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Some employers are not obligated to pay at least minimum wages to all employees. U.S. farm employers comprise one of these groups. Employees of large farms and H-2A workers (lawfully admitted, nonimmigrant workers performing temporary or seasonal agricultural work) are protected by minimum wage legislation, while some migrant workers (often those paid piece rates) are exempt. U.S. agriculture also is characterized by a large percentage of unauthorized workers who may or may not earn above minimum wage. Following insights from dual labor market theory and from theories of the signaling capacity of the minimum wage, we compare labor market outcomes in the agricultural sector (where minimum wage coverage is limited) to low wage/skill non-agricultural sectors (where minimum wage coverage is more complete) nationally using data from the Current Population Survey. We then extend our analysis to a detailed state-level case study of agricultural workers in California using a representative survey of employed farm workers. Results suggest wage increases for covered workers that exceed those for uncovered workers, but insignificant differences in hours worked. This is the first study to our knowledge to examine the impacts of minimum wage coverage on agricultural workers relative to other workers for the U.S. [ABSTRACT FROM AUTHOR]

Prior research has found that places and people that are more economically disadvantaged have higher rates and risks, respectively, of sexually transmitted infections (STIs). Economic disadvantages at the level of places and people, however, are themselves influenced by economic policies. To enhance the policy relevance of STI research, we explore, for the first time, the relationship between state-level minimum wage policies and STI rates among women in a cohort of 66 large metropolitan statistical areas (MSAs) in the US spanning 2003–2015. Our annual state-level minimum wage measure was adjusted for inflation and cost of living. STI outcomes (rates of primary and secondary syphilis, gonorrhea and chlamydia per 100,000 women) were obtained from the CDC. We used multivariable hierarchical linear models to test the hypothesis that higher minimum wages would be associated with lower STI rates. We preliminarily explored possible socioeconomic mediators of the minimum wage/STI relationship (e.g., MSA-level rates of poverty, employment, and incarceration). We found that a $1 increase in the price-adjusted minimum wage over time was associated with a 19.7% decrease in syphilis rates among women and with an 8.5% drop in gonorrhea rates among women. The association between minimum wage and chlamydia rates did not meet our cutpoint for substantive significance. Preliminary mediation analyses suggest that MSA-level employment among women may mediate the relationship between minimum wage and gonorrhea. Consistent with an emerging body of research on minimum wage and health, our findings suggest that increasing the minimum wage may have a protective effect on STI rates among women. If other studies support this finding, public health strategies to reduce STIs among women should include advocating for a higher minimum wage. [ABSTRACT FROM AUTHOR]

Objectives: To describe the relationship between minimum wage and overweight and obesity across countries at different levels of development. Methods: A cross-sectional analysis of 27 countries with data on the legislated minimum wage level linked to socio-demographic and anthropometry data of non-pregnant 190,892 adult women (24–49 y) from the Demographic and Health Survey. We used multilevel logistic regression models to condition on country- and individual-level potential confounders, and post-estimation of average marginal effects to calculate the adjusted prevalence difference. Results: We found the association between minimum wage and overweight/obesity was independent of individual-level SES and confounders, and showed a reversed pattern by country development stage. The adjusted overweight/obesity prevalence difference in low-income countries was an average increase of about 0.1 percentage points (PD 0.075 [0.065, 0.084]), and an average decrease of 0.01 percentage points in middle-income countries (PD -0.014 [-0.019, -0.009]). The adjusted obesity prevalence difference in low-income countries was an average increase of 0.03 percentage points (PD 0.032 [0.021, 0.042]) and an average decrease of 0.03 percentage points in middle-income countries (PD -0.032 [-0.036, -0.027]). Conclusion: This is among the first studies to examine the potential impact of improved wages on an important precursor of non-communicable diseases globally. Among countries with a modest level of economic development, higher minimum wage was associated with lower levels of obesity. [ABSTRACT FROM AUTHOR]

Background: Even though human hookworm infection is highly endemic in many countries throughout the world, its global economic and health impact is not well known. Without a better understanding of hookworm’s economic burden worldwide, it is difficult for decision makers such as funders, policy makers, disease control officials, and intervention manufacturers to determine how much time, energy, and resources to invest in hookworm control. Methodology/Principle Findings: We developed a computational simulation model to estimate the economic and health burden of hookworm infection in every country, WHO region, and globally, in 2016 from the societal perspective. Globally, hookworm infection resulted in a total 2,126,280 DALYs using 2004 disability weight estimates and 4,087,803 DALYs using 2010 disability weight estimates (excluding cognitive impairment outcomes). Including cognitive impairment did not significantly increase DALYs worldwide. Total productivity losses varied with the probability of anemia and calculation method used, ranging from $7.5 billion to $138.9 billion annually using gross national income per capita as a proxy for annual wages and ranging from $2.5 billion to $43.9 billion using minimum wage as a proxy for annual wages. Conclusion: Even though hookworm is classified as a neglected tropical disease, its economic and health burden exceeded published estimates for a number of diseases that have received comparatively more attention than hookworm such as rotavirus. Additionally, certain large countries that are transitioning to higher income countries such as Brazil and China, still face considerable hookworm burden. [ABSTRACT FROM AUTHOR]

Human toxoplasmosis, a protozoonosis caused by Toxoplasma gondii, has been described as a worldwide foodborne disease with important public health impact. Despite infection has reportedly varied due to differences in alimentary, cultural and hygienic habits and geographic region, social vulnerability influence on toxoplasmosis distribution remains to be fully established. Accordingly, the present study has aimed to assess T. gondii seroprevalence and factors associated to social vulnerability for infection in households of Ivaiporã, southern Brazil, with 33.6% population making half minimum wage or less, ranked 1,055th in population (31,816 habitants), 1,406th in per capita income (U$ 211.80 per month) and 1,021st in HDI (0.764) out of 5,570 Brazilian cities. Serum samples and epidemiological questionnaires were obtained from citizen volunteers with official City Secretary of Health assistance in 2015 and 2016. In overall, serosurvey has revealed 526/715 (73.57%) positive samples for anti-T. gondii antibodies by Indirect Fluorescent Antibody Test. Logistic regression has shown a significant increase associated to adults (p = 0.021) and elderly (p = 0.014) people, illiterates (p = 0.025), unemployment (p <0.001) and lack of household water tank (p = 0.039). On the other hand, sex (male or female), living area (urban or rural), yard hygiene, meat ingestion, sand or land contact, owning pets (dog, cat or both) were not significant variables of positivity for anti-T. gondii antibodies in the surveyed population. Although no significant spatial cluster was found, high intensity areas of seropositive individuals were located in the Kernel map where the suburban neighborhoods are located. In conclusion, socioeconomic vulnerability determinants may be associated to Toxoplasma gondii exposure. The increased risk due to illiteracy, adult or elderly age, unemployment and lack of household water tank were confirmed by multivariate analysis and the influence of low family income for seropositivity by the spatial analysis. [ABSTRACT FROM AUTHOR]

Purpose: To quantify costs to patients of accessing HIV care prior to ART initiation. Materials and methods: Using a cross-sectional study design, costs incurred by HIV-positive patients prior to ART initiation were estimated at urban primary healthcare facilities in South Africa. Costs included direct costs, indirect (productivity) costs, carer and coping costs (value of assets sold and money borrowed). The percentage of individual income spent on healthcare was calculated and compared by patient income tertiles and CD4 count strata. Results: 289 patients (69% female, mean age 37 (SD: 10) years, median CD4 317 (IQR: 138–494) cells/mm3) were interviewed. The total mean monthly cost of pre-ART care was US$15.71. Indirect costs accounted for $2.59 (16.49%) of this when time was valued using the patient’s reported income. The mean monthly patient costs were $31.61, $12.78, $12.65 and $11.93 for those with a CD4 count <100, 101–350, 351–500 and >500 cells/mm3 respectively. The percentage of individual income spent on healthcare was 7.25% for those with a CD4 count <100 cells/mm3 and 4.05% for those with a CD4 count >500 cells/mm3. Conclusions: Despite the provision of charge-free services at public clinics, care prior to ART initiation can be costly, particularly for the poor and unemployed. Our study adds to the growing body of evidence that highlights the need to consider policies to reduce the economic barriers to HIV service access, particularly for low income or unwell patient groups, such as improving access to disability grants. [ABSTRACT FROM AUTHOR]

