Oral health behavior of pregnant women in Nigeria: a scoping review.

BACKGROUND: Oral health care behaviors during pregnancy affects maternal and child health outcomes. This scoping review sought to map the existing literature on the oral healthcare behaviors of pregnant women in Nigeria. METHODS: PubMed, Science Direct, Web of Science, EBSCOHOST, Sabinet, African Index Medicus, and Scopus data based were searched in August 2023. Articles with reports on the oral health behavior of pregnant women in Nigeria, published in English in peer review were included in the review. Articles whose full lengths could not be accessed, and commentaries on studies, and letters to the editor were also excluded. Data on authors and year of publication of the study, study location, study objective, study design, methodological approach for data collection, and study outcomes were extracted and descriptively synthesized. RESULTS: The search yielded a total of 595 articles of which 573 were unique. Only 21 articles were left after titles and abstracts screening and only 18 articles met the eligibility criteria. The proportion of pregnant women had utilized dental services ranged from 4 to 62.9%, the use of toothbrush and toothpaste ranged from 59.6 to 99.3%, twice daily tooth brushing ranged from 5.2 to 66.9%, and the use of toothbrush among pregnant women in the studies varies from 70.9 to 100%. Chewing stick was used by 0.1-27.7% of study participants. Dental problems such as caries, pain, swollen gums, and excessive salivation were reasons for seeking dental care. We identified individual, structural, and behavioral factors, including myths as barriers for dental service utilization. CONCLUSION: This scoping review shows that dental service utilization by pregnant women in Nigeria is poor and mainly due to curative than preventive needs. Oral health behaviours also need to be improved through tailored oral health education accessible to pregnant women in Nigeria.

A Narrative Review of the Current Research in Cancer-Related Pain Inequities: The Necessity of Applying Intersectionality to Advance Cancer Pain Research.

Cancer-related pain has a significant impact on quality of life for patients with cancer. In populations without cancer, there are documented pain inequities associated with minoritized racial and/or ethnic groups, women, and low socioeconomic status. However, our understanding of pain inequities specifically among patients with cancer remains incomplete. We narratively synthesized published quantitative research on cancer-related pain inequities in the US in the past decade. A search identified 17 English-language articles examining pain for patients with various cancer types at different treatment stages. Our review revealed mixed findings comparing cancer-related pain by racial group (e.g., Black vs White) and sex (male vs female), but consistent findings indicating that people with lower (vs higher) socioeconomic status and younger (vs older) patients report more cancer-related pain. Research on cancer pain among sexual and gender minorities remains scant. Key research gaps include a need for more research that incorporates an intersectional perspective by exploring intersecting subgroups and measuring social and structural processes that drive pain inequities. These findings underscore an important need for researchers to use an intersectional approach to cancer pain to help elucidate key populations at-risk for exacerbated cancer-related pain and identify ways to mitigate social and structural processes that drive these inequities.

There are known differences in pain experiences among people from different racial or ethnic groups, sex (male or female) or gender (men or women), and socioeconomic groups such as low income people. However, we don't fully understand these differences among cancer patients yet. This review looks at the past 10 years of research on how cancer-related pain may differ for people from different sociodemographic groups. We collected information from 17 studies in the US that looked at how pain from different types of cancer and different stages of treatment may differ for people from these different groups. We found mixed results when comparing pain between racial groups and sex and/or gender groups, but consistently found that people with lower incomes and younger patients reported more pain. There's not much research on how cancer pain affects sexual and gender minorities (LGBTQ+ people). Our review suggests that we need an intersectional approach to best understand cancer-related pain in order to best address how structural discrimination influences pain. Researchers should use an intersectional perspective, which will help us find out who's most at risk of severe cancer pain and find ways to help them better.

Age, period, cohort effects in trends of depressive symptoms among middle-aged and older Chinese adults.

