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Depression is the leading cause of disability worldwide. However, it is under recognized and undertreated. Self-rated health is a one-item question that has been used for population health monitoring. It was aimed to examine the prospect of using ‘self-rated health’ (SRH) in identifying people with depression among adult community-based population in Bangladesh over a one-year period controlling for socio-demographic, chronic diseases and symptoms, physical disability, smoking, and life events. We examined data from 3455 participants aged 18 years and above who participated in the 2015 January and 2016 January Health and Socio-Economic Survey of Independent University, Bangladesh. Using multiple logistic regressions, depression at baseline was examined to predict self-rated health at one-year follow-up adjusting for socio-demographic variables, chronic diseases, risk behaviors, and life events. Respondents with depression at baseline had 35% higher odds of reporting poor SRH in the follow-up round compared to those with no depression (OR=1.35, 95% CI=1.03 1.78, P

Digital, OBJECTIVE We aimed to compare cardiovascular (CV) events, all-cause mortality, and CV mortality rates among adults with and without diabetes in countries with differing levels of income. RESEARCH DESIGN AND METHODS The Prospective Urban Rural Epidemiology (PURE) study enrolled 143,567 adults aged 35–70 years from 4 high-income countries (HIC), 12 middle-income countries (MIC), and 5 low-income countries (LIC). The mean follow-up was 9.0 6 3.0 years. RESULTS Among those with diabetes, CVD rates (LIC 10.3, MIC 9.2, HIC 8.3 per 1,000 personyears, P < 0.001), all-cause mortality (LIC 13.8, MIC 7.2, HIC 4.2 per 1,000 personyears, P < 0.001), and CV mortality (LIC 5.7, MIC 2.2, HIC 1.0 per 1,000 person-years, P < 0.001) were considerably higher in LIC compared with MIC and HIC. Within LIC, mortality was higher in those in the lowest tertile of wealth index (low 14.7%, middle 10.8%, and high 6.5%). In contrast to HIC and MIC, the increased CV mortality in those with diabetes in LIC remained unchanged even after adjustment for behavioral risk factors and treatments (hazard ratio [95% CI] 1.89 [1.58–2.27] to 1.78 [1.36–2.34]). CONCLUSIONS CVD rates, all-cause mortality, and CV mortality were markedly higher among those with diabetes in LIC compared with MIC and HIC with mortality risk remaining unchanged even after adjustment for risk factors and treatments. There is an urgent need to improve access to care to those with diabetes in LIC to reduce the excess mortality rates, particularly among those in the poorer strata of society., Ciencias Médicas y de la Salud

Objectives: We aimed to compare cardiovascular (CV) events, all-cause and CV mortality rates, among adults with and without diabetes in countries with differing levels of income. Research design and methods: Prospective Urban Rural Epidemiological (PURE) enrolled 143,567 adults aged 35 to 70 years from 4 high income countries (HIC), 12 middle income countries (MIC) and 5 low income countries (LIC). The mean follow-up was 9.0±3.0 years. Results: Among those with diabetes, CVD rates (LIC 10.3, MIC 9.2, HIC 8.3 per 1000 person years, p Conclusions: CVD rates, all-cause and CV mortality were markedly higher among those with diabetes in LIC compared to MIC and HIC with mortality risk remaining unchanged even after adjustment for risk factors and treatments. There is an urgent need to improve access to care to those with diabetes in LIC to reduce the excess mortality rates, particularly among those in the poorer strata of society.

Maternal health care seeking behavior (HSB) is a vital determinant of the overall maternal and child health of a country. The present study, which focused on women's autonomy as an important factor in the care-seeking behavior of women, is based on data from BDHS 2014, a nationally representative survey in Bangladesh. A total of 17,863 ever-married women (age 15 years and older) were enrolled in the study. Results showed that, after we controlled for all other predictive variables, higher autonomy status of women remained significantly associated with HSB (OR 1.31, CI 1.025, 1.674). Eliminating disparities in social class and stigma and challenging traditional and religious beliefs through mass media may help to alleviate the unmet health seeking.

The present study examines changes in defense maturity from mid to late life using data from an over 70-year longitudinal study. A sample of 72 men was followed beginning in late adolescence. Participants' childhoods were coded for emotional warmth. Defense mechanisms were coded by independent raters using the Q-Sort of Defenses (Roston et al., 1992, Ego mechanisms of defense: A guide for clinicians and researchers 217–233) based on interview data gathered at approximately ages 52 and 75. We examined psychosocial correlates of defenses at midlife, late life, and changes in defense from mid to late life. Overall, defenses grew more adaptive from midlife to late life. However, results differed on the basis of the emotional warmth experienced in the participants' childhoods. In midlife, men who experienced warm childhoods used more adaptive (mature) defenses; yet by late life, this difference in defensive maturity had disappeared. Men who experienced less childhood warmth were more likely to show an increase in adaptive defenses during the period from mid to late life.

