Total Monthly Household Income Research Articles

Relationship Between Empathy and Depression in Adolescents: The Mediating Role of Family Functioning

To investigate the effect of empathy on depressive symptoms in adolescents and to explore the potential mediating role of family functioning in the effect of empathy on depressive symptoms. The 2022 cross-sectional data from the Chengdu Positive Child Development (CPCD) cohort were analyzed in the study. A survey was conducted in Chengdu in June 2022, involving 3020 students in grades 5-8 from three randomly selected stratified schools. The Interpersonal Reactivity Index (IRI-C), the Chinese Family Assessment Instrument (C-FAI), and the Center for Epidemiologic Studies Depression Scale for Children (CES-DC) were used in the survey. Chi-square test or one-way analysis of variance was performed to examine the differences in various demographic characteristics (sex, grade, region, and total monthly household income) between groups of respondents, as well as the differences in family functioning, empathy, and depression. Pearson correlation coefficient was used to examine the correlation between family functioning, empathy, and depressive symptoms. Structural equation modeling and SPSS PROCESS component Model 4 were used to analyze whether family functioning played a mediating role in the effect of empathy on depressive symptoms in adolescents. The detection rate of depressive symptoms among survey respondents was 25.40%. The results of the difference analysis revealed significant differences in the detection rates of depressive symptoms among respondents of different grades, regions, and monthly household incomes (P<0.05). There was no significant difference in the detection rates of depressive symptoms between male and female students. There was a significant difference in the detection rate of depressive symptoms between respondents with different scores for family dysfunction and empathy ability (P<0.001). Correlation analysis results showed that empathy scores were negatively correlated with depression (r=-0.11, P<0.001), that family dysfunction was positively correlated with depression (r=0.29, P<0.001), and that empathy scores were negatively correlated with family functioning (r=-0.37, P<0.001). The mediating role of family dysfunction in the relationship between empathy and depressive symptoms was established, with the direct effect being 0.039 (95% confidence interval [CI]: 0.010-0.069, P<0.001) and the indirect effect value being -0.096 (95% CI: -0.115--0.079, P<0.001). The direct effect value accounted for 28.89% of the total effect value, while the mediation effect value accounted for 71.11% of the total effect value. The empathy ability of adolescents is correlated to depressive symptoms, and family functioning plays a mediating role between empathy and depressive symptoms in adolescents. It is suggested that adolescents' empathy ability and family functioning should be enhanced through multiple channels to reduce the occurrence of depressive symptoms.

Characteristics of dietary intakes including NOVA foods among pre-adolescents living in urban Kuala Lumpur – Findings from the PREBONE-Kids study

Introduction: Evidence showed considerable variability of health risk factors within different socioeconomic groups. This study aimed to characterise dietary intakes by total household income among a sample of Malaysian pre-adolescents in urban Kuala Lumpur. Methods: Baseline data of 243 healthy, pre-adolescent children between 9 and 11 years old including socio-demographic background (gender, ethnicity, and total household monthly income), anthropometry (body weight and height), and 7-day diet histories were collected. Secondary analysis was performed on dietary intakes to quantify food groups based on the Malaysian Dietary Guidelines and NOVA classification systems besides nutrients. Differences and associations between total monthly household income categories with anthropometry and dietary intakes were tested using independent t-test/Mann-Whitney U (depending on normality) and chi-square tests, respectively. Results: Most children in this study population had dietary intakes below the recommended serving sizes for five food groups, except meat/poultry (195.2±107.2%) and fish (110.1±106.3%) and consumed about 32% of energy from ultra-processed foods (NOVA food group 4). While there was no difference in dietary intake between the bottom 40% with the middle 40% and high 20% household income groups, the percentage of energy contributed by NOVA food group 4 (processed fats/oils, condiments, and sauces) was higher in the bottom 40% households (p=0.024). Conclusion: Most pre-adolescent children in this study, regardless of household income, did not meet dietary recommendations and ate diets comprised of less nutritious foods. Comprehensive approaches that aim to improve dietary patterns and reduce the risk of diet-related chronic diseases are warranted.

