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Jing Han,1,&ast; Jie Liu,1– 4,&ast; Yakun Wu,1,5,&ast; Qiuxing Lin,1– 3,5 Dandan Guo,1 Xin Zhang,1 Jun Tu,1– 3,5 Xianjia Ning,1– 3,5 Jinghua Wang1– 3,5 1Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China; 2Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People’s Republic of China; 3Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People’s Republic of China; 4Center of Clinical Epidemiology & Evidence-Based Medicine, The Jizhou People’s Hospital, Tianjin, 301999, People’s Republic of China; 5Department of Neurology, Tangshan Gongren Hospital, Tangshan, 063000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jinghua Wang; Xianjia Ning Email jwang3@tmu.edu.cn; xning@tmu.edu.cnObjective: Although stroke mortality has remained stable over the past decade, the long-term trends of stroke burden are scarce in China, especially in low-income populations. Thus, we aimed to explore the secular trends in the prognosis of stroke in a low-income population in China.Methods: This was a population-based stroke surveillance study that included all of the participants in the Tianjin Brain Study. Stroke management and outcomes were evaluated for all stroke patients. Trends in the burden of stroke were assessed as annual percentage changes.Results: Overall, 1462 stroke cases occurred from 1992 to 2018, and 58.7% of patients were male. The rates of diagnosis by neuroimaging and of hospitalization increased noticeably across sexes and ages for all stroke types, and the greatest increases were observed among elderly women; diagnosis by neuroimaging increased by 4.7% and the rate of hospitalization increased by 12.4% (all P< 0.001). Stroke fatality decreased by 3.7% annually among those aged < 65 years and by 3.1% among patients aged ≥ 65 years; the corresponding rates were 7.4% and 3.5%, respectively, for women. The recurrence rate of ischemic stroke significantly decreased among all men, by 9.6% for those aged < 65 years and by 3.1% for those aged ≥ 65 years; however, for women, this rate only significantly decreased for those aged ≥ 65 years.Conclusion: Our findings suggest that the allocation of medical resources has improved over the past decades. However, it is crucial to enhance secondary stroke prevention for women aged < 65 years by controlling risk factors in low-income populations.Keywords: stroke burden, case fatality, recurrence, trends, low-income population

Background: The attempt to manage patients with acute myeloid leukemia as outpatients has become increasingly common due to high hospitalization costs, low availability for beds and patient preference. Publications on the subject are scarce, especially in low-income regions and the safety in this population remains to be determined. The present study aims to assess the safety of consolidation with high-dose cytarabine in the outpatient setting. Materials and Methods: We retrospectively analyzed 39 patients who underwent consolidation with highdose cytarabine, between 2009 and 2018, at Ophir Loyola Hospital, in Belém, Brazil. Patients treated after 2015 were given high-dose cytarabine as outpatients due to the decision of medical staff. Results: Twenty-seven patients received 76 cycles of cytarabine as outpatients; males were 48.14% of the total population, with a median age of approximately 45 years. The occurrence of delay between cycles was significantly lower among outpatients (48.14% vs. 83.33%, p = 0.04). There was no difference in relapse rates, transfusion requirements and non-relapse mortality between both groups. Hospitalization was required in 40.74% of patients during outpatient cycles and 18.51% of blood cultures were positive for pathogens. Nonrelapse mortality was significantly higher among patients above 50 years old and treated on an outpatient basis (44.4% vs. 5.60%, p = 0.03). Conclusion: High-dose cytarabine administration on an outpatient basis appears to be safe and effective in a low-income population at the Brazilian Amazon region, but toxicity seems to be increased for patients older than 50 years.

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.

Background Anticoagulation with warfarin represents a transportation‐sensitive treatment state. Transportation barrier is a common reason for not using health care services. Objective To assess the association between transportation barriers to anticoagulation clinic and anticoagulation control (AC) among an inner‐city, low‐income population. Patients/Methods Adults expected to be on chronic warfarin therapy were recruited from an ambulatory anticoagulation clinic. Participants completed a validated questionnaire that assessed transportation barriers to clinic, defined as self‐reported trouble getting transportation to a clinic and a composite score of the presence of transportation barriers. Suboptimal AC was defined as time in therapeutic range (TTR)

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).

This article examines the relationship between fuel poverty and poor health among the population in the two lower income quintiles in Europe using the 2012 EU-SILC dataset. Results confirm that fuel poverty is a key determinant of health among the low-income population: the probability of being fuel poor is substantially higher among the low-income population; fuel poverty among the low-income population is a prevalent problem across European countries, particularly in southern and transition countries, and among renters; the low-income population in fuel poverty is more likely to report poor health than the whole low-income population; and the low-income population in severe fuel poverty has a higher likelihood of reporting poor health than the whole fuel poor low-income population. In addition, variations between countries in prevalence ratios of poor health by fuel poverty indicator and housing tenure suggest that there are different types of fuel poverty in terms of health-related outcomes.

