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This work aims to provide a non-moralistic exploration and understanding of the high prevalence of adolescent pregnancy and resulting motherhood among low-income adolescent women in Greater Mendoza, Argentina. The study acknowledges that, based on official statistics, adolescent pregnancy remains a significant issue within this social group compared to teenagers from other socioeconomic backgrounds. By delving into the sexual and reproductive practices of these adolescents, the research seeks to uncover their life strategies within the context of their challenging living conditions, characterized by limited job opportunities and an inadequate, reactive educational system. Through in-depth interviews and focus groups, the study captures the lived experiences and perspectives of adolescent mothers themselves. Utilizing a sociological analysis of this empirical data, the research argues that in the face of extreme social exclusion, a lack of family support, and limited cultural capital, the concept of "class habitus " sheds light on and explains the adolescent practices that contribute to not avoid pregnancies, often influenced by traditional societal expectations of women's roles. [ABSTRACT FROM AUTHOR]

Background: Palliative care is seldom integrated in healthcare in fragile, conflict affected and vulnerable settings with significant refugee populations. Aim: This study aimed to evaluate the integration of palliative care into a fragile, conflict affected and vulnerable community in Northern Uganda. Design: Consecutive Rapid Participatory Appraisals were conducted to evaluate the integration of palliative care in Adjumani District. The first established a baseline and the second, 4 years later, evaluated progress. Data collection included documentary review, key informant interviews and direct observation. Setting/participants: A rural district in Uganda with equal numbers of refugees and host populations living side-by-side. 104 key informants were interviewed, and practice observed in 11 health facilities. Results: At baseline, palliative care was not routinely integrated in the health system. Barriers included health system challenges, cultural beliefs, understanding and trust, mental health issues, gaps in palliative care provision, the role of the community and beliefs about illness impacted care with the village health teams being a trusted part of the health system. Following integration activities including training, mentorship and community sensitisation, the repeat rapid appraisal after 4 years showed a significant increase in palliative care delivery. New themes identified included increased provision of palliative care, the impact of training and community engagement and ownership of palliative care. Conclusion: Community engagement and participation, training interventions and referral pathways enabled the integration of palliative care. Rapid Participatory Appraisal provides a useful framework to evaluate activities aimed at integration of palliative care in a community. [ABSTRACT FROM AUTHOR]

Abstract This study aimed to understand the health status of low-income individuals living alone and to identify influencing factors. Using systematic random sampling methods, low-income individuals living alone were randomly selected. Via telephone interviews, we gathered information about their general health status. A logistic regression model was used to analyze relevant factors about the physical health of this population. The study included 1583 low-income individuals living alone. The prevalence rate of all kinds of diseases in low-income living alone in this survey was 88.63%. The multifactorial logistic regression analysis revealed that the risk factors for illness in this population were age ≥ 60 (OR 1.842, 95% CI 1.135–2.926, P = 0.006), self-rated poor mental health (OR 2.538, 95% CI 1.128–3.828, P = 0.005), and self-rated poor hearing status (OR 2.781, 95% CI 1.586–3.647, P = 0.001). Being female (OR 0.469, 95% CI 0.178–0.821, P = 0.033) was identified as a protective factor. Low-income individuals living alone are a unique group who lack familial care and economic and social support, and are thus in a disadvantaged social position. Therefore, this population requires increased attention, especially regarding their physical health. Implementing targeted assistance policies to improve their health status and enhance their quality of life is essential.

During an educational visit to the Sierra Leone in April 2024, a team of healthcare professionals from the UK were confronted with the stark realities faced by people living with diabetes and those dedicated to their care. The visit was organised by the DSN Forum UK and the Help Madina charity, and funded by a grant from The TransPetrol Foundation. As the prevalence of diabetes rises globally, Sierra Leone has its own set of obstacles in managing this chronic condition. In this article, these challenges are discussed within the context of Sierra Leone's cultural, economic and healthcare landscape. These include the lingering effects of civil war, extreme poverty, malnutrition, limited access to fundamental healthcare resources and the burden of infectious diseases. [ABSTRACT FROM AUTHOR]

ObjectiveTo understand the physical health condition and its influencing factors among the low-income population.MethodLow-income residents who visited or consulted at our Hospital during 2022 were selected for this study. Through telephone or face-to-face interviews, a self-made basic information questionnaire was used for data collection. The physical health level of the low-income population was analyzed, and a logistic regression model was applied to study its influencing factors.ResultsA total of 2,307 people were included in this study, of which 2,069 had various types of diseases, indicating a disease rate of 89.68%. Multivariate logistic regression analysis showed that age ≥ 60 years old (OR = 1.567, 95%CI: 1.122–2.188), poor mental health status (OR = 2.450, 95%CI: 1.203–3.678), smoking (OR = 1.752, 95%CI: 1.269–2.206), pulse pressure difference ≥ 60 (OR = 1.485, 95%CI: 1.164–1.787), and poor hearing (OR = 1.268, 95%CI: 1.026–1.324) were risk factors for disease, whereas being female (OR = 0.729, 95%CI: 0.540–0.984) was a protective factor for physical health.ConclusionAs a developing country with a large population, we should particularly focus on the physical health issues of the low-income population, take targeted measures for disease situations, and improve the quality of life of the low-income population.

Introduction: Home visitation programs that reach families of young children offer a unique opportunity for large-scale early childhood obesity prevention efforts. The objective of this qualitative research was to determine stakeholder attitudes, subjective norms, perceived ease of use and usefulness, behavioral control, and behavioral intentions towards utilizing technology in a home visitation program targeting early childhood obesity prevention. Methods: Staff from the Florida Maternal, Infant, and Early Childhood Home Visiting Program (n = 27) were interviewed individually by a trained research assistant using a semi-structured script based on constructs from the Technology Acceptance Model and Theory of Planned Behavior. Demographic and technology use information were collected. Interviews were recorded and transcribed verbatim, with data extracted and coded by two trained researchers using a theoretical thematic analysis approach. Results: Most of the home visiting staff (78%) were white and non-Hispanic and employed for an average of 5 years with the program. Most staff (85%) indicated they were currently using videoconferencing for home visits. Themes and subthemes emerged, including positive attitudes towards technology as a flexible and time-efficient program alternative for childhood obesity prevention with recommendations to keep content short, at a low literacy level, and available in more than one language for ease of use. Participants recommended developing training tutorials to improve program implementation. Internet access and potential social disconnect were cited as concerns for using technology. Discussion: Overall, home visitation staff had positive attitudes and intentions for using technology in home visiting programs with families for early childhood obesity prevention. Significance: What is already known on this subject? Home visitation programs have adopted technology for virtual service delivery during unforeseen circumstances that prevent in-person visits, such as COVID-19 restrictions. What does this study add? This qualitative study revealed positive attitudes and intentions of staff members of home visitation programs towards the use of digital learning technology in conjunction with home visits to enhance content related to early childhood obesity prevention for families participating in home visitation programs. Key suggestions to consider in the development of future childhood obesity digital interventions include appropriateness for the audience of interest (i.e., available in different languages, suitable literacy level), ease of use (i.e., simple, user-friendly, interactive features), and practical strategies to support the implementation (i.e., staff trainings, built-in flexibility). It is important to also consider technology-specific challenges that communities may face when incorporating technology in interventions (i.e., lack of access to devices, costs associated with reliable internet and data, compatibility of devices). Findings will help inform and guide the development of future childhood obesity digital interventions. [ABSTRACT FROM AUTHOR]

Objective: Addressing social inequality in oral health and access to dental care is a global concern. This study aims to describe the utilization of a public subsidy scheme targeting vulnerable individuals out of labor in Copenhagen municipality (2013–2018) and to identify key characteristics of individuals eligible to apply. Material and Methods: Data from Copenhagen municipality were combined with data from population and health registers. Employing logistic regression analyses, we examined the association between demographic, socioeconomic, and health-related characteristics and (1) having applied, (2) being granted, and (3) using the subsidy. Results: The study included 65,174 individuals aged 18–65. Of these 10,369 (15.9%) applied for subsidies, submitting a total of 18,529 applications. Overall, 83% of the applications were granted and 85% were used. Significantly increased odds of applying for subsidies were observed among individuals receiving social benefits non-stop over the past year versus none (odds ratio [OR] = 15.45, 95% confidence interval [CI] = 14.24–16.76), aged 50–65 versus 18–29 years (OR = 4.41, CI= 4.15–4.69), and having combined indicators of social vulnerability versus none (OR = 2.90, CI= 2.73–3.07). Conclusions: While the utilization of the public subsidy scheme is low, individuals who apply are likely to be granted a subsidy and use it. Vulnerability was associated with greater utilization of the scheme, yet a substantial portion of those at risk of poor oral health did not take advantage of it.

