Low Socioeconomic Level Research Articles

The Social Divide of Social Distancing: Shelter-in-Place Behavior in Santiago During the Covid-19 Pandemic

Voluntary shelter-in-place directives and lockdowns are the main nonpharmaceutical interventions that governments around the globe have used to contain the Covid-19 pandemic. In this paper, we study the impact of such interventions in the capital of a developing country, Santiago, Chile, that exhibits large socioeconomic inequality. A distinctive feature of our study is that we use granular geolocated mobile phone data to construct mobility measures that capture (1) shelter-in-place behavior and (2) trips within the city to destinations with potentially different risk profiles. Using panel data linear regression models, we first show that the impact of social distancing measures and lockdowns on mobility is highly heterogeneous and dependent on socioeconomic levels. More specifically, our estimates indicate that, although zones of high socioeconomic levels can exhibit reductions in mobility of around 50%–90% depending on the specific mobility metric used, these reductions are only 20%–50% for lower income communities. The large reductions in higher income communities are significantly driven by voluntary shelter-in-place behavior. Second, also using panel data methods, we show that our mobility measures are important predictors of infections: roughly, a 10% increase in mobility correlates with a 5% increase in the rate of infection. Our results suggest that mobility is an important factor explaining differences in infection rates between high- and low-incomes areas within the city. Further, they confirm the challenges of reducing mobility in lower income communities, where people generate their income from their daily work. To be effective, shelter-in-place restrictions in municipalities of low socioeconomic levels may need to be complemented by other supporting measures that enable their inhabitants to increase compliance. This paper was accepted by David Simchi Levi, healthcare management.

Comparison of obstetric and neonatal outcomes between Syrian adolescent refugees and local Turkish adolescent citizens

The provision of antenatal care in adolescents in refugee populations presents particular difficulties because of conflict, nutritional deficiencies, language barriers and lack of access to health care facilities. Due to the absence of prenatal care, associated medical complications can occur. A total of 525 adolescent women who gave birth to singletons agreed to participate in this study. Data about maternal demographic and obstetric characteristics, as well as neonatal outcomes were analysed. In conclusion, adolescent pregnancy continues to be an important social problem due to health support needs. However, the results of our present study are important in terms of showing that perinatal care is quietly improving in Turkey. Impact Statement What is already known on this subject? Adolescent pregnancies are at much higher risk than adult pregnancies in terms of complications. These complications include preterm delivery, intrauterine growth retardation, maternal morbidity and mortality, neonatal morbidity and mortality. According to various beliefs and traditions, marriages in early ages are observed in some societies and as a result, adolescents become pregnant. Additionally, the present study includes early adolescent aged pregnancies as 14,15 and 16. As far as we search in the literature, there is no reported about early adolescent pregnancies. What do the results of this study add? Often, such pregnancies occur more frequently in societies with low socioeconomic levels. For this reason routine pregnancy screening, support during pregnancy, prenatal care is not adequately provided. Some of the complications develop on them. Primarily, the adolescent pregnancies should be gotten under control, if not, some complications can be prevented by routine pregnancy follow-up and adequate provision of prenatal care and support. What are the implications of these findings for clinical practice and/or further research? As a guide on clinical practices and further studies; an effective method of contraception should be applied to sexually active women at early maternal age. If not, pregnancies should be kept under close follow-up and with adequate support to avoid complications.

La dépression du post-partum chez la primipare : prévalence, facteurs de risque et liens avec la douleur de l’accouchement