Chronic Disease Management Behaviours among Malaysian Low-Income Workers: A Descriptive Study

Chronic disease is a global issue and is a growing concern in the world, including Malaysia. It is one of the most common causes of decreased quality of life, disability, and mortality [1]. Moreover, it has become a common problem in the community, especially among low-income households in Malaysia. Some evidence demonstrates that health problems associated with low-income workers are obesity, high body mass index (BMI), waist circumference (WC), cardiovascular disease, hypertension, diabetes, kidney disease, coronary heart disease and cancer [2-12]. Prevention is better than cure; therefore, chronic disease management behaviours play a pivotal role dealing with the diseases and improving quality of life. Given the above scenario, it is crucial to understand chronic disease management behaviours. This study aims to assess the level of chronic disease management behaviours among low-income workers in Malaysia. This cross-sectional study was conducted among 280 support staff in the selected ministries in Putrajaya, Malaysia. The sampling technique was random cluster sampling, and the data was collected via online platforms from July 2021 to November 2021. Respondents received a questionnaire comprising two sections: (1) Sociodemographic data, (2) Self-management disease by the Chronic Illness Resources Survey (CRIS). Socio-demographic data included gender, age, ethnicity, level of education, marital status, and total monthly household income. Chronic Illness Resources Survey (CRIS) adapted from (13), which requires the respondents to rate their self-management disease from (1) Not at all to (5) A great deal consists of eight items. The items were measured on health care, planning and disease management goals. Descriptive statistics were used to analyse the data using IBM SPSS version 26.0. The quantitative data were analysed descriptively for frequency, percentages, mean and standard deviation. Most of the respondents were females (73.6%), Malay (95.0%), married (72.5%), aged between 30 to 39 years old (61.8%), had monthly household incomes ranging from RM 2501 – RM3000 (25.0%) and had educational levels of STPM/ Matriculation/ Diploma (43.6%). Table 2 indicates that more than half of the respondents (53.2%) had a high level of chronic disease management behaviours. This finding indicates that most respondents had good non-communicable disease management behaviours (Mean =3.73, SD =0.769). Table 3 shows that respondents had a higher score for items such as ‘I use prayer/ worship or meditation in managing the disease’, ‘I spend time taking care of my health and doing the things I enjoy’, ‘Chronic disease behaviours management is important to me in managing disease’ and ‘I focus on the things I do well to manage the disease’. Whereas the moderate score is ‘I reward myself for managing illness’, ‘I share with others about disease management’, ‘I evaluate or think about my accomplishments in achieving goals for disease management” and I arrange the schedule so that it is easy to manage the disease’. From these data, it is clear the respondents taking care of their health.&#x0D; &#x0D; It can be concluded that most respondents had good non-communicable disease management behaviours. The reason for these findings may be due to the current health issues about non-communicable diseases and communicable diseases, leading them to possibly adopting a new normative lifestyle in daily life. While their chronic disease management behaviours are good, they still need to be improved. Therefore, it is important to continuously apply chronic disease management behaviours in daily life for improving health. This step will ensure longer life expectancy and better quality of life. Besides, the government should continue their efforts in raising awareness on health management among the community, especially among the low-income in Malaysia. The study has contributed additional knowledge to the current literature about chronic disease management behaviours. This finding showed that respondents had good non-communicable disease management behaviours. The reason for these findings may be due to the current health issues about non-communicable diseases and communicable diseases have led to them possibly adopting a new normative lifestyle in daily life. Nonetheless, chronic disease management behaviours are good, but they still need to be improved. Therefore, it is important to continuously apply chronic disease management behaviour in daily life for improving health. This will ensure longer life expectancy as well as better quality of life. Besides that, the government should continue their efforts in raising awareness on health management among the community, especially low-income in Malaysia.

