Association between Socio-demographic Factors, Involvement Status in Gardening and Diet Quality among B40 Households in Taman Keramat, Kuala Lumpur

@#Introduction: COVID-19 pandemic has impacted the livelihood of Malaysians and gardening activities have contributed positively to the diet quality. This study aimed to determine the factors associated with diet quality among adults in AU2 Keramat, Kuala Lumpur. Methods: The cross-sectional study involved adults aged 18 to 59 via convenience sampling. The socio-demographic, physical activity level and involvement status in gardening were obtained through a questionnaire, while food intake was from a single-day 24-hour diet recall. The diet quality was determined through Malaysian Healthy Eating Index (MHEI) and dietary misreporting was calculated using the Goldberg cut-off method. Results: A total of 117 respondents (65.8% females, 35.2% males) with a mean age of 40.98 were involved in this study. Findings showed that most respondents did not engage in gardening activities (72.6%) and the prevalence of poor diet quality in this study was 89.7%, with a mean score of 44.51. The older respondents (r= 0.20, p= 0.034) and community gardeners (t= -2.63, p= 0.011) had a significantly higher diet quality but not home gardeners (t= 0.12, p= 0.902). The respondents involved in gardening activity also had a significantly higher fruit serving intake, Mann-Whitney U= 1045.00, p= 0.036) and lower total fat intake (t= 2.27, p= 0.025). Conclusion: The diet quality of the respondents remains poor but community gardeners had significantly higher diet quality and fruit intake while lower total fat intake. Interventions need to be developed to address the persistent poor diet quality of adults in the community.

Abordaje del desarrollo en la primera infancia y sus dificultades en Turquía: programa de capacitación para las unidades de pediatría del desarrollo / Addressing early childhood development and developmental difficulties in Turkey: a training program for developmental pediatrics units

Introducción. El abordaje del desarrollo en la primera infancia (DPI) y las dificultades del desarrollo (DD) en los países de ingresos bajos o medios (PIBM) requiere de programas aplicables y sostenibles. Se evaluó el programa de capacitación para las unidades de pediatría del desarrollo (UPD) en los centros de referencia tras siete años. Población y métodos. Diseño transversal con métodos cualicuantitativos para evaluar los servicios, la capacitación, la investigación y la promoción de las UPD. Resultados. Se mantuvieron los servicios clínicos, la capacitación, investigación y promoción. En total, 23710 niños fueron derivados. La motivación y resistencia del personal, el respaldo de los administradores y la satisfacción del paciente facilitaron el programa, aunque la invisibilidad dentro del sistema de salud fue un obstáculo. Conclusiones. En Turquía, y posiblemente otros PIBM, el programa de capacitación para las UPD es aplicable y sostenible si se abordan los obstáculos del sistema de salud.

Introduction. Addressing early childhood development (ECD) and developmental difficulties (DDs) in low and middle-income countries (LMICs) requires applicable and sustainable programs. Seven years after its implementation in 2010, we evaluated the Developmental Pediatrics Unit (DPU) Training Program in pediatric referral centers in Turkey. Population and methods. We applied crosssectional design and quantitative/qualitative methods to assess services, training, research and advocacy of the DPUs. Results. Five of six established DPUs sustained clinical services, training, research, and advocacy. A total of 23,710 children (9085 new cases in 2017) had been referred mainly for perinatal risks and chronic illness, all centers contributed with similar proportions of children. Staff motivation and endurance, hospital administrator support, and client satisfaction facilitated the program; whereas invisibility within the performance based healthcare system was a barrier. Conclusions. In Turkey and possibly other LMICs, the DPU Training Program is applicable and sustainable if health system barriers are addressed

Características e demandas da população em situação de vulnerabilidade social acompanhadas em Belford Roxo (RJ) / Characteristics and demands of the population in a situation of social vulnerability attended in Belford Roxo (RJ)

RESUMO O objetivo deste estudo foi o descrever as características e demandas das famílias em acompanhamento no Centro de Referência de Assistência Social (Cras) de Santa Marta, município de Belford Roxo (RJ), no período de 2006 a 2017. Trata-se de estudo transversal descritivo com dados extraídos das fichas de acompanhamento. Um total de 87 famílias foi acompanhada no período. A maioria dos responsáveis familiares era do sexo feminino (92,0%), menor de 40 anos (59,8%), solteira (92,0%) e com ensino fundamental incompleto (89,7%). As principais demandas se referiram ao descumprimento de condicionalidade do Programa Bolsa Família (28,7%) e evasão escolar (26,4%). O serviço de saúde (33,3%) apresentou o maior encaminhamento intersetorial. A mediana do tempo de acompanhamento foi de 53 meses. Não houve diferença no tempo de acompanhamento em função do grupo etário, sexo, vínculo de trabalho informal ou precário, para recebimento de benefício, forma de acesso, tipo de demanda e registro de plano de acompanhamento (p≥0,272). A demanda espontânea foi a razão de a maioria das famílias estar em acompanhamento (86,2%), mas não havia registro sobre sua situação de vulnerabilidade. A identificação das famílias que necessitam de acompanhamento é importante para garantir acesso aos direitos socioassistenciais, além de contribuir para superar as desigualdades sociais existentes.

