Drug Use Patterns in Wastewater and Socioeconomic and Demographic Indicators.

Importance: Measuring drug use behaviors in individuals and across large communities presents substantial challenges, often complicated by socioeconomic and demographic variables. Objectives: To detect spatial and temporal changes in community drug use by analyzing concentrations of analytes in influent wastewater and exploring their associations with area-based socioeconomic and sociodemographic metrics like the area deprivation index (ADI) and rural-urban commuting area (RUCA) codes. Design, Setting, and Participants: This longitudinal, cross-sectional wastewater study was performed from May 2022 to April 2023 and included biweekly influent wastewater samples of 39 analytes from 8 sampling locations across 6 wastewater treatment plants in southern Nevada. Statistical analyses were conducted in December 2023. Main Outcomes and Measures: It was hypothesized that wastewater monitoring of pharmaceuticals and personal care products (PPCPs) and high-risk substances (HRSs) could reveal true spatial and temporal drug use patterns in near-real time. Data collection of samples for PPCPs and HRSs was performed using mass spectrometry. Both ADI and RUCA scores were utilized to characterize neighborhood contexts in the analysis. The false discovery rate (FDR) method was utilized to correct for multiple comparisons (PFDR). Results: Over the 12-month wastewater monitoring period, 208 samples for PPCPs and HRSs were collected, and analysis revealed an increase in the consumption of HRSs and the seasonal variation in PPCP use in southern Nevada. There was a significant increase in levels of stimulant-associated analytes, such as cocaine (ß = 9.17 × 10-4; SE = 1.29 × 10-4; PFDR = 1.40 × 10-10), and opioids or their metabolites, notably norfentanyl (ß = 1.48 × 10-4; SE = 1.88 × 10-4; PFDR = 1.66 × 10-12). In contrast, DEET, an active ingredient in mosquito and tick repellents, demonstrated a seasonal use pattern (ß = -4.85 × 10-4; SE = 2.09 × 10-4; PFDR = 4.87 × 10-2). Wastewater from more disadvantaged or rural neighborhoods, as assessed through ADI and RUCA scores, was more likely to show a significant positive correlation with HRSs, such as cocaine (ß = 0.075; SE = 0.038; P = .05) and norfentanyl (ß = 0.004; SE = 0.001; P = 1.64 × 10-5). Conclusions and Relevance: These findings suggest that wastewater monitoring of PPCPs and HRSs offers a complementary method to existing public health tools, providing timely data for tracking substance use behaviors and use of PPCPs at a population level.

Longitudinal analysis of social and community factors effective in increasing the number of liver donors in the United States.

In this research, it was aimed to evaluate of social and community factors effective in increasing the number of liver donors. Descriptive and relational scanning models were used to conduct the research. Data on liver donors was gathered from the USA Health Resources & Services Administration's Organ Procurement and Transplantation Network between 1988 and 2023. The United States (USA) World Bank Country Reports provided the mortality rates. The data was analyzed using Spearman rho correlation, year-controlled partial correlation, and Generalized Linear Model-Logit analysis. Deceased donor numbers were significantly and negatively correlated with government health expenditure (r = -0.816; P < .01), current health expenditure (r = -0.768; P < .01), female education attainment (r = -0.804; P < .01) and Gini index (r = 0.434; P < .05). Living donor numbers were significantly and negatively correlated with government health expenditure (r = -0.731; P < .01), current health expenditure (r = -0.781; P < .01), male percentage (r = -0.786; P < .01), female education attainment (r = -0.640; P < .05), employment (r = 0.751; P < .01), GDP (r = -0.792; P < .01) and Gini index (r = -0.486; P < .01). Living donor numbers were significantly and positively correlated with age dependency (r = 0.815; P < .01). Generalized Linear Model-Logit (GLM-L) results showed that effect of female education attainment had significant contribution on deceased liver donor (B = -3290.605; P < .01). Effects of significantly correlated community factors on living liver donor numbers were found to be statistically insignificant (P > .05). Research findings reveal that among community factors, especially women's participation in education has a statistically significant effect on liver donors. These results show that the health expenditures made over the years do not provide any added value for liver donors, and role of women on liver donor is significantly dominant.

Demographic factors effect stoke-related healthcare utilisation among Australian stroke survivors.

