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Health care organizations are increasingly assessing patients' social needs (eg, food, utilities, transportation) using various measures and methods. Prior studies have assessed social needs at the point of care and many studies have focused on correlates of 1 specific need (eg, food). This comprehensive study examined multiple social needs and medical and pharmacy claims data. Medicaid beneficiaries in Louisiana (n = 10,275) completed a self-report assessment of 10 social needs during July 2018 to June 2019. Chronic health conditions, unique medications, and health care utilization were coded from claims data. The sample was predominantly female (72%), Black (45%) or White (32%), had a mean age of 42 years, and at least 1 social need (55%). In bivariate analyses, having greater social needs was associated with greater comorbidity across conditions, and each social need was consistently associated with mental health and substance use disorders. In multivariable logistic analyses, having ≥2 social needs was positively associated with emergency department (ED) visits (OR = 1.39, CI = 1.23 – 1.57) and negatively associated with wellness visits (OR = 0.87, CI = 0.77 – 0.98), inpatient visits (OR = 0.87, CI = 0.76 – 0.99), and 30-day rehospitalization (OR = 0.66, CI = 0.50 – 0.87). Findings highlight the greater concomitant risk of social needs, mental health, and substance use. Admission policies may reduce the impact of social needs on hospitalization. Chronic disease management programs offered by health plans may benefit from systematically assessing and addressing social needs outside point-of-care interactions to impact health outcomes and ED utilization. Behavioral health care management programs would benefit from integrating interventions for multiple social needs.

Background: Despite the availability of effective direct-acting antiviral (DAA) treatments for Hepatitis C virus (HCV) infection, many people remain undiagnosed and untreated. We assessed the cost-effectiveness of a Médecins Sans Frontières (MSF) HCV screening and treatment program within a primary health clinic in Karachi, Pakistan. Methods: A health state-transition Markov model was developed to estimate the cost-effectiveness of the MSF program. Program cost and outcome data were analyzed retrospectively. The incremental cost-effectiveness ratio (ICER) was calculated in terms of incremental cost (2016 US$) per disability-adjusted life year (DALY) averted from the provider’s perspective over a life-time horizon. The robustness of the model was evaluated using deterministic and probabilistic sensitivity analyses (PSA).Results: The ICER for implementing testing and treatment compared to no program was US$450/DALY averted, with 100% of PSA runs falling below the per-capita Gross Domestic Product threshold for cost-effective interventions for Pakistan (US$1,422). The ICER increased to US$532/DALY averted assuming national HCV sero-prevalence (5.5% versus 33% observed in the intervention). If the cost of liver disease care was included (adapted from resource use data from Cambodia which has similar GDP to Pakistan), the ICER dropped to US$148/DALY, while it became cost-saving if a recently negotiated reduced drug cost of $75/treatment course was assumed (versus $282 in base case) in addition to cost of liver disease care. Conclusion: Screening and DAA treatment for HCV infection is expected to be highly cost-effective in Pakistan, supporting the expansion of similar screening and treatment programs across Pakistan.

Objective:To examine trends from 2015 to 2017 in dietary behaviours and diet quality among low-income mothers, teenagers and children.Design:Cross-sectional telephone surveys using a validated 24 h dietary assessment.Setting:Randomly sampled households with incomes ≤185 % of the US federal poverty level across California.Participants:Survey participants were 13 247 mothers (≥18 years), 3293 teenagers (12–17 years) and 6043 children (5–11 years). Respondents were mostly Latino.Results:Over the 3-year study period, consumption of fruits and vegetables with and without 100 % fruit juice increased (P ≤ 0·05) by at least 0·3 cups/d for mothers, teenagers and children. Intake of water also increased (P ≤ 0·001) by more than 1 cup/d for mothers and children and 2 cups/d for teenagers. Sugar-sweetened beverage (SSB) consumption was unchanged over the 3 years. Overall diet quality, as assessed by the Healthy Eating Index-2015, improved (P ≤ 0·01) for mothers, teenagers and children. Covariates for the fifteen regression models (three age groups by five outcome variables) included race/ethnicity, age, education for mothers, and gender for teenagers and children.Conclusions:The observed increases in fruit and vegetable intake and improvements in overall diet quality during the 3-year period suggest that low-income Californians may have lowered their risk of preventable diseases. However, more intense or strategic SSB-reduction interventions are required. Regional- or state-level, population-based surveillance of dietary behaviours is useful for public health nutrition policy and programme decision making, and can be used to assess potential trends in future negative health outcomes and related costs associated with poor dietary behaviours within at-risk populations.

Children in low-income families are at risk for delayed diagnosis of autism spectrum disorder (ASD). The cascade-of-care model, which examines steps of care for quality and efficacy, can identify lesions in the process for evaluation and diagnosis for children at risk for ASD. Little is known about predictors that influence key steps in this process. We performed a retrospective chart review of 110 children under age five years from an academic medical center with social communication concerns. We assessed predictors of age of referral for ASD diagnostic evaluation, time to diagnosis, and likelihood of diagnostic completion. Children with continuity of primary care were referred at an earlier age than those receiving primary care at multiple centers. Compared with children with missed visits, children attending all well-child visits had a shorter median time to diagnosis. These findings illustrate a need for primary medical homes to facilitate early and timely ASD evaluations.

Stroke is a worldwide leading cause of mortality and disability, and there are substantial economic costs for poststroke care. Disadvantaged populations show increased incidence, severity, and unfavorable outcomes. This study aimed to report the survival, functional outcome, and caregiver satisfaction of low-income patients diagnosed with a large hemispheric infarction (LHI) who underwent decompressive craniectomy (DC).A retrospective analysis was conducted in consecutive adult patients with an LHI who underwent DC at a single center between October 2015 and September 2019. Demographic, clinical, and radiologic data were reviewed. The primary outcomes were 1-year survival and favorable functional outcome.Forty-nine patients were included; those60 years of age showed a higher proportion of favorable functional outcomes (76% vs. 33%; P = 0.031) but similar survival (52% vs. 56%; P = 0.645) than older patients, respectively. Performing the craniectomy in48 hours from stroke onset compared with ≥48 hours showed no statistically significant differences in survival (59% vs. 46%; P = 0.352) and favorable functional outcomes (56% vs. 70%; P = 0.683), respectively. In retrospective thinking, 79% of caregivers would decide to perform the surgery again.Age group and time from stroke onset to craniectomy were not associated with survival; notwithstanding, a higher proportion of patients60 years of age were associated with a favorable functional outcome compared with older patients. Additionally, if given the option, most caregivers would decide to perform the surgery again, independently of the grade of disability of the patient.

