Areas Of Socio-economic Disadvantage Research Articles

Excess Mortality in an Inception Cohort of Childhood Diabetes Diagnosed 1990–2010

Objective. Evaluate the mortality risk of childhood-onset type 1 diabetes compared to the general population. Research Design and Methods. The study population, identified from the Australasian Paediatric Endocrinology Group diabetes register, was diagnosed with type 1 diabetes at age < 16 in New South Wales (NSW), Australia, from 1990 to 2010. The register was linked to National Death Index registrations to ascertain timing and cause of death up to 31/12/2022. Risk factors for mortality were assessed using multivariable Cox regression models and observed mortality rate compared to “expected” rates in the Australian general population using indirect-standardized mortality ratios (SMR), overall and by sex and age at diagnosis. Diabetes-related cause of death categories were identified. Results. Of 5,417 children diagnosed with type 1 diabetes, 157 subsequently died, with all-cause mortality of 1.37/1,000 person years. Increased mortality risk was associated with living in most disadvantaged areas (aHR 1.81 (1.05, 3.11)) but not living in a rural area. Overall SMR was 2.83 (95% CI 2.40, 3.33) with females having higher SMR than males (4.18 vs. 2.19). Most common causes of death recorded were acute diabetes complications (26%), including diabetes ketoacidosis, accident/misadventure (21%), and chronic diabetes complications (15%). Alcohol and/or drug use contributed to 17% of deaths. Conclusion. Compared to the general population, higher risk of mortality in people with type 1 diabetes was associated with female sex and living in area of socioeconomic disadvantage. Education about minimizing risk-taking behaviors should be communicated to young adults with type 1 diabetes.

Ready for Discharge, but Are They Ready to Go Home? Examining Neighborhood-Level Disadvantage as a Marker of the Social Exposome and the Swallowing Care Process in a Retrospective Cohort of Inpatients With Dementia.

Socioeconomically disadvantaged areas are more resource poor, impacting adherence to swallowing care recommendations. Neighborhood-level disadvantage metrics, such as the Area Deprivation Index (ADI), allow for examination of social determinants of health (SDOH) in a precise region. We examined ADI in a cohort of persons living with dementia (PLWD) to determine representation of those residing in areas of socioeconomic disadvantage (high ADI), distribution of swallowing care provided, and frequency of SDOH-related counseling or resource linking prior to discharge. A retrospective chart abstraction was performed for all inpatients with a diagnosis of dementia (N = 204) seen by the Swallow Service at a large academic hospital in 2014. State ADI Deciles 1 (least) to 10 (most socioeconomic disadvantage) and decile groups (1-3, 4-7, and 8-10) were compared with the surrounding county. Frequency of videofluoroscopic swallowing evaluations (VFSEs) based on ADI deciles was recorded. To determine whether SDOH-related counseling or resource linking occurred for those in high ADI (8-10) neighborhoods, speech-language pathology notes, and discharge summaries were reviewed. Descriptive statistics, independent samples t tests, and one-way analysis of variance were calculated. ADI was significantly higher in this cohort (M = 3.84, SD = 2.58) than in the surrounding county (M = 2.79, SD = 1.88, p = .000). There was no significant difference in utilization of swallowing services across decile groups (p = .88). Although the majority (85%) in high ADI areas was recommended diet modifications or alternative nutrition likely requiring extra resources, there was no documentation indicating that additional SDOH resource linking or counseling was provided. These findings raise important questions about the role and responsibility of speech-language pathologists in tailoring swallowing services to challenges posed by the lived environment, particularly in socioeconomically disadvantaged areas. This underscores the need for further research to understand and address gaps in postdischarge support for PLWD in high-ADI regions and advocate for more equitable provision of swallowing care.

The impact of the COVID-19 pandemic on childhood obesity rates, by Health Board area, in Wales, UK.

The aim of this study was to examine the possible impact of the coronavirus pandemic on rates of children living with obesity and severe obesity, by Health Board area in Wales. The pre-pandemic data consisted of all children included in the Wales Childhood Measurement Programme (2014/15-2018/19). The 2021/22 Child Measurement Programme data were used as the post-pandemic data set. Body mass index for obesity and severe obesity were calculated as 95th and 99.6th centiles, respectively. Of the 163277 children measured pre-pandemic (2014/15 to 2018/19), the overall prevalence of children with obesity and severe obesity were 12.1 and 3.2%, respectively. In the post-pandemic year (2021/22), obesity increased to 15.5% and severe obesity increased to 4.8%, with clear deprivation differentials (noting one of the seven Health Boards was unable to submit data post-pandemic). Two Health Boards had significantly higher rates of obesity post-pandemic compared to pre-pandemic. Increased levels of severe obesity were observed in all Health Boards with available data. The post-pandemic rise in obesity and severe obesity in young children living in Wales demonstrates a need for more work on the prevention of obesity and severe obesity, targeting the early years and areas of socio-economic disadvantage.

