Poor Socio-economic Areas Research Articles

The effects of obesity on the human body, part I: Skin and musculoskeletal.

Obesity is a worldwide issue that many global health authorities consider a growing epidemic. Having a positive correlation between increases in the industrialization of processed foods and sedentary occupations as well as a lack of access to healthcare in poorer socioeconomic areas, obesity is a multifactorial disease affecting several organ systems. The tendency for obesity to cause detrimental changes to the human body is a focal point for healthcare providers to establish more effective clinical treatment and management plans. Implementing comprehensive global educational programs to decrease the prevalence of this unforgiving disease is imperative for a healthier future. Herein, we have provided a comprehensive review of the health effects of obesity upon the human body for the interest of many practicing clinicians managing this health crisis.

An educational intervention to prevent overweight in pre-school years: a cluster randomised trial with a focus on disadvantaged families

BackgroundEarly prevention is a promising strategy for reducing obesity in childhood, and Early Years settings are ideal venues for interventions. This work evaluated an educational intervention with the primary aim of preventing overweight and obesity in pre-school children.MethodsA pragmatic, cluster randomised trial with a parallel, matched-pair design was undertaken. Interventions were targeted at both the cluster (Early Years’ Centres, matched by geographical area) and individual participant level (families: mother and 2-year old child). At the cluster level, a staff training intervention used the educational resource Be Active, Eat Healthy. Policies and provision for healthy eating and physical activity were evaluated at baseline and 12-months. The intervention at participant level was the Healthy Heroes Activity Pack: delivered over 6 months by Centre staff to promote healthy eating and physical activity in a fun, interactive way. Child and parent height and weight were measured at four time-points over 2 years. The trial primary outcome was the change in BMI z-score of the child between ages 2 and 4 years. Secondary outcomes consisted of parent-reported measures administered at baseline and two-year follow-up.ResultsFive pairs of Early Years’ Centres were recruited. Four pairs were analysed as one Centre withdrew (47 intervention families; 34 control families). At the cluster level, improvement in Centre policies and practices was similar for both groups (p = 0.830). At the participant level, the intervention group reduced their mean BMI z-score between age 2 and 4 years (p = 0.002; change difference 0.49; 95% CI 0.17 to 0.80) whereas the control group showed increasing BMI z-score throughout. Changes in parent-reported outcomes and parent BMI (p = 0.582) were similar in both groups.ConclusionsThe Healthy Heroes educational resource deterred excess weight gain in pre-school children from poor socioeconomic areas. With training, Early Years’ staff can implement the Healthy Heroes programme.Trial registrationISRCTN22620137 Registered 21st December 2016.

Patterns of blunt force homicide in the West Metropole of the City of Cape Town, South Africa


 
 
 There is currently a lack of information regarding the prevalence of and characteristics associated with blunt force trauma related homicides in South Africa. Information relating to the patterns of blunt force trauma could assist in the development and implementation of interventions targeted at specific areas or individuals as well as direct future research towards areas in need of investigation. This study is a 5-year retrospective review of autopsy reports obtained from Salt River Mortuary (Cape Town, South Africa). The prevalence of blunt force trauma was considered for unnatural deaths with a focus on homicide. The patterns of homicidal blunt force trauma are also presented. A total of 15 519 autopsy cases was analysed. In 1198 (7.72%) of these cases, the cause of death was found to be blunt force trauma and 828 (5.32%) of these cases were classified as homicides. Approximately 11% of blunt force homicide cases occurred in combination with sharp and/or ballistic trauma. Men from poor socio-economic areas were shown to be most at risk of blunt force homicide in the City of Cape Town.
 
 
 
 
 Significance: 
 
 
 
 The prevalence of homicidal blunt force trauma in the Western Metropole of the City of Cape Town is comparable to other regions in South Africa.
 The vast majority of victims sustained injury to the head, highlighting the need for further research in cranial blunt force trauma.
 Interventions should target young men, particularly in low socio-economic regions.
 