Objectives: To investigate the effects of age, period, and cohort on the trends of depression; and to examine the influence of these three temporal effects on residential disparities in depression. Methods: Using data from the China Health and Retirement Longitudinal Study (CHARLS) during 2011 to 2020, involving 77,703 respondents aged 45 years old and above. The measurement of depressive symptoms was the score of 10-question version of the Center for Epidemiologic Studies Depression Scale (CES-D 10). The hierarchical age-period-cohort cross-classified random effects models were conducted to examine trends in depressive symptoms related to age, period and cohort. Results: CES-D scores increased with age and slightly decreased at older age. The cohort trends mostly increased except for a downward trend among those born in 1950s. As for the period effect, CES-D scores decreased gradually from 2011 to 2013 followed by a upward trend. Rural residents were associated with higher level of depression than those live in urban area. These residence gaps in depression enlarged before the age of 80, and then narrowed. The urban-rural disparities in CES-D scores gradually diminished across cohorts, while the corresponding period-based change in urban-rural gaps was not significant. Conclusion: When age, period, cohort factors are considered, the age effects on depression dominated, and the period and cohort variations were relatively small. The residence disparities in depression reduced with successive cohorts, more attention should be paid to the worsening depression condition of younger cohorts in urban areas.

Enhancing food access in a comprehensive cancer center area of influence through local partner capacity building.

BACKGROUND: Food insecurity, an economic and social condition of limited food access, is associated with poor diet quality-a risk factor for several common cancers. The University of Texas MD Anderson Cancer Center supports healthy food access through community-led evidence translation by actively partnering with community-based organizations (CBOs). These partnerships aim to enhance the capacity of food assistance CBOs to effectively implement evidence-based food insecurity mitigation programs in the cancer center's area of influence. METHODS: This case study aims to describe the cancer center's model for local food access capacity building and detail operationalization in the context of a whole-community cancer prevention effort (Be Well Baytown) in Baytown, Texas. RESULTS: Elements central to the capacity building model include (i) assessment of baseline needs and capacity, (ii) empowering a community champion within a relevant CBO, (iii) mapping inter-sectoral community partnerships, collaborations, and linkages, and (iv) leveraging systems, connections, and resources to provide an enabling environment for overall food access systems growth. Through this process, Be Well Baytown enhanced the capacity of a local food pantry leading to increases in total reach, pounds of food distributed, and number of food distribution events in collaboration with intersectoral partners from 2018 to 2023. CONCLUSION: This case study highlights the model's implementation as a co-benefit community partnership strategy to maximize the impact of food security programs integrated with comprehensive cancer center prevention efforts.

Childhood obesity and comorbidities-related perspective and experience of parents from Black and Asian minority ethnicities in England: a qualitative study.

Background: Preventing childhood obesity and associated comorbidities is often hampered by disproportionate disparity in healthcare provision in minority ethnic populations. This study contextualized factors influencing childhood obesity and related comorbidity from the perspectives and experiences of parents of ethnic minority populations. Methods: Following ethical approval, families (n = 180) from ethnic minority populations in the Northeast of England were contacted through flyers, community social groups and online forum. Of the 180 families contacted, 22 expressed interests, of whom 12 parents were eligible to participate in the study, and one family dropped out due to time constraints. Therefore 11 parents from ethnic minority communities living with at least one child with obesity were interviewed. Each family was separately visited at home and took part in a semi-structured interview based on the study's qualitative, descriptive phenomenological design. Nine of the families had one child who was diagnosed with an obesity-related comorbidity (non-alcoholic fatty liver disease, musculoskeletal problems or respiratory disorder). Semi-structured interviews were standardized around parents' perspective and experience on how their children were impacted by obesity and comorbidities, healthcare preventative interventions including lifestyle physical activity and nutrition, and views on tackling obesity impact on their lives. All interviews were analyzed using qualitative thematic analysis. Results: Parents' perspectives revealed 11 themes centered around experience of living with a child with obesity, risks, and impact of obesity related Non-Communicable Diseases; and access to support, and barriers unique to minority ethnic groups. Parents revealed social disadvantages, fear of victimization by social services, perceptions on their cultural and religious traditions, and racial stigmatization related to their child's weight. Parents reported closer bonding with their children to protect them from the untoward consequences of overweight, and little awareness of healthcare obesity prevention programs. Work pressure, lack of time, absence of guidance from professionals were seen as barriers to healthy lifestyle, while support from friends and closer family bond in adopting healthy lifestyle behaviors were facilitators. However, there was little awareness or access to current healthcare obesity preventive offerings. Conclusion: Minority ethnic communities' perspective on childhood obesity prevention does not match the healthcare system preventative offerings. Community and family-oriented obesity preventative approaches, especially lifestyle interventions are needed beyond those administered by the primary healthcare system.

Using Natural Language Processing on Expert Panel Discussions to Gain Insights for Recruitment, Retention and Intervention Adherence for Online Social Support Interventions on a Stage II-III Clinical Trial Among Hispanic and African American Dementia Caregivers.

