Nutritional status and age at menarche in amazonian students

OBJECTIVES

Age at menarche (MA) is a proxy for biological maturation and a parameter of socioeconomic changes. Worldwide, anticipation of menarche is associated with nutritional transition and excess weight. The objective of this study was to evaluate the MA in Amazonian students and its association with nutritional status, ethnicity, and socioeconomic level.

METHODS

Cross-sectional study with 1,017 students aged 6 to 17 living in the city of Manaus, Brazil. MA was analyzed by status quo and recall; its association with body mass index (BMI), race, socioeconomic status, and adult height was examined.

RESULTS

559 (51.9%) participants had already experienced menarche. In 91.7%, menarche occurred between 10 and 14 years of age; the mean age at the onset of menarche was 11.9 years. Overweight (11.6 years) and obese (11.4 years) participants reached menarche earlier than those with normal weight (12 years) and lean (12.7 years) participants. The associations between MA and nutritional status showed that overweight and obesity are risk factors for the early occurrence of menarche. MA was not associated with socioeconomic status/parental education or race. However, excess weight was associated with earlier MA in all races and social classes. The adult height was slightly lower in girls with menarche before 12 years old (157.9 vs 159.4 cm).

CONCLUSION

Regardless of socioeconomic level or ethnicity, excess weight was associated with earlier menarche in Amazonian students.

Is there a relationship between socioeconomic level, vegetation cover, free-roaming cats and dogs, and the diversity of native birds? A study in a Latin American capital city

Understanding how social and environmental factors influence biodiversity can contribute to sustainable development and promote environmental justice in cities. This knowledge is especially important in developing countries with strong social and environmental inequalities. This study investigates native bird diversity in relation to the socioeconomic level of neighborhoods, their plant cover, and the abundance of free-roaming cats and dogs in a Latin American city. Two causal hypotheses were tested: 1) socioeconomic level (defined by education and income) influence native bird diversity indirectly, as an effect mediated by plant cover, as well as directly; 2) in addition socioeconomic conditions also influence free-roaming cats and dogs which could affect native bird diversity. To test these hypotheses, data were collected at 120 sites located in neighborhoods of different socioeconomic levels across the city of Santiago de Chile and fit to Structural Equation Models. Evidence supported the second hypothesis: in wealthier neighborhoods there was greater plant cover that, in turn, positively influenced native bird diversity; in addition, fewer free-roaming cats and dogs were found in these neighborhoods but they had no effect on native bird diversity. Results suggest that increasing plant cover, especially in more socioeconomically vulnerable neighborhoods, would contribute to urban environmental justice and more equitable opportunities to access native bird diversity.

Intelligent tutoring systems for word problem solving in COVID-19 days: could they have been (part of) the solution?

The COVID-19 pandemic led to the lockdown of schools in many countries, forcing teachers and students to carry out educational activities remotely. In the case of mathematics, developing remote instruction based on both synchronous and asynchronous technological solutions has proven to be an extremely complex challenge. Specifically, this was the case in topics such as word problem solving, as this domain requires intensive supervision and feedback from the teacher. In this piece of research, we present an evaluation of how technology is employed in the teaching of mathematics, with particular relevance to learning during the pandemic. For that purpose, we conducted a systematic review, revealing the almost complete absence of experiments in which the use of technology is not mediated by the teacher. These results reflect a pessimistic vision within the field of mathematics education about the possibilities of learning when the student uses technology autonomously. Bringing good outcomes out of a bad situation, the pandemic crisis may represent a turning point from which to start directing the research gaze towards technological environments such as those mediated by artificial intelligence. As an example, we provide a study illustrating to what extent intelligent tutoring systems can be cost-effective compared to one-to-one human tutoring and mathematic learning-oriented solutions for intensive supervision in the teaching of word problem solving, especially appropriate for remote settings. Despite the potential of these technologies, the experience also showed that student socioeconomic level was a determining factor in the participation rate with an intelligent tutoring system, regardless of whether or not the administration guaranteed students' access to technological resources during the COVID-19 situation.

[Epidemiologic and clinical profile, 90 days survival of incident end stage renal patient in haemodialysis during SARS-CoV2 pandemic: Experience of the General Hospital of Douala]

BACKGROUND

The effect of COVID-19 pandemic on end stage renal disease patient who should initiated dialysis are limited in Sub-Saharan Africa is unknown. We sought to describe the epidemiologic and clinical profile of newly admitted patient in chronic haemodialysis during the COVID-19 pandemic in Cameroon and evaluate their survival between 90days of dialysis initiation.