The purpose of the study is to analyze the reasons for low efficiency of state social assistance based on a social contract and to prepare proposals for the program development and its inclusion in the state policy measures system to reduce the poverty level of the population of the Russian Federation. The program effectiveness problems have been studied in the chronology of its regulatory and methodological framework formation and development stages. By now the lack of significant results of the use of the social contract technology as a special type of state social assistance to low-income families in the research has been explained by the lack of a program’s theoretical model with target indicators defined at the basic stage and mechanisms for achieving them. As a possible solution to the problem of increasing the effectiveness of program, the prospects for its transformation into an activating type program have been examined. Various modifications of such programs are now widely used in international practice and recognized as effective tools in ensuring the growth and stabilization of income of poor people.

This article consists of a scoping review completed to describe the impacts of refurbished hearing aids (HAs) for people with hearing loss, and to identify existing HA refurbishing programs around the world. In this review, JBI methodological guidance for scoping reviews was followed. All types of sources of evidence were considered. Thirty-six sources of evidence were included, 11 articles and 25 web pages. Results suggest that refurbished HAs may improve communication and social participation for individuals with hearing loss and provide monetary savings to them and to governmental agencies. Twenty-five HA refurbishing programs were identified, all based in developed countries and distributing refurbished HAs mostly locally, but also in developing countries. Issues related to refurbished HAs were highlighted, such as potential cross-contamination, quick obsolescence, and repairing problems. Some facilitators for the success of this intervention are to offer accessible and affordable follow-up services, repairs, and batteries, and to ensure awareness and participation of hearing healthcare professionals and citizens with hearing loss. In conclusion, the use of refurbished HAs appears to be a valuable option for low-income people with hearing loss, but it should be included in a more global intervention program to ensure its sustainability.

Introduction: COVID-19 pandemic has impacted the livelihood of Malaysians and gardening activities have contributed positively to the diet quality. This study aimed to determine the factors associated with diet quality among adults in AU2 Keramat, Kuala Lumpur. Methods: The cross-sectional study involved adults aged 18 to 59 via convenience sampling. The socio-demographic, physical activity level and involvement status in gardening were obtained through a questionnaire, while food intake was from a single-day 24-hour diet recall. The diet quality was determined through Malaysian Healthy Eating Index (MHEI) and dietary misreporting was calculated using the Goldberg cut-off method. Results: A total of 117 respondents (65.8% females, 35.2% males) with a mean age of 40.98 were involved in this study. Findings showed that most respondents did not engage in gardening activities (72.6%) and the prevalence of poor diet quality in this study was 89.7%, with a mean score of 44.51. The older respondents (r= 0.20, p= 0.034) and community gardeners (t= -2.63, p= 0.011) had a significantly higher diet quality but not home gardeners (t= 0.12, p= 0.902). The respondents involved in gardening activity also had a significantly higher fruit serving intake, Mann-Whitney U= 1045.00, p= 0.036) and lower total fat intake (t= 2.27, p= 0.025). Conclusion: The diet quality of the respondents remains poor but community gardeners had significantly higher diet quality and fruit intake while lower total fat intake. Interventions need to be developed to address the persistent poor diet quality of adults in the community. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine whether aspects of social capital, or benefits received from social relationships, are associated with regular bedtime and sleep duration across childhood in US families with lower income. METHODS: Cross-sectional study using the 2018-19 National Survey of Children's Health in participants with incomes <400% federal poverty level. Separately for early childhood (0-5 years), school-age (6-12 years), and adolescence (13-17 years), we used weighted logistic regression to examine associations between social capital (measured by family social cohesion, parent social support, child social support) and sleep (measured by regular bedtime, sleep duration, adequate sleep per American of Academy of Sleep guidelines). Path analysis tested whether regular bedtime mediated associations between social capital and sleep duration. RESULTS: In our sample (N = 35,438), 84.9% had a regular bedtime, 60.2% had adequate sleep. Family social cohesion was associated with sleep duration and adequate sleep (infancy: adjusted odds ratio [aOR] 2.18 [95% confidence interval [CI], 1.32, 3.60]; school age: aOR 2.03 [95% CI, 1.57, 2.63]; adolescence: aOR 2.44 [95% CI, 1.94, 3.09]). In toddlerhood, parent social support was associated with adequate sleep (aOR 1.44 [95% CI, 1.06, 1.96]). In adolescence, child social support was associated with regular bedtime (aOR 1.70 [95% CI, 1.25, 2.32]. Across childhood, associations between family social cohesion and sleep duration were partially mediated by regular bedtime. CONCLUSIONS: Family social cohesion was associated with adequate sleep across childhood, this was partially mediated by regular bedtime. Associations between social support and sleep outcomes varied by development stage. Future work should consider how supportive relationships may influence child sleep outcomes. [ABSTRACT FROM AUTHOR]

This paper is a part of a research project that aimed at developing a smart spatial decision support system to assess the upgrading of informal areas in Egypt. The system is based on a multi-criteria assessment tool called SRQL Index to enhance sustainability, resilience, and quality of life. Spatial access to healthcare services is one of the most essential components of the SRQL. Planning for basic services and facilities and ensuring equal access to health care services for low-income people has become a guide for planning sustainable city strategies. Improving accessibility has transformed from a transportation goal to a scheme for supporting sustainability and climate change goals. This paper aims to define a framework and method for assessing the fairness of spatial distribution and sustainability of free primary healthcare services for low-income people. Thus, spatial access to services in deteriorating residential areas of the city can be used as an index to measure the quality of life, social justice, sustainability, and resilience. This paper used the spatial network analysis in geographic information systems to assess the spatial accessibility to health care services for residents of poor and deteriorated areas in Assiut city - as a case study. Spatial Accessibility - on foot and by public/mass transport - to primary health care services is assessed, as well as to hospitals that offered free or affordable outpatient clinics. Possible recommendations for policymakers to determine the importance of allocating health care services as equalizers in urban areas characterized by social and spatial inequalities were reached, which will contribute to the transition to comprehensive urban development. هذه الورقة جزء من مشروع بحثي يهدف إلى تطوير نظام ذكي لدعم اتخاذ القرار؛ بهدف تقييم واقتراح المزيد من التدخلات المناسبة لتطوير المناطق العشوائية في مصر. يعتمد النظام على أداة تقييم متعددة المعايير، وهي مؤشرSRQL، تم تطويرها لتعزيز الاستدامة والصمود وجودة الحياة للعشوائيات في مصر. ويعد الوصول المكاني لخدمات الرعاية الصحية واحد من اهم مكونات SRQL. تهدف هذه الورقة إلى تحديد إطار وطريقة لتقييم عدالة التوزيع المكاني واستدامة خدمات الرعاية الصحية لذوي الدخل المنخفض. وبذلك يمكن أن يستخدم الوصول المكاني للخدمات بالنسبة لسكان المناطق المتدهورة كمؤشر لقياس جودة الحياة، والعدالة الاجتماعية. في هذه الورقة، تم استخدام التحليل المكاني والشبكي spatial network analysis في GIS لتقييم الوصول المكاني لخدمات الرعاية الصحية لسكان المناطق الفقيرة في مدينة أسيوط. وتم تقييم الوصول باستخدام وسائل النقل المستدام- لخدمات الرعاية الصحية الأولية والمجانية او الميسرة. تم التوصل إلى توصيات لواضعي السياسات لتحديد أهمية تخصيص خدمات الرعاية الصحية لتكون بمثابة عوامل التعادل في المناطق الحضرية التي تتميز بعدم المساواة الاجتماعية والمكانية؛ بحيث يصبح التخطيط للخدمات والمرافق الأساسية، وضمان المساواة في الحصول على خدمات الرعاية الصحية لذوي الدخل المنخفض، هو الموجه لاستراتيجيات التخطيط لمدن مستدامة.