This article analyzes the bioethical implications of using a control/placebo group when conducting clinical trials (CTs) investigating the treatment of periodontitis. For this, the deductive method was used, proposing the interrelation of values, and a scoping systematic review was carried out. A total of 53% of the CTs reviewed were performed in low- and middle-income (LMI) countries, and 92% used a control/placebo group as a comparison group. Although there is a gold standard for the adjunctive treatment of periodontitis, the research ethics committees of most of the analyzed studies approved the use of control/placebo groups for the performance of CTs that did not explore new therapeutic alternatives. In some cases, the CT protocols were not approved by ethics committees, nor was informed consent used. In the LMI countries, a shorter period of recruitment was observed for patients who attended universities and public hospitals. Likewise, most of the CTs reviewed had public funding, a significant amount of which came from the pharmaceutical industry. Only one CT reported the low economic and educational level of its participants. Furthermore, none of the authors of the reviewed CTs declared conflicts of interest. Although the axiology of techno-science always takes into account at least the epistemic, technical and economic value systems, the hegemony of the economic values imposed by the pharmaceutical industry is evident in the performance of CTs investigating the treatment of periodontitis in LMI countries.

Many women in low-income countries carry heavy loads of drinking water for their families in difficult terrain. This can adversely affect their health and well-being. The present study is the first to investigate the physical burden of water carrying and women’s psychosocial well-being, and how this relationship is moderated by environmental and health conditions. Trained local interviewers conducted interviews with 1001 women across five rural communities in Nepal. In addition, objective measurement was used to assess the weight carried and distance from the water source. The physical burden of water carrying was calculated from weight, distance, and frequency of trips. Its association with psychosocial well-being was modeled using generalized estimating equations. Two additional models included the terrain and uterine prolapse as moderators. The physical burden of water carrying is directly related to higher emotional distress and reduced daily functioning. This correlation was exacerbated for women carrying in hilly versus flat terrain, and for those who had uterine prolapse. Our results underline the importance of adequate water access for women’s psychosocial well-being, especially for vulnerable populations such as women with impaired health (e.g., uterine prolapse) or those living in hilly terrain. The results further highlight the interconnectedness of the Sustainable Development Goal (SDG) 6: water access, SDG 3: health and well-being, and SDG 5: gender equality.

Childhood trauma is strongly associated with poor health outcomes. Although many studies have found associations between adverse childhood experiences (ACEs), a well-established indicator of childhood trauma and diet-related health outcomes, few have explored the relationship between ACEs and diet quality, despite growing literature in epidemiology and neurobiology suggesting that childhood trauma has an important but poorly understood relationship with diet. Thus, we performed a cross-sectional study of the association of ACEs and adult diet quality in the Southern Community Cohort Study, a largely low-income and racially diverse population in the southeastern United States. We used ordinal logistic regression to estimate the association of ACEs with the Healthy Eating Index-2010 (HEI-10) score among 30 854 adults aged 40–79 enrolled from 2002 to 2009. Having experienced any ACE was associated with higher odds of worse HEI-10 among all (odds ratio (OR) 1⋅22; 95 % confidence interval (CI) 1⋅17, 1⋅27), and for all race–sex groups, and remained significant after adjustment for adult income. The increasing number of ACEs was also associated with increasing odds of a worse HEI-10 (OR for 4+ ACEs: 1⋅34; 95 % CI 1⋅27, 1⋅42). The association with worse HEI-10 score was especially strong for ACEs in the household dysfunction category, including having a family member in prison (OR 1⋅34; 95 % CI 1⋅25, 1⋅42) and parents divorced (OR 1⋅25; 95 % CI 1⋅20, 1⋅31). In summary, ACEs are associated with poor adult diet quality, independent of race, sex and adult income. Research is needed to explore whether trauma intervention strategies can impact adult diet quality.

Objective: The objective of this study was to determine the interpretation, understanding, and implementation of the Dietary Guidelines for Americans (DGA) consumer messages among low-incom...

Background Latino children in the US experience high rates of obesity, increasing their risk of subsequent diabetes. There are few clinical trials among low-income, Latino families to test interventions that account for and address their unique situation. Methods/design This trial, conducted in a Head Start (early childhood education) setting, randomly assigns children 2–5 years of age who have obesity by CDC (Centers for Disease Control and Prevention) guidelines (at least 95th percentile body mass index) and their parents to one of three conditions: (1) control, (2) parent mentor with an experimental curriculum, or (3) parent mentor with a standard curriculum (active control). We designed the experimental arm (2) using data from positive deviants: low-income, Latino families who had been successful in moving their child toward a healthy weight. Parent mentors are recruited and trained from the Head Start centers. Parent mentors then facilitate the teaching and coaching of parent–child dyads with weekly interactions over the course of a 6-month period. The primary outcome is change in adjusted body mass index z-score at the end of intervention and at 6 months post-intervention. Secondary outcomes include generalized self-efficacy, dietary intake, the home food environment, and reported physical activity. Discussion This clinical trial contributes to the field by evaluating parent mentoring interventions that are potentially scalable for a population at high risk for continued obesity and subsequent morbidity and mortality. Trial registration This trial was registered on October 31, 2017 (ClinicalTrials.gov identifier: NCT03330743).

Introduction: Unintended pregnancy, a major global health issue resulting in unsafe terminations of pregnancy and maternal deaths in low- and middle-income countries, could be significantly reduced through increased use of modern contraception, including long-acting reversible contraceptives (LARC). Training of healthcare providers to administer such contraceptives may improve uptake. We conducted a systematic review to collate the end-user uptake data following training of healthcare providers in low- and middle-income countries. Material and methods: We searched PubMed, Embase, the Global Health Library and the Cochrane Library up to 23 May 2020. The review was restricted to low- and middle-income countries and focused on healthcare providers who had received training in LARC. Studies that reported contraceptive uptake among women, preference of LARC among healthcare workers and/or women, and unplanned pregnancies within 12 months of LARC initiation were included. All included studies underwent quality assessment using either the Cochrane Risk of Bias Tool or the Newcastle-Ottawa Scale. PROSPERO registration number CRD42020185291. Results: A total of 28 studies (end-users n = 6 112 544) were included (27 cohort studies and one randomized trial). Nineteen studies were set in Africa, five in Asia, one in Central America and four were multi-country studies. Twenty-eight studies reported LARC use among women, and 25 studies found an increase in uptake of LARC by women using short-acting methods switching to longer-acting methods or by recruiting new users of LARC. The randomized controlled trial was assessed as high quality and reported positive findings; however, there was great heterogeneity in the type of intervention and of how outcomes were measured among the other included studies. Further, the quality of these studies varied, although it should be noted that the poor-quality studies reflected the trends of those of higher quality. Conclusions: Despite heterogeneity, current evidence indicates that training of healthcare providers in LARC may increase the uptake among women in low- and middle-income countries. More robust studies are warranted to inform policy.