Background: Chlamydia trachomatis is the most prevalent bacterial sexually transmitted infection (STI) in the world. Approximately 80% of infected women are asymptomatic, although this infection can lead to serious complications in the female reproductive tract. Few data on Chlamydia infection are available in rural Amazonian communities. Objectives: To evaluate the prevalence of sexual C. trachomatis infection in women from Marajó Archipelago communities in the Amazon region of Brazil and to identify associated factors and genotypes. Methods: We utilized amplification of the ompA gene by nested PCR. Positive samples were genotyped by sequencing. Study participants completed a questionnaire on social, epidemiological, and reproductive health variables. A Poisson regression was used to evaluate the degree of association of these variables with the infection. Results: The sexual infection by C. trachomatis was observed in 4% (16/393) of the subjects, and was more often found in women aged ≤25 (14.3%; 95% CI = 2.83–35.47; p <0.001), and in women with a household income of less than one Brazilian monthly minimum wage (5.2%; 95% CI = 1.33–11.37; p = 0.014). The ompA gene was sequenced in 13 samples, revealing F genotypes (38.4%, n = 5), D (23%, n = 3), E (15.3%, n = 2), Ia (7.6%, N = 1), J (7.6%, n = 1) and B (7.6%, n = 1). Conclusions: We recorded a high prevalence of sexual infection by C. trachomatis in young and poor women from the interior of the Brazilian Amazon. This high prevalence and the frequencies of the main genotypes were similar to those found in major Brazilian urban centers. Our results reinforce the importance of the screening of this neglected infection, and the prevention of later sequelae in young women from rural and urban areas of Brazil. [ABSTRACT FROM AUTHOR]

Background: Medications and their prices are key issues for healthcare. Although access to medicines at affordable prices had been specified as a key objective of the European Health Policy, it seems that these goals have not been achieved. Therefore, we attempted an evaluation of affordability of selected medicines at full prices. Methods: The analysis concerned 2012 and was conducted between 2013 and 2015 in all the European Union (EU) countries divided into 3 groups depending on the date of their accession to the EU. Finally, we considered 9 originators used in the treatment of schizophrenia and multiple sclerosis. Information on drug prices were collected from pharmacies. Participation in the study was voluntary and anonymous in order to avoid accusations of advertising. To evaluate affordability, several factors were used (e.g. minimum earnings and Gini coefficient). Due to unavailability in some countries, the exact number of analyzed medicines varies. Results: Drug prices vary significantly between EU Member States. Almost eleven fold difference was observed between Germany (EUR 1451.17) and Croatia (EUR 132.77) in relation to Interferone beta-1a 22 μg. Generally, prices were the highest in Germany. The cheapest drugs were found in various countries but never in the poorest ones like Bulgaria or Romania. Discrepancies in wages were observed too (the smallest minimum wage was EUR 138.00 in Bulgaria and the highest EUR 1801.00 in Luxembourg). Full price of olanzapine 5mg, however, was higher in Bulgaria (EUR 64.53) than, for instance, in Belgium (EUR 37.26). Conclusions: Analyzed medications are still unaffordable for many citizens of the EU. Besides, access to medicines is also impaired e.g. due to parallel trade. Unaffordability of medications may lead to the patients’ non-compliance and therefore to increased direct and indirect costs of treatment. Common European solutions are needed to achieve a real affordability and accessibility of medications. [ABSTRACT FROM AUTHOR]

Introduction: HIV disproportionately affects women in Sub-Saharan Africa. Swaziland bears the highest HIV prevalence of 41% among pregnant women in this region. This heightened HIV-epidemic reflects the importance of context-specific interventions. Apart from routine HIV surveillance, studies that examine structural and behavioral factors associated with HIV infection among women may facilitate the revitalization of existing programs and provide insights to inform context-specific HIV prevention interventions. Methods and Findings: This cross-sectional study employed a two-stage random cluster sampling in ten antenatal health care facilities in the Hhohho region of Swaziland in August and September 2015. Participants were eligible for the study if they were 18 years or older and had tested for HIV. Self-administered tablet-based questionnaires were used to assess HIV risk factors. Of all eligible pregnant women, 827 (92.4%) participated, out of which 297 (35.9%) were self-reportedly HIV positive. Among structural factors, family function was not significantly associated with self-reported HIV positive status, while lower than high school educational attainment (AOR, 1.65; CI, 1.14–3.38; P = 0.008), and income below minimum wage (AOR, 1.81; CI, 1.09–3.01; P = 0.021) were significantly associated with self-reported HIV positive status. Behavioral factors significantly associated with reporting a positive HIV status included; ≥2 lifetime sexual partners (AOR, 3.16; CI, 2.00–5.00; P<0.001), and ever cohabited (AOR, 2.39; CI, 1.66–3.43; P = 0.00). The most cited reason for having multiple sexual partners was financial gain. HIV/AIDS-related knowledge level was high but not associated to self-reported HIV status (P = 0.319). Conclusions: Structural and behavioral factors showed significant association with self-reported HIV infection among pregnant women in Swaziland while HIV/AIDS-related knowledge and family function did not. This suggests that HIV interventions should be reinforced taking into consideration these findings. The findings also suggest the importance of future research sensitive to the Swazi and African sociocultural contexts, especially research for family function. [ABSTRACT FROM AUTHOR]

The dental pulp is a sterile highly vascularized tissue and has been commonly used as a biological material to detect the genome of infectious agents that reach the dental tissue. Indeed, the pulp is also used to reveal past and ancient infections in the field of paleomicrobiology. The present study aimed to detect the presence of Hepatitis C virus (HCV) in a small community (approximately 400 inhabitants) in the Amazon region of Brazil (Nossa Senhora do Perpetuo Socorro, Vizeu, Para, Brazil) and standardize a technique for the detection of the virus in the dental pulp. Serum samples were collected from 48 patients whose teeth were clinically recommended for surgical extraction. The group comprised an equal number of males and females, mostly agriculture workers and housewives, respectively. The majority (64.6%) received less than one minimum wage and were ill educated (less than four years of school years). An enzyme immune assay was used to detect antibodies to HCV and the 9 (18.8%) positive samples were submitted to nucleic acid extraction in the blood (using the EXTRAzol) and the pulp (QIAamp DNA Micro Kit e kit RNeasy Plus Micro). The pulp was removed using a modified protocol without the use of liquid nitrogen. Nucleic acid was found in 8 of the dental pulp, but in 7 of the blood samples. Sequencing of one of the samples showed the presence of genotype 1. Conclusions: A novel simplified methodology for the extraction and amplification of HCV nucleic acid was successful to detect the presence of persistent infections of the virus within the dental pulp tissue. The protocol may be helpful to detect past and ancient infections and to better understand the natural history of HCV. [ABSTRACT FROM AUTHOR]

Systematically evaluating scientific literature is a time consuming endeavor that requires hours of coding and rating. Here, we describe a method to distribute these tasks across a large group through online crowdsourcing. Using Amazon's Mechanical Turk, crowdsourced workers (microworkers) completed four groups of tasks to evaluate the question, “Do nutrition-obesity studies with conclusions concordant with popular opinion receive more attention in the scientific community than do those that are discordant?” 1) Microworkers who passed a qualification test (19% passed) evaluated abstracts to determine if they were about human studies investigating nutrition and obesity. Agreement between the first two raters' conclusions was moderate (κ = 0.586), with consensus being reached in 96% of abstracts. 2) Microworkers iteratively synthesized free-text answers describing the studied foods into one coherent term. Approximately 84% of foods were agreed upon, with only 4 and 8% of ratings failing manual review in different steps. 3) Microworkers were asked to rate the perceived obesogenicity of the synthesized food terms. Over 99% of responses were complete and usable, and opinions of the microworkers qualitatively matched the authors' expert expectations (e.g., sugar-sweetened beverages were thought to cause obesity and fruits and vegetables were thought to prevent obesity). 4) Microworkers extracted citation counts for each paper through Google Scholar. Microworkers reached consensus or unanimous agreement for all successful searches. To answer the example question, data were aggregated and analyzed, and showed no significant association between popular opinion and attention the paper received as measured by Scimago Journal Rank and citation counts. Direct microworker costs totaled $221.75, (estimated cost at minimum wage: $312.61). We discuss important points to consider to ensure good quality control and appropriate pay for microworkers. With good reliability and low cost, crowdsourcing has potential to evaluate published literature in a cost-effective, quick, and reliable manner using existing, easily accessible resources. [ABSTRACT FROM AUTHOR]

Background: Hookworm-related cutaneous larva migrans (HrCLM) is a neglected tropical skin disease associated with significant clinical pathology. Little knowledge exists about prevalence and risk factors of HrCLM in endemic regions. Methodology/ Principal Findings: To understand the epidemiology of HrCLM in Amazonia, we conducted a cross-sectional study in a resource-poor township in Manaus, Brazil. HrCLM was diagnosed in 8.2% (95% CI, 6.3–10.1%) of the study population (N = 806) with a peak prevalence of 18.2% (95% CI, 9.3–27.1%) in children aged 10–14. Most of the tracks (62.4%) were located on the feet, and 10.6% were superinfected. HrCLM was associated independently with age under 15, male sex, presence of animal faeces on the compound, walking barefoot on sandy ground and poverty. Conclusions/ Significance: HrCLM is common in resource-poor communities in Amazonia and is related to poverty. To reduce the disease burden caused by HrCLM, living conditions have to be improved. [ABSTRACT FROM AUTHOR]

