Maternal and foetal risks associated with teenage pregnancy - a comparative retrospective study in Turkey.

BACKGROUND: Adolescent pregnancy is defined as pregnancy occurring in young women between the ages of 10 and 19 years. Adolescent pregnancies, which are among the social healthcare concerns in developed and developing countries, have negative effects on maternal and infant health. Pregnancy in adolescence puts the health of both the mother and child at risk, as adolescent pregnancies have higher rates of eclampsia, systemic infection, low birth weight, and preterm delivery compared to other pregnancies. In this study, the effects of education level, smoking, and marital status on maternal and foetal outcomes in adolescent pregnancies were evaluated. METHODS: The records of a total of 960 pregnant women (480 pregnant adolescents aged 15-19 years and 480 pregnant adult women aged 20-26 years) were examined retrospectively. The demographic data of the groups and maternal and foetal outcomes of the pregnancies were compared. A logistic regression model was established as a statistical method for reducing confounding effects. RESULTS: Unmarried women were statistically significantly more prevalent in the adolescent group (38.3% vs. 7.3%). Among the considered risk factors, preeclampsia (2.9% vs. 0.8%) and smoking (29.8% vs. 9.8%) were statistically significantly more common in the adolescent group. When the groups were compared in terms of risk factors in pregnancy, it was found that pregnancy in adolescence was associated with a 3.04-fold higher risk of smoking, 5.25-fold higher risk of being unmarried, 3.50-fold higher risk of preeclampsia, and 1.70-fold higher risk of intrauterine growth retardation (IUGR). CONCLUSIONS: This study demonstrates an increased risk of preeclampsia, IUGR, and smoking during pregnancy in adolescent pregnant women. These findings can be used to identify adolescent pregnancies requiring specific assistance and to take measures to reduce the probability of adverse outcomes.

In this study, we examine the risks of adolescent pregnancies. Adolescent pregnancy is a public health problem, and it is more common in underdeveloped or developing countries. We believe that non-governmental organisations and governments should take precautions regarding adolescent pregnancies and protect this legally vulnerable sociodemographic group from pregnancy. For healthier and more conscientious pregnancy experiences, mothers must be of appropriate age, having passed the period of adolescence. Adolescent pregnancies, which come with many risks, and especially risks of preeclampsia, premature birth, and maternal death, should be minimised or prevented.

[Factors influencing cognitive function among the older adults in Beijing].

OBJECTIVE: To explore the current status of cognitive function of the older adults in Beijing, and to analyze the factors affecting their cognitive function. METHODS: It was a cross-sectional study. A questionnaire survy was conducted in 2023 among the older adults in Beijing. The cognitive function of the older adults was assessed with the Hong Kong brief cognitive test (HKBC) scale, a simple cognitive assessment tool. Using SPSS 27.0 to perform the descriptive analysis and multiple linear regression analysis of factors, which affect cognitive function among the older adults. RESULTS: Totally 349 older adults were recruited, with the highest percentage of respondents aged 60-69 years (41.3%), of whom 58.7% were female, 88.0% of the respondents had a junior high school or above education level. Most of the older adults (68.8%) worked 35-48 h/week before they retired, and 14.0% of the older adults had a family history of dementia. After controlling age and gender, the linear regression analysis showed that marital status married (ß=0.501, 95%CI: 0.144-0.859) and 3-4 times physical activity per week (ß=0.617, 95%CI: 0.087-1.148) were protective factors of cognitive function in the older adults, and depressive symptoms were a risk factor (ß= -0.723, 95%CI: -1.198 to -0.247) of cognitive function for the older adults. CONCLUSION: In this study, the factors influencing cognitive function among the older adults was analyzed based on a life-cycle perspective. Lack of physical activity and depressive symptoms were risk factors for cognitive function among the older adults. It was suggested that strengthening physical activity, improving mental health of the older adults, as well as conducting preventive intervention in early stages of the life-cycle will be benefit for preventing and slowing cognitive decline in the older adults.

Psychosocial predictors of health behavior adherence in heart-failure patients with comorbid depression: a secondary analysis of the Hopeful Heart trial.

