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1.
PLoS One ; 15(10): e0239576, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33113548

RESUMO

In the global context, health and the quality of life of people are adversely affected by either one or more types of chronic diseases. This paper investigates the differences in the level of income and expenditure between chronically-ill people and non-chronic population. Data were gathered from a national level survey conducted namely, the Household Income and Expenditure Survey (HIES) by the Department of Census and Statistics (DCS) of Sri Lanka. These data were statistically analysed with one-way and two-way ANOVA, to identify the factors that cause the differences among different groups. For the first time, this study makes an attempt using survey data, to examine the differences in the level of income and expenditure among chronically-ill people in Sri Lanka. Accordingly, the study discovered that married females who do not engage in any type of economic activity (being unemployed due to the disability associated with the respective chronic illness), in the age category of 40-65, having an educational level of tertiary education or below and living in the urban sector have a higher likelihood of suffering from chronic diseases. If workforce population is compelled to lose jobs, it can lead to income insecurity and impair their quality of lives. Under above findings, it is reasonable to assume that most health care expenses are out of pocket. Furthermore, the study infers that chronic illnesses have a statistically proven significant differences towards the income and expenditure level. This has caused due to the interaction of demographic and socio-economic characteristics associated with chronic illnesses. Considering private-public sector partnerships that enable affordable access to health care services for all as well as implementation of commercial insurance and community-based mutual services that help ease burden to the public, are vital when formulating effective policies and strategies related to the healthcare sector. Sri Lanka is making strong efforts to support its healthcare sector and public, which was affected by the coronavirus (COVID-19) in early 2020. Therefore, findings of this paper will be useful to gain insights on the differences of chronic illnesses towards the income and expenditure of chronically-ill patients in Sri Lanka.


Assuntos
Betacoronavirus , Doença Crônica/epidemiologia , Infecções por Coronavirus/epidemiologia , Gastos em Saúde/estatística & dados numéricos , Renda/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Análise de Variância , Criança , Pré-Escolar , Doença Crônica/economia , Comorbidade , Infecções por Coronavirus/economia , Países em Desenvolvimento/economia , Pessoas com Deficiência/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Características da Família , Feminino , Alimentos/economia , Humanos , Lactente , Recém-Nascido , Masculino , Indigência Médica/estatística & dados numéricos , Pessoa de Meia-Idade , Pandemias/economia , Pneumonia Viral/economia , Pobreza , Fatores Socioeconômicos , Sri Lanka/epidemiologia , Inquéritos e Questionários , Adulto Jovem
2.
Artigo em Inglês | MEDLINE | ID: mdl-33053788

RESUMO

Early information on public health behaviors adopted to prevent the spread of coronavirus (COVID-19) may be useful in controlling the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission. The objective of this study was to assess the role of income level (IL) and the perception of older adults, regarding COVID-19 susceptibility and severity, on adopting stay-at-home preventive behavior during the first week of the outbreak in Mexico. Participants in this cross-sectional study were urban community dwellers, aged ≥ 65 years from Mexico City. A total of 380 interviews were conducted over the phone. The mean respondent age was 72.9 years, and 76.1% were women. Over half (54.2%) of the participants perceived their susceptibility to COVID-19 as very low or low. Similarly, 33.4% perceived COVID-19 severity as being very low or low, and 57.6% had decided to stay at home: this behavior was associated with IL (ß = 1.05, p < 0.001), and its total effect was partially mediated (15.1%) by perceived severity. Educational attainment was also associated with staying at home (ß = 0.10, p = 0.018) and its total effect was partially mediated (15.0%) by perceived susceptibility. Interventions aimed at low income and less educated older adults should be developed to improve preventive behaviors in this vulnerable group during the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Renda/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Isolamento Social/psicologia , Idoso , Cidades/epidemiologia , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , México/epidemiologia , Pneumonia Viral/epidemiologia , Medição de Risco
3.
PLoS One ; 15(9): e0237970, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32903268

RESUMO

Germany has experienced sharply rising earnings inequalities, both between and within workplaces. Working from prior literature on rising employment dualization and the fissuring of workplaces into high and low wage employers, we explore a set of organizational explanations for rising between and within workplace inequality focusing on the role of employment dualization, skill segregation/complexity, and firm fissuring. We describe and model these hypothesized processes with administrative data on a large random sample panel of German workplaces. We find that rising inequalities are associated with polarization in industrial wage rates and the birth of new low wage workplaces, as well as increased establishment skill specialization and the growth of part-time jobs in workplace divisions of labor. We conclude with recommendations for future research that directly examines more proximate mechanisms and their relative importance in different institutional contexts.


