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   Table of Contents - Current issue
April-June 2023
Volume 6 | Issue 2
Page Nos. 47-91

Online since Tuesday, May 30, 2023

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What explains the rural − Urban inequalities in maternal health services utilization in tanzania? A fairlie decomposition analysis Highly accessed article p. 47
Magashi Joseph Ntegwa, Evaline Gabriel Mcharo, Joseph Faustine Mlay
Introduction: Maternal mortality remains a public health issue in developing countries, with rural areas having higher rates as compared to the urban areas. Since effective utilization of maternal health-care services has the potential to reduce maternal mortality, this study measures the factors contributing to the existing rural − urban differences in the utilization of maternal healthcare services in Tanzania. Methods: We used Tanzania Demographic and Health Survey 2015/2016 data. Multi-stage stratified sampling was used to select the study participants and we estimated a Fairlie decomposition to understand the factors that contribute to inequality in maternal health-care services utilization between the rural and urban areas in Tanzania using Stata 17. Results: The study findings revealed a considerably wide rural-urban disparity in the utilization of maternal health-care services. As the findings indicated, household wealth status is the major factor for that disparity. Other factors are women's exposure to the media, women's working status, and distance from the homesteads to the health facilities. Conclusion: Therefore, any policy geared toward bridging the gap between the rural and urban areas in the utilization of maternal health-care services should focus on empowering women in terms of household economic status, media exposure, and employment.
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Socioeconomic disparities in adolescents' caries prevalence: Do oral health-related behaviors play intermediary roles? p. 56
Seongha Cho
Introduction: Policymakers and academics have explored the behavioral approach in their attempts to explain and address the socioeconomic disparities in adolescents' oral health. However, evidence regarding this issue is scarce in the Korean adolescent population. This study aimed to examine whether socioeconomic status is associated with dental caries and whether oral health-related behaviors (OHRBs) explain or moderate the hypothesized association in Korean adolescents. Methods: A secondary analysis was conducted using the Korea National Health and Nutrition Examination Survey data from 2016 to 2019. Adolescents (n = 1062) aged 13–18 years were included in the analysis. The association between income and untreated decayed permanent teeth (DT) was investigated, focusing on the intermediary roles of OHRBs, using hierarchical negative binomial regression models. Results: Higher income (incidence rate ratio [IRR] 0.70, P < 0.001), regular breakfast intake (IRR 0.64, P < 0.001), higher fruit and vegetable consumption (IRR 0.93, P < 0.001), preventive dental check-ups (IRR 0.84, P < 0.001), and frequent toothbrushing (IRR 0.73, P < 0.001) were associated with lower DT. The income-DT association remained significant and its magnitude was only slightly attenuated, after adjusting for OHRBs (IRR 0.74, P < 0.001). Significant interaction effects were found between income and each OHRB on DT (all with P < 0.001), and interaction patterns differed by behavior type: The income-DT association was stronger in the presence of unfavorable dietary-and favorable dental care-behaviors. Conclusion: The study findings suggested that adolescent oral health equity interventions should prioritize the structural approach and give more thorough consideration to the interactions between socioeconomic and behavioral factors.
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Associations between Affiliate Stigma and Quality of Life among Caregivers of Individuals with Dementia: Mediated Roles of Caregiving Burden and Psychological Distress p. 64
Yi-Ling Hu, Chih-Cheng Chang, Chiu-Hsiang Lee, Chieh-Hsiu Liu, Yi-Jung Chen, Jian-An Su, Chung-Ying Lin, Mark D Griffiths
Introduction: The associations between affiliate stigma, caregiving burden, psychological distress, and quality of life (QoL) among family caregivers of people living with dementia (PwD) have been demonstrated in the literature. However, there is a dearth of literature regarding how these factors could form a psychological mechanism. The present study proposed a theoretical model to portray the relationships between these factors. Methods: Utilizing convenience sampling and cross-sectional study design, 275 family caregivers (145 females [52.7%]; mean age = 52.71 years) were recruited from a general hospital from October 2013 to September 2014. Each participant completed the following instruments in a quiet room in the general hospital without disturbance: Caregiver Burden Inventory, World Health Organization QoL Questionnaire-Brief, Affiliate Stigma Scale, and Beck Anxiety Inventory alongside the Taiwan Depression Questionnaire (assessing psychological distress). Structural equation modeling was used to examine the proposed theoretical model. Results: Affiliate stigma (standardized coefficient [β] = −0.338; P = 0.011) and psychological distress (β = −0.538; P < 0.001) were negatively associated with QoL, caregiving burden was positively associated with psychological distress (β = 0.818; P < 0.001), and affiliate stigma was positively associated with caregiving burden (β = 0.793; P < 0.001). Moreover, a significant mediated effect was observed between affiliate stigma and QoL via sequential mediators of caregiving burden and psychological distress (unstandardized coefficient = −1.17 and 95% confidence interval = −1.88, −0.46). Conclusion: Affiliate stigma, caregiving burden, and psychological distress are key factors contributing to low QoL among family caregivers of PwD. Health-care providers should design programs to help reduce affiliate stigma, caregiving burden, and psychological distress for family caregivers of PwD to facilitate their QoL.
