Social determinants, suboptimal health behavior, and morbidity in urban slum population: an Indian perspective.
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ABSTRACT:
SUBMITTER: Pawar AB
PROVIDER: S-EPMC2443249 | biostudies-other | 2008 Jul
REPOSITORIES: biostudies-other
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Project description:Why do people gamble? Conventional views hold that gambling may be motivated by irrational beliefs, risk-seeking, impulsive temperament, or dysfunction within the same reward circuitry affected by drugs of abuse. An alternate, unexplored perspective is that gambling is an extension of natural foraging behavior to a financial environment. However, when these foraging algorithms are applied to stochastic gambling outcomes, undesirable results may occur. To test this hypothesis, we recruited participants based on their frequency of gambling-yearly (or less), monthly, and weekly-and investigated how gambling frequency related to irrational beliefs, risk-taking/impulsivity, and foraging behavior. We found that increased gambling frequency corresponded to greater gambling-related beliefs, more exploratory choices on an explore/exploit foraging task, and fewer points earned on a Patchy Foraging Task. Gambling-related beliefs negatively related to performance on the Patchy Foraging Task, indicating that individuals with more gambling-related cognitions tended to leave a patch too quickly. This indicates that frequent gamblers have reduced foraging ability to maximize rewards; however, gambling frequency -and by extension, poor foraging ability- was not related to risk-taking or impulsive behavior. These results suggest that gambling reflects the application of a dysfunctional foraging process to financial outcomes.
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Project description:ObjectivesTo test whether social ties play any roles in mitigating depression and anxiety, as well as in fostering mental health among young men living in a poor urban community.SettingA cohort of all young men living in an urban slum in Dhaka, the capital of Bangladesh.ParticipantsAll men aged 18-29 years (n=824) living in a low-income urban community at the time of the survey.Primary and secondary outcome measuresUnspecified psychological morbidity measured using the General Health Questionnaire, 12-item (GHQ-12), where lower scores suggest better mental status.ResultsThe GHQ scores (mean=9.2, SD=4.9) suggest a significant psychological morbidity among the respondents. However, each additional friend is associated with a 0.063 SD lower GHQ score (95%?CI -0.106 to -0.021). Between centrality measuring the relative importance of the respondent within his social network is also associated with a 0.103 SD lower GHQ score (95%?CI -0.155 to -0.051), as are other measures of social network ties. Among other factors, married respondents and recent migrants also report a better mental health status.ConclusionsOur results underscore the importance of social connection in providing a buffer against stress and anxiety through psychosocial support from one's peers in a resource-constraint urban setting. Our findings also suggest incorporating a social network and community ties in designing mental health policies and interventions.
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Project description:BackgroundDelivery in health facilities is a proxy for skilled birth attendance, which is an important intervention to reduce maternal and neonatal mortality. We investigated the determinants of facility based deliveries among women in urban slums of Kampala city, Uganda.MethodsA cross sectional study using quantitative methods was used. A total of 420 mothers who had delivered in the past one year preceding the survey, were randomly selected and interviewed using a pre-tested interviewer administered questionnaire. Univariate and multivariable logistic regression analysis was done to determine independent predictors of facility based deliveries.ResultsNinety-five percent of respondents attended at least one antenatal care visit and 66.1%delivered in a health facility. Independent predictors of health facility births included exposure to media concerning facility delivery (OR = 2.5, 95% CI = 1.6-3.9), ANC attendance less than 4 times (OR = 0.6, 95% CI = 0.3-0.9) and timing of first ANC visit in the 2 and 3rd trimesters of pregnancy (OR = 0.5 95% CI = 0.3-0.8).ConclusionDespite good physical access, a third of mothers did not deliver in health facilities. Increasing health facility births among the slum dwellers can be improved through interventions geared at increased awareness, starting ANC in early stages of pregnancy and attending at least 4 ANC visits.
| S-EPMC6472760 | biostudies-literature
Project description:Throughout the developing world, urban centres with sprawling slum settlements are rapidly expanding and invading previously forested ecosystems. Slum communities are characterized by untended refuse, open sewers and overgrown vegetation, which promote rodent infestation. Norway rats (Rattus norvegicus) are reservoirs for epidemic transmission of many zoonotic pathogens of public health importance. Understanding the population ecology of R. norvegicus is essential to formulate effective rodent control strategies, as this knowledge aids estimation of the temporal stability and spatial connectivity of populations. We screened for genetic variation, characterized the population genetic structure and evaluated the extent and patterns of gene flow in the urban landscape using 17 microsatellite loci in 146 rats from nine sites in the city of Salvador, Brazil. These sites were divided between three neighbourhoods within the city spaced an average of 2.7 km apart. Surprisingly, we detected very little relatedness among animals trapped at the same site and found high levels of genetic diversity, as well as structuring across small geographical distances. Most F(ST) comparisons among sites were statistically significant, including sites <400 m apart. Bayesian analyses grouped the samples in three genetic clusters, each associated with distinct sampling sites from different neighbourhoods or valleys within neighbourhoods. These data indicate the existence of complex genetic structure in R. norvegicus in Salvador, linked to the heterogeneous urban landscape. Future rodent control measures need to take into account the spatial and temporal linkage of rat populations in Salvador, as revealed by genetic data, to develop informed eradication strategies.
