Child anemia in Cambodia: A descriptive analysis of temporal and geospatial trends and logistic regression-based examination of factors associated with anemia in children

Anemia in children remains a public health concern in many resource-limited countries. To better understand child anemia in Cambodia, we examined temporal and geospatial trends of childhood anemia and used logistic regression to analyze its association with individual and household characteristics using data from the Cambodia Demographic and Health Surveys for 2005, 2010, and 2014. The prevalence of childhood anemia decreased from 62.2% in 2005 to 56.6% in 2014. The prevalence of childhood anemia was highest in Pursat (84.3%) for 2005, Kampong Thom (67%) for 2010, and Preah Vihear and Steung Treng (68.6%) for 2014. After adjusting for other variables, factors positively associated with childhood anemia included having a mother who was anemic (adjusted odds ratio (AOR) = 1.77, 95% CI: 1.58-1.97); being male vs. female (AOR = 1.20, 95% CI: 1.07-1.33), underweight (AOR = 1.24, 95% CI: 1.14-1.57), or stunted (AOR = 1.24, 95% CI: 1.09-1.41); or having had a recent episode of fever (AOR = 1.16, 95% CI: 1.03-1.31). Children were less likely to have anemia if they were older than 12 months. They were also less likely to have anemia if they were from a wealthier household (AOR = 0.64; 95% CI: 0.50-0.84) or had taken medications for intestinal parasites (AOR = 0.86; 95% CI: 0.89-0.93). These associations were generally consistent across time and space. Public health interventions and policies to alleviate anemia should be prioritized to address these factors across geospatial divides. Anemia remains highly prevalent among children aged 6-59 months in Cambodia.

Measuring Food Insecurity: The Problem with Semantics

Rising rates of hunger and food insecurity have sparked a major re-evaluation of all aspects of food systems. Because of the multifaceted nature of food insecurity, however, determining what actions should be taken is challenging, especially since reevaluation efforts are led by experts from several disciplines and there is no consensus about which indicators should be used and how they should be measured. Confusion surrounding the meaning of the terms 'food security' and 'food insecurity' has contributed to this lack of consensus. As indicators inform action, such confusion has slowed those committed to alleviating hunger in identifying the most pressing targets. This review highlights (1) the importance of clearly defining food security and food insecurity and (2) how such definitions affect measures of food insecurity in the United States. While some might say that definitions are an issue of the past or a trivial matter of semantics, we believe that the world's present rates of hunger and malnutrition are attributable, at least in part, to the lack of consensus on these definitions and their accompanying measurements and indicators. Although the present review can be helpful to academics and policy makers, the primary purpose is to be a resource to those involved in the day-to-day production of food, such as ranchers and farmers by providing an overview of definitions, indicators, and measurements used when discussing food security.

New Conceptual Model of Social Sustainability: Review from Past Concepts and Ideas

The social dimension of sustainability has remained relatively underdefined, despite the efforts to specify and integrate this dimension into the general sustainability conversation of scholars and practitioners. This study aims to advance the conversation of social sustainability by examining past the multi-disciplinary literature and policy documents, as well as proposing a comprehensive conceptual model of social sustainability. We present a model with five dimensions: safety and security, equity, adaptability, social inclusion and cohesion, and quality of life. Through these dimensions, we propose social sustainability as a process that strives for effective management and allocation of social capital as a constitutive resource, and the confrontation of such controllable and uncontrollable risks as natural disasters and climate change. Our model was constructed with the purpose of providing scholars, policymakers, and practitioners with a comprehensive guideline to create social sustainability policy with human beings as the priority and cultural awareness as a grounding approach to initiating disaster-related and climate-change resilience.

Privilege and Place: an exploratory study about healthcare bypass behavior

AIM

Bypass, or utilizing healthcare outside of one's community rather than local health care, can have serious consequences on rural healthcare availability, quality, and outcomes. Previous studies of the likelihood of healthcare bypass used various individual and community characteristics. This study includes measures for individuals and communities, as well as place-based characteristics. The authors introduce the Social Vulnerability of Place Index (SoVI) - a well-established measure in disaster literature - into healthcare studies to further explain the impact of place on healthcare selection behavior. Additionally, with the use of open-ended questions, this study explains why people choose to bypass. By including each of these measures, this study provides a more nuanced and detailed understanding of how individual healthcare selection is affected by the privilege of the individual, community ties, place of residence, and primary motivator for bypass.

