The effect of socio-economic status on children's dental health.

The aim of the present study was to record the oral health status of children from different socioeconomic backgrounds and correlate these findings with parent-associated factors. It comprised a cross-sectional study of healthy children, aged 6-12 years, attending either the Reception and Solidarity Center of the Municipality of Athens or the Postgraduate Paediatric Dentistry Department (NKUA) for dental care. Data regarding the demographics of both parents-guardians, as well as the children, and oral hygiene and dietary habits were collected through a structured questionnaire. This was followed by a thorough clinical examination evaluating oral hygiene status, gingival inflammation and caries experience. Analysis was based on the socioeconomic status (SES) of the parents which was according to the family income. Families with a monthly income of <1400 euros were considered as being of a low SES and families with incomes of >1400 euros as medium. Data were presented in frequency tables and significance of calculated differences was tested using chi-square and Fisher's exact tests. Multivariate regression analysis was used to detect possible risk factors for development of poor dental health. The sample consisted of 216 children (146 from a low and 70 from a medium SES) with a mean chronological age of 9.19 years. Parents from low SES were younger, of lower education, had lived abroad most of their lives and were unemployed or worked in the private sector. Children from low SES backgrounds reported infrequent dental visits, consumed more meals and had more sugary snacks. This was reflected in their worse dental health with significantly higher values for oral hygiene and caries indices. Despite the above differences, none of the parent-associated factors were significantly correlated to worse dental health. In conclusion, SES of parents is reflected in the oral health of children, although it is not a significant predictor of dental health.

Heart failure in first- and second-generation immigrants aged 18-54 years in Sweden: A national study.

PURPOSE: We aimed at analysing the risk of congestive heart failure (CHF) among first- and second-generation immigrants in younger age groups. METHODS: All individuals aged 18-54 years, n = 3 973 454 in the first-generation study and n = 3 817 560 in the second-generation study, were included. CHF was defined as at least one registered diagnosis in the National Patient Register between 1 January 1998 and 31 December 2018. Cox regression analysis was used to estimate the relative risk [hazard ratios (HRs) with 99% confidence intervals (CIs)] of incident CHF with adjustments for age, co-morbidities and socio-demographics. RESULTS: In the first-generation study, a total of 85 719 cases of CHF were registered, 54 369 men and 31 350 women, where fully adjusted models showed HRs for all foreign-born men of 1.12 (99% CI 1.06-1.17) and for women of 0.99 (0.92-1.05). Groups with higher risk included men from Eastern Europe, Central Europe, Africa and Asia and women from Africa and Asia, and a lower risk was found among Latin American women. In the second-generation study, a total of 88 999 cases of CHF were registered, 58 403 men and 30 596 women, where fully adjusted models showed HRs for second-generation men of 1.04 (0.99-1.09) and women of 0.97 (0.90-1.04). CONCLUSIONS: The higher risk in some foreign-born groups needs to be paid attention to in clinical practice. The fact that almost all increased risks were attenuated and absent in second-generation immigrants suggests that lifestyle and environmental factors are more important than genetic differences in the risk of CHF.

Parental health risk preferences, socio-economic status and offspring's alcohol behavior in South Africa.

Alcohol consumption represents a widespread behavior with detrimental effects on both individuals and society. Understanding the factors influencing offspring alcohol consumption is crucial for identifying potential risk factors and informing prevention and intervention strategies. Existing empirical literature underscores the intricate interplay of biological, environmental, and social factors in shaping offspring alcohol consumption. Building upon this foundation, this study investigates the determinants of health risk preferences, such as alcohol consumption, among South African offspring, utilizing a dataset comprising the 2008, 2010, 2012, and 2014 waves of the National Income Dynamic Study (NIDS). Logistic regressions are employed to model the determinants of offspring alcohol consumption, while ordered logits are utilized to assess the impact of parental drinking on offspring drinking frequency. The findings indicate that parental drinking significantly influences offspring alcohol intake. Specifically, daughters' alcohol consumption is influenced solely by maternal drinking, whereas sons are affected by both parents' alcohol consumption. Furthermore, while daughters from currently disadvantaged backgrounds may exhibit higher tendencies towards alcohol consumption, those with mothers from such backgrounds and fathers from more affluent backgrounds are less likely to engage in such behavior. Additionally, the results suggest that male offspring from higher-income brackets are less likely to consume alcohol, yet sons of wealthy fathers are more likely to adopt such lifestyles.

