Exploring Spoken Discourse and Its Neural Correlates in Women With Alzheimer's Disease With Low Levels of Education and Socioeconomic Status.

Little is known about story retelling and comprehension abilities in groups with lower levels of education and socio-economic status (SES). A growing body of evidence suggests the role of an extended network supporting narrative comprehension, but few studies have been conducted in clinical populations, even less in developing countries. To extend our knowledge of the impact of a stroke on macrostructural aspects of discourse processes, namely main and complementary information, in individuals with middle-low to low SES and low levels of education. Relationships were tested between the performance in story retell and comprehension and reading and writing habits (RWH). Also, the associations between retelling and comprehension measures and their structural grey matter (GM) correlates were explored. A total of 17 adults with unilateral left hemisphere (LH) chronic ischaemic stroke without the presence of significant aphasia and 10 matched (age, education and SES) healthy controls (HC) participated in the study. Retell and comprehension tasks were performed after listening or reading narrative stories. Voxel-based morphometry (VBM) analysis was conducted on a subgroup of nine individuals with LH stroke and the 10 matched controls using structural magnetic resonance imaging (MRI). Retelling and comprehension abilities were not significantly different between LH and HC, nonetheless quantitively lower in LH. Exploratory correlations showed that retelling and comprehension abilities in both written and auditory modalities were correlated with naming abilities. At the neural level, written comprehension positively correlated with GM density of the LH, including areas in the temporal pole, superior and middle temporal gyrus as well as the orbitofrontal cortex, precentral and postcentral gyri. Auditory narrative comprehension was associated with GM density of the lingual gyrus in the right hemisphere. The present results suggest that retelling and comprehension of auditory and written narratives are relatively well-preserved in individuals with a LH stroke without significant aphasia, but poorer than in HC. The findings replicate previous studies conducted in groups with higher levels of education and SES both at the behavioural and neural levels. Considering that naming seems to be associated with narrative retell and comprehension in individuals with lower SES and education, this research provides evidence on the importance of pursuing further studies including larger samples with and without aphasia as well as with various SES and education levels. What is already known on this subject Story retell and comprehension of auditory and written discourse have been shown to be affected after stroke, but most studies have been conducted on individuals with middle to high SES and high educational levels. What this paper adds to existing knowledge The study reports on narrative retell and comprehension in both auditory and written modalities in groups of HC and individuals with LH brain damage, with low-to-middle SES and lower levels of education. What are the potential or actual clinical implications of this work? This study highlights the importance of taking into consideration the sociodemographic and RWH of patients when assessing discourse retell and comprehension in both auditory and written modalities. It also underlines the importance of including patients without significant aphasia following LH stroke to look at the effect of both stroke and aphasia on narrative comprehension and story retelling.

To examine the association of all forms of malnutrition and socioeconomic status (SES), educational level and ethnicity in children <5 years, non-pregnant adolescent women (11-19 years) and non-pregnant adult women (20-49 years) in Colombia. Cross-sectional analysis of data from the 2010 Colombian National Nutrition Survey. The prevalence of malnutrition was compared across categories of SES, educational level and ethnicity. Colombia. The sample for the current analysis comprised children <5 years, non-pregnant adolescent women (11-19 years) and non-pregnant adult women (20-49 years). In children <5 years, a low SES and maternal educational level were significantly associated with a lower prevalence of overweight/obesity compared with high levels of SES and maternal education, that is, the prevalence of overweight/obesity was 1·4 and 1·6 times lower in categories of low SES and educational levels, respectively. In contrast, the prevalence of wasting, stunting and anaemia was higher in the lowest SES and maternal educational categories (the prevalence was between 1·1 and 1·8 times higher for these indicators). In women, the lowest SES (11 and 19 years) and educational levels (20 and 49 years) exhibited a higher prevalence in all forms of malnutrition compared with their counterparts in the highest categories (i.e. overweight/obesity, stunting and anaemia). Additionally, indigenous or Afro-Colombian children and women had the highest prevalence of malnutrition in comparison with other ethnicities. These results suggest that public policies should address all forms of malnutrition that occur in the most vulnerable populations in Colombia using multiple strategies.

