Determinant of catastrophic costs associated with treatment for rifampicin-resistant TB in households in the Republic of Moldova.

SETTING: The Republic of Moldova is a lower-middle-income country. Patients with TB face some barriers to accessing TB services. Welfare benefits are available during TB treatment. OBJECTIVES: We aimed to determine the proportion of rifampicin-resistant TB (RR-TB) households that experienced catastrophic costs due to TB at a threshold of ≥20% of household income and investigate the associated risk factors. DESIGN: A cross-sectional countrywide study comprised 430 patients with RR-TB who had received TB treatment as an inpatient or outpatient for at least 2 months. RESULTS: RR-TB patients lost 30% of their household income in inpatient and 70% in outpatient TB care. TB-related costs were associated with being unofficially employed or unemployed (aOR 1.9, 95% CI 1.1-3.3), having fewer household members (aOR 2.1, 95% CI 1.3-3.5), having an income that accounted for over 50% of household income (aOR 2.4, 95% CI 1.5-3.8), and being a poor household (aOR 2.2, 95% CI 1.2-3.9). CONCLUSION: Although TB health services are provided to patients free of charge, 26% of RR-TB households experienced catastrophic TB costs. The associated factors should be considered to improve patient-centred TB care, especially in vulnerable groups. Welfare payments mitigate TB costs.

CADRE: La République de Moldova est un pays à revenu intermédiaire de la tranche inférieure. Les patients atteints de TB se heurtent à certains obstacles pour accéder aux services de lutte contre la TB. Des prestations sociales sont disponibles pendant le traitement de la TB. OBJECTIFS: Nous avons cherché à déterminer la proportion de ménages atteints de TB résistant à la rifampicine (RR-TB) qui ont subi des coûts catastrophiques dus à la TB à un seuil de ≥20% du revenu du ménage et à étudier les facteurs de risque associés. MÉTHODE: Une étude transversale à l'échelle nationale a porté sur 430 patients atteints de RR-TB qui avaient reçu un traitement antituberculeux en hospitalisation ou en consultation externe pendant au moins 2 mois. RÉSULTATS: Les patients atteints de RR-TB ont perdu 30% du revenu de leur ménage en hospitalisation et 70% en soins ambulatoires. Les coûts liés à la TB étaient associés au fait d'avoir un emploi non officiel ou un chômeur (OR ajusté [ORa] 1,9 ; IC à 95% 1,1 à 3,3), d'avoir moins de membres du ménage (ORa 2,1 ; IC à 95% 1,3 à 3,5), d'avoir un revenu représentant plus de 50 % du revenu du ménage (ORa 2,4 ; IC à 95% 1,5 à 3,8) et d'être un ménage pauvre (ORa 2,2 ; IC à 95% 1,2 à 3,9). CONCLUSION: Bien que les services de santé liés à la TB soient fournis gratuitement aux patients, 26% des ménages atteints de RR-TB ont subi des coûts catastrophiques. Les facteurs associés doivent être pris en compte pour améliorer les soins de la TB centrés sur le patient, en particulier dans les groupes vulnérables. Les prestations sociales atténuent les coûts de la TB.

Exploring the poverty-reduction benefits of agricultural machinery socialization services in China: Implications for the sustainable development of farmers.

Sustainable development is crucial for alleviating poverty among farmers. In this study, we examined the impact, and the mechanism underlying this impact, of the adoption of agricultural machinery services by farmers on their relative poverty from a multidimensional poverty perspective by employing the logit and ordered logit models and the Karlson-Holm-Breen (KHB) method. These results indicate that adopting agricultural machinery services can significantly reduce the probability of relative poverty among farmers, thereby expediting the sustainability of rural development. However, this poverty-reduction effect varies based on age and sex. The adoption of agricultural machinery services mainly reduces poverty by increasing farmers' human capital. Training in employment skills and non-agricultural work experience are the main transmission mechanisms. Therefore, the socialization of agricultural machinery services can be used as an effective policy tool to reduce relative poverty in developing countries, promote sustained improvements in farmers' incomes, and achieve sustainability in rural development.

The Impact of digital finance on rural energy poverty-empirical evidence from rural China.