Assuntos
Eficiência Organizacional , Emprego/economia , Renda/estatística & dados numéricos , Salários e Benefícios/estatística & dados numéricos , Fatores Socioeconômicos , Local de Trabalho/normas , Adulto , Emprego/tendências , Feminino , Alemanha , Humanos , Masculino , Fatores de Tempo
4.
PLoS One ; 15(9): e0237307, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915825

RESUMO

OBJECTIVE: To estimate the prevalence of multimorbidity and investigate the socioeconomic factors that are associated with multimorbidity among persons 70 years and older in Trinidad and Tobago. DESIGN AND METHODS: The data were obtained from a nationally representative comprehensive cross-sectional survey conducted in 2014 among elderly persons in the targeted age group. The prevalence of multimorbidity among the elderly population was estimated. A logit model was utilized to determine the socioeconomic characteristics that are associated with multimorbidity in the elderly. RESULTS: The results of the study show that multimorbidity in the elderly population is strongly associated with age, ethnicity, lower education, smoking history, no physical activity and being female. An interesting finding is that elderly persons in the richest quintile are in general, more prone to multimorbidity. CONCLUSION: The findings suggest that interventions to reduce multimorbidity among the elderly population must encourage greater levels of physical activity, provide education on the risk factors of multimorbidity, and discourage smoking.


Assuntos
Escolaridade , Renda/estatística & dados numéricos , Expectativa de Vida , Idoso , Idoso de 80 Anos ou mais , Feminino , Estilo de Vida Saudável , Humanos , Masculino , Morbidade , Fatores Sexuais , Fumar/epidemiologia , Trinidad e Tobago
5.
JAMA Netw Open ; 3(9): e2019686, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32876685

RESUMO

Importance: The coronavirus disease 2019 (COVID-19) pandemic and the policies to contain it have been a near ubiquitous exposure in the US with unknown effects on depression symptoms. Objective: To estimate the prevalence of and risk factors associated with depression symptoms among US adults during vs before the COVID-19 pandemic. Design, Setting, and Participants: This nationally representative survey study used 2 population-based surveys of US adults aged 18 or older. During COVID-19, estimates were derived from the COVID-19 and Life Stressors Impact on Mental Health and Well-being study, conducted from March 31, 2020, to April 13, 2020. Before COVID-19 estimates were derived from the National Health and Nutrition Examination Survey, conducted from 2017 to 2018. Data were analyzed from April 15 to 20, 2020. Exposures: The COVID-19 pandemic and outcomes associated with the measures to mitigate it. Main Outcomes and Measures: Depression symptoms, defined using the Patient Health Questionnaire-9 cutoff of 10 or higher. Categories of depression symptoms were defined as none (score, 0-4), mild (score, 5-9), moderate (score, 10-14), moderately severe (score, 15-19), and severe (score, ≥20). Results: A total of 1470 participants completed the COVID-19 and Life Stressors Impact on Mental Health and Well-being survey (completion rate, 64.3%), and after removing those with missing data, the final during-COVID-19 sample included 1441 participants (619 participants [43.0%] aged 18-39 years; 723 [50.2%] men; 933 [64.7%] non-Hispanic White). The pre-COVID-19 sample included 5065 participants (1704 participants [37.8%] aged 18-39 years; 2588 [51.4%] women; 1790 [62.9%] non-Hispanic White). Depression symptom prevalence was higher in every category during COVID-19 compared with before (mild: 24.6% [95% CI, 21.8%-27.7%] vs 16.2% [95% CI, 15.1%-17.4%]; moderate: 14.8% [95% CI, 12.6%-17.4%] vs 5.7% [95% CI, 4.8%-6.9%]; moderately severe: 7.9% [95% CI, 6.3%-9.8%] vs 2.1% [95% CI, 1.6%-2.8%]; severe: 5.1% [95% CI, 3.8%-6.9%] vs 0.7% [95% CI, 0.5%-0.9%]). Higher risk of depression symptoms during COVID-19 was associated with having lower income (odds ratio, 2.37 [95% CI, 1.26-4.43]), having less than $5000 in savings (odds ratio, 1.52 [95% CI, 1.02-2.26]), and exposure to more stressors (odds ratio, 3.05 [95% CI, 1.95-4.77]). Conclusions and Relevance: These findings suggest that prevalence of depression symptoms in the US was more than 3-fold higher during COVID-19 compared with before the COVID-19 pandemic. Individuals with lower social resources, lower economic resources, and greater exposure to stressors (eg, job loss) reported a greater burden of depression symptoms. Post-COVID-19 plans should account for the probable increase in mental illness to come, particularly among at-risk populations.


