Quality of Life of Colorectal Cancer Patients and Its Association With Anxiety and Depression: Cross-Sectional Study at a Tertiary Care Hospital in Low Middle Income Country.

INTRODUCTION: Colorectal cancer (CRC) and its therapy profoundly affect the quality of life (QoL) of patients. The emotional distress: anxiety and depression also negatively affect wellbeing of these patients. This study aims to evaluate the QoL, anxiety, and depression in CRC patients and their association with clinic-pathological features at a tertiary care hospital in Karachi Pakistan, a low middle income country. METHODS: An analytical cross-sectional study was conducted on adult CRC patients. QoL was assessed using the European Organization for Research and Treatment of Cancer QoL questionnaire C30 and CR29. Hospital Anxiety and Depression Score was used to evaluate the anxiety and depression. Analyses were performed using STATA version 12, including multivariable linear and multivariate analysis of variance. A P value of < 0.05 was considered as significant. RESULTS: A total of 127 CRC patients with mean age of 53 ± 15 y participated. Mean global QoL score was 69.08 ± 1.78. Among symptoms scales: stoma care problem and among functional scales: sexual interest (women > men) were the most significantly affected aspect. Anxiety and depression were seen in 26 (20.9%) and 24 (18.9%) patients, respectively. Lower global QoL was significantly associated with depression (-25.33 [95% confidence interval: -34.4, -16.23]), on adjuvant treatment (-15.14 [-21.84, -8.44]), and neoadjuvant treatment (-11.75 [-19.84, -3.65]). CONCLUSIONS: This is the first study assessing the QoL in CRC patients in Pakistan. Depression was found to be significantly associated with poor QoL. Numerous factors correlated with low QoL scores indicating the need to develop local guidelines to address psychological distress in our patients.

Improvements in habitability and housing satisfaction after dwelling regeneration in social housing complexes. The RUCAS study.

Housing is a pressing problem worldwide and a key determinant of health and wellbeing. The right to adequate housing, as a pillar of the right to an adequate standard of living, means more than a roof to live under. Adequate means the dwelling must fulfill material functions and psychosocial functions, thus contributing to dwellers health and wellbeing. Social housing policies aim to fulfill the right to housing, but frequently fail in fulfilling the right to it being adequate. This study capitalizes on the implementation of a national urban regeneration program in two social housing villas in central Chile (one in Santiago, in the central valley, the other in Viña del Mar, a coastal city) to run a natural experiment assessing the impact of dwelling renovation on several dimensions of perceived habitability and housing satisfaction among the -mostly female-household homemakers. We use 5 waves of survey data collected with a step-wedge design to estimate the association between a time-varying exposure status (the intervention) and 7 binary outcomes for habitability and 5 for housing dissatisfaction, including overall housing satisfaction. We use Poisson regression models with robust variance and a random intercept at the respondent level. At baseline, reports of poor habitability and dissatisfaction across all features were markedly high, the highest levels of dissatisfaction being with acoustic insulation and dwelling size in both villas, and with indoor temperature in Santiago. The intervention resulted in statistically significant and markedly large improvements in reported habitability and dissatisfaction relative to those housing components targeted by the intervention, as well as with overall dwelling satisfaction in both study cases. Implications are, first, that the policy response to quantitative housing deficits must not overlook housing quality; second, that housing renovation appears as a promising intervention for qualitative housing crises; third, that while improvements in habitability and satisfaction are specific to the interventions in place, overall housing satisfaction can improve in more limited, tailored, dwelling renovation interventions. Social housing renovation in Latin America appears as a promising intervention to improve quality of life among the urban poor dwellers and reduce inequalities in health related to housing conditions.

Social inequity in chiropractic utilisation - a cross-sectional study in Denmark, 2010 and 2017.

