Residential Areas Research Articles

Uterine rupture: Epidemiology, Risk Factors and Maternal-Fetal Prognosis at the Bougouni Reference Health Center

Introduction: the objective of this study was to study the epidemiological aspects, risk factors and maternal-fetal prognosis of uterine rupture in the Gynecology-Obstetrics Unit of the CSRéf of Bougouni Methodology: We carried out a case-control study from January 1 to December 31, 2019 in the Gynecology-Obstetrics Unit of the Bougouni Reference Health Center. All patients treated in the uterine rupture department were included and two controls (delivery without rupture) for one case (uterine rupture). The data were entered and analyzed on SPSS version 21 software. The significance threshold has been set at 5%. The association between 2 qualitative variables was studied by the Chi². Results: At the end of our study, we had recorded 43 cases of uterine rupture out of a total of 1161 deliveries, i.e. a frequency of 3.7%. The average age of the cases: 30.77 ± 2 years with extremes of 18 and 40 years compared to 26.01 ± 1 years for controls with extremes of 14 and 42 years. Ninety-five percent of our patients for the cases were out of school compared to 86% for the controls, 97% were housewives compared to 82% for the controls. Risk factors were dominated: caesarean section scar (p=0.038); OR=2.99, non-follow-up of pregnancy (p=0.002) and residence in a rural area (p=0.000) and intergenerational interval ≤ 2 years (Chi-square = 9.1735; p = 0.002). The maternal-fetal prognosis is reserved with 1 case of maternal death (2.3%) and 28 cases of perinatal death (65.1%). Keywords: Uterine rupture, Risk factors, maternal-fetal prognosis, case-control study.

Factors of unmet dental care needs due to the time, economic, and physical constraints among older people

Objectives: We aim to identify factors associated with unmet dental care needs in older adults and explore the impact of time, economic and physical constraints on each. Methods: The analysis was based on the 2023 Community Health Survey. Statistical analyses were conducted using chi-square test and multinomial logistic regression for 65,952 people aged 65 years and older. Results: First, we looked whether subjects experienced unmet dental care needs and found that 8.4% did. Second, according to the type of unmet dental care needs, 54.1% of the time, economic, and physical constraints were economic constraints. Analyzing each of the time, economic, and physical constraints, we found that time constraints were associated with younger age. For economic constraints, lower education level and health security type of recipients in medical aid program were more likely to experience unmet dental care needs. In terms of physical constraints, those living in rural areas were more than three times more likely to experience unmet dental care needs than those living in urban areas. Conclusions: The results showed that time constraints were related to age, economic constraints were related to household income level, and physical constraints were related to residential area.

Evaluation of stormwater runoff pollutant distributions combined with land-use information in a regional karst aquifer in Texas, USA.

Fast urbanization can result in significant stormwater runoff pollution due to changes in land use. A 3-year study on the distribution and temporal variations of urban water pollutants in stormwater runoff was conducted, with a specific focus on the influence of land-use patterns in the recharge zone of a regional karst aquifer in Texas (Edwards Aquifer). The presence and concentration of various water pollutants including total suspended solids (TSS), total dissolved solids (TDS), nutrients (nitrite, nitrate, ammonia and phosphate), total carbon (TC) and total organic carbon (TOC), oil and grease (O&G), and eight heavy metals (Fe, Mg, Cu, Pb, Zn, Ni, Cr, Cd) were measured in stormwater samples collected from three bioswales. Results show that average TSS in site S1 (598.87mg/L) and S2 (628.69mg/L), COD in site S1 (103.97mg/L), phosphate in sites S1 (1.44mg/L) and S3 (0.65mg/L), and O&G (ranging from 50.63 to 84.32mg/L) in all three sites surpassed the national average (NSQD). While residential areas were identified as the main sources of nutrients, roads and parking lots were associated with heavy metals. Temporal variations indicated the effect of antecedent dry days on the concentrations of TSS and phosphate. Growing seasons as well as pet feces were associated with elevated nitrate concentrations in residential areas. Organic carbon was found overall higher during warmer months, while heavy metals during cooler months. The study also identified specific land-use practices that can be enhanced to mitigate stormwater pollution, such as the implementation of permeable pavements, rain gardens, and stricter waste disposal regulations. The results of this study offer valuable insights for enhancing stormwater management strategies to better mitigate stormwater pollution in urban regions.