ABSTRACT The objective of this study was to describe the characteristics and demands of the families under follow-up at Social Assistance Referral Center (Cras) of Santa Marta, municipality of Belford Roxo, State of Rio de Janeiro, from 2006 to 2017. This is a descriptive cross-sectional study whose data were retrieved from the families' accompanying records. A total of 87 families were followed up within the study period. Most of the family heads were female (92.0%), under 40 (59.8%), single (92.0%) and incomplete elementary school (89.7%). Main demands referred to noncompliance with the Bolsa Família Program (28.7%) and school dropout (26.4%) conditionalities. Health service (33.3%) showed the greatest intersectoral referral. The median following-up time was 53 months. There was no difference in the following-up time due to the age group, gender, informal or precarious employment relationship, benefit payment, access type, demand type, and follow-up plan registration (p≥0,272). Spontaneous demand was the reason for most of the families to be under follow-up (86.2%), although no record existed on their vulnerability situation. The identification of the families in the need to be followed is important to guarantee access to social and care rights, besides contributing to overcome the existing social inequalities.

Domestic violence and risk of internalizing and externalizing problems in adolescents living with relatives displaying substance use disorders / Violência doméstica e risco de problemas de internalização e externalização em adolescentes com familiares apresentando transtornos por uso de substâncias

OBJECTIVE: To investigate the association between exposure to domestic violence and increased risk of internalizing and externalizing problems and substance use among adolescents living with relatives with substance use disorder (SUD) at a low-income community of São Paulo, Brazil. METHODS: A crosssectional study was conducted with 102 adolescents aged 12-17 years (M = 14.2, SD = 1.7) who were living with relatives suffering from SUD. Outcomes were measured using the Youth Self-Report (YSR), psychosocial stress factors questionnaire, Drug Use Screening Inventory (DUSI) and Phrase Inventory of Intrafamily Child Abuse (PIICA). RESULTS: The sample presented high prevalence of emotional/behavioral problems with YSR's scores in the clinical range for Internalizing Problems (24.5%), Externalizing Problems (21.6%), and Total Problems (26.5%). The presence of mental health problems predicted substance use (PR = 2.22; 95% CI = 1.2-4.13), and substance use predicted increased risk of mental health problems. Alcohol use predicted more than double the risk of emotional/behavioral problems (PR = 2.01; 95% CI = 1.08-3.76), while illicit drug use was associated with an almost threefold increase in the prevalence of Internalizing (PR = 2.87; 95% CI = 1.19-6.89) and Externalizing Problems (PR = 3.3; 95% CI = 1.35-8.04). CONCLUSION: Adolescents of relatives with SUD are at risk of developing emotional and behavioral problems. These findings reinforce the need to develop public mental health policies, which include protective interventions to adolescents living in families affected by substance use disorders.

OBJETIVO: Investigar a associação entre exposição à violência doméstica e aumento do risco de problemas internalizantes e externalizantes e uso de substâncias entre adolescentes que vivem em famílias com transtorno por uso de substâncias (TUS) em uma comunidade de baixa renda de São Paulo, Brasil. MÉTODOS: Estudo transversal com 102 adolescentes de 12 a 17 anos (M = 14,2, DP = 1,7) que vivem com familiares com TUS. Os desfechos foram avaliados por meio do Inventário de Autoavaliação para Adolescentes (YSR), questionários de fatores de estresse psicossociais, Drug Use Screening Inventory (DUSI) e Inventário de Frases de Violência Doméstica (IFVD). RESULTADOS: A amostra apresentou altas taxas de problemas emocionais/comportamentais no YSR, sendo 24,5% com escores na faixa clínica para Problemas Internalizantes, 21,6% para Problemas Externalizantes e 26,5% para Problemas Totais. A presença de problemas de saúde mental foi preditora do uso de substâncias (RP = 2,22; IC 95% = 1,2-4,13) e o uso de substâncias foi preditor do aumento da prevalência de problemas emocionais/comportamentais. O uso de álcool prediz mais do que o dobro do risco de problemas emocionais/comportamentais (RP = 2,01; IC 95% = 1,08-3,76), enquanto o uso de substâncias ilícitas esteve associado com um aumento de quase três vezes na prevalência de Problemas Internalizantes (RP = 2,87; IC 95% = 1,19-6,89) e Externalizantes (RP = 3,3; IC 95% = 1,35-8,04). CONCLUSÃO: Adolescentes que convivem diretamente com familiares com TUS estão em risco para o desenvolvimento de problemas emocionais/comportamentais. Os achados reforçam a necessidade de políticas públicas que incluam programas de proteção para adolescentes que vivem em famílias com transtornos causados pelo uso de substâncias.