Health equity is a fast emerging priority for most healthcare systems around the world. Factors impacting health equity include education level, geographical location, age, gender, employment status and income. However, research examining the effect of these demographic variables on health service utilisation among mid-aged and older post-stroke adults is limited. Data was obtained from a sub-study of the Sax Institute's 45 and Up Study, which is conducted in Australia. The sub-study survey collected demographic, health service utilisation and health status information from 576 participants who had a previous stroke diagnosis. Poisson regression was used to examine the association between demographic characteristics and number of consultations with a doctor and/or an allied health practitioner over a 12 month period. All demographic measures were significantly associated with the number of consultations with doctors and/or allied health practitioners. The number of doctor consultations increased for those who struggled to live on their available income (IRR = 1.41), but decreased for females (IRR = 0.81), those who reside in an inner regional area (IRR = 0.83), those who were separated, divorced or widowed (IRR = 0.61), and for those who completed a trade, apprenticeship or diploma (IRR = 0.83). The number of allied health practitioner consultations increased for those who completed a trade, apprenticeship or diploma (IRR = 1.27), and for those who struggled to live on their available income (IRR = 1.38), but decreased for increasing age (IRR = 0.87), females (IRR = 0.78), and for those who reside in an outer regional or remote area (IRR = 0.49). We identified several demographic factors associated with a lower frequency and type of health care services used by post-stroke adults. These possible barriers need to be explored further, as reduced use of healthcare services may lead to poorer stroke outcomes in these demographics. Specifically, researching strategies to best support individuals facing these additional challenges is necessary to ensure equitable healthcare for all Australians.

Household financial burden associated with out-of-pocket payments for healthcare in Iran: insights from a cross-sectional survey.

BACKGROUND: One of the key functions and ultimate goals of health systems is to provide financial protection for individuals when using health services. This study sought to evaluate the level of financial protection and its inequality among individuals covered by the Social Security Organization (SSO) health insurance between September and December 2023 in Iran. METHODS: We collected data on 1691 households in five provinces using multistage sampling to examine the prevalence of catastrophic healthcare expenditure (CHE) at four different thresholds (10%, 20%, 30%, and 40%) of the household's capacity to pay (CTP). Additionally, we explored the prevalence of impoverishment due to health costs and assessed socioeconomic-related inequality in OOP payments for healthcare using the concentration index and concentration curve. To measure equity in out-of-pocket (OOP) payments for healthcare, we utilized the Kakwani progressivity index (KPI). Furthermore, we employed multiple logistic regression to identify the main factors contributing to households experiencing CHE. FINDINGS: The study revealed that households in our sample allocated approximately 11% of their budgets to healthcare services. The prevalence of CHE at the thresholds of 10%, 20%, 30%, and 40% was found to be 47.1%, 30.1%, 20.1%, and 15.7%, respectively. Additionally, we observed that about 7.9% of the households experienced impoverishment due to health costs. Multiple logistic regression analysis indicated that the age of the head of the household, place of residence, socioeconomic status, utilization of dental services, utilization of medicine, and province of residence were the main factors influencing CHE. Furthermore, the study demonstrated that while wealthy households spend more money on healthcare, poorer households spend a larger proportion of their total income to healthcare costs. The KPI showed that households with lower total expenditures had higher OOP payments relative to their CTP. CONCLUSION: The study findings underscore the need for targeted interventions to improve financial protection in healthcare and mitigate inequalities among individuals covered by SSO. It is recommended that these interventions prioritize the expansion of coverage for dental services and medication expenses, particularly for lower socioeconomic status household.

[Introduction of complementary feeding and associated factors in preterm and low birthweight newborns: a prospective cohort study]. / Introdução da alimentação complementar e fatores associados em recém-nascidos pré-termo e com baixo peso: estudo de coorte prospectivo.

This study aimed to analyze the association between sociodemographic factors, maternal and neonatal characteristics and the time taken to introduce complementary feeding in low birthweight and preterm newborns. This is a prospective cohort study of 79 preterm newborns weighing less than or equal to 1,800g. Data were collected at the time of hospital discharge and at the 6th, 9th ,and 12th months of corrected gestational age (CGA), using a structured questionnaire to analyze the time taken to introduce complementary feeding and the texture of the foods introduced. Furthermore, the Survey of Well-being of Young Children (SWYC-BR) was used to assess the risk of developmental delay. Cox proportional hazards regression was used to analyze the variables. The introduction of complementary feeding was assessed in preterm newborns based on the median age of introduction of liquid foods (3.50; IQR: 2.50-5.00), followed by solid (4.70; IQR: 3.20-5.20) and soft foods (5.00; IQR: 4.50-5.50). There was also an association with gestational age (RR = 1.25; 95%CI: 1.02-1.52) throughout the process of food introduction. For solid and soft foods, those with the longest length of stay (RR = 1.03; 95%CI: 1.10-1.05) and on mixed breastfeeding (RR = 2.97; 95%CI: 1.24-7.09) delayed the introduction of complementary feeding the longest. For liquid foods, less severe preterm newborns (Score for Neonatal Acute Physiology and Perinatal Extension - SNAPPE II [RR = 0.96; 95%CI: 0.94-0.98]) and mothers who were breastfeeding at hospital discharge (RR = 11.49; 95%CI: 1.57-84.10) delayed the introduction of complementary feeding. Guidelines are needed to better advise professionals and parents and/or guardians on the ideal time to introduce feeding.

