Iniquidades Sociais e Saúde Mental no Meio Rural / Social Inequality and Mental Health in Rural Areas / Inequidades Sociales y Salud Mental en Contexto Rural

Esse artigo objetiva discutir casos de comorbidade de transtornos mentais comuns e uso abusivo de álcool e suas determinações entre moradores de assentamentos de reforma agrária. Trata-se de um estudo de delineamento combinado quantitativo-qualitativo, com amostra inicial de 2.012 moradores, resultando, após aplicação de questionário sociodemográfico e ferramentas de rastreamento (SRQ-20 e AUDIT) na identificação de 39 casos de comorbidade, aos quais foi aplicada entrevista semiestruturada. Para análise descritiva dos dados quantitativos utilizou-se o software SPSS for Windows, versão 20 e a construção de mapas dialógicos para os qualitativos. Aspectos envolvendo educação e trabalho, ambientes de interação/coesão social (redes e apoio social), mobilidade e transporte, acesso a equipamentos e serviços, falta de espaços de lazer, são fatores que interferem na saúde mental. Considera-se, dessa forma, a interdependência entre condições socioeconômicas, características dos territórios, padrões culturais, histórias de vida dos indivíduos e os agravos em saúde e morbidades psiquiátricas, em particular.(AU)

The vulnerable psychosocial conditions found within poverty are made worse when dealing with populations from rural areas. These groups suffer the most from a lack of basic infrastructure and the problems that arise from the lack of social development. These people are hit the hardest, but remain less visible and far out of reach of public policies, especially in the case of mental health. For this discussion, we analyze cases of comorbidity of common mental disorders and alcohol abuse and its determinations among residents of land reform settlements. It is a combined quantitative-qualitative delineated study, with na initial sample of 2,012 residents. After the administration of a sociodemographic questionnaire and screening tools (SRQ-20 e Audit), 39 cases of comorbidity were identified, to which semi-structured interviews were administered. For descriptive analysis of the quantitative data, we used SPSS for Windows version 20, and the construction of dialogic maps for qualitative data. We bserved the interdependence between socioeconomic conditions, the characteristics of territories, cultural patterns, individuallife stories and mental diseases in particular.(AU)

El objetivo de este artículo fue discutir casos de comorbilidad de trastornos mentales comunes y uso exagerado de alcohol y sus determinaciones entre vecinos de la reforma agraria.Se trata de un estudio de delineamiento combinado cuantitativo - cualitativo,con una muestra inicial de 2012 participantes, resultando después de aplicarse un cuestionario sociodemógrafico y herramientas de rastreamiento (SRQ-20 y AUDIT), la identificación de 39 casos de comorbilidad, a los cuales les fue aplicada una entrevista semiestructurada.Para el análisis descriptivo de los datos cuantitativos se utilizó el software for Windows, versión 20 y la construcción de mapas dialógicos para los datos cualitativos. Aspectos relativos a educación y trabajo, ambientes de interacción/cohesión social (redes y apoyo social) movilidad y transporte,acceso a equipamientos y servicios, falta de espacios de recreación, son factores que interfieren en la salud mental.Por lo tanto se considera la interdependencia entre condiciones socieconómicas, características de los territorios, padrones culturales, historia de vida de los individuos, y losagravios en salud y morbilidad psiquiátricas, en particular.(AU)

Correlates of out-of-pocket spending on health in Nepal: implications for policy.

Background: A key objective of universal health coverage is to address inequities in the financial implications of health care. This paper examines the level and trend in out-of-pocket spending (OOPS) on health, and the consequent burden on Nepalese households. Methods: Using data from the Nepal Living Standard Survey for 1995–1996 and 2010–2011, the paper looks at the inequity of this burden and its changes over time; across ecological zones or belts, development regions, places of residence, or consumption expenditure quintiles; and according to the gender of the head of the household. Results: The average per capita OOPS on health in Nepal increased sevenfold in nominal terms between 1995–1996 and 2010–2011. The share of OOPS in household consumption expenditure also increased during the same period, primarily as a result of higher health spending by poorer households. Thirteen per cent of all households were found to incur catastrophic health expenses in 2010– 2011. This proportion of households incurring such expenditure rose between the two time periods most sharply in the Terai belt, eastern region and poorest quintile. Conclusion: The health-financing system in Nepal has become regressive over the years, as the share of the bottom two quintiles in the total number of households facing catastrophic burden increased by 14% between the two periods.

Constructing Indices of Rural Living Standards in Northwestern Bangladesh.

This study aimed to construct indices of living standards in rural Bangladesh that could be useful to study health outcomes or identify target populations for poverty-alleviation programmes. The indices were constructed using principal component analysis of data on household assets and house construction materials. Their robustness and use was tested and found to be internally consistent and correlated with maternal and infant health, nutritional and demographic indicators, and infant mortality. Indices derived from 9 or 10 household asset variables performed well; little was gained by adding more variables but problems emerged if fewer variables were used. A ranking of the most informative assets from this rural, South Asian context is provided. Living standards consistently and significantly improved over the six-year study period. It is concluded that simple household socioeconomic data, collected under field conditions, can be used for constructing reliable and useful indices of living standards in rural South Asian communities that can assist in the assessment of health, quality of life, and capabilities of households and their members.

Influence of Environmental Living Standards on Helicobacter pylori Infection in Korean Elementary School Children / 대한소아소화기영양학회지

PURPOSE: We measured anti-H. pylori IgG in Korean elementary school children living in Shinchon area of Seoul, Korea to evaluate the influence of environmental living standards on H. pylori infection. METHODS: IgG antibodies to H. pylori were measured in plasma using a commercial ELISA kit (GAP IgG Helicobacter pylori, Bio-Rad Laboratories Inc., Hercules, CA, USA). Information on environmental status such as place of birth, parental income, type of housing, number of persons in the household, parents' occupation, family history of peptic ulcer disease and gastric cancer was obtained. Statistical analysis was done by Chi-square and logistic regression test using SPSS 7.0(TM) for Windows. RESULTS: Study subjects consisted of 571 children, and the age distribution ranged from 6.0 to 13.6 years with a mean of 9.6+/-1.8 years. Male-to-female ratio was 1.1:1. The seropositive rates of H. pylori infection ranged from 10.4% in children aged 6 years to 30.9% in 12 year-old group, overall 16.8%. The prevalence of H. pylori infection progressively increased with age, but there was no significant difference in seropositive rates among children in different age groups (p=0.06). Seropositive rates of anti-H. pylori IgG on the basis of gender, place of birth, parental income, type of housing, parents' occupation, family history of peptic ulcer disease and gastric cancer showed no statistically significant difference. Interestingly, however, seropositive rate of anti-H. pylori IgG showed statistical significance in relation to number of persons in the household (p=0.003; Odds ratio 1.50 by logistic regression test). CONCLUSION: These results suggest that number of persons in the household is the most important factor among environmental living standards, and that risk of H. pylori infection increases by increment of 1.5 times as the number of persons in the household increases by one.