Global neonatal perioperative mortality: A systematic review and meta-analysis.

STUDY OBJECTIVE: There are large differences in health care among countries. A higher perioperative mortality rate (POMR) in neonates than in older children and adults has been recognized worldwide. The aim of this study was to provide a systematic review of published 24-h and 30-day POMRs in neonates from 2011 to 2022 in countries with different Human Development Index (HDI) levels. DESIGN AND SETTING: A systematic review with a meta-analysis of studies that reported 24-h and 30-day POMRs in neonates was performed. We searched the databases from January 2011 to July 30, 2022. MEASUREMENTS: The POMRs (per 10,000 procedures under anesthesia) were analyzed according to country HDI. The HDI levels ranged from 0 to 1, representing the lowest and highest levels, respectively (very-high-HDI: ≥ 0.800, high-HDI: 0.700-0.799, medium-HDI: 0.550-0.699, and low-HDI: < 0.550). The magnitude of the POMRs by country HDI was studied using meta-analysis. MAIN RESULTS: Eighteen studies from 45 countries were included. The 24-h (n = 96 deaths) and 30-day (n = 459 deaths) POMRs were analyzed from 33,729 anesthetic procedures. The odds ratios (ORs) of the 24-h POMR in low-HDI countries were higher than those in very-high- (OR 8.4, 95% CI 1.7-40.4; p = 0.008), high- (OR 7.3, 95% CI 2.2-24.4; p = 0.001) and medium-HDI countries (OR 7.7, 95% CI 3.1-18.7; p < 0.0001) but with no odds differences between very-high- and high-HDI countries (p = 0.879), very-high- and medium-HDI countries (p = 0.915) and high- and medium-HDI countries (p = 0.689). The odds of a 30-day POMR in low-HDI countries were higher than those in very-high-HDI countries (OR 6.9, 95% CI 1.9-24.6; p = 0.002) but not in high-HDI countries (OR 1.4, 95% CI 0.6-3.0; p = 0.396). CONCLUSIONS: The review demonstrated very high global POMRs in a surgical population of neonates independent of the country HDI level. We identified differences in 24-h and 30-day POMRs between low-HDI countries and other countries with higher HDI levels.

Utilization of a public subsidy scheme for dental care services among socially vulnerable citizens out of labor in Copenhagen, Denmark.

OBJECTIVE: Addressing social inequality in oral health and access to dental care is a global concern. This study aims to describe the utilization of a public subsidy scheme targeting vulnerable individuals out of labor in Copenhagen municipality (2013-2018) and to identify key characteristics of individuals eligible to apply. MATERIAL AND METHODS: Data from Copenhagen municipality were combined with data from population and health registers. Employing logistic regression analyses, we examined the association between demographic, socioeconomic, and health-related characteristics and (1) having applied, (2) being granted, and (3) using the subsidy. RESULTS: The study included 65,174 individuals aged 18-65. Of these 10,369 (15.9%) applied for subsidies, submitting a total of 18,529 applications. Overall, 83% of the applications were granted and 85% were used. Significantly increased odds of applying for subsidies were observed among individuals receiving social benefits non-stop over the past year versus none (odds ratio [OR] = 15.45, 95% confidence interval [CI] = 14.24-16.76), aged 50-65 versus 18-29 years (OR = 4.41, CI = 4.15-4.69), and having combined indicators of social vulnerability versus none (OR = 2.90, CI = 2.73-3.07). CONCLUSIONS: While the utilization of the public subsidy scheme is low, individuals who apply are likely to be granted a subsidy and use it. Vulnerability was associated with greater utilization of the scheme, yet a substantial portion of those at risk of poor oral health did not take advantage of it.

Unpacking the Impact of Early Adverse Childhood Experiences on Early Onset of Sexual Intercourse Among an Urban Birth Cohort of Early Adolescents.