Prevention of internalizing difficulties in the middle years: Protocol for a noninferiority randomized trial of Mindfulness-Based Cognitive Therapy for Children and Cognitive Behavioural Therapy.

Mindfulness-based interventions have been tested as preventive programs for childhood internalizing difficulties, but most research has been at a 'universal' level with small to null effects. Mindfulness-Based Cognitive Therapy for Children (MBCT-C) has similar effects to Cognitive Behaviour Therapy (CBT) when used as a small-group, targeted preventive program. Knowledge gaps include the longer-term effectiveness of MBCT-C relative to CBT and the benefits of adding a parent module. This trial aims to compare MCBT-C to traditional CBT, including a parent module, to 15-months post-intervention and to test the feasibility and acceptability of adding a parent module. Participants will be recruited from primary schools in areas of socio-economic disadvantage in South Australia (n = 194). Children (aged 9-12) years with signs of internalizing difficulties (e.g., shy, withdrawn, worried), and their parents, will be eligible for this two-armed randomized controlled non-inferiority trial (RCT). Children will participate in 10 group sessions of MBCT-C or CBT, facilitated by psychologists, and parents from both conditions will participate in two parent-only group sessions. Child self-report measures include depression and anxiety, as well as attention, mindfulness and self-compassion. Parent measures include symptoms of depression and anxiety, mindfulness, and parent-child relationship strength. The primary outcome will be child anxiety and depression (Revised Child Anxiety and Depression Scale-25). Measures will be collected pre and post intervention, and at 3, 6, 12 and 15-month follow up. Schools will be recruited from October 2022. Nomination of children will commence from February 2023. Program implementation will begin May 2023. This trial will have implications for the feasibility of involving parents in preventative programs, as well as whether mindfulness-based interventions prevent internalizing difficulties over time.

Benchmarking non-attendance patterns in paediatric medical imaging: A retrospective cohort study spotlighting First Nations children

IntroductionNon-attendance at Medical Imaging (MI) appointments can result in inefficiencies in healthcare resource allocation, increased financial burdens, and lead to potential barriers to effective healthcare delivery. We evaluated factors associated with non-attendance of MI appointments for children including variables: gender; age groups; residential postcodes; Indigenous status; appointment dates; appointment reminders and socio-economic status. MethodRetrospective cohort study of children with scheduled MI appointments at a Tertiary paediatric hospital in Australia, between January and December 2022. Data were extracted from the Radiology Information System and integrated with socio-economic census data through linking with postcode. Chi-squared, and logistic regression analysis were performed to identify significant predictors of non-attendance. ResultsOut of 17,962 scheduled outpatient appointments, 6.2 % did not attend. Males were less likely to attend than females (7.3 % vs. 5.8 %; p < 0.001). Older children had the highest frequency of non-attendance (p < 0.001). First Nations identified children had a higher likelihood of non-attendance at 14.5 % compared to non-First Nations at 5.8 %, and the odds ratio (OR) of First Nation children not attending was 2.54 (CI 2.13–3.03; p < 0.001) higher than non-First Nations children. Children from areas of disadvantage were less likely to attend (p < 0.001). Bone mineral densitometry had the highest odds of non-attendance (19.4 % of bookings) compared to other imaging modalities (p < 0.001). ConclusionThe following characteristics were associated with non-attendance: older male gender, residing in areas of socio-economic disadvantage, or identifying as First Nations Australians. By reviewing these findings with the cultural and professional experience of our Indigenous co-author, we have identified some strategies for improving attendance amongst First Nations children. Implications for practiceFactors associated with non-attendance, or “missed opportunities for care”, provide opportunities for intervention to improve attendance for vulnerable groups of children who require medical imaging.