Lifestyle Clusters of Diet Quality, Sleep, and Screen Time and Associations with Weight Status in Children from Madrid City: ENPIMAD Study.

BACKGROUND: Childhood overweight and obesity is a global concern and has increased in Spain over the last decades. Combinations of lifestyle behaviors (i.e., diet, sleep, and sedentarism) are highly related to weight status. Therefore, this study aimed to identify lifestyle patterns among children from Madrid City, and analyze associations with the prevalence of overweight, obesity, and abdominal obesity, considering socio-economic factors. METHODS: A cross-sectional analysis was conducted on 4545 children from the ENPIMAD study with data on diet, sleep, anthropometric, and socio-economic variables. K-means cluster analysis was used to identify lifestyle clusters, and logistic regressions were used to examine the associations between socio-economic indicators and cluster membership, and between clusters and weight status. RESULTS: Findings show three lifestyle clusters (healthy, mixed, and unhealthy), with boys and older children more represented in the unhealthy cluster. Food insecurity and low socio-economic status were associated with unhealthier clusters in boys and girls. Children in unhealthier clusters were more likely to have obesity and abdominal obesity. However, these associations disappeared in girls after controlling for food insecurity. CONCLUSION: These results provide insight into the combination of behaviors and socio-economic factors associated with childhood obesity that may aid in the design of future interventions.

Changes in Household Wealth over the Process of Widowhood Across European Countries.

OBJECTIVES: Widowhood has been shown to decrease surviving spouses' economic wellbeing. However, previous research has focused mostly on income-related outcomes, and has been less attentive to the importance of wealth, the processual nature of spousal death, and cross-national variation. In this study, we assessed how total, housing, and non-housing wealth changes over the process of widowhood across eleven European countries. METHODS: Individual fixed-effects regressions and longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE) were used to estimate how household net total wealth, housing wealth, and non-housing wealth changed three years prior and six or more years after spousal death relative to four or more years prior to widowhood in eleven European countries. RESULTS: In all countries, household net wealth stayed relatively constant across the widowhood process, except for in Austria, the Czech Republic and Poland where wealth declines were observed especially in the years following death. However, we found declines in housing wealth over the widowhood process, including prior to spousal death, across most countries in our sample, particularly in Austria, France, Denmark, the Czech Republic, and Poland. Declines in housing wealth were generally not reflected by changes in non-housing wealth but coincided with leaving homeownership and downsizing. DISCUSSION: Widowhood is associated with lower wealth, especially housing wealth, even in the years before spousal loss. Future research should focus on adjudicating the mechanisms behind country differences and exploring the implications of lost wealth following widowhood for surviving spouses' wellbeing and intergenerational transfers.

Patterns of Telemedicine Use in Primary Care for People with Dementia in the Post-pandemic Period.

BACKGROUND: The pandemic rapidly expanded telemedicine, which has persisted as a widely available primary care modality. The uptake of telemedicine among people with dementia specifically in the primary care setting, who have more complex care needs but also benefit from more accessible primary care, is unknown. OBJECTIVE: Among people with dementia, assess uptake of telemedicine-based primary care in the post-pandemic period and determine associations with key socio-demographic characteristics. DESIGN: Retrospective observational study. SUBJECTS: People with dementia at UCSF and Kaiser Permanente Northern CA (KPNC) with at least one primary care encounter in pre- (3/1/2019-2/29/2020) or post-COVID (3/1/2021-2/28/2022) periods, post-COVID sample: N= 419 individuals (UCSF), N=18,037 (KPNC). MAIN MEASURES: Encounter modality: in-person, video telemedicine, or telephone telemedicine. Focal socio-demographic characteristics: age, limited English proficiency, socioeconomic status, driving distance to clinic, and caregiver at encounter. KEY RESULTS: There was a large increase in telemedicine among people with dementia in the post-pandemic period at both sites. At KPNC, those with only in-person primary care visits shrunk from 60.47% (pre) to 26.95% (post). At UCSF, the change was even greater: 98.99% to 35.08%. Across both sites, the only measure significantly associated with use of telemedicine was greater driving distance from home to clinic. At KPNC, those over age 90 were most likely to use telemedicine while patients with limited English proficiency and those with a caregiver at the encounter used telemedicine at lower levels. The relationships were similar at UCSF but not statistically significant. CONCLUSIONS: Telemedicine use is high for people with dementia in the primary care setting in the post-pandemic period. Those with longer drives to clinic and the oldest patients were most likely to use telemedicine, likely due to challenges traveling to appointments. Still, not all people with dementia used telemedicine equally-particularly those with limited English proficiency.

