Evaluation of the Olo Prenatal Nutrition Follow-up Care for Vulnerable Pregnant Women.

Olo nutritional follow-up care offers vulnerable pregnant women food vouchers, multivitamin supplements, tools, and nutritional counselling to support healthy pregnancy outcomes.Purpose: To evaluate the contribution of Olo follow-up care to nutritional intakes and eating practices, as well as to assess the programme-related experience of participants.Methods: Participants (n = 30) responded to questionnaires and web-based 24-hour dietary recalls and participated in a semi-structured interview (n = 10).Results: Olo follow-up care reduced the proportion of participants below the recommended intake for groups for many micronutrients, with the greatest reduction for folate (by 96.7%), vitamin D (by 93.3%), iron (by 70.0%), calcium (by 50.0%), and zinc (by 30.0%), mainly due to the prenatal multivitamin supplements. Most participants (96.7%) did not follow Olo's typical recommendations but, if they had, hypothetically they would have consumed an average of 746 additional calories per day and be above the recommendations for excessive intakes of folic acid and iron (100% and 33.3%, respectively). More than half of the participants were moderately to severely food insecure. Olo contributed to reducing the impact of isolation and increased food accessibility and budget flexibility among participants.Conclusion: Olo follow-up care helped reduce the proportion of women below the recommended intake for micronutrients, but revising the food offered and strategies to address food insecurity may be necessary.

Mental health and sleep quality of low-income mothers of one-year-olds during the COVID-19 pandemic.

The COVID-19 pandemic and subsequent social restrictions created an unprecedented context for families raising young children. Although studies have documented detrimental effects of the pandemic on maternal well-being, less is known about how the pandemic specifically impacted low-income mothers. We examined depression, anxiety, and sleep quality among low-income mothers of one-year-olds during the early months of the pandemic using data from the Baby's First Years study. Focusing on the control group (n = 547), we compared mothers interviewed before March 14th, 2020 (n = 342) to mothers interviewed between March 14th and June 30th, 2020 (n = 205) to determine whether the pandemic was associated with differences in mental health and sleep quality. Mothers were recruited from four cities in the United States, and most of the sample identified as Hispanic (42.2%) or Black, non-Hispanic (38.6%). We found that mothers interviewed during the pandemic reported better mental health and sleep quality. While we cannot speak to longer-term impacts of the pandemic, it is possible low-income mothers experienced relief from daily stressors during the initial shelter-in-place orders, which may have led to improvements in well-being. These results have implications for understanding how complex life stressors influence mental health and sleep quality among low-income mothers raising young children.

La pandemia del COVID-19 y las subsecuentes restricciones sociales crearon un contexto sin precedentes para las familias que estaban criando niños pequeños. Aunque los estudios han documentado los efectos perjudiciales de la pandemia sobre el bienestar materno, menos se conoce acerca de cómo la pandemia específicamente tuvo un impacto sobre madres de bajos recursos económicos. Examinamos la depresión, ansiedad y calidad del sueño entre madres de bajos recursos económicos de niños de un año de edad durante los primeros meses de la pandemia usando datos del estudio Primeros Años del Bebé. Enfocándonos en el grupo de control (n = 547), comparamos las madres entrevistadas antes del 14 de marzo de 2020 (n = 342) con madres entrevistadas entre el 14 de marzo y el 30 de junio de 2020 (n = 205) para determinar si la pandemia se asociaba con diferencias en salud mental y calidad del sueño. A las madres se les reclutó en cuatro ciudades de Estados Unidos y la mayor parte del grupo muestra se identificaron como Hispanas (42.2%) o Negras no Hispanas (38.6%). Encontramos que las madres entrevistadas durante la pandemia reportaron mejor salud mental y calidad del sueño. A pesar de que no podemos hablar sobre el impacto a largo plazo de la pandemia, es posible que las madres de bajos recursos económicos experimentaran alivio en los factores diarios de estrés durante el inicial mandato de quedarse en su casa, lo cual pudiera haber llevado a mejoras en el bienestar. Estos resultados tienen implicaciones para comprender cómo los complejos factores de estrés influyen en la salud mental y la calidad del sueño entre madres de bajos recursos económicos que crían a niños pequeños.