II. The research ethics involving vulnerable groups

Abstract Vulnerability in research occurs when the participant is incapable of protecting his or her interests and therefore, has an increased probability of being intentionally or unintentionally harmed. This manuscript aims to discuss the conditions that make a group vulnerable and the tools and requirements that can be used to reduce the ethical breaches when including them in research protocols. The vulnerability can be due either to an inability to understand and give informed consent or to unequal power relationships that hinder basic rights. Excluding subjects from research for the only reason of belonging to a vulnerable group is unethical and will bias the results of the investigation. To consider a subject or group as vulnerable depends on the context, and the investigator should evaluate each case individually.

Dietary patterns and gestational diabetes mellitus in a low income pregnant women population in Brazila cohort study

Our aim is to verify the association between dietary patterns during early pregnancy and development of gestational diabetes mellitus (GDM) in a low income Brazilian population. A cohort study followed 841 healthy pregnant women from the 15-20th gestational week until delivery. This study was conducted at the Instituto de Medicina Integral Prof. Fernando Figueira, Brazil. 838 pregnant women during the first half of a healthy pregnancy with a monthly family income below US $ 500.00 were selected. 95 (11.3%) pregnant women developed gestational diabetes mellitus. Three dietary patterns from factor analysis were extracted. The traditional pattern was characterized by dairy products, fruits, vegetable and fish. The mixed pattern included fried food, pizza, juice, manioc flour, red meat and candies. The western pattern was characterized by eggs, white bread, cookies, pasta, pizza, fried food, chicken, candies, chocolate, salty snacks and soft drinks. There were no differences among GDM incidence according to these three dietary patterns. This finding remained after adjustment for maternal age, maternal education, body mass index pre-pregnancy and parity. We concluded that eating patterns studied during early pregnancy were not associated to the development of GDM in this sample of Brazilian pregnant women with low income(AU)

Hábitos dietéticos e diabetes mellitus gestacional em uma população de gestantes de baixa renda no Brasil estudo de coorte. Nosso objetivo foi verificar a associação entre o padrão alimentar no começo da gravidez com o desenvolvimento de diabetes mellitus gestacional (DMG) em um grupo populacional de baixa renda no Brasil. Um estudo de coorte seguiu 841 gestantes saudáveis da 15-20 semana gestacional até o parto. Esse estudo foi realizado no Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Brasil. Oitocentas e trinta e oito gestantes no curso da primeira metade da gestação e com uma renda familiar abaixo de US $ 500.00 foram selecionadas. Noventa e cinco gestantes (11.3%) desenvolveram DMG. Três padrões alimentares distintos foram extraídos através da técnica do fator de análise. O padrão alimentar tradicional foi caracterizado pela ingestão de produtos lácteos, frutas, vegetais e peixes. O padrão alimentar misto incluiu frituras, pizza, sucos, farinha de mandioca, carne vermelha e doces. O padrão alimentar ocidental foi caracterizado por ovos, pão branco, biscoitos, massa, pizza, carne de galinha, doces, chocolate, salgadinhos e refrigerantes. Não foi observado diferença na incidência de DMG entre os três padrões alimentares identificados. Esse achado permaneceu inalterado após o ajuste para a idade e nível de educação maternal, assim como para o IMC antes da gravidez e paridade. Em conclusão, o padrão alimentar materno durante o começo da gravi- dez entre gestantes de baixa renda não parece estar associado com o desenvolvimento de DMG(AU)

Não foi bom pai, nem bom marido: Conjugalidade e parentalidade em famílias separadas de baixa renda / He was neither a good father nor a good husband: Marital and parental roles in low-income separated families

RESUMO O objetivo deste estudo foi conhecer a diferença entre parentalidade e conjugalidade de pais e mães em situação de separação conjugal, de baixa renda e com filhos pequenos. Esta pesquisa foi realizada em uma clínica-escola universitária de Psicologia, a partir da metodologia qualitativa. Quatro mães e três pais participaram de entrevistas individuais semiestruturadas. Por meio de análise temática, os resultados evidenciaram a realidade dinâmica, paradoxal e recursiva dessas famílias, apresentando aspectos particulares e semelhantes a outros contextos socioeconômicos. Movimentos de manutenção e encerramento da conjugalidade e inclusão de terceiros no conflito conjugal contribuem para confusão entre os papéis parentais e conjugais. Tentativas de diferenciação entre esses papéis também foram observadas, oferecendo recursos que devem ser enfatizados.

ABSTRACT This study aims to differentiate parental and marital roles of low-income separated parents with small children. This survey was conducted in a university school clinic of Psychology, based on qualitative methodology. Four mothers and three fathers participated in semi-structured individual interviews. Through thematic analysis, the outcomes showed the dynamic, paradoxical, and recursive reality of these families, with particularities and similarities to other socioeconomic contexts. Movements to maintain and to end the marital roles and inclusion of third parties in the marital conflict contribute to confusion between parental and marital roles. Attempts to differentiate these roles were also observed, offering strengths that should be emphasized.