ADAPTATION STRATEGIES TO HUMAN PHYSIOLOGICAL DISCOMFORT AMONG ELDERLY PEOPLE IN KATSINA URBAN, KATSINA STATE, NIGERIA

Information on adaptation strategies to human physiological discomfort is very important for individuals, groups of people, planners, and policymakers in the world's tropical regions where thermal stress poses a significant threat to life, especially among elderly people. Based on this, the aim of the study, therefore, is to assess adaptation strategies to human physiological discomfort among elderly people due to temperature and humidity extremes in residential areas and workplaces during the hot and cold seasons in Katsina. A total of 100 copies of a questionnaire were administered to the elderly people to obtain information on their adaptation strategies. A stratified random sampling method was used to select the respondents in the study area. Descriptive statistics were then used to describe their perception of adaptation strategies to human physiological discomfort. Results obtained revealed that in the hot season, the majority of the respondents at residence areas and working places perceived outdoor and indoor with fans "respectively" as their best-adapting strategies to human physiological discomfort due to temperature and humidity extremes. However, in the cold season, the study revealed that the majority of the respondents in residence areas and workplaces perceived thick dress as their best-adapting strategy for human physiological discomfort due to temperature and humidity extremes. Adapting strategies to human physiological discomfort depends primarily not only on environmental conditions but relaxing in natural environments and using customized clothing materials. People are encouraged to continue planting trees in and around their homes, working workplaces and to adequately prepare to adapt to extreme hot and cold seasons.

Design and Implementation of a Community Waimai Delivery Assistant System Based on Path Optimization Algorithm

With the rapid development of the food delivery industry, how to efficiently complete delivery tasks in complex community environments has become an important challenge for food delivery platforms and delivery personnel. This project focuses on the problem of planning delivery routes for b0oth inside and outside residential areas, and designs and implements a delivery assistant system based on the Internet of Things and path optimization algorithms. The system utilizes the DFRobot IoT platform to achieve real-time communication between Python programs and mobile apps. Through various path optimization algorithms such as genetic algorithm and simulated annealing algorithm, the system automatically generates the optimal delivery path, significantly improving delivery efficiency and reducing delivery costs. The experimental results show that the system has good operability and reliability in practical applications, providing an effective solution for improving the intelligence level of food delivery

Early Childhood Education and Care Services, and Parents’ Work–Life Balance

Parents’ work–life balance represents a major challenge, especially for those who have young children. The present article aims to identify the perceptions of parents relating to the purpose of early childhood education and care (ECEC) services, care responsibilities, and factors that affect the balance between caring responsibilities for children and the professional career of parents. Using a database with 825 parents, who have children aged between 0 and 6 years enrolled in the ECEC system (nurseries, kindergartens), we performed a descriptive statistical analysis and a logistic regression to identify factors that affect the balance between caring responsibilities and career. The results indicate an appreciation of the usefulness of ECEC services (nurseries/kindergartens) by parents and underline the importance of parents’ involvement in the activities of ECEC services. Results also show that three factors affect the balance between caring responsibilities for children and professional career as follows: the residence area, the educational level, and the proximity to ECEC services. The need to develop ECEC services in Romania is correlated with the work–family balance field. Policymakers should focus more on structural changes and the development of early childhood education and care services, as well as the expansion of such services in both rural and urban areas.

