Sex-differences in the association of social health and marital status with blood-based immune and neurodegeneration markers in a cohort of community-dwelling older adults.

BACKGROUND: The immune system has been proposed to play a role in the link between social health and all-cause dementia risk. We explored cross-sectional and longitudinal associations between social health, immune system balance and plasma neurodegeneration markers in community-dwelling older adults, and explored whether the balance between innate and adaptive immunity mediates associations between social health and both cognition and total brain volume. METHODS: Social health markers (social support, marital status, loneliness) were measured in the Rotterdam Study between 2002-2008. Immune system cell counts and balance were assessed repeatedly from 2002 to 2016 using white blood-cell-based indices and individual counts (granulocyte-to-lymphocyte ratio (GLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII)). Plasma neurodegeneration biomarkers (amyloid-ß40, amyloid-ß42, total tau and neurofilament light chain) were measured once from blood samples collected between 2002-2008. Global cognitive function and total brain volume (MRI) were measured at the follow-up visit between 2009-2014. We used linear mixed models to study longitudinal associations and performed causal mediation analyses. RESULTS: In 8374 adults (mean age 65.7, 57 % female), never married participants (n = 394) had higher GLR, PLR and SII compared to married peers at baseline and during follow-up, indicating imbalance towards innate immunity. Being never married was associated with higher plasma amyloid-ß40, and being widowed or divorced with higher plasma total tau levels at baseline. Widowed or divorced males, but not females, had higher GLR, PLR and SII at baseline. Higher social support was associated with lower PLR in females, but higher PLR in males. Loneliness was not associated with any of the immune system balance ratios. Never married males had higher levels of all plasma neurodegeneration markers at baseline. Immune system balance did not mediate associations between social health and cognition or total brain volume, but does interact with marital status. CONCLUSION: This study indicates that marital status is associated with blood-based immune system markers toward innate immunity and higher levels of plasma neurodegeneration markers. This is particularly evident for never married or previously married male older adults compared to married or female peers.

Improving the validity of studies on the relationship between social health and Immunity of older Adults: Letter to the editor.

The recent study by Isabelle F. van der Velpen et al., (2024), published in Brain Behavior and Immunity, explores the intricate relationship between social health, marital status, and their effects on immune markers and neurodegeneration in the elderly. It highlights significant gender and marital status differences impacting immune system health and plasma biomarkers. Despite its depth, the study's reliance on self-reported measures for loneliness and social support may not fully capture the complexity of social health, which includes dynamic components like social integration. The use of broad immune indices, such as the Granulocyte to Lymphocyte Ratio and Systemic Immune Inflammation index, limits the detailed understanding of specific immune pathways. The study's cross-sectional design restricts causal inferences, underscoring the need for longitudinal research to establish temporal sequences and causality in the relationship between social health, immune function, and neurodegeneration. Additionally, while the study identifies gender differences, it does not delve into the mechanisms driving these differences, nor does it account for psychosocial factors such as mental health, physical activity, and diet. These findings emphasize the importance of gender-specific health interventions and policies to address social determinants like marital status, which significantly impact long-term health outcomes in older adults.

The role of playgrounds in promoting children's health - a scoping review.