The profiles of polytraumatized patients in intensive care units were characterized. Serum and salivary markers were compared with normality between Classes I and II of APACHE II and between periods of hospitalization; these results were correlated. This was a prospective study on saliva charts and collection (n = 70). Profile: male, 27 years old, blunt traumas and collisions. Serum parameters with normality: decrease in pH, creatinine at admission to Class I, and at 48 and 72 hours in both classes; K+ at 48 h in Class II; Ca+ on admission in both classes and at 72 h in Class I. Increase in urea at 72 h in Class II, glucose at all times and in all classes, and Ca+ at 48 h in both classes. Class II had high Na+ at 48 and 72 h compared to Class I. In Class I, creatinine reduction occurred in 48 h and 72 h compared to admission and an increase of Ca+ at 48 h with admission. In Class II, pH and Na+ increased at 48 h and 72 h compared to admission. K+ decreased from admission to 48 h and increased from 48 h to 72 h. Urea increased from 48 to 72 hours. Creatinine decreased from admission to 48 and 72 hours. Ca+ increased from admission to 48 hours and decreased from 48 to 72 hours. There was an increase in the saliva levels in both classes and times in relation to normality. There was an increase in urea at admission, glucose at 72 h, and Ca+ at 48 h in Class II compared with Class I. Class I urea increased from admission to 48 h and Ca+ decreased from admission to 48 h. Class II urea decreased from 48 h to 72 h. Strong or very strong positive correlation was identified between blood and creatinine saliva at all times and regular and negative Ca+ at 72 h. This study provides evidence that salivary and serum biomarkers can be used together to monitor the evolution of the clinical symptoms of ICU patients. [ABSTRACT FROM AUTHOR]

Background: In Peru, there is an ongoing high-incidence HIV epidemic among men who have sex with men (MSM) and transgender women (TW). Sexual concurrency, or having sex with a partner in between two acts of sex with another partner, may be a key factor in onward HIV transmission. In this study, we quantify concurrency, evaluate factors associated with concurrency, and assess condom use with concurrent partners among MSM and TW in Peru. Methods: We conducted a secondary analysis of data from the 2011 Peruvian Biobehavioral Survey. Pearson’s Chi-squared test was used to identify individual-level characteristics associated with concurrency. We estimated the association between participant characteristics, concurrent partnerships, partnership type (stable vs. non-stable), and CLAI within the context of concurrent partnerships using multivariate and repeated-measure Poisson regression. Results: 3-month cumulative prevalence of concurrency was higher among TW compared to MSM (30.7% vs 25.2%, p = 0.014). Among those with concurrent stable and non-stable partners, 45% used condoms with both partners (95% CI: 40%-50%) and 30% preferentially had CLAI with the stable partner only (95%CI: 26%-35%). Factors associated with CLAI within the context of concurrent partnerships varied between MSM and TW. Conclusions: Although concurrency is common among TW and MSM in Peru, patterns of concurrency and differential condom use may vary between TW and MSM. Future research may explore differential condom use with stable and non-stable partners to better understand behavioral factors that may alter vulnerability to HIV in TW compared to MSM. [ABSTRACT FROM AUTHOR]

Purpose: Asthma is an important cause of morbidity and mortality worldwide and information on the prevalence of asthma in Nigeria is inconsistent. Nationally representative data, important for health planning is unavailable. We aimed to determine the current prevalence of asthma and allergic rhinitis in Nigeria. Materials and methods: A cross-sectional population survey conducted between June 2017 and March 2018 across five cities representing five geo-political zones in Nigeria. Validated screening questionnaires were used to identify persons with asthma and allergic rhinitis respectively. Asthma was defined as physician diagnosed asthma, clinical asthma and by presence of wheeze in the last 12 months respectively. Socio-demographic information, tobacco smoking, sources of household cooking fuel were also obtained. Results: A total of 20063 participants from 6024 households were screened. The prevalence (95% confidence interval) of physician diagnosed asthma, clinical asthma and wheeze was 2.5% (2.3–2.7%), 6.4% (6.0–6.64%) and 9.0% (8.6–9.4%) respectively. The prevalence of allergic rhinitis was 22.8% (22.2–23.4%). The prevalence of asthma and rhinitis increased with age (prevalence of clinical asthma: 3.1% (2.8–3.4%), 9.8% (9.1–10.5) and 10.7% (9.4%-12.0) among 6–17 years, 18–45 years and >45 years respectively). Prevalence also varied across different cities with the highest prevalence of clinical asthma occurring in Lagos (8.0%) and the lowest in Ilorin (1.1%). The frequency of allergic rhinitis among persons with clinical asthma was 74.7%. Presence of allergic rhinitis, family history of asthma, current smoking and being overweight were independent determinants of current asthma among adults. Conclusion: The prevalence of asthma and allergic rhinitis in Nigeria is high with variabilities across regions and age groups. The number of persons with clinical asthma in Nigeria (approximately 13 million) is likely to rank among the highest in Africa. This warrants prioritization by stakeholders and policy makers to actively implement risk reduction measures and increase investment in capacity building for the diagnosis and treatment of asthma and allergic rhinitis. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus (GDM) is a common complication of pregnancy. It may predispose offspring to increased fat mass (FM) and the development of obesity, however few data from Latin America exist. Objective: To investigate the influence of GDM on newborn FM in mother-newborn pairs recruited from a public maternity care center in São Paulo, Brazil. Methods: Data were collected cross-sectionally in 2013–2014 from 72 mothers diagnosed with GDM, and 211 mothers with normal glucose tolerance (NGT). Newborn FM was evaluated by air-displacement plethysmography (PEA POD), and relevant demographic and obstetric data were collected from hospital records. Associations between maternal GDM status and newborn FM were investigated by multiple linear regression analysis, with adjustment for maternal age, pre-pregnancy BMI, gestational weight gain, type of delivery, sex of the child, and gestational age. Results: FM was greater in GDM versus NGT newborns in a bivariable model (Median (IQR), GDM: 0.35 (0.3) kg vs. NGT: 0.27 (0.2) kg, p = 0.02), however GDM status was not a significant predictor of FM with adjustment for other variables. Rather, pre-pregnancy BMI (coefficient (β) 1.46; 95% confidence interval (CI) 0.66, 2.27), gestational weight gain (β 1.32; 95% CI 0.49, 2.15), and male sex (β -17.8; 95% CI -27.2, -8.29) predicted newborn FM. Analyzing GDM and NGT groups separately, pre-pregnancy BMI (β 6.75; 95% CI 2.36, 11.1) and gestational weight gain (β 5.64; 95% CI 1.16, 10.1) predicted FM in the GDM group, while male sex alone predicted FM in the NGT group (β -12.3; 95% CI -18.3, -6.34). Conclusions: Combined model results suggest that in our cohort, pre-pregnancy BMI and gestational weight gain are more important risk factors for increased neonatal FM than GDM. However, group-specific model results suggest that GDM status may contribute to variation in the relationship between maternal/offspring factors and FM. Our use of a binary GDM variable in the combined model may have precluded clearer results on this point. Prospective cohort studies including data on maternal pre-pregnancy BMI, GWG, and glycemic profile are needed to better understand associations among these variables and their relative influence on offspring FM. [ABSTRACT FROM AUTHOR]

Once a fixture of research in the social and behavioral sciences, volunteer subjects are now only rarely used in human subjects research. Yet volunteers are a potentially valuable resource, especially for research conducted online. We argue that online volunteer laboratories are able to produce high-quality data comparable to that from other online pools. The scalability of volunteer labs means that they can produce large volumes of high-quality data for multiple researchers, while imposing little or no financial burden. Using a range of original tests, we show that volunteer and paid respondents have different motivations for participating in research, but have similar descriptive compositions. Furthermore, volunteer samples are able to replicate classic and contemporary social science findings, and produce high levels of overall response quality comparable to paid subjects. Our results suggest that online volunteer labs represent a potentially significant untapped source of human subjects data. [ABSTRACT FROM AUTHOR]

Coastal marine ecosystems provide livelihoods for small-scale fishers and coastal communities around the world. Small-scale fisheries face great challenges since they are difficult to monitor, enforce, and manage, which may lead to overexploitation. Combining territorial use rights for fisheries (TURF) with no-take marine reserves to create TURF-reserves can improve the performance of small-scale fisheries by buffering fisheries from environmental variability and management errors, while ensuring that fishers reap the benefits of conservation investments. Since 2012, 18 old and new community-based Mexican TURF-reserves gained legal recognition thanks to a regulation passed in 2012; their effectiveness has not been formally evaluated. We combine causal inference techniques and the Social-Ecological Systems framework to provide a holistic evaluation of community-based TURF-reserves in three coastal communities in Mexico. We find that, overall, reserves have not yet achieved their stated goals of increasing the density of lobster and other benthic invertebrates, nor increasing lobster catches. A lack of clear ecological and socioeconomic effects likely results from a combination of factors. First, some of these reserves might be too young for the effects to show (reserves were 6–10 years old). Second, the reserves are not large enough to protect mobile species, like lobster. Third, variable and extreme oceanographic conditions have impacted harvested populations. Fourth, local fisheries are already well managed, and while reserves may protect populations within its boundaries, it is unlikely that reserves might have a detectable effect in catches. However, even small reserves are expected to provide benefits for sedentary invertebrates over longer time frames, with continued protection. These reserves may provide a foundation for establishing additional, larger marine reserves needed to effectively conserve mobile species. [ABSTRACT FROM AUTHOR]

