The dynamics of health and its determinants among the elderly in developing countries

Economic shocks, health, and social protection: The effect of COVID-19 income shocks on health and mitigation through cash transfers in South Africa

COVID-19 caused an unprecedented health and economic crisis. Nation-wide lockdowns triggered major economic disruptions across the world. We provide evidence of the impact of these extreme economic shocks on health outcomes across wealth levels. We further identify if cash transfers can mitigate the negative health effects for the most economically vulnerable. The study focuses on South Africa, an Upper Middle-Income Country with high levels of inequality, a large informal labor market and with low levels of social welfare. Using difference-in-difference estimation (DD) on a longitudinal sample of 6437 South Africans, we find that the lockdown income shock significantly reduces health by 0.2 standard deviations (SD). We find no difference of the effect across wealth quartiles. Exposure to a cash transfer program mitigates the negative health effects for recipients in the lowest wealth quartile to 0.25 SD compared to 0.4 SD for non-recipients. Full mitigation occurs for individuals exposed to an on average higher scale-up of the cash transfer program. Our analysis shows that a lockdown induced income shock caused adverse health outcomes; however, a pro-poor cash transfer program protected the most economically vulnerable from these negative health effects.

Interaction Between Self-rated Health and Labour Force Participation: A Panel Data Probit Model with Survival Estimates

This study aimed to reveal the relationship between health and labour in Turkey under the intervention of demographic variables. Four waves of the TurkStat Income and Living Conditions Panel Survey (2008–2011) were used. Demographic, education, self-rated health and labour force participation indicators were used to examine different generalised linear model (GLM)-like panel binomial probit model specifications using self-assessed health (SAH) status and self-reported working status (SRWS) as dependent variables. Kaplan–Meier (KM) estimates for the probability of survival in SAH and SRWS were examined using the X2 values of the log-rank and Peto–Peto–Prentice tests for equality of survivor functions by study variables. Study results reveal that the hazard of assessing good health and currently working increases for individuals who are married ( p < 0.001), highly educated ( p < 0.001), do not have any chronic disease ( p < 0.001), do not have any health restrictions ( p < 0.001) and occupy high-qualification jobs ( p < 0.001). KM estimates support the panel model results. The present study reveals that demographic, education, self-rated health and labour force participation are the driving forces in the interaction of health and labour dynamics. Reducing income inequality, increasing the minimum wage and improving working conditions, while promoting gender equality, are essentials of better management of health and labour markets.

Re-Irradiation in Patients with Recurrent Rectal Cancer is Safe and Feasible

BACKGROUND

There is no consensus yet for the best treatment regimen in patients with recurrent rectal cancer (RRC). This study aims to evaluate toxicity and oncological outcomes after re-irradiation in patients with RRC in our center. Clinical (cCR) and pathological complete response (pCR) rates and radicality were also studied.

METHODS

Between January 2010 and December 2018, 61 locally advanced RRC patients were treated and analyzed retrospectively. Patients received radiotherapy at a dose of 30.0-30.6 Gy (reCRT) or 50.0-50.4 Gy chemoradiotherapy (CRT) in cases of no prior irradiation because of low-risk primary rectal cancer. In both groups, patients received capecitabine concomitantly.

RESULTS

In total, 60 patients received the prescribed neoadjuvant (chemo)radiotherapy followed by surgery, 35 patients (58.3%) in the reRCT group and 25 patients (41.7%) in the long-course CRT group. There were no significant differences in overall survival (p = 0.82), disease-free survival (p = 0.63), and local recurrence-free survival (p = 0.17) between the groups. Patients in the long-course CRT group reported more skin toxicity after radiotherapy (p = 0.040). No differences were observed in late toxicity. In the long-course CRT group, a significantly higher cCR rate was observed (p = 0.029); however, there was no difference in the pCR rate (p = 0.66).

CONCLUSIONS

The treatment of RRC patients with re-irradiation is comparable to treatment with long-course CRT regarding toxicity and oncological outcomes. In the reCRT group, less cCR was observed, although there was no difference in pCR. The findings in this study suggest that it is safe and feasible to re-irradiate RRC patients.

