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Quantum mechanics imposes limits on the statistics of certain observables. Perhaps the most famous example is the uncertainty principle. Similar trade-offs also exist for the simultaneous violation of multiple Bell inequalities. In the simplest case of three observers, it has been shown that if two observers violate a Bell inequality, then none of them can violate any Bell inequality with the third observer, a property called monogamy of Bell violations. Forms of Bell monogamy have been linked to the no-signaling principle, and the inability of simultaneous violations of all inequalities is regarded as their fundamental property. Here, we show that the Bell monogamy does not hold universally and that in fact the only monogamous situation exists for only three observers. Consequently, the nature of quantum nonlocality is truly polygamous. We present a systematic methodology for identifying quantum states, measurements, and tight Bell inequalities that do not obey the monogamy principle for any number of more than three observers. The identified polygamous inequalities enable any subset of [Formula: see text] observers to reveal nonlocality, which is also shown experimentally by measuring Bell-type correlations of six-photon Dicke states. Our findings may be exploited for multiparty quantum key distribution as well as simultaneous self-testing of multiple nodes in quantum networks.
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Despite major advances, our understanding of the neurobiology of life course socioeconomic conditions is still scarce. This study aimed to provide insight into the pathways linking socioeconomic exposures-household income, last known occupational position, and life course socioeconomic trajectories-with brain microstructure and cognitive performance in middle to late adulthood. We assessed socioeconomic conditions alongside quantitative relaxometry and diffusion-weighted magnetic resonance imaging indicators of brain tissue microstructure and cognitive performance in a sample of community-dwelling men and women (N = 751, aged 50-91 years). We adjusted the applied regression analyses and structural equation models for the linear and nonlinear effects of age, sex, education, cardiovascular risk factors, and the presence of depression, anxiety, and substance use disorders. Individuals from lower-income households showed signs of advanced brain white matter (WM) aging with greater mean diffusivity (MD), lower neurite density, lower myelination, and lower iron content. The association between household income and MD was mediated by neurite density (B = 0.084, p = 0.003) and myelination (B = 0.019, p = 0.009); MD partially mediated the association between household income and cognitive performance (B = 0.017, p < 0.05). Household income moderated the relation between WM microstructure and cognitive performance, such that greater MD, lower myelination, or lower neurite density was only associated with poorer cognitive performance among individuals from lower-income households. Individuals from higher-income households showed preserved cognitive performance even with greater MD, lower myelination, or lower neurite density. These findings provide novel mechanistic insights into the associations between socioeconomic conditions, brain anatomy, and cognitive performance in middle to late adulthood.
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Encéfalo , Cognição , Substância Branca , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Cognição/fisiologia , Substância Branca/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Fatores Socioeconômicos , Envelhecimento/fisiologia , Envelhecimento/psicologia , Imagem de Difusão por Ressonância Magnética , RendaRESUMO
SignificanceContemporary social sciences aim to be diverse and inclusive, but traces of the historical dominance of Western European and North American academic institutions persist in scientific practices. One such practice is the phrasing of article titles. Our analysis shows that articles studying the global North are systematically less likely to mention the name of the country they study in their title compared to articles on the global South. This constitutes, potentially, an unwarranted claim on universality and may lead to lesser recognition of global South studies. Social and behavioral scientists must reflect on the phrasing of their article titles to avoid reproducing harmful relations of intellectual domination which limit inclusivity and constitute a barrier to the generalizability of scientific knowledge.
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This paper presents estimates of the prevalence of dementia in the United States from 2000 to 2016 by age, sex, race and ethnicity, education, and a measure of lifetime earnings, using data on 21,442 individuals aged 65 y and older and 97,629 person-year observations from a nationally representative survey, the Health and Retirement Study (HRS). The survey includes a range of cognitive tests, and a subsample underwent clinical assessment for dementia. We developed a longitudinal, latent-variable model of cognitive status, which we estimated using the Markov Chain Monte Carlo method. This model provides more accurate estimates of dementia prevalence in population subgroups than do previously used methods on the HRS. The age-adjusted prevalence of dementia decreased from 12.2% in 2000 (95% CI, 11.7 to 12.7%) to 8.5% in 2016 (7.9 to 9.1%) in the 65+ population, a statistically significant decline of 3.7 percentage points or 30.1%. Females are more likely to live with dementia, but the sex difference has narrowed. In the male subsample, we found a reduction in inequalities across education, earnings, and racial and ethnic groups; among females, those inequalities also declined, but less strongly. We observed a substantial increase in the level of education between 2000 and 2016 in the sample. This compositional change can explain, in a statistical sense, about 40% of the reduction in dementia prevalence among men and 20% among women, whereas compositional changes in the older population by age, race and ethnicity, and cardiovascular risk factors mattered less.
