Pathways to retirement in West Germany: Does divorce matter?

The aim of this paper is to explore how divorce is linked to pathways to retirement in West Germany and to understand whether and how patterns are gendered. Using German pension insurance data, I employ sequence and cluster analysis to map and group pathways to retirement of women and men who retired in 2018. Pathways to retirement are defined based on monthly pension insurance histories from age 50 to 65. I find nine distinct pathways to retirement, ranging from unemployment to stable low to high income pathways and to an early retirement pathway through the reduced-earnings-capacity pension, the latter representing 9.3% of the sample. Based on multinomial logistic regression models, I analyse how marital status, distinguishing between divorced and (re)married, was related to different pathways to retirement. The results show that divorced people were more likely than married people to retire through indirect and unstable pathways to retirement characterised by early exit from the labour market and receipt of reduced-earnings-capacity pensions and/or unemployment benefits. Whereas the relationship between divorce and pathways to retirement seemed to be overall unfavourable for men, the results for women are more ambiguous. Divorced women were also more likely to retire through a stable high-income pathway than married women. Nevertheless, the results suggest that divorce is associated with an early retirement pathway through the reduced-earnings-capacity pension for both women and men.

The association of widowhood and living alone with depression among older adults in India.

Widowhood is a catastrophic event at any stage of life for the surviving partner particularly in old age, with serious repercussions on their physical, economic, and emotional well-being. This study investigates the association of marital status and living arrangement with depression among older adults. Additionally, the study aims to evaluate the effects of factors such as socio-economic conditions and other health problems contributing to the risk of depression among older adults in India. This study utilizes data from the nationally representative Longitudinal Ageing Study in India (LASI-2017-18). The effective sample size was 30,639 older adults aged 60 years and above. Descriptive statistics and bivariate analysis have been performed to determine the prevalence of depression. Further, binary logistic regression analysis was conducted to study the association between marital status and living arrangement on depression among older adults in India. Overall, around nine percent of the older adults suffered from depression. 10.3% of the widowed (currently married: 7.8%) and 13.6% of the older adults who were living alone suffered from depression. Further, 8.4% of the respondents who were co-residing with someone were suffering from depression. Widowed older adults were 34% more likely to be depressed than currently married counterparts [AOR: 1.34, CI 1.2-1.49]. Similarly, respondents who lived alone were 16% more likely to be depressed compared to their counterparts [AOR: 1.16; CI 1.02, 1.40]. Older adults who were widowed and living alone were 56% more likely to suffer from depression [AOR: 1.56; CI 1.28, 1.91] in reference to older adults who were currently married and co-residing. The study shows vulnerability of widowed older adults who are living alone and among those who had lack of socio-economic resources and face poor health status. The study can be used to target outreach programs and service delivery for the older adults who are living alone or widowed and suffering from depression.

Marital status differences in suicidality among transgender people.

The suicide rate for transgender people is among the highest of any group in the United States. Yet, we know little about disadvantages or resources available to transgender people to prevent suicide. The overall purpose of this study is to assess how marital status modifies the risk of suicide among transgender people. We analyzed data from the 2015 U.S. Transgender Survey to predict marital status differences in both suicide ideation and suicide attempt in the past year. The analytic sample for suicide ideation included 17,117 transgender respondents (9,182 transwomen and 7,935 transmen), and the analytic sample for suicide attempt was limited to 8,058 transgender respondents (4,342 transwomen and 3,716 transmen) who reported suicide ideation in the last 12 months. Results from binary logistic regression models suggested that never married and previously married transmen and transwomen, regardless of their partnership status, generally had higher risk of both suicide ideation and attempt than their married transgender counterparts with only one exception: never married transwomen had lower risk of suicide ideation (but not attempt) than their married transwomen counterpart after sociodemographic characteristics were accounted for. These findings draw attention to the heterogeneity of the transgender population, highlighting marital status as a key social factor in stratifying the life experiences of transgender people.

The effect of marital and insurance status on the survival of elderly patients with stage M1b colon cancer: a SEER-based study.