Introduction. Today, Ukraine faces a sharp poverty problem, aggravated by low level of population incomes. This is because the transformation processes in the economy and social structure has led to an increase in the number of people needing social protection and support from the state. Today a significant part of Ukraine’s population is below the poverty line. The most important task of socially oriented economy is the work of the social protection of all sectors of society and development of a strategy for effective social policies. Purpose. To define methodological approaches to optimal social protection of vulnerable groups of the population. Results. The tendencies of financial development in social security providing have been revealed. The author examines the factors that affect to the state financing of the social security system; the methods of realization of effective social support of the population. Non-contributory social benefits and services schemes, that from the State Budget, following items: social assistance; privileges; housing subsidies; and social services. Ukrainians rank among the world’s poorest people. But Ukraine recorded one of the sharpest declines in poverty of any transition economy in recent years. The poverty rate, measured against an absolute poverty line, fell from a high of 51.4 percent in 2013 to 38.2 percent in 2017. Since 2014, the government’s social reforms have focused on the implementation of the tasks of creating a fair pension insurance system; ensuring effective state social support of the population, etc. The minimum wage has doubled, and the subsistence minimum is 10.1%, the minimum pension is 16.4%. The largest share of Consolidated Budgets’ expenditures on social protection is expenditure on pensioners (more than 49%). Conclusions. In terms of social protection system, key challenges are to improve the quality and efficiency of social services. Assessing the effectiveness of social payments requires regular monitoring in order to determine their effect on the demographic, social and financial situation in the country.

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.

Portable health clinic (PHC) is a remote healthcare system, jointly developed by Grameen Communications in Bangladesh and Kyushu University in Japan with the aim to providing affordable primary healthcare services to people who do not have regular access to healthcare facilities including the low-income population living in rural unreached communities. This chapter introduces the basic concept and architecture of PHC; status of different pilot projects, findings, and observations; the technical and social challenges the projects faced during the implementation.

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.

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. 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.

We study to what extent the Health and Retirement Study (HRS) is representative of all income groups, but with a particular emphasis on low-income groups. To focus on the HRS sample composition and abstract from potential measurement issues associated with measures of income and program participation, we exploit the SSA administrative data matched to the HRS sample and compare their distribution against the distribution of the same variables for the same population in the SSA databases. We find that overall, for cohorts and years that can be most reliably compared, the distributions are very similar and conclude that the HRS is representative for the population it covers. However, for some subgroups in the low-income population (e.g., recipients of Supplemental Security Income, Medicaid beneficiaries), there are some differences and thus we caution against estimating population totals for such small subpopulations. The HRS samples for which restricted matched administrative data are available are often not representative of a broad population of interest, because not all HRS respondents were asked permission to match in any given year. Therefore, the restricted HRS datafiles are generally not suitable for estimating population distributions, although they are still very useful for modeling purposes.

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.

Aim. To gather information regarding endodontic treatment protocols and continuing education attendance of dentists in some cities located in Northeastern Brazil (Sergipe and Bahia States), a region that comprises a very-low-income population.Methods. A questionnaire containing different questions (e.g., routine treatment protocols, the use of new technologies, time required to conclude the treatment, and attendance in an endodontic continuing education) was distributed to 250 dentists. The collected data were analyzed through descriptive statistics and Poisson regression (p<0.05).Results. A total of 199 dentists practicing endodontic treatment in the cities of Aracaju (n = 58), Salvador (n = 83), and towns of Estância (n = 8), Itabaiana (n = 16), Itabaianinha (n = 5), Lagarto (n = 10), Ribeirópolis (n = 3), Simão Dias (n = 6), and Tobias Barreto (n = 10) participated in this research. Most of the respondents have concluded their graduation in Dentistry in less than 10 years (62.3%), with nearly 75.4% of the sample having attended postgraduation education in the field. Regarding treatment protocols, the frequency for using rotary/reciprocating systems and for always using rubber dam isolation during root canal treatment (RCT) was 78% and 62%, respectively, which was also more prevalent among dentists who attended a continuous education program (p<0.05). Lastly, the professionals who attended (p<0.05) to a continuous education program in Endodontics were more frequently associated to performing incisors and molars RCT in one clinical appointment (p<0.05).Conclusions. The results of this survey indicated that even in an area where most of the population has low-income conditions, the professionals are seeking for knowledge by attending to postgraduation programs, following the new tendencies in Endodontics with most of the professionals having employed technological resources.

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.

