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 Public Health News Snippets  25-31th March, 2024 

Does Morel mushroom exposure cause gastrointestinal illness?

  • The Montana Department of Public Health and Human Services (MTDPHHS) and Gallatin City County Health Department (GCCHD), with the support of the CDC, conducted a case-control study to identify illnesses that are associated with food and to assess the dose-response relationship.

  • Questionnaire data were collected by state and county health department staff members using Jotform software, and those deidentified were sent for analysis to CDC, where matched and unmatched logistic regression analysis was conducted using SAS software.

  • The odds of consuming a special sushi roll with morel mushrooms among cases were 15.78 times higher than those of control patients and 10.77 times higher among cases for eating any morels.

  • The FDA has published information on morels and other mushrooms that can be cultivated.

  • The MTDPHHS and GCCHD gave recommendations on proper storage and preparation to reduce the illness risk.

  • Findings from the investigation suggested uncooked or undercooked morel mushrooms were the source of the outbreak and there was a clear association between the consumption of morels and gastrointestinal illness.

Content Editor: Dr. Soundhar

Center for Disease Control

Source : 

Published on :

March 30, 2024 at 3:00:00 PM

Public health outbreak, International health news.

Updates in polio

  • The polio advocate, Paul Alexander, who contracted polio at age 6 and spent over 70 years in an iron lung, has passed away. 

  • Alexander became a lawyer, author, and tireless advocate for ending polio through vaccination efforts worldwide.

  • Also, on International Women's Day, the global polio eradication program recognized the crucial contributions of female health workers, leaders, and partners to progress against the disease.

  • Their advocacy, vaccination work, and collaboration have been instrumental to their success.

  • Though polio vaccination campaigns continue globally, several countries have reported new cases of circulating vaccine-derived poliovirus type 2 (cVDPV2), which can emerge in under-immunized communities:

  1. Angola: 1 cVDPV2 sample

  2. Côte d'Ivoire: 4 cVDPV2 samples

  3. Mali: 1 cVDPV2 case

  4. Nigeria: 1 cVDPV2 case

  5. Sierra Leone: 1 cVDPV2 sample

  6. Yemen: 3 cVDPV2 cases

  • In response to the detection of cVDPV2 in wastewater samples from September 2023 to January 2024, Sudan's health ministry will launch a polio immunization campaign in April 2024.

Content Editor: Dr. Chinmay Kelkar

Global Polio Eradication Initiative

Source : 

Published on :

March 30, 2024 at 3:00:00 PM

Polio eradication, International health news, WHO

Ensuring hospital safety: Best practices for fire prevention

  • The Union Health Ministry and NDMA advised States/UTs to take measures to prevent hospital fires during the summer heat.

  • Hospitals are instructed to ensure compliance with fire safety regulations through comprehensive inspections, electrical load audits, and obtaining valid fire No-Objection Certificates (NOCs) to rectify any identified discrepancies and prioritize safety measures.

  • Some of the comprehensive instructions that were released to conduct the activities are as follows -

  1. Regularly inspect fire equipment for expiration dates, accessibility, water pressure, and audibility.

  2. A maintenance schedule involving monthly checks for extinguishers, and quarterly tests for alarms/hydrants.

  3. Implement no-smoking policies and controls in oxygen areas And staff Training regarding risks.

  4. Install smoke detectors and fire alarms, test them monthly, and replace batteries annually.

  5. Avoid overloading of power sources.

  6. Installation of water sprinklers and accessible Hosepipes.

  7. Review/update hospital infrastructure and renew the fire safety NOC  to comply with fire safety standards.

  8. Implement continuous training on fire prevention and emergency procedures with bi-annual fire drills, including evacuation drills

Click here to read more.

Content Editor: Dr. Sumana Mukhopadhyay

Press Information Bureau

Source : 

Published on :

March 30, 2024 at 3:00:00 PM

Climate change measures, Fire safety

Inclusive education: A step ahead to ensuring social equity

  • The Ministry of Social Justice and Empowerment has made efforts to break social barriers in education, which is evident from the following:

1. A financial allocation of Rs. 165.81 crore for accommodating 5456 students, with 6 hostels for OBC and 28 for SC students.

2. As far as student enrolment was concerned:

  • For SC students, there has been 44% surge since 2014-15

  • For OBC students, an overall expansion of 45% since 2014-15 was noted.