Objective: To explore the association between socioeconomic status (SES) and overweight/obesity in Yi people in Sichuan province. Methods: A cross-sectional study was conducted in Liangshan Yi Autonomous Prefecture in 2015. Stratified cluster sampling method was used to enroll Yi farmers and rural-to-urban Yi migrants aged 20-80 years. SES was measured by education level, personal annual income, and compound SES index. Unconditional logistic regression models were used to determine the association between SES and overweight/obesity (BMI≥24.0 kg/m(2)). Results: 1 894 Yi farmers and 1 162 rural-to urban migrants were included in the analysis. After adjustment for age, smoking, drinking and physical activity, compared with illiteracy, OR for farmer males with higher education level (primary or junior school, senior high school or higher) were 1.71 (95%CI: 1.13-2.58) and 4.15 (95%CI: 2.10-8.22). Compared with lower income group (<5 000 CNY/y), the higher income group had increased risk (OR=1.66, 95%CI: 1.12-2.44). For farmer males with medium and high SES level, the risk of overweight/obesity were 1.65 (95%CI: 1.02-2.67) and 3.26 (95%CI: 1.97-5.42) compared with low level of SES. For farmer females, the risk increased with the higher income, with OR as 1.49 (95%CI: 1.10-2.02). Compared with low SES level, farmer females with medium level of SES was associated with 1.47 (95%CI: 1.11-1.95) times higher risk of overweight/obesity. In Yi migrants, the association between SES and overweight/obesity was not found. Conclusion: Socioeconomic status was positively associated with overweight/obesity only in Yi farmers.

Alzheimer's disease (AD) is a major cause of disability and mortality in older adults. This study aimed to investigate the association of AD with education and genetic factors. We conducted a prospective cohort study using data from the UK Biobank. Genetic risk was assessed using a polygenic risk score for AD. The educational level was categorized as either low, intermediate, or high. AD was defined using the International Classification of Diseases and Related Health Problems, 10th revision. Logistic regression models were used to investigate the independent and combined effects of genetic factors and educational levels on the risk of AD. We included 318,535 participants in this study (age: 56.53 ± 8.09 years; male: 44.81%). Compared with a low genetic risk, a high genetic risk was associated with a significantly greater risk of AD (OR = 7.09, 95% CI: 6.09-8.26). A high educational level was associated with a 30% lower risk of AD compared with a low educational level (OR = 0.70, 95% CI: 0.60-0.81). Combining genetic risk and education categories, individuals with a low genetic risk and high educational level had a more than 90% (OR = 0.09, 95% CI: 0.05-0.16) lower risk of AD compared to those with a high genetic risk and low educational level. There was no significant interaction between genetic risk and educational level regarding AD risk (p for interaction = 0.359). Education counteracts the genetic risk of AD, without an interaction effect. Increasing education to reduce the incidence of AD is of same importance across individuals with different genetic risk.

AimA disadvantaged socioeconomic status (SES) was previously associated with higher incidence and poor outcomes both of non-communicable diseases (NCDs) and infectious diseases. Inequalities in health services also have a negative effect on the coronavirus disease 2019 (COVID-19) morbidity and mortality.Subject and methodsThe study analysed the role of SES measured by the educational level (EL) in hospitalised patients with COVID-19 between 9 March 2020 and 20 September 2021 at our centre of infectious diseases. Clinical outcomes were: length of hospitalisation, in-hospital mortality and the need of intensive-care-unit (ICU) support.ResultsThere were 566 patients included in this retrospective analysis. Baseline EL was: illiterate (5, 0.9%), primary school (99, 17.5%), secondary school (228, 40.3%), high school (211, 37.3%), degree (23, 4.1%); median age was higher in low EL (72.5 years vs 61 years, p = 0.003), comorbidity (56% in low EL, 34.6% in high EL, p < 0.001), time from the symptoms and PCR diagnosis (8.5 days in low EL, 6.5 days in high EL, p < 0.001), hospitalisation length (11.5 days in low EL, 9.5 days in high EL, p = 0.011), mortality rate (24.7% in low EL, 13.2% in high EL, p < 0.001). In the multivariate analysis there were predictors of mortality: age (OR = 4.981; 95%CI 2.172–11.427; p < 0.001), comorbidities (OR = 3.227; 95%CI 2.515–11.919; p = 0.007), ICU admission (OR = 6.997; 95%CI 2.334–31.404; p = 0.011), high vs low EL (OR = 0.761; 95%CI 0.213–0.990; p = 0.021). In survival analysis, higher EL was associated with a decreased risk of mortality up to 23.9%.ConclusionEven though the EL is mainly related to the age of patients, in our analysis, it resulted as an independent predictor of in-hospital mortality and hospitalisation time. Unfortunately, this is a study focused only on hospitalised patients, and we did not examine the possible effect of EL in outpatients. Further analyses are required to confirm this suggestion and provide novel information.