It is of critical importance to address energy poverty in rural areas if inclusive prosperity is to be achieved. Digital finance offers new opportunities to alleviate energy poverty in these regions. However, previous studies have mainly focused on the impact of digital finance on poverty, neglecting research on its impact in rural areas and on specific forms of poverty. This study aims to fill this gap by investigating the impact of digital finance on rural energy poverty. The period 2011-2021 was selected as the observation period, with 31 provinces serving as the study objects. The fixed effects model was employed to investigate the impact of digital finance on rural energy poverty, while exploring the mediating effect. The results indicate that digital finance alleviates the level of rural energy poverty, and this conclusion remains valid following a series of robustness tests. Furthermore, digital finance can indirectly alleviate rural energy poverty through technological innovation and agricultural entrepreneurship activities. Further research indicates that the impact of digital finance on rural energy poverty is more pronounced in regions with abundant human capital, robust government intervention, and minimal urban-rural disparities. This study extends the theoretical support for digital finance to indirectly support rural energy to alleviate poverty. Likewise, this finding provides a new perspective for the government and relevant departments to improve the welfare of residents and alleviate rural energy poverty.

The Role of Single Motherhood in America's High Child Poverty.

Many claim a high prevalence of single motherhood plays a significant role in America's high child poverty. Using the Luxembourg Income Study, we compare the "prevalences and penalties" for child poverty across 30 rich democracies and within the United States over time (1979-2019). Several descriptive patterns contradict the importance of single motherhood. The U.S. prevalence of single motherhood is cross-nationally moderate and typical and is historically stable. Also, child poverty and the prevalence of single motherhood have trended in opposite directions in recent decades in the United States. More important than the prevalence of single motherhood, the United States stands out for having the highest penalty across 30 rich democracies. Counterfactual simulations demonstrate that reducing single motherhood would not substantially reduce child poverty. Even if there was zero single motherhood, (1) the United States would not change from having the fourth-highest child poverty rate, (2) the 41-year trend in child poverty would be very similar, and (3) the extreme racial inequalities in child poverty would not decline. Rather than the prevalence of single motherhood, the high penalty for single motherhood and extremely high Black and Latino child poverty rates, which exist regardless of single motherhood, are far more important to America's high child poverty.

Pooled lagged effect of runoff on leptospirosis cases in Colombia.

Leptospirosis is a global zoonotic disease caused by spirochete bacteria of the genus Leptospira. The disease exhibits a notable incidence in tropical and developing countries, and in Colombia, environmental, economic, social, and cultural conditions favor disease transmission, directly impacting both mortality and morbidity rates. Our objective was to establish the pooled lagged effect of runoff on leptospirosis cases in Colombia. For our study, we included the top 20 Colombian municipalities with the highest number of leptospirosis cases. Monthly cases of leptospirosis, confirmed by laboratory tests and spanning from 2007 to 2022, were obtained from the National Public Health Surveillance System. Additionally, we collected monthly runoff and atmospheric and oceanic data from remote sensors. Multidimensional poverty index values for each municipality were sourced from the Terridata repository. We employed causal inference and distributed lag nonlinear models to estimate the lagged effect of runoff on leptospirosis cases. Municipality-specific estimates were combined through meta-analysis to derive a single estimate for all municipalities under study. The pooled results for the 20 municipalities suggest a lagged effect for the 0 to 2, and 0-3 months of runoff on leptospirosis when the runoff is < 120 g/m2. No effect was identified for longer lagged periods (0-1, 0 to 4, 0 to 5, and 0-6 months) or higher runoff values. Incorporation of the multidimensional poverty index into the meta-analysis of runoff contributed to the models for the lagged periods of 0-3, and 0-4 months.

Income disparities and risk: Geographical manifestations of extreme inequities in the United States.