We have gone from lamenting health professional out-migration from the developing world to welcoming it, recognizing that there is substantial potential for promoting health sector development in the developing world via the transfer of financial and social capital from health professional diasporas. In the case of Bangladesh, actualizing this potential requires changes both abroad and at home. Diaspora health professional organizations have to significantly expand their membership base and systematically identify members with appropriate skill sets and match them with Bangladeshi institutional partners. On the Bangladeshi side, what is required is (i) strategies to change prevailing attitudes about brain drain and significantly increase the size of the health professional diaspora and (ii) a clear articulation of gaps and needs, coupled with the active recruitment of diaspora professionals by the provision of positive incentives and the removal of bureaucratic and legal hurdles that constrain effective c...

Purpose: This study examines the value of selfreported health (SRH) as an indicator of underlying health status in a developing country setting. Design and Methods: Logistic regression methods with adjustments for multistage sampling are used to examine the factors associated with SRH in 2,921 men and women aged 50 and older in rural Bangladesh. Results: SRH incorporates multiple dimensions of health status (including physical disability assessed by measured physical performance; selfreported limitations in activities of daily living, or ADLs; self-reported chronic morbidity; and selfreported acute morbidity), severity, comorbidity, and trajectory in a similar fashion for both men and women and for different age groups. Older individuals are more likely to report poor SRH than their younger counterparts, and women report significantly worse SRH than their male peers at each age group. In both cases, this disadvantage can be fully accounted for by differences in measured physical performance, ADL limitations, and chronic and acute morbidity. Implications: Among older Bangladeshis, SRH is an easily recorded, multifaceted, nuanced indicator of underlying health status that is significantly associated with measured physical performance. Moreover, SRH appears to be independent of age- and gender-related norms.

This study uses high quality longitudinal data on kin availability, proximity, and marital status from the Matlab surveillance area in rural Bangladesh to explore the impact of kin members on the survival of the elderly over a six year period. The results - from discrete time hazard models- suggest that the presence of a spouse, sons, and brothers substantially improves survivorship, but with differing effects by the sex of the elderly and the number of sons and brothers. This study offers little support of any of the following as mechanisms by which kin affect the survival of the elderly: changes in the economic status of the elderly as proxied by land holdings; improved access to instrumental support as proxied by the marital status of sons; decreases in social isolation as proxied by proximity of kin.

ObjectiveThe goal of the present study was to examine the influence of community environment on the nutritional status (weight-for-age and height-for-age) of children (aged 0–59 months) in Bangladesh. In addition, we tested the association between specific characteristics of community environments and child nutritional status.DesignCross-sectional survey.SettingThe data are from the nationally representative 2004 Bangladesh Demographic and Health Survey.SubjectsRespondents were ever-married women (aged 15–49 years) and their children (n 5731), residing in 361 communities. Child nutritional outcomes are physical measurements of weight-for-age and height-for-age in sd units. We considered the following attributes of community environments potentially related to child nutrition: (i) community water and sanitation infrastructure; (ii) availability of community health and education services; (iii) community employment and social participation; and (iv) education level of the community.ResultsMultilevel regression analysis showed that the spatial distribution of maternal and child covariates did not entirely explain the between-community variation in child nutritional status. The education level of the community emerged as the strongest community-level predictor of child height-for-age (highest v. lowest tertile, β = 0·18 (se 0·07)) and weight-for-age (highest v. lowest tertile, β = 0·21 (se 0·06)). In the height-for-age model, community employment and social participation also emerged as being statistically significant (highest v. lowest tertile, β = 0·13 (se = 0·06)).ConclusionsThe community environment influences child nutrition in Bangladesh, and maternal- and child-level covariates may fail to capture the entire influence of communities. Interventions to reduce child undernutrition in developing countries should take into consideration the wider community context.

This paper uses prospective data from the Matlab surveillance system in rural Bangladesh to demonstrate that initially co-resident spouses and sons have a major impact on the subsequent mortality of old people, with significant differences by the sex of the elderly person, and the age of the son. Spouses significantly reduce mortality by similar magnitudes for both elderly men and women. On the other hand, co-resident adult sons reduce mortality for elderly women much more than for elderly men, with younger sons being more beneficial than older sons. Furthermore, both married and unmarried females appear to benefit equally from co-resident adult sons. Finally, this analysis suggests that the impact of spouses and sons on mortality in old age is not substantially mediated through changes in elderly economic status.This study uses a prospective data with a large sample size from rural Bangladesh to examine the impact of co-resident spouses and sons on the subsequent mortality of old people, with significant differences depending on the sex of the elderly person and the age of the son. Findings revealed that spouses significantly reduce mortality by similar magnitudes for both elderly men and women. On the other hand, co-resident adult sons reduce mortality for elderly women much more than for elderly men, with younger sons being more beneficial than older sons. Furthermore, both married and unmarried females appear to benefit equally from co-resident adult sons. In conclusion, it is clear that in the study population, the presence of co-resident sons and spouses acts in a complex way to affect mortality in old age, with elderly women being particularly vulnerable to these effects. No single mechanism can fully explain the varying impact of spouses and sons. Not only may different mechanisms (protection through increased social integration/enhanced stress buffering/improved information networks, protection through improved economic status, and selection into co-residences on the basis of health status) be operative in the case of spouses versus son, but more than one mechanism may be responsible in each case.