Prenatal care content and utilization among pregnant women enrolled in managed care programs in Harris County, Texas

This research study was conducted as a descriptive study of prenatal care experiences of women enrolled in public and private managed care programs. The study's aim was to describe the demographic characteristics of the women in the study and to analyze and compare their prenatal care experiences. ^ The objective of this study was to examine the research question: Do pregnant women enrolled in Medicaid Managed Care receive the same level of care as women enrolled in other Managed Care Programs in Harris County, Texas? ^ The study population was a convenience sample of pregnant women enrolled in managed care programs who presented to one of the two hospital study sites for delivery of their infant. The study utilized a self administered survey to measure adequacy and content of prenatal care received by the women during this pregnancy. Adequacy of prenatal care utilization was determined based on the Kessner Index criteria of timing of initiation of care and number of visits. Content of care was measured by the number of different medical services the women reported they had received and the number of health information topics the women reported on which they had received information. Demographic characteristics were described with univariate and bivariate statistics of frequencies and cross tabulations. Associations were evaluated using measures of linear correlations. ^ Results from the study showed there is an association between enrollment in Medicaid Managed Care (public) and prenatal care received compared to women enrolled in other Managed Care Programs (private). The results were derived from statistical tests on data the postpartum women gave when they completed the self-administered survey. Provider type was a moderate predictor of quality and quantity of prenatal care. The results also indicate that in the study population, minority ethnicity, income and lower educational status were associated with intermediate and inadequate prenatal care. ^

Access to oral care --- A systematic review of a continuing public health issue among older adults

Oral health is essential for the general well being of the individual and collectively for the health of the population. Oral health can be maintained by routine dental care and visits to dental professionals, but accessing professional dental care may be a continuing difficulty in vulnerable older adult population. Many older adults are not frequent users of dental care, though oral health is crucial to their well-being and overall health. Access to care is the timely use of personal health services to achieve the best possible health outcomes. ^ Objectives: The aims of this review are to (i) to analyze and elucidate the relationship between socio-economic disparities in gender, ethnicity, poverty status, education and the continuing public issue of access to oral care, (ii) to identify the underlying causes through which these factors can affect access to oral care. This review will provide a knowledgeable basis for development of interventions to provide adequate access to oral care in older adults and implementing policies to ensure access to oral care; through highlighting the various socio economic factors that affect access to oral care among older adults. ^ Methods: This paper used a purposeful review of literature on socioeconomic disparities in access to oral care among older adults. The references considered in this review included all the relevant articles, surveys and reports published in English language, since the year 1985 to 2010, in the United States. The articles selected were scrutinized for relevancy to the topic of access to oral care and which included discussions of the effects of gender, ethnicity, poverty status, educational status in accessing oral care. ^ Results: Evidence confirmed the continuing disparity in access to oral care among older adults. The possible links identified were gender inequality, ethnic differences, income levels and educational differences affecting access to oral care. The underlying causes linking these factors with access to oral care were established. ^ Conclusion: The analysis of the literature review findings supported the prevalence of disparities in gender, ethnicity, income and education with its possible links affecting access to oral care. The underlying causes helped to understand the reasons behind this growing issue of inaccessible oral care. Further research is needed to develop policies and target dental public health efforts towards specific problem areas ensuring equitable access to oral services and consequently, improve the health of older adults.^

Deprivation of Education in Urban Areas: A Basic Profile of Slum Children in Delhi, India

This paper showed the basic educational status of slum children between 5 and 14 years old. The attendance ratio of slum children is much lower than that of children in Delhi as a whole. Parental perception of education and financing education are the major constraints. Even if children are attending schools, the majority of them are over-aged. There are both demand and supply side reasons for discouraging slum children from attending schooling. As opposed to school-based surveys in previous literature, children in slums are more likely to go to government schools rather than low-fee paying private schools. Some policies are suggested.

Literacy and health in the United States : selected annotations.

Includes indexes.

Trends in selected maternal characteristics associated with infant mortality : Illinois, 1980-1989 /

"March 1994."

