Rural-urban disparities in child nutrition in Bangladesh and Nepal

Background The persistence of rural-urban disparities in child nutrition outcomes in developing countries alongside rapid urbanisation and increasing incidence of child malnutrition in urban areas raises an important health policy question - whether fundamentally different nutrition policies and interventions are required in rural and urban areas. Addressing this question requires an enhanced understanding of the main drivers of rural-urban disparities in child nutrition outcomes especially for the vulnerable segments of the population. This study applies recently developed statistical methods to quantify the contribution of different socio-economic determinants to rural-urban differences in child nutrition outcomes in two South Asian countries – Bangladesh and Nepal. Methods Using DHS data sets for Bangladesh and Nepal, we apply quantile regression-based counterfactual decomposition methods to quantify the contribution of (1) the differences in levels of socio-economic determinants (covariate effects) and (2) the differences in the strength of association between socio-economic determinants and child nutrition outcomes (co-efficient effects) to the observed rural-urban disparities in child HAZ scores. The methodology employed in the study allows the covariate and coefficient effects to vary across entire distribution of child nutrition outcomes. This is particularly useful in providing specific insights into factors influencing rural-urban disparities at the lower tails of child HAZ score distributions. It also helps assess the importance of individual determinants and how they vary across the distribution of HAZ scores. Results There are no fundamental differences in the characteristics that determine child nutrition outcomes in urban and rural areas. Differences in the levels of a limited number of socio-economic characteristics – maternal education, spouse’s education and the wealth index (incorporating household asset ownership and access to drinking water and sanitation) contribute a major share of rural-urban disparities in the lowest quantiles of child nutrition outcomes. Differences in the strength of association between socio-economic characteristics and child nutrition outcomes account for less than a quarter of rural-urban disparities at the lower end of the HAZ score distribution. Conclusions Public health interventions aimed at overcoming rural-urban disparities in child nutrition outcomes need to focus principally on bridging gaps in socio-economic endowments of rural and urban households and improving the quality of rural infrastructure. Improving child nutrition outcomes in developing countries does not call for fundamentally different approaches to public health interventions in rural and urban areas.

Direct and indirect effects of pathological gambling on risk attitudes

We study individual decision making in a lottery-choice task performed by three different populations: gamblers under psychological treatment ("addicts"), gamblers’ spouses ("victims"), and people who are neither gamblers or gamblers’ spouses ("normals"). We find that addicts are willing to take less risk than normals, but the difference is smaller as a gambler’s time under treatment increases. The large majority of victims report themselves unwilling to take any risk at all. However, addicts in the first year of treatment react more than other addicts to the different values of the risk-return parameter.

EU free movement law and the legal recognition of same-sex relationships: the case for mutual recognition

This article seeks to examine the cross-border legal recognition of same-sex relationships in the EU. Although the Member States maintain an exclusive competence in the field of family law and, thus, it is up to them to determine whether they will provide a legal status to same-sex couples within their territory, they need to exercise their powers in that field in a way that does not violate EU law. This, it is suggested, requires that Member States mutually recognize the legal status of same-sex couples and do not treat same-sex couples worse than opposite-sex couples, if the basis of the differentiation is, merely, the (homosexual) sexual orientation of the two spouses/partners. Nonetheless, the current legal framework does not make it clear that Member States are under such an obligation. The main argument of the article, therefore, is that the EU must adopt a more hands-on approach towards this issue.

Fri vilja eller tradition? : Prästrespektive i den prästerliga kulturen

The purpose of the study was to investigate, using data from the sacerdotal culture, t h espouses of five priests. The main questions were: How does the priestly calling affect thespouse? Do the spouses involve themselves with voluntary work? Do the spouses feel thecongregation have expectations? Do the female and male answers differ?The sacerdotal culture has consisted of several elements. The main element is the priest’scalling for his work. As far as the spouse is concerned within the congregation, the spouseshave been seen as necessary for voluntary work. The congregation has also expected thespouse to act in a certain way and to undertake certain tasks.How the five informants feel about and react to the sacerdotal culture is focus for this study.The study shows that the sacerdotal culture is still strong today and it is something that thespouses take into account. They can choose not to participate but that might involve, forinstance, having to live somewhere else. The study found that the calling affects the femaleinformants, but not so much the males. The amount of participation varies from spouse tospouse and is a matter of their own choice. Expectations can also vary and participation inthe congregation can create higher expectations.

