Poor Financial Status Research Articles

Accessibility of People with Visual Impairment To Dental Services: A Prospective, Observational, Mixed Method Study

Objectives: This prospective, observational, mixed method study aims to assess patients with visual impairment general and oral health status, oral health-related quality of life, oral health knowledge, and adherence to recommended oral hygiene advice. Methods: Participants were interviewed using a semi-structured questionnaire at two sequential time points. At the day of recruitment (Time 1), participants were interviewed using questions from the adult dental health survey and the Arabic version of the oral health impact profile-14. At Time 2 (one-month post-dental education given at Time 1), participants were phoned after one month to assess their adherence to recommended oral hygiene instructions given at Time 1. The DMF Index was used to assess prevalence of dental caries. Results: The mean age of the participants was 21 years (SD = 2.98). Most participants (62.5%) had acute dental pain, brushed their teeth less than twice daily, and were not registered with dentists. Each person experienced a mean of six problems (median = 6) on oral health impact profile-14 and had an average of 7.1 (SD = 4.12) active caries. At Time 2, all participants had registered with a general dentist, and all brushed their teeth at least twice daily. Thematic analyses explored crucial barriers experienced by participants to access dental services. Conclusions: People with visual impairment reported poor oral health-related quality of life due to poor oral health status, oral health knowledge and education. Participants experienced long waiting lists for appointments in governmental dental hospitals, poor financial status to afford private dental care, and issues with accessibility to dental services due to transportation and caring issues.

Abstract 12620: Effects of Financial Status on Engagement in Self-care in Rural Caregivers With Cardiovascular Risk Factors

Introduction: Caring for adults with chronic illnesses increases the risk of developing cardiovascular disease (CVD). Engaging in self-care of healthy behaviors is critical for caregivers, but it may be more difficult due to financial hardship and psychological distress among those living in socioeconomically distressed rural areas. The study's purpose was to examine the association of financial status with engagement in self-care and whether this association is mediated by depressive symptoms in rural caregivers. Methods: We used baseline data from 300 rural caregivers (mean age 55 years, 76% female) with at least 2 CVD risk factors participating in a CVD risk reduction intervention trial. They provided data on financial status (3 groups: more than enough, enough, and not enough to make ends meet), depressive symptoms (Patient Health Questionnaire), self-care engagement (MOS-Specific Adherence Scale), caregiving time/difficulty (Oberst Caregiving Burden Scale), and physical assessments for estimating Framingham CVD risk score. Mediation analysis with a multi-categorical antecedent was conducted controlling Framingham risk score and caregiving time/difficulty. Results: Those with more than enough (27%), enough (56%), and not enough (56%) to make ends meet had similar Framingham risk scores (M = 12.3, P = .61). Compared to the more than enough group (Figure 1), the not enough group had lower self-care engagement scores (direct effect = -6.48) that were reduced further by the influence of depressive symptoms (indirect effect = -1.19). The results were similar for the enough to make ends meet group (direct effect= - 2.67; indirect effect = -.70). Conclusion: Poor financial status was directly associated with decreased engagement in self-care and indirectly associated through increased depressive symptoms. Promoting self-care strategies should include managing depressive symptoms for rural caregivers with a high risk of CVD who report financial hardship.

Abstract 9799: Financial Status, Fatalism and Self-Care of Cardiovascular Disease Risk Factors Among Rural Adults Living in Socioeconomically Distressed Areas

