Space-time distribution of intestinal infectious diseases and their association with socioeconomic variables in Ecuador.

Background: Intestinal infectious diseases are a global concern in terms of morbidity, and they are closely linked to socioeconomic variables such as quality of life, weather and access to healthcare services. Despite progress in spatial analysis tools and geographic information systems in epidemiology, studies in Ecuador that evaluate temporal trends, specific geographic groups, and their correlation with socioeconomic variables are lacking. The absence of such information makes it challenging to formulate public health policies. This study sought to identify the spatial and temporal patterns of these diseases in Ecuador, along with their correlation with socioeconomic variables. Methods: In Ecuador, the study was carried out in a continental territory, focusing on data related to intestinal infectious diseases collected from the National Institute of Statistics and Census (Instituto Nacional de Estadística y Censos) during the period from 2014 to 2019. This study involved spatial and temporal analyses using tools such as the global Moran's index and Local Indicators of Spatial Association to identify spatial clustering patterns and autocorrelation. Additionally, correlations between morbidity rates and socioeconomic variables were examined. Results: During the investigated period, Ecuador registered 209,668 cases of these diseases. Notable variations in case numbers were identified, with a 9.2% increase in 2019 compared to the previous year. The most impacted group was children under 5 years old, and the highest rates were centered in the southern and southwestern regions of the country, with Limón Indanza and Chunchi being the cantons with the highest rates, notably showing a significant increase in Limón Indanza. Additionally, there were significant correlations between morbidity rates and socioeconomic variables, school dropout rates, low birth weight, and access to water services. Conclusion: This study emphasizes the importance of considering socioeconomic variables when addressing these diseases in Ecuador. Understanding these correlations and geospatial trends can guide the development of health policies and specific intervention programs to reduce the incidence in identified high-risk areas. More specific research is needed to understand the underlying causes of variability in morbidity and develop effective prevention strategies.

Determinants of Parental Attitudes towards Children's Vaccination in Lithuania: An Online Survey.

Background: Data from recent years show that the COVID-19 pandemic has significantly reduced the scope of child immunisation worldwide. If the numbers continue to fall, we may have a vaccination crisis. In order to understand the local factors of this phenomenon, we studied parents' viewpoint towards childhood vaccination in Lithuania. Therefore, the aim of our study was to determine the impact of parental attitudes on children's vaccination. Materials and Methods: A web-based cross-sectional study was made in Lithuania from October 20th to November 3rd, 2020, using Google Forms. An anonymous questionnaire included both quantitative and qualitative questions. The questionnaire was distributed to the general population in Lithuania via social media and a snowball sampling. Only parents who have at least one child under 18 years old were involved in the study. We analysed the parents' attitudes towards vaccination by their socioeconomic and demographic determinants using MS Excel and OpenEpi tools. The respondents were considered vaccine supporters if they vaccinated all their children with state-reimbursed vaccines or only vaccinated some of their children, and vaccine sceptics if they did not vaccinate their children with state-reimbursed vaccines. Results: The population of our research consisted of 775 parents. There were more males against vaccination than females, respectively, 59.6% and 33.2%. 65.0% of all respondents stated that they vaccinated their children with the full course of vaccines, while the remaining 35.0% did not vaccinate. University-level education dominated in both pro-vaccine and anti-vaccine groups. We found that 16.9% of parents who were unvaccinated as children themselves tend not to vaccinate their children. However, in the pro-vaxx group, only 0.7% of parents were unvaccinated during childhood. 50.8% of vaccine sceptics were not fully informed by healthcare professionals about the benefits and risks of vaccination, while only 31.6% of vaccine supporters were not informed. Social environment did not have an impact on the decision whether to vaccinate or not to vaccinate a child among both vaccine advocates and vaccine deniers (accordingly, 51.2% and 42.9%). 29.3% of respondents stated that the cost of paid vaccinations was too high. Open-text survey responses gave us more in-depth insight about the parental decision-making process. Protection of children and society from infectious diseases (31.7%) was mentioned as the main reason for vaccination. Whereas vaccine-hesitant parents were mostly concerned about already-occurring side effects or their risk (43.4%). Conclusions: Our findings confirmed that vaccine hesitancy was associated with not being vaccinated in childhood themselves, lack of information from medical practitioners and male gender. The price of vaccines also had an impact on immunisation rates - more than one-third of the vaccine supporting parents indicated that the cost of paid vaccinations was too high. The main incentive for vaccine compliance was parents' desire to protect their children and society from infectious diseases. Whereas vaccine-hesitant parents were mostly concerned about already occurring side effects or their risk. There was no consensus, whether vaccination of children should be mandatory in Lithuania, as the answers to the question were almost evenly distributed. The formation of parents' attitudes towards children's vaccination is a complex process that is determined by parents' attitudes towards the health care system, lack of trust in doctors, and gaps in communication about the benefits and risks of vaccination. All of this information should be taken into account in health policy-making.