BACKGROUND: Active outdoor play is important for children's health and development, and playgrounds provide good places for play. However, the importance of playground use for health and well-being is unclear. Our scoping review aims to create an overview of all research on playground use and health benefits for children. METHODS: Scopus, Web of Science, SportDiscus, and PsycInfo were searched using two search blocks, focusing on 'playground' and 'children' respectively, for publications from 2000 to November 2023. The primary inclusion criterion was examining the relationship between playground use and positive physical, mental, or social health outcomes. Only papers published in English were reviewed. For each publication, we synthesized and condensed the results, categorizing them by playground setting, reported health outcome, participant age group, study design, methodologies, publication's country, year, and 'stage of evidence'. RESULTS: Data from 247 studies were extracted and nearly 80% of these publications were descriptive or exploratory studies. Fifty-two were intervention studies. Adding playground markings to schoolyards led to increased physical activity. Greening schoolyards had mainly positive effects on social and mental health. In Early Childhood Education and Care, renewing play structures had a positive effect on physical activity in three publications. All Public Open Space interventions we found were different, with mixed effects on health outcomes. CONCLUSIONS: The existing evidence provides good arguments for policy makers, city planners and school-leaders to invest in adding playground markings in schoolyards as this will likely result in more physical activity. The evidence for the health benefits of investing in new play structures indicated that tailoring the playground to local needs is important as 'one size does not fit all' and playgrounds need to be designed as engaging and interesting places for children's play if they are to generate health benefits. Investing in 'greening' playgrounds is likely to result in social and mental health benefits for children, but does not always result in more physical activity. The research field needs more efficacy and effectiveness studies, and in particular replication and scale-up studies to demonstrate which type of playground interventions are successful. PROTOCOL: The review protocol was registered at Open Science Framework ( https://doi.org/10.17605/OSF.IO/UYN2V ).

Maternal social deprivation and preterm birth: The PreCARE cohort study.

BACKGROUND: Maternal exposure to unfavourable social conditions is associated with a higher rate of perinatal complications, such as placental vascular pathologies. A higher risk of preterm birth (PTB) has also been reported, and variations across studies and settings suggest that different patterns may be involved in this association. OBJECTIVE: To assess the association between maternal social deprivation and PTB (overall and by phenotype). METHODS: We analysed 9365 patients included in the PreCARE cohort study. Four dimensions (social isolation, insecure housing, no income from work and absence of standard health insurance) defined maternal social deprivation (exposure). They were considered separately and combined into a social deprivation index (SDI). The associations between social deprivation and PTB <37 weeks (primary outcome) were analysed with univariable and multivariable log-binomial models (adjusted for maternal age, parity, education level and birthplace). Then we used multinomial analysis to examine the association with preterm birth phenotypes (secondary outcome): spontaneous labour, preterm prelabour rupture of membranes (PPROM) and placental vascular pathologies. RESULTS: In all, 66.3%, 17.8%, 8.9% and 7.0% of patients had an SDI of 0, 1, 2 and 3, respectively. Social isolation affected 4.5% of the patients, insecure housing 15.5%, no income from work 15.6% and no standard health insurance 22.4%. Preterm birth complicated 7.0% of pregnancies (39.8% spontaneous labour, 28.3% PPROM, 21.8% placental vascular pathologies and 10.1% other phenotypes). Neither the univariable nor multivariable analyses found any association between social deprivation and the risk of preterm birth overall (SDI 1 versus 0: aRR 1.02, 95% confidence interval [CI] 0.83, 1.26; 2 versus 0: aRR 1.05, 95% CI 0.80, 1.38; 3 versus 0: aRR 0.92, 95% CI 0.66, 1.29) or its different phenotypes. CONCLUSIONS: In the French PreCARE cohort, we observed no association between markers of social deprivation and the risk of preterm birth, regardless of phenotype.

Does supplemental private health insurance impact health care utilization and seeking behavior of residents covered by social health insurance? Evidence from China National Health Services Survey.

