Lower Median Income Research Articles

An example of working women in Mexico City: How can their vision reshape transport policy?

This paper focuses on mobility and accessibility in Mexico City especially for low-medium income working women using a qualitative approach. Through in-depth interviews, we discuss different mobility and transport issues to understand what the main factors that influence their travel patterns are, how the different services are perceived and evaluated, and what their dairy constraints are. Our final aim is to understand what is still missing and to discuss the following steps regarding transport policy in Mexico City and its Metropolitan area through a gender perspective. Interestingly, even if there are important gender issues raised by participants, they have assumed these issues as being part of their daily life, modifying their transport patterns accordingly. They also perceive that there are many problems, which concern the transport system in general, others related to the complexity of the metropolis and the lack of civic-mindedness. The results also show a huge gap between women’s needs, depending on their income and place of residence.

The Rural Artistic Entrepreneur: Exploring Motivational Tension and Creative Production in Rural Economies

This paper explores the significance of co-existing and conflicting motives in creative production within rural areas. The financial productiveness of creative activity is investigated in the varying levels of artistic and economic tension seen in the creation of visual art. In this situation, the intrinsic desire to engage in the creative process may work in opposition to economic perspectives, such as an extrinsic appreciation of rewards gained from the finished product. Intrinsic and extrinsic motivation framework (Amabile, Hill, Hennessey & Tighe, 1994) and self-determination theory (Deci & Ryan, 2002) are used to identify the paradoxical motives experienced by artistic entrepreneurs operating in rural areas. Findings identify the four main motivational factors for such artistic entrepreneurs as: income, recognition, self-fulfilment and lifestyle. In order to balance these perspectives three main balancing strategies are evidenced, producing high satisfaction and lower income, medium satisfaction and higher income and low satisfaction and medium income. These strategies are used by artistic entrepreneurs to gain both personal satisfaction and financial reward from the production of visual art. They are presented in the concluding section of this paper in relation to current rural strategies, to consider how investment in those who effectively balance motivational tension can contribute to rural economies.

Do socio-economic determinants affect residential fire-related injuries and deaths among Canadian children?

Abstract BACKGROUND Fire is a leading cause of unintentional injuries among children in Canada. More specifically, residential fires are responsible for too many preventable deaths and injuries. Yet, there is no national database that reports on residential fire-related injuries and deaths among children. Although socio-economic determinants (SED) have been associated with increased risk of residential fire in the USA and UK, little is known about the significance of this impact on the Canadian child population. OBJECTIVES This study examined the role of SED (low education, median income and average number of persons per dwelling (ANPD)) in residential fire-related injuries and deaths, and assessed the relationship between age and the severity of residential fire-related injuries and deaths, among children and youth in Canada. DESIGN/METHODS A cross-sectional study design was used to examine data from the National Fire Information Database (NFID), which includes 10-years (2005–2015) of microdata information on fire incidents and losses reported by provincial/territorial Fire Marshals and Fire Commissioners Offices across Canada. Census 2011 data at the CSD level, from Statistics Canada, provided the SED variables. Our outcome of interest was the odds of death and major injury over minor injury. A logistic regression model was applied to test the relationship between age and SED with our outcome of interest, while adjusting for province. RESULTS For every 1 person increase in the average ANPD at the CSD level, there is a 31% decrease in the odds of dying or being severely injured in a residential fire (p=0.0003). For every 1% increase in CSD’s low education proportion, there is a 2.5% increase in the odds of dying or being severely injured in a residential fire (p=0.0002). Median income was not significantly associated with the odds of death and major injury over minor injury. The odds of death and major injury were not significantly different for youths and adults, compared to children, controlling for ANDP, low education and median income. CONCLUSION The National Fire Information Database is one of the first to amass reliable fire incident and loss information across Canada into one database. Using this novel dataset, we determined that increased ANPD strongly decreased the odds of death and major injury over minor injury. Thus, the number of persons living in a household should be considered when targeting vulnerable children and youth for residential fire prevention and safety promotion programs.

