scholarly journals Cohort profile: the mature adults cohort of the Malawi longitudinal study of families and health (MLSFH-MAC)

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038232
Author(s):  
Iliana V Kohler ◽  
Chiwoza Bandawe ◽  
Alberto Ciancio ◽  
Fabrice Kämpfen ◽  
Collin F Payne ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Rural Communities ◽  
Low Income ◽  
Healthcare Providers ◽  
Population Based ◽  
Eastern Africa ◽  
Mature Adults ◽  
Open Population ◽  
Survival Expectations ◽  
Global Ageing

PurposeThe Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC) contributes to global ageing studies by providing a rare opportunity to study the processes of individual and population ageing, the public health and social challenges associated with ageing and the coincident shifts in disease burdens, in a low-income, high HIV prevalence, sub-Saharan African (SSA) context.ParticipantsThe MLSFH-MAC is an open population-based cohort study of mature adults aged 45+ years living in rural communities in three districts in Malawi. Enrolment at baseline is 1266 individuals in 2012. Follow-ups were in 2013, 2017 and 2018 when the cohort size reached 1626 participants in 2018.Findings to dateSurvey instruments cover ageing-related topics such as cognitive and mental health, non-communicable diseases (NCDs) and related health literacy, subjective survival expectations, measured biomarkers including HIV, grip strength, hypertension, fasting glucose, body mass index (BMI), broad individual-level and household-level social and economic information, a 2018 qualitative survey of mature adults and community officials, 2019 surveys of village heads, healthcare facilities and healthcare providers in the MLSFH-MAC study areas. Across many domains, MLSFH-MAC allows for comparative research with global ageing studies through harmonised measures and instruments. Key findings to date include a high prevalence of depression and anxiety among older adults, evidence for rapid declines in cognitive health with age, a low incidence of HIV among mature adults, rising prevalence of HIV due to increased survival of HIV-positive individuals and poor physical health with high NCD prevalence.Future plansAn additional wave of MLSFH-MAC is forthcoming in 2021, and future expansions of the cohort are planned. MLSFH-MAC data will also be publicly released and will provide a wealth of information unprecedented for ageing studies in a low-income SSA context that broadly represents the socioeconomic environment of millions of individuals in south-eastern Africa.

The Virginia Twin-Family Study of Adolescent Behavioral Development: assessing sample biases in demographic correlates of psychopathology

1996 ◽  
Vol 26 (6) ◽  
pp. 1119-1133 ◽  
Author(s):  
J. M. Meyer ◽  
J. L. Silberg ◽  
E. Simonoff ◽  
K. S. Kendler ◽  
J. K. Hewitt
Keyword(s):  
Rural Communities ◽  
Low Income ◽  
Family Study ◽  
Behavioral Development ◽  
Population Based ◽  
Prevalence Rates ◽  
Psychiatric Interview ◽  
Psychiatric Genetic ◽  
Twin Registry ◽  
Adult Psychopathology

SynopsisThe Virginia Twin-Family Study of Adolescent Behavioral Development (VTSABD) is a current longitudinal study of psychopathology in 1412 pairs of 8–16-year-old Caucasian twins and their parents. The primary aim of the study is to evaluate family–genetic and environmental risk factors for major domains of psychopathology in families representative of the Virginia Caucassian population. In this report, we utilize census-derived indices of neighbourhood income and urban residence to identify departures from population representation arising at the time of family enrolment in the twin registry and family participation in a psychiatric interview. Furthermore, we consider whether demographic sample biases influenced prevalence rates of adult psychopathology (including major depression, generalized anxiety disorder, alcohol dependence, phobias, and panic disorder) in the VTSABD. Results indicated that families that enrolled in the twin registry (83% of those identified by Virginia schools) and that participated in the home interview (75% of those targeted) resided in urban and rural communities with a range of per capita income levels representative of the Virginia population. However, participation biases operated throughout the study and were primarily characterized by losses of families living in low income, urban communities. There was also a smaller number of families living in high income neighbourhoods that did not enrol in the twin registry or that indefinitely postponed the psychiatric interview. These biases had small effects on prevalence rates of adult psychopathology in the VTSABD sample, even though neighbourhood income was significantly related to a subset of adult diagnoses. We emphasize the usefulness of the census methodology in evaluating sample biases in population based psychiatric genetic studies.