Cranial fluctuating asymmetry and its relationship with non-specific physiological stress indicators in a contemporary South African cadaveric skeletal sample.

OBJECTIVES: Biological anthropologists frequently explore skeletal asymmetry, together with population health and disease. Given the conflicting findings in existing literature, this study aimed to clarify whether an association exists in a South African sample. MATERIALS: Dry bone and cranial micro-focus X-ray Computed Tomography (micro-XCT) scans of 115 South African individuals were assessed. METHODS: Fluctuating asymmetry (FA) indices were calculated from interlandmark distances, and the frequency of four types of non-specific signs of physiological stress were documented to explore the relationship between FA and disease. RESULTS: Black South Africans did not exhibit a high FA index; however, they had the highest prevalence of non-specific signs of physiological stress. However, no significant correlations were detected between FA indices and pathological lesions. CONCLUSION: No correlation was observed between FA and populations from different socio-economic backgrounds. However, individuals of lower socio-economic status (SES) demonstrated a greater prevalence of non-specific signs of physiological stress. SIGNIFICANCE: This research suggests that skeletal indicators of stress may be a suitable biological marker for assessing differences in SES among population groups, while indicating that levels of cranial FA is an inadequate biological marker. LIMITATIONS: Possible limitations may include measurement error, and the lack of information on the life history and medical records of individuals in this sample. SUGGESTIONS FOR FURTHER RESEARCH: Future research should include a larger sample with more South African groups, and should evaluate the potential association among age, FA, and expression of skeletal markers of disease.

Do social economic status modify the association between air pollution and depressive or anxiety symptoms? A big sample cross-sectional study from the rural areas of Central China.

BACKGROUND: Fewer studies have examined the relationship between air pollution and depressive or anxiety symptoms in rural residents. Social economic status (SES), as an important indicator of the current state of socioeconomic development, we know little about how it modifies the relationship between air pollution and symptoms of depression or anxiety. METHODS: The patient health questionnaire (PHQ-2) and generalized anxiety scale (GAD-2) were used to learn about the prevalence of depressive and anxiety symptoms, the social economic status of the participants was categorized into two levels: lower and higher, and a binary logistic regression model was used to analyze the relationship between air pollution and residents' symptoms of depression or anxiety. RESULTS: A total of 10,670 adults were enrolled in this study, of which a total of 1292 participants suffered from depressive symptoms and 860 suffered from anxiety symptoms. Short-term exposure to PM2.5 and O3, singly or in combination, may be associated with the onset of depression symptoms, and there was a significant interaction between SES and exposure to PM2.5 or O3. Residents of areas with higher SES may have a lower risk of suffering from anxiety symptoms after O3 exposure compared to participants living in lower SES. LIMITATIONS: The study was a cross-sectional study, which may have lowered the quality level of the evidence. CONCLUSIONS: Short-term PM2.5 and O3 exposure may be associated with an increased prevalence risk of depressive symptoms. Higher levels of SES may reduce the adverse effects of air pollution on depressive or anxiety symptoms.

Role of Socioeconomic Status in National Health Insurance Ownership in Indonesia's Rural Areas.