This article consists of a scoping review completed to describe the impacts of refurbished hearing aids (HAs) for people with hearing loss, and to identify existing HA refurbishing programs around the world. In this review, JBI methodological guidance for scoping reviews was followed. All types of sources of evidence were considered. Thirty-six sources of evidence were included, 11 articles and 25 web pages. Results suggest that refurbished HAs may improve communication and social participation for individuals with hearing loss and provide monetary savings to them and to governmental agencies. Twenty-five HA refurbishing programs were identified, all based in developed countries and distributing refurbished HAs mostly locally, but also in developing countries. Issues related to refurbished HAs were highlighted, such as potential cross-contamination, quick obsolescence, and repairing problems. Some facilitators for the success of this intervention are to offer accessible and affordable follow-up services, repairs, and batteries, and to ensure awareness and participation of hearing healthcare professionals and citizens with hearing loss. In conclusion, the use of refurbished HAs appears to be a valuable option for low-income people with hearing loss, but it should be included in a more global intervention program to ensure its sustainability. [ABSTRACT FROM AUTHOR]

Objective: Financial toxicity is of increasing concern in the United States. The Comprehensive Score for Financial Toxicity (COST) is a validated measure; however, it has not been widely utilized among low-income patients and may not fully capture financial toxicity in this population. Furthermore, the relationships between financial toxicity, quality of life (QOL), and patient well-being are poorly understood. We describe the experience of financial toxicity among low-income adults receiving cancer care. We hypothesized that higher financial toxicity would be associated with less income and lower quality of life. Qualitative interviews focused on the financial impact of cancer treatment. Method: This study was conducted at a cancer clinic in Central Texas. Quantitative and qualitative data were collected in Fall and Spring 2018, respectively. The quantitative sample (N = 115) was dichotomized by annual income (<$15,000 vs. >$15,000). Outcomes included financial toxicity (COST), quality of life (FACT-G), and patient well-being (PROMIS measures: Anxiety, Depression, Fatigue, Pain Interference, and Physical Function). Associations between quality of life, patient well-being, and financial toxicity were evaluated using linear regression. Sequential qualitative interviews were conducted with a subsample of 12 participants. Results: Patients with <$15k had significantly lower levels of QOL and patient well-being such as depression and anxiety compared to patients with >$15k across multiple measures. A multivariate linear regression found QOL (Β = 0.17, 95% CI = 0.05, 0.29, p = 0.008) and insurance status (Β = −3.79, 95% CI = −7.42, −0.16, p = 0.04), but not income, were significantly associated with financial toxicity. Three qualitative themes regarding patient's access to cancer care were identified: obtaining healthcare coverage, maintaining financial stability , and receiving social support. Significance of results: Low-income patients with cancer face unique access barriers and are at risk for forgoing treatment or increased symptom burdens. Comprehensive assessment and financial navigation may improve access to care, symptom management, and reduce strain on social support systems. [ABSTRACT FROM AUTHOR]

Abstract Objectives Remote consultations were common in general practice during the COVID-19 pandemic. This approach may have affected access to GP care for people with low socio-economic status: this group has a high prevalence of chronic conditions and a higher mortality rate due to COVID-19. This study explores the association of sociodemographic and health factors with the decision to contact a GP practice, and care utilisation, among patients in low-income neighbourhoods in the Netherlands. Design Cross-sectional survey study. Setting General practice in low-income neighbourhoods in the Netherlands. Participants Patients from low-income neighbourhoods were selected from fourteen general practices on the basis of ethnic background, chronic disease or health literacy. Participants were stratified according to categories of these background characteristics to obtain equal numbers per category. A total of 213 surveys were retained for analysis. Main outcome measures Need for GP contact, decision to contact a GP practice, and GP service utilisation. Results Forty-five percent (N = 88) of the participants experienced health problems for which they wished to consult their GP at the start of the outbreak of COVID-19. A majority of them (81%) had contact with a GP service. The need to contact the GP was significantly associated with financial difficulties (OR 2.20 CI (1.10 to 4.39)). An interaction effect was found of health literacy with concerns about COVID-19 with in respondents with low health literacy a significant association between concerns about COVID-19 and a need for a GP appointment (OR 5.33 CI (2.09 to 13.59)) and absence of a significant association in the higher health literacy group (OR 1.14 CI (0.51 to 2.56)) . Moreover, 56% (N = 74) of the participants received remote care at least one time during the first wave of COVID-19. Female participants used remote care more often (OR 3.22 CI (1.57 to 6.59)) and participants aged 50 and over used remote care less often (OR 0.46 CI (0.21 to 0.97)). Conclusion Many patients in low-income neighbourhoods were able to consult a GP, often remotely. However from the equity perspective, access to GP care should be safeguarded for patients with health problems, financial difficulties and low health literacy because of their greater need to consult a GP during times of crisis.

ObjectiveTo use cognitive interviewing and pilot testing to develop a survey instrument feasible for administering in the food pantry setting to assess daily intake frequency from several major food groups and dietary correlates (e.g. fruit and vegetable barriers) - the FRESH Foods Survey.DesignNew and existing survey items were adapted and refined following cognitive interviews. After piloting the survey with food pantry users in the USA, preliminary psychometric and construct validity analyses were performed.SettingThree US food banks and accompanying food pantries in Atlanta, GA, San Diego, CA, and Buffalo, NY.ParticipantsFood pantry clients (n 246), mostly female (68 %), mean age 54·5 (sd 14·7) years.ResultsMeasures of dietary correlates performed well psychometrically: Cronbach's α range 0·71-0·90, slope (α) parameter range 1·26-6·36, and threshold parameters (β) indicated variability in the 'difficulty' of the items. Additionally, all scales had only one eigenvalue above 1·0 (range 2·07-4·71), indicating unidimensionality. Average (median, Q1-Q3) daily intakes (times/d) across six dietary groups were: fruits and vegetables (2·87, 1·87-4·58); junk foods (1·16, 0·58-2·16); fast foods and similar entrées (1·45, 0·58-2·03); whole-grain foods (0·87, 0·58-1·71); sugar-sweetened beverages (0·58, 0·29-1·29); milk and milk alternatives (0·71, 0·29-1·29). Significant correlations between dietary groups and dietary correlates were largely in the directions expected based on the literature, giving initial indication of convergent and discriminant validity.ConclusionsThe FRESH Foods Survey is efficient, tailored to food pantry populations, can be used to monitor dietary behaviours and may be useful to measure intervention impact.

Assessing the relationship between empowerment and nutrition along the agriculturenutrition pathway is limited by dissimilar emic and etic views of the construct, limited understanding of its contextual variation, and measurement difficulties. This study explored local meanings and perceptions of empowerment among women and men farmers in rural Ghana. The qualitative study took place within the LinkINg Up project, a quasi-experimental, nutrition-sensitive agriculture intervention (ClinicalTrials.gov NCT03869853) in three sub-districts of the Eastern Region. The intervention was implemented through farmer-based organizations (FBO) that were selected using a set of criteria such as female representation and level of member participation. Within the FBO, all women were recruited to participate along with one male adult family member (spouse/partner, older son, father). Non-FBO members (women and their male family member) from the same communities were also enrolled as a comparison group. This manuscript addresses an independent research question on empowerment, not the LinkINg Up intervention outcomes. For the question, participants (53 females and 45 males) were selected purposefully based on FBO membership of the woman (member, non-member). During the first three months of the project, eight focus group discussions (FGD) with women and seven FGD with men were conducted to probe into local understandings of empowerment and women's empowerment (WE). The FGD were translated to English from the local language and transcripts were coded using a Constructivist Grounded Theory approach (open, axial, selective coding) with MAXQDA 2022. Women and men described empowerment in terms of an individual's capability to improve circumstances by setting and meeting intentional and measurable goals. The construct of empowerment was made up of internal and external components. Internal components were those that were essential to allow one to be empowered, such as self-confidence, while the external components of empowerment were related to personal and community factors that empowered people, for example, asset ownership and social support. Emic understandings of WE were often related to women's relationships with others and their roles (reproductive, productive, and community) within the studied context. The local descriptions of an empowered woman were categorized as someone who: i) exhibits qualities that are perceived to help one achieve goals, ii) takes actions to achieve goals, and iii) works with others to achieve own goals or common goals. When assessing WE in the study area, it is important to incorporate measures for women's goal-setting capacity in relation to farming and business activities, and their ability to implement their goals, while taking into account relational aspects. [ABSTRACT FROM AUTHOR]

This article analyzes the bioethical implications of using a control/placebo group when conducting clinical trials (CTs) investigating the treatment of periodontitis. For this, the deductive method was used, proposing the interrelation of values, and a scoping systematic review was carried out. A total of 53% of the CTs reviewed were performed in low‐ and middle‐income (LMI) countries, and 92% used a control/placebo group as a comparison group. Although there is a gold standard for the adjunctive treatment of periodontitis, the research ethics committees of most of the analyzed studies approved the use of control/placebo groups for the performance of CTs that did not explore new therapeutic alternatives. In some cases, the CT protocols were not approved by ethics committees, nor was informed consent used. In the LMI countries, a shorter period of recruitment was observed for patients who attended universities and public hospitals. Likewise, most of the CTs reviewed had public funding, a significant amount of which came from the pharmaceutical industry. Only one CT reported the low economic and educational level of its participants. Furthermore, none of the authors of the reviewed CTs declared conflicts of interest. Although the axiology of techno‐science always takes into account at least the epistemic, technical and economic value systems, the hegemony of the economic values imposed by the pharmaceutical industry is evident in the performance of CTs investigating the treatment of periodontitis in LMI countries. [ABSTRACT FROM AUTHOR]