Prevalence study of compulsive buying in a sample with low individual monthly income / Estudo de prevalência de compra compulsiva em uma amostra com baixo rendimento mensal individual

Introduction: Compulsive buying can be characterized as an almost irresistible impulse to acquire various items. This is a current issue and the prevalence rate in the global population is around 5 to 8%. Some surveys indicate that the problem is growing in young and low-income populations. Objectives: To evaluate the prevalence of compulsive buying among people with low personal monthly incomes and analyze relationships with socio-demographic data. Methods: The Compulsive Buying Scale was administered to screen for compulsive buying and the Hospital Anxiety and Depression Scale was used to assess anxiety and depression in a sample of 56 participants. Pearson coefficients were used to test for correlations. Results: The results indicated that 44.6% presented an average family income equal to or greater than 2.76 minimum wages. It is possible that compulsive buying is not linked to the purchasing power since it was found in a low-income population. Conclusion: Despite the small sample, the results of this study are important for understanding the problem in question.

Introdução: A compra compulsiva pode ser caracterizada como um impulso quase irresistível de obter diversos itens. Considerada um problema da atualidade, estima-se que sua taxa de prevalência seja em torno entre 5 a 8% na população mundial. Algumas pesquisas sinalizam um aumento do problema entre jovens e populações de baixa renda. Objetivos: Avaliar a prevalência da compra compulsiva em sujeitos com baixa renda mensal individual e analisar as relações entre os dados sociodemográficos. Método: A Compulsive Buying Scale (CBS) foi utilizada para rastrear compra compulsiva, e a Hospital Anxiety and Depression Scale (HADS), para avaliar ansiedade e depressão em uma amostra de 56 participantes. Correlações foram verificadas através do teste de Pearson. Resultados: Os resultados indicaram que 44,6% apresentavam renda média familiar igual ou maior a 2,76 salários mínimos. É possível que a compra compulsiva não esteja vinculada ao poder aquisitivo, uma vez que ela foi encontrada em uma população com baixa renda. Conclusão: Embora a amostra seja pequena, os resultados obtidos são importantes para compreender o problema em questão.

Comparação do perfil de idosos ativos e não ativos do programa bolsa família / Comparison of profile of beneficiary and non-beneficiary elderly of the bolsa família program

OBJETIVOS: Descrever o perfil dos idosos do Cadastro Único da Assistência Social (CADÚNICO), da Secretaria Municipal de Assistência Social de Betim-MG e verificar se há diferença nas condições de vida entre ativos e não ativos inseridos no Programa Bolsa Família (PBF). METODOLOGIA: Estudo transversal com base nos dados secundários obtidos no CADÚNICO no período de janeiro de 2004 a janeiro de 2011. Os idosos foram divididos em dois grupos: ativos (aqueles que recebiam o benefício) e não ativos (aqueles que, apesar de cadastrados, não o recebiam). As variáveis sociodemográficas e de saúde analisadas para comparação entre os grupos foram: sexo, faixa etária, renda, raça/cor, escolaridade, estado civil, situação no mercado de trabalho, moradia e deficiência. RESULTADOS: Dos 8.555 idosos cadastrados, 14,1% eram ativos no PBF. A média de idade foi de 68 anos (mediana de 67 anos), com maior proporção de mulheres (58,0%). A mediana de distribuição da "renda" entre ativos foi de R$60,00 (Q1= R$40,00 e Q3= R$100,00) e de R$100,00 entre não ativos (Q1= R$60,00 e Q3= R$170,00). À medida que a escolaridade aumenta, menor a chance de o idoso estar ativo no PBF. Já para os idosos solteiros e divorciados, a chance de estar ativo no PBF era maior [OR 1,79 (IC 1,54-2,09); OR 1,46 (IC 1,20-1,78), respectivamente]. Sobre a presença ou ausência de deficiências, não houve diferença significativa entre os dois grupos. De modo geral, os idosos viviam em casa própria, construída com tijolo/alvenaria, com rede pública de água e esgoto, com iluminação própria e lixo coletado. CONCLUSÃO: O Programa Bolsa Família representa garantia necessária de renda mínima para o idoso em situação de vulnerabilidade social. Por outro lado, a comparação do perfil de idosos ativos e não ativos põe em relevo a limitação do programa, a saber, ser direcionado apenas aos mais necessitados, sendo incapaz de se estender, como direito, a todos cuja situação assim exige.