La pandémie du COVID-19 et les restrictions sociales qui en ont découlé ont créé un contexte sans précédent pour les familles élevant de jeunes enfants. Bien que des études aient documenté des effets préjudiciables de la pandémie sur le bien-être maternel, on en sait moins sur la manière dont la pandémie a spécifiquement impacté les mères de milieux défavorisés. Nous avons examiné la dépression, l'anxiété, et la qualité du sommeil chez des mères de milieux défavorisés avec un enfant d'un an durant les premiers mois de la pandémie, en utilisant des données de l'étude Baby's First Years. Nous concentrant sur le groupe de contrôle (n = 547), nous avons comparé des mères interviewées avant le 14 mars 2020 (n = 342) à des mères interviewées entre le 14 mars et le 30 juin 2020 (n = 205) afin de déterminer si la pandémie était liée à des différences en santé mentale et en qualité de sommeil. Les mères ont été recrutées dans quatre villes des Etats-Unis et la plupart de l'échantillon s'identifiait comme Hispanique (42,2%) ou Noires, non hispaniques (38,6%). Nous avons trouvé que les mères interviewées Durant la pandémie faisaient état d'une meilleure santé mentale et d'une meilleure qualité de sommeil. Bien que nous ne puissions pas parler des impacts de la pandémie à long terme, il est possible que les mères de milieux défavorisés aient fait l'expérience d'un soulagement des facteurs de stress quotidiens durant la période initiale de confinement, ce qui pourrait avoir mené à des améliorations dans le bien-être. Ces résultats ont des implications pour la compréhension de la manière dont des facteurs de stress complexes influencent la santé mentale et la qualité du sommeil chez les mères de milieux défavorisés élevant de jeunes enfants.

[A hospital foundation for research on precariousness and social exclusion]. / Une fondation hospitalière pour la recherche sur la précarité et l'exclusion sociale.

The hospital in Nanterre (92) offers a wide range of services for the reception, orientation and medical care of people in precarious situations on a daily basis, both in the social medicine department and in other departments. The medical teams wanted to create a structure that could document and analyze the life trajectories and experiences of people in precarious situations, but above all innovate, propose adapted systems and evaluate them, in order to develop knowledge and practices. The hospital foundation for research on precariousness and social exclusion was thus created at the end of 2019 [1], with the structuring support of the Île-de-France regional health agency.

Enhancing maternal sensitivity in contexts of urban extreme poverty in Sierra Leone: A pilot study.

This pilot study presents preliminary data on the efficacy of Strong Bonds, Strong Pikin (SBSP), a brief intervention program that aims to enhance sensitivity among mothers who care for their preschool children in a slum settlement in Freetown (Sierra Leone). SBSP adapts principles of attachment theory to intervention within a non-Western cultural setting, where families suffer from extreme poverty. A combination of psychoeducation, group work, video-feedback, and storytelling defines the methodology of the program. Maternal sensitivity, parenting stress, and the use of violent discipline practices were measured before (pretest) and after the intervention (posttest) in a sample of 43 mothers who participated in the program. Analyses showed a significant increase in observed maternal sensitivity, as well as a decrease in mother-reported parenting stress, child problems, and use of violent discipline practices from pretest to posttest. These results are discussed in terms of the potential value of culturally sensitive, attachment-centered interventions with caregivers who raise their children in non-Western settings affected by economic vulnerability.

Este estudio experimental presenta información preliminar acerca de la efectividad de "Fuertes Lazos, Fuertes Niños" (Strong Bonds, Strong Pikin - SBSP) un programa de intervención breve para mejorar la sensibilidad entre madres que cuidad a sus niños de edad prescolar en un asentamiento de barrios bajos en Freetown (Sierra Leona). El programa SBSP adapta principios de la teoría de la afectividad para la intervención dentro de un escenario cultural no occidental, donde las familias sufren extrema pobreza. Una combinación de educación sicológica, trabajo de grupo, información acerca de videos, así como el recuento de historias definen la metodología del programa. La sensibilidad materna, el estrés de crianza y el uso de severas prácticas de disciplinas del tipo "disciplinaviolenta" se midieron antes (pre-examen) y después de la intervención (posterior al examen) en un grupo muestra de 43 madres que participaron en el programa. Los análisis mostraron un aumento significativo en la observada sensibilidad materna, así como una reducción en el estrés de crianza reportado por la madre, problemas del niño y el uso de severas prácticas de disciplinas del tipo "disciplinaviolenta" desde el pre-examen hasta después del examen. Estos resultados se discuten en términos del valor potencial de las culturalmente sensibles intervenciones centradas en la afectividad con cuidadores que crían a sus niños en asentamientos no occidentales afectados por la vulnerabilidad económica.

Cette étude pilote présente des données préliminaires sur l'efficacité de « Strong Bonds, Strong Pikin ¼ (SBSP), un programme d'intervention brève qui a pour but d'améliorer la sensibilité chez les mères qui prennent soin de leur enfant d'âge préscolaire dans un bidonville de Freetown en Sierra Leone. Le SBSP adapte les principes de la théorie de l'attachement à une intervention dans un contexte non-occidentale, où les familles souffrent d'une pauvreté extrême. Une combinaison de psychoéducation, de travail de groupe, de commentaires vidéo, et de d'art de conter définit la méthodologie de ce programme. La sensibilité maternelle, le stress de parentage et l'utilisation de pratiques disciplinaires dures et violentes sont mesurés avant (prétest) et après l'intervention (post-test) chez un échantillon de 43 mères qui ont participé au programme. Les analyses ont montré une augmentation importante dans la sensibilité maternelle observée ainsi une baisse dans le stress de parentage rapporté par les mères, une baisse des problèmes avec l'enfant et une baisse dans l'utilisation de pratiques disciplinaires dures et violentes du prétest au post test. Ces résultats sont discutés en termes de valeur potentielle d'interventions sensibles culturellement adaptées et centrées sur l'attachement avec des personnes qui élèvent leurs enfants dans des contextes non-occidentaux et affectées par une vulnérabilité économique.