BACKGROUND: Supplemental private health insurance (PHI) plays a crucial role in complementing China's social health insurance (SHI). However, the effectiveness of incorporating PHI as supplementary coverage lacks conclusive evidence regarding its impact on healthcare utilization and seeking behavior among SHI-covered individuals. Therefore, investigating the effects of supplementary PHI on health care utilization and seeking behavior of residents covered by social health insurance is essential to provide empirical evidence for informed decision-making within the Chinese healthcare system. METHODS: Data from the 2018 China National Health Services Survey were analyzed to compare outpatient and inpatient healthcare utilization and choices between PHI purchasers and non-purchasers across three SHI schemes: urban employee-based basic medical insurance (UEBMI), urban resident-based basic medical insurance (URBMI), and the new rural cooperative medical scheme (NRCMS). Using the Andersen Healthcare Services Utilization Behavior Model as the theoretical framework,binary logistic regression and multinomial logistic regression (MNL) models were employed to assess the impact of PHI on healthcare utilization and provider preferences. RESULTS: Among UEBMI, URBMI, and NRCMS participants with PHI, outpatient visit rates were 17.9, 19.8, and 21.7%, and inpatient admission rates were 12.4, 9.9, and 12.9%, respectively. Participants without PHI exhibited higher rates for outpatient visits (23.6, 24.3, and 25.6%) and inpatient admissions (15.2, 12.8, and 14.5%). Binomial logistic regression analyses revealed a higher probability of outpatient visits and inpatient admissions among UEBMI participants with PHI (p < 0.05). NRCMS participants with PHI showed a lower probability of outpatient visits but a higher probability of inpatient admissions (p < 0.05). Multinomial logistic regression indicated that NRCMS participants with PHI were more likely to choose higher-level hospitals, with a 17% increase for county hospitals and 27% for provincial or higher-level hospitals compared to primary care facilities. CONCLUSION: The findings indicate that the possession of PHI correlated with increased utilization of outpatient and inpatient healthcare services among participants covered by UEBMI. Moreover, for participants under the NRCMS, the presence of PHI is linked to a proclivity for seeking outpatient care at higher-level hospitals and heightened utilization of inpatient services. These results underscore the nuanced influence of supplementary PHI on healthcare-seeking behavior, emphasizing variations across individuals covered by distinct SHI schemes.

Revisiting a decade of inequality in healthcare financial burden in Cambodia, 2009-19: trends, determinants and decomposition.

BACKGROUND: Out-of-pocket healthcare expenditure (OOPHE) without adequate social protection often translates to inequitable financial burden and utilization of services. Recent publications highlighted Cambodia's progress towards Universal Health Coverage (UHC) with reduced incidence of catastrophic health expenditure (CHE) and improvements in its distribution. However, departing from standard CHE measurement methods suggests a different storyline on trends and inequality in the country. OBJECTIVE: This study revisits the distribution and impact of OOPHE and its financial burden from 2009-19, employing alternative socio-economic and economic shock metrics. It also identifies determinants of the financial burden and evaluates inequality-contributing and -mitigating factors from 2014-19, including coping mechanisms, free healthcare, and OOPHE financing sources. METHODS: Data from the Cambodian Socio-Economic Surveys of 2009, 2014, and 2019 were utilized. An alternative measure to CHE is proposed: Excessive financial burden (EFB). A household was considered under EFB when its OOPHE surpassed 10% or 25% of total consumption, excluding healthcare costs. A polychoric wealth index was used to rank households and measure EFB inequality using the Erreygers Concentration Index. Inequality shifts from 2014-19 were decomposed using the Recentered Influence Function regression followed by the Oaxaca-Blinder method. Determinants of financial burden levels were assessed through zero-inflated ordered logit regression. RESULTS: Between 2009-19, EFB incidence increased from 10.95% to 17.92% at the 10% threshold, and from 4.41% to 7.29% at the 25% threshold. EFB was systematically concentrated among the poorest households, with inequality sharply rising over time, and nearly a quarter of the poorest households facing EFB at the 10% threshold. The main determinants of financial burden were geographic location, household size, age and education of household head, social health protection coverage, disease prevalence, hospitalization, and coping strategies. Urbanization, biased disease burdens, and preventive care were key in explaining the evolution of inequality. CONCLUSION: More efforts are needed to expand social protection, but monitoring those through standard measures such as CHE has masked inequality and the burden of the poor. The financial burden across the population has risen and become more unequal over the past decade despite expansion and improvements in social health protection schemes. Health Equity funds have, to some extent, mitigated inequality over time. However, their slow expansion and the reduced reliance on coping strategies to finance OOPHE could not outbalance inequality.

Understanding cannabis use and mental health difficulties in context with women's experiences of stressful events and social health issues in pregnancy: The Aboriginal Families Study.