BACKGROUND: Inequity in healthcare utilisation refers to differences between groups that remain after adjustment for need for health care. To our knowledge, no previous studies have aimed to assess social inequity in chiropractic utilisation in a general population. Therefore, the objective of this study was to evaluate social inequity in chiropractic utilisation in the general Danish population adjusted for health status as a proxy of need for chiropractic care. METHODS: A population-based repeated cross-sectional study design was used based on the Danish National Health Survey in 2010 and 2017. Overall, we included 288,099 individuals aged 30 years or older in 2010 or 2017. For each individual, information on chiropractic utilisation, socioeconomic status, and health status as a proxy of need for chiropractic care was retrieved from nationwide registers using the unique personal identification number. Measures of health status included demographics, poor self-rated physical health, activity limitations, musculoskeletal pain, number of musculoskeletal conditions, and number of chronic diseases. We investigated social inequity in chiropractic utilisation (yes, no) using logistic regression adjusted for health status, stratified by sex and year. Three characteristics of socioeconomic status (educational level, employment status and income) were investigated. To further quantify the degree of social inequity in chiropractic utilisation, we estimated the concentration index of inequity for each of the three characteristics of socioeconomic status. RESULTS: We found significantly higher odds of chiropractic utilisation among individuals with short or medium/long education compared with individuals with elementary education, and among employed individuals compared with individuals who were unemployed, receiving disability pension or retired. Furthermore, the odds of chiropractic utilisation increased with higher income. The concentration index indicated social inequity in chiropractic utilisation in favour of individuals with higher socioeconomic status, with income and employment status contributing more to inequity than educational level. CONCLUSION: The study demonstrated social inequity in chiropractic utilisation in Denmark beyond differences in health status as a proxy of need for chiropractic care in the general population. The results suggest that new strategies are required if equal treatment for equal need is the goal.

Feasibility of focused parathyroidectomy in developing countries-a scoping review.

Background: The mainstay of treatment of primary hyperparathyroidism involves a parathyroidectomy, which depending on the number of affected parathyroid glands and the availability of resources, may involve a bilateral neck exploration with four gland assessment or a minimally invasive, focused parathyroidectomy (FP) necessitating pre-operative localisation. The feasibility of the latter is yet to be demonstrated in developing countries. Methods: A scoping review was performed with published literature evaluated from the past 15 years (2007 & onwards). Articles were screened and only included if they discussed FP, preoperative localisation, economic impact and they originated from a developing country (upper middle or lower middle-income). Results: A total of 18 articles met the inclusion criteria, comprising seven developing countries (two upper middle-income and five lower middle-income countries). Preoperative localisation was performed in all studies, with overall accuracy rates of 75.5% for ultrasound and 85.7% for 99mTc sestamibi. A total 1,202 patients (70%) had FP. Five hundred and fifty-five patients underwent FP without intraoperative adjuncts and 647 underwent FP with intraoperative adjuncts, with adjusted cure rates of 95.3% and 99.2% respectively. Overall cure rate for FP was 96.4%. Conclusions: With access to accurate preoperative localisation and excellent cure rates with and without intraoperative adjuncts, we conclude that FP is feasible in developing countries.

Socioeconomic Status and Adherence to Preventive Measures During the COVID-19 Pandemic in Switzerland: A Population Based Digital Cohort Analysis.

Objectives: To assess the association between socioeconomic status (SES) and self-reported adherence to preventive measures in Switzerland during the COVID-19 pandemic. Methods: 4,299 participants from a digital cohort were followed between September 2020 and November 2021. Baseline equivalised disposable income and education were used as SES proxies. Adherence was assessed over time. We investigated the association between SES and adherence using multivariable mixed logistic regression, stratifying by age (below/above 65 years) and two periods (before/after June 2021, to account for changes in vaccine coverage and epidemiological situation). Results: Adherence was high across all SES strata before June 2021. After, participants with higher equivalised disposable income were less likely to adhere to preventive measures compared to participants in the first (low) quartile [second (Adj.OR, 95% CI) (0.56, 0.37-0.85), third (0.38, 0.23-0.64), fourth (0.60, 0.36-0.98)]. We observed similar results for education. Conclusion: No differences by SES were found during the period with high SARS-CoV-2 incidence rates and stringent measures. Following the broad availability of vaccines, lower incidence, and eased measures, differences by SES started to emerge. Our study highlights the need for contextual interpretation when assessing SES impact on adherence to preventive measures.

The impact of credit accessibility and information communication technology on the income of small-scale sugarcane farmers in Ndwedwe Local Municipality, KwaZulu-Natal Province, South Africa.