Childbirth of primiparous women is sometimes associated with severe pain that could predispose mothers to develop anxiety and depressive symptoms. ObjectiveTo assess the prevalence of postpartum depression among primiparous women, to determine risk factors that can contribute to this psychiatric disorder and to study the links between labor pain and postpartum depression. MethodsTo that end, we conducted a prospective and longitudinal study, including 183 primiparous women. In the first step, corresponding to the first 48hours after delivery, we assessed pain experienced during childbirth using the “Saint-Antoine Pain Questionnaire”. In the second phase, 6 to 8 weeks after delivery, we used the Edinburgh Postnatal Depression Scale (EPDS) and the Hospital Anxiety and Depression Scale (HADS) to assess anxiety and depressive symptoms. ResultsThe average total score on the “Saint-Antoine Pain Questionnaire” was 74.44, with an average score of 45.01 for sensory pain and that of 29.44 for emotional pain. A depressive state was diagnosed in 18.7% of mothers. Edinburgh Postnatal Depression Scale scores were significantly higher among primiparous women in case of an unwanted pregnancy, vaginal delivery, instrumental delivery, complicated childbirth and when the marital relationship was considered to be conflictual. An anxiety state was objectified in 20% of women. Significantly higher anxiety scores were found in single mothers, those with a low socioeconomic level, those with a low level of education, in case of a vaginal delivery, when the sex of the baby was unwanted and when the quality of the marital bond and the contact with the healthcare team were judged to be of poor quality. Higher childbirth pain scores were associated with significantly higher scores of depression and anxiety. Moreover, Edinburgh Postnatal Depression Scale scores were significantly higher in primiparous mothers with higher scores of anxiety (P<0.001). ConclusionIt seems judicious to assess the childbirth pain, to improve its management by support strategies and to make health professionals aware of postpartum anxiety and depression disorders.

VP12: Rates of Insurance Denial for Breast Surgery: A Systematic Review of the Literature

INTRODUCTION: Indications for insurance reimbursement in breast surgery mainly include breast reduction and reconstruction. The process of requesting reimbursement and insurance policies vary greatly. Consequently, while a large majority of these procedures are not aesthetic, they are not always reimbursed. Our aim was to systematically review the existing literature and identify the rates and the reasons for insurance denials in the context of breast surgery. MATERIALS AND METHODS: A systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines on PubMed/MEDLINE. We included all articles where reimbursement of plastic surgery interventions were correlated with accepted guidelines for breast reduction or reconstruction. Studies where the information was reported unclearly or where it was impossible to assess the direct link between pathological condition and reimbursement were excluded. RESULTS: Thirteen studies, published between 1980 and 2017 met inclusion criteria. The majority of the papers (12/13) referred to the United States context, while one was an international survey collecting reports from different countries. A key factor to explain insurance denial was the use of different algorithms to define “medical” vs “esthetic” breast surgery between insurer (weight of the resection or Schur score) and healthcare workers (symptomatology). This explained in particular regarding breast reductions a certain disparity between surgical indications posed by plastic surgeons and indications accepted for reimbursement. Reconstruction with prosthesis would be better reimbursed than reconstruction with autologous flaps. In particular it is described limited access to autologous reconstructions in patients of low socio-economic level. This explains the increased incidence of prosthetic reconstructions in the United States despite the evidence of long-term economical superiority of autologous reconstructions, especially with the gold standard Deep Inferior Epigastric Artery Perforator Flap. CONCLUSION: A standardized, and common documentation between insurance companies and hospitals could reduce insurance denials and finally optimize financial resources utilization.

Low Socio-Economic Level: A Major Obstacle to Therapeutic Observation (Survey of 125 Diabetic Patients)

Introduction: Diabetic patients adhering to their treatment are less likely to face complication from their disease. For this reason, we studied the compliance of diabetics with their treatment. Materials and Method: This was a comprehensive cross-sectional study of adherence in diabetic patients. All patients meeting the inclusion criteria were enrolled in the study. This study took place at a private pharmacy called “pharmacy Elhadj Seydou Nourou Tall” located in the city of Pikine during the period from April 1 to September 30, 2019. Results: In total, the study population was composed of 125 diabetics; frequency of 8.47%. The average age was 62.5 years and there were more women (58.4%). Of the patients, 87% had a low socioeconomic level and 72% a low educational level. Only 65.6% of the patients knew their diabetes type. Even though 97.6% of the patients were confident in the treatment but due to financial reasons 20.8% did not adhere to the prescribed treatment and 16.8% to their diets. Moreover, 15.2% of the patients had changed the dosage of the prescribed medication, 44.4% had forgotten to take their medication regularly. 78.4% of them thought they were taking too much medication. No factors were found to be statistically associated with poor adherence, but the proportion of poor adherence patients was higher in patients over 60 years of age, with low socio-economic status and low education. Conclusion: Low socio-economic status is the main barrier to good adherence. Recommendations have been formulated to improve this adherence.

