Vulnerable Populations

Maternal Obesity, Caesarean Delivery and Caesarean Delivery on Maternal Request: a Cohort Analysis from China

Maternal Obesity, Caesarean Delivery and Caesarean Delivery on Maternal Request: a Cohort Analysis from China
Paediatric and Perinatal Epidemiology. 2015, 29, 232–240.

Y Zhou, J Blustein, H Li, R Ye, L Zhu, J Liu
07/22/2015

BackgroundTo quantify the association between maternal obesity and cesarean delivery, particularly cesarean delivery on maternal request [CDMR], a fast-growing component of cesarean delivery in many nations around the world.

MethodsWe follow 1 187 053 women registered in the Perinatal Healthcare Surveillance System during 1993-2010. Maternal body mass index (BMI, Kg/m2), before pregnancy or during early pregnancy, was classified as underweight (BMI <18.5), normal (BMI 18.5~<23; reference), overweight (BMI 23~<27.5), or obese (³27.5), consistent with WHO guidelines for Asian people. The association between maternal obesity and overall cesarean delivery and its subtypes was modeled using log binomial regression.

ResultsDuring the 18-year period, 450 436 (37.9%) cesarean deliveries and 103 723 (8.7%) CDMRs were identified. Maternal obesity was positively associated with overall cesarean and CDMR. Adjusted risk ratios for overall cesarean in the four ascending maternal BMI categories were 0.95, 1.00, 1.17, 1.40 [corresponding 95% confidence intervals (CIs): 0.94, 0.96; 1.00; 1.15, 1.18; 1.35, 1.44; P <0.001 for trend], and adjusted risk ratios for CDMR were 0.94, 1.00, 1.20, 1.47 [corresponding 95% CIs: 0.93, 0.96; 1.00; 1.19, 1.22; 1.43, 1.51; P<0.001 for trend]. Positive associations were consistently found in subgroups stratified by maternal age, education, rural or urban residence, level of delivering hospital, year of delivery, birthweight, and parity.

Conclusions—In a large prospective Chinese cohort, maternal obesity was associated with an increased risk of cesarean delivery and its subtypes, including CDMR. Given the rising global prevalence of obesity, and in view of the growth of CDMR, it seems likely that cesarean births will increase, absent changes in obstetrical practice

Time to Consider the Risks of Caesarean Delivery for Long Term Child Health

Time to Consider the Risks of Caesarean Delivery for Long Term Child Health
BMJ [British Medical Journal] 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h2410

Jan Blustein and Jianmeng Liu
06/10/2015

Jan Blustein and Jianmeng Liu examine the evidence linking caesarean delivery with childhood chronic disease and say that guidelines on delivery should be reviewed with these risks in mind.

Assessment of a government-subsidized supermarket in a high-need area on household food availability and children's dietary intakes

Assessment of a government-subsidized supermarket in a high-need area on household food availability and children's dietary intakes

Brian Elbel, Alyssa Moran, L Beth Dixon. Kamila Kiszko, Jonathan Cantor, Courtney Abrams and Tod Mijanovich
01/07/2015

Objective: To assess the impact of a new government-subsidized supermarket in a
high-need area on household food availability and dietary habits in children.
Design: A difference-in-difference study design was utilized.
Setting: Two neighbourhoods in the Bronx, New York City. Outcomes were
collected in Morrisania, the target community where the new supermarket was
opened, and Highbridge, the comparison community.
Subjects: Parents/caregivers of a child aged 3–10 years residing in Morrisania
or Highbridge. Participants were recruited via street intercept at baseline (presupermarket
opening) and at two follow-up periods (five weeks and one year
post-supermarket opening).
Results: Analysis is based on 2172 street-intercept surveys and 363 dietary recalls
from a sample of predominantly low-income minorities. While there were small,
inconsistent changes over the time periods, there were no appreciable differences
in availability of healthful or unhealthful foods at home, or in children’s dietary
intake as a result of the supermarket.
Conclusions: The introduction of a government-subsidized supermarket into an
underserved neighbourhood in the Bronx did not result in significant changes in
household food availability or children’s dietary intake. Given the lack of healthful
food options in underserved neighbourhoods and need for programmes that
promote access, further research is needed to determine whether healthy food
retail expansion, alone or with other strategies, can improve food choices of
children and their families.

Syndemic Vulnerability, Sexual and Injection Risk Behaviors, and HIV Continuum of Care Outcomes in HIV-Positive Injection Drug Users

Syndemic Vulnerability, Sexual and Injection Risk Behaviors, and HIV Continuum of Care Outcomes in HIV-Positive Injection Drug Users
AIDS & Behavior, Sep 2014. DOI: 10.1007/s10461-014-0890-0

Mizuno, Y., D.W. Purcell, A.R. Knowlton, J.D. Wilkinson, M.N. Gourevitch, and K.R. Knight
09/24/2014

Limited investigations have been conducted on syndemics and HIV continuum of care outcomes. Using baseline data from a multi-site, randomized controlled study of HIV-positive injection drug users (n = 1,052), we examined whether psychosocial factors co-occurred, and whether these factors were additively associated with behavioral and HIV continuum of care outcomes. Experiencing one type of psychosocial problem was significantly (p < 0.05) associated with an increased odds of experiencing another type of problem. Persons with 3 or more psychosocial problems were significantly more likely to report sexual and injection risk behaviors and were less likely to be adherent to HIV medications. Persons with 4 or more problems were less likely to be virally suppressed. Reporting any problems was associated with not currently taking HIV medications. Our findings highlight the association of syndemics not only with risk behaviors, but also with outcomes related to the continuum of care for HIV-positive persons.