Introduction: Access to credit and information and communication technology (ICT) plays a pivotal role in enhancing the practices of small-scale sugarcane farmers, impacting their financial, social, and economic wellbeing. However, many small-scale farmers need help accessing these resources, thereby affecting their ability to generate sustainable income. This study aimed to assess the factors influencing the adoption of ICT and access to credit and their subsequent impact on small-scale farmers' income. Methods: Employing a multistage sampling technique, 300 small-scale farmers were selected as participants in the study. The recursive bivariate probit regression model was used to assess the factors affecting adoption ICT and a selectivity-corrected ordinary least square regression model was utilized to estimate the synergistic effect of ICT adoption and access to credit on the income of small-scale sugarcane farmers. Results and discussion: The findings revealed that approximately 77% of small-scale farmers had access to credit, while more than 80% had adopted ICT. The results derived from the recursive bivariate probit (RBP) regression model indicated that access to credit, education, and extension support positively and significantly influenced the adoption of ICT. Conversely, marital status and non-farm income exhibited a negative and significant influence on the adoption of ICT. Gender and marital status were positively and significantly associated with access to credit, whereas age, education, and non-farm income showed a negative and significant relationship on access to credit. Subsequently, a selectivity-corrected ordinary least square regression model analysis revealed that factors such as gender, marital status, extension, government support, and transportation costs positively and significantly influenced farmer's income. In contrast, education, employment status, and non-farm income exhibited a negative and significant influence on income. Conclusion and recommendations: The study concludes that socio-demographic factors, such as gender, marital status, extension support, government support, and transportation costs, positively contribute to farmers' income. Small-scale sugarcane farmer involvement in other non-farm activities is associated with reduced farm income. This implies that farmers' livelihoods options are reduced as they can only focus on sugarcane development as a source of income. There is a pressing need to educate small-scale farmers on ICT and provide them with access to agricultural credit. Additionally, extension workers should offer advisory support to small-scale farmers requiring assistance in accessing agricultural credit. There is a need to train sugarcane farmers on different agricultural income generating activities to reduce their over-reliance on sugarcane development. By addressing the identified socio-demographic factors and implementing targeted policy interventions, stakeholders can foster an enabling environment for small-scale farmers to thrive, ultimately contributing to the sustainable development of the sugarcane sector and the broader agricultural landscape in South Africa.

Social Networks, Social Determinants and Mortality: Western New York Exposures and Breast Cancer (WEB) Study.

BACKGROUND: There are few studies of social support and other social determinants of health after breast cancer (BC) diagnosis and their associations with mortality; results have been inconclusive. Further, it is not known if observed associations are specific to women with BC diagnosis or if associations would be similar among healthy women. METHODS: Women with incident, pathologically confirmed invasive BC, stage I-IV (n = 1012) and healthy frequency age-matched controls (n = 2036), answered a social support questionnaire in prospective follow-up of a population-based case-control study, the Western New York Exposures and Breast Cancer (WEB) Study. At interview, all participants were aged 35-79 years and resident of two counties in Western New York State. Mortality status was ascertained from the National Death Index. Participants were queried regarding the number of their close friends, frequency of seeing them, household size, household income, and marital status. Hazard ratios (HR) and 95% confidence intervals (CI) for BC specific mortality (BC women only) and all-cause mortality were estimated. RESULTS: Lower household income was associated with higher all-cause mortality among women diagnosed with BC (HR 2.48, 95% CI, 1.24-4.97) and similarly among the healthy women (HR 2.63, 95% CI, 1.25-5.53). Number and frequency of seeing friends, marital status, and household size were not associated with mortality, either among BC patients or among healthy women. CONCLUSION: Among both those diagnosed with BC and healthy women, lower income was associated with more than twice the mortality. Marital status, household size, number or frequency of meeting friends were not associated with survival.

