3,985 results on '"Social Deprivation"'
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2. A Comprehensive Insight into the Economic Profile of People Receiving Metabolic and Bariatric Surgery Use in France.
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Benamran, Dorith, Chierici, Andrea, Bulsei, Julie, Fontas, Eric, and Iannelli, Antonio
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GASTRIC banding ,SLEEVE gastrectomy ,GASTRIC bypass ,BARIATRIC surgery ,SOCIOECONOMIC status - Abstract
Background: The use of metabolic and bariatric surgery (MBS) is not uniformly distributed within the population, even if it is governed by established guidelines. This disparity seems to be associated, among other factors, with the economic profile of people receiving this surgery. Objectives: We investigated the disparities in the use of MBS with respect to the socio-economic level in France based on socio-economic status (SES). Materials and Methods: A descriptive observational study was conducted to compare the population of individuals with obesity who underwent MBS (MBS group) with individuals with obesity with no history of MBS (obese group). Data were extracted from the French National Hospital discharge database ("Programme De Médicalisation des Systèmes d'Information," PMSI). Socio-economic status (SES) was assessed through the French Deprivation Index (FDep). Results: The use of MBS was significantly lower in patients having a higher SES compared to those having a lower one. There was no statistically significant difference in the use of MBS between individuals within the 4th and 5th SES quintiles compared to those in the 2nd and 3rd quintiles. No difference was found in the specific MBS procedures used depending on the SES. The obesity level was significantly lower in patients from the 1st and 3rd SES quintiles compared to the patients having a lower SES. Conclusion: Our study provides valuable insights into the complex interrelationships between the use of MBS, patients' SES, and obesity levels according to the FDep. These findings underscore the importance of developing targeted interventions to address disparities in the use of bariatric care. [ABSTRACT FROM AUTHOR]
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- 2024
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3. Early social isolation disrupts adult personality expression in group‐living mites.
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Schausberger, Peter and Nguyen, Thi Hanh
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PREDATORY mite , *INTRACLASS correlation , *SOCIAL isolation , *SEA anemones , *SOCIAL impact - Abstract
Animal personalities are characterized by intra‐individual consistency and consistent inter‐individual variability in behaviour across time and contexts. Personalities abound in animals, ranging from sea anemones to insects, arachnids, birds, fish and primates, yet the pathways mediating personality formation and expression remain elusive. Social conditions during the early postnatal period are known determinants of mean behavioural trait expressions later in life, but their relevance in shaping personality trajectories is unknown. Here, we investigated the consequences of early social isolation on adult personality expression in plant‐inhabiting predatory mites Phytoseiulus persimilis. These mites are adapted to live in groups. We hypothesized that transient experience of social isolation early in life, that is, deprivation of any social contact during a sensitive window in the post‐hatching phase, has enduring adverse effects on adult personality expression. Newly hatched mites were transiently reared in isolation or in groups and tested as adults for repeatability of various within‐group behaviours, such as movement patterns and mutual interactions including sociability, defined as the propensity to associate and interact benignly with conspecifics, and activity patterns when alone. Groups composed of individuals with the same or different early‐life experiences were repeatedly videotaped and individual behaviours were automatically analysed using AnimalTA. Social experiences early in life had persistent effects on mean behavioural traits as well as adult personality expression, as measured by intraclass correlation coefficients (indicating repeatability). On average, isolation‐reared females moved at higher speeds, meandered less, kept greater distances from others and had fewer immediate neighbours than group‐reared females. Group‐reared females were highly repeatable in inter‐individual distance, moving speed, meandering and area explored, whereas isolation‐reared females were repeatable only in the number of immediate neighbours. Activity, quantified as the proportion of time spent moving within groups, was only repeatable in group‐reared females, whereas activity, quantified as the proportion of time spent moving when alone, was only repeatable in females reared in isolation. Strikingly, also the early‐life experiences of male mates influenced personality expression of mated females, with isolation‐reared males boosting the repeatability of behavioural traits of group‐reared females. Overall, our study provides evidence that a transient phase of social isolation during a critical period early in life has lasting effects that extend into adulthood, impairing adult personality expression. These effects should cascade upward, changing the phenotypic composition and diversity within populations. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Equity in the provision of helicopter emergency medical services in the United Kingdom: a geospatial analysis using indices of multiple deprivation.
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McHenry, Ryan D., Leech, Caroline, Barnard, Ed B. G., and Corfield, Alasdair R.
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Background: Helicopter Emergency Medical Services (HEMS) in the United Kingdom (UK) are provided in a mixed funding model, with the majority of services funded by charities alongside a small number of government-funded operations. More socially-deprived communities are known to have greater need for critical care, such as that provided by HEMS in the UK. Equity of access is an important pillar of medical care, describing how resource should be allocated on the basis of need; a concept that is particularly relevant to resource-intensive services such as HEMS. However, the Inverse Care Law describes the tendency of healthcare provision to vary inversely with population need, where healthcare resource does not meet the expected needs in areas of higher deprivation. It is not known to what extent the Inverse Care Law applies to HEMS in the UK. Methods: Modelled service areas were created with each small unit geography locus in the UK assigned to its closest HEMS operational base. The total population, median decile on index of multiple deprivation, and geographic area for each modelled service area was determined from the most recently available national statistics. Linear regression was used to determine the association between social deprivation, geographic area, and total population served for each modelled service area. Results: The provision of HEMS in the UK varied inversely to expected population need; with HEMS operations in more affluent areas serving smaller populations. The model estimated that population decreases by 18% (95% confidence interval 1–32%) for each more affluent point in median decile of index of multiple deprivation. There was no significant association between geographic area and total population served. Conclusion: The provision of HEMS in the UK is consistent with the Inverse Care Law. HEMS operations in more deprived areas serve larger populations, thus providing a healthcare resource inversely proportional with the expected needs of these communities. Funding structures may explain this variation as charities are more highly concentrated in more affluent areas. [ABSTRACT FROM AUTHOR]
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- 2024
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5. 多维社会剥夺感对老年人衰弱的影响-抑郁的中介效应分析.
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冉光权, 王 延, 刘 帅, and 刘丹萍
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RANK correlation (Statistics) ,CONVENIENCE sampling (Statistics) ,OLDER people ,SOCIAL participation ,SOCIAL support - Abstract
Copyright of Journal of Sichuan University (Medical Science Edition) is the property of Editorial Board of Journal of Sichuan University (Medical Sciences) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2024
6. Évolution des impacts de la pollution atmosphérique sur la mortalité entre 2009 et 2019 dans le territoire du plan de protection de l'atmosphère de Toulouse.
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Poinat, Patrice, Cheniki, Sandrine, Delpierre, Cyrille, Ruiz, Inca, Corso, Magali, Chanel, Olivier, and Cassadou, Sylvie
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URBAN pollution ,VALUE (Economics) ,ECONOMIC impact ,COST benefit analysis ,POLLUTANTS ,AIR pollution - Abstract
Copyright of Environnement, Risques & Santé is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2024
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7. Equity in the provision of helicopter emergency medical services in the United Kingdom: a geospatial analysis using indices of multiple deprivation
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Ryan D. McHenry, Caroline Leech, Ed B. G. Barnard, and Alasdair R. Corfield
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Pre-hospital emergency medicine ,Health inequalities ,Geospatial modelling ,Social deprivation ,Delivery of health care ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Helicopter Emergency Medical Services (HEMS) in the United Kingdom (UK) are provided in a mixed funding model, with the majority of services funded by charities alongside a small number of government-funded operations. More socially-deprived communities are known to have greater need for critical care, such as that provided by HEMS in the UK. Equity of access is an important pillar of medical care, describing how resource should be allocated on the basis of need; a concept that is particularly relevant to resource-intensive services such as HEMS. However, the Inverse Care Law describes the tendency of healthcare provision to vary inversely with population need, where healthcare resource does not meet the expected needs in areas of higher deprivation. It is not known to what extent the Inverse Care Law applies to HEMS in the UK. Methods Modelled service areas were created with each small unit geography locus in the UK assigned to its closest HEMS operational base. The total population, median decile on index of multiple deprivation, and geographic area for each modelled service area was determined from the most recently available national statistics. Linear regression was used to determine the association between social deprivation, geographic area, and total population served for each modelled service area. Results The provision of HEMS in the UK varied inversely to expected population need; with HEMS operations in more affluent areas serving smaller populations. The model estimated that population decreases by 18% (95% confidence interval 1–32%) for each more affluent point in median decile of index of multiple deprivation. There was no significant association between geographic area and total population served. Conclusion The provision of HEMS in the UK is consistent with the Inverse Care Law. HEMS operations in more deprived areas serve larger populations, thus providing a healthcare resource inversely proportional with the expected needs of these communities. Funding structures may explain this variation as charities are more highly concentrated in more affluent areas.
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- 2024
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8. Area Deprivation Index in patients with invasive lobular carcinoma of the breast: associations with tumor characteristics and outcomes
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Kaur, Mandeep, Patterson, Anne, Molina-Vega, Julissa, Rothschild, Harriet, Clelland, Elle, Ewing, Cheryl A, Mujir, Firdows, Esserman, Laura J, Olopade, Olufunmilayo I, and Mukhtar, Rita A
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Biomedical and Clinical Sciences ,Health Sciences ,Oncology and Carcinogenesis ,Cancer ,Breast Cancer ,Female ,Humans ,Breast Neoplasms ,Carcinoma ,Ductal ,Breast ,Carcinoma ,Lobular ,Progression-Free Survival ,Retrospective Studies ,Residence Characteristics ,Socioeconomic Factors ,Social Deprivation ,Healthcare Disparities ,Middle Aged ,Medical and Health Sciences ,Epidemiology ,Biomedical and clinical sciences ,Health sciences - Abstract
BackgroundAlthough investigators have shown associations between socioeconomic status (SES) and outcomes in breast cancer, there is a paucity of such data for invasive lobular carcinoma (ILC), the second most common type of breast cancer. Herein we evaluated the relationship between SES with tumor features and outcomes in stage I to III patients with ILC.MethodsWe analyzed a prospectively maintained institutional ILC database and utilized the area deprivation index (ADI) to determine neighborhood adversity, an indicator of SES. We used Cox proportional hazards models in Stata 17.0 to evaluate relationships between ADI quintile (Q), race, body mass index (BMI), clinicopathologic features, treatment type, and event-free survival (EFS).ResultsOf 804 patients with ILC, 21.4% lived in neighborhoods classified as ADI Q1 (least resource-deprived) and 19.7% in Q5 (most resource-deprived). Higher deprivation was significantly associated with larger tumor size (3.6 cm in Q5 vs. 3.1 cm in Q1), increased presence of lymphovascular invasion (8.9% in Q5 vs. 6.7% in Q1), and decreased use of adjuvant endocrine therapy (67.1% in Q5 vs. 73.6% in Q1). On multivariable analysis, tumor size, receptor subtypes, and omission of adjuvant endocrine therapy were associated with reduced EFS.ConclusionsThese data show that patients with ILC and higher ADI experience more aggressive tumors and differences in treatment. More data evaluating the complex relationships between these factors is needed to optimize outcomes for patients with ILC, regardless of SES.ImpactADI is associated with differences in patients with ILC.