We applied natural language processing (NLP) to a corpus extracted from 4 hours of expert panel discussion transcripts to determine the sustainability of a Stage II-III clinical trial of online social support interventions for Hispanic and African American dementia caregivers. Prominent topics included Technology/hard to reach populations, Training younger populations, Building trust, Privacy and security issues, Simplification of screening questions and recruitment procedures, Understanding participants' needs, Planning strategies and logistics, Potential recruitment places, Adjusting intervention size downwards to engage elderly participants, Targeting different generations, Internet-based interventions by age range, and Providing step-by-step instructions and an overview of the entire research process during recruitment. The application of NLP to qualitative data on a dementia caregiving clinical trial provides useful insights for recruitment, retention, and adherence to guidelines for such interventions serving Hispanic and African American dementia caregivers.

Racial, ethnic and sex disparity in acute heart failure patients with COVID-19: A nationwide analysis.

Background: Patients with acute heart failure (AHF) exacerbation are susceptible to complications in the setting of COVID-19 infection. Data regarding the racial/ethnic and sex disparities in patients with AHF and COVID-19 remains limited. Objective: We aim to evaluate the impact of race, ethnicity, and sex on the in-hospital outcomes of AHF with COVID-19 infection using the data from the National Inpatient Sample (NIS). Methods: We extracted data from the NIS (2020) by using ICD-10-CM to identify all hospitalizations with a diagnosis of AHF and COVID-19 in the year 2020. The associations between sex, race/ethnicity, and outcomes were examined using a multivariable logistic regression model. Results: We identified a total of 158,530 weighted AHF hospitalizations with COVID-19 infection in 2020. The majority were White (63.9 %), 23.3 % were Black race, and 12.8 % were of Hispanic ethnicity, mostly males (n = 84,870 [53.5 %]). After adjustment, the odds of in-hospital mortality were lowest in White females (aOR 0.83, [0.78-0.98]) and highest in Hispanic males (aOR 1.27 [1.13-1.42]) compared with White males. Overall, the odds of cardiac arrest (aOR 1.54 [1.27-1.85]) and AKI (aOR 1.36 [1.26-1.47] were higher, while odds for procedural interventions such as PCI (aOR 0.23 [0.10-0.55]), and placement on a ventilator (aOR 0.85 [0.75-0.97]) were lower among Black males in comparison to White males. Conclusion: Male sex was associated with a higher risk of in-hospital mortality in white and black racial groups, while no such association was noted in the Hispanic group. Hispanic males had the highest odds of death compared with White males.

Sexually transmitted infection testing and diagnosis in adolescents and young adults with sickle cell disease.

BACKGROUND: Sexually transmitted infections (STIs) are common and disproportionately affect Black adolescents and young adults (AYAs). Less is known about STIs among Black AYAs with chronic conditions, such as sickle cell disease (AYAs-SCD). This study compared STI testing and diagnosis between AYAs-SCD and their peers, overall and among STI-related encounters. PROCEDURE: This retrospective, cross-sectional study used diagnosis and billing codes in the Pediatric Health Information System (PHIS) to identify inpatient and emergency department encounters from January 1, 2022 to May 31, 2023 among all AYAs 15-24 years and those with STI-related diagnoses (e.g., "cystitis"). STI testing and diagnosis rates were compared between AYAs-SCD, non-Black AYAs, and Black AYAs, controlling for age, sex, and encounter setting. RESULTS: We identified 3602 AYAs-SCD, 177,783 Black AYAs, and 534,495 non-Black AYAs. AYAs-SCD were less likely to be tested for STIs than non-Black AYAs (odds ratio [OR] = 0.26; adj. p < .001) and Black AYAs (OR = 0.53; adj. p < .001). When tested, AYAs-SCD were more likely to be diagnosed with an STI than non-Black AYAs (OR = 2.39; adj. p = .006) and as likely as Black AYAs (OR = 0.67; adj. p = .15). Among STI-related encounters, AYAs-SCD were less likely to be tested than non-Black AYAs (OR = 0.18; adj. p < .001) and Black AYAs (OR = 0.44; adj. p < .001). No significant differences in STI diagnoses were found in this subset between AYAs-SCD and non-Black AYAs (OR = 0.32; adj. p = .28) or Black AYAs (OR = 1.07; adj. p = .99). CONCLUSIONS: STI care gaps may disproportionately affect AYAs-SCD. STIs should be considered when evaluating symptomatic AYAs-SCD in acute settings. More research is needed to further contextualize STI care for AYAs-SCD.