Acquisition of foods that make up the new basic food basket by low-income brazilian families in 2017-2018: socioeconomic and demographic distribution / Aquisição de alimentos que compõem a nova cesta básica pelas famílias brasileiras de baixa renda em 2017-18: distribuição socioeconômica e demográfica

In 2024, the Brazilian government promulgated a decree with new guidelines for the basic food basket, based on the Brazilian Dietary Guidelines. This study describes the acquisition of foods that make up the new basic basket by low-income families in Brazil, using data from the latest edition of the Household Budget Survey, conducted in 2017-18. The household food acquisitions of families with a per capita income of up to half a minimum wage were analyzed, both for the country as a whole and according to housing situation, region of the country, and race/skin color of the head of the family (n=13,706 households). The foods that make up the basket, identified according to Ordinance 966 of the Ministry of Social Development, represented 84.1% of the total calories acquired by low-income households. The food groups with the highest contributions to total calories were cereals (33.4%), sugars and oils/fats (21.3%), and meats and eggs (11.5%). Rice, corn and other grains, and beans represented 19.6% and 4.6% of total calories, respectively. Poultry and beef were the most consumed meats, representing 4.9% and 4.0% of the calories. Fruits contributed to 1.9%, and vegetables and greens to 0.7%. The caloric share of foods that make up the new basic basket was higher in rural areas (88.0%) and in the North (88.2%) and Northeast (85.9%) regions. There were no significant differences between race/skin color categories. Our data show that, in 2017-18, the foods that make up the new basic basket were the foundation of the diet of the poorest population, reinforcing the cultural feasibility of its implementation and the need for policies that ensure continuous access to these foods.

Em 2024, o governo brasileiro promulgou um decreto com novas diretrizes para a cesta básica de alimentos, baseadas no Guia Alimentar para a População Brasileira. Este estudo descreve a aquisição dos alimentos que compõem a nova cesta básica por famílias de baixa renda no Brasil, utilizando dados da última edição da Pesquisa de Orçamentos Familiares, realizada em 2017-8. Foram analisadas as aquisições domiciliares de alimentos das famílias com renda per capita de até meio salário-mínimo, no país como um todo e segundo situação de moradia, região do País e raça/cor da pele do chefe da família (n=13.706 domicílios). Os alimentos que compõem a cesta, identificados conforme a Portaria 966 do Ministério do Desenvolvimento Social, representaram 84,1% do total de calorias adquiridas pelos domicílios de baixa renda. Os grupos alimentares com maiores contribuições para o total de calorias foram cereais (33,4%), açúcares e óleos/gorduras (21,3%), e carnes e ovos (11,5%). Arroz, milho e outros grãos e feijões contribuíram com 19,6% e 4,6% das calorias, respectivamente. Carnes de ave e de boi foram as mais consumidas, representando 4,9% e 4,0% das calorias. Frutas contribuíram com 1,9% e legumes e verduras com 0,7%. A participação calórica de alimentos da nova cesta básica foi maior na área rural (88,0%) e nas regiões Norte (88,2%) e Nordeste (85,9%). Não houve diferenças significativas entre as categorias de raça/cor da pele. Nossos dados mostram que, em 2017-8, os alimentos que compõem a nova cesta eram a base da alimentação da população mais pobre, reforçando a viabilidade cultural da sua implementação e a necessidade de políticas que garantam o acesso contínuo a esses alimentos.

Evaluating the Association of the Increase in the WIC Cash Value Benefit on the Diversity of MyPlate Fruits and Vegetables Redeemed and Consumed By Children in Low-Income Households.

Background: Fruits and vegetables (FV) are a critical source of nutrients, yet children in the United States are not meeting the Dietary Guidelines for Americans (DGA). The monthly FV cash value benefit (CVB) included in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)'s food package to support child FV intake (FVI) received a substantial increase for economic relief during the COVID-19 pandemic. Objectives: To evaluate how an expansion of the monthly WIC CVB to purchase FV for WIC children ages 1-4 y is associated with diversity in FV redeemed, and how changes in redeemed FV are related to FVI. Methods: Caregivers representing 1463 WIC-participating children recruited from Los Angeles County, California, completed surveys during the CVB augmentation (T1: CVB = $9/mo; T2 = $35/mo; T3 = $24/mo). Redeemed price look-up codes (PLUs), corresponding to a food item, were assigned to its corresponding MyPlate FV group. Multivariable generalized estimating equation regression models assessed changes in amount and diversity of FV redemption across MyPlate groups and associations between changes in FV diversity and changes in FVI. Results: Slightly over half of all households were food insecure (55%), half of the children were female (52%), and most were Hispanic (78%). Compared with T1, significant increases in the number of PLUs and dollars redeemed were observed in most MyPlate FV groups. From T1 to T2, significant increases in diversity scores were observed for total fruit (ß: 1.6 pts; 95% confidence interval [CI]: 1.4, 1.7), total vegetable (ß: 3.6 pts; 95%CI: 3.4, 3.9), and total FV (ß:7.8 pts; 95%CI: 7.4, 8.2). Similarly, increases in diversity score were observed at T3 compared with T1. Changes in FV diversity redeemed were not associated with changes in FVI. Conclusions: During the CVB augmentation, WIC participants redeemed a greater amount and variety of FV according to DGA MyPlate recommendations, supporting its permanent increase.