Socioeconomic and sociodemographic correlations to COVID-19 variability in the United States in 2020.

The COVID-19 pandemic provided an additional spotlight on the longstanding socioeconomic/health impacts of redlining and has added to the myriad of environmental justice issues, which has caused significant loss of life, health, and productive work. The Centers for Disease Control and Prevention (CDC) reports that a person with any selected underlying health conditions is more likely to experience severe COVID-19 symptoms, with more than 81% of COVID-19-related deaths among people aged 65 years and older. The effects of COVID-19 are not homogeneous across populations, varying by socioeconomic status, PM2.5 exposure, and geographic location. This variability is supported by analysis of existing data as a function of the number of cases and deaths per capita/1,00,000 persons. We investigate the degree of correlation between these parameters, excluding health conditions and age. We found that socioeconomic variables alone contribute to ~40% of COVID-19 variability, while socioeconomic parameters, combined with political affiliation, geographic location, and PM2.5 exposure levels, can explain ~60% of COVID-19 variability per capita when using an OLS regression model; socioeconomic factors contribute ~28% to COVID-19-related deaths. Using spatial coordinates in a Random Forest (RF) regressor model significantly improves prediction accuracy by ~120%. Data visualization products reinforce the fact that the number of COVID-19 deaths represents 1% of COVID-19 cases in the US and globally. A larger number of democratic voters, larger per-capita income, and age >65 years is negatively correlated (associated with a decrease) with the number of COVID cases per capita. Several distinct regions of negative and positive correlations are apparent, which are dominated by two major regions of anticorrelation: (1) the West Coast, which exhibits high PM2.5 concentrations and fewer COVID-19 cases; and (2) the middle portion of the US, showing mostly high number of COVID-19 cases and low PM2.5 concentrations. This paper underscores the importance of exercising caution and prudence when making definitive causal statements about the contribution of air quality constituents (such as PM2.5) and socioeconomic factors to COVID-19 mortality rates. It also highlights the importance of implementing better health/lifestyle practices and examines the impact of COVID-19 on vulnerable populations, particularly regarding preexisting health conditions and age. Although PM2.5 contributes comparable deaths (~7M) per year, globally as smoking cigarettes (~8.5M), quantifying any causal contribution toward COVID-19 is non-trivial, given the primary causes of COVID-19 death and confounding factors. This becomes more complicated as air pollution was reduced significantly during the lockdowns, especially during 2020. This statistical analysis provides a modular framework, that can be further expanded with the context of multilevel analysis (MLA). This study highlights the need to address socioeconomic and environmental disparities to better prepare for future pandemics. By understanding how factors such as socioeconomic status, political affiliation, geographic location, and PM2.5 exposure contribute to the variability in COVID-19 outcomes, policymakers and public health officials can develop targeted strategies to protect vulnerable populations. Implementing improved health and lifestyle practices and mitigating environmental hazards will be essential in reducing the impact of future public health crises on marginalized communities. These insights can guide the development of more resilient and equitable health systems capable of responding effectively to similar future scenarios.

Vector mosquito distribution and richness are predicted by socio-economic, and ecological variables.

Mosquitoes of vectorial importance represent a ubiquitous and constant threat of potentially devastating arboviral outbreaks. Our ability to predict such outcomes is still restricted. To answer this, we have used an extensive data collection of 23 vector and 233 non-vector mosquito species distributed throughout the Mexican territory and linked them to social and environmental factors. Our aim was to predict vector and non-vector mosquitoes' distribution and species richness based on socioeconomic and environmental data. We found that lack of health services, human population variation, ecological degradation, and urban-rural categorization contributed significantly to explain the distribution of vector mosquitoes. mosquitoes. This phenomenon is probably attributed to the degradation of natural ecosystems as it creates favorable conditions for the proliferation of vector mosquitoes. The richness of vector mosquitoes was similarly explained by most of these variables as well as altitude. As for non-vector mosquitoes, social marginalization, ecological degradation, anthropogenic impact, and altitude explain species richness and distribution. These findings illustrate the complex interaction of environmental and socioeconomic factors behind the distribution of mosquitoes, and the potential for arboviral disease outbreaks. Areas with human populations at highest risk for mosquito-borne diseases should be primary targets for vector control.