Tax filing choices for the household under separable spheres bargaining

If household choices can be rationalized by the maximization of a well defined utility function, allowing spouses to file individually or jointly is equivalent to offering the envelope of the two tax schedules. If, instead, household ’preferences’ are constantly being redefined through bargaining, the option to file separately may affect outcomes even if it is never chosen. We use Lundberg and Pollak’s (1993) separate spheres bargaining model to assess the impact of filing options on the outcomes of primary and secondary earners. Threat points of the household’s bargain are given for each spouse by the utility that he or she attains as a follower of a counter-factual off-equilibrium Stackelberg game played by the couple. For a benchmark tax system which treats a couple’s average taxable income as if it were that of a single individual, we prove that if choices are not at kinks, allowing couples to choose whether to file jointly or individually usually benefits the secondary earner. In our numeric exercises this is also the case when choices are at kinks as well. These findings are, however, quite sensitive to the details of the tax system, as made evident by the examination of an alternative tax system.

Significados e percepções do homem diante da gravidez de sua companheira com síndromes hipertensivas

The general aim of the research was to comprehend the Social Representations constructed by the man in the face of his companion s risk pregnancy caused by hypertensive syndromes. The study is of exploratory and descriptive character in a qualitative approach developed at two public maternity hospitals, both located in Natal-RN, with 65 men whose wives had undergone high-risk pregnancy. The project was submitted to the Ethics on Research Committee of the Federal University of Rio Grande do Norte, Brazil (CEP-UFRN), with favorable report no. 81/07. For data collection, the following multimethods were employed: a word free association test; a projective test for registering mental images; and a semistructured interview schedule. The speech contents were analyzed in accordance with the Theory of Social Representations and complemented by the Central Nucleus Theory. The discussion of the results was grounded on literary findings of the companion s participation in pregnancy as well as in risk pregnancy associated with hypertensive syndromes. The data showed fear as representation s central nucleus, while recollections of that feeling referred to death of both companion and child in addition to fear of the unknown. The categories preoccupation and carefulness, other feelings, and clinical picture of the disease represented components of the peripheral nucleus. The results concerning mental images followed the same category criteria of the word free association test fear, other feelings, preoccupation, carefulness, and clinical picture of the disease. After being processed in accordance with the principles of content analysis, the statements originated three thematic unities: fear and insecurity in the presence of the companion s risk pregnancy; attitudes of carefulness to the risk pregnancy of the partner; and humanized assistance during the companion s risk pregnancy. Considering the results, the conclusion is that the partner s risk pregnancy caused by hypertensive syndromes represents, for the man, feelings of fear, preoccupation, insecurity, lack of acceptance and information, as well as attitudes of carefulness. The results reveal necessity of reorganizing the obstetric assistance with an eye to including the man as participant in the reproductive process. That demands extension of humanized carefulness to the companion with a view to make him an active coadjutor in the assistance of high-risk pregnant

Adaptação sociocultural de gestores espanhóis expatriados no Brasil

This study aims at understanding how sociocultural adjustment occurs in the case of managers, and their spouses, expatriated to Brazil by private and public Spanish organizations. To do so, it adopts as main theoretical frame the expatriate adaptation model proponed by Parker & McEvoy (1993), based on Black, Mendenhall & Oddou s model (1991), which establishes three dimensions of adaptation: adjustment to work; adjustment to general environment and adjustment to interaction with host country nationals. This work, of exploratory and descriptive nature, used field research to gather primary data subsequently analyzed with a qualitative approach. Data collection came from individual in-depth interviews with three Spanish managers expatriated in Brazil and two of their spouses. Resulting data were analyzed through one of content analysis procedures, thematic analysis. This research shows that adjustment is obstructed by cultural distance or cultural novelty rather than by work role characteristics, being more successful in expatriates that carry previous solid sociocultural knowledge about host country. It also verifies that the degree of expatriate adjustment is enhanced by the comprehension of cultural differences that originate values and behaviors different from those of the expatriate. It points out that individual factors such as perception and relation skills, flexibility, empathy and self-efficacy are positively linked to the three dimensions of adjustment: work, general adjustment and interaction adjustment. It finds expatriate adjustment to be lowered by spouse unsuccessful adjustment and shows that location in an environment perceived as short in key infrastructures is negatively linked to adjustment in expatriates coming from strongly urban environments. It concludes that expatriate adjustment occurs through progressive understanding of host country environment and through comprehension of the sociocultural context that explains differences between host country behaviors and values and those from the country of origin, a process which is favored by expatriate individual characteristics not directly linked to his/her technical qualification, such as perception and relation skills, flexibility and empathy, together with solid sociocultural knowledge about the host country. This research propones, therefore, that organizations involved in expatriation processes should include in their selection criteria the degree to which candidates possess personal characteristics and sociocultural knowledge that may facilitate adaptation

Giving up reporting the aggressor: reports of female victims of domestic violence

