A latent profile analysis of Pacific health values

Introduction: Pacific health models that centre Pacific values, can serve as a tool to address Pacific disparities in healthcare. In this study, we broadly draw upon the health concepts of these models to determine how Pacific values are translate across Pacific health and wellbeing. Methods: Using data from the New Zealand Attitudes and Values Study, we identified proxy indicators of common Pacific values. With these proxy indicators we developed a LP Latent Profile Analysis A to uncover subgroups of Pacific peoples based on their orientation towards each proxy indicator and their association with psychological distress. Findings: We identified four subgroups of Pacific peoples: (1) 65% of Pacific peoples identified strongly with Pacific values with low associated psychological distress (2) 18% of Pacific peoples identified moderately with Pacific values with medium associated psychological distress (3) 5% of Pacific peoples identified less with Pacific values with low associated psychological distress (4) 12% of Pacific peoples identified ambivalent with Pacific values with high associated psychological distress. Conclusions: These results suggest that Pacific values and the utility of Pacific health models are an appropriate way of framing health and wellbeing for a vast majority of our Pacific population. However, we also need to recognise the incredible diversity among our Pacific community and be understanding and accommodating of the diverse ways that Pacific peoples can express what they consider valuable.

Proxy longitudinal indicators of household food insecurity in the UK

Background: Rising food bank usage in the UK suggests a growing prevalence of food insecurity. However, a formalised, representative measure of food insecurity was not collected in the UK until 2019, over a decade after the initial proliferation of food bank demand. In the absence of a direct measure of food insecurity, this article identifies and summarises longitudinal proxy indicators of UK food insecurity to gain insight into the growth of insecure access to food in the 21st century. Methods: A rapid evidence synthesis of academic and grey literature (2005–present) identified candidate proxy longitudinal markers of food insecurity. These were assessed to gain insight into the prevalence of, or conditions associated with, food insecurity. Results: Food bank data clearly demonstrates increased food insecurity. However, this data reflects an unrepresentative, fractional proportion of the food insecure population without accounting for mild/moderate insecurity, or those in need not accessing provision. Economic indicators demonstrate that a period of poor overall UK growth since 2005 has disproportionately impacted the poorest households, likely increasing vulnerability and incidence of food insecurity. This vulnerability has been exacerbated by welfare reform for some households. The COVID-19 pandemic has dramatically intensified vulnerabilities and food insecurity. Diet-related health outcomes suggest a reduction in diet quantity/quality. The causes of diet-related disease are complex and diverse; however, evidence of socio-economic inequalities in their incidence suggests poverty, and by extension, food insecurity, as key determinants. Conclusion: Proxy measures of food insecurity suggest a significant increase since 2005, particularly for severe food insecurity. Proxy measures are inadequate to robustly assess the prevalence of food insecurity in the UK. Failure to collect standardised, representative data at the point at which food bank usage increased significantly impairs attempts to determine the full prevalence of food insecurity, understand the causes, and identify those most at risk.

Dementia and Dependency vs. Proxy Indicators of the Active Ageing Index in Indonesia

Dementia prevalence is increasing worldwide and developing countries are expected to carry the highest burden of this. Dementia has high care needs and no current effective long-term treatment. However, factors associated with active ageing (e.g., longer employment; participation in society; independent, healthy and secure living; and enabling environments to allow people to remain psychosocially and physically active) could help maintain independence in older people for longer. We investigated proxy indicators of the Active Ageing Index (AAI), which were offset against dementia and dependency (assessed by Instrumental Activities of Daily Living or IADL) in multi-ethnic urban (Jakarta) and rural (Sumedang and Borobudur) health care districts on Java, Indonesia. Dementia was assessed using validated cognitive dementia screening tests, the IADL and carer reports. Dementia and dependency prevalence showed large interregional differences and were highest in rural Borobudur. Dementia and dependency were associated with an older age, lower education (for dementia), worse physical health (for dependency) and not engaging in psychosocial activities, such as attending community events, reading (for dementia) and sport activities (for dependency). By supporting active ageing activities in Puskesmas (primary health care centers) and improving access to medical care, rural areas could possibly reduce dementia and dependency risk. Our follow-up study planned in 2021 should illustrate whether recent relevant policies have rendered success in these areas. Using active ageing indicators could focus policies to support regions with targeted interventions to compress care needs in older people.

