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Background Maternal nutrition is crucial for health in pregnancy and across the generations. Experiencing food insecurity during pregnancy is a driver of inequalities in maternal diet with potential maternal and infant health consequences. This systematic review explored associations between food insecurity in pregnancy and maternal and infant health outcomes. Methods and findings Searches included 8 databases (MEDLINE, Embase, Scopus, Web of Science, PsychInfo, ASSIA, SSPC in ProQuest, and CINAHL), grey literature, forwards and backwards citation chaining, and contacting authors. Studies in high-income countries (HICs) reporting data on food insecurity in pregnancy and maternal or infant health, from January 1, 2008 to November 21, 2023 were included. Screening, data extraction, and quality assessment were carried out independently in duplicate. Random effects meta-analysis was performed when data were suitable for pooling, otherwise narrative synthesis was conducted. The protocol was registered on PROSPERO (CRD42022311669), reported with PRISMA checklist (S1 File). Searches identified 24,223 results and 25 studies (n = 93,871 women) were included: 23 from North America and 2 from Europe. Meta-analysis showed that food insecurity was associated with high stress level (OR 4.07, 95% CI [1.22, 13.55], I.sup.2 96.40%), mood disorder (OR 2.53, 95% CI [1.46, 4.39], I.sup.2 55.62%), gestational diabetes (OR 1.64, 95% CI [1.37, 1.95], I.sup.2 0.00%), but not cesarean delivery (OR 1.42, 95% CI [0.78, 2.60], I.sup.2 56.35%), birth weight (MD -58.26 g, 95% CI [-128.02, 11.50], I.sup.2 38.41%), small-for-gestational-age (OR 1.20, 95%, CI [0.88, 1.63], I.sup.2 44.66%), large-for-gestational-age (OR 0.88, 95% CI [0.70, 1.12] I.sup.2 11.93%), preterm delivery (OR 1.18, 95% CI [0.98, 1.42], I.sup.2 0.00%), or neonatal intensive care (OR 2.01, 95% CI [0.85, 4.78], I.sup.2 70.48%). Narrative synthesis showed food insecurity was significantly associated with dental problems, depression, anxiety, and maternal serum concentration of perfluoro-octane sulfonate. There were no significant associations with other organohalogen chemicals, assisted delivery, postpartum haemorrhage, hospital admissions, length of stay, congenital anomalies, or neonatal morbidity. Mixed associations were reported for preeclampsia, hypertension, and community/resilience measures. Conclusions Maternal food insecurity is associated with some adverse pregnancy outcomes, particularly mental health and gestational diabetes. Most included studies were conducted in North America, primarily the United States of America, highlighting a research gap across other contexts. Further research in other HICs is needed to understand these associations within varied contexts, such as those without embedded interventions in place, to help inform policy and care requirements., Author(s): Zoë Bell 1,2,*, Giang Nguyen 1,3,*, Gemma Andreae 1, Stephanie Scott 1,3, Letitia Sermin-Reed 1, Amelia A. Lake 3,4, Nicola Heslehurst 1,3 Introduction Food insecurity is 'the limited or [...]