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- 2023
9. Digital Exclusion, Social Deprivation, and Clinical Outcomes of Patients Undergoing Hyperacuity Home Monitoring.
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Mendall, Jessica, Islam, Meriam, Wong, Karen, Sansome, Stafford, Sim, Dawn A., Bachmann, Lucas M., Huemer, Josef, and Kang, Swan
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Introduction: Digital exclusion is a growing challenge when deploying digital patient care pathways and a potential barrier to widespread implementation, especially in the field of smartphone-based self-monitoring of vision. This retrospective case series seeks to examine the characteristics of individuals who adhere to a smartphone home monitoring programme using the Alleye app for retinal disease, with a focus on digital exclusion, social deprivation and clinical outcomes. Methods: We conducted a retrospective analysis of 89 patients with retinal pathologies including diabetic retinopathy and retinal vein occlusions at Moorfields Eye Hospital participating in an Alleye home monitoring programme between April 2020 and November 2022. Postcodes were used to determine the Digital Exclusion Risk Index (DERI) and the Index of Multiple Deprivation (IMD) rebased for London. Clinical information from the electronic patient record and Alleye app usage data were extracted for each patient. Associations between the DERI/IMD, clinical parameters and app use were examined using multivariable regression models. Results: Mean DERI was 2.56 (standard deviation [SD] = 0.36), IMD was 6.25 (SD = 2.79), visual acuity (VA) in the better eye at study entry was 83.28 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (SD = 7.92), and mean follow-up was 344.46 days (SD = 260.13). During the observation period, 36% received an intravitreal injection (IVI) and VA fell by at least ten letters in approximately one in four patients. In 87.5% of patients requiring IVI, the use of the app increased. We found no association between clinical parameters and programme adherence for DERI or IMD. Conclusions: We found no association between high digital exclusion risk and high social deprivation with monitoring adherence to smartphone-based self-monitoring of vision, contrary to the currently available evidence. This suggests that smartphone-based self-monitoring of vision is accessible to population groups of varying digital exclusion and social deprivation risk, and can be safely employed to monitor clinical progression. [ABSTRACT FROM AUTHOR]
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- 2024
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10. Social Support Buffers the Effect of Social Deprivation on Comorbidity Burden in Adults with Cancer.
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Bellizzi, Keith M, Fritzson, Emily, Ligus, Kaleigh, and Park, Crystal L
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Background Adults with cancer have higher rates of comorbidity compared to those without cancer, with excess burden in people from lower socioeconomic status (SES). Social deprivation, based on geographic indices, broadens the focus of SES to include the importance of "place" and its association with health. Further, social support is a modifiable resource found to have direct and indirect effects on health in adults with cancer, with less known about its impact on comorbidity. Purpose We prospectively examined associations between social deprivation and comorbidity burden and the potential buffering role of social support. Methods Our longitudinal sample of 420 adults (M age = 59.6, SD = 11.6; 75% Non-Hispanic White) diagnosed with cancer completed measures at baseline (~6 months post-diagnosis) and four subsequent 3-month intervals for 1 year. Results Adjusting for age, cancer type, and race/ethnicity, we found a statistically significant interaction between social support and the effect of social deprivation on comorbidity burden (β = −0.11, p = 0.012), such that greater social support buffered the negative effect of social deprivation on comorbidity burden. Conclusion Implementing routine screening for social deprivation in cancer care settings can help identify patients at risk of excess comorbidity burden. Clinician recognition of these findings could trigger a referral to social support resources for individuals high on social deprivation. [ABSTRACT FROM AUTHOR]
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- 2024
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11. Social deprivation and spatial clustering of childhood asthma in Australia
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Jahidur Rahman Khan, Raghu Lingam, Louisa Owens, Katherine Chen, Shivanthan Shanthikumar, Steve Oo, Andre Schultz, John Widger, K. Shuvo Bakar, Adam Jaffe, and Nusrat Homaira
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Childhood asthma ,Spatial pattern ,Social deprivation ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Asthma is the most common chronic respiratory illness among children in Australia. While childhood asthma prevalence varies by region, little is known about variations at the small geographic area level. Identifying small geographic area variations in asthma is critical for highlighting hotspots for targeted interventions. This study aimed to investigate small area-level variation, spatial clustering, and sociodemographic risk factors associated with childhood asthma prevalence in Australia. Methods Data on self-reported (by parent/carer) asthma prevalence in children aged 0–14 years at statistical area level 2 (SA2, small geographic area) and selected sociodemographic features were extracted from the national Australian Household and Population Census 2021. A spatial cluster analysis was used to detect hotspots (i.e., areas and their neighbours with higher asthma prevalence than the entire study area average) of asthma prevalence. We also used a spatial Bayesian Poisson model to examine the relationship between sociodemographic features and asthma prevalence. All analyses were performed at the SA2 level. Results Data were analysed from 4,621,716 children aged 0–14 years from 2,321 SA2s across the whole country. Overall, children’s asthma prevalence was 6.27%, ranging from 0 to 16.5%, with significant hotspots of asthma prevalence in areas of greater socioeconomic disadvantage. Socioeconomically disadvantaged areas had significantly higher asthma prevalence than advantaged areas (prevalence ratio [PR] = 1.10, 95% credible interval [CrI] 1.06–1.14). Higher asthma prevalence was observed in areas with a higher proportion of Indigenous individuals (PR = 1.13, 95% CrI 1.10–1.17). Conclusions We identified significant geographic variation in asthma prevalence and sociodemographic predictors associated with the variation, which may help in designing targeted asthma management strategies and considerations for service enhancement for children in socially deprived areas.
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- 2024
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12. Prevalence of gestational diabetes mellitus in Germany: Temporal trend and differences by regional socioeconomic deprivation
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Lukas Reitzle, Christin Heidemann, Laura Krause, Jens Hoebel, and Christa Scheidt-Nave
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pregnancy ,gestational diabetes ,surveillance ,social deprivation ,germany ,Medicine - Abstract
Background: Gestational diabetes mellitus (GDM) increases the risk for adverse pregnancy outcomes. In 2012, a general screening for GDM was introduced in Germany. Methods: The analysis is based on data from the external inpatient quality assurance for obstetrics from the years 2013 to 2021. Women with pregestational diabetes were excluded. GDM was defined either by documentation in the maternity record or by ICD diagnosis O24.4 during hospitalisation. We reported the prevalence stratified by year, maternal age and regional socioeconomic deprivation. Results: The age-standardized prevalence of GDM continuously rose from 4.7 % in 2013 to 8.5 % in 2021. The increase was observed in all age groups. In 2021, this corresponded to 63,563 women with GDM. The prevalence was higher in highly deprived regions than in low deprived regions. Conclusion: A steady increase in GDM prevalence and evidence of health inequalities emphasise the need for primary prevention strategies for GDM.
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- 2024
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13. Social deprivation and diabetic kidney disease: A European view
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Caoimhe Casey, Claire M Buckley, Patricia M Kearney, Matthew D Griffin, Sean F Dinneen, and Tomás P Griffin
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diabetes mellitus ,diabetic kidney disease ,social deprivation ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Abstract There is a large body of literature demonstrating a social gradient in health and increasing evidence of an association between social deprivation and diabetes complications. Diabetic kidney disease (DKD) increases mortality in people with diabetes. Socioeconomic deprivation is increasingly recognized as a modifier of risk factors for kidney disease but also an independent risk factor itself for kidney disease. This may not be truly appreciated by clinicians and warrants further attention and exploration. In this review we explore the literature to date from Europe on the relationship between social deprivation and DKD. The majority of the studies showed at least an association with microalbuminuria, an early marker of DKD, while many showed an association with overt nephropathy. This was seen across many countries in Europe using a variety of different measures of deprivation. We reviewed and considered the mechanisms by which deprivation may lead to DKD. Health related behaviors such as smoking and suboptimal control of risk factors such as hypertension, hyperglycemia and elevated body mass index (BMI) accounts for some but not all of the association. Poorer access to healthcare, health literacy, and stress are also discussed as potential mediators of the association. Addressing deprivation is difficult but starting points include targeted interventions for people living in deprived circumstances, equitable roll out of diabetes technology, and flexible outpatient clinic arrangements including virtual and community‐based care.
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- 2024
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14. Diabetes-related amputations in Germany: analysis of time trend from 2015 to 2022 and differences by area-level socioeconomic deprivation
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Oktay Tuncer, Yong Du, Niels Michalski, and Lukas Reitzle
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diabetes ,amputations ,quality of care ,diabetes-surveillance ,social deprivation ,germany ,Medicine - Abstract
Background: Diabetes-related amputations reduce health-related quality of life and are an indicator of the quality of care of diabetes. Methods: Population-based age-standardized rates for diabetes-related cases of major and minor amputation were calculated and reported for the years 2015 – 2022 using the Diagnosis-related groups statistics. For 2022 these rates were also reported according to area-level socioeconomic deprivation. Results: Diabetes-related major amputations decreased from 6.8 to 5.2 per 100,000 residents in women and from 18.6 to 17.5 per 100,000 residents in men between 2015 and 2022. In 2021 and 2022, there was no further decrease in men compared to the previous year. Diabetes-related minor amputations decreased in women between 2015 and 2022, but increased in men. Amputation rates were higher in regions with high deprivation than in regions with low deprivation. Conclusions: Diabetes care should consider socioeconomic differences into account. The monitoring of the trends in amputations needs to be continued.