Unpacking and unpicking the challenge of 600 hours of preschool attendance

The Australian Government’s (2022) Preschool Reform Funding Agreement and initiatives by state governments aim to lift enrolment and maximise the benefits of early childhood education (ECE) in the year before school. The Agreement is particularly relevant for children and families from vulnerable and disadvantaged backgrounds, many of whom do not utilise the annual attendance target of 600 hours available to every child. Children’s enrolment and daily attendance records are key to understanding participation in ECE, but few studies or government reports have examined this information in detail. Drawing on administrative records provided by 19 long day care and preschool centres/schools in areas of socio-economic disadvantage, we analysed weekly attendance for 971 preschool-aged children over four 10-week terms. Results for the ‘percentage of enrolled days’ attended (M = 88%) and ‘total hours’ attended (M = 576 h) approached the target but differed for children enrolled in preschool versus long day care.

Outpatient encounters, continuity of care, and unplanned hospital care for children and young people with cerebral palsy.

To describe the relationships between outpatient encounters, continuity of care, and unplanned hospital care in children/young people with cerebral palsy (CP). In this population-based data-linkage cohort study we included children/young people with CP identified in the New South Wales/Australian Capital Territory CP Register (birth years 1994-2018). We measured the frequency of outpatient encounters and unplanned hospital care, defined as presentations to emergency departments and/or urgent hospital admissions (2015-2020). Continuity of outpatient care was measured using the Usual Provider of Care Index (UPCI). Of 3267 children/young people with CP, most (n = 2738, 83.8%, 57.6% male) had one or more outpatient encounters (123 463 total encounters, median six outpatient encounters per year during childhood). High UPCI was more common in children/young people with mild CP (Gross Motor Function Classification System levels I-III, with no epilepsy or no intellectual disability), residing in metropolitan and areas of least socioeconomic disadvantage. Low UPCI was associated with four or more emergency department presentations (adjusted odds ratio [aOR] 2.34; 95% confidence interval [CI] 1.71-3.19) and one or more urgent hospital admissions (aOR 2.02; 95% CI 1.57-2.61). Children/young people with CP require frequent outpatient services. Improving continuity of care, particularly for those residing in regional/remote areas, may decrease need for unplanned hospital care. Many children with cerebral palsy use multiple and frequent outpatient services. Better continuity of care is associated with living in metropolitan and less socioeconomically disadvantaged areas. Outpatient service utilization reduces at the time of transition to adult services. High outpatient utilization is associated with unplanned hospital care. Decreased continuity of care is associated with unplanned hospital care.

Internet Use and Perceived Parental Involvement among Adolescents from Lower Socioeconomic Groups in Europe: An Exploration.

Internet usage is a salient developmental factor in adolescents' lives. Although relevant correlates of Internet use have been documented earlier, there is a lack of information on lower socioeconomic status groups. This is important, as these adolescents have increased risk of negative online experiences. The current survey aimed to explore Internet use and parental involvement amongst adolescents from areas of socio-economic disadvantage in 30 urban schools across five European countries. A total of 2594 students participated, of whom 90% were 14-16 years. Virtually all adolescents of socioeconomic disadvantage had Internet access, with 88.5% reporting spending more than two hours per day online, often on apps such as Instagram, Snapchat, and YouTube. Almost one-third of adolescents did not talk with their parents about their Internet use and almost two-thirds indicated that their parents were only a little or not interested in their Internet use. A consistent finding across countries was that girls more often talked with their parents about their Internet use and more often reported that their parents were interested in their Internet use than boys. The results suggest that parents have an important task in explicitly showing interest in their adolescents' Internet use, with special attention needed for boys.

Serum vitamin C status of people in New South Wales: retrospective analysis of findings at a public referral hospital.

To examine the relationship between vitamin C status and demographic factors in New South Wales on the basis of serum vitamin C test results undertaken at the central pathology laboratory in Sydney, and to assess associations with age, gender, social disadvantage, and geographic remoteness. Retrospective observational study; analysis of vitamin C test results undertaken at the Royal Prince Alfred Hospital, 1 January 2017 - 31 December 2021. Vitamin C status (normal, serum concentration ≥ 40 μmol/L; hypovitaminosis C, 12-39 μmol/L; significant deficiency, < 12 μmol/L); associations of vitamin C status with year of testing, age, gender, socio-economic status (Index of Relative Socio-Economic Advantage and Disadvantage quintile), and geographic remoteness (Australian Statistical Geography Standard); rate of hypovitaminosis C or significant deficiency test results (relative to findings of normal levels; per 100 000 estimated resident population) by Statistical Area 3. Of 17 507 vitamin C tests undertaken during 2017-2021, 4573 were excluded (multiple tests for individuals); of 12 934 included results, 6654 were for women (51.5%), 9402 for people living in major cities (73.5%), and 81 for people in remote or very remote areas (0.6%). In multivariable multinomial regression analyses, significant deficiency (relative to normal test results) was more likely for men than women (adjusted odds ratio [aOR], 1.39; 95% confidence interval [CI], 1.27-1.52); the likelihood of hypovitaminosis C (IRSAD quintile 1 v 5, aOR, 1.35; 95% CI, 1.19-1.53) or significant deficiency (aOR, 2.07; 95% CI, 1.79-2.40) generally increased with postcode-level socio-economic disadvantage. Several of the population areas with the highest low vitamin C rates were areas of greatest disadvantage in NSW. The prevalence of vitamin C deficiency among older people and people living in areas of socio-economic disadvantage indicates that population assessment of vitamin C levels would be appropriate.