We examined hazard and risk-related metrics of the highest- and lowest-income counties and municipalities in each U.S. state. Indicators of natural and anthropogenic hazards, health outcomes, location of locally unwanted land uses, food insecurity, and other metrics were used to measure social and environmental justice. As expected, the highest-income places have better health outcomes, access to assets that protect health, and high municipal ratings of place quality compared with their poorest counterparts. Yet, they also have higher natural hazard risks and are more likely to live near concentrations of anthropogenic hazards. That is, high-income places have a lot to lose. Although the poorest jurisdictions demonstrate cumulative disadvantages, those in rural areas are exposed to less dense motor vehicle traffic and other hazards and risks associated with urban life. Relationships between income and the geography of hazards and risks are not simple. Even the highest-income areas face challenges. We suggest improvements in databases and tools to increase the focus on and monitoring of the breadth of risks people face in all areas.

A scoping review of the links between early childhood caries and clean water and sanitation: the Sustainable Development Goal 6.

INTRODUCTION: The United Nation's Sustainable Development Goal (SDG) 6 calls for universal access to clean water, sanitation and hygiene (WASH), which are crucial elements of health and well-being and fundamental for a life in dignity. Early childhood caries (ECC) is a preventable disease affecting health and quality of life of millions of young children worldwide. This scoping review aims to explore the connection between ECC and access to clean water and sanitation. METHODS: This scoping review, registered on the Open Science Framework and following PRISMA-ScR guidelines, conducted a thorough search in databases (PubMed, Web of Science, Embase, Google Scholar, SciELO) and websites (via Google) in November 2023. The search, without date limitations, targeted studies in English and Spanish linking ECC to SDG6. Exclusions were made for studies solely focusing on ECC without a direct connection to clean water and sanitation. Descriptive statistics summarized the retrieved papers. RESULTS: The initial search yielded 303 articles. After removing duplicates, 264 articles remained for title and abstract screening after which 244 were excluded and one report was added through citation searching. The 21 remaining articles underwent full text review. There were no studies on a direct association between access to clean water and sanitation and the prevalence of ECC. There were nine studies that showed indirect associations between ECC and access to clean water and sanitation through the links of: water and sanitation access as a marker for poverty (n = 1), water consumption as a feeding practice (n = 4), and the effectiveness of water fluoridation (n = 4). These were used to develop a conceptual model. CONCLUSIONS: While it is conceivable that a direct link exists between ECC and access to clean water and sanitation, the available body of research only offers evidence of indirect associations. The exploration of potential pathways connecting water access to ECC warrants further investigation in future research.

Adaptation of the Foster-Greer-Thorbecke poverty measures for the measurement of catastrophic health expenditures.

In this paper we provide an adaptation of the Foster-Greer-Thorbecke (FGT) family of poverty measures for the measurement and analysis of catastrophic health expenditure (CHE). The adaptation entails introducing the FGT-type family of CHE measures with a single CHE aversion parameter whose value can be increased to put greater emphasis on the health expenditure proportions that overshoot the prescribed threshold proportions for CHE characterization by the greatest margins. The subgroup decomposition property of the FGT-type family of CHE measures (i.e., the ability to isolate the contributions of the various mutually exclusive population subgroups to the overall FGT-type CHE measure) is discussed along with other normative properties. We also show how the estimation and subgroup decomposition of the FGT-type family of CHE measures can be conveniently accomplished using ordinary least squares regression. An illustrative example is also provided to show how the FGT approach can provide valuable insights into the distribution of CHE among the healthcare spending units that incur CHE.

Socio-Ecologic Influences on Weight Trajectories Among Children with Obesity Living in Rural and Urban Settings.

Background: Childhood obesity is a risk factor for poor cardiovascular, metabolic, and respiratory health. The studies examining influences of socio-ecologic factors on weight trajectories using longitudinal data are limited, often examine single measures (e.g., proximity to parks), and have not examined the specific trajectories of children with obesity. Methods: We examined influences on weight among 1518 children, 6-12 years of age, who had obesity using body mass index (BMI) criteria. BMI slope trajectories were categorized as decreasing, flat, or increasing, with a median of 2.1 years of follow-up. We examined socio-ecologic exposures, stratified by rural and urban settings, using census tracts to map indices, including food access, proximity to parks, normalized difference vegetation index, and area deprivation index (ADI). We used ordinal logistic regression to examine the associations between the socio-ecologic factors and BMI trajectories. Results: Among the 1518 children, 360 (24%) had a decreasing BMI trajectory with the remainder having flat (23%) or increasing (53%) trajectories. Children in rural areas were more likely to live in high disadvantage areas, 85%, compared with urban children, 46%. In the multivariable ordinal model, living in a lower ADI census tract had a 0.78 (95% CI 0.61-0.99) lower odds of being in an increasing BMI slope group, and no other socio-ecologic factor was associated. Conclusions: The area deprivation index captures a range of resources and social context compared with the built environment indicators, which had no association with BMI trajectory. Further work examining how to develop effective interventions in high deprivation areas is warranted.