Socioeconomic associations of poorly controlled epilepsy in the Republic of Guinea: cross-sectional study.

OBJECTIVE: To explore the socioeconomic factors associated with epilepsy in the Republic of Guinea. METHODS: People living with epilepsy (PLWE) were prospectively recruited at Ignace Deen Hospital, Conakry, in 2018. An instrument exploring household assets as a measure of wealth was designed and administered. Multivariate logistic regression models with fixed effects were fitted to assess the associations of sociodemographic and microeconomic factors with self-reported frequency of seizures in the prior month and regular intake of antiseizure medications (ASMs). Participants were stratified by age group: children (<13 years), adolescents (13-21) and adults (>21). RESULTS: A total of 285 participants (mean age 19.5 years; 129 females; 106 children, 72 adolescents, 107 adults, median household size 8) had an average of 4.2 seizures in the prior month. 64% were regularly taking ASMs. Direct costs of epilepsy were similar across income strata, averaging 60 USD/month in the lowest and 75 USD/month in the highest wealth quintiles (P = 0.42). The poorest PLWE were more likely to spend their money on traditional treatments (average 35USD/month) than on medical consultations (average 11 USD/month) (P = 0.01), whereas the wealthiest participants were not. Higher seizure frequency was associated with a lower household education level in adolescents and children (P = 0.028; P = 0.026) and with being male (P = 0.009) in children. Adolescents in higher-educated households were more likely to take ASMs (P = 0.004). Boys were more likely to regularly take ASMs than girls (P = 0.047). CONCLUSIONS: Targeted programming for children and adolescents in the households with the lowest education and for girls would help improve epilepsy care in Guinea.

OBJECTIF: Explorer les facteurs socioéconomiques associés à l'épilepsie en République de Guinée. MÉTHODES: Des personnes vivant avec l'épilepsie (PVE) ont été recrutées prospectivement à l'hôpital Ignace Deen, à Conakry, en 2018. Un outil explorant les actifs des ménages en tant que mesure de la richesse a été conçu et administré. Des modèles de régression logistique multivariée avec des effets fixes ont été ajustés pour évaluer les associations de facteurs sociodémographiques et microéconomiques avec la fréquence autodéclarée des crises au cours du mois précédent et la prise régulière de médicaments antiépileptiques (MAE). Les participants ont été stratifiés par groupe d'âge: enfants (<13 ans), adolescents (13-21) et adultes (> 21). RÉSULTATS: 285 participants (âge moyen 19,5 ans; 129 femmes; 106 enfants, 72 adolescents, 107 adultes, taille médiane du ménage 8) ont eu en moyenne 4,2 crises au cours du mois précédent. 64% prenaient régulièrement des MAE. Les coûts directs de l'épilepsie étaient similaires dans toutes les strates de revenus, atteignant en moyenne 60 USD/mois dans les quintiles de richesse les plus bas et 75 USD/mois dans les quintiles de richesse les plus élevés (p = 0,42). Les PVE les plus pauvres étaient plus susceptibles de dépenser leur argent pour des traitements traditionnels (35 USD/mois en moyenne) que pour des consultations médicales (11 USD/mois en moyenne) (p = 0,01), contrairement aux participants les plus riches. Une fréquence de crises plus élevée était associée à un niveau d'éducation du ménage plus faible chez les adolescents et les enfants (p = 0,028; p = 0,026) et au fait d'être de sexe masculin (p = 0,009) chez les enfants. Les adolescents des ménages avec un niveau d'éducation plus élevé étaient plus susceptibles de prendre des MAE (p = 0,004). Les garçons étaient plus susceptibles de prendre régulièrement des MAE que les filles (p = 0,047). CONCLUSIONS: Des programmes ciblés pour les enfants et les adolescents dans les ménages les moins scolarisés et pour les filles aideraient à améliorer les soins de l'épilepsie en Guinée.

Impact of integrated mental health care on food insecurity of households of people with severe mental illness in a rural African district: a community-based, controlled before-after study.

OBJECTIVES: To evaluate the impact of integrated mental health care upon food insecurity (FI) in households of people with severe mental illness (SMI) in a rural Ethiopian district, and to investigate mediation by improved work impairment and discrimination. METHODS: A community-based, controlled before-after study was conducted. People with probable SMI were identified in the community, diagnosed by primary healthcare workers, with diagnostic confirmation from a psychiatric nurse. Households of a person with SMI were matched to control households. District-wide integration of mental health care was implemented. Change in FI status over 12 months of follow-up was measured using the Household Food Insecurity Access Scale. Multivariable models were used to assess improvement in FI. Direct and indirect mediators of change in FI status were modelled using path analysis. RESULTS: A total of 239 (81.8%) people with SMI and 273 (96.5%) control households were assessed after 12 months. Maintenance of food security or improvement in food insecurity status was observed in 51.5% of households of a person with SMI vs. 39.7% of control households (adjusted risk ratio 1.41: 95% CI 1.11, 1.80). Reduction in symptom severity was indirectly associated with improved FI status via an impact on reducing work impairment and discrimination (P < 0.001). CONCLUSIONS: Improving access to mental health care may reduce food insecurity in households of people with SMI. Optimising engagement in care and adding interventions to improve work functioning and tackle discrimination may further reduce food insecurity.