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- 2024
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15. Patterns and trends of medicinal poisoning substances: a population-based cohort study of injuries in 0–11 year old children from 1998–2018
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Edward G Tyrrell, Elizabeth Orton, Laila J Tata, and Denise Kendrick
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Injury ,Accident ,Child safety ,Child public health ,Epidemiology ,Social deprivation ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background There have been sharp increases in antidepressant and opioid prescriptions over the last 10 years, as well as increased over-the-counter medicine availability. However, the impact on childhood medicinal poisonings rates, particularly by socioeconomic deprivation is unclear. This study reports population level medicinal poisoning substance patterns in England among children aged 0–11 years, helping inform safety advice and poisoning prevention interventions. Methods An open cohort study of 1,489,620 0–11 year olds was conducted from 1998 to 2018, using the Clinical Practice Research Datalink, to examine inpatient hospital admissions for poisoning. Incidence rates and adjusted incidence rate ratios (aIRR) were calculated for poisoning substance groups by age, sex, socio-economic deprivation and year. Results 3,685 medicinal poisoning hospital admissions were identified. The most common substances were paracetamol (33.2%), dependence/withdrawal risk drugs (DWRD - antidepressants, opioids, gabapentinoids, benzodiazepines) (13.5%) and other over-the-counter (OTC) analgesics/anti-common cold drugs (13.0%). Over the study period DWRD poisonings decreased 33% (aIRR 0.67, 95%CI 0.50–0.90 comparing 2013/14-2017/18 to 1998/99-2002/03), while paracetamol poisonings increased 43% (aIRR 1.43, 95%CI 1.20–1.70 for the same periods), with no change in incidence rates for other OTC drugs (aIRR 0.82, 95% CI 0.60–1.12) or all medications combined (aIRR 0.97, 95%CI 0.88–1.07). A gradient in poisonings by area-level socioeconomic deprivation was shown for all medications (aIRR 1.32, 95%CI 1.18–1.47 for most deprived compared to least deprived quintile), and DWRDs (aIRR 2.03, 95%CI 1.42–2.88 for 4th most deprived quintile and aIRR 1.88, 95%CI 1.32–2.66 for 5th most deprived quintile, compared to least deprived quintile), but not for paracetamol or other OTC drug poisonings. Conclusions Poisonings from DWRDs decreased by 33%, while paracetamol poisonings increased by 43% during the study period. There was a gradient by area-level socioeconomic deprivation in prescribed medication poisonings, including drugs with withdrawal/dependence risk, but not OTC medication poisonings. Households in more socioeconomically deprived areas have the potential to benefit most from measures to improve safe storage of medicines and are likely to require targeted interventions providing education and safety equipment. In addition, universal promotion of the safe storage of OTC and prescribed medicines must be provided by prescribers, community pharmacies and other outlets of such medication.
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- 2024
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16. Association of socioeconomic deprivation with outcomes in critically ill adult patients: an observational prospective multicenter cohort study
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Morgan Benaïs, Matthieu Duprey, Laura Federici, Michel Arnaout, Pierre Mora, Marc Amouretti, Irma Bourgeon-Ghittori, Stéphane Gaudry, Pierre Garçon, Danielle Reuter, Guillaume Geri, Bruno Megarbane, Jordane Lebut, Armand Mekontso-Dessap, Jean-Damien Ricard, Daniel da Silva, and Etienne de Montmollin
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Social deprivation ,Socioeconomic factor ,Socioeconomic status ,Critical illness ,Intensive care units ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background The influence of socioeconomic deprivation on health inequalities is established, but its effect on critically ill patients remains unclear, due to inconsistent definitions in previous studies. Methods Prospective multicenter cohort study conducted from March to June 2018 in eight ICUs in the Greater Paris area. All admitted patients aged ≥ 18 years were enrolled. Socioeconomic phenotypes were identified using hierarchical clustering, based on education, health insurance, income, and housing. Association of phenotypes with 180-day mortality was assessed using Cox proportional hazards models. Results A total of 1,748 patients were included. Median age was 62.9 [47.4–74.5] years, 654 (37.4%) patients were female, and median SOFA score was 3 [1–6]. Study population was clustered in five phenotypes with increasing socioeconomic deprivation. Patients from phenotype A (n = 958/1,748, 54.8%) were without socioeconomic deprivation, patients from phenotype B (n = 273/1,748, 15.6%) had only lower education levels, phenotype C patients (n = 117/1,748, 6.7%) had a cumulative burden of 1[1–2] deprivations and all had housing deprivation, phenotype D patients had 2 [1–2] deprivations, all of them with income deprivation, and phenotype E patients (n = 93/1,748, 5.3%) included patients with 3 [2–4] deprivations and included all patients with health insurance deprivation. Patients from phenotypes D and E were younger, had fewer comorbidities, more alcohol and opiate use, and were more frequently admitted due to self-harm diagnoses. Patients from phenotype C (predominant housing deprivation), were more frequently admitted with diagnoses related to chronic respiratory diseases and received more non-invasive positive pressure ventilation. Following adjustment for age, sex, alcohol and opiate use, socioeconomic phenotypes were not associated with increased 180-day mortality: phenotype A (reference); phenotype B (hazard ratio [HR], 0.85; 95% confidence interval CI 0.65–1.12); phenotype C (HR, 0.56; 95% CI 0.34–0.93); phenotype D (HR, 1.09; 95% CI 0.78–1.51); phenotype E (HR, 1.20; 95% CI 0.73–1.96). Conclusions In a universal health care system, the most deprived socioeconomic phenotypes were not associated with increased 180-day mortality. The most disadvantaged populations exhibit distinct characteristics and medical conditions that may be addressed through targeted public health interventions.
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- 2024
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17. Diabetes mellitus as a cause of premature death in small areas of Spain by socioeconomic level from 2016 to 2020: A multiple-cause approach.
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Quesada, José A., López-Pineda, Adriana, Orozco-Beltrán, Domingo, Carratalá-Munuera, Concepción, Barber-Vallés, Xavier, Gil-Guillén, Vicente F., Nouni-García, Rauf, and Carbonell- Soliva, Álvaro
- Abstract
This study aimed to assess premature mortality due to Diabetes in small areas of Spain between 2016 and 2020, and its relationship with socioeconomic level and the immediate cause of death. As a secondary objective, we evaluated the effect of the Covid 19 pandemic. This was an ecological study of premature mortality due to Diabetes from 2016 to 2020, with a focus on small areas. All deaths in people under 75 years of age due to Diabetes as the underlying cause were included The final sample comprised 7382 premature deaths in 5967 census tracts. Women living in census tracts with an high level of deprivation(RR=2.40) were at a significantly higher risk. Mortality from Diabetes increased with deprivation, especially people aged 0–54(RR=2.40). People with an immediate cause of death related to a circulatory disease, living in census tracts with an high level of deprivation(RR=3.86) was associated with a significantly greater risk of death with underlying Diabetes. When a disease of the circulatory system was recorded as the immediate cause of death, being 65–74 years (RR=71.01) was associated with a significantly higher risk of premature mortality. Living in geographic areas with higher levels of socioeconomic deprivation is associated with a higher risk of premature death from Diabetes in Spain. This relationship has a greater impact on women, people under 54 years, and people at risk of death caused directly by diseases of the circulatory system. Premature mortality due to diabetes saw a modest increase in 2020. • 49,943 died in Spain (2016–2020) from DM; 16.6% (8307) under 75. Study excluded 925 due to unestablished deprivation index. • Deprivation linked to higher DM mortality; women more affected. Most DM deaths (57%) tied to circulatory diseases. • DM mortality increases with deprivation, notably higher when circulatory system is the immediate cause. [ABSTRACT FROM AUTHOR]
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- 2024
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18. Vascular service provision during the COVID-19 pandemic worsened major amputation rates in socially deprived diabetic populations.
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AlMajali, Ali S., Richards, Thomas, Yusuf, Syed Waquar, and Telgenkamp, Bjorn
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COVID-19 pandemic ,AMPUTATION ,COVID-19 ,SOCIAL background ,PEOPLE with diabetes ,MEDICAL records - Abstract
Introduction: The Coronavirus Disease - 2019 (COVID-19) pandemic significantly impacted healthcare service provision and put diabetic patients at increased risk of adverse health outcomes. We aimed to assess the impact of the COVID-19 pandemic on the incidence and demographic shift of major lowerlimb amputation in diabetic patients. Methods: We performed a retrospective analysis of diabetic patient records undergoing major lower-limb amputation between 01/03/2019 and 01/03/2021 at the Royal Sussex County Hospital, the regional arterial hub for Sussex. Primary outcomes were amputation incidence rates and patient demographics compared between the prepandemic and pandemic cohorts. Results: The incidence rate ratio of major lower-limb amputations shows a drop in amputations during the pandemic compared to pre-pandemic (IRR 0.82; 95% CI 0.57-1.18). Data suggests a shift in the social deprivation background of patients receiving amputations to disproportionately affect those in the more deprived 50% of the population (p=0.038). Younger patients received more amputations during the pandemic compared to prepandemic levels (p=0.001). Conclusion: Results suggest that during the COVID-19 pandemic there was a paradoxical reduction in amputations compared to prepandemic levels. However, changes to the demographic makeup of patient's receiving amputations are alarming as younger, and more deprived patients have been disproportionately affected by the pandemic. [ABSTRACT FROM AUTHOR]
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- 2024
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19. Diagnosis rates, therapeutic characteristics, lifestyle, and cancer screening habits of patients with diabetes mellitus in a highly deprived region in Hungary: a cross-sectional analysis.
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Pártos, Kata, Major, David, Dósa, Norbert, Fazekas-Pongor, Vince, Tabak, Adam G., Ungvári, Zoltán, Horváth, Ildikó, Barta, Ildikó, Pozsgai, Éva, Bodnár, Tamás, Fehér, Gergely, Lenkey, Zsófia, Fekete, Mónika, and Springo, Zsolt
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EARLY detection of cancer ,PEOPLE with diabetes ,DIABETES ,CROSS-sectional method ,DIAGNOSIS ,METFORMIN - Abstract
Introduction: Low socioeconomic status affects not only diagnosis rates and therapy of patients with diabetes mellitus but also their health behavior. Our primary goal was to examine diagnosis rates and therapy of individuals with diabetes living in Ormánság, one of the most deprived areas in Hungary and Europe. Our secondary goal was to examine the differences in lifestyle factors and cancer screening participation of patients with diagnosed and undiagnosed diabetes compared to healthy participants. Methods: Our study is a cross-sectional analysis using data from the "Ormánság Health Program". The "Ormánság Health Program" was launched to improve the health of individuals in a deprived region of Hungary. Participants in the program were coded as diagnosed diabetes based on diagnosis by a physician as a part of the program, self-reported diabetes status, and self-reported prescription of antidiabetic medication. Undiagnosed diabetes was defined as elevated blood glucose levels without self-reported diabetes and antidiabetic prescription. Diagnosis and therapeutic characteristics were presented descriptively. To examine lifestyle factors and screening participation, patients with diagnosed and undiagnosed diabetes were compared to healthy participants using linear regression or multinomial logistic regression models adjusted for sex and age. Results: Our study population consisted of 246 individuals, and 17.9% had either diagnosed (n=33) or undiagnosed (n=11) diabetes. Metformin was prescribed in 75.8% (n=25) of diagnosed cases and sodium-glucose cotransporter-2 inhibitors (SGLT-2) in 12.1% (n=4) of diagnosed patients. After adjustment, participants with diagnosed diabetes had more comorbidities (adjusted [aOR]: 3.50, 95% confidence interval [95% CI]: 1.34--9.18, p<0.05), consumed vegetables more often (aOR: 2.49, 95% CI: 1.07--5.78, p<0.05), but desserts less often (aOR: 0.33, 95% CI: 0.15--0.75, p<0.01) than healthy individuals. Patients with undiagnosed diabetes were not different in this regard from healthy participants. No significant differences were observed for cancer screening participation between groups. Conclusions: To increase recognition of diabetes, targeted screening tests should be implemented in deprived regions, even among individuals without any comorbidities. Our study also indicates that diagnosis of diabetes is not only important for the timely initiation of therapy, but it can also motivate individuals in deprived areas to lead a healthier lifestyle. [ABSTRACT FROM AUTHOR]
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- 2024
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20. Social deprivation and diabetic kidney disease: A European view.