BACKGROUND: Few population-based data sources fully recognise the intersections between stressful events, social health issues, and cannabis use in pregnancy, and little is known about sequelae for women's mental health. METHODS: We draw on two waves of population-based data for 344 families participating in the Aboriginal Families Study longitudinal cohort. We examine women's mental health in the first year postpartum and when children were aged 5-9 years in context with life experiences and use of cannabis in pregnancy. OUTCOMES: One in five women (19·5%) used cannabis during pregnancy (with or without co-use of tobacco). Within this group of women, 88·3% experienced 3 or more (3+) stressful events or social health issues. Psychological distress (Kessler-5 scale, K-5) in the year postpartum was substantially higher amongst women who had used cannabis or experienced 3+ stressful events or social health issues. High proportions of women met criteria for support and referral for depression and/or anxiety (52·5% of women who had used cannabis compared to 20·9% amongst women who had neither used cannabis nor tobacco; 43·2% of women who had experienced 3+ stressful events or social health issues compared to 15·6% amongst women who had not indicated these experiences). Similar patterns of psychological distress, depressive (9-item adapted Personal Health Questionnaire, aPHQ-9) and anxiety symptoms (7-item Generalised Anxiety Disorder score, GAD-7) were evident when the study children were aged 5-9 years. INTERPRETATION: Amongst women who had used cannabis in pregnancy, a high burden of psychological distress, depression, and anxiety is evident in the postpartum period and as their children turn 5-9 years. The overlay of stressful events and social health issues and the high proportion of women meeting criteria for referral for mental health assessment and support indicate an urgent need to offer women opportunities for safe disclosure of cannabis use and opportunities to access sustained holistic services. Reducing the harms of cannabis use on Aboriginal and Torres Strait Islander families must be coupled with culturally safe ways of addressing the social, historical, and structural determinants of mental health distress and harmful use of substances.

A mixed methods evaluation of the impact of ECHO® telementoring model for capacity building of community health workers in India.

INTRODUCTION: India has the largest cohort of community health workers with one million Accredited Social Health Activists (ASHAs). ASHAs play vital role in providing health education and promoting accessible health care services in the community. Despite their potential to improve the health status of people, they remain largely underutilized because of their limited knowledge and skills. Considering this gap, Extension for Community Healthcare Outcomes (ECHO)® India, in collaboration with the National Health System Resource Centre (NHSRC), implemented a 15-h (over 6 months) refresher training for ASHAs using a telementoring interface. The present study intends to assess the impact of the training program for improving the knowledge and skills of ASHA workers. METHODS: We conducted a pre-post quasi-experimental study using a convergent parallel mixed-method approach. The quantitative survey (n = 490) assessed learning competence, performance, and satisfaction of the ASHAs. In addition to the above, in-depth interviews with ASHAs (n = 12) and key informant interviews with other stakeholders (n = 9) examined the experience and practical applications of the training. Inferences from the quantitative and qualitative approaches were integrated during the reporting stage and presented using an adapted Moore's Expanded Outcomes Framework. RESULTS: There was a statistically significant improvement in learning (p = 0.038) and competence (p = 0.01) after attending the training. Participants were satisfied with the opportunity provided by the teleECHO™ sessions to upgrade their knowledge. However, internet connectivity, duration and number of participants in the sessions were identified as areas that needed improvement for future training programs. An improvement in confidence to communicate more effectively with the community was reported. Positive changes in the attitudes of ASHAs towards patient and community members were also reported after attending the training. The peer-to-peer learning through case-based discussion approach helped ensure that the training was relevant to the needs and work of the ASHAs. CONCLUSIONS: The ECHO Model ™ was found effective in improving and updating the knowledge and skills of ASHAs across different geographies in India. Efforts directed towards knowledge upgradation of ASHAs are crucial for strengthening the health system at the community level. The findings of this study can be used to guide future training programs. Trial registration The study has been registered at the Clinical Trials Registry, India (CTRI/2021/10/037189) dated 08/10/2021.

Autonomy and its relevance for the construction of personhood in dementia- a thematic synthesis.