O objetivo deste artigo foi analisar a associação entre os fatores sociodemográficos, as características maternas e neonatais e o tempo de introdução da alimentação complementar em recém-nascidos pré-termo e com baixo peso. Trata-se de um estudo de coorte prospectivo feito com 79 recém-nascidos pré-termo com peso menor ou igual a 1.800g. Os dados foram coletados no momento da alta hospitalar e ao 6º, 9º e 12º mês de idade gestacional corrigida (IGC), com auxílio de um questionário estruturado para analisar o tempo de introdução da alimentação complementar e texturas dos alimentos introduzidos. Além disso, para avaliar o risco de atraso de desenvolvimento, utilizou-se o Survey of Well-being of Young Children (SWYC-BR). Para análise das variáveis, aplicou-se regressão de riscos proporcionais de Cox. A introdução da alimentação complementar foi observada nos recém-nascidos pré-termo, com a mediana de idade de introdução de alimentos líquidos (3,50; IQ: 2,50-5,00), seguido por sólidos (4,70; IQ: 3,20-5,20) e pastosos (5,00; IQ: 4,50-5.50). Ainda, verificou-se associação da idade gestacional (RR = 1.25; IC95%: 1,02-1,52) em todo o processo da introdução alimentar. Para os alimentos sólidos e pastosos, aqueles com o maior tempo de internação (RR = 1,03; IC95%: 1,10- 1,05) e em amamentação mista (RR = 2,97; IC95%: 1,24-7,09) adiaram mais o tempo para introduzir a alimentação complementar. Para alimentos líquidos, recém-nascidos pré-termo menos graves (Score for Neonatal Acute Physiology and Perinatal Extension - SNAPPE II [RR = 0,96; IC95%: 0,94-0,98]) e mães que estavam amamentando na alta hospitalar (RR = 11,49; IC95%: 1,57-84,10) postergaram a introdução alimentar. Diretrizes para melhor orientação de profissionais e pais e/ou responsáveis sobre o momento ideal de introdução alimentar se faz necessário.

El objetivo de este estudio fue analizar la asociación entre los factores sociodemográficos, características maternas y neonatales y el momento de introducción de la alimentación complementaria en recién nacidos pretérmino (recém-nascidos pré-termo) y de bajo peso. Se trata de un estudio de cohorte prospectivo realizado con 79 recém-nascidos pré-termo con un peso menor o igual a 1.800g. Los datos se recopilaron en el momento del alta hospitalaria y al 6º, 9º y 12º mes de edad gestacional corregida (EGC), con la ayuda de un cuestionario estructurado para analizar el momento de introducción de la alimentación complementaria y las texturas de los alimentos introducidos. Además, para evaluar el riesgo de retraso en el desarrollo, se utilizó la Survey of Well-being of Young Children (SWYC-BR). Para analizar las variables, se aplicó la regresión de riesgos proporcionales de Cox. La introducción de la alimentación complementaria se observó en los recém-nascidos pré-termo, con la mediana de edad de introducción de alimentos líquidos (3,50; IIC: 2,50-5,00), seguido de los sólidos (4,70; IIC: 3,20-5,20) y pastosos (5,00; IIC: 4,50-5,50). Además, se constató la asociación de la edad gestacional (RR = 1,25; IC95%: 1,02-1,52) durante todo el proceso de introducción alimentaria. En el caso de alimentos sólidos y pastosos, aquellos con mayor tiempo de hospitalización (RR = 1,03; IC95%: 1,10-1,05) y en lactancia mixta (RR = 2,97; IC95%: 1,24-7,09) retrasaron más la introducción de alimentación complementaria. En el caso de alimentos líquidos, los recém-nascidos pré-termo menos graves (Score for Neonatal Acute Physiology and Perinatal Extension - SNAPPE II [RR = 0,96; IC95%: 0,94-0,98]) y las madres que estaban amamantando al alta hospitalaria (RR = 11,49; IC95%: 1,57-84,10) pospusieron la introducción de alimentos. Se hacen necesarias pautas para una mejor orientación a profesionales y padres o tutores sobre el momento ideal para la introducción alimentaria.

Consideration of inequalities in effectiveness trials of mHealth applications - a systematic assessment of studies from an umbrella review.