METHODS

A systematic random sample of residents from 25 rural towns in the western US state of Utah were surveyed in 2017 in the Rural Utah Community Survey. After accounting for missing data, the total sample size was 1061. This study used logistic regression to better predict the likelihood of rural healthcare bypass behavior. Measures associated with community push factors (dissatisfaction with various local amenities), community pull factors (friends in community and length of residence), individual ability (demographics, self-reported health, and distance to a hospital), and SoVI, were added to the models to examine their impact on the likelihood of bypass. The SoVI was made using census data with variables that measure both social and place inequality. Each town in the study received a SoVI score and was then categorized as having low, mean, or high social vulnerability. Qualitative open-ended responses about healthcare selection were coded for explanations given for bypassing.

RESULTS

The pooled model showed that bypass was more likely amongst residents who were dissatisfied with local health care and more likely for females. Breaking bypass down, according to SoVI, provides a more nuanced understanding of bypass. For people living in low socially vulnerable areas, privileges such as graduating college made them more likely to bypass. For high socially vulnerable areas, privilege did not help people bypass, but disadvantages such as aging made residents less likely to bypass. Thus, by introducing the SoVI into healthcare literature, this study can compare healthcare selection behaviors of residents in low vulnerable towns, average vulnerable towns, and highly vulnerable towns. Additionally, the analysis of open-ended responses showed patterns explaining why people bypass.

CONCLUSION

Policymakers and public health workers can use the SoVI to better target their healthcare outreach. Reasons for bypass include quality, selection, consistency, cost of insurance, one-stop shop, and confidentiality. Rural clinics can help residents avoid the need to bypass by improving in these areas and thus gaining patients and minimizing the risk of closure. Healthcare policymakers should focus resources on high socially vulnerable places as well as underprivileged people in low socially vulnerable places.

Community recovery after a natural disaster: Core data from a survey of communities affected by the 2010 Mt. Merapi eruptions in Central Java, Indonesia

The ``Community Recovery after a Natural Disaster: A Survey of Communities Affected by Mt. Merapi Eruptions'' data that are described herein were gathered 16 months after the 2010 Mt. Merapi volcanic eruptions in Central Java, Indonesia. Data collection was organized as a pilot effort to document victim experiences of the disaster; including disaster preparation, mitigation, and recovery. Three-stage clustered random sampling was conducted to create a sample that was representative of varying levels of destruction experienced by victims of the eruptions as well as one that included respondents who were still living in a disaster shelter, who had returned to their previous community, and who had moved on to a new community. By drawing respondents from 10 different villages or shelter communities, a total respondent sample of 400 was collected.

Taking another look at the sense of community index: Six confirmatory factor analyses

Previous studies focusing on the effects of the social aspects of community have often used the Sense of Community Index (SCI), despite other research showing that it is not a good-fit measure for its expected dimensions. Using a sample of students from Brigham Young University, we performed confirmatory factor analysis of the SCI to assess 1-factor, 4-factor, 1-factor revised, 3-factor revised, 1-factor revised, 4-factor revised, and 1-factor revised models. Our study resulted in mixed findings: models were neither a poor-fit nor a good fit. Although the 4-factor revised model was the best fit, it did not measure the intended dimensions well. Our analysis indicates that future research investigating sense of community should use measures other than the SCI.

The Louisiana Community Oil Spill Survey (COSS) dataset

This article presents an overview of the Louisiana Community Oil Spill Survey (COSS), the dataset used in “Community Sentiment following the Deepwater Horizon Oil Spill Disaster: A Test of Time, Systemic Community, and Corrosive Community Models” [1] as well as elsewhere [2–6]. The COSS, administered by the Louisiana State University's Public Policy Research Laboratory, consists of five waves of cross-sectional trend data attuned to the characteristics and effects of the 2010 BP Deepwater Horizon (BP-DH) oil spill on those coastal Louisiana residents most affected by the disaster. Respondents were randomly drawn from a list of nearly 6,000 households in the coastal Louisiana zip codes located in Lafourche Parish, Plaquemines Parish, Terrebonne Parish, and the community of Grand Isle. COSS data were initially collected in June 2010 when oil was still flowing from the wellhead, with additional data waves, collected in October 2010, April 2011, April 2012, and April 2013. The respective response rates were: June 2010, 20%; October 2010, 24%; April 2011, 25%; April 2012, 20%; and April 2013, 19%.

Infants without health insurance: Racial/ethnic and rural/urban disparities in infant households' insurance coverage

In order to gain insights into how the effects of the uneven adoption of Medicaid expansion varies across the rural/urban spectrum and between racial/ethnic groups in the United States, this research used the fertility question in the 2011–2015 American Community Survey to link infants’ records to their mothers’ household health insurance status. This preliminary exploration of the Medicaid expansion used logistic regression to examine the probability that an infant will be born without health insurance coverage. Overall, the states that adopted Medicaid expansion improved the health insurance coverage for households with infants. However, rural households with infants report lower percentages of coverage than urban households with infants. Furthermore, the rural/urban gap in health insurance coverage is wider in states that adopted the Medicaid expansion. Additionally, Hispanic infants remain significantly less likely to have health insurance coverage compared to Non-Hispanic White infants. Understanding infant health insurance coverage across ethnic/racial groups and the rural/urban spectrum will become increasingly important as the U.S. population transitions to a minority-majority and also becomes more urban. Although not a perfect solution, our findings showed that the Medicaid expansion of health insurance coverage had a mainly overall positive effect on the percentage of U.S. households with infants who have health insurance coverage.