CONTEXT: The COVID-19 pandemic highlights the importance of strong public health (PH) and primary health care (PHC) systems to respond nimbly and effectively during times of crisis. Both play a crucial role in triage and prevention, management, vaccination, and communication. PH and PHC systems, however, often act in parallel streams, but rarely together. OBJECTIVE: This study aims to describe PH and PHC collaboration during the COVID-19 pandemic in eight high-income countries. METHODS: In-depth case study reports were generated for each country or jurisdiction. Reports searched both peer-review publications and grey literature on five dimensions identified by the World Health Organization regarding COVID-19 management. Reports included country-specific health system descriptions, PH and PHC actions during the pandemic, and an evaluation of strengths and weaknesses. Expert validation was conducted by internal country stakeholders prior to cross-jurisdiction analyses. ANALYSIS: Thematic content analysis was conducted on all reports to develop a coding framework. Codes were identified that were relevant to the research questions. The study team discussed and reconciled discrepancies in themes until consensus was reached. RESULTS: Data was collected from eight high-income countries (Belgium, Canada, Germany, Italy, Japan, the Netherlands, Norway, and Spain) from March 2020 to July 2021. Four key themes were identified along with respective strengths/weaknesses. 1) Health information systems: this played a critical role for disease containment and management when designed for efficient data management and cross-sectoral data-sharing. 2) Communication: In countries where PHC was engaged early on, PH messages were amplified; in other countries, a lack of cohesion in communication resulted in poor or delayed community-level responses. 3) Human resource capacity: Health human resources were overwhelmed, with many staff redeployed and undertrained. 4) Professional training: Health professionals who received dual training in PH and PHC acted as strong community champions and may be a bridge for future pandemics. CONCLUSION: Health system needs shifted dramatically throughout the COVID-19 pandemic. Our findings highlight four key lessons regarding PH and PHC collaboration from eight high-income countries. Future pandemic preparedness should focus on health information systems and data management, PH communication, health human resources, and education and training., Presenters Jane Zhao, MSc, Carnelle Lawes, MPH, BSW, Dorien Vanden Bossche, Sara Willems, PhD, Ayu Pinky Hapsari, MSc, Sara Ares Blanco, Maria Pilar Astier Pena, MD, PhD, Peter Decat, Naoki [...]

The Coronavirus Disease 2019 (COVID-19) pandemic has changed many social, economic, environmental and healthcare determinants of health. We applied an ensemble of 16 Bayesian models to vital statistics data to estimate the all-cause mortality effect of the pandemic for 21 industrialized countries. From mid-February through May 2020, 206,000 (95% credible interval, 178,100-231,000) more people died in these countries than would have had the pandemic not occurred. The number of excess deaths, excess deaths per 100,000 people and relative increase in deaths were similar between men and women in most countries. England and Wales and Spain experienced the largest effect: ~100 excess deaths per 100,000 people, equivalent to a 37% (30-44%) relative increase in England and Wales and 38% (31-45%) in Spain. Bulgaria, New Zealand, Slovakia, Australia, Czechia, Hungary, Poland, Norway, Denmark and Finland experienced mortality changes that ranged from possible small declines to increases of 5% or less in either sex. The heterogeneous mortality effects of the COVID-19 pandemic reflect differences in how well countries have managed the pandemic and the resilience and preparedness of the health and social care system. Application of Bayesian models to vital statistics data from 21 industrialized countries shows that approximately 206,000 additional people died than if the COVID-19 pandemic had not occured. The heterogeneous distribution of excess deaths across the countries reflects differences in how the pandemic has been managed as well as the resilience of healthcare systems in these nations., Author(s): Vasilis Kontis [sup.1] , James E. Bennett [sup.1] , Theo Rashid [sup.1] , Robbie M. Parks [sup.2] [sup.3] , Jonathan Pearson-Stuttard [sup.1] , Michel Guillot [sup.4] [sup.5] , Perviz [...]

Author(s): Beryne Odeny *, Raffaella Bosurgi Colonial science, also known as parachute or parasitic science, is an extractive practice whereby researchers-typically from highly resourced countries-do research and extract data and [...]

In this study we used receiver-operating characteristic (ROC) analysis to comparatively evaluate maternal periodontal parameters to predict preterm (PB) delivery and low birth weight (LBW) delivery among Jordanian women. A total of 277 pregnant women (20 weeks of gestation or less) had periodontal examination at baseline and followed up until delivery. Gestational age and birth weight were retrieved from their medical records. ROC curve analyses were used to examine the overall discriminatory power of the studied periodontal parameters to predict PB, LBW, and PB or LBW. For the three outcome variables, the area under curve (AUC) ranged from 0.84 to 0.87 for average clinical attachment level (CAL), 0.78-0.86 for percent of sites with CAL ≥ 5 mm, 0.63-0.74 for percent of sites with CAL ≥ 6 mm, and 0.71-0.82 for number of missing teeth indicating that they had high discriminating power to predict adverse pregnancy outcomes. All other parameters had AUC less than 0.60 and thus had low discriminating power. Average CAL performed the best in predicting the studied adverse pregnancy outcomes because it has the highest AUC. The severity and extent of periodontal disease as measured by CAL can be used to predict the occurrence of adverse pregnancy outcomes. Keywords Preterm birth * Low birth weight * Clinical attachment loss * Number of teeth * Receiver-operating characteristic curve * Periodontal disease, Introduction Preterm low birth weight (PLBW) is a major clinical problem contributing to 80% of perinatal mortality and 50% of neurologic problems in the neonatal period in developed countries [1]. [...]