PURPOSE: Early adverse childhood experiences (ACEs) predict early onset of sexual intercourse. However, patterns of ACEs identified using latent class analysis (LCA) and their links to early sexual intercourse have been less examined. In this study, we apply LCA to identify ACEs profiles at age five and to examine whether these profiles differentially predict adolescents' sexual initiation. METHODS: We analyzed data obtained from the Future of Families and Child Wellbeing Study for 3,185 participants (male = 1,638; female = 1,547). This included parental/caregivers' reports of 10 types of ACEs when participants were on average at age five and youth self-report data on sexual intercourse before or at age 15. We used LCA to classify the participants into subgroups and multinomial logistic regressions to examine differences in early sexual initiation among the ACEs subgroups. RESULTS: LCA showed evidence of four classes for both genders: low adversity (51.8%), socioeconomic adversity (32.0%), family dysfunction (12.0%), and abuse (4.2%). We found class membership differences in early sexual intercourse in all three adversity classes compared to the low adversity group. Pairwise comparison tests further revealed that adolescents in the family dysfunction class had lesser odds of engaging in early sexual intercourse than their counterparts in the socioeconomic adversity and abuse classes. DISCUSSION: Our findings suggest that LCA could help identify meaningful and distinctive child adversity patterns while accounting for the co-occurrence of ACEs. This is particularly helpful in evaluating who might be at greatest health risk which can further inform more effective and targeted interventions.

Usual nutrient intakes and diet quality among United States older adults participating in the Supplemental Nutrition Assistance Program compared with income-eligible nonparticipants.

BACKGROUND: The proportion of older adults with food insecurity at 8% has increased faster than that of the general United States population from 2001 to 2017. Many low-income food-insecure older adults rely on food-assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP), for meeting energy and nutrient needs, whereas others are eligible but do not participate. Neither updated nutrient intake estimates nor potential differences in meeting the Dietary Reference Intakes from foods alone and with dietary supplements (DS) among low-income older adults using or eligible for SNAP are known. OBJECTIVES: This study assessed and compared national estimates of usual nutrient adequacy and dietary quality of United States older adults using SNAP and income-eligible nonparticipants. METHODS: Usual dietary intake was estimated among older adults (≥60 y; n = 2582) in the 2007-2016 NHANES cross-sectional national survey. Data on food-assistance participation and eligibility (poverty-income-ratio ≤130%), DS use, and ≥24-h dietary recalls were used. The NCI method (Markov Chain Monte Carlo approach) was applied to estimate mean usual nutrient intakes, proportion of inadequate nutrient intake, and dietary quality using the 2015 Healthy Eating Index. RESULTS: Neither usual nutrient intake from dietary and total sources nor dietary quality differed between older adult SNAP participants and eligible nonparticipants. Low dietary quality and high percentage of inadequate intake for several nutrients were apparent among both groups, especially from food sources alone, including vitamins A (56%), C (55%), D (97%), E (99%), calcium (73%), and magnesium (74%), but rates were attenuated when DS were also considered (i.e., 36% reduced risk for vitamin D inadequacy). CONCLUSIONS: Diet quality and usual nutrient intake among older adult SNAP participants and eligible nonparticipants were poor, but DS lowered the risk of nutrient inadequacy. Future policies and programs should focus on improving the intake of vitamins A, C, D, E, calcium, and magnesium and dietary quality for all older adults.

Home Visitation Program Staff Attitudes and Intentions Towards Using Digital Technology to Educate Families About Preventing Early Childhood Obesity: A Qualitative Study.