Background: Adults with fewer financial resources often have poor self-care. Fatalism is a belief that events in life are determined by outside forces. Rural adults commonly have fewer financial resources than urban dwellers and are often stereotyped as fatalistic about their health. Our aim was to determine whether fatalism mediates the association of financial status with cardiovascular disease (CVD) self-care in rural adults in economically distressed areas. Hypothesis: We hypothesized that those with fewer financial resources would have poorer self-care and fatalism would mediate this relationship. Methods: We enrolled 1118 adults (mean age 53 ± 15 years; 75.6% female) at risk for CVD. Financial status was reflected by individuals’ perceptions of how well they made “ends meet” with their financial resources (i.e., more than enough, enough, or not enough to make ends meet), fatalism by CVD-Fatalism Instrument, and self-care of CVD risk factors by Medical Outcomes Study-Specific Adherence Scale. We used conditional process analysis with PROCESS macro and 5000 bootstrap samples. Results: Financial status was associated directly with self-care. Those with with not enough to make ends meet (C' = -3.51, p = .003) and those with enough (C' = -1.57, p = .016) compared to those with more than enough had worse self-care. Fatalism was associated with self-care. Those hose with higher levels of fatalism had worse self-care (b = -1.78, p = .001). Financial status was indirectly associated with self-care through fatalism. Compared to those with more than enough, those with not enough (indirect effect = -.269, CI = -.609, -.021) and enough (indirect effect = -.182, CI = - .376, -.041) had higher fatalism levels and thus worse self-care. Conclusion: Poor financial status drives fatalism in rural dwellers, which in turn results in poor self-care.

Perceived and Experienced Anti-Chinese Discrimination and Its Associated Psychological Impacts Among Chinese Canadians During the Wave 2 of the COVID-19 Pandemic

ABSTRACT The current study examined the sociodemographic factors associated with perceived and experienced anti-Chinese discrimination and discrimination as a predictor of psychological distress and loneliness among Chinese Canadians. A cross-sectional online survey was conducted in early 2021 with a sample of 899 Chinese Canadians (i.e., immigrants, citizens, visitors, and international students) during the Wave 2 of the COVID-19 pandemic. Overall, anti-Chinese discrimination was generally associated with younger age and poor financial or health status. Christianity/Catholicism believers were less likely to report perceived discrimination, whereas being married/partnered and living with family reduced the incidences of experienced discrimination. Most importantly, hierarchical linear regression models showed that both perceived and experienced discrimination predicted higher psychological distress ( β s = 4.90–7.57, ps ≤ .001) and loneliness ( β s = .89–1.73, ps ≤ .003), before and after controlling for all related sociodemographic covariates. Additionally, older age, higher education, better financial or health status could all buffer psychological distress, whereas living with family or in a house and better financial or health status could mitigate feeling of loneliness. The results suggested that discrimination has a robust detrimental impact on mental health conditions among Chinese Canadians.

Health literacy and gender differences in colorectal cancer screening

Abstract Introduction Colorectal cancer (CRC) is one of the major causes of death worldwide. Previous research reported differences in screening adherence both by gender and socioeconomic determinants. However, little is known about the extent to which Health Literacy (HL) may affect gender differences in CRC screening rates. Here, we aimed to assess HL levels in both genders and their relations with CRC screening adherence. Methods The study was performed within the Tuscan population sample selected in the Italian Behavioral Risk Factor Surveillance System (PASSI - Progress by local health units toward a healthier Italy) in 2017-2019. Socioeconomic status was measured by education level, occupation, financial status, and nationality, while HL by the Italian version of the 6-items European Health Literacy Survey Questionnaire (HLS-EU-Q6). Multivariate analysis was performed to investigate associations between CRC screening rates, social determinants, and HL. Results Among 4,268 people aged 50-69 years included in PASSI, 64% undergo to CRC screening in the 2 years preceding the interview. No statistically significant differences in screening adherence were found by gender. In the multivariate analysis, the odds of adherence to CRC screening increased in both genders for being aged 60-69 years (Males: OR 1.43, 95% CI 1.12-1.82; Females: OR 1.72, 95% CI 1.37-2.14) and high education level (Males: OR 1.34, 95% CI 1.08-1.66; Females: OR 1.30, 95% CI 1.05-1.60). Males with a poor financial status and females with a low HL level were less likely to undergo CRC screening (OR 0.71, 95% CI 0.57-0.88 and OR 0.68 95% CI 0.49-0.95 respectively). Conclusions Our findings suggest that adherence to CRC screening is associated with HL in females only, while it depends on financial status in males. Therefore, gender specific interventions, tailored on different factors, are needed to increase the CRC screening rates. Key messages

Anxiety symptoms in older Chinese adults in primary care settings: Prevalence and correlates.

