The selective child welfare funnel. Children's exposure to violence and CWS investigations in Sweden

BACKGROUND

Research indicates that child welfare services reach out to children exposed to violence unequally depending on the child's social background, living conditions and violence type.

OBJECTIVE

Based on the notion of selective recognition of vulnerability and risk, this study explores which children CWS pursue to a complete child welfare investigation.

PARTICIPANTS AND SETTING

A register was set up including all children (n = 1764) between 7 and 12 years that were investigated for suspected exposure to violence by CWS in the municipality of the City of Stockholm, Sweden, in 2019.

METHODS

This cohort was systematically compared to demographic data and national self-report prevalence studies to explore possible biases regarding which children CWS investigates. Descriptive analysis, cluster analysis and logistic regressions were used.

RESULTS

The results confirm previous research that children exposed to violence have reduced access to material resources and inferior living conditions compared to non-exposed children. Physical abuse is more prevalent among boys of foreign backgrounds in stable, two-parent families residing in higher-status suburbs. Conversely, neglect is more common among children of Swedish backgrounds in low-income, single-parent households living in low-status suburbs. In comparison with self-reported prevalence studies, sexual and psychological abuse seem underrepresented in the study group, while neglect and violence in the family are relatively more frequently investigated compared to self-reported prevalence studies.

CONCLUSIONS

The results indicate that CWS should develop its methods to reach certain vulnerable groups that are underrepresented for safeguarding and support, for example, girls exposed to sexual abuse.

Prognostic factors for long-term outcome in children with fetal alcohol spectrum disorders

INTRODUCTION

Known protective factors for long-term outcome in children with fetal alcohol spectrum disorders (FASD) are early diagnosis and a stable, non-violent supportive environment. Which factors contribute to the stability of care is not yet known. Thus, the aim of our study was to evaluate whether the age at diagnosis and the complexity of brain dysfunction play a role for placement changes in children with FASD.

MATERIALS AND METHODS

An online survey was conducted among caregivers and professionals caring for children with FASD and seeking help at the German FASD Competence Centre Bavaria (N = 232). The survey collected information about diagnosis, brain dysfunctions, behavioural factors influencing everyday life and changes of placement. The association of timing of diagnosis, brain dysfunctions and neurobehavioral impairment with changes of placement (<2 vs. 2 or more changes) was evaluated via logistic regression models.

RESULTS

About 50% of the children received their diagnosis of FASD after the age of 5 years. The complexity of brain dysfunctions in children with FASD affecting everyday life was high. 15% of the children experienced four or more changes of placement. Children with more neuropsychological impairments experienced more changes of placement (OR: 2.53, 95% CI: 1.36-4.71).

CONCLUSIONS

Even though our results need to be interpreted with caution due to methodological limitations such as the use of a convenience sample and limited statistical power, they imply that severely affected children with FASD experience a less stable environment. These children may therefore be at high risk for a negative prognosis. To warrant a better prognosis for the affected children, professionals urgently need to pay attention to early recognition and the complexity of neuropsychological impairments in children with FASD as well as to the support that caregivers urgently need.

A house is not a home: a network model perspective on the dynamics between subjective quality of living conditions, social support, and mental health of refugees and asylum seekers

BACKGROUND

Providing adequate living conditions for forcibly displaced people represents a significant challenge for host countries such as Germany. This study explores refugee mental health's reciprocal, dynamic relationship with post-migration living conditions and social support.

METHODS

The study sample included 325 Arabic- or Farsi-speaking asylum seekers and refugees residing in Germany since 2014 and seeking mental health treatment. Associations between reported symptoms of post-traumatic stress and depression and the subjective quality of living conditions and perceived social support were analyzed using a two-level approach including multiple linear regression and network analyses.

RESULTS

Post-migration quality of living conditions and perceived social support were significantly associated with negative mental health outcomes on both levels. In the network, both post-migration factors were negatively connected with overlapping symptoms of psychiatric disorders, representing potential target symptoms for psychological treatment.

CONCLUSION

Post-migration quality of living conditions and social support are important factors for refugee mental health and should be targeted by various actors fostering mental well-being and integration.

Opportunistic non-communicable diseases in times of COVID-19

We previously proposed the term "opportunistic non-communicable diseases (NCDs)" to raise awareness of how NCDs thrive in societies with inadequate healthcare services. However, we did not anticipate that within the next year the new corona virus disease (COVID-19) would sweep the globe. Lockdowns became the primary strategy for mitigation in most countries. However, the extensive restrictions and allocation of resources towards the containment of the pandemic has likely served as a catalyst of NCDs, especially in populations, societies, and individuals already at high risk. We are presenting evidence to qualify two primary factors responsible for the potential impact on the development of NCDs during the COVID-19 pandemic. The first is disrupted healthcare services including avoidance and postponement of health care visits. The second is effects of changing lifestyle and living conditions including isolation, loss of job and income. The accumulated effect of these factors will likely further accelerate the development of NCDs and impair their management, especially in low- and middle-income countries. Insufficient vaccination coverage due to inequality in vaccine distribution and vaccine hesitancy left room for the incubation of immune-evasive variants that threatened to sustain or reinitiate the pandemic. We believe the concept of opportunistic NCDs and the potential catalytic effect that pandemics may have on the development of NCDs and their management, should be used as further arguments to secure equal vaccine distribution, promote global vaccine acceptance and to speed up and increase investments in primary health care in low and middle-income countries to cope with the already existing NCD crisis and to prepare for future epidemics.