BACKGROUND: Depression affects 20-30% of individuals with heart failure (HF), and it is associated with worse health outcomes independent of disease severity. One potential explanation is the adverse impact of depression on HF patients' adherence to the health behaviors needed to self-manage their condition. The aim of this study is to identify characteristics associated with lower adherence in this population, which could help to recognize individuals at higher risk and eventually tailor health behavior interventions to their needs. METHODS: Using data from a randomized, controlled, collaborative care treatment trial in 629 patients with HF and comorbid depression, we performed mixed effects logistic regression analyses to examine the cross-sectional and prospective relationships between medical and psychosocial variables and health behavior adherence, including adherence to medications, a low-sodium diet, and physician appointments. RESULTS: In cross-sectional analyses, married marital status and higher physical health-related quality of life (HRQoL) were associated with greater overall adherence (compared to married, single Odds Ratio [OR] = 0.46, 95% Confidence Interval [CI] = 0.26-0.80; other OR = 0.60, CI = 0.38-0.94; p = .012. Physical HRQoL OR = 1.02, CI = 1.00-1.04, p = .047). Prospectively, greater levels of social support were associated with improved overall adherence one year later (OR = 1.04, 95% CI = 1.00-1.08, p = .037). Social support, HF symptom severity, race and ethnicity, and age were predictors of specific types of adherence. Neither depression nor optimism was significantly associated with adherence outcomes. CONCLUSIONS: These results provide important preliminary information about risk factors for poor adherence in patients with both HF and depression, which could, in turn, contribute to the development of interventions to promote adherence in this high-risk population. TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT02044211 ; registered 1/21/2014.

[Progress in research of relationship between marital status and cancer].

In recent 30 years, the global burden of cancer has become more serious, and one of social problem is population aging, plus declining birth rate, declining marriage rate and increasing divorce rate. Marriage is one of the most intimate and long-term social relations, and previous research had piecemeal reports of its impact on cancer morbidity and mortality without systematic review of evidence in high-quality population based epidemiological research. This paper summarizes the progress in research of the relationship between marital status and cancer to provide reference for future research and cancer prevention and control.

Emergency department involvement in the diagnosis of cancer among older adults: a SEER-Medicare study.

BACKGROUND: Internationally, 20% to 50% of cancer is diagnosed through emergency presentation, which is associated with lower survival, poor patient experience, and socioeconomic disparities, but population-based evidence about emergency diagnosis in the United States is limited. We estimated emergency department (ED) involvement in the diagnosis of cancer in a nationally representative population of older US adults, and its association with sociodemographic, clinical, and tumor characteristics. METHODS: We analyzed Surveillance, Epidemiology, and End Results Program-Medicare data for Medicare beneficiaries (≥66 years old) with a diagnosis of female breast, colorectal, lung, and prostate cancers (2008-2017), defining their earliest cancer-related claim as their index date, and patients who visited the ED 0 to 30 days before their index date to have "ED involvement" in their diagnosis, with stratification as 0 to 7 or 8 to 30 days. We estimated covariate-adjusted associations of patient age, sex, race and ethnicity, marital status, comorbidity score, tumor stage, year of diagnosis, rurality, and census-tract poverty with ED involvement using modified Poisson regression. RESULTS: Among 614 748 patients, 23% had ED involvement, with 18% visiting the ED in the 0 to 7 days before their index date. This rate varied greatly by tumor site, with breast cancer at 8%, colorectal cancer at 39%, lung cancer at 40%, and prostate cancer at 7%. In adjusted models, older age, female sex, non-Hispanic Black and Native Hawaiian or Other Pacific Islander race, being unmarried, recent year of diagnosis, later-stage disease, comorbidities, and poverty were associated with ED involvement. CONCLUSIONS: The ED may be involved in the initial identification of cancer for 1 in 5 patients. Earlier, system-level identification of cancer in non-ED settings should be prioritized, especially among underserved populations.

Unmarried Status Effect on Stage at Presentation and Treatment Patterns in Non-Metastatic Upper Tract Urothelial Carcinoma Patients.