Os impactos causados por desastres naturais podem ser minimizados ao identificar populacoes em situacao de vulnerabilidade. Para contribuir com o planejamento territorial e reduzir tais impactos, este trabalho analisa metodologias para identificacao espacial da vulnerabilidade socioambiental. Foi estudada a bacia do rio Mane Dende, em Salvador, caracterizada pelo alto adensamento populacional e concentracao da populacao de baixa renda, com ocorrencias de ocupacoes irregulares. Para a geracao dos produtos foram utilizadas tecnicas de geoprocessamento, identificando espacialmente as areas de risco e as populacoes em situacao de vulnerabilidade e representa-las graficamente, obtendo mapas tematicos como resultado. O mapa de vulnerabilidade ambiental foi gerado ao identificar areas de risco de deslizamento de terra e inundacao. Foi determinado um Indice de Vulnerabilidade Social baseado no censo demografico do IBGE, gerando o mapa de vulnerabilidade social. O mapa de vulnerabilidade socioambiental foi gerado por algebra de mapas. A metodologia de obtencao da vulnerabilidade social foi considerada satisfatoria e segue os padroes adotados em trabalhos aplicados no Brasil e internacionalmente. E recomendado que seja feita uma analise dos criterios de vulnerabilidade ambiental, para que o resultado possa representar uma ferramenta mais segura para a tomada de decisao. Social-Environmental Vulnerability Diagnosis in Urban Areas Using Geomatics A B S T R A C T The impacts caused by natural disasters can be minimized by identifying populations in situations of social vulnerability. Aiming to contribute with land-use planning and to reduce such impacts caused by these natural disasters in urban centers, this project proposes a methodology to for spatial identification of social and environmental vulnerability. The method was applied in Mane Dende River’s basin, at Salvador, Bahia. This study area is characterized by its high population density and great concentration of low income population, with high occurrence of irregular settlements. It was used geoprocessing techniques to identify the areas and the population that are vulnerable and graphically represent them through the generation of thematic maps. The environmental vulnerability map was generated through identifying the areas with risk of landslide and floods. It was determined a Social Vulnerability Index based on the 2010 census database published by the Brazilian Institute of Geography and Statistics. Then, it was generated the social vulnerability map. The social and environmental vulnerability map was made by applying the map algebra technique. The social vulnerability method was considered satisfactory once it follows the pattern adopted by similar works, applied in Brazil and around the world. However, it is recommended for future works a deeper analysis of the criteria used to obtain the environmental vulnerability map so that the final result will be able to represent a reliable tool for the decision making in the scope of territorial management planning. Keywords: geoprocessing, zoning, social vulnerability, environmental vulnerability.

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 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.

Background Current practice in the Western Cape region of South Africa is to discharge newborns born in-hospital within 24 h following uncomplicated vaginal delivery and two days after caesarean section. Mothers are instructed to bring their newborn to a clinic after discharge for a health assessment. We sought to determine the rate of newborn follow-up visits and the potential barriers to timely follow-up. Methods Mother-newborn dyads at Tygerberg Hospital in Cape Town, South Africa were enrolled from November 2014 to April 2015. Demographic data were obtained via questionnaire and medical records. Mothers were contacted one week after discharge to determine if they had brought their newborns for a follow-up visit, and if not, the barriers to follow-up. Factors associated with follow-up were analyzed using logistic regression. Results Of 972 newborns, 794 (82%) were seen at a clinic for a follow-up visit within one week of discharge. Mothers with a higher education level or whose newborns were less than 37 weeks were more likely to follow up. The follow-up rate did not differ based on hospital length of stay. Main reported barriers to follow-up included maternal illness, lack of money for transportation, and mother felt follow-up was unnecessary because newborn was healthy. Conclusions Nearly 4 in 5 newborns were seen at a clinic within one week after hospital discharge, in keeping with local practice guidelines. Further research on the outcomes of this population and those who fail to follow up is needed to determine the impact of postnatal healthcare policy.

Background: Mobile health (mHealth) apps have shown to improve health indicators, but concerns remain about the inclusion of populations from low- and medium-income countries (LMIC) in these new technologies. Atrial fibrillation (AF) is a chronic condition with a challenging management. Previous studies have shown socioeconomic differences in the prescription of anticoagulant treatment and shared decision strategies are encouraged to achieve better outcomes. mHealth can aid both doctors and patients in this matter. Objective: We describe the development of an mHealth app (aFib) idealized to aid shared decision between doctor and patient about anticoagulation prophylaxis in AF in a low-income and low-literacy population in Brazil. On the basis of our research, we suggest the processes to be followed when developing mHealth apps in this context. Methods: A multidisciplinary team collected information about the target population and its needs and detected the best opportunity to insert the app in their current health care. Literature about the subject was reviewed and important data were selected to be delivered through good navigability, easy terminology, and friendly design. The app was evaluated in a multimethod setting. Results: The steps suggested to develop an mHealth app target to LMIC are: (1) characterize the problem and the target user, (2) review the literature, (3) translate information to knowledge, (4) protect information, and (5) evaluate usability and efficacy. Conclusions: We expect that these recommendations can guide the development of new mHealth apps in LMIC, on a scientific basis. [JMIR Mhealth Uhealth 2017;5(4):e41]

This study seeks to examine the exposure of low-income people to floods in Austin. This exposure of low-income people could financially and psychologically be more serious than that of others because they have less capacity to recover from the hazards. This study conducts four methods to track the vulnerability of the population. The results are as follows: first, property values are lower inside floodplains than outside floodplains; second, many floodplain areas have been developed for multi-family housings, mobile homes, and single family housings in the very low-income neighborhoods between 1990 and 2000; third, low-income people are more likely to live in floodplains, compared to higher-income people and the number has grown in floodplains; fourth, people with the lower income are more likely to live in the areas including more floodplain. The more serious exposure and the increase of low-income people in the floodplains could give a rationale for policy intervention in floodplain management and regulation. This study proposes several policies for Austin to reduce property damage in floodplains, where low-income people tend to live.