BACKGROUND: Colon cancer is largely implicated in elderly patients (age ≥ 60 years). The prognosis of patients diagnosed with the M1b stage is vastly poor. Marital and insurance status has been considered important prognostic factors in various cancer types. However, how these factors influence elderly patients with stage M1b colon cancer remains to be explored. This study aims to uncover the role of marital and insurance status in the survival of elderly patients with stage M1b colon cancer. METHODS: We retrieved data for patients diagnosed with stage M1b colon cancer between 2010 and 2016 from the Surveillance, Epidemiology, and End Results (SEER) database. Our analysis of the clinicopathological features, overall survival (OS), and cancer-specific survival (CSS) was based on the marital and insurance status, respectively. RESULTS: In sum, 5709 stage M1b colon cancer patients with complete information from SEER were enrolled for analysis. The OS and CSS of the Non-married group were poorer compared to that of the Married group. The OS and CSS of the Uninsured group were poorer than both of the Insured group and Medicaid group. However, OS was comparable between Uninsured group and Medicaid groups. The findings allude that marital and insurance status potentially impact the long-term survival of elderly patients with M1b colon cancer. The subgroup survival analyses revealed the lowest risk for death among the Insured Married group based on the comparison of the OS and CSS across all other groups. Moreover, Univariate and multivariate analyses revealed race, marital status, surgery, and chemotherapy as independent predictors for OS, whereas insurance status, surgery,and chemotherapy were independent predictors for CSS in elderly patients with M1b colon cancer. CONCLUSION: The marital and insurance status greatly impact the survival of elderly patients with M1b colon cancer. Therefore, it is imperative to provide more support to this vulnerable patient group who are lonely and uninsured, particularly in the psychological and health insurance aspect.

Cigarette Smoking in an Acute Partial Hospital Program.

ABSTRACT: This study explored demographic and clinical features, plus clinical outcomes, in a smoke-free acute partial hospital (PH) among current smokers, former smokers, and those who had never smoked (nonsmokers). Compared with nonsmokers, current smokers were younger and more likely to be unmarried and unpartnered, unemployed, or receiving disability benefits. They had more prior inpatient (IP) and PH episodes. They also had more problems with interpersonal relationships, mood lability, psychosis, and substance use. Compared with nonsmokers, current smokers were more likely to miss PH treatment days and drop out. They also had longer time to readmission to PH or IP. Former smokers resembled nonsmokers, except that former smokers also had a high rate of dropout. Changes in symptoms and functioning for patients who completed PH were the same among all groups. In an acute PH setting, smoking is a marker for psychiatric and psychosocial impairment plus treatment interruption.

Assessment of Modifiable Factors for the Association of Marital Status With Cancer-Specific Survival.

Importance: Married patients with cancer have better cancer-specific survival than unmarried patients. Increasing the early diagnosis and definitive treatment of cancer among unmarried patients may reduce the survival gap. Objectives: To evaluate the extent to which marriage is associated with cancer-specific survival, stage at diagnosis, and treatment among patients with 9 common solid cancers and to recommend methods for reducing the survival gap. Design, Setting, and Participants: This retrospective, population-based cohort study included patients older than 18 years who were diagnosed with 1 of 9 common cancers between January 1, 2007, and December 31, 2016. Patient data were retrieved from the Surveillance, Epidemiology, and End Results Program. Statistical analyses were performed from August 1 to October 1, 2020. Exposures: Marital status, classified as married and unmarried (including single, separated, divorced, widowed, and unmarried patients or domestic partners). Main Outcomes and Measures: The primary outcome was the time ratio (TR) of cancer-specific survival (married vs unmarried). Mediation analyses were conducted to determine the extent to which the association of marriage with cancer-specific survival was mediated by stage at diagnosis and treatment. Results: This study included 1 733 906 patients (894 379 [51.6%] women; 1 067 726 [61.6%] married; mean [SD] age, 63.76 [12.60] years). Multivariate analyses found that those who were married were associated with better cancer-specific survival than unmarried patients (TR, 1.36; 95% CI, 1.35-1.37). Early diagnosis in breast cancer, colorectal cancer, endometrial cancer, and melanoma mediated the association between marital status and cancer-specific survival (breast cancer: proportion mediated [PM], 11.4%; 95% CI, 11.2%-11.6%; colorectal cancer: PM, 10.9%; 95% CI, 10.7%-11.2%; endometrial cancer: PM, 12.9%; 95% CI, 12.5%-13.3%; melanoma: PM, 12.0%; 95% CI, 11.7-12.4%). Surgery mediated the association between marital status and cancer-specific survival in lung (PM, 52.2%; 95% CI, 51.9%-52.4%), pancreatic (PM, 28.9%; 95% CI, 28.6%-29.3%), and prostate (PM, 39.3%; 95% CI, 39.0%-39.6%) cancers. Chemotherapy mediated the association of marital status with cancer-specific survival in lung (PM, 37.7%; 95% CI, 37.6%-37.9%) and pancreatic (PM, 28.6%; 95% CI, 28.4%-28.9%) cancers. Improved cancer-specific survival associated with marriage was greater among men than women (men: TR, 1.27; 95% CI, 1.25-1.28; women: TR, 1.20; 95% CI, 1.19-1.21). The contribution of receiving an early diagnosis and treatment with surgery or chemotherapy to the association between marital status and cancer-specific survival was greater among men than women (early diagnosis: PM, 21.7% [95% CI, 21.5%-21.9%] vs PM, 20.3% [95% CI, 20.2%-20.4%]; surgery: PM, 26.6% [95% CI, 26.4%-26.7%] vs PM, 11.1% [95% CI, 11.0%-11.2%]; chemotherapy: PM, 6.8% [95% CI, 6.7%-6.8%] vs PM, 5.1% [95% CI, 5.0%-5.2%]). Conclusions and Relevance: In this study, survival disparities associated with marital status were attributable to early diagnosis in breast, colorectal, and endometrial cancers as well as melanoma and to treatment-related variables in lung, pancreatic, and prostate cancers. The findings also suggest that marriage may play a greater protective role in the cancer-specific survival of men than of women.