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Demência , Etnicidade , Estados Unidos/epidemiologia , Humanos , Masculino , Feminino , Prevalência , Escolaridade , Aposentadoria , Demência/epidemiologiaRESUMO
BACKGROUND: Long-standing health inequalities in Australian society that were exposed by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic were described as "fault lines" in a recent call to action by a consortium of philanthropic organizations. With asthma a major contributor to childhood disease burden, studies of its spatial epidemiology can provide valuable insights into the emergence of health inequalities early in life. OBJECTIVE: The aims of this study were to characterize the spatial variation of asthma prevalence among children living within Australia's 4 largest cities and quantify the relative contributions of climatic and environmental factors, outdoor air pollution, and socioeconomic status in determining this variation. METHODS: A Bayesian model with spatial smoothing was developed to regress ecologic health status data from the 2021 Australian Census against groups of explanatory covariates intended to represent mechanistic pathways. RESULTS: The prevalence of asthma in children aged 5 to 14 years averages 7.9%, 8.2%, 8.5%, and 7.6% in Sydney, Melbourne, Brisbane, and Perth, respectively. This small inter-city variation contrasts against marked intracity variation at the small-area level, which ranges from 6% to 12% between the least and most affected locations in each. Statistical variance decomposition on a subsample of Australian-born, nonindigenous children attributes 66% of the intracity spatial variation to the assembled covariates. Of these covariates, climatic and environmental factors contribute 30%, outdoor air pollution contributes 19%, and areal socioeconomic status contributes the remaining 51%. CONCLUSION: Geographic health inequalities in the prevalence of childhood asthma within Australia's largest cities reflect a complex interplay of factors, among which socioeconomic status is a principal determinant.
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Asma , Disparidades nos Níveis de Saúde , Humanos , Asma/epidemiologia , Criança , Prevalência , Austrália/epidemiologia , Adolescente , Pré-Escolar , Masculino , Feminino , Poluição do Ar/efeitos adversos , Teorema de Bayes , Fatores Socioeconômicos , COVID-19/epidemiologia , SARS-CoV-2 , População Urbana , Classe Social , Cidades/epidemiologiaRESUMO
Women diagnosed with melanoma have better survival than men, but little is known about potential intervention targets to reduce this survival gap by sex. We conducted a population-based study using Victorian Cancer Registry data including 5833 women and 6780 men aged 15 to 70 years when diagnosed with first primary melanoma between 2007 and 2015. Deaths to the end of 2020 were identified through linkage to the Victorian and national death registries. We estimated the effect of age at diagnosis, tumour thickness and tumour site on reducing the melanoma-specific survival gap by sex (ie, interventional indirect effects [IIEs]) on risk difference (RD) scale. Compared to women, there were 211 (95% CI: 145-278) additional deaths per 10 000 in men within 5 years following diagnosis. We estimated that 44% of this gap would be reduced by a hypothetical intervention shifting the distribution of melanoma thickness in men to be the same as that observed for women (IIEthickness RD 93 [95% CI: 75-118] per 10 000) and 20% by an intervention on tumour site (head and neck/trunk vs upper limb/lower limb; IIEsite RD 42 [95% CI: 15-72] per 10 000), while an intervention on age at diagnosis would have a negligible effect. Tumour thickness, tumour site and age at diagnosis mediated 65% of the effect of sex on 5-year melanoma survival in Victoria. Of these factors, tumour thickness had the most considerable mediating effect, suggesting that effective promotion of earlier detection of melanoma in men could potentially nearly halve the gap in melanoma-specific survival by sex.
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Melanoma , Neoplasias Cutâneas , Feminino , Humanos , Masculino , Melanoma/patologia , Neoplasias Cutâneas/patologia , Caracteres Sexuais , Análise de Mediação , Dados de Saúde Coletados Rotineiramente , Sistema de Registros , IncidênciaRESUMO
Early diagnosis remains a major limitation of cancer outcomes with ethnicity and deprivation being determinants of inequalities that impact outcomes. Prostate cancer suffers from lower incidence rates and higher mortality rates in the most deprived versus the least deprived groups. We developed the 'Man Van' to enable high-risk male patients' from deprived communities and ethnic minorities increased access to health care to address these health inequalities. Between December 2021 and December 2022 the Man Van project was piloted in eight different locations chosen using geospatial targeting based on ethnic minority populations and deprivation scores. The primary outcome measures were the prevalence of prostate cancer and other health conditions. 810 men were recruited to be seen at our Man Van clinics with 610 men attending. 48% of attendees were non-White including 30% of men who were Black. 420 men had PSA tests performed with a median PSA of 1 µg/L. 15 prostate cancers were diagnosed (3.6%; 95% CI 2.0-5.9) with 10 of these being clinically significant disease. Black men were more likely to be diagnosed compared to white men: 7.1% versus 1.8% (p < .05). The Man Van project is a novel approach to tackling health inequalities combining awareness raising, improved access to healthcare as well as ease of follow-up. Comparatively high levels of prostate cancers were diagnosed at early stages and high levels of other health conditions were found which could improve the economic value of the service.
