Low Status Groups Research Articles

High-Resolution PM2.5 Emissions and Associated Health Impact Inequalities in an Indian District.

Health and livelihood impacts from ambient air pollution among populations in developing countries are disproportional. These disparities are often overlooked due to a lack of information on microlevel emission data, especially in smaller cities and rural areas. The current work in an Indian district, Saharanpur, proposes the use of novel data sets to estimate microlevel emissions from air-polluting infrastructure sectors in urban and rural areas for use in pollutant transport models. Health impacts estimated based on the surface PM2.5 concentration suggest that the rate of premature deaths is 158 (95% CI: 122-163) and 143 (95% CI: 65-151) deaths per 100 000 people in urban and rural areas, respectively. Sixty-eight percent of the 6372 (95% CI: 3321-6987) annual premature deaths occurs in rural areas. Depicting higher contribution-exposure disparities among socioeconomic groups, the study observed that compared to their contribution to air pollution, low socioeconomic status (SES) groups in the region experience 6,7, 7, and 26% more premature deaths from PM2.5 exposure for industries, household cooking fuel burning, open waste burning, and transportation, respectively. The majority of disability-adjusted life years (DALYs) in the study domain are observed in economically weaker worker categories. Reduced income due to the loss of these life years will significantly impact these groups due to their dependence on daily wages for basic life necessities. Microlevel pollution mitigation policies with a focus on these inequalities are critical for promoting environmental equity and justice.

THE SELF-RATED PRESTIGE BASED SOCIAL STATUS OF THE PEASANTS IN TWO VILLAGES OF BANGLADESH

Peasants usually lack financial, social, physical, and human capital in nearly every aspect of their lives. Many parts of the world depict them as a subjugated and low-status group. Many studies have found a correlation between peasants prestige-based social status and their degree of homogeneity as measured by objective class. Nevertheless, the association between objective class and social status may differ according to a persons subjective interpretation of social status. This study examines how peasants perceive their own social status, as well as how their income, land ownership, and educational attainment correlate with prestige-based social status. Two villages in TanoreUpazilaof Rajshahi, Bangladesh were selected as study villages. In this study, quantitative and qualitative data were combined to minimize the weaknesses of each data type and to improve their accuracy and validity. To gain a comprehensive understanding of the research problem, focus groups and pre-tested questionnaire surveys were conducted simultaneously. The results of the study indicate that even though peasants do not possess large farmland, higher income, or higher educational attainment, a significant number of respondents claim to be in the good or very good social status category. According to the survey, approximately 62% of the peasants rated their social status as good (53.70%) and very good (7.70%). A noteworthy finding is that only 3.80% of respondents ranked their social status as bad or very bad. Survey results indicate that 38.40% of respondents claim to be in the middle of the social status spectrum. Income, ownership of farmland, and educational attainment do not represent a strong association with the prestige-based social status of the peasantry. Rather, in settings where peasants cultivate their land, grow their own food, and provide food for others, they regard their occupation as more prestigious. Respondents reported that they scored highly in their occupation because they are not entirely dependent upon the market for their daily needs, especially for food. While there may be a degree of heterogeneity among peasants in terms of income, education, and occupation, they are still referred to as sons of the soil in general. Thus, the peasants appear to be homogenous, and they value their status as well.

Low system justification drives ideological differences in joke perception: a critical commentary and re-analysis of Baltiansky et al. (2021)

Abstract A recent study by Baltiansky et al. (2021), which was published in HUMOR: International Journal of Humor Research tested two hypotheses related to system justification and the perception of stereotypical humor. They reported to have found evidence for a cross-over interaction, with judgments of jokes being contingent on a combination of the social status of the targets of jokes and raters’ system justification motivations. Here, we discuss the original analysis, presentation, and interpretation of the data in the target article, before presenting a re-analysis of the authors’ shared data file. We show that the framing of claims such as that “high system-justifiers found jokes targeting low-status groups (e.g., women, poor people, racial/ethnic minorities) to be funnier than low system-justifiers did” are misleading. Instead, our re-analyses suggest that ideological differences in joke perception are driven primarily by those scoring low on the system justification motivation rating jokes about ostensibly low-status groups as less funny than jokes about other social groups.