BACKGROUND: This article examines the concept of autonomy in the context of person-centred dementia research and care, which is frequently being used but not clearly defined. Also, there is no clear conceptual relation between autonomy and personhood in this context. METHODS: Therefore, literature on person-centred dementia research and care was examined to answer the following question: How is the concept of autonomy discussed in person-centred dementia research and care literature? RESULTS: This analysis revealed heterogeneous perspectives on autonomy within the context of dementia. These were assigned to two different perspectives on personhood: one that links personhood to the existing cognitive abilities and the other one, that understands personhood relationally as the result of a socially constructed process. These results are discussed with regard to a nursing and care practice that could be considered as being deficit-oriented, but also with regard to the concept of social health in dementia. CONCLUSIONS: Derived from this analysis, there is a clear need for general conceptual sensitivity in this field. Also, an in-depth examination of the social constructionist approach to personhood in the context of dementia is warranted.

Exploring the shift in newborn care practices among mothers and grandmothers in rural Odisha, India - a qualitative study.

BACKGROUND: This study delves into newborn care and infant-feeding practices in rural Odisha, specifically focusing on the rural KBK + region of Odisha (Kalahandi-Bolangir-Koraput region), inhabited predominantly by Schedule Tribes and Schedule Castes individuals. There has been an improvement in the health indicators in these areas in recent times. In the background of improved health indicators in these areas, this research explores the current and changing newborn care practices and attempts to gain insight into people's perceptions of the factors that brought about the changes. METHODS: This qualitative study was conducted between February and July 2023 at Christian Hospital, Bissamcuttack in Odisha. The methodology involved focused group discussions with mothers and grandmothers. RESULTS: Analysis revealed healthy practices like exclusive breastfeeding till six months of age, appropriate timing of the first bath, and prompt healthcare-seeking behavior for minor illnesses among the mothers. The use of cow ghee or breast milk in a baby's eyes, the application of ash on the umbilical cord, and the use of herbal medicines for minor illnesses were practiced more by the grandmothers in the past and were not as popular among the mothers. It is noteworthy that the cultural practices to ward off the 'evil eye' were practiced by both mothers and grandmothers alike. Despite the influence of traditional cultural practices on the beliefs and norms of the community, the study identified a shift in health-seeking behavior, with increased reliance on healthcare providers and safe healthcare practices. The study identifies the pivotal role of Accredited Social Health Activists (ASHAs) as a bridge between the rural communities and the healthcare system. CONCLUSIONS: This research provides valuable insights for healthcare providers aiming to enhance community-centric safe newborn care practices in rural settings. The emphasis is on the importance of understanding the current and changing local practices. This would help the healthcare providers to encourage healthy practices while eliminating the harmful practices related to newborn care through community workers like ASHA and Anganwadi workers.

Does younger children's social health insurance alleviate household impoverishment due to illness?

BACKGROUND: The ambitious expansion of social health insurance in China has played a crucial role in preventing and alleviating poverty caused by illness. However, there is no government-sponsored health insurance program specifically for younger children and inequities are more pronounced in healthcare utilization, medical expenditure, and satisfaction in some households with severely ill children. This study assessed the effectiveness of child health insurance in terms of alleviating poverty caused by illness. METHODS: Data were collected from two rounds of follow-up surveys using the China Family Panel Studies 2016 and 2018 child questionnaires to investigate the relationship between child health insurance and household medical impoverishment (MI). Impoverishing health expenditure (IHE) and catastrophic health expenditure (CHE) were measured to quantify "poverty due to illness" in terms of absolute and relative poverty, respectively. Propensity score matching with the difference-in-differences (PSM-DID) method, robustness tests, and heterogeneity analysis were conducted to address endogeneity issues. RESULTS: Social health insurance for children significantly reduced household impoverishment due to illness. Under the shock of illness, the incidences of IHE and CHE were significantly lower in households with insured children. The poverty alleviation mechanism transmitted by children enrolled in social health insurance was primarily driven by hospitalization reimbursements and the proportion of out-of-pocket medical payments among the total medical expenditure for children. CONCLUSIONS: Children's possession of social health insurance significantly reduced the likelihood of household poverty due to illness. The poverty-reducing effect of social medical insurance is most significant in rural areas, low-income families, no-left-behind children, and infants. Targeted poverty alleviation strategies for marginalized groups and areas would ensure the equity and efficiency of health system reforms, contributing to the goal of universal health insurance coverage in China.