OBJECTIFS: Evaluer l'impact des soins de santé mentale intégrés sur l'insécurité alimentaire (IA) dans les ménages de personnes souffrant de maladie mentale sévère (MMS) dans un district rural éthiopien, et investiguer sur la médiation en améliorant les perturbations au travail et la discrimination. MÉTHODES: Une étude communautaire contrôlée avant et après a été menée. Des personnes avec une MMS probable ont été identifiées dans la communauté, diagnostiquées par des agents de santé primaires, avec confirmation diagnostique d'une infirmière psychiatrique. Les ménages de personnes atteintes de MMS ont été appariés pour effectuer des ajustements sur les ménages. Une intégration des soins de santé mentale à l'échelle du district a été mise en œuvre. Le changement de statut de l'IA au cours un suivi de 12 mois a été mesuré à l'aide de l'Echelle d'Accès à l'Insécurité Alimentaire des ménages. Des modèles multivariés ont été utilisés pour évaluer l'amélioration de l'IA. Les médiateurs directs et indirects du changement de statut de l'IA ont été modélisés à l'aide d'une analyse de chemin. RÉSULTATS: Un total de 239 (81,8%) ménages de personnes avec une MMS et 273 (96,5%) ménages témoins ont été évaluées après 12 mois. Le maintien de la sécurité alimentaire ou l'amélioration de l'état d'insécurité alimentaire a été observé dans 51,5% des ménages d'une personne avec une MMS vs 39,7% des ménages témoins (rapport de risque ajusté: 1,41 ; IC95%: 1,11 à 1,80). La réduction de la sévérité des symptômes était indirectement associée à une amélioration du statut de l'IA via un impact sur la réduction des perturbations au travail et de la discrimination (p <0,001). CONCLUSIONS: L'amélioration de l'accès aux soins de santé mentale peut réduire l'IA dans les ménages de personnes atteintes de MMS. L'optimisation de l'engagement dans les soins et l'ajout d'interventions pour améliorer le fonctionnement au travail et lutter contre la discrimination peuvent encore réduire l'IA.

Association between social determinants of health and trends in prevalence of hypertension in patients of the Peruvian Ministry of Health.

OBJECTIVE: To evaluate the association between social determinants of health and trends in the prevalence of hypertension among patients of the Peruvian Ministry of Health 2007-2016. METHODS: We conducted an ecological study with secondary data sources using health care and death records obtained from the Peruvian Ministry of Health, data from the Peruvian National Household Survey and data from the Regional Information System for Decision Making. We determined the standardised prevalence of hypertension at national and region level, conducted a geospatial exploratory analysis at region level, and applied generalised linear mixed models to evaluate the association between social determinants of health and the prevalence of HT, according to the domains suggested by Healthy People 2020. RESULTS: The prevalence of hypertensive patients of the Peruvian Ministry of Health increased from 966.8/100 000 in 2007 to 1619.1/100 000 in 2016. The prevalence of hypertension rose by 17.7/100 000 per 1% increase of insurance coverage and by 2.2/100 000 per 1% increase in the number of hospitals. In contrast, it decreased by 12.3/100 000 per 1% increase of the poverty rate, by 9.8/100 000 per 1% increase of the proportion of people with native language, by 3.6/100 000 per 1% increase of GDP per capita and by 3/100 000 per 1% increase in the number of local health centres. CONCLUSIONS: The growing trend of HT prevalence in Peru is directly associated with insurance coverage and number of hospitals, and inversely associated with poverty rate, proportion of people with native language, GDP per capita and number of local health centres.

OBJECTIF: Evaluer l'association entre les déterminants sociaux de la santé et les tendances de la prévalence de l'hypertension chez les patients du Ministère de la Santé du Pérou 2007-2016. MÉTHODES: Nous avons mené une étude écologique avec des sources de données secondaires utilisant des données de santé et de décès obtenues du ministère péruvien de la santé, des données de l'enquête nationale sur les ménages péruviens et du système d'information régional pour la prise de décision. Nous avons déterminé la prévalence standardisée de l'hypertension (HT) aux niveaux national et régional, mené une analyse exploratoire géospatiale au niveau régional et appliqué des modèles mixtes linéaires généralisés pour évaluer l'association entre les déterminants sociaux de la santé et la prévalence de l'HT, selon les domaines suggérés par Healthy People 2020. RÉSULTATS: La prévalence des patients HT du Ministère de la Santé du Pérou est passée de 966,8/100.000 en 2007 à 1.619,1/100.000 en 2016. La prévalence de l'HT a augmenté de 17,7/100.000 pour 1% d'augmentation de la couverture d'assurance et de 2,2/100.000 pour 1% d'augmentation du nombre d'hôpitaux. En revanche, elle a diminué de 12,3/100.000 pour 1% d'augmentation du taux de pauvreté, de 9,8/100.000 pour 1% d'augmentation de la proportion de personnes de la langue locale, de 3,6/1000.000 pour 1% d'augmentation du PIB par habitant et de 3/100.000 pour 1% d'augmentation du nombre de centres de santé locaux. CONCLUSIONS: La tendance croissante de la prévalence de l'HT au Pérou est directement liée à la couverture d'assurance et au nombre d'hôpitaux et inversement associée au taux de pauvreté, à la proportion de personnes de la langue locale, au PIB par habitant et au nombre de centres de santé locaux.