The effects of living and learning conditions on the health-related quality of life of children and adolescents during the COVID-19 lockdown in the French Grand Est region

INTRODUCTION

COVID-19 lockdown measures resulted in children and adolescents staying and learning at home. This study investigated health-related quality of life (HRQoL) and its associated factors among youth during the first lockdown.

METHODS

A cross-sectional study was conducted among 8- to 18-year-olds from the French Grand Est region. Sociodemographic data and information on living and learning conditions were collected using an online survey. HRQoL was assessed using the KIDSCREEN-27. Multiple regression analysis was performed to explore factors related to low HRQoL in each dimension.

RESULTS

In total, 471 children from 341 households were included. Difficulties isolating at home were associated with low HRQoL in the psychological well-being (OR = 2.2, 95% CI: 1.2-4.0) and parent relations and autonomy (OR = 2.1, 95% CI: 1.2-3.8) dimensions. Conflicts with dwelling occupants were related to increased ORs in the psychological well-being (OR = 2.9, 95% CI: 1.9-4.6), parent relations and autonomy (OR = 2.2, 95% CI: 1.4-3.4) and school environment (OR = 2.4, 95% CI: 1.5-3.7) dimensions. Living in an apartment (OR = 1.8, 95% CI: 1.1-3.1), never leaving home (OR = 2.6, 95% CI: 1.2-5.9), having indoor noise at home (OR = 2.3, 95% CI: 1.2-4.6), and having a parent with high anxiety (OR = 1.8, 95% CI: 1.1-3.1) were associated with low HRQoL in the social support and peers dimension. Children working less than 1 h/day on schoolwork had an increased OR of 3.5 (95% CI: 1.4-9.0) in the school environment dimension.

CONCLUSION

Living and learning conditions were associated with low HRQoL among children and adolescents during the COVID-19 lockdown. Prevention and intervention programs are needed to support youth by facilitating their interactions and improving their coping and to prepare for future waves.

Effect of the COVID-19 outbreak and lockdown on mental health among post-secondary students in the Grand Est region of France: results of the PIMS-CoV19 study

BACKGROUND

The COVID-19 epidemic has sent students around the world in to lockdown. This study sought to assess the prevalence of impaired self-perceived mental health and identify associated factors among French post-secondary students during the lockdown.

METHODS

A cross-sectional study was conducted among French students living in the Grand Est area in France from May 7 to 17, 2020 during the first lockdown. An online survey was used to collect sociodemographic data, learning and teaching conditions, living conditions, and exposure to COVID-19, and self-perceived mental health was assessed with mental composite score (MCS) of the SF-12.

RESULTS

Overall, 4018 were analyzed. Most participants were female (70.7%), and the mean age was 21.7 years (SD 4.0). The mean MCS score was 44.5 (SD 17.3). Impaired mental health, defined by a MCS < 1st Quartile, was mainly associated with female sex; decreased time for learning; not having access to the outside with a garden, a terrace or a balcony; difficulties with the living situation and having someone in the home affected by the SARS-COV2 requiring hospitalization or not.

CONCLUSIONS

This study showed that living conditions during lockdown had a clear impact on the mental health of French post-secondary students. There is a need to improve prevention and to access distance education as well as an urgent need for measures to develop healthy coping strategies for students. This is significant challenge and will assist in moderating the risk for the development of further distress and mental health concerns.

Urban environments and COVID-19 in three Eastern states of the United States

The United States has the highest numbers of confirmed cases and deaths during the novel coronavirus disease 2019 (COVID-19) pandemic. Previous studies reported that urban residents are more vulnerable to the spread and mortality of COVID-19 than rural residents. However, the pathways through which urban environments affect COVID-19 spread and mortality are unclear. We collected daily data on the number of confirmed cases and deaths of COVID-19 from Mar. 01 to Nov. 16, 2020 for all 91 counties in New York, New Jersey, and Connecticut in the United States. We calculated the COVID-19 incidence %, daily reproduction number, and mortality %, then estimated the associations with urban environment indicators using regression models. COVID-19 outcomes were generally highest in areas with high population density, and this pattern was evident in the early period of epidemic. Among the area-level demographic variables, the percentage of Black or Hispanic residents showed the strongest positive association with COVID-19 outcomes. Higher risk of COVID-19 outcomes was also associated with higher percentage of overcrowded households, uninsured people, and income inequality. The percent elderly, sex ratio (the ratio of males to females), and greenness were negatively associated with risk of COVID-19 outcomes. The results of this study could indicate where resources are most needed.