BackgroundIntegrating mental health services into primary care is a potentially cost-effective way to decrease the treatment gap for anxiety in older adults but data on the epidemiology of anxiety symptoms in older Chinese adults in primary care settings have been very limited. This study investigated the prevalence and correlates of anxiety symptoms in Chinese older primary care patients.MethodsA total of 753 older primary care patients (≥65 years) were consecutively recruited from 13 primary care clinics in Wuhan, China, and interviewed with the validated Chinese version of the short form of the Geriatric Anxiety Inventory (GAI-SF).ResultsThe prevalence of anxiety symptoms (GAI-SF ≥ 3) in older primary care patients was 21.1%. Statistically significant correlates of anxiety symptoms were female sex (vs. male, OR = 1.85, P = 0.002), poor economic status (vs. good, OR = 2.31, P = 0.013), fair and poor family relationship (vs. good, OR = 1.85, P = 0.006), hypertension (OR = 2.01, P < 0.001), chronic gastric ulcer (OR = 6.82, P < 0.001), and Parkinson's disease (OR = 7.83, P = 0.031).ConclusionsAnxiety symptoms are prevalent among older adults attending primary care clinics. Efforts for preventing or reducing anxiety symptoms in older primary care patients may be more useful to target those who are women, have poor financial status, don't have a good family relationship, suffer from hypertension, have chronic gastric ulcer, and suffer from Parkinson's disease.

Challenges and Implications of the COVID-19 Pandemic on Mental Health: A Systematic Review

The measures put in place to contain the rapid spread of COVID-19 infection, such as quarantine, self-isolation, and lockdown, were supportive but have significantly affected the mental wellbeing of individuals. The primary goal of this study was to review the impact of COVID-19 on mental health. An intensive literature search was conducted using PsycINFO, PsyciatryOnline, PubMed, and the China National Knowledge Infrastructure (CNKI) databases. Articles published between January 2020 and June 2022 were retrieved and appraised. Reviews and retrospective studies were excluded. One hundred and twenty-two (122) relevant articles that fulfilled the inclusion criteria were finally selected. A high prevalence of anxiety, depression, insomnia, and post-traumatic stress disorders was reported. Alcohol and substance abuse, domestic violence, stigmatization, and suicidal tendencies have all been identified as direct consequences of lockdown. The eminent risk factors for mental health disorders identified during COVID-19 include fear of infection, history of mental illness, poor financial status, female gender, and alcohol drinking. The protective factors for mental health include higher income levels, public awareness, psychological counseling, social and government support. Overall, the COVID-19 pandemic has caused a number of mental disorders in addition to economic hardship. This strongly suggests the need to monitor the long-term impact of the COVID-19 pandemic on mental health.

Childhood deprivations predict late-life cognitive impairment among older adults in India