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Project description:IntroductionAmerican Indians and Alaska Natives (AIAN) experience significant health inequities, yet there are very few curricula dedicated to training a culturally sensitive workforce to care for this population. There is a further dearth of curricula that center on Indigenous values and ways of knowing.MethodsWe developed a 90-minute interactive workshop aimed at increasing faculty and trainee understanding of the social and structural determinants of urban AIAN health. The workshop consisted of a PowerPoint presentation, two videos, an interactive storytelling exercise, and reflection exercises. Participants also completed pre-/postworkshop questionnaires. The workshop was implemented three times at two medical schools.ResultsThere were a total of 35 diverse participants. Regarding the effect of the workshop on participants' knowledge base, a comparison of pre- and postworkshop questionnaire responses showed a statistically significant (p < .05) increase in the correct answer being chosen for each question. All participants agreed or strongly agreed that each of the three learning objectives had been met. Participants particularly valued the workshop's interactive nature, as well as its use of storytelling and multimedia to reinforce policy impact.DiscussionThis workshop provided an interactive and effective method to increase participant knowledge of the importance of a land acknowledgment, of connecting federal Indian policy to health outcomes, and of how AIAN identity may impact access to health care.
| S-EPMC6543927 | biostudies-literature
Project description:Among ethnic minority groups in Europe, blood pressure (BP) control is often suboptimal. We aimed to identify determinants of suboptimal BP control in a multi-ethnic population. We analyzed cross-sectional data of the Healthy Life in an Urban Setting (HELIUS) study, including 3571 participants aged 18-70 with prescribed antihypertensive medication, of various ethnic backgrounds (500 Dutch, 1052 African Surinamese, 656 South-Asian Surinamese, 637 Ghanaian, 433 Turkish, and 293 Moroccan) living in Amsterdam, the Netherlands. 53.3% of the population had suboptimal BP control, defined as BP ≥140/90 mmHg despite prescribed antihypertensives. Using multivariate logistic regression analysis, female sex (OR 0.50, 95%CI 0.43-0.59), being married (0.83, 0.72-0.96), smoking (0.78, 0.65-0.94), alcohol intake (0.80, 0.66-0.96), obesity (1.67, 1.35-2.06), cardiovascular disease (CVD) history (0.56, 0.46-0.68), non-adherence to antihypertensives (1.26, 1.00-1.58), and family history of hypertension (1.19, 1.02-1.38) were identified to be independently associated with suboptimal BP control in the total population. In the ethnic-stratified analysis, factors associated with better BP control were female sex (all ethnic groups), smoking (Turks), and CVD history (Dutch, South-Asian Surinamese, and African Surinamese), whereas factors associated with suboptimal BP control were older age (Turks), obesity (Dutch, African Surinamese, Ghanaian, and Turks), and non-adherence to antihypertensives (Dutch). In conclusion, our analysis identifies several key determinants that are independently associated with suboptimal BP control in a multi-ethnic population, with some important variations between ethnic groups. Targeting these determinants may help to improve BP control.
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Project description:IntroductionGlobally, eye diseases are considered as one of the major contributors of nonfatal disabling conditions. In Bangladesh, 1.5% of adults are blind and 21.6% have low vision. Therefore, this paper aimed to identify the community-based prevalence and associated risk factors of eye diseases among slum dwellers of Dhaka city.MethodsThe study was carried out in two phases. In the first phase, a survey was conducted using multistage cluster sampling among 1320 households of three purposively selected slums in Dhaka city. From each household, one family member (≥ 18 years old) was randomly interviewed by trained data collectors using a structured questionnaire. After that, each of the participants was requested to take part in the second phase of the study. Following the request, 432 participants out of 1320 participants came into the tertiary care hospitals where they were clinically assessed by ophthalmologist for presence of eye diseases. A number of descriptive and inferential statistics were performed using Stata 13.ResultThe majority of total 432 study participants were female (68.6%), married (82.6%) and Muslim (98.8%). Among them almost all (92.8%) were clinically diagnosed with eye disease. The most prevalent eye diseases were refractive error (63.2%), conjunctivitis (17.1%), visual impairment (16.4%) and cataract (7.2%). Refractive error was found significantly associated with older age, female gender and income generating work. Cataract was found negatively associated with the level of education, however, opposite relationship was found between cataract and visual impairment.ConclusionOur study provides epidemiologic data on the prevalence of eye diseases among adult population in low-income urban community of Dhaka city. The high prevalence of refractive error, allergic conjunctivitis, visual impairment, and cataract among this group of people suggests the importance of increasing access to eye care services.
