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The coronavirus disease 2019 (COVID-19) pandemic has resulted in rapid and drastic changes to daily lives, posing a threat to residents' mental health and well-being. Filipinos are disproportionately impacted by COVID-19 and have one of the highest COVID-19 prevalence in Hawai'i. The COVID-19 pandemic has been associated with a rise in mental health concerns, yet little is known about the impact on the mental health of Filipinos in Hawai'i. Using publicly available polling data from the SMS Community Pulse Survey, this study sought to describe the mental distress experienced by Filipino residents during the COVID-19 pandemic. Data were collected from an online panel of Hawai'i residents over 4 timepoints (May 5-10; June 11-17; July 31-August 8; October 19-31, 2020). Compared to non-Filipinos, a higher proportion of Filipinos reported feeling stress and sadness during 3 of the 4 timepoints. Across all timepoints, Filipinos were more likely to respond affirmatively to mental health indicators (62.5%). Similarly, Filipinos reported food insecurity in higher proportions relative to non-Filipinos in most timepoints, particularly notable in Timepoint 4 where 33.0% of Filipino respondents reported food insecurity. These findings suggest that Filipinos would benefit from social policy and community-supported initiatives to address social determinants of health, reduce chronic stress, and prevent further mental health disparities. [ABSTRACT FROM AUTHOR]

Physical activity (PA) among older adults is understudied in middle-income countries. The authors examined the associations of factors across levels of the social ecological model (individual, interpersonal, organizational, and community) with older adults meeting guidelines of 150 min of moderate- to vigorous-intensity PA per week through walking in three middle-income countries: Albania (n = 387), Colombia (n = 404), and Brazil (n = 402). Using 2012 International Mobility in Aging Study data, multivariate logistic regression models identified the following significant associations with meeting PA guidelines through walking (a) individual level: depression (odds ratio [OR] = 0.62, 95% confidence interval, CI [0.45, 0.86]), being female (OR = 0.74, 95% CI [0.56, 0.998]), and high relative education (OR = 1.79, 95% CI [1.33, 2.41]) and (b) interpersonal level: high life partner (OR = 1.38, 95% CI [1.04, 1.83]) and friend social ties (OR = 1.39, 95% CI [1.05, 1.83]). While individual and interpersonal variables were associated with meeting PA guidelines, community-level social and environmental variables were not. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Inuit in Canada experience alarming levels of food insecurity, but nutritional and physiological consequences are poorly documented, especially in school-age children. The objective of this study was to assess the relation of food insecurity to iron deficiency and stature in school-aged Inuit children from Nunavik (Northern Quebec). METHODS: Food insecurity, iron deficiency, and stature were assessed in a cohort of children. Food insecurity was determined by interviewing the children's mothers. Multiple logistic regression was used to evaluate the association of food insecurity to iron deficiency and short stature. We defined short stature as a height in the lowest tertile for age and sex, based on Canadian growth charts. The relation of food insecurity to height (cm) was analyzed with a general linear model. Statistical models controlled for age, sex, normal/overweight/obese status, prenatal lead exposure and postnatal polychlorinated biphenyls exposure. RESULTS: Half of the children (49.7%, n=145) were food insecure, while one third were iron depleted, 12.6% had anaemia, and 8.7% had irondeficiency anaemia. The multivariate odds ratio of anaemia was 1.82 (95% CI: 0.97, 3.42, p=0.06) for food-insecure children. Prevalence of short stature was 18.7%. Food-insecure children were an average of 2 cm shorter (95% CI: -0.48, -3.17) than food-secure children (p CONCLUSION: In this population, food-insecure children have greater burdens of nutritional deficiencies and slower linear growth. Considering the high prevalence of food insecurity among Inuit children in Nunavik, nutritional deficiencies and adverse effects on development should be carefully monitored. KEY TERMS: Food insecurity; nutritional deficiencies; iron; growth; children; indigenous health OBJECTIFS: Les Inuits du Canada presentent des niveaux d'insecurite alimentaire alarmants dont les consequences nutritionnelles et physiologiques sont meconnues, surtout chez les enfants d'age scolaire. L'objectif de notre etude etait d'evaluer la relation entre l'insecurite alimentaire, d'une part, et la carence en fer et la taille, d'autre part, chez les enfants inuits du Nunavik (Nord-du-Quebec) en age de frequenter l'ecole. METHODE: Nous avons evalue l'insecurite alimentaire, la carence en fer et la taille dans une cohorte d'enfants. L'insecurite alimentaire a ete determinee en interviewant les meres des enfants. Par regression logistique multiple, nous avons evalue l'association entre l'insecurite alimentaire et la carence en fer et la petite taille. Nous avons defini la petite taille comme etant la taille dans le tertile inferieur pour l'age et le sexe, selon les fiches de croissance canadiennes. Le rapport entre l'insecurite alimentaire et la taille (en centimetres) a ete analyse selon un modele lineaire general. Des modeles statistiques ont permis de rajuster les donnees selon l'age, le sexe, le poids normal/le surpoids/l'obesite, l'exposition prenatale au plomb et l'exposition postnatale aux biphenyles polychlores. RESULTATS: La moitie des enfants (49,7%, n=145) etaient confrontes a l'insecurite alimentaire, le tiers des enfants etaient carences en fer, 12,6% faisaient de l'anemie, et 8,7% presentaient une anemie ferriprive. Le rapport de cotes multivarie de l'anemie etait de 1,82 (IC de 95%: 0,97, 3,42, p=0,06) chez les enfants confrontes a l'insecurite alimentaire. La prevalence de la petite taille etait de 18,7%. Les enfants touches par l'insecurite alimentaire mesuraient en moyenne 2 cm de moins (IC de 95%: -0,48, -3,17) que les enfants epargnes par l'insecurite alimentaire (p CONCLUSION: Dans cette population, les enfants confrontes a l'insecurite alimentaire avaient un plus lourd fardeau de carences alimentaires et une croissance lineaire plus lente. Etant donne la forte prevalence de l'insecurite alimentaire chez les enfants inuits du Nunavik, les carences alimentaires et leurs effets indesirables sur le developpement devraient etre suivis attentivement. MOTS CLES: insecurite alimentaire; carences alimentaires; fer; croissance; enfant; sante autochtone, Food insecurity attains alarming levels in Inuit populations of northern Canada. (1) Measures of food insecurity traditionally encompass concepts of availability and access to sufficient food, as well as food [...]