Large population-based studies on the associations of childhood factors with late-life cognition are lacking in many low and middle income countries including India. In this study, we assessed the prevalence of late-life cognitive impairment and examined the associations of childhood socioeconomic status (SES) and health conditions with cognitive impairment among older adults in India. Data for this study were derived from the Longitudinal Ageing Study in India conducted in 2017–18. The effective sample size was 31,464 older adults aged 60 years and above. Cognitive functioning was measured through five global domains (memory, orientation, arithmetic function, executive function, and object naming). The overall score ranged between 0 and 43, and the score was reversed indicating cognitive impairment. Descriptive statistics along with mean scores of cognitive impairment were presented. Additionally, moderated multivariable linear regression models were employed to examine the association between explanatory variables, including childhood SES and health conditions and late-life cognitive impairment. The mean score of cognitive functioning among the study participants was 21.72 (CI 2.64–21.80). About 15% of older adults had poor health conditions, and 44% had lower financial status during their childhood. Older adults who had a fair health during their childhood were more likely to suffer from cognitive impairment in comparison to older adults who had good health during their childhood (Coef: 0.60; CI 0.39, 0.81). In comparison to older adults who had good childhood financial status, those who had poor childhood financial status were more likely to suffer from cognitive impairment (Coef: 0.81; CI 0.56, 1.07). Older adults who had fair childhood health status and poor childhood financial status were more likely to suffer from cognitive impairment in comparison to older adults who had good childhood health and good financial status (Coef: 1.26; CI 0.86, 1.66). Social policies such as improving educational and financial resources in disadvantaged communities and socioeconomically poor children and their families, would help to enhance a better cognitive ageing and a healthy and dignified life in old age.

Early life factors associated with old age physical frailty: evidence from India

BackgroundPhysical frailty is one of the most important phenotypes used to understand the vulnerable nature of older adults. The paper examined the association of childhood factors, including birth order, childhood socioeconomic status, and other exposures with old age physical frailty. The study further explored the gender dimensions of physical frailty prevalence. MethodsData from the Longitudinal Ageing Study in India (LASI, 2017-18), wave-1 were used. The sample size for the study was 24,513 older adults aged 60 years and above (12,510 females and 12,003 males). Physical frailty was assessed using the measurement approach proposed by Fried and colleagues. ResultsThe results indicated significant gender difference in the prevalence of physical frailty with 39.03% of older women and 32.49% of men being frail. Older adults with lower levels of mothers’ (adjusted odds ratio (aOR): 1.26; 95% confidence interval (CI):1.01–1.58) or fathers’ education (aOR: 1.33; 95% CI:1.18–1.50) or poor childhood health status (aOR: 1.48; 95% CI:1.27–1.71) had higher odds of physical frailty. Compared to older women with a well-off childhood financial condition, women with average childhood financial status had 38% (aOR: 1.38, 95% CI:1.01-1.89) higher odds of reporting physical frailty. In contrast, older men with poor childhood financial status had lower odds (aOR: 0.73; 95% CI:0.56-0.96) of physical frailty than older men with well-off childhood financial status. ConclusionEarly life disadvantages in health, financial condition and lack of parental education had significant positive associations with old age physical frailty. The findings suggest the importance of childhood factors in policy and practice in terms of addressing old age physical frailty.

Mental Pain in People With Bipolar Disorder Hospitalized in a Psychiatric Hospital in Tehran, Iran

Background &amp; Aims: Mental disorders are associated with a complex self-centered experience of negative emotions such as despair and lack of mental pain. This study aims to determine the mental pain of people with bipolar disorder (BD) hospitalized in a psychiatric hospital in Tehran, Iran. Materials &amp; Methods: This is a cross-sectional study. Participants were 153 patients with BD admitted to Iran Psychiatric hospital, who were selected by continuous sampling. Data collection tools were a demographic form and Orbach Mikulincer Mental Pain (OMMP) Scale. Data were analyzed in SPSS software, version 16 software using descriptive and inferential statistics. Results: The mean score of OMMP scale in patients was 109.56±36.93. The variables of suicide attempt (P&lt;0.001), economic status (P=0.002), and employment status (P=0.02) status had a significant relation with the mental pain of patients. Conclusion: The mental pain of hospitalized patients with BD in Tehran is at a moderate level. Patients with poor financial status, unemployed patients, and those with a history of suicide attempt have higher mental pain.

Health Literacy, Socioeconomic Status and Vaccination Uptake: A Study on Influenza Vaccination in a Population-Based Sample.