Responding to the COVID-19 pandemic, the American Rescue Plan (2021) allowed state agencies of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) the option of temporarily increasing the Cash-Value Benefit (CVB) for fruit and vegetable (FV) purchases. To examine the impact of this enhancement on WIC caregiver experience, the MA WIC State Office invited 4600 randomly selected MA WIC caregivers to complete an online survey (February–March 2022). Eligible adults had at least one child, had been enrolled at least a year, and were aware of the increase. Of those who opened the screener (n = 545), 58.9% completed it (n = 321). We calculated the frequencies of reporting increased FV outcomes and tested whether responses differed by race/ethnicity, market access, and food security. Most caregivers perceived the CVB increase to benefit FV purchasing (amount and quality, 71.0% and 55.5%), FV consumption (offered to children and personally consumed, 70.1% and 63.2%), and satisfaction with the WIC food package (37.1% reported improved satisfaction, pre- vs. post-increase). Probability of reporting improved outcomes was not found to differ by race/ethnicity, market access, or food security. CVB increases may pose important implications for dietary behaviors and satisfaction with WIC. Policymakers should consider making this increase permanent. [ABSTRACT FROM AUTHOR]

Objectives: Remote consultations were common in general practice during the COVID-19 pandemic. This approach may have affected access to GP care for people with low socio-economic status: this group has a high prevalence of chronic conditions and a higher mortality rate due to COVID-19. This study explores the association of sociodemographic and health factors with the decision to contact a GP practice, and care utilisation, among patients in low-income neighbourhoods in the Netherlands. Design: Cross-sectional survey study. Setting: General practice in low-income neighbourhoods in the Netherlands. Participants: Patients from low-income neighbourhoods were selected from fourteen general practices on the basis of ethnic background, chronic disease or health literacy. Participants were stratified according to categories of these background characteristics to obtain equal numbers per category. A total of 213 surveys were retained for analysis. Main outcome measures: Need for GP contact, decision to contact a GP practice, and GP service utilisation. Results: Forty-five percent (N = 88) of the participants experienced health problems for which they wished to consult their GP at the start of the outbreak of COVID-19. A majority of them (81%) had contact with a GP service. The need to contact the GP was significantly associated with financial difficulties (OR 2.20 CI (1.10 to 4.39)). An interaction effect was found of health literacy with concerns about COVID-19 with in respondents with low health literacy a significant association between concerns about COVID-19 and a need for a GP appointment (OR 5.33 CI (2.09 to 13.59)) and absence of a significant association in the higher health literacy group (OR 1.14 CI (0.51 to 2.56)). Moreover, 56% (N = 74) of the participants received remote care at least one time during the first wave of COVID-19. Female participants used remote care more often (OR 3.22 CI (1.57 to 6.59)) and participants aged 50 and over used remote care less often (OR 0.46 CI (0.21 to 0.97)). Conclusion: Many patients in low-income neighbourhoods were able to consult a GP, often remotely. However from the equity perspective, access to GP care should be safeguarded for patients with health problems, financial difficulties and low health literacy because of their greater need to consult a GP during times of crisis. [ABSTRACT FROM AUTHOR]

Aim: The aim was to evaluate the feasibility of protective measures for infants of low‐income SARS‐CoV‐2 positive breastfeeding mothers. Background: Breastfeeding mothers with SARS‐CoV‐2 positive should avoid exposing the infant through protective measures (PM), but it could be challenging in a low‐income population. Methods: A prospective, multicentre study was conducted between July and October 2020 (BRACOVID). The participants were recruited at birth and interviewed through a structured questionnaire at 7 and 14 days in the home environment. The feasibility of PM during breastfeeding at home was defined by guidelines recommendations (mask using, handwashing, and distancing from newborn when not breastfeeding). Three groups according to the feasibility of guidelines: complete guidelines feasibility (CG): all PM; partial guidelines feasibility (PG): at least one PM feasible; no guidelines (NG): infeasibility to all of PM. Flu‐like neonatal symptoms and breastfeeding practices were analyzed. We evaluated the association between PM feasibility and socioeconomic factors. Results: One hundred seventeen infected mothers from 17 Brazilian hospitals were enrolled. Forty‐seven (40%) mothers followed all recommendations, 14 (11.9%) could not practice at least one recommendation, and 50 (42.7%) did not execute any of them. The breastfeeding rate was 98%. Factors associated with infeasibility were monthly family income <92.7 dollars/person, high housing density (>1 inhabitant/room), teenage mothers, responsive feeding, and poor schooling. Regarding infants' flu‐like symptoms, 5% presented symptoms at 14 days (NG group). Conclusion: The guidelines were not applied to infants of SARs‐CoV‐positive mothers in 54.6% of the dyads since the recommendations were unviable in their environments. During pandemics, we should look for feasible and effective guidelines to protect neonates from low‐income populations. Implications for Nursing Management: Poor socioeconomic conditions lead to the unfeasibility of protective measures for infants of low‐income SARS‐CoV‐2 positive breastfeeding mothers during the isolation period in the pandemics. The orientations and the support provided to dyad should consider the socioeconomic factors to guide feasible measures in the home environment and promote adequate protections; only an individual approach will allow a safe environment for low‐income infants. The Research Ethics Committee approved the project of the Medicine School in Ribeirão Preto, University of São Paulo, Brazil (CAAE: 31357320.9.1001.5440‐4.066.741/2020) and Brazilian hospitals and maternal services. [ABSTRACT FROM AUTHOR]

Purpose: Early identification of impairments is crucial to providing better care for preterm children, especially those from low-income families. The early motor assessment is the first step in monitoring their neurodevelopment. This study investigates if motor development in the first year of life predicts impairments in cognition and language at 3-year-old in a Brazilian preterm cohort. Materials and methods: Data were collected in a follow-up clinic for highrisk infants. The Bayley Scales were used to assess children at 4, 8, 12, and 36 months of age, considering composite scores. Cognitive and language impairments were considered if scores were ≤85. Children (N = 70) were assessed at 4 and 36 months, 79 were assessed at 8 and 36 months, and 80 were assessed at 12 and 36 months. Logistic regressions were used to analyze the predictability of cognitive and language impairments, and receiveroperating characteristics (ROC) curves were used to analyze the sensibility and specificity of motor assessment and cognitive and language impairments. Results: Poor motor scores at 8 and 12 months increased the chances of cognitive and language impairment at 3-year-old. The chance of cognitive impairment at 3-year-old increases by 6-7% for each point that the motor composite score decreases, and the chance of language impairment at 3-year-old increases by 4-5% for each point that the motor composite score decreases. No-significant results were found at 4-months. Adequate sensibility and specificity were found for language impairments considering 12 months scores and for cognitive impairments as soon as 8 months scores. Conclusion: Monitoring preterm motor development in the first year of life helps to identify preterm children at risk for impairment in other developmental domains. Since preterm children from low-income families tend to demonstrate poorer neurodevelopment outcomes, these children need early assessment and referral to intervention to prevent school failures and support from public policies. [ABSTRACT FROM AUTHOR]

To assess the quality of life (QOL) and describe associated factors in patients with chronic heart failure (HF) living in a low-income population in West Africa. This is was a cross-sectional study conducted from January 2017 to June 2018, in the department of cardiology of the University Teaching Hospital (CHU-Campus) in Lomé (Togo). Enrolled patients had stable chronic HF and have been hospitalized in the past 6 months; QOL was assessed using the Minnesota Living with Heart Failure questionnaire (MLHFQ). 171 patients were included (women = 40.9%, 33% unschooled, 75% without health insurance; 46.8% in NYHA class II). The prevalence of depression was 62%. The mean total score of MLHFQ was 37.2 ± 22.3. In univariate analysis, there was a positive correlation between the total score and the following factors: age (r= 0.33, p ˂0.0001), NYHA classes (r= 0.67, p ˂0.0001), number of rehospitalizations (r= 0.61, p ˂0.0001), number of comorbidities (r= 0.43, p ˂0.0001), and the depression score (r= 0.67, p ˂0.0001). After adjustments, positive correlation persisted with NYHA classes (p ˂0.0001), number of rehospitalizations (p= 0.02), and depression (p ˂0.0001). The QOL of HF patients was moderately impaired and was comparable to values reported among high-income populations. Factors associated with poor quality of life were advanced NYHA classes, number of rehospitalizations, and depression. [ABSTRACT FROM AUTHOR]