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Project description:BackgroundRat-borne leptospirosis is an emerging zoonotic disease in urban slum settlements for which there are no adequate control measures. The challenge in elucidating risk factors and informing approaches for prevention is the complex and heterogeneous environment within slums, which vary at fine spatial scales and influence transmission of the bacterial agent.Methodology/principal findingsWe performed a prospective study of 2,003 slum residents in the city of Salvador, Brazil during a four-year period (2003-2007) and used a spatiotemporal modelling approach to delineate the dynamics of leptospiral transmission. Household interviews and Geographical Information System surveys were performed annually to evaluate risk exposures and environmental transmission sources. We completed annual serosurveys to ascertain leptospiral infection based on serological evidence. Among the 1,730 (86%) individuals who completed at least one year of follow-up, the infection rate was 35.4 (95% CI, 30.7-40.6) per 1,000 annual follow-up events. Male gender, illiteracy, and age were independently associated with infection risk. Environmental risk factors included rat infestation (OR 1.46, 95% CI, 1.00-2.16), contact with mud (OR 1.57, 95% CI 1.17-2.17) and lower household elevation (OR 0.92 per 10m increase in elevation, 95% CI 0.82-1.04). The spatial distribution of infection risk was highly heterogeneous and varied across small scales. Fixed effects in the spatiotemporal model accounted for the majority of the spatial variation in risk, but there was a significant residual component that was best explained by the spatial random effect. Although infection risk varied between years, the spatial distribution of risk associated with fixed and random effects did not vary temporally. Specific "hot-spots" consistently had higher transmission risk during study years.Conclusions/significanceThe risk for leptospiral infection in urban slums is determined in large part by structural features, both social and environmental. Our findings indicate that topographic factors such as household elevation and inadequate drainage increase risk by promoting contact with mud and suggest that the soil-water interface serves as the environmental reservoir for spillover transmission. The use of a spatiotemporal approach allowed the identification of geographic outliers with unexplained risk patterns. This approach, in addition to guiding targeted community-based interventions and identifying new hypotheses, may have general applicability towards addressing environmentally-transmitted diseases that have emerged in complex urban slum settings.
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Project description:BackgroundNon-alcoholic fatty liver disease (NAFLD) is a spectrum of disease ranging from simple steatosis, non-alcoholic steatohepatitis (NASH), through to advanced fibrosis and cirrhosis. We assessed the prevalence, spectrum, and determinants of NAFLD among adults in urban and rural North India.MethodsA representative sample of adults aged 30-60 years were recruited from urban Delhi and rural Ballabhgarh during 2017-2019. Participants underwent abdominal ultrasonography (USG) and vibration controlled transient elastography (VCTE) with FibroScan to assess fatty liver and fibrosis, respectively. We estimated the age- and sex-standardised prevalence of NAFLD and its spectrum. The factors associated with 'ultrasound-diagnosed NAFLD' were identified using multivariate logistic regression.ResultsA total of 828 urban (mean ± SD age: 45.5 ± 8.0 years; women: 52.7%) and 832 rural (mean ± SD age: 45.1 ± 7.9 years; women: 62.4%) participants were recruited. The age- and sex-standardized prevalence of ultrasound-diagnosed NAFLD was 65.7% (95%CI: 60.3-71.2) in the urban and 61.1% (55.8-66.5) in the rural areas, respectively. The prevalence of NAFLD with elevated alanine transaminase (≥40IU/L) was 23.2% (19.8-26.6), and 22.5% (19.0-26.0) and any fibrosis by liver stiffness measurement on transient elastography (≥6.9 kPa) was 16.5% (13.8-19.8) and 5.2% (3.8-6.7) in urban and rural participants, respectively. In both urban and rural areas, diabetes, central obesity and insulin resistance were significantly associated with NAFLD.ConclusionNAFLD prevalence was high among rural and urban North Indian adults, including fibrosis or raised hepatic enzymes. The strong association of metabolic determinants confirms its linkage with metabolic syndrome.
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Project description:Urban agglomerations are fundamental regional units of development and attract large-scale migrant population. Previous studies have only focused on migrant population distribution in major urban agglomerations. Therefore, this study analysed the spatiotemporal characteristics of migrant population distribution in China during 2000-2010 at city level from the perspective of urban agglomerations. The results indicate that urban agglomerations were accumulation areas of migrant population. Numerous people have migrated into 19 urban agglomerations, which has enlarged regional differences in migrant population distribution. The interprovincial migrant population dominated within urban agglomerations, whereas the intraprovincial migrant population dominated outside urban agglomerations. In the future, intraprovincial migration will become the dominant migration mode. The evolution of migrant population distribution pattern in urban agglomerations agrees with classic theories of unbalanced regional development. The determinants of migration in different regions were compared. Results revealed that economic and government driving forces jointly influenced migration; however, economic forces exceeded government forces. Economic forces were more influential within urban agglomerations, whereas government forces played more important roles outside urban agglomerations. Increased income and job opportunities were the core attractions of urban agglomerations. Moreover, with an increase in the urban agglomeration development level, the influence of economic forces increased, whereas that of government forces decreased. The findings provide a deeper understanding of migrant population distribution in China, which will benefit population management across various regions.
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