MATERIAL AND METHOD

We conducted a cohort study of 6months from April to October 2020. End stage renal disease patients newly admitted in the haemodialysis facility of the General Hospital of Douala were included. Patients with confirmed or suspected COVID-19 were identified. Socio-demographic, clinical and biological data at dialysis initiation as well as mortality between the 90days of dialysis initiation were registered.

RESULTS

A total of 57 incident patients were recorded from April to October 2020 with a monthly mean of 9.5 patients. The mean age was 46.95±13.12years. Twenty-four COVID-19 were identified with a frequency of 49% among emergency admission. Pulmonary œdema (79.2% vs. 42.4%; P=0.006) and uremic encephalopathy (83.4% vs. 53.6%; P=0.022) were more common in COVID-19. The overall survival at 90days was 48% with a tendency to poor survival among COVID-19 and patients with low socioeconomic level. In Cox regression, low socioeconomic level increase the risk of instant death by 3.08.

CONCLUSION

SARS-CoV2 seem to increase nephrology emergency and poor survival in haemodialysis at 90days.

Dietary and sociodemographic factors associated with nonalcoholic fatty liver in obese pediatric patients

INTRODUCTION

Obesity is associated with nonalcoholic fatty liver disease (NAFLD) in children. Our aim was to analyze the association of dietary and sociodemographic factors with NAFLD in obese children and adolescents.

MATERIALS AND METHODS

Thirty-three obese patients from 6-16 years of age were included in the present analytic cross-sectional study. Obesity was diagnosed with a body mass index z-score > 2 SD. NAFLD was estimated by liver ultrasound, serum amino transferases, and elastography. The sociodemographic variables were evaluated using validated questionnaires. Diet was estimated through two 24-h recall dietary surveys focused on the quantity of food energy, simple sugars, polyunsaturated fatty acids (PUFAs), and antioxidants.

RESULTS

Hepatic steatosis was identified by abdominal ultrasound in 13 patients (39.4%) and the serum alanine aminotransferase level was above the upper reference value in 54.2%. A higher educational level in both parents, greater monthly food expenditure, and a higher socioeconomic level were associated with NAFLD. Overall, simple sugar and saturated fat consumption was above the recommended daily intake, whereas vitamin E and PUFA consumption was below those parameters.

CONCLUSIONS

NAFLD was identified in one-third of the cases. There was an association between NAFLD and sociodemographic variables. Both groups had an increased intake of simple sugars and a reduced intake of PUFAs. The selective occurrence of NAFLD could be related to a genetic predisposition that has been demonstrated in a Mexican population.

Impact of socioeconomic status on the clinical profile of patients with non-traumatic lower-limb amputation

INTRODUCTION

To analyse the influence of socioeconomic status on the clinical profile of patients undergoing non-traumatic lower-limb amputation.

METHODS

Retrospective study of 697 lower-limb amputee patients in an Angiology and Vascular Surgery Department during a 5-year period. Patients were classified according to their socioeconomic status (low, medium and high). We analysed demographic (age and gender) and clinical variables (cause of amputation, comorbidity, cardiovascular risk factors and amputation level).

RESULTS

Mean age was 70.5 ± 11.9 years, and the median was 72 years. The low socioeconomic status group presented a higher frequency of amputations in men. Cardiovascular risks factors were more frequent in this socioeconomic group, and the difference was statistically significant for diabetes (85.8% low, 69.3% medium, 65% high; P<.01) and obesity (31.4% low, 22.6% medium, 12.5% high, P<.01). Diabetic retinopathy was the only comorbidity with a significant association with low socioeconomic status (21.1% low, 15.3% medium, 12.5% high, P<.03). Regarding the cause for amputation, there was no difference in terms of socioeconomic status. The low socioeconomic level showed a higher frequency of major amputation, which was a significant difference (63.6% low, 41.2% medium, 55% high, P<.04) and a higher predisposition for this amputation level.