BACKGROUND: The growing use of mobile health applications (apps) for managing diabetes and hypertension entails an increased need to understand their effectiveness among different population groups. It is unclear if efficacy and effectiveness trials currently provide evidence of differential effectiveness, and if they do, a summary of such evidence is missing. Our study identified to what extent sociocultural and socioeconomic inequalities were considered in effectiveness trials of mobile health apps in diabetic and hypertensive patients and if these inequalities moderated app effectiveness. METHODS: We built on our recent umbrella review that synthesized systematic reviews (SRs) of randomized controlled trials (RCTs) on the effectiveness of health apps. Using standard SR methodologies, we identified and assessed all primary RCTs from these SRs that focused on diabetes and/or hypertension and reported on health-related outcomes and inequality-related characteristics across intervention arms. We used the PROGRESS-Plus framework to define inequality-related characteristics that affect health opportunities and outcomes. We used harvest plots to summarize the subgroups (stratified analyses or interaction terms) on moderating effects of PROGRESS-Plus. We assessed study quality using the Risk of Bias 2 tool. RESULTS: We included 72 published articles of 65 unique RCTs. Gender, age, and education were the most frequently described PROGRESS-Plus characteristics at baseline in more than half of the studies. Ethnicity and occupation followed in 21 and 15 RCTs, respectively. Seven trials investigated the moderating effect of age, gender or ethnicity on app effectiveness through subgroup analyses. Results were equivocal and covered a heterogenous set of outcomes. Results showed some concerns for a high risk of bias, mostly because participants could not be blinded to their intervention allocation. CONCLUSIONS: Besides frequently available gender, age, and education descriptives, other relevant sociocultural or socioeconomic characteristics were neither sufficiently reported nor analyzed. We encourage researchers to investigate how these characteristics moderate the effectiveness of health apps to better understand how effect heterogeneity for apps across different sociocultural or socioeconomic groups affects inequalities, to support more equitable management of non-communicable diseases in increasingly digitalized systems. REGISTRATION: https://osf.io/89dhy/ .

Prevalence of hysterectomy and its determinants in northern Iran: enrollment results of the Tabari cohort study.

BACKGROUND: To the best of our knowledge, no population-based studies have provided insights into the prevalence of hysterectomy and its risk factors among northern Iranian females. Thus, the present study aimed to investigate the prevalence and sociodemographic determinants of hysterectomy in a large cohort of northern Iranian females. METHODS: This cross-sectional study included data from the enrollment phase of the Tabari cohort study (TCS). The TCS consists of 10,255 adults (4,149 males and 6,106 females) aged 35-70 years who reside in Sari, Mazandaran, Iran, of which 6103 females were included in the study. Multiple logistic regression analysis was used to search for hysterectomy determinants. RESULTS: Our results revealed that the prevalence of hysterectomy among northern Iranian females was 9.7% (595/6103). Additionally, 50-59 (OR: 4.63, 95% CI: 3.57-6.01) and 60-70 (OR: 5.83, 95% CI: 4.28-7.95) age groups, higher socioeconomic levels (OR: 1.66, 95% CI: 1.13-2.42), a history of tubectomy (OR: 1.27, 95% CI: 1.05-1.53), and more gravida (OR: 5.35, 95% CI: 1.62-17.63) were found to increase the odds of hysterectomy, whereas living in mountainous areas (OR: 0.57, 95% CI: 0.43-2.75) and having a job (OR: 0.62, 95% CI: 0.45-0.86) were found to decrease the odds of hysterectomy. CONCLUSION: Older age groups, living in urban areas, higher socioeconomic levels, not having a job, a history of tubectomy, and more gravida were found to increase the odds of hysterectomy.

The effect of socioeconomic factors on malnutrition in Syrian children aged 0-6 years living in Turkey: a cross-sectional study.

BACKGROUND: This study was conducted to examine the prevalence of malnutrition in Syrian immigrant children living in Turkey. METHODS: The study was carried out in the city of Mardin, which is one of the cities with a high Syrian immigrant population in Turkey. Height, body weight and BMI values were recorded to determine the malnutrition status of the children. Z-scores of children were calculated using the malnutrition assessment WHOAntro program. RESULTS: The data show that 30.5% of Syrian children between the ages of 0 and 6 months are male, making up 55.8% of the total, and that 55.3% do not follow a regular breakfast schedule. The percentages of body weight for height, height for age, and BMI for age of Syrian children with a score between - 2 and + 2 SD Number were (89.3%), (74.3%), and (79.3%), respectively. Girls are more likely than boys to experience stunting and low body weight in the context of Syrian children (Stunting OR: 0.855(0.761-1.403), Underweight OR: 0.705(0.609-1,208)). Additionally, there is a link between levels of stunting and underweight and elements like the mother's educational level and the family's income. Contrary to the situation of adequate nutrition, it was discovered that the likelihood of stunting and low body weight in children increased by 0.809 and 1.039 times, respectively, when access to an adequate food supply was not available within the family (p < 0.05). CONCLUSION: s According to the results of the study, gender, family income, mother's education level and access to food affected the severity of malnutrition in children. Migration is an imporatnt factor affecting children's health. In this study malnutrition was found high im immigrant children. Programs should be developed to monitor the growth and development of disadvantaged children and to support their nutrition.