The broad goal of contemporary prenatal care is to promote the health of the mother, child, and family through the pregnancy, delivery, and the child's development. Although the vast majority of mothers giving birth in developed countries receive prenatal care, past research has not found compelling evidence that early or adequate prenatal care has favorable effects on birth outcomes. It is possible that prenatal care confers health benefits to the child that do not become apparent until after the perinatal period. Using data from a national urban birth cohort study in the US, we estimate the effects of prenatal care on four markers of child health at age 5--maternal-reported health status, asthma diagnosis, overweight, and height. Prenatal care, defined a number of different ways, does not appear to have any effect on the outcomes examined. The findings are robust and suggest that routine health care encounters during the prenatal period could potentially be used more effectively to enhance children's health trajectories. However, future research is needed to explore the effects of prenatal care on additional child health and developmental outcomes as well as the effects of preconceptional and maternal lifetime healthcare on child health. Keywords Prenatal care timing * Prenatal care adequacy * Child health outcomes, Introduction Standard prenatal care involves a series of encounters during the gestational period, educates women about pregnancy, monitors medical conditions, tests for gestational health problems, and refers expectant mothers to [...]

To assess women's experience of public antenatal care (ANC) services and reasons for late antenatal care attendance in inner-city Johannesburg, South Africa. This cross-sectional study was conducted at three public labour wards in Johannesburg. Interviews were conducted with 208 women who had a live-birth in October 2009. Women were interviewed in the labour wards post-delivery about their ANC experience. Gestational age at first clinic visit was compared to gestational age at booking (ANC service provided). ANC attendance was high (97.0 %) with 46.0 % seeking care before 20 weeks gestation (early). Among the 198 women who sought care, 19.2 % were asked to return more than a month later, resulting in a 3-month delay in being booked into the clinic for these women. Additionally 49.0 % of women reported no antenatal screening being conducted when they first sought care at the clinic. Delay in recognizing pregnancy (21.7 %) and lack of time (20.8 %) were among the reasons women gave for late attendance. Clinic booking procedures and delays in diagnosing pregnancy are important factors causing women to access antenatal care late. In a country where a third of pregnant women are HIV infected, early ANC is vital in order to optimise ART initiation and thereby reduce maternal mortality and paediatric HIV infection. It is therefore imperative that existing antenatal care policies are implemented and reinforced and that women are empowered to demand better services. Keywords Antenatal care * South Africa * Late ANC access * ANC booking experience * PMTCT * HIV, Introduction The maternal mortality ratio (MMR) and infant mortality rate (IMR) in South Africa are high at 410 per 100,000 live births and 56 per 1,000 live births respectively [1]. [...]

Recent research has shown that after long-term declining trends are excluded, mortality rates in industrial countries tend to rise in economic expansions and fall in economic recessions. In the present work, co-movements between economic fluctuations and mortality changes in postwar Japan are investigated by analyzing time series of mortality rates and eight economic indicators. To eliminate spurious associations attributable to trends, series are detrended either via Hodrick-Prescott filtering or through differencing. As previously found in other industrial economies, general mortality and age-specific death rates in Japan tend to increase in expansions and drop in recessions, for both males and females. The effect, which is slightly stronger for males, is particularly noticeable in those aged 45-64. Deaths attributed to heart disease, pneumonia, accidents, liver disease, and senility--making up about 41% of total mortality--tend to fluctuate procyclically, increasing in expansions. Suicides, as well as deaths attributable to diabetes and hypertensive disease, make up about 4% of total mortality and fluctuate countercyclically, increasing in recessions. Deaths attributed to other causes, making up about half of total deaths, don't show a clearly defined relationship with the fluctuations of the economy.

ABSTRACT Wealthy, industrialized countries of the developed world successfully underwent the 'epidemiologic transition' from infectious diseases to degenerative diseases, but developing countries have not yet achieved that transition. This article [...]

