Burden of Diabetic Retinopathy amongst People with Diabetes Attending Primary Care in Kerala: Nayanamritham Project

Background: The burden of diabetic retinopathy (DR) in people attending the public health sector in India is unclear. Thirty percent of the population in India is reliant on public healthcare. This study aimed to estimate the prevalence of DR and its risk factors in people with diabetes in the non-communicable disease registers who were attending the family health centres (FHCs) in the Thiruvananthapuram district in Kerala. Methods: This cross-sectional study was conducted over 12 months in 2019 within the framework of a pilot district-wide teleophthalmology DR screening programme. The age- and gender-adjusted prevalence of any DR and sight-threatening DR (STDR) in the whole sample, considering socio-demography, lifestyle and known clinical risk groups, are reported. Results: A total of 4527 out of 5307 (85.3%) screened in the FHCs had gradable retinal images in at least one eye. The age and gender standardised prevalence for any DR was 17.4% (95% CI 15.1, 19.7), and STDR was 3.3% (95% CI 2.1, 4.5). Ages 41–70 years, males, longer diabetes duration, hyperglycaemia and hypertension, insulin users and lower socio-economic status were associated with both DR outcomes. Conclusions: The burden of DR and its risk factors in this study highlights the need to implement DR screening programs within primary care to reduce health inequality.

‘Care co-ordinator in my pocket’: a feasibility study of mobile assessment and therapy for psychosis (TechCare)

ObjectivesThe aim of the project was to examine the acceptability and feasibility of a mobile phone application-based intervention ‘TechCare’, for individuals with psychosis in the North West of England. The main objectives were to determine whether appropriate individuals could be identified and recruited to the study and whether the TechCare App would be an acceptable intervention for individuals with psychosis.MethodsThis was a mixed methods feasibility study, consisting of a test-run and feasibility evaluation of the TechCare App intervention.SettingEarly Intervention Services (EIS) for psychosis, within an NHS Trust in the North West of England.ParticipantsSixteen participants (test-run n=4, feasibility study n=12) aged between 18 and 65 years recruited from the East, Central and North Lancashire EIS.InterventionA 6-week intervention, with the TechCare App assessing participants’ symptoms and responses in real-time and providing a personalised-guided self-help-based psychological intervention based on the principles of Cognitive Behaviorual Therapy (CBT).ResultsA total of 83.33% (n=10) of participants completed the 6-week feasibility study, with 70% of completers achieving the set compliance threshold of ≥33% engagement with the TechCare App system. Analysis of the qualitative data suggested that participants held the view that the TechCare was both an acceptable and feasible means of delivering interventions in real-time.ConclusionInnovative digital clinical technologies, such as the TechCare App, have the potential to increase access to psychological interventions, reduce health inequality and promote self-management with a real-time intervention, through enabling access to mental health resources in a stigma-free, evidence-based and time-independent manner.Trial registration numberClinicalTrials.gov Identifier: NCT02439619.

Health Inequalities of Intra-Family Expertise Accessibility: Evidence From China

Objectives To investigate whether unequal exposure to health-related expertise of intra-family is the root of health inequality in China, and to explore the underlying mechanisms through which health-related expertise shapes health outcome. Methods In a representative sample of Chinese adults ages over 18 from the 2017 Chinese General Social Survey (CGSS) (n = 3,047 respondents), we use multiple linear regression model and the two-stage least-squares model to analyze the correlation between health-related expertise of intra-family and self-rated health. Results The presence of a health professional (HP) in the family is associated with better self-rated health (SRH), and the effect is more important in rural areas than urban areas. An increased chance of exercising appears to explain a part of the association between HP and SRH. Discussions Health professionals doing for their family members would have the potential to make a substantial dent in population health and reduce health inequality. Future work will need to understand the patterns of intra-family expertise in health (and other) domains, and the potential replicability of this transmission by public policies.

Spatial Health Inequality and Regional Disparities

Geography and the quality of the environment may have long lasting effects on the living standards of individuals and this, in its turn, may affect even substantially the distribution of income and regional disparities. In this paper I consider malaria as a measure of “bad geography” and propose some evidence showing that it was a major determinant of the health of individuals (as measured by the height of conscripts) and its disparities between individuals and regions in Italy. In particular, to estimate the relationship between malaria exposure and height, I rely on the “fetal origins hypothesis”, that is I hypothesize that exposure to malaria in utero or during childhood has persistent effects on health. Periods under scrutiny in this paper are the last two decades of the XIX century, a period without major public health interventions, and the years around the eradication era in the 1950s. My results support the hypothesis that geographically targeted policies may reduce health inequality between regions and within regions.

Introduction to the training exercises

This chapter introduces the handbook spreadsheet training exercises, which are designed to provide hands-on experience in using the methods of distributional cost-effectiveness analysis (DCEA). Seven of the exercises form a cumulative step-by-step sequence relating to nicotine replacement therapy (NRT) in England, which is a classic example of a preventive healthcare programme designed to improve health and reduce health inequality. This allows us to illustrate all the main steps involved in conducting a DCEA using a single common example. There are also two stand-alone exercises relating to other topics in other countries.