Young adults face unemployment-related challenges, particularly in low- and middle-income countries. Self-employment is encouraged by the Tanzanian government and international institutions such as the World Bank. It has been found that young adults who are employed or self-employed show more functional independence and less inequality and social polarization, as well as a decrease in deviant behaviour. However, limited knowledge and skills related to entrepreneurial activities contribute to lack of motivation towards self-employment among young adults. In order to examine these behaviours, an intervention study implementing an entrepreneurship and beekeeping training in Dar es Salaam, Tanzania was conducted. After completion of the intervention, a qualitative study was conducted that used focus group discussions (FGDs) to explore the experiences and changes in behaviour of young adults following the intervention. A total of 36 of the original 57 young adults from four camps who fully participated in the four arms of interventions were recruited. Qualitative content analysis was used to analyze the FGD data. Three themes emerged from the findings: establishment and maintenance of an entrepreneurial business, changes in behaviour, and perceived challenges. Improved entrepreneurial skills, customer care, and financial management were expressed as positive changes the participants attained relating to business management. Similarly, changes in the participants’ behaviours, attitudes, and lifestyle practices led to improved health and increased recognition and respect in their communities. Insufficient start-up capital and long intervals between sessions were the main challenges. The study showed an improvement in the ability of the participants to generate the human, social, and financial capital prerequisite to business development. Increase in customer care, social capital and financial management are key factors for successful microbusiness activities for stable self-employment. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify the risk factors for tooth loss in an extended age group of adults over 4 years. The prospective cohort study assessed adults (20–64 years old) in 2011 and 2015, from Piracicaba, São Paulo, Brazil. The sample selection was planned based on the adult population in the city. The inclusion criteria were randomly selected residences per census tract unit (one adult per household). The exclusion criteria comprised of a physical or psychological state that prevented the achievement of clinical procedures or understanding of the questionnaire. The home oral examination was performed using the index of decayed, missing, and filled teeth (DMFT), the Community Periodontal Index according to the World Health Organization, and visible biofilm. Demographic and socio-economic data, information on health habits, and the use of dental services were obtained by questionnaire. The outcome was a presence incidence of tooth loss, assessed by the difference between Missing teeth (M>0) from DMFT in 2011 and that in 2015. The conceptual theoretical model ‘Ethnicity, aging and oral health outcomes’ was adapted for tooth loss and used in a Hierarchical multivariate Poisson Regression analysis (p<0.20). The reference category for the Poisson regression were individuals who had no missing teeth (M) due to caries or periodontal disease (p<0.05). There were a total of 143 (follow-up rate = 57.7%) participants in the four-year study, and there was incidence of tooth loss in 51 (35.7%) adults over this period. The risk factors for tooth loss were reason for seeking dental services by pain (RR = 2.72; 95.0% CI: 1.04–7.37), previous tooth loss (RR = 3.01; 95.0% CI: 1.18–7.73) and decayed teeth (RR = 2.87; 95.0% CI: 1.22–6.73). The risk factors for tooth loss were: reason for seeking dental services by pain, previous tooth loss and dental caries. [ABSTRACT FROM AUTHOR]

Background: Taenia solium cysticercosis is a public health and agricultural problem in many low and middle-income countries where health education, sanitation, pig management practices and meat inspection infrastructure are insufficient. Cysticercosis affects both human and animal health and has important economic consequences. Very few studies have been conducted to evaluate the monetary burden of cysticercosis. This study aimed at estimating the 2015 costs associated with cysticercosis in humans and pigs in Mexico. Methods: The monetary burden of human cysticercosis was estimated based on costs incurred by living with and treating epilepsy and severe chronic headaches associated with neurocysticercosis (NCC). The estimated cost of porcine cysticercosis took into consideration losses due to the reduction in the price of cysticercosis-infected animals. Epidemiologic and economic data were obtained from the published literature, government reports, and setting-specific questionnaires. Latin hypercube sampling methods were employed to sample the distributions of uncertain parameters and to estimate 95% credible regions (95% CRs). All results are reported in 2015 U.S.$. Findings: The overall monetary burden associated with NCC morbidity was estimated at U.S.$215,775,056 (95% CR U.S.$109,309,560 –U.S.$361,924,224), with U.S.$436 (95% CR: U.S.$296 –U.S.$604) lost per patient. If loss of future years of income and productivity due to NCC-associated deaths was included, this value increased by U.S.$54.26 million, assuming that these individuals earned Mexico’s median wage salary. An additional U.S.$19,507,171 (95% CR U.S.$5,734,782 –U.S.$35,913,487) was estimated to be lost due to porcine cysticercosis. Conclusions: This study suggests that T. solium cysticercosis results in considerable monetary losses to Mexico. [ABSTRACT FROM AUTHOR]

Background: Malaysia is widely credited to have achieved universal health coverage for citizens. However, the accessibility of healthcare services to migrant workers is questionable. Recently, medical fees for foreigners at public facilities were substantially increased. Mandatory health insurance only covers public hospital admissions and excludes undocumented migrants. This study explores barriers to healthcare access faced by documented and undocumented migrant workers in Malaysia. Methods: We use qualitative data from 17 in-depth interviews conducted with key informants from civil society organisations, trade unions, academia, medical professionals, as well as migrant workers and their representatives. We interviewed doctors working in public hospitals and private clinics frequented by migrants. Data were analysed using thematic analysis. Results: We found that healthcare services in Malaysia are often inaccessible to migrant workers. Complex access barriers were identified, many beyond the control of the health sector. Major themes include affordability and financial constraints, the need for legal documents like valid passports and work permits, language barriers, discrimination and xenophobia, physical inaccessibility and employer-related barriers. Our study suggests that government mandated insurance for migrant workers is insufficient in view of the recent increase in medical fees. The perceived close working relationship between the ministries of health and immigration effectively excludes undocumented migrants from access to public healthcare facilities. Language barriers may affect the quality of care received by migrant workers, by inadvertently resulting in medical errors, while preventing them from giving truly informed consent. Conclusions: We propose instituting migrant-friendly health services at public facilities. We also suggest implementing a comprehensive health insurance to enable healthcare access and financial risk protection for all migrant workers. Non-health sector solutions include the formation of a multi-stakeholder migration management body towards a comprehensive national policy on labour migration which includes health. [ABSTRACT FROM AUTHOR]

Past research has documented myriad pernicious psychological effects of high economic inequality, prompting interest into how people perceive, evaluate, and react to inequality. Here we propose, refine, and validate the Support for Economic Inequality Scale (SEIS)–a novel measure of attitudes towards economic inequality. In Study 1, we distill eighteen items down to five, providing evidence for unidimensionality and reliability. In Study 2, we replicate the scale’s unidimensionality and reliability and demonstrate its validity. In Study 3, we evaluate a United States version of the SEIS. Finally, in Studies 4–5, we demonstrate the SEIS’s convergent and predictive validity, as well as evidence for the SEIS being distinct from other conceptually similar measures. The SEIS is a valid and reliable instrument for assessing perceptions of and reactions to economic inequality and provides a useful tool for researchers investigating the psychological underpinnings of economic inequality. [ABSTRACT FROM AUTHOR]

Introduction: Disability follows the rapid rate of population ageing, imposing a huge burden on society. Functional assessment in older people can identify predictors of disability. Objective: Analyze the incidence and the risk factors for disability in activities of daily living (ADL) and instrumental activities of daily living (IADL) in older adults over six years. Methods: Six year-follow up study initiated in 2010. The baseline non-probabilistic sample consisted of 180 independent community dwelling individuals aged 60 and over. The procedures comprised an interview with sociodemographic data, questions about falls, urinary incontinence, self-rated health, and assessment of ADL, IADL, mobility, depression, vision, hearing, cognition, nutrition, grip strength and social support. The second research was carried out by telephone and assessed ADL and IADL. Logistic regression models calculated the odds of disability in ADL and IADL according to the age, sex and all other variables. Results: At six-year follow-up, 118 participants were still alive (65.6%), 31 died (17%) and other 31 were missed (17%). The incidence of disability to performADL and IADL were 25.4% and 32.3%, respectively. The regression logistic models revealed thaturinary incontinence (OR = 3.2; P = 0.03) and insufficient emotional support (OR = 3.8; P = 0.04) were associated with ADL disability, while visual problems (OR: 2.9; P = 0.03) and insufficient emotional support (OR: 5.6; P = 0.01) were associated with IADL disability. Conclusion: The current study has identified that insufficient emotional support, visual problems and urinary incontinence are associated with disability in older adults. The routine assessment of these problems in the primary care clinics enable the implementation of strategies aimed at reducing or postponing disability. Educating patients and families will also enable better choices to reduce the risk of functional decline. [ABSTRACT FROM AUTHOR]