Investigating Racial and Socioeconomic Characteristics in Pediatric Sepsis Using Electronic Health Data.

Racial/ethnic and socioeconomic disparities are reported in sepsis, with increased mortality for minority and low socioeconomic status groups; however, these studies rely on billing codes that are imprecise in identifying sepsis. Using a previously validated algorithm to detect pediatric sepsis using electronic clinical data, we hypothesized that racial/ethnic and socioeconomic status disparities would be evident in this group. We performed a retrospective study from a large, quaternary academic center, including sepsis episodes from January 20, 2011, to May 20, 2021, identified by an algorithm indicative of bacterial infection with organ dysfunction (cardiac, respiratory, renal, or hematologic). Multivariable logistic regression was used to measure association of race/ethnicity, insurance status, and social disorganization index, with the primary outcome of mortality, adjusting for age, sex, complex chronic conditions, organ dysfunction on day 1, source of admission, and time to hospital. Secondary outcomes were ICU admission, readmission, organ dysfunction-free days, and sepsis therapies. Among 4532 patient episodes, the mortality rate was 9.7%. There was no difference in adjusted odds of mortality on the basis of race/ethnicity, insurance status, or social disorganization. There was no significant association between our predictors and ICU admission. Hispanic patients and publicly insured patients were more likely to be readmitted within 1 year (Hispanic odds ratio 1.28 [1.06-1.5]; public odds ratio 1.19 [1.05-1.35]). Previously described disparities were not observed when using electronic clinical data to identify sepsis; however, data were only single center. There were significantly higher readmissions in patients who were publicly insured or identified as Hispanic or Latino, which require further investigation.

Explaining socioeconomic disparities in electoral participation: The role of health in the SES-voting relationship

The substantial gap in electoral participation between upper and lower socioeconomic status (SES) groups has long been a vexing problem for modern democracies and one that demands explanation. Following separate bodies of scholarship that suggest (1) socioeconomic disadvantage diminishes health and (2) poor health demobilizes eligible voters, this paper proposes that health serves as a pathway through which social inequality manifests in disparities in electoral participation. This paper tests this hypothesis by analyzing U.S. presidential election data, in which structural equation modeling was used to decompose the association between SES and turnout, through health. Results show that health mediates approximately 20% of the relationship between SES and electoral participation. These findings imply a political explanation for the endurance of population health disparities; they may self-sustain by disproportionately limiting the political voice of the disadvantaged, for whom more egalitarian social and health policy would be most beneficial.

Apples versus oranges, normative claims, and other things we did not mention: a response to Purser and Harper (2023)

Abstract In a previous article, we observed that system justification was positively associated with the appreciation of humor targeting low-status groups (Baltiansky, Craig, & Jost, 2021). We are pleased to learn that other researchers took interest in our study, reanalyzing the data set we made publicly available and writing a commentary. We are also pleased that, using Bayesian statistical analyses, Purser and Harper (2023) reached the same conclusion we did based on frequentist analyses, namely that low system-justifiers found jokes targeting low-status groups to be less funny than high system-justifiers did. However, we object to the commentators’ use of value-laden language in characterizing the pattern of results and to several unsubstantiated insinuations and allegations of an ideological nature that they make about our motives and opinions about “cancel culture” and the deplatforming of professional comedians.