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Casey, Caoimhe, Buckley, Claire M, Kearney, Patricia M, Griffin, Matthew D, Dinneen, Sean F, and Griffin, Tomás P
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DIABETIC nephropathies , *PEOPLE with diabetes , *HEALTH literacy , *DIABETES complications , *HEALTH behavior - Abstract
There is a large body of literature demonstrating a social gradient in health and increasing evidence of an association between social deprivation and diabetes complications. Diabetic kidney disease (DKD) increases mortality in people with diabetes. Socioeconomic deprivation is increasingly recognized as a modifier of risk factors for kidney disease but also an independent risk factor itself for kidney disease. This may not be truly appreciated by clinicians and warrants further attention and exploration. In this review we explore the literature to date from Europe on the relationship between social deprivation and DKD. The majority of the studies showed at least an association with microalbuminuria, an early marker of DKD, while many showed an association with overt nephropathy. This was seen across many countries in Europe using a variety of different measures of deprivation. We reviewed and considered the mechanisms by which deprivation may lead to DKD. Health related behaviors such as smoking and suboptimal control of risk factors such as hypertension, hyperglycemia and elevated body mass index (BMI) accounts for some but not all of the association. Poorer access to healthcare, health literacy, and stress are also discussed as potential mediators of the association. Addressing deprivation is difficult but starting points include targeted interventions for people living in deprived circumstances, equitable roll out of diabetes technology, and flexible outpatient clinic arrangements including virtual and community‐based care. [ABSTRACT FROM AUTHOR]
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- 2024
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21. Social deprivation, the Area Deprivation Index, and emergency department utilization within a community-based primary and preventive care program at a Florida medical school.
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Mayhew, Mackenzie, Denton, Alexa, Kenney, Anna, Fairclough, Jamie, Ojha, Anuj, Bhoite, Prasad, Hey, Matthew T., Seetharamaiah, Rupa, Shaffiey, Shahab, and Schneider, Gregory W.
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COMPETENCY assessment (Law) ,COMMUNITY health services ,HEALTH services accessibility ,SELF-evaluation ,POISSON distribution ,MORTALITY ,RISK assessment ,SOCIAL determinants of health ,INCOME ,PRIMARY health care ,EVALUATION of human services programs ,UNIVERSITIES & colleges ,PATIENT readmissions ,QUESTIONNAIRES ,HOSPITAL emergency services ,RETROSPECTIVE studies ,DESCRIPTIVE statistics ,SOCIAL case work ,LONGITUDINAL method ,MEDICAL schools ,HEALTH equity ,HEALTH education ,LEARNING strategies ,DATA analysis software ,COMPARATIVE studies ,SOCIAL isolation ,PREVENTIVE health services ,EMPLOYMENT ,NEIGHBORHOOD characteristics - Abstract
Introduction: Higher Area Deprivation Index (ADI) scores, indicating higher social deprivation, have been associated with more frequent emergency department (ED) utilization. Access to clinical and social services can help prevent inappropriate ED use. A community-based medical school administering a primary and preventive care program focused on the social determinants of health (SDOH) tracks annual ED utilization by its households. This retrospective study determined household ADI scores and evaluated for associations with ED use. Methods: The ADI uses 17 publicly available variables to assign composite scores of social deprivation at the block group level. The Green Family Foundation Neighborhood Health Education Learning Program at Florida International University provides outreach, clinical, and educational services to > 850 disadvantaged households. We conducted Poisson regression to evaluate the association between households' ADI scores and self-reported ED utilization over 2 calendar years. Results: For both the 2018 and 2019 cohorts, independent Poisson regression results indicate that ED visit count is significantly and inversely associated with ADI raw scores and deciles (p < 0.001). Discussion: Based on findings from earlier studies, we had hypothesized a positive, yet reduced association between annual ED utilization and ADI level but surprisingly, we found an inverse association. The combination of providing primary care and connecting with social and behavioral health services as needed appeared to reverse the expected higher ED use at higher ADI scores. Conclusion: Tracking of ED utilization in association with composite, area-based indices such as the ADI may prove useful for other clinical and community health endeavors focused on SDOH. [ABSTRACT FROM AUTHOR]
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- 2024
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22. Patterns and trends of medicinal poisoning substances: a population-based cohort study of injuries in 0–11 year old children from 1998–2018.
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Tyrrell, Edward G, Orton, Elizabeth, Tata, Laila J, and Kendrick, Denise
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NONPRESCRIPTION drugs ,COHORT analysis ,WOUNDS & injuries ,AGE groups ,SAFETY education ,DRUG toxicity - Abstract
Background: There have been sharp increases in antidepressant and opioid prescriptions over the last 10 years, as well as increased over-the-counter medicine availability. However, the impact on childhood medicinal poisonings rates, particularly by socioeconomic deprivation is unclear. This study reports population level medicinal poisoning substance patterns in England among children aged 0–11 years, helping inform safety advice and poisoning prevention interventions. Methods: An open cohort study of 1,489,620 0–11 year olds was conducted from 1998 to 2018, using the Clinical Practice Research Datalink, to examine inpatient hospital admissions for poisoning. Incidence rates and adjusted incidence rate ratios (aIRR) were calculated for poisoning substance groups by age, sex, socio-economic deprivation and year. Results: 3,685 medicinal poisoning hospital admissions were identified. The most common substances were paracetamol (33.2%), dependence/withdrawal risk drugs (DWRD - antidepressants, opioids, gabapentinoids, benzodiazepines) (13.5%) and other over-the-counter (OTC) analgesics/anti-common cold drugs (13.0%). Over the study period DWRD poisonings decreased 33% (aIRR 0.67, 95%CI 0.50–0.90 comparing 2013/14-2017/18 to 1998/99-2002/03), while paracetamol poisonings increased 43% (aIRR 1.43, 95%CI 1.20–1.70 for the same periods), with no change in incidence rates for other OTC drugs (aIRR 0.82, 95% CI 0.60–1.12) or all medications combined (aIRR 0.97, 95%CI 0.88–1.07). A gradient in poisonings by area-level socioeconomic deprivation was shown for all medications (aIRR 1.32, 95%CI 1.18–1.47 for most deprived compared to least deprived quintile), and DWRDs (aIRR 2.03, 95%CI 1.42–2.88 for 4th most deprived quintile and aIRR 1.88, 95%CI 1.32–2.66 for 5th most deprived quintile, compared to least deprived quintile), but not for paracetamol or other OTC drug poisonings. Conclusions: Poisonings from DWRDs decreased by 33%, while paracetamol poisonings increased by 43% during the study period. There was a gradient by area-level socioeconomic deprivation in prescribed medication poisonings, including drugs with withdrawal/dependence risk, but not OTC medication poisonings. Households in more socioeconomically deprived areas have the potential to benefit most from measures to improve safe storage of medicines and are likely to require targeted interventions providing education and safety equipment. In addition, universal promotion of the safe storage of OTC and prescribed medicines must be provided by prescribers, community pharmacies and other outlets of such medication. [ABSTRACT FROM AUTHOR]
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- 2024
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23. Social vulnerability adversely affects emergency-department utilization but not patient-reported outcomes after total joint arthroplasty.
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Baxter, Samantha N., Johnson, Andrea H., Brennan, Jane C., MacDonald, James H., Turcotte, Justin J., and King, Paul J.
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ARTHROPLASTY , *SOCIAL control , *UNIVARIATE analysis , *MULTIVARIATE analysis , *STATISTICAL significance - Abstract
Introduction: Multiple studies demonstrate social deprivation is associated with inferior outcomes after total hip (THA) and total knee (TKA) arthroplasty; its effect on patient-reported outcomes is debated. The primary objective of this study evaluated the relationship between social vulnerability and the PROMIS-PF measure in patients undergoing THA and TKA. A secondary aim compared social vulnerability between patients who required increased resource utilization or experienced complications and those who didn't. Materials and methods: A retrospective review of 537 patients from March 2020 to February 2022 was performed. The Centers for Disease Control Social Vulnerability Index (SVI) were used to quantify socioeconomic disadvantage. The cohort was split into THA and TKA populations; univariate and multivariate analyses were performed to evaluate primary and secondary outcomes. Statistical significance was assessed at p < 0.05. Results: 48.6% of patients achieved PROMIS-PF MCID at 1-year postoperatively. Higher levels of overall social vulnerability (0.40 vs. 0.28, p = 0.03) were observed in TKA patients returning to the ED within 90-days of discharge. Increased overall SVI (OR = 9.18, p = 0.027) and household characteristics SVI (OR = 9.57, p = 0.015) were independent risk factors for 90-day ED returns after TKA. In THA patients, increased vulnerability in the household type and transportation dimension was observed in patients requiring 90-day ED returns (0.51 vs. 0.37, p = 0.04). Conclusion: Despite an increased risk for 90-day ED returns, patients with increased social vulnerability still obtain good 1-year functional outcomes. Initiatives seeking to mitigate the effect of social deprivation on TJA outcomes should aim to provide safe alternatives to ED care during early recovery. [ABSTRACT FROM AUTHOR]
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- 2024
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24. Neighborhood Deprivation and Changes in Oral Health in Older Age: A Longitudinal Population-Based Study.
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Ganbavale, S.G., Papachristou, E., Mathers, J.C., Papacosta, A.O., Lennon, L.T., Whincup, P.H., Wannamethee, S.G., and Ramsay, S.E.