Cancer Education Status in China (2013-2022).

The incidence and mortality rates of cancer in China have an increasing trend, with a remarkable rise in the number of new cases and deaths. Despite this, cancer profile and regional distribution remained relatively stable. China realized a series of initiatives and issued strategic documents to improve cancer education. These include the establishment of a three-tier cancer prevention program and the fulfillment of various guidelines and plans, including the Healthy China Action-Cancer control Implementation Plan (2019-2022). This comprehensive review describes the status of cancer education in China from 2013 to 2022 discussing the role of different cancer education places and that of educators. It also highlights the use of innovative educational methods and educational evaluations, which are effective in improving patient outcomes and satisfaction. Although the Chinese government has taken many measures to improve cancer education in China, several issues remain unresolved. Challenges such as the wide spectrum of tumors, the aging population, and the huge urban-rural disparities require further investment from Chinese government. In addition, cancer control in China started relatively late and lacks the support of specific legislation to control it. It is therefore necessary to increase the investment in cancer education, especially in rural areas and the legislation in areas related to cancer control should be improved to increase the accessibility and quality of education on tumor prevention and treatment.

Association of TP53 Mutation Status and Sex with Clinical Outcome in NSCLC Treated with Immune Checkpoint Inhibitors: A Retrospective Cohort Study.

Purpose: Some studies suggest that TP53 mutations are associated with the response to immune checkpoint inhibitors (ICI) in patients with non-small cell lung cancer (NSCLC) and also contribute to sex disparities in several cancers. Thus, we hypothesized that TP53 mutations might serve as sex-dependent genomic biomarkers of ICI treatment response in patients with NSCLC. Materials and Methods: Clinical data of 100 patients with metastatic NSCLC treated with ICI monotherapy at Seoul National University Bundang Hospital (SNUBH) were retrospectively reviewed. Genomic and clinical datasets of TCGA and an ICI-treated lung cancer cohort (cBioPortal) were also analyzed. Results: In SNUBH cohort, no statistically significant difference was observed in disease control rate per the TP53 mutation status (p=0.503); however, female patients with TP53 mutated (MT) had a significantly prolonged median progression-free survival (PFS) compared to wild-type (WT) (6.1 months in TP53 MT vs. 2.6 months in TP53 WT; p=0.021). PD-L1 high (≥50%) expression was significantly enriched in female patients with TP53 MT (p=0.001). The analysis from publicly available dataset also revealed that females with NSCLC with TP53 MT showed significantly longer PFS than those with TP53 WT (p<0.001). In TCGA analysis, expression of immune-related genes, and TMB score in TP53 MT females were higher than in males without TP53 MT. Conclusion: Female patients with NSCLC with TP53 mutations had high PD-L1 expression and showed favorable clinical outcomes following ICI therapy, suggesting a need for further research to explore the role of TP53 mutations for sex disparities in response to ICI therapy.

Disparities in hepatitis B virus healthcare service access among marginalised poor populations: a mixed-method systematic review.