Longitudinal associations between allostatic load, pet ownership, and socioeconomic position among U.S. adults aged 50+

It is hypothesized that pets provide benefits to human health by buffering the deleterious effects of stress, but varying exposure to chronic stress via social position is rarely considered in these conceptual and empirical models. Allostatic load is an index of biological and physical measures that represents cumulative wear and tear on the body via chronic stress exposure. In this study, we use the 2006–2016 waves of the Health and Retirement Study, a nationally representative, longitudinal panel survey of adults aged 50+ in the United States, to test whether and to what extent pet ownership has an impact on allostatic load, and whether pet ownership moderates the effects of socioeconomic position on allostatic load. Linear mixed effects regression models revealed that pet owners had significantly lower allostatic load scores than those who do not own pets; however, after adjusting for socioeconomic position (i.e., wealth, education, race, ethnicity, gender, marital status), the effect of pet ownership was no longer significant. We estimated a series of models stratified by sociodemographic groups to test moderation effects. Among those who had a high school education, pet owners had lower allostatic load scores, whereas among those who had attended some college, pet owners had higher scores. Among those who were aged 80+, pet owners had higher scores than those who did not own pets. These findings suggest that the magnitude of the effect of pet ownership on allostatic load may not be sufficient to counteract experiences of high chronic stress as experienced by lower-status groups. Supporting the human-animal bond may contribute to improving older adult population health if paired with efforts to address the underlying causes of population health disparities.

Ventilatory, phonatory and swallowing impairments in advanced neuromuscular disease patients

PurposeTo analyze the ventilatory, phonatory and swallowing impairments and their relation with physical status in a group of advanced Neuromuscular Disease (NMD). MethodsA cross-sectional observational study was utilized 48 participants from the Association of NMD of Granada (Granada, España), university clinical research, University of Granada. A total of 24 advanced NMD patients and 24 healthy controls matched for age and sex were recruited. Advanced NMD patients were divided in two groups according to the level of their overall physical status (NMD higher physical status group or NMD lower physical status group). Hand grip strength, ventilatory, phonatory and swallowing features were analyzed. ResultsThere were significant differences (p<.05) among NMDs groups in ventilatory function. There were significant differences (p<.05) between NMDs groups in ventilatory, phonatory and swallowing function. Finally, there were significant differences (p<.05) among advanced NMDs groups in swallowing function and orofacial evaluation. ConclusionPatients with lower physical status have higher risk of suffer ventilatory, phonatory and swallowing complications after diagnosis of NMD.Registered in the Clinical Trials reference: NCT04473612.

Perceived barriers to vegetable intake among urban adolescents from socioeconomically disadvantaged backgrounds: A qualitative study from the perspective of youth workers and teachers.

Eating habits established during adolescence have been shown to track into adulthood. Adolescents from lower socioeconomic status groups tend to have lower intakes of vegetables as compared with their more affluent peers. However, there is limited evidence about the determinants of vegetable intake in this population group. Therefore, this study aimed to explore the barriers to vegetable intake in adolescents living in socioeconomically disadvantaged areas through the perspective of school teachers and youth workers. A total of 20 semi-structured interviews were conducted with post-primary school teachers and youth workers from disadvantaged areas in Dublin, Ireland. Thematic analysis was applied to analyze the data. Eleven themes were identified and fitted within the Socioecological Model of Health: adolescent's food preferences, lack of early exposure and familiarity with vegetables, lack of interest, knowledge and skills at the individual and family level, parenting practices around nutrition, living difficulties, peers’ influence and social norms around nutrition, dual role of social media, lack of resources and support to promote healthy eating, competition between unhealthy food vs. vegetables, lack of adequate approaches & initiatives at the community and at the public policy levels, and lack of State support to promote healthy eating. Although several actions could be taken at the personal and interpersonal levels, more efforts are needed at the organizational, community and public policy levels to improve dietary choices and vegetable intake among adolescents in socioeconomically deprived areas. These findings will inform the development of tailored intervention strategies and policies for these vulnerable youths.

An epidemiological study on body perception imaging and lifestyle behaviors among adolescents during COVID-19 pandemic in a rural area of West Bengal