Period poverty, reuse needs, and depressive symptoms among refugee menstruators in Jordan's camps: a cross-sectional study.

BACKGROUND: Period poverty is a significant issue that impacts the physical and psychological well-being of menstruators worldwide which can further contribute to poor mental health outcomes. For menstruators living in refugee camps, access to menstrual hygiene products is often limited or non-existent, leading to increased anxiety, shame, and embarrassment. Therefore, this study aimed to assess the prevalence of the period poverty and to comprehensively analyze the association between period poverty, reusing menstrual products, and depressive symptoms among menstruators living in refugee camps in Jordan. METHODS: A cross-sectional study surveyed refugee menstruators living in camps in Jordan, aged post-menarche to pre-menopause. Data collection included socio-demographics, menstrual practices, and depressive symptoms using the Patient Health Questionnaire (PHQ-9). Period poverty was assessed through affordability and frequency of struggles with menstrual products. Chi-squared test, independent sample t-test, One Way Analysis of variance (ANOVA) followed by Post hoc, and logistic regression models were used in the analysis. RESULTS: The study included a diverse sample of 386 refugee menstruators living in camps in Jordan (mean age 32.43 ± 9.95, age range 13-55). Period poverty was highly prevalent, with 42.0% reporting monthly struggles to afford menstrual products, and 71.5% reusing menstrual products. Univariate analysis revealed that experiencing period poverty was significantly associated with a younger age of marriage, increased number of children, lower education level, lower mother and father education levels, unemployment, decreased monthly income, absence of health insurance, lower reuse need score, and increased PHQ-9 score (p < 0.05). Menstruators experiencing monthly period poverty were 2.224 times more likely to report moderate to severe depression compared to those without period poverty (95% CI 1.069-4.631, P = 0.033). CONCLUSION: This study highlights a significant association between period poverty and depressive symptoms among refugee menstruators in living in camps in Jordan, as high rates of period poverty were associated with a 2.2-fold increased likelihood of reporting moderate to severe depression. Addressing period poverty in refugee settings is crucial for mitigating depression risks and enhancing overall well-being.

Longitudinal Exposure to Neighborhood Concentrated Poverty Contributes to Differences in Adiposity in Midlife Women.

Background: Neighborhood poverty is associated with adiposity in women, though longitudinal designs, annually collected residential histories, objectively collected anthropometric measures, and geographically diverse samples of midlife women remain limited. Objective: To investigate whether longitudinal exposure to neighborhood concentrated poverty is associated with differences in body mass index (BMI) and waist circumference (WC) among 2,328 midlife women (age 42-52 years at baseline) from 6 U.S. cities enrolled in the Study of Women's Health Across the Nation (SWAN) from 1996 to 2007. Methods: Residential addresses and adiposity measures were collected at approximately annual intervals from the baseline visit through a 10-year follow-up. We used census poverty data and local spatial statistics to identify hot-spots of high concentrated poverty areas and cold-spots of low concentrated poverty located within each SWAN site region, and used linear mixed-effect models to estimate percentage differences (95% confidence interval [CI]) in average BMI and WC levels between neighborhood concentrated poverty categories. Results: After adjusting for individual-level sociodemographics, health-related factors, and residential mobility, compared to residents of moderate concentrated poverty communities, women living in site-specific hot-spots of high concentrated poverty had 1.5% higher (95% CI: 0.6, 2.3) BMI and 1.3% higher (95% CI: 0.5, 2.0) WC levels, whereas women living in cold-spots of low concentrated poverty had 0.7% lower (95% CI: -1.2, -0.1) BMI and 0.3% lower (95% CI: -0.8, 0.2) WC. Site-stratified results remained in largely similar directions to overall estimates, despite wide CIs and small sample sizes. Conclusions: Longitudinal exposure to neighborhood concentrated poverty is associated with slightly higher BMI and WC among women across midlife.