Embora nos últimos anos tenha ocorrido redução na prevalência da cárie dentária, tem-se observado o fenômeno da polarização da doença, com uma pequena parcela da população concentrando a maior parte da doença. O controle da cárie é eficiente se os principais fatores envolvidos em sua etiologia puderem ser controlados. A dieta e a higiene são consideradas os principais fatores para a instalação da doença, porém o fator socioeconômico também é importante, sendo o diferencial na polarização da doença. Este estudo foi realizado em uma pequena cidade em que nem todas as pessoas têm acesso à água fluoretada. Neste estudo foram realizadas orientações sobre a higiene bucal e a dieta para a população de 6 a 9 anos de idade atendida no Programa de Erradicação do Trabalho Infantil (PETI) com o objetivo de reduzir o número de microrganismos cariogênicos e, assim, diminuir a incidência de cárie nesta população. O fator socioeconômico foi um dificultador para a modificação da dieta destas crianças. Para tentar solucionar este problema, foi sugerida a criação de hortas comunitárias. Os resultados foram verificados através do padrão de incidência de cárie através de exame clínico, pela avaliação do cardápio oferecido às crianças e pela contagem dos microrganismos. Foi obtida uma redução significativa dos microrganismos cariogênicos no início do trabalho, porém esta redução não se manteve quando as visitas se tornaram mais espaçadas. Para promover e manter saúde bucal, ações pontuais são de pouca valia. É importante o reforço periódico das orientações para que os resultados se tornem perenes.Palavras-chave: Dieta Saudável. Cárie Dentária. Higiene Bucal. AbstractAlthough in recent years there has been reduction in prevalence of tooth decay, it has also been observed the phenomenon of polarization of the disease, with a small portion of the population focusing most of the disease. The caries control is efficient if the main factors involved in its etiology can be controlled. Diet and hygiene are considered the main factors for the disease, but the socio-economic factor is also important, being the difference in polarization of the disease. This study was carried out in a small town where not all people have access to fluoridated water. In this study guidelines were carried out on oral hygiene and diet of the population from 6 to 9 years of age met in the program for the eradication of child labor (PETI) were introduced to reduce the number of cariogenic microorganisms and thus reduce the incidence of caries in this population. The diet modification was difficult due to the the economic situation of such children. The results were verified by the pattern of incidence of caries through clinical examination, by evaluating the menu offered to children and by counting of microorganisms. A significant reduction of cariogenic microorganisms was observed at the beginning of the work, but this reduction is not maintained when the visits became more spaced. To promote and maintain oral health, punctual actions are of little value. It is important that periodic reinforcement of the guidelines for the results become perennials.Keywords: Healthy Diet. Dental Caries. Oral Hygiene.

A alimentação é um direito assegurado constitucionalmente. Nesse contexto, associado à atenção que agencias multinacionais canalizam ao assunto, foram criados os Restaurantes Comunitários, meio pelo qual o Estado propõe fornecer alimentação saudável a população de baixa renda. No ano de 2017 a previsão da Lei Orçamentária Anual do Distrito Federal para a execução dessa política pública correspondia a R$ 39.150.000,00 (trinta e nove milhões cento e cinquenta mil reais). Tal informação associada à relevância que essa política possui diante da população e dos meios de comunicação motivaram a pesquisa. Diante disso, o objetivo desse estudo é verificar a eficiência dos gastos dos restaurantes comunitários do Distrito Federal, por meio do método de Análise Envoltória de Dados (DEA), nos anos de 2012 a 2016. Foram utilizados dados referentes a despesa empenhada, a despesa liquidada e a quantidade de habitantes por região administrativa. Os resultados indicaram que todos os restaurantes foram eficientes durante o período de análise. Sendo que o restaurante localizado na Estrutural se revelou o mais eficiente enquanto o do Itapoã, o menos eficiente. No entanto as regiões administrativas que apresentam maior número de famílias em situação de vulnerabilidade não possuem os restaurantes mais eficientes. Ressalta-se que esse resultado pode ser utilizado pelos gestores público como meio de aprimorar a formulação dessa política pública.

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.

Aim: To illustrate haematological adaptation to moderate altitude in Rwanda. Study Design: A population-based cross-sectional study. Place and Duration of Study: The study was carried out at moderate altitude (1,6491,768 m) among students of the National University of Rwanda and blood donors from Buhanda, Ruhango and Nyaruteja centres, from August to December 2011. Methods : Healthy volunteers (238 males and 106 females, age range: 18-40 years) were recruited in the study. Complete blood count was performed on a Coulter AcT 5diff and for some samples on a Sysmex KX-21N automated haematology analyzer. Results: Results (mean ± SD) were: erythrocyte count: males: 5.28 ± 0.53 X 10 12 /L

Social Marketing (SM) has been used to deliver public health interventions, and has the potential to deliver nutrition education interventions targeted to large, low-income population quickly at lo...

