also HB surface antigens (HBs Ag) positive; 27.3% were anti-HBc and anti-HBs reactive, and 6.2% had anti-HBc as only marker. The prevalence for anti-HBc was proportional to age, reaching its highest peak in age categories greater than 50. No serological marker was detected in children under the age of 2 years, however anti-HBc was present in 12 subjects with ages between 2 and 14 years, of these 8 (7.4%) were HBsAg positive. Among individuals over the age of 15 years, 99 were anti-HBc reactive, of these 16 (10.5%) were also HBsAg positive, thus suggesting an increased prevalence of HBV carriers among children and adolescents. The risk factors observed in this community that were significantly associated with anti-HBc positivity were age (over 20 years) and having an anti-HBc positive mother. Both HBeAg and anti-HBe were detected in 44.4% of the samples tested. HBsAg subtypes found in the studied population were adw2 (77.7%) and ayw2 (23.3%). While intrafamilial transmission was most likely responsible for HBV infection among children, other routes such as sexual contact might be considered for individuals with ages over 15 years.

Issues in the treatment of Mycobacterium tuberculosis in patients with human immunodeficiency virus infection.

The HIV/AIDS pandemic has led to a rise in the incidence of tuberculosis and an epidemic of co-infection in many developing countries. Treatment of Mycobacterium tuberculosis in persons with HIV infection presents several challenges to the clinician particularly in resource-poor countries. As will be discussed in this paper diagnosis of latent tuberculosis relies on tuberculin skin testing which has poor sensitivity and reproducibility in immunocompromised patients. The World Health Organization (WHO) recommends treatment of active tuberculosis as the primary means of global tuberculosis control. In practice treatment of active tuberculosis typically requires that a symptomatic patient self-report to a health service for evaluation and management. Even if this approach to tuberculosis control were sufficient many logistic and clinical problems remain involving tuberculosis diagnosis and therapy in the patient with HIV/AIDS. Recognizing the significant clinical and public health challenges surrounding the treatment of tuberculosis in patients with HIV infection this paper will address a number of issues relevant to the care of co-infected patients. These include current guidelines for the treatment of active tuberculosis as well as the diagnosis and treatment of latent tuberculosis in HIV-positive patients. The paper concludes with a discussion of promising new drugs for tuberculosis treatment. (excerpt)

Colonización bacteriana anormal del intestino delgado alto en escolares de nivel socioeconómico alto y bajo

Microbiological contamination ol the enviroment induces chronic enviromental enteropathy, characlerized by mild to moderate morphological and functional changes o( the small intestinal mucosa. Bacterial colonization was evaluated in 31 1 school aged children (1 55 of the high (H-SES] and 1 56 of the low (L-SES) socioeconomic strata) by means of Ihe breath H2 test. Samples were obtained after overnight fast and every 15 minutes for 240 minutes following the ingestion of 1 50 mg • kg laclulose. A health queslionaire that included information about food and medicines ingestion, alcohol consumption, smoking and intolerance to foodstuffs was also applied. In 30% of the children basal H2 excretion was above 10 ppm. In 18,1% of the H-SES and 4.5% of the L-SES (p 20 ppm between 90 and 240 minutes) were detected in 78./% of the H-SES and 40,4% of the L-SES [p< 0.0001). In 1 8.7% and 48.7% of the H-SES and L-SES, respectively, curves were flat (basal excretion < 10 ppm and increments < 20 ppm). Chronic environmental enteropathy is already present in school age children. The lower breath H? excretion observed in low socioeconomic individuals may be due to diferences in quality and quantity of the diet.