Serving inland rural communities through university clinics

2011 ◽  
Vol 70 (4) ◽  
pp. 475-480
Author(s):  
Julaine Allan ◽  
Rod Pope ◽  
Peter O’Meara ◽  
Joy Higgs ◽  
Jenny Kent
Keyword(s):  
Rural Communities ◽  
Low Income ◽  
Single Point ◽  
Healthcare Providers ◽  
Community Context ◽  
Review Of Literature ◽  
Public And Private ◽  
Clinical Placements ◽  
The Public ◽  
Key Aspects

Aim: To effectively provide clinical placements for students and increase healthcare options for rural communities, an investigation of university clinics was conducted. Method: This project adopted a consultative inquiry strategy and involved two processes: (1) a review of literature; and (2) interviews with existing health sciences clinic staff. Results: Low income population groups are more likely to find student-provided services acceptable and have a reliable demand for these services if they are accessible. University clinics reporting high client numbers had a consistent flow of low income clients with chronic problems. Private healthcare providers were often unable to meet the demand from this group. However, multiple methods and flexibility of delivery that fitted in with local services were required rather than single point of access clinics. Discussion: University clinics are an effective way of providing clinical placements for students and some healthcare for rural communities. Key aspects of the community context that make a university clinic viable are the degree of disadvantage in a community, the population density (or dispersion), the workforce available to supply health services in the public and private sectors, and the types of services that are demanded by policy or lobby groups and not yet supplied.

scholarly journals Relationship between Schizophrenia and Low-Income Based on Age and Sex: Results from a Nation-wide Population-Based Longitudinal Study

2018 ◽  
Vol 08 (03) ◽  
Author(s):  
Chun Te Lee ◽  
Chiu Yueh Hsiao ◽  
Jia Fu Lee ◽  
Yi Chyan Chen ◽  
Oswald Ndi Nfor ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Low Income ◽  
Population Based ◽  
Wide Population ◽  
Age And Sex

TURNING FARMERS INTO SOCIAL FARMER ENTREPRENEURS FOR DISADVANTAGED PEOPLE

2020 ◽  
Author(s):  
Remus Runcan
Keyword(s):  
Rural Communities ◽  
Low Income ◽  
Rural Areas ◽  
Urban Areas ◽  
Health And Safety ◽  
Physical Work ◽  
Healthy Environment ◽  
Rural And Urban Areas ◽  
Rural Development Programme ◽  
Rural And Urban

According to Romania’s National Rural Development Programme, the socio-economic situation of the rural environment has a large number of weaknesses – among which low access to financial resources for small entrepreneurs and new business initiatives in rural areas and poorly developed entrepreneurial culture, characterized by a lack of basic managerial knowledge – but also a large number of opportunities – among which access of the rural population to lifelong learning and entrepreneurial skills development programmes and entrepreneurs’ access to financial instruments. The population in rural areas depends mainly on agricultural activities which give them subsistence living conditions. The gap between rural and urban areas is due to low income levels and employment rates, hence the need to obtain additional income for the population employed in subsistence and semi-subsistence farming, especially in the context of the depopulation trend. At the same time, the need to stimulate entrepreneurship in rural areas is high and is at a resonance with the need to increase the potential of rural communities from the perspective of landscape, culture, traditional activities and local resources. A solution could be to turn vegetal and / or animal farms into social farms – farms on which people with disabilities (but also adolescents and young people with anxiety, depression, self-harm, suicide, and alexithymia issues) might find a “foster” family, bed and meals in a natural, healthy environment, and share the farm’s activities with the farmer and the farmer’s family: “committing to a regular day / days and times for a mutually agreed period involves complying with any required health and safety practices (including use of protective clothing and equipment), engaging socially with the farm family members and other people working on and around the farm, and taking on tasks which would include working on the land, taking care of animals, or helping out with maintenance and other physical work”

scholarly journals Sex disparities in cardiovascular health metrics among rural-dwelling older adults in China: a population-based study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaolei Han ◽  
Ziying Jiang ◽  
Yuanjing Li ◽  
Yongxiang Wang ◽  
Yajun Liang ◽  
...  
Keyword(s):  
Older Adults ◽  
Rural Communities ◽  
Cardiovascular Health ◽  
Rural China ◽  
Descriptive Analysis ◽  
Population Based ◽  
Baseline Survey ◽  
Chinese Older Adults ◽  
Face To Face ◽  
Sex Disparities