Prevalence, sociodemographic risk factors, and coverage of myopia correction among adolescent students in the central region of Portugal.

BACKGROUND: Knowing the prevalence of myopia at school age is essential to implement preventive measures and appropriate interventions, ensure access to vision care, promote a healthier educational environment and improve academic performance. The purpose of this study was to determine the prevalence of myopia and its associated sociodemographic risk factors, as well as to estimate the coverage of myopia correction among adolescents in center of Portugal. METHODS: This cross-sectional study evaluated 1115 adolescents from the 5th to the 9th year of school, with an average of 12.9 years (SD = 1.5) ranging from 10.0 to 18.0 years. Optometric evaluations were carried out in a school environment and consisted of the evaluation of distance visual acuity, assessed using a logarithmic visual acuity chart (ETDRS charts 1 and 2) at 4 m, and measured by refractive error with a pediatric autorefractometer (Plusoptix), by non-cycloplegic. Myopia was defined as spherical equivalent (SE ≤ -0.50 diopter (D)) and uncorrected visual acuity (UVA ≤ 95VAR). Adjusted logistic regression analysis was applied to investigate risk factors. RESULTS: We found a myopia rate of 21.5% and a high myopia rate of 1.4%. Higher school level and attendance at urban schools were associated with myopia, but no association was found with age or sex. Only 34.6% of myopic adolescents use the best optical correction and 26.4% do not use any type of optical correction. CONCLUSIONS: Data on the prevalence of refractive problems in Portugal are scarce and heterogeneous. This study, although regional, provides a valuable contribution with a clear and reproducible methodology, following international guidelines and filling gaps in the existing literature. The results show that the rate of myopia in this age group is similar to reports from other European studies. The high rate of adolescents with uncorrected or under-corrected myopia in Portugal is a problem that deserves attention.

Trends in Norwegian adolescents' substance use between 2014 and 2022: socioeconomic and gender differences.

BACKGROUND: Substance use is a global health concern and early onset among adolescents increases health risks. We explore national overall trends in prevalence and trends in socioeconomic inequalities in past year alcohol intoxication, cannabis use, and use of other illicit drugs among Norwegian adolescents (ages ∼ 15-19 years of age) between 2014 and 2022. METHOD: The present study builds on data from a nationwide repeated cross-sectional survey collected in 2014-2016 (T1), 2017-2019 (T2), 2021 (T3) and 2022 (T4). In total 415,560 adolescents (50.3% girls) completed the questionnaire during the study period. Trends in socioeconomic inequalities were assessed using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). RESULTS: While the prevalence of alcohol intoxication remained fairly stable, the prevalence of cannabis and other illicit drug use increased between 2014 and 2022 among upper secondary school boys (13.3-17.6%, and 2.0-5.2%, respectively) and girls (8.8-12.8%, and 1.1-2.7%, respectively). Similar trends were observed among 10th-grade adolescents. Boys were more likely than girls to use cannabis or other illicit drugs, but the gender gap in cannabis use narrowed during the study period. Among upper secondary girls, use of cannabis and other illicit drugs was higher among those from less affluent backgrounds, with absolute and relative inequalities in cannabis use increasing between 2014 and 2022. Small inequalities in cannabis use and decreasing relative inequalities in the use of other illicit drug were observed among upper secondary boys. CONCLUSIONS: The increasing use of cannabis and other illicit drugs among Norwegian adolescents is concerning. Future studies should explore the underlying causes of this rise and explore the complex factors influencing adolescent substance use behaviours. A comprehensive understanding of these factors is essential for developing targeted and effective interventions.

Dataset: a social accounting matrix for Germany.