 
 

The impact of socio-economic deprivation on burn injury: A nine-year retrospective study of 6441 patients

IntroductionLow socio-economic status is thought to be associated with increased burn risk, however the significance and generalisability across different populations and cultures has been questioned. MethodsA nine-year retrospective study of burn presentations to a large teaching hospital (2005–2014) was performed to investigate the association between socio-economic status and burns. Demographic and injury data was collected via the trust ‘Information portal’. The Welsh Index of Multiple: Deprivation 2011 was used to score for socio-economic status. Chi-squared test and Odds Ratios were calculated and statistical significance defined as p<0.05 throughout. Results6441 burns were identified, with 755 (11.7%) admitted. Overall incidence rates were the highest published in the UK (0.35/1000/year) with sub group analysis showing the highest rates in under fives and males. Significant relationships between both age and burn mechanism and gender and burn mechanism (p=0.0005) were identified. Scald (67.1%) was the most common mechanism with the upper limb (48%) most commonly burned. Chi square analysis demonstrated a significant relationship between socio-economic deprivation, age and burn incidence (p≤0.0005), with a disproportionately high number of burns in patients under the age of 16 in the most deprived quintile (OR 1.23; 95% CI 1.06–1.44). ConclusionThis study specifically highlights patients under the age of 16 living in poorer socio-economic areas as the most at risk of suffering burns receiving hospital attention. This study demonstrates burns as a significant public health issue, and the results should aid in designing specific burn prevention strategies to target high-risk groups.

Feeding Patterns and Predictors of Malnutrition in Infants from Poor Socioeconomic Areas in Pakistan: A Cross-sectional Survey.

Introduction: Malnutrition, a state of under or over nutrition caused by improper food intake, causes significant morbidity and mortality in developing countries. It leads to a number of diseases which can be further divided into those caused by protein-caloric malnutrition and those caused by vitamin deficiencies, micronutrient, and mineral deficiencies. The purpose of this study was to identify the factors which contribute to malnutrition and to assess the dietary pattern in the pediatric population from birth up to five months belonging to poor socioeconomic areas. The children in this sample presented to a tertiary care hospital in the district of Sargodha, Pakistan. The findings in this cohort will support the development of an effective plan to tackle these issues.Methods: This cross-sectional study was undertaken between June 2014 and December 2014 at the inpatient pediatric department of District Headquarter Hospital Sargodha. Data were collected and recorded on a predesigned form which consisted of four sections to record 1) demographics: parents' level of education, monthly income, number of dependent household members, and birth interval; 2) anthropometric and personal history, birth history, and degree of malnutrition; 3) any secondary causes of malnutrition; and 4) feeding history. The data were analyzed in SPSS v. 20. Chi-squared, phi statistics, and logistic regression analysis were run to analyze the data.Results: A total of 294 participants were included in the study. Logistic regression analysis showed that the degree of malnutrition was associated negatively with increasing age and positively with family size. A majority of children (144, 49%) were being breastfed for less than 5 minutes followed by 38 (13%) > 5 minutes to 15 minutes, and 2 (0.7%) > 15 minutes while 110 (37 %) infants were not breastfed. Children who were breastfed were less likely to have severe malnutrition than those who were given formula, fresh cow's or goat's milk, or more than one type of food.Conclusion: Children who were breastfed were less likely to have severe malnutrition. The degree of malnutrition was negatively associated with age and positively associated with family size.

Solitary Cecal Ulcer Presenting as Amebic Colitis

Purpose: A 24 y/o Polish male presented w/ diarrhea that was occasionally bloody and mixed w/ mucous for the past few weeks. Pt admitted to a 20 lb unintentional weight loss. He denied recent travel, sick contacts, or antibiotic use. The diarrhea was associated with crampy lower abdominal pain and tenesmus. Physical exam was completely normal. He was afebrile and CBC was within normal limits. Stool studies were negative for infection. The patient's family history was significant for Crohn's disease in his father. A colonoscopy was performed to the terminal ileum where a single cecal ulcer was visualized, and the remainder of the cecal mucosa was friable. The rest of the colonic as well as terminal ileal mucosa were normal. Biopsies taken from the ulcer margin were consistent w/ amebic colitis - E. histolytica. The patient was treated with metronidazole with good resolution of his symptoms. Dysentery has been documented to account for more than 90% of cases of invasive intestinal amebiasis, but is mainly seen in poor socioeconomic areas and rare in U.S. However, tissue invasion can occur leading to amebic colitis. It may be associated with other conditions including: ulcerative colitis, toxic megacolon, or amebic appendicitis. It may occur months to years after exposure so it's important to keep in mind as a differential diagnosis. Chronic intestinal amebiasis has also been described and may last for months to years with chronic abdominal pain, weight loss, and diarrhea. Typical intestinal amebic ulcers (“flask shaped”) are found in the cecum, sigmoid, and rectum and may be nodular or irregular. Irregular ulcers 1 to 5 cm are usually found in the cecum and are shallow with fibrin filled centers. However, most case reports describe presentation ranging from multiple ulcers to diffuse ulceration and hemorrhage. The pathogenesis of the ulcer has been described in 3 stages where the trophozoites are able to lyse the colonic mucosa, allowing the parasite to attach and cause further degradation of the extracellular matrix. However, studies are currently ongoing to fully understand the sequence of events during amebic invasion of the colon.Figure