‘Hidden Hot Springs’ as a Source of Groundwater Fluoride and Severe Dental Fluorosis in Malawi

Hidden hot springs likely impact rural water supplies in Malawi’s Rift Valley with excess dissolved fluoride leading to localised endemic severe dental fluorosis. Predicting their occurrence is a challenge; Malawi’s groundwater data archive is sporadic and incomplete which prevents the application of standard modelling techniques. A creative alternative method to predict hidden hot spring locations was developed using a synthesis of proxy indicators (geological, geochemical, dental) and is shown to be at least 75% effective. An exciting collaboration between geoscientists and dentists allowed corroboration of severe dental fluorosis with hydrogeological vulnerability. Thirteen hidden hot springs were identified based on synthesised proxy indicators. A vulnerability prediction map for the region was developed and is the first of its kind in Malawi. It allows improved groundwater fluoride prediction in Malawi’s rift basin which hosts the majority of hot springs. Moreover, it allows dentists to recognise geological control over community oral health. Collaborative efforts have proven mutually beneficial, allowing both disciplines to conduct targeted research to improve community wellbeing and health and inform policy development in their respective areas. This work contributes globally in developing nations where incomplete groundwater data and vulnerability to groundwater contamination from hydrothermal fluoride exist in tandem.

A Comparative Study of the Efficacy of Community Health Clubs in Rural Areas of Vietnam and Zimbabwe to Control Diarrhoeal Disease

The Community Health Club (CHC) Model in Makoni District, Zimbabwe operated 265 CHCs with 11,600 members from 1999 to 2001 at a cost of US$0.63 per beneficiary per annum. A decade later, 48 CHCs were started in three districts in Vietnam with 2,929 members at a cost of US$1.30. Hygiene behaviour change was compared using a similar survey of observable proxy indicators in both projects, before and after intervention. In Vietnam there was a mean of 36% change in 16 observable proxy indicators (p > 0.001) which compared positively with Makoni where there was a mean of 23% hygiene change in 10 indicators (p > 0.001). In Vietnam, 8 Health Centers reported a reduction of 117 cases of diarrhoeal diseases in CHC communes, compared to only 24 in non-CHC communes in one year; in 8 Health Centers in Makoni, Zimbabwe, a reduction of 1,219 reported cases over a 2–9 year period was reported, demonstrating the efficacy of CHC both in African and Asian context. We suggest that regular government data of reported cases at clinics may be a more reliable method than self-reported diarrhoea by carers in clustered-Randomised Control Trials, which have surprised practitioners by finding negligible impact of WASH interventions on diarrhoea in rural communities.

Design of proxy indicators estimating the appropriateness of antibiotics prescribed by French dentists: a cross-sectional study based on reimbursement data

Background – The literature shows that the prescription of antibiotics in dental care is often unnecessary or inappropriate. Indicators estimating the appropriateness of antibiotics prescribed by dentists based on routine databases are however not available in the literature. Our objectives were to: (i) design proxy indicators estimating the appropriateness of antibiotics prescribed by dentists; (ii) evaluate their clinimetric properties; and (iii) provide results for these proxy indicators for dentists located in a north-eastern French region. Methods – We selected and adapted proxy indicators from the literature. Using 2019 Regional Health Insurance data, we evaluated the proxy indicators’ clinimetric properties (measurability, applicability, and potential room for improvement), their results with performance scores (% of dentists who reached the target value), and the case-mix stability. Results – We included 3,014 general dental practitioners, who prescribed a total of 373,975 antibiotics to 308,123 patients in 2019. We identified four proxy indicators estimating antibiotic prescribing appropriateness in dental care. All proxy indicators had good clinimetric properties. Performance scores were generally low (10.5 to 73.0%, depending on the indicator), suggesting an important room for improvement. These results showed large variations between dentists (large interquartile ranges) and according to the patients’ characteristics (case-mix stability). Conclusion – These four proxy indicators might be used to guide antibiotic stewardship interventions in dental care.