Impacts of epizootic ulcerative syndrome on subsistence fisheries and wildlife.

Epizootic ulcerative syndrome (EUS), caused by the water mould (Oomycota) Aphanomyces invadans, has spread throughout the world's major continents over the last 50 years, with the apparent exception of South and Central America. With over 160 susceptible fish species representing 54 families and 16 orders recorded to date, EUS is of international concern and infection with A. invadans is a World Organisation for Animal Health (OIE) listed disease. This paper examines what little has been reported on the impacts of EUS on subsistence fisheries and wildlife, or what can be deduced about those impacts, and concludes that there is a need for systematic data collection on the size and socio-economic importance of subsistence fisheries. Such fisheries are often relied upon by the poorest communities, thus food and nutrition security impacts can be significant. Similarly, impacts on wildlife are poorly documented, emphasising the lack of, and the need for, research on and modelling of the ecosystem-level impacts of EUS and other aquatic animal diseases. The history of EUS and several other aquatic animal diseases also brings into question the effectiveness of current measures for controlling the international spread of aquatic animal diseases and calls for a re-think on how best to meet this ongoing challenge.

En l'espace d'un demi-siècle, le syndrome ulcératif épizootique dû à l'oomycète Aphanomyces invadans s'est propagé dans toutes les régions du monde, à l'exception, semble-t-il, de l'Amérique du Sud et Centrale. Avec plus de 160 espèces de poissons répertoriées comme sensibles, réparties en 54 familles et 16 ordres, le syndrome ulcératif épizootique est une maladie préoccupante à l'échelle internationale et figure parmi les maladies listées par l'Organisation mondiale de la santé animale (OIE) sous le nom d'infection à A. invadans. Les auteurs font état des très rares signalements concernant l'impact du syndrome ulcératif épizootique sur la pêche de subsistance et sur la faune sauvage et tentent d'en tirer quelques conclusions, en insistant sur la nécessité de procéder à une collecte systématique de données afin de déterminer l'envergure et l'importance socioéconomique de la pêche de subsistance. Les communautés les plus pauvres étant souvent celles qui dépendent le plus de cette activité, la maladie a sans doute un impact majeur sur la sécurité alimentaire et nutritionnelle de ces populations. De même, l'impact sur la faune sauvage n'a pas vraiment été étudié jusqu'à présent, d'où la nécessité de conduire des travaux de recherche et de modélisation sur l'impact du syndrome ulcératif épizootique (et d'autres maladies des animaux aquatiques) à l'échelle des écosystèmes. L'histoire du syndrome ulcératif épizootique et d'autres maladies des animaux aquatiques pose également la question de l'efficacité des mesures appliquées actuellement pour maîtriser la propagation internationale de ces maladies et invite à repenser la réponse à apporter à ce défi toujours présent.

En los últimos 50 años, el síndrome ulcerante epizoótico, causado por el hongo acuático (oomiceto) Aphanomyces invadans, se ha diseminado por casi todos los continentes del planeta, con la aparente salvedad de Sudamérica y Centroamérica. Se trata de una enfermedad de importancia internacional que, hasta donde consta a día de hoy, afecta a más de 160 especies piscícolas de 54 familias y 16 órdenes. De ahí que la infección por A. invadans sea una patología inscrita en la lista de la Organización Mundial de Sanidad Animal (OIE). Los autores, tras exponer lo poco que hasta ahora se ha descrito de los efectos de la enfermedad sobre la pesca de subsistencia y la fauna silvestre o lo que es posible inferir acerca de esos efectos, llegan a la conclusión de que se requiere una labor sistemática de obtención de datos sobre la magnitud e importancia socioeconómica de la actividad pesquera de subsistencia, de la que dependen a menudo las comunidades más pobres, por lo que las consecuencias para la seguridad nutricional y alimentaria pueden ser de calado. Tampoco están bien descritas las repercusiones de la enfermedad en los animales silvestres, lo que pone de relieve la ausencia, y por ende la necesidad, de investigaciones y de modelos sobre los efectos ecosistémicos del síndrome ulcerante epizoótico y otras varias enfermedades de los animales acuáticos. La historia de estas patologías también arroja dudas sobre la eficacia de las medidas aplicadas actualmente para controlar la propagación internacional de las enfermedades de los animales acuáticos y exige replantearse cuál es la respuesta idónea a este problema que no cesa.