Chicken meat taste preferences, perceived risk of human infection with avian influenza virus, and self-reported chicken meat consumption in China

Chinese consumers often prefer to buy live chickens for cooking at home rather than chilled or frozen chicken meat because of the superior flavor. Even though the purchase of live chickens for consumption was restricted by the Chinese government after the avian influenza (AI) virus outbreak in 2013, people continue to buy live chickens. Thus, it is important to understand why people make this decision. The goal of this study was to investigate the relationships among chicken meat taste preferences, perceived risk of human infection with AI virus, and chicken meat consumption behaviors in China. To address this, a survey of 1108 individuals was carried out in Jiangsu Province. This province was selected because its per capita consumption of poultry products is higher than the national average, and it is at the highest risk for avian influenza A H7N9 and H5N1 virus epidemics out of all provinces in China. Descriptive statistics, multivariate linear regression, and hierarchical regression modeling were used to analyze the data. The results showed that Chinese consumers still buy live chickens at a high rate due to taste preferences, and have a very low perceived risk of infection with AI virus. Multivariate linear and hierarchical regression analyses showed that total monthly household income was significantly and positively associated with the perceived importance of chicken taste; the number of people in the household and the perceived importance of chicken taste were significantly and positively associated with the purchase of live chickens for consumption; age was significantly and negatively associated with the purchase of chilled and frozen chicken for consumption; and education and expertize in livestock-related fields were significantly and positively associated with the purchase of live chickens for consumption. Expertize in livestock-related fields was significantly and positively associated with perceived risk of human infection with AI virus, and perceived risk was significantly and positively associated with the purchase of chilled chicken for consumption. However, the perceived risk of human infection with AI virus had no effect on the relationship between the perceived importance of chicken taste and the purchase of live chickens for consumption. The findings from this study suggest that, over time and with increasing public education, the purchase of live poultry for consumption will gradually decline in China. However, to accelerate this process, measures should be taken to reduce consumer perception of taste differences between chilled chicken meat and meat from freshly killed chickens. In addition, educating consumers about livestock to enhance their risk perception could also be another effective means of promoting the purchase of chilled and frozen chicken meat.

Hospital admission for symptoms exacerbation in 2,075 infants suffering from recurrent asthma-like symptoms: (EISL-3 South America).

Contrary to what happens in children and adults, the prevalence and the factors related to hospitalisation for asthma/wheezing in infants with recurrent asthma-like symptoms are poorly known. This study is part of the International Study of Wheezing in infants Phase 3; 2,079 infants (aged 12-18 months) with recurrent asthma-like symptoms, from 11 South American centres, were studied to determine the prevalence and the associated factors for wheezing exacerbation admission. Descriptive statistics and multivariate logistic regression were employed for analysis. The prevalence of admission for wheezing was 29.7% (95% CI 27.7-31.6) and was significantly associated to severe wheezing episodes (OR: 3.89; 95% CI: 2.93-5.18, p < 0.001), physician-diagnosed asthma (OR: 1.79; 95% CI: 1.33-2.41, p < 0.0001), use of inhaled corticosteroids (OR: 1.78; 95%CI: 1.38-2.29, p < 0.0001), maternal tobacco smoking during pregnancy (OR: 1.69; 95% CI: 1.19-2.39, p = 0.003) and onset of wheezing in the first trimester of life (OR: 1.30; 95% CI: 1.02-1.66, p = 0.038). Breast feeding ≥4 months (OR: 0.72; 95% CI: 0.54-0.96, p = 0.004), maternal high educational level (>12 years) (OR: 0.66; 95% CI: 0.51-0.85, p = 0.001) and total monthly household income ≥US$ 3,000 (OR: 0.34; 95% CI: 0.18-0.67, p = 0.002), were protective factors. Infants with recurrent asthma-like symptoms have a high rate of admissions. Tobacco smoking in pregnancy, viral respiratory illness in the first trimester of life and severe progression were risks for admissions. Improving medical management to prevent severe exacerbations, prolonging the postnatal period at home longer than 3 months, favouring breastfeeding and avoiding smoking during pregnancy may have a preventive role for admissions in infants with recurrent asthma-like symptoms.

Estimating the Economic Impact of Respiratory Syncytial Virus and Other Acute Respiratory Infections Among Infants Receiving Care at a Referral Hospital in Malawi.