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ORAL health ,NEIGHBORHOOD change ,XEROSTOMIA ,PERIODONTAL pockets ,OLDER people - Abstract
The aim of this study was to examine the extent to which neighborhood-level socioeconomic factors (objective and perceived) are associated with poor oral health in older adults over time, independent of individual socioeconomic position. Data for this cross-sectional and longitudinal observation study came from a socially and geographically representative cohort of men aged 71 to 92 y in 2010–12 (n = 1,622), drawn from British general practices, which was followed up in 2018–19 (aged 78–98 y; N = 667). Dental measures at both times included number of teeth, periodontal pocket depth, self-rated oral health, and dry mouth. Neighborhood deprivation was based on Index of Multiple Deprivation (IMD) and a cumulative index measuring perceptions about local environment. Individual-level socioeconomic position was based on longest-held occupation. Multilevel and multivariate logistic regressions, adjusted for relevant sociodemographic, behavioral, and health-related factors, were performed to examine the relationships of dental measures with IMD and perceived neighborhood quality index, respectively. Cross-sectionally, risks of tooth loss, periodontal pockets, and dry mouth increased from IMD quintiles 1 to 5 (least to most deprived); odds ratios (ORs) for quintile 5 were 2.22 (95% confidence interval [CI], 1.41–3.51), 2.82 (95% CI, 1.72–4.64), and 1.51 (95% CI, 1.08–2.09), respectively, after adjusting for sociodemographic, behavioral, and health-related factors. Risks of increased pocket depth and dry mouth were significantly greater in quintile 5 (highest problems) of perceived neighborhood quality index compared to quintile 1. Over the 8-y follow-up, deterioration of dentition (tooth loss) was significantly higher in the most deprived IMD quintiles after full adjustment (OR for quintile 5 = 2.32; 95% CI, 1.09–4.89). Deterioration of dentition and dry mouth were significantly greater in quintile 5 of perceived neighborhood quality index. Neighborhood-level factors were associated with poor oral health in older age, both cross-sectionally and longitudinally, particularly with tooth loss, and dry mouth, independent of individual-level socioeconomic position. [ABSTRACT FROM AUTHOR]
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- 2024
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25. Digital exclusion as a barrier to accessing healthcare: a summary composite indicator and online tool to explore and quantify local differences in levels of exclusion
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Mee, Paul, Gussy, Mark, Huntley, Phil, Kenny, Amanda, Jarratt, Theo, Kenward, Nigel, Ward, Derek, and Vaughan, Aiden
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- 2024
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26. Associations Between Social Deprivation, Cognitive Heath, and Depression among Older Adults in India: Evidence from the Longitudinal Aging Study in India (LASI)
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Barman, Poulami, Pandey, Mohit, Bramhnakar, Mahadevrao, Tyagi, Rishabh, and Rai, Balram
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- 2024
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27. Social prescribing: an inadequate response to the degradation of social care in mental health
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Rob Poole and Peter Huxley
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Social deprivation ,social functioning ,social prescribing ,psychosocial interventions ,social care ,Psychiatry ,RC435-571 - Abstract
Social prescribing is poorly defined and there is little evidence for its effectiveness. It cannot address the social determinants of mental health and it is unlikely to produce enduring change for that part of the population that suffers the worst physical and mental health, namely the most deprived and marginalised. It has emerged at a time of growing health inequity. This has occurred alongside the neglect of social care and of the social aspects of mental health intervention. Social prescribing gives a false impression of addressing social factors, and as such is counterproductive. We can do better than this.
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- 2024
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28. Social prescribing: an inadequate response to the degradation of social care in mental health.
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Poole, Rob and Huxley, Peter
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MENTAL health , *SOCIAL determinants of health , *HEALTH equity - Abstract
Social prescribing is poorly defined and there is little evidence for its effectiveness. It cannot address the social determinants of mental health and it is unlikely to produce enduring change for that part of the population that suffers the worst physical and mental health, namely the most deprived and marginalised. It has emerged at a time of growing health inequity. This has occurred alongside the neglect of social care and of the social aspects of mental health intervention. Social prescribing gives a false impression of addressing social factors, and as such is counterproductive. We can do better than this. [ABSTRACT FROM AUTHOR]
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- 2024
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29. Impact of social determinants of health on access to rhinology care and patient outcomes: A pilot study.
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Wang, Esther, Diaz, Ashley, Zhang, Douglas, Dimitroyannis, Rose, Kim, Daniel, Caballero, Nadieska, Pinto, Jayant M., and Roxbury, Christopher R.
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SOCIAL determinants of health , *HEALTH services accessibility , *PATIENT experience , *PATIENT care , *PATIENTS' attitudes - Abstract
Objective: This novel pilot study constructs a social deprivation index (SDI) and utilizes an area deprivation index (ADI) to evaluate the link between social determinants of health and rhinology patient experiences. Methods: Adult patients undergoing outpatient care of chronic rhinitis and chronic rhinosinusitis at a tertiary academic medical center were recruited to participate in a telephone survey assessing symptoms, social/emotional consequences of disease, and barriers to care on a 5‐point Likert scale. Sociodemographic characteristics were utilized to rate SDI on an 8‐point scale. ADI was obtained by area code of residence. Ordered logistic regression was used to examine associations between the SDI/ADI and perceptions of rhinology care. Results: Fifty patients were included. Individuals with higher SDI scores (i.e., more socially deprived) experienced more severe nasal congestion (p =.007). Furthermore, higher national ADI correlated with increased severity of smell changes (p =.050) and facial pressure (p =.067). No association was seen between either deprivation index and global/psychiatric symptoms. While no correlations were found between higher SDI and difficulties with the costs of prescriptions, rhinologist's visits, or saline, higher SDI was correlated with decreased difficulty with surgery costs (p =.029), and individuals with higher national ADI percentile had increased difficulties obtaining nasal saline (p =.029). Conclusion: Worse social deprivation is associated with difficulties obtaining saline rinses and increased severity of nasal/sinus symptoms in an urban, underserved, majority‐Black population. These findings suggest social factors affect access to and quality of rhinology care in a complex and nuanced way and highlight the need for a specific SDI to further study social determinants of health in rhinology. Level of Evidence: 2c. We construct a social deprivation index and utilize an area deprivation index to study social determinants of health and rhinology patient experiences. Worse social deprivation is associated with difficulties obtaining the most basic of rhinology care—saline rinses, as well as increased severity of nasal/sinus symptoms in an urban, underserved, majority‐Black population. [ABSTRACT FROM AUTHOR]
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- 2024
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30. Spatial Analysis of Determinants of COVID-19 Vaccine Hesitancy in Portugal.
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Pinto de Carvalho, Constança, Ribeiro, Manuel, Godinho Simões, Diogo, Pita Ferreira, Patrícia, Azevedo, Leonardo, Gonçalves-Sá, Joana, Mesquita, Sara, Gonçalves, Licínio, Pinto Leite, Pedro, and Peralta-Santos, André
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VACCINE hesitancy ,COVID-19 vaccines ,METROPOLITAN areas ,AGE groups ,SOCIODEMOGRAPHIC factors - Abstract
Vaccine hesitancy tends to exhibit geographical patterns and is often associated with social deprivation and migrant status. We aimed to estimate COVID-19 vaccination hesitancy in a high-vaccination-acceptance country, Portugal, and determine its association with sociodemographic risk factors. We used the Registry of National Health System Users to determine the eligible population and the Vaccination Registry to determine individuals without COVID-19 vaccine doses. Individuals older than five with no COVID-19 vaccine dose administered by 31 March 2022 were considered hesitant. We calculated hesitancy rates by municipality, gender, and age group for all municipalities in mainland Portugal. We used the spatial statistical scan method to identify spatial clusters and the Besag, Yorke, and Mollié (BYM) model to estimate the effect of age, gender, social deprivation, and migrant proportion across all mainland municipalities. The eligible population was 9,852,283, with 1,212,565 (12%) COVID-19 vaccine-hesitant individuals. We found high-hesitancy spatial clusters in the Lisbon metropolitan area and the country's southwest. Our model showed that municipalities with higher proportions of migrants are associated with an increased relative risk (RR) of vaccine hesitancy (RR = 8.0; CI 95% 4.6; 14.0). Social deprivation and gender were not associated with vaccine hesitancy rates. We found COVID-19 vaccine hesitancy has a heterogeneous distribution across Portugal and has a strong association with the proportion of migrants per municipality. [ABSTRACT FROM AUTHOR]
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- 2024
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31. The influence of socioeconomic deprivation on outcomes in transplant patients infected with SARS‐CoV‐2 in Wales.
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Koimtzis, Georgios, Geropoulos, Georgios, Chalklin, Christopher, Karniadakis, Ioannis, Szabo, Laszlo, Ilham, Mohammed Adel, Stephens, Michael, Asderakis, Argiris, and Khalid, Usman
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SOCIOECONOMIC factors , *SARS-CoV-2 , *WELSH people , *LOGISTIC regression analysis , *ACUTE kidney failure - Abstract
Introduction: SARS‐CoV‐2 infection has had a significant impact on vulnerable individuals including transplant patients. Socioeconomic deprivation negatively affects outcomes of many health conditions. The aim of this study was to evaluate the effect of socioeconomic deprivation on the incidence and severity of SARS‐CoV‐2 infection among Welsh transplant patients. Methods: This study is a retrospective, cross‐sectional study on the transplant population of Wales. The Welsh Index of Multiple Deprivation (WIMD) was used to assess the influence of socioeconomic deprivation on outcomes of Welsh transplant patients who developed SARS‐CoV‐2 infection. Outcome measures were the incidence of SARS‐CoV‐2 infection, rates of hospital and ICU admission, development of acute kidney injury (AKI) and mortality. A logistic binomial regression analysis was used to correlate the various risk factors with the incidence of SARS‐CoV‐2 infection. Results: Two hundred and sixty‐six (25%) of regular follow up patients had SARS‐CoV‐2 infection; of these 55 (20.7%) were admitted, 15 (5.6%) to ICU, 37 (13.9%) developed AKI, and 23 (8.6%) died. In a regression analysis, patients of younger age were associated with more (p =.001) and those with SPK (simultaneous pancreas kidney) transplant less chance of infection (p =.038), whereas social deprivation was not associated with the chance of infection (p =.14). In regression analysis increased social deprivation was associated with higher chance of AKI post SARS‐CoV‐2 (p =.049). Conclusions: Socioeconomic deprivation did not affect the rates or severity of SARS‐CoV‐2 infection apart from the degree of AKI in Welsh Transplant patients. Adherence to the preventive measures for this high‐risk population must continue to remain a priority. [ABSTRACT FROM AUTHOR]
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- 2024
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32. Communicative products of social networks and the Internet as a social glue in times of social crises and disasters.
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Tymofieieva, Halyna
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SOCIAL bonds , *SOCIOLOGICAL research , *SOCIAL networks , *CRITICAL literacy , *BROADCAST journalism , *MEDIA literacy - Abstract
The article presents the quantitative and qualitative impact of social networks and the Internet products on social bonding during crises and disasters. The study is based on the data of psychological experiments, the results of sociological research and various models of news broadcasting and presents consideration about the nature of this impact. In particular, it is shown that informal communication, being a "social glue", has been replenished with new powerful communication channels due to the development of Internet technologies. Despite such an important characteristic as unverified information and other features of counter-knowledge, these channels are massively used by people, thus, according to the author, their communicative and informational products can be studied regarding the possibilities and conditions their expansion and heuristic ability, so they can be analyzed as a factor of social bonding. It has been proven that informal communication in its massive forms are activated in situations of social crises and disasters, because the users are traumatized, often lose control, plunge into a state of social deprivation and need constant communication with like-minded people in similar circumstances. In this way, the community is bonding by social glue by overcoming common problems, and relevant information products and their rapid sharing by the Internet contribute to this. The very information content of for the informal communication through social networks and the Internet allows people to explain reality better and "modify" or alter its representation to a more comfortable one. It has been proven that such factors as "cognitive simplicity" of the information content, its myth-producing component and the high status of an addressee of a message contribute to this. The article also outlines considerations on how people could be taught to navigate the information and choose those products of social networks and the Internet that not only glue community together, but also unite it on the basis of real knowledge. People should be taught to approach information messages critically, to understand the nature and properties of media messages, their communicative and destructive influences. Media literacy and critical thinking could be very helpful in these situations as they facilitate informational culture, teach media literacy, increase personal self-confidence, help people shape their own view of reality and consciously choose partners for constructive communication. [ABSTRACT FROM AUTHOR]
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- 2024
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33. Social deprivation and kidney failure due to an undiagnosed nephropathy.