Radiation adaptive response for constant dose-rate irradiation in high background radiation areas

AbstractThe presented paper describes the problem of human health in regions with high level of natural ionizing radiation in various places in the world. The radiation adaptive response biophysical model was presented and calibrated for the special case of constant dose-rate irradiation. The calibration was performed for the data of residents of several high background radiation areas, like Ramsar in Iran, Kerala in India or Yangjiang in China. Studied end-points were: chromosomal aberrations, cancer incidence and cancer mortality. For the case of aberrations, among collected publications about 45% have shown the existence of adaptive response. Average reduction of chromosomal aberrations was ∼ 10%, while for the case of cancer incidence it was ∼ 15% and ∼ 17% for cancer mortality (each taking into account only results showing adaptive response). Results of the other 55% of data regarding chromosomal aberrations have been tested with the LNT (linear no-threshold) hypothesis, but results were inconsistent with the linear model. The conditions for adaptive response occurrence are still unknown, but it is postulated to correlate with the distribution of individual radiosensitivity among members of surveyed populations.

Construction 5.0 and Sustainable Neuro-Responsive Habitats: Integrating the Brain–Computer Interface and Building Information Modeling in Smart Residential Spaces

This study takes a unique approach by investigating the integration of Brain–Computer Interfaces (BCIs) and Building Information Modeling (BIM) within residential architecture. It explores their combined potential to foster neuro-responsive, sustainable environments within the framework of Construction 5.0. The methodological approach involves real-time BCI data and subjective evaluations of occupants’ experiences to elucidate cognitive and emotional states. These data inform BIM-driven alterations that facilitate adaptable, customized, and sustainability-oriented architectural solutions. The results highlight the ability of BCI–BIM integration to create dynamic, occupant-responsive environments that enhance well-being, promote energy efficiency, and minimize environmental impact. The primary contribution of this work is the demonstration of the viability of neuro-responsive architecture, wherein cognitive input from Brain–Computer Interfaces enables real-time modifications to architectural designs. This technique enhances built environments’ flexibility and user-centered quality by integrating occupant preferences and mental states into the design process. Furthermore, integrating BCI and BIM technologies has significant implications for advancing sustainability and facilitating the design of energy-efficient and ecologically responsible residential areas. The study offers practical insights for architects, engineers, and construction professionals, providing a method for implementing BCI–BIM systems to enhance user experience and promote sustainable design practices. The research examines ethical issues concerning privacy, data security, and informed permission, ensuring these technologies adhere to moral and legal requirements. The study underscores the transformational potential of BCI–BIM integration while acknowledging challenges related to data interoperability, integrity, and scalability. As a result, ongoing innovation and rigorous ethical supervision are crucial for effectively implementing these technologies. The findings provide practical insights for architects, engineers, and industry professionals, offering a roadmap for developing intelligent and ethically sound design practices.

Kinlessness at older ages: Prevalence and heterogeneity in 27 countries.

We provide recent and detailed estimates of the prevalence of kinlessness (i.e., people lacking [close] kin) among older individuals in 27 countries. We add to the literature by considering a broad range of kinship ties and examining within-country variabilities by age, sex, education, and rurality of the residential area. Using data from Wave 8 (2019-2020) of the Survey of Health, Ageing, and Retirement in Europe (SHARE), we estimated the prevalence of kinlessness among individuals aged 65 and over in 26 European countries and Israel. We considered different definitions of kinlessness, from a less restrictive (based on the absence of both a partner and children) to a more restrictive one (absence of partner, children, grandchildren, parents, and siblings). Kinlessness varied considerably across countries. The percentage of people aged 65 and over who lacked a partner and children ranged between 2-3.5% in the Czech Republic, Romania, Israel, and Bulgaria to more than 8% in Switzerland, Spain, Belgium, and Malta. The percentage of older people lacking all close kin considered (partner, children, grandchildren, parents, and siblings) ranged from 0.1 to 4.1%. In addition, there was substantial heterogeneity in kinlessness in some countries by age, sex, and rurality of the residential area, whereas, except for a few cases, we did not find significant differences by education. Understanding the prevalence of kinless older adults is critical for policymakers and healthcare providers to design appropriate support systems for this potentially vulnerable group of people.