Management of encounters related to subfertility and infertility in Australian general practice: a focus on Aboriginal and Torres Strait Islander females

ObjectiveTo investigate the management of subfertility and infertility among Aboriginal and Torres Strait Islander females attending Australian general practice.MethodsCross-sectional study of 1,258,581 women (18–49 years) attending general practice between January 2011 and June 2019, utilising data from NPS MedicineWise MedicineInsight, a national general practice database in Australia.ResultsThe prevalence of subfertility/infertility encounters was lower for Aboriginal and Torres Strait Islander females (12.37 per 1,000) than for non-Indigenous females (16.62 per 1,000). Aboriginal and Torres Strait Islander females with a subfertility/infertility encounter were younger and more likely to live outside Major cities and in areas of socioeconomic disadvantage than non-Indigenous females. Rates of prescribed infertility medications were not different between groups, however Aboriginal and Torres Strait Islander females were more likely to receive a pelvic ultrasound (24.30% vs. 19.90%); tests for luteinizing hormone (31.89% vs. 25.65%); testosterone (14.93% vs. 9.96%) and; glycated haemoglobin (HbA1c) (6.32% vs. 3.41%),but less likely to receive an anti-müllerian hormone test (2.78% vs. 7.04%).ConclusionsLower encounter rates for infertility/subfertility among Aboriginal and Torres Strait Islander peoples may indicate access issues, preferred use of Aboriginal community-controlled health centres or younger average age at first birth and thus less age-related infertility.Implications for public healthFuture efforts should focus on maximising the inclusiveness of infertility surveillance. There is also a need for further research into the experiences of and preferences for infertility care and associated barriers among Aboriginal and Torres Strait Islander people.

Socio-environmental and clinical features of invasive group A streptococcal disease in the Northern Territory of Australia.

To describe the socio-environmental profile and clinical features of invasive group A streptococcal (iGAS) infections in the Northern Territory (NT) of Australia over 10 years. Cases of iGAS disease diagnosed between 1 May 2011 and 30 April 2021 were retrospectively identified from the NT Notifiable Diseases System and electronic health records accessed. Remoteness of residence, socio-economic index, seasonality and clinical characteristics were recorded. There were 692 cases of iGAS disease identified in the NT during the period 1 May 2011 - 30 April 2021. The age-standardised incidence of iGAS disease was significantly higher in people living in very remote (57.1 cases per 100,000 population, 95% confidence interval [95% CI]: 48.6-65.5) and remote areas (40.9 cases per 100,000 population, 95% CI: 34.7-47.2) than in outer regional areas of the NT (15.7 cases per 100,000 population, 95% CI: 13.4-17.9). People with socio-economic disadvantage were also disproportionately affected, with an incidence of 52.6 cases per 100,000 population (95% CI: 46.2-58.9) in decile 1-3 populations, compared to 8.9 cases per 100,000 population (95% CI: 6.9-10.9) for decile 7-10. For cases with recorded severity data, 135 of 378 (36%) met locally-defined criteria for severe iGAS disease. Recurrent iGAS disease was commonly observed in the dialysis cohort, affecting 17 of the 106 patients during the study period (16% recurrence rate) and causing two deaths. Five molecularly-confirmed clusters of iGAS disease were identified from the study period. iGAS disease is unevenly affecting people in the NT. Those living in areas of socio-economic disadvantage, those in remote and very remote communities, and those receiving dialysis were most affected. It is important that primordial, primary and secondary prevention measures be directed towards supporting these disadvantaged population groups.