PRIORITAS KONSUMEN DALAM PEMBELIAN PRODUK BAKSO KEMASAN (STUDI KASUS PASAR TRADISIONAL WONOKROMO SURABAYA)

The development of consumer knowledge on purchased product includes severalcharacteristics which has to be fulfilled by producers. It becomes an important demandfor complete and clear information on purchased product which can include productbrand, quality, nutrition, and halal certificate the research took 3 kinds of packagingmeatball which was available in traditional market such as Yikko, KJM “Kijang Mas”,and AJ. This research was conducted to understand characteristic of the packagingmeatball consumer and to understand the relation between variabel and preference alsoto understand which attribute was considered important according to consumer inWonokromo traditional market. The sampling technique was conducted by nonprobability sampling through the accidental sampling method and the data analysis useddescriptive analysis, IPA (Important Performance Index). There were several similiaritiesof meatball consumer, such as: was dominated by women with average age was 17 – 24years old and was moeslem which were mostly student, private employee, housewife, andentrepreneur. The income level was around Rp 1.000.001 – Rp. 3.000.000 with the lasteducation level was SMU/SMK. The most important attribute according to consumerwere price, suppleness, flavor, halal certificate, quality and the less important attributefor consumer was composition. The attribute of packaging meatballs had a significantrelation to consumer preference such as price, flavor, suppleness, and quality. Price wasthe most important considerable attribute for consumer on purchasing because incomefactor which was classified to low medium income in Wonokromo traditional marketSurabaya.

Hospitalizations for Firearm Injuries in Children and Adolescents in the US: Rural versus Urban

Background: Firearm injuries are a leading cause of injury and death for children and adolescents in the United States. Prior research has identified male gender, non-white race, low median income and late adolescent age as risk factors for sustaining both fatal and non-fatal firearm injuries. There are limited data comparing rural versus urban firearm injuries in children and adolescents. Therefore, the objective of this study was to determine how hospitalization rates due to firearm injuries differ between rural and urban settings, and to compare rates by …

A Prostate Cancer Composite Score to Identify High Burden Neighborhoods

This study presents a novel geo-based metric to identify neighborhoods with high burdens of prostate cancer, and compares this metric to other methods to prioritize neighborhoods for prostate cancer interventions. We geocoded prostate cancer patient data (n = 10,750) from the Pennsylvania cancer registry from 2005 to 2014 by Philadelphia census tract (CT) to create standardized incidence ratios (SIRs), mortality ratios (SMRs), and mean prostate cancer aggressiveness. We created a prostate cancer composite (PCa composite) variable to describe CTs by mean-centering and standard deviation-scaling the SMR, SIR, and mean aggressiveness variables and summing them. We mapped CTs with the 25 highest PCa composite scores and compared these neighborhoods to CTs with the 25 highest percent African American residents and the 25 lowest median household incomes. The mean PCa composite score among the 25 highest CTs was 4.65. Only seven CTs in Philadelphia had both one of the highest PCa composite scores and the highest percent African American residents. Only five CTs had both the highest PCa composites and the lowest median incomes. Mean PCa composite scores among CTs with the highest percent African American residents and lowest median incomes were 2.08 and 1.19, respectively. The PCa composite score is an accurate metric for prioritizing neighborhoods based on burden. If neighborhoods were prioritized based on percent African American or median income, priority neighborhoods would have been very different and not based on PCa burden. These methods can be utilized by public health decision-makers when tasked to prioritize and select neighborhoods for cancer interventions.

Socioeconomic Factors Affecting Discharge Status of Patients with Uncomplicated Transsphenoidal Adenohypophysectomy.

Objectives The number of transsphenoidal adenohypophysectomies (TSAs) surgeries has grown significantly since 1993. While there has been an overall decreasing trend in length of stay (LOS), socioeconomic factors may impact hospitalization. This study explores the impact of socioeconomic factors on LOS and total charges in uncomplicated patients undergoing TSA. Design Retrospective cohort. Setting 2009 to 2013 Nationwide Inpatient Sample. Participants Patients undergoing TSA without medical complications. Main Outcomes Measures LOS and total charges. Results A total of 6,457 patients were identified, of which 17.2% had secreting tumors. Patients with secreting tumors stayed 2.95 days versus those with nonsecreting tumors stayed 3.26 days ( p < 0.001). Discharge to other than self-care was the largest contributing variable for both subsets, increasing both LOS and total charges. Patient factors that drove longer LOS and increased total charges for both subsets included metropolitan domicile, having a lower median income, Hispanic ethnicity, and having an increased amount of Agency for Healthcare Research and Quality (AHRQ) comorbidity indices. Having private insurance predicted a shorter LOS and lower total charges. Conclusions These results demonstrate that, even without complications, patients can be delayed in their discharge. While several socioeconomic factors significantly predict LOS and charges, the discharge disposition ultimately has the greatest effect. This suggests that efforts should focus on improving organizational factors such as coordination with social work and outside facilities to decrease LOS and charges for this patient population.