Challenges of high-fidelity air quality modeling in urban environments – PALM sensitivity study during stable conditions

Abstract. Urban air quality is an important part of human well-being, and its detailed and precise modeling is important for efficient urban planning. In this study the potential sources of errors in large eddy simulation (LES) runs of the PALM model in stable conditions for a high-traffic residential area in Prague, Czech Republic, with a focus on street canyon ventilation, are investigated. The evaluation of the PALM model simulations against observations obtained during a dedicated campaign revealed unrealistically high concentrations of modeled air pollutants for a short period during a winter inversion episode. To identify potential reasons, the sensitivities of the model to changes in meteorological boundary conditions and adjustments of model parameters were tested. The model adaptations included adding the anthropogenic heat from cars, setting a bottom limit of the subgrid-scale turbulent kinetic energy (TKE), adjusting the profiles of parameters of the synthetic turbulence generator in PALM, and limiting the model time step. The study confirmed the crucial role of the correct meteorological boundary conditions for realistic air quality modeling during stable conditions. Besides this, the studied adjustments of the model parameters proved to have a significant impact in these stable conditions, resulting in a decrease in concentration overestimation in the range 30 %–66 % while exhibiting a negligible influence on model results during the rest of the episode. This suggested that the inclusion or improvement of these processes in PALM is desirable despite their negligible impact in most other conditions. Moreover, the time step limitation test revealed numerical inaccuracies caused by discretization errors which occurred during such extremely stable conditions.

Defining digital health literacy profiles in Spanish adults: a latent class analysis

Abstract Background According to different reports, Spain is among the European countries that use digital health technologies the most. However, to develop inclusive and fair digital health services, there is the need to feature digital health knowledge, skills, confidence, and a positive attitude about their significance. This work aims to draw a picture of digital health literacy levels in Spain. Methods A stratified sample of the Spanish population regarding gender, age group and area of residence was used. Participants were recruited from an online panel and by direct approach to balance quotas. Between May 2021- May 2022, participants filled a self-administered online survey, including the Spanish version of the eHealth Literacy Questionnaire (eHLQ) and the eHealth Literacy Scale (eHEALS). Results Digital health literacy showed similar mean scores, between 2.6-2.7 out of 5 with similar SD on each of the 7 dimensions of the eHLQ. The highest scores were related to knowledge about filling data in digital health services and knowledge about health and how the body works, and feelings about the usefulness of digital technology for health. In contrast, lower scores were related to sharing health information by technology, thinking that using technology gives access to better health services, and the possibility to contact usual health professionals with technology. Latent profile analysis identified 5 user profiles. Significant differences were found according to age, inhabitants per municipality, technology use, self-perceived health status, educational level, socioeconomic index and eHEALS scores; not by gender. Conclusions As the scores are similar in the different subscales, competencies, attitudes and confidence in digital health that they measure are balanced. However, the main challenge appears in granting users access to digital services that work, which involves the definition and monitoring of strategies until the final implementation. Key messages • Digital Health literacy in Spain differs according to different aspects, not only age, educational or socioeconomic level. • Confidence in usefulness is a common denominator among the five digital health service user profiles identified.

Social patterning of health misinformation in two Eastern Mediterranean populations

Abstract Background Health misinformation, the spread of false or misleading information relevant to health, has been proposed as a major global public health thread by the WHO. We aimed to identify the major social determinants of health misinformation in the general Greek and Cypriot populations. Methods Following proportional quota sampling we recruited a nationwide sample of 585 adults from Greece and Cyprus between January 2022 and May 2023. A newly developed, culturally adopted questionnaire comprising 48 items, was used to assess misinformation on COVID-19 vaccines and the pandemic. Sociodemographic determinants of interest included gender, age, marital status, area of residence, educational attainment, and income. Multiple linear regression was used to determine associations between the aforementioned social factors and the two dimensions of health misinformation, applying mutual adjustment. Results Misinformation about both vaccination and the pandemic was higher in younger age groups (p-trend 0.026 and 0.007, respectively), among those separated, divorced, or widowed (mean difference, 95% CI compared to those single: 9.73, 0.45, 19.01), and among those living in semi-urban compared to urban areas (11.14, 1.32; 20.97 and 9.44, 1.96; 16.92, respectively). We also detected strong inverse socioeconomic gradients in health misinformation based on educational attainment and income (p-trend <0.001, for both). Conclusions Younger individuals, those living alone, those residing in semi-urban areas, and those with lower educational attainment and income are particularly prone to health misinformation. Our adjusted models show that this social phenomenon is not simply explained by differences in education, hence more complex, cultural, political, perceptual, and psychosocial dynamics might be in place. Addressing the social patterning of health misinformation would help manage the issue more effectively and also reduce health inequalities. Key messages • Health misinformation is strongly socially patterned in two Eastern Mediterranean European populations. • Targeting efforts to tackle health misinformation to those more vulnerable, would render such programmes more effective, also helping reduce social inequalities in health.