  • A significant surge in the enrollment of female students was witnessed in both categories.

3. This reflected in a substantial increase in the Gross Enrollment Ratio as compared to the previous year and a remarkable leap as compared to 2014-15.


Click here to read more.

Content Editor: Dr. Sivanthiga

Press Information Bureau

Source : 

Published on :

March 30, 2024 at 3:00:00 PM

Social equity, Educational Intervention

Expansion of District Disability Rehabilitation Centers

The Department of Empowerment of Persons with Disabilities, recently virtually inaugurated 35 additional District Disability Rehabilitation Centers (DDRC).

These are spread over the country as follows:

1.  Madhya Pradesh-13

2.  Andhra Pradesh- 07

3.  Odisha- 06

4.  Tripura-04

5.  Maharashtra- 02

6.  Assam -01

7.  Nagaland-01

8.  Manipur-01

These DDRCs emphasize the government’s commitment to providing the best services to the divyangjans.

This initiative will ensure that rehabilitative services are provided at the grassroots levels to the divyangjans.

The centers will provide comprehensive care, which includes, but is not restricted to the following:

1.  Medical provisions and rehabilitative services

2.  Education and skill training,

3.  Early identification,

4.  Assistive device fitment, prosthetics, and orthotics

5.  UDID Registration Facilitation

These centers will also ensure awareness generation and provide information regarding the various government schemes.

Content Editor: Dr. Swathi Shenoy

Press Information Bureau

Source : 

Published on :

March 29, 2024 at 2:45:00 PM

Rehabilitation, Universal health coverage, Divyangjans

Phenome India: To provide advancements in precision medicine

The Council of Scientific and Industrial Research (CSIR) recently initiated its novel health camp, named “Phenome India.”

The camp was organized for the staff of the institute, and its main objective was to ensure “Swasthya Bharath. Viksit Bharath.”

The camp was held at its Delhi campus and a total of 98 individuals participated in the camp.

It was organized by the National Institute of Science Communication and Policy Research, which is one of the laboratories under CSIR.

The camp aimed to understand the diverse population of India to provide insights and further advance precision medicine.

This camp was undertaken as part of a larger cohort study named, Phenome India- CSIR Health Cohort Knowledgebase (PI-CHeCK), which was designed to identify India-specific cardiovascular risk factors.

Content Editor: Dr. Swathi Shenoy

Press Information Bureau

Source : 

Published on :

March 29, 2024 at 2:45:00 PM

Cardiovascular, NCD, Precision medicine

Halving snakebite related deaths: India's vision for prevention and control

  • The inauguration of the National Action Plan for Prevention and Control of Snakebite Envenoming (NAP-SE) by Shri Apurva Chandra, Union Health Secretary, marks a pivotal milestone in India's battle against snakebite-related morbidity and mortality.

  • With the vision of halving snakebite deaths by 2030, the NAP-SE offers a comprehensive framework for states for action plans, employing a 'One Health' approach that integrates various sectors.

  • IEC materials, including educational booklets, posters, and videos, were unveiled to raise awareness and empower communities effectively to manage snakebite emergencies.

  • The notable initiatives include -

  1. The piloting of a Snakebite Helpline number 1540

  2. The launch of a National Rabies Control Programme Website for progress monitoring and vaccination reminders.

  • NAPSE identifies key stakeholders, support organizations, and strategic actions for human, wildlife, and animal health components.

  • The NAP-SE underscores the importance of stakeholder collaboration to strengthen surveillance systems, improve emergency care services, and promote intersectoral coordination in combating snakebite envenoming.

Click here to read more

Content Editor: Dr. Sumana Mukhopadhyay

Press Information Bureau

Source : 

Published on :

March 29, 2024 at 2:45:00 PM

Snakebite Prevention, One health approach

MTBVAC- In the quest of TB vaccine trials in India

  • Tuberculosis has claimed millions of lives since ancient times. 

  • Despite having effective treatment, the complexity of Mycobacterium tuberculosis has hindered progress towards disease control.

  • Numerous tuberculosis vaccine candidates are in the pipeline of development.

  • Prediction modeling studies have found that preventing the disease among adolescents and adults is one of the quickest means to achieve global tuberculosis control.

