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The air they breathe: a pediatrician on the frontlines of climate change
\"In the Air They Breathe, Dr. Hendrickson recounts patients she's seen who were harmed by worsening smoke, smog, and pollen. The climate crisis is a health crisis, and it is a health crisis first and foremost for children.\" -- adapted from book jacket.
Book
Social Determinants of Health in India: Reimagining of Dr. B.R. Ambedkar’s Vision in the Light of Marginalized Communities
The ongoing existence of health disparities in marginalized communities in India can be attributed to social health determinants such as poverty, caste, gender, and limited access to education and healthcare. Dr. B.R. Ambedkar, an iconic figure in Indian social reform and the driving force behind the Indian Constitution, acknowledged the significance of the social determinants of health influencing health outcomes. This paper explores Dr. Ambedkar’s vision of addressing health disparities, with a focus on his contributions to public health policy and the promotion of social justice. Additionally, it analyses the ongoing perpetuation of inequality through the examination of social determinants of health and explores how Ambedkar’s vision can provide guidance for present public health strategies. The analysis highlights the importance of strong primary healthcare systems, recognizing universal healthcare as an essential human right through the vision of Dr. Ambedkar. It also advocates for greater government funding and policy coordination to effectively tackle health disparities.
Journal Article
Women Health Literacy and Associated Factors on Women and Child Health Care in Ilu Ababor Public Health Facilities, Ethiopia
Maternal health literacy (MHL) is the ability of mothers to obtain, interpret, appraise, and apply women and child health information that contributes to a reduction in mortality among mothers and children. This is an important concern since a woman's health during pregnancy may be her first interaction with the healthcare system, and a woman's comprehension of health information has a direct impact on her unborn child's growth throughout the process of conception.
Assess the degree of maternal health literacy and related factors in women's and children's health care among mothers whose children have received basic immunizations at the public healthcare facilities in Ilu Abba Boor.
A cross-sectional study was carried out in the facility between December 2021 and January 2022. Investigators trained supervisors and data collectors for five days before data collection. Through basic random sampling, 411 mothers whose children had received the minimum set of vaccinations from health facilities in the Ilu Ababor zone of Oromia, Ethiopia, were chosen. Face-to-face interviews were used to gather the data, which were then imported into Epidata 4.1 and exported to SPSS. The factors associated with maternal health literacy in maternal and child healthcare were identified through the application of descriptive statistics, bivariate analysis, and multivariable logistic regression analyses. The findings are displayed in the form of graphs, tables, and figures.
This study had a 100% response rate when 411 participants were invited to participate. The mean maternal health literacy score was 28.5±10.3. Most of the women (293 [71.3%]) had inadequate health literacy levels while 118 (28.7%) had adequate. The multivariate analysis's findings indicated that the rate of adequate maternal health literacy was 12.2 times higher among urban women than among rural ones (AOR=12.2 [5.34, 24.48]). Women who gave birth vaginally were 0.24 times less likely to have adequate maternal health literacy than women who had a caesarean section (AOR=0.24 [0.112, 0.503]). Mothers who had four or more prenatal care follow-ups were found to have sufficient maternal health literacy higher than those who had just one (AOR=0.23[0.095, 0.556]), two (AOR=0.26[0.138, 0.307]), and three times (0.14{0.108, 0.167]) antenatal care contacts.
This study shows that inadequate maternal health literacy affects the healthcare of mothers and children. Given the significance of health literacy for women's health, national health authorities ought to develop more educational initiatives aimed at raising health literacy rates and empowering women who are of reproductive age.
Journal Article
Disclosure Patterns of Opioid Use Disorders in Perinatal Care During the Opioid Epidemic on X From 2019 to 2021: Thematic Analysis
In 2021, the United States experienced a 14% rise in fatal drug overdoses totaling 106,699 deaths, driven by harmful opioid use, particularly among individuals in the perinatal period who face increased risks associated with opioid use disorders (OUDs). Increased concerns about the impacts of escalating harmful opioid use among pregnant and postpartum persons are rising. Most of the current limited perinatal OUD studies were conducted using traditional methods, such as interviews and randomized controlled trials to understand OUD treatment, risk factors, and associated adverse effects. However, little is known about how social media data, such as X, formerly known as Twitter, can be leveraged to explore and identify broad perinatal OUD trends, disclosure and communication patterns, and public health surveillance about OUD in the perinatal period.
The objective is 3-fold: first, we aim to identify key themes and trends in perinatal OUD discussions on platform X. Second, we explore user engagement patterns, including replying and retweeting behaviors. Third, we investigate computational methods that could potentially streamline and scale the labor-intensive manual annotation effort.
We extracted 6 million raw perinatal-themed tweets posted by global X users during the opioid epidemic from May 2019 to October 2021. After data cleaning and sampling, we used 500 tweets related to OUD in the perinatal period by US X users for a thematic analysis using NVivo (Lumivero) software.
Seven major themes emerged from our thematic analysis: (1) political views related to harmful opioid and other substance use, (2) perceptions of others' substance use, (3) lived experiences of opioid and other substance use, (4) news reports or papers related to opioid and other substance use, (5) health care initiatives, (6) adverse effects on children's health due to parental substance use, and (7) topics related to nonopioid substance use. Among these 7 themes, our user engagement analysis revealed that themes 4 and 5 received the highest average retweet counts, and theme 3 received the highest average tweet reply count. We further found that different computational methods excel in analyzing different themes.