The Urban-Rural Divide in Neurocritical Care in Low-Income and Middle-Income Countries.

The term "urban-rural divide" encompasses several dimensions and has remained an important concern for any country. The economic disparity; lack of infrastructure; dearth of medical specialists; limited opportunities to education, training, and health care; lower level of sanitation; and isolating effect of geographical location deepens this gap, especially in low-income and middle-income countries (LMICs). This article gives an overview of the rural-urban differences in terms of facilities related to neurocritical care (NCC) in LMICs. Issues related to common clinical conditions such as stroke, traumatic brain injury, myasthenia gravis, epilepsy, tubercular meningitis, and tracheostomy are also discussed. To facilitate delivery of NCC in resource-limited settings, proposed strategies include strengthening preventive measures, focusing on basics, having a multidisciplinary approach, promoting training and education, and conducting cost-effective research and collaborative efforts. The rural areas of LMICs bear the maximum impact because of their limited access to preventive health services, high incidence of acquired brain injury, inability to have timely management of neurological emergencies, and scarcity of specialist services in a resource-deprived health center. An increase in the health budget allocation for rural areas, NCC education and training of the workforce, and provision of telemedicine services for rapid diagnosis, management, and neurorehabilitation are some of the steps that can be quite helpful.

Barriers and facilitators to the delivery of a biopsychosocial education and exercise programme for patients with chronic low back pain in Ghana. A qualitative study.

PURPOSE: Low back pain management has evolved with researchers advocating for a biopsychosocial management model. The biopsychosocial management model has been predominantly applied in high-income countries and underexplored in low- and middle-income countries including Ghana. This study aimed to explore the potential barriers and facilitators to patients with chronic low back pain (CLBP) and physiotherapists engagement with a biopsychosocial intervention (exercise and patient education) as part of a feasibility study. MATERIAL AND METHODS: This was a qualitative study embedded within a mixed-methods, sequential, feasibility study, in Ghana, applying semi-structured interviews. Two categories of participants involved in this study were, two trained physiotherapists, and six patients with CLBP, sampled within the feasibility study. RESULTS: Regarding the barriers and facilitators to the delivery of the BPS intervention, five interlinked themes emerged from the thematic analysis. These were: structure and process of delivery; patients' expectations; patients' health beliefs, autonomy, and engagement; external influences and personal and professional characteristics of physiotherapists. CONCLUSION: The themes that emerged from this study demonstrated many positive facilitators based on participants' improved understanding of LBP and the clarity and purpose of the biopsychosocial intervention. The results therefore demonstrate a potential to deliver the biopsychosocial intervention in a Ghanaian context.

A biopsychosocial approach to managing chronic low back pain offers a promising alternative to patients and physiotherapists in Ghana.A biopsychosocial approach to managing chronic low back pain has the potential to improve physiotherapists' thoughts and attitudes, and have a positive influence on their professional development in Ghana.A biopsychosocial approach to managing chronic low back pain has the potential to reverse patients' maladaptive beliefs, improve their understanding of their condition, improve outcomes in Ghana.

Defining a screening tool for post-traumatic stress disorder in East Africa: a penalized regression approach.