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Disparidades em Assistência à Saúde , Neoplasias da Próstata , Humanos , Masculino , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/diagnóstico , Projetos Piloto , Pessoa de Meia-Idade , Idoso , Disparidades em Assistência à Saúde/estatística & dados numéricos , Detecção Precoce de Câncer , Antígeno Prostático Específico/sangue , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Prevalência , Disparidades nos Níveis de Saúde , Fatores SocioeconômicosRESUMO
With the objective to investigate associations between sociodemographic characteristics and participation in interventions designed to increase participation in cervical cancer screening among under-screened women, we randomized a random sample of 6000 women in Norway aged 35-69 years who had not attended cervical screening for ≥10 years to receive either (i) a reminder to attend regular screening (control), (ii) an offer to order a self-sampling kit (opt-in), or (iii) a self-sampling kit unsolicited (send-to-all). We analyzed how sociodemographic characteristics were associated with screening participation within and between screening arms. In the send-to-all arm, increased screening participation ranged from 17.1% (95% confidence interval [95% CI] = 10.3% to 23.8%) to 30.0% (95% CI = 21.5% to 38.6%) between sociodemographic groups. In the opt-in arm, we observed smaller, and at times, non-significant increases within the range 0.7% (95% CI = -5.8% to 7.3%) to 19.1% (95% CI = 11.6% to 26.7%). In send-to-all versus control comparisons, there was greater increase in participation for women in the workforce versus not (6.1%, 95% CI = 1.6% to 10.6%), with higher versus lower income (7.6%, 95% CI = 2.2% to 13.1%), and with university versus primary education (8.5%, 95% CI = 2.4% to 14.6%). In opt-in versus control comparisons, there was greater increase in participation for women in the workforce versus not (4.6%, 95% CI = 0.7% to 8.5%), with higher versus lower income (6.3%, 95% CI = 1.5% to 11.1%), but lower increase for Eastern European versus Norwegian background (-12.7%, 95% CI = -19.7% to -5.7%). Self-sampling increased cervical screening participation across all sociodemographic levels, but inequalities in participation should be considered when introducing self-sampling, especially with the goal to reach long-term non-attending women.
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Detecção Precoce de Câncer , Infecções por Papillomavirus , Neoplasias do Colo do Útero , Humanos , Feminino , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/virologia , Neoplasias do Colo do Útero/epidemiologia , Pessoa de Meia-Idade , Noruega/epidemiologia , Adulto , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/estatística & dados numéricos , Idoso , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/virologia , Infecções por Papillomavirus/epidemiologia , Esfregaço Vaginal/métodos , Esfregaço Vaginal/estatística & dados numéricos , Manejo de Espécimes/métodos , Fatores Socioeconômicos , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Fatores Sociodemográficos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricosRESUMO
Prospective cohort studies of kidney equity are limited by a focus on advanced rather than early disease and selective recruitment. Whole population studies frequently rely on area-level measures of deprivation as opposed to individual measures of social disadvantage. Here, we linked kidney health and individual census records in the North of Scotland (Grampian area), 2011-2021 (GLOMMS-CORE) and identified incident kidney presentations at thresholds of estimated glomerular filtration rate (eGFR) under 60 (mild/early), under 45 (moderate), under 30 ml/min/1.73m2 (advanced), and acute kidney disease (AKD). Household and neighborhood socioeconomic measures, living circumstances, and long-term mortality were compared. Case-mix adjusted multivariable logistic regression (living circumstances), and Cox models (mortality) incorporating an interaction between the household and the neighborhood were used. Among census respondents, there were 48546, 29081, 16116, 28097 incident presentations of each respective eGFR cohort and AKD. Classifications of socioeconomic position by household and neighborhood were related but complex, and frequently did not match. Compared to households of professionals, people with early kidney disease in unskilled or unemployed households had increased mortality (adjusted hazard ratios: 95% confidence intervals) of (1.26: 1.19-1.32) and (1.77: 1.60-1.96), respectively with adjustment for neighborhood indices making little difference. Those within either a deprived household or deprived neighborhood experienced greater mortality, but those within both had the poorest outcomes. Unskilled and unemployed households frequently reported being limited by illness, adverse mental health, living alone, basic accommodation, lack of car ownership, language difficulties, and visual and hearing impairments. Thus, impacts of deprivation on kidney health are spread throughout society-complex, serious, and not confined to those living in deprived neighborhoods.