Assuntos
Infecções por Coronavirus/epidemiologia , Depressão/epidemiologia , Renda/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Estresse Psicológico/epidemiologia , Adolescente , Adulto , Betacoronavirus , Depressão/psicologia , Escolaridade , Feminino , Humanos , Masculino , Estado Civil/estatística & dados numéricos , Pessoa de Meia-Idade , Pandemias , Questionário de Saúde do Paciente , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , Estresse Psicológico/psicologia , Estados Unidos/epidemiologia , Adulto Jovem
6.
Soc Sci Med ; 263: 113365, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32981770

RESUMO

Can social contextual factors explain international differences in the spread of COVID-19? It is widely assumed that social cohesion, public confidence in government sources of health information and general concern for the welfare of others support health advisories during a pandemic and save lives. We tested this assumption through a time-series analysis of cross-national differences in COVID-19 mortality during an early phase of the pandemic. Country data on income inequality and four dimensions of social capital (trust, group affiliations, civic responsibility and confidence in public institutions) were linked to data on COVID-19 deaths in 84 countries. Associations with deaths were examined using Poisson regression with population-averaged estimators. During a 30-day period after recording their tenth death, mortality was positively related to income inequality, trust and group affiliations and negatively related to social capital from civic engagement and confidence in state institutions. These associations held in bivariate and mutually controlled regression models with controls for population size, age and wealth. The results indicate that societies that are more economically unequal and lack capacity in some dimensions of social capital experienced more COVID-19 deaths. Social trust and belonging to groups were associated with more deaths, possibly due to behavioural contagion and incongruence with physical distancing policy. Some countries require a more robust public health response to contain the spread and impact of COVID-19 due to economic and social divisions within them.


Assuntos
Infecções por Coronavirus/mortalidade , Saúde Global/estatística & dados numéricos , Renda/estatística & dados numéricos , Pandemias , Pneumonia Viral/mortalidade , Capital Social , Idoso , Feminino , Humanos , Masculino , Fatores Socioeconômicos , Confiança
7.
Ann Glob Health ; 86(1): 112, 2020 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-32944509

RESUMO

Background: Although "social isolation" protects the life and health of Vietnamese citizens from the adverse effects of the COVID-19 pandemic, it also triggers massive reductions in the economic activities of the country. Objective: our study aimed to identify negative impacts of COVID-19 on occupations of Vietnamese people during the first national lockdown, including the quality and quantity of jobs as well as adverse problems at work due to COVID-19. Methods: A cross-sectional study using web-based platforms was conducted during the first time of social isolation in Vietnam at the beginning of April 2020. We utilized a respondent-driven sampling technique to select 1423 respondents from 63 cities and provinces over Vietnam. Exploratory factor analysis (EFA) was used to define sub-domains of perceived impacts of COVID-19 on occupations. Findings: Approximately two-thirds of respondents reported decreases in their income (61.6%), and 28.2% reported that their income deficit was 40% and above. The percentage of female individuals having decreased revenue due to COVID-19 was higher than that of male respondents (65.2% and 54.7%, respectively). "Worry that colleagues exposed to COVID-19 patients" and "Being alienated because employment-related to COVID-19" accounted for the highest score in each factor. Compared to healthcare workers, being self-employed/unemployed/retired were less likely to suffer from "Increased workload and conflicts due to COVID-19" and "Disclosure and discrimination related to COVID-19 work exposure." Conclusion: Our study revealed a drastic reduction in both the quality and quantity of working, as well as the increased fear and stigmatization of exposure to COVID-19 at workplaces. Health protection and economic support are immediate targets that should be focused on when implementing policies and regulations.


Assuntos
Controle de Doenças Transmissíveis , Infecções por Coronavirus , Recessão Econômica/estatística & dados numéricos , Emprego/estatística & dados numéricos , Pandemias , Pneumonia Viral , Adulto , Betacoronavirus , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Feminino , Humanos , Renda/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Pandemias/economia , Pandemias/prevenção & controle , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Controle Social Formal/métodos , Vietnã/epidemiologia , Desempenho Profissional , Carga de Trabalho/estatística & dados numéricos
8.
BMC Public Health ; 20(1): 1472, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993592

RESUMO

BACKGROUND: Urban-rural disparity in mortality at older ages is well documented in China. However, surprisingly few studies have systemically investigated factors that contribute to such disparity. This study examined the extent to which individual-level socioeconomic conditions, family/social support, health behaviors, and baseline health status contributed to the urban-rural difference in mortality among older adults in China. METHODS: This research used the five waves of the Chinese Longitudinal Healthy Longevity Survey from 2002 to 2014, a nationally representative sample of older adults aged 65 years or older in China (n = 28,235). A series of hazard regression models by gender and age group examined the association between urban-rural residence and mortality and how this association was modified by a wide range of individual-level factors. RESULTS: Older adults in urban areas had 11% (relative hazard ratio (HR) = 0.89, p < 0.01) lower risks of mortality than their rural counterparts when only demographic factors were taken into account. Further adjustments for family/social support, health behaviors, and health-related factors individually or jointly had a limited influence on the mortality differential between urban and rural older adults (HRs = 0.89-0.92, p < 0.05 to p < 0.01). However, we found no urban-rural difference in mortality (HR = 0.97, p > 0.10) after adjusting for individual socioeconomic factors. Similar results were found in women and men, and among the young-old and the oldest-old populations. CONCLUSIONS: The urban-rural disparity in mortality among older adults in China was largely attributable to differences in individual socioeconomic resources (i.e., education, income, and access to healthcare) regardless of gender and age group.