Demographic and Socioeconomic Trends in Cervical Fusion Utilization from 2004 Through 2021 and the COVID-19 Pandemic.

BACKGROUND: Cervical fusion rates increased in the U.S. exponentially 1990-2014, but trends leading up to/during the COVID-19 pandemic have not been fully evaluated by patient socioeconomic status (SES). Here, we provide the most recent, comprehensive characterization of demographic and SES trends in cervical fusions, including during the pandemic. METHODS: We collected the following variables on adults undergoing cervical fusions, 1/1/2004-3/31/2021, in Optum's Clinformatics Data Mart: age, Charlson Comorbidity Index, provider's practicing state, gender, race, education, and net worth. We performed multivariate linear and logistic regression to evaluate associations of cervical fusion rates with SES variables. RESULTS: Cervical fusion rates increased 2004-2016, then decreased 2016-2020. Proportions of Asian, Black, and Hispanic patients undergoing cervical fusions increased (OR = 1.001,1.001,1.004, P < 0.01), with a corresponding decrease in White patients (OR = 0.996, P < 0.001) over time. There were increases in cervical fusions in higher education groups (OR = 1.006, 1.002, P < 0.001) and lowest net worth group (OR = 1.012, P < 0.001). During the pandemic, proportions of White (OR = 1.015, P < 0.01) and wealthier patients (OR ≥ 1.015, P < 0.01) undergoing cervical fusions increased. CONCLUSIONS: We present the first documented decrease in annual cervical surgery rates in the U.S. Our data reveal a bimodal distribution for cervical fusion patients, with racial-minority, lower-net-worth, and highly-educated patients receiving increasing proportions of surgical interventions. White and wealthier patients were more likely to undergo cervical fusions during the COVID-19 pandemic, which has been reported in other areas of medicine but not yet in spine surgery. There is still considerable work needed to improve equitable access to spine care for the entire U.S.

Preparing Cities for Future Pandemics: Unraveling the Influence of Urban and Housing Variables on COVID-19 Incidence in Santiago de Chile.

In this study, we analyzed how urban, housing, and socioeconomic variables are related to COVID-19 incidence. As such, we have analyzed these variables along with demographic, education, employment, and COVID-19 data from 32 communes in Santiago de Chile between March and August of 2020, before the release of the vaccines. The results of our Principal Component Analysis (PCA) confirmed that those communes with more economic, social, organizational, and infrastructural resources were overall less affected by COVID-19. As the dimensions affecting COVID-19 are based on structural variables, this study discusses to what extent our cities can be prepared for the next pandemic. Recommendations for local decision-makers in controlling illegal immigration and investing in housing and urban parks are drawn.

Evaluating global interest in biodiversity and conservation.

The first target of the Convention for Biological Diversity (Aichi target 1) was to increase public awareness of the values of biodiversity and actions needed to conserve it-a key prerequisite for other conservation targets. Monitoring success in achieving this target at a global scale has been difficult; however, increased digitization of human life in recent decades has made it easier to measure people's interests at an unprecedented scale and allows for a more comprehensive evaluation of Aichi target 1 than previously attempted. We used Google search volume data for over a thousand search terms related to different aspects of biodiversity and conservation to evaluate global interest in biodiversity and its conservation. We also investigated the correlation of interest in biodiversity and conservation across countries to variables related to biodiversity, economy, demography, research, education, internet use, and presence of environmental organizations. From 2013 to 2020, global searches for biodiversity components increased, driven mostly by searches for charismatic fauna (59% of searches were for mammal species). Searches for conservation actions, driven mostly by searches for national parks, decreased since 2019, likely due to the COVID-19 pandemic. Economic inequality was negatively correlated with interest in biodiversity and conservation, whereas purchasing power was indirectly positively correlated with higher levels of education and research. Our results suggest partial success toward achieving Aichi target 1 in that interest in biodiversity increased widely, but not for conservation. We suggest that increased outreach and education efforts aimed at neglected aspects of biodiversity and conservation are still needed. Popular topics in biodiversity and conservation could be leveraged to increase awareness of other topics with attention to local socioeconomic contexts.