The socio-economic status of families experiencing the sudden unexpected death of an infant - Is it possibly related to a higher rate of non-natural deaths among them.

Low socio-economic status is recognized as one of the risk factors for SIDS. In this study we have pointed out the similarities between families that have SIDS cases and families in which infant non-accidental injury has been proven, as well as the differences between them and the general population. This study was conducted in Montenegro, comparing 30 cases of SIDS with 25 cases of known infanticides and with a control group (60 cases) consisting of live newborns and their mothers from the general population, randomly selected from hospital-born newborns without exclusion criteria. We combined and compared the infant characteristics and mother characteristics between the above cases. There were significant similarities between the SIDS group and the infanticide group in terms of the following characteristics: the education level of the mothers (p = 0.086); maternal employment (p = 0.278); and place of residence (p = 0.269); while there were differences between the two groups regarding hospital birth (p = 0.027) and marital status (p = 0.011). The SIDS and infanticide groups, combined, had higher incidences of: out-of-hospital deliveries (p < 0.001); uneducated mothers (p < 0.001); unemployed mothers (p < 0.001); low socio-economic status (p < 0.001); and cases outside of marriage (p < 0.001), compared to the control groups. This study indicated a possible higher incidence of non-natural death among SIDS cases, as reflected by low socio-economic status and linked attributes, which is explained by their similarities with the infanticide groups and differences with the control groups.

Births: Final Data for 2019.

Objectives-This report presents 2019 data on U.S. births according to a wide variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. Methods-Descriptive tabulations of data reported on the birth certificates of the 3.75 million births that occurred in 2019 are presented. Data are presented for maternal age, livebirth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age are also shown. Trend data for 2010 through 2019 are presented for selected items. Trend data by race and Hispanic origin are shown for 2016-2019. Results-A total of 3,747,540 births were registered in the United States in 2019, down 1% from 2018. The general fertility rate declined from 2018 to 58.3 births per 1,000 women aged 15-44 in 2019. The birth rate for females aged 15-19 fell 4% between 2018 and 2019. Birth rates declined for women aged 20-34 and increased for women aged 35-44 for 2018-2019. The total fertility rate declined to 1,706.0 births per 1,000 women in 2019. Birth rates declined for both married and unmarried women from 2018 to 2019. The percentage of women who began prenatal care in the first trimester of pregnancy rose to 77.6% in 2019; the percentage of all women who smoked during pregnancy declined to 6.0%. The cesarean delivery rate decreased to 31.7% in 2019 (Figure 1). Medicaid was the source of payment for 42.1% of all births in 2019. The preterm birth rate rose for the fifth straight year to 10.23% in 2019; the rate of low birthweight was essentially unchanged from 2018 at 8.31%. Twin and triplet and higher-order multiple birth rates both declined in 2019 compared with 2018.

The Impact of Socioeconomic Risk Factors on the Survival Outcomes of Patients With Newly Diagnosed Multiple Myeloma: A Cross-analysis of a Population-based Registry and a Tertiary Care Center.