Background: Scalable PTSD screening strategies must be brief, accurate and capable of administration by a non-specialized workforce. Methods: We used PTSD as determined by the structured clinical interview as our gold standard and considered predictors sets of (a) Posttraumatic Stress Checklist-5 (PCL-5), (b) Primary Care PTSD Screen for the DSM-5 (PC-PTSD) and, (c) PCL-5 and PC-PTSD questions to identify the optimal items for PTSD screening for public sector settings in Kenya. A logistic regression model using LASSO was fit by minimizing the average squared error in the validation data. Area under the receiver operating characteristic curve (AUROC) measured discrimination performance. Results: Penalized regression analysis suggested a screening tool that sums the Likert scale values of two PCL-5 questions-intrusive thoughts of the stressful experience (#1) and insomnia (#21). This had an AUROC of 0.85 (using hold-out test data) for predicting PTSD as evaluated by the MINI, which outperformed the PC-PTSD. The AUROC was similar in subgroups defined by age, sex, and number of categories of trauma experienced (all AUROCs>0.83) except those with no trauma history- AUROC was 0.78. Conclusion: In some East African settings, a 2-item PTSD screening tool may outperform longer screeners and is easily scaled by a non-specialist workforce.

Urban regrets (Unhappy metros: Satisfaction with life scale (SWLS)).

This is the first study of urban-rural happiness gradient using multi-item Satisfaction With Life Scale (SWLS). A new finding is that urbanites fail especially on "If I could live my life over, I would change almost nothing"-urban way of life tends to result in regrets. Effect sizes of urbanicity on subjective wellbeing (SWB) are substantial-about half of health-living in a metro depresses one's happiness as much as going half way from fair health to poor health, for instance.

Computational Modeling Interpretation Underlying Elevated Risk-Taking Propensity in the Dynamic Risky Investment Process of Non-Labor Income.

Introduction: Money source influences risk-taking behaviors. Although studies consistently indicated that individuals demonstrate a higher propensity to make risky investments when utilizing non-labor income as opposed to labor income, explanations as to why non-labor income leads to continuously blowing money into risky investments are scarce. Methods: The current study leverages a computational modeling approach to compare the differences in the dynamic risk investment process among individuals endowed with income from different sources (ie, non-labor income vs labor income) to understand the shaping force of higher risk-taking propensity in individuals with non-labor income. A total of 103 participants were recruited and completed the Balloon Analogue Risk Task (BART) with an equal monetary endowment, either as a token for completion of survey questionnaires (representing labor income) or as a prize from a lucky draw game (representing non-labor income). Results: We found that individuals endowed with non-labor income made more risky investments in BART compared to those with labor income. With computational modeling, we further identified two key differences in the dynamic risk investment processes between individuals endowed with labor and those with non-labor income. Specifically, individuals endowed with non-labor income had a higher preset expectation for risk-taking and displayed desensitization towards losses during risk investments, in contrast to individuals with labor income. Discussion: This study contributed to a better understanding of the psychological mechanisms of why individuals make more risk-taking behaviors with non-labor income, namely higher preset expectations of risk-taking and desensitization towards losses. Future research could validate these findings across diverse samples with varying backgrounds and adopt different manipulations of labor and non-labor income to enhance the external validity of our study.

Rotation of tobacco health warnings and messages: challenges and recommendations for implementation.

Health warnings and messages-or health warning labels (HWLs)-are integral to tobacco control efforts, but their sustained impact necessitates regular rotation. This paper explores challenges in HWL rotation implementation across six diverse countries: Chile, Guyana, Indonesia, Jamaica, Mexico, and Vietnam. 19 in-depth interviews were conducted with government officials and representatives from civil society organisations and academia. Interviews explored the effectiveness of HWL regulations, the processes involved in their execution, and any challenges encountered along the way. Interviews were analysed thematically, using a combination of deductive and inductive approaches. Interviews revealed critical challenges that fall into two categories: specific and overarching. Government priorities and transitions, political will, time and bureaucracy, legal loopholes, lack of images, evaluation, and economic and human resources constitute HWL-specific challenges. Broad tobacco control challenges included tobacco industry interference and enforcement difficulties. To address HWL rotation challenges, international bodies such as WHO could establish extensive image banks, pre-evaluated for effectiveness and cultural relevance. In addition, countries must institutionalise the rotation process by establishing mechanisms that avoid having to pass complex legal instruments with each new round of warnings, delegating responsibilities to stable government institutions, addressing legal loopholesand planning for multiple rounds within a single legal instrument. Further, partnerships at national and international levels, along with systematic evaluations, are crucial for successful HWL implementation. These recommendations form a comprehensive framework for global collaboration, aiming to strengthen tobacco prevention through impactful HWLs on a sustainable basis.

Prevalence and risk factors of food insecurity among Syrian refugees in Türkiye.