BACKGROUND: Unmarried status has been associated with higher proportions of locally advanced stage and lower treatment dose intensification rates in several urological and non-urological malignancies. However, no previous investigators focused on the association between unmarried status and advanced stage (T3-4N0-2) at presentation and lower nephroureterectomy (RNU) and systemic therapy (ST) rates in non-metastatic upper tract urothelial carcinoma (UTUC) patients. METHODS: Using the Surveillance, Epidemiology, and End Results (SEER) database 2000-2020, all non-metastatic UTUC patients were identified. Multivariable logistic regression models (LRMs) tested for differences in stage at presentation and treatment (RNU and ST) according to marital status (married vs unmarried), in a sex-specific fashion. RESULTS: Of all 8544 non-metastatic UTUC patients, 4748 (56%) were male vs 3190 (44%) were female. Of all 4748 male UTUC patients, 1191 (25%) were unmarried. Of all 3190 female UTUC patients, 1608 (50%) were unmarried. In multivariable LRMs predicting RNU, unmarried status was an independent predictor of lower RNU rates in male (Odds Ratio [OR]: 0.56; P < .001), but not in female (OR: 0.81; P = .1) non-metastatic UTUC patients. In multivariable LRMs predicting ST exposure, unmarried status was an independent predictor of lower ST rates in both male (OR:0.73; P = .03) and female (OR:0.64; P < .001) UTUC patients. In multivariable LRMs predicting locally advanced stage (T3-4N0-2), unmarried status was not associated with an increased risk of locally advanced stage at presentation in either male (OR: 0.95; P = .5) or female (OR: 0.99; P = .9) UTUC patients. CONCLUSIONS: Unmarried male UTUC patients appear at risk of less being able to access RNU, relative to their married counterparts. Moreover, unmarried UTUC patients appear to less benefit from ST, regardless of sex. Conversely, unmarried status was not associated with an increased risk of locally advanced stage at presentation in either male or female UTUC patients.

Genetic propensity to depression and the role of partnership status.

Social relationships and genetic propensity are known to affect depression risk, but their joint effects are poorly understood. This study examined the association of a polygenic index for depression with time to antidepressant (AD) purchasing and the moderating role of partnership status. We analysed data from 30,192 Finnish individuals who participated in the FINRISK and Health 2000 and 2011 surveys and had register and medication data available. We measured genetic risk with a polygenic index (PGI) for depression. Depression was assessed through antidepressant purchases. We estimated an accelerated failure time model with partnership status as time-varying and different sets of confounder adjustments. The predicted cumulative hazard of antidepressant purchasing varied across PGI and partnership status. At follow-up year 10, being widowed was associated with the largest cumulative hazard of 0.34 (95%CI: 0.28-0.39) in the 80th and 0.20 (95%CI: 0.17-0.23) in the 20th PGI percentile, followed by divorced, single, married and cohabiting. Cohabiting was associated with a cumulative hazard of 0.19 (95%CI: 0.16-0.23) in the 80th and 0.11 (95%CI: 0.1-0.13) in the 20th PGI percentile. We found no evidence for an interaction between the PGI and partnership status. Results were robust to different model specifications, gender stratification, and the choice of PGI. Although antidepressant purchasing correlated with both PGI and partnership status, we found no evidence that partnership status could partially offset or amplify the association between the PGI for depression and antidepressant purchasing incidence.

Loneliness predicts decreased physical activity in widowed but not married or unmarried individuals.

Background: Physical activity is associated with improved health and function in older adults, yet most older adults are sedentary. Loneliness is associated with decreased physical activity at the cross-section, but longitudinal studies are scarce. We examined longitudinal associations between loneliness and physical activity-and whether they were modified by marital status and network size (the number of children, relatives, and friends a person interacts with at least once a month). Methods: We analyzed data from 1,931 older adults without dementia at baseline from the Rush Memory and Aging Project with a mean follow-up of 4.8 years (mean age 79.6 ± 7.7, 74.9% women). Loneliness was assessed using the de Jong Gierveld Loneliness Scale. Physical activity was assessed as the frequency with which participants engaged in five categories of activities (e.g., walking, gardening, calisthenics, bicycling, and swimming). Linear mixed effects models examined associations between baseline loneliness and change in physical activity over time after adjusting for demographics, depressive symptoms, global cognition, disability, network size, marital status, social support, and social and cognitive activities. We assessed for effect modification by marital status and network size. Results: Associations between loneliness and physical activity differed by marital status. In widowed individuals, baseline loneliness was associated with a 0.06 h/week greater decrease in physical activity per year compared to those who were not lonely (p = 0.005, CI -0.1, 0.02)-which equaled a 150% decrease in physical activity per year. Loneliness did not predict a statistically significant decrease in physical activity in married or unmarried individuals. Discussion: Loneliness is associated with decreased physical activity in widowed older adults and should be considered in the design of interventions to prevent or slow the decline in physical activity and promote healthy aging.