  • Among those in the Phase III clinical trial, MTBVAC is the first live, genetically- attenuated vaccine developed by Biofabri, a Spanish biopharmaceutical company.

  • Bharat Biotech in partnership with Biofabri is conducting an efficacy, immunogenicity, and safety trial in India aiming for:

  1. Prolonged effect in newborns compared to the BCG vaccine

  2. Prevention of disease among adolescents and adults.

  • The vaccine is under trial in different countries on safety and immunogenicity in HIV-infected and non-infected populations.

  • The limiting step is the cost of conducting trials on late-stage efficacy and the long post-vaccination follow-up.

  • Following the successful trial, vaccines would be required to obtain WHO policy recommendations for roll-out, globally.

Click here to read more.

Content Editor: Dr. Urmimala

International Journal of Infectious Diseases, Bharat Biotech

Source : 

Published on :

March 29, 2024 at 2:45:00 PM

Vaccine, Tuberculosis, Communicable Disease

New rules on habeus corpus petitions

  • Responding to a ruling by the Kerala High Court, a three-bench judge of the Supreme Court comprising CJI DY Chandrachud, Justices JB Pardiwala and Manoj Misra issued guidelines advising High Courts of the following points -

  1. Refrain from ordering counseling or paternal care for the individual in cases of illegal detention. The court may simply ascertain the wishes of the person.

  2. To prioritize habeas corpus petitions or petitions for protection filed by partners, friends, or a member of the natal family.

  3. To ensure that the wishes of the corpus are not influenced by the court, police, or their parents.

  4. The concept of family is not limited to the ‘natal family’. It may include friends, partners, etc. which are of greater significance in such cases.

Click here to read more.

Content Editor: Dr. Manu Goel

Supreme Court Judgement

Source : 

Published on :

March 29, 2024 at 2:45:00 PM

LGTQIA+, Indian Jurisprudence, Sexual Orientation and Identity, Equal Rights

Pollution in Yamuna - A sorry state of affairs

  • In a meeting held by the Delhi Pollution Control Committee (DPCC), the following points were discussed -

  1. A study will be conducted aiming to determine the pollution sources of the Yamuna River.

  2. The need for a revised protocol for testing water samples was stressed.

  3. A gap of 222 MGD (million Gallons/ day) in sewage treatment needs to be addressed.

  4. Further, DPCC will install 10 online continuous monitoring stations (OLMS) in Yamuna to collect real-time data on water quality.

  5. Decision to implement Common Bio-Medical waste treatment facility(ies) (CBWTFs)

  6. Renewal of Operation and Maintenance contract of Continuous Air Quality Monitoring Situations (CAAQMS)

  7. Strengthening of staff from the UPSC merit list

  8. To increase the number of NABL-accredited labs, empanelled by MoEF (Ministry of Environment and Forestry) & NCBC

  9. Extension of medical facilities to the employees of DPCC

Click here to read more

Content Editor: Dr Dr. Shubham Gupta

Delhi Pollution Control Committee

Source : 

Published on :

March 28, 2024 at 2:00:00 PM

Health & Sanitation, Water pollution

Advancing food safety: Insights from FSSAI's AMR action plan

  • The Food Safety and Standards Authority of India (FSSAI) unveiled its action plan on antimicrobial resistance (AMR) during the 43rd Central Advisory Committee (CAC) meeting in Coimbatore, Tamil Nadu.

  • The discussions focused on raising farmers' awareness about the responsible use of antibiotics in livestock and aquaculture as part of the AMR National Action Plan-II.

  • States and Union Territories' Food Safety Commissioners were urged to work on developing 100 'Healthy and Hygienic Food Streets'.

  • Emphasis was placed on surveillance sampling, with states directed to prepare surveillance plans and hold regular meetings with state labs on anti-microbial susceptibility in food.

  •  The following efforts were highlighted-

              1. Clean marketplace

              2. App-based awareness models

              3. Fortified rice kernels (FRK) 

              4. Training food handlers in canteens of educational institutions 


Click here to read more

Content Editor: Dr. Sumana Mukhopadhyay

Press Information Bureau

Source : 

Published on :

March 28, 2024

Food safety, Antimicrobial resistance

'Wheels are not just limbs but wings’: Let them be cherished.

  • International Wheelchair Day is celebrated every year on March 1 since its inception in 2008 to acknowledge the empowerment of wheelchair users.