Psychological distress and living conditions among Japanese single-mothers with preschool-age children: An analysis of 2016 Comprehensive Survey of Living Conditions

BACKGROUND

The early life period provides a critical foundation for child health and development, and mothers exert great influence as primary caregivers. Previous studies have shown that single-motherhood is associated with negative child outcomes. In Japan, few studies have addressed the situation faced by single-mothers with young children, such as living conditions and mental health issues.

METHODS

We utilized nationwide data from the Comprehensive Survey of Living Conditions (2016), collected by the Japanese Ministry of Health, Labour and Welfare and compared mothers from single-mother households with those from two-parent households, with further subdivision by intergenerational cohabitation. Socio-demographic characteristics, lifestyle habits, psychological distress, subjective health status, and stress were examined.

RESULTS

We observed that single-mothers without intergenerational cohabitation seemed to experience harsh living conditions compared to other types of households. Severe psychological distress was observed in 11% of single-mothers without cohabitation compared with 6% among single-mothers with cohabitation and 4% among mothers of two-parent households. Multivariate analysis adjusting for demographic variables showed about a two-fold increased risk of severe psychological distress (OR=2.34, 95% CI: 1.71-3.22) associated with single-mothers without intergenerational cohabitation compared to mothers from two-parent household without cohabitation. Single-mothers without cohabitation tended to smoke and drink alcohol frequently and seemed sleep-deprived.

LIMITATIONS

Due to the cross-sectional design, we could not make inference on causality.

CONCLUSIONS

Our study highlighted needs for targeted support for single-mothers without intergenerational cohabitation. Efforts in public health and other related fields may present opportunities to reduce negative intergenerational impacts of adversities among socially vulnerable families.

[Indirect and direct psychosocial consequences of the corona pandemic-part 1 of a (preliminary) review]

The pandemic triggered by the coronavirus disease 2019 (COVID-19) has, apart from a few positive effects, led to massive and manifold impairments of human living conditions for which this article suggests a taxonomy. According to the severity, these impairments have resulted in a deterioration of the psychological well-being for many people and an increased vulnerability for psychological disorders. This has been confirmed by numerous studies and review articles, which also dealt with the question of factors that positively as well as negatively influencing mental health. This review shows that, e.g. suffering from COVID-19 disease, younger age and female gender as well as a pre-existing psychiatric or somatic disease must be considered as special risk factors. Psychotherapists are confronted with the pandemic in different ways. In view of the societal impact psychotherapists have a special role. In addition, the pandemic raises questions on specific issues and specific groups which must be addressed.

The Reasons for Using Smokeless Tobacco: A Review

Background:

Smokeless tobacco use is a public health problem in some parts of the world. The major objective of this study was to investigate the reasons and factors of consumption.

Methods:

A content analysis was conducted on articles for the past thirty years (1989–2019). We reviewed and selected 400 abstracts of original articles from PubMed databases by the search strategy, and reviewed one by one. Among these, 45 abstracts were selected, in which the patterns of use, the reasons for using, and the determinants and predictors were described. Eleven papers were selected based on the results and related to the research objectives. The results of these articles were evaluated precisely word by word and phrase by phrase with content analysis method and inductive approach.

Results:

The reasons for the use of smokeless tobacco fell in two main themes: socio-cultural structure; and, beliefs, each contained Sub-themes such as “culture and living conditions”, “laws”, “family and peer relationships”, “beliefs related to psychological” and “beliefs related to physical influences”, “beliefs”, “The role of harm perceptions “.

Conclusion:

There was a difference between beliefs, cultures and social conditions among the people about using of smokeless tobacco and the association of these factors is investigated in future studies. We also suggest for the prevention and control of smokeless tobacco use, cultural norms and beliefs will need to address adequately.

[The suffering surgeon-How do German surgeons protect themselves? : Survey of the German Society of General and Visceral Surgery on the extent of occupational safety measures and health burden among German surgeons]

BACKGROUND

There are few data on how surgeons implement occupational safety measures to protect their own health and how they assess their subjective health burden.

OBJECTIVE

In times of a shortage of surgeons it makes sense to examine these relationships in order to evaluate future-oriented adjustments to increase the attractiveness of the profession of "surgeon".

MATERIAL AND METHODS

An online questionnaire was sent to the registered members of the German Society for General and Visceral Surgery (DGAV) in October 2016. The members were asked about the application of occupational safety measures, individual living conditions, working conditions and the subjective health burden depending on the level of training and type of hospital (basic, standard, maximum care).

RESULTS

The response rate was 21% (1065/5011). Occupational safety measures were not strictly implemented: routine use of dosimeters, thyroid radiation protection, smoke extraction and protective goggles only took place in 40% (427/1065), 39% (411/1065), 10% (104/1065) and 5% (55/1065), respectively. The majority of surgeons (51%, 548/1065) rated their lifestyle as unhealthy. The majority of them are senior physicians, 46% (250/548) consider their job to be a health hazard. The proportion of chief physicians and assistant physicians is only 21% (115/548) and 18% (98/548).

