[Self-rated health in adults: influence of poverty and income inequality in the area of residence]

[Intestinal parasites in schoolchildren, public health problem. Intervention from the National Integrated Health System of Uruguay]

OBJECTIVES

To generate a model of intervention, from the National Integrated Health System (NIHS, Uruguay), with school facilitators of health, web resources and approach from the schools to the community.

MATERIALS AND METHODS

Descriptive cross-sectional study of population base using a random sampling, non-clustered, during the months of April and December 2016. This was based in the model of schoolchildren health promoters, the use of web resources and community approach with the school as the centre of actions.

RESULTS

The prevalence of parasites was 14% for Giardiasis (6,5 and 22%) (IC95%: 11-17) and 26% for Oxiurosis (IC95%: 22-30) (20 and 44%). Soil transmitted helminthiases were geo-referenced: we found 45 clusters, mainly in slums without basic services.

CONCLUSIONS

These worrying results show that there are regions in Montevideo (Uruguay) with high levels of faecal home and environmental contamination. Community approaches with prevention activities from NIHS may have a positive impact on these vulnerable populations.

Comparing socio-economic inequalities in self-reported and undiagnosed hypertension among adults 45 years and over in India: what explains these inequalities?

BACKGROUND

Hypertension (HTN) is a leading cause of mortality and morbidity in developing countries. For India, the hidden burden of undiagnosed hypertension is a major concern. This study aims to assess and explain socio-economic inequalities among self-reported and undiagnosed hypertensives in India.

METHODS

The study utilized data from the Longitudinal Aging Study in India (LASI), a nationally-representative survey of more than 72,000 older adults. The study used funnel plots, multivariable logistic regression, concentration indices, and decomposition analysis to explain the socio-economic gap in the prevalence of self-reported and undiagnosed hypertension between the richest and the poorest groups.

RESULTS

The prevalence of self-reported and undiagnosed hypertension was 27.4 and 17.8% respectively. Monthly per capita consumption expenditure (MPCE) quintile was positively associated with self-reported hypertension but negatively associated with undiagnosed hypertension. The concentration index for self-reported hypertension was 0.133 (p < 0.001), whereas it was - 0.047 (p < 0.001) for undiagnosed hypertension. Over 50% of the inequalities in self-reported hypertension were explained by the differences in the distribution of the characteristics whereas inequalities remained unexplained for undiagnosed hypertension. Obesity and diabetes were key contributors to pro-rich inequality.

CONCLUSIONS

Results imply that self-reported measures underestimate the true prevalence of hypertension and disproportionately affect the poorer MPCE groups. The prevalence of self-reported HTN was higher in the richest group, whereas socio-economic inequality in undiagnosed hypertension was significantly concentrated in the poorest group. As majority of the inequalities remain unexplained in case of undiagnosed hypertension, broader health systems issues including barriers to access to health care may be contributing to inequalities.

Aging and self-reported health in 114 Latin American cities: gender and socio-economic inequalities

BACKGROUND

Understanding how urban environments influence people's health, especially as individuals age, can help identify ways to improve health in the rapidly urbanizing and rapidly aging populations.

OBJECTIVES

To investigate the association between age and self-reported health (SRH) in adults living in Latin-American cities and whether gender and city-level socioeconomic characteristics modify this association.

METHODS

Cross-sectional analyses of 71,541 adults aged 25-97 years, from 114 cities in 6 countries (Argentina, Brazil, Colombia, Chile, El Salvador, and Guatemala), as part of the Salud Urbana en America Latina (SALURBAL) Project. We used individual-level age, gender, education, and self-reported health (SRH) data from harmonized health surveys. As proxies for socioeconomic environment we used a city-level socioeconomic index (SEI) calculated from census data, and gross domestic product (GDP) per-capita. Multilevel Poisson models with a robust variance were used to estimate relative risks (RR), with individuals nested in cities and binary SRH (poor SHR vs. good SRH) as the outcome. We examined effect modification by gender and city-level socioeconomic indicators.

RESULTS

Overall, 31.4% of the sample reported poor SRH. After adjusting for individual-level education, men had a lower risk of poor SRH (RR = 0.76; CI 0.73-0.78) compared to women, and gender modified the association between age and poor SRH (p-value of interaction < 0.001). In gender stratified models, the association between older age and poor SRH was more pronounced in men than in women, and in those aged 25-65 than among those 65+ (RR/10 years = 1.38 vs. 1.10 for men, and RR/10 years = 1.29 vs. 1.02 for women). Living in cities with higher SEI or higher GDP per-capita was associated with a lower risk of poor SRH. GDP per-capita modified the association between age (25-65) and SRH in men and women, with SEI the interaction was less clear.

CONCLUSIONS

Across cities in Latin America, aging impact on health is significant among middle-aged adults, and among men. In both genders, cities with lower SEI or lower GDP per-capita were associated with poor SRH. More research is needed to better understand gender inequalities and how city socioeconomic environments, represented by different indicators, modify exposures and vulnerabilities associated with aging.

The Influence of Physical Activity, Anxiety, Resilience and Engagement on the Optimism of Older Adults

The purpose of this study was to learn how physical activity, anxiety, resilience and engagement can influence optimism in older adults. An observational, quantitative, descriptive and transversal design was used with non-probabilistic sampling. A descriptive statistical analysis of the sample, Cronbach's alpha test of internal consistency and linear correlation using Pearson's correlation coefficient (r) were performed. In addition, a t-Student test, analysis of variance (ANOVA), Kolmogorov-Smirnov test of normality and Levene test of homogeneity, as well as a multivariate linear regression model, were conducted. Participants who had not engaged in physical activity showed an increased total anxiety and significantly greater decrease in concentration compared to those who had engaged in physical activity. The Revised Life Orientation Test (LOT-R), Utrecht Work Engagement Scale (UWES) and resilience of participants who had not engaged in physical activity were significantly lower than those of the participants who had engaged in physical activity. Those with a partner showed significantly lower decreases in concentration compared to single women. Regarding UWES, the current scores and dedication of couples were significantly higher than singles, as for resilience. In addition, the levels of pessimism in participants living on the coast were significantly higher compared to those living inland; in addition, a greater number of days with less anxiety is seen in those who performed physical activity. A multivariate linear regression model, F(7, 349) = 30.6, p < 0.001, explained 38% of the variance of LOT-R; those attending a public center had a lower LOT-R than those who did not, and high values of anxiety were associated with low levels of LOT-R, while high values of resilience were associated with high values of LOT-R. The results from the study provide support for future programs for older adults, in order to be able to determine in a much more precise way the objectives of programs intended for users of this age group.