A Disparity.

As a living being that was passed down the role of storytelling, I describe the conditions under which individuals find themselves. Science, and specifically public health research, affords me the opportunity to deploy my storytelling skills toward advocacy and intervention for communities that disproportionately bear the burden of poor health. Although neither role makes space for the emotional toll of this work. Neither allows me to rest long enough to move through the emotional mist of what it means to be perceived as a queer, Black, cisgender woman, and storytelling scientist in a stratified and hateful world where I am so much more. This poem pools from various worlds within me for each stanza. The poem seeks to reconcile for my whole self, and others who experience marginality, why our colleagues, countrypersons, and community members see it fit to perpetuate notions of human difference along racialized, socioeconomic, sexualized, gendered, able-bodied, and other stratified lines-to the detriment of our lives. How can my colleagues, countrypersons, and community members be willing to receive the privileges of a democratic society but discard the lives from which that society was built? How can my colleagues, countrypersons, and community members be willing to receive our science but discard our health? This poem brings together multidisciplinary discourse from the humanities and the social and biological sciences to state plainly what many others have academically. May this poem be paired with existing literature on the falsity of biologized race, reparations, and methodologies of reflexivity in science.To view the original version of this poem, see the Supplemental Material section of this article online.

Predictors of older adults' health behaviours to prevent COVID-19 transmission: a multilevel analysis.

OBJECTIVES: While older adults showed higher mortality during COVID-19 pandemic, protective behaviours (knowledge regarding coping with COVID-19 symptoms and preventive behaviours) were highlighted to be important to prevent the spread of infection. This study aimed to identify individual and community-level variables influencing deficient knowledge regarding coping with COVID-19 and not-practicing COVID-19 of older adults during the pandemic. DESIGN: This is a secondary analysis of a cross-sectional study using the 2020 Korea Community Health Survey (KCHS). SETTING: 255 community public health centres nationwide, South Korea. METHODS AND ANALYSIS: Using 2020 KCHS data, multilevel logistic regression analysis was conducted on 55 005 adults aged 65 years or older. RESULTS: Older adults who reside alone, as opposed to with their spouse and who lack the support of another individual exhibited insufficient COVID-19 coping-related knowledge (OR: 1.142, p<0.001) and poor preventive behaviours (OR: 1.177, p<0.001). Furthermore, lower municipal social welfare budget levels were associated with worse health behaviours (OR: 0.062, p<0.001). Specifically, older adults living in rural areas were less likely to engage in COVID-19 preventive behaviours compared with those in urban areas (OR: 1.247, p<0.001). Additionally, the effectiveness of mass media as a motivating factor for adopting preventive measures was only significant in rural populations (OR: 0.944, p<0.05). CONCLUSIONS: Both individual-level and community-level approaches are necessary as an initial response during the pandemic. Since elderly people living alone with low socioeconomic status are vulnerable groups with poor health behaviours, it is helpful to provide social support on how to respond to infectious diseases and manage symptoms. In addition, it is important to expand the municipal social welfare budget to promote health equity between regions through appropriate health behaviour education and the strengthening of public medical services.

Socioeconomic Inequalities in the External Exposome in European Cohorts: The EXPANSE Project.

Socioeconomic inequalities in the exposome have been found to be complex and highly context-specific, but studies have not been conducted in large population-wide cohorts from multiple countries. This study aims to examine the external exposome, encompassing individual and environmental factors influencing health over the life course, and to perform dimension reduction to derive interpretable characterization of the external exposome for multicountry epidemiological studies. Analyzing data from over 25 million individuals across seven European countries including 12 administrative and traditional cohorts, we utilized domain-specific principal component analysis (PCA) to define the external exposome, focusing on air pollution, the built environment, and air temperature. We conducted linear regression to estimate the association between individual- and area-level socioeconomic position and each domain of the external exposome. Consistent exposure patterns were observed within countries, indicating the representativeness of traditional cohorts for air pollution and the built environment. However, cohorts with limited geographical coverage and Southern European countries displayed lower temperature variability, especially in the cold season, compared to Northern European countries and cohorts including a wide range of urban and rural areas. The individual- and area-level socioeconomic determinants (i.e., education, income, and unemployment rate) of the urban exposome exhibited significant variability across the European region, with area-level indicators showing stronger associations than individual variables. While the PCA approach facilitated common interpretations of the external exposome for air pollution and the built environment, it was less effective for air temperature. The diverse socioeconomic determinants suggest regional variations in environmental health inequities, emphasizing the need for targeted interventions across European countries.