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an essential program in the USA providing food benefits and nutritional and breast-feeding support to low-income pregnant or postpartum women, infants and children at nutritional risk. Despite similarities amongst federal regulations shared across WIC programs at the state level, important differences in the operations, policies and technologies between states exist. Nationally, nearly half of women, infants and children who were eligible to receive WIC benefits in 2018 were not participating in the program. In this paper, we evaluate common practices exhibited by states with the highest and lowest WIC coverage rates to identify strategies that may improve enrollment and retention rates in regions with low WIC coverage rates. We use WIC as a case study for identifying strategies that can be broadly applied to improve utilisation of similar food assistance programs globally, particularly those benefiting low-income women and children. The four strategies discussed here include utilising data to check adjunctive eligibility and reach eligible non-participants, increasing public awareness of WIC through outreach and referral efforts, implementing a centralised smartphone app and linking personal electronic benefits and streamlining the use of technologies for online applications, participant portals and remote communication. In most states, the COVID-19 pandemic and the federal waivers issued in response have offered the opportunity to promptly implement some of these strategies, particularly with regard to remote communication capabilities. With proper resources and implementation, these strategies can improve utilisation of WIC and similar programs globally. [ABSTRACT FROM AUTHOR]

Background: Non-pharmacologic treatment, including chiropractic care, is now recommended instead of opioid prescriptions as the initial management of chronic spine pain by clinical practice guidelines. Chiropractic care, commonly including spinal manipulation, has been temporally associated with reduced opioid prescription in veterans with spine pain. Purpose: To determine if chiropractic management including spinal manipulation was associated with decreased pain or opioid usage in financially disadvantaged individuals utilizing opioid medications and diagnosed with musculoskeletal conditions. Methods: A retrospective analysis of quality assurance data from a publicly funded healthcare facility was conducted. Measures included numeric pain scores of spine and extremity regions across three time points, opioid utilization, demographics, and care modalities. Results: Pain and opioid use significantly decreased concomitant with a course of chiropractic care. Conclusions: A publicly funded course of chiropractic care temporally coincided with statistically and clinically significant decreases in pain and opioid usage in a financially disadvantaged inner-city population. [ABSTRACT FROM AUTHOR]

Background: Studies have documented a heightened risk of suicidal ideation in response to stressors, especially among people from socioeconomically disadvantaged backgrounds. However, the mechanisms of this association remain elusive., Aims: Drawing on the social deterioration and counteractive models, this study aims to elucidate the pathways linking stressors to suicidal ideation through serial mediation of social support and mental health symptoms in Malaysia., Method: Data were collected from 404 low-income adults (33.2% male and 66.8% female) receiving monthly financial assistance from Malaysia's social welfare department. We employed stressor measures (i.e. financial, family and work), the Oslo Social Support Scale, the Patient Health Questionnaire and the Suicidal Behaviour Questionnaire-Revised., Results: A total of 46.8% of participants reported mild-to-severe anxiety and depressive symptoms, with 11.1% classified as high risk for suicide. Direct and indirect effects were found. After controlling for age and gender, social support and mental health symptoms mediated the link between stressors and suicidal ideation. The serial mediation analysis indicates that stressors are connected to heightened suicidal ideation through a sequence involving insufficient social support, followed by elevated levels of mental health symptoms., Conclusion: Understanding the multifaceted relationships among stressors, social support, mental health symptoms and suicide ideation expands the potential for developing targeted interventions and preventive strategies tailored for vulnerable populations. Clinical work with low-income individuals may include implementing early systematic efforts to develop accessible mental health and integrated care services.

Introduction: Early childhood caries (ECC), and the progression to severe ECC (S-ECC), is a serious oral health issue, leading to acute pain, sepsis, tooth loss, and compromised quality of life. Although the association between sociodemographic factors and ECC has been widely discussed, it remains unclear whether the same association exists between inequality and S-ECC., Objectives: To investigate the impact of low income on the oral health of preschool children and explore any additional risk factors for developing ECC and S-ECC during follow-up., Methods: The study used Taipei Child Development Screening Program data from 2014 to 2019. It included children aged 3 to 5 y who had more than 2 oral exams and completed baseline oral health questionnaires. Low-income children were matched 1:4 with controls by age and gender. Evaluation of ECC and S-ECC used the dmft index during follow-up exams. Generalized estimating equations (GEEs) assessed the impact of household income on ECC and S-ECC risk over time., Results: Of the 895 participants, 179 were from low-income households. We revealed a significantly higher risk of developing S-ECC (adjusted odds ratio [aOR] 1.99; 95% confidence interval [CI] 1.25-3.17) in children from low-income households, with no significantly increased of risk of developing ECC. Children who consumed sugary beverages >4 times per week showed elevated risks of developing both ECC (aOR 1.77; 95% CI 1.07-2.94) and S-ECC (aOR 1.89; 95% CI 1.13-3.17). Protective factors included children with mothers with a college education (S-ECC: aOR 0.50; 95% CI 0.32-0.79)., Conclusion: Children from low-income households have a significant risk of developing S-ECC compared with children from non-low-income households during follow-up. Factors contributing to this risk include lower maternal education, poor maternal oral health, and increased consumption of sugar-sweetened beverages. Policymakers should develop health measures to reduce the prevalence of ECC and S-ECC in children from low-income households whose mothers have lower educational levels and poor oral health., Knowledge Transfer Statement: The results of this study highlight the significant S-ECC risk among preschool children from low-income households in Taipei, with other risk factors including higher consumption of sugar-sweetened beverages, lower maternal education, and poor maternal oral health. Policymakers can use our findings to develop targeted policy and behavioral interventions to reduce S-ECC in vulnerable populations., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To understand the physical health condition and its influencing factors among the low-income population., Method: Low-income residents who visited or consulted at our Hospital during 2022 were selected for this study. Through telephone or face-to-face interviews, a self-made basic information questionnaire was used for data collection. The physical health level of the low-income population was analyzed, and a logistic regression model was applied to study its influencing factors., Results: A total of 2,307 people were included in this study, of which 2,069 had various types of diseases, indicating a disease rate of 89.68%. Multivariate logistic regression analysis showed that age ≥ 60 years old (OR = 1.567, 95%CI: 1.122-2.188), poor mental health status (OR = 2.450, 95%CI: 1.203-3.678), smoking (OR = 1.752, 95%CI: 1.269-2.206), pulse pressure difference ≥ 60 (OR = 1.485, 95%CI: 1.164-1.787), and poor hearing (OR = 1.268, 95%CI: 1.026-1.324) were risk factors for disease, whereas being female (OR = 0.729, 95%CI: 0.540-0.984) was a protective factor for physical health., Conclusion: As a developing country with a large population, we should particularly focus on the physical health issues of the low-income population, take targeted measures for disease situations, and improve the quality of life of the low-income population., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Li, Jiang, Wu, Ji, Tian, Yang and Zhu.)

Jing Han,1,&ast; Jie Liu,1– 4,&ast; Yakun Wu,1,5,&ast; Qiuxing Lin,1– 3,5 Dandan Guo,1 Xin Zhang,1 Jun Tu,1– 3,5 Xianjia Ning,1– 3,5 Jinghua Wang1– 3,5 1Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China; 2Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People’s Republic of China; 3Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People’s Republic of China; 4Center of Clinical Epidemiology & Evidence-Based Medicine, The Jizhou People’s Hospital, Tianjin, 301999, People’s Republic of China; 5Department of Neurology, Tangshan Gongren Hospital, Tangshan, 063000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jinghua Wang; Xianjia Ning Email jwang3@tmu.edu.cn; xning@tmu.edu.cnObjective: Although stroke mortality has remained stable over the past decade, the long-term trends of stroke burden are scarce in China, especially in low-income populations. Thus, we aimed to explore the secular trends in the prognosis of stroke in a low-income population in China.Methods: This was a population-based stroke surveillance study that included all of the participants in the Tianjin Brain Study. Stroke management and outcomes were evaluated for all stroke patients. Trends in the burden of stroke were assessed as annual percentage changes.Results: Overall, 1462 stroke cases occurred from 1992 to 2018, and 58.7% of patients were male. The rates of diagnosis by neuroimaging and of hospitalization increased noticeably across sexes and ages for all stroke types, and the greatest increases were observed among elderly women; diagnosis by neuroimaging increased by 4.7% and the rate of hospitalization increased by 12.4% (all P< 0.001). Stroke fatality decreased by 3.7% annually among those aged < 65 years and by 3.1% among patients aged ≥ 65 years; the corresponding rates were 7.4% and 3.5%, respectively, for women. The recurrence rate of ischemic stroke significantly decreased among all men, by 9.6% for those aged < 65 years and by 3.1% for those aged ≥ 65 years; however, for women, this rate only significantly decreased for those aged ≥ 65 years.Conclusion: Our findings suggest that the allocation of medical resources has improved over the past decades. However, it is crucial to enhance secondary stroke prevention for women aged < 65 years by controlling risk factors in low-income populations.Keywords: stroke burden, case fatality, recurrence, trends, low-income population