Respiratory syncytial virus (RSV) is a leading cause of respiratory illness among infants globally, yet economic burden data are scant, especially in low-income countries. We collected data from 426 infants enrolled in the Queen Elizabeth Central Hospital respiratory disease surveillance platform to estimate the household and health system costs of managing RSV and other respiratory pathogens in Malawian infants. Total household cost per illness episode, including direct and indirect costs and lost income, was reported by parents/guardians at the initial visit and 6 weeks post discharge. The total cost to the health system was based on patient charts and hospital expenditures. All-cause acute respiratory infections (ARIs) and RSV costs for inpatient and outpatients are presented separately. All costs are in the 2018 US Dollar. The mean costs per RSV episode were $62.26 (95% confidence interval [CI]: $50.87-$73.66) and $12.51 (95% CI: $8.24-$16.79) for inpatient and outpatient cases, respectively. The mean cost per episode for all-cause ARIs was slightly higher among inpatients at $69.93 (95% CI: $63.06-$76.81) but slightly lower for outpatients at $10.17 (95% CI: $8.78-$11.57). Household costs accounted for roughly 20% of the total cost per episode. For the lowest-income families, household cost per inpatient RSV episode was about 32% of total monthly household income. Among infants receiving care at a referral hospital in Malawi, the cost per episode in which RSV was detected is comparable to that of other episodes of respiratory illnesses where RSV was not detected. Estimates generated in this study can be used to evaluate the economic and financial impact of RSV and acute respiratory illness preventive interventions in Malawi.

Assessing the Determinants of Food Security Status in Bangladesh: A Micro-Econometric Analysis

Food security is an intricate issue which includes diverse aspects as well as many linkages. In Bangladesh, food security is tried to be achieved by increasing the production of rice both by employing modern agricultural technology as well as by increasing the area under rice production. Despite the impressive gains in increasing domestic food grain production, problems of food and nutrition security still remain. Bangladesh is yet to achieve comprehensive food security that resolves the problems of inadequate food intake and chronic malnutrition among those who are poor and vulnerable. The main objective of this paper is to the contribution of different factors behind household food security status of 180 households in three Northern districts of Bangladesh. The study area was chosen because relatively little energy consumption data are available concerning this geographical area. The study used both primary and secondary data. Food security status of each household was assessed on the basis of the food security line using the daily calorie intake recommended by FAO. This method has proven to be efficient in measuring food security at household level. Additionally, the use of a logistic regression model identified the factors that plays crucial role in determining the food security status of the households. Results from the food security index revealed that more than 60 percent of households were with food insecurity. In addition, we found that total monthly household income, age of household head, education level of household head, household size, farm size, gender of household head, livestock ownership and quantity of cereal production had significant influence on food security status at the household level.

The association between long working hours and marital status change: middle-aged and educated Korean in 2014-2015.

BackgroundWe investigated the association between long workhours and marital status change from married to divorced or separated status that might have bad health effects.MethodsA total of 40,654 participants with married status in 2014 were followed up in 2015. Weekly workhours were categorized into four groups: ≤ 40, 41–52, 53–60, and > 60 hours per week. Univariate and multivariate logistic regression analyses were performed to determine the relationship between groups of workhours and marital status change after adjusting for age, total monthly household income, working type, and depression with sex stratification.ResultsThe study populations consisted of 8,346 (20.5%) females and 32,308 (79.5%) males. Odd ratios (ORs) of marital status change for females working for more than 60 hours per week was 4.26 (95% confidence interval [CI]: 1.25–14.5), when working less than or equal to 40 hours per week was used as reference in the crude model. ORs of working more than 60 hours per week was 4.57 (95% CI: 1.02–20.5) in female workers when considering age, total household earning per month, working type of daytime, and depression in a dose-response manner. However, for male workers, long workhours were not significantly related to change of marriage status.ConclusionsLong workhours for more than 60 hours per week had significantly higher risk of divorce or separation in females, but not in males. Further follow-up studies are needed to evaluate long term effects of long workhours on divorce risk.

