Trajectories of adolescent poly-substance use and their long-term social and economic outcomes for males from low-income backgrounds

Abstract Background No population-based studies have examined chronic opioid use among cancer survivors who are diverse with respect to diagnosis, age group, and insurance status. Methods We conducted a retrospective cohort study using North Carolina (NC) cancer registry data linked with claims from public and private insurance (2006–2016). We included adults with non-metastatic cancer who had no prior chronic opioid use (N = 38,366). We used modified Poisson regression to assess the adjusted relative risk of chronic opioid use in survivorship (>90-day continuous supply of opioids in the 13–24 months following diagnosis) associated with patient characteristics. Results Only 3.0% of cancer survivors in our cohort used opioids chronically in survivorship. Predictors included younger age (adjusted risk ratio [aRR], 50–59 vs 60–69 = 1.23, 95% confidence interval [CI] = 1.05–1.43), baseline depression (aRR = 1.22, 95% CI = 1.06–1.41) or substance use (aRR = 1.43, 95% CI = 1.15–1.78) and Medicaid (aRR vs Private = 1.93, 95% CI = 1.56–2.40). Survivors who used opioids intermittently (vs not at all) before diagnosis were twice as likely to use opioids chronically in early survivorship (aRR = 2.62, 95% CI = 2.28–3.02). Those who used opioids chronically (vs intermittently or not at all) during active treatment had a nearly 17-fold increased likelihood of chronic use in survivorship (aRR = 16.65, 95 CI = 14.30–19.40). Conclusions Younger and low-income survivors, those with baseline depression or substance use, and those who require chronic opioid therapy during treatment are at increased risk for chronic opioid use in survivorship. Our findings point to opportunities improve assessment of psychosocial histories and to engage patients in shared decision-making around long-term pain management, when chronic opioid therapy is required during treatment.

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Associations Between Adverse Childhood Experiences and Prenatal Mental Health and Substance Use Among Urban, Low-Income Women

Community Mental Health Journal ◽

10.1007/s10597-021-00862-1 ◽

2021 ◽

Author(s):

Divya L. Jasthi ◽

Sarah Nagle-Yang ◽

Scott Frank ◽

Marie Masotya ◽

Alissa Huth-Bocks

Keyword(s):

Mental Health ◽

Substance Use ◽

Low Income ◽

Adverse Childhood Experiences ◽

Childhood Experiences ◽

Adverse Childhood ◽

Low Income Women ◽

Prenatal Mental Health

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The long term effect of pulmonary tuberculosis on income and employment in a low income, urban setting

Thorax ◽

10.1136/thoraxjnl-2020-215338 ◽

2020 ◽

pp. thoraxjnl-2020-215338

Author(s):

Jamilah Meghji ◽

Stefanie Gregorius ◽

Jason Madan ◽

Fatima Chitimbe ◽

Rachael Thomson ◽

...

Keyword(s):