We study the literature on willingness to pay (WTP) for local food by applying meta-regression analysis to a set of 35 eligible research papers that provide 86 estimates on consumers’ WTP for the attribute “local.” An analysis of the distribution of WTP measures suggests the presence of publication selection bias that favors larger and statistically significant results. The analyzed literature provides evidence for statistically significant differences among consumers’ WTP for various types of product. Moreover, we find that the methodological approach (choice experiments vs. other approaches) and the analyzed country can have a significant influence on the generated WTP for local. [ABSTRACT FROM AUTHOR]

Aim: To assess the prevalence of self-reported dental pain and its association with sociodemographic, clinical and behavioral/psychosocial indicators among 8- to 10-year-old Brazilian schoolchildren. Design: A cross-sectional study was carried out with 1,589 eight- to ten-year-old children randomly selected from public schools of Florianopolis, Brazil. Self-reports of dental pain were collected through a single question as follows: “In the last month, how many times have you had pain in your teeth?” Caries experience was determined by the DMFT/dmft index and its clinical consequences by the PUFA/pufa index. Dental trauma, dental fluorosis and molar-incisor hypomineralization were assessed through the Andreasen, Dean and European Academy of Pediatric Dentistry classifications, respectively. Clinical signs of dental erosion were also observed. Sociodemographic indicators were obtained through a questionnaire answered by the children’s caregivers. Information about behavioral/psychosocial indicators was collected through questions from the Brazilian version of the Child Perception Questionnaire 8–10 years (CPQ8–10). Descriptive analysis, chi-square test, and hierarchically adjusted Poisson regression models were performed. Results: 819 children (51.5%) reported episodes of dental pain in the last month prior to the study, whereas 55.6% (n = 509) were girls. The presence of dental pain was significantly associated with sex, trouble sleeping, difficulty eating, school absenteeism, difficulty with paying attention in class, difficulty doing homework, staying away from recreational activities, caries experience, PUFA/pufa index and ulceration (p<0.05). Conclusion: The prevalence of self-reported dental pain in 8- to 10- year-old Brazilian schoolchildren was high and was associated with sociodemographic, clinical and behavioral/psychosocial indicators. [ABSTRACT FROM AUTHOR]

Natural resource rules exist to control resources and the people that interact with them. These rules often fail because people do not comply with them. Decisions to comply with natural resource rules often are based on attitudes about legitimacy of rules and the perceived risks of breaking rules. Trust in agencies promulgating rules in part may determine perceptions of legitimacy of the rule, and in turn depends on individuals’ trust in different agency actors. The purpose of this research is to explore the relationship between fishing rule noncompliance and trust in scientists, a key group within management agencies. We interviewed 41 individuals in one rural fishing community in the Brazilian Pantanal from April to August, 2016, to assess (1) noncompliance rates, (2) noncompliance-related attitudes, and (3) the relationship between trust in scientists and noncompliance decisions in the region. We found that among study participants, noncompliance was common and overt. Trust in scientists performing research in the region was the best predictor of noncompliance rate with a fishing rule (nonparametric rank correlation ρ = -0.717; Probit model pseudo-R2 = 0.241). Baseline data from this research may help inform future interventions to minimize IUU fishing and protect the Pantanal fishery. Although our results are specific to one community in the Pantanal, trust in scientists is potentially an important factor for compliance decisions in similar situations around the world. These results build not only on compliance theory but also speak to the important role that many scientists play in rural areas where they conduct their research. [ABSTRACT FROM AUTHOR]

Background: Chronic pain is among the most burdensome conditions. Its prevalence ranges between 12% and 30% in Europe, with an estimated 21% among Austrian adults. The economic impact of chronic pain from a societal perspective, however, has not been sufficiently researched. This study aims to provide an estimate of the societal costs for working-age adults with chronic pain in Austria. It explores the impact of sex, number of pain sites, self-reported pain severity, health literacy and private health insurance on costs associated with chronic pain. Methods: A bottom-up cost-of-illness study was conducted based on data collected from 54 adult patients with chronic pain at three Viennese hospital outpatient departments. Information on healthcare costs including out-of-pocket expenses and productivity losses due to absenteeism and informal care were collected over 12 months. Resource use estimates were combined with unit costs and mean costs per patient were calculated in € for year 2016. Results: Mean annual societal costs were estimated at EUR 10191. Direct medical costs were EUR 5725 including EUR 1799 out-of-pocket expenses (mainly pain relieving activities and private therapy). Productivity losses including informal care amounted to EUR 4466. Total costs for women and patients with three or more pain sites were significantly higher. No association with health literacy was found but there was a tendency towards higher out-of-pocket expenses for patients with complementary private health insurance. Conclusion: This study is the first to provide a comprehensive assessment of the individual and societal burden of chronic pain in Austria. It highlights that chronic pain is associated with substantial direct medical costs and productivity losses. Patient costs may show systematic differences by health insurance status, implying a need for future research in this area. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between maternal anemia and low/insufficient birth weight. Design: A prospective cohort study of pregnant women who underwent prenatal care at the healthcare units in a municipality of northeast Brazil together with their newborn infants was carried out. The pregnant women were classified as having anemia when the hemoglobin level was below 11 g/dl. Infants who were born full term weighing less than 2500 grams were classified as low birth weight, and those weighing between 2500 and 2999 grams were classified as insufficient weight. The occurrence of maternal anemia and its association with birth weight was verified using crude and adjusted Relative Risk (RR) estimates with their corresponding 95% confidence intervals (95%CIs). Results: The final sample was comprised of 622 women. Maternal anemia was considered a risk factor for low/insufficient birth weight, after adjusting the effect measurement for maternal age, family income, urinary infection, parity, alcoholic beverage consumption during pregnancy and gestational body mass index: RRadjusted = 1.38 [95% CI: 1.07 to 1.77]. Conclusions: Maternal anemia was associated with low/insufficient birth weight, representing a risk factor for the gestational outcomes studied. [ABSTRACT FROM AUTHOR]

This cross-sectional study evaluated the quality of life and associated factors of climacteric women in Brazil using a random and representative sample of women assisted by primary care professionals. We investigated the variables using the Menopause-Specific Quality of Life Questionnaire, MENQOL, whose mean scores were compared using Mann–Whitney and Kruskal–Wallis tests according to the sample characteristics. The variables associated with the outcomes in univariate analyses with a p≤0.2 were jointly evaluated using multiple linear regression. In this study, 849 women ranging in age from 40 to 65 years were evaluated. The predictors of poor quality of life in the vasomotor domain were women with severe climacteric symptoms (p<0.001), increased Body Mass Index (BMI) (p = 0.006), sleep (p = 0.022), and postmenopausal (p<0.001) alterations. For the psychosocial domain, the associated variables were severe climacteric symptoms (p<0.001) and sleep alterations (p<0.001); for the physical domain, the associated variables were severe climacteric symptoms (p<0.001), increased BMI (p<0.001), sleep (p<0.001), and postmenopausal (p<0.001) alterations. Severe climacteric symptoms, low sleep quality, increased BMI, and postmenopausal status were factors that were more associated with impairments in quality of life. With the increase in life expectancy, we suggest that greater attention should be paid to women’s quality of life associated with climacteric symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis incidence is disproportionately high among people in poverty. Cash transfer programs have become an important strategy in Brazil fight inequalities as part of comprehensive poverty alleviation policies. This study was aimed at assessing the effect of being a beneficiary of a governmental cash transfer program on tuberculosis (TB) treatment cure rates. Methods: We conducted a longitudinal database study including people ≥18 years old with confirmed incident TB in Brazil in 2015. We treated missing data with multiple imputation. Poisson regression models with robust variance were carried out to assess the effect of TB determinants on cure rates. The average effect of being beneficiary of cash transfer was estimated by propensity-score matching. Results: In 2015, 25,084 women and men diagnosed as new tuberculosis case, of whom 1,714 (6.8%) were beneficiaries of a national cash transfer. Among the total population with pulmonary tuberculosis several determinants were associated with cure rates. However, among the cash transfer group, this association was vanished in males, blacks, region of residence, and people not deprived of their freedom and who smoke tobacco. The average treatment effect of cash transfers on TB cure rates, based on propensity score matching, found that being beneficiary of cash transfer improved TB cure rates by 8% [Coefficient 0.08 (95% confidence interval 0.06–0.11) in subjects with pulmonary TB]. Conclusion: Our study suggests that, in Brazil, the effect of cash transfer on the outcome of TB treatment may be achieved by the indirect effect of other determinants. Also, these results suggest the direct effect of being beneficiary of cash transfer on improving TB cure rates. [ABSTRACT FROM AUTHOR]