BACKGROUND: Multiple myeloma (MM) is a heterogeneous clonal plasma cell disorder leading to differences in clinical outcomes such as overall survival (OS) among patients. We hypothesized that with expensive, novel therapeutic agents and paradigm shifts to maintain continuous therapy and improvement in OS, patients with MM are subject to the pressures of financial toxicity and the need for social support, which may be of prognostic importance. MATERIALS AND METHODS: In this study, we examined the records of 122,458 patients from the National Cancer Database (NCDB) to determine the significance of socioeconomic factors such as estimated annual household income and education level, which were based on the patient's ZIP Code and the United States Census Bureau's 5-year report from 2008 to 2012. These socioeconomic factors, in addition to marital status, were then assessed individually and as a cumulative socioeconomic score for prognostic significance in a cohort of 2543 patients treated at a tertiary care center utilizing known biologic risk factors, such as cytogenetic risk, International Staging System classification, and serum lactate dehydrogenase levels. RESULTS: Only marital status and estimated annual household income at diagnosis negatively impacted OS in a univariate analysis, but not in the context of a multivariable analysis incorporating known biologic risk factors. CONCLUSION: Future analyses in other academic and non-academic centers located in urban and rural regions are required to understand the socioeconomic drivers of OS disparity among patients with MM observed nationally.

The interplay of sleep duration, working hours, and obesity in Korean male workers: The 2010-2015 Korea National Health and Nutrition Examination Survey.

The purpose of this study was to clarify the odds ratio for association between working hours and obesity in Korean male wage workers and investigate the role of sleep duration. This study is a cross-sectional one using large-scale national data from the Korea National Health and Nutrition Examination Survey collected between 2010 and 2015 to evaluate 2,592 male wage workers (between the ages of 19 and 60 years). Obesity was defined as 25kg/m2 or more and working hours per week were categorized into <40, 40-49, 50-59, and ≥60 hours. Multiple regression analysis was performed to examine the odds ratio for association between working hours and obesity, after controlling for age, education, income, marital status, smoking, drinking, physical activity, daily energy intake, sleep duration, hypertension, diabetes, dyslipidemia, work schedule, and job category. Next, to study the mediating effect of sleep duration on the association between working hours and obesity, an analysis was performed using the Baron and Kenny method and the Sobel test. Results showed that workers with 50 to 59 hours had 1.4 times higher odds (odds ratio [OR] = 1.4, confidence interval [CI]: 1.11-1.85) of obesity and workers with 60 hours or more had 1.4 times higher odds (OR = 1.4, CI: 1.06-1.90) of obesity than workers with less than 40 hours. Sleep was found to have a mediating effect on the association between working time and body mass index. Therefore, the results of this analysis suggest that practitioners should identify potential factors such as working time and sleeping time when preventing work-related obesity.

EGFR mutation testing and TKI treatment patterns among veterans with stage III and IV non-small cell lung cancer.

BACKGROUND: Epidermal growth factor receptor (EGFR) mutation testing is recommended in metastatic non-small cell lung cancer (NSCLC). The objective of this study was to assess changes in EGFR mutation testing patterns and tyrosine kinase inhibitor (TKI) use in US veterans with stage III-IV NSCLC between 2013 and 2017. PATIENTS AND METHODS: Retrospective study using linked data from Department of Veterans Affairs (VA) Cancer Registry System, Corporate Data Warehouse, commercial laboratories, and clinical notes. Generalized linear mixed models accounting for clustering by VA facility were used to determine factors associated with EGFR mutation testing. RESULTS: From 2013 to 2017, EGFR mutation testing increased from 29.5% to 38.4% among veterans with stage III-IV NSCLC and from 47.0% to 57.4% among veterans with stage IV non-squamous disease. Factors associated with increased odds of testing included being married, Medicare enrollment, and adenocarcinoma histology. Factors associated with decreased odds of testing included Medicaid eligibility, stage III disease, increasing age, being a current or former smoker, increasing Charlson-Deyo comorbidity score, and receiving cancer care in the South. Appropriate use of a TKI rose from 2013 to 2017 (17.2% to 74.1%). CONCLUSION: EGFR mutation testing rates increased to almost 60% in the stage IV non-squamous NSCLC population in 2017, with residual opportunity for further increase. Several sociodemographic characteristics, comorbidities, and geographic regions were associated with EGFR mutation testing suggestive of inequitable testing decisions. Appropriate use of TKI improved drastically from 2013 to 2017 demonstrating rapidly changing practice patterns through the adoption phase of new treatment options.