Background: Health Literacy (HL) has been recently hypothesized to affect the relationship between socio-economic status (SES) and health conditions. However, to date no study has yet assessed the potential contribution of HL in the pathway through which SES affects influenza vaccination status. We aim to examine the relationships among HL, SES factors, and influenza vaccination uptake in Tuscan (Italy) residents belonging to different high-risk groups (HRGs) for influenza. Methods: The study was performed within the Tuscan population sample selected in the Italian Behavioral Risk Factor Surveillance System in 2017–2018. HL was assessed using the Italian version of the 6-items European Health Literacy Survey Questionnaire (HLS-EU-Q6). Mediation analyses were conducted using SES variables as independent variables, influenza vaccination status as dependent variable and HL as mediator variable. Results: A total of 3278 people belonged to HRGs for influenza. In the whole sample, 19.4% of the participants were vaccinated against influenza. Participants who were not employed or had a poor financial status were more likely to be vaccinated against influenza (OR 1.56, 95%CI 1.26–1.94, p < 0.001, and OR 1.21, 95%CI 1.00–1.48, p = 0.047 respectively). HL did not mediate the relationship of any of the independent variables with influenza vaccination status. Conclusions: Some SES determinants resulted to influence influenza vaccination uptake, while HL did not affect the likelihood of influenza vaccination uptake among HRGs. Universal health care systems, as in the case of Italy, offering influenza vaccination free of charge to HRGs help in reducing inequalities and mitigating HL demands.

Variables Determining Higher Home Care Effectiveness in Patients with Chronic Cardiovascular Disease.

The aim of this cross-sectional study was to analyze the variables that influence the effectiveness of home care in patients with chronic cardiovascular disease and their informal caregivers. The study was conducted in 193 patients and their 161 informal caregivers. The study used the WHOQOL-BREF Quality of Life Questionnaire, the health behavior inventory questionnaire (HBI), the Camberwell assessment of need short appraisal schedule (CANSAS) and the hospital anxiety and depression scale–modified (HADS–M) version. Spearman’s rank correlation coefficient test and logistic regression were used for analyses. Analysis of patients revealed an association between home care effectiveness and the following variables (OR per unit): age (OR = 0.98, 95% CI: 0.95–0.99), educational level (OR = 1.45, 95% CI: 1.05–2.02), financial status (OR = 0.43, 95% CI: 0.21–0.83), medication irregularity (OR = 0.25, 95% CI: 0.07–0.72), presence of comorbidities (OR = 6.18, 95% CI: 1.83–23.78), health care services provided by a nurse (OR = 1.25, 95% CI: 1.03–1.64), and number of visits to a cardiology clinic (OR = 1.25, 95% CI: 1.02–1.59). There was no association between care effectiveness and sex (p = 0.28), place of residence (p = 0.757), duration of cardiovascular disease (p = 0.718), number of home visits (p = 0.154), nursing interventions (p = 0.16), and adherence to lifestyle change recommendations (p = 0.539) or proper dietary habits (p = 0.355). A greater chance of improved health care effectiveness was found in patients whose caregivers reported higher social (OR = 1.24, 95% CI: 1.09–1.44), psychological (OR = 1.68, 95% CI: 1.25–2.37), and physical (OR = 1.24, 95% CI: 1.05–1.49) quality of life. Patients with cardiovascular disease who were characterized by lower educational attainment, poorer financial status, fewer visits to cardiology clinics, lower utilization of medical services, poorer self-perception of mental and physical well-being, recent onset of disease symptoms, and irregular use of medications, were much more likely to have poorer health care effectiveness. Patients with cardiovascular disease and their caregivers can be well supported at home as long as the care model is tailored to the specific needs. This includes family care coordination in the health care team, home care, and general practice support.