21 ASSESSING SARCOPENIA, FRAILTY AND MALNUTRITION IN COMMUNITY-DWELLING DEPENDANT OLDER ADULTS – A HOME-BASED STUDY WITH AN UNDERREPRESENTED GROUP IN RESEARCH

Abstract Background Sarcopenia, frailty, and malnutrition are known determinants of adverse health outcomes. Adults of advanced age, with functional dependency, socioeconomic disadvantage, or a need for home care, are expected to be at high risk of these conditions yet are likely to be underrepresented in research. We aimed to examine the feasibility and preliminary outcomes of conducting home-based assessments in this group. Methods Home-based health assessments were conducted among older adults (n= 31), in receipt of state-funded home care. Assessments included probable sarcopenia [hand-grip strength (HGS), chair rise-test and SARC-F case-finding tool] in line with the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) guidelines, the Mini Nutritional Assessment (MNA), and the Clinical Frailty Scale (CFS). Results The study group was of mean age 83.2 ± 8.2 years, 74% female, 23% lived in socioeconomically disadvantaged areas, had comorbidities (n=30, 97%) and low physical activity (71%). We found that almost all met the criteria for probable sarcopenia (94%, 29/31), most were frail or vulnerable by CFA (97%, 30/31), and over a quarter were at risk of malnutrition (26%, n=8). In all participants, it was feasible to assess sarcopenia (by HGS and SARC-F, but not chair rise test), malnutrition (MNA), and frailty (CFS). Notably, in-home assessments required additional time, the adaptation of assessment tools, responsibility to address issues arising, including signposting to health services (36%, n=11), and navigating complex psychosocial environments; the latter was commonly observed in areas of socioeconomic disadvantage. Conclusion Assessing sarcopenia, frailty, and malnutrition in community-dwelling dependant older adults in-home was feasible, once potential challenges were considered. Moreover, our findings suggest that most participants were at risk of both sarcopenia and frailty, and over a quarter were at risk of malnutrition. This highlights a need for further research and proactive evidence-based multi-modal community interventions to support ageing in place.

The Impact and Lived Experience of Covid-19 Restrictions for Vulnerable Children and Families in a Low-Income Irish Community

ABSTRACT Background: The Covid-19 pandemic has impacted on all aspects of life. The physical health burden predominately impacts adults. However, the psychological burden has impacted significantly on the development and wellbeing of babies and young children. The aim of this research was to explore the impact of Covid-19 restrictions on vulnerable children (aged 0–6) and their families who were registered with a prevention and early intervention programme in an area of socio-economic disadvantage in southern Ireland. Methods: A convenience sample of 15 mothers were contacted by the staff from the multidisciplinary Infant Mental Health home visiting team. All participated in semi-structured telephone interviews. Two scales, the UCLA 3-Item Loneliness Scale and the Parental Stress Scale were included. A focus group was conducted with the home visiting team. Results: Parental concerns for their children related to six categories: altered behaviour; lack of services; social isolation; missed school; mental health; and physical health. Concerning behaviours regarding developmental regression, feeding, self-regulation, sleep and worrying new behaviours such as repetitive hand washing were reported. 27% of families experienced hunger during lockdown and staff raised concerns regarding substandard housing. Delayed or cancelled medical appointments included speech and occupational therapy, and developmental assessment. Loneliness and isolation were issues for parents. 67% scored greater than five on the loneliness scale. The mean stress score was 44 (range 37–56). Staff raised concerns regarding maternal mental health and highlighted the lack of services for parents. Conclusion: Covid 19 has had a disproportionate impact on vulnerable children. There is evidence of regression and issues regarding self-regulation and socio-emotional development. Lack of services and the offering of alternative appointments by phone resulted in loss of the crucial face-to-face contact with services. The pandemic has exacerbated inequalities in the early years and this is a crisis in the making.

Explaining differences in the frequency of lung cancer detection between the National Lung Screening Trial and community-based screening in Manchester, UK

BackgroundThe frequency of lung cancer detection in the Manchester Lung Health Checks (MLHCs), a community-based screening service, was higher than in the National Lung Screening Trial (NLST) over two screening rounds. We aimed to identify the potential reasons for this difference. MethodsWe analyzed individual-level data from NLST and MLHCs, restricting to MLHCs participants who met NLST eligibility criteria. We calculated ‘detection ratios’ comparing the frequency of lung cancer detection in MLHCs vs NLST, first after excluding NLST participants ineligible by MLHC eligibility criteria (6-year lung cancer risk ≥ 1.51 %), and then after standardization to remove the influence of different distributions of baseline lung cancer risk. ResultsAmong the 1,079 MLHCs participants who met NLST eligibility criteria, 4.7% were diagnosed with lung cancer over two screening rounds compared with 1.7% in NLST, giving an initial detection ratio of 2.6 (95%CI 2.2–3.0). This was reduced to 2.2 (95%CI 1.3–2.3) after imposing the MLHCs eligibility criterion on NLST, and further to 1.6 (95%CI 1.2–2.1) after removing the influence of different risk distributions. In stratified analyses, the standardized detection ratio was particularly elevated in individuals who were older, living in areas of high socioeconomic disadvantage, or had an FEV/FVC ratio less than 60. ConclusionsThe 2.6-fold higher lung cancer detection in the community-based MLHCs vs NLST is partly explained by differences in eligibility criteria and baseline risk distributions. The residual 60% increase may relate to higher detection in certain risk groups, including older participants, those with more obstructive lung disease, and those living in areas of socioeconomic disadvantage.