Background Patients on insulin glargine typically visit a clinician to obtain advice on how to adjust their insulin dose. These multiple clinic visits can be costly and time-consuming, particularly for low-income patients. It may be feasible to achieve insulin titration through text messages and phone calls with patients instead of face-to-face clinic visits. Objective The objectives of this study are to (1) evaluate if the Mobile Insulin Titration Intervention (MITI) is clinically effective by helping patients reach their optimal dose of insulin glargine, (2) determine if the intervention is feasible within the setting and population, (3) assess patient satisfaction with the intervention, and (4) measure the costs associated with this intervention. Methods This is a pilot study evaluating an approach to insulin titration using text messages and phone calls among patients with insulin-dependent type 2 diabetes in the outpatient medical clinic of Bellevue Hospital Center, a safety-net hospital in New York City. Patients will be randomized in a 1:1 ratio to either the MITI arm (texting/phone call intervention) or the usual-care arm (in-person clinic visits). Using a Web-based platform, weekday text messages will be sent to patients in the MITI arm, asking them to text back their fasting blood glucose values. In addition to daily reviews for alarm values, a clinician will rereview the texted values weekly, consult our physician-approved titration algorithm, and call the patients with advice on how to adjust their insulin dose. The primary outcome will be whether or not a patient reaches his/her optimal dose of insulin glargine within 12 weeks. Results Recruitment for this study occurred between June 2013 and December 2014. We are continuing to collect intervention and follow-up data from our patients who are currently enrolled. The results of our data analysis are expected to be available in 2015. Conclusions This study explores the use of widely-available text messaging and voice technologies for insulin titration. We aim to show that remote insulin titration is clinically effective, feasible, satisfactory, and cost saving for low-income patients in a busy, urban clinic. Trial Registration Trial Registration: Clinicaltrials.gov NCT01879579; http://clinicaltrials.gov/ct2/show/NCT01879579 (Archived by WebCite at http://www.webcitation.org/6WUEgjZUO).

Brazilian banks have developed innovative initiatives to deliver financial services for the low-income population through correspondent banking (CB). Banco Lemon is such an interesting case to be studied because it has implemented a business model based exclusively on CB outlets and its focus was on low-income clients. This paper describes Banco Lemon's adoption process of the CB technology to deliver financial services for the low-income population, promoting a historical description of the bank's activities, since its creation and up to the year 2009. Eventually, this paper concludes that bill payment initiatives were successful while credit initiatives led to unexpressive outcomes.

La distribution socio-professionnelle de la population active québécoise s’est transformée au cours du vingtième siècle, comme on peut le constater à l’aide des données des recensements canadiens de 1931 à 1981, offrant une codification des occupations comparable. De même, la composition sexuelle et ethnique de la main-d’oeuvre a considérablement évolué au cours de cette période. Les auteurs analysent la façon dont ces clivages sexuel et ethnique sont mis à contribution, à différents moments, pour assigner des agents aux différentes places dans la division du travail ; il s’agit en particulier de voir comment les groupes dominés définis par ces deux clivages sont utilisés pour remplir les fonctions inférieures dans la hiérarchie des emplois. L’usage de modèles complexes, du type log-linéaire, permet de distinguer d’une part des effets bruts, traduisant la réalité vécue des groupes sexuels et ethniques sur le marché du travail, et d’autre part les effets nets, correspondant aux règles plus ou moins permanentes, mais moins évidentes, régissant l’accès de ces groupes aux divers emplois., The socio-professional distribution of Quebec's total labour force has changed during the twentieth century, as one can observe from the 1931 to 1981 Canadian censuses that provide comparative occupation codes. As well, the sexual and ethnic composition of the labour force has changed substantially during this period. The authors analyse the manner in which these sexual and ethnic cleavages are, at various moments, called upon to assign agents to different places in the division of labour; in particular, it is a matter of seeing how the dominated groups, defined by these two cleavages, are used to fulfill the lower functions of the work hierarchy. The use of complex models of the linear log type, makes it possible to distinguish, on the one hand, crude effects relating the reality experienced by sexual and ethnic groups in the labour force; and on the other hand, the net effects corresponding to the more or less permanent, but less evident, rules which govern these groups' access to the various jobs., La distributión socio-profesional de la población activa de Quebec se ha ido transformando durante el siglo XX. Esto Io atestigua la información recogida en los censos canadienses de 1931 a 1981, que presentan una codificación semejante de la ocupación. Del mismo modo, la composición sexual y étnica de la mano de obra ha cambiado considerablemente en el curso de este período. Los autores analizan la forma en la que estos conjuntos discriminatorios, étnico y sexual, echan mano de agentes, en diferentes mornentos, para ocupar las vacantes diversas dentro de la división del trabajo; especificamente, se trata de enterarse cómo los grupos dominados, definidos por estos dos factores de segregación, son asimilados para cubrir las funciones inferiores dentro de la jerarquía del empleo. La utilización de modelos complejos, tipo logo-lineal, permiten distinguir, por un lado, los efectos brutos, que reflejan la vivencia de los grupos sexuales y étnicos dentro del mercado de trabajo, y por el otro, los efectos netos, que corresponden a las normas más o menos permanentes, pero menos evidentes que regulan el acceso de estos grupos a los diverses empleos.

Changes in the patterns of quotidian physical mobility of the population are at the very centre of transformations in contemporary urban life. The city of Santiago, Chile is no exception to this tr...

