Modernización y los cambios en las condiciones de vida de la mujer campesina = Modernization and the changing life chances of women in low-income rural families

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Condicionantes y consecuencias de los asentamientos precarios urbanos como marco para la formulación de políticas de vivienda, infraestructura y servicios para los grupos de menores ingresos = Determinants and consequences of makeshift settlements in urban areas as a framework for the formulation of policies relating to housing, infrastructure and services for low-income groups

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Paraguay: a housing finance proposal for middle- to low-income groups

The construction and ownership of homes is fundamental to economic development, the generation of wealth and the formation of the middle class. Although a number of studies have been conducted and programmes implemented in recent decades, there remains a significant housing deficit in Paraguay and Latin America, indicating that such programmes have been unsuccessful. For families unable to document a steady income, the main obstacle to homeownership is often financing. This paper aims to demonstrate the economic and financial feasibility —provided there is sufficient political will and coordination between public and private entities— of a project to build 75,000 homes for 300,000 people (4.5% of the Paraguayan population) with middle to low incomes. The median household income in this segment, for which there is a significant shortage of decent housing, is US$ 396.50. A maximum of US$ 63.44 per month may be set aside for housing costs.

Association of dietary patterns with metabolic syndrome components in low-income, free-living Brazilian adults

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Feasibility of solar heating systems composed of recyclable packaging for low-income rural communities

Solar heaters are an appropriate technology in tropical and sub-tropical climates to heat bath water by solar energy. Low-cost solar heaters meet the demand of low-income rural communities which currently do not have access to this technology. Current research analyzes the economic viability of solar heaters, built with recyclable materials, to reduce electric energy bill. A solar heating system was built consisting of recyclable materials in accordance with the manuals provided by the Secretariat of Environment of the state of Paraná (SEMA). Duration of use of electric showers by families of rural properties was determined to calculate expenses and billing of electricity. Simulation and material costs showed that the system was feasible. Commercial solar heaters could be replaced at a cost of R$ 22.61 per month during 13 months.

Poverty Reduction and the Income Inequality in China

In 2000, the United Nations adopted the Millennium Development Goals which set targets for raising living standards in low-income countries. The first goal was to “eradicate extreme poverty and hunger” (United Nations). The World Bank defines extreme poverty as income of less than $1.25 per day (World Bank, 2010a). Based on this definition, the World Bank estimates that the percentage of the population in China living in extreme poverty has fallen from 84 percent in 1981 to about 16 percent in 2005, a period during which China’s population grew by more than 300 million people (see Table 1 on last page). Because China is a very large country with a current population approaching 1.4 billion (more than four times the United States population), its dramatic reduction in poverty over the past 30 years has had a profound effect on global poverty measures. In fact, poverty reduction in China is the main reason that the incidence of extreme poverty in developing countries has fallen from about 52 percent in 1981 to 25 percent in 2005 (Table 1). While the absolute number of poor in China fell by some 627 million, the number of poor in other developing countries actually grew slightly (from 1,065 million to 1,166 million). These figures represent a decline in the percentage of the total population in poverty in other developing countries because of general population growth over that 25-year period (World Bank, 2010b).

Suicidal ideation during pregnancy: prevalence and associated factors among low-income women in Sao Paulo, Brazil

The aim of this study was to estimate the prevalence and correlates of suicidal ideation among low-income pregnant women living in Brazil. We performed a cross-sectional analysis of 831 women surveyed during 20 to 30 weeks of pregnancy using the Self-Report Questionnaire-20. The prevalence of suicidal ideation was 6.3%. The factors associated with suicidal ideation were common mental disorders, single partner status, past psychiatric history, and smoking tobacco. All cases of suicidal ideation were associated with common mental disorders.

Nutritional transition of school children from low income families of a northeastern urban area, Brazil

Background: Evaluating child growth is, in practice, performed by measuring the development of a child's weight, height, and body composition in comparison to averages observed among a reference population. Objective: To describe the nutritional status of children of low income families who live in urban region in northeastern Brazil. Methods: This study is a population case series with a transversal and observational design. The study population consisted of 257 children, aged 5 to 10 years, who were enrolled in a public school to children of low income families. We used the cutoff point for short stature of -2 Z scores for age, and underweight, overweight, and obese were classified as the 5th, 85th, and 95th percentiles, respectively, of the body mass index (BMI) for age, with both classifications in accordance with the Center for Disease Control and Prevention (CDC 2000). Comparisons by gender were performed for the measures of the central tendency and the frequency of diagnoses, in addition to the tendency of the evolution of BMI by age. Results: The prevalence of short stature was 3.5% (95% CI: 1.9-6.5). In the evaluation of BMI for age, the prevalences found for underweight, overweight, and obese were 5.8% (95% CI: 3.6-9.4), 4.7% (95% CI: 2.7-8.0), and 2.3% (95% CI: 1.1-5.0), respectively. We found a significant trend in the reduction of BMI with the increase in age. Conclusions: According to CDC references, the prevalences of underweight and short stature were higher than expected and for the overweight and obesity were lower than expected, indicating that the nutritional transition had still not reached, as commonly is described, these low income children from the urban outskirts of the Northeast region.