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Sakhi, Hamza, Beaumier, Mathilde, Couchoud, Cécile, Prezelin-Reydit, Mathilde, Radenac, Jennifer, Lobbedez, Thierry, Morin, Denis, Audard, Vincent, and Chatelet, Valérie
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KIDNEY failure , *CHRONIC kidney failure , *KIDNEY diseases , *GENERAL practitioners , *MULTIVARIATE analysis - Abstract
Background In France, kidney diseases of undetermined origin account for 5%–20% of all causes of end-stage kidney disease. We investigated the impact of social disadvantage on the lack of aetiological diagnosis of nephropathies. Methods Data from patients who started dialysis in France between 1 January 2017 and 30 June 2018 were extracted from the French Renal Epidemiology and Information Network registry. The social deprivation of each individual was estimated by the European Deprivation Index (EDI) defined by the patient's address. Logistic regression was used to perform mediation analysis to study the potential association between social deprivation and unknown nephropathy. Results Of the 7218 patients included, 1263 (17.5%) had unknown kidney disease. A total of 394 (31.4%) patients in the unknown kidney disease belonged to the most deprived quintile of the EDI [fifth quintile (Q5)], vs 1636 (27.5%) patients in the known kidney disease group. In the multivariate analysis, unknown kidney disease was associated with Q5 (odds ratio 1.40, 95% confidence interval 1.12–1.74, P = .003). Mediation analysis did not identify any variables (e.g. obesity, initiation of dialysis in emergency, number of visits to the general practitioner and nephrologist before initiation of dialysis, date of first nephrology consultation) that mediated the association between social deprivation and nephropathy of unknown origin. Conclusions Our results show that, compared with nondeprived subjects, individuals experiencing social deprivation have a higher risk of unknown nephropathy at dialysis initiation. However, mediation analysis did not identify any variables that explained the association between social deprivation and nephropathy of unknown origin. [ABSTRACT FROM AUTHOR]
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- 2024
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34. Vascular service provision during the COVID-19 pandemic worsened major amputation rates in socially deprived diabetic populations
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Ali S. AlMajali, Thomas Richards, Syed Waquar Yusuf, and Bjorn Telgenkamp
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diabetic foot ,social deprivation ,COVID-19 ,amputation ,surgical ,public health ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
IntroductionThe Coronavirus Disease – 2019 (COVID-19) pandemic significantly impacted healthcare service provision and put diabetic patients at increased risk of adverse health outcomes. We aimed to assess the impact of the COVID-19 pandemic on the incidence and demographic shift of major lower-limb amputation in diabetic patients.MethodsWe performed a retrospective analysis of diabetic patient records undergoing major lower-limb amputation between 01/03/2019 and 01/03/2021 at the Royal Sussex County Hospital, the regional arterial hub for Sussex. Primary outcomes were amputation incidence rates and patient demographics compared between the prepandemic and pandemic cohorts.ResultsThe incidence rate ratio of major lower-limb amputations shows a drop in amputations during the pandemic compared to pre-pandemic (IRR 0.82; 95% CI 0.57–1.18). Data suggests a shift in the social deprivation background of patients receiving amputations to disproportionately affect those in the more deprived 50% of the population (p=0.038). Younger patients received more amputations during the pandemic compared to prepandemic levels (p=0.001).ConclusionResults suggest that during the COVID-19 pandemic there was a paradoxical reduction in amputations compared to prepandemic levels. However, changes to the demographic makeup of patient’s receiving amputations are alarming as younger, and more deprived patients have been disproportionately affected by the pandemic.
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- 2024
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35. Diagnosis rates, therapeutic characteristics, lifestyle, and cancer screening habits of patients with diabetes mellitus in a highly deprived region in Hungary: a cross-sectional analysis
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Kata Pártos, David Major, Norbert Dósa, Vince Fazekas-Pongor, Adam G. Tabak, Zoltán Ungvári, Ildikó Horváth, Ildikó Barta, Éva Pozsgai, Tamás Bodnár, Gergely Fehér, Zsófia Lenkey, Mónika Fekete, and Zsolt Springó
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diabetes mellitus ,diabetes diagnosis ,undiagnosed diabetes ,diagnosed disease ,social deprivation ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
IntroductionLow socioeconomic status affects not only diagnosis rates and therapy of patients with diabetes mellitus but also their health behavior. Our primary goal was to examine diagnosis rates and therapy of individuals with diabetes living in Ormánság, one of the most deprived areas in Hungary and Europe. Our secondary goal was to examine the differences in lifestyle factors and cancer screening participation of patients with diagnosed and undiagnosed diabetes compared to healthy participants.MethodsOur study is a cross-sectional analysis using data from the “Ormánság Health Program”. The “Ormánság Health Program” was launched to improve the health of individuals in a deprived region of Hungary. Participants in the program were coded as diagnosed diabetes based on diagnosis by a physician as a part of the program, self-reported diabetes status, and self-reported prescription of antidiabetic medication. Undiagnosed diabetes was defined as elevated blood glucose levels without self-reported diabetes and antidiabetic prescription. Diagnosis and therapeutic characteristics were presented descriptively. To examine lifestyle factors and screening participation, patients with diagnosed and undiagnosed diabetes were compared to healthy participants using linear regression or multinomial logistic regression models adjusted for sex and age.ResultsOur study population consisted of 246 individuals, and 17.9% had either diagnosed (n=33) or undiagnosed (n=11) diabetes. Metformin was prescribed in 75.8% (n=25) of diagnosed cases and sodium-glucose cotransporter-2 inhibitors (SGLT-2) in 12.1% (n=4) of diagnosed patients. After adjustment, participants with diagnosed diabetes had more comorbidities (adjusted [aOR]: 3.50, 95% confidence interval [95% CI]: 1.34–9.18, p
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- 2024
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36. Epidemiological features of depression and anxiety among homeless adults with healthcare access problems in London, UK: descriptive cross-sectional analysis
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Sujit D. Rathod, P. J. Annand, Paniz Hosseini, Andrew Guise, and Lucy Platt
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Depressive disorders ,anxiety or fear-related disorders ,epidemiology ,social deprivation ,polypharmacy ,Psychiatry ,RC435-571 - Abstract
Background In England in 2021, an estimated 274 000 people were homeless on a given night. It has long been recognised that physical and mental health of people who are homeless is poorer than for people who are housed. There are few peer-reviewed studies to inform health and social care for depression or anxiety among homeless adults in this setting. Aims To measure the symptoms of depression and anxiety among adults who are homeless and who have difficulty accessing healthcare, and to describe distribution of symptoms across sociodemographic, social vulnerability and health-related characteristics. Method We completed structured questionnaires with 311 adults who were homeless and who had difficulty accessing healthcare in London, UK, between August and December 2021. We measured anxiety and depression symptoms using the 4-item Patient Health Questionnaire (PHQ-4) score. We compared median PHQ-4 scores across strata of the sociodemographic, social vulnerability and health-related characteristics, and tested for associations using the Kruskal–Wallis test. Results The median PHQ-4 score was 8 out of 12, and 40.2% had scores suggesting high clinical need. Although PHQ-4 scores were consistently high across a range of socioeconomic, social vulnerability and health-related characteristics, they were positively associated with: young age; food insecurity; recent and historic abuse; joint, bone or muscle problems; and frequency of marijuana use. The most common (60%) barrier to accessing healthcare related to transportation. Conclusions Adults who are homeless and have difficulty accessing healthcare have high levels of depression and anxiety symptoms. Our findings support consideration of population-level, multisectoral intervention.
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- 2024
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37. Communicative products of social networks and the Internet as a social glue in times of social crises and disasters
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Галина Тимофєєва
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communicative product of social networks and the Internet ,"social glue ,social bonding ,"counter-knowledge ,hype techniques ,social deprivation ,History (General) and history of Europe ,Philosophy. Psychology. Religion - Abstract
The article presents the quantitative and qualitative impact of social networks and the Internet products on social bonding during crises and disasters. The study is based on the data of psychological experiments, the results of sociological research and various models of news broadcasting and presents consideration about the nature of this impact. In particular, it is shown that informal communication, being a "social glue", has been replenished with new powerful communication channels due to the development of Internet technologies. Despite such an important characteristic as unverified information and other features of counter-knowledge, these channels are massively used by people, thus, according to the author, their communicative and informational products can be studied regarding the possibilities and conditions their expansion and heuristic ability, so they can be analyzed as a factor of social bonding. It has been proven that informal communication in its massive forms are activated in situations of social crises and disasters, because the users are traumatized, often lose control, plunge into a state of social deprivation and need constant communication with like-minded people in similar circumstances. In this way, the community is bonding by social glue by overcoming common problems, and relevant information products and their rapid sharing by the Internet contribute to this. The very information content of for the informal communication through social networks and the Internet allows people to explain reality better and "modify" or alter its representation to a more comfortable one. It has been proven that such factors as "cognitive simplicity" of the information content, its myth-producing component and the high status of an addressee of a message contribute to this. The article also outlines considerations on how people could be taught to navigate the information and choose those products of social networks and the Internet that not only glue community together, but also unite it on the basis of real knowledge. People should be taught to approach information messages critically, to understand the nature and properties of media messages, their communicative and destructive influences. Media literacy and critical thinking could be very helpful in these situations as they facilitate informational culture, teach media literacy, increase personal self-confidence, help people shape their own view of reality and consciously choose partners for constructive communication.
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- 2024
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38. Investigating social deprivation and comorbid mental health diagnosis as predictors of treatment access among patients with an opioid use disorder using substance use services: a prospective cohort study
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Emma A Adams, Justin C Yang, Amy O’Donnell, Sarah Minot, David Osborn, and James B Kirkbride
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Cohort ,Opioid-related disorders ,Social deprivation ,Electronic health records ,Mental health services ,Public aspects of medicine ,RA1-1270 ,Social pathology. Social and public welfare. Criminology ,HV1-9960 - Abstract
Abstract Background Opioid use is a major public health concern across the globe. Opioid use and subsequent access to care is often shaped by co-occurring issues faced by people using opioids, such as deprivation, mental ill-health, and other forms of substance use. We investigated the role of social deprivation and comorbid mental health diagnoses in predicting re-engagement with substance use services or contact with crisis and inpatient services for individuals with opioid use disorder in secondary mental health care in inner-city London. Methods We conducted a prospective cohort study which followed individuals diagnosed with a first episode of opioid use disorder who accessed substance use services between September 2015 and May 2020 for up to 12 months, using anonymised electronic health records. We employed negative binominal regression and Cox proportional survival analyses to assess associations between exposures and outcomes. Results Comorbid mental health diagnoses were associated with higher contact rates with crisis/inpatient services among people with opioid use disorder: incidence rate ratios (IRR) and 95% confidence intervals (CI) were 3.91 (1.74–9.14) for non-opioid substance use comorbidity, 8.92 (1.81–64.4) for a single comorbid mental health diagnosis, and 15.9 (5.89–47.5) for multiple comorbid mental health diagnoses. Social deprivation was not associated with contact rates with crisis/inpatient services within this sample. Similar patterns were found with time to first crisis/inpatient contact. Social deprivation and comorbid mental health diagnoses were not associated with re-engagement with substance use services. Conclusion Comorbid substance and mental health difficulties amongst people with an opioid use disorder led to earlier and more frequent contact with crisis/inpatient mental health services during the first 12 months of follow up. Given the common co-occurrence of mental health and substance use disorders among those who use opioids, a better understanding of their wider needs (such as social, financial and other non-medical concerns) will ensure they are supported in their treatment journeys.