Contribution of NTFPs on livelihood of forest-fringe communities in Jaldapara National Park, India

ABSTRACTWe expected that the indigenous communities of Jaldapara National Park depend on the non-timber forest products (NTFPs), and there would be a relationship between socioeconomic variables and their dependency on NTFPs. The study also documented the gap between prices of NTFP items at the household level and in local markets. Multistage sampling procedures were applied with a sample size of 205. The data collected were analyzed through descriptive statistics and Chi-Square (χ2) test. Insignificant values of Chi-Square (χ2) test reveal that there is no association or relationship of NTFP dependency with the socioeconomic and demographic variables of the respondents. The communities do rely on NTFPs for their daily, sociocultural, and cash requirements and assure a safety net during scarcity. There is a variable contribution of NTFPs to total monthly household income (1–70%). We documented 43 species of NTFPs sold either as raw or as processed form. The NTFPs sold were in the form of twigs, shoot, fruit, seed, leaves, mushroom, and fish. A wide gap exists between the price realized by the community from the sale of NTFPs and those sold in the local markets. This calls for institutional intervention for capacity building and empowering the community for processing or value addition and market intelligence.

Knowledge of Osteoporosis among Men Attending Primary Care Clinic and the Associated Factors

Introduction: Osteoporosis has frequently been regards as a disease of women only. However, men are also at risk of developing osteoporosis. We aimed to evaluate the knowledge of osteoporosis among men and its associated factors. Materials and method: A cross-sectional study of 245 male patients aged 50 and above was conducted in the primary care clinic, University Kebangsaan Malaysia Medical Centre. The research instrument used in this study was a validated self-administered questionnaire which consists of socio-demographic data and 16 items of knowledge of osteoporosis among men. Results: The mean score for knowledge was 7.78± 3.32 out of 16 points. Most of the subjects (83 percent) knew the definition of osteoporosis but were not aware that osteoporosis was a silent disease. Only a quarter of subjects (38 percent) recognized family history as a risk factors for osteoporosis. Despite 78 percent of subjects answer correctly regarding importance of calcium intake in their diet however only 7 percent of them knew the recommended dosage of daily calcium intake. Knowledge of osteoporosis was found to be significantly associated with education and total monthly household income. Conclusion: Findings indicate limited knowledge of osteoporosis among the subjects. Public education of osteoporosis among men is important to increase their knowledge. Meanwhile, primary care doctors should also emphasize and educate men regarding osteoporosis to enhance their knowledge of the disease.

Examination of burnout level of academics in terms of demographic variables

The burnout which is one of the issues coming to the fore in recent years, which expressed as emotional exhaustion, depersonalization and feel personal accomplishment and which can be resulted from individual / organizational factors is especially more common in certain professions. It can be said that burnout is an important issue for academicianship which required spend a lot of time with students, conduct appropriate quantity and quality researches in a particular time and face to face communication. Individual demographic characteristics such as gender, age, marital status and number of children affects burnout levels of the person. In this direction, it was aimed to determine that whether or not, there is a significant relation between burnout level of the academics and some demographic variables such as age and seniority and there is a significant difference in burnout level of the academics according to some demographic variables and occupational demographic variables such as number of publication or weekly course hours in this work. At the end of the research done on 417 academics working in public and foundation universities in Istanbul, it was determined that there is a significant and negative relation between burnout level of the academics and age and between burnout level of the academics and seniority. Also it was determined that there is a significant difference in burnout level of the academics according to marital status, academic title, number of children, weekly course hours, seniority in existing university, work experience abroad and total monthly household income.

Patterns of complementary and alternative medicine use among a group of patients with type 2 diabetes receiving outpatient care in Singapore

This study aims to identify patterns and evaluate factors associated with complementary and alternative medicine (CAM) use among type 2 diabetes patients in Singapore. A cross-sectional descriptive study using a self-administered questionnaire was performed among type 2 diabetes patients at an outpatient diabetes centre, and participants' medical records were accessed for diabetes complications and conventional medicine for managing diabetes. Among 304 participants, 43.4% used CAM and 61.2% did not inform health-care professionals of their CAM use. Three most common CAM were nutritional supplements, Chinese herbal medicine and massage. Friends (44.2%), partner and family (38%) were top sources of information for CAM, whereas factors significantly associated with CAM use were gender (P = 0.049), total monthly household income (P = 0.048) and frequency of self-monitoring of blood glucose (P = 0.036). Results highlight a need for improved health-care professionals-patients communication and for health-care professionals to be educated on CAM to provide relevant education to patients.