Association between socioeconomic status and academic performance in children and adolescents with chronic kidney disease

BackgroundLower socioeconomic status (SES) is associated with lower academic achievement; however, this relationship is understudied in children with chronic kidney disease (CKD). This study examined the relationship between SES and academic performance in children and adolescents with CKD.MethodsA total of 377 participants aged 6–18 years with CKD stages 1–5 (n = 199), on dialysis (n = 43) or with a kidney transplant (n = 135) were recruited. Five SES measures and a composite SES index were examined for associations with parent-rated average or above average academic performance in numeracy and literacy using multivariable logistic regression.ResultsParticipants’ median age was 12.6 years (IQR 8.9–15.5). Adjusted odds ratios (aOR) (95%CI) for better performance in numeracy and literacy, respectively, were 0.71 (0.44–1.15) and 0.75 (0.45–1.23) for children whose caregivers had lower educational attainment; 0.46 (0.26–0.80) and 0.53 (0.30–0.93) for lower household income; 0.52 (0.32–0.85) and 0.44 (0.26–0.73) for caregivers who were unemployed; 0.68 (0.41–1.12) and 0.59 (0.35–1.00) for caregivers with poor self-rated financial status; and 0.93 (0.53–1.64) and 1.00 (0.56–1.79) for caregivers who did not own their own home. Compared with the highest SES index quartile, the aORs for better performance by SES quartile in descending order were 1.24 (0.60–2.54), 0.76 (0.37–1.58), and 0.39 (0.18–0.86) for numeracy and 0.88 (0.41–1.85), 0.77 (0.35–1.66), and 0.32 (0.14–0.72) for literacy. No interactions were identified between SES and CKD stage, child age, or gender.ConclusionsAcross all CKD stages, children from lower SES families are less likely to perform well in literacy and numeracy than those from higher SES households.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

Does childhood financial status relate to satisfaction in late life: Findings from the longitudinal aging study in India

BackgroundLate-life physical and mental conditions are produced by the experiences of an individual during critical developmental periods. In this study, we aim to investigate the association of childhood financial status with life satisfaction among older population in India. We also explore the moderating role of gender and education in such association. MethodsData for this study were derived from the Longitudinal Ageing Study in India (LASI) conducted during 2017–18. Descriptive statistics along with cross-tabulation were presented in the study. Additionally, multivariate linear regression analyses were conducted to find out the associations of childhood financial status and other explanatory variables with life satisfaction. ResultsA proportion of 28.96% older men and 32.54% older women had low life satisfaction, whereas, 44.45% older men and 41.77% older women reported poor childhood financial status. The poor childhood financial status after controlling for various individual-, health-, and household-related factors, was significantly negatively associated with life satisfaction (β= -0.11; p<0.001). Older women reported higher life satisfaction than older men (β= 0.03; p<0.001). Furthermore, we found that older men (β= -0.07; p<0.001) and women (β= -0.08; p<0.001) with poor childhood financial status reported significantly lower life satisfaction than older men with good childhood financial status. It is also revealed that older adults with good childhood financial status and a secondary (B = 3.9; 95% CI: 3.0, 4.7) or higher education (B = 3.7; 95% CI: 2.6, 4.7) had nearly 4 units of increased levels of life satisfaction in comparison to older adults with poor childhood financial status and no education. ConclusionThe results highlight that the psychological well-being of an older person can be a function of his or her childhood financial status and education plays an important role in such association.

Mental health and fear of COVID-19 in Iranian pregnant women: A multi-center study