Telelactation Within the Landscape of Breastfeeding Support: Experiences of Latina Parents.

BACKGROUND: Despite increasing breastfeeding initiation rates in the United States, disparities in breastfeeding continuation and exclusivity by race and ethnicity persist. RESEARCH AIM: We aimed to understand the perceptions and experiences of Latina parents who received access to telelactation, and assessed the implications of integrating telelactation into pediatric settings. METHODS: This cross-sectional qualitative study drew from participants enrolled in a randomized controlled trial about breastfeeding support. We recruited 20 participants from among those participating in a randomized controlled trial assessing the effect of telelactation on breastfeeding outcomes. The study design was informed by an Equity-Centered Model and authentic entry. We conducted a thematic content analysis through an iterative approach, where we systematically generated themes to describe code application patterns. RESULTS: We identified three themes: (1) telelactation within the broader landscape of breastfeeding support; (2) perceptions of telelactation support; and (3) recommendations on the use of telelactation in the context of pediatric care. We found that participants had an escalation approach for seeking breastfeeding support and propose a new model: Breastfeeding Support Escalation Protocol, which can be applied to lactation support in pediatric care. Parents' perceptions and recommendations highlighted their desire for care coordination, expanded options for telelactation engagement, and care continuity, which are important reflections for pediatric offices considering integrating telelactation services into their practice. CONCLUSIONS: Latina parents found telehealth to be helpful and an acceptable alternative to in-person services. Pediatric offices can take steps toward becoming Breastfeeding-Friendly by partnering with telelactation services. More research is needed on the logistical implications and cost-effectiveness of telelactation services as part of the pediatric practice.

Un/met: a mixed-methods study on primary healthcare needs of the poorest population in Khyber Pakhtunkhwa province, Pakistan.

BACKGROUND: Access of all people to the healthcare they need, without financial hardship is the goal of Universal Health Coverage (UHC). As UHC initiatives expand, assessing the needs of vulnerable populations can reveal gaps in the system which may be covered by relevant policies. In this study we (i) identify the met and unmet primary healthcare needs of the poorest population of Khyber Pakhtunkhwa province (KP), Pakistan, and (ii) explore why the gaps exist. METHODS: We used Leveque's Framework of Patient-centred Access to Healthcare to examine unmet primary healthcare (PHC) needs and their underlying causes for the poorest population in four districts of Khyber Pakhtunkhwa province, Pakistan. Using a triangulation mixed methods design, we analysed data from a quantitative household survey of744 households, 17 focus group discussions with household members and, 11 interviews with healthcare providers. RESULTS: Our results show that indicate that despite service utilization, PHC needs were not met, primarily due to prohibitively high costs at each stage of access. Furthermore, gaps in outreach and information (approachability), and varying availability of medicines and diagnostics at facilities (appropriateness) the supply side as well as difficulties in navigating the system (inability to perceive) and adhering to prescriptions (inability to engage) on the demand side, also led to unmet PHC needs. Going beyond utilization, our findings highlight that engagement with care is an important determinant of met needs for vulnerable populations. CONCLUSION: Social health protection policies can contribute to advancing UHC for primary care. However, in our setting, enhancing communication and outreach, addressing gender and age disparities, and improving quality of care and health infrastructure are necessary to fully meet the needs of the poorest populations.

Estimated GFR in the Korean and US Asian Populations Using the 2021 Creatinine-Based GFR Estimating Equation Without Race.