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- 2023
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39. Influence of Environmental Factors and the Condition of Fish on Schooling Behavior.
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Kasumyan, A. O. and Pavlov, D. S.
- Abstract
Despite being innate, schooling behavior is subject to the influence of external factors that change the condition of fish or the conditions of their environment and reception. Of the abiotic factors, the strongest influence is exerted by the illumination and the water turbidity, the abundance of visual landmarks, and the flow velocity. The effect of temperature and the gas composition of water (oxygen content) is much less pronounced; only the first information is available about the effect of water salinity. Among biotic factors, schooling behavior is significantly influenced by various social conditions (fish stocking density, social deprivation), feeding and defensive motivations of fish (fish gut fullness, presence of predators), and parasite infestation. The ability of fish to exhibit schooling behavior is reduced in the presence of virtually all pollutants studied. [ABSTRACT FROM AUTHOR]
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- 2023
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40. A worldwide review of the impact of COVID-19 disruptions on learner development and resilience.
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Malindi, Macalane Junel and Hay, Johnnie
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- *
PSYCHOLOGICAL adaptation , *STAY-at-home orders , *PSYCHOLOGICAL resilience , *COVID-19 , *SCHOOL closings , *ORGANIZATIONAL resilience - Abstract
The COVID-19 pandemic necessitated school closures and movement restrictions that disrupted holistic development and adaptive coping in learners worldwide. Adaptive coping is also referred to as resilience. Holistic development covers the biophysiological, psychological, social, spiritual and educational domains of child development. Several researchers have explored the impact of developmental risks caused by school closures and movement restrictions on learner development. With this article we aim to present a synthesis of these reviewed papers. We reviewed 81 peer-reviewed papers that were published globally from 2020 to 2023. The focus of these papers was on biophysical, psychological, social, religious and academic development in learners. We did not develop a priori themes to guide us; instead, themes emerged from the articles that were reviewed. The findings show that although the lockdown restrictions were aimed at preventing the spread of the virus and saving lives, the imposed restrictions affected the development of learners in biophysiological, psychological, social, educational and religious domains. Furthermore, the findings show that the impact of the lockdown necessitated multisystemic interventions on different levels to enable learners to overcome backlogs and promote resilience. [ABSTRACT FROM AUTHOR]
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- 2023
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41. Can Professional Interventions Contribute to an Escalation in Cases of Youth Violence ? Considering the Impact of the Shift from Informal to Formal Youth Support on an Inner City Housing Estate.
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Alexander, James
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PLANNED communities ,INNER cities ,YOUTH violence ,YOUNG adults ,CITIES & towns ,YOUTH development - Abstract
Youth violence is on the increase across many UK cities and although national trends, such as more networked entrepreneurial drug dealing, are contributing to the spread of such incidents, localised community environments play a significant role in the development of violent youth cultures. Based on a 4-year ethnographic study, this article explores how the shift from a resident led, relationship-based interaction, to a more professionalised evidenced-based intervention model, increased the risk of young people getting involved in youth violence. Efforts to address youth violence should consider including more relational informal support networks, alongside more specialist interventions. [ABSTRACT FROM AUTHOR]
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- 2023
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42. The Effect of Social Deprivation on Patient Satisfaction in Otolaryngology Clinics.
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Redding, Taylor S., Stephens, Andrew R., and Gurgel, Richard K.
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- *
STATISTICS , *CONFIDENCE intervals , *MULTIVARIATE analysis , *PATIENT satisfaction , *PATIENT-centered care , *SOCIOECONOMIC factors , *COMPARATIVE studies , *DESCRIPTIVE statistics , *DEPRIVATION (Psychology) , *LOGISTIC regression analysis , *ODDS ratio , *OTOLARYNGOLOGY - Abstract
Objectives: Multiple factors have been associated with lower satisfaction scores. We hypothesize that patients with a more deprived socioeconomic status will have different patient satisfaction scores than patients of higher socioeconomic status. Methods: We reviewed Press Ganey satisfaction scores for new, outpatient visits between January 1, 2014, and December 31, 2018. Due to the high ceiling effects of the survey, "satisfaction" was defined as achieving a perfect score of 100. We determined social deprivation using the 2015 Area Deprivation Index (ADI) which serves as a proxy for socioeconomic status derived from zip codes. Patient satisfaction was defined as a binary variable. Univariate and multivariate binary logistic regression analyses were used to identify factors correlated with patient satisfaction. Results: There were 3239 unique new patients with completed surveys. Univariate analysis demonstrated decreased odds of achieving satisfaction for both the Total Score and Provider Sub-Score for each decile increase in ADI (OR 0.94; CI = 0.908-0.981; P =.003 and OR 0.94; CI = 0.91-0.98; P =.002 respectively). Multivariate analysis revealed the odds for reporting satisfaction for each decile increase in ADI were 0.96 for Total Score (CI = 0.921-0.998; P =.038) and 0.96 for Provider Sub-Score (CI = 0.92-0.993; P =.019). Patients in the most deprived quartile, compared to the least deprived, were significantly less likely to be satisfied with their care for both Total Score (OR 0.70; CI = 0.564-0.865; P =.001) and Provider Sub-Score (OR 0.69; CI = 0.558-0.852; P =.001). Conclusions: Increased social deprivation was an independent predictor of lower patient satisfaction in otolaryngology outpatients using the Press Ganey survey. This non-modifiable outcome should be taken into consideration when evaluating patient satisfaction scores and offers further support to the need of addressing and improving healthcare discrepancies in the field of otolaryngology. Level of Evidence: Level 3 [ABSTRACT FROM AUTHOR]
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- 2023
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43. Health Disparities in Hand and Upper Extremity Surgery: A Scoping Review.
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Chen, Kevin, Duan, Grace Y., Wolf, Jennifer M., and Stepan, Jeffrey G.
- Abstract
Social determinants of health (SDOH) are linked to poor health care outcomes across the different medical specialties. We conducted a scoping review to understand the existing literature and identify further areas of research to address disparities within hand surgery. A systematic search of PubMed, Scopus, and Cochrane was conducted. Inclusion criteria were English studies examining health disparities in hand surgery. The following were assessed: the main SDOH, study design/phase/theme, and main disease/injury/procedure. A previously described health disparities research framework was used to determine study phase: detecting (identifying risk factors), understanding (analyzing risk factors), and reducing (assessing interventions). Studies were categorized according to themes outlined at the National Institute of Health and American College of Surgeons: Summit on Surgical Disparities. The initial search yielded 446 articles, with 49 articles included in final analysis. The majority were detecting-type (31/49, 63%) or understanding-type (12/49, 24%) studies, with few reducing-type studies (6/49, 12%). Patient factors (31/49, 63%) and systemic/access factors (16/49, 33%) were the most frequently studied themes, with few investigating clinical care/quality factors (4/49, 8%), clinician factors (3/49, 6%), and postoperative/rehabilitation factors (1/49, 2%). The most commonly studied SDOH include insurance status (13/49, 27%), health literacy (10/49, 20%), and social deprivation (6/49, 12%). Carpal tunnel syndrome (9/49, 18%), upper extremity trauma (9/49, 18%), and amputations (5/49, 10%) were frequently assessed. Most investigations involved retrospective or database designs (29/49, 59%), while few were prospective, cross-sectional, or mixed-methods. Despite an encouraging upward trend in health disparities research, existing studies are in the early phases of investigation. Most of the literature focuses on patient factors and systemic/access factors in regard to insurance status. Further work with prospective, cross-sectional, and mixed-method studies is needed to better understand health disparities in hand surgery, which will inform future interventions. [ABSTRACT FROM AUTHOR]
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- 2023
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44. Sociodemographic variations in the uptake of faecal immunochemical tests in primary care: a retrospective study.
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Bailey, James A, Morton, Alastair J, Jones, James, Chapman, Caroline J, Oliver, Simon, Morling, Joanne R, Patel, Heetan, Banerjea, Ayan, and Humes, David J
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BLOOD cell count ,PRIMARY care ,ETHNIC groups ,SOCIODEMOGRAPHIC factors ,SECONDARY care (Medicine) - Abstract
Background: Faecal immunochemical test (FIT) usage for symptomatic patients is increasing, but variations in use caused by sociodemographic factors are unknown. A clinical pathway for colorectal cancer (CRC) was introduced in primary care for symptomatic patients in November 2017. The pathway was commissioned to provide GPs with direct access to FITs. Aim: To identify whether sociodemographic factors affect FIT return in symptomatic patients. Design and setting: A retrospective study was undertaken in Nottingham, UK, following the introduction of FIT as triage tool in primary care. It was mandated for all colorectal referrals (except rectal bleeding or mass) to secondary care. FIT was used, alongside full blood count and ferritin, to stratify CRC risk. Method: All referrals from November 2017 to December 2021 were retrospectively reviewed. Sociodemographic factors affecting FIT return were analysed by multivariate logistic regression. Results: A total of 35 289 (90.7%) patients returned their index FIT, while 3631 (9.3%) did not. On multivariate analysis, males were less likely to return an FIT (odds ratio [OR] 1.11, 95% confidence interval [CI] = 1.03 to 1.19). Patients aged ≥65 years were more likely to return an FIT (OR 0.78 for non-return, 95% CI = 0.72 to 0.83). Unreturned FIT more than doubled in the most compared with the least deprived quintile (OR 2.20, 95% CI = 1.99 to 2.43). Patients from Asian (OR 1.82, 95% CI = 1.58 to 2.10), Black (OR 1.21, 95% CI = 0.98 to 1.49), and mixed or other ethnic groups (OR 1.29, 95% CI = 1.05 to 1.59) were more likely to not return an FIT compared with patients from a White ethnic group. A total of 599 (1.5%) CRCs were detected; 561 in those who returned a first FIT request. Conclusion: FIT return in those suspected of having CRC varied by sex, age, ethnic group, and socioeconomic deprivation. Strategies to mitigate effects on FIT return and CRC detection should be considered as FIT usage expands. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
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45. Investigating social deprivation and comorbid mental health diagnosis as predictors of treatment access among patients with an opioid use disorder using substance use services: a prospective cohort study.