OBJECTIVES: To describe the elderly's profile in the Unified Register of Social Service (CADUNICO), of the Municipal Social Service in the city of Betim, Minas Gerais state, Brazil, and assess the differences in living conditions between beneficiaries and non-beneficiaries of the Bolsa Familia Program (BFP). METHODS: Cross-sectional study based on secondary data obtained in the CADUNICO from January 2004 to January 2011. The elderly were divided into two groups: beneficiaries (those who received the benefit), and non-beneficiaries (those who, although registered, did not receive it). Sociodemographic and health variables analyzed to compare the groups were: gender, age, income, race / color, educational level, marital status, situation in the labor market, housing and disability. RESULTS: Of the 8,555 registered elderly, 14.1% were active in the BFP. The average age was 68 years (median 67 years), with higher proportion of women (58.0%). The median distribution of "income" among beneficiaries was R$60.00 (Q1 = R$40.00 and Q3 = R$100.00) and R$100.00 for non-beneficiaries (Q1 = R$60.00 and Q3 = R$170.00). As education increases, the less chance of the elderly to be active in the BFP. As for the single and divorced elderly, the chance to be active in the BFP was greater [OR 1.79 (CI 1.54-2.09); OR 1.46 (CI 1.20-1.78), respectively]. On the presence or absence of failures, there was no significant difference between the two groups. In general, older people living in their own houses, built with brick / masonry, with public water and sewage, with its own lighting and garbage collected. CONCLUSION: The BFP is a necessary warranty of minimum income for socially vulnerable elderly. On the other hand, the comparison of profiles of beneficiary and non-beneficiary seniors highlights the program's limitations, namely, to be directed only to the neediest, being unable to extend, as a right, to all whose situation so requires.

Socioeconomic Profile and Academic Performance of Students of Campus VIII of the State University of Paraíba, Araruna, Brazil, 2013

Aims: The aim of the present study was to analyze the socioeconomic profile and academic performance of students of three courses on Campus VIII of the State University of Paraíba. Study Design: A quantitative, descriptive, cross-sectional study with an inductive approach was carried out involving students in the courses of dentistry, civil engineering and natural science on Campus VIII of the State University of Paraíba (northeastern Brazil) in 2013. Methodology: A total of 321 students were enrolled, and the sample was made up of 238 participants who answered a semi-structured questionnaire addressing socioeconomic characteristics and academic performance. Results: Most students were female and beneficiaries of the quota system, had a family income of more than two times the Brazilian minimum monthly wage and had a academic performance coefficient (APC) greater than 7.0. The best academic performance was found among the students of the dentistry course, in which non-beneficiaries achieved a statistically higher mean APC in comparison to beneficiaries of the quota system (P=.004). Although higher mean coefficients were also found among the non-beneficiaries in the other courses analyzed, the differences did not achieve statistical significance. The students of the civil engineering course had the worst academic performance among the three courses analyzed. A greater frequency of failures was found among the beneficiaries of the quota system in comparison to non-beneficiaries for the campus as a whole (P=.010) as well as for the dentistry course (P=.004). Conclusion: The present findings suggest flaws in the quota system as a strategy for promoting social inclusion and underscore the importance of strengthening elementary and high school education in Brazil.

Aperfeiçoamento de estratégias para intervenção institucional e comunitária / Improvement of institutional and community intervention strategies / Mejoramiento de las estrategias de intervención institucional y comunidad

O objetivo da investigação aqui relatada foi examinar procedimentos para trabalho com populações de baixa renda e preparo de pessoas que prestam assistência a essas populações. O relato apresenta uma descrição das intervenções implementadas, assim como uma avaliação de tais intervenções com base, principalmente, em depoimentos dos participantes e na produção de trabalhos socioambientais gerada por esses participantes. Vinculada ao projeto "Coletivo Educador da Região Norte da Cidade de São Paulo", que envolvia a formação de grupos participativos de líderes comunitários e de profissionais que assistiam a comunidades carentes, a pesquisa implementou e avaliou as estratégias adotadas para a constituição e o acompanhamento da maioria de tais grupos. Os resultados, verificados por meio de relatórios de atividade, questionários de avaliação e observação direta, mostraram-se bastante positivos. Foram estruturados e trabalhados, no presente estudo, três grupos de profissionais da área educacional e um de líderes comunitários. Seus participantes, além de avaliarem as intervenções implementadas favoravelmente, realizaram 18 projetos socioambientais, o que evidenciou ainda mais a eficácia da estratégia empregada.

The aim of the current study was to examine procedures for working with low-income populations and preparation of people who provide assistance to these populations. The report presents a description of the interventions implemented, and an evaluation of such interventions based mainly on testimonies of the participants and the production of social-environmental works generated by these participants. Associated to the project "Coletivo Educador da Região Norte da Cidade de São Paulo", that involved the structuring of participative groups of community leaders and of professionals who used to assist poor communities, the research implemented and evaluated the interventions adopted to organize and accompany most of such groups. The results, verified through activity reports, evaluation questionnaires and direct observation, were very positive. Three groups of education professionals and one of community leaders were structured. Their participants, in addition to assessing the implemented interventions positively, generated 18 social-environmental projects, what showed even more the effectiveness of the employed strategy.

El objetivo de la investigación informada aquí fue examinar los procedimientos para el trabajo con poblaciones de bajos recursos y preparar a las personas que prestan asistencia a estas poblaciones. El informe presenta una descripción de intervenciones implementadas, así como una evaluación de tales intervenciones basada principalmente en testimonios de los participantes y en la producción de trabajos socio-ambientales generada por estos participantes. Vinculado al proyecto "Colectivo Educador en el Norte de la Ciudad de São Paulo ", que implica la formación de grupos participativos de líderes comunitarios y profesionales que asistieron a las comunidades pobres, la investigación ha implementado y evaluado las estrategias adoptadas para el establecimiento y seguimiento de la mayoría de esos grupos. Los resultados verificados a través de informes de actividades, cuestionarios de evaluación y observación directa, fueron muy positivos. En el presente estudio, fueron estructurados y si trabajó tres grupos de profesionales de la educación y un grupo de líderes de la comunidad. Sus participantes, además de evaluar favorablemente las intervenciones implementadas, han hecho 18 proyectos socio-ambientales, lo que puso de manifiesto aún más la eficacia de la estrategia empleada.