INTRODUCTION: Home visitation programs that reach families of young children offer a unique opportunity for large-scale early childhood obesity prevention efforts. The objective of this qualitative research was to determine stakeholder attitudes, subjective norms, perceived ease of use and usefulness, behavioral control, and behavioral intentions towards utilizing technology in a home visitation program targeting early childhood obesity prevention. METHODS: Staff from the Florida Maternal, Infant, and Early Childhood Home Visiting Program (n = 27) were interviewed individually by a trained research assistant using a semi-structured script based on constructs from the Technology Acceptance Model and Theory of Planned Behavior. Demographic and technology use information were collected. Interviews were recorded and transcribed verbatim, with data extracted and coded by two trained researchers using a theoretical thematic analysis approach. RESULTS: Most of the home visiting staff (78%) were white and non-Hispanic and employed for an average of 5 years with the program. Most staff (85%) indicated they were currently using videoconferencing for home visits. Themes and subthemes emerged, including positive attitudes towards technology as a flexible and time-efficient program alternative for childhood obesity prevention with recommendations to keep content short, at a low literacy level, and available in more than one language for ease of use. Participants recommended developing training tutorials to improve program implementation. Internet access and potential social disconnect were cited as concerns for using technology. DISCUSSION: Overall, home visitation staff had positive attitudes and intentions for using technology in home visiting programs with families for early childhood obesity prevention.

Impacts and Identification of Hearing Aid Refurbishing Programs for People with Hearing Loss: A Scoping Review.

This article consists of a scoping review completed to describe the impacts of refurbished hearing aids (HAs) for people with hearing loss, and to identify existing HA refurbishing programs around the world. In this review, JBI methodological guidance for scoping reviews was followed. All types of sources of evidence were considered. Thirty-six sources of evidence were included, 11 articles and 25 web pages. Results suggest that refurbished HAs may improve communication and social participation for individuals with hearing loss and provide monetary savings to them and to governmental agencies. Twenty-five HA refurbishing programs were identified, all based in developed countries and distributing refurbished HAs mostly locally, but also in developing countries. Issues related to refurbished HAs were highlighted, such as potential cross-contamination, quick obsolescence, and repairing problems. Some facilitators for the success of this intervention are to offer accessible and affordable follow-up services, repairs, and batteries, and to ensure awareness and participation of hearing healthcare professionals and citizens with hearing loss. In conclusion, the use of refurbished HAs appears to be a valuable option for low-income people with hearing loss, but it should be included in a more global intervention program to ensure its sustainability.

Clinical and biological profile of Sickle Cell Anemia children in a rural area in Central Africa.

BACKGROUND: Sickle Cell Anemia (SCA) is the most common genetic disease worldwide caused by a single mutation in the gene HBB. The disease severity is very variable and depends on many factors. We evaluated the clinical and biological profile of sickle cell anemia children in rural Central Africa. METHODS: This cross-sectional study was conducted in the Hôpital Saint Luc de Kisantu, located 120 km away from Kinshasa-DR Congo in an area of 35 km around Kisantu with a population of roughly 80 000 individuals. We included SCA patients aged 6 months to 18 years. We collected clinical and hematological data. The SCA scoring system proposed by Adegoke et al. in 2013 was applied to determine the disease severity. We searched for factors associated to the disease severity. RESULTS: This study included 136 patients, 66 males and 70 females (sex-ratio M/F 0.94). The mean severity score was 8.21 ± 5.30 (ranges 0-23). Fifty-nine (43.4%) children had mild disease, 62 (45.6%) moderate and 15 (11%) severe disease. Girls had higher levels of HbF than boys (p = 0.003). An inverse correlation was observed between fetal hemoglobin and the disease severity (p = 0.005, r -0.239, IC95% -6.139; -1.469). Some factors such age influence the occurrence of certain chronic complications such as avascular bone necrosis. CONCLUSION: In conclusion, the disease severity of SCA depends on multiple factors. In this study, fetal hemoglobin was the main modulator of the disease severity. These data may also serve as a baseline to initiate HU treatment in this setting.

Food security and diet quality among urban poor adolescents in Kuala Lumpur, Malaysia.