Evaluación del interés mundial en la biodiversidad y la conservación Resumen La primera meta del Convenio sobre la Diversidad Biológica (Meta 1 de Aichi) era aumentar la conciencia pública sobre los valores de la biodiversidad y las acciones necesarias para conservarla, un requisito previo clave para otras metas de conservación. Ha sido difícil monitorear el éxito en la obtención de esta meta a escala mundial; sin embargo, la creciente digitalización de la vida humana en las últimas décadas ha facilitado la medición de los intereses de la gente a una escala sin precedentes y permite una evaluación más exhaustiva de la Meta 1 de Aichi que la que se había intentado previamente. Utilizamos datos sobre el volumen de búsquedas en Google de más de mil términos relacionados con distintos aspectos de la biodiversidad y la conservación para evaluar el interés mundial en la biodiversidad y su conservación. También investigamos la correlación del interés por la biodiversidad y la conservación en los distintos países con variables relacionadas a la biodiversidad, la economía, la demografía, la investigación, la educación, el uso del internet y la presencia de organizaciones ambientalistas. Las búsquedas mundiales sobre los componentes de la biodiversidad aumentaron de 2013 a 2020, impulsadas sobre todo por búsquedas de especies carismática (el 59% de las búsquedas correspondían a especies de mamíferos). Las búsquedas de acciones de conservación, impulsadas principalmente por búsquedas de parques nacionales, han disminuido desde 2019, probablemente debido a la pandemia de COVID-19. La desigualdad económica se correlacionó negativamente con el interés en la biodiversidad y la conservación, mientras que el poder adquisitivo se correlacionó indirectamente de manera positiva con niveles más altos de educación e investigación. Nuestros resultados sugieren un éxito parcial en la obtención de la Meta 1 de Aichi en el sentido de que aumentó ampliamente el interés por la biodiversidad, pero no por la conservación. Sugerimos que se necesitan mayores esfuerzos de divulgación y educación dirigidos a aspectos desatendidos de la biodiversidad y la conservación. Los temas populares de biodiversidad y conservación podrían aprovecharse para aumentar la conciencia sobre otros temas si se presta atención a los contextos socioeconómicos locales.

How COVID-19 changed Italian consumers' behavior.

We investigate how the COVID-19 pandemic affected people's health-related choices and spending habits in Italy, the first European country to be heavily affected by the pandemic. We collected about 3000 questionnaires in May and June 2020 (that is, during the stabilization phase that followed the country's lockdown), asking questions taken from the "Survey tool and guidance: rapid, simple, flexible behavioural insights on COVID-19" issued by the World Health Organization (WHO), and correlated the responses with respondents' demographic and socioeconomic profiles. A principal component analysis (PCA) shows three main components that we label "Unusual behavior," "Precautionary spending," and "Augmented social distancing," which vary with demographic and socioeconomic characteristics.

Methodological limitations in studies assessing the effects of environmental and socioeconomic variables on the spread of COVID-19: a systematic review.

BACKGROUND: While numerous studies have assessed the effects of environmental (meteorological variables and air pollutants) and socioeconomic variables on the spread of the COVID-19 pandemic, many of them, however, have significant methodological limitations and errors that could call their results into question. Our main objective in this paper is to assess the methodological limitations in studies that evaluated the effects of environmental and socioeconomic variables on the spread of COVID-19. MAIN BODY: We carried out a systematic review by conducting searches in the online databases PubMed, Web of Science and Scopus up to December 31, 2020. We first excluded those studies that did not deal with SAR-CoV-2 or COVID-19, preprints, comments, opinion or purely narrative papers, reviews and systematic literature reviews. Among the eligible full-text articles, we then excluded articles that were purely descriptive and those that did not include any type of regression model. We evaluated the risk of bias in six domains: confounding bias, control for population, control of spatial and/or temporal dependence, control of non-linearities, measurement errors and statistical model. Of the 5631 abstracts initially identified, we were left with 132 studies on which to carry out the qualitative synthesis. Of the 132 eligible studies, we evaluated 63.64% of the studies as high risk of bias, 19.70% as moderate risk of bias and 16.67% as low risk of bias. CONCLUSIONS: All the studies we have reviewed, to a greater or lesser extent, have methodological limitations. These limitations prevent conclusions being drawn concerning the effects environmental (meteorological and air pollutants) and socioeconomic variables have had on COVID-19 outcomes. However, we dare to argue that the effects of these variables, if they exist, would be indirect, based on their relationship with social contact. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12302-021-00550-7.