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Taxa de Filtração Glomerular , Humanos , Masculino , Escócia/epidemiologia , Feminino , Pessoa de Meia-Idade , Estudos Prospectivos , Idoso , Adulto , Características da Vizinhança/estatística & dados numéricos , Fatores Socioeconômicos , Fatores de Risco , Características de Residência/estatística & dados numéricos , Determinantes Sociais da Saúde , Disparidades nos Níveis de Saúde , Desemprego/estatística & dados numéricos , Nefropatias/epidemiologia , Nefropatias/mortalidade , Nefropatias/diagnóstico , Nefropatias/fisiopatologiaRESUMO
Ethnic disparities exist within asthma; however, country of birth is rarely investigated. We described demographic and clinical characteristics by ethnicity and country of birth within the UK Biobank. Lung function and asthma hospitalisations were similar for white, black and North-East Asian participants, however, South-East (SE) Asians more commonly had an FEV1 below the lower limits of normal (LLN; 53.8% vs 32.3%, p<0.001), blood eosinophilia (38.6% vs 23.8%, p<0.001) and asthma hospitalisation (12.5% vs 8.3%, p<0.001) than white participants. First-generation SE Asian immigrants had poorer lung function (57.7% vs 27.7% FEV1 below LLN, p<0.001) than UK/Ireland born participants. These data demonstrate inter-ethnic and intra-ethnic disparities.
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Asma , Biobanco do Reino Unido , Humanos , Estudos Transversais , Bancos de Espécimes Biológicos , EtnicidadeRESUMO
BACKGROUND: Delays to breast cancer treatment can lead to more aggressive and extensive treatments, increased expenses, increased psychological distress, and poorer survival. We explored the individual and area level factors associated with the interval between diagnosis and first treatment in a population-based cohort in Queensland, Australia. METHODS: Data from 3216 Queensland women aged 20 to 79, diagnosed with invasive breast cancer (ICD-O-3 C50) between March 2010 and June 2013 were analysed. Diagnostic dates were sourced from the Queensland Cancer Registry and treatment dates were collected via self-report. Diagnostics-treatment intervals were modelled using flexible parametric survival methods. RESULTS: The median interval between breast cancer diagnosis and first treatment was 15 days, with an interquartile range of 9-26 days. Longer diagnostic-treatment intervals were associated with a lack of private health coverage, lower pre-diagnostic income, first treatments other than breast conserving surgery, and residence outside a major city. The model explained a modest 13.7% of the variance in the diagnostic-treatment interval [Formula: see text]. Sauerbrei's D was 0.82, demonstrating low to moderate discrimination performance. CONCLUSION: Whilst this study identified several individual- and area-level factors associated with the time between breast cancer diagnosis and first treatment, much of the variation remained unexplained. Increased socioeconomic disadvantage appears to predict longer diagnostic-treatment intervals. Though some of the differences are small, many of the same factors have also been linked to screening and diagnostic delay. Given the potential for accumulation of delay at multiple stages along the diagnostic and treatment pathway, identifying and applying effective strategies address barriers to timely health care faced by socioeconomically disadvantaged women remains a priority.
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Neoplasias da Mama , Feminino , Humanos , Queensland/epidemiologia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/terapia , Diagnóstico Tardio , Fatores Socioeconômicos , AustráliaRESUMO
PURPOSE: Breast cancer is the second leading cause of death from cancer among Canadian females. This study aimed to quantify and assess trends in education and income inequalities in the mortality rate of breast cancer in Canada from 1992 to 2019. METHODS: We constructed a census division-level dataset pooled from the Canadian Vital Death Statistics Database (CVSD), the Canadian Census of the Population (CCP), and the National Household Survey (NHS) to examine trends in education and income inequalities in the mortality rate of breast cancer in Canada over the study period. The age-standardized Concentration index (C) was used to quantify income and education inequalities in breast cancer mortality over time. RESULTS: The national crude mortality rate of breast cancer has decreased in Canada from 1992 to 2019, with Alberta, British Columbia, Manitoba, Ontario, Prince Edward Island, and Quebec having the greatest decreases in mortality rate. The age-standardized C for education and income inequalities were always negative for all the study years, meaning that the mortality rate of breast cancer was higher among less-educated and poorer females. Moreover, the results indicate a growing trend in the concentration of breast cancer mortality among females with lower income and education from 1992 to 2019. CONCLUSION: The increasing concentration of breast cancer mortality among low socioeconomic status females remains a challenge in Canada. Continuous efforts are needed within Canadian healthcare system to improve the prevention and treatment of breast cancer for this population.