Background: Adolescence is the intermediary linking phase from childhood to adulthood. Physical, sexual, psychological and social developmental changes during this period. Adolescence is a period of increased awareness of bodily cues and self-reflection, including evaluation of one’s own body and appearance. Body misconception and body dissatisfaction, two very important potential causative factors of bad nutritional status of adolescents, have not been adequately investigated in rural India. Aims and Objectives: The present study on adolescents was conducted to assess the lifestyle factors and degree of dissatisfaction and misconception of their body. Materials and Methods: An observational, descriptive, and community-based cross-sectional study was conducted by interviewing adolescents residing in the field practice area of the Department of Community Medicine, Medical College, Kolkata, during the months of March–April, 2022. The data were analyzed with the Statistical Package for the Social Sciences. Results: A total of 239 respondents were interviewed (74.1% male and 25.9% female). About 47.3% were early adolescents, 46.4% were middle adolescents, and rest 6.3% were late adolescents. About 56.5% was indulged in some kind of exercise. According to the total adolescent body image satisfaction scale score, 66.5% seemed to be satisfied with their body image. Body image dissatisfaction was associated with participants’ age, gender, socio-economic status, and type of family. Conclusion: It is evident from the study that girl children, adolescents of the lower socio-economic status group, and middle, and late adolescents are more prone to be dissatisfied with their body image. Hence, they need to be given extra focus for restoration of their mental health.

Demographic and Psychosocial Characteristics, Air Pollution Exposure, and Housing Mobility of Mexican Immigrant Families.

People of color and lower socioeconomic status groups in the USA, including those of Mexican origin, are exposed to higher concentrations of air pollution, including fine particulate matter (PM2.5). Associations were examined between neighborhood air pollution levels and the psychosocial and demographic characteristics of linguistically isolated Mexican-origin immigrant families. Housing mobility and changes in air pollution levels due to changes in residence were also examined. A sample of 604 linguistically isolated Mexican-origin families in central TX provided data on demographic and psychosocial experiences. Outdoor air pollution concentrations at participants' home addresses were based on high-resolution estimates of fine particulate matter (PM2.5) and its constituents. Movers were identified as families whose residential addresses changed during the study period; these participants were further grouped and compared based on the change in their residential PM2.5 concentration from before to after their move. Lower PM2.5 concentrations were associated with reports of more ethnic discriminatory experiences, higher socioeconomic status, and higher perceived neighborhood safety. Among the 23% of families who changed residences, PM2.5 concentrations were generally lower at the new family address. Families with mothers reporting a greater sense of neighborhood safety or acculturation levels tended to move from one area low in air pollutants to another, and mothers reporting the lowest levels of neighborhood safety or acculturation tended to move from one area high in air pollutants to another. There are limits to assimilation for Mexican immigrant families. Living in more advantaged neighborhoods is associated with experiencing better air quality, but this advantage may come at the cost of experiencing more ethnic discrimination.

Servant-Leadership at ServiceMaster: A Commitment to Love, Development, and Diversity