The role of sociodemographic factors on herpes zoster vaccine uptake among hard-to-reach populations

Abstract Background The anti-Herpes Zoster (HZ) vaccination program was expanded with the adjuvated recombinant vaccine (HZR) in the Lazio Region, Italy, in 2022, restricting its use only to certain categories at risk due to pathological conditions, such as dialysis patients or immunocompromised individuals. This study focuses on the role of clinical and socio-demographic factors on HZR vaccine uptake within the fragile resident population of the Local Health Authority Rome 2 (ASL RM2). Methods This population-based, retrospective cohort study leveraged data from various registries and databases. The study population comprised 835,779 individuals aged ≥18 years who were both RM2 residents and registered with an RM2 general practitioner (GP). Among these, 143,242 individuals with at least one chronic condition were assessed for vaccination uptake using a multivariate logistic model, exploring associations with gender, age, nationality, marital status, household size, and level of deprivation. Results At the conclusion of the study period, a small fraction (1.5%) of the fragile subjects had received at least one dose of the HZR vaccine, and a majority (78%) completed the vaccination course of two doses. The analysis indicated that vaccine adherence was significantly higher in males (OR = 1.15) and individuals aged 65 + (OR = 1.13) while lower among residents in areas of medium (OR = 0.61) and high deprivation (OR = 0.44) and with specific living arrangements - widowed people living alone (OR = 0.66) and families ≥ 6 people (OR = 0.63). Conclusions The ASL RM2 vaccination strategy for hard-to-reach individuals includes an integrated approach, with the engagement of local healthcare facilities and hospitals. Despite these efforts, lower adherence in socioeconomically disadvantaged fragile patients suggests a pressing need for targeted communication strategies and interventions to ensure equitable access to the HZ vaccine, as these groups are more vulnerable to developing chronic diseases. Key messages • Socio-demographic factors significantly influence Herpes Zoster vaccine uptake in hard-to-reach populations, with lower adherence in socially deprived groups. • Tailored, equity-driven approaches are essential for enhancing vaccine coverage among hard-to-reach fragile individuals, mitigating the higher disease risks in these communities.

The Influence of Iconnet Product Personal Selling on the Purchase Interest of Housing Residents in Medan City

This study aims to analyze the influence of ICONNET product personal selling on the purchase interest of housing residents in Medan City. The research method used is quantitative with a survey approach. Data were collected through questionnaires distributed to 150 respondents who are housing residents in Medan City. Data analysis was conducted using simple linear regression to test the influence of personal selling on purchase interest. The results of the study indicate that personal selling has a positive and significant influence on the purchase interest of housing residents. Effective personal selling increases consumer purchase interest in ICONNET products. These findings have implications for marketing management that personal selling strategies can be an effective tool to boost sales, particularly in the telecommunications industry in residential areas. Recommendations for future research include adding other variables such as product quality and price to see their effects on purchase interest more comprehensively.