CONCLUSIONS

The low socioeconomic status has been shown to determine an unfavourable vascular risk profile in lower-limb non-traumatic amputees and a higher predisposition of a major amputation. This socioeconomic level demonstrates a negative influence on these patients' diabetes, obesity and diabetic retinopathy.

Socioeconomic inequalities and type 2 diabetes complications: A systematic review

BACKGROUND AND OBJECTIVES

A socioeconomic gradient related to type 2 diabetes (T2D) prevalence has been demonstrated in high-income countries. However, there is no evidence of such a socioeconomic gradient regarding diabetes complications. Thus, the aim of this systematic review was to collect data on risk of complications according to socioeconomic status in patients with T2D.

METHODS

PubMed and EMBASE were searched for English-language observational studies evaluating the prevalence or incidence of micro- and macrovascular complications according to individual and geographical socioeconomic status (SES). Observational studies reporting the prevalence and risk of micro- and macrovascular diabetes complications, according to an individual or geographical index of deprivation, were selected, and estimated crude and adjusted risks for each complication were reported.

RESULTS

Among the 28 included studies, most described a clear relationship between SES and diabetes complications, especially retinopathy (in 9 of 14 studies) and cardiopathy (in 8 of 9 studies). Both individual and area-based low SES was associated with an increased risk of complications. However, very few studies adjusted their analyses according to HbA_1c level.

CONCLUSION

Evaluation of SES is necessary for every T2D patient, as it appears to be a risk factor for diabetes complications. However, the available studies are insufficient for gradation of the impact of low socioeconomic level on each of these complications. Regardless, strategies for the improved screening, follow-up and care of high-risk patients should now be implemented.

Tuberculosis incidence inequalities and its social determinants in Manaus from 2007 to 2016

Background

Brazil is among the 30 countries with high-burden of tuberculosis worldwide, and Manaus is the capital with the highest tuberculosis incidence. The accelerated economic and population growth in Manaus in the last 30 years has strengthened the process of social stratification that may result in population groups that are less favored in terms of healthcare and are vulnerable to infection and illness due to tuberculosis. This study aimed to characterize inequalities associated with tuberculosis incidence in relation to the socioeconomic and demographic characteristics of the resident population of Manaus and to identify their determinants from 2007 to 2016.

Methods

An ecological study was conducted using the data from the Diseases Notification Information System. Tuberculosis incidence rates by population characteristics (gender, ethnicity, and socioeconomic level) were calculated for each year, studied, and represented in equiplot charts. To measure the disparity of tuberculosis incidence in the resident population in Manaus, the Gini index of tuberculosis in each neighborhood was calculated based on the incidence rates of the census sectors. A thematic map was constructed to represent the spatial distribution of tuberculosis incidence inequality. Linear regression models were used to identify the relationship between the tuberculosis incidence inequality and its social determinants.

Results

From 2007 to 2016, there was an increase in the tuberculosis incidence in Manaus, together with an increase in incident inequality among genders, ethnic groups, and socioeconomic level. The incidence of tuberculosis inequality was associated with the inequalities of its possible determinants (Gini of the proportion of male population, Gini of the proportion of indigenous population, Gini of the proportion of illiteracy, Gini of income, Gini of the proportion of households connected to the water network, and Gini of the mean number of bathrooms per inhabitant), the per capita income, and the proportion of cases with laboratory confirmation.

Conclusions

Disparities in tuberculosis incidence in the resident population in neighborhoods can be explained by the sociodemographic and economic heterogeneity. Our findings recommend that public policies and tuberculosis control strategies consider differences in the determinants of tuberculosis inequality for the development of specific actions for each population group.

Social inequalities in oral health in a group of older people in a Middle Eastern country: a cross-sectional survey

BACKGROUND AND OBJECTIVE

The percentage of Lebanese older people has increased considerably. Given that Lebanese seniors are marginalized in the health policy-making process, we suggest a high social inequality in oral health that has not been studied so far. The purpose of our study was to describe and compare oral health status in a group of Lebanese older people according to their socioeconomic status (SES) MATERIALS AND METHODS: Participants were recruited from three different primary health care clinics in Beirut, Lebanon. Data were collected from an administered questionnaire that included sociodemographic variables, perception of oral health, and regular dental visits. Oral examination included the number of missing and decayed teeth, the prosthetic status, and the number of functional dental units (FUs). The SES of the participants was determined by educational level, previous or actual work, and neighborhood level.