Prevalência de doenças durante a gravidez em uma grande amostra sul-americana não selecionada

Our aim was to describe the prevalence of diseases during pregnancy and the association between fetal exposure to the most frequent maternal diseases and the risk of preterm (PTB) and/or small for gestational age (SGA) newborns in an unselected sample of women who gave birth in South American countries. We conducted a descriptive, cross-sectional study including 56,232 mothers of non-malformed infants born between 2002 and 2016, using data from the Latin American Collaborative Study of Congenital Malformations (ECLAMC). Diseases with higher- than-expected PTB/SGA frequencies were identified. Odds ratios of confounding variables for diseases and birth outcomes were calculated with a multivariable logistic regression. Of the 14 most reported diseases, hypertension, genitourinary infection, epilepsy, hypothyroidism, diabetes, and HIV/AIDS showed higher PTB and/or SGA frequencies. Advanced and low maternal age, previous fetal loss, low socioeconomic level, and African-American ancestry were associated with PTB, while advanced maternal age, primigravidity, previous fetal loss, low socioeconomic level, and African-American ancestry were associated with SGA. After adjusting for the associated variables, the identified illnesses maintained their association with PTB and all, except epilepsy, with SGA. The description of an unselected population of mothers allowed identifying the most frequent diseases occurring during gestation and their impact on pregnancy outcomes. Six diseases were associated with PTB and two with SGA newborns. To the best of our knowledge, there are no similar reports about women not intentionally selected by specific diseases during pregnancy in South American populations.

Survival of Acute Myeloid Leukaemia Patients- A Retrospective Study from the Yopougon University Hospital, Abidjan, Ivory Coast

Introduction: The survival of acute leukaemia patients has improved significantly thanks to multidrug chemotherapy and the development of cell therapy and marrow transplantation. However, this is not the case in Middle Income Countries (MICs), particularly in Côte d’Ivoire, West Africa where much efforts are still needed to improve the treatment of these patients.This study raises the issue of the fate and survival of Acute Myeloid Leukaemia (AML) patients in these countries. Aim: To study the overall survival and survival factors of patients with AML under the present practice conditions. Materials and Methods: This retrospective study was conducted in the Department of Haematology of Yopougon University Hospital in Abidjan, Ivory Coast. The data was collected from January 2005-April 2019 and data processing happened over a duration of one year from November 2019-November 2020. The mortality and survival were studied on 75 AML patients.The socio-demographic, pretherapeutic and therapeutic characteristics were recorded. Statistical Package for the Social Sciences (SPSS) statistics version 26 was used for data analysis, comparisons were done using by the Chi-square test and survival through the Kaplan Meier method and the log rank test. Results: The patient’s age ranged from 1 to 74 years, with two peaks (37 and 49 years old) with a sex ratio at 1.03. Majority of patients (50.7%) had a low socio-economic level. Overall, 81.6% of patients started treatment within two weeks. Out of total patients 38 (50.7%) patients received chemotherapy, which was curative for 10 (13.33%) patients and palliative for 28 (37.33%) patients. There was not a single patient of complete remission. A total of 4 (5.3%) were alive, 51 (68%) died, and 10 (26.7%) were lost to follow-up. The average overall survival (OS) was 90 days and the probabilitý of Overall Survival (OS) was 62% at one month, 49% at six months, and 10% at one year. The predictive factors for prolonged survival were high socioeconomic level (p=0.046) - absence of bleeding syndrome (p-0.04) - haemoglobin level ≥10 g/dL (p-0.02) - cytological type different from AML-M0 (p-0.05). Conclusion: The therapeutic results were inferior to those obtained in developed countries where high level diagnostic and therapeutic techniques give very promising results. This study highlighted the difficulties of AML management and identified five prognostic factors of survival in the care conditions of MIC.