Food insecurity, defined as the inability to access sufficient food for an active, healthy life, affects 11.1% of the US population and is primarily assessed using the United States Department of Agriculture’s (USDA) 18-item Household Food Security Survey Module (HFSSM). The HFSSM is a self-report measure presumed to represent all household members, but it is unknown if cohabiting parents report food security differently. This pilot study aimed to determine (i) the inter-rater reliability of the HFSSM; (ii) the direction of any difference between responses to the HFSSM; and (iii) the item-level response similarities and differences among mothers and fathers of young children. Twenty-five pairs of low-income, food-insecure cohabiting parents of 2.5- to 10-year-old children participated in cognitive interviews assessing their level of food security using the USDA’s HFSSM and completed related questionnaires. Intraclass correlations were computed to compare the responses of each dyad on the HFSSM overall and by item. Results revealed that overall report of food security was significantly but weakly correlated (r = .40, p = .02) within dyads. The majority of fathers (60%) reported higher food security scores on the HFSSM than their respective female partners. Furthermore, item-level intraclass correlations revealed that some HFSSM questions had poor reliability between cohabiting parents. This research identifies that a potential shortcoming of the HFSSM is the under-reporting of food insecurity by fathers compared with mothers within the household. These findings have implications for the utility of this measure used in national monitoring of the nation’s food security.

The neonatal period is the most vulnerable time in terms of a child’s survival, with mortality during this period accounting for approximately half of the deaths before the age of 5 years. The Neonatal Essential Survival Technology (NEST) project is a program aiming to reduce mortality by improving the quality of neonatal care in sub-Saharan Africa. This study presents the evaluation of the first phase of the NEST intervention program at Saint Camille Hospital Ouagadougou (HOSCO), Burkina Faso, in terms of the reduction in neonatal mortality. This is a retrospective analysis, based on “pre-intervention” data collected in 2015, and “post-intervention” data collected in 2018, including all infants admitted to the neonatal unit of HOSCO. The intervention period (2016 and 2017) comprised a structured quality improvement process conducted by a multidisciplinary working group that focused on improving infrastructure, equipment, training and use of clinical protocols, team working within the neonatal unit and with other hospital departments, and communication with referring healthcare facilities. Mortality data were compared pre- vs. post-intervention using a logistic regression model. The analysis included 1427 infants in the pre-intervention period, and 819 post-intervention. In both time periods, more than 75% of admissions were infants with low birth weight, and nearly 50% were very low birth weight. Post-intervention, while there was a decrease in overall admission, the proportion of multiple births increased from 20% to 24% (p = .01). The overall mortality rate was 44.9% (641/1427) pre-intervention, and 42.2% (346/819) post-intervention (OR 0.90, 95% confidence interval (CI) 0.76–1.07; p = .23). Adjusting for clinically relevant factors, the intervention was not associated with a change in overall mortality (OR 1.39, 95% CI 0.91–2.12; p = .13), but was associated with a reduced likelihood of mortality in outborn infants compared to inborn infants (OR 0.57, 95% CI 0.36–0.92; p = .02). The first phase of the NEST quality improvement program was associated with a decrease in mortality in outborn infants admitted to the neonatal unit at HOSCO. Long-term assessment is expected to provide a more comprehensive evaluation of the program in a low-income setting.

Background Childhood obesity represents a global public health crisis: the number of obese children and adolescents (aged 5–19 years) worldwide has risen tenfold in the past four decades. The vast majority of overweight and obese children live in high-income countries, and low socio-economic status (SES) is a significant risk factor. Family Based Interventions (FBI) have demonstrated positive results in preventing obesity, although these results are strongly influenced by SES. Moreover, we still poorly understand how FBI can determine a positive trend in weight status in low-income communities. Therefore, there is an urgent need to define and evaluate innovative and multi-target projects to reduce obesity risk behaviors and health inequalities and the present study aims to present the study protocol of FIVALIN a FBI that pretends to achieve this goal. Methods We will conduct a quasi-experimental design within 60 Community Child Centers (CCC) in Barcelona metropolitan area. Each cluster (CCC) will be assigned by convenience to the intervention and control groups. For the whole study, a total of 810 children aged 8–12 years and 600 parents will be recruited during 3 consecutive editions (1st – 2019/2020; 2nd – 2020/2021; 3rd – 2021/2022) of 10 months each. The action is a regular multicomponent health-promotion intervention targeting children, families, and CCC. All activities are based on the Motivational Interviewing (MI) approach and will focus on promoting good dietary habits, physical activity, appropriate screen time and sleep duration, and psychological well-being. The control group participate in a unique workshop on general awareness of healthy lifestyles for families. We will perform a comparative analysis of the evolution of weight status, healthy lifestyles, and socioeconomic variables, between the intervention and control groups. Discussion There is a need for more evidence on how to target and evaluate holistic interventions in low SES families. Our multi-targeting intervention for obesity prevention tackles risky behaviors that go beyond diet and physical activity (PA). Therefore, future interventions can effectively promote all the behavioral domains that determine trends in the weight status. Trial registration ISRCTN Registry: ISRCRN12682870. Registered 9 July 2020. Retrospectively registered. Protocol version: 30 April 2021, version 5.

Rwanda and Bhutan, 2 low- and middle-income countries, implemented primarily school-based national human papillomavirus (HPV) vaccination in 2011 (Rwanda) and 2010 (Bhutan). We estimated vaccination effectiveness through urine-based HPV prevalence surveys in schools in 2013–2014 and 2017. In Rwanda, 912 participants from baseline surveys and 1,087 from repeat surveys were included, and in Bhutan, 973 participants from baseline surveys and 909 from repeat surveys were included. The overall effectiveness against vaccine-targeted HPV types (i.e., HPV-6/11/16/18) was 78% (95% CI 51%–90%) in Rwanda, and 88% (6%–99%) in Bhutan and against other α-9 types was 58% (21–78) in Rwanda and 63% (27–82) in Bhutan. No effect against other HPV types was detectable. Prevalence of vaccine-targeted HPV types decreased significantly, as well as that of other α-9 types, suggesting cross-protection. These findings provide direct evidence from low- and middle-income countries of the marked effectiveness of high-coverage school-based, national HPV vaccination programs.

Background Child poverty rates are rising in Norway with potential negative consequences for children. Services for families with low income are often fragmented and poorly integrated, and few coordinated initiatives have been implemented and evaluated in Norway. Aims: The aim of the current study is to evaluate how integrated and coordinated services provided over a prolonged period by a family coordinator are related to changes across a wide range of health, wellbeing and home environment indicators for the participants. Methods: The study uses a mixed methods approach utilising survey and register data, as well as information from interviews and shadowing, to document and evaluate outcomes associated with the intervention and the process of implementation. Data are gathered at baseline and annually throughout the duration of the study. Participants are identified to facilitate longer-term follow-up using register data. Conclusions: This project will develop important knowledge about the implementation of coordinated services to families with a low income, and how this way of organizing services influences important outcomes for the family members in the short and long term.