Housing tenure and acute lower respiratory tract infection admissions in two Scottish birth cohorts

Abstract Introduction Early-life acute lower respiratory tract infections (LRTI) have been associated with increased morbidity and mortality. Despite young children spending much of their time at home, the contribution of home ownership status, on LRTI hospital admissions is unknown. Objectives To estimate the association between housing tenure and the odds of LRTI hospitalization in children <2 years in two birth cohorts. Methods De-identified Scottish birth records were linked to maternal Census data (2001 and 2011) and to hospital admission data to construct two birth cohorts (Cohort 1 (C1), born 2000-2002; Cohort 2 (C2), 2010-2012). Using logistic regression we estimated the association of housing tenure (owned, social rented, private rented, rent-free) with the odds of LRTI hospital admission, before and after adjustment for maternal age, residential area, and maternal qualification level. Results Over the 2-year follow-up, there were 14,833 LRTI admissions in 12,527 children (10,832 children had 1 LRTI admission and 1,695 >1 LRTI admission). 75.6 % of all LRTI admissions were due to bronchiolitis. In C1 and C2, 4.0% and 5.3% children, respectively, had one or more LRTI admission. Compared to children living in owned housing, the odds of LRTI admission were higher in children living in social rented housing (C1: Odds ratio=1.40, 95% confidence interval: 1.31-1.49; C2: 1.23, 1.16-1.31), private rented (C1:1.24, 1.11,1.39; C2: 1.14, 1.06-1.21), and rent-free housing (C1: 1.53, 1.35,1.74; C2: 1.04, 0.80-1.36) after confounder adjustment. Conclusions We found an association between non-owned housing and higher odds of LRTI admission which was more marked in C1 than in C2. Further research is warranted to unpick the mechanisms underlying the association between housing tenure and LRTI admission. Interventions to prevent LRTI admissions could usefully target children living in non-owned housing. Key messages • This study demonstrates the value of administrative and health data linkage in improving our understanding of how socio-environmental factors might impact children’s respiratory health. • Children living in social and private rented housing (compared to owned housing) have a higher risk of LRTI hospital admission and could benefit the most from LRTI-lowering interventions.

What Makes a Home.Evaluating a Novel Low Support Homeless Accommodation Model Using Co-design Methods

Abstract Background Homelessness is a global challenge, with a prevalence of 4%; the problem is underestimated due to limitations in data collection. In Ireland, 1% of the population, including children, adults, and families, experience homelessness due to housing shortages and systemic complexities. Homeless accommodation is defined as emergency and temporary; the wording is used interchangeably. The ETHOS typology of homelessness comprises two dimensions - housing-focused and support-focused. Supports range from high to low levels. This study evaluated an emergency housing accommodation with low support to assess its feasibility and impact. Methods Previous residents of an urban residential area with low support [introduced in August 2021] and key stakeholders, including policymakers and health and social care professionals, were invited to collaborate in a half-day co-design workshop [February 2024]. The workshop modified Stanford D’s five-stage design thinking processes to consider ‘How might we harness strengths and abilities to create a home and beyond’. Qualitative data were captured on flip charts, post-its, and via photographs over three rounds of activities following initial reflection regarding 1) identifying emerging challenges, 2) exploring potential solutions, and 3) considering resources for advocacy and success. Results Data analyses from 16 participants highlight 1)Personal insights: silence, freedom in decision-making, feeling overwhelmed, valuing independence and understanding accommodation transitions; 2)Organisational insights: developing and promoting independent skills, managing resident preferences and personalities, balancing regulations within emergency accommodation, and staff training. Space was critical in fostering therapeutic well-being and a sense of home environment. Conclusions Effective organisational structures are required to facilitate coherent transfers and transitions. Using co-design methods enabled real-world partnerships and engagement. Key messages • Homelessness is a significant public health challenge, and a model of low support emergency accommodation has value in supporting transition through and out of services. • Engaging with people with lived experience of homelessness is essential for developing supported accommodation models.

