Socio-economic determinants of healthcare costs in early life: a register-based study in the Netherlands

Background Children with low socioeconomic status (SES) have an increased risk of a suboptimal start in life with ensuing higher healthcare costs. This study aims to investigate the effects of individual- (monthly household income) and contextual-level SES (household income and neighborhood deprivation), and perinatal morbidity (preterm birth and small for gestational age ((<10th percentile), SGA)) on healthcare costs in early life (0–3 years of age). Methods Individual-linked data from three national registries (Perinatal Registry Netherlands, Statistics Netherlands, and Healthcare Vektis) were obtained of all children born between 2011 and 2014 (N = 480,471) in the Netherlands. Binomial logistic regression was used to model annual healthcare costs as a function of their household income (per €1000), neighborhood deprivation index (range − 13.26 – 10.70), their perinatal morbidity and demographic characteristics. Annual healthcare cost were dichotomized into low healthcare costs (Q1-Q3 below €1000) and high healthcare costs (Q4 €1000 or higher). Results Children had a median of €295 annual healthcare costs, ranging from €72 to €4299 (5–95%). Binomial logistic regression revealed that for every €1000 decrease in monthly household income, the OR for having high healthcare costs is 0.99 (0.99–0.99). Furthermore, for every one-unit increase in neighborhood deprivation the OR for having high healthcare costs increase 1.02 (1.01–1.02). Finally, the model revealed an OR of 2.55 (2.48–2.61) for preterm born children, and an OR of 1.44 (1.41–1.48) for children SGA, to have high healthcare costs compared to their healthy peers. Conclusion More neighborhood deprivation was directly related to higher healthcare costs in young children. On top of this, lower household income was consistently and independently related to higher healthcare costs. By optimizing conditions for low SES populations, the impact of low SES circumstances on their healthcare costs can be positively influenced. Additionally, policies that influence more timely and appropriate healthcare use in low SES populations can reduce healthcare costs further.

Factors contributing to urinary aflatoxin M1 occurrence among residents in Hulu Langat district, Malaysia

Introduction: Chronic exposure to aflatoxin can lead to complications such as liver failure and cancer. There are many factors that affect aflatoxin occurrence. This study aimed to assess the association between sociodemographic factors and the knowledge, attitude and practice towards aflatoxin with urinary aflatoxin M1 occurrence among residents in Hulu Langat district, Malaysia. Methods: This was a cross-sectional study conducted among healthy Malaysian adults aged 18 to 60 years residing in Hulu Langat district, Malaysia. Socio-demographic background and the knowledge, attitude and practice of respondents towards aflatoxin were assessed through questionnaires. Non-fasting urine sample (15 ml) was collected in the morning and urinary aflatoxin M1 level was quantified. Results: Of the 444 healthy Malaysian adults, 199 urine samples were detected with aflatoxin M1. From 37 positive samples with aflatoxin M1 level above detection limit (0.64 ng/ml), mean value was 1.23±0.91 ng/ml (range = 0.65-5.34 ng/ml). Urinary aflatoxin M1 occurrence was significantly different across ethnicity, age group, monthly household income, attitude and practice towards aflatoxin. Binomial logistic regression confirmed ethnicity and monthly household income as factors contributing to urinary aflatoxin M1 occurrence. Chinese were 3.20 times more likely to have aflatoxin exposure than non-Chinese. Detected urinary aflatoxin M1 was more common among household with a monthly income above RM1,500. Conclusion: The results provided an insight to explain the variation in aflatoxin occurrence among the population.

Cross-cultural adaptation and validation of Malay version of Rapid Estimate of Adult Literacy in Dentistry (MREALD-30) among Orang Asli population in Malaysia

Background The aim of this study was to adapt, translate and validate the Rapid Estimate of Adult Literacy in Dentistry (MREALD-30) instrument for the Orang Asli population in Malaysia. Methods After translation and cross-cultural adaptation, interviews were conducted with 326 participants of the Temuan tribe from village Kampung Tering in Johol, Negeri Sembilan, Malaysia. The instrument's validity was assessed using the scores of MREALD-30, which were compared based on occupation, monthly household income, educational attainment, general literacy, use of dental services, and three dental outcomes. A questionnaire containing socio-behavioral information and validated Malay Oral Health Impact Profile (M-OHIP-14) was also administered. The reliability of the MREALD-30 was assessed by re-administering it to 30 subjects after two weeks. Its correlations evaluated convergent and discriminative validity of MREALD-30 with the level of education and dental visiting habits, monthly household income, respectively. Predictive validity was assessed with M-OHIP-14, while construct validity was evaluated by exploratory factor analysis using the Rasch model. Results The internal consistency of the MREALD-30 measured by Cronbach's alpha was 0.89. The test–retest reliability was excellent (ICC 0.95, k = 0.85). MREALD-30 exhibited good construct validity. Rasch analysis showed two factors, and infit mean-square statistics for MREALD-30 were all within the desired range of 0.50–2.0. The discriminant validity and predictive validity were statistically significant (p < 0.05). Conclusions MREALD-30 showed very strong reliability, good construct, discriminant, and predictive validity, but poor convergent validity. Overall, it showed good psychometric properties and can be used in these community settings.

