Community health workers for maternal and child health

In this factsheet, the Population Council notes the shortage of trained health professionals in the developing world; virtually all of sub-Saharan Africa stands below the critical threshold of 2.3 doctors, nurses, and midwives per thousand people. Doctors are especially unevenly distributed between urban and rural areas, with shortages being even more acute in rural communities. This document summarizes the important role of community health workers (CHWs) who can considerably increase coverage where access to health facilities is difficult and service utilization is already low. CHWs can play a vital role in increasing access to family planning and work within a community-based team to educate women on the importance of attending antenatal, delivery, and postnatal care with a skilled professional. However, many challenges exist; standardization of training, sustainability of funding, and other obstacles must be addressed for the CHW model to achieve its full potential

Different Slopes for Different Folks: Socioeconomic and Racial/Ethnic Disparities in Asthma and Hay Fever among 173,859 U.S. Men and Women.

Although allergic diseases such as asthma and hay fever are a major cause of morbidity in industrialized countries, most studies have focused on patterns of prevalence among children and adolescents, with relatively few studies on variations in prevalence by race/ethnicity and socioeconomic position among adults. Our study examined racial/ethnic and socioeconomic patterns in the prevalence of asthma overall, asthma with hay fever, asthma without hay fever, and hay fever overall, in a population of 173,859 women and men in a large prepaid health plan in northern California. Using education as a measure of socioeconomic position, we found evidence of a positive gradient for asthma with hay fever with increasing level of education but an inverse gradient for asthma without hay fever. Hay fever was also strongly associated with education. Compared with their White counterparts, Black women and men were more likely to report asthma without hay fever, and Black women were less likely to have asthma with hay fever. Asian men were also more likely to report asthma with hay fever, and Asian women and men were much more likely to have hay fever. Racial/ethnic disparities in prevalence of allergic diseases were largely independent of education. We discuss implications for understanding these social inequalities in allergic disease risk in relation to possible differences in exposure to allergens and determinants of immunologic susceptibility and suggest directions for future research

Lifetime Socioeconomic Position and Twins' Health: An Analysis of 308 Pairs of United States Women Twins

BACKGROUND: Important controversies exist about the extent to which people's health status as adults is shaped by their living conditions in early life compared to adulthood. These debates have important policy implications, and one obstacle to resolving them is the relative lack of sufficient high-quality data on childhood and adult socioeconomic position and adult health status. We accordingly compared the health status among monozygotic and dizygotic women twin pairs who lived together through childhood (until at least age 14) and subsequently were discordant or concordant on adult socioeconomic position. This comparison permitted us to ascertain the additional impact of adult experiences on adult health in a population matched on early life experiences. METHODS AND FINDINGS: Our study employed data from a cross-sectional survey and physical examinations of twins in a population-based twin registry, the Kaiser Permanente Women Twins Study Examination II, conducted in 1989 to 1990 in Oakland, California, United States. The study population was composed of 308 women twin pairs (58% monozygotic, 42% dizygotic); data were obtained on childhood and adult socioeconomic position and on blood pressure, cholesterol, post-load glucose, body mass index, waist-to-hip ratio, physical activity, and self-rated health. Health outcomes among adult women twin pairs who lived together through childhood varied by their subsequent adult occupational class. Cardiovascular factors overall differed more among monozygotic twin pairs that were discordant compared to concordant on occupational class. Moreover, among the monozygotic twins discordant on adult occupational class, the working class twin fared worse and, compared to her professional twin, on average had significantly higher systolic blood pressure (mean matched difference = 4.54 mm Hg; 95% confidence interval [CI], 0.10–8.97), diastolic blood pressure (mean matched difference = 3.80 mm Hg; 95% CI, 0.44–7.17), and low-density lipoprotein cholesterol (mean matched difference = 7.82 mg/dl; 95% CI, 1.07–14.57). By contrast, no such differences were evident for analyses based on educational attainment, which does not capture post-education socioeconomic position. CONCLUSION: These results provide novel evidence that lifetime socioeconomic position influences adult health and highlight the utility of studying social plus biological aspects of twinship

Increase in CD5+ B Cells in Juvenile Rheumatoid Arthritis

Objective. To investigate the association between CD5+ B cell expression and IgM rheumatoid factor (IgM-RF) in juvenile rheumatoid arthritis (JRA). Methods. CD5+ B cell levels analyzed by flow cytometry and IgM-RF expression determined by enzymelinked immunosorbent assay were compared in children with JRA, children with other collagen vascular diseases, and healthy controls. Results. Children with polyarticular JRA had expanded populations of CD5+ B cells, and expansion of CD5+ B cells and IgM-RF both correlated with disease activity. Conclusion. The results indicate that an expanded CD5+ B cell population leads to IgM-RF production in patients with polyarticular JRA, as well as patients with RA.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/37790/1/1780350213_ftp.pd

The Fall and Rise of US Inequities in Premature Mortality: 1960–2002

Nancy Krieger and colleagues found evidence of decreasing, and then increasing or stagnating, socioeconomic and racial inequities in US premature mortality and infant death from 1960 to 2002

Performance Measures Using Electronic Health Records: Five Case Studies

Presents the experiences of five provider organizations in developing, testing, and implementing four types of electronic quality-of-care indicators based on EHR data. Discusses challenges, and compares results with those from traditional indicators

Impacts of Census Differential Privacy for Small-Area Disease Mapping to Monitor Health Inequities

The US Census Bureau will implement a new privacy-preserving disclosure avoidance system (DAS), which includes application of differential privacy, on publicly-released 2020 census data. There are concerns that the DAS may bias small-area and demographically-stratified population counts, which play a critical role in public health research, serving as denominators in estimation of disease/mortality rates. Employing three DAS demonstration products, we quantify errors attributable to reliance on DAS-protected denominators in standard small-area disease mapping models for characterizing health inequities. We conduct simulation studies and real data analyses of inequities in premature mortality at the census tract level in Massachusetts and Georgia. Results show that overall patterns of inequity by racialized group and economic deprivation level are not compromised by the DAS. While early versions of DAS induce errors in mortality rate estimation that are larger for Black than non-Hispanic white populations in Massachusetts, this issue is ameliorated in newer DAS versions

The inverse hazard law: Blood pressure, sexual harassment, racial discrimination, workplace abuse and occupational exposures in US low-income black, white and Latino workers

http://dx.doi.org/10.1016/j.socscimed.2008.09.03