Risk factors for scabies in school children: a systematic review

Scabies is one of the most common itchy dermatoses, mainly in vulnerable age groups such as young children and the elderly. Although rarely fatal, it can lead to several severe complications. Its occurrence has been attributed to low-income countries, low socioeconomic level, lack of knowledge of scabies and preventive health behaviors, overcrowding, and poor sanitation. This review aims to determine the risk factors for scabies in children. Materials and methods. The search was performed in 4 main databases: PubMed, SCOPUS, World of Science (WOS), and Google Scholar. The target population was school children (community/boarding/primary school) that fulfilled the inclusion criteria. The case studies articles, narrative articles, review papers, and articles focusing on general skin outcomes were excluded from this review. Results. A total of 11 studies were included in this review after systematic assessment and appraisal. Scabies infection is significantly higher in children living in the urban areas with an adjusted odds ratio (aOR) of 6.9 times compared to rural areas. Scabies occurrence in children is significantly higher in illiterate parents (aOR = 3.49), low annual household income (aOR = 2.13), inaccessibility and poor utilization of water (aOR = 1.64), and large families (family size &gt;4) (aOR = 1.82). School factors that are significant risk factors for scabies include the level of education (aOR = 1.67), number of students per dormitory ≤ 10 (aOR = 6.99), and no access to the school infirmary (aOR = 1.62). Individual factors such as poor personal hygiene (aOR = 1.69) and environmental factors such as high temperature and low humidity (adjusted hazard ratio (aHR) = 2.37) also significantly contribute to scabies infection. Conclusion. Risk factors for scabies are multifactorial, including sociodemographic factors, parent socioeconomic status, housing, family, school, individual and environmental factors. Hence, public health interventions should address all the factors to ensure effective prevention and control of scabies among children. Key words: scabies, systematic review, children, risk factors

Determinants of therapeutic nonadherence in Tunisian hypertensive patients in the rural population

Poor adherence to antihypertensive treatment is one of the major factors of poor blood pressure control, particularly in rural areas. The objectives of our study were to assess treatment adherence and identify factors associated with poor adherence in rural areas. We carried out a cross-sectional descriptive study carried out in a regional hospital in Kasserine during the months of January and February 2021. We measured therapeutic compliance using the Girerd questionnaire and we studied the associations between poor blood pressure medications adherence and demographic, socioeconomic, hygieno-dietetic and therapeutic covariates. One hundred patients were included. The mean age was 66.86 years ± 11.97 with a sex ratio of 2.33. Factors associated with poor adherence were age ≥ 65 years ( P = 0.007), hypertension duration more than 1 year ( P = 0.008), physical inactivity ( P < 0.001), diabetes ( P = 0.024), history of stroke and/or heart disease ( P < 0.001), treatment with a number ≥ 2 of antihypertensive drugs ( P = 0.0035), without a fixed association ( P = 0.040), existence of adverse effects (0.034) and treatment with ACE inhibitors (0.015). On the other hand, we did not find a significant effect of sex, educational level, type of medical insurance and adherence to the low-sodium diet on therapeutic adherence, whereas treatment with ARB was significantly associated with better adherence ( P = 0.018). Our study found poor adherence in this rural population with a low socioeconomic level, with more significant problems found in elderly, poly-pathological subjects treated with several antihypertensive drugs, a fortiori without a fixed association. To improve drug adherence, it is important to include therapeutic education programs adapted to the socioeconomic level of this population in the therapeutic arsenal.

Effectiveness of multicomponent lifestyle intervention programs on adiposity indicators in schoolchildren from vulnerable groups: a review article.