Objective:The main objective was to assess the cost, acceptability and affordability of the Cypriot Diabetic Healthy Food Basket (DHFB).Design:The development of DHFB was based on the Cypriot HFB with adjustments based on the nutritional guidelines for diabetes as developed by the American Diabetes Association (ADA) and information retrieved through the questionnaires. Two DHFB were constructed for adult women and adult men (±40 years) diagnosed with diabetes. Affordability was defined as the cost of DHFB as a percentage of the Guaranteed Minimum Income (GMI).Setting:Cyprus.Participants:422 diabetic patients aged 18–87 years from different socioeconomic backgrounds.Results:DHFB consists of eight food categories, similar to Cypriot HFB, but different specific food items. The total monthly budget for a diabetic woman is about 15 % (25·68 Euros less) lower compared with HFB, and the relative percentage for a diabetic man is about 16 % (37·58 Euros less). The total monthly budget for a diabetic woman is about 30 % lower (60·32 Euros less) compared with that of a diabetic man. For low-income adults receiving GMI, the proportion of income that would need to be spent on DHFB ranges from around 30 to 42 % for women and men, respectively.Conclusions:The cost of DHFB is lower compared with HFB, meaning that nutritional treatment based on the practice guidelines for diabetes could be a cost-efficient therapy for these patients. DHFB is still not affordable among low-income persons.

Background: Myelophthisis (MPT) has been associated with a dreadful prognosis. Patients’ access to palliative care (PC) and factors influencing its clinical outcomes are poorly described. Our aim was to analyze the impact of patient- and disease-specific characteristics on survival of patients with MPT and describe their use of PC in a resource-limited setting. Methods: Retrospective study including patients with solid tumor MPT, diagnosed between 1996 and 2018. Results: Seventy patients ( median 58 years) were included. 58% were synchronously diagnosed with MPT at time of primary tumor diagnosis. Most common oncologic diagnoses were prostate (25.7%), gastrointestinal (20%), and breast (18.6%) neoplasms. Median overall survival (OS) was 1.9 months. Primaries other than prostate, breast, and lung (HR 1.37, 95% CI 1.15 - 1.8; p = 0.02) and transfusion requirements (HR 2.8, 95% CI 1.01 – 7.9; p = 0.04) were independently associated with decreased OS. Administration of multiple systemic therapeutic interventions (HR 0.15, 95% CI 0.06 – 0.39; p = 0.01) was the sole factor improving OS. Assessment by PC was pursued in 51.4% of patients. The median number of consults per patient was two, with no difference in assessment rate or consult number across different primaries ( P = 0.96). Four cases of palliative sedation were reported, all performed by the primary care team. Conclusion: MPT is highly heterogeneous and risk stratification to optimize the use of therapeutic interventions in unison with palliative interventions is needed to maximize efforts toward improving patient quality of life. There is an alarming need of PC services in the multidisciplinary management of patients within developing regions.

Objective This study examines the development of active television (TV) watching behaviors across the first 2 years of life in a racially and ethnically diverse, low-income cohort and identifies caregiver and child predictors of early TV watching. Methods We used longitudinal data from infants enrolled in the active control group (N = 235; 39% Latino; 29% Black; 15% White) of Greenlight, a cluster randomized multisite trial to prevent childhood obesity. At preventive health visits from 2 months to 2 years, caregivers were asked: "How much time does [child's first name] spend watching television each day?" Proportional odds models and linear regression analyses were used to assess associations among TV introduction age, active TV watching amount at 2 years, and sociodemographic factors. Results Sixty-eight percent of children watched TV by 6 months, and 88% by 2 years. Age of TV introduction predicted amount of daily active TV watching at 2 years, with a mean time of 93 minutes if starting at 2 months; 64 minutes if starting at 4 or 6 months; and 42 minutes if starting after 6 months. Factors predicting earlier introduction included lower income, fewer children in household, care away from home, male sex, and non-Latino ethnicity of child. Conclusions Many caregivers report that their infants actively watch TV in the first 6 months of life. Earlier TV watching is related to sociodemographic factors yet predicts more daily TV watching at 2 years even controlling those factors. Interventions to limit early TV watching should be initiated in infancy.

The COVID-19 pandemic has caused high mortality rates among older people, and in order to avoid a healthcare system crisis, almost all countries worldwide have adopted social isolation measures to prevent the spread of the disease. However, in Brazil, a country demarcated by economic inequalities, in which approximately 25% of the population live below the poverty line, these measures will cost severe economic losses and accentuated starvation. For this reason, the underprivileged population should be immediately prioritized and well informed through good practice to avoid the virus. Since, government discrepancies in dealing with the COVID-19 outbreak leaves the population without congruent guidelines on how to react or what to believe, allowing the spread of fake news and political crises. Here, we discuss who will pay the price of the Brazilian government denying the impact of COVID-19 pandemic and suggest some measures to ensure that clear information and protection reach this population.

This cohort study examines a process of digitized informed consent for the enrollment of a rural population in research.

Objectives: China has already entered the aging society, and its aging population is the largest worldwide. Accordingly, several aging-related conditions including hyperuricemia are becoming a publ...

Background Low-resource settings are disproportionally burdened by chronic lung disease due to early childhood disadvantages and indoor/outdoor air pollution. However, data on the socioeconomic impact of respiratory diseases in these settings are largely lacking. Therefore, we aimed to estimate the chronic lung disease-related socioeconomic burden in diverse low-resource settings across the globe. To inform governmental and health policy, we focused on work productivity and activity impairment and its modifiable clinical and environmental risk factors. Methods We performed a cross-sectional, observational FRESH AIR study in Uganda, Vietnam, Kyrgyzstan, and Greece. We assessed the chronic lung disease-related socioeconomic burden using validated questionnaires among spirometry-diagnosed COPD and/or asthma patients (total N = 1040). Predictors for a higher burden were studied using multivariable linear regression models including demographics (e.g. age, gender), health parameters (breathlessness, comorbidities), and risk factors for chronic lung disease (smoking, solid fuel use). We applied identical models per country, which we subsequently meta-analyzed. Results Employed patients reported a median [IQR] overall work impairment due to chronic lung disease of 30% [1.8–51.7] and decreased productivity (presenteeism) of 20.0% [0.0–40.0]. Remarkably, work time missed (absenteeism) was 0.0% [0.0–16.7]. The total population reported 40.0% [20.0–60.0] impairment in daily activities. Breathlessness severity (MRC-scale) (B = 8.92, 95%CI = 7.47–10.36), smoking (B = 5.97, 95%CI = 1.73–10.22), and solid fuel use (B = 3.94, 95%CI = 0.56–7.31) were potentially modifiable risk factors for impairment. Conclusions In low-resource settings, chronic lung disease-related absenteeism is relatively low compared to the substantial presenteeism and activity impairment. Possibly, given the lack of social security systems, relatively few people take days off work at the expense of decreased productivity. Breathlessness (MRC-score), smoking, and solid fuel use are potentially modifiable predictors for higher impairment. Results warrant increased awareness, preventive actions and clinical management of lung diseases in low-resource settings from health policymakers and healthcare workers.