Assuntos
Comportamentos Relacionados com a Saúde , Nível de Saúde , Renda/estatística & dados numéricos , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Feminino , Humanos , Longevidade , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Risco , Percepção Social , Apoio Social , Fatores Socioeconômicos , Adulto Jovem
9.
BMC Public Health ; 20(1): 1469, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993602

RESUMO

BACKGROUND: Few studies have examined the association between physical activity (PA) and various causes of mortality in Korea. The aim of our study was to evaluate mortality and causes of death between PA and insufficient PA using Korean national cohort data. METHODS: The health screening cohort data from the Korean National Health Insurance Service-National Sample Cohort from 2009 to 2015 were used. 'PA' was determined if participants walked or performed moderate-intensity activity ≥5 d/week for ≥30 min, or vigorous-intensity activity ≥3 d/week for ≥20 min. Other participants were classified as 'insufficient PA'. The PA and insufficient PA groups were matched by age, sex, income, and region of residence in a 1:1 ratio. Causes of death were classified into 13 categories. Crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for all mortality rates were analyzed using a stratified Cox proportional hazard model. Age, sex, income, and region of residence were stratified. Subgroup analyses were performed according to age, sex, and obesity status. The odds ratio according to the causes of death was calculated by the chi-square test. RESULTS: The adjusted HR for mortality in the PA group was 0.85 (95% CI = 0.82-0.88). In subgroup analyses according to age, sex, and obesity status, results were consistent with the main findings in < 60-year-old females, ≥ 60-year-old males and females, and in all subgroups by obesity. The death rate by neoplasm, mental diseases, neurologic disease, circulatory disease, respiratory disease, digestive disease, abnormal finding, and trauma were lower in the PA than the insufficient PA group. CONCLUSIONS: These results suggest that PA is inversely associated with mortality caused specifically by diseases reflected by mental, respiratory, cancer, and cardiovascular conditions. Additionally, PA is inversely associated with mortality compared to insufficient PA in all obesity status.


Assuntos
Doença Crônica/mortalidade , Exercício Físico , Comportamentos Relacionados com a Saúde , Comportamento Sedentário , Adulto , Idoso , Causas de Morte , Estudos de Coortes , Feminino , Seguimentos , Humanos , Renda/estatística & dados numéricos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Atividade Motora , Modelos de Riscos Proporcionais , República da Coreia
10.
PLoS One ; 15(8): e0237107, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745121

RESUMO

OBJECTIVE: In this study we aimed to estimate the effect of diabetes, educational level and income on the risk of mortality and cardiovascular events in primary care patients with hypertension. METHODS: We followed 62,557 individuals with hypertension diagnosed 2001-2008, in the Swedish Primary Care Cardiovascular Database. Study outcomes were death, myocardial infarction, and ischemic stroke, assessed using national registers until 2012. Cox regression models were used to estimate adjusted hazard ratios of outcomes according to diabetes status, educational level, and income. RESULTS: During follow-up, 13,231 individuals died, 9981 were diagnosed with diabetes, 4431 with myocardial infarction, and 4433 with ischemic stroke. Hazard ratios (95% confidence intervals) for diabetes versus no diabetes: mortality 1.57 (1.50-1.65), myocardial infarction 1.24 (1.14-1.34), and ischemic stroke 1.17 (1.07-1.27). Hazard ratios for diabetes and ≤9 years of school versus no diabetes and >12 years of school: mortality 1.56 (1.41-1.73), myocardial infarction 1.36 (1.17-1.59), and ischemic stroke 1.27 (1.08-1.50). Hazard ratios for diabetes and income in the lowest fifth group versus no diabetes and income in the highest fifth group: mortality 3.82 (3.36-4.34), myocardial infarction 2.00 (1.66-2.42), and ischemic stroke 1.91 (1.58-2.31). CONCLUSIONS: Diabetes combined with low income was associated with substantial excess risk of mortality, myocardial infarction and ischemic stroke among primary care patients with hypertension.