Abstract Background Cardiovascular health (CVH) metrics among Chinese older adults are poorly understood. We investigated sex disparities in CVH metrics and their management among rural-dwelling older adults in China. Methods This community-based study included 5026 participants (age ≥ 65 years; 57.2% women) in the baseline survey of a multimodal intervention study in rural China. In March–September 2018, data were collected through face-to-face interviews, clinical examinations, and laboratory tests. We defined six CVH metrics (three behavioral factors—smoking, body mass index, and physical activity; three biological factors—blood pressure, total cholesterol, and blood glucose) following the modified American Heart Association’s recommendations. We performed descriptive analysis separately for men and women. Results Of all participants, only 0.8% achieved ideal levels in all six CVH metrics. Men were more likely than women to have ideal levels in all CVH metrics but smoking. Women had higher prevalence of ideal global (9.7% vs. 7.8%) and behavioral (18.3% vs. 9.5%) CVH metrics (p < 0.001), whereas men had higher prevalence of ideal biological CVH metrics (5.4% vs. 3.5%, p < 0.001). The prevalence of ideal global and behavioral CVH metrics increased with age in both women and men (p for trend< 0.001). Women were more likely to be aware of their hypertension and diabetes, and to receive antihypertensive treatment, while men were more likely to achieve the goal of high cholesterol treatment (p < 0.05). Conclusions The CVH metrics among older adults living in the rural communities in China are characterized by an extremely low proportion of optimal global CVH metrics and distinct sex differences, alongside poor management of major biological risk factors. Trial registration ChiCTR1800017758 (Aug 13, 2018).

scholarly journals Presentation, Management, and Outcomes across the Rural-Urban Continuum for Hepatocellular Carcinoma

2020 ◽  
Author(s):  
Kali Zhou ◽  
Trevor A Pickering ◽  
Christina S Gainey ◽  
Myles Cockburn ◽  
Mariana C Stern ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Rural Communities ◽  
Urban Areas ◽  
Tumor Stage ◽  
The United States ◽  
Population Based ◽  
Urban Residents ◽  
Place Of Residence ◽  
Incidence And Mortality ◽  
Receive Treatment

Abstract Background Hepatocellular carcinoma is one of few cancers with rising incidence and mortality in the United States. Little is known about disease presentation and outcomes across the rural-urban continuum. Methods Using the population-based SEER registry, we identified adults with incident hepatocellular carcinoma between 2000–2016. Urban, suburban and rural residence at time of cancer diagnosis were categorized by the Census Bureau’s percent of the population living in non-urban areas. We examined association between place of residence and overall survival. Secondary outcomes were late tumor stage and receipt of therapy. Results Of 83,368 cases, 75.8%, 20.4%, and 3.8% lived in urban, suburban, and rural communities, respectively. Median survival was 7 months (IQR 2–24). All stage and stage-specific survival differed by place of residence, except for distant stage. In adjusted models, rural and suburban residents had a respective 1.09-fold (95% CI = 1.04–1.14, p &lt; .001) and 1.08-fold (95% CI = 1.05–1.10, p &lt; .001) increased hazard of overall mortality as compared to urban residents. Furthermore, rural and suburban residents had 18% (OR = 1.18, 95% CI 1.10–1.27, p &lt; .001) and 5% (OR = 1.05, 95% CI = 1.02–1.09, p = .003) higher odds of diagnosis at late stage and were 12% (OR = 0.88, 95% CI = 0.80–0.94, p &lt; .001) and 8% (OR = 0.92, 95% CI = 0.88–0.95, p &lt; .001) less likely to receive treatment, respectively, compared to urban residents. Conclusions Residence in a suburban and rural community at time of diagnosis was independently associated with worse indicators across the cancer continuum for liver cancer. Further research is needed to elucidate the primary drivers of these rural-urban disparities.

scholarly journals Experiences and impact of international medical volunteering: a multi-country mixed methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e041599 ◽  
Author(s):  
Mary McCauley ◽  
Joanna Raven ◽  
Nynke van den Broek
Keyword(s):  
Low Income ◽  
Online Survey ◽  
Positive Impact ◽  
Healthcare Providers ◽  
International Medical ◽  
Middle Income ◽  
Use Of Resources ◽  
The Uk ◽  
Medical Volunteers ◽  
The Impact