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Challenges related to health care for Iranian women with breast cancer during the COVID-19 pandemic: A qualitative study p. 72
Vajihe Atashi, Sepideh Mohammadi, Zahra Salehi, Zahra Shafiei, Mitra Savabi-Esfahani, Kobra Salehi
Introduction: COVID-19 has widely affected the health and care of people with chronic diseases, especially those with breast cancer. Because the health status of women with breast cancer in Iran has been unknown during the COVID-19 outbreak, we aimed to explore the challenges related to care of Iranian women with breast cancer during this pandemic. Methods: Using the qualitative content analysis design, 31 semi-structured face-to-face interviews were conducted from September 2020 to January 2021, with purposefully selected participants including 17 women with breast cancer, 7 health-care providers, and 7 family caregivers. Data were analyzed using the conventional content analysis. Results: Challenges related to health care for Iranian women with breast cancer can be classified into ten subcategories and three main categories. “Lack of specific functional and information resources,” “Limited equipment and active medical centers,” and “Intensification of the chemotherapy drug crisis” comprised the main category of “Inefficiency of care and treatment services.” “Lack of access to family caregiver,” “Ignoring the psychological burden imposed on patients,” and “Inadequate financial support from insurance organizations” were categorized as “Inadequate patient support.” “Avoiding receiving timely and appropriate treatment and care,” “Failure to accept self-responsibility for health,” “Misconceptions about COVID-19,” and “Ignoring breast cancer in the COVID-19 pandemic” comprised the subcategories of “ineffective self-care.” Conclusion: The present study provided a new understanding of the challenges regarding the health status of women with breast cancer during the COVID-19 pandemic. The findings could be used to develop effective interventions.
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Social networking sites usage and quality of life among senior citizens p. 79
Poh Chua Siah, Chia Sin Ooi, Wirawahida Binti Kamarul Zaman, Sew Kim Low
Introduction: Using social networking sites (SNS) is an effective way to improve senior citizens' quality of life (QOL). However, SNS usage among senior citizens is relatively low compared to the younger generation. Accordingly, this study aims to identify the factors associated with SNS usage among senior citizens and its relationship with QOL. A conceptual framework combining the technology acceptance model and the subjective norm was proposed. Methods: Purposive sampling and cross-sectional survey methods were used to recruit 214 senior citizens. Results: The results supported the predictions: perceived ease of use, perceived usefulness, and subjective norms are positively associated with intention to use SNS, and intention to use SNS mediates the effects of these predictors on SNS usage. Besides, SNS usage is positively associated with QOL. Conclusion: Based on the findings, promoting SNS usage among senior citizens should include an SNS that is easier for them and a program to encourage their significant others to use SNS with senior citizens.
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Social determinants of health and diabetes: Results from a cohort study in Iran p. 86
Seyed Jalal Hashemi, Mehrnoosh Jasemzadeh, Nader Saki, Bahman Cheraghian, Sara Sarvandian, Ali Montazeri, Maedeh Raeisizadeh, Marzieh Araban
Introduction: The relationship between social factors and diabetes has mainly been studied in developed countries. Few studies investigated the relationship between social factors and diabetes in developing countries. This study aimed to identify the social factors affecting diabetes in the population covered by the Hoveyzeh Cohort Study (HCS) in Iran. Methods: This was a cross-sectional analysis conducted on the participants of the HCS (recruited from May 2016 to August 2018), in Iran. The desired information included age, sex, marital status, education, body mass index (BMI), physical activity, Townsend deprivation index, and wealth index and their relation to diabetes. A logistic regression model was used to explore the data. Results: In all, the data from 10,009 adults aged from 35 to 70 years were analyzed. Of these, 2226 were diabetic and 7783 were nondiabetic. The results of multiple logistics indicated significant associations between age, physical activity, BMI, and diabetes status. In addition, the analysis showed that people who reside in most affluent areas (odds ratio [OR] = 1.39, 95% confidence interval [CI]: 1.21–1.60) and individuals who reside in affluent areas (OR = 1.25, 95% CI: 1.08–1.46] were more likely to experience a higher risk of diabetes compared to those who live in most deprived areas. Conclusion: The findings showed that people with older age, lower physical activity, higher BMI, and affluent background were more likely to develop diabetes. Future studies are needed to confirm such an observation. Perhaps social class might play different roles in low-, middle-, and high-income countries. Health promotion interventions to reduce diabetes should incorporate socioeconomic situations in their plans in a deprived area like Hoveyzeh, Iran.
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