BACKGROUND: Marginalised poor populations, characterised by poverty and social exclusion, suffer disproportionately from hepatitis B virus (HBV) infections and encounter substantial disparities in access to healthcare. This has further exacerbated the global HBV burden and precluded progress towards HBV elimination. This mixed-method systematic review aimed to synthesise their utilisation and influencing factors in HBV healthcare services, including screening, vaccination, treatment, and linkage-to-care. METHODS: Eleven databases were searched from their inception to May 4, 2023. Quantitative and qualitative studies examining the factors influencing HBV healthcare access among marginalised poor populations were included. A meta-analysis was conducted to synthesise the pooled rates of HBV healthcare utilisation. The factors influencing utilisation were integrated and visualised using a health disparity research framework. RESULTS: Twenty-one studies were included involving 13,171 marginalised poor individuals: sex workers, rural migrant workers, irregular immigrants, homeless adults, and underprivileged individuals. Their utilisation of HBV healthcare ranged from 1.5% to 27.5%. Meta-analysis showed that the pooled rate of at least one dose of the HBV vaccine barely reached 37% (95% confidence interval: 0.26‒0.49). Fifty-one influencing factors were identified, with sociocultural factors (n = 19) being the most frequently reported, followed by behavioural (n = 14) and healthcare system factors (n = 11). Socio-cultural barriers included immigration status, prison history, illegal work, and HBV discrimination. Behavioural domain factors, including previous testing for sexually transmitted diseases, residential drug treatment, and problem-solving coping, facilitated HBV healthcare access, whereas hostility coping exerted negative influences. Healthcare system facilitators comprised HBV health literacy, beliefs, and physician recommendations, whereas barriers included service inaccessibility and insurance inadequacies. The biological and physical/built environments were the least studied domains, highlighting that geographical mobility, shelter capacity, and access to humanitarian health centres affect HBV healthcare for marginalised poor populations. CONCLUSIONS: Marginalised poor populations encounter substantial disparities in accessing HBV healthcare, highlighting the need for a synergistic management approach, including deploying health education initiatives to debunk HBV misperceptions, developing integrated HBV management systems for continuous tracking, conducting tailored community outreach programmes, and establishing a human rights-based policy framework to guarantee the unfettered access of marginalised poor populations to essential HBV services.

Mosaic evolution underlies feliform morphological disparity.

Constraint is a fundamental concept in evolutionary theory. Morphology and ecology both are limited by functional, historical and developmental factors to a subset of the theoretical range species could occupy. Cat-like carnivorans (Feliformia) offer a unique opportunity to investigate phenotypic constraint, as several feliform clades are purported to be limited to generalized ecomorphological roles, while others possess extremely specialized durophagous (bone-crushing) and sabretooth morphology. We investigated the evolutionary history of feliforms by considering their phylogeny, morphological disparity and rates of evolution. We recover results that show a mosaic pattern exists in the degree of morphological disparity per anatomical region per clade and ecology. Non-hypercarnivores, such as viverrids (civets and genets), Malagasy euplerids and lophocyonids (extinct hypocarnivores), have the greatest dental disparity, while hypercarnivores (felids, nimravids, many hyaenids) have the lowest dental disparity but highest cranial and mandibular disparity (excluding dentition). However, high disparity is not necessarily associated with high rates of evolution, but instead with ecological radiations. We reveal that relationships between specialization and disparity are not as simple as past research has concluded. Instead, morphological disparity results from an anatomical mosaic of evolution, where different ecologies correlate with and likely channel unique patterns/combinations of disparity per anatomical partition.

Association between physical activity and cardiovascular parameters in 7-year-old children: a Chinese cross-sectional study.

INTRODUCTION: Physical activity (PA) is believed to play an important part in many aspects during childhood and adolescence, especially cardiorespiratory fitness and cardiometabolic health. However, whether different levels of PA in daily life influence the structure or function of heart in school-aged children remains unknown. We aimed to investigate the association between PA and cardiovascular parameters in 7-year-old children. METHODS: Follow-up data from the Shanghai Prenatal Cohort Study and the Shanghai Birth Cohort was analyzed. Perinatal information including both maternal and offspring datum was recorded. A refined questionnaire was used to evaluate the frequency and duration of children's PA levels. Blood pressure, echocardiography, and anthropometry assessment were conducted during the follow-up of 7-year-old children. RESULTS: Overall, high PA level was associated with higher left ventricle posterior wall thickness in diastole (LVPWd, ß coefficient: 0.36, 95% CI: 0.12, 0.61), higher left ventricle mass index (LVMI, ß = 0.28, 95% CI: 0.07, 0.48), mitral E/a ratio (ß = 0.47, 95% CI: 0.22, 0.71) and slower heart rate (ß = -0.32, 95% CI: -0.57, -0.07), compared to low PA level. Medium PA level was associated with lower diastolic blood pressure (DBP, ß = -0.18, 95% CI: -0.35, -0.01). In subgroup analysis, increased relative wall thickness (RWT) was found in high PA level boys (ß = 0.36, 95% CI: 0.05, 0.67), and systolic blood pressure (SBP) showed a significant decrease in high PA level girls (ß = -0.42, 95% CI: -0.78, -0.06). CONCLUSIONS: This study suggested non-athlete children having higher PA level were associated with thicker left ventricle (LV) walls and better LV diastolic function, as well as slower heart rate and DBP at the age of 7. Furthermore, disparity in the association between PA level with morphological heart patterns and blood pressure existed in different sex category.