The characteristics and risk factors of breast cancer patients trend distinctive regional differences: a cross-sectional study.

OBJECTIVE: To determine the characteristics and risk factors of breast cancer patients in a tertiary care setting. METHODS: The retrospective, cross-sectional study was conducted at the Sindh Institute of Urology and Transplantation, Karachi, and comprised data of all patients diagnosed with breast cancer from March 2017 to December 2021. Demographic characteristics, clinical presentation, stage of the disease and histopathological characteristics were noted. Data related to all the variables was not available in all cases. Data was analysed using SPSS 23. RESULTS: Of the 690 patients, 683(99%) were females and 7(1%) were males. The mean age at presentation was 49.3±13.5 years, while the mean duration of symptoms was 10.24±17.64) months. Most of the females were married 642(93%) and multiparous 484(70.9%), while 293(42.5%) had breastfed their children for >1 year, and 412(59.7%) had no history of contraception use. The most common stage at presentation was stage II (48.6%), and most patients had grade II 395(57.2%) invasive ductal carcinoma, with Luminal A molecular subtype noted in 287(41.6%) cases. CONCLUSIONS: The characteristics of breast cancer in the sample had certain distinctions compared to other populations. It is important to integrate all datasets and develop guidelines appropriate to Pakistani population.

Quality of life and its related-influencing factors in patients with cervical cancer based on the scale QLICP-CE(V2.0).

BACKGROUND: Quality of life research can guide clinical workers to adopt more targeted treatment and intervention measures, so as to achieve the purpose of improving patients' quality of life. The objective of this study was to evaluate health-related quality of life in Chinese patients with cervical cancer and to explore its influencing factors. METHODS: A total of 186 patients with cervical cancer were investigated by using the QLICP-CE (V2.0) scale (Quality of Life Instruments for Cancer Patients-Cervical Cancer) developed by our group in China. The data were analyzed by t-test, one-way ANOVA, univariate analysis, and multivariate linear regression. RESULTS: The total score of quality of life scale for cervical cancer patients was (62.58 ± 12.69), Univariate analysis of objective clinical indexes showed that creatinine concentration was a negative influence factor in the psychological domain, potassium ion concentration was a negative influence factor in the common symptoms and side effect domain, erythrocyte content was a positive influence factor physical domain and common general domain. Multiple linear regression results suggested that clinical staging was the influencing factor of common symptom and side effect domain, common general module and total score of scale. Marital status has different degrees of influence on the psychological, social, and common general domains. The level of education also influenced scores in the social domain. CONCLUSION: The total score of quality of life in patients with cervical cancer who received active treatment was acceptable. Marital status, clinical staging, and educational level are the factors that affect the quality of life of patients with cervical cancer. At the same time, potassium ion concentration, red blood cell count and creatinine concentration also have important effects on quality of life in patients with cervical cancer. Therefore, it is very important to give personalized treatment and nursing to patients based on various factors.

Experiential Narratives of Factors Limiting and Boosting Access to Support Services for Women with Obstetric Fistula in Southeast Nigeria.

PURPOSE: Obstetric fistula is a chronic health condition that leaves affected women battered and traumatized, thereby exposing them to social recluse life as a result of associated discomfort and odor. Support services to those with challenging health conditions are reputed to help cushion the adverse effects on them; thus women with fistula and other chronic diseases receiving adequate support will help them to cope and recuperate from such illnesses. This study explores the factors limiting and boosting access to support services for those with obstetric fistulainNigeria. MATERIALS AND METHOD: Focus Group Discussions and In-depth Interviews were employed to obtain data from 44 participants. The thematic data analysis method was deployed in analyzing the data collected. RESULTS: Factors like the limited number of fistula specialist doctors, poor funding, withdrawal from seeking help, long distance, and discrimination limit patients' access to support services and adequate fistula care. The study highlighted that community involvement in fistula care, adequate funding, training, and retraining of professionals will boost support services for fistula patients. CONCLUSION: The study recommends the adoption of a multidisciplinary approach in the management of obstetric fistula patients including the involvement of not only medical personnel but also social workers, families, groups, and community leaders.