OBJETIVOS: comparar a adequação aparente da ingestão dos nutrientes utilizando os valores de referência "Consumo Dietético de Referência" (Dietary Reference Intake-DRIs) de 35 crianças de uma creche filantrópica, em dois momentos, no ato da matrícula (momento 1) e após seis meses de freqüência na creche (momento 2). MÉTODOS: A avaliação sócio-demográfica foi realizada através de questionário abordando renda, escolaridade, condições de moradia e saneamento básico. Para avaliação do consumo alimentar, no ato da matrícula, a história dietética foi determinada em entrevista com o responsável, com o propósito de obter informações sobre consumo habitual da criança na sua residência. Após o período de seis meses foi utilizado o método de pesagem direta de alimentos (na creche) complementando com o consumo alimentar da criança na residência. A análise dos nutrientes como proteínas, ferro, cálcio e vitamina C, além das fibras alimentares, foi realizada através um programa computacional. Para comparar a adequação dos nutrientes nos dois momentos do estudo utilizou-se o teste t de Student para dados pareados (p < 0,05). RESULTADOS: observou-se que ocorreu uma melhora significativa no consumo médio de nutrientes e de fibras alimentares das crianças, após seis meses de frequência na creche. Chama atenção que nenhuma criança atingiu o nível de adequação de fibras alimentares nos dois momentos do estudo, apesar da diferença significativa. CONCLUSÕES: os resultados sugerem que as creches podem ter um importante papel na melhora do estado nutricional de crianças de estratos sociais menos favorecidos. OBJECTIVES: to compare nutrients intake apparent adequacy through reference values of Dietary Reference Intake (DRIs) of 35 children of a charity daycare center in two instances, when they enrolled (instance 1) and six months after (instance 2). METHODS: socio-demographic assessment was performed through a questionnaire collecting information pertaining to income, school level, living conditions and basic sanitation. To assess food consumption at enrollment, dietary history was informed through an interview with the parent, family member or guardian on the usual intake of the child at home. Following a six month period the weighed food record method (in the daycare center) was performed complemented by the food intake of the child at home. Nutrient analysis such as proteins, iron, calcium and vitamin C in addition to food fibers was performed by specific software. To compare nutrients' adequacy in the two instances of the study the paired Student test (t) (p < 0.05) was used. RESULTS: a significant improvement in the median intake for all nutrients and fiber six moths after child's attendance to the daycare center was determined. No child reached the level of fiber apparent adequacy of the ingestion at the two moments of the study, despite the significant difference. CONCLUSIONS: results suggest that daycare centers can have an important role in the improvement of lower income children nutritional status.

Objectives . To examine the acceptability of non-medical, community-based interviewers obtaining blood samples during in-home interviews from low-income study participants. Methods . Two separate focus groups were conducted, one with ten non-medical community-based interviewers and the other with eight research participants from a low- income population. (Both the interviewers and the research participants had previously taken part in a research project over the course of five years.) Results . Participants and interviewers were comfortable with finger stick blood samples performed in the home. The interviewers felt that adequate training was critical. Participants identified key issues: blood would not be used for other purposes and that the interviewers would be trained to handle blood safely. Both groups felt that it was crucial to communicate the study purpose and results. Recommendations from the focus groups were implemented and the acceptance rate for blood sampling was 99.5% (205/206). Conclusion. Proper training of interview- ers, organization of supplies, and communication with participants can be combined to maximize acceptance of in-home, finger stick blood sample collection by community-based interviewers among a low-income population.

Background Numerous epidemiological studies have compared outcomes between laparoscopic appendectomies (LA) and open appendectomies (OA); however, few studies have assessed the efficacy of LA specifically in a low-income population (LIP). Methods We analyzed the trends in the utilization and outcomes of LA versus OA in an LIP in Taiwan using data from the National Health Insurance (NHI) Research Database. Results Steady temporal growth trends were observed for the patients who underwent LA in both the LIP and general population (GP); however, in each study year, the proportion of LIP patients who underwent LA was lower than the proportion of GP patients who underwent the procedure. The LIP patients were more susceptible to payment policies than the GP patients; thus, more attention should be paid to vulnerable patient populations when formulating and revising NHI payment policies. Compared with OAs, LAs were associated with a slightly higher rate of routine patient discharges and a lower rate of in-hospital complications (1.48 % vs. 3.76 %, p

DOI: http://dx.doi.org/10.12957/rdc.2015.16951 Trabalho enviado em 11 de fevereiro de 2015. Aceito em 31 de marco de 2015. Resumo O presente trabalho tem como foco expor as ameacas de remocao e a luta da populacao pobre de frente as obras realizadas em funcao do megaevento Copa do Mundo FIFA 2014 na cidade de Fortaleza – CE. Para isso, f az uma recuperacao historica a partir da urbanizacao da cidade na decada de 1930 e do processo de industrializacao atrelado a politica habitacional a partir da decada de 1970, onde, neste periodo, analisa surgimento dos movimentos sociais urbanos e sua atuacao frente a luta para conquistar moradia e bens de consumo coletivo . P osteriormente, com o anuncio da Copa do Mundo FIFA 2014, expoe as acoes do Estado, a realidade das comunidades ameacadas de remocao e o surgimento e a atuacao de um novo movimento social que questiona as violacoes do direito a moradia digna em decorrencia do megaevento. Para concluir, questiona a quem de fato serve esse modelo de cidade e quem usufrui do direito a cidade. Palavras-chave: Copa do Mundo. Fortaleza. Moradia . Abstract This work focuses on exposing the threats of removal and the fight of the poor population in the face of the works carried out as a result of the 2014 FIFA World Cup mega event in the city of Fortaleza - CE. For it makes a historic recovery of the urbanization of the city in the 1930s and the industrialization process linked to housing policy from the 1970s, which, in this period, analyzes the emergence of urban social movements and their fight for housing and collective consumption goods. Later, with the announcement of the FIFA World Cup 2014 exposes the State's actions, the reality of threatened removal communities, in addition to the appearance and the performance of a new social movement that questions violations of the right to decent housing as a result of the mega event. Finally, the question for who actually serves this city model and who enjoys the right to the city. Keywords: World Cup. Fortaleza. Dwelling .