Vulnerable groups are those who, due to their age, sex, race/ethnicity, health status, income level, etc., are at higher risk of poor health. Vulnerable school populations are distinguished by having predisposing factors to overweight and obesity, which results in a greater risk of suffering from the disease and its ravages. Additionally, the effects of the COVID-19 contingency can worsen the situation. Previous reviews of prevention, treatment and control of the disease have focused on schoolchildren from high- and middle-income countries. The objective of this review was to gather the evidence from the studies that evaluate the effectiveness of multicomponent lifestyle intervention programs (MLIP) on adiposity indicators in vulnerable populations. Five electronic databases were searched: PubMed, MEDLINE, Cochrane Library, EMBASE, and Google Scholar. The eligibility criteria were schoolchildren (5 to 12 years old), inhabitants of rural area, with low socioeconomic level and/or belonging to an indigenous community. Randomized and quasi-experimental controlled trials were included. Interventions that included two or more of the following components were considered: physical activity, nutrition, psychology, school meals and/or family/community involvement. Of the 11 interventions included 73 % had significant improvements in at least one variable related to adiposity. The most successful interventions had components of nutrition, physical activity and family/community involvement, the majority (80 %) had a duration of ≥ 6 months and were provided, in 80 % of the cases, by previously trained teachers. In conclusion, there is evidence that MLIPs are effective in improving indicators of adiposity in vulnerable schoolchildren.

Epidemiological Profile of Patients Suffering from Urolithiasis in African Urological Environments from 2016 to 2020

Introduction: Urolithiasis is a very common pathology in the world. Its epidemiological profile varies from one region to another. In Africa in general and in the Congo in particular, it seems to be unknown. Objective: To determine the sociodemographic, diagnostic, therapeutic and evolutionary paraclinical parameters of 167 adult patients with urolithiasis. Patients and Methods: Cross-sectional, descriptive, retrospective study conducted in the urology department of Brazzaville University Hospital over a period of five years. We studied sociodemographic, therapeutic and evolutive. Results: During the study period 167 patients were treated for urolithiasis out of 2236 patients, a hospital frequency of 7.46%. The sex ratio M/F was 1.49. The average age of the patients was 42.05 years. They were overweight and/or obese in 53% of cases. Workers accounted for 46.53% of cases, with a low socio-economic level (42.5%) and a lower level of education (68.31%). There was a high percentage of complications, dominated by hydronephrosis (66.33%) and urinary tract infection (59.4%). The treatment was surgical in the majority of cases or 74.8%. Thirty-three patients had a lithiasis recurrence, a frequency of 19.7%. Conclusion: Urolithiasis is common. Being overweight is the most found risk factor. Lithiasis recurrence affects nearly one in five patients.

Туберкулез и ВИЧ-инфекция: пространственное распределение на территории Алтайского края

The aim of the study is to analyze the spatial distribution of the prevalence of tuberculosis, HIV infection and combined pathology in the Altai Territory. Materials and methods. The statistical data provided by the Department of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare in the Altai Territory, the Ministry of Health of the Altai Territory, Center for the Prevention and Control of AIDS and Other Infectious Diseases, Altai Tuberculosis Dispensary on the incidence of tuberculosis and HIV infection were used. The ranking was carried out by the method of sigma deviations for all administrative territories of the Altai Territory for 2019, and the cartogram was plotted. Statistical processing and graphical representation of the data obtained was carried out using the programs Statistica 13.0, Microsoft Excel 2014, and ArcGIS. The preparation of the text of the work was carried out using the Microsoft Word 2014 program. Results. A territorial analysis of TB prevalence, HIV infection and the incidence of combined pathology indicated the spread of the zone characterized by an average incidence rate. The zones of high TB prevalence are defined as 5 territories (from 270.5 to 479.4.0 per 100 thousand population). Also, Barnaul, Biysk, Belokurikhinskaya and Rubtsovskaya were defined as zones of high prevalence of HIV infection (from 843.2 to 1158.3 per 100 thousand population). The territorial distribution of the incidence of combined pathology (Tuberculosis + HIV) mirrors the zoning of HIV prevalence in 4 main zones, and the fifth zone (Slavgorod) is set. Conclusion. The zones of high prevalence of HIV infection and tuberculosis were determined by the negative socio-economic conditions of the region's development. The involvement of young people in drug addiction at a low socio-economic level of the region ensured the rapid development of the epidemic process of this infection. Modern conditions characterized by the development of resort business and tourism have determined the formation of new zones with a high incidence rate.