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Neoplasias da Mama , Fatores Socioeconômicos , Humanos , Feminino , Neoplasias da Mama/mortalidade , Neoplasias da Mama/epidemiologia , Canadá/epidemiologia , Pessoa de Meia-Idade , Adulto , Idoso , Renda , Mortalidade/tendências , História do Século XXI , Escolaridade , História do Século XX , Classe SocialRESUMO
BACKGROUND: Preterm birth is a major cause of infant mortality and morbidity and accounts for 7-8% of births in the UK. It is more common in women from socially deprived areas and from minority ethnic groups, but the reasons for this disparity are poorly understood. To inform interventions to improve child survival and their quality of life, this study examined the socioeconomic and ethnic inequalities in preterm births (< 37 weeks of gestation at birth) within Health Trusts in England. METHODS: This study investigated socioeconomic and ethnic inequalities in preterm birth rates across the National Health Service (NHS) in England. The NHS in England can be split into different units known as Trusts. We visualised between-Trust differences in preterm birth rates. Health Trusts were classified into five groups based on their standard deviation (SD) variation from the average national preterm birth rate. We used modified Poisson regression to compute risk ratios (RR) and 95% confidence intervals (95% CI) with generalised estimating equations. RESULTS: The preterm birth rate ranged from 6.8/100 births for women living in the least deprived areas to 8.8/100 births for those living in the most deprived areas. Similarly, the preterm birth rate ranged from 7.8/100 births for white women, up to 8.6/100 births for black women. Some Health Trusts had lower than average preterm birth rates in white women whilst concurrently having higher than average preterm birth rates in black and Asian women. The risk of preterm birth was higher for women living in the most deprived areas and ethnicity (Asian). CONCLUSIONS: There was evidence of variation in rates of preterm birth by ethnic group, with some Trusts reporting below average rates in white ethnic groups whilst concurrently reporting well above average rates for women from Asian or black ethnic groups. The risk of preterm birth varied substantially at the intersectionality of maternal ethnicity and the level of socioeconomic deprivation of their residency. In the absence of other explanations, these findings suggest that even within the same Health Trust, maternity care may vary depending on the women's ethnicity and/or whether she lives in an area of high socioeconomic deprivation. Thus, social factors are likely key determinants of inequality in preterm birth rather than provision of maternity care alone.
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Etnicidade , Nascimento Prematuro , Fatores Socioeconômicos , Humanos , Nascimento Prematuro/etnologia , Nascimento Prematuro/epidemiologia , Feminino , Inglaterra/epidemiologia , Gravidez , Adulto , Recém-Nascido , Adulto JovemRESUMO
BACKGROUND: Healthy Start (HS) is a government scheme in England, Wales and Northern Ireland that offers a financial payment card and free vitamins to families experiencing low income. Pregnant women and families with children < 4 years can use the HS card to buy fruit, vegetables, cow's milk, infant formula and pulses. HS was fully digitalised in March 2022. While digitalisation has improved the user experience for many families, in the context of the cost-of-living crisis and increasing dietary inequalities, it is important to understand why HS is not reaching more families. This study aimed to (i) assess the perceptions and experiences of HS from stakeholders across the system including those who promote, implement and are eligible for HS, and (ii) identify recommendations to improve the scheme's effectiveness and uptake. METHODS: The study design was a post-implementation rapid qualitative evaluation using stakeholder interviews. Data were collected between January and June 2023 via semi-structured interviews (50% online; 50% in person) with 112 stakeholders, including parents (n = 59), non-government organisations (n = 13), retailers (n = 11) and health and community professionals (n = 29) at national and local levels. Findings were confirmed by a sub-sample of participants. RESULTS: Six core themes cut across stakeholders' perceptions and experiences, and stakeholders collectively outlined seven recommendations they felt could be acted upon to maximise uptake and efficiency of HS, with actions at both national and local levels. A novel finding from this study is that raising awareness about HS alone is unlikely to result automatically or universally in higher uptake rate. Recommendations include: continuing to provide this scheme that is universally valued; the need for many families to be provided with a helping hand to successfully complete the application; reframing of the scheme as a child's right to food and development to ensure inclusivity; improved leadership, coordination and accountability at both national and local levels. CONCLUSIONS: HS provides benefits for child development and family wellbeing. The study's recommendations should be actioned by national and local governments to enable all families eligible for the scheme to benefit from this nutritional safety net.