Objectives. To examine maternal folic acid supplementation and plasma folate concentrations in the Boston Birth Cohort, a predominantly urban, low-income, minority population in Boston, Massachusetts. Methods. This report includes 7612 mothers with singleton live births (3829 Black, 2023 Hispanic, 865 White, and 895 others) enrolled in the Boston Birth Cohort at the Boston Medical Center, during 1999 to 2014. Folic acid supplementation during preconception and each trimester was obtained via interview questionnaire. In a subset (n = 2598), maternal plasma folate concentrations were measured in blood samples drawn within a few days of delivery. Results. The percentage of mothers taking folic acid supplementation almost daily during preconception and the first, second, and third trimesters were 4.3%, 55.9%, 59.4%, and 58.0%, respectively. Most striking, we observed a wide range of maternal plasma folate concentrations, with approximately 11% insufficient ( 45.3 nmol/L). Conclusions. Findings indicate that fewer than 5% of mothers in the Boston Birth Cohort started folic acid supplements before pregnancy, and approximately one third of mothers had either too low or too high plasma folate levels, which may have important health consequences on both the mother and the child.

Background Raising Well® (RW) was initiated in 2015 by Envolve PeopleCare™ at the request of health plans seeking a solution to work with families on Medicaid that have a child with overweight or obesity. RW uses expert clinical coaches via phone contact to deliver an educational intervention promoting lifestyle change to families with at least one overweight or obese child in an eligible Medicaid health plan. This gives RW significant potential for reach and population impact. This project aimed to understand how to maximize this impact by exploring perspectives of RW, using a conceptual framework informed by the Conceptual Model of Implementation Research, including assessment of the feasibility, acceptability, and appropriateness of RW; determining satisfaction among those experiencing coaching; identifying reasons individuals do not participate; and developing recommendations to enhance interest and participation. Methods Semi-structured interviews were conducted with 70 RW-eligible families across four states, who were described as: active participants, respondents who dropped or stopped RW, and RW non-participants. Following the interviews, the transcripts were coded inductively and deductively using a grounded theory approach, considering themes from the conceptual framework; themes also emerged from the data. Results From this sample, 19 families reported to be active coaching participants, 24 had dropped coaching, and 27 were RW non-participants. A number of themes were identified. Feasibility themes included coaches’ flexibility and willingness to work with the family’s schedule. Acceptability themes suggest providing actionable strategies tailored to the family’s context and needs, beyond just nutrition information and tips, early in the coaching relationship so the family perceives a benefit for continued participation. With regard to appropriateness, families were also interested in other methods of communication including email, texting, and in person visits. Access to resources for activity and healthy eating in their local community was also recommended. Conclusions RW has the potential to improve health and promote wellness. To enhance the impact of this program, RW could incorporate these findings to promote feasibility, acceptability, and appropriateness and improve program implementation. Strategies may include modifying the information provided or the mode of delivering the information.

Background. It is a priority to develop population-based strategies for reducing barriers to smoking cessation among low-income populations. Harnessing secondary transmission such as interpersonal communication (IC) has helped to reduce tobacco use, but there is a dearth of quasi-experimental research that examines IC and the full spectrum of smoking cessation behaviors, particularly in the context of population-level programs. Aims. Using quasi-experimental methods, we examined IC in response to a population-level intervention and its impact on the full spectrum of smoking cessation outcomes among low-income smokers. Method. We used propensity score matching; three different propensity score matching procedures were used to estimate and approximate experimental effects. We assessed four cessation outcomes: utilization of a free tobacco quitline (QL), making a quit attempt, and being smoke-free for 7 and 30 days at follow-up. We also examined predictors of IC. Results. IC was significantly related to QL utilization (effect sizes ranging from 0.135 to 0.166), making a quit attempt (effect sizes ranging from 0.115 to 0.147), being smoke-free for 7 days (effect sizes ranging from 0.080 to 0.121), and being smoke-free for 30 days at follow-up (effect sizes ranging from 0.058 to 0.082). Program-related and participant characteristics predicted IC, such as receiving emotional direct mail materials and living with a fellow smoker. Discussion. IC in response to a population-based program affected the cessation process, and IC had a marked impact on sustained cessation. Conclusion. Population-based programs should aim to harness psychosocial dynamics such as IC to promote sustained cessation among low-income populations.

The COVID-19 pandemic has profoundly impacted the economy and human lives worldwide, particularly the vulnerable low-income population. We employ a large panel data of 5.6 million daily transactions from 2.6 million debit cards owned by the low-income population in the U.S. to quantify the joint impacts of the state lockdowns and stimulus payments on this population’s spending along the inter-temporal, geo-spatial, and cross-categorical dimensions. Leveraging the difference-in-differences analyses at the per card and zip code levels, we uncover three key findings. (1) Inter-temporally, the state lockdowns diminished the daily average spending relative to the same period in 2019 by $3.9 per card and $2,214 per zip code, whereas the stimulus payments elevated the daily average spending by $15.7 per card and $3,307 per zip code. (2) Spatial heterogeneity prevailed: Democratic zip codes displayed much more volatile dynamics, with an initial decline three times that of Republican zip codes, followed by a higher rebound and a net gain after the stimulus payments; also, Southwest exhibited the highest initial decline whereas Southeast had the largest net gain after the stimulus payments. (3) Across 26 categories, the stimulus payments promoted spending in those categories that enhanced public health and charitable donations, reduced food insecurity and digital divide, while having also stimulated non-essential and even undesirable categories, such as liquor and cigar. In addition, spatial association analysis was employed to identify spatial dependency and local hot spots of spending changes at the county level. Overall, these analyses reveal the imperative need for more geo- and category-targeted stimulus programs, as well as more effective and strategic policy communications, to protect and promote the well-being of the low-income population during public health and economic crises.

The ability of health care providers to work together is essential for favourable outcomes in neonatal resuscitation, but perceptions of such teamwork have rarely been studied in low-income settings.Neonatal resuscitation is a proven intervention for reducing neonatal mortality globally, but the long-term effects of clinical training for this skill need further attention. Having an understanding of barriers to teamwork among nurse midwives can contribute to the sustainability of improved clinical practice.To explore nurse midwives' perceptions of teamwork when caring for newborns in need of resuscitation.Nurse midwives from a tertiary-level government hospital in Nepal participated in five focus groups of between 4 and 11 participants each. Qualitative Content Analysis was used for analysis.One overarching theme emerged: looking for comprehensive guidelines and shared responsibilities in neonatal resuscitation to avoid personal blame and learn from mistakes. Participants discussed the need for protocols relating to neonatal resuscitation and the importance of shared medical responsibility, and the importance of the presence of a strong and transparent leadership.The call for clear and comprehensive protocols relating to neonatal resuscitation corresponded with previous research from different contexts.Nurse midwives working at a maternity health care facility in Nepal discussed the benefits and challenges of teamwork in neonatal resuscitation. The findings suggest potential benefits can be made from clarifying guidelines and responsibilities in neonatal resuscitation. Furthermore, a structured process to deal with clinical incidents must be considered. Management must be involved in all processes.