Epidemiology of Admissions in a Pediatric Emergency Department in Albert Royer Hospital Dakar

Background: Pediatric emergencies are a public health priority in Senegal. The objective was to describe the epidemiology of admissions to the emergency department of the Albert Royer National Children’s Hospital in Dakar, Senegal. Methods: Prospective, descriptive and analytical study over a period of 4 months (January-April 2020). The study population was children admitted for vital distress. Results: A total of 300 children met the inclusion criteria and represented the study population (2.83%). The majority (70.67%) were younger than 60 months, compared with 2.00% of newborns. Boys represented 53.8%, sex ratio 1.16. A proportion of 35.1% was referred. More than half of our patients (55.88%) were managed within 30 minutes of arrival. Medicalized transport concerned 21.5% against 78.5% of nonmedicalized. Emergencies were dominated by respiratory distress (56.33%), dehydration (29%) and shock (13.33%). We recorded 16 deaths (5.3%). This mortality was significantly related to the low socio-economic level (p = 0.000), as well as the young age of the children (p = 0.01). Conclusion: Life-threatening emergencies are frequent and responsible for significant lethality. Health policy efforts are still needed to reduce this infant and child morbidity and mortality.

Association between potential risk factors and the occurrence of coronary artery disease

Coronary artery disease is the major reason for high death rates in the United States and other European countries. In Pakistan, men are at greater risk of developing (CAD) in early ages as compared to women. A good deal of people suffering from CAD in Pakistan, belongs to the lower middle socioeconomic level. Aims of the present study were to observe risk factors associated with coronary artery disease e.g. smoking, hypertension, diabetes and obesity. Methods: It was a case control study carried out in Mayo hospital, a tertiary care hospital of Lahore. The study sample was 200, from which 100 were cases and other 100 were controls. In cases 77 were males and 23 were females and in controls 52 were males and 48 females were enrolled by using non-probability sampling. SPSS software was used to analyze the data and for finding out the association between different risk factors and CAD. Results: CAD was 4 times more in hypertensive cases as compared to non hypertensive cases; there is statistically significant association of hypertension with coronary artery disease. 42 were diabetics and 58 were non diabetic, and in controls 16 were diabetics and 84 were non-diabetic. There is statistically significant association of diabetes with coronary artery disease. In CAD patients 49 were smokers and 52 were non smokers. In controls 22 were smokers and 78 were non smokers. There is statistically significant association of smoking with coronary artery disease. In coronary artery disease patients 48 were obese and 52 were non-obese. In controls 27 were obese and 73 were non obese. There is statistically significant association of obesity with CAD. Conclusion: The present research has highlighted the increasing prevalence of CAD and its risk factors e.g. hypertension, diabetes mellitus, smoking and obesity. Development of focused strategies to improve awareness regarding coronary artery disease and its potential risk factors along with stressing on lifestyle modification is need of the hour.

Eating behavior in a group of overweight pregnant women in two municipalities of Antioquia, Colombia: qualitative study