Background: In Mexico, breastfeeding rates are one of the lowest of Latin America, with 14.4% of infants under 6 months being exclusively breastfed. Our objective was to identify the main obstacles to breastfeeding in a low-income population in Tijuana, Mexico. We assess individual factors in this study, which are those associated directly to the mother, infant and the 'mother-infant dyad'. Methods: We used a socio-ecological framework to determine factors affecting breastfeeding practices. In four low-income communities in Tijuana we conducted focus groups and interviews with mothers, fathers, grandparents, and key informants. Interview notes and focus group transcripts were then studied in depth independently by three researchers. The primary analytic technique was constant comparison. Results: One hundred twenty-nine subjects participated in this study: six focus groups (n = 53) and 51 interviews among mothers, fathers, and grandparents, as well as 25 interviews among key informants. Main individual ob...

While financial management programs for the low-income population have developed in recent years, little is known about financial knowledge levels of participants in these programs. This study examines pre-training financial knowledge and related participant characteristics among participants in one large financial management training program for low-income people. Results indicate that knowledge deficiencies exist on basic financial management issues, especially with respect to public and work-related benefits and savings and investing. Results from regression analyses also indicate that participants' education, English proficiency, race/ethnicity and banking experience are among the factors associated with financial knowledge levels. Policy and practice implications for developing effective financial management training for low-income audiences are discussed.

Neste artigo, o autor apresenta dados preliminares de pesquisa etnográfica com jovens de ambos os sexos em grande bairro popular na periferia de São Gonçalo, Região Metropolitana do Rio de Janeiro. O objetivo da pesquisa é interrogar sobre a experiência da modernização em ambiente de pobreza e subcidadania e, mais especificamente, como as práticas e representações de raça e gênero são mobilizadas pelos agentes nesse contexto. O debate sobre modernização e relações raciais, assim como uma descrição sociológica sintética do bairro, ajudam a enquadrar as observações etnográficas, relacionadas principalmente aos usos do corpo, sua racialização e gendering; a experiência da subalternidade de classe; e o sentimento de excentricidade ou condição periférica. In this article the author displays some ethnographic data from a research with young people of both sexes in a big popular periphery neighborhood of São Gonçalo city, Metropolitan Area of Rio de Janeiro. The research main goal is to interrogate the modernization experience in an environment of sub-citizenship and poverty. More specifically the question is how the agents mobilize race/gender practices and representations in that context. The discussion about modernization and race relations as well a brief sociological description of the neighborhood help to better understand the ethnographic observations which are related with the body uses, its racialization and gendering; the class subalternity experience; and the feeling of eccentricity or peripheral condition.

The relationships between blood lead (PbB) and saliva lead (PbSa) concentrations and the determinants of PbB and PbSa status in 970 low-income adults in the city of Detroit, Michigan were explored. Average PbB and PbSa values in the sample population were found to be 2.7+/-0.1 microg/dl and 2.4+/-0.13 microg/l (equivalent to 0.24+/-0.13 microg/dl), respectively, and a weak but statistically significant association was found between the lead levels in the two types of body fluid samples. The average PbB level for men (4.0+/-0.56 microg/dl) was higher than that for women (2.7+/-0.11 microg/dl); other significant predictors of PbB included age, level of education, being employed, income level, the presence of peeling paint on the wall at home and smoking. There was no gender- or age-dependent difference in blood saliva values but statistically significant correlations were found between PbSa and level of education, employment, income level and smoking. Dental caries was severe in this population. Only 0.5% of the participants had no clinical signs of caries, over 80% had cavitated carious lesions (i.e., lesions that had progressed into dentin), and the number of lost teeth and carious lesions averaged 3.4 and 30, respectively. Weak but significant associations were found between PbB as well as PbSa and measures of dental caries in the study population. The positive associations are believed to be a reflection of the fact that the risk factors for dental caries, especially in low-income populations of the US, overlap extensively with those of lead poisoning and may not have a causal significance.

Objectives: The utility of the SF-8 for assessing health-related quality of life (HRQL) is demonstrated. Race and gender differences in physical component (PCS) and mental component (MCS) summary scores among participants in the CENLA Medication Access Program (CMAP), along with comparisons to the United States population are made. Methods: Age-adjusted multiple linear regression analyses were used to compare 1687 CMAP participants to the US population. Internal race and gender comparisons, adjusting for age and the number of self reported diagnoses, were also obtained. The paired t-test was used to assess 6-month change in PCS and MCS scores for a subset of 342 participants. Results: CMAP participants have PCS and MCS scores that are significantly 10–12 points lower than the US population, indicating lower self-reported HRQL. Females have significantly higher PCS and significantly lower MCS than males. African–Americans have significantly higher MCS than Caucasians. Significant increases in both PCS and MCS were observed for the subset of participants after 6 months of intervention. Conclusions: The expected lower baseline PCS and MCS measures and the expected associations with age and number of diagnoses indicate that the SF-8 survey is an effective tool for measuring the HRQL of participants in this program. Preliminary results indicate significant increases in both PCS and MCS 6 months after intervention.

(2003). False-Belief Understanding in a Low-Income Population. Early Education and Development: Vol. 14, No. 4, pp. 425-440.