Rationale & Objective: In 2021, the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) updated the creatinine-based estimated glomerular filtration rate (eGFR) equation and removed the coefficient for race. The development and validation of this equation involved binarizing race into African American and non-African American, involving few Asian participants. This study aimed to examine the difference between the 2021 equation and the previous 2009 equation on CKD prevalence estimates in 2 Asian populations. Study Design: Observational study using 2 national surveys. Setting & Participants: Participants from the 2019 Korea National Health and Nutrition Survey and participants self-reported as Asian from the 2011-2020 US National Health and Nutrition Survey. Exposure: eGFR using 2009 and 2021 CKD-EPI creatinine equation. Outcomes: Prevalence of CKD (eGFR <60 mL/min/1.73 m2 or urine albumin-creatinine ratio ≥30 mg/g). Analytical Approach: Sampling-weighted prevalence estimated using the 2009 and 2021 equations as well as the percentage of individuals with CKD G3+ using the 2009 equation being reclassified as not having CKD G3+ using the 2021 equation. Results: The prevalence of CKD estimated using the 2021 equation was 9.75% (95% confidence intervals [CI], 8.80-10.80%) in Koreans and 11.60% (95% CI, 10.23-13.13%) in US Asians. The prevalence of CKD estimated using the 2021 equation was slightly lower than that using the 2009 equation in both Korean and US Asian populations by 0.63% (95% CI, 0.44-0.90%) and 0.84% (95% CI, 0.52-1.34%), respectively. Furthermore, 32.8% and 30.2% of Koreans and US Asians with CKD G3-5, respectively, estimated using the 2009 equation were reclassified as not having CKD G3-5 when the eGFR was calculated using the 2021 equation. Limitations: Measured GFR was not available. Conclusions: Use of the 2021 CKD-EPI creatinine equation leads to a small decrease in CKD prevalence in both Korean and US Asian populations, and of similar magnitude, resulting in significant reclassification among those originally classified as having CKD G3+.

The 2009 serum creatinine-based kidney function estimating equation used demographic information including race. Because race is a social construct, race was eliminated in the new equation developed in 2021. As race was categorized into African American and non-African American during its development, this study examined the impact of the 2021 equation in 2 distinct Asian populations (Koreans and US Asians) using 2 national datasets. We found that the prevalence of chronic kidney disease (CKD) estimated using the 2021 equation was slightly lower that estimated using the 2009 equation in both Koreans and US Asians. Approximately one-third of people with CKD estimated using the 2009 equation were reclassified as not having CKD estimated using the 2021 equation.

Associations between Minority Health Social Vulnerability Index Scores, Rurality, and Histoplasmosis Incidence, 8 US States.

To explore associations between histoplasmosis and race and ethnicity, socioeconomic status, and rurality, we conducted an in-depth analysis of social determinants of health and histoplasmosis in 8 US states. Using the Minority Health Social Vulnerability Index (MH SVI), we analyzed county-level histoplasmosis incidence (cases/100,000 population) from the 8 states by applying generalized linear mixed hurdle models. We found that histoplasmosis incidence was higher in counties with limited healthcare infrastructure and access as measured by the MH SVI and in more rural counties. Other social determinants of health measured by the MH SVI tool either were not significantly or were inconsistently associated with histoplasmosis incidence. Increased awareness of histoplasmosis, more accessible diagnostic tests, and investment in rural health services could address histoplasmosis-related health disparities.

Harnessing Hope in Digital Spaces for Health Equity: How Group Comparison Information and Supportive Comments Influence Bone Marrow Donor Intentions for African Americans.

Pursuing health equity necessitates recognizing health disparities that disproportionately impact disadvantaged groups and eliminating their barriers to essential health resources. Interactive digital technologies-specifically, popular social media platforms such as blogs and social networks-can be leveraged to engage underserved minority populations in collective social action aimed at addressing key determinants of health disparities and promoting equitable health outcomes. The present research focuses on the plight of African Americans-a minority group facing significant health disparities. Particularly in the domain of bone marrow donation, African Americans remain the group least likely to find a matching donor. Guided by the social comparison framing literature, we conducted an online experiment to investigate how group comparison information (GCI) emphasizing group-based disparities and supportive user comments on social media platforms influence African Americans' intentions to join a bone marrow registry. In doing so, we considered hope as a mediator and group identification as a moderator. Results based on a conditional process analysis showed that GCI led to greater bone marrow donor intentions in the presence of supportive comments through elicitation of hope, particularly among those low in group identification. The current findings demonstrate that it is important to consider the role of supportive message environments and group identification when addressing health disparities with GCI. Theoretical and practical implications are discussed.

Housing Insecurity and Older Adults' Health and Well-Being in a Gentrifying City: Results from the EPIPorto Cohort Study.