A Description of Advertisements for Alcohol on LinkNYC Kiosks in Manhattan, New York City: A Pilot Study.

Excessive alcohol consumption compromises health and increases risk of mortality. Advertisements for alcohol in city environments have been shown to influence consumption. The aim of this pilot study was to estimate the prevalence of alcohol advertisements displayed on LinkNYC kiosks, a new communication channel that provides outdoor Wi-Fi access and advertising on streets within urban environments. Direct observations were conducted to document advertisements on a 20% random sample of the 500 LinkNYC kiosks in Manhattan, NYC. From May to September of 2017, each of the 100 selected kiosks was observed for a 10-min period to document advertisements for alcohol. In addition, differences in prevalence of alcohol advertisements were examined by the location of the kiosk based on NYC zip codes' median annual income. Of the 2025 advertisements observed, 5.09% (N = 103) were for an alcohol product (including duplicates). Such advertisements were observed on 17% of the kiosks. No health warnings or age warnings were presented in any of the alcohol advertisements. Compared with kiosks located in zip codes with lower median annual income, significantly more alcohol advertisements were displayed in zip codes with higher median annual income. This is the first study to estimate the prevalence of alcohol advertising on the LinkNYC Wi-Fi and telecommunication system, now ubiquitous on Manhattan's sidewalks. This study adds to the current literature that suggests New York City residents could benefit from health-promoting versus health-compromising advertising. The findings also highlight the potential of LinkNYC kiosk marketing to undermine health-related social marketing efforts by City government and other organizations.

Readmission Rates and Diagnoses Following Total Hip Replacement in Relation to Insurance Payer Status, Race and Ethnicity, and Income Status.

Total hip replacements (THRs) are the sixth most common surgical procedure performed in the USA. Readmission rates are estimated at between 4.0 and 10.9%, and mean costs are between $10,000 and $19,000. Readmissions are influenced by the quality of care received. We sought to examine differences in readmissions by insurance payer, race and ethnicity, and income status. We analyzed all THRs from 2007 to 2011 in California, Florida, and New York from the State Inpatient Databases, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Primary outcomes were readmission at 30 and 90days after THR. Descriptive statistics were calculated, and multivariate logistic regression analysis was used to estimate adjusted odds ratio (OR) for readmissions. Statistical significance was evaluated at the < 0.05 alpha level. A total of 274,851 patients were included in the analyses. At 30days (90days), 5.6% (10.2%) patients had been readmitted. Multivariate logistic regression analysis showed that patients insured by Medicaid (OR 1.23, 95%CI 1.17-1.29) and Medicare (OR 1.58, 95%CI 1.44-1.73) had increased odds of 30-day readmission, as did patients living in areas with lower incomes, Black patients, and patients treated at lower volume hospitals. Ninety-day readmissions showed similar significant results. The present study has shown that patients on public insurance, Black patients, and patients who live in areas with lower median incomes have higher odds of readmission. Future research should focus on further identifying racial and socioeconomic disparities in readmission after THR with an eye towards implementing strategies to ameliorate these differences.

Health Status of Urban Medium-Low-Income Elderly at the Community

Background: Nonagenarians are uncommon in our population. The study aim was to profile physical mobility, declared health problems, hypertension and diabetes frequency, awareness, treated and good control in urban low-income elders. Method: The study had cross-sectional design in population sample. Subjects were urban men and women older than 59 years at the medium low income stratum at a developing country. Survey was carried out from October 2008 to October 2009. All elder dwellers in randomly selected houses were surveyed; clinical exam after consent. Good Control: Systolic/Diastolic 0.05. The frequency, proportions for: known diagnosis, on treatment, and good control were 75 (69.4%), 55 (73.3%), 45 (60.0%) and 12 of 45 (26.7%) for hypertension; 53 (49.1%), 47 (88.7%), 42 (79.2%) and 9 of 42 (21.4%) for diabetes. The most frequent unstable conditions were cardiovascular. Conclusions: Data suggest unstable health no association with the oldest old. The small proportion in good control of Diabetes and/or hypertension could explain the large frequency of elders with unstable health and prevention of reaching nonagenarian age.