Nutritional Status and Risk Factors for Malnutrition in Low-income Urban Elders

PURPOSE: The purpose of this study was to evaluate the nutritional status of low-income urban elders by diversified ways, and to analyze the risk factors for malnutrition. METHODS: The participants in this study were 183 low-income elders registered at a visiting healthcare facility in a public health center. Data were collected using anthropometric measurements, and a questionnaire survey. For data analysis, descriptive statistics, chi2-test, t-test, Fisher's exact test, multiple logistic regression analysis were performed using SPSS 20.0. RESULTS: Regarding the nutritional status of low-income elders as measured by the Mini Nutritional Assessment (MNA), 10.4% of the elders were classified as malnourished; 57.4% as at high risk for malnutrition; and 32.2% as having normal nutrition levels. The main factors affecting malnutrition for low-income elders were loss of appetite (OR=3.34, 95% CI: 1.16~9.56) and difficulties in meal preparation (OR=2.35, 95% CI: 1.13~4.88). CONCLUSION: In order to effectively improve nutrition in low-income urban elders, it is necessary to develop individual intervention strategies to manage factors that increase the risk of malnutrition and to use systematic approach strategies in local communities in terms of a nutrition support system.

Exploring Household-level Risk Factors for Self-reported Prevalence of Allergic Diseases Among Low-income Households in Seoul, Korea

PURPOSE: Indoor risk factors for allergic diseases in low-income households in Korea have been characterized only partially. We evaluated the prevalences of atopic dermatitis, asthma, and allergic rhinitis in Seoul, Korea, to identify key housing and behavioral risk factors of low-income households. METHODS: Statistical analysis of the prevalence of these diseases and various risk factors was conducted using data from a 2010 Ministry of Environment household survey. Logistic regression models were generated using data from 511 low-income household apartments in districts of Seoul. RESULTS: In general, housing factors such as renovation history (P<0.1) and crowding status (P<0.01) were associated with allergic rhinitis, whereas behavioral factors such as frequency of indoor ventilation (P<0.05) and cleaning (P<0.1) were inversely correlated with atopic dermatitis. Indoor smoking was a major trigger of asthma and atopic dermatitis in low-income households (P<0.05). The presence of mold and water leakage in houses were the most important risk factors for all three diseases (P<0.05). CONCLUSIONS: Various risk factors play a role in triggering allergic diseases among low-income households in Seoul, and health or environmental programs mitigating allergic diseases should be tailored to address appropriate housing or behavioral factors in target populations.

Health Disparity and Health Welfare among Children from Low-Income Families

Children from low income families are vulnerable to physical problems including obesity, asthma, hypertension and psychological problems including depression, anxiety. This study was done to identify trends in welfare policy for children from low-income families and future direction for solving health disparity problems. Dream Start is a government-sponsored project that offers services for vulnerable children, ages 0 (include pregnant woman) to 12 years and their families. The Korean Government has made an effort to alleviate health disparity through the 'Health Plan' by establishing health objectives. However, in spite of these efforts by the Korean government, health disparity has worsened in Korea. In order to strengthen family function as well as promote growth and development for vulnerable children, experts in child care need to be significantly involved in identifying neglected children in the community.

Visual impairment in urban school children of low-income families in Kolkata, India.

To evaluate pattern of visual impairment in school children from low-income families in Kolkata, India, an institutional cross-sectional study was conducted among 2570 children of 10 primary schools. Ocular examination including refraction was done and pattern of visual impairment and refractive error was studied. The age range was 6-14 years. Refractive error was seen in 14.7%. Only 4 children were already wearing correction. Myopia and hypermetropia was present in 307 (11.9%) and 65 (2.5%) children, respectively. Visual acuity of less than 6/12 in better eye was present in 109 (4.2%) and 5 (0.2%) children pre- and post-correction, respectively. Eighteen children had amblyopia. Although prevalence of refractive error in this group is less compared to school children of all income categories reported from other cities of India, it is more compared to school children of all income categories from the same city. Refractive error mostly remains uncorrected in this group.