Vaccine conspiracy beliefs are the main determinant of adult vaccine hesitancy

Abstract Background Many factors influence the level of vaccine hesitancy. The COVID-19 pandemic demonstrated that conspiracy beliefs are an important element of overwhelming misinformation. The main aim of the study was to assess the relationship between vaccine hesitancy (VH) and vaccine conspiracy beliefs (VCB) in Polish society. Methods The analysis was conducted using data from an online survey of 2189 Internet users conducted in November 2021. Uni- (ULRM) and multivariable linear regression (MLRM) models were developed for vaccine hesitancy as a dependent variable. The independent variables included VCB score (VCBS), health (HL) and e-health literacy (eHL), Internet (IU) and social media use (SMU), political views (PV), and sociodemographic variables. Results The VCBS, eHL, HL, age, income, vocational and marital status, place of residence, PV, IU, and SMU were significant predictors of VH in ULRMs. A significant relationship with VH was maintained in MLRM for all independent variables enlisted earlier, apart from age, income, and vocational status. Respondents with higher VCBS were more likely to have higher VH (B, 95%CI: 0.38, 0.37-0.40). Those with undetermined HL had higher VH than persons with sufficient HL (B, 95%CI: 0.13, 0.06-0.20). A higher level of eHL predicted a lower level of VH (B, 95%CI: -0.01, -0.012 - -0.03). Lower IU and higher SMU were associated with higher VH (B, 95%CI: 0.16, 0.02-0.30, and 0.10, 0.03-0.17, respectively). Supporters of far right-wing party showed higher HV than supporters of the governmental party (B, 95%CI: 0.16, 0.07-0.27). Finally, singles showed higher HV than married (B, 95%CI: 0.07, 0.01-0.13), and residents of small cities had higher HV than residents of rural areas (B, 95%CI: 0.08, 0.004-0.15). Conclusions The vaccine conspiracy beliefs play a major role in the development of VH. The interventions aimed at the change of antivaccination attitudes should address the problem of widespread conspiracy beliefs. Key messages • Conspiracy beliefs are an important determinant of attitudes toward vaccination. • The development of adequate digital health literacy may be a protective factor against vaccine hesitancy.

Escalation to Biologics After Methotrexate Among US Veterans with Rheumatoid Arthritis Grouped by Rural Versus Urban Areas.

Racial and ethnic disparities in rheumatoid arthritis (RA) outcomes are well recognized. However, whether disparities in RA treatment selection and outcomes differ by urban versus rural residence, independent of race, have not been studied. Our objective was to evaluate whether biologic disease modifying anti-rheumatic drugs (bDMARD) initiation after methotrexate use differs by rural versus urban residence among Veterans with RA. In this retrospective cohort study utilizing national U.S. Veterans Affairs databases, we identified adult patients with RA based on presence of diagnostic codes and DMARD use. We included patients receiving an initial prescription of methotrexate (index date) between 2005 and 2014, with data through 2016 used for follow-up. Urban-rural status was categorized using the Veteran Health Administration's Urban/Rural classification. Our primary outcome of interest was time to biologic initiation within two years of starting methotrexate. Multivariable Cox proportional hazards models were conducted adjusting for demographics, comorbidities, and rheumatoid factor or anti-CCP positivity. Among 17,395 veterans with RA (88% male, 42% with rural residence) fulfilling eligibility criteria, 3,259 (19%) initiated a biologic within the first two years of follow up. In multivariable models, residence in an urban area was associated with a statistically significant higher biologic use compared to rural areas (adjusted hazard ratio (aHR) 1.10, 95% CI 1.02-1.18). Our study found only modest differences in initiation of biologic therapies among rural versus urban residing Veterans with RA in the VA healthcare system. These findings suggest that disparities are not easily explained by rurality within the VA healthcare system.