Conceptions of health held by Aboriginal, Torres Strait Islander and Papua New Guinea health care students

Health is considered to be a fundamental human right. Concurrently health is assumed to be a global social goal (Bloom, 1987) yet many third-world countries and some sub-populations within developed countries do not enjoy a healthy existence. The research reported in this paper examined the conceptions of health, conceptions of illness and health practices for a group of Aboriginal, Torres Strait Islander, and Papua New Guinea university students studying health science courses. Results found three conceptions of health and three conceptions of illness that showed these students held traditional/cultural and Western beliefs about health and health practices. These findings may contribute to the development of health care courses that are more specific to how these students understand health. This may also serve to improve the educational status of Aboriginal and Torres Strait Islander people and potentially improve the health status within these communities (author abstract)

Clean Cookstoves and Health in Samlout, Cambodia

This paper discusses results from a study of the use of cleaner cooking solutions and general health status of people in rural areas from the Battambang province of Cambodia. Data collection included 372 demographic, health and socio-economic surveys with households living in 6 villages in the Samlout district, general health examinations, and measurements of stove use and household concentrations of PM 2.5. The data reveal that health in this population is a major concern, with a very high prevalence of reported abdominal pain, nausea, chronic cough, chest pains, and fever during examinations.  At the household level, we find that clean stove ownership is significantly correlated with the educational status of household head and socio-economic status of a household. Respondents from households with clean stoves appear less likely (though not statistically significantly so) to report household individuals having health problems such as occasional cough, high blood pressure and tuberculosis. Concentrations of PM2.5 are positively correlated with prevalence of occasional cough, high blood pressure and tuberculosis. Based on these results, we advise field testing and evaluation of targeted health interventions in these villages to address the numerous concerns of the local population, including exploring the potential role of clean stoves.

Men's knowledge and attitudes about cervical cancer screening in Kenya.

BACKGROUND: A number of studies have identified male involvement as an important factor affecting reproductive health outcomes, particularly in the areas of family planning, antenatal care, and HIV care. As access to cervical cancer screening programs improves in resource-poor settings, particularly through the integration of HIV and cervical cancer services, it is important to understand the role of male partner support in women's utilization of screening and treatment. METHODS: We administered an oral survey to 110 men in Western Kenya about their knowledge and attitudes regarding cervical cancer and cervical cancer screening. Men who had female partners eligible for cervical cancer screening were recruited from government health facilities where screening was offered free of charge. RESULTS: Specific knowledge about cervical cancer risk factors, prevention, and treatment was low. Only half of the men perceived their partners to be at risk for cervical cancer, and many reported that a positive screen would be emotionally upsetting. Nevertheless, all participants said they would encourage their partners to get screened. CONCLUSIONS: Future interventions should tailor cervical cancer educational opportunities towards men. Further research is needed among both men and couples to better understand barriers to male support for screening and treatment and to determine how to best involve men in cervical cancer prevention efforts.

Intergenerational effects of parental substance-related convictions and adult drug treatment court participation on children's school performance.

This study examined the intergenerational effects of parental conviction of a substance-related charge on children's academic performance and, conditional on a conviction, whether completion of an adult drug treatment court (DTC) program was associated with improved school performance. State administrative data from North Carolina courts, birth records, and school records were linked for 2005-2012. Math and reading end-of-grade test scores and absenteeism were examined for 5 groups of children, those with parents who: were not convicted on any criminal charge, were convicted on a substance-related charge and not referred by a court to a DTC, were referred to a DTC but did not enroll, enrolled in a DTC but did not complete, and completed a DTC program. Accounting for demographic and socioeconomic factors, the school performance of children whose parents were convicted of a substance-related offense was worse than that of children whose parents were not convicted on any charge. These differences were statistically significant but substantially reduced after controlling for socioeconomic characteristics; for example, mother's educational attainment. We found no evidence that parent participation in an adult DTC program led to improved school performance of their children. While the children of convicted parents fared worse on average, much--but not all--of this difference was attributed to socioeconomic factors, with the result that parental conviction remained a risk factor for poorer school performance. Even though adult DTCs have been shown to have other benefits, we could detect no intergenerational benefit in improved school performance of their children.