Assuntos
Diabetes Mellitus/epidemiologia , Cardiopatias/epidemiologia , Hipertensão/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Escolaridade , Feminino , Cardiopatias/mortalidade , Humanos , Hipertensão/mortalidade , Renda/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/mortalidade , Suécia
11.
PLoS One ; 15(8): e0237337, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760125

RESUMO

Mobile phone use is increasing in Sub-Saharan Africa, spurring a growing focus on mobile phones as tools to increase agricultural yields and incomes on smallholder farms. However, the research to date on this topic is mixed, with studies finding both positive and neutral associations between phones and yields. In this paper we examine perceptions about the impacts of mobile phones on agricultural productivity, and the relationships between mobile phone use and agricultural yield. We do so by fitting multilevel statistical models to data from farmer-phone owners (n = 179) in 4 rural communities in Tanzania, controlling for site and demographic factors. Results show a positive association between mobile phone use for agricultural activities and reported maize yields. Further, many farmers report that mobile phone use increases agricultural profits (67% of respondents) and decreases the costs (50%) and time investments (47%) of farming. Our findings suggest that there are opportunities to target policy interventions at increasing phone use for agricultural activities in ways that facilitate access to timely, actionable information to support farmer decision making.


Assuntos
Uso do Telefone Celular/estatística & dados numéricos , Produção Agrícola/estatística & dados numéricos , Eficiência , Fazendeiros/estatística & dados numéricos , Fazendas/estatística & dados numéricos , Adulto , Uso do Telefone Celular/economia , Produção Agrícola/economia , Fazendas/economia , Feminino , Humanos , Renda/estatística & dados numéricos , Invenções , Masculino , População Rural/estatística & dados numéricos , Autorrelato/estatística & dados numéricos , Tanzânia , Zea mays
12.
PLoS One ; 15(8): e0237217, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32780758

RESUMO

This study examines catastrophic health expenditures and the potential for such payments to impoverish South African households. The analysis applies three different catastrophic expenditure measurements, and we apply them across four South African Income and Expenditure Surveys. Since households have limited resources, they are also limited in their capacity to purchase health care. Thus, if a household devotes a large share of that capacity to health care, it may not be able to cover other necessary expenses, which could be catastrophic. The measurements differ in their definition of household capacity. Despite the differences in measurements, and, therefore, results, we find limited incidence of health care expenditure catastrophe, although larger shares of capacity are being devoted to health care in more recent years. In line with the finding that catastrophe is rare, we find that very few households are subsequently impoverished, because of health care costs.


Assuntos
Financiamento Pessoal , Gastos em Saúde , Pobreza , Características da Família , Financiamento Pessoal/economia , Financiamento Pessoal/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Pobreza/economia , Pobreza/estatística & dados numéricos , América do Sul
13.
Lancet Glob Health ; 8(11): e1380-e1389, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32857955

RESUMO

BACKGROUND: Stay-at-home orders (lockdowns) have been deployed globally to control COVID-19 transmission, and might impair economic conditions and mental health, and exacerbate risk of food insecurity and intimate partner violence. The effect of lockdowns in low-income and middle-income countries must be understood to ensure safe deployment of these interventions in less affluent settings. We aimed to determine the immediate impact of COVID-19 lockdown orders on women and their families in rural Bangladesh. METHODS: An interrupted time series was used to compare data collected from families in Rupganj upazila, rural Bangladesh (randomly selected from participants in a randomised controlled trial), on income, food security, and mental health a median of 1 year and 2 years before the COVID-19 pandemic to data collected during the lockdown. We also assessed women's experiences of intimate partner violence during the pandemic. RESULTS: Between May 19 and June 18, 2020, we randomly selected and invited the mothers of 3016 children to participate in the study, 2424 of whom provided consent. 2414 (99·9%, 95% CI 99·6-99·9) of 2417 mothers were aware of, and adhering to, the stay-at-home advice. 2321 (96·0%, 95·2-96·7) of 2417 mothers reported a reduction in paid work for the family. Median monthly family income fell from US$212 at baseline to $59 during lockdown, and the proportion of families earning less than $1·90 per day rose from five (0·2%, 0·0-0·5) of 2422 to 992 (47·3%, 45·2-49·5) of 2096 (p<0·0001 comparing baseline with lockdown period). Before the pandemic, 136 (5·6%, 4·7-6·6) of 2420 and 65 (2·7%, 2·1-3·4) of 2420 families experienced moderate and severe food insecurity, respectively. This increased to 881 (36·5%, 34·5-38·4) of 2417 and 371 (15·3%, 13·9-16·8) of 2417 during the lockdown; the number of families experiencing any level of food insecurity increased by 51·7% (48·1-55·4; p<0·0001). Mothers' depression and anxiety symptoms increased during the lockdown. Among women experiencing emotional or moderate physical violence, over half reported it had increased since the lockdown. INTERPRETATION: COVID-19 lockdowns present significant economic, psychosocial, and physical risks to the wellbeing of women and their families across economic strata in rural Bangladesh. Beyond supporting only the most socioeconomically deprived, support is needed for all affected families. FUNDING: National Health and Medical Research Council, Australia.