Using 2022 data from 600 adults (≥ 60 years) in Porto, Portugal, we explored the association between housing insecurity and various health outcomes. We examined housing conditions, affordability, and stability in relation to loneliness, quality of life, cognitive function, perception of healthy ageing, and sleep using regression models. Older adults without house heating (ß = 2.293; 95%CI = 0.753, 3.833), with leaks/dampness/rot (ß = 3.741; 1.818, 5.664), insufficient daylight (ß = 2.787; 0.095, 5.479), living in neighborhoods with noise (ß = 1.793, 0.280 to 3.305), pollution/grime (ß = 2.580; 0.746, 4.414), and violence/crime/vandalism (ß = 3.940; 1.723, 6.157), who faced housing cost overburden (ß = 2.001; 0.426, 3.577), eviction (ß = 12.651; 0.852, 24.450), and moved frequently (ß = 4.129; 1.542, 6.716) exhibited higher levels of loneliness. Similarly, lack of house heating (ß = - 1.942; - 3.438, - 0.445), leaks/dampness/rot (ß = - 4.157; - 5.999, - 2.316), insufficient daylight (ß = - 3.124; - 5.714, - 0.534), noise (ß = - 2.143; - 3.600, - 0.686), pollution/grime (ß = - 2.093; - 3.860, - 0.325), violence/crime/vandalism (ß = - 2.819; - 4.948, - 0.691), and those with housing cost overburden (ß = - 2.435; - 3.930, - 0.940) reported lower quality of life. Those with no toilet (ß = - 1.891; - 3.760, - 0.021) or shower (ß = - 1.891; - 3.760, - 0.021) and who faced forced displacement (ß = - 2.179; - 3.516, - 0.842) presented lower cognitive function. Furthermore, those living in neighborhoods with pollution/grime (OR = 0.494; 0.322, 0.756) and violence/crime/vandalism (OR = 0.477; 0.284, 0.801), those in social housing (OR = 0.728; 0.575, 0.922), and those who moved frequently (OR = 0.475; 0.257, 0.879) reported lower levels of perceived healthy ageing. Insufficient sleep was more common among residents in social housing (OR = 2.155; 1.102, 4.213), while poor sleep quality was least likely both among those living in social housing (OR = 0.445; 0.220, 0.900) and affordable housing (OR = 0.381; 0.162, 0.896). Good quality, stable, and affordable housing seems crucial for healthy ageing.

"I'm His Voice": Parent Perspectives on Obtaining an Autism Diagnosis and Services and the Influence of Personal and Cultural Factors.

To assess caregiver-reported barriers and facilitators to receiving a diagnosis of Autism Spectrum Disorder (ASD) and accessing services as well as the influence of personal and cultural factors.Participants included 29 parents whose children had been diagnosed with ASD between January 2019 and November 2021 while receiving primary care at one of two urban, hospital-affiliated clinics. Semi-structured interviews and surveys were conducted between May 2022 and June 2023 in both English and Spanish. Transcripts were coded and themes developed using thematic content analysis. In the survey portion of the study, 80% of parents said the experience of getting the diagnosis was "very easy/somewhat easy," while 28% of parents said the process of accessing autism services was "very difficult." Four general categories emerged from the qualitative analysis: (1) experience getting the diagnosis, (2) service navigation after diagnosis, (3) need for parent advocacy, and (4) perception of condition by others. Parents generally reported positive experiences with their pediatricians, but some felt their concerns were discounted due to personal factors. The most common frustration expressed was difficulty accessing Applied Behavior Analysis therapy after a diagnosis due to long waiting lists, staff turnover and poor quality. Many parents felt that it would be helpful to have a family navigator to assist with paperwork, insurance complexities, and service access. Parents reported many challenges obtaining an autism diagnosis as well as accessing services. Widespread system change will be required to meet the needs of families equitably and effectively.

Bridging Language Barriers in COVID-19 Research: Descriptive Study of AccesoCovid.com's Reach and User Engagement.