Towards universal health coverage in Vietnam: a mixed-method case study of enrolling people with tuberculosis into social health insurance.

BACKGROUND: Vietnam's primary mechanism of achieving sustainable funding for universal health coverage (UHC) and financial protection has been through its social health insurance (SHI) scheme. Steady progress towards access has been made and by 2020, over 90% of the population were enrolled in SHI. In 2022, as part of a larger transition towards the increased domestic financing of healthcare, tuberculosis (TB) services were integrated into SHI. This change required people with TB to use SHI for treatment at district-level facilities or to pay out of pocket for services. This study was conducted in preparation for this transition. It aimed to understand more about uninsured people with TB, assess the feasibility of enrolling them into SHI, and identify the barriers they faced in this process. METHODS: A mixed-method case study was conducted using a convergent parallel design between November 2018 and January 2022 in ten districts of Hanoi and Ho Chi Minh City, Vietnam. Quantitative data were collected through a pilot intervention that aimed to facilitate SHI enrollment for uninsured individuals with TB. Descriptive statistics were calculated. Qualitative interviews were conducted with 34 participants, who were purposively sampled for maximum variation. Qualitative data were analyzed through an inductive approach and themes were identified through framework analysis. Quantitative and qualitative data sources were triangulated. RESULTS: We attempted to enroll 115 uninsured people with TB into SHI; 76.5% were able to enroll. On average, it took 34.5 days to obtain a SHI card and it cost USD 66 per household. The themes indicated that a lack of knowledge, high costs for annual premiums, and the household-based registration requirement were barriers to SHI enrollment. Participants indicated that alternative enrolment mechanisms and greater procedural flexibility, particularly for undocumented people, is required to achieve full population coverage with SHI in urban centers. CONCLUSIONS: Significant addressable barriers to SHI enrolment for people affected by TB were identified. A quarter of individuals remained unable to enroll after receiving enhanced support due to lack of required documentation. The experience gained during this health financing transition is relevant for other middle-income countries as they address the provision of financial protection for the treatment of infectious diseases.

Associations of Mental, Social and Pathophysiological factors with Pain Intensity and Capability in Patients with Shoulder Osteoarthritis Prior to Shoulder Arthroplasty: A Dutch Arthroplasty Register study.

BACKGROUND: Mounting evidence suggests that mental health accounts for greater variation in levels of comfort and capability than pathophysiology severity across a range of musculoskeletal conditions. Using nationwide Dutch Arthroplasty Register (LROI) data, we tested the null hypothesis that none of the available mental, social, and pathophysiological factors are associated with variation in levels of comfort and capability among people with shoulder osteoarthritis prior to arthroplasty. METHODS: We included all adult patients who underwent primary total shoulder arthroplasty for osteoarthritis in the period 2014-2021 with complete measures of shoulder specific capability (Oxford Shoulder Score), pain intensity (10-point Numeric Rating Scale), general wellbeing (the EQ-5D 3-L), the grade of pathophysiology (Walch classification) and categorized social health based on a social deprivation index. In total, 1342 patients with shoulder osteoarthritis preparing for shoulder arthroplasty were included in a regression analysis to seek factors associated with variation in levels of pain intensity and capability. RESULTS: Greater pain intensity at rest was associated with greater symptoms of anxiety and depression (Regression Coefficient [RC] = -0.41; 95% Confidence Interval [CI] = 0.17 to 0.64; P = <0.01), and women (RC = 0.38; 95% CI = 0.11 to 0.66; P = <0.01). Greater incapability was associated with greater symptoms of anxiety and depression (RC = -3.2; 95% CI = -4.0 to -2.4; P = <0.01), an ASA score of III and IV (RC = -3.1; 95% CI = -4.8 to -1.4; P = <0.01), older age (RC = -0.098; 95% CI = -0.15 to -0.047; P = <0.01), and women (RC = -3.9; 95% CI = -4.9 to -3.0; P = <0.01). Neither comfort nor capability were associated with Walch classification or social deprivation index. CONCLUSION: The confirmation that variation in levels of comfort and capability among people preparing for shoulder arthroplasty are associated with mindset rather than a measure of glenoid pathophysiology points to the potential benefits of addressing mental health in musculoskeletal health strategies.