Ambiente alimentar em São Leopoldo, Rio Grande do Sul, Brasil: associação com variáveis sociodemográficas da vizinhança / Food environment in São Leopoldo, Rio Grande do Sul, Brazil: the association with neighborhood sociodemographic variables

Resumo O objetivo deste estudo é descrever o ambiente alimentar de um município de médio porte do Sul do Brasil e relacionar a disponibilidade de diferentes tipos de comércios de alimentos com características socioeconômicas e demográficas do entorno. Trata-se de estudo ecológico em 45 buffers, de 400m, em São Leopoldo, Rio Grande do Sul. O buffer foi calculado a partir do centróide das residências das mulheres participantes de um projeto de pesquisa maior. Todas as ruas foram percorridas para a identificação dos estabelecimentos de alimentos, que tiveram suas coordenadas geográficas registradas, bem como foram avaliados, através do questionário NEMS (Nutrition Environment Measures Survey in Stores), sobre disponibilidade, preço e qualidade de 108 itens. Os comércios foram classificados em supermercados, mercearias, fruteiras e lojas de conveniência. Os supermercados e as mercearias estavam em maior número nos buffers de menor renda e mercearias mais presentes naqueles de maior tercil populacional. Observa-se relação direta entre escores do NEMS e tercil de renda para supermercados, mercearias e fruteiras e indireta para os mesmos comércios e tercil populacional. A disponibilidade de alimentos saudáveis se mostrou mais elevada em áreas de maior renda e menor número de habitantes, o que sinaliza a necessidade de melhor distribuição dos comércios e variedades de alimentos.

Abstract The scope of this study is to describe the food environment of a medium-sized municipality in southern Brazil and compare the availability of different types of food outlets in neighborhood socioeconomic and demographic environments. An ecological study was carried out in 45 buffers of 400m in São Leopoldo county, RS. The buffer was calculated from the center point of the residences of women participating in a larger research project. All streets were surveyed to identify food stores and record their geographical coordinates, as well as apply the NEMS questionnaire on the availability, price and quality of 108 items. The commercial outlets were classified as supermarkets, grocery stores, fruit stores and convenience stores. Supermarkets and grocery stores were present in higher quantity in lower income buffers and grocery stores were more prevalent in those with higher population tertiles. Another result was a direct relationship between NEMS and tertile income scores for supermarkets, grocery stores and fruit stores, and an indirect relationship for the same stores and population tertile. The availability of healthy food was higher in areas with higher income and lower numbers of inhabitants, indicating the need for better distribution of food stores and availability of varieties of food in the municipality.

Age of Natural Menopause Among Jordanian Women and Factors Related to Premature and Early Menopause.

OBJECTIVE: The aim of this study was to assess factors related to the onset of premature/early natural menopause among Jordanian women. METHODS: A cross-sectional study was conducted in early 2016. Subjects were enrolled based on random drop-off technique to the Obstetrics and Gynecology clinics at the Jordan University Hospital. Women 18 years of age and above were initially eligible to enroll, and women who had surgically induced menopause or specific disease were excluded from the analysis. Relevant data were collected using a questionnaire that included 30 questions. The following variables were collected: socio-demographic, body mass index, chronic conditions, diseases, reproductive characteristics, and health status. Hormone indicators of menopause were tested by measuring estrogen (E2) and follicle-stimulating hormone (FSH) levels. Age at natural menopause (ANM) was self-reported retrospectively and considered an independent variable against BMI, smoking, hormone therapy, and concomitant diseases. Association analysis and multinomial logistic regression were used to examine the associated factors of ANM with adjusted odds ratios (ORs), and their 95% confidence intervals (CIs) were reported. RESULTS: A total of 409 women were included in the analysis, aged between 20-75 years. The mean ANM in our sample was 48.5±5.0, with 2.7% of the women experienced premature menopause (ANM <40) and 7.8% early menopause (ANM 40-44). Within the menopause women (n=242), the percentage of women who had premature menopause was 4.5%, 13.6% with early menopause, and 21.1% with late menopause (ANM >52). Smoking was the major risk factor for premature/early menopausal age among Jordanian women with an OR of 2.46 (95% CI: 1.08-5.59, p<0.05). On the other hand, women with occasional arthritis symptoms and diseases such as hypertension, diabetes, dyslipidemia, and their combination were associated with average (45-52 years) or late menopause (>52 years). CONCLUSION: Smoking is the main contributor of premature/early menopause in Jordanian women. Increased awareness and public health policy about the adverse effects of smoking on women's reproductive health are needed.