Rural-urban disparity in community-based health insurance enrollment in Ethiopia: a multivariate decomposition analysis using Ethiopian Mini Demographic Health Survey 2019.

Background: In sub-Saharan Africa, achieving universal health coverage (UHC) and protecting populations from health-related financial hardship remain challenging goals. Subsequently, community-based health insurance (CBHI) has gained interest in low and middle-income countries, such as Ethiopia. However, the rural-urban disparity in CBHI enrollment has not been properly investigated using multivariate decomposition analysis. Therefore, this study aimed to assess the rural-urban disparity of CBHI enrollment in Ethiopia using the Ethiopian Mini Demographic Health Survey 2019 (EMDHS 2019). Methods: This study used the latest EMDHS 2019 dataset. STATA version 17.0 software was used for analyses. The chi-square test was used to assess the association between CBHI enrollment and the explanatory variables. The rural-urban disparity of CBHI enrollment was assessed using the logit-based multivariate decomposition analysis. A p-value of <0.05 with a 95% confidence interval was used to determine the statistical significance. Results: The study found that there was a significant disparity in CBHI enrollment between urban and rural households (p < 0.001). Approximately 36.98% of CBHI enrollment disparities were attributed to the compositional (endowment) differences of household characteristics between urban and rural households, and 63.02% of the disparities were due to the effect of these characteristics (coefficients). The study identified that the age and education of the household head, family size, number of under-five children, administrative regions, and wealth status were significant contributing factors for the disparities due to compositional differences between urban and rural households. The region was the significant factor that contributed to the rural-urban disparity of CBHI enrollment due to the effect of household characteristics. Conclusion: There were significant urban-rural disparities in CBHI enrollment in Ethiopia. Factors such as age and education of the household head, family size, number of under-five children, region of the household, and wealth status of the household contributed to the disparities attributed to the endowment, and region of the household was the contributing factor for the disparities due to the effect of household characteristics. Therefore, the concerned body should design strategies to enhance equitable CBHI enrollment in urban and rural households.

Discrepancy in Opioid Prescription Patterns for Black or African American Patients Following Lower Extremity Bypass Surgery for Chronic Limb-Threatening Ischemia.

INTRODUCTION: Disparity in the allocation of medical services and resources based on race is present within the health care industry today including the prescription of postoperative analgesics. The purpose of this study was to evaluate the presence of race-based disparity in the prescription of post discharge opioids following lower extremity bypass (LEB) surgery for chronic limb-threatening ischemia (CLTI). METHODS: Retrospective analysis was conducted on adult CLTI patients who underwent LEB from 2000 to 2023 in the TrinetX database. Patients were stratified into two groups based on race: White (Group I) and black or African American (Group II). Primary outcomes were defined as oral opioid prescriptions at 7 days and 30 days post discharge, and mortality at 1 year postoperatively. Secondary outcomes included length of stay (LOS) and 30-day postoperative outcomes including myocardial infarction (MI), pulmonary embolism (PE), cerebral vascular accident (CVA), deep vein thrombosis (DVT), acute kidney injury (AKI), major amputation, minor amputation, Major Adverse Cardiac Events (MACE), and Major Adverse Limb Events (MALE). Stratified analysis was conducted based on disease stage (rest pain vs lower extremity ulcer vs gangrene). Univariate analysis was performed via two-sample t-test and Chi-squared test. Logistic regression was performed to estimate the association of Black or AA (vs. White) race while controlling for pertinent preoperative potential confounders. RESULTS: 3,345 patients met inclusion criteria. Group I included 2,661 White patients and Group II included 684 Black or African American patients. Group II patients were more likely to be younger, female, present with gangrene, and have a history of hypertension, diabetes, chronic kidney disease, or diabetic neuropathy. At both seven- and thirty-days post discharge, the Black or AA cohort had significantly lower rates of opioid prescriptions (33.2% vs 42.5% and 35.8% vs 47.2%, respectively) (all p<0.05). Stratification by indication showed that opioid prescription disparity persisted despite black or AA patients presenting at worse stages of disease both at seven and thirty days post discharge (7-days: Rest pain 43.4% vs. 33.7%, p=0.013, Ulcer 41.4% vs 31.7%, p=0.027, Gangrene, 42.7% vs 33.6%, p=0.006 & 30-days: Rest pain 47.8% vs. 37.1%, p=0.007, Ulcer 45.4% vs 33.5%, p=0.007, Gangrene, 48.2% vs 36.1%, p<0.001). Adjusted analysis confirmed that Black or African American race was associated with lower rates of seven (AOR 0.607, p=0.001) and thirty-day (AOR 0.56, p=0.001) post discharge opioid prescriptions. CONCLUSION: Black or African American patients were less likely to receive post discharge opioid prescriptions compared with their white counterparts at seven- and 30-days following LEB for CLTI.