Foram analisadas, quanto à exposição a fatores de risco para o baixo peso ao nascer, 77 gestantes no último trimestre da gestação, residentes em favelas da região de Vila Mariana, município de São Paulo, acompanhadas pelo Projeto Favela, desenvolvido pela Universidade Federal de São Paulo/Escola Paulista de Medicina. As variáveis maternas de maior impacto sobre o peso ao nascer foram paridade e estatura. Primíparas geraram crianças com diferença média de peso ao nascer de -264g em relação aos recém-nascidos das multíparas. Mulheres com estaturas abaixo de 150cm tiveram crianças com diferença média de peso ao nascer de -287g em comparação com os neonatos de mães com estaturas maiores. Apenas 2,6% das crianças nasceram com baixo peso, apesar da alta exposição da população estudada aos fatores de risco.

O Projeto Favela, da Escola Paulista de Medicina, Universidade Federal de São Paulo, realiza diversas atividades de educação e promoção das ações básicas de saúde em comunidades carentes do Município de São Paulo, visando principalmente a prevenção e controle de carências nutricionais. O objetivo do estudo foi comparar a situação nutricional de crianças com idades entre 12 e 26 meses, antes e após a implantação de um conjunto de ações preventivas. Formaram-se dois grupos, pré e pós implantação, com 57 e 65 crianças respectivamente, que foram submetidas à avaliação antropométrica e dosagem de hemoglobina. O grupo exposto a todas as ações não apresentou nenhum caso de desnutrição (0%) para os indicadores P/I e P/E, comparado a 12,3% e 1,8%, respectivamente, no grupo pré implantação. Houve redução da prevalência de anemia, sobretudo a de maior gravidade, que passou de 33% para 7%, com aumento do valor médio da hemoglobina (de 10,1 g/dl para 11,0 g/dl) além de maior porcentual de crianças com aleitamento materno total acima de 180 dias no grupo pós-implantação. The so-called "Slum Project" or Projeto Favela at the São Paulo School of Medicine, Federal University in São Paulo, conducts numerous primary health care activities in low-income communities in the city of São Paulo to prevent and control nutritional deficiencies. The aim of this study was to compare the nutritional status of children from 12 to 26 months of age before and after preventive intervention. The study was conducted with two groups, before and after intervention, with 57 and 65 children, respectively. Anthropometric measures and hemoglobin values were obtained. In the before-intervention group, the prevalence of malnutrition as measured by weight for age and weight for height was 12.3% and 1.8% respectively, whereas there were no cases of malnutrition in the after-intervention group. There was a reduction in the prevalence of anemia, especially the severe form, from 33% to 7%. Mean hemoglobin increased from 10.1 to 11.0 g/dl, and the duration of breastfeeding was greater (> 180 days) after intervention.

Este estudo trata da importância das práticas e estratégias da população de baixa renda no enfrentamento dos problemas cotidianos. Visa ao direcionamento de ações em saúde coletiva. Desvendar as formas de enfrentamento desses grupos populacionais tem a ver com o processo saúde-doença, e neste estudo específico, com a alimentação. O estudo indica uma opção metodológica interdisciplinar e conceitual, relacionando conceitos de práticas, estratégias, situações de vida e saúde. Parte-se do princípio de que a compreensão das formas de enfrentamento da realidade pela população de baixa renda abrange a utilização de estratégias num processo de (re)apropriação e (re)construção de saberes e de que a identificação das redes sociais facilitam o reconhecimento dessas práticas e o direcionamento das ações em saúde coletiva.

Spreads are high-viscosity fat products prepared by mixing dried powdered ingredients with a vegetable fat chosen for its viscosity. Spreads are not traditionally used for feeding infants or young children and were initially proposed for feeding severely malnourished children during the recovery phase. The advantages of these products include a high energy and nutrient density, a very good acceptability, and resistance to bacterial contamination. Adapted spreads could be designed to boost the nutritional density of diets of young children from poor communities. Spreads could be mixed with the meals or porridges traditionally given to infants or eaten by themselves as snacks. Formulation of spread products is flexible, and acceptability and efficacy trials are required to optimize their composition and fortification levels and to select the best-adapted ingredients for each setting.

To describe the impact of epilepsy surgery on quality of life through the application of the quality of life in epilepsy (QOLIE-10) scale in a low income population.We conducted an observational, descriptive, and cross-sectional study. The data for all patients who underwent epilepsy surgery from the aforementioned period were registered retrospectively through a review of their clinical history. Clinical variables of interest for this study were obtained through phone contact, and the QOLIE-10 scale was applied.This study included a total of 89 patients with whom phone contact was established and who met the inclusion criteria. Of these patients, 30.3% were without anti-seizure medication at the time of the survey's application, and only 19.1% were still under polytherapy. A total of 47.1% of the patients had returned to some work activity that they would have not been able to perform before because of their disease. All of the components of the QOLIE-10 scale improved significantly (p0.05) after the surgical procedure, except the variable of "fear of the sudden occurrence of seizures". The variables with greatest impact after the surgical procedure were depression, work activity, and quality of life in general.Epilepsy surgery has a positive impact on the quality of life of patients with low resources and in vulnerable social conditions. It is still to be determined if, in this population, work and social reintegration have a greater impact on the quality of life than other clinical and/or paraclinical variables.