The impact of respiratory symptoms presence on quality of life of tobacco smokers

Introduction: Quality of life is a broad term that refers to the total well-being of the individual in terms of physical, psychological, emotional, mental, and social well-being, and which is in turn influenced by numerous factors including age, gender, socioeconomic status, risk factors in behavior, the environment, and the absence or presence of disease. Goal: The goal was to determine the presence of respiratory symptoms in smokers and to compare them with non-smokers as well as determine the relationship between quality of life with the frequency of respiratory symptoms from the aspect of gender, age, the environment in which they live, and the total monthly income of smokers compared to non-smokers. Material and Methods: The study was conducted on a sample of 600 subjects who were divided into two groups. The first group consisted of regular smokers (300 subjects) and the second group consisted of non-smokers. Former smokers were not included in the study. The survey questionnaire was designed on the basis of the following. A questionnaire to test the quality of life SF-36; Inventory of socioeconomic status EuroQoL; Basic respiratory symptoms were examined by MRC questionnaire (consisting of 9 questions). Results: The presence of respiratory symptoms was not associated with gender and the area of origin of the respondents, while the level of education, age, total monthly household income, and smoking status were directly related to the presence of respiratory symptoms, so that respondents with lower education levels, older ones, those with lower incomes, and smokers have more pronounced symptoms of respiratory problems. There is large negative impact of respiratory symptoms presence on respondent's quality of life. Conclusion: Smoking status were directly related to the presence of respiratory symptoms. There is large negative impact of respiratory symptoms presence on respondent's quality of life.

Incidence and Determinants of Acute Diarrhoea in Malaysia: A Population-based Study

Acute diarrhoea is a major health problem in many parts of the world, contributing to about 1.8 million deaths globally. The objectives of the study were to assess the incidence, determinants, and severity of acute diarrhoea in the population. A nation-wide cross-sectional survey involving about 57,000 respondents was conducted via face-to-face interview among eligible respondents of all ages. An acute diarrhoeal episode was defined as having three or more episodes of loose stools in any 24-hour period within the past four weeks before the interview. The severity was measured by duration of acute diarrhoea and associated symptoms. The variables tested as determinants were age, sex, ethnicity, the highest educational level, total monthly household income, and locality. Univariate, bivariate and multivariate procedures meant for complex study design were used in the analyses. The four-week incidence of acute diarrhoea was 5% [95% confidence interval (CI) 4.8-5.2]. The incidence of acute diarrhoea among the estimated population was the highest among young adults aged 20-29 years, Other Bumiputras (the pre-dominant ethnic group in East Malaysia), those with tertiary-level of education, those earning a monthly household income of less than RM 400, and rural dwellers. Only age, ethnicity, the highest level of education attained, and locality were significantly associated with acute diarrhoea in bivariate analysis. In multivariate analysis, these four variables were found to be the determinants of acute diarrhoea. Sex and monthly household income were excluded from the model. The mean duration of acute diarrhoea was 2.0 days (standard deviation 1.3). Forty-six percent of the respondents reported stomach cramps as an associated symptom. The findings revealed that acute diarrhoea is still a major public-health concern in Malaysia and grossly under-notified. There is a need for intensification of public-health intervention efforts to reduce the incidence of acute diarrhoea while improving surveillance and notification of the disease.

Water usage habits and the incidence of diarrhea in rural Ankara, Turkey

This aim of this study was to determine water usage behavior and incidence of diarrhea during the summer months among people in rural areas of Turkey. Information was collected using a questionnaire during face-to-face interviews with people aged 18 years and over in their homes. Diarrhea was detected in 31.7% of the 543 households included in the study in the summer of 2003. The percentage of those living in the study area experiencing at least one bout of diarrhea was 10.0%. The diarrhea episode rate was 18.7%. A logistic regression model of factors that could influence the incidence of diarrhea showed that the reported distance between the septic tank and the well, the total monthly household income and water shortages of longer than 12h had a significant effect on diarrhea incidence (P<0.05). The fact that water shortages are the biggest risk factor for diarrhea points to the need for (i) health education to raise awareness and (ii) the supply of equipment to enable households to use both the first running water after a water shortage and the water they have collected during the shortage as drinking water.