Assessing Food Security in Selected Mediterranean Countries

Food Security has become an important issue in the international debate, particularly during the latest economic crisis. It relevant issue also for the Mediterranean Countries (MCs), particularly those of the southern shore, as they are is facing complex economic and social changes. On the one hand there is the necessity to satisfy the increasing and changing food demand of the growing population; on the other hand it is important to promote economic growth and adjust the agricultural production to food demand in a sustainable perspective. The assessment of food security conditions is a challenging task due to the multi-dimensional nature and complexity of the matter. Many papers in the scientific literature focus on the nutritional aspects of food security, while its economic issues have been addressed less frequently and only in recent times. Thus, the main objective of the research is to assess food (in)security conditions in the MCs. The study intends to identify and implement appropriate theoretical concepts and methodological tools to be used in the assessment of food security, with a particular emphasis on its economic dimension within MCs. The study follows a composite methodological approach, based on the identification and selection of a number of relevant variables, a refined set of indicators is identified by means of a two-step Principal Component Analysis applied to 90 countries and the PCA findings have been studied with particular attention to the MCs food security situation. The results of the study show that MCs have an higher economic development compared to low-income countries, however the economic and social disparities of this area show vulnerability to food (in)security, due to: dependency on food imports, lack of infrastructure and agriculture investment, climate condition and political stability and inefficiency. In conclusion, the main policy implications of food (in)security conditions in MCs are discussed.

Tuberculosis in HIV programmes in lower-income countries: practices and risk factors

BACKGROUND: Tuberculosis (TB) is a common diagnosis in human immunodeficiency virus (HIV) infected patients on antiretroviral treatment (ART). OBJECTIVE: To describe TB-related practices in ART programmes in lower-income countries and identify risk factors for TB in the first year of ART. METHODS: Programme characteristics were assessed using standardised electronic questionnaire. Patient data from 2003 to 2008 were analysed and incidence rate ratios (IRRs) calculated using Poisson regression models. RESULTS: Fifteen ART programmes in 12 countries in Africa, South America and Asia were included. Chest X-ray, sputum microscopy and culture were available free of charge in respectively 13 (86.7%), 14 (93.3%) and eight (53.3%) programmes. Eight sites (53.3%) used directly observed treatment and five (33.3%) routinely administered isoniazid preventive treatment (IPT). A total of 19 413 patients aged ≥16 years contributed 13 227 person-years of follow-up; 1081 new TB events were diagnosed. Risk factors included CD4 cell count (>350 cells/μl vs. <25 cells/μl, adjusted IRR 0.46, 95%CI 0.33–0.64, P < 0.0001), sex (women vs. men, adjusted IRR 0.77, 95%CI 0.68–0.88, P = 0.0001) and use of IPT (IRR 0.24, 95%CI 0.19–0.31, P < 0.0001). CONCLUSIONS: Diagnostic capacity and practices vary widely across ART programmes. IPT prevented TB, but was used in few programmes. More efforts are needed to reduce the burden of TB in HIV co-infected patients in lower income countries.

Impact of antiretroviral therapy on tuberculosis incidence among HIV-positive patients in high-income countries

The lower tuberculosis incidence reported in human immunodeficiency virus (HIV)-positive individuals receiving combined antiretroviral therapy (cART) is difficult to interpret causally. Furthermore, the role of unmasking immune reconstitution inflammatory syndrome (IRIS) is unclear. We aim to estimate the effect of cART on tuberculosis incidence in HIV-positive individuals in high-income countries.