Low Income ◽

Disease Onset ◽

Treatment Completion ◽

Well Being ◽

Urban Setting ◽

Financial Strain ◽

First Episode ◽

Health Seeking ◽

Tb Treatment

BackgroundMitigating the socioeconomic impact of tuberculosis (TB) is key to the WHO End TB Strategy. However, little known about socioeconomic well-being beyond TB-treatment completion. In this mixed-methods study, we describe socioeconomic outcomes after TB-disease in urban Blantyre, Malawi, and explore pathways and barriers to financial recovery.MethodsAdults ≥15 years successfully completing treatment for a first episode of pulmonary TB under the National TB Control Programme were prospectively followed up for 12 months. Socioeconomic, income, occupation, health seeking and cost data were collected. Determinants and impacts of ongoing financial hardship were explored through illness narrative interviews with purposively selected participants.Results405 participants were recruited from February 2016 to April 2017. Median age was 35 years (IQR: 28–41), 67.9% (275/405) were male, and 60.6% (244/405) were HIV-positive. Employment and incomes were lowest at TB-treatment completion, with limited recovery in the following year: fewer people were in paid work (63.0% (232/368) vs 72.4% (293/405), p=0.006), median incomes were lower (US$44.13 (IQR: US$0–US$106.15) vs US$72.20 (IQR: US$26.71–US$173.29), p<0.001), and more patients were living in poverty (earning <US$1.90/day: 57.7% (211/366) vs 41.6% (166/399), p<0.001) 1 year after TB-treatment completion compared with before TB-disease onset. Half of the participants (50.5%, 184/368) reported ongoing dissaving (use of savings, selling assets, borrowing money) and 9.5% (35/368) reported school interruptions in the year after TB-treatment completion. Twenty-one participants completed in-depth interviews. Reported barriers to economic recovery included financial insecurity, challenges rebuilding business relationships, residual physical morbidity and stigma.ConclusionsTB-affected households remain economically vulnerable even after TB-treatment completion, with limited recovery in income and employment, persistent financial strain requiring dissaving, and ongoing school interruptions. Measures of the economic impact of TB disease should include the post-TB period. Interventions to protect the long-term health and livelihoods of TB survivors must be explored.

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Limits of the current implementation of incremental housing

Architectural Research Quarterly ◽

10.1017/s135913552000041x ◽

2021 ◽

pp. 1-10

Author(s):

Goran Ivo Marinovic

Keyword(s):

Middle Class ◽

Housing Policy ◽

Low Income ◽

Bank Loans ◽

Housing Project ◽

Middle Income ◽

Specific Location ◽

Current Implementation ◽

Incremental Housing

In the case of conventional public housing, urban planners and policymakers design the layout of a housing project in a specific location and then estimate how many households can afford a home. This housing policy has been pursued as a legitimate solution for housing low- and middle-income households where the houses are individually financed by bank loans or mortgages raised by the occupants. John Turner criticised conventional housing solutions by affirming that ‘developing governments take the perspective of the elite and act as if the process of low-income houses were the same as in high-income countries and the same as for the small upper-middle class of their own countries’. Bruce Ferguson and Jesus Navarrete extend this argument with their critique of distributing finished houses to low-income populations and then requiring long-term payments, which are harmful to the beneficiaries. They note that ‘governments think of housing as complete units built by developers that households must purchase with a long-term loan rather than as a progressive process’.

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Influences on catch-up growth using relative versus absolute metrics: evidence from the MAL-ED cohort study

BMC Public Health ◽

10.1186/s12889-021-11120-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Stephanie A. Richard ◽

Benjamin J. J. McCormick ◽

Laura E. Murray-Kolb ◽

Pascal Bessong ◽

Sanjaya K. Shrestha ◽

...

Keyword(s):

Cohort Study ◽

Low Income ◽

Cognitive Outcomes ◽

Absolute Difference ◽

Maternal Height ◽

Z Score ◽

Linear Regression Models ◽

Poor Growth ◽

Micronutrient Status

Abstract Background Poor growth in early childhood has been considered irreversible after 2–3 years of age and has been associated with morbidity and mortality over the short-term and with poor economic and cognitive outcomes over the long-term. The MAL-ED cohort study was performed in eight low-income settings with the goal of evaluating relationships between the child’s environment and experience (dietary, illness, and pathogen exposure, among others) and their growth and development. The goal of this analysis is to determine whether there are differences in the factors associated with growth from 24 to 60 months using two different metrics. Methods Across six MAL-ED sites, 942 children had anthropometry data at 24 and 60 months, as well as information about socioeconomic status, maternal height, gut permeability (lactulose-mannitol z-score (LMZ)), dietary intake from 9 to 24 months, and micronutrient status. Anthropometric changes were in height- or weight-for-age z-score (HAZ, WAZ), their absolute difference from the growth standard median (HAD (cm), WAD (kg)), as well as recovery from stunting/underweight. Outcomes were modeled using multivariate regression. Results At 24 months, almost half of the cohort was stunted (45%) and 21% were underweight. Among those who were stunted at 24 months (n = 426), 185 (43%) were no longer stunted at 60 months. Most children increased their HAZ from 24 to 60 months (81%), whereas fewer (33%) had positive changes in their HAD. Linear regression models indicate that girls improved less than boys from 24 to 60 months (HAZ: -0.21 (95% CI -0.27, -0.15); HAD: -0.75 (-1.07, -0.43)). Greater intestinal permeability (higher LMZ) at 0–24 months was associated with lower relative and absolute changes from 24 to 60 months (HAZ: -0.10 (-0.16, -0.04); HAD: -0.47 (-0.73, -0.21)). Maternal height (per 10 cm) was positively associated with changes (HAZ: 0.09 (0.03, 0.15); HAD: 0.45 (0.15, 0.75)). Similar relationships were identified for changes in WAZ and WAD. Conclusions The study children demonstrated improved growth from 24 to 60 months of age, but only a subset had positive changes in HAD and WAD. The same environmental factors were associated with growth from 24 to 60 months regardless of metric used (change in HAZ or HAD, or WAZ and WAD).