The effect of married status on cancer-specific mortality in nonmetastatic pelvic liposarcoma patients according to sex.

BACKGROUND: In nonmetastatic pelvic liposarcoma patients, it is unknown whether married status is associated with better cancer-control outcome defined as cancer-specific mortality (CSM). We addressed this knowledge gap and hypothesized that married status is associated with lower CSM rates in both male and female patients. METHODS: Within the Surveillance, Epidemiology, and End Results database (2000-2020), nonmetastatic pelvic liposarcoma patients were identified. Kaplan-Meier plots and univariable and multivariable Cox regression models (CRMs) predicting CSM according to marital status were used in the overall cohort and in male and female subgroups. RESULTS: Of 1078 liposarcoma patients, 764 (71%) were male and 314 (29%) female. Of 764 male patients, 542 (71%) were married. Conversely, of 314 female patients, 192 (61%) were married. In the overall cohort, 5-year cancer-specific mortality-free survival (CSM-FS) rates were 89% for married versus 83% for unmarried patients (Δ = 6%). In multivariable CRMs, married status did not independently predict lower CSM (hazard ratio [HR]: 0.74, p = 0.06). In males, 5-year CSM-FS rates were 89% for married versus 86% for unmarried patients (Δ = 3%). In multivariable CRMs, married status did not independently predict lower CSM (HR: 0.85, p = 0.4). In females, 5-year CSM-FS rates were 88% for married versus 79% for unmarried patients (Δ = 9%). In multivariable CRMs, married status independently predicted lower CSM (HR: 0.58, p = 0.03). CONCLUSIONS: In nonmetastatic pelvic liposarcoma patients, married status independently predicted lower CSM only in female patients. In consequence, unmarried female patients should ideally require more assistance and more frequent follow-up than their married counterparts.

Analyzing Depressive Symptoms Among Elderly Cancer Patients: A Comprehensive Examination of Demographic and Medical Correlates.

OBJECTIVE: This study aimed to explore the relationship between depressive symptoms and demographic as well as health-related variables in elderly individuals diagnosed with cancer. METHODS: A cohort of 50 elderly cancer patients participated in the study. Data collection involved the completion of surveys and assessments encompassing demographic characteristics, medical profiles, levels of depression, cognitive functioning, activities of daily living, and perceived social support. RESULTS: Findings revealed that among the elderly participants, 45% experienced mild depression, 20% exhibited moderate depression, and 5% showed severe depression. Depression levels were found to be linked to marital status (P = 0.03), with widowed individuals reporting the highest depression rates (80%) and single individuals reporting the lowest (4%). Living arrangements were significantly associated with depression (P = 0.012), with participants cohabiting with their partner and children showing lower depression rates (6%) compared to those living solely with their children (40%). Additionally, depression showed a significant correlation with income (P = 0.01), as individuals reporting insufficient income for living expenses displayed higher levels of depression (58%). Furthermore, depression was notably linked to chronic health conditions like diabetes and respiratory ailments (P = .023), with individuals grappling with respiratory issues reporting the highest depression scores. CONCLUSION: Recognizing and addressing factors such as marital status, living situation, income level, and the presence of chronic illnesses hold the potential for healthcare professionals to tailor interventions effectively to meet the specific requirements of this vulnerable demographic. This tailored approach has the capability to contribute significantly to enhancing the overall well-being and mental health outcomes of elderly cancer patients.

Characterizing provider bias in contraceptive care in Tanzania and Burkina Faso: A mixed-methods study.