Implications of fuel poverty for indoor black carbon concentrations from space heating.

Despite the global transition towards cleaner energy sources observed over the last decade, disparities in access persist worldwide. The dependence on biomass for household heating exacerbates fuel poverty, as economically vulnerable households face challenges in obtaining certified firewood and often resort to using contaminated biomass as a substitute, either partially or completely. We examined black carbon (BC) particle concentrations -a marker for combustion- during wood stove operation through a five-day case study in a typical Chilean household. BC increased rapidly following the ignition of the stove, with the combustion of dry Eucalyptus globulus logs yielding a substantially lower peak (5.29 µg/m3) than when using unclean biomass: 35.75 µg/m3 with demolition wood and painted furniture, and 87.11 µg/m3 with the addition of a blend of particleboard with polystyrene foam. During the latter two events, BC particles remained indoors for about 20 h before the concentrations reverted to pre-spike levels. The slow decay in BC concentrations was further influenced by the infiltration of outdoor air. The mean indoor BC concentrations were comparable to or even exceeded those observed on busy roads in major cities worldwide. These results highlight the risks associated with limited access to clean fuels for indoor heating, alongside inadequate insulation. This study sheds light on the problem of fuel poverty and its adverse effects on health and well-being.

Determinants of community engagement and its role in income poverty reduction: Evidence from Jajarkot, Nepal.

This study examined the determinants of community engagement and its contribution to poverty reduction in Jajarkot, Nepal. Primary data were collected from 448 households using a structured questionnaire survey and key informant interviews. The collected data were analyzed using mean comparison t-tests, probit analysis, and binary logistic regression models. The results indicated that the education level of respondents, months of sufficient food, willingness to work as a team, and the level of social participation positively and significantly influenced community engagement. Furthermore, community engagement, participation in the decision-making process, and skill related training were found to be positively correlated with income. The study identified a significant difference in mean income between the engaged and non-engaged groups, with a margin of 471 USD, suggesting that community engagement can increase the income of the engaged groups and thereby contribute to poverty reduction. Community groups, local governments, and national and international organizations should develop an inclusive strategy that involves households in community groups to produce more effective results in society.

Comparative sanitation data from high-frequency phone surveys across 3 countries.

With less than half of the world's urban population having safely managed sanitation due to the high cost and difficulty of building sewers and treatment plants, many rely on off-grid options like pit latrines and septic tanks, which are hard to empty and often lead to illegal waste dumping; this research focuses on container-based sanitation (CBS) as an emerging off-grid solution. Off-grid sanitation refers to waste management systems that operate independently of centralized infrastructure and CBS is a service providing toilets that collect human waste in sealable containers, which are regularly emptied and safely disposed of. These data relate to a project investigating CBS in Kenya, Peru, and South Africa, focusing on how different user groups access and utilize sanitation - contrasting CBS with other types. Participants, acting as citizen scientists, collected confidential data through a dedicated smartphone app designed by the authors and external contractors. This project aimed to explore the effective scaling, management, and regulation of off-grid sanitation systems, relevant to academics in urban planning, water and sanitation services, institutional capability, policy and governance, and those addressing inequality and poverty reduction. The 12-month data collection period offered participants small incentives for weekly engagement, in a micro payment for micro tasks approach. Participants were randomly selected, attended a training workshop, and (where needed) were given a smartphone which they could keep at the end of the project. We conducted weekly smartphone surveys in over 300 households across informal settlements. These surveys aimed to understand human-environment interactions by capturing daily life, wellbeing, income, infrastructural service use, and socioeconomic variables at a weekly resolution, contributing to more informed analyses and decision-making. The smartphone-based approach offers efficient, cost-effective, and flexible data collection, enabling extensive geographical coverage, broad subject areas, and frequent engagement. The Open Data Kit (ODK) tools were used to support data collection in the resource-constrained environment with limited or intermittent connectivity.

Impact of power outages: Unveiling their influence on micro, small, and medium-sized enterprises and poverty in Sub-Saharan Africa - An in-depth literature review.