Background & aims: In 2016, Médecins Sans Frontières established the first general population Hepatitis C virus (HCV) screening and treatment site in Cambodia, offering free direct-acting antiviral (DAA) treatment. This study analysed the cost-effectiveness of this intervention. Methods: Costs, quality adjusted life years (QALYs) and cost-effectiveness of the intervention were projected with a Markov model over a lifetime horizon, discounted at 3%/year. Patient-level resource-use and outcome data, treatment costs, costs of HCV-related healthcare and EQ-5D-5L health states were collected from an observational cohort study evaluating the effectiveness of DAA treatment under full and simplified models of care compared to no treatment; other model parameters were derived from literature. Incremental cost-effectiveness ratios (cost/QALY gained) were compared to an opportunity cost-based willingness-to-pay threshold for Cambodia ($248/QALY). Results: The total cost of testing and treatment per patient for the full model of care was $925(IQR $668-1631), reducing to $376(IQR $344-422) for the simplified model of care. EQ-5D-5L values varied by fibrosis stage: decompensated cirrhosis had the lowest value, values increased during and following treatment. The simplified model of care was cost saving compared to no treatment, while the full model of care, although cost-effective compared to no treatment ($187/QALY), cost an additional $14 485/QALY compared to the simplified model, above the willingness-to-pay threshold for Cambodia. This result is robust to variation in parameters. Conclusions: The simplified model of care was cost saving compared to no treatment, emphasizing the importance of simplifying pathways of care for improving access to HCV treatment in low-resource settings. Keywords: Markov process; cost-effectiveness; direct-acting antiviral treatment; healthcare costs; hepatitis C; low-income population; treatment costs.

Objective:To use cognitive interviewing and pilot testing to develop a survey instrument feasible for administering in the food pantry setting to assess daily intake frequency from several major food groups and dietary correlates (e.g. fruit and vegetable barriers) – the FRESH Foods Survey.Design:New and existing survey items were adapted and refined following cognitive interviews. After piloting the survey with food pantry users in the USA, preliminary psychometric and construct validity analyses were performed.Setting:Three US food banks and accompanying food pantries in Atlanta, GA, San Diego, CA, and Buffalo, NY.Participants:Food pantry clients (n 246), mostly female (68 %), mean age 54·5 (sd 14·7) years.Results:Measures of dietary correlates performed well psychometrically: Cronbach’s α range 0·71–0·90, slope (α) parameter range 1·26–6·36, and threshold parameters (β) indicated variability in the ‘difficulty’ of the items. Additionally, all scales had only one eigenvalue above 1·0 (range 2·07–4·71), indicating unidimensionality. Average (median, Q1–Q3) daily intakes (times/d) across six dietary groups were: fruits and vegetables (2·87, 1·87–4·58); junk foods (1·16, 0·58–2·16); fast foods and similar entrées (1·45, 0·58–2·03); whole-grain foods (0·87, 0·58–1·71); sugar-sweetened beverages (0·58, 0·29–1·29); milk and milk alternatives (0·71, 0·29–1·29). Significant correlations between dietary groups and dietary correlates were largely in the directions expected based on the literature, giving initial indication of convergent and discriminant validity.Conclusions:The FRESH Foods Survey is efficient, tailored to food pantry populations, can be used to monitor dietary behaviours and may be useful to measure intervention impact.

Background: Limited evidence-based guidance is available to parents regarding optimal child feeding practices to prevent early childhood obesity from birth to 24 months of age (B–24). The ...

Background In low-resource settings, the lack of mental health professionals and cross-culturally validated screening instruments complicates mental health care delivery. This is especially the case for very young children. Here, we aimed to develop and cross-culturally validate a simple and rapid tool, the PSYCa 6–36, that can be administered by non-professionals to screen for psychological difficulties among children aged six to 36 months. Methods A primary validation of the PSYCa 6–36 was conducted in Kenya (n = 319 children aged 6 to 36 months; 2014), followed by additional validations in Kenya (n = 215; 2014) Cambodia (n = 189; 2015) and Uganda (n = 182; 2016). After informed consent, trained interviewers administered the PSYCa 6–36 to caregivers participating in the study. We assessed the psychometric properties of the PSYCa 6–36 and external validity was assessed by comparing the results of the PSYCa 6–36 against a clinical global impression severity [CGIS] score rated by an independent psychologist after a structured clinical interview with each participant. Results The PSYCa 6–36 showed satisfactory psychometric properties (Cronbach’s alpha > 0.60 in Uganda and > 0.70 in Kenya and Cambodia), temporal stability (intra-class correlation coefficient [ICC] > 0.8), and inter-rater reliability (ICC from 0.6 in Uganda to 0.8 in Kenya). Psychologists identified psychological difficulties (CGIS score > 1) in 11 children (5.1%) in Kenya, 13 children (8.7%) in Cambodia and 15 (10.5%) in Uganda, with an area under the receiver operating characteristic curve of 0.65 in Uganda and 0.80 in Kenya and Cambodia. Conclusions The PSYCa 6–36 allowed for rapid screening of psychological difficulties among children aged 6 to 36 months among the populations studied. Use of the tool also increased awareness of children’s psychological difficulties and the importance of early recognition to prevent long-term consequences. The PSYCa 6–36 would benefit from further use and validation studies in popula`tions with higher prevalence of psychological difficulties. Electronic supplementary material The online version of this article (10.1186/s12887-019-1461-3) contains supplementary material, which is available to authorized users.

INTRODUCTION: Strategies are needed to improve recruitment of low-income adolescents into oral health studies. OBJECTIVES: In this study, we assessed the feasibility of recruiting Medicaid-enrolled adolescents into a neighborhood-level oral health study using Medicaid enrollment files and to evaluate the degree of bias in the final recruited study population. METHODS: We obtained Medicaid enrollment files from the Oregon Health Authority for 15,440 Medicaid enrollees aged 12 to 17 y from Multnomah, Hood River, and Tillamook counties. We attempted to contact the primary caregiver of each adolescent by telephone, and we tracked contact, recruitment, enrollment, and study completion rates. We further assessed if these rates were different across county-level rurality, neighborhood-level income, and caregiver-level language preference (Spanish vs. English). The Pearson chi-square test was used to compare rates (α = 0.05). We contacted 6,202 caregivers (40.2%), recruited 738 adolescents (11.9%), enrolled 335 (45.4%), and had complete data for 284 (84.8%). The overall enrollment yield from contacted caregivers was 5.4%. Contact rates did not differ significantly by rurality (P = 0.897), but they were significantly lower in the lowest-income neighborhoods (P = 0.023). Recruitment rates were significantly higher for adolescents from rural counties (P = 0.001), but they did not differ by income or language preference. Enrollment rates were significantly higher among adolescents from rural counties (P < 0.001) and were significantly associated with income (P = 0.041), but they were not different by language preference (P = 0.083). Among participants with complete data, there were no differences by rurality or income, but a significantly larger proportion of adolescents with complete data had caregivers with a language preference for Spanish (P = 0.043). RESULTS AND CONCLUSIONS: It is feasible to recruit Medicaid-enrolled adolescents into a neighborhood oral health study through the use of Medicaid files. County-, neighborhood-, and caregiver-level factors may influence characteristics of the final study population. Additional research is needed to improve recruitment of Medicaid enrollees into neighborhood oral health studies. KNOWLEDGE TRANSFER STATEMENT: Researchers can use the results of this study to plan neighborhood-level oral health studies involving recruitment of low-income adolescents. Findings further underscore the importance of assessing factors related to recruitment to evaluate participant bias and the generalizability of study findings.