BACKGROUND: The COVID-19 pandemic underscored the challenge of swiftly disseminating research findings to a global audience. Language barriers further exacerbated disparities in access to timely scientific information, particularly for non-English speaking communities. The majority of COVID-19 research was published in English, limiting accessibility for Spanish-speaking populations. OBJECTIVE: This paper aims to assess the reach and effectiveness of AccesoCovid.com, a platform designed to disseminate up-to-date COVID-19 research in both English and Spanish, addressing the language gap in scientific communication. METHODS: AccesoCovid.com was developed through a partnership between the University of California, San Francisco (UCSF) and Universidad Nacional Autónoma de México (UNAM). The website's performance and user engagement were evaluated using Google Analytics over a span of 2 years. Key metrics included user language preference, geographical distribution, and site traffic. The website summarized and translated 1032 articles on various COVID-19 topics, such as "Pharmaceutical Interventions and Vaccines." RESULTS: From February 2021 to February 2023, the platform attracted 57,000 users. Of the 43,000 unique new visitors, 84.2% (n=36,219) hailed from Spanish-speaking regions. The majority accessed the site organically through search engines, with 88.4% (n=38,000) of users arriving this way, while 5000 (11.6%) users accessed the site directly. Most users (n=30,894, 72.1%) preferred the Spanish version of the site. The website's most accessed category was "Pharmaceutical Interventions and Vaccines," followed by "Clinical Presentation and Management" and "Mental Health." Regarding language distribution, 72.1% (n=30,894) of users primarily used Spanish; 21.4% (n=9215) used English; and 6.7% (n=2891) spoke other languages, including Portuguese, Chinese, and German. Geographically, the website attracted visitors from 179 countries, with the highest visitor counts from Mexico (n=12,342, 28.7%), Spain (n=6405, 14.9%), the United States (n=4416, 10.3%), and Peru (n=3821, 8.9%). CONCLUSIONS: AccesoCovid.com successfully bridged a critical language gap in the dissemination of COVID-19 research. Its success underscores the pressing need for multilingual scientific resources. The platform demonstrated significant user engagement and reach, particularly in Spanish-speaking countries. This highlights the potential for similar platforms to ensure equitable access to scientific knowledge across diverse linguistic communities. Future efforts should focus on expanding to other languages and conducting formal evaluations to enhance user satisfaction and impact.

Development and validation of the Florey Dementia Risk Score web-based tool to screen for Alzheimer's disease in primary care.

Background: It is estimated that ∼60% of people with Alzheimer's disease (AD) are undetected or undiagnosed, with higher rates of underdiagnosis in low-to middle-income areas with limited medical resources. To promote health equity, we have developed a web-based tool that utilizes easy-to-collect clinical data to enhance AD detection rate in primary care settings. Methods: This study was leveraged on the data collected from participants of the Australian Imaging, Biomarker & Lifestyle (AIBL) study and the Religious Orders Study and Memory and Aging Project (ROSMAP). The study included three phases: (1) constructing and evaluating a model on retrospective cohort data (1407 AIBL participants), (2) performing simulated trials to assess model accuracy (30 AIBL participants) and missing data tolerability (30 AIBL participants), and (3) external evaluation using a non-Australian dataset (500 ROSMAP participants). The auto-score machine learning algorithm was employed to develop the Florey Dementia Risk Score (FDRS). All the simulated trials and evaluation were performed using a web-based FDRS tool. Findings: FDRS achieved an area under the curve (AUC) of approximately 0.82 [95% CI, 0.75-0.88], with a sensitivity of 0.74 [0.60-0.86] and a specificity of 0.73 [0.70-0.79]. The accuracy of the simulated pilot trial for 30 AIBL participants with complete record was 87% (26/30 correct), while it only slightly decreased (80.0-83.3%, depending on imputation methods) for another 30 AIBL participants with one or two missing data. FDRS achieved an AUC of 0.82 [0.77-0.86] of 500 ROSMAP participants. Interpretation: The FDRS tool offers a potential low-cost solution to AD screening in primary care. The present study warrants future trials of FDRS for optimization and to confirm its generalizability across a more diverse population, especially people in low-income countries. Funding: National Health and Medical Research Council, Australia (GNT2007912) and Alzheimer's Association, USA (23AARF-1020292).

Inequity in cardiometabolic hospital admissions and blood screening in New Zealand Indigenous Maori with psychosis.