Equity dimensions of the availability and quality of reproductive, maternal and neonatal health services in Zambia.

OBJECTIVE: To assess how quality and availability of reproductive, maternal, neonatal (RMNH) services vary by district wealth and urban/rural status in Zambia. METHODS: We conducted a retrospective analysis of data from the Millennium Development Goal Acceleration Initiative baseline assessment of 117 health facilities in 9 districts. Quality was assessed through a composite score of 23 individual RMNH indicators, ranging from 0 to 1. Availability was evaluated by density of providers and facilities. Districts were divided into wealth groups based on the multidimensional poverty index (MPI). Relative inequity was calculated using the concentration index for quality indicators (positive favours rich, negative favours poor). Multivariable linear regression was performed for the dependent variable composite quality indicator using MPI, urban/rural, and facility level of care as independent variables. RESULTS: 13 hospitals, 85 health centres and 19 health posts were included. The RMNH composite quality indicator was 0.64. Availability of facilities and providers was universally low. The concentration index for the composite quality indicator was -0.015 [-0.043, 0.013], suggesting no clustering to favour either rich or poor districts. Rich districts had the highest absolute numbers of health facilities and providers, but lowest numbers per facility per 1 000 000 population. Urban districts had slightly better service quality, but not availability. Using regression analysis, only facility level of care was significantly associated with quality outcome. CONCLUSIONS: Composite quality of RMNH services did not vary by district wealth, but was slightly higher in urban districts. The availability data suggest that the higher population in richer districts outpaces health infrastructure.

[Characteristics and health status of homeless women born in France and abroad: Results of Insee-Ined 2012 survey]. / Caractéristiques et état de santé des femmes sans-domicile nées en France et à l'étranger : résultats de l'enquête Insee­Ined 2012.

BACKGROUND: French national surveys among the homeless population in 2001 and 2012 provided a general description of the homeless beneficiaries of medical and social aids. However, given the increasing number of women in this population, mostly born abroad and accompanied by their children, a descriptive study of homeless women according to the fact of being born in France or abroad was conducted. METHODS: A probability sample of 1470 French-speaking homeless women was recruited for the Insee-Ined 2012 survey. Socio-demographic characteristics, life trajectories, work and employment over the last 12 months, perceived health, reported morbidity, use of care and medical coverage have been described, comparing homeless women born abroad with those born in France. RESULTS: Homeless women are young (median age=34 y.), often single (55%), without a partner (71%) and often accompanied by children (52%). The vast majority (60%) reported no salary during the previous 12 months. Housing conditions were less precarious in women born in France, but these women had a more difficult life history, a more unfavorable perception of their health status, and a higher frequency of chronic health problems. Homeless women born abroad seemed to have more precarious conditions of life and more difficulties to access aids and medical coverage. Overall, despite a relatively good availability of medical insurance, homeless women, regardless of the place of birth, often reported health problems, which were not treated. CONCLUSION: This study suggests that homeless women often have to deal with chronic health problems that are not treated. Homeless women born abroad are characterized by more precarious living conditions that women born in France. Although younger, with an overall favorable perception of their health and declaring less often an addiction, their general state of health appears to be as fragile as for women born in France. Actions towards homeless women should be implemented to promote their access to care.

CAREGIVER'S DEPRESSIVE SYMPTOMS AND YOUNG CHILDREN'S SOCIOEMOTIONAL DEVELOPMENT DELAYS: A CROSS-SECTIONAL STUDY IN POOR RURAL AREAS OF CHINA.

Poverty and its associated factors put people at risk for depression. The aims of this study were to describe the prevalence of depressive symptoms (DS) of primary caregivers and socioemotional development (SED) delays of young children in poor rural areas of China, and to explore the association between them. Cross-sectional data of 2,664 children aged 3 to 35 months and their primary caregivers were used for analysis. Characteristics of the child, caregiver, and family were collected through face-to-face caregiver interviews. DS were assessed by the Zung Self-Rating Depression Scale (W.W. Zung, 1965, as cited in World Health Organization, ), and SED was evaluated by the Ages and Stage Questionnaires: Social-Emotional (J. Squires, D. Bricker, & L. Potter, 1997). The χ2 test, stratification analysis, and logistic regression analyses were used to explore the association. Among the caregivers, 40.3% (95% confidence interval [CI] [38.4, 42.1]), reported DS. Caregivers who were male, older and ethnic minorities as well as had a low level of education, a low family income, or more children were more likely to have DS. Of the children, 24.4% (95% CI [22.8, 26.0]) were recognized with SED delays. Older children displayed more delays than did younger children, but no significant differences between males and females were found. SED delays were significantly associated with mother outmigrating, male caregivers, older age, ethnic minorities, and low education or families with a single parent, low-income, and having more children. Caregivers having DS, odds ratio (OR) = 2.40, 95% CI [1.99, 2.88], was a significant predictor of increased odds of SED delays; other factors were single-parent family, OR = 1.99, 95% CI [1.37, 2.89], inadequate care, OR = 1.69, 95% CI [1.30, 2.21], physical punishment, OR = 1.61, 95% CI [1.33, 1.95], ethnic minorities, OR = 1.41, 95% CI [1.17, 1.71], and child age in months, OR = 1.03, 95% CI [1.02, 1.04], according to the logistic regression analysis. DS are prevalent among caregivers with young children in poor rural areas. Interventions to improve the mental health of caregivers and their parenting behaviors are needed to improve children's SED.