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Pesquisa Qualitativa , Humanos , Inglaterra , Lactente , Feminino , Pré-Escolar , Masculino , PobrezaRESUMO
BACKGROUND: This study investigates the association between socioeconomic status (SES) and glycemic control in individuals with type 1 diabetes (T1D) using flash glucose monitoring (FGM) devices within a public health system where these technologies are freely available and utilized according to recommended guidelines. METHODS: A follow-up study of 1060 adults (mean age 47.4 ± 15.0 years, 49.0% women) with T1D, receiving care at three Spanish university hospitals that regularly employ the FGM system. SES was assessed using the Spanish Deprivation Index and the average annual net income per person. Glycemic data were collected over a 14-day follow-up period, including baseline glycated hemoglobin (HbA1c) levels prior to sensor placement, the last available HbA1c levels, and FGM-derived glucose metrics. Individuals with sensor usage time < 70% were excluded. Chronic micro and macrovascular complications related to diabetes were documented. Regression models, adjusted for clinical variables, were employed to determine the impact of SES on optimal sensor control (defined as time in range (TIR) ≥ 70% with time below range < 4%) and disease complications. RESULTS: The average follow-up was of 2 years. The mean TIR and the percentage of individuals with optimal control were higher in individuals in the highest SES quartile (64.9% ± 17.8% and 27.9%, respectively) compared to those in the lowest SES quartile (57.8 ± 17.4% and 12.1%) (p < 0.001). Regression models showed a higher risk of suboptimal control (OR 2.27, p < 0.001) and ischemic heart disease and/or stroke (OR 3.59, p = 0.005) in the lowest SES quartile. No association was observed between SES and the risk of diabetic nephropathy and retinopathy. FGM system improved HbA1c levels across all SES quartiles. Although individuals in the highest SES quartile still achieved a significantly lower value at the end of the follow-up 55 mmol/mol (7.2%) compared to those in the lowest SES quartile 60 mmol/mol (7.6%) (p < 0.001), the significant disparities in this parameter between the various SES groups were significantly reduced after FGM technology use. CONCLUSIONS: Socioeconomic status plays a significant role in glycemic control and complications in individuals with T1D, extending beyond access to technology and its proper utilization. The free utilization of FGM technology helps alleviate the impact of social inequalities on glycemic control.
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Diabetes Mellitus Tipo 1 , Adulto , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Seguimentos , Glicemia , Hemoglobinas Glicadas , Glucose , Automonitorização da Glicemia , Classe SocialRESUMO
BACKGROUND: Highlighted by the rise of COVID-19, climate change, and conflict, socially vulnerable populations are least resilient to disaster. In infectious disease management, mathematical models are a commonly used tool. Researchers should include social vulnerability in models to strengthen their utility in reflecting real-world dynamics. We conducted a scoping review to evaluate how researchers have incorporated social vulnerability into infectious disease mathematical models. METHODS: The methodology followed the Joanna Briggs Institute and updated Arksey and O'Malley frameworks, verified by the PRISMA-ScR checklist. PubMed, Clarivate Web of Science, Scopus, EBSCO Africa Wide Information, and Cochrane Library were systematically searched for peer-reviewed published articles. Screening and extracting data were done by two independent researchers. RESULTS: Of 4075 results, 89 articles were identified. Two-thirds of articles used a compartmental model (n = 58, 65.2%), with a quarter using agent-based models (n = 24, 27.0%). Overall, routine indicators, namely age and sex, were among the most frequently used measures (n = 42, 12.3%; n = 22, 6.4%, respectively). Only one measure related to culture and social behaviour (0.3%). For compartmental models, researchers commonly constructed distinct models for each level of a social vulnerability measure and included new parameters or influenced standard parameters in model equations (n = 30, 51.7%). For all agent-based models, characteristics were assigned to hosts (n = 24, 100.0%), with most models including age, contact behaviour, and/or sex (n = 18, 75.0%; n = 14, 53.3%; n = 10, 41.7%, respectively). CONCLUSIONS: Given the importance of equitable and effective infectious disease management, there is potential to further the field. Our findings demonstrate that social vulnerability is not considered holistically. There is a focus on incorporating routine demographic indicators but important cultural and social behaviours that impact health outcomes are excluded. It is crucial to develop models that foreground social vulnerability to not only design more equitable interventions, but also to develop more effective infectious disease control and elimination strategies. Furthermore, this study revealed the lack of transparency around data sources, inconsistent reporting, lack of collaboration with local experts, and limited studies focused on modelling cultural indicators. These challenges are priorities for future research.