BACKGROUND: National Health Insurance (NHI) is one of the Indonesian Government's policies to increase public access to health services. The study analyzed the role of socioeconomic status in NHI ownership in rural Indonesia. Study Design: A cross-sectional study. METHODS: The study population included residents of rural Indonesia. The study examined secondary data from the survey entitled "Abilities and Willingness to Pay, Fee, and Participant Satisfaction in Implementing National Health Insurance in Indonesia in 2019", involving 33225 respondents representing Indonesia's rural areas. The study was conducted from March to December 2019. The variables analyzed included NHI, socioeconomic level, age group, gender, education level, employment status, and marital status. In the final step, the study employed binary logistic regression to explain the relationship between socioeconomic status and NHI ownership. RESULTS: The results show that 63.8% of the population in rural Indonesia participated in the NHI. The poorer residents were 1.235 times more likely to have NHI than the most impoverished population (AOR 1.235; 95% CI 1.234-1.237). People with middle wealth status were 1.086 times more likely to have NHI than the poorest (AOR 1.086; 95% CI 1.085-1.087). The richer residents were 1.134 times more likely to have NHI than the poorest (AOR 1.134; 95% CI 1.133-1.136). The richest residents were 1.078 times more likely to have NHI than the poorest residents (AOR 1.078; 95% CI 1.077-1.079). CONCLUSION: The study concluded that socioeconomic status is related to NHI ownership in rural Indonesia. The analysis indicated that all socioeconomic categories were more likely to become NHI participants than the poorest in Indonesia.

Adult child educational attainment and older parents' psychosocial outcomes during the COVID-19 pandemic.

BACKGROUND: Older adults' psychosocial outcomes during the COVID-19 pandemic have been inequitable by socio-economic status (SES). However, studies have focused solely on own SES, ignoring emerging evidence of the relationship between adult child SES and late-life health. We evaluated whether adult child educational attainment - a core marker of SES - is associated with older parents' psychosocial outcomes during the pandemic. METHODS: We used data from the Survey of Health, Aging, and Retirement in Europe (SHARE) 2004-2018 and the SHARE Corona Surveys (SCS) 2020 and 2021. We included 40,392 respondents ≥ 65 years who had pre-pandemic information on adult child educational attainment and self-reported psychosocial outcomes during the pandemic, including self-assessments of worsened psychosocial outcomes compared to the pre-pandemic period. We used generalized estimating equations with a Poisson distribution and a log link, adjusted for respondent and family-level characteristics, including respondents' own educational attainment. RESULTS: Older adults whose adult children averaged levels of educational attainment at or above (vs. below) their country-specific mean had a lower prevalence of feeling nervous (Prevalence Ratio [PR]: 0.94, 95% Confidence Interval [CI]: 0.90, 0.97), sad or depressed (PR: 0.94, 95% CI: 0.91, 0.98), and having sleep problems (PR: 0.94, 95% CI: 0.90, 0.97) during the pandemic. Additionally, higher adult child educational attainment was associated with a lower risk of perceiving worsened feelings of nervousness (PR: 0.95, 95% CI: 0.90, 1.01) and worsened sleep problems (PR: 0.91, 95% CI: 0.82, 1.01) as compared to the pre-pandemic. In stratified models, protective associations were observed only in countries experiencing "high" levels of COVID-19 intensity at the time of the survey. All of these results are derived from adjusted models. CONCLUSIONS: Adult child SES may have "upward" spillover effects on the psychosocial wellbeing of older parents during periods of societal duress like the pandemic.

Echoes Beyond Hearing: Psycho-Social Impacts of OAE Outcomes on Families of Neonates: An Indian Perspective.

The main aim of this study was to explore the psycho-social impacts of Otoacoustic Emissions (OAE) screenings on families. This involved understanding the initial responses of parents to test results, identifying any resulting concerns, and acknowledging the coping mechanisms utilized to handle these unexpectedly encountered difficulties. This retrospective observational study was conducted from January 2021 to December 2022 at a tertiary care facility. An extensive assessment was carried out on 1100 newborns that had undergone the OAE screening. Parental emotional reactions, worries regarding their child's prospects, and employed coping mechanisms were determined using structured questionnaires and interviews. The study aimed to explore the link between socio-economic status and varying levels of post-test anxiety and to study the effect of immediate post-screening counselling. A notable emotional reaction was observed, with 85% of parents, whose neonates were advised for subsequent tests, showing signs of shock and denial. Apprehensions related to the child's growth and societal acceptance were dominant, with 70% parents concerned about potential hurdles. There was a marked correlation between a lower socio-economic status and elevated post-test anxiety. Prompt counselling post-screening resulted in a substantial reduction in parental stress and anxiety levels. While the relevance of OAE testing concerning neonatal health is unequivocal, the psycho-social repercussions it imposes on families are significant. The findings underscore the need for holistic healthcare approaches that not only focus on physiological outcomes but also prioritize the mental well-being of families. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04486-1.