Objectives: This study aims to assess the interaction between Breastfeeding and ALL incidence and different ALL variables in children. Methods: Our case-control study was conducted in the major paediatric cancer centre in Syria. Information was obtained from the hospital's records of patients who did not have a hereditary or chromosomal syndrome and aged 4 years and less. The cases had ALL and controls were hospital inpatients. Children were divided into 3 groups depending on their feeding habits before the age of 6 months. Results: Sixty (85.7%) cases and 59 (72%) controls were exclusively breastfed. Exclusive breastfeeding was found more frequently in the case group P=0.04 (OR, 2.339; CI, 1.025 -5.336). In case group, parents of a low educational level breastfed their children more frequently (P<0.05). Number of siblings was not associated with ALL or any of its variables. Furthermore, infancy feeding pattern correlation with gender, being born with no complications, consanguinity, CD10, FAB classification, ALL-subtype, risk, and family history were insignificant. Conclusion: There are certain practices among the Syrian people, especially among parents of a low educational level that has possibly exposed to carcinogenic substances which were possibly transferred through BF. However, BF had minor effects on the prognosis and subtype of ALL, and number of siblings had no effect on ALL. [ABSTRACT FROM AUTHOR]

Food pantries have traditionally focused on meeting emergency food needs. However, for many clients, food assistance is a long‐term need. The frequency with which long‐term clients visit food pantries varies; and in general, visiting frequency has been understudied because the focus has largely been on emergency, rather than long‐term, food assistance impacts. We leveraged a program innovation to identify the impact of visiting frequency on client outcomes. Using fixed‐effect models, we analyzed a panel of 1663 long‐term food pantry users observed monthly from 2017 to 2019. Within‐client increases in visiting frequency were associated with within‐in client improvements in food security and health. [ABSTRACT FROM AUTHOR]

Daily carrying of heavy loads of domestic water, especially during pregnancy and postpartum, bears a threat to maternal health in low‐income countries. Using an extended health action process approach (HAPA), we examined women's reasons for and psychosocial determinants of safe water‐carrying during pregnancy and postpartum. In a mixed‐methods study, trained local interviewers conducted 1001 quantitative interviews with women of reproductive age (n = 921 analyzed) and 21 qualitative interviews with women of reproductive age, in‐laws, and spouses in rural Nepal. We analyzed the quantitative data with generalized estimating equations to model the HAPA‐based psychosocial determinants of avoiding water‐carrying during pregnancy and postpartum. Subjective perspectives were investigated with thematic analysis. Outcome expectancies (B = 0.24), self‐efficacy (B = 0.20), and injunctive norms (B = 0.23) were significantly associated with the intention to avoid water‐carrying. Self‐efficacy (B = 0.36) and instrumental support (B = 0.05) are related to behavior (all p < 0.05). Women explained water‐carrying during pregnancy by a lack of family support, a shift of health decision‐making power to in‐laws, and low behavioral control. Overall, the necessity of water, family decision‐making structures, and low support make it difficult for women to discontinue water‐carrying. Additionally to infrastructural improvements, behavioral interventions may increase women's self‐efficacy for safe water‐carrying (e.g. reducing weight) and social support. [ABSTRACT FROM AUTHOR]

The purpose of this study was to better understand the number and types of social needs experienced by Medicaid beneficiaries with type 2 diabetes, and how their social needs are associated with key health indicators. Also examined were factors that influence patients' interest in navigation services for health and social needs to inform future interventions and service delivery. The study expands upon prior research, much of which has focused on only one social need (e.g., food insecurity) or one health outcome. The hypothesis was that among individuals with type 2 diabetes, those with a greater number of social needs would report more health‐related problems and be more interested in receiving social needs navigation services. Participants completed a cross‐sectional survey by phone (n = 95) or online (n = 14). Most (85%) reported having at least one social need (M = 2.5, SD = 2.2), most commonly not having enough money for unexpected expenses (68%) or necessities like food, shelter and clothing (31%), medical costs (24%), and utilities (23%). Results supported our comprehensive conceptual model. Having more social needs was associated with greater perceived stress, diabetes distress, problems with sleep and executive and cognitive functioning, less frequent diabetes self‐care activities, more days of poor mental health and activity limitations, worse self‐reported health and more hospitalisations. Number of social needs also was positively associated with interest in having a social needs navigator. Social needs were not associated with days of poor physical health, BMI, self‐reported A1C or smoking status. Social needs were associated with a wide range of indicators of poor health and well‐being. Participants with the greatest social need burden were most open to intervention. [ABSTRACT FROM AUTHOR]

Abstract Background Childhood obesity represents a global public health crisis: the number of obese children and adolescents (aged 5–19 years) worldwide has risen tenfold in the past four decades. The vast majority of overweight and obese children live in high-income countries, and low socio-economic status (SES) is a significant risk factor. Family Based Interventions (FBI) have demonstrated positive results in preventing obesity, although these results are strongly influenced by SES. Moreover, we still poorly understand how FBI can determine a positive trend in weight status in low-income communities. Therefore, there is an urgent need to define and evaluate innovative and multi-target projects to reduce obesity risk behaviors and health inequalities and the present study aims to present the study protocol of FIVALIN a FBI that pretends to achieve this goal. Methods We will conduct a quasi-experimental design within 60 Community Child Centers (CCC) in Barcelona metropolitan area. Each cluster (CCC) will be assigned by convenience to the intervention and control groups. For the whole study, a total of 810 children aged 8–12 years and 600 parents will be recruited during 3 consecutive editions (1st – 2019/2020; 2nd – 2020/2021; 3rd – 2021/2022) of 10 months each. The action is a regular multicomponent health-promotion intervention targeting children, families, and CCC. All activities are based on the Motivational Interviewing (MI) approach and will focus on promoting good dietary habits, physical activity, appropriate screen time and sleep duration, and psychological well-being. The control group participate in a unique workshop on general awareness of healthy lifestyles for families. We will perform a comparative analysis of the evolution of weight status, healthy lifestyles, and socioeconomic variables, between the intervention and control groups. Discussion There is a need for more evidence on how to target and evaluate holistic interventions in low SES families. Our multi-targeting intervention for obesity prevention tackles risky behaviors that go beyond diet and physical activity (PA). Therefore, future interventions can effectively promote all the behavioral domains that determine trends in the weight status. Trial registration ISRCTN Registry: ISRCRN12682870 . Registered 9 July 2020. Retrospectively registered. Protocol version: 30 April 2021, version 5.

There are large differences in health care among countries. A higher perioperative mortality rate (POMR) in neonates than in older children and adults has been recognized worldwide. The aim of this study was to provide a systematic review of published 24-h and 30-day POMRs in neonates from 2011 to 2022 in countries with different Human Development Index (HDI) levels. A systematic review with a meta-analysis of studies that reported 24-h and 30-day POMRs in neonates was performed. We searched the databases from January 2011 to July 30, 2022. The POMRs (per 10,000 procedures under anesthesia) were analyzed according to country HDI. The HDI levels ranged from 0 to 1, representing the lowest and highest levels, respectively (very-high-HDI: ≥ 0.800, high-HDI: 0.700–0.799, medium-HDI: 0.550–0.699, and low-HDI: < 0.550). The magnitude of the POMRs by country HDI was studied using meta-analysis. Eighteen studies from 45 countries were included. The 24-h (n = 96 deaths) and 30-day (n = 459 deaths) POMRs were analyzed from 33,729 anesthetic procedures. The odds ratios (ORs) of the 24-h POMR in low-HDI countries were higher than those in very-high- (OR 8.4, 95% CI 1.7–40.4; p = 0.008), high- (OR 7.3, 95% CI 2.2–24.4; p = 0.001) and medium-HDI countries (OR 7.7, 95% CI 3.1–18.7; p < 0.0001) but with no odds differences between very-high- and high-HDI countries (p = 0.879), very-high- and medium-HDI countries (p = 0.915) and high- and medium-HDI countries (p = 0.689). The odds of a 30-day POMR in low-HDI countries were higher than those in very-high-HDI countries (OR 6.9, 95% CI 1.9–24.6; p = 0.002) but not in high-HDI countries (OR 1.4, 95% CI 0.6–3.0; p = 0.396). The review demonstrated very high global POMRs in a surgical population of neonates independent of the country HDI level. We identified differences in 24-h and 30-day POMRs between low-HDI countries and other countries with higher HDI levels. • A review on the neonatal 24-h and 30-day perioperative mortality rates (POMRs) • Mortality was assessed according to countries' Human Development Indexes (HDIs) • The review showed high global 24-h POMR and very high global 30-day POMR • The 24-h and 30-day POMRs are substantially high in low-HDI countries • Neonates represent a challenge in perioperative care in all countries in this century [ABSTRACT FROM AUTHOR]