Getting below the Surface of the Principal Recruitment ‘Crisis’ in New Zealand Primary Schools

Since 1989 in New Zealand, the work of the primary school principal has been transformed in official policy texts from that of leading professional to chief executive officer. Surveys document the changing nature of the role and the workload and other pressures that have resulted, particularly for principals with teaching responsibilities in smaller schools. There is a generally accepted crisis of preparation, recruitment, development and retention. Below the surface, however, are deeper-seated, structural difficulties: women comprise the majority of teachers, yet are a minority of principals and their career advancement is largely limited to small schools and those in poorer socioeconomic areas. This article reviews the situation and examines the reasons why dominant images of the primary school principalship may be both partial and counterproductive.

The assumption of self_ responsibility for health behaviour change in patients with hypertension from poor socio-economic areas

Patients with hypertension need to convert their knowledgeabout the disease and its management into meaningful action to be able to change their health behaviour. By doing this they are able to reduce the risk of the cardiovascular complications that are associated with hypertension If they can change their health behaviour it can be said that they have taken responsibility for their health. In this study a group of patients with hypertension who assumed responsibility for health behaviour change during a health behaviour modification programme was identified and compared to a group who did not. There were significant differences between the group that assumed responsibility for health behaviour change and the group that did not. The group that assumed responsibility:• had the support of a health care practitioner and a family member (p&lt;0,000); • were employed (p=0.03); • were not anxious or depressed (p=0.07); • experienced their usual sex-lives (p=0.03); • did not have symptoms of heart pounding present (p=0.03). The adjusted odds ratio obtained from a logistic regression analysis showed a seven- times more likelihood ofpatients becoming responsible for their health if they were supported by their families and a health-care practitioner

The role of team dentistry in improving access to dental care in the UK.

The role of professionals complementary to dentistry (PCDs) in improving access to NHS primary dental care is discussed. The pattern of under-supply of dentists in poor socio-economic areas is highlighted and identified, in drawing a parallel to the workings of primary medical teams, as a possible area where PCDs could be used.

The effect of metabolic programming on atherosclerosis and obesity risk factors in UK adolescents living in poor socioeconomic areas.

The effect of metabolic programming on atherosclerosis and obesity risk factors in UK adolescents living in poor socioeconomic areas.

Preventable mortality following sharp penetrating chest trauma.

We examined the determinants of outcome following sharp penetrating chest trauma (SPCT) in Cape Town, South Africa. During a 6-month period, 248 nonsurvivors (comprising 231 prehospital and 17 in-hospital deaths) and 474 survivors admitted to the Groote Schuur Hospital Trauma Unit were located. Most (77%) of the deaths resulted from cardiac or great vessel injuries. An unexpected finding was that in 47 (19%) of the prehospital deaths, the only injury at autopsy was a unilateral lung wound. There were no deaths in the 442 patients with this injury admitted to the hospital. The survival rate following equivalent injuries was unexpectedly better in patients from poorer socioeconomic areas, possibly because of increased use of private transport to reach the hospital. The key to improved outcome after survivable SPCT lies in rapid transportation to adequate emergency care by the quickest available means.

The association of low socio-economic status in metropolitan Adelaide with maternal demographic and obstetric characteristics and pregnancy outcome.

The South Australian perinatal statistics collection for 1988 was used to consider the association of low socio-economic status in metropolitan Adelaide (South Australia) with maternal demographic and obstetric characteristics and pregnancy outcome in 12047 singleton births. Socio-economic status--low, middle or high--was inferred from the socio-economic rating of the postcode of residence. Chi-squared analyses were carried out to test for significant trends in proportions of pregnancy and pregnancy outcome variables across the socio-economic groupings. There was trend for the proportions of adverse obstetric and perinatal outcomes to decrease with increasing level of socio-economic status. Logistic regression analysis, adjusted for maternal age, marital status, race, parity and gestational age, confirmed the findings of the trend analyses, namely that mothers from the poor socio-economic areas were at a greater risk for poor pregnancy outcome. These poor outcomes included Apgar scores of less that 7 at both 1 and 5 minutes after birth, delay in onset of regular breathing of 5 minutes or longer; the need for intubation; the use of narcotic antagonists; low birthweight of under 2500 g; the need for special nursey care; and neonatal death.