The goal of this study is to describe the experience of female victims of domestic violence, who forfeited the lawsuits against their aggressors. The interviews were oriented by the question: What was your experience of forfeiting the denunciation of your aggressor? Three themes emerged from the convergence of the testimonies: time passed from the aggression to the denunciation and then to the forfeiting; the partner, the family, the women's precinct; reflecting about the experience, which described the studied phenomenon. The women expressed ambiguous feelings for their aggressor: affection, anger, humiliation and fear. They recognize that they are dominated and humiliated, but notions of justice and equality between spouses do not appear in the testimonies. Forfeiting can be understood in the context of the reproduction of the traditional family structure, conditioned to economic and social factors. Results highlight implications about the role of the Women's Precinct and the healthcare institutions in the care for women who were victims of domestic violence.

Desistindo da denúncia ao agressor: relato de mulheres vítimas de violência doméstica

O objetivo do estudo é descrever a experiência de mulheres, vítimas da violência doméstica, que desistiram do processo contra seu agressor. As entrevistas foram orientadas pela questão: Como foi sua experiência de desistir da denúncia contra seu agressor? Das convergências dos depoimentos emergiram três temas: o tempo vivido da agressão até a denúncia e desistência; o companheiro, a família, a delegacia da mulher; refletindo sobre a experiência vivida, que descrevem o fenômeno estudado. As participantes expressam sentimentos ambíguos em relação ao agressor: afetividade, raiva, humilhação e medo. Reconhecem que são dominadas e humilhadas. Porém, noções de justiça e igualdade entre os cônjuges não aparecem nos depoimentos. A desistência do processo pode ser compreendida na concepção da reprodução da estrutura familiar, condicionada a fatores econômicos e sociais. Os resultados remetem à reflexão sobre o papel da Delegacia da Mulher e das instituições de saúde na assistência à mulher vítima da violência doméstica.

Relations between Depression, Alcohol and Gender in the Metropolitan Region of São Paulo, Brazil

Como parte do projeto GENACIS, este artigo visou estimar a prevalência de depressão em amostra urbana de São Paulo, Brasil, assim como a associação entre depressão e padrão de uso de álcool segundo gênero. Para tanto, foi realizado inquérito epidemiológico com amostra probabilística e por conglomerados, com um total de 2083 adultos. Utilizou-se o CIDI SF para identificação de depressão. A análise estatística utilizou o teste de Rao Scott e regressão logística multivariada. A taxa de resposta foi de 74,9%. Predominaram mulheres (58,8%), menores de 40 anos de idade (52%). A prevalência de depressão foi de 28,3% para as mulheres e 12,7% para os homens. Entre os homens, 61,1% são de bebedores no último ano e a depressão esteve associada ao padrão de consumo de álcool, à maior frequência de binge drinking e à presença de problemas decorrentes do álcool. Entre as mulheres, 69,5% são abstinentes e a depressão se associou à convivência com cônjuge com problemas devidos ao álcool. Os resultados ressaltam que a associação entre depressão e consumo de álcool é distinta entre os gêneros.

Desigualdade da sobrevivência de trabalhadores de Botucatu, São Paulo, Brasil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Satisfação e percepção do usuário do SUS sobre o serviço público de saúde

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Analysis of the ethical aspects of professional confidentiality in dental practice

From the point of view of deontological ethics, privacy is a moral right that patients are entitled to and it is bound to professional confidentiality. Otherwise, the information given by patients to health professionals would not be reliable and a trustable relationship could not be established. The aim of the present study was to assess, by means of questionnaires with open and closed questions, the awareness and attitudes of 100 dentists working in the city of Andradina, São Paulo State, Brazil, with respect to professional confidentiality in dental practice. Most dentists (91.43%) reported to have instructed their assistants on professional confidentiality. However, 44.29% of the interviewees showed to act contradictorily as reported talking about the clinical cases of their patients to their friends or spouses. The great majority of professionals (98.57%) believed that it is important to have classes on Ethics and Bioethics during graduation and, when asked about their knowledge of the penalties imposed for breach of professional confidentiality, only 48.57% of them declared to be aware of it. Only 28.57% of the interviewees affirmed to have exclusive access to the files; 67.14% reported that that files were also accessed by their secretary; 1.43% answered that their spouses also had access, and 2.86% did not answer. From the results of the present survey, it could be observed that, although dentists affirmed to be aware of professional confidentiality, their attitudes did not adhere to ethical and legal requirements. This stand of health professionals has contributed to violate professional ethics and the law itself, bringing problems both to the professional and to the patient.

Associação entre o diagnóstico adaptativo, indicadores de evolução clínica e o teste de relações objetais em pacientes com infecção pelo HIV-1, doentes ou não

Pós-graduação em Doenças Tropicais - FMB