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COVID-19 , Doenças Transmissíveis , Humanos , Vulnerabilidade Social , Doenças Transmissíveis/epidemiologia , Controle de Doenças Transmissíveis , Modelos TeóricosRESUMO
BACKGROUND: Migrants in the UK and Europe face vulnerability to vaccine-preventable diseases (VPDs) due to missed childhood vaccines and doses and marginalisation from health systems. Ensuring migrants receive catch-up vaccinations, including MMR, Td/IPV, MenACWY, and HPV, is essential to align them with UK and European vaccination schedules and ultimately reduce morbidity and mortality. However, recent evidence highlights poor awareness and implementation of catch-up vaccination guidelines by UK primary care staff, requiring novel approaches to strengthen the primary care pathway. METHODS: The 'Vacc on Track' study (May 2021-September 2022) aimed to measure under-vaccination rates among migrants in UK primary care and establish new referral pathways for catch-up vaccination. Participants included migrants aged 16 or older, born outside of Western Europe, North America, Australia, or New Zealand, in two London boroughs. Quantitative data on vaccination history, referral, uptake, and sociodemographic factors were collected, with practice nurses prompted to deliver catch-up vaccinations following UK guidelines. Focus group discussions and in-depth interviews with staff and migrants explored views on delivering catch-up vaccination, including barriers, facilitators, and opportunities. Data were analysed using STATA12 and NVivo 12. RESULTS: Results from 57 migrants presenting to study sites from 18 countries (mean age 41 [SD 7.2] years; 62% female; mean 11.3 [SD 9.1] years in UK) over a minimum of 6 months of follow-up revealed significant catch-up vaccination needs, particularly for MMR (49 [86%] required catch-up vaccination) and Td/IPV (50 [88%]). Fifty-three (93%) participants were referred for any catch-up vaccination, but completion of courses was low (6 [12%] for Td/IPV and 33 [64%] for MMR), suggesting individual and systemic barriers. Qualitative in-depth interviews (n = 39) with adult migrants highlighted the lack of systems currently in place in the UK to offer catch-up vaccination to migrants on arrival and the need for health-care provider skills and knowledge of catch-up vaccination to be improved. Focus group discussions and interviews with practice staff (n = 32) identified limited appointment/follow-up time, staff knowledge gaps, inadequate engagement routes, and low incentivisation as challenges that will need to be addressed. However, they underscored the potential of staff champions, trust-building mechanisms, and community-based approaches to strengthen catch-up vaccination uptake among migrants. CONCLUSIONS: Given the significant catch-up vaccination needs of migrants in our sample, and the current barriers to driving uptake identified, our findings suggest it will be important to explore this public health issue further, potentially through a larger study or trial. Strengthening existing pathways, staff capacity and knowledge in primary care, alongside implementing new strategies centred on cultural competence and building trust with migrant communities will be important focus areas.
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Medicina Geral , Migrantes , Vacinação , Humanos , Projetos Piloto , Masculino , Adolescente , Feminino , Adulto , Reino Unido , Adulto Jovem , Vacinação/estatística & dados numéricos , Medicina Geral/estatística & dados numéricos , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Atopic dermatitis (AD) is a common chronic skin disorder in children. We aimed to investigate trends and regional disparities of burden in paediatric AD at global, regional and national levels, and to explore potential associated factors. METHODS: Based on data from Global Burden of Disease study 2019, we assessed trends in burden of AD aged <19 years from 1990 to 2019, including prevalent and incident cases, age-standardised prevalence and age-standardised incidence. For potential associated factors, correlations of above trends and indexes of socio-economic status (sociodemographic index, SDI) and health service coverage (universal health coverage index, UHCI) were evaluated. We conducted decomposition analysis to understand the net contribution of population-level factors and their contribution proportions on changes of prevalent and incident cases, including age structure, population change and epidemiological change. RESULTS: Global prevalent and incident cases of paediatric AD increased by about 5.7 and 0.7 million between 1990 and 2019, respectively. Global age-standardised prevalence and incidence decreased by -0.17% (-0.19% to -0.16%) and -0.12% (-0.13% to -0.11%) per year from 1990 to 2019, respectively. Regionally, the highest increase of prevalent and incident cases was in low SDI region (by 96.77% and 84.85%); the highest decrease of age-standardised prevalence and incidence was in high SDI regions (by -0.20% and -0.27% per year). The correlation analyses identified significant negative correlations between trends and SDI and UHCI. Population change was a major driver of case rise; epidemiological change and age structure showed negative impact of case rise. Regional disparities in contribution of three population-level factors were seen, including net contribution direction (positive or negative) and contribution proportion levels. CONCLUSION: Global paediatric AD case numbers increased, primarily due to population growth. Prevalence and incidence decreased slightly. Geographic inequalities were seen. Developing region-specific strategies targeting potential factors is essential to reduce paediatric AD burden.