CONCLUSION

Guidelines for standardizing the perioperative protection of German surgeons are desirable. Health-promoting behavior could have a positive effect on the occupational safety of surgeons and ultimately also on patient safety. This can contribute to increasing the attractiveness of the profession "surgeon" in the long term.

Increased incidence of metabolic syndrome among older survivors relocated to temporary housing after the 2011 Great East Japan earthquake & tsunami

Background

Beyond the immediate toll of injuries and deaths, major disasters are often associated with long-term increased risks of chronic disease. We sought to investigate the incidence of metabolic syndrome (MetS) among survivors of the 2011 Great East Japan Earthquake and tsunami.

Methods

Subjects aged ≥18 years from the tsunami-stricken area participated in a prospective cohort study of disaster survivors (the RIAS Study) from 2011 to 2015. After excluding subjects who were previously diagnosed with MetS, we observed the cumulative incidence of MetS across four annual examinations among 7318 subjects (mean age, 59.8 years; 43.5% men). We defined MetS using the International Diabetes Foundation criteria.

Results

The 4-year cumulative incidence of MetS was 18.0% in the overall sample. The incidence was significantly higher among older women survivors relocated to prefabricated temporary housing (40.9%, 95% confidence interval, 36.4-44.6), and other types of housing (36.2%, 95% CI: 32.3-40.6) compared to those who were not relocated (34.1%, 95% CI: 30.9-37.4). An increase in incidence of MetS was not observed for older men, or younger survivors aged ≤64 years.

Conclusion

Relocation to prefabricated temporary housing was a risk factor for increased incidence of MetS in older women.

Quality of life outcomes for people with serious mental illness living in supported accommodation: systematic review and meta-analysis

PURPOSE

To conduct a systematic review and meta-analysis of quality of life (QoL) outcomes for people with serious mental illness living in three types of supported accommodation.

METHODS

Studies were identified that described QoL outcomes for people with serious mental illness living in supported accommodation in six electronic databases. We applied a random-effects model to derive the meta-analytic results.

RESULTS

13 studies from 7 countries were included, with 3276 participants receiving high support (457), supported housing (1576) and floating outreach (1243). QoL outcomes related to wellbeing, living conditions and social functioning were compared between different supported accommodation types. Living condition outcomes were better for people living in supported housing ([Formula: see text]= - 0.31; CI = [- 0.47; - 0.16]) and floating outreach ([Formula: see text]= - 0.95; CI = [- 1.30; - 0.61]) compared to high-support accommodation, with a medium effect size for living condition outcomes between supported housing and floating outreach ([Formula: see text]= - 0.40; CI = [- 0.82; 0.03]), indicating that living conditions are better for people living in floating outreach. Social functioning outcomes were significant for people living in supported housing compared to high support ([Formula: see text] = - 0.37; CI = [- 0.65; - 0.09]), with wellbeing outcomes not significant between the three types of supported accommodation.

CONCLUSION

There is evidence that satisfaction with living conditions differs across supported accommodation types. The results suggest there is a need to focus on improving social functioning and wellbeing outcomes for people with serious mental illness across supported accommodation types.

New anthropometric evidence on living standards in nineteenth-century Chile

A sample of over 44 thousand Chilean marines was used to estimate the trend of mean heights from the 1820s to the 1890s. We confirm that there was height stagnation in the last decades of the nineteenth-century Chile despite sizeable per capita GDP growth; there were hidden nutritional costs to this economic growth. This situation resembles a similar puzzle in antebellum USA or early industrial Britain, but in the case of Chile GDP growth is not explained by industrialization but by export-led-growth. Still, the results are similar: height stagnation. Regarding the determinants of adult male height, our data also convincingly showed that there was a significant correlation between height and literacy. There was a positive correlation between height and white ethnicity, and, linked to this, a strong negative correlation between stature and eyes reported as "black". Finally, living in urban environments (or environments with higher population density) also negatively affected height.

Helicobacter pylori infection: association with dietary habits and socioeconomic conditions

INTRODUCTION

Few studies have investigated factors possibly related to the source of Helicobacter pylori infection in humans.

MATERIALS AND METHODS

This was a retrospective study including a population of 201 H.pylori positive patients and 259 H. pylori negative subjects observed at a tertiary referral center in Apulia. The H. pylori status was assessed by urea breath test. Data on socio-demographic characteristics and the consumption of different foods and beverages in the last year were collected by a questionnaire.