Background: The new coronavirus (COVID-19) pandemic has extensive psychological effects on pregnant women. Objectives: The aim of this study was to assess mental health, fear of COVID-19, and their association among pregnant women. Methods: This cross-sectional study was conducted on 607 pregnant women in Isfahan, Iran, from September 26 to December 20, 2020. The pregnant women were randomly selected from health centers affiliated with Isfahan University of Medical Sciences using a two-stage cluster sampling. A three-part web-based questionnaire (i.e., a demographic questionnaire, the Fear of COVID-19 Scale, and the General Health Questionnaire) was used to collect data. Chi-square test, independent-samples t-test, and logistic regression analysis were used for data analysis. Results: Most participants (73%) had a high level of fear of COVID-19, while 11% had a history of COVID-19 infection. In the final model, poor financial status (odds ratio [OR] = 3.06, 95% confidence interval [CI]: 1.32–7.10), COVID-19 infection (OR = 2.25, 95% CI: 1.22–4.16), history of mental disorders (OR = 10.11, 95% CI: 2.44–41.75), and number of pregnancies (OR = 2.59, 95% CI: 1.39–4.81) were associated with a significant increase in the chance of mental health disorder. A high COVID-19 fear score resulted in a 29% increase in mental health disorders, although this increase was not statistically significant. Conclusion: The prevalence of fear of COVID-19 was high among pregnant women. Poor financial status, number of pregnancies, history of COVID-19 infection, and a history of mental problems were associated with an increased risk of mental health disorders in pregnant women.

Predicting non-initiation of care and dropout in a blended care CBT intervention: Impact of early digital engagement, sociodemographic, and clinical factors.

ObjectiveThis study examines predictors of non-initiation of care and dropout in a blended care CBT intervention, with a focus on early digital engagement and sociodemographic and clinical factors.MethodsThis retrospective cohort analysis included 3566 US-based individuals who presented with clinical levels of anxiety and depression and enrolled in a blended-care CBT (BC-CBT) program. The treatment program consisted of face-to-face therapy sessions via videoconference and provider-assigned digital activities that were personalized to the client's presentation. Multinomial logistic regression and Cox proportional hazard survival analysis were used to identify predictors of an increased likelihood of non-initiation of therapy and dropout.ResultsIndividuals were more likely to cancel and/or no-show to their first therapy session if they were female, did not disclose their ethnicity, reported poor financial status, did not have a college degree, endorsed more presenting issues during the onboarding triage assessment, reported taking antidepressants, and had a longer wait time to their first appointment. Of those who started care, clients were significantly more likely to drop out if they did not complete the digital activities assigned by their provider early in treatment, were female, reported more severe depressive symptoms at baseline, reported taking antidepressants, and did not disclose their ethnicity.ConclusionsVarious sociodemographic and clinical predictors emerged for both non-initiation of care and for dropout, suggesting that clients with these characteristics may benefit from additional attention and support (especially those with poor early digital engagement). Future research areas include targeted mitigation efforts to improve initiation rates and curb dropout.

Socio-legal needs of rape and defilement victims: Beyond punishment

Ghana passed the Domestic Violence Act in the year 2007 despite pockets of resistance from some conservatives who thought the act will endanger family life and lead to a high divorce rate. A special unit within the Ghana Police Service called the Domestic Violence and Victims Support Unit (DOVVSU) was established to handle all cases under the Act. The law prescribes custodial punishment for suspects upon conviction. However, data collected from secondary sources, through key informants and in-depth interviews show that most cases of rape and defilement are withdrawn for settlement which is against the law. Most often, the victims who are not financially endowed are forced to accept settlement outside the courts or withdraw from the court processes, which often do not inure to their benefits. The Act and the establishment of DOVVSU have improved access to justice for rape and defilement victims, however, some critical issues need to be addressed to ensure that victims of sexual offences are well catered for. It is in connection with this that the paper seeks to highlight some of the conditions confronting victims of sexual violence and what must be done to mitigate these challenges. Prominent among these challenges is the poor financial status of the victims which makes them succumb to the pressure of out-of-court settlement. It is recommended that the government and other stakeholders review the justice system/processes for rape and defilement victims to ensure that they are not forced by circumstances to withdraw from the court processes to accept other settlement options which are not in consonance with the law.&#x0D;

Health Literacy, Socio-Economic Determinants, and Healthy Behaviours: Results from a Large Representative Sample of Tuscany Region, Italy.