Provider bias based on age, marital status, and parity may be a barrier to quality contraceptive care. However, the extent to which bias leads to disparities in care quality is not well understood. In this mixed-methods study, we used four different data sources from the same facilities to assess the extent of bias and how much it affects contraceptive care. First, we surveyed providers in Tanzania and Burkina Faso (N = 295) to assess provider attitudes about young, unmarried, and nulliparous clients. Second, mystery clients anonymously visited providers for contraceptive care and we randomly assigned the reported age, marital status, and parity of each visit (N = 306). We used data from these visits to investigate contraceptive care disparities across 3 domains: information provision and counseling quality, contraceptive method provision, and perceived treatment. Third, we complemented mystery client data with client exit surveys (N = 31,023) and client in-depth interviews (N = 36). In surveys, providers reported biased attitudes against young, unmarried, and nulliparous clients seeking contraceptives. Similarly, we found disparities according to these characteristics in the reporting of contraceptive care quality; however, we found that each characteristic affected a different quality of care domain. Among mystery clients we found age-related disparities in the provision of methods; 16/17-year-old clients were 18 and 11 percentage points less likely to perceive they could take a contraceptive method relative to 24-year-old clients in Tanzania and Burkina Faso, respectively. Unmarried mystery clients perceived worse treatment from providers compared to married clients. Nulliparous mystery clients reported lower quality contraceptive counseling than their parous counterparts. These results suggest that clients of different characteristics likely experience bias across different elements of care. Improving care quality and reducing disparities will require attention to which elements of care are deficient for different types of clients.

The relationship between marital status and cognitive impairment in Chinese older adults: the multiple mediating effects of social support and depression.

BACKGROUND: Marital status is a potentially essential factor for cognitive impairment. Relevant research examining the potential pathways through which the marital status of spouseless older people is associated with cognitive impairment needs to be more adequate. Therefore, this study aims to investigate the serial mediating effects of various forms of social support and depression between marital status and cognitive impairment in older Chinese people. METHODS: This study involved a secondary analysis of data from the 2014-2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), with a total of 2,647 Chinese older adults and 53.6% being males. Mediation analysis using the SPSS process macro was conducted. RESULTS: The results indicated that marital status was significantly predictive of cognitive impairment among older people, and those with a spouse exhibited higher cognitive functioning. Informal social support and depression were found to play partial mediating roles in the association between marital status and cognitive impairment. The findings also revealed that marital status was unrelated to formal social support, and no association between formal social support and cognitive impairment was found. CONCLUSIONS: The study findings highlight the need for social service providers to design programs for promoting connections associated with informal support to reduce their risk of depression and cognitive impairment and for policymakers to develop effective formal social support systems for older people without spouses. This study indicated that older people could regain the benefits of marriage to lower the risk of depression and improve their mental health.

Sample, time, and wording effects on estimating the prevalence of childfree adults: Insights from Japan.

Childfree adults neither have nor want children, but estimates of their prevalence vary widely, leading to ambiguity about how common this family status actually is. The goal of this study is to examine the effects of sample composition, time, and question wording on estimates of the prevalence of childfree adults. We pool 83 nationally representative estimates of the prevalence of childfree adults in Japan since 2000 using meta-regression to identify the influence of sex, marital status, year, and survey question. Prevalence estimates are higher when computed from samples of women than men, from samples of singles than married people, from samples collected more recently, and from surveys asking questions about expectations than wants. Most of the variation in estimates of the prevalence of childfree adults can be attributed to differences in sample composition, time, and question wording. Taking these factors into account, we estimate that over 2.5 million Japanese adults age 18-50, or 5.64% of this population, were childfree in 2020.

Exploring the inequalities experienced by health and care workforce and their bases - A scoping review protocol.