Air Pollution and Long Term Mental Health

We study the long-term consequences of air pollution on mental health, using a natural experiment in Indonesia. We find that exposure to severe air pollution has significant and persistent consequences on mental health. An extra standard deviation in the pollution index raises the probability of clinical depression measured 10 years past exposure by almost 1%. Women in particular seem to be more affected, but some effects persist for men as well. Pollution exposure increases the likelihood of clinical depression for women and also the severity of depressive symptoms for both sexes. It is not clear if men are more resistant to pollution or they simply recover faster from it. Education, perceived economic status, and marriage seem to be the best mitigators for these negative effects.

Parental human capital and child health at birth in India

Health at birth shapes an individual's well-being over her life cycle. We categorize the Indian states into high and low infant mortality regions to capture the diverse disease environment and analyze the nature of the association between parental human capital and child survival and nutrition measures at birth. We restrict our analysis only to firstborns to avoid confounding from a number of factors including sex-selective abortions in the higher birth orders. We broadly find that parental human capital, especially maternal health, is a strong and significant predictor of a child's birth outcomes under adverse disease environment. In the rural areas of the high infant mortality states, a 10-centimeter increase in maternal height is associated with 1.7% lower probability of a child dying as a neonate and 5% increase in birth weight around the mean. These estimates suggest that an investment in human capital of the mothers from this region could accompany large gains in survival and nutrition outcomes of their children.

The Association between Height and Hypertension in Indonesia

There is growing interest in the influence of early-life conditions on the development of disease. Among diseases in adulthood, hypertension is particularly important for the developing world because considerably more people there are and will be afflicted with the disease than in the developed world and hypertensives there are often unaware of their disease status. We employed height as a proxy for the influence of early-life conditions and estimated the relation between height and hypertension status in Indonesia. We analysed 9,597 men and 10,143 women, aged 25-70. We employed a linear probability model to relate height to hypertension status by sex and age. When we controlled for an array of covariates, a 10cm increase in height was related to an approximately 7% point reduction in the likelihood of being hypertensive for both men and women. This is about a quarter of the prevalence of hypertension in Indonesia. This relation was linear and stronger among older individuals. In addition, the pre- and post-pubertal environments (measured by leg and trunk lengths, respectively) contributed similarly to hypertension. Further evidence suggests that women are more likely to be hypertensive at older ages because they are on average shorter than men.

Long-run health consequences of air pollution: Evidence from Indonesia's forest fires of 1997

While many studies in the medical literature documented causal relationships between air pollution and negative health outcomes immediately following exposure, much less is known about the long run health consequences of pollution exposure. Using the 1997 Indonesian forest fires as a natural experiment, we estimate the long term effects of air pollution on health outcomes. We take advantage of the longitudinal nature of the Indonesia Family Life Survey (IFLS), which collects detailed individual data on a multitude of health outcomes, in both 1997 and 2007. We find significant negative effects of pollution, which persist in the long run. Men and the elderly are impacted the most, while children seem to recover almost completely from these early shocks. For the entire population, an extra standard deviation in the pollution level increases the likelihood of a poor general health status by almost 3%.

Sustaining Effect of Intensive Nutritional Intervention Combined with Health Education on Dietary Behavior and Plasma Glucose in Type 2 Diabetes Mellitus Patients

Diabetes mellitus is very common in elderly Chinese individuals. Although nutritional intervention can provide a balanced diet, the sustaining effect on at-home dietary behavior and long-term plasma glucose control is not clear. Consequently, we conducted a long-term survey following one month of experiential nutritional intervention combined with health education. Based on the Dietary Guidelines for a Chinese Resident, we found that the food items met the recommended values, the percentages of energy provided from fat, protein, and carbohydrate were more reasonable after one year. The newly formed dietary patterns were “Healthy”, “Monotonous”, “Vegetarian”, “Japanese”, “Low energy”, and “Traditional” diets. The 2h-PG of female participants as well as those favoring the “Japanese diet” decreased above 12 mmol/L. Participants who selected “Japanese” and “Healthy” diets showed an obvious reduction in FPG while the FPG of participants from Group A declined slightly. “Japanese” and “Healthy” diets also obtained the highest DDP scores, and thus can be considered suitable for T2DM treatment in China. The results of the newly formed dietary patterns, “Japanese” and “Healthy” diets, confirmed the profound efficacy of nutritional intervention combined with health education for improving dietary behavior and glycemic control although health education played a more important role. The present study is encouraging with regard to further exploration of comprehensive diabetes care.