Sense of coherence, mental health, and hair cortisol concentrations among older people during the COVID -19 pandemic: a cross-sectional study.

BACKGROUND: A person's sense of coherence (SoC) is likely to affect coping when exposed to a life changing event like the COVID -19 pandemic, which impacted the older population especially hard, an age group that already suffers from a lot of mental illness. Thus, the aim of this study was to investigate the associations between SoC and mental health in older adults using both screening scales and hair cortisol concentrations (HCC). METHOD: A cross-sectional design studying a cohort of 70-80 years old, N = 260, set in Swedish primary care during the pandemic years 2021-2022. Instruments used are sense of coherence 13 (SoC-13), EQ-5D-3L, Geriatric depression scale 20 (GDS-20), Hospital anxiety and depression scale (HADS), and Perceived stress scale 10 (PSS-10). Sociodemography and factors concerning SoC, and mental health are explored. HCC are measured using radioimmunoassay. Outcome measures are factors independently associated with SoC. Linear regression models were performed with SoC as dependent variable, and priory path analyses explored whether associations with SoC were direct, or indirect via anxiety. RESULTS: SoC was significantly associated with anxiety (p < 0.001), perceived economic status (p = 0.003), belief in the future (p = 0.001), and perceived negative mental effect from the COVID -19 pandemic (p = 0.002). The latter was 96% indirectly associated with SoC (p < 0.001), whereas perceived economic status together with belief in the future was 82% directly associated with SoC (p = 0.17). HCC and sex were not significantly associated with SoC, but, noticeably, high HCC was equally distributed between women and men. Women reported significantly lower quality of life (p = 0.03), and more symptoms of anxiety (p = 0.001) and depression (p < 0.001). CONCLUSION: Anxiety, belief in the future, perceived negative effect on mental health due to the pandemic, and perceived economic status were significantly associated with SoC. Anxiety is suggested to be important in explaining the association between perceived negative mental effect from the COVID-19 pandemic and SoC. Women reported significantly poorer mental health and life quality than men.

Quality of Life and Socioeconomic Status in Northwest of Iran: First Wave of the Persian Traffic Cohort Study.

This study aimed to evaluate the association between Quality of Life (QOL) and independent factors, emphasizing Socio Economic Status (SES) in northwestern Iran. A population-based cross-sectional study was performed within the Persian Traffic safety and health Cohort in 2020. Participants were chosen using stratified random sampling method. The majority of participants (69%) were aged between 30 and 65. Around half of the participants were males (54.44%). Most of the female respondents were categorized as very low and medium levels of SES Based on multiple linear regression analysis, the QOL among females was lower compared to males (ß: - 0.92, 95% CI - 1.82 to - 0.22). There was a negative association between SES and QOL; individuals with low and very low levels of SES had a lower QOL than those with a medium level of SES (ß: - 4.38, 95% CI - 5.9 to - 2.86) (ß: - 2.65, 95% CI - 4.08 to - 1.22). The current study highlights that higher SES and educational levels are positively associated with higher QOL. Conversely, older age, females, and widowed individuals are linked with lower QOL.

Educational gradient in hip fracture incidence in Norway. The Norwegian Epidemiologic Osteoporosis Studies (NOREPOS).