  • The Department of Empowerment of Persons with Disabilities and other organizations celebrated International Wheelchair Day by raising awareness and conducting training sessions for wheelchair users.

  • Under the Ministry of Social Justice and Empowerment, The Department of Empowerment of Persons with Disabilities works to improve the Quality of Life of individuals with mobility challenges through the following agencies and organizations:

  1. ALIMCO provided wheelchairs to the beneficiaries of the ADIP scheme at various centers. They also provided training sessions on how to use the wheelchairs.

  2. The National Institute for Empowerment of Persons with Intellectual Disabilities, Secunderabad, conducted practical demonstrations of various wheelchairs and training programs.

  3. Composite Regional centers, which usually provide preventive and promotional aspects of rehabilitation, organized training programs, sports activities, and awareness rallies to celebrate empowerment, freedom, and unity.

Click here to read more.

Content Editor: Dr. Sivanthiga

Press Information Bureau

Source : 

Published on :

March 27, 2024

People with Disability, Rehabilitation, Tertiary Prevention

National conference on accelerating SDGs- An example of cooperative federalism

  • A 2-day national conference was held in Jaipur, Rajasthan in the 1st week of March.

  • The conference, titled, “National Conference on Accelerating Sustainable Development Goals”, was organized by NITI Aayog in collaboration with UNDP, UN, and the government of Rajasthan.

  • The conference's objectives included:

  1. To motivate States and UTs to evaluate the localization of the Sustainable Development Goals (SDGs),

  2. Share insights on how to institutionalize the SDGs at the subnational level.

  3. Examine the national and subnational context for SDG financing

  4. Outlining a strategy for quickening the 2030 SDG agenda's progress.

  • The conference also included technical sessions on the second day and covered various topics related to the SDGs.

  • On the occasion of the conference, three knowledge portals were also launched:

  1. UNDP ‘SDG Knowledge Hub’

  2. ‘Food and Nutrition Security Analysis Dashboard’ of the Government of Rajasthan

  3. ‘SDG -2 (Zero Hunger) Dashboard’ of the Government of Rajasthan

  • The conference was a perfect example of cooperative federalism.

Click here to read more.

Content Editor: Dr. Swathi Shenoy

Press Information Bureau

Source : 

Published on :

March 26, 2024

SDGs, Cooperative Federalism

Will household-level interventions help combat the problem of TB and NCDs?

  • Recently, a systematic review and meta-analysis was conducted to assess the bi-directional linkage between NCD and NCD risk factors among TB contacts.

  • The SRMA included national and sub-national TB surveys which included at least one NCD or NCD risk factor.

  • The results were presented as participants with NCD or NCD risk factors and were divided into 3 groups as follows:

  1. People with TB

  2. Members of households with a TB patient

  3. Members of households with no TB patient

  • The outcome variable was the prevalence of NCD or NCD risk factors, which included smoking, alcohol intake, DM, hypertension, and BMI.

  • The findings of the SRMA are as follows:

  1. The members of households with TB had a higher chance of smoking when compared to those with no TB

  2. On sensitivity analysis, the members of households with TB had higher odds of alcohol use when compared to those with no TB

  3. There was no significant association between the other NCD such as diabetes mellitus and hypertension

  • However, the study underscores that the national-level surveys included self-reporting of NCDs, which might have led to the underreporting of NCDs and hence the findings.

  • The study concluded that household-level interventions addressing smoking can help reduce the risk of NCD and TB in households.

Click here to read more

Content Editor: Dr. Swathi Shenoy

PloS One

Source : 

Published on :

March 26, 2024

Tobacco, Tuberculosis, NCD

Calls for action: committee recommends ban on deadly dog breeds

  • To outlaw specific breeds as pets, the Department of Animal Husbandry and Dairying formed an Expert Committee under the direction of the Animal Husbandry Commissioner.

  • The recent deaths served as the impetus for this choice.

  1. The committee identified hazardous breeds such as Pitbull Terriers, Tosa Inu, Rottweilers, and many more.

  2. Also, a prohibition on the import, breeding, and sale of identified breeds, including crossbreeds, has been proposed.

  3. The local bodies and the Animal Husbandry Department were instructed to enforce license-issue restrictions and sterilize existing pets.