Involuntary Childlessness and Marital Infidelity Among Women in Sub-Saharan African Countries: An Assessment of the Moderating Role of Women's Education.

A considerable number of married women in sub-Saharan African countries are childless and may be likely to engage in marital infidelity to avoid social stigma, economic insecurities, and other debilitating experience associated with being involuntarily childless. This study sought to investigate the relationship between involuntary childlessness and marital infidelity and how it may be moderated by women's educational attainment. Data were obtained from 23,847 women in their first union for at least 2 years and participated in the demographic and health surveys of five sub-Saharan African countries comprising Cameroon, Gabon, Lesotho, Liberia, and Sierra Leone. Data were analyzed using multivariate logistic regression, adjusted for socioeconomic, union, and partner characteristics. Involuntarily childless women in Cameroon (AOR: 2.34, 95% CI 1.62-3.39) and Sierra Leone (AOR: 2.22, 95% CI 1.42-3.49) were about two times more likely to engage in marital infidelity compared to non-childless married women. In Gabon, Lesotho, and Liberia, the odds of marital infidelity did not significantly differ between involuntarily childless and non-childless married women. Although involuntarily childless women with secondary or higher education reported higher levels of marital infidelity than non-childless women with a similar level of education, we found no statistical evidence in all the countries that the relationship between involuntary childlessness and marital infidelity was moderated by women's educational attainment. These findings suggest that involuntary childlessness is a critical factor potentially related to marital infidelity and may be an important target for intervention and prevention, particularly in settings with high levels of sexually transmitted infections.

Predictive Model and Online Calculator for Discharge Disposition in Brain Tumor Patients.

BACKGROUND: In the era of value-based payment models, it is imperative for neurosurgeons to eliminate inefficiencies and provide high-quality care. Discharge disposition is a relevant consideration with clinical and economic ramifications in brain tumor patients. We developed a predictive model and online calculator for postoperative non-home discharge disposition in brain tumor patients that can be incorporated into preoperative workflows. METHODS: We reviewed all brain tumor patients at our institution from 2017 to 2019. A predictive model of discharge disposition containing preoperatively available variables was developed using stepwise multivariable logistic regression. Model performance was assessed using receiver operating characteristic curves and calibration curves. Internal validation was performed using bootstrapping with 2000 samples. RESULTS: Our cohort included 2335 patients who underwent 2586 surgeries with a 16% non-home discharge rate. Significant predictors of non-home discharge were age >60 years (odds ratio [OR], 2.02), African American (OR, 1.73) or Asian (OR, 2.05) race, unmarried status (OR, 1.48), Medicaid insurance (OR, 1.90), admission from another health care facility (OR, 2.30), higher 5-factor modified frailty index (OR, 1.61 for 5-factor modified frailty index ≥2), and lower Karnofsky Performance Status (increasing OR with each 10-point decrease in Karnofsky Performance Status). The model was well calibrated and had excellent discrimination (optimism-corrected C-statistic, 0.82). An open-access calculator was deployed (https://neurooncsurgery.shinyapps.io/discharge_calc/). CONCLUSIONS: A strongly performing predictive model and online calculator for non-home discharge disposition in brain tumor patients was developed. With further validation, this tool may facilitate more efficient discharge planning, with consequent improvements in quality and value of care for brain tumor patients.

The Association Between Race and 5-year Survival in Patients With Clear Cell Renal Cell Carcinoma: A Cohort Study.

OBJECTIVE: To determine if race was associated with 5-year cause-specific survival in patients with clear cell renal cell carcinoma. MATERIALS AND METHODS: Outcomes were investigated using the Surveillance Epidemiology and End Results database with data from 13 states between the years 2007-2015. Covariates included age, sex, insurance, marital status, and tumor stage at diagnosis. Patients <18 years old or with missing data for race, survival time or insurance status were excluded. Cox regression models were used to determine associations through hazard ratios (HR) with 95% confidence intervals (CI) and to adjust for covariates. RESULTS: A total of 8421 subjects were included in the analysis. After adjustment, there was no association between race and 5-year cause-specific survival in patients with ccRCC (Black- HR: 0.96, 95%CI: 0.83,1.12; American Indian/Alaskan- HR: 1.01, 95%CI: 0.75,1.36; Asian Pacific Islander- HR: 0.99, 95%CI: 0.82,1.12). Older individuals and those with regional or distant tumors showed an increased hazard of death, while females and insured patients showed decreased hazard. CONCLUSION: Our study found that race was not associated with 5-year cause-specific survival from clear cell renal cell carcinoma. However inferior overall survival in Blacks with RCC has been well demonstrated in the literature. Our findings suggest that differences in survival may not be driven by cause-specific factors such as renal cell carcinoma, but rather social determinants of health which disproportionality affect Black patients. Further studies with more power that incorporate information on income, comorbidities, education status, and access to care are therefore necessary.