Assuntos
Dermatite Atópica , Humanos , Dermatite Atópica/epidemiologia , Criança , Pré-Escolar , Masculino , Feminino , Lactente , Prevalência , Adolescente , Incidência , Carga Global da Doença/tendências , Fatores Socioeconômicos , Recém-Nascido , Saúde Global , Efeitos Psicossociais da DoençaRESUMO
BACKGROUND: Despite initiatives to eradicate racial inequalities in pain treatment, there is no clear picture on whether this has translated to changes in clinical practice. OBJECTIVE: To determine whether racial disparities in the receipt of pain medication in the emergency department have diminished over a 22-year period from 1999 to 2020. DESIGN: We used data from the National Hospital Ambulatory Medical Care Survey, an annual, cross-sectional probability sample of visits to emergency departments of non-federal general and short-stay hospitals in the USA. PATIENTS: Pain-related visits to the ED by Black or White patients. MAIN MEASURES: Prescriptions for opioid and non-opioid analgesics. KEY RESULTS: A total of 203,854 of all sampled 625,433 ED visits (35%) by Black or White patients were pain-related, translating to a population-weighted estimate of over 42 million actual visits to US emergency departments for pain annually across 1999-2020. Relative risk regression found visits by White patients were 1.26 (95% CI, 1.22-1.30; p<0.001) times more likely to result in an opioid prescription for pain compared to Black patients (40% vs. 32%). Visits by Black patients were also 1.25 (95% CI, 1.21-1.30; p<0.001) times more likely to result in non-opioid analgesics only being prescribed. Results were not substantively altered after adjusting for insurance status, type and severity of pain, geographical region, and other potential confounders. Spline regression found no evidence of meaningful change in the magnitude of racial disparities in prescribed pain medication over 22 years. CONCLUSIONS: Initiatives to create equitable healthcare do not appear to have resulted in meaningful alleviation of racial disparities in pain treatment in the emergency department.
Assuntos
Analgésicos não Narcóticos , Analgésicos Opioides , Humanos , Estados Unidos/epidemiologia , Analgésicos Opioides/uso terapêutico , Analgésicos não Narcóticos/uso terapêutico , Estudos Transversais , Padrões de Prática Médica , Dor/tratamento farmacológico , Serviço Hospitalar de Emergência , Pesquisas sobre Atenção à SaúdeRESUMO
BACKGROUND: Cancer treatment attrition refers to the discontinuation of prescribed cancer therapies before completion. It can significantly impact patient outcomes and cancer survival rates making it a critical concern. There is growing evidence on inequalities in cancer care, the avoidable systematic differences in the health of different groups of people. Understanding the extent of treatment attrition, why it happens, for whom, and associated inequalities may improve cancer care delivery and patient outcomes. METHODS: A rapid review was conducted to identify existing evidence on measures of cancer treatment attrition, definitions, reasons for attrition and potential inequalities. The review followed a systematic approach but with abbreviated processes to facilitate quicker evidence synthesis. Searches were restricted to MEDLINE and Embase databases from their inception dates to May 7, 2024. Additional searches were performed in PubMed, Google Scholar, and key grey literature from relevant organizations. Inclusion criteria were adults with any type of cancer undergoing treatment, with studies reporting quantitative or qualitative data on treatment attrition conducted outside of clinical trials. Exclusion criteria included studies on children or adolescents, clinical trials, non-English publications, and various non-research article types. Data extraction and quality assessment were performed using standardized tools, and studies were synthesized narratively. RESULTS: The search retrieved 1,353 references, with 40 studies meeting inclusion criteria. Most studies were retrospective. Studies covered various cancer types and treatments, reporting measures of attrition and reasons for treatment drop-out. Factors influencing attrition included disease progression, death, clinical deterioration, treatment toxicity, and socioeconomic factors such as lower income or socioeconomic disadvantage. CONCLUSIONS: This review highlights significant variability in how treatment attrition is measured and defined, and suggests potential inequalities in who discontinues treatment. Standardized measures of attrition and data collection on reasons for discontinuation are essential to improve cancer care outcomes and equity. Future research should focus on developing these standardized metrics and exploring interventions targeting identified disparities to support cancer patients to complete treatment and improve outcomes.