Background: Health Literacy (HL) is one of the main determinants of health and is crucial for the prevention of noncommunicable diseases, by influencing key health-related behaviours. The aim of the present study was to assess the role of HL and sociodemographic factors in predicting the adoption of two healthy behaviours—physical activity and fruits and vegetables consumption. Methods: This study was conducted on the Tuscan population subsample of the Italian Behavioral Risk Factor Surveillance System in 2017–2018. HL was assessed using the Italian version of the six-item European Health Literacy Survey Questionnaire (HLS-EU-Q6). Results: About 40% of the 7157 interviewees reported an inadequate or problematic HL level. Female sex, poor financial status, foreign nationality, and low education were associated with a problematic HL level, while an inadequate HL level was associated with being 50–69 years old, low education level, foreign nationality, poor financial status and unemployment or inactive status. Inadequate HL level was a strong predictor of both eating less than three portions of fruits/vegetables per day and not engaging in sufficient PA during leisure times. Conclusions: Our findings showed that an inadequate level of HL could negatively affect physical activity and diet, independently from the other sociodemographic conditions, confirming the role of HL as a relevant social determinant of health.

Health literacy and associated factors among undergraduates: A university-based cross-sectional study in Nepal.

Health literacy is one of the most critical aspects of health promotion. Limited health literacy is also accounted for adverse health outcomes and a huge financial burden on society. However, a gap exists in the level of health literacy, especially among undergraduates. This study aimed to assess the levels of health literacy and its socio-demographic determinants among undergraduate students of Tribhuvan University, Nepal. A web-based cross-sectional survey was conducted among 469 undergraduate students from five institutes of Tribhuvan University, Nepal. The 16-item short version of the European Health Literacy Survey Questionnaire (HLS-EU-Q16) was used to measure students' health literacy levels. Associated factors were examined using Chi-square tests followed by multivariate logistic regression analyses at the level of significance of 0.05. Nearly 61% of students were found to have limited health literacy (24.5% had "inadequate" and 36.3% had "problematic" health literacy). Female students (aOR = 1.6, 95% CI: 1.1-2.5), students from non-health related majors (aOR = 1.9, 95% CI: 1.2-3.0), students with unsatisfactory health status (aOR = 2.8, 95% CI: 1.7-4.5), students with poor financial status (aOR = 2.9, 95% CI: 1.2-6.8) and students with low self-esteem (aOR = 2.5, 95% CI: 1.5-4.1) were significantly more likely to have limited health literacy. The majority of the undergraduates were found to have limited health literacy. Gender, sector of study, self-rated health status, self-rated financial status, and self-esteem were significantly associated with limited health literacy. This study indicates university students should not be assumed to be health-literate and interventions to improve students' health literacy especially for those whose majors are not health-related should be implemented. Further studies using a longer version of the health literacy survey questionnaire and qualitative methods to explore more on determinants of health literacy are recommended.

Factors influencing patient’s choice of type of surgery: Laparoscopic vs Open

Aim: To evaluate the preference of patients presenting to a government sector hospital in Lahore regarding type of gall bladder surgery. Methodology: A cross sectional observation study was conducted at the Department of General Surgery, Services Hospital, Lahore from 1st January 2020 to 30th June 2021. A simple questionnaire to collect and analyze the data of the patients admitted for cholecystectomy. The content of the questionnaire included socio-demographic characteristics and lists of factors for making choice regarding type of surgery by the patient. Data was entered and analyzed using EXCEL 2013. Frequencies and Percentages were calculated as descriptive statistics whereas Fisher's exact test was conducted as inferential statistics. Results: The results of our study showed that the age (p=0.0001) of patient and cost (p=0.0427) of surgery played the most significant role in patient’s decision regarding the type of surgery. Conclusion: Age of the patient and financial constraints are important factors when patients decide about the type of surgery they want have. Despite advantages of laparoscopic surgery many patients chose open surgery due to poor financial status. Keywords: Cholecystectomy, type of surgery, patient’s choice, factors