Abstract Background In Mali and Senegal, over 1% of women die giving birth in hospital. At some hospitals, over a third of infants are stillborn. Many deaths are due to substandard medical practices. Criterion-based clinical audits (CBCA) are increasingly used to measure and improve obstetrical care in resource-limited settings, but their measurement properties have not been formally evaluated. In 2011, we published a systematic review of obstetrical CBCA highlighting insufficient considerations of validity and reliability. The objective of this study is to develop an obstetrical CBCA adapted to the West African context and assess its reliability and validity. This work was conducted as a sub-study within a cluster randomized trial known as QUARITE. Methods Criteria were selected based on extensive literature review and expert opinion. Early 2010, two auditors applied the CBCA to identical samples at 8 sites in Mali and Senegal (n = 185) to evaluate inter-rater reliability. In 2010–11, we conducted CBCA at 32 hospitals to assess construct validity (n = 633 patients). We correlated hospital characteristics (resource availability, facility perinatal and maternal mortality) with mean hospital CBCA scores. We used generalized estimating equations to assess whether patient CBCA scores were associated with perinatal mortality. Results Results demonstrate substantial (ICC = 0.67, 95% CI 0.54; 0.76) to elevated inter-rater reliability (ICC = 0.84, 95% CI 0.77; 0.89) in Senegal and Mali, respectively. Resource availability positively correlated with mean hospital CBCA scores and maternal and perinatal mortality were inversely correlated with hospital CBCA scores. Poor CBCA scores, adjusted for hospital and patient characteristics, were significantly associated with perinatal mortality (OR 1.84, 95% CI 1.01-3.34). Conclusion Our CBCA has substantial inter-rater reliability and there is compelling evidence of its validity as the tool performs according to theory. Trial registration Current Controlled Trials ISRCTN46950658

Abstract Until 2010, Burkina Faso was an exception to the international trend of abolishing user fees for antiretroviral treatment (ART). Patients were still expected to pay 1,500F CFA (2 Euros) per month for ART. Nevertheless, many non-governmental organizations (NGOs) exempted patients from payment. The objective of this study was to investigate how NGOs selected the beneficiaries of payment exemptions for government-provided ART and rationed out complementary medical and psychosocial services. For this qualitative study, we conducted 13 individual interviews and three focus group discussions (n = 13 persons) with program staff in nine NGOs (4,000 patients), two NGO coordinating structures and one national program. These encounters were recorded and transcribed, and their content was thematically analyzed. The results were presented to the NGOs for feedback. Results indicate that there are no concrete guidelines for identifying patients warranting payment exemptions. Formerly, ART was scarce in Burkina Faso and the primary criterion for treatment selection was clinical. Our results suggest that this scarcity, mediated by an approach we call sociotherapeutic rationality (i.e. maximization of clinical success), may have led to inequities in the provision of free ART. This approach may be detrimental to assuring equity since the most impoverished lack resources to pay for services that maximize clinical success (e.g. viral load) that would increase their chances of being selected for treatment. However, once selected into treatment, attempts were made to ration-out complementary services more equitably. This study demonstrates the risks entailed by medication scarcity, which presents NGOs and health professionals with impossible choices that run counter to the philosophy of equity in access to treatment. Amid growing concerns of an international funding retreat for ART, it is important to learn from the past in order to better manage the potentially inequitable consequences of ART scarcity.