Social media platforms such as X can serve as a valuable tool for analyzing real-time discourse and exploring public perceptions, opinions, and behaviors related to maternal substance use, particularly, harmful opioid use in the perinatal period. More health promotion strategies can be carried out on social media platforms to provide educational support for the OUD perinatal population.
Journal Article
Family health sheets: a vital instrument for village health workers providing comprehensive healthcare
Introduction
Community Health Worker (CHW) programs have long been used to provide acute care for children and women in healthcare shortage areas, but their provision of comprehensive longitudinal care for chronic problems is rare. The Village Health Worker (VHW) program, initiated in 2007, is an example of a long standing “horizontal” CHW program in rural Southwestern Uganda that has delivered village-level care for chronic disease based on a biannual village health census that identifies individual and family health risks. To facilitate continuity of care for problems identified, health census data were electronically transformed into family-specific Family Health Sheets (FHS) in 2016 which summarize the pertinent demographic and health data for each family, as well as health topics the family would like to learn more about. The FHS, evaluated and discussed here, serves as an epidemiologically-informed “bedside” tool to help VHWs provide longitudinal care in their villages.
Methods
48 VHWs in the program completed a survey on the utility of the FHS and 24 VHWs participated in small discussion groups. Responses were analyzed using both quantitative and standard conceptual content analysis models
Results
46 out of 48 VHWs reported that the FHS made them a “much better VHW.” In addition to helping target interventions in child health, women’s health, and sanitation, the FHS assisted follow-up of non-communicable diseases in the community. In discussion groups, VHWs reported that the FHS helped them understand risks for future disease, facilitated earning stipends, and increased credibility and trust in the community. Limitations cited were the infrequent updates of the FHS, only biannually with the census, and the lack of cross-reference capability by health
problem
.
Discussion
The FHS supports VHWs in providing longitudinal and comprehensive healthcare of chronic diseases in their villages. Limitations, potential solutions, and future directions are discussed.
Journal Article
Help-seeking for mental health issues in deployed Canadian Armed Forces personnel at risk for moral injury
Objective: Potentially morally injurious experiences (PMIE) (events that transgress an individual's subjective moral standards) have been associated with psychologically distressing moral emotions such as shame and guilt. Military leaders and clinicians have feared that those with PMIEs may be less likely to seek help due to the withdrawing nature of shame/guilt; however, to date, help-seeking patterns of military personnel with PMIEs has not been explored. Our objective is to address this research gap.
Method: Data from a nationally-representative mental health survey of active Canadian military personnel were analysed. To assess the association between exposure to three PMIEs and past-year help-seeking across different provider categories (i.e. professionals, para-professionals (those delegated with mental health advisory tasks but are not licenced to practice as medical professionals), non-professionals), a series of logistic regressions were conducted, controlling for exposure to other deployment and non-deployment-related psychological trauma, psychiatric variables, military factors, and sociodemographic variables. Analytical data frame included only personnel with a history of Afghanistan deployment (N = 4854).
Results: Deployed members exposed to PMIEs were more likely to seek help from their family doctor/general practitioner (OR = 1.72; 95%CI = 1.25-2.36), paraprofessionals (OR = 1.72; 95%CI = 1.25-2.36), and non-professionals (OR = 1.44; 95%CI = 1.06-1.95) in comparison to members not exposed to PMIEs. Those exposed to PMIEs were also more likely to seek professional care from the civilian health care system (OR = 1.94; 95%CI = 1.27-2.96).
Conclusion: Contrary to long-held, but untested, assumptions regarding the impact of PMIEs on help-seeking, we found those with PMIEs are more likely to seek help from gatekeeper professionals (i.e. general practitioners), para-professionals, and non-professionals rather than specialized mental health professionals (e.g. psychologists). Increased utilization of civilian professionals raises concerns that active military members may be avoiding military health services. Clinically, this highlights the need to increase awareness of moral injury to ensure that actively serving military members are provided with appropriate advice and treatment.
Journal Article
Parental child care in single-parent, cohabiting, and married-couple families
The time that parents spend caring for their children is a topic of intense interest among researchers, policy makers, and parents themselves. Parental inputs in time are enormously valuable investments in children's well-being and development. However, the declining prevalence of two-parent, married-couple families and the steady influx of mothers into the labor market are generally believed to have placed these investments at risk. The authors use time-diary data from the United Kingdom 2000 Time Use Study (UKTUS) to investigate how parents' time spent in child care differs with their martial status and other characteristics. Unlike previous economic studies, this study examines different families. The household production model indicates that single-parent households may differ from married or cohabitation households either because there are fewer time resources or because there are fewer opportunities for economies of scale or specialization in household activities.
Journal Article
Vanishing Children: From High Unemployment to Low Fertility in Developed Countries
During the last four decades the average total fertility rate in OECD countries witnessed a dramatic fall: from 2.9 in 1960 to 2.0 in 1975 and then to 1.6 in the last 1990s (reaching 1.25 in Southern Europe). With the exception of the United States, all advanced countries now have fertility rates well below the replacement rate of 2.1. In the absence of either sharp changes in fertility behavior or large inflows of immigrants, their populations are set to shrink, particularly in Europe. Still, within this generalized fall, cross-national differences in fertility behavior have remained significant. By 2000, fertility rates ranged from 2.1 in the United States to over 1.8 in France and Norway to less than 1.3 in Greece, Italy and Spain. Most standard accounts attribute this fall in fertility rates to a shift in personal preferences over the size of the family due to either changes in religious beliefs or growing female participation in the labor market. Yet, even though the ideal number of children for men and women 20-34 years old has declined, it is fairly similar across the European Union at around the replacement level of 2.1.
Journal Article