Migration and Mental Health in the Aftermath of Disaster: Evidence from Mt. Merapi, Indonesia

Migration is a standard survival strategy in the context of disasters. While prior studies have examined factors associated with return migration following disasters, an area that remains relatively underexplored is whether moving home to one's original community results in improved health and well-being compared to other options such as deciding to move on. In the present study, our objective is to explore whether return migration, compared to other migration options, results in superior improvements to mental health. We draw upon data from a cross-sectional pilot study conducted 16 months after a series of volcanic eruptions in Merapi, Indonesia. Using ordinal logistic regression, we find that compared to respondents who were still displaced (reference category), respondents who had "moved home" were proportionally more likely to report good mental health (proportional odds ratios (POR) = 2.02 [95% CI = 1.05, 3.91]) compared to average or poor mental health. Likewise, respondents who had "moved on" were proportionally more likely to report good mental health (POR = 2.64 [95% CI = 0.96, 7.77]. The results suggest that while moving home was an improvement from being displaced, it may have been better to move on, as this yielded superior associations with self-reported mental health.

Native American Vietnam-era Veterans' Access to VA Healthcare: Vulnerability and Resilience in Two Montana Reservation Communities

As a growing segment of the military, Native Americans are expected to increase enrollment in Department of Veterans Affairs (VA) healthcare. Currently, 20% of Native American veterans are aged 65-74, which means they served during the Vietnam era. This study explores the experiences of rural American Indian veterans from two Montana reservations with accessing VA health services. Utilizing detailed data obtained in focus group and individual interviews, we examine the experiences, attitudes, barriers and needs of rural Vietnam-era veterans. Analyses indicate that while Native American Vietnam-era veterans experienced a poor reception returning to the US after military service, they had more positive receptions in their home reservation communities. However, reintegration was often impeded by poor local opportunity structures and limited resources. As they have aged and turned to the VA for healthcare, these veterans have encountered barriers such as lack of information regarding eligibility and services, qualifying for care, excessive distances to health services, the cost of travel, and poor quality of assistance from VA personnel. Despite variations in their resources, tribal community efforts to honor veterans have begun to facilitate better access to healthcare. Focusing on the roles and importance of place-based resources, this study clarifies challenges and obstacles that Native American Vietnam-era veterans experience with accessing VA health services in rural, reservation communities. Additionally, findings show how tribal efforts are facilitating access as they begin to implement the 2010 agreement between the VA and Indian Health Services to better serve Native veterans.

Does time heal all wounds? Community attachment, natural resource employment, and health impacts in the wake of the BP Deepwater Horizon disaster

On April 20, 2010, the BP-leased Deepwater Horizon (BP-DH) oil rig exploded, resulting in the largest marine oil spill in history. In this paper we utilize one-of-a-kind household survey data-the Louisiana Community Oil Spill Survey-to examine the impacts of the BP-DH disaster on the mental and physical health of spill affected residents in coastal Louisiana, with a special focus on the influence of community attachment and natural resource employment. We find that levels of both negative mental and physical health were significantly more pronounced at baseline compared to later time points. We show that greater community attachment is linked to lower levels of negative health impacts in the wake of the oil spill and that the disaster had a uniquely negative impact on households involved in the fishing industry. Further, we find evidence that the relationship between community attachment and mental health is more pronounced at later points in time, and that the negative health impacts on fishers have worsened over time. Implications for research and policy are discussed.

Can CT determine the site of traumatic osteochondral defects in the paediatric knee?

Currently the ability of pre-operative CT imaging to determine the origin of traumatic osteochondral lesions (OCL) in the knee in children is yet to be established. The surgical approach to the knee will to some extent be determined by the origin of the lesion. It is important to directly determine the site of the lesion from pre-operative scanning both to facilitate surgery, to have a better cosmetic result for the patient and have a quicker rehabilitation period. In a tertiary referral centre, from May 2004 to April 2005, eight patients were diagnosed as having an OCL. The initial reporting was done by either a senior registrar or consultant paediatric radiologist. Those children that had an OCL underwent an arthroscopy or definitive open surgery. The exact site of the lesion was then determined and recorded in the operative notes. All the original pre-operative CT scans were given to a senior paediatric radiologist. The consultant on this occasion had no access to operative findings, or original CT reports. CTs reported by the paediatric radiology department are only able to correctly identify the site of origin of the OCL 50% of the time. Recent MR scanning techniques have improved the visualization of OCL. We authors therefore feel that in the future MRI should be used to assess the paediatric knee when an acute OCL is suspected.