Magnitude and factors associated with Availability of Adequately Iodized Salt at Households of Pregnant Mothers in Wonago district, south Ethiopia

Background Salt iodization is the most cost-effective, safe and sustainable strategy to eliminate iodine deficiency disorders. It is especially damaging during pregnancy and in early child hood. Adding iodine to salt provides protection from brain damage due to iodine deficiency for whole populations. However, little was known about the availability of adequately iodized salt in South Ethiopia. The aim of this study was to assess prevalence and factors associated with availability of adequately iodized salt at the households of pregnant mothers in Wonago District, South Ethiopia, 2018. Methods Community-based cross-sectional study was conducted from May 14-29, 2018 in Wonago district. Using a stratified two stage random sampling technique, a total of 604 pregnant mothers were included in the study. The level of salt iodine content was determined using the rapid field test kit, considering a value of <15 parts per million (PPM) and ≥15 PPM with the corresponding color chart on the rapid test kit for classification. Multivariable logistic regression model was fitted to identify factors associated with the availability of adequately iodized salt. Adjusted Odds Ratio (AOR) with the corresponding 95% Confidence Interval (CI) was calculated to show the strength of association. Result Availability of adequately iodized salt at households of pregnant mothers was 19.9%. House hold head, husband education, average monthly household income and time of salt addition during cooking were independently associated with adequately iodized salt availability. Accordingly, participatory male headed households [AOR=2.1(95%CI 1.08, 3.96)], women with an average monthly household income of ≥ 817 ETB [AOR=7.3(95%CI 3.03, 17.70)] and those who added salt late or after cooking during food preparation [AOR=2.17(1.08, 4.38)] were more likely to utilize adequately iodized salt. Conversely, women whose husband had no formal education were less likely [AOR=0.33(95%CI 0.11, 0.88)] to utilize iodized salt. Conclusion Compared to the recommended standard, use of adequately iodized salt among pregnant women is very low. Paternal conditions and household income level are key predictors of use of adequately iodized salt.

HAV infection in Brazilian men who have sex with men: The importance of surveillance to avoid outbreaks

Background Hepatitis A is a fecal-oral infection caused by hepatitis A virus (HAV). Men who have sex with men (MSM) and transgender women (TW) have been reported as target groups for HAV infection. This study aimed to determine the seroprevalence, risk factors, and circulating strains associated with HAV infection among MSM and TW in Central Brazil. Methods A cross-sectional study was conducted from November 2011 to September 2013. Serum samples were collected from 425 individuals for anti-HAV antibody testing and HAV molecular characterization. Of them, 149 (35.1%) participants were self-identified as transgender women. Statistical analysis was performed to evaluate the risk factors of HAV seropositivity. Results The seroprevalence of HAV exposure was 69.7% (95% Confidence Interval: 65.3–74.0%). Serological evidence of HAV was significantly higher in participants who self-identified as transgender women (83.2%) than MSM (62.3%). Increasing age, non-white race, and lower monthly household income were independently associated with HAV exposure among MSM. Only lower monthly household income was independently associated with HAV exposure among TW. One anti-HAV IgM positive sample, from a transgender woman (0.2%), was detected and classified as subgenotype IA. Conclusions High HAV prevalence was observed, markedly among TW. Considering the risky sexual behaviors this population is exposed to, HAV vaccination and prevention programs targeting this population should be considered to prevent outbreaks and the burden of the disease.

The relationship between postmenopausal women’s body image and the severity of menopausal symptoms