Examining relationships between perceptions and objective assessments of neighborhood environment and sedentary time: Data from the Washington, D.C. Cardiovascular Health and Needs Assessment.

Sedentary time (ST) and neighborhood environment (NE) are predictors of cardiovascular (CV) health. However, little is known about ST's relationship with NE. We examined associations of perceived and objective NE with ST in the predominantly African American faith-based population of the Washington, D.C. CV Health and Needs Assessment. After using community-based research principles, participants reported NE perceptions, including sidewalks, recreational areas, and crime presence. Factor analysis was conducted to explore pertinent constructs; factor sums were created and combined as Total Perception Score (TPS) (higher score = more favorable perception). Objective NE was assessed using Google Maps and the Active Neighborhood Checklist (ANC). ST was self-reported. Linear regression determined relationships between TPS and ST, and ANC scores and ST, for 1) overall population, 2) lower median-income D.C. areas, and 3) higher median-income DC and Maryland areas. For the sample (N = 98.9% African-American, 78% female), lower median-income areas had significantly lower mean TPS and ANC scores than higher median-income areas (p < 0.001). Three factors (neighborhood violence, physical/social environment, and social cohesion) were associated with overall NE perception. Among those in lower median-income areas, there was a negative association between TPS and ST that remained after covariate adjustment; this was not observed in higher median-income areas. There was no association between ANC scores and ST. Poorer NE perception is associated with greater ST for those in lower income areas, while objective environment is not related to ST. Multi-level interventions are needed to improve NE perceptions in lower-median income areas, reduce ST, and improve CV health.

Applicability of energy-positive net-zero water management in Alaska: technology status and case study.

Challenges of water and wastewater management in Alaska include the potential need for above-grade and freeze-protected piping, high unit energy costs and, in many rural areas, low population density and median annual income. However, recently developed net-zero water (NZW), i.e., nearly closed-loop, direct potable water reuse systems, can retain the thermal energy in municipal wastewater, producing warm treated potable water without the need for substantial water re-heating, heat pumping or transfer, or additional energy conversion. Consequently, these systems are projected to be capable of saving more energy than they use in water treatment and conveyance, in the temperate USA. In this paper, NZW technology is reviewed in terms of potential applicability in Alaska by performing a hypothetical case study for the city of Fairbanks, Alaska. Results of this paper study indicate that in municipalities of Alaska with local engineering and road access, the use of NZW systems may provide an energy-efficient water service option. In particular, case study modeling suggests hot water energy savings are equivalent to five times the energy used for treatment, much greater savings than in mid-latitudes, due largely to the substantially higher energy needed for heating water from a conventional treatment system and lack of need for freeze-protected piping. Further study of the applicability of NZW technology in cold regions, with expanded evaluation in terms of system-wide lifecycle cost, is recommended.

Do geographic differences or socioeconomic disparities affect survival in sinonasal squamous cell carcinoma?

Squamous cell carcinoma (SCC) is the most common malignancy in the sinonasal tract. We present the first population-based analysis that examines geographic differences in demographic and clinical characteristics, socioeconomic factors, treatment modality, and disease-specific survival (DSS) of this entity. All cases of sinonasal squamous cell carcinoma (SNSCC) were queried using the U.S. Surveillance, Epidemiology, and End Results (SEER) registry from 1973 to 2013. Patients were stratified by geographic location and characteristics such as demographics (age, gender, race, metropolitan/nonmetropolitan status, and income), stage at diagnosis, and treatment modality. Survival data were generated using Kaplan-Meier regression analysis. In total, 6094 patients were identified; 15.3% were from the East, 16.3% from the Midwest, 19.3% from the South, and 49.1% from the West. Patients from the South were younger (p < 0.001). The South had the highest proportion of patients who were black (p < 0.001), lived in nonmetropolitan areas (p < 0.001), and presented with localized disease (p < 0.001). Southern patients also had the lowest median income (p < 0.05), and were least likely to be treated with both surgery and radiotherapy (p < 0.001). The South exhibited the lowest 20-year DSS compared to all other regions (p < 0.001). SNSCC patients from the South had the poorest long-term DSS, despite being most likely to present with localized disease. The South had the highest proportion of patients who were black, resided in rural or urban towns, had the lowest median income, and did not receive standard combination therapy, compared to the East, Midwest, and West.