MATERNAL PERCEPTIONS OF PARENTING FOLLOWING AN EVIDENCE-BASED PARENTING PROGRAM: A QUALITATIVE STUDY OF LEGACY FOR CHILDRENTM.

This article presents the findings of a qualitative study of maternal perceptions of parenting following participation in Legacy for ChildrenTM (Legacy), an evidence-based parenting program for low-income mothers of young children and infants. To further examine previous findings and better understand participant experiences, we analyzed semistructured focus-group discussions with predominantly Hispanic and Black, non-Hispanic Legacy mothers at two sites (n = 166) using thematic analysis and grounded theory techniques. The qualitative study presented here investigated how mothers view their parenting following participation in Legacy, allowing participants to describe their experience with the program in their own words, thus capturing an "insider" perspective. Mothers at both sites communicated knowledge and use of positive parenting practices targeted by the goals of Legacy; some site-specific differences emerged related to these parenting practices. These findings align with the interpretation of quantitative results from the randomized controlled trials and further demonstrate the significance of the Legacy program in promoting positive parenting for mothers living in poverty. This study emphasizes the importance of understanding real-world context regarding program efficacy and the benefit of using qualitative research to understand participant experiences.

PREDICTORS OF INFANT AND TODDLER BLACK BOYS' EARLY LEARNING: SEIZING OPPORTUNITIES AND MINIMIZING RISKS.

Using the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B) data set (U.S. Department of Education Institute of Education Sciences, National Center for Education Statistics, 2001), this study examined child, family, and community factors in the early years (infant and toddler years) to predict the cognitive and language outcomes for preschool-age Black boys in relation to Black girls and White boys. Findings indicate that Black children face many challenges, with Black boys experiencing less sensitive parenting as compared to their peers. We live in a highly complex, racialized environment. While there are universal indicators that predict children's preschool outcomes such as strong social positioning and positive parenting, there are, in addition, some indicators that are more beneficial for Black boys' early development, including a stable, less urban home environment with parents engaging in "tough love."

PUBLIC POLICY, CHILD DEVELOPMENT RESEARCH AND BOYS AT RISK: CHALLENGING, ENDURING AND NECESSARY PARTNERSHIP.

Research findings documenting the issues and challenges of boys prebirth through age 5 years have barely penetrated the arena of public policy making nor has it permeated the public agenda of politicians, government, or other funding stakeholders. The purpose of this article is to articulate pathways for researchers to enter into the policy-making process. We review critical issues related to implementing the process of public policy. We argue that the policy process needs to be informed by more dynamic theoretical models of human development, and that researchers and clinicians need to be exposed more deeply to the processes required to inform and subsequently change public policy. We contend that most quantitative research on boys at risk occurs at the micro- and the mesosystem level rather than at the exo- and the macrosystem levels where structural societal policies embedded in economic and racial inequities contribute to risk. Researchers, clinicians, and policy makers need to create collaborative partnerships designed to develop, advocate, and implement more evidence-based policies designed to enhance the quality of life for boys at risk.

EARLY HEAD START FAMILIES' EXPERIENCES WITH STRESS: UNDERSTANDING VARIATIONS WITHIN A HIGH-RISK, LOW-INCOME SAMPLE.

The federal Early Head Start program provides a relevant context to examine families' experiences with stress since participants qualify on the basis of poverty and risk. Building on previous research that has shown variations in demographic and economic risks even among qualifying families, we examined possible variations in families' perceptions of stress. Family, parent, and child data were collected to measure stressors and risk across a variety of domains in families' everyday lives, primarily from self-report measures, but also including assay results from child cortisol samples. A cluster analysis was employed to examine potential differences among groups of Early Head Start families. Results showed that there were three distinct subgroups of families, with some families perceiving that they experienced very high levels of stress while others perceived much lower levels of stress despite also experiencing poverty and heightened risk. These findings have important implications in that they provide an initial step toward distinguishing differences in low-income families' experiences with stress, thereby informing interventions focused on promoting responsive caregiving as a possible mechanism to buffer the effects of family and social stressors on young children.

Rotavirus vaccines contribute towards universal health coverage in a mixed public-private healthcare system.