Examining fracture dynamics by socioeconomic status may inform healthcare and prevention. We found a higher risk of hip fracture in men and women with lower educational level in Norway. However, by age 90 + years, the cumulative incidence was higher in those with higher education, due to their higher life expectancy. PURPOSE: Socioeconomic gradients are seen for several health outcomes in high-income countries. We aimed to examine possible educational gradients in risk of hip fracture in Norway and to describe the cumulative incidence of hip fracture by educational level. METHODS: In a population-wide cohort of Norwegians aged ≥ 50 years, information on attained education from Statistics Norway was linked to hospital-treated hip fractures and deaths during 2002-2019. We estimated relative fracture risk by educational level (primary, secondary or tertiary) in Cox proportional hazards regression. We also examined the cumulative incidence over attained age by gender and educational level in competing risk regression. RESULTS: The population included N = 1,389,858 individuals with 135,938 incident hip fractures. Compared with men who had attained tertiary education, hazard ratios (95% confidence intervals) for hip fracture were 1.44 (1.40, 1.49) in men with primary education only and 1.26 (1.22, 1.29) in men with secondary education. In women, the corresponding estimates were 1.28 (1.25, 1.31) and 1.16 (1.13, 1.19). In the age range 50 to 90 years, the highest cumulative incidence of hip fracture was seen in those with primary education. The gradient gradually diminished with advancing age and was reversed in the oldest (> 90 years) in both genders. CONCLUSIONS: There was a clear educational gradient in hip fracture incidence in both men and women in Norway, with a higher risk in people with lower education. Despite this, the cumulative incidence of hip fracture in old age was highest among people with higher education, due to their higher life expectancy.

Factors associated with PrEP-era HIV seroconversion in a 4-year U.S. national cohort of n = 6059 sexual and gender minority individuals who have sex with men, 2017-2022.

INTRODUCTION: Community-based cohort studies of HIV seroconversion can identify important avenues for enhancing HIV prevention efforts in the era of pre-exposure prophylaxis (PrEP). Within individuals, one can assess exposure and outcome variables repeatedly and with increased certainty regarding temporal ordering. This cohort study examined the association of several risk factors with subsequent HIV seroconversion. METHODS: We report data from a 4-year study (2017-2022) of 6059 HIV seronegative sexual and gender minority individuals who have sex with men who had indications for-, but were not using-, PrEP at enrolment. Participants completed repeat exposure assessments and self-collection of biospecimens for HIV testing. We examined the roles of race and ethnicity, socio-economic status, methamphetamine use and PrEP uptake over the course of follow-up in relation to HIV seroconversion. RESULTS: Over 4 years, 303 of the participants seroconverted across 18,421 person-years (incidence rate = 1.64 [95% CI: 1.59-1.70] per 100 person-years). In multivariable discrete-time survival analysis, factors independently associated with elevated HIV seroconversion risk included being Black/African American (adjusted risk ratio [aRR]: 2.44, 1.79-3.28), Hispanic/Latinx (1.53, 1.19-1.96), housing instability (1.58, 1.22-2.05) and past year methamphetamine use (3.82, 2.74-5.33). Conversely, time since study enrolment (24 vs. 12 months, 0.67, 0.51-0.87; 36 months, 0.60, 0.45-0.80; 48 months, 0.48, 0.35-0.66) and higher education (master's degree or higher vs. less than or equal to high school, 0.36, 0.17-0.66) were associated with reduced seroconversion risk. Compared to non-PrEP users in the past 2 years without a current clinical indication, those who started PrEP but then discontinued had higher seroconversion risk, irrespective of clinical indication (3.23, 1.74-6.46) or lack thereof (4.30, 1.85-9.88). However, those who initiated PrEP in the past year (0.14, 0.04-0.39) or persistently used PrEP in the past 2 years (0.33, 0.14-0.74) had a lower risk of seroconversion. Of all HIV seroconversions observed during follow-up assessments (12, 24, 36 and 48 months), methamphetamine was reported in the 12 months prior 128 (42.2%) times (overall). CONCLUSIONS: Interventions that acknowledge race and ethnicity, economic variables such as education and housing instability, and methamphetamine use are critically needed. Not only are interventions to engage individuals in PrEP care needed, but those that retain them, and re-engage those who may fall out of care are essential, given the exceptionally high risk of seroconversion in these groups.

Access to COVID-19 vaccination by socio-economic status in older Singaporean adults: a population-based cohort study.