Background Body image is the main element of an individual’s personality that may be influenced by many factors during menopause. We aimed to assess the relationship between postmenopausal women’s body image with the severity of menopausal symptoms. Methods This was a cross-sectional study on 300 postmenopausal women, aged 45 to 65 years old, in Tehran, Iran. We recruited the samples using the multi-stage sampling method. Tools for data collection were: 1) the Menopausal Rating Scale (MRS), 2) the Fisher’s Body Image questionnaire and 3) a socio-demographic questionnaire. We analyzed data using the independent samples t-test, Pearson correlation coefficient, Spearman’s correlation coefficient, and multiple linear regression tests. Results Three hundred women aged 55.11 ± 3.99 years old, participated in the study. Mean scores for body image and MRS were 163.07 ± 21.17 (Range: 46–230) and 16.45 ± 8.38 (Range: 0–44), respectively. About 50% of women had severe symptoms of menopause (MRS score ≥ 17). There was a negative correlation between the total score and the score of all dimensions of body image with the total score and all dimensions of MRS (P < 0.001). There were also significant relationships between women’s body image with: their education (P < 0.001, r = 0.20) the spouse’s education (P < 0.001, r = 0.26), adequacy of monthly household income (P < 0.001, r = 0.32), marital status (P = 0.36), their occupation (P = 0.007) and housing status (P = 0.012). There was also a significant negative correlation between women’s lower body organs image with the number of children (P = 0.017, r = − 0.14). According to the multiple linear regressions model, severity of menopausal symptoms (Beta = − 0.45, P < 0.001) and adequacy of monthly household income (Beta = 0.15, P = 0.005) are the significant related factors with postmenopausal women’s body image. Conclusions Body image is correlated with menopausal symptoms of women during menopause. Therefore, it seems that interventions aimed at relieving the annoying symptoms of menopause can help to improve their body image. Also, body image could be influenced by some socio-demographic factors which should be considered in menopause health promotion programs.

Influencing Factors of Psychosocial Stress among Korean Adults during the COVID-19 Outbreak

The restriction of an individual’s daily life due to the strengthening of quarantine and lockdown increases psychosocial stress. This study aimed to determine the factors that influence psychosocial stress during a period of strict quarantine and lockdown to curb the COVID-19 pandemic in Korea. A total of 338 adults participated in a cross-sectional online survey conducted from 19–25 May 2020, which measured knowledge of COVID-19, health belief, resilience, and psychosocial stress. According to the results, there was no difference between the participants’ scores from the Daegu area (with concentrated confirmed COVID-19 cases) and the non-Daegu area except for health belief. Eighty-two percent of participants constituted the high-risk group for psychosocial stress. Individual resilience was positively correlated with health belief and negatively correlated with psychosocial stress (p < 0.001). Further, the following factors affected the level of psychosocial stress: resilience, subjective health status, and monthly household income, with an explanatory power of 39.8%. Therefore, those with higher subjective health and higher monthly household income experienced higher psychosocial stress, whereas higher resilience indicated lower psychosocial stress.

Health-Related Quality of Life and Associated Factors of Children with Transfusion-Dependent Thalassemia in Dubai, United Arab Emirates

BACKGROUND: Patients with transfusion-dependent thalassemia require lifelong blood transfusions and iron chelation therapy. Iron overload associated with regular blood transfusion leads to a significant defect in the health-related quality of life (HRQoL) of patients with transfusion-dependent thalassemia (TDT). Quality of life has become a significant component of care, and it is therefore necessary to focus on the HRQoL of patients with transfusion-dependent thalassemia. OBJECTIVES: To assess the HRQoL of children with transfusion-dependent thalassemia, identify the sociodemographic and clinical characteristics that affect the HRQoL, and identify the risk factors for poor HRQoL in children with transfusion-dependent thalassemia. STUDY DESIGN: A descriptive cross-sectional study was used to address the study&rsquo;s objectives. SETTING: A representative sample was recruited from the Dubai Thalassemia Center in the United Arab Emirates. PARTICIPANTS: A total of 68 patients with transfusion-dependent thalassemia aged 2-18 years. INTERVENTION: PedsQL 4.0 was applied to assess the HRQoL. The total HRQoL score was treated as the dependent variable in the study. Regression analysis was applied to study the effect of sociodemographic and clinical characteristics on HRQoL. RESULTS: This study included 68 patients with TDT. Among them, 55.9% fell into the 13-18-year age group, and 42.6% were male. In addition, 57.4% were non-UAE nationals, and 44.1% of the children had less than 10,000 AED as monthly household income. The median (IQR) physical health summary score was 89.9 (15.6) and the psychosocial health summary score was 90.0 (10.3). Total PedsQL scores were significantly higher for younger children, those with a higher monthly household income, and those without complications. Increasing children&rsquo;s age was significantly correlated with lower total, physical, and psychosocial health summary PedsQL scores, whereas lower monthly household income was significantly correlated with lower total and psychosocial health summary PedsQL scores. Controlling for other variables, increasing patients&rsquo; age was associated with worse total PedsQL scores. CONCLUSIONS: Children with TDT and their families require long-term support for the prevention of physical and mental problems associated with TDT.