BACKGROUND: People with psychosis experience worse cardiometabolic health than the same-aged general population. In New Zealand, Indigenous Maori experiencing psychosis have greater risk of cardiometabolic and other physical health problems. AIMS: To identify a cohort of adults accessing secondary mental health and addiction services in New Zealand, with a previous psychosis diagnosis as of 1 January 2018, and compare odds of hospital admission outcomes, mortality and receipt of cardiometabolic blood screening between Maori and non-Maori in the following 2 years. METHOD: Crude and adjusted logistic regression models compared odds of hospital admission outcomes, mortality and receipt of cardiometabolic blood screening (lipids and haemoglobin A1c) between Maori and non-Maori, occurring between 1 January 2018 and 31 December 2019. RESULTS: A cohort (N = 21 214) of Maori (n = 7274) and non-Maori (n = 13 940) was identified. Maori had higher adjusted risk of mortality (odds ratio 1.26, 95% CI 1.03-1.54), and hospital admission with diabetes (odds ratio 1.64, 95% CI 1.43-1.87), cardiovascular disease (odds ratio 1.54, 95% CI 1.25-1.88) and any physical health condition (odds ratio 1.07, 95% CI 1.00-1.15) than non-Maori. Around a third of people did not receive recommended cardiometabolic blood screening, with no difference between Maori and non-Maori after covariate adjustment. CONCLUSIONS: Maori experiencing psychosis are more likely to die and be admitted to hospital with cardiovascular disease or diabetes than non-Maori. Because of the higher cardiometabolic risk borne by Maori, it is suggested that cardiometabolic screening shortfalls will lead to worsening physical health inequities for Maori experiencing psychosis.

Association of sociodemographic characteristics with the timeliness of surgery for patients with open tibial fractures.

BACKGROUND: The American College of Surgeons recommends operative debridement of open tibial fractures within 24 h of presentation. It is unknown what the compliance rates are with this recommendation and what factors contribute to delays to operation. METHODS: To determine the characteristics associated with delays to operation for open tibial fractures, we conducted a retrospective cohort study utilizing American College of Surgeons Trauma Quality Improvement Program data from 2017 to 2021. Individuals aged 18 and older presenting to a trauma center with an open tibial fracture were included. Associations were determined with a hierarchal regression model nesting patients within facilities. RESULTS: Of the 24,102 patients presenting to 491 trauma centers, 66.3 % identified as White, 21.7 % as Black, 1.5 % as Asian, 1.1 % as American Indian, and 10.6 % as Other race. In total, 15.8 % identified as Hispanic. Patients were most often men (75.9 %) and privately insured (47.6 %). The median time to OR was 10.2 h (IQR 4.4-17.7) with 84.6 % receiving surgery within 24 h. In adjusted analyses, Black and American Indian patients had 5.5 % (CI 1.3 %-9.9 %) and 17.8 % (CI 2.2 %-35.8 %) longer wait times, respectively, and a decreased odds of receiving surgery within 24 h (AOR 0.85, CI 0.8-0.9; AOR 0.69, CI 0.5-0.9) when compared to White patients. Female patients had 6.5 % (CI 3.0 %-10.2 %) longer wait times than men. Patients with Medicaid had 5.5 % (CI 1.2 %-9.9 %) longer wait times than those with private insurance. Greater time to OR was associated with increasing age (p < 0.001), increasing injury severity (p < 0.001), and the presence of altered mentation (p < 0.001). CONCLUSION: We identified longer wait times to operative irrigation and debridement of open tibial fractures for Black and American Indian patients, women, and those with Medicaid. The implementation of health equity focused quality metrics may be necessary to achieve equity in trauma care.

Implementation Evaluation of a Parks- and Faith-Based Multilevel Intervention to Promote Physical Activity Among Latinos.

BACKGROUND: Latinos in the United States face multiple barriers to engaging in physical activity (PA). We implemented a faith-based multilevel intervention to promote PA in parks for Latino adults, which was partially adapted to a virtual platform during the COVID-19 pandemic, and evaluated it using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. METHODS: We conducted in-depth semistructured interviews (83% in Spanish) with 24 intervention participants (75% women) participating in a cluster randomized controlled trial in 2019-2022 that linked 6 churches (3 intervention, 3 control) with parks in East Los Angeles, CA. The intervention included in-person, park-based fitness classes, which were adapted to Facebook during the pandemic; PA motivational text messages; and other activities. Interviews assessed Reach (participation), Effectiveness (perceived impacts), Implementation (participation barriers/facilitators), and Maintenance (plans for sustaining PA), as well as perceived pandemic impacts. RESULTS: About 80% of interviewees participated in ≥1 park class and 67% in ≥1 virtual class (Reach). Interviewees perceived positive intervention impacts across multiple health and well-being domains (Effectiveness) despite perceived negative pandemic impacts; several facilitators to participation (personal, social, program) and few barriers (personal, virtual, environmental; Implementation); and plans for maintaining PA (eg, revisiting intervention text messages and video recordings; Maintenance). CONCLUSIONS: Findings support the utility of Reach, Effectiveness, Adoption, Implementation, and Maintenance to understand the broad impacts of a faith-based PA intervention. Findings point to the adaptability and robustness of the intervention during a public health crisis. Overall, findings may help inform the translation of the intervention to other communities to advance health equity.