BACKGROUND/OBJECTIVES: This study aimed to examine the food security status of urban poor adolescents and its association with diet quality. SUBJECTS/METHODS: A cross-sectional survey was conducted among 188 adolescents aged 13-18 yrs living in Kuala Lumpur, Malaysia. Household food insecurity and dietary intake data were collected using the Radimer/Cornell hunger and food insecurity instrument and 2-day 24-h dietary recalls, respectively. Diet quality was determined using the Malaysian Healthy Eating Index (HEI). Weight and height were measured and body mass index-for-age, as well as height-for-age z scores were calculated. RESULTS: The present study revealed that 47.9% of the adolescents experienced household food insecurity, 24.5% experienced individual food insecurity, 18.6% household food security, and 9.0% child hunger. The mean score of diet quality was 56.83 ± 10.09, with a significantly lower HEI score among food insecure adolescents (household food insecure, individual food insecure, and child hunger) than household food secure adolescents (P = 0.001). The differences between food secure and food insecure households were found to be significant for energy (P = 0.001) and nutrients including proteins (P = 0.006), carbohydrates (P = 0.005), dietary fiber (P = 0.001), folate (P < 0.001), and vitamin C (P = 0.006). The multiple linear regression showed that adolescents who experienced food insecurity (ß = -0.328; P = 0.003) were found to be significantly associated with poor diet quality (F = 2.726; P < 0.01), wherein 13.3% of the variation in the diet quality was explained by the food security status. CONCLUSIONS: Experiencing food insecurity contributed to poor diet quality among urban poor adolescents. Further longitudinal studies are needed to comprehensively understand this association to improve food insecurity and diet quality among urban poor communities.

BabyByte: Qualitative Research to Inform the Development of an App to Improve Responsive Feeding Practices in Parents of Infants and Toddlers.

Responsive feeding is associated with a reduced risk of childhood obesity. The objective of this qualitative study was to determine parental preferences for mobile health (mHealth) app content and features designed to improve responsive feeding practices. Parents of 0-2-year-old children were interviewed individually. Interview questions were informed by the Technology Acceptance Model, and parents provided feedback on sample app content and features. Interviews were audio-recorded, transcribed verbatim, and coded by two researchers using thematic analysis; responses were compared by parent gender and income. Parents (n = 20 fathers, n = 20 mothers) were, on average, 33 years old, low-income (50%), identified as non-white (52.5%), and had a bachelor's degree or higher (62%). Overall, parents were most interested in feeding tips and recipe content, and app features that allowed tracking child growth and setting feeding goals. Fathers were most interested in content about first foods, choking hazards, and nutrition information, while mothers preferred content on breastfeeding, picky eating, and portion sizes. Parents with lower incomes were interested in nutrition guidelines, breastfeeding, and introducing solids. Non-low-income parents preferred information related to food allergies, portion sizes, and picky eating. The findings of this study provide considerations when developing mHealth apps to improve responsive feeding practices in parents.

Oral Health Workforce in Africa: A Scarce Resource.

The World Health Organization (WHO) African Region (AFR) has 47 countries. The aim of this research was to review the oral health workforce (OHWF) comprising dentists, dental assistants and therapists, and dental prosthetic technicians in the AFR. OHWF data from a survey of all 47 member states were triangulated with the National Health Workforce Accounts and population data. Descriptive analysis of workforce trends and densities per 10,000 population from 2000 to 2019 was performed, and perceived workforce challenges/possible solutions were suggested. Linear regression modelling used the Human Development Index (HDI), years of schooling, dental schools, and levels of urbanization as predictors of dentist density. Despite a growth of 63.6% since 2010, the current workforce density of dentists (per 10,000 population) in the AFR remains very low at 0.44, with marked intra-regional inequity (Seychelles, 4.297; South Sudan 0.003). The stock of dentists just exceeds that of dental assistants/therapists (1:0.91). Workforce density of dentists and the OHWF overall was strongly associated with the HDI and mean years of schooling. The dominant perceived challenge was identified as 'mal-distribution of the workforce (urban/rural)' and 'oral health' being 'considered low priority'. Action to 'strengthen oral health policy' and provide 'incentives to work in underserved areas' were considered important solutions in the region. Whilst utilising workforce skill mix contributes to overall capacity, there is a stark deficit of human resources for oral health in the AFR. There is an urgent need to strengthen policy, health, and education systems to expand the OHWF using innovative workforce models to meet the needs of this region and achieve Universal Health Coverage (UHC).