Credit is Not a Right [REVISED]

Credit is Not a Right [REVISED]
Forthcoming in volume edited by Tom Sorell and Luis Cabrera: Microfinance, Rights, and Global Justice. Cambridge University Press.

Gershman, John and Jonathan Morduch
09/15/2014

Muhammad Yunus, the microcredit pioneer, has proposed that access to credit should be a human right. We approach the question by drawing on fieldwork and empirical scholarship in political science and economics. Evidence shows that access to credit may be powerful for some people some of the time, but it is not powerful for everyone all of the time, and in some cases it can do damage. Yunus’s claim for the power of credit access has yet to be widely verified, and most rigorous studies find microcredit impacts that fall far short of the kinds of empirical assertions on which his proposal rests. We discuss ways that expanding the domain of rights can diminish the power of existing rights, and we argue for a right to non-discrimination in credit access, rather than a right to credit access itself.

 

Application of global positioning system methods for the study of obesity and hypertension risk among low-income housing residents in New York City: a spatial feasibility study

Application of global positioning system methods for the study of obesity and hypertension risk among low-income housing residents in New York City: a spatial feasibility study
Geospatial Health, Vol. 9, no. 1, pp. 57-70. DOI: http://dx.doi.org/10.4081/gh.2014.6

Duncan, D.T., S.D. Regan, D. Shelley, K. Day, R.R. Ruff, M. Al-Bayan, and B. Elbel
09/01/2014

The purpose of this study was to evaluate the feasibility of using global positioning system (GPS) methods to understand the spatial context of obesity and hypertension risk among a sample of low-income housing residents in New York City (n = 120). GPS feasibility among participants was measured with a pre- and post-survey as well as adherence to a protocol which included returning the GPS device as well as objective data analysed from the GPS devices. We also conducted qualitative interviews with 21 of the participants. Most of the sample was overweight (26.7%) or obese (40.0%). Almost one-third (30.8%) was pre-hypertensive and 39.2% was hypertensive. Participants reported high ratings of GPS acceptability, ease of use and low levels of wear-related concerns in addition to few concerns related to safety, loss or appearance, which were maintained after the baseline GPS feasibility data collection. Results show that GPS feasibility increased over time. The overall GPS return rate was 95.6%. Out of the total of 114 participants with GPS, 112 (98.2%) delivered at least one hour of GPS data for one day and 84 (73.7%) delivered at least one hour on 7 or more days. The qualitative interviews indicated that overall, participants enjoyed wearing the GPS devices, that they were easy to use and charge and that they generally forgot about the GPS device when wearing it daily. Findings demonstrate that GPS devices may be used in spatial epidemiology research in low-income and potentially other key vulnerable populations to understand geospatial determinants of obesity, hypertension and other diseases that these populations disproportionately experience.

Promoting Transportation Flexibility in Extreme Events through Multi-Modal Connectivity

Promoting Transportation Flexibility in Extreme Events through Multi-Modal Connectivity
U.S. Department of Transportation Region II Urban Transportation Research Center, New York, NY: NYU-Wagner, June 2014.

R. Zimmerman, C.E. Restrepo, J. Sellers, A. Amirapu, and Theodore R. Pearson
06/01/2014

Extreme events of all kinds are increasing in number, severity, or impacts. Transportation provides a vital support service for people in such circumstances in the short-term for evacuation and providing supplies where evacuation is not undertaken, yet, transportation services are often disabled in disasters. Nationwide and in New York and New Jersey record-setting weather disasters have occurred and are expected to continue. Disadvantaged populations are particularly vulnerable. Network theories provide insights into vulnerability and directions for adaptation by defining interconnections, such as multi-modality. Multi-modal connectivity provides passenger flexibility and reduces risks in extreme events, and these benefits are evaluated in the NY area. Focusing on public transit, selected passenger multimodal facilities are identified that connect to transit, emphasizing rail-bus connectivity. Publicly available databases are used from MTA, NJ rail, and U.S. DOT’s IPCD. For NYC, statistical analyses suggest there may be some differences by poverty levels. For NYC and three northeastern NJ cities connectivity differs for stations that are terminuses and have high rail convergence. This report provides statistical summaries, cases, and a literature review to characterize multi-modal facilities and their use in extreme events. Recommendations and future research directions are provided for the role of passenger multi-modality to enhance transit flexibility.

The research was funded by a faculty research grant from the U.S. Department of Transportation, Region 2 University Transportation Research Center to NYU-Wagner, 2012-2014.

Functional Performance and Social Relations Among the Elderly in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil: a Population-Based Epidemiological Study

Functional Performance and Social Relations Among the Elderly in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil: a Population-Based Epidemiological Study
Cadernos de Saude Publica, Vol. 30, no. 5 (May 2014), pp. 1018-1028. doi: 10.1590/0102-311X00102013

Torres, J.L., R.C. Dias, F.R. Ferreira, J. Macinko, and M.F. Lima-Costa
05/01/2014

This study was conducted in a probabilistic sample of 2,055 elderly in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil, to examine components of social network (conjugal status and visits by the children, other relatives, and friends) and social support (satisfaction with personal relations and having persons on whom to rely) associated with limitations in performing basic activities of daily living (ADL). Multivariate analysis used the Hurdle model. Performance of ADL showed independent and statistically significant associations with social network (fewer meetings with friends and not having children) and personal support (dissatisfaction/indifference towards personal relations). These associations remained after adjusting for social and demographic characteristics, health status, and other indicators of social relations. Our results emphasize the need for greater attention to social network and social support for elderly with functional limitations and those with weak social networks and social support.

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