Trends in pelvic inflammatory disease emergency department visits, United States, 2006–2013

Pelvic inflammatory disease is a female genital tract disorder with severe reproductive sequelae. Because of the difficulties in diagnosing pelvic inflammatory disease, it is not a reportable condition in many states. Females seeking care in emergency departments are a sentinel population for pelvic inflammatory disease surveillance. The objective of the study was to determine trends in diagnoses of acute pelvic inflammatory disease in a nationally representative sample of emergency departments. All emergency department visits among females aged 15-44 years with an International Classification of Diseases, ninth revision, Clinical Modification diagnosis code indicating pelvic inflammatory disease during 2006-2013 were assessed from the HealthCare Utilization Project Nationwide Emergency Department Sample. Total and annual percentage changes in the proportion of pelvic inflammatory disease emergency department visits were estimated using trend analyses. While the number of emergency department visits among females aged 15-44 years during 2006-2013 increased (6.5 million to 7.4 million), the percentage of visits due to pelvic inflammatory disease decreased from 0.57% in 2006 to 0.41% in 2013 (total percentage change, -28.4%; annual percent change, -4.3%; 95% confidence interval, -5.7% to -2.9%). The largest decreases were among those aged 15-19 years (total percent change, -40.6%; annual percentage change, -6.6%; 95% confidence interval, -8.6% to -4.4%) and living in the South (total percentage change, -38.0%; annual percentage change, -6.2%; 95% confidence interval, -7.8% to -4.6%). Females aged 15-19 years who lived in the South had a 47.9% decrease in visits duetopelvic inflammatory disease (annual percentage change, -8.4%, 95% confidence interval, -10.4 to -6.5). Patients living in ZIP codes with the lowest median income (<$38,000) had the highest percent of visits with a pelvic inflammatory disease diagnosis; the smallest declines over time were in patients living in ZIP codes with the highest median income (i.e., >$64,000, total percent change, -24.4%; annual percent change, -3.8%; 95% confidence interval, -5.2% to -2.4%). The percentage of emergency department visits due to pelvic inflammatory disease was highest among patients not charged for their visit, self-paying, or those covered by Medicaid, with total percentage changes in these 3 groups of -27.8%, -30.7%, and -35.1%, respectively. Patients with Medicaid coverage had the largest decrease in visits with a diagnosis of pelvic inflammatory disease (total percent change, -35.1%; annual percent change, -5.8%; 95% confidence interval, -7.2% to -4.3%). Nationally representative data indicate the percentage of emergency department visits with a pelvic inflammatory disease diagnosis decreased during 2006-2013 among females aged 15-44 years, primarily driven by decreased diagnoses of pelvic inflammatory disease among females aged 15-19 years and among women living in the southern United States. Despite declines, a large number of females of reproductive age are receiving care for pelvic inflammatory disease in emergency departments. Patients with lower median income and no or public health insurance status, which may decrease access to and use of health care services, consistently had the highest percentage of emergency department visits due to pelvic inflammatory disease. Future research should focus on obtaining a better understanding of factors influencing trends in pelvic inflammatory disease diagnoses and ways to address the challenges surrounding surveillance for this condition.

Patient-level Factors Associated with HIV Suppression at Admission Across a Large Integrated Healthcare System