In society and business, there is increased energy and focus on caring and inclusive forms of leadership. An emphasis on control and exchange has shifted to more personalized forms, including but not limited to transformational, authentic, ethical, and spiritual leadership. Servant-leadership in particular is gaining traction as a practice that potentially facilitates multiple benefits for organizations and individuals. While servant-leadership ideals and practices have resonated with religious, non-profit, and educational institutions, they have also emerged in the for-profit business sector. In management scholarship, curiosity about the model in the 1990s has evolved into an earnest examination of the framework (Eva et al., 2019; Parris &amp; Peachey, 2013). The management origins of servant-leadership harken back to Robert Greenleaf (1977, 1998), a long-time manager at AT&amp;T who was deeply interested in conceptualizing the work of leaders as empowering others. Beyond individual leaders, business was also to act as a “serving institution” for its members and customers (Greenleaf, 1996). The servant-leader is motivated by the desire to serve and their efforts are measured by the development and well-being of those who are served (Sendjaya &amp; Sarros, 2002). This leader model is evident at ServiceMaster, a Fortune 500 firm differentiated by servant-leadership practices of the founder and early leaders, for whom biblical accounts of servanthood (e.g., Jesus washing the disciples’ feet and instructing them to do the same for each other, John 13:13-15) shaped the firm’s leadership praxis. In 2006, CEO Bill Pollard identified several important themes of servant-leadership germane to this paper—leadership as a means rather than an end, leadership as service rather than position or power, and leadership as an act of loving the diverse world created by God. Pollard’s speech illustrates a theologically rooted model of the servant-leader who is motivated to serve first. Such subordination is perhaps more remarkable when the person who serves is of higher status than the one being served. Leadership theory often fails to account for the leader’s identity, context, and position or power (Tilghman-Havens, 2018), assuming that all leaders share a similar baseline of perceived legitimacy. People’s implicit concepts of the prototypical leader (Northouse, 2022) are shaped by experience, personality, and cultural values (Lord &amp; Emrich, 2001). In U.S. society, the Euro American male is consciously or unconsciously regarded as an ideal leader. In contrast, servant-like behaviors are often attributed to the female gender or members of lower status groups which has negative implications for their visibility as leaders, performance evaluations, and advancement (Bowles &amp; McGinn, 2005). Researchers and practitioners must address possible implications of the leader prototype mismatch. Investigating this question necessitates an exploration of the costs and benefits related to adopting a servant-leadership framework. Although servant-leadership is ultimately about outcomes for those who are served, there is a substantial demand on personal leadership, and organizations should work to bolster their support of leaders to maximize positive benefits and mitigate costs. The purpose of this paper is to examine servant-leadership from a critical perspective, proposing a conceptual framework for investigating the potential costs and benefits to individuals who adopt servant-leadership in their organizations. I begin by briefly highlighting the salient benefits of servant-leadership and the current literature gap in addressing issues of identity related to gender, race, and ethnicity. I will also propose possible pathways for organizations to support servant-leaders from minority groups, extrapolated from the stories and practices of ServiceMaster, a firm that pursued servant-leadership over multiple generations.

Humble with God? How Education and Race Shape the Association Between God-Mediated Control and Humility in Later Life.

In contrast to the vibrant interdisciplinary literature on other virtues, such as forgiveness and gratitude, the study of humility has developed more slowly. Over the 2decades, there has been a proliferation of research on humility. In this study, we assess the interrelationship between a core feature of religious life, God-mediated control, and humility. We assess the interrelationship between God-mediated control (the belief that God is a collaborative partner working together with humans) and humility. We also assess how the relationship between God-mediated control and humility may be conditional on two sociodemographic characteristics among middle-aged and older adults, education and race. Data for this study come from Wave 5 of the Religion, Aging, and Health Study (2013), a nationwide survey of Whites and African Americans (N = 1152). We test our hypotheses with a series of OLS regression models. We find that stronger perceptions of God-mediated control were associated with greater humility among older adults. Results from our moderation analyses also show that the relationship between God-mediated control and greater humility was stronger for low status groups, namely, the less educated and Black older adults. The cognitive belief that God can be trusted as an intimate collaborator in the chaos of human life appears to predict humility among older adults, perhaps by acknowledging one's dependence on a superior being and appreciating the limits of human finitude and acknowledging God's greatness outside one's self. Devoid of secular resources, the less educated and Black Americans might find greater meaning and significance in their association with God and may feel no need to establish their own worth through the attainment of worldly accomplishments or knowledge. Given the centrality of humility to religious/spiritual life, we suggest how future interdisciplinary research can build on the findings of our study.

“Magnitude of community-based health insurance utilization and associated factors in Bassona Worena District, North Shoa Zone, Ethiopia: a community-based cross-sectional study”

IntroductionThe health insurance system has been proven to offer effective and efficient health care for the community, particularly community-based health insurance is expected to ensure health care access for people with low economic status and vulnerable groups. Despite the significance of evidence-based systems and implementation, there is a limited report about the magnitude of CBHI utilization. Therefore, this study was done to assess factors associated with community-based health insurance utilization in Basona Worena District, North Shewa Zone, Ethiopia.MethodA community-based cross-sectional study was employed. We have included 530 households from 6 randomly selected kebeles. The data was entered using Epi-Data V 3.1 and exported to SPSS version 20.0 for statistical analysis. Bi-variable and multivariable logistic regression analyses were computed to determine factors associated with community-based health insurance utilization.ResultThe study finding shows that 58.6% of the respondents were members of community-based health insurance. Respondents who had primary and secondary education levels were 2 times more likely to be members than those who had no formal education. As compared to those who had awareness, respondents who had no awareness about CBHI were 0.27 times less likely to be insured. Respondents who did not experience illness were 0.27 times less likely to be members than respondents who experienced illness.ConclusionEducational status, awareness about CBHI, perception of CBHI scheme and illness experience of family influence CBHI utilization. There is a need to strengthen awareness creation to improve the CBHI utilization.