The paper explores the review on the impact of electricity outages on MSMEs in Sub-Saharan Africa, analyzing their effects on productivity and poverty levels based on a review of 102 studies spanning from 2010 to 2023. The review organizes the studies by subject, theme, and major research findings to analyze the impact of power outages in Sub-Saharan Africa on poverty reduction. Power outages in the region hinder income generation and employment, perpetuating the cycle of poverty. The key findings emphasize the importance of proactive action to minimize the negative consequences of power outages on small businesses and poverty. MSMEs face disruptions that lead to reduced productivity, operational inefficiencies, higher production costs, and supply chain disruptions. Strategies to lessen power outage effects on MSMEs, the review proposed promoting energy source diversification, such as renewables. The research review concludes that power outages are a major challenge for MSMEs and energy diversification is a key solution to reduce poverty in the region.

Pediatric tuberculosis in a high burden setting: Socio-spatial distribution, blood elements features, and outcomes.

Background: The childhood tuberculosis (TB) epidemic has been long neglected. Data on pediatric tuberculosis is needed to develop effective strategies against TB. Methods: We retrospectively reviewed 200 medical records from children aged 0-15 years who suffered from tuberculosis between 2011 and 2021 in Libreville, Gabon. We collected and analyzed socio-demographic data and clinical data. Results: 141 children files were selected (43 % girls and 57 % boys). The mean age of the patients was 9.2 years (CI: 8.5-10). Sixty per cent (60 %) of cases were from precarious housing areas, 35.34 % from mixed housing areas, and 4.51 % from residential. The cure rate was 75.24 %, 9.52 % relapsed, and 15.24 % died. Deaths were significantly higher in older children (Dunn's post-test p < 0.01). Children who recovered had higher haemoglobin and platelet counts than those who died (Dunn's test: haemoglobin p < 0.0001; thrombocytes p < 0.05). The haemoglobin threshold value of 5.5 g/dL identified children death with up to 80 % sensitivity and 86 % specificity. Thrombocytes count identified children's death with a sensitivity of 80 % and a specificity of 51 %. Conclusion: Precariousness is associated with childhood tuberculosis. The directly observed therapy (DOTS) in older children should be reinforced to limit tuberculosis-associated deaths. Haemoglobin concentration and platelet are vital prognosis markers in pediatric tuberculosis.

Socio-economic impacts of commercialisation of agriculture in the Kingdom of Eswatini: A case of Siphofaneni.

The transformation of subsistence agriculture into market-oriented production has been in the policy spotlight in many countries in the global South, including the Kingdom of Eswatini. Although agricultural commercialisation continues to gain popularity as a development strategy in the rural spaces of Eswatini, there is still lack of scientific evidence on its effectiveness in rural poverty alleviation and contribution to rural livelihoods and welfare. This study aims to contribute to the 'agricultural commercialisation and poverty' debate by exploring the socio-economic impacts of agricultural commercialisation in rural Eswatini. Among the key findings of the study was that the commercialisation project (in Siphofaneni) improved income levels, income sources, and employment opportunities of rural people in Siphofaneni. Access to food and food consumption patterns (meal frequency & diets) were also improved. The study concluded that agricultural commercialisation improved the welfare outcomes of rural households in Siphofaneni and reduced poverty levels for some households. The study has made a timely contribution by providing some illumination on the role and contribution of the country's agricultural commercialisation project with regards to the improvement of the living conditions of people in Eswatini. The study recommended that the government of Eswatini expands the project into other food-deficit and deprived rural areas of the country rather than confining it to the drought-prone areas of Siphofaneni.

A study of poverty alleviation strategies for sustainable development: A scientometric analysis.