Prioritizing health problems in women in developing countries: comparing the financial burden of reproductive tract infections, anaemia and depressive disorders in a community survey in India

To compare the health care and opportunity costs of three common health problems [depressive disorders, reproductive tract infections (RTIs) and anaemia] affecting women and their associated risks of catastrophic health expenditure (defined a priori as out-of-pocket expenditure on health care exceeding 10% of the total monthly household income). Cross-sectional survey of 2494 women who consented to participate, from a randomly selected sample of 3000 women aged 18-50, living in the catchment area of a primary health centre in Goa, India. Depressive disorders were diagnosed with the Revised Clinical Interview Schedule; anaemia on the basis of a fingerprick sample of blood using the Haemocue system; and RTI using PCR, culture and microscopy with vaginal or urine specimens. Economic consequences were measured using the Costs of Illness Schedule and the WHO Disability Assessment Schedule. Health provision costs were calculated using previously derived unit costs for services for the main types of health care provider. Catastrophic health expenditure, defined a priori as >10% of total household income spent out of pocket on health in the previous month, was reported by 138 women (5.5%; CI: 4.7-6.5%); they were more likely to report economic difficulties, such as having gone hungry in the past 3 months because of lack of money (OR 1.99, CI 1.1-3.6, P = 0.02). Only depressive disorder was associated with significantly higher health care costs, lost time costs and risk of catastrophic health expenditure (OR 2.66, CI 1.6-4.4, P < 0.001, after adjustment for possible sociodemographic confounders and other physical health problems). There was a linear association between the psychological morbidity score (arranged into quintile groups) and the risk of catastrophic health expenditure (adjusted). If economic arguments were considered a key driver for global health policy, then depressive disorder should be considered a major health priority for women in developing countries.

Effect of asthma on the quality of life among children and their caregivers in the Atlanta Empowerment Zone.

Asthma is the most common chronic pediatric disease and exacts a toll on the health-related quality of life of affected children and their primary caregivers. This investigation describes the relationship between the clinical severity of asthma among inner-city children and their quality of life and that of their primary adult caregivers. Telephone interview data were collected from individual adult caregivers of 5-12-year-old children with asthma. Questions addressed the history, diagnosis, and management of the child's asthma, the child's family and social background, the family's socioeconomic status, the caregiver's knowledge and attitude about asthma, and the health-related quality of life of both the child and the caregiver. An asthma severity score was calculated from the caregiver's responses to questions about their child's wheezing frequency, nocturnal and early morning symptoms, and speaking during an asthma attack, as well as the impact of the disease on their child's physical activity and breathing during the prior 4-month period. A clinical asthma triage score was determined from information collected at the emergency department about the child's oxygen saturation, alertness, use of accessory respiratory muscles, extent of breathlessness, and peak expiratory flow. Spearman correlation coefficients were used to identify association between quality of life and disease severity, caretaker's asthma knowledge, and functional impact of asthma symptoms. Data from 240 of 755 eligible children were analyzed. Most children were younger than 11 years, male, black, and non-Hispanic. The children's median duration of asthma diagnosis was 86% of their life (range less than 1 to 11.3 years, median 5.0 years). Of the primary caregivers, 69% had at least completed high school, and 90% reported a total monthly household income of $1,600 or less. The maximum possible quality-of-life score and the median for caregivers were 91 and 70, respectively; for children, the same scores were 69 and 58, respectively. In addition, there was significant negative correlation of the quality-of-life scores of both the caregivers and children with the number of schooldays the children missed (r = -0.24 and r = -0.26, respectively, P < .001 for both) and the caregivers' and children's asthma severity scores (r = -0.39 and r = -0.47, respectively, P < .001 for both). The quality-of-life scores of the children and caregivers did not correlate significantly with the asthma triage scores. The questionnaires captured baseline quality-of-life information about this urban population and will facilitate longitudinal monitoring. The fact that the quality-of-life scores of children with asthma correlated with those of their adult caregivers, but not with their clinical triage scores, highlights the impact of asthma on families and the importance of having a long-term comprehensive management plan that is not based on exacerbations, but that includes both the children and their primary caregivers.