  4. This was regarded as an urgent action urged to ensure the safety of humans and animals.

  • The  Central Government has also emphasized strict enforcement of the existing animal welfare regulations- Prevention of Cruelty to Animal (Dog Breeding and Marketing) Rules, 2017, and Prevention of Cruelty to Animal (Pet Shop) Rules, 2018.

Content Editor: Dr. Sumana Mukhopadhyay

Ministry of Fisheries, Animal Husbandry and Dairying letter

Source : 

Published on :

March 26, 2024

Rabies Control, Dog bite, Animal control

Report on progress to end female genital mutilation

  • FGM assaults girls’ and women’s human rights, having lasting physical, psychosocial, and social consequences.

  • On this International Women’s Day, a report released by WHO revealed that progress toward ending FGM remains slow to meet the UN’s Sustainable Development Goal to eliminate the practice.

  • According to the report, more than 230 million girls and women have undergone FGM.

  • It is most prevalent in Africa, Asia, and the Middle East.

  • The most challenging aspect of eliminating this practice is that more and more girls undergoing FGM are under the age of 5 years, leaving little time for intervention.

  • 4 in 10 of all the survivors of FGM are from conflict-affected areas- where population growth is fast, and education and health services are disrupted, making it more challenging to tackle FGM due to diversion of resources towards crises.

  • However, Kenya, Sierra Leone, and Egypt provide a ray of hope, with declining rates of FGM, and changing attitudes towards FGM.

  • The report concluded that greater investment in services for girls and also a provision of laws and policies to safeguard their rights should be put in place to eliminate such practices.

  • Way ahead: the eradication of FGM requires leaders and communities to make focused efforts to end gender-based discrimination, greater investment in services for girls and laws and policies to safeguard their rights and better track the prevalence of FGM through better quality data.

Content Editor: Dr. Niharika

UNICEF Press Release

Source : 

Published on :

March 26, 2024

Human Rights, Women Health, International Health News

Waterborne disease outbreaks associated with drinking water - A surveillance by the United States, 2015-2020.

  • NORS was launched by the CDC in 2009 as a web-based platform, where public health departments from the United States can voluntarily enter information regarding the outbreak.

  • Through NORS, enteric as well as non-enteric disease outbreak data are reported.

  • During 2015-2020, 214 outbreaks were associated with drinking water, and health officials reported 454 contributing factors from 28 states.

  • Public water was the most common source of these outbreaks, leading to 172 outbreaks.

  • Among enteric illnesses, Norovirus, Shigella, and Campylobacter, or multiple etiologies including these pathogens, resulted in 94% of cases, and often the cause was the source of drinking water.

  • In biofilm-related outbreaks, 98% were Legionella, and the rest were non-tuberculous bacteria and pseudomonas.

  • NORS enhances the efforts of the CDC to estimate the healthcare cost impacts of waterborne and drinking water-associated diseases.

Content Editor: Dr. Soundhar

Center for Disease Control

Source : 

Published on :

March 26, 2024

Disease Outbreak, Public Health Action, International Health News

Evidence-based psychological interventions for non-specialists addressing mental health conditions.

  • Globally, 1 in 8 people grapples with a mental health condition, yet a substantial treatment gap persists due to stigma and limited service accessibility.

  • Integrating these interventions into existing health services promises to enhance mental health care quality.

  • This integration approach involves:

  1. Developing implementation plans,

  2. Adapting interventions to fit specific contexts,

  3. Preparing the workforce,

  4. Identifying, assessing, and supporting potential beneficiaries,

  5. Monitoring and evaluating service delivery.

  • These interventions were rolled out by the WHO in March 2024, to address the treatment gap in mental health care, fostering collaboration with community stakeholders.

Content Editor: Dr. Ravisankar

WHO News Section

Source : 

Published on :

March 26, 2024

Mental Health, International Health News, New Update

Factors that played a role in Swachh Survekshan 2023 clean city rankings

  • Vijayawada processes about 520 tons of garbage per day (TPD) and is backed by a committed team consisting of over 4,000 sanitation personnel and 300 wet waste workers.

  • The VMC's sophisticated processing capabilities, which have contributed to its standing as the sixth cleanest city in the Swachh Survekshan 2023 rankings, are as follows:

  1. For dry waste management: A Materials Recovery Facility (MRF) plant and a Waste-to-energy plant

  2. Vermicompost plants-6

  3. Windrow compost plants-4

  4. 1 bio-methanation plant to process wet waste at low cost

  5. An information park to raise awareness.

  6. 200-TPD capacity processing plant where construction & demolition (C&D) waste generated is and converted into bricks and paver blocks.