Cultural Ecosystem Services in the Natura 2000 Network: Introducing Proxy Indicators and Conflict Risk in Greece

Within the ecosystem services framework, cultural ecosystem services (CES) have rarely been applied in state-wide surveys of protected area networks. Through a review of available data and online research, we present 22 potential proxy indicators of non-material benefits people may obtain from nature in Natura sites in Greece. Despite the limitations due to data scarcity, this first distance-based study screens a recently expanded protected area system (446 Natura sites) providing steps towards an initial CES capacity review, site prioritization and data gap screening. Results identify hot spot Natura sites for CES values and wider areas of importance for the supply of CES. Additionally, a risk analysis mapping exercise explores the potential risk of conflict in the Natura sites, due to proposed wind farm developments. Α number of sites that may suffer serious degradation of CES values due to the large number of proposed wind turbines within these protected areas is identified, with 26% of Greece’s Natura sites showing serious and high risk of degradation of their aesthetic values. Screening-level survey exercises such as these may play an important role in advancing conservation effectiveness by increasing the appreciation of the multiple benefits provided by Natura protected areas. Based on this review, we propose recommendations through an adaptive approach to CES inventory and research initiatives in the protected area network.

Standard Minimum Dietary Diversity Indicators for Women or Infants and Young Children Are Good Predictors of Adequate Micronutrient Intakes in 24–59-Month-Old Children and Their Nonpregnant Nonbreastfeeding Mothers in Rural Burkina Faso

ABSTRACT Background Simple proxy indicators are needed to assess and monitor micronutrient intake adequacy of vulnerable populations. Standard dichotomous indicators exist for nonpregnant women of reproductive age and 6–23-mo-old children in low-income countries, but not for 24–59-mo-old children or pregnant or breastfeeding women. Objectives This study aimed to evaluate the performance of 2 standard food group scores (FGSs) and related dichotomous indicators to predict micronutrient adequacy of the diet of rural Burkinabe 24–59-mo-old children and women of reproductive age by physiological status. Methods A 24-h recall survey was conducted at dry season among 1066 pairs of children and caregivers. Micronutrient adequacy was evaluated by the mean probability of adequacy (MPA) of intake over 11 micronutrients. Proxy indicators were FGS-10 [10 food groups based on the FAO/FHI360 minimum dietary diversity for women (MDD-W) guidelines] and related MDD-W (FGS-10 ≥5); and FGS-7 [7 groups based on the WHO infant and young child (IYC) feeding MDD guidelines] and related MDD-IYC (FGS-7 ≥4). Results FGS-10 and FGS-7 were similar across children and women (∼3 groups). FGS-10 performed better than FGS-7 to predict MPA in children (Spearman rank correlation = 0.59 compared with 0.50) and women of all 3 physiological statuses (Spearman rank correlation = 0.53–0.55 compared with 0.42–0.52). MDD-W and MDD-IYC performed well in predicting MPA >0.75 in children and MPA >0.6 in nonpregnant nonbreastfeeding (NPNB) women, but a 4-group cutoff for FGS-10 allowed a better balance between sensitivity, specificity, and proportion of correct classification. MPA levels for pregnant and breastfeeding women were too low to assess best cutoff points. Conclusions MDD-IYC or an adapted MDD-W (FGS-10 ≥4 instead of FGS-10 ≥5) can be extended to 24–59-mo-old children and NPNB women in similar-diet settings. The inadequacy of micronutrient intakes in pregnant and breastfeeding women warrants urgent action. Micronutrient adequacy predictors should be validated in populations where a higher proportion of these women do meet dietary requirements.