RESULTS

264 participants aged 71.4 ± 6.27 years (64.7% female) were included in the study. Regular dental visit, dental status, FU, and oral health perception were significantly related to the participants' place of residence, educational level, and work. Moreover, the mean number of missing teeth (p = 0.048) and decayed teeth (p = 0.018) was significantly elevated in the low SES.

CONCLUSION

There is a clear socioeconomic inequality in oral health among the Lebanese older people. Further researches should explore the potential contribution of psychosocial and behavioral factors in explaining these disparities.

Assessing the determinants of healthcare expenditures in single-person households

BACKGROUND

The study documents a direct relationship between individuals' health and patterns of healthcare expenditure by isolating single-person households and creating a new reference group in which household healthcare expenditure is based on one person's expenditure patterns in accordance with his or her own state of health.

METHOD

The study matched two surveys using Propensity Score Matching based on single-person household, age, and gender. Structural Equation Modeling (SEM) explores paths of relation between the population's income and socioeconomic level and its health self-assessment and expenditure.

RESULTS

Single-person households' health expenditure increases with age and the differences in most expenditure categories are significant. The current study looks into the direct and indirect effects of income, gender, and SES on health insurance and other out-of-pocket health expenses among single-person households. A direct link exists between income, gender, and socioeconomic status (SES) and several aspects of health expenditure, depending on the specific age group. The indirect effects are attested via health status assessment, in which a negative correlation is found between self-assessed health status and various health-expenditure categories.

CONCLUSIONS

The last-mentioned result may support the general perception that single-person households who feel that they are doing better than their near-equals enjoy better health. This line of inquiry yields a better examination of how a single-person household's state of health affects expenditure patterns without assuming ab initio that expenditure patterns attest to state of health.

Prevalence and comorbidity of osteoporosis- a cross-sectional analysis on 10,660 adults aged 50 years and older in Germany

Background

Knowledge on prevalence of osteoporosis stratifying for socioeconomic background is insufficient in Germany. Little is known in Europe about other diseases that go along with it although these aspects are important for implementing effective public health strategies.

Methods

This cross-sectional analysis was based on the national telephone survey “German Health Update” (GEDA 2012) performed in 2012/2013. GEDA 2012 provides information on self-reported diseases and sociodemographic characteristics for nearly 20,000 adults. Descriptive statistical analysis and multiple logistic regression were used to examine the association between osteoporosis and age, sex, other diseases and education defined by ISCED. Analyses were limited to participants aged 50 years and older.

Results

Overall, 8.7% of the 10,660 participants aged 50+ years had osteoporosis (men 4.7%, women 12.2%). More than 95% of the adults with osteoporosis had at least one coexisting disease. The odds for arthrosis (OR 3.3, 95% CI 2.6-4.1), arthritis (OR 3.0, 95% CI 2.2-4.2), chronic low back pain (OR 2.8, 95% CI 2.3-3.5), depression (OR 2.3, 95% CI 1.7-3.1) and chronic heart failure (OR 2.3, 95% CI 1.6-3.1), respectively, were greater for adults with osteoporosis. Education showed no significant association with osteoporosis.

Conclusions

There was no clear evidence of socioeconomic differences regarding osteoporosis for adults in Germany. However, clinicians need to be aware that multimorbidity is very common in adults with osteoporosis. Health care interventions for osteoporosis could be improved by offering preventive care for other diseases that go along with it. Over- or under-diagnosis in different socioeconomic levels has to be further explored.

Contextual determinants of participation in cervical cancer screening in France, 2010

BACKGROUND

Some contextual factors associated with participation in cervical cancer screening are reported in the literature, but few studies have examined their combined effect. Our objective was to assess the role of contextual characteristics, separately and in combination, in participation in cervical cancer screening in France.

METHODS

Marginal Poisson regression models - taking into account the correlation between women in a given commune - were conducted using data from the Baromètre Santé 2010 survey. The characteristics of the commune of residence of the women studied were the potential spatial accessibility to general practitioners (GP) and gynecologists, the agglomeration category, and the socioeconomic level.