The Determinants of Food Insecurity Among Hispanic/Latinx Households With Young Children: A Narrative Review.

Food insecurity has disproportionately impacted Hispanic/Latinx households in the United States, specifically those with young children. Although the literature provides evidence of an association between food insecurity and adverse health outcomes in young children, minimal research has addressed the social determinants and related risk factors associated with food insecurity among Hispanic/Latinx households with children under three, a highly vulnerable population. Using the Socio-Ecological Model (SEM) as a framework, this narrative review identified factors associated with food insecurity among Hispanic/Latinx households with children under three. A literature search was conducted using PubMed and four additional search engines. Inclusion criteria consisted of articles published in English from November 1996 to May 2022 that examined food insecurity among Hispanic/Latinx households with children under three. Articles were excluded if conducted in settings other than the US and/or focused on refugees and temporary migrant workers. Data were extracted (i.e., objective, setting, population, study design, measures of food insecurity, results) from the final articles (n = 27). The strength of each article's evidence was also evaluated. Results identified individual factors (i.e., intergenerational poverty, education, acculturation, language, etc.), interpersonal factors (i.e., household composition, social support, cultural customs), organizational factors (i.e., interagency collaboration, organizational rules), community factors (i.e., food environment, stigma, etc.), and public policy/societal factors (i.e., nutrition assistance programs, benefit cliffs, etc.) associated with a food security status of this population. Overall, most articles were classified as "medium" or higher quality for the strength of evidence, and more frequently focused on individual or policy factors. Findings indicate the need for more research to include a focus on public policy/society factors, as well as on multiple levels of the SEM with considerations of how individual and policy levels intersect and to create or adapt nutrition-related and culturally appropriate interventions to improve food security of Hispanic/Latinx households with young children.

Evaluating Johnson and Johnson COVID-19 Vaccination Outcomes in a Low-Income Hispanic Population.

BACKGROUND: A pilot study was performed at a low-income emergency care clinic to assess the humoral immune response to the Johnson & Johnson (J&J) COVID-19 vaccine (Ad26.COV2.S) to better understand how to evaluate the COVID-19 health status of its Hispanic patient population following vaccination. METHODS: This study used the Clungene® SARS-CoV-2 IgG/IgM Rapid Test Cassette to determine the presence of binding antibodies resulting from the J&J COVID-19 vaccine. The Clungene test principle is based on the receptor-binding domain (RBD) of the spike protein. Antibodies targeting the spike protein are considered an appropriate measure of humoral response from spike-based vaccines. RESULTS: The study confirmed previous research that antibodies wane over time, and results are consistent with reported vaccine efficacy. There was a statistically significant relationship between the humoral immune response and demographic and health status variables. CONCLUSIONS: COVID-19 negative patients can be easily and efficiently monitored to determine the success and durability of COVID-19 vaccines in low-income minority populations. The use of simple low-cost spike targeted COVID-19 antibody lateral flow devices may serve as a useful adjunct to assist community-based physicians on the COVID-19 health status of its patients. Further research is needed to confirm the utility of this approach.

Social Capital and Sleep Outcomes Across Childhood in United States Families.

OBJECTIVE: To examine whether aspects of social capital, or benefits received from social relationships, are associated with regular bedtime and sleep duration across childhood in US families with lower income. METHODS: Cross-sectional study using the 2018-19 National Survey of Children's Health in participants with incomes <400% federal poverty level. Separately for early childhood (0-5 years), school-age (6-12 years), and adolescence (13-17 years), we used weighted logistic regression to examine associations between social capital (measured by family social cohesion, parent social support, child social support) and sleep (measured by regular bedtime, sleep duration, adequate sleep per American of Academy of Sleep guidelines). Path analysis tested whether regular bedtime mediated associations between social capital and sleep duration. RESULTS: In our sample (N = 35,438), 84.9% had a regular bedtime, 60.2% had adequate sleep. Family social cohesion was associated with sleep duration and adequate sleep (infancy: adjusted odds ratio [aOR] 2.18 [95% confidence interval [CI], 1.32, 3.60]; school age: aOR 2.03 [95% CI, 1.57, 2.63]; adolescence: aOR 2.44 [95% CI, 1.94, 3.09]). In toddlerhood, parent social support was associated with adequate sleep (aOR 1.44 [95% CI, 1.06, 1.96]). In adolescence, child social support was associated with regular bedtime (aOR 1.70 [95% CI, 1.25, 2.32]. Across childhood, associations between family social cohesion and sleep duration were partially mediated by regular bedtime. CONCLUSIONS: Family social cohesion was associated with adequate sleep across childhood, this was partially mediated by regular bedtime. Associations between social support and sleep outcomes varied by development stage. Future work should consider how supportive relationships may influence child sleep outcomes.