OBJECTIVES: To evaluate rotavirus vaccination in Malaysia from the household's perspective. The extended cost-effectiveness analysis (ECEA) framework quantifies the broader value of universal vaccination starting with non-health benefits such as financial risk protection and equity. These dimensions better enable decision-makers to evaluate policy on the public finance of health programmes. METHODS: The incidence, health service utilisation and household expenditure related to rotavirus gastroenteritis according to national income quintiles were obtained from local data sources. Multiple birth cohorts were distributed into income quintiles and followed from birth over the first five years of life in a multicohort, static model. RESULTS: We found that the rich pay more out of pocket (OOP) than the poor, as the rich use more expensive private care. OOP payments among the poorest although small are high as a proportion of household income. Rotavirus vaccination results in substantial reduction in rotavirus episodes and expenditure and provides financial risk protection to all income groups. Poverty reduction benefits are concentrated amongst the poorest two income quintiles. CONCLUSION: We propose that universal vaccination complements health financing reforms in strengthening Universal Health Coverage (UHC). ECEA provides an important tool to understand the implications of vaccination for UHC, beyond traditional considerations of economic efficiency.

Control and management of congenital Chagas disease in Europe and other non-endemic countries: current policies and practices.

OBJECTIVES: Identifying pregnant women infected with Trypanosoma cruzi is one of the major challenges for preventing and controlling Chagas disease (CD) in non-endemic countries. The aim of this paper was to perform a policy evaluation of the current practices of congenital Chagas disease (CCD) control in non-endemic countries and to propose specific targets for enhanced interventions to tackle this emerging health problem outside the endemic areas of Latin America. METHODS: We conducted a mixed method review of CCD policy strategies by searching the literature in the PubMed, Google Scholar and the World Health Organization (WHO) databases using the key terms 'CCD', 'paediatric Chagas disease' and 'non-endemic countries'; as free text and combined as one phrase to increase the search sensitivity. Reviews, recommendations, guidelines and control/surveillance programme reports were included. RESULTS: Of 427 CCD papers identified in non-endemic countries, 44 matched the inclusion. Although local programmes were launched in different countries with large numbers of Latin American immigrants, there were considerable disparities in terms of the programmes' distribution, delivery, integration and appropriated CCD control strategies. Moreover, Catalonia, Spain is the only region/country with an established systematic monitoring of CCD in pregnant women from Latin American countries. CONCLUSIONS: Given the worldwide dissemination of CD, the nature of its vertical transmission, and the gaps of the current strategies in non-endemic countries, there is an urgent need to standardise, expand and reinforce the control measures against CCD transmission.

Effectiveness of Interventions for Meaningful Activity Participation in Homelessness: A Systematic Review.

Background. Meaningful activity participation has been identified as a key outcome of services designed to support individuals during and following homelessness. Little is known about the effectiveness of interventions for promoting this outcome. Purpose. To identify the range and effectiveness of interventions on promoting meaningful activity participation among persons with experiences of homelessness. Method. We conducted a systematic review using the Joanna Briggs Institute methodology following PRISMA guidelines including a critical appraisal and narrative synthesis. Findings. Of 12,343 titles and abstracts screened, we included 12 studies. The authors of the included studies primarily used standardized measures of meaningful activity engagement. Critical appraisal scores ranged from 50.0 to 77.8. The most common interventions evaluated in the included studies were psychosocial interventions (n = 6; 50.0%), followed by case management and housing support interventions (n = 4; 33.3%) and Housing First (n = 2; 16.7%). While several interventions demonstrated effectiveness in promoting meaningful activity participation including psychosocial and case management interventions, Housing First, Critical Time Intervention, and a peer support intervention were found to be ineffective for promoting engagement in meaningful activity. Conclusion. Few intervention studies have been conducted that demonstrate effectiveness for promoting participation in meaningful activity for individuals during and following homelessness. Occupational therapy researchers and practitioners can build on existing evidence by developing and evaluating novel approaches by co-designing interventions in collaboration with persons with experiences of homelessness and service providers.

Leisure Possibilities of Adults Experiencing Poverty: A Community-Based Participatory Study.

Background. Poverty disproportionally affects persons with disabilities, elderly individuals and racialized groups. Leisure, play and rest are not prioritized in either services for or research with people living in poverty. Purpose. This study aims to examine the facilitators and barriers to participation in meaningful leisure activities for adults living in poverty. Method. We used community-based participatory research and art-based elicitation strategies with 39 service users at a food security organization. Findings. Individuals experiencing poverty value and engage in a variety of free and affordable leisure activities, but they are not afforded the necessary leisure opportunities, accommodations and supports as the general population. We co-created a map of local leisure resources to foster collective capacity in leisure planning, and to support organizations working with this population. Implications. Occupational therapists can work alongside members of underserved communities to uncover and address the systemic and local contextual barriers to engagement in leisure activities.

[People in precarious situations, between indifference and discrimination]. / Personnes en situation précaire, entre indifférence et discrimination.

Poverty is an absolute evil. It corrodes society. France is not the most affected country, because a social protection system allows the most vulnerable to avoid falling into extreme poverty. The current health crisis is, however, aggravating situations of exclusion. It is therefore urgent to question the effectiveness of public policies and to construct indicators capable of measuring the well-being of citizens who are both contributors and beneficiaries.