Introduction: The Malawian government recently introduced cost-covering consultation fees for self-referral patients in tertiary public hospitals. Previously, patients received medicines free of charge in government-owned health facilities, but must pay elsewhere. Before the government implements a payment policy in other areas of health care, it is important to investigate the prices, affordability and availability of essential medicines in Malawi. Methods: Data on availability and prices of 50 essential medicines were collected in 44 health facilities in two major cities and two districts. These included 12 public facilities, 11 facilities of the Christian Health Association of Malawi (CHAM), nine retail pharmacies, eight wholesalers and four private clinics/hospitals. Price, availability and affordability were assessed based on the methodology developed by the World Health Organization and Health Action International, which compares local prices to international reference prices. Results and discussion: The overall availability of medicines was 48.5% in public facilities, 71.1% in retail pharmacies, 62.9% in CHAM facilities and 57.5% in private clinics. The availability of essential medicines varied from 0% for ethosuximide to 100% for amoxicillin and cotrimoxazole tablets. Antibiotic formulations for adults were widely available, in contrast to the low availability of pediatric formulations. Several medicines for non-communicable diseases like sodium valproate, phenytoin, paraldehyde, captopril and simvastatin showed poor availability and affordability. The overall median price ratio compared to the international reference price was 1.11 for wholesalers, 2.54 in CHAM facilities, 2.70 in retail pharmacies, and 4.01 in private clinics, which is low compared to other countries. But nevertheless, for 18 out of 32 medicines assessed, the cost of one course exceeded the statutory minimum daily wage, making them unaffordable to a majority of the population. Therefore, continued provision of free public health care is still of critical importance for the foreseeable future until other financing mechanisms have been explored. [ABSTRACT FROM AUTHOR]

Sustainability standards for seafood mainly address environmental performance criteria and are less concerned with the welfare of fisheries workers who produce the seafood. Yet human rights violations such as slavery and human trafficking are widespread in fisheries around the world, and underscore the need for certification bodies and other seafood supply chain actors to improve social performance, in addition to addressing environmental challenges. Calls for socially responsible seafood have referenced human rights law and policy frameworks to shape the guiding principles of socially responsible seafood and to provide the legal machinery to implement these aspirations, but practical guidance on how to achieve this is lacking. To provide clarity on this challenge, we reviewed the literature concerning human rights in the seafood supply chain, and prepared an analysis of opportunities and challenges to implement socially responsible seafood through relevant human rights, legal and policy instruments. We observe that human rights laws are generally framed in favour of addressing violations of civil and political rights, but there remains considerable scope for applying economic, social and cultural (ESC) rights in this context. Other challenges include weakly defined ESC rights infringements, a lack of straightforward mechanisms to enforce human rights entitlements, and practical difficulties such as resources to support and secure rights. On the positive side, governments can draw on international instruments to inspire national policies and legislation to eliminate illegalities from the seafood supply chain. However, for socially responsible seafood principles to translate into tangible actions, these objectives must be rooted in clear legal obligations and be supported by sufficient national capacity and political will. [ABSTRACT FROM AUTHOR]

Background: A high quality modern diet is associated with reduced risk of metabolic disease and diabetes. However, it remains unclear whether the quality of predominantly traditional ethnic diets is associated with such conditions. Moreover, the relationship between dietary quality and microbiota, a potential mediator of metabolic disease, has not been studied. Objective: We investigated the relationship of dietary quality of traditional ethnic diets in Indonesia with fasting blood glucose (FBG), HbA1c, and the number of fecal Bifidobacterium. Design: A cross-sectional study was conducted in selected districts with predominantly animal- or plant-based traditional diets of West Sumatera and West Java provinces, respectively. A total of 240 apparently healthy women aged 19–50 years were randomly selected from 360 women screened by a cluster sampling design. Dietary quality was assessed by 2-day repeated 24-hour food recall, and scored using the Healthy Eating Index (HEI) 2010. FBG was quantified with the enzymatic colorimetric method, and HbA1c by using hexokinase and high-performance liquid chromatography, and total fecal Bifidobacterium by real-time quantitative polymerase chain reaction. Results: The HEI scores of 99% of women were <51, indicating a low-quality diet. In adjusted multivariate regression, HEI was inversely associated with FBG (ß = -0.403; 95% CI = -0.789 to -0.016; p = 0.041) and HbA1c (ß = -0.018; 95% CI = -0.036 to 0.000; p = 0.048) but was not significantly associated with total levels of Bifidobacterium (ß = -0.007, p = 0.275). Bifidobacterium count was not significantly associated with either FBG or HbA1c levels. Conclusion: Low dietary quality is clearly associated with risk of increased markers of blood glucose. However, any mediating role of Bifidobacterium between dietary quality and glucose outcomes was not apparent. Innovative interventions for healthy eating should be implemented to increase dietary quality of populations transitioning from predominantly traditional to modern diets, to reduce the risk of diabetes, especially in women. [ABSTRACT FROM AUTHOR]

Small-scale fisheries are large contributors to regional economies and livelihoods in coastal communities of Latin America. While Mexico is one of the cases where small-scale fisheries play an important role, overfishing and poor management strategies have led to the collapse of many of its fisheries. The callo de hacha scallop fishery of the Ensenada de La Paz in Baja California Sur is an example of such a fishery which, after years of mismanagement, was closed by the Mexican authorities in 2009. The present study evaluated the recovery efforts in the cove and the potential outcomes of a collaboration between a non-governmental organization and a fishing community working towards the restoration of this pen-shell fishery. After more than four years of closure and active monitoring of the recovering process, the callo de hacha population has shown a significant population recovery, with potential solvency for reopening fishing activities. Four scenarios of uncertainty are evaluated with two of them providing positive net present values from reopening the fishery. We also document the involvement of a non-governmental organization with a fishing community, which created social capital and, in our opinion, was essential for a successful restoration. Having an actively involved community helped raise funds for the fishing closure so fishers were able to comply with Mexican legislation; it also fostered community building and self-organization that will be crucial to maintaining the sustainability of the fishery. [ABSTRACT FROM AUTHOR]

To reduce morbidity and mortality caused by visceral leishmaniasis (VL), the Brazilian Visceral Leishmaniasis Control and Surveillance Program promotes the diagnosis and treatment of cases, vector control, euthanasia of seropositive dogs, and health education. Nevertheless, the effectiveness of these measures is questionable as they lead to little reduction in the transmission of the disease. Thus, the effectiveness of strategies such as insecticide-impregnated collars, spot-on insecticides, and immunization of dogs should be assessed. Herein, we evaluated the effectiveness of deltamethrin-impregnated collars on reducing the incidence of Leishmania infantum infection in dogs living in an endemic area of VL. An intervention study was conducted and a total 5,850 dogs were analyzed in baseline. Of these 3,742 seronegative dogs were divided into two groups: collared and uncollared (control). Dogs were followed for 12 months and three interventions were performed. The Cox regression model was used to evaluate the effectiveness of the collar. All analyzes were performed by Intention-to-treat and per-protocol. By intention-to-treat, the incidence rates of L. infantum infection were 7.5 and 7.9 in the collar group, and 6.5 and 13.2 per 1,000 dogs-months in the control group after 6 and 12 months, respectively. In the per-protocol analysis, the incidence rates in the control group were similar to those observed in the intention-to-treat analysis. In the collar group, the incidence rate was 5.1/1,000 dogs-months after 6 and 12 months. The effectiveness by intention-to-treat after adjustment by the multivariate Cox model was 48%. In the analysis per-protocol, the effectiveness increased to 63%. Although collar use was effective when it was evaluated by intention-to-treat, higher effectiveness was found in the per-protocol analysis after one year of follow-up. The data emphasize the importance of the uninterrupted use of deltamethrin-impregnated collars to increase protection against canine VL. [ABSTRACT FROM AUTHOR]

Objective: Previous studies show that multiparity and a number of chronic conditions are correlated among women. Also, low respiratory muscle strength has been associated to adverse health outcomes such as chronic lung disease and early mortality. This study aimed to investigate associations between the number of lifetime pregnancies and maximal inspiratory/expiratory pressures. Methods: In a cross-sectional study, 204 women ages 41–80 years-old, from the rural community of Santa Cruz, Brazil, provided data regarding demographics, socioeconomic characteristics, health behaviors, and number of lifetime pregnancies (≤3, 4–6 or ≥7). Maximal respiratory pressures were measured with a digital manometer. Multiple linear regression analysis was used to examine the association of multiple childbearing on maximal respiratory pressures. Results: Of the participants, 44.1% had ≤3 pregnancies, 30.4% had 4–6 pregnancies and 25.5% had >7 pregnancies. In the unadjusted analyses, maximal inspiratory and expiratory pressures varied significantly according to multiple childbearing categories. After adjustment, the values remained statistically significant only for maximal expiratory pressure. Compared to women with ≤3 lifetime pregnancies, those who had ≥7 pregnancies had significantly lower maximal expiratory pressure values (β = -18.07, p = 0.01) Conclusion: Multiple childbearing appears to be negatively associated with maximal respiratory pressures; women with a higher number of lifetime pregnancies had lower values of maximal respiratory pressures when compared to those with fewer pregnancies. This association may be due to biomechanical changes in the respiratory muscles promoted by multiple lifetime pregnancies. This finding indicates a need to motivate women, from the prenatal to postpartum period, to safely exercise their respiratory muscles, including abdominal muscle exercises as well as respiratory muscle training. [ABSTRACT FROM AUTHOR]