RESULTS

No significant relationship was found between H. pylori infection and gender or age, type of employment, working in direct contact with the public, residence, level of education or exposure to pets. No association between H.pylori status and the consumption of fish, fruits, legumes, honey, spices, meats, milk and milk products including some typical product of our area was found. The same was true for the consumption of several kind of beverage including green tea and wine. Cigarette smoking and living in the same house with H.pylori positive relatives were significantly associated with H. pylori positivity. The intake of uncooked seafood (mussels and other molluscs) as well as some uncooked vegetables such as tomatos,pepper,and chicory,municipal water and the number of cups of coffee consumed per week correlated significantly with H. pylori status. The consumption of raw vegetables purchased from street vendors and the consumption of meals outside home were also associated with H.pylori infection.

CONCLUSIONS

Foods may represent an important route in the transmission of H. pylori among humans.

Height development of men and women from China, South Korea, and Taiwan during the rapid economic transformation period of the 1960s-1980s

We study height trends among Chinese, South Korean, and Taiwanese groups during the rapid economic growth period of the 1960s to the 1980s. Heights rose strongly as income grew. Did rapid income growth also cause a decline in gender inequality? Or did it rise because the gains were unevenly distributed? Gender inequality is particularly interesting given the traditionally strong son preference in the region. For mainland China, we find that gender inequality was relatively modest in the pre-reform period (before the 1980s). Especially in comparison to the early 20th century, female heights grew faster than male heights. In contrast, the 1980s transition period to an economic system with market elements was characterized by increasing gender inequality in China. This was the case to an even greater extent in South Korea, where gender dimorphism noticeably increased during the 1980s, paralleling a similar increase in sex-selective abortions. Moreover, we also study other inequality patterns in the three countries, focusing on socioeconomic, regional, and educational differences between groups.

[Housing wishes of people with complex disabilities]

BACKGROUND

Article 19 of the United Nations (UN) Convention on the Rights of Persons with Disabilities requires people with disabilities to have the same possibilities as other people when choosing their place of residence and living environment. The question arises as to what extent this entitlement is currently ensured for people with complex disabilities and how their wishes can be ascertained in respect of living conditions.

OBJECTIVE

Identification and (further) development of methods and procedures to document the housing wishes of people with complex disabilities and nursing care needs.

METHODS

Implementation and evaluation of a systematic international literature search, survey of residential changes in the form of guided interviews, experimental testing and further development of methods and procedures for the identification of wishes related to living conditions.

RESULTS

It transpired that people with complex disabilities have limited choices regarding their housing situation. Useful information about housing and living wishes of the target group results, in particular, from employing person-centered methods. Furthermore, influencing factors and challenges, such as long-term experience of socialization in inpatient settings and of custodial decision-making are also identified.

CONCLUSION

Currently, housing and special wishes related to living conditions of the described target group are not high on the agenda. The recording of such wishes requires extensive knowledge of the individual and involves intensive personal interaction, so that the process of determining the ideal housing format proves to be time-consuming and resource-intensive.

Biological living standards in North Korea as reflected in famine to post-famine trends in birthweight, 1998-2009

This research investigates the trend in birthweight as an indicator of living conditions in early life inside North Korea, one of the most secluded nations in the world that experienced a great famine in the 1990s. Descriptive analysis based on data taken from officially released national nutrition survey reports suggests that prevalence of low birthweight (= below 2500 g) declined from 9.0% in the famine year of 1998-5.7% in the post-famine period of 2009. Mean birthweight improved from 2800 g in 1998-2940 g in 2002, although more recent surveys await implementation. Based on raw data comprising 2495 newborns measured at birth from 2000 to 2002 from a national nutrition survey conducted in 2002, neither contingency analysis nor error bar analysis showed statistically significant improvements during the observed periods. Regression analysis indicates that there is a significant positive relation between birthweight and birthyear, but the effect is negligibly small (0.0001 g). Raw data analysis of the 2002 survey further revealed that prevalence of low birthweight hovered at around 7% from 2000 to 2002. Overall, this prevalence of low birthweight was closer to the mean percentage for industrialized nations (6%) than that of developing nations (17%), although being expectedly much higher (that is, twice the rate) compared to its "twin" in South Korea (3.5%) at that time. Some technical, biological, and socio-economic biases affecting birthweight measurements in North Korea are discussed in a latter section of this paper.

Prevalence and risk factors for intestinal parasitic infections in pregnant women residing in three districts of Bogotá, Colombia

BACKGROUND

Intestinal parasitic infections (IPI) lead to significant morbidity and mortality in pediatric and adult populations worldwide. Intestinal parasitism during pregnancy is of interest as it may affect the health of pregnant women and their offspring. This study determined the prevalence of IPI in pregnant women living in substandard conditions in three urban districts of Bogotá, Colombia. Associations between prevalence and sociodemographic factors, housing, and living conditions were also evaluated.

METHODS

In a cross-sectional and community-based study, pregnant women were recruited from three districts of Bogotá. A total of 550 participants answered a questionnaire; 331 of these also provided stool samples, with 233 providing one and 98 providing two stool samples. Questionnaire responses were associated with the presence of intestinal parasites, which was determined using a standard combined microscopy technique including direct wet mount and formol-ether concentration. Results were verified by supplementary examination of 48 stool samples by quantitative polymerase chain reaction (qPCR).