Background Adherence to highly active antiretroviral therapy (HAART) medication is the greatest patient-enabled predictor of treatment success and mortality for those who have access to drugs. We systematically reviewed the [...]

In industrialized countries where HIV infection is becoming a chronic, episodic condition, rehabilitation services have the potential to play an expanded role for people living with HIV/AIDS (PLHAs). However, little is known about rehabilitation in the context of HIV. This paper documents the development of an enhanced, multidisciplinary conceptual framework of rehabilitation in the context of HIV, using the perceptions of PLHAs and rehabilitation professionals. Rehabilitation, broadly defined, is a dynamic process that includes all prevention and/or treatment activities and/or services that address body impairments, activity limitations and participation restrictions for an individual. The framework was developed through broad consultation and interviews with thirteen key informants. Themes that emerged from analysis of interviews related to concepts of rehabilitation in the context of HIV, rehabilitation professionals' roles in the context of HIV, and barriers to access and delivery of rehabilitation services. While there was some variation, key informants generally viewed rehabilitation as a goal-oriented and client-centered process with the potential to impact a range of life domains. Themes were presented to members of a national advisory committee (including PLHAs and health care providers), who produced the foundation of the HIV rehabilitation framework. The framework uses the perspective of the person living with HIV/AIDS, and includes individual life domains that may be affected by HIV, drawing and expanding upon the World Health Organization's (WHO's) International Classification of Functioning, Disability and Health.

In this paper we highlight what we consider to be a lack of adequate conceptualisation, operationalisation and measurement of 'place effects'. We briefly review recent historical trends in the study of the effects of place on health in industrial countries, and argue that 'place effects' often appear to have the status of a residual category, an unspecified black box of somewhat mystical influences on health which remain after investigators have controlled for a range of individual and place characteristics. We note that the distinction between 'composition' and 'context' may be more apparent than real, and that features of both material infrastructure and collective social functioning may influence health. We suggest using a framework of universal human needs as a basis for thinking about how places may influence health, and recommend the testing of hypotheses about specific chains of causation that might link place of residence with health outcomes. Keywords: Place; Area effects; Compositional explanations; Contextual explanations; Collective social functioning; Universal human needs

Objective: To measure the distribution of self-reported health by income in order to compare the level of health inequality in Australia with other industrialized countries. Method: Using data from the two National Health Surveys undertaken in 1989-90 and 1995, concentration indexes were calculated to quantify the distribution of self-reported health by equivalent income. The concentration index for Australia was compared with those reported for nine industrialized countries in Europe and North America. Results: The estimated income-related concentration indexes were -0.1172 in 1989-90 and -0.1094 in 1995. Conclusion: The level of health inequality is not significantly different from the US or the UK, but significantly greater than seven other European nations. Implications: Australia has significant income related health inequalities and the distribution of health appears to be more unequal than in many other industrialized nations. There is a need to further investigate and quantify those features of the anglophone societies that set them apart from some other industrialized nations.

A major element in the accepted philosophy of the cancer medical establishment, is an assumption that cancer ran rampant among traditional people to as great an extent, if not greater, than that of modern industrial society, and as such is largely an unavoidable disease. But can such an assumption, so vital for the legitimization of a medical philosophy based on accommodation, rather than the prevention, of ill-health, be justified?, The 'health' of industrialized economies no longer represents the health of societies on which that ubiquitous Western economic model has been imposed. On the contrary, economic growth as a process [...]

A number of studies have suggested that inequalities in the distribution of income may be an important cause of variations in the average level of population health among rich industrial nations. However, what is missing from the debate so far is any systematic review of evidence about the relationship between different measures of income distribution and indicators of population health. This paper aims to bridge that gap. First, it summarizes the recent English language literature on this topic and illustrates the methodological problems that weaken the inferences that can be derived from it. Secondly, it presents new empirical estimates of the relationship between different measures of income distribution, infant mortality and life expectancy based on the most authoritative data published to date. In contrast to most earlier studies, we find very little support for the view that income inequality is associated with variations in average levels of national health in rich industrial countries. Some possible explanations for these differences are outlined. Key words - inequality, income distribution, life expectancy, infant mortality, OECD countries

Iron deficiency prevention should be targeted at those sections of the population in developed countries that are at risk, including migrants, vegetarians, the elderly, pregnant women, adolescents and young children. Iron deficiency is not a great health risk for the general population in developed countries and measures should not be taken to increase iron intake for all, as iron overload poses a health risk for approximately 10% of the white population who are vulnerable to hereditary haemochromatosis. Over 500 million people worldwide have iron deficiency anaemia.