Effects of a Mentoring Program on Stress and Self-esteem for Middle School Girls of Low Income Families / 정신간호학회지

PURPOSE: The purpose of this study was to evaluate the effects of a mentoring program designed to help middle school girls from low income families cope with stress and improve self-esteem. METHODS: A non-equivalent control group, pretest-posttest design was used. The independent variable was the mentoring program, in which the mentors were nursing students and the mentees were middle school girls. The dependent variables were stress and self-esteem scores. The program was conducted using group activities and personal approaches through the mentor-mentee relationship. The program was conducted from September 1 to December 11, 2010 in a middle school in A city, South Korea. RESULTS: At follow-up, the stress and mental health scores had improved significantly in the intervention group compared to the control group. The self-esteem scores in the intervention group were significantly higher after the intervention than scores before the intervention. However there was no significant difference between the two groups. CONCLUSION: The results of this study suggest that mentoring programs have the potential to be developmentally appropriate interventions for stress management and self-esteem improvement in adolescents from vulnerable families and also enable nursing students as mentors to gain confidence in their professional capability.

As indicações freudianas para a formação dos analistas e a clínica com a população de baixa renda / Freud’s guidelines for the education of analysts and the clinic for lower income population / Les indications freudiennes pour la formation des analystes et la clinique avec les pauvres

De Freud a Lacan há um consenso de que os limites e as possibilidades de intervenção da psicanálise no laço social são proporcionais à formação e à experiência dos analistas. A prática da psicanálise com brasileiros de baixa renda, pouco escolarizados e não familiarizados com o discurso psicanalítico coloca em questão esses limites. Por que Freud considerava que a população mais pobre deveria ser atendida por analistas mais experientes? A partir teoria das pulsões, ele estabeleceu as relações entre o empobrecimento do eu e o empobrecimento econômico e social. O pacto civilizado decorre do modo como o eu realiza simultaneamente a satisfação pulsional e atende às exigências da realidade. Porém, a resultante desse processo é uma divisão constitucional do eu. Esse artigo retoma essa temática freudiana com o objetivo de resgatar as diretrizes necessárias à pesquisa sobre a expansão da psicanálise aplicada

From Freud to Lacan there is consensus that the limits and possibilities of psychoanalysis’s intervention in the social ties are related to the education and the experience of the therapists. The practice of psychoanalysis with the brazilians that perceive the lowest incomes, have less education and are not familiar with the speech of psychoanalysis raises a question as to how far these limits go. Why did Freud believe that the poorer population should be treated by more experienced analysts? From the theory of drive, he has estableshed the connections between the impoverishment of the self and socio-economical impoverishment. The pact of civilization is a consequence of the manner that the self fulfills his drive and answers to the expectations of society. However, this process results in a constitutional division of it. This article revisits this freudian theme with the purpose of retrieving the guidelines for the research on the expansion of applied psychoanalysis

Entre Freud et Lacan, il y a consensus au sujet de la proportionalité entre les limites et possibilités de l’intervention de la psychanalyse dans le lien social e la formation et l’expérience des analystes. La pratique psychanalytique avec des brésiliens pauvres , peu scolarisés et non familiers du discours psychanalytique met ces limites en question. Pourquoi Freud considérait-il que la population plus pauvre devrait-être traitée par des analystes plus expérimentés ? Prenant la théorie des pulsions comme fondement, il a établi les relations entre l’appauvrissement du moi et l’appauvrissement socio-économique. Le pacte de la civilisation est le résultat de la manière dont le sujet réalise au même temps la satisfaction pulsionelle et les attentes du réel. Toutefois, le résultat de ce processus est un moi divisé dans sa constitution. Cet article reprend ce thème freudien avec le but de retrouver les directives necéssaires pour la recherche sur l’expansion de la psychanalyse appliquée

Effects of a Health Diary Program on Fall-Related Outcomes in Low-Income Elderly Women with Osteoarthritis / 農村醫學 地域保健

PURPOSE: This study was done to identify the effects of a health diary program on fall related outcomes the low-income elderly women. METHODS: The study was carried out with a nonequivalent control group with pretest-posttest design. The study was composed of two groups, each made up of 24 subjects: experimental group and control group. The subjects were low-income women aged over 65 years with osteoarthritis and both the experimental and control groups were made up of subjects with the same age profiles. The independent variable was the health diary program, and the dependent variables were fall related outcomes (fear of falling, fall-efficacy, knowledge of fall) difficulty of performing activity, and mood state. The health diary program was performed for 50 minutes each session and twice a week for 8 weeks. Data were collected before the health diary program 10 weeks after the beginning of the program. RESULTS: The experimental group showed significant differences in knowledge of fall, fear of falling, and mood state compared to the control group. However there was no significant differences in difficulty of performing activity and fall efficacy. CONCLUSION: The results of this study may be used as part of an education to prevent falls for low-income elderly women with osteoarthritis.

Itinerários terapêuticos face à hipertensão arterial em famílias de classe popular / Experience with treatment of high blood pressure in low-income families

Na compreensão sobre a hipertensão arterial sistêmica (HAS) é importante considerar a influência dos conhecimentos e crenças associados à doença, bem como, os recursos disponíveis para o seu tratamento. Este trabalho analisa itinerários terapêuticos de três famílias de classe popular do tipo extensa que possuíam portadores de HAS. Investigou-se as alternativas adotadas, os determinantes das escolhas, a avaliação sobre os serviços utilizados e os reflexos da interação com os serviços no cuidado doméstico. Foi realizado um estudo etnográfico em um bairro popular de Salvador por meio de observação e entrevistas semi-estruturadas com informantes em espaços domiciliares e institucionais. Constatou-se que os itinerários das famílias participantes não seguiam um padrão rígido, sendo influenciados pelas experiências prévias com a hipertensão e outras doenças, pelo suporte social disponível e pelas condições do atendimento do sistema formal no bairro. Observou-se, também, a apropriação e adaptação do conhecimento técnico de saúde pelos grupos familiares.