Lung cancer screening (LCS) offers a teachable moment for smoking cessation, but socioeconomic status (SES) may affect treatment success. This study assesses whether educational level or neighborhood SES are associated with smoking abstinence and completion of a smoking cessation intervention offered in the LCS context. This is a secondary analysis of a clinical trial (NCT03611881) testing the effectiveness of smoking cessation treatment for older smokers scheduled for LCS (N=615). Outcomes were self-reported 7-day smoking abstinence and study follow-up completion at 6-months. Independent variables were educational level (high school graduation or less [low] vs. post-high school education [high]); neighborhood SES (Area Deprivation Index [ADI], ranging 1 [low SES] to 100 [high SES] categorized as: highest 15% vs. remaining 85% scores), and a combination of both measures. Logistic regression models tested the association between outcomes and SES measures, adjusted for covariates. 32.7% of the sample had low educational level, and the mean sample ADI was 19.9 (SD: 12.8). Smoking cessation was higher among those with higher vs. lower neighborhood SES (15.7% vs. 7.4%, p-value=0.03). Study completion was lower among those with lower vs. higher educational level (78.1% vs. 84.5%, p=0.05). In multivariable models, these associations were not significant but individuals with high educational level and low neighborhood SES were more likely to complete the study than those with both low educational level and low neighborhood SES (OR: 6.04, 95%CI: 1.47-24.7). Smoking cessation in the LCS context might be improved by targeting community factors that affect neighborhood SES and educational level.

To test the hypothesis that among children of lower socioeconomic status (SES), children of single mothers would have relatively worse access to care than children in two-parent families, but there would be no access difference by family structure among children in higher SES families. The National Health Interview Surveys of 1993-95, including 63,054 children. Logistic regression was used to examine the relationship between the child's family structure (single-mother or two-parent family) and three measures of health care access and utilization: having no physician visits in the past year, having no usual source of health care, and having unmet health care needs. To examine how these relationships varied at different levels of SES, the models were stratified on maternal education level as the SES variable. The stratified models adjusted for maternal employment, child's health status, race and ethnicity, and child's age. Models were fit to examine the additional effects of health insurance coverage on the relationships between family structure, access to care, and SES. Children of single mothers, compared with children living with two parents, were as likely to have had no physician visit in the past year; were slightly more likely to have no usual source of health care; and were more likely to have an unmet health care need. These relationships differed by mother's education. As expected, children of single mothers had similar access to care as children in two-parent families at high levels of maternal education, for the access measures of no physician visits in the past year and no usual source of care. However, at low levels of maternal education, children of single mothers appeared to have better access to care than children in two-parent families. Once health insurance was added to adjusted models, there was no significant socioeconomic variation in the relationships between family structure and physician visits or usual source of care, and there were no significant disparities by family structure at the highest levels of maternal education. There were no family structure differences in unmet needs at low maternal education, whereas children of single mothers had more unmet needs at high levels of maternal education, even after adjustment for insurance coverage. At high levels of maternal education, family structure did not influence physician visits or having a usual source of care, as expected. However, at low levels of maternal education, single mothers appeared to be better at accessing care for their children. Health insurance coverage explained some of the access differences by family structure. Medicaid is important for children of single mothers, but children in two-parent families whose mothers are less educated do not always have access to that resource. Public health insurance coverage is critical to ensure adequate health care access and utilization among children of less educated mothers, regardless of family structure.

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 (β: - 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 (β: - 4.38, 95% CI - 5.9 to - 2.86) (β: - 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.