High rates of obesity and chronic disease exist in the southeastern United States (US). Knowledge about the attitudes, beliefs, and barriers of the rural low-income Louisiana population regarding healthy eating is limited. Focus Group discussions based on the Theory of Planned Behavior (TPB) were conducted in rural parishes (N = 3) with low-income residents of Louisiana (N = 29). Grounded Theory methods and cross-case analysis were used. The participants were primarily single Black females of age 18–30 years who earned a high school diploma, were employed, and had children. Beliefs included healthy eating was physically beneficial, yet financial impacts and the low palatability of healthy foods were barriers. Professional resources for nutrition education were limited which led to reliance on friends, family, and the internet. Friends and family were positive and negative influences on eating choices. Control beliefs included the high prices and low palatability of healthy foods, the wide availability of Energy Dense Nutrient Poor (EDNP) foods, and low motivation to sustain eating behavior changes. Formative research to optimize campaign distribution channels may improve accessibility to social marketing support and healthy eating resources. Persuasive messages that address control beliefs are needed in social marketing campaigns for rural low-income Louisiana environments.

Introduction: Compulsive buying can be characterized as an almost irresistible impulse to acquire various items. This is a current issue and the prevalence rate in the global population is around 5 to 8%. Some surveys indicate that the problem is growing in young and low-income populations. Objectives: To evaluate the prevalence of compulsive buying among people with low personal monthly incomes and analyze relationships with socio-demographic data. Methods: The Compulsive Buying Scale was administered to screen for compulsive buying and the Hospital Anxiety and Depression Scale was used to assess anxiety and depression in a sample of 56 participants. Pearson coefficients were used to test for correlations. Results: The results indicated that 44.6% presented an average family income equal to or greater than 2.76 minimum wages. It is possible that compulsive buying is not linked to the purchasing power since it was found in a low-income population. Conclusion: Despite the small sample, the results of this study are important for understanding the problem in question.

Aims To estimate the cost‐effectiveness at population‐level of the OPT‐IN proactive tobacco cessation outreach program for adult smokers enrolled in publicly funded health insurance plans for low‐income persons (e.g. Medicaid). Design Cost‐effectiveness analysis using a state transition model based on data from the Offering Proactive Treatment Intervention (OPT‐IN) randomized control trial. Setting The trial was conducted in Minnesota, USA, and the economic analysis was conducted from the Medicaid program perspective. Participants Data were used from 2406 smokers who were randomized into the intervention or comparator groups. Intervention and comparator The intervention was comprised of proactive outreach (mailed invitation and telephone calls) and free cessation treatment (nicotine replacement therapy and intensive telephone counseling). The comparator was usual care, which comprised access to a primary care physician, insurance coverage of Food and Drug Administration (FDA)‐approved smoking cessation medications and the state's telephone quitline. Measurements Smoking status, quality of life and health‐care use at varying times, including at baseline and 1 year. Findings The OPT‐IN program cost an average of $84 per participant greater than the comparator. One year after randomization, the population‐level, 6‐month prolonged smoking abstinence rate was 16.5% in the proactive outreach intervention group and 12.1% in the usual care group (P

The objective of this report was to demonstrate the use of discourse analysis as a qualitative nutrition research analysis tool based on a case study of food-insecure parents. The US Department of Agriculture 18-item Household Food Security Module served as a framework for cognitive interviews. Data were analyzed using a basic inductive technique and then reanalyzed using discourse analysis. Discourse analysis tools including position design and identity building, I and we statements, collocational patterns, and the figured world tool unveiled findings otherwise not detected using basic inductive techniques. Discourse analysis and corresponding tools can contribute to qualitative nutrition research, particularly in inductive thesis-generating work.

As access to healthy food (or lack thereof) could be considered a social justice issue, social workers should be concerned about this issue and willing to collaborate with colleagues of various disciplines to address it. This study was a formative evaluation conducted to understand best practices, recommendations, and feasibility of a social-marketing-based nutrition education program tailored to the needs of adults with limited income. The authors report findings from focus groups conducted with Cooperative Extension Agents (CEAs) and region coordinators (n = 45) and Supplemental Nutrition Assistance Program Education (SNAP-Ed) (n = 69) eligible participants to inform the development of a social marketing nutrition intervention for SNAP-Ed in Georgia. Barriers to healthy eating included cultural preferences, costs of healthy food, lack of time, and lack of availability. Social marketing has a potential to deliver effective and efficient SNAP-Ed targeted to large, limited-resource Georgians. Segmenting the low-income population based on geographical location as well as best methods for outreach can allow tailored messages to meet identified needs, lifestyles, and other variables that make these individuals most likely to respond to the program. Food security and nutrition education are topics of concern for all health care professionals interested in addressing complex health issues of many low-income adults.

This study evaluates the healthfulness of the meals offered to and consumed by low-income Brazilians in Popular Restaurants (PR). It is a cross-sectional, exploratory study. The final sample includes 36 PRs, respecting the stratification criteria for each of the five Brazilian regions. To identify the quantity and quality of food consumption, consumers’ meals are evaluated. The sample calculation uses a minimum of 41 consumers in each PR. Consumption evaluation is carried out by weighing and direct observation of the meal that each consumer served to his plate. Each dish of the meals had its Technical preparation files (TPF) developed by observing the production and weighing all the ingredients. Evaluations of Energy density (ED), meal’s weight components and sodium composition are conducted. Plate’s composition is compared to “My plate” guidelines United States Department of Agriculture (USDA). The final sample includes 1771 low-income Brazilians consumers. The plate of PRs consumers is adequate only for the “protein group” in comparison to “My plate”. Rice and beans compose more than 50% of the plate’s weight, as expected, since it is a Brazilian habit of consumption at lunch. Thus, grains are the major group consumed by PRs consumers. The average ED for all PRs is 1.34 kcal/g. Regarding sodium content, rice and main courses presented the highest values and are classified as high, according to Food and Drug Administration (FDA). Concerning sodium, PRs are putting Brazilian low-income population at risk for chronic diseases. However, in general, PRs are good choices because they promote access to cheap and quality traditional Brazilian foods.

Objective: This cross-sectional study assessed the effect of food donations on total nutrient intake of clients of a food pantry in Central Texas. Methods: Nutrient intakes of total, base and food donation diets were estimated for 112 food pantry recipients using specific questionnaires; and then compared to the dietary reference intakes (DRI) and 2015–2020 US Dietary Guidelines. Results: Food donations accounted for more than half of the client’s daily intake of energy, carbohydrates, vitamin B6, phosphorus, copper and selenium. Yet, daily total intake remained less than their DRIs for carbohydrates, poly-unsaturated fats, dietary fiber, fat soluble vitamins and vitamin C, and was even lower for calcium, magnesium and potassium. Total food intake of clients almost met the US Dietary Guidelines for refined grains, fruits, vegetables, and meat; however, the amount of whole grains and dairy was inadequate. Conclusions: Supplemental foods offered at food pantries are an important resource for improving nutrient intake of low-income populations.