Women's delay in presenting breast cancer symptoms in Kurdistan-Iraq.

BACKGROUND: Women in developing countries usually delay in presenting their symptoms as a part of the early diagnosis program. This study was conducted for analyzing the reason of patient's delay and its relation with socioeconomic and health conditions, knowledge, and women's belief about breast cancer (BC). METHODOLOGY: This study used a cross-sectional design in the early detection center in Kurdistan (North Iraq). Women were interviewed about socioeconomic and health background, knowledge, and belief about BC. RESULTS: The median of patient delay in the BC symptomatic women in this study was higher (30 days) as compared with developed countries. Patient delay was longer in women who were widows, had a barely self-perceived economic status, and had chronic diseases. There was a significant relationship of patient delay with women's health motivation and perceived barrier to seeking medical care. CONCLUSIONS: Health promotion program should emphasize on the women's motivation about early diagnosis and seeking to early detection.

Perfil epidemiológico de mortalidade por suicídio no Brasil entre 2006 e 2015 / Epidemiological profile of mortality by suicide in Brazil between 2006 and 2015

OBJETIVOS: Descrever o perfil sociodemográfico das vítimas de suicídio no Brasil entre 2006- 2015. MÉTODOS E MATERIAIS: Utilizaram-se dados do SIM e DATASUS. Analisaram-se incidências por raça/cor, escolaridade, faixa etária, de 2006-2015. Compararam-se variações na mortalidade por suicídio com mudanças regionais nos indicadores de características socioeconômicas e demográficas. RESULTADOS: As maiores causas de suicídio foram enforcamento, lesão por armas de fogo, autointoxicação por pesticidas. Os mais acometidos foram os menos escolarizados, adultos jovens (entre 20-39 anos) ou maiores de 60 anos. As taxas entre homens são 3,7 vezes maiores em todas as regiões. A mortalidade mais elevada se encontra na região Sudeste e o maior crescimento percentual, no Norte. CONSIDERAÇÕES FINAIS: A mortalidade por suicídio continua a crescer no país, com importantes variações regionais. O Brasil ainda carece de programas governamentais que trabalhem efetivamente na prevenção do suicídio.

OBJECTIVES: To describe the sociodemographic profile of suicide victims in Brazil between 2006-2015. METHODS AND MATERIALS: Data from SIM and DATASUS were used. Incidences by race / color, education, age range, from 2006-2015 were analyzed. Variations in suicide mortality were compared with regional changes in indicators of socioeconomic and demographic characteristics. RESULTS: The main causes of suicide were hanging, firearms injuries, self-poisoning by pesticides. The most affected were the least educated, young adults (between 20-39 years old) or over 60 years old. Rates among men are 3.7 times higher in all regions. The highest mortality is found in the Southeast and the highest percentage growth in the North. FINAL CONSIDERATIONS: Death by suicide continues to increase in the country, with important regional variations. Brazil still lacks government programs that work effectively in preventing suicide.

Determinants of environmental conservation in Lake Tana Biosphere Reserve, Ethiopia.