Understanding health outcomes and patterns of health care utilization associated with patients' cumulative social determinant of health (SDOH) risk is essential to supporting better health care. This study compared mental and physical health outcomes and health care utilization by increasing number of social needs among a clinical adult population. Surveys were sent to 6000 patients with recent visits to 7 primary care clinics in Portland, Oregon in 2018. The final study sample included respondents who matched to medical claims data, N = 1748. The authors used a modified logistic regression model to estimate risk ratios for the relationship between cumulative SDOH factors and self-reported chronic conditions, and a 2-part model to estimate the effects of cumulative SDOH risk on health care utilization. Increased SDOH need was associated with increasing likelihood of worse self-reported health outcomes, especially mental health. Compared with those with no SDOH need, having 1–2 SDOH need(s) (adjusted risk ratio [aRR] 1.25; 95% confidence interval [CI]: 1.06–1.46) and 3 or more SDOH needs (aRR 1.45; 95% CI: 1.22–1.73) had a greater risk of reporting any behavioral health condition. However, the number of SDOH had a graded but inverse impact on use of mental health care services where fewer visits were observed among those using care. Having SDOH was associated with increased likelihood of having an emergency department visit and increased number of primary care visits. This study demonstrates the compounding impact of SDOH on health and health care use. This highlights the importance of collecting SDOH, including the total number of SDOH needs, when considering a patient's health and health care. [ABSTRACT FROM AUTHOR]

Background Little is known about how the level of program participation affects child nutrition in rural interventions. Objectives This study examined the association between participation level in a nutrition-sensitive agriculture intervention and children's diet and anthropometric outcomes in rural Ghana. Methods Nutrition Links was a cluster randomized controlled trial (clinicaltrials.gov NCT01985243), which enrolled caregivers with children (aged less than 2 mo in 2014–2015 and less than 18 mo in 2016–2017). Of the 287 caregivers in 19 intervention communities who enrolled, 233 adopted the intervention and received layer poultry, garden inputs, and weekly child feeding education. The egg production and repayment of poultry were monitored, and feed was sold at the weekly meetings. After endline, the nutrition educators rated each woman who adopted the intervention on a scale [very poor (1) to excellent (5)] for: 1) meeting attendance, 2) egg productivity, 3) feed and poultry loan payment, 4) contributions during meetings, and 5) attentiveness towards group members. Participation level was classified as high, medium, and low by dividing the sum of these 5 items into tertiles; 54 women who did not adopt the intervention were classified as "no participation." Generalized mixed linear models tested the difference in changes in children's diet and anthropometric indices between the participation levels and the control category – 213 caregiver-child dyads in 20 communities who received standard-of-care health and agricultural services. Results Compared with the control category, only high participation was associated with egg consumption [adjusted OR (aOR) = 3.03; 95% CI: 1.15, 7.94]. Both medium and high participation levels were associated with length‐for‐age z ‐scores (LAZ)/height‐for‐age z ‐scores (HAZ) [adjusted β-coefficients (aβ) = 0.44; 95% CI: 0.16, 0.72 and 0.40; 95% CI: 0.12, 0.67, respectively]. Conclusion These results highlight the importance of promoting and monitoring the level of beneficiary participation to estimate the full potential of nutrition-sensitive agriculture interventions to improve nutritional outcomes. [ABSTRACT FROM AUTHOR]

Background: Persons with disabilities comprise more than one billion people in the world, yet they are one of the most discriminated groups and face significant health disparities. Particularly in developing countries, which contain 80% of the entire population with disabilities, these individuals experience major barriers in accessing sexual and reproductive health (SRH) services. Education is an important factor that greatly affects individuals' SRH service utilization. Hence, we sought to investigate the relationship between education and SRH service utilization for persons with disabilities in Bangladesh. Methods: Using an explanatory sequential mixed-methods design, a total of 5000 persons with disabilities were surveyed for the quantitative component and 15 mini-ethnographic case studies were conducted with persons with disabilities for the qualitative component. Chi-squared tests and logistic regression analyses were performed on the survey data, while the qualitative interviews were coded and their SRH themes synthesized accordingly. Results: Our quantitative findings show that education statistically significantly increases persons with disabilities' SRH service utilization of antenatal care, delivery care, postnatal care, and family planning (P < 0.05). Interestingly, for persons with disabilities, primary education shows increased adjusted odds of family planning use but is likely not enough to increase antenatal care, delivery care, or postnatal care use; secondary or post-secondary education may be required to improve utilization of these latter services. Qualitative findings support the association between higher education levels and greater SRH service use. Persons with disabilities of lower educational attainment held misinformation and distrust in SRH services and experienced mistreatment by SRH healthcare providers, discouraging them from seeking future SRH services. Conclusions: We report that higher formal education level is associated with greater SRH service use for persons with disabilities in Bangladesh. Formally educating persons with disabilities expands their SRH knowledge and familiarity with SRH services, as well as leads to more economic opportunities so they can afford SRH services. Increasing formal education levels for persons with disabilities, paired with integrating comprehensive sexuality education (CSE) in their schools, will likely help close the gap in SRH health disparities for this vulnerable population. Plain Language Summary: Out of more than one billion persons with disabilities in the world, 80% of them live in developing countries. Persons with disabilities commonly face discrimination and health disparities, particularly experiencing major barriers in accessing sexual and reproductive health (SRH) services. Education is a key factor that often leads to social and economic empowerment, which positively contributes towards individuals' SRH service utilization. In this paper, we examined the relationship between education and SRH service utilization for persons with disabilities in Bangladesh. We surveyed persons with disabilities across all of Bangladesh on their utilization of SRH services and conducted mini-ethnographic case studies with selected participants to more deeply understand their SRH issues and SRH service utilization. Our survey findings show that education significantly increases persons with disabilities' SRH service utilization of antenatal care, delivery care, postnatal care, and family planning in Bangladesh. Interestingly, for persons with disabilities, primary education may only be able to increase family planning use while secondary or post-secondary education may be required to increase antenatal care, delivery care, and postnatal care use. Our qualitative findings support the association between higher education levels and greater SRH service use. Persons with disabilities of higher education prioritized obtaining formal SRH services from qualified health care providers, even when financially constrained, while lower educated participants tended to be misinformed and distrustful of formal SRH services. We recommend helping persons with disabilities attain higher formal education levels and including comprehensive sexuality education (CSE) in their schools, as it likely will reduce SRH health disparities for this vulnerable group. [ABSTRACT FROM AUTHOR]

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Health care organizations are increasingly assessing patients' social needs (eg, food, utilities, transportation) using various measures and methods. Prior studies have assessed social needs at the point of care and many studies have focused on correlates of 1 specific need (eg, food). This comprehensive study examined multiple social needs and medical and pharmacy claims data. Medicaid beneficiaries in Louisiana (n = 10,275) completed a self-report assessment of 10 social needs during July 2018 to June 2019. Chronic health conditions, unique medications, and health care utilization were coded from claims data. The sample was predominantly female (72%), Black (45%) or White (32%), had a mean age of 42 years, and at least 1 social need (55%). In bivariate analyses, having greater social needs was associated with greater comorbidity across conditions, and each social need was consistently associated with mental health and substance use disorders. In multivariable logistic analyses, having ≥2 social needs was positively associated with emergency department (ED) visits (OR = 1.39, CI = 1.23 – 1.57) and negatively associated with wellness visits (OR = 0.87, CI = 0.77 – 0.98), inpatient visits (OR = 0.87, CI = 0.76 – 0.99), and 30-day rehospitalization (OR = 0.66, CI = 0.50 – 0.87). Findings highlight the greater concomitant risk of social needs, mental health, and substance use. Admission policies may reduce the impact of social needs on hospitalization. Chronic disease management programs offered by health plans may benefit from systematically assessing and addressing social needs outside point-of-care interactions to impact health outcomes and ED utilization. Behavioral health care management programs would benefit from integrating interventions for multiple social needs. [ABSTRACT FROM AUTHOR]