Planning for investment in human resources for health (HRH) is critical to achieve Universal Health Coverage (UHC) and establish a sustainable health system. Informed planning warrants a better understanding of the health labour market (HLM) to tackle a variety of health and care workforce challenges: from addressing critical supply shortage, to ensuring optimal skills mix and distribution, and addressing motivation and performance challenges. Scant evidence around the overall role of socioeconomic and cultural factors like gender, race, marital status, citizenship (migrant) status, workplace hierarchy etc. in determining workforce composition, deployment, distribution, retention, un- and underemployment, sub-optimal work environments and other factors in the 'HRH crisis' warrants further exploration. This scoping review protocol aims to map and present the available evidence on inequalities experienced by health and care workforce, the socio-economic, cultural and other bases of these inequalities, and their outcomes/ consequences. PubMed, Web of Science, CINAHL and SCOPUS will be used to identify relevant literature. All types of published study designs in English language will be included if they discuss any inequality experienced by any category of health and care workers. Elaborate keyword categories for health and care workers and inequalities context have been developed, tested and reduced to the near-final search string. Eligible articles will be charted using the Joanna Briggs Institute checklist. The sample data extraction chart in JBI manual will be used as a basic skeleton with fields added to it to serve the needs of the scoping review. Descriptive analysis will be performed, depicting basic frequencies. While no further analysis has been advised in the JBI and PRISMA protocol, thematic analysis will be undertaken; following the Braun and Clarke's method with some modification and open coding as suggested by Maquire and Delahunt.

Participatory methods used in the evaluation of medical devices: a comparison of focus groups, interviews, and a survey.

BACKGROUND: Stakeholder engagement in evaluation of medical devices is crucial for aligning devices with stakeholders' views, needs, and values. Methods for these engagements have however not been compared to analyse their relative merits for medical device evaluation. Therefore, we systematically compared these three methods in terms of themes, interaction, and time-investment. METHODS: We compared focus groups, interviews, and an online survey in a case-study on minimally invasive endoscopy-guided surgery for patients with intracerebral haemorrhage. The focus groups and interviews featured two rounds, one explorative focussing on individual perspectives, and one interactive focussing on the exchange of perspectives between participants. The comparison between methods was made in terms of number and content of themes, how participants interact, and hours invested by all researchers. RESULTS: The focus groups generated 34 themes, the interviews 58, and the survey 42. Various improvements for the assessment of the surgical procedure were only discussed in the interviews. In focus groups, participants were inclined to emphasise agreement and support, whereas the interviews consisted of questions and answers. The total time investment for researchers of focus groups was 95 h, of interviews 315 h, and survey 81 h. CONCLUSIONS: Within the context of medical device evaluation, interviews appeared to be the most appropriate method for understanding stakeholder views since they provide a scope and depth of information that is not generated by other methods. Focus groups were useful to rapidly bring views together. Surveys enabled a quick exploration. Researchers should account for these methodological differences and select the method that is suitable for their research aim.

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 influence of marital status at diagnosis on survival of adult patients with mantle cell lymphoma.

PURPOSE: Marital status has been reported to influence the survival outcomes of various cancers, but its impact on patients with mantle cell lymphoma (MCL) remains unclear. This study aimed to assess the influence of marital status at diagnosis on overall survival (OS) and cancer-specific survival (CSS) in patients with MCL. METHODS: The study utilized data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER)-18 databases, including 6437 eligible individuals diagnosed with MCL from 2000 to 2018. A 1:1 propensity matching method (PSM) minimized confounding factor. Univariate and multivariate analyses determined hazard ratios (HR). Stratified hazard models were developed for married and unmarried statuses across time intervals. RESULTS: Married patients exhibited better 5-year OS and CSS rates compared to unmarried patients (54.2% vs. 39.7%, log-rank p < 0.001; 62.6% vs. 49.3%, log-rank p < 0.001). Multivariate analysis indicated that being unmarried was an independent risk factor for OS (adjusted HR 1.420, 95% CI 1.329-1.517) and CSS (adjusted HR 1.388, 95% CI 1.286-1.498). After PSM, being unmarried remained an independent risk factor for both OS and CSS. Among unmarried patients, widowed individuals exhibited the poorest survival outcomes compared to patients with other marital statuses, with 5-year OS and CSS rates of 28.5% and 41.0%, respectively. Furthermore, in the 10-year OS and CSS hazard model for widowed individuals had a significantly higher risk of mortality, with the probability of overall and cancer-specific mortality increased by 1.7-fold and 1.6-fold, respectively. CONCLUSION: Marital status at diagnosis is an independent prognostic factor for MCL patients, with widowed individuals showing worse OS and CSS than those who are married, single, or divorced/separated. Adequate psychological and social support for widowed patients is crucial for improving outcomes in this patient population.