The use and availability of thyroid shields in orthopaedic theatres: a telephone questionnaire of English hospitals

There are no published guidelines issued for the use of thyroid shields by either the Royal College of Radiologists or the British Orthopaedic Association. It has previously been demonstrated that a thyroid shield should be worn during fluoroscopic screening using a portable image intensifier. Scrub staff not wearing a thyroid shield are currently being exposed to ionising radiation on a regular basis, with potentially harmful effects. Of the 210 hospitals in England with orthopaedic departments, 179 were telephoned and the use and availability of thyroid shields was asked. The results demonstrated that 98 orthopaedic theatres had sufficient numbers of thyroid shields available. Of these 98 orthopaedic theatres, thyroid shields were routinely used in only 28 theatres during fluoroscopic screening on a regular basis. It is the authors' recommendation that thyroid shields should be worn during orthopaedic procedures involving the use of an image intensifier.

The influence of the posterior cruciate ligament in the maintenance of joint line in primary total knee arthroplasty: a radiologic study

The aim of this study was to compare 2 total knee arthroplasty (TKA) designs radiologically to determine if a posterior cruciate ligament (PCL)-substituting design led to a built-in error of elevation of the joint line postoperatively. The restoration of the true joint line is a goal in primary TKA, although its effect on outcome has not been established fully. A total of 47 patients had 56 TKAs performed by 2 surgeons using either the Howmedica Kinemax Plus (Rutherford, NJ) PCL-retaining or PCL-substituting TKAs. The patients were randomized to receive one of these designs, and the height of the joint line was assessed radiographically preoperatively and postoperatively. The joint line position preoperatively averaged 2.2 cm from the tibial tuberosity and postoperatively averaged 2.4 cm (PCL substituting) and 2.5 cm (PCL sparing). No difference in the thickness of the polyethylene insert used was seen with either design. The theoretical elevation of the joint line that occurs with the sacrifice of the PCL was not found to occur radiologically.

Does diplopia persist after blow-out fractures of the orbital floor in children?

Blow-out fractures of the orbital floor are comparatively rare in children, particularly those less than 8 years old. Published reports have suggested that the long-term outcome in children is worse than that in adults with similar injuries. In this study, we examine this question in the light of data from 45 children from Birmingham and Glasgow who were divided into three age ranges: 0-9 years (n = 9), 10-12 years (n = 11) and 13-15 years (n = 25). Fourteen were treated conservatively and 31 were treated surgically. The 0-9-year-old group were more likely to have small- or medium-sized defects in the anterior part of the orbital floor, which were of a linear 'trapdoor' type. The 13-15-year-olds tended to have larger 'open-door' defects. More than half the 0-9-year-olds had persistent diplopia compared with just under a third of the two other age groups. This diplopia took twice as long to resolve in the younger group compared with the other two groups. Our results confirm the view that younger patients have more persistent problems than adults after blow-out fractures of the orbital floor.

The compressible silicone rubber prosthesis in temporomandibular joint disease

An alternative technique for temporomandibular joint arthroplasty is described, in which the mandibular condyle is replaced by a soft compressible silicone rubber prosthesis. A modified Nicolle-Calnan metacarpo-phalangeal joint prosthesis was used to reconstruct 31 joints in 24 patients. Results suggest that in those patients where there has been no loss of the prosthesis, function continues to be markedly improved when compared with the pre-operative condition. Painful symptoms were relieved in cases of specific joint pathology but the technique was of little value in the management of dysfunctional pain when radiographic evidence of joint pathology was absent. A specifically designed TMJ prosthesis of this type may be a useful addition to the surgeon's armamentarium.

Spontaneous fracture of an atrophic endentulous mandible treated without fixation

The positive clinical decision to treat a spontaneously fractured edentulous mandible passively depends on a careful evaluation of local and general factors pertaining. These include: (1) Preferably simple fractures with minimal displacement and an intact periosteal sheath. (2) Elderly and infirm patients and others in whom surgery is contra-indicated. (3) Case in which discomfort and inconvenience with fixation is likely to be worse than without, bearing in mind that fixation does not guarantee firm bony union and that many patients wear dentures and masticate successfully in the presence of complete failure of fragments to unite. It must be stressed that it is not suggested that this line of treatment be followed routinely, but that is is valid in certain selected cases.