This study has investigated the factors that determine the conservation of one of the major ecosystem in Ethiopia, Lake Tana Biosphere Reserve, using primarily quantitative followed by qualitative approach to provide adequate results of the problem under study. The study has employed the descriptive design and a total of 305 samples from rural households (n = 159) and tourism-related enterprises (n = 146) were selected based on a stratified random sampling technique. Samples were drawn based on their direct attachment either in their livelihood and possess a responsibility to the study area. Data were collected through questionnaires, observation, focus group discussion, unstructured interview and secondary data was consulted. Exploratory factor analysis was used to extract dimensions for environmental awareness. Binary logistic regression was used to analyze data using SPSS version 23. Ten Socio-demographic variables of samples were used as an independent variable and environmental conservation dimensions as dependent variables. The result revealed that out of the 10 variables employed in the analysis, six variables were found significant. Hence, marital status, household size, income source, household income, membership to club and resident location were found to be significant. Qualitative analysis revealed wrong reports for political consumption driven little government attention and lack of integrated natural resource management policy and plan were major factors hindering conservation. A vivid and holistic destination management policy making with enough room to stakeholders' involvement shall be a prior task for the government for better conservation of the ecosystem and sustainable development.

Patients' understanding of health information in Germany.

Background: Patient-physician communication and textual health information are central to health care. Yet, how well patients understand their physicians and written materials is under-studied. Objectives: Focusing on outpatient health care in Germany, the aim of this research was to assess patients' levels of understanding oral and written health information and to identify associations with socioeconomic variables. Methods: This analysis drew on a 2017 health survey (n=6,105 adults 18 years of age and above). Measures for the quality of patient-physician communication were derived from the Ask Me 3 program questions for consultations with general practitioners (GPs) and specialists (SPs), and for textual health information via a question on the comprehensibility of written materials. Correlations with socioeconomic variables were explored using bivariate and multivariable logistic regression analyses. Results: Over 90% of all respondents reported that they had understood the GP's and SP's explanations. A lack of understanding was most notably correlated with patients' self-reported very poor health (odds ratio [OR]: 5.19; 95% confidence interval [CI]: 2.23-12.10), current health problem (OR: 6.54, CI: 1.70-25.12) and older age (65 years and above, OR: 2.97, CI: 1.10-8.00). Fewer patients reported that they understood written materials well (86.7% for last visit at GP, 89.7% for last visit at SP). Difficulties in understanding written materials were strongly correlated with basic education (OR: 4.20, CI: 2.76-6.39) and older age (65 years and above, OR: 2.66, CI: 1.43-4.96). Conclusions: In order to increase patients' understanding of health information and reduce inequalities among patient subgroups, meeting the communication needs of patients of older age, low educational status and with poor health is essential.

Twinning Rates in Uruguay Between 1999 and 2015: Association with Socioeconomic and Demographic Factors.

Twinning is rare among humans, but there is much variability among populations. Several studies show that certain demographic and socioeconomic factors, such as maternal age, mother's educational level and income, influence twinning rate. There is no background of analytical studies of twins in Uruguay. To the best of our knowledge, this is the first study that has focused on describing and analyzing Uruguayan twinning rates over a period of 17 years (1999-2015). The birth data were collected from the website of Uruguay's Ministry of Public Health. Economic data were obtained from Uruguay's Instituto Nacional de Estadísti's website for the period 2001-2013, since these variables are defined specifically for that period of time. The statistical software R (The R Project for Statistical Computing) was used. The twinning rate varied from 8.51 to 13 in the studied period. Montevideo has the highest median and the smallest variability in comparison with the other departments. In Uruguay (1999-2015), the highest twinning rate (28.94%) was observed in women aged 45 and older. The analysis also showed a relationship between twin birth rates and the mother's educational level. In three regions of the country (West, Center and East), twin births show a random pattern but in the other two (North and Metropolitan), there is an increasing trend in the number of twins over time. In conclusion, this study recognizes social, economic and demographic factors that influence in the rate of twin births in Uruguay.

GASTO EN ALIMENTOS ULTRAPROCESADOS Y RELACIÓN CON VARIABLES SOCIOECONÓMICAS EN LA REPÚBLICA ARGENTINA, 2012-2013 / EXPENDITURE ON ULTRAPROCESSED FOOD AND RELATIONSHIP WITH SOCIOECONOMIC VARIABLES IN THE ARGENTINE REPUBLIC, 2012-2013

la tendencia al consumo de alimentos ultraprocesados aumentó en Latinoamérica, y los factores sociales y económicos condicionan los hábitos alimentarios

the trend towards the consumption of ultraprocessed foods has increased in Latin America and the social and economic factors condition the eating habits

Organized screening programmes for breast and cervical cancer in 17 EU countries: trajectories of attendance rates.