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Birth weight and adult earnings: a systematic review and meta-analysis

Journal of Developmental Origins of Health and Disease ◽

10.1017/s2040174421000404 ◽

2021 ◽

pp. 1-8

Author(s):

Mark J. Lambiris ◽

Mia M. Blakstad ◽

Nandita Perumal ◽

Goodarz Danaei ◽

Lilia Bliznashka ◽

...

Keyword(s):

Birth Weight ◽

Low Income ◽

Meta Analysis ◽

Biomedical Literature ◽

Economic Outcomes ◽

Childhood Development ◽

Low Income Countries ◽

Standard Deviation Increase ◽

Beneficial Effects ◽

Adult Earnings

Abstract While substantial evidence has identified low birth weight (LBW; <2500 g) as a risk factor for early life morbidity, mortality and poor childhood development, relatively little is known on the links between birth weight and economic outcomes in adulthood. The objective of this study was to systematically review the economics (EconLit) and biomedical literature (Medline) and estimate the pooled association between birth weight and adult earnings. A total of 15 studies from mostly high-income countries were included. On average, each standard deviation increase in birth weight was associated with a 2.75% increase in annual earnings [(95% CI: 1.44 to 4.07); 9 estimates]. A negative, but not statistically significant, association was found between being born LBW and earnings, compared to individuals not born LBW [mean difference: −3.41% (95% CI: −7.55 to 0.73); 7 estimates]. No studies from low-income countries were identified and all studies were observational. Overall, birth weight was consistently associated with adult earnings, and therefore, interventions that improve birth weight may provide beneficial effects on adult economic outcomes.

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Integrated photothermal decontamination device for N95 respirators

Scientific Reports ◽

10.1038/s41598-020-80908-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Marcelo Muñoz ◽

Maxime Comtois-Bona ◽

David Cortes ◽

Cagla Eren Cimenci ◽

Qiujiang Du ◽

...

Keyword(s):

Low Income ◽

Temperature Treatment ◽

Low Income Countries ◽

Effective Vaccine ◽

Global Pandemic ◽

Photothermal Treatment ◽

Mild Temperature ◽

N95 Respirators ◽

Uv C

AbstractThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) responsible for the COVID-19 global pandemic has infected over 25 million people worldwide and resulted in the death of millions. The COVID-19 pandemic has also resulted in a shortage of personal protective equipment (PPE) in many regions around the world, particularly in middle- and low-income countries. The shortages of PPE, such as N95 respirators, is something that will persist until an effective vaccine is made available. Thus, devices that while being easy to operate can also be rapidly deployed in health centers, and long-term residences without the need for major structural overhaul are instrumental to sustainably use N95 respirators. In this report, we present the design and validation of a decontamination device that combines UV-C & B irradiation with mild-temperature treatment. The device can decontaminate up to 20 masks in a cycle of < 30 min. The decontamination process did not damage or reduce the filtering capacity of the masks. Further, the efficacy of the device to eliminate microbes and viruses from the masks was also evaluated. The photothermal treatment of our device was capable of eradicating > 99.9999% of the bacteria and > 99.99% of the virus tested.

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