Assuntos
Infecções por Coronavirus/prevenção & controle , Abastecimento de Alimentos/estatística & dados numéricos , Renda/estatística & dados numéricos , Violência por Parceiro Íntimo/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Quarentena/legislação & jurisprudência , Adulto , Bangladesh/epidemiologia , Pré-Escolar , Infecções por Coronavirus/epidemiologia , Família , Feminino , Humanos , Lactente , Análise de Séries Temporais Interrompida , Masculino , Mães/psicologia , Mães/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , População Rural/estatística & dados numéricos , Adulto Jovem
14.
PLoS One ; 15(8): e0237519, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810162

RESUMO

INTRODUCTION: Microfinance is a widely promoted developmental initiative to provide poor women with affordable financial services for poverty alleviation. One popular adaption in South Asia is the Self-Help Group (SHG) model that India adopted in 2011 as part of a federal poverty alleviation program and as a secondary approach of integrating health literacy services for rural women. However, the evidence is limited on who joins and continues in SHG programs. This paper examines the determinants of membership and staying members (outcomes) in an integrated microfinance and health literacy program from one of India's poorest and most populated states, Uttar Pradesh across a range of explanatory variables related to economic, socio-demographic and area-level characteristics. METHOD: Using secondary survey data from the Uttar Pradesh Community Mobilization project comprising of 15,300 women from SHGs and Non-SHG households in rural India, we performed multivariate logistic and hurdle negative binomial regression analyses to model SHG membership and duration. RESULTS: While in general poor women are more likely to be SHG members based on an income threshold limit (government-sponsored BPL cards), women from poorest households are more likely to become members, but less likely to stay members, when further classified using asset-based wealth quintiles. Additionally, poorer households compared to the marginally poor are less likely to become SHG members when borrowing for any reason, including health reasons. Only women from moderately poor households are more likely to continue as members if borrowing for health and non-income-generating reasons. The study found that an increasing number of previous pregnancies is associated with a higher membership likelihood in contrast to another study from India reporting a negative association. CONCLUSION: The study supports the view that microfinance programs need to examine their inclusion and retention strategies in favour of poorest household using multidimensional indicators that can capture poverty in its myriad forms.


Assuntos
Participação da Comunidade/estatística & dados numéricos , Organização do Financiamento/estatística & dados numéricos , Acesso aos Serviços de Saúde , Serviços de Saúde Materno-Infantil , Grupos de Autoajuda/organização & administração , Adolescente , Adulto , Características da Família , Feminino , Organização do Financiamento/organização & administração , Letramento em Saúde/economia , Letramento em Saúde/organização & administração , Promoção da Saúde , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Índia/epidemiologia , Recém-Nascido , Serviços de Saúde Materno-Infantil/economia , Serviços de Saúde Materno-Infantil/organização & administração , Serviços de Saúde Materno-Infantil/provisão & distribução , Pessoa de Meia-Idade , Pobreza/economia , Pobreza/estatística & dados numéricos , Gravidez , População Rural/estatística & dados numéricos , Grupos de Autoajuda/estatística & dados numéricos , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem
15.
Biomed Environ Sci ; 33(7): 502-509, 2020 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-32807269

RESUMO

Objective: To determine the factors influencing insomnia and construct early insomnia warning tools for rescuers to informbest practices for early screening and intervention. Methods: Cluster sampling was used to conduct a cross-sectional survey of 1,133 rescuers from one unit in Beijing, China. Logistic regression modeling and R software were used to analyze insomnia-related factors and construct a PRISM model, respectively. Results: The positive rate of insomnia among rescuers was 2.74%. Accounting for participants' age, education, systolic pressure, smoking, per capita family monthly income, psychological resilience, and cognitive emotion regulation, logistic regression analysis revealed that, compared with families with an average monthly income less than 3,000 yuan, the odds ratio ( OR) values and the [95% confidence interval ( CI)] for participants of the following categories were as follows: average monthly family income greater than 5,000 yuan: 2.998 (1.307-6.879), smoking: 4.124 (1.954-8.706), and psychological resilience: 0.960 (0.933-0.988). The ROC curve area of the PRISM model (AUC) = 0.7650, specificity = 0.7169, and sensitivity = 0.7419. Conclusion: Insomnia was related to the participants' per capita family monthly income, smoking habits, and psychological resilience on rescue workers. The PRISM model's good diagnostic value advises its use to screen rescuer early sleep quality. Further, advisable interventions to optimize sleep quality and battle effectiveness include psychological resilience training and smoking cessation.