Purpose: The present study aims to investigate the current and future trends in poverty alleviation strategies for sustainable development, show the gaps and propose the way forward for future research. Methods: This research covers four decades from 1981 to 2023. We identified a corpus of 5,982 articles from the Scopus database using the bibliometric and scientometric methods. We excluded 653 to remain, with 5,329 fulfilling the conditions of non-duplicates, suitable authorship, and conform content. These documents include articles, reviews, journals, books and other publications in our study field. With the help of VOS viewer and R-Studio software, we have performed two significant tests: performance analysis and science mapping. Results: Despite the poverty alleviation strategies for sustainable development that emerged in 1981, it has experienced steady growth from 2000 onwards and has reached the pick in 2022 with 316 publications. The most prolific countries are China, the USA and the UK. At the same time, the most contributing authors are Liu Y, Wang Y, and Lily, both from China and Ravaillion, M from Australia. They have discussed more about poverty alleviation and poverty reduction. Furthermore, we realize that the household, remittance and land use have no connection with any item besides the government and IMF. Conclusion: We have underlined the countries and authors that contributed the most and revealed the challenges in poverty alleviation via thematic mapping. Therefore, we recommend that future researchers, while keeping an eye on Africa, livelihoods, gender inequality, and India, focus more on poverty alleviation, China, and sustainable development. Special attention also must focus on the household, remittance, land use, government, and IMF and find ways to improve their role in poverty alleviation strategies for sustainable development.

Racial and economic segregation and diabetes mortality in the USA, 2016-2020.

BACKGROUND: The purpose of this study was to examine the association between racial and economic segregation and diabetes mortality among US counties from 2016 to 2020. METHODS: We conducted a cross-sectional ecological study that combined county-level diabetes mortality data from the National Vital Statistics System and sociodemographic information drawn from the 2016-2020 American Community Survey (n=2380 counties in the USA). Racialized economic segregation was measured using the Index Concentration at the Extremes (ICE) for income (ICEincome), race (ICErace) and combined income and race (ICEcombined). ICE measures were categorised into quintiles, Q1 representing the highest concentration and Q5 the lowest concentration of low-income, non-Hispanic (NH) black and low-income NH black households, respectively. Diabetes was ascertained as the underlying cause of death. County-level covariates included the percentage of people aged ≥65 years, metropolitan designation and population size. Multilevel Poisson regression was used to estimate the adjusted mean mortality rate and adjusted risk ratios (aRR) comparing Q1 and Q5. RESULTS: Adjusted mean diabetes mortality rate was consistently greater in counties with higher concentrations of low-income (ICEincome) and low-income NH black households (ICEcombined). Compared with counties with the lowest concentration (Q1), counties with the highest concentration (Q5) of low-income (aRR 1.93; 95% CI 1.79 to 2.09 for ICEincome), NH black (aRR 1.93; 95% CI 1.79 to 2.09 for ICErace) and low-income NH black households (aRR 1.32; 95% CI 1.18 to 1.47 for ICEcombined) had greater diabetes mortality. CONCLUSION: Racial and economic segregation is associated with diabetes mortality across US counties.

Resilience of individuals with chronic illness who reside in low resource communities: a concept analysis.

Background: Chronic illness diagnosis while living in low resourced communities creates ongoing adversity in the process of adaptation. Resilience is an important phenomenon of study to improve health outcomes. The subject in this particular population has been poorly studied. Objective: To conceptualize resilience of individuals with chronic illness who reside in low resource communities. Design: Concept analysis. Data sources: Seminal works and current studies were searched in PubMed (including Medline), Science Direct, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), ProQuest, Google Scholar, OVID, Ebsco, and the Cochrane Database. Qualitative and quantitative studies that investigated individual resilience of adults in the setting of chronic illness who reside in low resource communities were included. Exclusions included children with chronic illness and resilience of communities and populations. Methods: Walker and Avant's method of concept analysis was utilized. The key elements for conceptualizing resilience in the setting of chronic illness who reside in low resource communities included defining attributes, antecedents and consequences of resilience identified from the literature search. Results: Analysis revealed three defining attributes: (1) reflection, contemplation, and the will to live despite adversity through hope; (2) personal transcendence through action; and (3) continuous personal transcendence and maintenance. Antecedents and consequences of resilience in the setting of chronic illness who reside in low resource communities were described and outlined. Conclusions: The conceptualization of resilience in the setting of chronic illness who reside in low resource communities is based on the defining attributes, antecedents, and consequences that resulted in a preliminary conceptual model. The model can be further tested in diverse populations to add to the existing knowledge on the subject, and develop interventions to foster resilience aimed to improve health outcomes and quality of life.