Patient perspectives of a diagnosis of myeloproliferative neoplasm in a case control study

Background: Myeloproliferative neoplasms (MPNs) including the classic entities; polycythemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis are rare diseases with unknown aetiology. The MOSAICC study, is an exploratory case–control study in which information was collected through telephone questionnaires and medical records. Methods: As part of the study, 106 patients with MPN were asked about their perceived diagnosis and replies correlated with their haematologist’s diagnosis. For the first time, a patient perspective on their MPN diagnosis and classification was obtained. Logistic regression analyses were utilised to evaluate the role of variables in whether or not a patient reported their diagnosis during interview with co-adjustment for these variables. Chi square tests were used to investigate the association between MPN subtype and patient reported categorisation of MPN. Results: Overall, 77.4 % of patients reported a diagnosis of MPN. Of those, 39.6 % recognised MPN as a ‘blood condition’,23.6 % recognised MPN as a ‘cancer’ and 13.2 % acknowledged MPN as an ‘other medical condition’. There was minimal overlap between the categories. Patients with PV were more likely than those with ET to report their disease as a ‘blood condition’. ET patients were significantly more likely than PV patients not to report their condition at all.Patients from a single centre were more likely to report their diagnosis as MPN while age, educational status, and WHO re-classification had no effect. Conclusions: The discrepancy between concepts of MPN in patients could result from differing patient interest in their condition, varying information conveyed by treating hematologists, concealment due to denial or financial concerns. Explanations for the differences in patient perception of the nature of their disease, requires further, larger scale investigation.

Agricultural microcredit and technical efficiency: The case of smallholder rice farmers in Northern Ghana

In the current study, we compared technical efficiency of smallholder rice farmers with and without credit in northern Ghana using data from a farm household survey. We fitted a stochastic frontier production function to input and output data to measure technical efficiency. We addressed self-selection into credit participation using propensity score matching and found that the mean efficiency did not differ between credit users and non-users. Credit-participating households had an efficiency of 63.0 percent compared to 61.7 percent for non-participants. The results indicate significant inefficiencies in production and thus a high scope for improving farmers’ technical efficiency through better use of available resources at the current level of technology. Apart from labour and capital, all the conventional farm inputs had a significant effect on rice production. The determinants of efficiency included the respondent’s age, sex, educational status, distance to the nearest market, herd ownership, access to irrigation and specialisation in rice production. From a policy perspective, we recommend that the credit should be channelled to farmers who demonstrate the need for it and show the commitment to improve their production through external financing. Such a screening mechanism will ensure that the credit goes to the right farmers who need it to improve their technical efficiency.

Motivação para amamentação em função da escolaridade materna

Enquadramento: Atualmente a prevalência da amamentação à saída da maternidade é elevada, no entanto não temos valores semelhantes quanto ao aleitamento materno exclusivo, nem no seu prolongamento até aos dois anos. Objetivos: Verificar as relações entre a motivação das puérperas para a amamentação e variáveis sociodemográficas e obstétricas e analisar a influência das variáveis sociodemográficas e obstétricas na motivação para a amamentação quando mediadas pela escolaridade da puérpera. Material e métodos: Estudo não experimental, quantitativo, descritivo correlacional e analítico. O tipo de amostragem é não probabilístico por conveniência. O instrumento de colheita de dados foi o questionário, aplicado a 479 puérperas (média de idade 30,56 anos) no dia da alta hospitalar. O questionário permitiu fazer a caracterização da amostra em termos sociodemográficos e obstétricos. Foi ainda utilizada a escala de Motivação para Amamentação de Nelas, Ferreira & Duarte (2008). Resultados: Os resultados obtidos revelam que 86,6% são casadas ou vivem em união de fato e pertencem a uma família nuclear (89,1%). Na amostra, 59,5% tem o Ensino Superior e 73.9% encontra-se empregada e 55,3% reside em meio urbano. A maioria (43,0%), esteve grávida só uma vez e 34.4% já tinha tido uma gestação anterior. São mães pela primeira vez 48,0%, 79,3% realizou seis ou mais consultas tal como o preconizado, e 92,4% planeou a gravidez. A maioria dos partos foi de termo (68,4%). A quase totalidade (9 em cada 10) revela elevada motivação para amamentar. A idade, o estado civil, a residência e as habilitações literárias não influenciam a motivação geral para a amamentação As puérperas desempregadas são as mais motivadas. As puérperas mais motivadas tiveram duas ou mais gestações, e são multíparas. Não foi provada a relação entre as outras variáveis obstétricas e a motivação para a amamentação. A variável mediadora apenas teve impacto com o local de residência, onde as participantes residentes em meio urbano e com ensino superior são as mais motivadas na dimensão fisiológica, seguidas das residentes em meio urbano e com habilitações literárias até ao ensino secundário. Conclusões: Sugerimos a criação de um grupo de trabalho com atuação na comunidade escolar para capacitar os jovens sobre a importância do aleitamento materno, recriando uma 8 cultura de amamentação assente nas orientações emanadas na política de aleitamento materno dos Hospitais amigos dos bebés. Palavras-chave: Amamentação, Motivação, Escolaridade.