Assuntos
Renda/estatística & dados numéricos , Doenças Profissionais/epidemiologia , Trabalho de Resgate/estatística & dados numéricos , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Fumar/epidemiologia , Adolescente , Adulto , China/epidemiologia , Estudos Transversais , Humanos , Incidência , Masculino , Modelos Teóricos , Doenças Profissionais/etiologia , Resiliência Psicológica , Fatores de Risco , Distúrbios do Início e da Manutenção do Sono/etiologia , Fatores Socioeconômicos , Adulto Jovem
16.
Yakugaku Zasshi ; 140(8): 1035-1040, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32741861

RESUMO

For many of the novel antiepileptics, immunoassays, used for routine therapeutic drug monitoring (TDM), cannot be used. We could monitor eight novel antiepileptics using an LC/MS method since July 2017. The purpose of this study was to evaluate the significant changes associated with the transition from outsourcing to in-hospital monitoring of novel antiepileptics. The number of measurements of novel antiepileptics was significantly increased during the first (p<0.01) and second (p<0.001) years of in-hospital monitoring as compared to that one year prior to in-hospital monitoring which was outsourced. The proportion of measurements of novel antiepileptics to all antiepileptics was 19.7%, 31.1%, and 38.4% during outsourcing, and first, and second years of in-hospital monitoring, respectively. The measurement cost was significantly reduced during the first (p<0.001) and second (p<0.001) years of in-hospital monitoring as compared to that during outsourcing. In addition, the revenue from TDM of antiepileptic drugs was significantly increased during the first (p<0.05) and second (p<0.01) years of in-hospital monitoring as compared with that during outsourcing. In conclusion, the switch from outsourcing to in-hospital monitoring led to an increase in the number of orders, a reduction in the measurement-related expenses of novel antiepileptics, and an increase in the revenue from TDM of antiepileptic drugs, which could promote the proper use of novel antiepileptics through TDM.


Assuntos
Anticonvulsivantes , Monitoramento de Medicamentos/métodos , Monitoramento de Medicamentos/estatística & dados numéricos , Serviços Terceirizados/estatística & dados numéricos , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Cromatografia Líquida , Monitoramento de Medicamentos/economia , Humanos , Renda/estatística & dados numéricos , Espectrometria de Massas , Fatores de Tempo
17.
BMJ ; 370: m2588, 2020 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-32732322

RESUMO

OBJECTIVE: To assess whether differences in income between male and female physicians vary according to the sex composition of physician practices. DESIGN: Retrospective observational study. SETTING: US national survey of physician salaries, 2014-18. PARTICIPANTS: 18 802 physicians from 9848 group practices (categorized according to proportion of male physicians ≤50%, >50-75%, >75-90%, and >90%). MAIN OUTCOME MEASURES: Sex differences in physician income in relation to the sex composition of physician practices after multivariable adjustment for physician specialty, years of experience, hours worked, measures of clinical workload, practice type, and geography. RESULTS: Among 11 490 non-surgical specialists, the absolute adjusted sex difference in annual income (men versus women) was $36 604 (£29 663; €32 621) (95% confidence interval $24 903 to $48 306; 11.7% relative difference) for practices with 50% or less of male physicians compared with $91 669 ($56 587 to $126 571; 19.9% relative difference) for practices with at least 90% of male physicians (P=0.03 for difference). Similar findings were observed among surgical specialists (n=3483), with absolute adjusted sex difference in annual income of $46 503 ($42 198 to $135 205; 10.2% relative difference) for practices with 50% or less of male physicians compared with $149 460 ($86 040 to $212 880; 26.9% relative difference) for practices with at least 90% of male physicians (P=0.06 for difference). Among primary care physicians (n=3829), sex differences in income were not related to the proportion of male physicians in a practice. CONCLUSIONS: Among both non-surgical and surgical specialists, sex differences in income were largest in practices with the highest proportion of male physicians, even after detailed adjustment for factors that might explain sex differences in income.


Assuntos
Prática de Grupo/organização & administração , Prática de Grupo/estatística & dados numéricos , Renda/estatística & dados numéricos , Médicos/economia , Médicos/estatística & dados numéricos , Feminino , Humanos , Masculino , Médicas/economia , Médicas/estatística & dados numéricos , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Distribuição por Sexo , Cirurgiões/economia , Cirurgiões/estatística & dados numéricos , Estados Unidos
18.
Nutrients ; 12(9)2020 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-32825251

RESUMO

The coronavirus disease (COVID-19) pandemic has increased unemployment and food insecurity in the United States (US). Prior to the pandemic, college students exhibited higher rates of food insecurity than nonstudent households. The objectives of this study were to assess the prevalence and determinants of food insecurity among college students during the COVID-19 pandemic. We administered an online survey to 651 students on three diverse campuses at a state-funded university in Texas, US, in May 2020. Food security was assessed using a multistep approach that included the 2-item Food Sufficiency Screener and 6-Item USDA Food Security Survey Module (FSSM). Overall, 34.5% of respondents were classified as food insecure within the last 30 days. The strongest predictors of food insecurity were change in current living arrangement (OR = 2.70, 95% CI: 2.47, 2.95), being furloughed (OR = 3.22, 95% CI: 2.86, 3.64), laid off (OR = 4.07, 95% CI: 3.55, 4.66), or losing part-time work (OR = 5.73, 95% CI: 5.09, 6.46) due to the COVID-19 pandemic. These findings highlight the high prevalence of food insecurity among college students during the COVID-19 pandemic, with students who experienced housing insecurity and/or loss of income due to the pandemic being impacted the most.