Early loss of HIV-infected patients on potent antiretroviral therapy programmes in lower-income countries

OBJECTIVE: To analyse the early loss of patients to antiretroviral therapy (ART) programmes in resource-limited settings. METHODS: Using data on 5491 adult patients starting ART (median age 35 years, 46% female) in 15 treatment programmes in Africa, Asia and South America with (3) 12 months of follow-up, we investigated risk factors for no follow-up after treatment initiation, and loss to follow-up or death in the first 6 months. FINDINGS: Overall, 211 patients (3.8%) had no follow-up, 880 (16.0%) were lost to follow-up and 141 (2.6%) were known to have died in the first 6 months. The probability of no follow-up was higher in 2003-2004 than in 2000 or earlier (odds ratio, OR: 5.06; 95% confidence interval, CI: 1.28-20.0), as was loss to follow-up (hazard ratio, HR: 7.62; 95% CI: 4.55-12.8) but not recorded death (HR: 1.02; 95% CI: 0.44-2.36). Compared with a baseline CD4-cell count (3) 50 cells/microl, a count < 25 cells/microl was associated with a higher probability of no follow-up (OR: 2.49; 95% CI: 1.43-4.33), loss to follow-up (HR: 1.48; 95% CI: 1.23-1.77) and death (HR: 3.34; 95% CI: 2.10-5.30). Compared to free treatment, fee-for-service programmes were associated with a higher probability of no follow-up (OR: 3.71; 95% CI: 0.97-16.05) and higher mortality (HR: 4.64; 95% CI: 1.11-19.41). CONCLUSION: Early patient losses were increasingly common when programmes were scaled up and were associated with a fee for service and advanced immunodeficiency at baseline. Measures to maximize ART programme retention are required in resource-poor countries.

Frequency of patient-reported infections among sicker adults in high-income countries: an international perspective

The frequency of patient-reported health care-associated infections across several high-income countries was analyzed in representative population samples based on data from "The Commonwealth Fund's 2011 International Survey of Sicker Adults in Eleven countries." Across countries, 8.9% of patients who were hospitalized and/or had surgery reported an infection, but this rate varied considerably from 5.3% in the United States to 11.9% in New Zealand. Patients who reported infection were more likely to rate the quality of medical care received as fair or poor (odds ratio [OR], 2.4; 95% confidence interval [CI]: 1.9-3.1, P < .001). Female sex (OR, 1.2; 95% CI: 1.0-1.5, P = .027), reporting 2 or more chronic conditions (OR, 1.5; 95% CI: 1.1-2.0, P = .004), poor health (OR, 1.6; 95% CI: 1.2-2.1, P < .001), and surgery (OR, 1.8; 95% CI: 1.4-2.3, P < .001) were significant predictors for health care-associated infection across countries. Being above 64 years of age (OR, 0.78; 95% CI: 0.64-0.95, P = .013) and day-surgery (OR, 0.62; 95% CI: 0.48-0.79, P < .001) decreased the likelihood for reporting infection.

Risk of tuberculosis following HIV seroconversion in high-income countries

Background Few data exist on tuberculosis (TB) incidence according to time from HIV seroconversion in high-income countries and whether rates following initiation of a combination of antiretroviral treatments (cARTs) differ from those soon after seroconversion. Methods Data on individuals with well estimated dates of HIV seroconversion were used to analyse post-seroconversion TB rates, ending at the earliest of 1 January 1997, death or last clinic visit. TB rates were also estimated following cART initiation, ending at the earliest of death or last clinic visit. Poisson models were used to examine the effect of current and past level of immunosuppression on TB risk after cART initiation. Results Of 19 815 individuals at risk during 1982–1996, TB incidence increased from 5.89/1000 person-years (PY) (95% CI 3.77 to 8.76) in the first year after seroconversion to 10.56 (4.83 to 20.04, p=0.01) at 10 years. Among 11 178 TB-free individuals initiating cART, the TB rate in the first year after cART initiation was 4.23/1000 PY (3.07 to 5.71) and dropped thereafter, remaining constant from year 2 onwards averaging at 1.64/1000 PY (1.29 to 2.05). Current CD4 count was inversely associated with TB rates, while nadir CD4 count was not associated with TB rates after adjustment for current CD4 count, HIV-RNA at cART initiation. Conclusions TB risk increases with duration of HIV infection in the absence of cART. Following cART initiation, TB incidence rates were lower than levels immediately following seroconversion. Implementation of current recommendations to prevent TB in early HIV infection could be beneficial.

Commentary: Dedication of Additional Resources to Evaluation and Low-Income Schools is Critical to Increasing Levels of Safe Walking and Bicycling to School

A commentary on Mendoza et al.'s article entitled, "Ethnic Minority Children’s Active Commuting to School and Association with Physical Activity and Pedestrian Safety Behaviors."