  7. The 25- acres of reclaimed land that were created by eliminating waste dumpsites have been repurposed into a park.

  8. Thermocol processing facility

  9. 3 permanent Reduce, Reuse, and Recycle (RRR) centers

  10. The Wall of Kindness and plastic collection centers encourage citizens to donate waste/unused items.

  • 6 Sewage Treatment Plants (STP) where waste is collected through a network of underground waste drainage systems and repurposed for agricultural irrigation, road cleaning, and watering plantations.

Content Editor: Dr. Tanya Tanu

Social Trends

Source : 

Published on :

March 25, 2024

Waste Management, Swachh Bharat, Swachh Survekshan 2023

Surge of psittacosis cases in Europe

  • There has been a surge in the cases of psittacosis in Austria, Denmark, Germany, Sweden, and The Netherlands since late 2023, leading to increased fatalities.

  • The source of infections is usually infected birds, which can include both domestic and wild birds.

  • In Austria, the surge was not associated with wild birds, whereas in Denmark, the source of infection was found to be wild birds.

  • In contrast, the surge in Germany and Sweden was found to be due to increased contact with infected domestic birds and small birds, respectively.

  • However, no such association was found in the Netherlands.

  • The countries are now investigating and testing wild birds to understand better.

  • The World Health Organization (WHO) is closely monitoring the situation and says the overall risk is low.

  • The following measures have been suggested by the WHO:

  1. Testing sick people,

  2. Keeping new birds separate, and

  3. Checking wild birds for signs of the disease to prevent psittacosis from spreading further.


Content Editor: Dr. Rashmi Verma

WHO News Section

Source : 

Published on :

March 25, 2024

Zoonotic Diseases, Disease Outbreak, International Health News

Which is superior- Covishield or Covaxin?

  • A non-randomized, single-blinded (laboratory) study was conducted among the healthy general population across four sites (Bangalore & Pune) between June 2021 and Jan 2022.

  • No sample size was determined.

  • Recruited participants were grouped into two groups based on serostatus [positivity/negativity] at baseline.

  • The clinical sites integrated unbiased enrollment with pre-screening for anti-spike antibodies to ensure equitable recruitment within each serostatus.

  • Seroconversion rates due to Covaxin after the first and second vaccination doses were 36.6% and 74.4%, respectively.

  • Whereas Covishield resulted in 93.2% and 98.3% seroconversion in the baseline seronegative population.

  • Hence Covishield was proved superior to Covaxin, as interpreted from both:

  1. Seroconversion rate and

  2. Anti-spike antibody levels in both groups of participants.

Content Editor: Dr. KH Reddy

Lancet Regional Health- South East Asia

Source : 

Published on :

March 25, 2024

Healthcare Research, COVID, Vaccines, Covishield, Public Health

The rise of the billionaire raj: A report by the World Inequality Lab

  • The study brought together:

  1. National income accounts, tax tabulations,

  2. Wealth aggregates, billionaire rankings, rich lists,

  3. Surveys on wealth, consumption, and income- within a unified framework to provide long-run homogeneous wealth and income inequality series that extended back to 1961 for wealth and 1922 for incomes

  • According to the publication, "the British Raj, led by the colonialist forces, was less unequal than the 'Billionaire Raj,' headed by India's modern capitalists."

  • It also says, "Without significant social and political upheaval, it is unclear how long such inequality levels can be sustained."

  • The wealthiest in India are getting richer, while the poor are getting impoverished.

  • The paper's authors also placed India's income and wealth inequality levels (as of 2022) in a global context by contrasting them with those of the United States, the United Kingdom, Brazil, China, South Africa, and France.

  • India comes in second place for income shares in the top 10% while topping the list for shares in the top 1%.

  • To address the growing disparities, the authors proposed implementing a super tax on Indian billionaires and multimillionaires and restructuring the tax schedule to include both income and wealth, which could be effective.

Click here to read more

Content Editor: Dr. Sakshi

World Inequality Lab

Source : 

Published on :

March 25, 2024

Economic inequality, Socioeconomic status

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