RESULTS

Among pregnant women who lived in selected poor residential areas in Bogotá, the overall prevalence of intestinal parasitism was 41% with 9% polyparasitism. Pathogenic parasites were present in 1.2% of the 331 participants including Giardia lamblia and Ascaris lumbricoides. Higher prevalence was found for parasites with debated pathogenicity, including Blastocystis hominis (25%), Endolimax nana (15%), Entamoeba coli (8%), and Iodamoeba butschlii (2%). Entamoeba histolytica/dispar complex was also detected (1.5%). When comparing a subset of stool samples using the combined microscopy technique and qPCR, the latter detected a higher 58.3% overall IPI prevalence. Higher prevalence of infections by any intestinal parasite was found in participants who had never been dewormed (p = 0.01). Higher but not statistically significant associations were found between any parasite and women living with a partner, and intestinal polyparasitism and being from a minority group and not having a water sink.

CONCLUSIONS

This first study of the prevalence of intestinal parasitism in Bogotá focused on pregnant women living in poverty, found a high prevalence of intestinal parasites of debated pathogenicity, and confirmed a low prevalence of pathogenic intestinal parasites. These results highlight the need for educational interventions to disrupt transmission routes for prevalent parasites.

Violations of workers' rights and exposure to work-related abuse of live-in migrant and live-out local home care workers - a preliminary study: implications for health policy and practice

BACKGROUND

Home care workers work in an isolated environment, with limited supervision and guidance which makes them more prone to abuse and exploitation. While past research focused mostly on the well-being of care recipients, this study aimed to shed light on the care workers' daily reality and explore if and how boundaries of professional care work are blurred. Our primary aim was to assess the working conditions and the prevalence of abuse and exploitation among live-in migrant home care workers and live-out local home care workers.

METHODS

A random stratified sample of Israeli older adults aged over 70, who are entitled by law to home care services was used to recruit 338 migrant live-in home care workers and 185 local live-out home care workers to a face-to-face survey. The participants were asked about their relationship with the care recipient and their exposure to violations of workers' rights and work-related abuse.

RESULTS

Almost all the participants reported exposure to certain workers' rights violations. Among the migrant live-in care workers, it was found that 58% of them did not receive any vacation days besides the weekly day-off, about 30% reported not get even a weekly day-off on a regular basis, and 79% did not get paid sick days. Local live-out care workers also suffered from a high prevalence of exploitation - 58% did not get any vacation days besides the weekly day-off, and 66% did not get paid sick leave. 20% of the local live-out care workers, and 15% of the migrant live-in care workers did not receive a signed contract. A smaller portion (7.4% among migrant care workers, 2.5% among local care workers) reported work-related abuse. When compared to local workers, migrant home care workers were more vulnerable to some worker's rights violations, as well as emotional abuse.

CONCLUSION

These findings are disturbing, as work-related abuse and exploitation affect not only the well-being of the care worker but also the health of the care recipients, as the quality of care provided deteriorates. At the public policy level, more significant attention and regulation of the home care industry is needed. The frequency and the nature of home visits made by home care agencies must be changed. Also, home care workers should be offered emotional support.

Hypertension prevalence and living conditions related to air pollution: results of a national epidemiological study in Lebanon

Hypertension is a risk factor of several diseases, linked to high mortality and morbidity, particularly in developing countries. Some studies have linked indoor and outdoor pollution exposure items to hypertension, but results were inconsistent. Our objective was to assess the association of living conditions related to air pollution to hypertension in Lebanon, a Middle Eastern country. A national cross-sectional study was conducted all over Lebanon. Blood pressure and its related medications were assessed to be able to classify participants as hypertensive or not. Moreover, in addition to living conditions related to air pollution exposure, we assessed potential predictors of hypertension, including sociodemographic characteristics, self-reported health information and biological measurements. Furthermore, we assessed dose-effect relationship of air pollution items in relation with hypertension. Living conditions related to indoor and outdoor air pollution exposures were associated with hypertension, with or without taking biological values into account. Moreover, we found a dose-effect relationship of exposure with risk of disease (15% increase in risk of disease for every additional pollution exposure item), after adjustment for sociodemographics and biological characteristics (Ora = 1.15 [1.03-1.28]). Although additional studies would be necessary to confirm these findings, interventions should start to sensitize the population about the effect of air pollution on chronic diseases. The work on reducing pollution and improving air quality should be implemented to decrease the disease burden on the population and health system.