The mediating role of dietary factors and leisure time physical activity on socioeconomic inequalities in body mass index among Australian adults

BACKGROUND: The relationship between socioeconomic position and obesity has been clearly established, however, the extent to which specific behavioural factors mediate this relationship is less clear. This study aimed to ascertain the contribution of specific dietary elements and leisure-time physical activity (LTPA) to variations in obesity with education in the baseline (1990-1994) Melbourne Collaborative Cohort Study (MCCS).

METHODS: 18, 489 women and 12, 141 men were included in this cross-sectional analysis. A series of linear regression models were used in accordance with the products of coefficients method to examine the mediating role of alcohol, soft drink (regular and diet), snacks (healthy and sweet), savoury items (healthy and unhealthy), meeting fruit and vegetable guidelines and LTPA on the relationship between education and body mass index (BMI).

RESULTS: Compared to those with lowest educational attainment, those with the highest educational attainment had a 1 kg/m2 lower BMI. Among men and women, 27% and 48%, respectively, of this disparity was attributable to differences in LTPA and diet. Unhealthy savoury item consumption and LTPA contributed most to the mediated effects for men and women. Alcohol and diet soft drink were additionally important mediators for women.

CONCLUSIONS: Diet and LTPA are potentially modifiable behavioural risk factors for the development of obesity that contribute substantially to inequalities in BMI. Our findings highlight the importance of specific behaviours which may be useful to the implementation of effective, targeted public policy to reduce socioeconomic inequalities in obesity.

The relation between non-occupational physical activity and years lived with and without disability

OBJECTIVES: The effects of non-occupational physical activity were assessed on the number of years lived with and without disability between age 50 and 80 years. METHODS: Using the GLOBE study and the Longitudinal Study of Aging, multi-state life tables were constructed yielding the number of years with and without disability between age 50 and 80 years. To obtain life tables by level of physical activity (low, moderate, high), hazard ratios were derived for different physical activity levels per transition (non-disabled to disabled, non-disabled to death, disabled to non-disabled, disabled to death) adjusted for age, sex and confounders. RESULTS: Moderate, compared to low non-occupational physical activity reduced incidence of disability (HR 0.66, 95% CI 0.51 to 0.86), increased recovery (HR 1.95, 95% CI 1.32 to 2.87), and represents a gain of disability-free years and a loss of years with disability (male 3.1 and 1.2; female 4.0 and 2.8 years). Performing high levels of non-occupational physical activity further reduced incidence, and showed a higher gain in disability-free years (male 4.1; female 4.7), but a similar reduction in years with disability. CONCLUSION: Among 50-80-year-olds promoting physical activity is a fundamental factor to achieve healthy ageing.

Effects of a free school breakfast programme on school attendance, achievement, psychosocial function, and nutrition: a stepped wedge cluster randomised trial

BACKGROUND: Approximately 55,000 children in New Zealand do not eat breakfast on any given day. Regular breakfast skipping has been associated with poor diets, higher body mass index, and adverse effects on children's behaviour and academic performance. Research suggests that regular breakfast consumption can improve academic performance, nutrition and behaviour. This paper describes the protocol for a stepped wedge cluster randomised trial of a free school breakfast programme. The aim of the trial is to determine the effects of the breakfast intervention on school attendance, achievement, psychosocial function, dietary habits and food security.

METHODS/DESIGN: Sixteen primary schools in the North Island of New Zealand will be randomised in a sequential stepped wedge design to a free before-school breakfast programme consisting of non-sugar coated breakfast cereal, milk products, and/or toast and spreads. Four hundred children aged 5-13 years (approximately 25 per school) will be recruited. Data collection will be undertaken once each school term over the 2010 school year (February to December). The primary trial outcome is school attendance, defined as the proportion of students achieving an attendance rate of 95% or higher. Secondary outcomes are academic achievement (literacy, numeracy, self-reported grades), sense of belonging at school, psychosocial function, dietary habits, and food security. A concurrent process evaluation seeks information on parents', schools' and providers' perspectives of the breakfast programme.

DISCUSSION: This randomised controlled trial will provide robust evidence of the effects of a school breakfast programme on students' attendance, achievement and nutrition. Furthermore the study provides an excellent example of the feasibility and value of the stepped wedge trial design in evaluating pragmatic public health intervention programmes.