E kaua e hoki i te waewae tutuki, a, apa ano hei te upoko pakaru - a systematic review of neurosurgical disease and care for Maori in New Zealand.

BACKGROUND: The Royal Australasian College of Surgeons (RACS) Te Rautaki Maori cites the need for more research dedicated to health equity in surgery for Maori. However, the gaps in research for Maori in surgery have not yet been highlighted. This review is the first in a series of reviews named Te Ara Pokanga that seeks to identify these gaps over all nine surgical specialties. The aim of this study was to assess neurosurgical disease incidence and perioperative outcomes for Maori at any point from referral through to the postoperative period. METHODS: A systematic review of Maori neurosurgical disease and care for Maori in NZ was performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement assisted study selection and reporting. Kaupapa Maori (Maori-centred) research methodology and the Maori Framework were utilized to evaluate Maori research responsiveness. RESULTS: Nine studies were included in this review. All studies were retrospective cohort studies and only two studies had at least one Maori clinical or academic expert named on their research team. Therefore, only one study was deemed responsive to Maori. Studies assessing long-term outcomes from the management of neurosurgical disease for Maori and patient and whanau experiences of neurosurgical care are lacking. CONCLUSION: This study indicates the limited scope of research conducted for Maori in neurosurgery. The broader clinical implications of this review highlight the need for good quality research to investigate access to and long-term outcomes from the management of neurosurgical disease for Maori.

Building a healthy generation together: parents' experiences and perceived meanings of a family-based program delivered in ethnically diverse neighborhoods in Sweden.

INTRODUCTION AND AIM: Ethnically diverse neighborhoods encounter pronounced inequalities, including housing segregation and limited access to safe outdoor spaces. Residents of these neighborhoods face challenges related to physical inactivity, including sedentary lifestyles and obesity in adults and children. One approach to tackling health inequalities is through family-based programs tailored specifically to these neighborhoods. This study aimed to investigate parents' experiences and perceptions of the family-based Open Activities, a cost-free and drop-in program offered in ethnically diverse and low socioeconomic neighborhoods in Sweden. METHODS: Researchers' engagement in 15 sessions of the Open Activities family-based program during the spring of 2022, and individual interviews with 12 participants were held. Data were analyzed using reflexive thematic analysis. RESULTS: The analysis resulted in three main themes and seven sub-themes representing different aspects of the program's meaning to the participants as parents, their families, and communities. The main themes describe how parents feel valued by the program, which actively welcomes and accommodates families, regardless of cultural differences within these neighborhoods. The themes also show how cultural norms perceived as barriers to participation in physical activity can be overcome, especially by mothers who express a desire to break these norms and support girls' physical activity. Additionally, the themes highlight the importance of parents fostering safety in the area and creating a positive social network for their children to help them resist criminal gang-related influences. CONCLUSIONS: The program's activities allowed parents to connect with their children and other families in their community, and (re)discover physical activity by promoting a sense of community and safety. Implications for practice include developing culturally sensitive activities that are accessible to and take place in public spaces for ethnically diverse groups, including health coordinators that can facilitate communication between groups. To enhance the impact of this program, it is recommended that the public sector support the creation of cost-free and drop-in activities for families who are difficult to reach in order to increase their participation in physical activity, outreach, and safety initiatives.

Fatherhood and men's participation in antenatal care in rural sub-Saharan Africa: a scoping review protocol.