Cross-Sector Partnerships to Deliver Health Equity.

Cross-Sector Partnerships to Deliver Health Equity Wengora E. Thompson, DrPH, MPH (bio), Kelly Jean Thomas Craig, PhD (bio), Kyu B. Rhee, MD, MPP (bio), Sreekanth K. Chaguturu, Md (bio), and Joneigh S. Khaldun, Md, Mph, Facep (bio) The coronavirus disease 2019 (COVID-19) pandemic has been an awakening to the entire globe and has unveiled to the public long-standing and unaddressed social inequities in the United States (U.S.). Over one million people in the U.S. have lost their lives to this terrible disease,1 and the long-term health, economic, and psychological impacts—while still undefined in detail—are significant,2 and for many remain unaddressed. The impacts of the pandemic have been much greater among those who are historically marginalized;3 these groups include people of color, LGBTQIA+ populations, those living with a disability, immigrants, people living in rural areas, the elderly, and those with lower socioeconomic status (education, income, and occupation) including the uninsured/underinsured. In 2021, over 30 million people in the U.S. suffered from food insecurity,4 which can be a temporary or long-term condition; lack of consistent access to affordable nutritious food leaves many households hungry. Furthermore, in 2021 15% of all renters were behind on their rent payments resulting in housing insecurity and many evictions.5 These preventable conditions are inequitably distributed, falling more heavily on racial/ethnic minority groups and low socioeconomic status groups across many health conditions. For example, concerning U.S. rates of maternal morbidity and mortality, women of color face risks of pregnancy-related complications and death that are more than double those of White women.6 In other examples of health disparities, the burden of death and illness associated with chronic diseases (such as diabetes,7 hypertension,8 cardiovascular disease,8 cancer,9 sickle cell disease,10 and human immunodeficiency virus11) experienced by people of color is markedly heavier than that of White populations. Non-Hispanic Black people are twice as likely as non-Hispanic White people to die from diabetes.7 Furthermore, when compared with White people, Black people have hypertension that [End Page 1] is earlier-onset, harder to control, and associated with worse outcomes;12 the Black population has five times as many potentially preventable hospitalizations and more end-organ damage; half of the cardiovascular mortality disparity between Black and White populations is attributed to hypertension.8 These health disparities reflect harsh, longstanding inequities—often stemming from structural racism—in education, employment, housing, and health care that were exacerbated by the pandemic.2 The reasons for these inequities, and thus the solutions to address them, are complex and require input from and collaboration among multiple stakeholders, as well as genuine and sustained input and partnership with communities. Many organizations, both private (e.g., health care, technology, and private nonprofits) and public (government), are extending their reach by establishing cross-sector partnerships to initiate actions that promote health and wellness in communities, workplaces, schools, and other settings in addition to addressing social determinants of health (SDoH) for all community members. Recognizing the contributions of social and physical environment to health (i.e., SDoH) and cooperatively addressing needs—such as housing, food, safety, and transportation—have the potential to deliver a scaled and community-specific impact. Public-private partnerships can identify both the social and health needs of community members and offer the promise of improving health outcomes and reducing health care costs with tailored interventions, assistance programs, and other personalized resources. The focus of this supplemental issue is the potential of public-private partnerships to advance health equity and address unmet needs. CVS Health® has a longstanding history of identifying and addressing health disparities and inequities and using partnerships to integrate care and services based on comparable missions and complementary capacities. When Aetna®, acquired by CVS Health in 2018,13 became the first national health plan to collect race and ethnicity data in 2003,14 it was a progressive and unmatched step towards improving population health on behalf of payers. The acquisition of these standardized demographic data is key to identifying disparities in quality of care and targeting quality interventions to achieve equity. Further, the curation of an equity-centric...