RESULTS

The analyses were performed in 3380 women, 88.2% of whom were up to date with their cervical cancer screening. Once the individual characteristics were taken into account, the screening participation rate was similar in all the communes, with the exception of those with poor access to a gynecologist and good access to a GP, where the rate was 6% lower (95%CI: 0.5-11%) than in the communes with good access to both GP and gynecologist. The same association with accessibility was observed in small agglomerations. Compared to women living in the more advantaged communes, the screening participation rate was 8% (2-12%) lower in those living in the more disadvantaged ones, except when accessibility to both types of physician was high.

DISCUSSION

We observed an association between potential spatial accessibility to care in women's residential communities and their cervical cancer screening practices, in particular in small agglomerations, rural communes, and more disadvantaged communes.

Risk factors for recurrent wheezing in the first year of life in the city of Córdoba, Argentina

BACKGROUND

Wheezing is a very common respiratory symptom in infants. The prevalence of wheezing in infants, conducted in developed countries shows prevalence rates ranging between 20% and 30%. However, we do not know the risk factors in our population of wheezing infants.

METHODS

A standardised written questionnaire (WQ-P1-EISL) in infants between 12 and 18 months of age residing in the city of Cordoba was used; population/sample included 1031 infants. Recurrent wheezing (RW) was defined as three or more episodes of wheezing reported by the parents during the first 12 months of life. Data obtained were coded in Epi-Info™ (version 7) and statistically analysed with SPSS (version 17.5) software in Spanish. Parametric tests (one-way ANOVA) were performed for identifying significantly associated variables.

RESULTS

The prevalence of wheezing infants was 39.7%; recurrent wheezing 33%; and severe wheezing 14.7%; 13.7% had pneumonia before the first year and of these 6.3% were hospitalised, multiple variables as risk factors for wheezing were found such as: >6 high airway infections and bronchiolitis in the first three months of life, smokers who smoke in the home among other risk factors and protective factors in those who have an elevated socioeconomic status.

CONCLUSION

It is known that persistent respiratory problems in children due to low socioeconomic status is a risk factor for wheezing, pneumonia and could be a determining factor in the prevalence and severity of RW in infants. Research suggests that there are areas for improvement in the implementation of new educational strategies.

[Breast cancer screening in thirteen French departments]

BACKGROUND

In France, breast cancer screening programme, free of charge for women aged 50-74 years old, coexists with an opportunistic screening and leads to reduction in attendance in the programme. Here, we reported participation in organized and/or opportunistic screening in thirteen French departments.

POPULATION AND METHODS

We analyzed screening data (organized and/or opportunistic) of 622,382 women aged 51-74 years old invited to perform an organized mammography screening session from 2010 to 2011 in the thirteen French departments. The type of mammography screening performed has been reported according to women age, their health insurance scheme, the rurality and the socioeconomic level of their area or residence. We also represented the tertiles of deprivation and participation in mammography screening for each department.

RESULTS

A total of 390,831 (62.8%) women performed a mammography screening (organized and/or opportunistic) after the invitation. These women were mainly aged from 55-69 years old, insured by the general insurance scheme and lived in urban, semi-urban or affluent areas.

CONCLUSION

The participation in mammography screening (organized and opportunistic) in France remains below the target rate of 70% expected by health authorities to reduce breast cancer mortality through screening.

Preterm children have unfavorable motor, cognitive, and functional performance when compared to term children of preschool age

OBJECTIVE

to compare the motor coordination, cognitive, and functional development of preterm and term children at the age of 4 years.

METHODS

this was a cross-sectional study of 124 four-year-old children, distributed in two different groups, according to gestational age and birth weight, paired by gender, age, and socioeconomic level. All children were evaluated by the Movement Assessment Battery for Children - second edition (MABC-2), the Pediatric Evaluation of Disability Inventory (PEDI), and the Columbia Mental Maturity Scale (CMMS).

RESULTS

preterm children had worse performance in all tests, and 29.1% of the preterm and 6.5% of term groups had scores on the MABC-2 indicative of motor coordination disorder (p=0.002). In the CMMS (p=0.034), the median of the standardized score for the preterm group was 99.0 (± 13.75) and 103.0 (± 12.25) for the term group; on the PEDI, preterm children showed more limited skill repertoire (p=0.001) and required more assistance from the caregiver (p=0.010) than term children.

CONCLUSION

this study reinforced the evidence that preterm children from different socioeconomic backgrounds are more likely to have motor, cognitive, and functional development impairment, detectable before school age, than their term peers.