BACKGROUND: The aim was to analyse participation trajectories in organised breast and cervical cancer screening programmes and the association between socioeconomic variables and participation. METHODS: A pooled, cross-sectional, time series analysis was used to evaluate secondary data from 17 European countries in 2004-2014. RESULTS: The results show that the mammographic screening trend decreases after an initial increase (coefficient for the linear term = 0.40; p = 0.210; 95% CI = - 0.25, 1.06; coefficient for the quadratic term = - 0.07; p = 0.027; 95% CI = - 0.14, - 0.01), while the cervical screening trend is essentially stable (coefficient for the linear term = 0.39, p = 0.312, 95% CI = - 0.42, 1.20; coefficient for the quadratic term = 0.02, p = 0.689, 95% CI = - 0.07, 0.10). There is a significant difference among the country-specific slopes for breast and cervical cancer screening (SD = 16.7, p < 0.001; SD = 14.4, p < 0.001, respectively). No association is found between participation rate and educational level, income, type of employment, unemployment and preventive expenditure. However, participation in cervical cancer screening is significantly associated with a higher proportion of younger women (≤ 49 years) and a higher Gini index (that is, higher income inequality). CONCLUSIONS: In conclusion three messages: organized cancer screening programmes may reduce the socioeconomic inequalities in younger people's use of preventive services over time; socioeconomic variables are not related to participation rates; these rates do not reach a level of stability in several countries. Therefore, without effective recruitment strategies and tailored organizations, screening participation may not achieve additional gains.

Socioeconomic, emotional, and physical execution variables as predictors of cognitive performance in a Spanish sample of middle-aged and older community-dwelling participants.

BACKGROUND: Cognitive performance is not easily predicted, since different variables play an important role in the manifestation of age-related declines. The objective of this study is to analyze the predictors of cognitive performance in a Spanish sample over 50 years from a multidimensional perspective, including socioeconomic, affective, and physical variables. Some of them are well-known predictors of cognition and others are emergent variables in the study of cognition. METHODS: The total sample, drawn from the "Longitudinal Study Aging in Spain (ELES)" project, consisted of 832 individuals without signs of cognitive impairment. Cognitive function was measured with tests evaluating episodic and working memory, visuomotor speed, fluency, and naming. Thirteen independent variables were selected as predictors belonging to socioeconomic, emotional, and physical execution areas. Multiple linear regressions, following the enter method, were calculated for each age group in order to study the influence of these variables in cognitive performance. RESULTS: Education is the variable which best predicts cognitive performance in the 50-59, 60-69, and 70-79 years old groups. In the 80+ group, the best predictor is objective economic status and education does not enter in the model. CONCLUSIONS: Age-related decline can be modified by the influence of educational and socioeconomic variables. In this context, it is relevant to take into account how easy is to modify certain variables, compared to others which depend on each person's life course.

Inferior outcomes for black children with high risk acute lymphoblastic leukemia and the impact of socioeconomic variables.

BACKGROUND: While significant improvements have been made for children with acute lymphoblastic leukemia (ALL) in the United States over the past 20 years, black patients continue to have inferior outcomes. The full impact of socioeconomic variables on outcomes in this minority population is not entirely understood. PROCEDURE: Disease characteristics, demographic, and socioeconomic status (SES) variables were collected on black (n = 44) and white (n = 178) patients diagnosed at the University of Alabama at Birmingham. Cox proportional hazard regression was used to evaluate the influence of SES and insurance status on survival. RESULTS: As a cohort, 5-year overall survival (OS) was 87% (82-91%), with a median follow-up of 99 months. In univariable analysis, black race was not significantly associated with a higher risk of death or relapse and death. White and black patients with standard-risk leukemia had excellent outcomes, with 97% (91-99%) and 96% (75-99%) 5-year OS, respectively. In contrast, for high-risk disease, white patients had a statistically significant improved 5-year OS rates compared with black patients (79% [68-87%] vs. 52% [28-72%]). Black children were more likely to have public insurance, and, in multivariable analysis, this was associated with a trend toward an improved outcome. Black patients also had poorer census tract-level SES parameters, but these variables were not associated with survival. CONCLUSION: Our study demonstrates significantly inferior outcomes for black children with high-risk leukemia. These outcome disparities were not related to SES variables, including poverty or private insurance coverage, suggesting the involvement of other factors and highlighting the need for a prospective investigative analysis.