Health Literacy and Its Related Factors in Non-Medical College Students

Introduction: Health literacy plays a vital role in health education and health promotion and has received increasing attention as a means to improve health outcomes and reduce health inequality. The students’ awareness of health literacy and their weaknesses in this area are essential for educational planning. Objective: This study aimed to investigate the health literacy of non-medical college students and it’s affecting factors. Materials and Methods: This is a correlational study conducted on 250 non-medical students at the Islamic Azad University of Rasht branch, Rasht City, Iran in the academic year 2018-2019. They were selected using a random sampling method. The data collection tool was the Health Literacy For Iranian Adults (HELIA) questionnaire. The collected data were analyzed using the descriptive and analytical statistics (t-test, the Pearson correlation test, and the Chi-square test). Results: The Mean±SD of the HELIA score was 68.44±12.72 (out of 100). About 6.8% of students had inadequate health literacy, 29.6% problematic health literacy, 54.4% adequate health literacy, and 9.2% excellent health literacy. Students had the highest score in the dimensions of understanding Mean±SD (77.11±15.82) and access Mean±SD (72.35±16.73), while in decision-making and applying health information Mean±SD (55.62±15.01) they had the lowest score. There was no statistically significant correlation between students’ age and health literacy scores, but a statistically significant relationship was reported between their gender and health literacy levels (P=0.049). The Internet (54.8%) and physicians and health workers (27.2%) were the most important sources of information about health for students. Conclusion: Many students lacked sufficient health literacy. Since most of them received information about health issues through the Internet, educational health programs and contents can be provided to them through the Internet and social networks.

Optimal Social Insurance and Health Inequality

This paper integrates into public economics a biologically founded, stochastic process of individual aging. The novel approach enables us to quantitatively characterize the optimal joint design of health and retirement policy behind the veil of ignorance for today and in response to future medical progress. Calibrating our model to Germany, our analysis suggests that the current social insurance policy instruments are set close to the (constrained) socially optimal levels, given proportional contribution rates for health and pension finance, the equivalence principle in the pension system, and a common statutory retirement age. Future progress in medical technology calls for a potentially drastic increase in health spending and a higher retirement age without lowering the pension contribution rate. Interestingly, from an ex ante point of view, medical progress and higher health spending are in conflict with the goal to reduce health inequality.

Housing affordability effects on physical and mental health: household survey in a population with the world’s greatest housing affordability stress

BackgroundWe examined the association of housing affordability with physical and mental health in Hong Kong, where there is a lack of related research despite having the worst housing affordability problem in the world, considering potential mediating effect of deprivation.MethodsA stratified random sample of 1978 Hong Kong adults were surveyed. Housing affordability was defined using the residual-income (after housing costs) approach. Health-related quality of life was assessed by the Short-Form Health Survey version 2 (SF-12v2), from which the physical component summary (PCS) and mental component summary (MCS) measures were derived. Multivariable linear regressions were performed to assess associations of housing affordability with PCS and MCS scores, adjusting for sociodemographic, socioeconomic and lifestyle factors. Mediation analyses were also conducted to assess the mediating role of deprivation on the effect of housing affordability on PCS or MCS.ResultsDose–response relationships were observed between housing affordability and mean PCS score (β (95% CI) compared with the highest affordable fourth quartile: −2.53 (−4.05 to −1.01), −2.23 (−3.54 to −0.92), −0.64 (−1.80 to 0.51) for the first, second and third quartiles, respectively) and mean MCS score (β (95% CI): −3.87 (−5.30 to –2.45), −2.35 (−3.59 to −1.11), −1.28 (−2.40 to –0.17) for the first, second and third quartiles, respectively). Deprivation mediated 34.3% of the impact of housing unaffordability on PCS and 15.8% of that on MCS.ConclusionsHousing affordability affects physical and mental health, partially through deprivation, suggesting that housing policies targeting deprived individuals may help reduce health inequality in addition to targeting the housing affordability problem.

Regional variations of amenable mortality rate in Latvia

Background Death can be considered as amenable if all or most deaths from that cause (at certain age group if appropriate) could be avoided through optimal quality of health care. Amenable mortality is one of indicators to use for assessing health system performance and outcome. Methods For amenable death causes using list of diseases and conditions from Office for National Statistics of United Kingdom (used by Eurostat). Calculation of amenable death rate (per 100000 population) for ages 0 to 74 years at regional level (six statistical regions) for time period 2015-2017, direct age-standardization to the overall national population. Results accompanied by confidence intervals (95%). Results There is a slight decline in amenable mortality of Latvia at national level over the period 2015-2017. Amenable death rate of Latvia in 2017 was 309 per 100 000 (95% CI, 308.95 - 309.05). Death rates at regional level varies from 274.34 (274.23 - 274.44) in Pieriga region to 375.49 (375.37 - 375.62) per 100 000 in Latgale region. There are no significant changes in ranking of regions for three years period. Conclusions Results shows that there are differences of amenable mortality rates between regions of Latvia. There are health inequalities between regions: Pieriga region show the best health care services performance, while Latgale displays the worst performance. There is field for deeper analysis and find better interventions for improvements at national level and reducing variability between regions. Key messages There are regional variations of amenable mortality in Latvia. Regional variations show places to reduce health inequality.