Policy interplay among social health insurance system, pension system, delayed retirement initiative and implications for the self-rated health status of older workers.

Delayed retirement initiative proposed in China attaches greater importance to the sustainability of pension systems and the labour shortage, but less to the health status of older people. The existing social health insurance and pension system are not well established to match this initiative. This study investigates the policy mix of delayed retirement, employment-based social health insurance, social pension participation for health status of older people. Results of the data from the China Health and Retirement Longitudinal Study (CHARLS-2018) show that late retirement could benefit health status among older adults. Moreover, such effect of late retirement appears more salient for those uninsured by employment-based social health insurance and those still in the pension contribution phase upon reaching the statutory retirement age. Hence, in countries with inadequate health insurance and pension systems, such as China, delayed retirement may serve as an important alternative to social security for the health of older people.

Perceived Health Benefits of Nature Prescriptions on Employee Health and Wellness.

The objective of this study was to assess the effectiveness of a nature prescription program on mental, physical, and social health offered to Salt Lake County employees. The program was conducted in two separate phases during 2020 and 2021 by a wellness program for Salt Lake County employees. Participants received a nature prescription and bi-weekly newsletters, and were offered additional wellness benefits for completing weekly prescriptions. Data were collected by a post-survey that assessed participants' time spent outdoors, perceived health benefits (physical, mental, and social), and perceived benefit of the nature prescription program. Due to the post only study design, descriptive statistics were calculated and analyzed. About two-thirds of participants were female. Of the 285 participants who completed the 2020 post-survey, the majority reported improved mood, decreased stress and sedentary behavior, improved anxiety and relationships with others, and increased energy. In addition, almost half reported improved cognition and an increased connection with their community. Of the 143 first-time participants who completed the 2021 post-survey, similar results were found where the majority reported improved mood and relationships with others, decreased stress and sedentary behavior, and increased energy. The cost of the 2020 program, aside from employee salary, was US$1.52 per completed participant. The success of this program provides evidence to suggest that incorporating nature prescriptions into employee wellness programs is both beneficial and cost effective.

Status of Healthy Choices, Attitudes and Health Education of Children and Young People in Romania-A Literature Review.

Background and Objectives: This study aims to assess the health status and factors influencing healthy choices among children and young people in Romania, as well as the efficacy of related health education programs. Through understanding these dynamics, the study seeks to provide insights that can shape targeted interventions, policies, and educational strategies to improve this demographic's overall health and well-being. Materials and Methods: For this study, we performed a literature review of original published papers on the health status, healthy habits, health education, predisposition to making healthy choices in the future, and accessibility to the paediatric health system of Romanian children and young people, as well as the effects of different types of educational interventions on this demographic in Romania. Results: The prevalence of dental caries is high in Romania. In terms of eating habits and nutritional status, a worrying proportion of children are overweight or obese, which can lead to a variety of future physical and psychological problems. In terms of physical activity, few adolescents demonstrate regular fitness practices. Romania presents an increase in alcohol and tobacco consumption among adolescents. The mental health of students has become a pressing public health concern, exacerbated by the COVID-19 pandemic. The use of social networks is linked to mental health issues among young people. Romania still has one of the highest rates of sexually transmitted diseases and faces a high incidence of cervical cancer, with a mortality rate three times higher than the EU average. High rates of teenage pregnancies are linked to limited information about sexuality and a lack of access to family planning at a young age. There are large discrepancies in the accessibility of medical services between urban and rural areas. Conclusions: Romania faces significant obstacles to providing high-quality healthcare to children and young people. Improving nutrition, immunisation rates, and access to medical services represent essential areas for enhancing the health of children and young people in Romania.