BACKGROUND: Although Türkiye (Turkey) hosts the largest number of Syrian refugees, studies on food insecurity are limited. This study examined the prevalence and risk factors of food insecurity among Syrian refugees living in Istanbul, which has the highest number of refugees in Türkiye. METHODS: A cross-sectional survey was conducted among Syrian refugees in Istanbul between September 2021 and March 2022. The main income earners of 103 households were interviewed by a research dietitian, with the assistance of an Arabic speaking interpreter through hour-long face-to-face. Data on sociodemographic characteristics (age, gender, nationality, marital status, educational status, the family income, the major source of family income, and the number of family members living in the household etc.) and household food insecurity status were collected. Household food insecurity status was assessed with the eighteen-item Household Food Security Survey Module. RESULTS: The household food insecurity rate was 90.3%, and those of adults and children were 88.4% and 84.8%, respectively. It was observed that family income level was significantly associated with food insecurity. A one-unit increase in monthly income increased food security by 0.02 times (p < 0.001). The number of employed refugees in the food security group was higher than that in the food insecurity group (p = 0.018). A significant difference was found in the rate of occupation type of the major income earner between the groups (p = 0.046). CONCLUSIONS: High rates of food insecurity, particularly severe food insecurity, were found among Syrian refugees living in Istanbul. While more research is warranted to explore the root causes and efficacy of the current support system, it requires the immediate attention of policymakers at the national and international levels to implement effective policies and interventions.

Income disparities and risk: Geographical manifestations of extreme inequities in the United States.

We examined hazard and risk-related metrics of the highest- and lowest-income counties and municipalities in each U.S. state. Indicators of natural and anthropogenic hazards, health outcomes, location of locally unwanted land uses, food insecurity, and other metrics were used to measure social and environmental justice. As expected, the highest-income places have better health outcomes, access to assets that protect health, and high municipal ratings of place quality compared with their poorest counterparts. Yet, they also have higher natural hazard risks and are more likely to live near concentrations of anthropogenic hazards. That is, high-income places have a lot to lose. Although the poorest jurisdictions demonstrate cumulative disadvantages, those in rural areas are exposed to less dense motor vehicle traffic and other hazards and risks associated with urban life. Relationships between income and the geography of hazards and risks are not simple. Even the highest-income areas face challenges. We suggest improvements in databases and tools to increase the focus on and monitoring of the breadth of risks people face in all areas.

Screening rates for hepatitis B and C among low-income US veterans: Data from the National Veteran Homeless and Other Poverty Experiences Study.

Screening for viral hepatitis is considered a high-priority area in the Veterans Health Administration (VHA). Yet, few studies have examined viral hepatitis screening test use among low-income veterans who are considered high-risk with limited healthcare access. Using cross-sectional data from 933 participants in the 2021-2022 National Veteran Homeless and Other Poverty Experiences (NV-HOPE) study, we examined rates and correlates of lifetime screening for hepatitis B (HBV) and hepatitis C (HCV) infections. Multivariable logistic regression models evaluated characteristics associated with HBV/HCV screening. Nearly 16% and 21% reported lifetime HBV and HCV screening, respectively. These rates are considerably lower than HBV (47.3%) and HCV (92.9%) screening rates documented among contemporaneous veterans in VHA electronic health records. In the NV-HOPE data, veterans 50-79 years were more likely than those ≥80 years of age to ever-screen for HBV/HCV. Whereas, household income was inversely related to lifetime screening behaviours, veterans reporting 'other' employment types (vs. full-time/part-time employment) were more likely to ever-screen for HBV/HCV. Ever-screening for HBV was more likely among veterans reporting non-Hispanic 'other' (vs. non-Hispanic 'white') race, housing instability, Medicaid insurance, as well as drug use and cognitive disorder histories. Living with ≥5 members (vs. alone), histories of alcohol use, cancer, and liver disorders were also correlated with ever-screening for HCV. HIV/AIDS history correlated with ever-screening for HBV/HCV. In conclusion, fewer than one-third of low-income US veterans ever-screened for HBV/HCV, with lower screening rates among those less likely to be exposed to viral hepatitis, thereby informing interventions aimed at promoting available screening, treatment and vaccinations for HBV/HCV.