RESUMENObjetivo: Describir el comportamiento, frente a la alimentación, de un grupo de gestantes con exceso de peso.Materiales y métodos: Estudio cualitativo, desde la perspectiva de etnografía enfocada. Se incluyeron mujeres gestantes mayores de 18 años con sobrepeso u obesidad, o ganancia excesiva de peso en el embarazo, y que asistieron al programa de control prenatal de dos instituciones públicas de salud pertenecientes al régimen subsidiado por el Estado en el Sistema General de Seguridad Social, en dos municipios del departamento de Antioquia (Colombia). Se realizaron 13 entrevistas semiestructuradas individuales y tres entrevistas grupales. Análisis por triangulación y codificación abierta y axial. Resultados: Participaron 22 mujeres gestantes. Se encontraron cinco factores que condicionan el comportamiento alimentario de esta población: el nivel socioeconómico bajo que limita el acceso a una alimentación variada, la red social de apoyo, el estado de salud en los embarazos previos o en la gestación actual, las recomendaciones genéricas brindadas por el personal de salud sobre alimentación y nutrición, y, por último, los conocimientos de las participantes sobre alimentación y las implicaciones del exceso de peso materno en la salud madre-hijo.Conclusión: Es imperante que la atención y educación alimentaria y nutricional sean brindadas desde las particularidades que inciden en la adopción de cambios del comportamiento alimentario de las mujeres embarazadas con exceso de peso; los profesionales del control prenatal deben contar con capacitación que promueva la unificación de criterios y una atención adaptada a la realidad social de la gestante.

Case Report on: Appendicitis

Introduction: Acute appendicitis (AA) is the most common surgical infection, with a 7–8% lifetime risk. The mortality rate following appendectomy is quite low, ranging from 0.07 to 0.7 percent in patients without perforation to 0.5 to 2.4 percent in patients with perforation, which is an acute inflammation of the appendix. It affects people of all ages, with the majority of cases occurring between the ages of 10 and 30, and both boys and females are afflicted equally. Appendicitis is substantially less common in developing nations, particularly regions of Africa, and among lower socioeconomic levels. After being diagnosed with appendicitis, a 24-year-old male was taken to AVBRH with complaints of pain in the right iliac fossa, nausea, and vomiting. The findings of the examination were consistent with acute appendicitis. His systemic health remained unaffected, and testing such as blood tests, urine samples, and abdominal ultrasounds were inconclusive. Acute appendicitis (AA) is the most common surgical condition, and in the vast majority of cases, appendectomy is the treatment of choice. An accurate diagnosis is essential for lowering the rate of negative appendectomy. In the case of a complex appendicitis, management can be tough. The diagnostic process must be improved in order to reduce the negative appendectomy rate and the danger of misdiagnosis. The diagnosis of acute appendicitis was primarily relied on symptoms, signs, and laboratory evidence prior to the widespread use of CT scans.

Psychosocial risk factors in cardiac practice

Cardiovascular diseases (CVD) remain the leading cause of death in Russia. Apart from conventional modified risk factors, population health, including CVD progression and related death, is influenced by psychosocial risk factors (PS RF). In theory, the role of PS RF can be explained by the significant changes in death rates within the Russian population during social and economic alterations. However, the significance of primary CVD RF has remained unchanged since the Soviet times. Nonetheless, PS RF does not receive much attention in our country. Thus, the current review aimed to introduce specialists focusing primarily on PS RF, such as low socioeconomic status, social isolation and low levels of social support, depressive disorders and personality traits (hostility and type D personality), which are now undoubtedly closely associated with unfavourable prognosis in patients with CVD. This summary also discusses the main pathophysiological mechanisms that may facilitate the progression of CVD, which include the activation of the hypothalamic–pituitary–adrenal axis, sympathoadrenal system with increased cardiovascular reactivity, endothelial function, inflammatory markers, platelets, coagulation factors, fibrinogen and lifestyle-associated factors. Thus, PS RF have considerable practical significance, not only for individual risk estimation but also in primary and secondary interventions for the prevention of CVD.Received 4 May 2021. Revised 6 June 2021. Accepted 11 June 2021.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors: The authors contributed equally to this article.