Is diversity enough? Cross-race and cross-class interactions in college occur less often than expected, but benefit members of lower status groups when they occur.

More than ever before, institutions of higher education are seeking to increase the racial and social class diversity of their student bodies. Given these efforts, the present research asks two broad questions. First, how frequently do intergroup interactions occur across the lines of race and social class, and to what extent do these interactions reflect the diversity of a setting? Second, when cross-race and cross-class interactions occur, how do individuals experience them and what consequences do they have for their outcomes in these settings? Leveraging a longitudinal design and daily diary methods, we conducted the first large study (Ninteractions = 11,460) which tracks the frequency, experience, and consequences of meaningful cross-race and cross-class interactions. We found that students reported far fewer cross-race and cross-class interactions than would occur at chance given the racial and social class diversity of their student bodies. Furthermore, students experienced less satisfaction and perspective-taking in cross-race and cross-class interactions compared to same-race and same-class interactions, respectively. Nevertheless, these cross-group interactions predicted better academic performance for underrepresented racial minority students and students from working and lower class backgrounds. They did so, in part, by increasing students' feelings of inclusion (i.e., increased belonging and reduced social identity threat). Together, these findings suggest that the mere presence of diversity is not enough to foster meaningful intergroup interactions. Furthermore, fostering intergroup interactions may be one important pathway toward reducing racial and social class disparities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

REVIEW OF MATERNAL MORTALITY AT A TERTIARY CARE HOSPITAL - A ONE YEAR STUDY

Background:Mothers are the nurturing pillar of the family. When a woman dies, the consequences have the potential to affect not only the woman herself, but her family, society and the nation as well.In 2015 globally 303,000 women died of various causes related to maternity. Aim:To determine the Maternal Mortality ratio at the tertiary care hospital for a period of one year and to identify the causes and factors leading to Maternal mortality. Material and Methods:This was a retrospective observational study carried out in the department of Obstetrics and Gynaecology at Andhra MedicalCollege and King George Hospital, Visakhapatnam, which is atertiary care centre of North Andhra.The hospital runs one ICU and Obstetric HDU, one blood bank and emergency operation theatre round the clock to provide emergencyobstetric services and critical care to their patients.The female deaths which met the WHO Criteria for Maternal Death were included in this study.The details of all the maternal deaths from January 2021 toDecember 2021 were collected from the individual case sheets and facility-based maternal death review forms. Results:During the study period January 2021 to December 2021, therewere 18,892 live births and 86 maternal deaths. The MMR in thestudy period was 455.2/100,000 live births.The maximum number of maternal deaths was seen in the age group 20-25 years, 61 cases (70.93%).The number of maternal deaths were maximum in the low socioeconomic status group with 71 cases (82.55%). Type I delay was seen in 49 cases (56.97 %). Direct causes of maternal death in the study was due to abortion in 3 cases (3.4%), hypertension in 37 cases (43.02%), obstetric hemorrhage in 22 cases (25.58%), infection/sepsis in 21 cases (24.41%) and embolism in 3 cases (3.4%) The most common indirect cause of maternal death was anemia seen in 51 cases (59.3%) Conclusion:Hypertension, hemorrhage and sepsis continue to be the leading causes of direct maternal deaths and anemia indirect cause of maternal death. Majority of deaths are preventable and with proper strategies and focusing on the 3 delays, maternal deaths can be reduced.