Regional disparities in the prevalence and correlated factors of myopia in children and adolescents in Gansu, China.

Background: Myopia is a significant public health problem across the globe. This study aimed to examine the regional disparity in prevalence and correlated factors of myopia in children and adolescents in two typical regions, Gannan Tibetan Autonomous Prefecture (Gannan Prefecture for short, a Tibetan residential area) and Wuwei City (a Han residential area) in Gansu Province, China, and to provide a reference for the prevention and control of regional myopia. Methods: The study was a cross-sectional study of children and adolescents in Gansu Province, China. A total of 6,187 (Wuwei City: 3,266, Gannan Tibetan Autonomous Prefecture: 2,921) students were selected by stratified cluster sampling. Eye examinations and questionnaires were administered to the participants. Myopia is defined as a condition in which the spherical equivalent refractive error of an eye is less than or equal to -0.50 D when ocular accommodation is relaxed. The χ2 test and multivariate logistic regression analysis were used to analyze the correlated factors of myopia. Results: The myopia rate of 6,187 students was 71.4%, and students had a higher rate of myopia (77.5%) in Wuwei City compared to Gannan Prefecture (64.6%) (p < 0.001). The results of multivariate analysis in Wuwei City showed that girls (odds ratio (OR) = 1.325), junior students (OR = 2.542), senior students(OR = 4.605), distance between eyes and book less than one foot (OR = 1.291), and parents with myopia (one, OR = 2.437; two, OR = 4.453) had higher risks of myopia (all, p < 0.05). For Gannan Prefecture, girls (OR = 1.477), senior students (OR = 1.537), daily time spent doing homework ≥2 h (OR = 1.420), the distance between eyes and book less than one foot (OR = 1.205), mean time continuous eye use (0.25-<0.5 h, OR = 1.345, 0.5-<1 h, OR = 1.317, ≥1 h, OR = 1.313), average daily sleep duration <8 h (OR = 1.399), and parents with myopia (one, OR = 1.852; two, OR = 2.913) had higher risks of myopia (all, p < 0.05). Conclusion: The prevalence of myopia is at a relatively high level in Gansu Province. The prevalence and risk factors for myopia vary by region.

A scoping review of social determinants of health's impact on substance use disorders over the life course.

BACKGROUND: Substance use is a public crisis in the U.S. Substance use can be understood as a series of events in the life course, from initiation to mortality. Social Determinants of Health (SDoH) have increasingly been recognized as essential contributors to individuals' health. This scoping review aims to examine available evidence of SDoH impact on the life course of substance use disorder (SUD). METHODS: This study identified peer-reviewed articles that reported longitudinal studies with SDoH factors as independent variables and substance use and disorders as dependent variables from PubMed, Embase, and Web of Science. The reported associations between SDoH and substance use stages over the life course were narratively and graphically summarized. RESULTS: Among the 50 studies identified, ten revealed parental monitoring/support and early childhood education as protective factors, while negative peer influences and neighborhood instability were risk factors of substance use initiation. Nineteen articles reported factors associated with escalation in substance use, including unemployment, neighborhood vulnerability, negative peer influence, violence/trauma, and criminal justice system (CJS) involvement. Ten articles suggested that employment, social support, urban living, and low-barrier medication treatment facilitate treatment participation, while stigma and CJS involvement negatively impact on treatment trajectory. Social support and employment could foster progress in recovery and CJS involvement and unstable housing deterred recovery. Four studies suggested that unemployment, unstable housing, CJS involvement, and lack of social support were associated with overdose and mortality. CONCLUSIONS: This review underscores the influence of social networks and early life experiences on the life course of SUD. Future SDoH research should investigate overdose and mortality and the impact of broader upstream SDoH on SUD. Interventions addressing these social factors are needed to mitigate their detrimental effects on the trajectories of SUD over the life course.

Obesity-related behaviors and health-related quality of life in socioeconomically vulnerable children: A cross-sectional study.