Examination of parents refusing administration of childhood vaccinations: Turkey example

Background. Vaccination is an important health service that reduces the morbidity and mortality of infectious diseases. In our study, it was aimed to examine the knowledge, attitude, risk perception of parents about vaccine refusal, and the vaccination status of their children in a province of Turkey with a low socioeconomic level. Materials and methods. In the study designed in a cross-sectional type, 105 parents (participation rate: 80.2 %) who rejected the vaccine were reached. Results. The most refused vaccine by the parents is DaBT-İPA-Hib (90.5 %) and the least rejected vaccine is BCG (58.1 %). It was determined that who thought vaccines have no benefits (p = 0.003), those who were doubtful about the content of the vaccine (p = 0.001), those who did not want the vaccine due to their religious beliefs (p = 0.006), and those who believed in natural immunity (p = 0.002) were less convinced about vaccinating their children at a statistically significant level than the other group. The vaccine with the highest rate is HAV (35.0 %, n = 7), and the vaccine with the lowest rate is BCG (8.3 %, n = 1) in terms of the rate of vaccination that they declare to be convinced to have it. Conclusions. When evaluated on the causes of vaccine refusal and persuasion, the primary source of information is provided by health workers with scientific evidence through different communication methods (social media, etc.) should be reached.

Examination of Mothers' Over-The-Counter-Medication (OTC) Usage at Home According to Different Socioeconomic and Health Literacy Levels

Aim: The purpose of this study was to examine mothers’ OTC medication usage at home according to different socioeconomic and health literacy levels and the effecting factors. Materials and Methods: This cross-sectional descriptive study was carried out in three family health centers from different socioeconomic levels (low-middle-high) between September 2018 and February 2019. The sample of the study consisted of 300 mothers of 0-18 year old children who met the research criteria. Data were collected through “Data Collection Form” and “Adult Health Literacy Scale”. Results: It was determined that mothers in low socioeconomic group had high level of OTC medication usage to their children at home. A significant relationship was found between the mean scores of mothers’ health literacy and socioeconomic level (p<0.000). The mean scores of mothers’ health literacy in low socioeconomic group who used OTC medication to their children at home are lower than mothers who did not use OTC medication (p: 0.041). It was determined that child’s age (OR: 1.01, p: 0.045), regular medication usage in mother (OR: 2.11, p: 0.014) and reading the prospectus before giving medication to their child (OR: 3.14, p: 0.005) effected to mothers’ OTC medication usage at home. Conclusion: This study emphasized that low socioeconomic and health literacy levels may cause mothers’ OTC medication usage to their children at home. OTC medication usage can be decreased with education programs that take into account the effecting factors to mothers’ OTC medication usage and aim to increase health literacy levels.

Study of the association of the nutritional profile of pregnant women with the birth weight of newborns in Morocco.

Low birth weight (LBW) is an important predictor of neonatal morbidity and mortality. It reflects the nutritional status of the mother and the quality of health care services during pregnancy. The objective of this study is to determine the factors associated with low birth weight of children born to Moroccan pregnant women in the province of El Jadida. This cross-sectional case-control study was carried out in the maternity ward of El Jadida provincial hospital on 344 parturient women, half of whom had given birth to children with an LBW and the other half of children with normal weight (NW) at birth. Information on maternal gestational and socioeconomic characteristics as well as eating habits was collected using a questionnaire and anthropometric measurements were taken on the newborns. The study identified 172 parturient who gave birth to newborns with LBW and 172 parturient who gave birth to newborns of NW. The proportions of LBW are greater in first-time mothers (50.6%) and professionally inactive (86.6%). The mean weight of LBW newborns is 2013.95 ± 372.95g compared to 3380 ± 217.59g for NW newborns. The determined factors associated with LBW are the low socio-economic level (OR = 3.18; 95% CI: 1.09-9.23), insufficient monitoring of prenatal consultation (OR = 2.91; 95% CI: 1, 71-4.95), origin from rural areas (OR = 0.52; 95% CI: 0.30-0.91) and lack of nutritional education (OR = 0.17; 95% CI: 0, 09-0.34). The daily calcium intake in mothers of newborns with LBW is 33.82% of the recommended daily allowance (RDA), the daily iron requirement coverage was 50%, folates 66, 16% and zinc 87.72% of the RDA. Well-targeted and coordinated education and awareness-raising actions on early pregnancy and feeding pregnant women could have a positive impact on improving the birth rate of children with a weight deficit.