Assuntos
Infecções por Coronavirus/economia , Abastecimento de Alimentos/estatística & dados numéricos , Pandemias/economia , Pneumonia Viral/economia , Determinantes Sociais da Saúde/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Adolescente , Adulto , Betacoronavirus , Feminino , Humanos , Renda/estatística & dados numéricos , Masculino , Prevalência , Texas/epidemiologia , Estados Unidos/epidemiologia , Universidades , Adulto Jovem
19.
Geriatr Gerontol Int ; 20(10): 860-866, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32830907

RESUMO

AIM: A better income condition has always been associated with better cognition; however, studies that have demonstrated the pathway of this relationship are limited. We aim to evaluate the mediation effect of depression in this association, and whether this mediation is moderated by the place of residence. METHODS: We conducted a face-to-face study, including 3230 older adults aged >60 years in Xiamen, China, in 2016. The income condition of participants was categorized into three groups: income less than expenditure, income equals expenditure and income more than expenditure. Depression was measured using the Geriatric Depression Scale and cognition was evaluated using the Montreal Cognitive Assessment tool. We first examined a simple mediation model where depression was a mediator between income condition and cognition. Furthermore, residence was systematically integrated into the model as a moderator, and the model was adjusted for age, gender, number of year of education, hypertension and diabetes. All mediation and moderated mediation effects were estimated by the plug-in "PROCESS" in SPSS. RESULTS: In total, 2852 participants were finally included. Depression partially mediated the relationship between income condition and cognition (indirect effect = 0.25, total effect = 0.72). Moderated mediation analyses indicated that a direct effect only existed among urban older adults (B = 0.92; 95% confidence interval [CI]: [0.47-1.38]), whereas an indirect effect was stronger for individuals in urban (B = 0.28; 95% CI: [0.18-0.41]) rather than rural environments (B = 0.17; 95% CI: [0.11-0.26]). CONCLUSIONS: A better income condition is a protective factor for cognition and it partially benefits work through milder depressive symptoms, particularly in older adults in urban residences. Geriatr Gerontol Int 2020; 20: 860-866.


Assuntos
Cognição , Depressão/epidemiologia , Renda/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Idoso , China/epidemiologia , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade
20.
Lancet Public Health ; 5(7): e386-e394, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32619540

RESUMO

BACKGROUND: The rapid growth of the size of the older population is having a substantial effect on health and social care services in many societies across the world. Maintaining health and functioning in older age is a key public health issue but few studies have examined factors associated with inequalities in trajectories of health and functioning across countries. The aim of this study was to investigate trajectories of healthy ageing in older men and women (aged ≥45 years) and the effect of education and wealth on these trajectories. METHODS: This population-based study is based on eight longitudinal cohorts from Australia, the USA, Japan, South Korea, Mexico, and Europe harmonised by the EU Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) consortium. We selected these studies from the repository of 17 ageing studies in the ATHLOS consortium because they reported at least three waves of collected data. We used multilevel modelling to investigate the effect of education and wealth on trajectories of healthy ageing scores, which incorporated 41 items of physical and cognitive functioning with a range between 0 (poor) and 100 (good), after adjustment for age, sex, and cohort study. FINDINGS: We used data from 141 214 participants, with a mean age of 62·9 years (SD 10·1) and an age range of 45-106 years, of whom 76 484 (54·2%) were women. The earliest year of baseline data was 1992 and the most recent last follow-up year was 2015. Education and wealth affected baseline scores of healthy ageing but had little effect on the rate of decrease in healthy ageing score thereafter. Compared with those with primary education or less, participants with tertiary education had higher baseline scores (adjusted difference in score of 10·54 points, 95% CI 10·31-10·77). The adjusted difference in healthy ageing score between lowest and highest quintiles of wealth was 8·98 points (95% CI 8·74-9·22). Among the eight cohorts, the strongest inequality gradient for both education and wealth was found in the Health Retirement Study from the USA. INTERPRETATION: The apparent difference in baseline healthy ageing scores between those with high versus low education levels and wealth suggests that cumulative disadvantage due to low education and wealth might have largely deteriorated health conditions in early life stages, leading to persistent differences throughout older age, but no further increase in ageing disparity after age 70 years. Future research should adopt a lifecourse approach to investigate mechanisms of health inequalities across education and wealth in different societies. FUNDING: European Union Horizon 2020 Research and Innovation Programme.


Assuntos
Escolaridade , Disparidades nos Níveis de Saúde , Envelhecimento Saudável , Renda/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Austrália , Estudos de Coortes , Europa (Continente) , Feminino , Humanos , Japão , Masculino , México , Pessoa de Meia-Idade , República da Coreia , Estados Unidos
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