OBJECTIVES: The Social Accounting Matrix (SAM) is an extension of Input-Output tables that records macro and meso-economic accounts of a socio-economic system. Its main objective is to provide a comprehensive understanding of the interrelationships among different economic sectors and agents. The SAM can be used for various purposes, including economic analysis, policy evaluation, and economic modelling. It allows policymakers to make more informed decisions, understand potential consequences of different policy options and serve as the foundation for constructing Computable General Equilibrium (CGE) models. DATA DESCRIPTION: The SAM for Germany is a comprehensive source of data that reveals the incomes and expenditures of 163 different production sectors, along with data on factors of production, households, corporations, government, and external accounts with the rest of the world. Additionally, it provides information on gross fixed capital formation, changes in inventories, and natural capital accounts. This SAM was compiled by extending the EXIOBASE Input-Output (IO) accounts with data from the Federal Statistical Office of Germany. Balancing items were also used to ensure that the Total Income and Total Expenditure of the main transactors are in balance.

Geographical characteristics and influencing factors of the health level of older adults in the Yangtze River Economic Belt, China, from 2010 to 2020.

The health of older adults is crucial for the overall health of the entire life cycle. Based on population sampling survey data and census data from 131 prefecture level units in the Yangtze River Economic Belt (YREB) during 2010-2020, this study used exploratory spatial data analysis, geographical detector, stepwise regression analysis, and GTWR model to analyze the spatiotemporal pattern and influencing factors of the health level of older adults in the YREB. The results show that the health level of older adults in the YREB slightly increased from 2010 to 2020, with the most significant improvement in the upstream region and the most significant decline in the midstream region. The older adults' health level in the YREB displays a gradient decreasing pattern of the downstream, midstream, and upstream regions. The health level of older adults in the YREB is influenced by a combination of natural and social environment factors. Areas with lower altitude and moderate humidity climates are more conducive to the health of older adults. The increase in influencing factors such as population migration rate, per capita GDP, average years of education, per capita housing construction area, per capita park green area, and green coverage rate in built-up areas is conducive to improving the health level of older adults, while lower number of health institutions per 1,000 people and higher household support rate are not conducive to improving the health level of older adults. In addition, over time, the health-promoting effect of natural environmental factors is enhanced from 2010 to 2020, and the influence of annual precipitation on shaping the spatial pattern of older adults' health level became more obvious. Although the promoting effect of population migration on the health level of older adults tends to weaken, it remains the primary factor affecting the spatiotemporal differentiation of older adults' health level in the YREB. The impact of social development on the health level of older adults has changed from a positive health effect (improvement) to a negative health effect (loss). The health-promoting effect of living environment factors is enhanced. The health-inhibitory effect of household support rate increased, and showed a gradient decreasing pattern from downstream to midstream to upstream. The findings of this study can provide a more in-depth understanding of the spatiotemporal pattern of the health level of older adults in the YREB and the factors influencing it, improve the health level of older adults in the region, and promote the development of healthy and active aging in the YREB, and improve the human health. At the same time, this study also supplements the related research on aging and the health level of the elderly. Firstly, it can provide reference for the research on the health of old adults in other countries and regions around the world. Secondly, it can also provide a basis for research on aging and the health of old adults in cities and counties under YREB.

Using Household Dietary Diversity Score and Spatial Analysis to Inform Food Governance in Chile.

This study explores how the Household Dietary Diversity Score (HDDS) and spatial visualization can inform food governance in Chile, focusing on socio-demographic and geographical determinants affecting food consumption patterns. A national household database (n = 4047), including households from 2019 (n = 3967; 98.02%) and 2020 (n = 80; 1.98%), provided by the "Family Support Program of Food Self-Sufficiency" (FSPFS) of the Ministry of Social Development and Family, was analyzed. The findings revealed that Chilean vulnerable households were led mostly by women (86.6%), with an age average of 55.9 ± 15.6 years old, versus 68.9 ± 12.9 years in the case of men. The intake frequency analysis showed that dairy, fruits, and vegetables were below the recommended values in at least half of the households, and that fats and sugars were above recommended levels. Regarding the HDDS (0-189), the national average was 91.4 ± 20.6 and was significantly influenced by the number of minors in the households, water access, food access issues, and residing in the Zona Sur. Finally, the spatial visualization showed that the Zona Central had higher consumption of fruits and vegetables, while the extreme zones Norte Grande and Zona Austral showed higher intakes of fats and sugars. These findings emphasize the importance of leveraging data insights like the HDDS and spatial visualization to enhance food security and inform food governance strategies.

The Happy Child Program's Intersectionality: Prenatal Home Visit Frequency, Food Insecurity Risk, Symptoms of Depression, and Parental Practices in Brazilian Women Assisted during Pregnancy.