INTRODUCTION: Men's participation is imperative for improving antenatal care (ANC) access and mother and child health outcomes in sub-Saharan Africa (SSA). Research looking at improving men's participation in ANC often focuses on their instrumental and psychosocial roles and on biomedical ANC systems. There is limited understanding of how context-specific cultural experiences of fatherhood influence men's participation in ANC within broader communal support networks and across different ANC systems in SSA. Against this background, and to understand how local communities in SSA conceive men's participation in ANC, a scoping review will be undertaken to synthesise existing literature around local cultural experiences of fatherhood and men's participation in ANC in rural settings in SSA. METHODS AND ANALYSIS: The classical scoping review methodology developed by Arksey and O'Malley will be used to conduct the scoping review described above. Empirical studies published between 1 January 2000 and 31 August 2024 will be systematically searched for in key online databases (eg, PubMed/MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Library, African Index Medicus, African Journals Online) and grey literature (eg, reports from key organisations like UNICEF and the WHO). Literature reviews, personal opinion articles and theoretical or conceptual articles that do not systematically analyse data, and non-English texts, will be excluded. Data will be extracted from the included texts in the form of study characteristics, which will be analysed using descriptive statistics, and key issues to be analysed thematically. ETHICS AND DISSEMINATION: No ethical approvals are needed for this scoping review since data will be abstracted from already-published literature and no additional data will be collected. The findings will be shared with policymakers, practitioners, researchers, students and local communities through peer-reviewed journal publication(s), conference presentations, public lectures and policy-focused stakeholder and community meetings in and outside SSA.

Association of housing status and cancer diagnosis, care coordination and outcomes in a public hospital: a retrospective cohort study.

OBJECTIVES: Cancer is a leading cause of death in unhoused adults. We sought to examine the association between housing status, stage at diagnosis and all-cause survival following cancer diagnosis at a public hospital. DESIGN: Retrospective cohort study examining new cancer diagnoses between 1 July 2011 and 30 June 2021. SETTING: A public hospital in San Francisco. EXPOSURE: Housing status (housed, formerly unhoused, unhoused) was ascertained via a county-wide integrated dataset that tracks both observed and reported homelessness. METHODS: We reported univariate analyses to investigate differences in demographic and clinical characteristics by housing group. We then constructed Kaplan-Meier curves stratified by housing group to examine unadjusted all-cause mortality. Finally, we used multivariable Cox proportional hazards models to compare the hazard rate of mortality for each housing status group, adjusting for demographic and clinical factors. RESULTS: Our cohort included 5123 patients with new cancer diagnoses, with 4062 (79%) in housed patients, 623 (12%) in formerly unhoused patients and 438 (9%) in unhoused patients. Unhoused and formerly unhoused patients were more commonly diagnosed with stage 4 disease (28% and 27% of the time, respectively, vs 22% of housed patients). After adjusting for demographic and clinical characteristics, unhoused patients with stage 0-3 disease had a 50% increased hazard of death (adjusted HR (aHR) 1.5, 95% CI 1.1 to 1.9; p<0.004) as did formerly unhoused patients (aHR 1.5, 95% CI 1.2 to 1.9; p=0.001) compared with housed individuals 3 months after diagnosis. CONCLUSIONS: Unhoused and formerly unhoused patients diagnosed with non-metastatic cancer had substantially increased hazards of death compared with housed patients cared for in a public hospital setting. Current or former lack of housing could contribute to poor outcomes following cancer diagnoses via multiple mechanisms.

How Can Newborn Toxicology Testing Be More Equitable? An Interactive Ethics Workshop.

Introduction: Practice variation in newborn toxicology testing during the birth hospitalization exists across institutions and legal jurisdictions. While testing can provide benefits, indiscriminate testing has been shown to perpetuate health care inequities. In the backdrop of an opioid epidemic and a charged medicolegal landscape, this workshop guides participants to reexamine newborn toxicology testing through a shared ethical lens. Methods: We conducted a live, 90-minute workshop in English at an international pediatric conference. Physicians, residents, and fellows participated in large- and small-group breakout sessions to learn relevant clinical and bioethical frameworks, share their own local context and expertise, and explore ethical applications through case-based discussions. We administered two anonymous online follow-up surveys to assess self-perceived impact on participant knowledge, behavior, and clinical practice. Results: Seven facilitators and 45 individuals participated in the workshop. Eighteen participants completed survey 1 immediately following workshop conclusion, and six participants completed survey 2 after 3 months had elapsed. Immediately following the workshop, 94% of respondents reported that they had been introduced to a new idea, and 82% were considering practice change. A low response rate to survey 2 limited interpretation, but some respondents reported self-perceived change following workshop attendance. Discussion: This workshop facilitated conversation between physician participants on a complex pediatric health care inequity issue using an ethical framework.