An exploration of financial toxicity among low-income patients with cancer in Central Texas: A mixed methods analysis.

OBJECTIVE: Financial toxicity is of increasing concern in the United States. The Comprehensive Score for Financial Toxicity (COST) is a validated measure; however, it has not been widely utilized among low-income patients and may not fully capture financial toxicity in this population. Furthermore, the relationships between financial toxicity, quality of life (QOL), and patient well-being are poorly understood. We describe the experience of financial toxicity among low-income adults receiving cancer care. We hypothesized that higher financial toxicity would be associated with less income and lower quality of life. Qualitative interviews focused on the financial impact of cancer treatment. METHOD: This study was conducted at a cancer clinic in Central Texas. Quantitative and qualitative data were collected in Fall and Spring 2018, respectively. The quantitative sample (N = 115) was dichotomized by annual income (<$15,000 vs. >$15,000). Outcomes included financial toxicity (COST), quality of life (FACT-G), and patient well-being (PROMIS measures: Anxiety, Depression, Fatigue, Pain Interference, and Physical Function). Associations between quality of life, patient well-being, and financial toxicity were evaluated using linear regression. Sequential qualitative interviews were conducted with a subsample of 12 participants. RESULTS: Patients with <$15k had significantly lower levels of QOL and patient well-being such as depression and anxiety compared to patients with >$15k across multiple measures. A multivariate linear regression found QOL (Β = 0.17, 95% CI = 0.05, 0.29, p = 0.008) and insurance status (Β = -3.79, 95% CI = -7.42, -0.16, p = 0.04), but not income, were significantly associated with financial toxicity. Three qualitative themes regarding patient's access to cancer care were identified: obtaining healthcare coverage, maintaining financial stability, and receiving social support. SIGNIFICANCE OF RESULTS: Low-income patients with cancer face unique access barriers and are at risk for forgoing treatment or increased symptom burdens. Comprehensive assessment and financial navigation may improve access to care, symptom management, and reduce strain on social support systems.

Association between Socio-demographic Factors, Involvement Status in Gardening and Diet Quality among B40 Households in Taman Keramat, Kuala Lumpur

@#Introduction: COVID-19 pandemic has impacted the livelihood of Malaysians and gardening activities have contributed positively to the diet quality. This study aimed to determine the factors associated with diet quality among adults in AU2 Keramat, Kuala Lumpur. Methods: The cross-sectional study involved adults aged 18 to 59 via convenience sampling. The socio-demographic, physical activity level and involvement status in gardening were obtained through a questionnaire, while food intake was from a single-day 24-hour diet recall. The diet quality was determined through Malaysian Healthy Eating Index (MHEI) and dietary misreporting was calculated using the Goldberg cut-off method. Results: A total of 117 respondents (65.8% females, 35.2% males) with a mean age of 40.98 were involved in this study. Findings showed that most respondents did not engage in gardening activities (72.6%) and the prevalence of poor diet quality in this study was 89.7%, with a mean score of 44.51. The older respondents (r= 0.20, p= 0.034) and community gardeners (t= -2.63, p= 0.011) had a significantly higher diet quality but not home gardeners (t= 0.12, p= 0.902). The respondents involved in gardening activity also had a significantly higher fruit serving intake, Mann-Whitney U= 1045.00, p= 0.036) and lower total fat intake (t= 2.27, p= 0.025). Conclusion: The diet quality of the respondents remains poor but community gardeners had significantly higher diet quality and fruit intake while lower total fat intake. Interventions need to be developed to address the persistent poor diet quality of adults in the community.