Self-reported history of stroke and long-term living conditions near air pollution sources: results of a national epidemiological study in Lebanon

Stroke is a disease related to high mortality and morbidity, particularly in developing countries. Some studies have linked self-reported indoor and outdoor pollution to stroke and mini-stroke, while some others showed no association. Our objective was to assess this association in Lebanon, a Middle Eastern developing country. A national cross-sectional study was conducted all over Lebanon. In addition to self-reported items of pollution exposure, we assessed potential predictors of stroke and mini-stroke, including sociodemographic characteristics, self-reported health information, and biological measurements. Moreover, we assessed dose-effect relationship of pollution items in relation with stroke. Self-reported indoor pollution exposure was associated with stroke and mini-stroke, with or without taking biological values into account. Moreover, we found a dose-effect relationship of exposure with risk of disease, but this effect did not reach statistical significance after adjustment for sociodemographics and biological characteristics. No association was found for any outdoor pollution item. Although additional studies would be necessary to confirm these findings, sensitizing the population about the effect of pollution on chronic diseases, working on reducing pollution, and improving air quality should be implemented to decrease the burden of the disease on the population and health system.

Living Conditions and Psychological Distress in Latino Migrant Day Laborers: The Role of Cultural and Community Protective Factors

The purpose of this study was to examine the relationship between typically difficult living conditions and psychological distress in Latino migrant day laborers (LMDLs), with attention to the potentially protective roles of contact with family in country of origin (i.e., communication, sending money, etc.), availability of local culture (i.e., food, music, people from one's country of origin), and utilization of community resources perceived to be culturally competent (i.e., services that are respectful, able to serve Latinos, able to solve problems, in Spanish, etc.). Participants were 344 LMDLs surveyed in the San Francisco Bay Area. As hypothesized: (a) difficult living conditions were related to depression, anxiety, and desesperación [desperation], the latter a popular Latino idiom of psychological distress recently validated on LMDLs; (b) contact with family moderated the relation between difficult living conditions and depression and desesperación but not anxiety and (c) access to local culture, and utilization of community resources, mediated the relation between difficult living conditions and depression and desesperación but not anxiety. Implications for intervening at local and larger levels in order to provide some protection against distress built into the LMDL experience in the United States are discussed.

Health-related quality of life and associated factors in functionally independent older people

BACKGROUND

Health-related quality of life (HRQL) is a key indicator of elderly people's health status that can be affected by different factors. However, little is known about which variables are associated with it in functionally independent elderly people. The aim of this project was to study HRQL and a wide variety of health, lifestyle, social and contextual aspects and their relation to HRQL in a sample of functionally independent, non-cognitively impaired community-dwelling adults, over 65 years of age, from a northern region of Spain.

METHODS

A cross-sectional study for which data was collected by face-to-face interviews with the selected individuals. HRQL was measured with the EuroQol-5D scale, consisting of a 5 item descriptive system and a visual analogue scale (VAS). VAS values lower than 70 were considered poor HRQL. Binary logistic regression was used to identify factors related to the outcome.

RESULTS

Six hundred and thirty-four individuals were included in the study. The mean age was 74.8 (SD 6.7) years, 55% of the participants were women and 46% rated their HRQL as poor. Several variables were found to be significantly associated with a poor HRQL in the multivariate model, adjusted for age and sex: polypharmacy (OR: 2.32, 95% CI: 1.62-3.31), the presence of sensory impairment (OR: 1.83, 95% CI: 1.24-2.69), not being engaged in cognitively stimulating activities (OR: 2.51, 95% CI: 1.03-6.16), or in group social activities (OR: 1.57, 95% CI: 1.11-2.22), low level of social support (OR: 3.12, 95%CI: 1.78-5.46) and the presence of obstacles in the closest home environment (OR: 1.83, 95%CI: 1.11-3.02).

CONCLUSIONS

The study identified a set of health, social and contextual variables as strongly related to HRQL in functionally independent community-dwelling older people. The results highlight the multidimensional nature of HRQL. They also reveal the importance of a comprehensive assessment of HRQL when designing adequate health-related programmes aiming to enhance active and healthy ageing and delay the onset of dependence.

Childhood Adversity and Trajectories of Disadvantage Through Adulthood: Findings from the Stockholm Birth Cohort Study

Children whose parents experience adverse social, economic, or health-related living conditions are more likely to face similar types of disadvantage in their adult life. However, a limitation of many earlier studies is that they do not account for the multidimensionality of the concept of living conditions, and that the child generation's life courses are targeted as static and independent from the societal context in which they are imbedded. The current investigation addressed these aspects by focusing on the complexity, duration, and timing of disadvantage with regard to how adverse circumstances in the family of origin are associated with trajectories of social, economic, and health-related living conditions across adulthood. We also examined the role of educational attainment for these associations. Analyses were based a Swedish cohort born in 1953 (n = 14,294). We first conducted sequence analysis, followed by hierarchical cluster analysis, to generate 'outcome profiles', i.e. trajectories of adult disadvantage. Second, several indicators of adverse circumstances in childhood were analysed by means of multinominal regression analysis, showing the odds of ending up in the different trajectories. The results indicated that individuals who grew up under adverse conditions were more likely to experience disadvantaged social, economic, and health-related trajectories. This was particularly the case for trajectories characterised by a high degree of complexity, i.e. coexisting disadvantages, and-among men only-by a longer duration of disadvantage. Educational attainment was identified as a powerful mediator, suggesting that efforts to increase equal educational opportunity may be a way of reducing the intergenerational transmission of disadvantage.