In order to properly understand high blood pressure (HBP), or arterial hypertension, it is important to examine the influence of knowledge and beliefs associated with the condition, as well as the resources available for its treatment. This study analyzes the treatment experiences of three low-income extended families that include members with HBP. The study investigated the various alternatives that were adopted, determinants of choices, evaluation of the services used, and the impact of interaction with health services on care in the home. An ethnographic study was performed in a low-income neighborhood in Salvador, Bahia State, using direct observation and semi-structured interviews with key informants in home and institutional settings. The study found that the treatment experiences of the participating families did not follow a rigid pattern, but were influenced by prior experiences with hypertension and other diseases, available social support, and conditions in the formal health care system available in the neighborhood. The study also detected a grasp and adaptation of technical health knowledge by families.

Esteatose hepática em uma população escolar de adolescentes com sobrepeso e obesidade / Hepatic steatosis in a school population of overweight and obese adolescents

Objetivo: Avaliar esteatose hepática pelo método de ultrassom como fator de risco concomitante entre adolescentes com sobrepeso. Métodos: Estudo de caso-controle incluindo 83 casos (47 com sobrepeso e 36 obesos) e 89 controles (peso normal), frequência pareada por gênero, ano de nascimento, estágio pubertário (Tanner 4/5) e renda. Casos e controles foram selecionados de 1.420 alunos matriculados em uma escola pública de ensino médio na Vila Mariana, São Paulo. Os critérios de Must et al. foram usados para classificação do estado nutricional. A doença hepática gordurosa não-alcoólica foi diagnosticada por meio de ultrassonografia realizada e analisada por um radiologista. Foram medidas atividades enzimáticas hepáticas (alanina e aspartato transaminases, fosfatase alcalina, gama-glutamil transpeptidase) e bilirrubina direta. Oito co-variáveis foram inseridas em modelos de regressão logística; o critério de inclusão de variáveis foi a associação com sobrepeso nas análises bivariadas (p < 0,20). Um valor de p < 0,05 foi estabelecido como critério de inclusão nos modelos finais de regressão logística. Resultados: A prevalência de esteatose hepática diagnosticada por ultrassonografia foi de 27,7 por cento em alunos com sobrepeso/obesos e de 3,4 por cento em alunos com peso normal. Razões de chances ajustadas (IC95 por cento) para imagens compatíveis com doença hepática gordurosa não-alcoólica e gama-glutamil transpeptidase > 24 U/L foram 10,77 (2,45-47,22) e 4,18 (1,46-11,94), respectivamente. Conclusões: Este é o primeiro estudo populacional mostrando que a esteatose hepática tem forte associação com sobrepeso/obesidade entre adolescentes matriculados em uma escola pública brasileira. A ferramenta de diagnóstico usada nesta investigação é um método não-invasivo que poderia ser aplicado para monitorar adolescentes com sobrepeso e obesos e propor ações para prevenir doenças hepáticas mais graves na fase adulta.

Objective: To assess hepatic steatosis by ultrasound method as a concomitant risk factor among overweight adolescents. Methods: A case-control study including 83 cases (47 overweight and 36 obese) and 89 controls (normal weight), frequency matched by gender, year of birth, pubertal stage (Tanner 4/5), and income. Cases and controls were selected from 1,420 students enrolled in a Vila Mariana public high school, in São Paulo, Brazil. Must et al. criteria were used for nutritional status classification. Nonalcoholic fatty liver disease was diagnosed through hepatic ultrasonography performed and analyzed by one radiologist. Hepatic enzymatic activities (alanine and aspartate transaminases, alkaline phosphatase, gamma-glutamyl transpeptidase) and direct bilirubin were measured. Eight covariables were fitted into logistic regression models; criterion for inclusion of variables was the association with overweight in the bivariate analyses (p < 0.20). A value of p < 0.05 was set as the criterion for inclusion into the final logistic regression models. Results: Prevalence of hepatic steatosis diagnosed through ultrasonography was 27.7 percent in overweight/obese students and 3.4 percent in normal weight students. Adjusted odds ratios (95 percentCI) for images compatible with nonalcoholic fatty liver disease and gamma-glutamyl transpeptidase > 24 U/L were 10.77 (2.45-47.22) and 4.18 (1.46-11.94), respectively. Conclusions: This is the first population-based study showing that hepatic steatosis is strongly associated with overweight/obesity among adolescents attending a Brazilian public school. The diagnostic tool used in this investigation is a non-invasive method that might be applied to monitor overweight and obese adolescents and to propose actions for preventing more severe hepatic diseases in adulthood.