The very long-term risk of stroke after acute coronary syndrome and geographic differences. The ABC-10* study on heart disease

Abstract Background Little is known about the very long-term risk of stroke among acute coronary syndrome (ACS) survivors. Methods In this prospective study, we enrolled 535 ACS patients admitted to hospitals in three Italian provinces, discharged alive and followed for 24 years or death. The patient's residency was classified into three urban and three nearby rural areas. Results All patients completed the follow-up (6142 Perso-years). 85 (16%) patients suffered an acute stroke. Patients median age was 67 years, 70% were male, and 318 patients were residing in rural areas. Patients who had a stroke and those who had not shared most of the demographic and clinical characteristics. The incidence rate of overall stroke was 14/1000 person-year. Cox analyses showed older age (HR 3.13;95%CI 2.31-4.26), male gender (HR 1.88;95%CI 1.20-2.95), baseline diabetes (HR 2.25 95%CI 1.37-3.69), heart failure (HR 2.69;95%CI 1.71-4.24), and higher albumin/creatinine ratio (HR 1.75;95%CI 1.33-2.30) were all associated with an increased risk of stroke. while higher baseline eGFR, reperfusion, statin and beta-blockers treatment during follow-up were associated with a decreased risk; HR (0.55 (95%CI 0.42-0.72), 0.45(95%CI 0.29-0.71), 0.21(95%CI 0.13-0.34), and 0.37(95%CI 0.23-0.57), respectively). In the multivariate analysis, only older age (HR1.55;95%CI 1.08-2.21; p=0.02) was an independent predictor of stroke while statin treatment was independently associated with a lower risk (HR 0.35;95% CI 0.21-0.58; p<0.0001). However, all these variables did not predict the risk of stroke in competing risk regression analysis where death was treated as the competing event. A sub-analysis of the 43 patients who had a fatal stroke (FS) revealed 7/1000 person-year FS IR. The Cox regression and competing risk analyses of predictors of FS showed similar results. Interestingly, we observed an association between geographic areas of residence and the long-term FS risk as the risk increased going from rural to urban (HR 2.08;95%CI 1.14-3.80; p=0.02) areas and from north to middle and south provinces (HR 1.47;95%CI 1.00-2.15; p=0.04) in the univariate Cox regression analysis. Results kept true using multivariate Cox and Competing risk regression models. Conclusion This analysis reveals the significant urban-rural difference in the very long–term risk of fatal stroke among unselected ACS patients which highlights the importance of implementing a preventive policy based on area-specific knowledge.

Socioeconomic inequalities in avoidable mortality: results from the Italian nationwide cohort

Abstract Background Inequalities in avoidable mortality have been well evaluated in many European countries. We aimed to assess the association between socioeconomic status and avoidable mortality in Italy. Methods The nationwide closed cohort of the 2011 Census of Population and Housing was followed up for 2012- 2019 mortality. Outcomes of preventable and of treatable mortality were evaluated among people aged 30-74. Exposures were education level and residence macro area (North-West, North-East, Center, South-Islands). Adjusted mortality rate ratios (MRRs) were estimated through multivariate quasi-Poisson regression models, by sex and group of causes, taking into account age at death and macro area of residence. Relative index of inequalities (RII) was estimated for preventable, treatable, and non-avoidable mortality and for some specific causes. Results The cohort consisted of 35,708,459 residents (48.8% men, 17.5% aged 65-74), 34% with a high school diploma, 33.5% living in the South-Islands; 1,127,760 deaths were observed, of which 65.2% for avoidable causes (40.4% preventable and 24.9% treatable). Inverse trends between education level and mortality were observed for all causes; comparing the least with the most educated groups, a strong association was observed for preventable (males MRR = 2.39; females MRR = 1.65) and for treatable causes of death (males MRR = 1.93; females MRR = 1.45). Highest RII were observed for HIV/AIDS and alcohol-related diseases (both sexes), drug-related diseases and tuberculosis (males), and diabetes mellitus, cardiovascular diseases, and renal failure (females). Higher risks of preventable and of treatable mortality were found for those living in the South-Islands. Conclusions We documented relevant socioeconomic inequalities in avoidable mortality in Italy, especially in the Southern regions. They represent a possible missed gain in health and suggest a reassessment of priorities and definition of health targets with the lens of equity. Key messages • An inverse socioeconomic gradient in avoidable mortality was observed in Italy, both for preventable and for treatable mortality, with geographical heterogeneity. • Greatest social disparities were found in mortality for causes strongly associated with risk behavior and for which it is possible to identify risk factors on which to intervene.