Food insecurity (FI) is a critical issue in developing countries, particularly in low-resource settings, where it can worsen women's mental health. Psychosocial factors such as low household income, limited education, multiparity, and vulnerability are linked to depressive symptoms during pregnancy. Additionally, the family environment influences parental practices, which may impact mental health. This study evaluates the association of socioeconomic factors, parental practices, FI risk, and home visit frequency with depressive symptoms in pregnant women enrolled in the Happy Child Program (Programa Criança Feliz-PCF) in the Federal District, Brazil. In this cross-sectional study, 132 pregnant women monitored by PCF from May to July 2023 were assessed using a self-administered questionnaire for socioeconomic data, the two-item Triage for Food Insecurity (TRIA) instrument for FI risk, the Scale of Parental Beliefs and Early Childhood Care Practices, and the Beck Depression Inventory-II for depressive symptoms. Most participants were multiparous (87.9%), had low income (under 200 USD/month; 80.8%), presented depressive symptoms (67.4%) and were at risk of FI (81.8%). About half demonstrated adequate parental practices (50.8%) and received four home visits per month during pregnancy (54.5%). Women who received four PCF home visits had a lower prevalence of depressive symptoms compared to those with fewer visits (PR 0.76, 95% CI 0.59-0.98). No significant association was found between FI or parental practices and depressive symptoms. These findings suggest that the PCF home-visiting program may strengthen vulnerable families, support social networks, and improve mental health during pregnancy. Additionally, the results of this study highlight the need for targeted interventions aimed at reducing food insecurity and promoting mental health during pregnancy, particularly among socially vulnerable populations. Furthermore, they reinforce the importance of expanding access to home-visiting programs as an effective strategy to improve maternal mental health and well-being, while fostering healthier prenatal environments for both mothers and their children.

Evaluating food security and nutritional pathways of rural farm families: Empirical evidence from northeast India.

The study aimed to ascertain a relationship between agricultural status, socioeconomic factors, and nutrition of farm families. The study was conducted in selected villages in the West Garo Hills district of Meghalaya, using Stratified Random Sampling (St. RS). Using pretested interview schedules, we collected primary data from respondents in 2020 and 2021, focusing on socioeconomic variables, body mass index, and income from agriculture and related sectors. The data was analysed using correlation analyses and separate combined regression estimates for each year and month were obtained. Results from the study indicate that agricultural income significantly influenced nutritional status (p < 0.05) and household income growth was also found significant. The region's agricultural production of cereals, pulses, and vegetables was insufficient, as was the production of meat and meat products, milk, and milk products. Hence, expenditure towards purchasing the above food groups from the market was found to be significant (p < 0.05). Therefore, the markets near the mainland especially in the hilly region play a crucial role in the nutritional pathway of rural farm families.

How enabling factors determine unmet healthcare needs? A panel data approach for countries.

Health service need refers to the essential care required to achieve optimal health outcomes within resource constraints. When necessary services to address identified health issues are not received, unmet needs arise. This research focuses on the determinants of unmet healthcare needs across the 34 countries within the European region from 2011 to 2019, focusing on Andersen's Behavioral Model's enabling factors. We employed a static and robust panel regression model using Stata 14.0 software. Key determinants analyzed include GDP per capita, urbanization rate, and physicians per capita. Findings reveal that lower GDP per capita and lower urbanization rates are significantly correlated with higher levels of unmet healthcare needs, highlighting income level and geographical accessibility as critical factors. Additionally, a higher number of physicians per capita is associated with reduced unmet healthcare needs, indicating the importance of healthcare resources in addressing healthcare access gaps. These findings underscore the importance of targeted healthcare policies that address income level, improve healthcare accessibility, and enhance healthcare resource allocation to reduce unmet healthcare needs effectively. These findings equip policymakers and administrators with empirically grounded insights to comprehend the factors contributing to unmet healthcare needs and to develop policies aimed at addressing this challenge.

The Unequal Economic and Livelihood Impacts of COVID-19 Lockdowns: Qualitative Evidence from Uganda.

Lockdowns were a key policy response to the COVID-19 pandemic. While they were viewed as a necessary intervention, concerns were raised about their potential for harmful economic and livelihood impacts. However, few studies have addressed the unequal economic and livelihood impacts of lockdowns. Our article reports findings from a qualitative study conducted in Uganda on economic and livelihood impacts of COVID-19 lockdowns in urban and rural settings. This study used 14 focus group discussions, 40 household, and 31 key informant interviews in both urban (Kampala district) and rural (Wakiso district) areas in central Uganda. Data analysis was conducted thematically with NVivo 2020 (QSR International). The findings emphasize the unequal impacts of the COVID-19 lockdowns across a range of dimensions: informal sector activities, formal employment, fluctuating prices alongside scarcity and surpluses, food insecurity, and government interventions. Wealthier households in urban areas were least affected, with urban households reliant on informal sector activities experiencing the most significant impacts. Our findings also suggest that longer-term development strategies, such as increased food self-sufficiency and informal sector interventions can support future pandemic preparedness and response. To address these impacts, policymakers should provide targeted support, alongside protecting key productive sectors, and supply chains.