Background: Sub-Saharan Africa, including Zambia, has experienced an increase in overweight and obesity due to rapid lifestyle changes associated with recent economic growth. We explored the prevalence and correlates of overweight and obesity in rural Zambia. We also investigated the role of self-perception of body weight in weight control given the local socio-cultural context. Methods: In this cross-sectional study, we recruited 690 residents of the Mumbwa district aged 25–64 years through a multistage, clustered, household random sampling. We administered a questionnaire and collected anthropometric and bio-behavioral data from May to July 2016. Factors associated with body mass index (BMI) ≥25 kg/m2 and underestimation of body weight were assessed using multiple logistic regression. Results: Of the weighted sample of 689 participants (335 men and 354 women), 185 (26.8%) had BMI ≥25 kg/m2. In multivariate analyses, female gender, age 45–64 years, tertiary education, higher fruit and vegetable intake, high blood pressure, abnormal blood lipid profile, and Hemoglobin A1c ≥5.7% were significantly associated with BMI ≥25 kg/m2. Among participants with BMI ≥25 kg/m2, 14.2% and 58.2% perceived themselves as being underweight and normal weight, respectively. Age 45–64 years was the only factor significantly associated with body weight underestimation. Preference for obesity was reported by 17.5% and 3.6% of respondents with BMI <25 kg/m2 and BMI≥25 kg/m2, respectively; “looks attractive” and “fear of being perceived as HIV-positive” were the main reasons. Conclusion: In rural Zambia, overweight and obesity are prevalent and significantly associated with alterations in blood pressure, blood lipid profile, and glucose metabolism. However, most subjects with BMI ≥25 kg/m2 underestimated their body weight; some preferred obesity, in part due to cultural factors and HIV-related stigma. A health promotion program that addresses such perceptions and body weight underestimation should be urgently introduced in Zambia. [ABSTRACT FROM AUTHOR]

This study analyzed differences between men and women regarding the use of psychotropic drugs and associated factors in a population of adults and seniors in the city of Campinas, Brazil. A population-based, cross-sectional study was conducted using data from the ISACamp 2014/2015 health survey in the city of Campinas. The sample was composed of 1999 individuals aged 20 years or older. For each sex, prevalence rates and prevalence ratios were estimated for the use of psychotropic drugs according to demographic characteristics, socioeconomic characteristics, health problems, degree of limitation and type of emotional/mental problem. The most used classes of medications were also determined. The prevalence of the use of psychotropic drugs was 11.7% (7.3% among men and 15.8% among women). The most common therapeutic classes were antidepressants (38.2%) and benzodiazepines (24.0%). The frequency of antidepressant use was higher among women (44.3%) than men (25.5%). Regarding associated factors, reports of emotional/mental problems were associated with the greater use of this type of drug in both sexes. Among the men, white skin color, a lack of an occupational activity, a greater number of complaints of health problems and the occurrence of insomnia were associated with the use psychotropic drugs. Among the women, a significant increase in the use of these drugs was found with the increase in age and higher prevalence rates were found among those with a higher level of schooling, those with a greater number of diagnosed chronic diseases and those with a common mental disorder. The present results confirm the greater use of psychotropic agents, especially antidepressants, in the female sex and reveal that the pattern of associated factors differs between sexes. It is therefore necessary to understand the peculiarities of each sex that exert an influence on the perception of health problems and the desire to seek care, which, in turn, affect the use of psychotropic agents. [ABSTRACT FROM AUTHOR]

Background: A third of new cases of breast cancer could be detected early, which would prevent more serious consequences, such as mastectomy and death. Access to the subjectivity of mastectomized patients becomes relevant to elucidate failures in early detection of breast cancer and thus improve the cancer care network. Given that, the present study aimed to identify mastectomized women’s perception of the quality of care provided by the cancer care network for the early detection and diagnosis of breast cancer. Methods: Qualitative study carried out at a public outpatient cancer center in the city of Fortaleza, Ceará, Northeastern Brazil, to analyze the perceptions of 26 women who had undergone mastectomy after breast cancer based on Symbolic Interactionism. Results: The thematic analysis showed how women (re)structure their lives in the face of the structural and social aspects of coping with breast. Two essential themes emerged: “Contradictions regarding access to primary health care services and obstacles to the organization of SUS formal care network services” and “The informal and private health care network increase quality care coverage”. Conclusions: The absence of effective measures in Primary Health Care and patients’ ‘pilgrimage’ in the formal health care network have delayed early detection breast cancer. [ABSTRACT FROM AUTHOR]

Non-contributory pension programs in the developing world seek to provide older adults with an income that may improve their health and wellbeing in old age by enabling access to health care and better nutrition. There is no previous evidence of the effects of non-contributory pensions on frailty, a comprehensive measure of health and well-being of the oldest old. We aimed to estimate the effects of non-contributory pension programs on frailty of older adults in the state of Yucatan, Mexico. We use rich panel data, including objective markers and self-reported assessments of health and well-being, for 944 adults at least 70 years of age in two communities of Yucatan, Mexico. The first wave was collected in 2008; the second wave was collected in 2010, 18 months after implementation of a monthly state pension in one community and 12 months after a federal pension paid every two months in the other. We found the state pension led to a statistically significant decrease in the severity of frailty for women, but the federal pension was associated with an increase. We found no statistically significant change in the frailty index for men in either community. Among explanations for these findings are monthly payments being more likely to be spent on health care, medicines, and more regular food expenditures, enabling women who previously lacked independent means of support to increase their longer-term health. The federal program paid every two months led to irregular patterns of food expenditure and increased ownership of durable goods but had no effects on health care utilization, subsequently leading to deterioration in longer-term health for women. [ABSTRACT FROM AUTHOR]

We investigated the prevalence of maternal dissatisfaction with their child's body size and its associated factors among mothers of first- to third-grade elementary school students in private schools in the Federal District, Brazil. This is a cross-sectional study with 548 mother-schoolchildren pairs. We measured children’s weight and height, and collected their mother’s sociodemographic data and Body Mass Index using an online questionnaire. We also verified maternal body dissatisfaction and maternal dissatisfaction with their child's body size using Shape Scales. Most mothers (50.5%) were dissatisfied with their child's body size. Mothers of boys (Adjusted OR = 2.85) were more likely to want a larger silhouette for their child, while mothers of girls (Adjusted OR = 3.18), overweight (Adjusted OR = 24.83) and obese (Adjusted OR = 189.86) children were more likely to want a thinner silhouette for their child. A positive correlation was observed between maternal dissatisfaction with their own body and maternal dissatisfaction with their children's body size (rs = 0.178). There was a high prevalence of maternal dissatisfaction with their child's body size, particularly among mothers of overweight and obese children. Additional studies should be conducted to better understand the influence of this dissatisfaction on maternal practices and attitudes related to their child’s body, food consumption, and lifestyle. [ABSTRACT FROM AUTHOR]

The purpose of this work is to estimate the costs associated with managing patients with MS in Panama and evaluating the impact of the disease on their health-related quality of life (HRQoL). Multicentric observational, retrospective, cross-sectional study. The costs were estimated from societal and patient perspectives and expressed in USD, 2015. The focus of the study is based on prevalence and on a “bottom-up” approach. To estimate the total cost per patient, annual reported use for each resource was multiplied by its unit cost. To evaluate HRQoL, patients completed the EQ-5D-3L questionnaire. 108 patients took part in the study. 82.41% were women with 44.78 (SD: 12.27) years. 61.11% presented mild (EDSS = 0–3.5), 25.93% moderate (EDSS = 3.5–6) and 12.96%, severe disability (EDSS≥6.5). The mean annual cost from the patient’s perspective was estimated at 777.99 USD (SD: 1,741.45) per patient. The mean cost from a societal perspective was estimated at 23,803.21 USD (SD: 13,331.83) per patient. Disease-modifying therapies (DMT) accounted for the main component of the cost. A deterioration in HRQoL was observed as the disease advances and as disability increases, with mobility and usual activities being the areas most affected by its progression. From both perspective, the cost per MS patient in Panama is high. In addition to the high economic impact, MS also exerts a negative impact on patient HRQoL, which increases as the disease advances. [ABSTRACT FROM AUTHOR]