Caregivers' Perceived Impact of WIC's Temporary Cash-Value Benefit (CVB) Increases on Fruit and Vegetable Purchasing, Consumption, and Access in Massachusetts.

Responding to the COVID-19 pandemic, the American Rescue Plan (2021) allowed state agencies of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) the option of temporarily increasing the Cash-Value Benefit (CVB) for fruit and vegetable (FV) purchases. To examine the impact of this enhancement on WIC caregiver experience, the MA WIC State Office invited 4600 randomly selected MA WIC caregivers to complete an online survey (February-March 2022). Eligible adults had at least one child, had been enrolled at least a year, and were aware of the increase. Of those who opened the screener (n = 545), 58.9% completed it (n = 321). We calculated the frequencies of reporting increased FV outcomes and tested whether responses differed by race/ethnicity, market access, and food security. Most caregivers perceived the CVB increase to benefit FV purchasing (amount and quality, 71.0% and 55.5%), FV consumption (offered to children and personally consumed, 70.1% and 63.2%), and satisfaction with the WIC food package (37.1% reported improved satisfaction, pre- vs. post-increase). Probability of reporting improved outcomes was not found to differ by race/ethnicity, market access, or food security. CVB increases may pose important implications for dietary behaviors and satisfaction with WIC. Policymakers should consider making this increase permanent.

The role of socio-demographic and health factors during COVID-19 in remote access to GP care in low-income neighbourhoods: a cross-sectional survey of GP patients.

OBJECTIVES: Remote consultations were common in general practice during the COVID-19 pandemic. This approach may have affected access to GP care for people with low socio-economic status: this group has a high prevalence of chronic conditions and a higher mortality rate due to COVID-19. This study explores the association of sociodemographic and health factors with the decision to contact a GP practice, and care utilisation, among patients in low-income neighbourhoods in the Netherlands. DESIGN: Cross-sectional survey study. SETTING: General practice in low-income neighbourhoods in the Netherlands. PARTICIPANTS: Patients from low-income neighbourhoods were selected from fourteen general practices on the basis of ethnic background, chronic disease or health literacy. Participants were stratified according to categories of these background characteristics to obtain equal numbers per category. A total of 213 surveys were retained for analysis. MAIN OUTCOME MEASURES: Need for GP contact, decision to contact a GP practice, and GP service utilisation. RESULTS: Forty-five percent (N = 88) of the participants experienced health problems for which they wished to consult their GP at the start of the outbreak of COVID-19. A majority of them (81%) had contact with a GP service. The need to contact the GP was significantly associated with financial difficulties (OR 2.20 CI (1.10 to 4.39)). An interaction effect was found of health literacy with concerns about COVID-19 with in respondents with low health literacy a significant association between concerns about COVID-19 and a need for a GP appointment (OR 5.33 CI (2.09 to 13.59)) and absence of a significant association in the higher health literacy group (OR 1.14 CI (0.51 to 2.56)) . Moreover, 56% (N = 74) of the participants received remote care at least one time during the first wave of COVID-19. Female participants used remote care more often (OR 3.22 CI (1.57 to 6.59)) and participants aged 50 and over used remote care less often (OR 0.46 CI (0.21 to 0.97)). CONCLUSION: Many patients in low-income neighbourhoods were able to consult a GP, often remotely. However from the equity perspective, access to GP care should be safeguarded for patients with health problems, financial difficulties and low health literacy because of their greater need to consult a GP during times of crisis.

A retrospective analysis of pain changes and opioid use patterns temporally associated with a course of chiropractic care at a publicly funded inner-city facility.