ObjectiveTo assess the experience and impact of medical volunteers who facilitated training workshops for healthcare providers in maternal and newborn emergency care in 13 countries.SettingsBangladesh, Ghana, India, Kenya, Malawi, Namibia, Nigeria, Pakistan, Sierra Leone, South Africa, Tanzania, UK and Zimbabwe.ParticipantsMedical volunteers from the UK (n=162) and from low-income and middle-income countries (LMIC) (n=138).Outcome measuresExpectations, experience, views, personal and professional impact of the experience of volunteering on medical volunteers based in the UK and in LMIC.ResultsUK-based medical volunteers (n=38) were interviewed using focus group discussions (n=12) and key informant interviews (n=26). 262 volunteers (UK-based n=124 (47.3%), and LMIC-based n=138 (52.7%)) responded to the online survey (62% response rate), covering 506 volunteering episodes. UK-based medical volunteers were motivated by altruism, and perceived volunteering as a valuable opportunity to develop their skills in leadership, teaching and communication, skills reported to be transferable to their home workplace. Medical volunteers based in the UK and in LMIC (n=244) reported increased confidence (98%, n=239); improved teamwork (95%, n=232); strengthened leadership skills (90%, n=220); and reported that volunteering had a positive impact for the host country (96%, n=234) and healthcare providers trained (99%, n=241); formed sustainable partnerships (97%, n=237); promoted multidisciplinary team working (98%, n=239); and was a good use of resources (98%, n=239). Medical volunteers based in LMIC reported higher satisfaction scores than those from the UK with regards to impact on personal and professional development.ConclusionHealthcare providers from the UK and LMIC are highly motivated to volunteer to increase local healthcare providers’ knowledge and skills in low-resource settings. Further research is necessary to understand the experiences of local partners and communities regarding how the impact of international medical volunteering can be mutually beneficial and sustainable with measurable outcomes.

scholarly journals “My coupons are like gold”: experiences and perceived outcomes of low-income adults participating in the British Columbia Farmers’ Market Nutrition Coupon Program

2021 ◽  
pp. 1-30
Author(s):  
Stéphanie Caron-Roy ◽  
Sayeeda Amber Sayed ◽  
Katrina Milaney ◽  
Bonnie Lashewicz ◽  
Sharlette Dunn ◽  
...  
Keyword(s):  
British Columbia ◽  
Rural Communities ◽  
Low Income ◽  
Well Being ◽  
Qualitative Description ◽  
Farmers Markets ◽  
Social Connections ◽  
Structured Interviews ◽  
Program Outcomes ◽  
Farmers Market

ABSTRACT Objective: The British Columbia Farmers’ Market Nutrition Coupon Program (FMNCP) provides low-income households with coupons valued at $21/week for 16 weeks to purchase healthy foods in farmers’ markets. Our objective was to explore FMNCP participants’ experiences of accessing nutritious foods, and perceived program outcomes. Design: This study used qualitative description methodology. Semi-structured interviews were conducted with FMNCP participants during the 2019 farmers’ market season. Directed content analysis was used to analyse the data whereby the five domains of Freedman et al’s framework of nutritious food access provided the basis for an initial coding scheme. Data that did not fit within the framework’s domains were coded inductively. Setting: One urban and two rural communities in British Columbia, Canada. Participants: 28 adults who were participating in the FMNCP. Results: Three themes emerged: Autonomy and Dignity; Social Connections and Community Building; and Environmental and Programmatic Constraints. Firstly, the program promoted a sense of autonomy and dignity through financial support, increased access to high-quality produce, food-related education and skill development, and mitigating stigma and shame. Secondly, shopping in farmers’ markets increased social connections and fostered a sense of community. Finally, participants experienced limited food variety in rural farmers’ markets, lack of transportation, and challenges with redeeming coupons. Conclusions: Participation in the FMNCP facilitated access to nutritious foods and enhanced participants’ diet quality, well-being and health. Strategies such as increasing the amount and duration of subsidies, and expanding programs may help improve participants’ experiences and outcomes of farmers’ market food subsidy programs.

scholarly journals Stillbirth outcome capture and classification in population-based surveys: EN-INDEPTH study