BackgroundLinkage to care is a critical step for achieving HIV viral suppression and improving outcomes in newly diagnosed individuals. An unexpectedly high number of patients who have undiagnosed HIV or ineffective viral suppression are identified upon admission to acute care. This study aims to understand factors that may be associated with lack of viral suppression for patients who are newly diagnosed at admission.MethodsPatients with HIV, admitted to one of our eight acute care facilities were identified (n = 1,632) from medical records. Of these, 94 were newly diagnosed and 1,538 had a prior diagnosis of HIV. Factors that may impact the viral suppression status (<200 copies/mL) prior to admission were examined. Median income and percentage of individuals living below poverty were inferred from the American Community Survey (U.S. Census) data based on a patient’s zipcode. All other factors were extracted from the medical record at the time of admission. Chi square tests and t-tests were used to compare patients who were virally suppressed to those who were not.ResultsThe average age was 48 years old and 60% were male and 82% black race. Patients who presented and were not virally suppressed were more likely to be between the ages of 40–60 and of black race. Distributions of age groups and race were significantly different between those virally suppressed and those who were not suppressed at admission (P < 0.05 for both). Blacks and whites between 40 and 60 years were more likely than other race and age groups to present at admission without viral suppression. Patients from geographic areas associated with high poverty and lower median income were less likely to be virally suppressed at admission (23.2% vs. 25.2%; P < 0.05 for poverty and $41,183 vs. $43,757; P < 0.05) for income.ConclusionThese results indicate that age, race and geographically inferred income and poverty are significantly different between patients who are virally suppressed at admission and those who have a detectable viral load. Further investigation is needed to better understand how these patient-level factors, including socioeconomics, impact linkage to care as well as how best to allocate resources to better engage and retain patients in HIV care to improve their long-term outcomes.Disclosures All authors: No reported disclosures.

Comparison of demographic variables related to 30-day readmission in cancers with similar risk factors: Analysis of 290,270 hospitalizations.

e15596 Background: There has been increasing focus on reducing hospital readmissions which are an ongoing economic challenge. This study was targeted at cancer of the esophagus (CE), stomach (CS), and pancreas (CP) which share similar risk factors to identify if these patient subsets also share risk for hospital readmission. Methods: Data was extracted from Nationwide Inpatient Sample database, which approximates 20% of U.S. community hospitals. Patients with a diagnosis CE, CS, and CP were identified by Clinical Classification Software code 11, 12, and 17, respectively. Demographic parameters associated with high readmission rates were collected for patients readmitted within 30 days over 2009-2013. Chi-square test was used to asses differences between variables. Results: We identified a total of 290,270 hospitalizations over the 5-year period of which 26.2% were readmitted within 30 days. The total number of readmissions were comparable for CS (28.0%), CP (27.89%), and CE (26.81%). Patients 45 to 64 years (28.58%, p &lt; 0.001), Medicaid insurances (33.4%, p &lt; 0.001), and metropolitan areas (26.8%, p &lt; 0.001) were associated with higher 30-day readmission rates amongst all three cancers. Males had higher readmission rates in CS (25.64%, p &lt; 0.001) and CP (28.6%, p &lt; 0.001) compared to females in CE (28.0%, p &lt; 0.001). Lowest median income for zip code patients were readmitted more often in CS (26.2%, p &lt; 0.001) vs. third median income in CP (27.78, p &lt; 0.001) and fourth (highest) median income in CE (28.38 %, p &lt; 0.001). The most common identified causes of readmission in all three cancers were complications of surgical procedures or medical care (8.51% ± 2.03%), and septicemia (6.5% ± 1.95%). Conclusions: Our analysis shows that some variables for readmission are similar however more studies are needed to further elucidate whether this is primarily due to analogous treatment techniques. If so interventions to limit readmissions related to these treatments should be taken. Differences in readmissions rate amongst income classes could be related to the ease of accessing the most endorsed treatments for each individual cancer, however further studies are needed to clarify this discrepancy.

Urban responses to restrictive conservation policy during drought

AbstractWith climate change, the extent, severity, and frequency of droughts around the world are expected to increase. This study analyzed the ability of water districts to meet mandatory urban water conservation targets, which are a common policy response to drought. During California's recent record‐breaking drought, a 25% state‐wide use reduction objective was set and met. However, only 50% of urban water districts analyzed in this study reached their individual conservation target, which offers an opportunity to evaluate the factors associated with successful water use reduction. The findings show that the inclusion of water districts in the polycentric import structure may improve water conservation, but that source diversity may offer water districts a perceived buffer from the need for immediate water use reductions. Drought severity and lower median incomes are associated with greater water conservation, and conservation varies by hydrologic region. This analysis offers insights into institutional design and suggests that local biophysical and economic conditions shape responses in systematic ways that should be addressed by public policy responses to drought.