Stroke is a worldwide leading cause of mortality and disability, and there are substantial economic costs for poststroke care. Disadvantaged populations show increased incidence, severity, and unfavorable outcomes. This study aimed to report the survival, functional outcome, and caregiver satisfaction of low-income patients diagnosed with a large hemispheric infarction (LHI) who underwent decompressive craniectomy (DC). A retrospective analysis was conducted in consecutive adult patients with an LHI who underwent DC at a single center between October 2015 and September 2019. Demographic, clinical, and radiologic data were reviewed. The primary outcomes were 1-year survival and favorable functional outcome. Forty-nine patients were included; those <60 years of age showed a higher proportion of favorable functional outcomes (76% vs. 33%; P = 0.031) but similar survival (52% vs. 56%; P = 0.645) than older patients, respectively. Performing the craniectomy in <48 hours from stroke onset compared with ≥48 hours showed no statistically significant differences in survival (59% vs. 46%; P = 0.352) and favorable functional outcomes (56% vs. 70%; P = 0.683), respectively. In retrospective thinking, 79% of caregivers would decide to perform the surgery again. Age group and time from stroke onset to craniectomy were not associated with survival; notwithstanding, a higher proportion of patients <60 years of age were associated with a favorable functional outcome compared with older patients. Additionally, if given the option, most caregivers would decide to perform the surgery again, independently of the grade of disability of the patient. [ABSTRACT FROM AUTHOR]

Purpose: Oral microbiome plays an important role in oral health and systemic diseases, including cancer. We aimed to prospectively investigate the association of oral microbiome with lung cancer risk. Methods: We analyzed 156 incident lung cancer cases (73 European Americans and 83 African Americans) and 156 individually matched controls nested within the Southern Community Cohort Study. Oral microbiota were assessed using 16S rRNA gene sequencing in pre-diagnostic mouth rinse samples. Paired t test and the permutational multivariate analysis of variance test were used to evaluate lung cancer risk association with alpha diversity or beta diversity, respectively. Conditional logistic regression models were used to evaluate the association of individual bacterial abundance or prevalence with lung cancer risk. Results: No significant differences were observed for alpha or beta diversity between lung cancer cases and controls. Abundance of families Lachnospiraceae_[XIV], Peptostreptococcaceae_[XI], and Erysipelotrichaceae and species Parvimonas micra was associated with decreased lung cancer risk, with odds ratios (ORs) and 95% confidence intervals (CIs) of 0.76 (0.59–0.98), 0.80 (0.66–0.97), 0.81 (0.67–0.99), and 0.83 (0.71–0.98), respectively (all p < 0.05). Prevalence of five pre-defined oral pathogens were not significantly associated with overall lung cancer risk. Prevalence of genus Bacteroidetes_[G-5] and species Alloprevotella sp._oral_taxon_912, Capnocytophaga sputigena, Lactococcus lactis, Peptoniphilaceae_[G-1] sp._oral_taxon_113, Leptotrichia sp._oral_taxon_225, and Fretibacterium fastidiosum was associated with decreased lung cancer risk, with ORs and 95% CIs of 0.55 (0.30–1.00), 0.36 (0.17–0.73), 0.53 (0.31–0.92), 0.43 (0.21–0.88), 0.43 (0.19–0.94), 0.57 (0.34–0.99), and 0.54 (0.31–0.94), respectively (all p < 0.05). Species L. sp._oral_taxon_225 was significantly associated with decreased lung cancer risk in African Americans (OR [95% CIs] 0.28 [0.12–0.66]; p = 0.00012). Conclusion: Results from this study suggest that oral microbiota may play a role in the development of lung cancer. [ABSTRACT FROM AUTHOR]

Understanding how to support children from low‐income families as they begin kindergarten is paramount, because they may have delays in developing cognitive and social skills in preschool, putting them at risk for poorer outcomes. Importantly, further research needs to be conducted on how specific constructs that relate to school readiness interact, such as inhibitory control (IC) and emotion knowledge (EK). Previous research has examined relations between IC and EK, but the directionality reported is inconsistent, and few studies have the longitudinal data necessary to assess the interaction fully. Thus, the present study (N = 539) aimed to expand previous research by assessing the directionality of the relationship over four time points using cross‐lagged panel models in a low‐income population. The results showed positive bidirectional relations between the two constructs from preschool to kindergarten, but not kindergarten to first grade, perhaps indicating a shift in these constructs' interdependency to increased specificity. This study clarified the directionality of these related constructs from preschool into first grade, expanding previous research that focuses on this interaction primarily in the preschool years in samples of convenience. Implications for curricula and intervention for children from low‐income families are discussed. [ABSTRACT FROM AUTHOR]

Abstract Background Low-resource settings are disproportionally burdened by chronic lung disease due to early childhood disadvantages and indoor/outdoor air pollution. However, data on the socioeconomic impact of respiratory diseases in these settings are largely lacking. Therefore, we aimed to estimate the chronic lung disease-related socioeconomic burden in diverse low-resource settings across the globe. To inform governmental and health policy, we focused on work productivity and activity impairment and its modifiable clinical and environmental risk factors. Methods We performed a cross-sectional, observational FRESH AIR study in Uganda, Vietnam, Kyrgyzstan, and Greece. We assessed the chronic lung disease-related socioeconomic burden using validated questionnaires among spirometry-diagnosed COPD and/or asthma patients (total N = 1040). Predictors for a higher burden were studied using multivariable linear regression models including demographics (e.g. age, gender), health parameters (breathlessness, comorbidities), and risk factors for chronic lung disease (smoking, solid fuel use). We applied identical models per country, which we subsequently meta-analyzed. Results Employed patients reported a median [IQR] overall work impairment due to chronic lung disease of 30% [1.8–51.7] and decreased productivity (presenteeism) of 20.0% [0.0–40.0]. Remarkably, work time missed (absenteeism) was 0.0% [0.0–16.7]. The total population reported 40.0% [20.0–60.0] impairment in daily activities. Breathlessness severity (MRC-scale) (B = 8.92, 95%CI = 7.47–10.36), smoking (B = 5.97, 95%CI = 1.73–10.22), and solid fuel use (B = 3.94, 95%CI = 0.56–7.31) were potentially modifiable risk factors for impairment. Conclusions In low-resource settings, chronic lung disease-related absenteeism is relatively low compared to the substantial presenteeism and activity impairment. Possibly, given the lack of social security systems, relatively few people take days off work at the expense of decreased productivity. Breathlessness (MRC-score), smoking, and solid fuel use are potentially modifiable predictors for higher impairment. Results warrant increased awareness, preventive actions and clinical management of lung diseases in low-resource settings from health policymakers and healthcare workers.

Health systems are increasingly assessing and addressing social needs with referrals to community resources. The objective of this randomized controlled trial was to randomize adult Medicaid members with type 2 diabetes to receive usual care ( n = 239) or social needs navigation ( n = 234) for 6 months and compare HbA1c (primary outcome), quality of life (secondary outcome), and other exploratory outcomes with t -tests and mixed-effects regression. Eligible participants had an HbA1c test in claims in the past 120 days and reported 1+ social needs. Data were collected from November 2019 to July 2023. Surveys were completed at baseline and at 3-, 6-, and 12-month follow-up. Health plan data included care management records and medical and pharmacy claims. The sample was from Louisiana, USA, M = 51.6 (SD = 9.5) years old, 76.1% female, 66.5% Black, 29.4% White, and 3.0% Hispanic. By design, more navigation (91.5%) vs. usual care (6.7%) participants had a care plan. Social needs persisted for both groups. No group differences in HbA1c tests and values were observed, though the large amount of missing HbA1c lab values reduced statistical power. No group differences were observed for other outcomes. Proactively eliciting and attempting to provide referrals and resources for social needs did not demonstrate significant health benefits or decrease healthcare utilization in this sample.

Purpose Studies have supported the use of packaging interventions such as pillboxes or blister packs to improve medication adherence but have not evaluated the efficacy of these interventions in a population of low socioeconomic status. The aim of this study was to assess the effect of home-delivered pill packs on medication adherence in a low-income Black American population with Medicaid insurance. Methods This study was an open-label, randomized, controlled trial. The patient population studied included 80 patients followed by primary care physicians at the Cleveland Clinic. Patients were randomized to a study group who received delivery of their multidrug medical therapy, defined as a minimum of 4 medications daily, in prepackaged blisters or a control group who obtained their prescriptions from their routine pharmacy. Results The primary analysis compared the mean percentage of missed pills between the 2 groups using t -test analysis. The percentage of missed pills in the study group was significantly lower than in the control group (mean [SD]: 3.7% [6.0%] vs 17.4% [16.6%] missed daily pills; P < 0.001). The number of daily missed doses was also significantly lower in the study group (0.3 [0.5] vs 0.7 [0.6]; P = 0.002). Patients were on a mean of 8.1 (SD, 2.3) and 8.1 (SD, 2.6) medications in the study and control groups, respectively (P = 0.96). Conclusion Delivery of prepackaged medications in a low-income Black American community was demonstrated to improve medication adherence. The use of prepackaged blisters for medication home delivery is a model that can be utilized on a larger scale for patients on multidrug medical therapy. [ABSTRACT FROM AUTHOR]