OBJECTIVE The aim of this study was to measure the impact of osteoarthritis on the functioning and health status of individuals living in a low-income urban community in Mexico. METHODS We conducted a cross-sectional, community-based study from December 2014 to November 2015, using the Community Oriented Program for Control of Rheumatic Diseases methodology to identify cases of musculoskeletal disease in a sample of adults older than 18 years in Pueblo Nuevo, Apodaca, Mexico. Two rheumatologists confirmed all cases of osteoarthritis (OA) using predefined criteria. Functioning was evaluated through (a) self-report of difficulty doing personal care, work, and leisure activities; (b) the modified Stanford Health Assessment Questionnaire-Disability Index; and (c) the Timed Up and Go test. Health status was evaluated using the EuroQoL 5 Dimensions. Statistical analyses were performed using χ tests and logistic regression models. RESULTS Four hundred thirty-nine individuals with a mean age of 45.2 years were included, and 83 cases of OA were confirmed. The presence of OA was not significantly associated with having difficulties to do personal care, work, or leisure activities, but it was significantly associated with a higher Health Assessment Questionnaire-Disability Index score, longer time to complete the Timed Up and Go, and lower health status. CONCLUSIONS Osteoarthritis is associated with having higher disability and worse health status in the community studied. A disability paradox was detected as some individuals perceived disability for doing standard activities but did not present disability performing their real-life activities. This underlies the importance of addressing the mental dimension during the management of this population.

Objectives To evaluate chronic pain management in a multistate, low-income Hispanic population, and to examine predictors of exercising and prescription pain medication (PPM) use. Design Online survey administered to a representative sample of Hispanic adults in June 2015. Setting Five southwestern states. Participants Among all online panel members who were Hispanic (N=1007), aged 35 to 75 years from 5 states, representing 11,016,135 persons, the survey was completed by 516 members (51%). Among these, 102 participants were identified with chronic noncancer pain representing 1,140,170 persons. Interventions Not applicable. Main Outcome Measures Exercising or using PPM for chronic pain in past year. Results Most participants reported using PPM (58%) and exercise (54%) to manage pain. Compared with annual household incomes >$75,000, adjusted odds ratios [AORs] for exercising were .20 for P =.12); .40 for $10,000 to $34,999 ( P =.22); and .15 for $35,000 to $74,999 ( P =.015). Conversely, AORs for PPM were over 4-fold higher for lower-income groups as follows: 14.2, 4.79, and 4.85, respectively (all P P =.01), while exercisers rated the feasibility of gym access to manage pain higher ( P =.001). Conclusions In a Hispanic population-based sample with chronic pain, lower-income groups tended to exercise less but use PPM more. Barriers to gym access and use may play a role in these disparities.

Background: As many as one-third of all pregnancies in Bangladesh are unplanned, with nearly one-half of these pregnancies ending in either menstrual regulation (MR) or illegal clandestine abortion. Although MR is provided free of charge, or at a nominal cost, through the public sector and various non-profits organizations, many women face barriers in accessing safe, affordable MR and post-MR care. Mobile health (mHealth) services present a promising platform for increasing access to MR among low-income women at risk for clandestine abortion. We sought to investigate the knowledge, attitudes and practices regarding mHealth of both MR clients and formal and informal sexual and reproductive healthcare providers in urban and rural low-income settlements in Bangladesh.Methods: A total of 58 interviews were conducted with MR clients, formal MR providers, and informal MR providers in four low-income settlements in the Dhaka and Sylhet districts of Bangladesh. Interview data was coded and qualitatively analysed for themes using standard qualitative research practices.Results: Our findings suggest that low-income MR clients in Bangladesh have an inadequate understanding of how to use their mobile phones to obtain health service information or counselling related to MR, and correspondingly low levels of formal or informal mHealth service utilization. Few were aware of any formal mHealth services in place in their communities, despite the fact that providers stated that hotlines were available. Overall, MR clients expressed positive opinions of mHealth services as a means of improving women's access to affordable and timely MR. Formal and informal MR providers believed that mobile phones had benefits with respect to information dissemination and making appointments, but emphasized the necessity of in-person consultations for effective sexual and reproductive healthcare.Conclusions: We report low utilization yet high acceptability of mHealth services among low-income MR clients in Bangladesh. Expanding formal and informal mHealth services targeted towards MR – and increasing publicity of these services in low-income communities – may help increase timely access to accurate MR information and formal providers among women at risk for clandestine abortion. While expanding formal and informal mHealth services for SRHR in Bangladesh may be useful in disseminating information about MR and connecting women with formal providers, in-person visits remain necessary for adequate treatment.

Background: The global burden of stillbirth and neonatal deaths remains a challenge in low-income countries. Training in neonatal resuscitation can reduce intrapartum stillbirth and early neonatal mortality. Previous results demonstrate that infants who previously would have been registered as stillbirths are successfully resuscitated after such training, suggesting that there is a process of selection for resuscitation that needs to be explored. Objective: To compare neonatal resuscitation of low birth weight and normal birth weight infants born at a facility in a low-income setting. Methods: Motion-triggered video cameras were installed above the resuscitation tables at a maternity health facility during an intervention study (ISRCTN97846009) employing the Helping Babies Breathe resuscitation protocol in Kathmandu, Nepal. Recordings were analysed, noting crying, stimulation, ventilation, suctioning and oxygen administration during resuscitation. Birth weight, Apgar scores and sex of the infant were retrieved from matched hospital registers. The results were analysed by chi-square and logistic regression. Results: A total of 2253 resuscitation cases were recorded. Low birth weight infants in need of resuscitation had higher odds of receiving ventilation (aOR 1.73, 95% CI 1.24–2.42) and lower odds of receiving suctioning (aOR 0.53, 95% CI 0.34–0.82) after adjustment for the Helping Babies Breathe intervention, sex of the infant and place of resuscitation within the facility. The rates of stimulation and administration of oxygen were the same in both groups. Conclusions: Low birth weight was associated with more ventilation and less suctioning during neonatal resuscitation in a low-income setting. As ventilation is the most important intervention when the infant does not initiate breathing after birth, low birth weight was not a predictor for the decision to withhold resuscitation. Frequent routine use of suctioning of the lower airways continues to be a problem in the studied context, even after the introduction of the Helping Babies Breathe protocol.

Objective: To investigate the predictors of fresh fruit and vegetable purchases in a low-income population and identify subgroups in which interventions to increase such purchases might prove useful. Methods: Retrospective analysis of 209 shopping transactions from 30 households. Individual and household characteristics obtained from primary shopper. Data collected covered April 1-June 30, 2010. Primary outcome was number of servings of fresh produce purchased per week. Bivariate and multivariable analyses were conducted. Results: Controlling for household size, the average number of servings of fresh produce per week was higher in families with more children (P ¼ .008) and in families with a wider age range of children (P ¼ .04). Conclusions and Implications: Households with more children purchased more fresh produce. Purchase data combined with shopper household characteristics helped to distinguish relatively high from low purchasers of fresh produce among low-income families.