Health-care systems occupy from 6% up to 15% of developed countries' GDPs. Therapeutics, particularly hospital care, occupy the bulk of these expenditures, despite their focus on dealing with disease after it arises. In the 21st century health-care systems will focus on health gains. Therapeutics will have broadened to encompass prevention and treatment, and will be focused on each individual's unique biological, psychological and social needs. Major killers, most particularly heart disease and cancer, will be far more preventable or curable, because of changes in therapeutic paradigms to more holistic approaches as well as important biomedical breakthroughs. There are a variety of negative possibilities, including continued preeminence of the medical model, growing costs, increased inequality in access, and greater poverty and social disintegration. The movement to therapeutics more focused on health gains will be accelerated by a variety of trends, particularly the development by communities in the USA and many other countries of shared visions that guide the evolution of health care in these directions. (Reprinted by permission of the publisher.)

The United States may need to improve health care for children by learning from the lessons of developing countries. The first lesson involves making health care a realistic and simple priority. Compared to poverty and disease overseas, medical care in the United States focuses on technological advancement and the funding of expensive research projects. The emphasis on complex medicine overlooks the needs of the poor. Community efforts towards bridging the gap of crucial services and prevention are just beginning in the United States. To achieve good medical care, families must take charge of their own health and learn problem-solving. That is the second lesson to be learned. For example, challenging ingrained beliefs about the proper care of newborns may actually give way to less sickness and death. The third lesson is to establish health care for all who need it. Poverty can be a motivating, not a defeatist, starting point for developing universal access to medical care everywhere., UNICEF, United Nations International Children's Fund; FHWs, family health workers; WHO, World Health Organization; ORT, oral rehydration therapy; IV, intravenous; CHWs, community health workers. In the past 40 years the [...]

The accumulation of free-living energy expenditure data is vital to the identification of the energy requirements of populations and specific subgroups. Energy expenditure measurements should involve socioeconomic and other nutritional factors of various groups of humans to avoid false estimates. Research in developed countries indicate that food availability is not measured through economic constraints and that energy expenditures are often underreported.

Road traffic-related mortality has traditionally been regarded as a problem primarily of industrialized countries. There is, however, growing evidence of a strong negative relationship between economic development and exposure-adjusted traffic-related [...]

This paper analyzes changes in sex mortality ratios between 1979 and 1987 for adults in 23 developed countries. (A sex mortality ratio is the ratio of male to female death rates.) Previous analyses have shown that during the mid-twentieth century sex mortality ratios increased for all adult age groups. During the 1980s sex mortality ratios continued to increase for 25-34 year olds, but showed mixed trends for other adult age groups. For example, for older adults aged 55-64, sex mortality ratios increased in Southern and Eastern European countries and Japan, but sex mortality ratios decreased in Northern European and Anglophone countries. Trends in several causes of death contributed to these trends in sex mortality ratios. For example, for 25-34 year olds, increases in men's suicide rates and HIV or AIDS mortality contributed to the increases in sex mortality ratios. For older adults, it was hypothesized that decreasing sex differences in cigarette smoking in recent decades would result in decreasing sex differences in lung cancer and ischemic heart disease mortality during the 1980s. The predicted decrease in sex differences in lung cancer mortality was observed in many countries; women had more unfavorable lung cancer mortality trends than men in the Anglophone countries and Northern and Central Western European countries. In contrast, very little evidence was found for the predicted decrease in sex differences in ischemic heart disease. The paper presents additional data concerning the contributions of trends in specific causes of death to changes in sex mortality ratios and briefly reviews evidence concerning probable causes of the observed mortality trends. It appears that recent trends in sex mortality ratios have been influenced by changing sex differences in smoking and a variety of additional factors, such as the effects of improvements in health care interacting with inherent sex differences in vulnerability to ischemic heart disease.