2021 ◽  
Vol 19 (S1) ◽  
Author(s):  
Hannah Blencowe ◽  
◽  
Matteo Bottecchia ◽  
Doris Kwesiga ◽  
Joseph Akuze ◽  
...  
Keyword(s):  
Gestational Age ◽  
A Priori ◽  
Healthcare Providers ◽  
Population Based ◽  
Reproductive Age ◽  
Group Discussions ◽  
Cross Sectional ◽  
Vital Status ◽  
Neonatal Deaths ◽  
Adverse Pregnancy

Abstract Background Household surveys remain important sources of stillbirth data, but omission and misclassification are common. Classifying adverse pregnancy outcomes as stillbirths requires accurate reporting of vital status at birth and gestational age or birthweight for every pregnancy. Further categorisation, e.g. by sex, or timing (intrapartum/antepartum) improves data to understand and prevent stillbirth. Methods We undertook a cross-sectional population-based survey of women of reproductive age in five health and demographic surveillance system sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda (2017–2018). All women answered a full birth history with pregnancy loss questions (FBH+) or a full pregnancy history (FPH). A sub-sample across both groups were asked additional stillbirth questions. Questions were evaluated using descriptive measures. Using an interpretative paradigm and phenomenology methodology, focus group discussions with women exploring barriers to reporting birthweight for stillbirths were conducted. Thematic analysis was guided by an a priori codebook. Results Overall 69,176 women reported 98,483 livebirths (FBH+) and 102,873 pregnancies (FPH). Additional questions were asked for 1453 stillbirths, 1528 neonatal deaths and 12,620 surviving children born in the 5 years prior to the survey. Completeness was high (> 99%) for existing FBH+/FPH questions on signs of life at birth and gestational age (months). Discordant responses in signs of life at birth between different questions were common; nearly one-quarter classified as stillbirths on FBH+/FPH were reported born alive on additional questions. Availability of information on gestational age (weeks) (58.1%) and birthweight (13.2%) was low amongst stillbirths, and heaping was common. Most women (93.9%) were able to report the sex of their stillborn baby. Response completeness for stillbirth timing (18.3–95.1%) and estimated proportion intrapartum (15.6–90.0%) varied by question and site. Congenital malformations were reported in 3.1% stillbirths. Perceived value in weighing a stillborn baby varied and barriers to weighing at birth a nd knowing birthweight were common. Conclusions Improving stillbirth data in surveys will require investment in improving the measurement of vital status, gestational age and birthweight by healthcare providers, communication of these with women, and overcoming reporting barriers. Given the large burden and effect on families, improved data must be made available to end preventable stillbirths.

scholarly journals Young adults’ perceptions of living with atopic dermatitis in relation to the concept of self-management: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e044777
Author(s):  
Susanne Lundin ◽  
Marina Jonsson ◽  
Carl-Fredrik Wahlgren ◽  
Emma Johansson ◽  
Anna Bergstrom ◽  
...  
Keyword(s):  
Young Adults ◽  
Atopic Dermatitis ◽  
Qualitative Study ◽  
Healthcare Providers ◽  
Transition Process ◽  
Population Based ◽  
Self Management ◽  
School Age ◽  
Perceived Availability ◽  
Semistructured Interviews

ObjectivesLearning to take control of one’s health is an important part of the transition from adolescence to adulthood. This study aimed to explore young adults’ perceptions of living with atopic dermatitis (AD) in relation to the concept of self-management.DesignA qualitative study with an inductive approach was performed through semistructured interviews (n=15). The interviews were recorded, transcribed verbatim and analysed with systematic text condensation.ParticipantsYoung adults (mean age 23,4 years) with persistent AD in a longitudinal population-based birth cohort. To capture experience of living with persistent AD (preschool/school-age onset) of different severity (mild to severe/very severe), a purposive selection was performed. In total, 15 young adults were included. Persistent AD (preschool/school-age onset) was defined as dry skin in combination with itchy rash of typical localisation in the 12 months preceding the 16-year and the 24-year follow-ups. Severity was self-assessed using the Patient Oriented Eczema Measure.ResultsDespite having experience of AD since childhood, the respondents expressed uncertainty about treatment and how it affected their bodies. Their uncertainties and feelings affected how they used topical corticosteroids. The respondents emphasised that they perceived availability of healthcare and knowledge about treatment of AD among healthcare providers to be limited. The participants did not state any experiences of support to self-management from healthcare, which affect young adults’ possibilities to take full control of their AD care.ConclusionsYoung adults with preschool/school-age onset of AD are unsure how to treat and manage the disease. One explanation may be insufficient transition process.

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