OBJECTIVES: Socio-economic status (SES) disparities exist in the uptake of COVID-19 vaccination; however, most studies were conducted during the initial pandemic wave when vaccination was less discretionary, limiting generalizability. We aimed to determine whether differences in vaccination uptake across SES strata widened after the removal of vaccination-differentiated measures prior to the rollout of the second boosters, in a nationwide cohort of older Singaporeans at higher risk of severe-COVID-19. STUDY DESIGN: Retrospective population-based cohort study. METHODS: Retrospective population-based cohort study of all Singaporeans aged ≥60 years from 22nd February 2021-14th February 2023. Cox regression models controlling for demographics and comorbidities were used to estimate hazard-ratios (HRs) for the uptake of primary vaccination as well as first/second boosters, as recorded in the national vaccination registry, according to SES (housing type). RESULTS: 836,170 individuals were included for completion of a primary vaccine series; 784,938 individuals for completion of the first booster and 734,206 individuals for the completion of the second booster. Differences in vaccination uptake by SES strata were observed (e.g. vaccination uptake in lowest-SES [1-2 room public-housing] versus highest-SES [private housing]: second booster, 47.6% vs. 58.1%; first booster, 93.9% vs. 98.0%). However, relative differences did not markedly widen during second booster rollout when vaccination was more discretionary (e.g. amongst those aged 60-69 years: 0.75 [95% CI = 0.73-0.76] for the first booster; 0.81 [95% CI = 0.79-0.84] for the second booster). CONCLUSION: While differences in vaccination uptake across SES strata by housing type persisted during the rollout of primary vaccination and subsequent boosters in a nationwide cohort of older Singaporeans, differences did not widen substantially when vaccination was made more discretionary.

Social determinants of health and their relation to suboptimal health status in the context of 3PM: a latent profile analysis.

Background: Suboptimal health is identified as a reversible phase occurring before chronic diseases manifest, emphasizing the significance of early detection and intervention in predictive, preventive, and personalized medicine (PPPM/3PM). While the biological and genetic factors associated with suboptimal health have received considerable attention, the influence of social determinants of health (SDH) remains relatively understudied. By comprehensively understanding the SDH influencing suboptimal health, healthcare providers can tailor interventions to address individual needs, improving health outcomes and facilitating the transition to optimal well-being. This study aimed to identify distinct profiles within SDH indicators and examine their association with suboptimal health status. Method: This cross-sectional study was conducted from June 16 to September 23, 2023, in five regions of China. Various SDH indicators, such as family health, economic status, eHealth literacy, mental disorder, social support, health behavior, and sleep quality, were examined in this study. Latent profile analysis was employed to identify distinct profiles based on these SDH indicators. Logistic regression analysis by profile was used to investigate the association between these profiles and suboptimal health status. Results: The analysis included 4918 individuals. Latent profile analysis revealed three distinct profiles (prevalence): the Adversely Burdened Vulnerability Group (37.6%), the Adversity-Driven Struggle Group (11.7%), and the Advantaged Resilience Group (50.7%). These profiles exhibited significant differences in suboptimal health status (p < 0.001). The Adversely Burdened Vulnerability Group had the highest risk of suboptimal health, followed by the Adversity-Driven Struggle Group, while the Advantaged Resilience Group had the lowest risk. Conclusions and relevance: Distinct profiles based on SDH indicators are associated with suboptimal health status. Healthcare providers should integrate SDH assessment into routine clinical practice to customize interventions and address specific needs. This study reveals that the group with the highest risk of suboptimal health stands out as the youngest among all the groups, underscoring the critical importance of early intervention and targeted prevention strategies within the framework of 3PM. Tailored interventions for the Adversely Burdened Vulnerability Group should focus on economic opportunities, healthcare access, healthy food options, and social support. Leveraging their higher eHealth literacy and resourcefulness, interventions empower the Adversity-Driven Struggle Group. By addressing healthcare utilization, substance use, and social support, targeted interventions effectively reduce suboptimal health risks and improve well-being in vulnerable populations. Supplementary Information: The online version contains supplementary material available at 10.1007/s13167-024-00365-5.

Nicotine pouch use by sex, school type and tobacco product use among Finnish adolescents during the 2023 change in regulatory scheme with deregulated sales.