Coexisting Disadvantages in later Life: Demographic and Socio-Economic Inequalities

In this study, we aimed to identify which of certain demographic and socio-economic groups in the oldest part of the population that have an increased probability of experiencing simultaneous disadvantages in different life domains - here termed coexisting disadvantages. To do so, we compared analyses of coexisting disadvantages, measured as two or more simultaneous disadvantages, with analyses of single disadvantages and specific combinations of disadvantages. Indicators of physical health problems, ADL limitations, psychological health problems, limited financial resources, and limited social resources were included. We used nationally representative data from 2011 on people aged 76 and older in Sweden (n = 765). Results showed that coexisting disadvantages were associated with specific demographic and socio-economic groups, particularly certain marital status groups. Moreover, the differences between the demographic and socio-economic groups were only found for those who reported coexisting disadvantages, and not for those who reported only one disadvantage, which suggests that demographic and social factors become more important as disadvantages compound. Further, we analysed pairwise combinations of disadvantages. We found that different combinations of disadvantages tended to be associated with different groups, information useful from a social planning perspective since different combinations of disadvantages may imply different needs for help and support.

A cross-European view by poverty status

Although there is an extensive body of literature on the use of residential satisfaction to measure the impact of housing conditions on well-being in later life, less is known about differences and similarities between sub-populations and national contexts. By means of a cross-European analysis (EU15), this study aims to examine how objective and subjective factors of living conditions shape the perceptions of older Europeans about the adequacy of their residential environment. Two patterns of housing quality are explored: (1) international heterogeneity of the EU15 countries, and (2) intra-national heterogeneity, where we distinguish between households at risk of poverty and those not at risk in the elderly population of these countries. Data were drawn from the 2007 wave of the European Union Statistics on Income and Living Conditions survey, providing a sample of more than 58,000 individuals aged 65 years and older. The housing characteristics surveyed were reduced using tetrachoric correlations in a principal component analysis. The resulting predictors, as well as control variables (including gender, age, health status and tenure), are assessed using multiple linear regression analysis to explore their association with a high or low level of residential satisfaction. Despite a generally positive assessment by older Europeans of their living space, major geographic and household income differences existed in the factors that explained residential satisfaction. Identifying factors associated with residential satisfaction in different household income groups and national contexts may facilitate the development of EU policies that attempt to make 'ageing in place' a viable and suitable option for older Europeans.

Effect of tumor length, diameter and volume on survival of patients with stage N0 thoracic esophageal cancer after radiation therapy

AIM: To investigate the effect of tumor length, diameter and volume on the survival of patients with stage N0 thoracic esophageal cancer after radiation therapy.

METHODS: Eighty-eight patients with stage N0 thoracic esophageal cancer who received radiation therapy from January 2007 to December 2008 at our hospital were included. The effect of the length, diameter and volume of gross tumor volume (GTV) on the short and long term survival after radiation therapy was analyzed.

RESULTS: The complete remission rate and 5-year survival rate were lower in the GTV length ≥ 5 cm group than in the < 5 cm group (14.29% vs 36.96%, 19.05% vs 43.48%). The complete remission rate and 5-year survival rate in the GTV diameter > 3 cm group were lower than those in the ≤ 3 cm group (16.00% vs 39.47%, 20.00% vs 47.37%). The complete remission rate and 5-year survival rate in the tumor volume ≥ 35 cm³ group were lower than those in the < 35 cm³ group (14.58% vs 40.00%, 20.83% vs 45.00%). Cox risk model analysis showed that tumor length and diameter were risk factors affecting survival in patients with stage N0 thoracic esophageal cancer.

CONCLUSION: GTV length, diameter and volume can affect survival in patients stage with N0 thoracic esophageal cancer after radiotherapy, and tumor length and diameter are independent risk factors for survival of the patients.

Childhood peer status and the clustering of social, economic, and health-related circumstances in adulthood

Within the school-class context, children attain a social position in the peer hierarchy to which varying amounts of status are attached. Studies have shown that peer status - i.e. the degree of acceptance and likeability among classmates - is associated with adult health. However, these studies have generally paid little attention to the fact that health problems are likely to coincide with other adverse circumstances within the individual. The overarching aim of the current study was therefore to examine the impact of childhood peer status on the clustering of social, economic, and health-related circumstances in adulthood. Using a 1953 cohort born in Stockholm, Sweden (n = 14,294), four outcome profiles in adulthood were identified by means of latent class analysis: 'Average', 'Low education', 'Unemployment', and 'Social assistance recipiency and mental health problems'. Multinomial regression analysis demonstrated that those with lower peer status had exceedingly higher risks of later ending up in the more adverse clusters. This association remained after adjusting for a variety of family-related and individual factors. We conclude that peer status constitutes a central aspect of children's upbringing with important consequences for life chances.