Association Between Parental Marital Status and Types of Suicidal Behavior Among Korean Adolescents: A Cross-sectional Study.

OBJECTIVES: Adolescent suicide is a global problem. This study aimed to identify associations between parental marital status and suicidal behavior. METHODS: This study analyzed 118 715 middle and high school students from the 13th and 14th Korea Youth Risk Behavior Web-based Survey. The odds ratios (ORs) of suicidal ideation, planning, and attempts were calculated based on parental marital status, living situation, and socioeconomic factors. The data were analyzed using multiple logistic regression. RESULTS: When compared to those living with 2 married biological parents, the ORs of suicidal ideation among adolescents living with either remarried or no parents were 1.34 (95% confidence interval [CI], 1.17 to 1.53) and 1.36 (95% CI, 1.11 to 1.66), respectively. For suicidal planning, the OR of those living with 1 remarried biological parent was 1.24 (95% CI, 1.01 to 1.52), and that of those living without parents was 1.28 (95% CI, 0.95 to 1.73), when compared to adolescents living with 2 married biological parents. For suicide attempts, when compared to adolescents with 2 married biological parents, the OR of those living with 1 remarried biological parent was 1.48 (95% CI, 1.17 to 1.87) and that of those living without parents was 2.02 (95% CI, 1.44 to 2.83). For adolescents living with 1 remarried biological parent, suicidal behavior was strongly associated with having no siblings and were weakly associated with not living with grandparents. CONCLUSIONS: Suicidal behavior among adolescents was associated with the remarriage and loss of parents. Therefore, special attention and interventions are needed for adolescents in those situations.

Determinants of unintended pregnancies among currently married women in Uganda.

BACKGROUND: Unintended pregnancies are no longer bound to teenagers or school-going children, married women in Uganda, as well do experience such pregnancies though little has been investigated on them. This study examines the determinants of unintended pregnancies among currently married women in Uganda. METHODS: In this study, we used data from the 2016 Uganda Demographic and Health Survey (UDHS) which comprised of 10,958 married women aged 15-49 years who have ever been pregnant. The analysis was done using descriptive analysis, logistic regression, and the generalized structural equation model. RESULTS: The study showed that 37% of pregnancies among married women were unintended. Young women, living in poor households, staying in rural areas, women in the Eastern and Northern region, Muslim women, lack of knowledge on ovulation period, discontinuation of contraceptives, non-use of and intention for contraceptives, high age at sexual debut, high age at first birth, and high parity were directly associated with a higher risk of unintended pregnancies. Relatedly, discontinuation of contraceptives regardless of the place of residence, region, woman's age, education, household wealth, access to family planning messages were associated with higher odds of unintended pregnancies. Older women and those in rural areas who had more children were also at a higher risk of similar pregnancies. However, having more children while using contraceptives, being educated, living in a wealthier household, and having access to family planning messages significantly lowered the risk of unintended pregnancies. CONCLUSION: Increased access to family planning messages, empowering women as well as having improved household incomes are key preventive measures of unintended pregnancies. There is a need to provide quality contraceptive counseling through outreaches so that women are informed about the different contraceptive methods and the possible side effects. Having a variety of contraceptive methods to choose from and making them accessible and affordable will also encourage women to make informed choices and reduce contraceptive discontinuation. All these coupled together will help women have their desired family sizes, increase the uptake of contraceptives and significantly reduce unintended pregnancies.

Socioeconomic and marital status among liver cirrhosis patients and associations with mortality: a population-based cohort study in Sweden.