[The social health of modern student youth: sociological analysis].

The article presents results of sociological analysis of social health of modern student youth. The empirical basis of study was composed with results of monitoring study of student youth carried out by sociological laboratory of the Department of Sociology and Social Technologies. Within a framework of sociological monitoring, were evaluated such components of social health of student youth as relationships with friends and relatives, relationships in student community, inter-ethnic relations in University and region, participation in public life, social well-being, active life position and family practices and values. It is established that modern possibilities of living conditions allow each person to organize one's life-style in such a way as to develop synergetic effect for social health, combining achieved standards of organization of everyday life and fashion for healthy lifestyle. It is namely such synergistic effect can be enhanced and induced in social environment. The main role at that is played by namely large multi-generational family.

[Social inequalities in health]. / Les inégalités sociales de santé.

Social inequalities in health include all the impacts caused by the different social characteristics of individuals on their health. They strongly influence the health status of the French population. Socio-professional category, gender and ethnic origin are all determining factors in the health of people who, however, are not dependent on the healthcare system. Action in the healthcare field will therefore focus on the effects of these inequalities, to limit the number of people who forego healthcare, and to promote collective and individual health.

Hardship financing, productivity loss, and the economic cost of illness and injury in Cambodia.

BACKGROUND: Financial risk protection is a core dimension of universal health coverage. Hardship financing, defined as borrowing and selling land or assets to pay for healthcare, is a measure of last recourse. Increasing indebtedness and high interest rates, particularly among unregulated money lenders, can lead to a vicious cycle of poverty and exacerbate inequity. METHODS: To inform efforts to improve Cambodia's social health protection system we analyze 2019-2020 Cambodia Socio-economic Survey data to assess hardship financing, illness and injury related productivity loss, and estimate related economic impacts. We apply two-stage Instrumental Variable multiple regression to address endogeneity relating to net income. In addition, we calculate a direct economic measure to facilitate the regular monitoring and reporting on the devastating burden of excessive out-of-pocket expenditure for policy makers. RESULTS: More than 98,500 households or 2.7% of the total population resorted to hardship financing over the past year. Factors significantly increasing risk are higher out-of-pocket healthcare expenditures, illness or injury related productivity loss, and spending of savings. The economic burden from annual lost productivity from illness or injury amounts to US$ 459.9 million or 1.7% of GDP. The estimated household economic cost related to hardship financing is US$ 250.8 million or 0.9% of GDP. CONCLUSIONS: Such losses can be mitigated with policy measures such as linking a catastrophic health coverage mechanism to the Health Equity Funds, capping interest rates on health-related loans, and using loan guarantees to incentivize microfinance institutions and banks to refinance health-related, high-interest loans from money lenders. These measures could strengthen social health protection by enhancing financial risk protection, mitigating vulnerability to the devastating economic effects of health shocks, and reducing inequities.

The effect of health financing systems on health system outcomes: A cross-country panel analysis.

Several low- and middle-income countries are considering health financing system reforms to accelerate progress toward universal health coverage (UHC). However, empirical evidence of the effect of health financing systems on health system outcomes is scarce, partly because it is difficult to quantitatively capture the 'health financing system'. We assign country-year observations to one of three health financing systems (i.e., predominantly out-of-pocket, social health insurance (SHI) or government-financed), using clustering based on out-of-pocket, contributory SHI and non-contributory government expenditure, as a percentage of total health expenditures. We then estimate the effect of these different systems on health system outcomes, using fixed effects regressions. We find that transitions from OOP-dominant to government-financed systems improved most outcomes more than did transitions to SHI systems. Transitions to government financing increases life expectancy (+1.3 years, p < 0.05) and reduces under-5 mortality (-8.7%, p < 0.05) and catastrophic health expenditure incidence (-3.3 percentage points, p < 0.05). Results are robust to several sensitivity tests. It is more likely that increases in non-contributory government financing rather than SHI financing improve health system outcomes. Notable reasons include SHI's higher implementation costs and more limited coverage. These results may raise a warning for policymakers considering SHI reforms to reach UHC.