- Author
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Adams, Emma A, Yang, Justin C, O'Donnell, Amy, Minot, Sarah, Osborn, David, and Kirkbride, James B
- Subjects
- *
OPIOID abuse , *SUBSTANCE abuse , *MENTAL health services , *HEALTH services accessibility , *MENTAL health - Abstract
Background: Opioid use is a major public health concern across the globe. Opioid use and subsequent access to care is often shaped by co-occurring issues faced by people using opioids, such as deprivation, mental ill-health, and other forms of substance use. We investigated the role of social deprivation and comorbid mental health diagnoses in predicting re-engagement with substance use services or contact with crisis and inpatient services for individuals with opioid use disorder in secondary mental health care in inner-city London. Methods: We conducted a prospective cohort study which followed individuals diagnosed with a first episode of opioid use disorder who accessed substance use services between September 2015 and May 2020 for up to 12 months, using anonymised electronic health records. We employed negative binominal regression and Cox proportional survival analyses to assess associations between exposures and outcomes. Results: Comorbid mental health diagnoses were associated with higher contact rates with crisis/inpatient services among people with opioid use disorder: incidence rate ratios (IRR) and 95% confidence intervals (CI) were 3.91 (1.74–9.14) for non-opioid substance use comorbidity, 8.92 (1.81–64.4) for a single comorbid mental health diagnosis, and 15.9 (5.89–47.5) for multiple comorbid mental health diagnoses. Social deprivation was not associated with contact rates with crisis/inpatient services within this sample. Similar patterns were found with time to first crisis/inpatient contact. Social deprivation and comorbid mental health diagnoses were not associated with re-engagement with substance use services. Conclusion: Comorbid substance and mental health difficulties amongst people with an opioid use disorder led to earlier and more frequent contact with crisis/inpatient mental health services during the first 12 months of follow up. Given the common co-occurrence of mental health and substance use disorders among those who use opioids, a better understanding of their wider needs (such as social, financial and other non-medical concerns) will ensure they are supported in their treatment journeys. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
46. Neighbourhood‐level social deprivation and the risk of recurrent heart failure hospitalizations in type 2 diabetes.
- Author
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Deo, Salil V., Al‐Kindi, Sadeer, Motairek, Issam, Elgudin, Yakov E., Gorodeski, Eiran, Nasir, Khurram, Rajagopalan, Sanjay, Petrie, Mark C., and Sattar, Naveed
- Subjects
- *
TYPE 2 diabetes , *HEART failure , *BLACK people - Abstract
Background: The importance of type 2 diabetes mellitus (T2D) in heart failure hospitalizations (HFH) is acknowledged. As information on the prevalence and influence of social deprivation on HFH is limited, we studied this issue in a racially diverse cohort. Methods: Linking data from US Veterans with stable T2D (without prevalent HF) with a zip‐code derived population‐level social deprivation index (SDI), we grouped them according to increasing SDI as follows: SDI: group I: ≤20; II: 21‐40; III: 41‐60; IV: 61‐80; and V (most deprived) 81‐100. Over a 10‐year follow‐up period, we identified the total (first and recurrent) number of HFH episodes for each patient and calculated the age‐adjusted HFH rate [per 1000 patient‐years (PY)]. We analysed the incident rate ratio between SDI groups and HFH using adjusted analyses. Results: In 1 012 351 patients with T2D (mean age 67.5 years, 75.7% White), the cumulative incidence of first HFH was 9.4% and 14.2% in SDI groups I and V respectively. The 10‐year total HFH rate was 54.8 (95% CI: 54.5, 55.2)/1000 PY. Total HFH increased incrementally from SDI group I [43.3 (95% CI: 42.4, 44.2)/1000 PY] to group V [68.6 (95% CI: 67.8, 69.9)/1000 PY]. Compared with group I, group V patients had a 53% higher relative risk of HFH. The negative association between SDI and HFH was stronger in Black patients (SDI × Race pinteraction <.001). Conclusions: Social deprivation is associated with increased HFH in T2D with a disproportionate influence in Black patients. Strategies to reduce social disparity and equalize racial differences may help to bridge this gap. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
47. Social Deprivation and the Risk of Screening Positive for Glaucoma in the MI-SIGHT Telemedicine-Based Glaucoma Detection Program.
- Author
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Newman-Casey, Paula Anne, Aliancy, Joah, Lu, Ming-Chen, Woodward, Maria A., Hicks, Patrice M., Niziol, Leslie M., Musch, David C., Bicket, Amanda K., John, Denise, Killeen, Olivia, Wood, Sarah D., Johnson, Leroy, Kershaw, Martha, Zhang, Jason, and Elam, Angela R.
- Subjects
- *
MEDICAL screening , *FISHER exact test , *GLAUCOMA , *MONTE Carlo method , *VISUAL fields , *OPEN-angle glaucoma - Abstract
To assess whether increased poverty is associated with increased risk of screening positive for glaucoma or suspected glaucoma in a large public screening and intervention program. Cross-sectional study from 2020 to 2022. Adults ≥ 18 years old without acute ocular symptoms. Michigan Screening and Intervention for Glaucoma and eye Health through Telemedicine (MI-SIGHT) program participants' sociodemographic characteristics and area deprivation index (ADI) values were summarized from the clinical sites, which included a free clinic and a Federally Qualified Health Center (FQHC). The ADI, a composite measure of neighborhood deprivation (range, 1–10; 10 is worst deprivation), was assigned on the basis of the participants' addresses. Group comparisons were performed via 2-sample t tests or Wilcoxon Mann–Whitney tests for continuous measures and chi-square tests or Fisher exact tests with Monte Carlo simulation for categorical measures; Holm adjustment was used for multiple comparisons. Risk factors for screening positive for glaucoma or suspected glaucoma. Of the 1171 enrolled participants, 1165 (99.5%) completed the screening: 34% at the free clinic and 66% at the FQHC. Participants were on average aged 55.1 ± 14.5 years, 62% were women, 54% self-reported as Black/African-American, 34% White, 10% Hispanic or Latino, and 70% earned < $30 000 annually. The mean ADI was 7.2 ± 3.1. The FQHC had higher (worse) ADI than the free clinic (free clinic: 4.5 ± 2.9, FQHC: 8.5 ± 2.1, P < 0.0001). One-quarter (24%) of participants screened positive for glaucoma or suspected glaucoma. Screening positive for glaucoma or suspected glaucoma was associated with being older (P = 0.01), identifying as Black/African-American (P = 0.0001), having an established eyecare clinician (P = 0.0005), and not driving a personal vehicle to the appointment (P = 0.001), which is a proxy for increased poverty. Participants who screened positive had worse ADI than those who screened negative (7.7 ± 2.8 vs. 7.0 ± 3.2, P = 0.002). A larger percentage of White participants screened positive at the FQHC compared with White participants at the free clinic (21.3% vs. 12.3%, P = 0.01). FQHC White participants had worse ADI than free clinic White participants (7.5 ± 2.5 vs. 3.7 ± 2.7, P < 0.0001). Personal poverty, assessed as not driving a personal vehicle to the appointment, and neighborhood-level poverty were both associated with increased rates of screening positive for glaucoma or suspected glaucoma. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
48. Epidemiology, natural evolution, pathogenesis, clinical spectrum, and management of Legg–Calvé–Perthes.
- Author
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Joseph, Benjamin, Shah, Hitesh, and Perry, Daniel C
- Abstract
Background: Legg–Calvé–Perthes disease is a self-limiting disorder that develops in children following interruption of the blood supply to the capital femoral epiphysis. This review outlines the current knowledge on the epidemiology, natural evolution, clinical spectrum, and management of the disease. Methods: The literature pertaining to these aspects of the disease were studied and summarized in this review. Results: Epidemiological studies suggest that environmental factors contribute to the causation of the disease. Incidence rates monitored over time indicate that the incidence of Legg–Calvé–Perthes disease is declining. The natural evolution followed on sequential plain radiographs enables division of the disease into Stages Ia, Ib, IIa, IIb, IIIa, IIIb, and IV. Reversible deformation of the capital occurs in Stages Ia–IIa simply on standing while irreversible deformation may occur in Stages IIb and IIIa. Treatment of Legg–Calvé–Perthes disease in Stages Ia–IIa aims to prevent the femoral head from getting deformed by containment and avoidance of weight-bearing. In Stages IIb and IIIa, treatment aims to remedy the effects of early irreversible deformation of the femoral head. In Stage IIIb and IV, treatment is directed to correcting the altered shape of the femoral head. The impression that these treatment methods are helpful is based on poor quality evidence. Conclusion: There is an urgent need to undertake Level I studies to establish the efficacy of currently treatment. Level of evidence: level V. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
49. The impact of socioeconomic deprivation on liver transplantation
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Paolo De Simone, Giacomo Germani, Quirino Lai, Juri Ducci, Francesco Paolo Russo, Stefano Gitto, and Patrizia Burra
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liver transplantation ,social deprivation ,disparities ,equity ,outcomes ,Specialties of internal medicine ,RC581-951 - Abstract
Despite global expansion, social disparities impact all phases of liver transplantation, from patient referral to post-transplant care. In pediatric populations, socioeconomic deprivation is associated with delayed referral, higher waitlist mortality, and reduced access to living donor transplantation. Children from socially deprived communities are twice as much less adherent to immunosuppression and have up to a 32% increased incidence of graft failure. Similarly, adult patients from deprived areas and racial minorities have a higher risk of not initiating the transplant evaluation, lower rates of waitlisting, and a 6% higher risk of not being transplanted. Social deprivation is racially segregated, and Black recipients have an increased risk of post-transplant mortality by up to 21%. The mechanisms linking social deprivation to inferior outcomes are not entirely elucidated, and powered studies are still lacking. We offer a review of the most recent evidence linking social deprivation and post-liver transplant outcomes in pediatric and adult populations, as well as a literature-derived theoretical background model for future research on this topic.
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- 2024
- Full Text
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50. Is family social exclusion associated with child motor and socioemotional development delay? A cross‐sectional exploratory study
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Clariana Vitória Ramos De Oliveira, Cláudia Nery Teixeira Palombo, Joshua Jeong, Katherine Maria Solís Cordero, and Elizabeth Fujimori
- Subjects
child development ,cross‐sectional study ,developing countries ,social deprivation ,social disadvantage ,Nursing ,RT1-120 - Abstract
Abstract Aim The objective was to identify if family social exclusion is associated with child motor and social development delay in Southeastern Brazil. Design A cross‐sectional study was conducted using data from a sample of 348 children under 3 years, proportional to the number of children registered in the primary care centres of the municipality. Methods Child development was measured using the “Developmental Surveillance Instrument” which was developed by the Ministry of Health in Brazil and is used for public health nurses and clinicians in their practice. An index was used to evaluate social exclusion. Results The prevalence of child motor and socioemotional developmental delay was 27.6% and 17.2%, respectively. Children in the most social excluded group were more likely to have delayed motor development (OR = 3.4; 95% CI = 1.14; 10.55) and socioemotional developmental delay (OR = 3.9; 95% CI = 1.05; 9.02) than children in the least social excluded group.
- Published
- 2023
- Full Text
- View/download PDF
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