BACKGROUND: The importance of socioeconomic status for survival in cirrhosis patients is more or less pronounced within different populations, most likely due to cultural and regional differences combined with dissimilarities in healthcare system organisation and accessibility. Our aim was to study the survival of patients with cirrhosis in a population-based Swedish cohort, using available data on marital status, employment status, and occupational skill level. METHODS: We conducted a retrospective cohort study of 582 patients diagnosed with cirrhosis in the Region of Halland (total population 310,000) between 2011 and 2018. Medical and histopathologic data, obtained from registries, were reviewed. Cox regression models were used to estimate associations between survival and marital status (married, never married, previously married), employment status (employed, pensioner, disability retired, unemployed), and occupational skill level (low-skilled: level I; medium-skilled: level II; medium-high skilled: level III; professionals: level IV); adjusting for sex, age, aetiology, Model for End-stage Liver Disease (MELD) score, Child-Pugh class, and comorbidities. RESULTS: Alcohol was the most common aetiology (51%). Most patients were male (63%) and the median age was 66 years. Occupational skill level was associated with the severity of cirrhosis at diagnosis and the prevalence of Child-Pugh C gradually increased from professionals through low-skilled. The mean survival for professionals (6.39 years, 95% CI 5.54-7.23) was higher than for low-skilled (3.00 years, 95% CI 2.33-3.67) and medium-skilled (4.04 years, 95% CI 3.64-4.45). The calculated hazard ratios in the multivariate analysis were higher for low-skilled (3.43, 95% CI 1.89-6.23) and medium-skilled (2.48, 95% CI 1.48-4.12), compared to professionals. When aggregated, low- and medium-skilled groups also had poorer mean survival (3.79 years, 95% CI 3.44-4.14; vs 5.64 years, 95% CI 5.00-6.28) and higher hazard ratios (1.85, 95% CI 1.32-2.61) compared to the aggregated medium-high skilled and professional groups. Marital and employment status were not statistically significant predictors of mortality in the multivariate analysis. CONCLUSIONS: Occupational skill level was strongly associated with mean survival and mortality risk. Poorer prognosis among patients with low and medium occupational skill level could not be explained by differences in sex, age, marital status, employment status, MELD score, Child-Pugh class, or comorbidity.

Predicting the 10-year risk of death from other causes in men with localized prostate cancer using patient-reported factors: Development of a tool.

OBJECTIVE: To develop a tool for estimating the 10-year risk of death from other causes in men with localized prostate cancer. SUBJECTS AND METHODS: We identified 2,425 patients from the Surveillance Epidemiology and End Results-Medicare Health Outcomes Survey database, age <80, newly diagnosed with clinical stage T1-T3a prostate cancer from 1/1/1998-12/31/2009, with follow-up through 2/28/2013. We developed a Fine and Gray competing-risks model for 10-year other cause mortality considering age, patient-reported comorbid medical conditions, component scores and items of the SF-36 Health Survey, activities of daily living, and sociodemographic characteristics. Model discrimination and calibration were compared to predictions from Social Security life table mortality risk estimates. RESULTS: Over a median follow-up of 7.7 years, 76 men died of prostate-specific causes and 465 died of other causes. The strongest predictors of 10-year other cause mortality risk included increasing age at diagnosis, higher approximated Charlson Comorbidity Index score, worse patient-reported general health (fair or poor vs. excellent-good), smoking at diagnosis, and marital status (all other vs. married) (all p<0.05). Model discrimination improved over Social Security life tables (c-index of 0.70 vs. 0.59, respectively). Predictions were more accurate than predictions from the Social Security life tables, which overestimated risk in our population. CONCLUSIONS: We provide a tool for estimating the 10-year risk of dying from other causes when making decisions about treating prostate cancer using pre-treatment patient-reported characteristics.

Willingness to engage in and current status of social participation among Chinese merchant sailors.

China has the largest population of sailors in the world, but little is known of their social participation. This study examined Chinese merchant sailors' social participation using a nationwide survey. Across 12 Chinese provinces, 7,296 merchant sailors completed the questionnaire on sailor' willingness to engage in and status of social participation. The results showed that most Chinese merchant sailors were willing to participate in social affairs, but few of them reported having joined relevant social organizations, over half of sailors reported never having participated in public affairs, and half of them chose to ignore when they faced with an obvious mistake in shipping-related information in the media. Most of sailors reported unknowing the role of the labor union related to Chinese seafarers and NGO related to navigation well, and their evaluation of these organizations were mostly negative. Chinese merchant sailors reported higher expectations of services in terms of protection of rights, providing information and technology, and providing employment opportunity. We conclude that Chinese merchant sailors have willingness to social participation although the reality is not positive and discuss implications for improving the social participation of Chinese merchant sailors.