BACKGROUND AND AIMS: In Finland, nicotine pouches entered the national market abruptly in 2023, following a change in April 2023 from medicinal product classification into less regulated tobacco surrogate status. This study aimed to measure adolescent nicotine pouch use and associated characteristics. DESIGN AND SETTING: A cross-sectional, nationwide school-based survey among students in comprehensive schools (COMP), general upper secondary schools (GEN) and vocational institutes (VOC) in 2023 in Finland. PARTICIPANTS: A total of 151 224 respondents aged 14-20 years (mean age 16.18 years, standard deviation 1.20 years). MEASUREMENTS: Nicotine pouch use was used as the outcome variable. Demographics included age, sex, school type and tobacco product use (smoking, snus use and e-cigarette use). Covariates included parental education and parental smoking. All measures were self-reported. FINDINGS: Unadjusted results showed that current nicotine pouch use was more common among boys (11.3%) than among girls (3.3%), adolescents in VOC (15.4%) compared with COMP (6.8%) and GEN (4.3%), whereas daily use of other tobacco and nicotine products was associated with current nicotine pouch use compared with never using such products and the association was especially strong for snus use. The fully adjusted estimates of current nicotine pouch use remained strong for daily use of other tobacco and nicotine products (snus use: adjusted prevalence ratio [aPR] = 74.95, 95% confidence interval [CI] = 65.65-84.25; smoking: aPR = 1.43, 95% CI = 1.36-1.50; e-cigarette use: aPR = 2.15, 95% CI = 2.04-2.27) and for sex (boys aPR = 1.53, 95% CI = 1.48-1.57). There was no clear evidence of differences in current nicotine pouch use by school type, age or parental factors in the fully adjusted model. CONCLUSIONS: In Finland in 2023, during which the availability of nicotine pouches became less regulated, nicotine pouch use appeared to be more common among boys and adolescents who used other nicotine products.

The epidemiology of acute pancreatitis in Tasmania over a 12-year period: Is this a disease of disadvantage?

BACKGROUND: The global incidence of acute pancreatitis (AP) is increasing, but little information exists about trends in Australia. This study aimed to describe incidence trends, along with clinical and socio-demographic associations, in the state of Tasmania over a recent 12-year period. METHODS: The study cohort was obtained by linking clinical and administrative datasets encompassing the whole Tasmanian population between 2007 and 2018, inclusive. Pancreatitis case definition was based on relevant ICD-10 hospitalization codes, or elevated serum lipase or amylase in pathology data. Age-standardised incidence rates were estimated, overall and stratified by sex, aetiology, and Index of Relative Socio-economic Disadvantage (IRSD). RESULTS: In the study period, 4905 public hospital AP episodes were identified in 3503 people. The age-standardised person-based incidence rate across the entire period was 54 per 100,000 per year. Incidence was inversely related to IRSD score; 71 per 100,000 per year in the most disadvantaged quartile compared to 32 in the least disadvantaged. Biliary AP incidence was higher than that of alcohol-related AP, although the greatest incidence was in "unspecified" cases. There was an increase in incidence for the whole cohort (average annual percent change 3.23 %), largely driven by the two most disadvantaged IRSD quartiles; the least disadvantaged quartile saw a slight overall decrease. CONCLUSION: This is the first Australian study providing robust evidence that AP incidence is increasing and is at the upper limit of population-based studies worldwide. This increased incidence is greatest in socio-economically disadvantaged areas, meriting further research to develop targeted, holistic management strategies.

Mental well-being and sleep quality among vocational college students in Sichuan, China during standardized COVID-19 management measures.

Purpose: This research investigated the impact of the COVID-19 pandemic on the mental well-being and sleep quality of students in higher vocational colleges in Sichuan, China, identifying key factors influencing their psychological health during this period. Methods: Between January and February 2022, a comprehensive survey was conducted among students from several higher vocational colleges in Sichuan, utilizing a randomized selection approach to involve 3,300 participants. Data were collected through direct interviews executed by skilled interviewers. Results: Out of 3,049 valid responses, a significant number reported experiencing symptoms of poor mental health, anxiety, depression, and insomnia, with prevalence rates of 21.2%, 9.7%, 14.1%, and 81.9%, respectively. Factors contributing positively to mental health and sleep included a higher family economic status, reduced stress from the pandemic, and decreased online activity. Conversely, lack of physical activity post-pandemic, disruptions to education and employment, and deteriorating relationships emerged as negative influencers. Interestingly, a lack of pre-pandemic mental health knowledge acted as a protective factor against insomnia. Conclusion: The ongoing management of COVID-19 has notably influenced the psychological and sleep health of vocational college students, driven by economic, emotional, lifestyle, and educational factors. The findings underscore the necessity for targeted interventions to address these challenges effectively.