Background: Non-pharmacologic treatment, including chiropractic care, is now recommended instead of opioid prescriptions as the initial management of chronic spine pain by clinical practice guidelines. Chiropractic care, commonly including spinal manipulation, has been temporally associated with reduced opioid prescription in veterans with spine pain. Purpose: To determine if chiropractic management including spinal manipulation was associated with decreased pain or opioid usage in financially disadvantaged individuals utilizing opioid medications and diagnosed with musculoskeletal conditions. Methods: A retrospective analysis of quality assurance data from a publicly funded healthcare facility was conducted. Measures included numeric pain scores of spine and extremity regions across three time points, opioid utilization, demographics, and care modalities. Results: Pain and opioid use significantly decreased concomitant with a course of chiropractic care. Conclusions: A publicly funded course of chiropractic care temporally coincided with statistically and clinically significant decreases in pain and opioid usage in a financially disadvantaged inner-city population.

Contexte: Conformément aux directives de pratique clinique, un traitement non pharmacologique, notamment des soins chiropratiques, à la place de prescriptions d'opioïdes est désormais recommandé dans le traitement initial de la douleur chronique à la colonne vertébrale. Les soins chiropratiques, qui comprennent habituellement la manipulation vertébrale, ont été liés de manière provisoire à une consommation réduite d'opioïdes sur ordonnance chez les vétérans souffrant de douleurs à la colonne vertébrale. Objectif: Déterminer si un traitement chiropratique, y compris la manipulation vertébrale, était lié à une diminution de la douleur ou de la consommation d'opioïdes chez les personnes défavorisées sur le plan financier utilisant des médicaments à base d'opioïdes et souffrant de problèmes musculosquelettiques. Méthodologie: Une analyse rétrospective des données sur l'assurance de la qualité provenant d'un établissement de soins de santé financé par l'État a été menée. Les mesures portaient sur des résultats numériques de la douleur à la colonne vertébrale et des extrémités des membres à trois moments différents, la consommation d'opioïdes, des données démographiques et les modes de soins. Résultats: La douleur et la consommation d'opioïdes ont sensiblement diminué dans le cadre de soins chiropratiques. Conclusions: Une diminution importante de la douleur et de la consommation d'opioïdes observée de façon statistique et clinique a coïncidé de manière provisoire avec des soins chiropratiques financés par l'État dans un groupe de personnes défavorisées sur le plan financier vivant au centre-ville.

Motor development in the first year of life predicts impairments in cognition and language at 3 years old in a Brazilian preterm cohort of low-income families.

Purpose: Early identification of impairments is crucial to providing better care for preterm children, especially those from low-income families. The early motor assessment is the first step in monitoring their neurodevelopment. This study investigates if motor development in the first year of life predicts impairments in cognition and language at 3-year-old in a Brazilian preterm cohort. Materials and methods: Data were collected in a follow-up clinic for high-risk infants. The Bayley Scales were used to assess children at 4, 8, 12, and 36 months of age, considering composite scores. Cognitive and language impairments were considered if scores were ≤85. Children (N = 70) were assessed at 4 and 36 months, 79 were assessed at 8 and 36 months, and 80 were assessed at 12 and 36 months. Logistic regressions were used to analyze the predictability of cognitive and language impairments, and receiver-operating characteristics (ROC) curves were used to analyze the sensibility and specificity of motor assessment and cognitive and language impairments. Results: Poor motor scores at 8 and 12 months increased the chances of cognitive and language impairment at 3-year-old. The chance of cognitive impairment at 3-year-old increases by 6-7% for each point that the motor composite score decreases, and the chance of language impairment at 3-year-old increases by 4-5% for each point that the motor composite score decreases. No-significant results were found at 4-months. Adequate sensibility and specificity were found for language impairments considering 12 months scores and for cognitive impairments as soon as 8 months scores. Conclusion: Monitoring preterm motor development in the first year of life helps to identify preterm children at risk for impairment in other developmental domains. Since preterm children from low-income families tend to demonstrate poorer neurodevelopment outcomes, these children need early assessment and referral to intervention to prevent school failures and support from public policies.