Background: The employment rate among people with severe mental illness has recently increased, though it is still low. The motivation to work appears to be an important role as an intermediate outcome measure in vocational rehabilitation programs. In addition, measuring the work motivation for people with severe mental illness appears to be essential to identify candidates who are likely to benefit and monitor candidates’ motivation in a supported employment program. This study aimed to develop a new measure for assessing both intrinsic and extrinsic motivation to work among people with severe mental illness, as there are currently no well-established instruments of this kind. Methods: A focus group interview and review of previous qualitative research were used to identify possible items for inclusion in the new scale. A provisional scale was constructed and further refined for content and format based on feedback from a researcher and also three peer workers with severe mental illness. The resulting provisional 38-item version of the scale was completed by 136 respondents with severe mental illness, and we performed exploratory factor analysis to identify latent constructs within the new measure. The finalized scale was analyzed for test-retest reliability, internal consistency, and convergent validity. Result: An exploratory factor analysis yielded a four-factor scale with 23 items. The finalized 23 items had high internal consistency (Cronbach’s alpha = 0.91) and relatively high test-retest reliability (ICC = 0.83). The four subscales had fair internal consistency (Cronbach’s alpha ≥ 0.69) and good test-retest reliability (ICC ≥ 0.61). Convergent validity was weakly supported by the significant positive correlations with the overall question on motivation to work (r ≥ 0.19, p < 0.01). Besides these correlations, only the “Pressure from others” subscale was negatively and significantly correlated with the negative symptoms evaluated using the Positive and Negative Syndrome Scale (r = -0.18, p = 0.04). Conclusions: This study used factor analysis to develop a new multidimensional scale assessing motivation for competitive employment among persons with severe mental illness. The scale showed acceptable levels of reliability and factor-based and convergent validity. The new measure can be used for measuring the motivation for competitive employment among people with severe mental illness, and it would be useful to identify candidates who are likely to benefit from a certain supported employment program, and to monitor interim progress of the state of participants’ motivation in a program. [ABSTRACT FROM AUTHOR]

Background: Cancer is one of the leading causes of death in the world, among which, oral cancer is associated with significant morbidity, and low survival. A large part of the budget allocated to health care is attributed to cancer. In this study we aim to estimate the economic burden of oral cancer in Iran for the year 2014. Methods: In this study, we generated a prevalence-based estimate of the cost-of-illness of oral cancer in Iran. A societal perspective was used for this study, in which the direct costs and productivity losses of oral cancer cases in 2014 were estimated. The human capital approach was adopted for estimating productivity losses. Several data sources contributed to this study, including national cancer registry reports, hospital records, occupational data, and interviews with experts. Result: Nearly 53% of patients were diagnosed in an advanced stage of oral cancer. The economic burden of oral cancer was $64,245,173 most of which (50%) was attributed to productivity losses. The direct medical cost accounted for 42% of the estimated total cost. Treatment expenses for advanced stages were five times higher than the early stages ($10,532 vs. $2,225). Conclusion: The economic burden of oral cancer is high in Iran. Planning an early detection and screening program for oral cancer may potentially decrease health care costs, morbidity, and mortality. [ABSTRACT FROM AUTHOR]

This study aimed to estimate prevalence of common mental disorders (CMD) and associated factors among dental students. In this cross-sectional study, 230 students answered a questionnaire and instruments to assess CMD (Self Reporting Questionnaire-20), hazardous alcohol consumption (Alcohol Use Disorder Identification Test), social support (Social Support Scale), perceptions of academic life (Dundee Ready Education Environment Measure), coping (Ways of Coping Inventory) and resilience (Resilience Scale). Bivariate analysis was conducted using the Chi-Square and Mann-Whitney tests. Logistic regression included all explanatory variableswith p<0.20 in the bivariate analysis, besides sex and academic year. The explanatory variables were analyzed in five successive blocks (backward-stepwise), until all variables presented statistical significance in the final model (p<0.05). The prevalence of CMD was 45.2% (95%CI: 38.7–51.6), with no significant differences between sexes. Students with no extracurricular activities, who had negatively self- assessed their health status and their academic performance, were about four times more likely to present CMD, followed by receiving psychological or psychiatric treatment during university (AOR: 2.65; 95%CI: 1.1–6.1) and those with high scores for confrontive coping (AOR: 1.20; 95%CI: 1.0–1.4). Resilience was a protective factor for CMD among dental students (AOR: 0.93; 95%CI: 0.9–1.0). Aspects related to academic performance, health status and confrontive coping strategies were risk factors to students’ mental health. Individuals with high levels of resilience showed lower prevalence of CMD. Further prospective studies could contribute to understanding the role of resilience among this population. [ABSTRACT FROM AUTHOR]

This study aims to estimate the migration effect of the overall samples and different flowing scales for the floating population from the perspective of personal wages. Although we used both the OLS and PSM methods to estimate the migration effect, we found that the PSM method was preferred in the study of migration as a result of the selection bias. The empirical results show that there is a significant difference in wage before and after migration. In fact, migration increased wages by 15.18% to 23.63% overall. Additionally, wages were increased by 44.96% to 59.20%, 23.06% to 26.18%, and 10.89% to 15.08% respectively for these three migration patterns: flowing into the three largest megacities, inter-provincial migration, and inter-city migration within a province, but for this pattern of inter-district migration within a city, the migration effect is not significant. We concluded that the floating population removing policies of the largest megacities maybe are effective because of the administrative power of their government. On the other hand, for these policies of non-largest megacities to attract labor and local employment and local urbanization near the floating population’s place of origin, they were not effective enough as a result of the lack of significant migration effect in these cities. [ABSTRACT FROM AUTHOR]

The recent Zika outbreak and its link to microcephaly and other birth defects in infants exposed in utero have garnered widespread international attention. Based on the severity of birth defects the extent of impairment in these infants is expected to be profound; however, virtually nothing is known regarding the developmental and behavioral sequela of congenital Zika syndrome. This pilot study collected parent-reported patterns of development and sleep in 47 infants with confirmed congenital Zika syndrome who are being followed for clinical services at the Altino Ventura Foundation (FAV) in Recife, Brazil. With assistance from clinicians at FAV, caregivers completed Brazilian Portuguese versions of the Ages and Stages Questionnaire, 3rd edition (ASQ-3) and the Brief Infant Sleep Questionnaire (BISQ). All infants were between 13–22 months of age at the time of the assessment. At 16 months of age, none of the children displayed age appropriate developmental skills. Most (~ 75%) mastered some communication and gross motor skills at around a 6–8-month level. Communication and gross motor skills were relative strengths for the sample, while problem-solving and fine motor skills were relative weaknesses. Sleep was noted to be a problem for around 18% of the sample. In utero exposure to the Zika virus will have lifelong consequences for affected children and their families. Understanding the developmental and behavioral trajectories of affected infants will help identify appropriate family supports to improve quality of life. [ABSTRACT FROM AUTHOR]

Background: The Philippines has built an extensive decentralised network of Animal Bite Treatment Centers (ABTCs) to help bite victims receive timely rabies post-exposure prophylaxis (PEP) at little cost. This study surveyed patients in the community and at ABTCs of three provinces to assess animal bite/scratch incidence, health-seeking behaviour and PEP-related out-of pocket expenses (OOPE). Methodology and principal findings: During community surveys in 90 barangays (neighbourhoods), 53% of households reported at least one animal bite /scratch injury over the past 3 years, similar across urban and rural barangays. Overall bite/scratch incidences in 2016–17 were 67.3, 41.9 and 48.8 per 1,000 population per year for Nueva Vizcaya, Palawan and Tarlac respectively. Incidences were around 50% higher amongst those under 15 years of age, compared to -those older than 15. Household awareness of the nearest ABTCs was generally over 80%, but only 44.9% sought proper medical treatment and traditional remedies were still frequently used. The proportion of patients seeking PEP was not related to the distance or travel time to the nearest ABTC. For those that did not seek medical treatment, most cited a lack of awareness or insufficient funds and almost a third visited a traditional healer. No deaths from bite/scratch injuries were reported. A cohort of 1,105 patients were interviewed at six ABTCs in early 2017. OOPE varied across the ABTCs, from 5.53 USD to 37.83 USD per patient, primarily dependent on the need to pay for immunization if government supplies had run out. Overall, 78% of patients completed the recommended course, and the main reason for non-completion was a lack of time, followed by insufficient funds. Dog observation data revealed that 85% of patients were not truly exposed to rabies, and education in bite prevention might reduce provoked bites and demand for PEP. An accompanying paper details the ABTC network from the health provider’s perspective. [ABSTRACT FROM AUTHOR]

Background: Hookworm-related cutaneous larva migrans (HrCLM) is a neglected parasitic skin disease, widespread in resource-poor communities in tropical and subtropical countries. Incidence and risk factors have never been investigated in a cohort study. Methodology/Principal findings: To understand the seasonal epidemiology of HrCLM, an open cohort of 476 children in a resource-poor community in Manaus, Brazil was examined for HrCLM monthly over a period of 6 months. Monthly prevalence and intensity of infection were correlated with the amount of monthly precipitation. Multivariable Cox regression analysis indicated male sex (hazard ratio [HR] 3.29; 95% confidence interval [CI] 1.95–5.56), walking barefoot on sandy ground (HR 2.30; 95% CI 1.03–5.16), poverty (HR 2.13; 95% CI 1.09–4.17) and age between 10 and 14 years (HR 1.87; 95% CI 1.01–3.46) as predictors of HrCLM. Monthly incidence rates ranged between 0.21 and 1.05 cases per person-year with an overall incidence of 0.52 per person-year. Conclusions/Significance: HrCLM is a frequent parasitic skin disease in this resource-poor community. Every second child theoretically becomes infected during one year. Boys, 10 to 14 years old, belonging to the poorest households of the community, are the most vulnerable population group. Even in the tropical monsoonal climate of Amazonia there is a considerable seasonal variation with monthly incidence and number of lesions peaking in the rainy season. [ABSTRACT FROM AUTHOR]