Prevalence and factors associated with antenatal care service access among Indigenous women in the Chittagong Hill Tracts, Bangladesh: A cross-sectional study

Background Prevalence of accessing antenatal care (ANC) services among Indigenous women in the Chittagong Hill Tracts (CHT) is unknown. This study aims to estimate the prevalence of accessing ANC services by Indigenous women in the CHT and identify factors associated with knowledge of, and attendance at, ANC services. Methods Using a cross-sectional design three Indigenous groups in Khagrachari district, CHT, Bangladesh were surveyed between September 2017 and February 2018. Indigenous women within 36 months of delivery were asked about attending ANC services and the number who attended was used to estimate prevalence. Socio-demographic and obstetric characteristics were used to determine factors associated with knowledge and attendance using multivariable logistic regression techniques adjusted for clustering by village; results are presented as odds ratios (OR), adjusted OR, and 95% confidence intervals (CI). Results Of 494 indigenous women who met the inclusion criteria in two upazilas, 438 participated (89% response rate) in the study, 75% were aged 16–29 years. Sixty-nine percent were aware of ANC services and the prevalence of attending ANC services was 53% (n = 232, 95%CI 0.48–0.58). Half (52%; n = 121) attended private facilities. Independent factors associated with knowledge about ANC were age ≥30 years (OR 2.2, 95%CI 1.1–4.6), monthly household income greater than 20,000 Bangladeshi Taka (OR 3.4, 95%CI 1.4–8.6); knowledge of pregnancy-related complications (OR 3.6, 95%CI 1.6–8.1), knowledge about nearest health facilities (OR 4.3, 95%CI 2.1–8.8); and attending secondary school or above (OR 4.8, 95%CI 2.1–11). Independent factors associated with attending ANC services were having prior knowledge of ANC benefits (OR 7.7, 95%CI 3.6–16), Indigenous women residing in Khagrachhari Sadar subdistrict (OR 6.5, 95%CI 1.7–25); and monthly household income of 20,000 Bangladeshi Taka or above (OR 2.8, 95%CI 1.1–7.4). Conclusion Approximately half of Indigenous women from Chittagong Hill Tracts Bangladesh attended ANC services at least once. Better awareness and education may improve ANC attendance for Indigenous women. Cultural factors influencing attendance need to be explored.

Investigating Health Status Among Women Aged 50-70 years old in Hunan Province, China: A Cross-Sectional study

Background: As promotion of the Global strategy and action plan on ageing and health 2016-2020 and the Outline of the "Healthy China 2030" Plan, healthy ageing becomes a hot pot. It is crucial to identify health status of senior women and acquire characteristics of them. The purpose of this paper was to investigate the health of women aged 50-70 in Hunan Province of China, come out coping strategy and prompt an active discussion for healthy ageing.Methods: A cross-sectional study was conducted in 20 communities randomly selected from 5 sampled districts and 5counties in Hunan Province. A self-designed and structured questionnaire was used, included demographic data, diseases-related information, self-reported health, health behaviors, and psychological health. The data was collected by well-trained workers, double-entered into EpiData 3.0 and analyzed by SPSS 19.0.Results: Among the 2585 senior women, 51.0% was chronic diseases, 49.6% was gynecopathy and 23.6% was mastopathy. Age [OR=1.394, 95% CI=(1.63-1.670)], household type [OR=1.700, 95% CI=(1.416-2.042)], BMI [OR=1.194, 95% CI=(1.043-1.367)], average monthly household income [OR=0.884, 95% CI=(0.809-0.965)] and self-reported physical health [OR=4.659, 95% CI=(3.913-5.546)] were significantly associated with chronic diseases. Age [OR=0.668, 95% CI=(0.564-0.792)], household type [OR=1.335, 95% CI=(1.094-1.629)], occupation [OR=1.045, 95% CI=(1.002-1.090)], average monthly household income [OR=1.243, 95% CI=(1.143-1.352)] and self-reported physical health [OR=1.748, 95% CI=(1.510-2.024)] were significantly associated with gynecopathy. Age [OR=0.749, 95% CI=(0.616-0.910)], household type [OR=1.603, 95% CI=(1.269-2.026)], occupation [OR=1.057, 95% CI=(1.009-1.108)], average monthly household income [OR=1.233, 95% CI=(1.127-1.350)] and self-reported physical health [OR=1.272, 95% CI=(1.077-1.502)] were significantly associated with mastopathy. Age [OR=0.778, 95% CI=(0.645-0.939)], household type [OR=2.090, 95% CI=(1.733-2.520)], and BMI [OR=1.218, 95% CI=(1.061-1.399)] were significantly associated with exposure to secondhand smoke. Age [OR=0.829, 95% CI=(0.701-0.980)] and occupation [OR=0.956, 95% CI=(0.923-0.990)] were significantly associated with regular physical examinations. Household type [OR=0.642, 95% CI=(0.398-1.035)] and self-reported physical health [OR=1.983, 95% CI=(1.340-2.935)] were significantly associated with anxiety.Conclusion: This cross-sectional study shows good description as an appropriate investigation for the identification of women aged 50-70 with certain diseases, health behaviors and psychological health problems in a representative and community-conducted sample of women in Hunan Province of China. It discloses their poor health status.