PURPOSE: This study aims to explore obesity-related behaviors (ORB) and health-related quality of life (HRQoL) in socioeconomically vulnerable children, while also examining potential associations between these variables. DESIGN AND METHODS: A total of 721 children enrolled in after-school care programs for socioeconomically vulnerable children participated in this study. Height (in cm) and weight (in kg) were measured directly by trained research assistants. ORB, including eating behaviors and physical activity, was assessed utilizing the Nutrition Quotient Questionnaire. HRQoL was measured utilizing the PedsQL™ 4.0. Data were analyzed using logistic regression. RESULTS: The findings revealed that participants exhibited lower levels of ORB and reduced HRQoL, particularly in the physical health dimension of HRQoL. Inadequate physical activity and poor dietary habits were strongly associated with a 2.625-fold (OR = 2.625, 95% CI = 1.867-3.691) and a 4.251-fold (OR = 4.251, 95% CI = 2.466-7.328) increase, respectively, in the likelihood of having low HRQoL. Surprisingly, the study did not find a significant link between ORB levels and obesity, and obesity status did not predict a higher probability of low HRQoL. CONCLUSIONS: This study underscores the need for tailored interventions designed specifically for children from socioeconomically vulnerable families to address their unique challenges. PRACTICE IMPLICATIONS: This research provides valuable insights for pediatric nurses and healthcare providers, highlighting the crucial role of promoting healthy ORB in socioeconomically vulnerable children to address disparities in childhood obesity and HRQoL.

Racial Disparity in Adherence to Endocrine Therapy among Women with Early-Stage Hormone Receptor Positive Breast Cancer: An Analysis of Arkansas All-Payers Claims Database.

INTRODUCTION/BACKGROUND: To assess racial/ethnic disparities in endocrine therapy (ET) adherence among women with breast cancer. MATERIALS AND METHODS: A retrospective cohort study of Arkansas All-Payer Claims Database (APCD) linked to Arkansas Cancer Registry (ACR). Women with stages 0-3 HR+ breast cancer diagnosed in 2013-2017 were followed from cancer diagnosis for a year to determine ET initiation. Among women who initiated ETs within 1 year of diagnosis, we assessed first-year compliance (proportion of days covered ≥ 0.8) and followed them for 5 years, censoring at death, end of data availability (December 21, 2019), or disenrollment from insurance coverage, whichever occurred first, to determine time to discontinuation. Regression analysis was conducted to determine racial/ethnic disparities in ET use adjusting for patients demographic, clinical, tumor characteristics and county-level socioeconomic factors. RESULTS: Among women with continuous insurance coverage, 81% initiated ET within 1 year of diagnosis; 80% were compliant in the first year of ET use and 27.4% discontinued ET by year 5 among those who initiated ET in the first year. There were no racial/ethnic differences in ET initiation or first-year compliance adjusting for covariates. NHB women were significantly less likely to discontinue ET within 5 years after ET initiation compared to NHW women after (HR, 95% CI, 0.76, 0.58-0.98; P = .035). CONCLUSION: After adjusting for patients' and tumor characteristics, there were no racial/ethnic differences in ET initiation within 1 year of diagnosis and ET compliance within first year of ET use. However, NHB women were less likely to discontinue ET within 5 years of initiation.

Hyper-Acute Stroke Systems of Care and Workflow.

PURPOSE OF REVIEW: Recent stroke treatment advances have necessitated agile, broad-scale healthcare system redesign, to achieve optimal patient outcomes and access equity. Optimised hyperacute stroke care requires integrated pre-hospital, emergency department, stroke specialist, radiology, neurosurgical and endovascular neurointervention services, guided by a population-wide needs analysis. In this review, we survey system integration efforts, providing case studies, and identify common elements of successful initiatives. RECENT FINDINGS: Different regions and nations have evolved varied acute stroke systems depending on geography, population density and workforce. However, common facilitators to these solutions have included stroke unit care as a foundation, government-clinician synergy, pre-hospital pathway coordination, service centralisation, and stroke data guiding system improvement. Further technological advantages will minimize the geographical distance disadvantages and facilitate virtual expertise redistribution to remote areas. Continued treatment advances necessitate an integrated, adaptable, population-wide trans-disciplinary approach. A well-designed clinician-led and government-supported system can facilitate hyperacute care and scaffold future system enhancements.