Determination of appropriate policy targets to reduce the prevalence of stunting in children under five years of age in urban-poor communities in Indonesia: a secondary data analysis of the 2022 Indonesian national nutritional status survey.

OBJECTIVE: Based on previous studies, urban-poor societies are very vulnerable to stunted children under five. The study aims to determine the appropriate policy targets to reduce the prevalence of stunted under-five children in urban-poor communities in Indonesia. DESIGN: A study was conducted using a secondary data analysis. The study analysed existing data from the 2022 Indonesian National Nutritional Status Survey. SETTING AND PARTICIPANTS: At the national level, Indonesia encompassed 43 284 toddlers. INTERVENTIONS: Non-intervention study. PRIMARY AND SECONDARY OUTCOMES: The study's eight independent factors were the mother's age, education, marital status, employment, wealth, antenatal care (ANC), children's age and sex, with nutritional status as the dependent variable. We employed a binary logistic regression test for the most recent exam. RESULTS: Maternal age was related to stunted toddlers in communities of urban poor in Indonesia. The lower the education, the higher the possibility of having stunted kids. Unemployed mothers were 1.153 times more likely than employed mothers to have stunted under-five children (95% CI 1.145 to 1.160). The poorest were 1.235 times more likely to get stunted under-five than the poorer (95% CI 1.227 to 1.242). Mothers without ANC during pregnancy were 1.212 times more likely to get stunted kids than those with ANC during pregnancy (95% CI 1.186 to 1.240). All kids' ages were more probable than 0-11 to be stunted. Boys were 1.099 times more likely to be stunted than girls (AOR 1.099; 95% CI 1.093 to 1.105). CONCLUSION: The appropriate policy targets to reduce the prevalence of stunted under-five children in urban-poor communities in Indonesia were younger mothers, those with poor education, those unemployed, the most impoverished, those without ANC, those with older under-five and those with boy kids.

Factors affecting poor sleep quality in last trimester pregnant women: a cross-sectional research from Turkey.

OBJECTIVE: The aim of the study was to determine the factors affecting poor sleep quality in the last trimester pregnant women. METHODS: A cross-sectional study was conducted at a tertiary care maternity hospital in Ankara, Turkey. The research was conducted between May and September 2019 with 570 pregnant women in the last trimester. The data were collected through the Personal Information Form, Pittsburgh Sleep Quality Index, International Physical Activity Questionnaire Short Form, Restless Legs Syndrome Form, Brief Fatigue Inventory, and Perceived Stress Scale. RESULTS: The mean Pittsburgh Sleep Quality Index score of the pregnant women was 5.98±3.31, and 48.9% of them were found to have over five Pittsburgh Sleep Quality Index scores. Hemoglobin levels, income perceptions, smoking habits, attending pregnant schools, experiencing leg pains or cramping, experiencing back, waist, or neck pains, Restless Legs Syndrome, fatigue levels, and perceived stress levels of the pregnant women were found to be important determinants of sleep quality (p<0.05). CONCLUSION: According to the findings, increasing hemogram levels, attending antenatal education programs, and improving the ability of pregnant women to manage stress are opportunities to improve sleep quality during pregnancy. Careful evaluation of pregnant women in terms of insomnia and affecting factors can be suggested during antenatal follow-up.

Family caregivers' perceptions of the quality of primary healthcare services for people with disabilities: a cross-sectional study.

BACKGROUND: How do caregivers of people with disabilities perceive the quality of health services in primary healthcare? OBJECTIVE: The objective of this study was to show the quality of health services for people with disabilities in primary healthcare, based on the perceptions of family caregivers. METHODS: This is a cross-sectional study. During data collection, 49 family caregivers who use the center were interviewed. The assessment instruments used were the Socio-Economic and Demographic Questionnaire and the PCATool-Brasil (Primary Care Assessment Tool), in the reduced adult and child versions, to assess the level of essential and derived characteristics of primary healthcare. RESULTS: Women were the main caregivers (40; 82%), and the main disability was mental (28; 58%). The highest scores were observed in affiliation (100%), utilization (73.4%), and information system (83.7%). The lowest scores were found in longitudinal (26.5%), integration of care, available services, services provided (28.6%), and derived scores (28.6-22.4%) related to family guidance and community guidance. The population showed a low orientation toward primary healthcare, with a high total score (22.4%). The economic situation showed a positive association (p=0.017). CONCLUSION: According to the characteristics of primary healthcare, care is fragmented and disjointed and does not meet the needs of people with disabilities and their caregivers.