Quitting smoking and willingness to pay for cessation in Panama

To characterize the desire for cessation and willingness to pay for abandonment therapy. The data source is the Global Adult Tobacco Survey (GATS). Cessation and willingness to pay were characterized by sociodemographic (SD) and socioeconomic (SE) variables. Logistic regressions were performed to estimate associations. A greater desire for cessation was observed in variables: women, education, non-governmental and inactive employees, rural areas, occasional smokers and middle income, and greater willingness to pay, in: education, over 60 years old, non-governmental, self-employed, urban area, occasional smokers and low median income. There is a high relation between the desire for abandonment, and willingness to pay with SD and SE variables. Cessation therapies can be applied in work centers, and require a change of focus in the intervention.

Impact of therapeutic food compared to oral nutritional supplements on nutritional outcomes in mildly underweight healthy children in a low-medium income society

Therapeutic foods (RUTF) are used to treat severe acute malnutrition in children 5 years and under in low and middle income countries (LMI), while liquid nutritional supplements (ONS) are used in affluent societies. With globalisation and economic growth in LMI, there will be an inclination to move towards practices applied in affluent countries. This study compared the effect of supplementation with a RUTF and an ONS, on nutritional outcomes in mildly underweight children. 68 Pakistani (5-10y), mildly underweight (weight Z-score:-2 to-1) children randomly received either RUTF or ONS (500kcal/day), in addition to their habitual diet for four weeks. Weight, height, skinfolds and their changes during intervention, were compared between the two groups and at follow up, post-supplementation. All nutritional outcomes and height improved with both supplements, but net weight gain (kg) and changes from baseline for weight, height, triceps and sub-scapular thickness Z-scores did not differ between the two supplements [mean (SD), RUTF vs ONS; weight gain (kg), 0.59 (0.30) vs 0.65 (0.42), p=0.483; weight Z-score, 0.12 (0.09) vs 0.15 (0.13), p=0.347; height Z-score, 0.04 (0.08) vs 0.04 (0.08), p=0.908; triceps Z-score, 0.29 (0.24) vs 0.31 (0.23), p=0.796; subscapular Z-score, 0.37 (0.29) vs 0.31 (0.25), p=0.385]. Weight gain (0.6kg) for both groups was lower than anticipated (2kg). Post-supplementation, there was a tendency for weight and height Z-score to return to baseline. RUTF and ONS are equivalently effective in improving nutritional outcomes in children 5 to 10yat risk of malnutrition but the observed benefit is less than expected and not sustainable. This trial was registered at www.controlled-trials.com reference: ISRCTN51555749. This trial was registered at www.controlled-trials.com reference: ISRCTN51555749.

Mental health service availability and delivery at the global level: an analysis by countries' income level from WHO's Mental Health Atlas 2014.

The World Health Organization (WHO)'s Mental Health Atlas series has established itself as the single most comprehensive and most widely used source of information on the global mental health situation. The data derived from the latest Mental Health Atlas survey carried out in 2014 describes the availability and delivery of mental health services in the WHO's Member States, focussing on differences by country's income level. The data contained in this paper are mainly derived from questions relating to mental health service availability and uptake, as well as on financial and human resources for mental health. Results are presented as median values and analysed by World Bank income group. Interquartile ranges are also provided as measures of statistical dispersion. In total, 171 out of WHO's 194 Member States were able to at least partially complete the Atlas questionnaire. The results highlight a wide gap between high and low-medium income countries in a number of areas: for example, high-income countries have 20 times more beds in community-based inpatient units and 30 times more admissions; the rate of patients cared by outpatient facilities is 40 times higher; and there are 66 times more community outpatient contacts and 15 times more mental health staff at outpatient level. Overall resources for mental health are not distributed efficiently: globally about 60% of financial resources and over two-thirds of all available mental health staff are concentrated in mental hospitals, which serve only a small proportion of patients. Results indicate that outpatient care is the only effective means of increasing the coverage for mental disorders and is expanding, but it is strongly influenced by country income level. Two elements of the network of mental health facilities are particularly scarce in low- and middle-income countries: day treatment facilities and community residential facilities. The WHO Mental Health Atlas 2014 survey provides basic mental health information at the level of WHO's Member States, concerning mental health resources and activities. Atlas promotes the use of information, usually underestimated not only in low- and middle-income countries but also in high-income countries. Information is needed not only for monitoring the scaling up of the mental health system at country level, but also for improving transparency and accountability for users, families and the public.