Purpose: To evaluate the association of county level characteristics with the incidence of invasive squamous cell carcinoma of the cervix among Hispanic women. Methods: The Surveillance, Epidemiology, and End Results (SEER) Program's 18 registries from 2000-2009 were queried and average annual age-adjusted incidence rates per 100,000 Hispanic women for invasive squamous cell carcinoma of the cervix (SCC) were calculated. Patients were stratified by residence in a county with high versus low percent language isolation, percent of Hispanics with less than a high school education and percent of Hispanic families below the poverty level. Results: Between 2000-2009, 5,534 Hispanic women were diagnosed with SCC in SEER. Incidence rates were highest among those living in counties with high levels of LI (8.9 v 10.7), or low levels of education (8.9 v 10.8) or income (8.7 v 11.0). The incidence of SCC was significantly less in women living in counties with higher levels of education and income and lower levels of LI than among those living in counties with lower levels of education and income and higher levels of LI (8.6 v. 11.3). Counties that have higher levels of income and education are less likely to be LI whereas counties with lower levels of income and education are more likely to be LI. Conclusions: Among Hispanic women, county level characteristics such as LI, education, and income have a complex interaction that appears to be associated with the incidence of SCC. Community level interventions need to be evaluated to decrease the high incidence of SCC in this population. Citation Format: Kristy K. Ward, Angelica M. Roncancio, Steven C. Plaxe. The association of county level characteristics with the incidence of squamous cell carcinoma of the cervix in Hispanic women. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A54.

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): 1. SHE Foundation and "la Caixa" 2. Fondo de Investigación Sanitaria - Instituto de Salud Carlos III. Background Family socioeconomic status (SES) impacts childhood health and could influence the effect of school-based health promotion interventions. Purpose This work aims to evaluate the impact of SES on the effects of the SI! Program randomized controlled trials for cardiovascular health promotion in preschoolers carried out in Colombia, Spain, and USA. Specifically, this work analyzed the effect of SES in the change of knowledge, attitudes and habits (KAH) and body mass index z-scores (zBMI) from baseline to immediately after the end of the health promotion intervention. Methods Children completed a KAH questionnaire (from 0 to 80 points) at baseline and immediate post-intervention. Families reported household income and education level through a dedicated questionnaire. Household income was categorized as low or high, and education level as low, intermediate, or high based on local census data. Adjusted baseline scores were calculated and stratified by SES using linear mixed models. The impact of the intervention was assessed by an individual participant-level meta-analysis using a random-effects model (DerSimonian-Laird method). Estimates of the difference between groups were derived from linear mixed models. Results A total of 3839 children were included in the analysis (48.9% girls, 4.0 (SD=0.8) years at baseline). Children of families with high education level and high household income tended to have a higher KAH score at baseline than those with low education level or low income (47.2 points [95%CI: 43.9; 50.5] vs. 45.7 points [95%CI: 42.4; 48.9]; 47.4 points [95%CI: 44.6; 50.2] vs. 45.8 points [95%CI: 43.0; 48.6], respectively) (Fig. 1A). Children from high education level and high income families had a lower zBMI at baseline than those from low education level and low income families (0.23 [95%CI: -0.20; 0.67] vs. 0.47 [95% CI: 0.03; 0.90]; 0.25 [95%CI: -0.15; 0.66] vs. 0.44 [95%CI: 0.04; 0.85], respectively) (Fig. 1B). The mean difference in KAH change between the intervention and control groups was 4.76 points (95%CI: 2.78; 6.74). The effect of the intervention on KAH score change was higher for children of families reporting high income or an intermediate/high education level than for those reporting low income or education level (Fig. 2A). The overall mean difference in zBMI change between groups was -0.06 (95%CI: -0.14; 0.02), and no significant differences were found in relation to SES indicators (Fig. 2B). Conclusions These results suggest that children from a low SES background benefit less from lifestyle interventions than those from high SES families. Health promotion interventions may implement strategies to counteract this effect and, consequently, avoid the potential risk of increasing health inequalities.