Socioeconomic status and survival in medieval Canterbury

The adverse urban environment of medieval Canterbury possibly influenced poor health conditions and diseases which ultimately led to death. Individuals of low socioeconomic status may have been more at risk of death than those of higher socioeconomic status due to dense living conditions, consistently encountering unhygienic waste management, and less access to resources during famines and disease outbreaks. This study evaluates survivorship and mortality risk patterns of high- and low-status groups to determine the effect of socioeconomic status on survival and mortality in medieval Canterbury. A sample of 796 low- and 74 high-status individuals were examined from St. Gregory’s Priory. Kaplan-Meier analysis and Cox Regression were used to assess mortality and survival between the socioeconomic status groups. The results reveal lower survivorship for high-status than low-status non-adults, and lower survivorship and high mortality risk for high-status adult females compared to low-status adult males. Meanwhile there were no significant differences found in mortality risks and survivorship between low- and high-status adult males, low- and high-status adult females, and low-status adult females and high-status adult males. High risk of mortality and decreased survivorship of high-status adult females may reflect decreased survivorship of high-status non-adults due to poor nutritional intake during and after pregnancy as well as rationing food. In comparison, low-status adult males would have benefited from the pilgrimage culture that allowed them abundant access to nutritious foods.

Social inequalities in multimorbidity patterns in southern Spain: findings from the DEMMOCAD survey

Abstract Background Multimorbidity (MM) is associated with lower quality of life, greater disability, and higher use of health services. It is a complex problem that is difficult to capture due to the broad spectrum of concurrent chronic diseases involved. There is a need to identify and characterize patterns of chronic conditions in the local context of specific population groups. The DEMMOCAD project aims to respond to this knowledge gap by detecting patterns of MM and their inequalities in the province of Cadiz (Spain). Methods A cross-sectional study was carried out by means of telephone interviews with people over 50 years of age. The final sample was 1592 individuals with MM. A latent class analysis was carried out to identify patterns of MM from 31 chronic conditions. First, the appropriate number of classes was established, considering model fit indices, class size, and clinical interpretability. Subsequently, covariates were introduced into the model using the three-step approach, a technique that minimizes biases in the multinomial regression model. Results Preliminary analyses of the goodness-of-fit indices of the model derived five MM patterns (entropy = 0.727): (C1) mild MM; (C2) cardiovascular; (C3) musculoskeletal; (C4) musculoskeletal plus mental; and (C5) complex MM. Compared with class C1, persons in class C5 were significantly older and less educated, class C4 had a lower income, class C3 was smokers and disabled, and class C2 was characteristic among older males. All four classes also showed lower scores on mental and physical dimensions of the SF12 scale compared to class C1. Conclusions In addition to providing an adjusted characterization of the population of the area analyzed, these initial findings highlight the existence of social inequalities in multimorbidity at the local level that should be addressed by implementing policies targeting the most vulnerable groups in Cadiz (low socioeconomic status groups, people with disabilities, and the elderly). Key messages

Low Prognostic Nutritional Index Contributes to High Adverse Events in Preeclampsia.

Background Preeclampsia (PE) is a common obstetric complication that has caused significant harm to pregnant mothers. The clinical significance of poor nutritional status in PE patients is unclear. The aim of our study was to evaluate the nutritional status as measured by the prognostic nutritional index (PNI) score at admission, and its ability to predict in-hospitalization adverse events in patients with PE. Methods We enrolled patients diagnosed with PE in the Third Affiliated Hospital of Guangzhou Medical University from January 2019 to December 2021. Patients were divided into low and high nutritional status group according to the cut-off value of PNI score at admission using the receiver operating characteristic (ROC) curve. PNI score were used to explore the relationship between PNI score and in-hospitalization adverse events presented with hazard ratio (HR) and 95% confidence intervals (CI). Results A total of 733 patients were included in the study. The proportion of adverse events and admission to intensive care unit (ICU) was higher in the low nutritional status group than in the high nutritional status group (P < 0.05). ROC curve analysis revealed an area under curve (AUC) of 0.628 for PNI score and the cut-off value of PNI was 37. The free-event rates determined by KM analysis were significantly lower in the low nutritional status compared to the high nutritional status (P < 0.05). Adjusted multivariate analysis showed that PNI score was independently associated with favorable outcomes (HR: 2.66; 95% CI: 1.724-4.050, P < 0.001). Conclusion High PNI score at admission was associated with reduced in-hospitalization risk of adverse events in patients with PE. Additional enhancing nutritional status during hospitalization may help to prevent unfavorable prognosis in clinical practices.