Background Dutch legislation stimulates active participation of employees in their return-to-work (RTW) process. Earlier research showed that employees, particularly with low levels of education, are not always able to self-direct RTW. Empowering leadership may support this process. This study answers two research questions: (1) What differences and similarities do employers of employees with low versus high levels of education show in their management of RTW? (2) To what degree do the roles of employers in both types of organizations resemble empowering leadership? Methods We performed semi-structured, in-depth interviews with 10 HR professionals and supervisors working at a Dutch university. We also analysed transcripts from a study in which 13 HR professionals and supervisors from multiple Dutch industries (employing workers with low levels of education) were interviewed. We used purposive sampling to recruit participants. For question 1, the transcripts were analysed thematically. For question 2, pattern matching was applied. Results Preliminary results indicate that supervisors of both types of employees, show several similarities in managing RTW, such as the focus on possibilities instead of impossibilities, asking the advice of the occupational physician, and seeking support to increase employability. We also found that supervisors of employees with low levels of education have a stronger tendency to control and steer RTW and feel that possibilities for RTW are limited, while supervisors of high-educated employees tend to engage in dialogue more often and search for possibilities for work adjustments. Empowering leadership seems to be less common among supervisors of employees with low levels of education. Conclusions This study will benefit employers (of workers with both low and high levels of education) who aim to enable employees' self-direction in RTW, and help supervisors to develop more empowering leadership styles. This may lead to more sustainable RTW. Key messages Supervisors of employees with lower levels of education have a strong tendency to control and steer their employees’ return-to-work. Enabling employees’ self-direction in return-to-work requires empowering leadership.

Incidence of type 2 diabetes in the elderly in Central Spain: Association with socioeconomic status, educational level, and other risk factors

Impacts of low socioeconomic status and polycyclic aromatic hydrocarbons exposure on lung function among a community-based Chinese population

This study aims to determine parents' expectations of children's education in the perspective of economic education in Beroanging Village, West Bangkala District, Jeneponto Regency, South Sulawesi Province. This study is a qualitative study with a phenomenological approach. The informants in this study were parents who had school-age children at the elementary, junior high, high school, and university levels which were determined purposively based on the criteria of parents who had a high level of economic status but low education, parents who had a high level of education, and elderly who have a low level of education and social status. The results of this study indicate that parents' expectations of children's education in the perspective of economic education in Beroanging Village are divided into three, namely the expectations of parents who consider education as an investment are parents who have a low level of education but a high level of economic status, expectations of education as an economic good or consumption are parents who have a low level of education and economic status, and the expectation of education as a consumption good as well as an investment is parents with a high level of education. Keywords : Ekspektasi Orang Tua, Pendidikan Anak, Pendidikan Ekonomi Informal

The association between socioeconomic status (SES) and alcohol-related diseases has been widely explored. Less is known, however, on whether the association of moderate drinking with all-cause mortality is modified by educational level (EL). Using harmonized data from 16 cohorts in the MORGAM Project (N = 142,066) the association of pattern of alcohol intake with hazard of all-cause mortality across EL (lower = primary-school; middle = secondary-school; higher = university/college degree) was assessed using multivariable Cox-regression and spline curves. A total of 16,695 deaths occurred in 11.8years (median). In comparison with life-long abstainers, participants drinking 0.1-10g/d of ethanol had 13% (HR = 0.87; 95%CI: 0.74-1.02), 11% (HR = 0.89; 0.84-0.95) and 5% (HR = 0.95; 0.89-1.02) lower rate of death in higher, middle and lower EL, respectively. Conversely, drinkers > 20g/d had 1% (HR = 1.01; 0.82-1.25), 10% (HR = 1.10; 1.02-1.19) and 17% (HR = 1.17; 1.09-1.26) higher rate of death. The association of alcohol consumption with all-cause mortality was nonlinear, with a different J-shape by EL levels. It was consistent across both sexes and in various approaches of measuring alcohol consumption, including combining quantity and frequency and it was more evident when the beverage of preference was wine. We observed that drinking in moderation (≤ 10g/d) is associated with lower mortality rate more evidently in individuals with higher EL than in people with lower EL, while heavy drinking is associated with higher mortality rate more evidently in individuals with lower EL than in people with higher EL, suggesting that advice on reducing alcohol intake should especially target individuals of low EL.