Large-scale, design-based research facilitating iterative change in Irish schools – the Trinity Access approach

ABSTRACT Trinity Access (TA) is a post-primary initiative, in the authors’ university, that offers programmes for students, teachers and schools in areas of socio-economic disadvantage. The aims of the programme include helping students develop the knowledge, networks and skills needed to make informed decisions about future educational opportunities, and supporting teachers and schools to foster collaborative and reflective learning environments, which help students develop the academic capital they need to attain their aspirations. This is achieved by delivering programmes for students and professional development for teachers, embedded in an iterative cycle of data collection/analysis and feedback. A distinguishing feature of TA is its long-term commitment to its partner schools (20 years in some cases). This sustained engagement enables the depth and breadth of longitudinal research described herein. The research follows an observational study design within an overarching design-based research methodology. Data are collected annually from consenting students, teachers and management in 20 schools, enabling the researchers to establish students’ levels of exposure/non-exposure to the intervention and to identify correlations between exposure and behaviours/aspirations. The goal of this paper is to provide an overview of the research design and methodology, illustrating its potential to deliver insights into practices that may alleviate educational inequalities.

Socioeconomic status of practice location and Australian GP registrars\u2019 training: a cross-sectional analysis

BackgroundSocioeconomic status (SES) is a major determinant of health. In Australia, areas of socioeconomic disadvantage are characterised by complex health needs and inequity in primary health care provision. General Practice (GP) registrars play an important role in addressing workforce needs, including equitable health care provision in areas of greater socioeconomic disadvantage.We aimed to characterize GP registrars’ practice location by level of socioeconomic disadvantage, and establish associations (of registrar, practice, patient characteristics, and registrars’ clinical behaviours) with GP registrars training being undertaken in areas of greater socioeconomic disadvantage.MethodsA cross-sectional analysis from the Registrars’ Clinical Encounters in Training (ReCEnT) study. ReCEnT is an ongoing, multi-centre, cohort study that documents 60 consecutive consultations by each GP registrar once in each of their three six-monthly training terms. The outcome factor was the practice location’s level of socioeconomic disadvantage, defined using the Index of Relative Socio-economic Disadvantage (SEIFA-IRSD). The odds of being in the lowest quintile was compared to the other four quintiles. Independent variables related to the registrar, patient, practice, and consultation.ResultsA total of 1,736 registrars contributed 241,945 consultations. Significant associations of training being in areas of most disadvantage included: the registrar being full-time, being in training term 1, being in the rural training pathway; patients being Aboriginal or Torres Strait Islander, or from a non-English-speaking background; and measures of continuity of care.ConclusionsTraining in areas of greater social disadvantage, as well as addressing community need, may provide GP registrars with richer learning opportunities.

Maternal and neonatal outcomes of women with gestational diabetes and without specific medical conditions: an Australian population-based study comparing induction of labor with expectant management.

Background/aimsTo evaluate maternal birth and neonatal outcomes among women with gestational diabetes mellitus (GDM), but without specific medical conditions and eligible for vaginal birth who underwent induction of labour (IOL) at term compared with those who were expectantly managed.Materials and methodsPopulation‐based cohort study of women with GDM, but without medical conditions, who had a singleton, cephalic birth at 38–41 completed weeks gestation, in New South Wales, Australia between January 2010 and December 2016. Women who underwent IOL at 38, 39, 40 weeks gestation (38‐, 39‐, 40‐induction groups) were compared with those who were managed expectantly and gave birth at and/or beyond the respective gestational age group (38‐, 39‐, 40‐expectant groups). Multivariable logistic regression analysis was used to assess the association between IOL and adverse maternal birth and neonatal outcomes taking into account potential confounding by maternal age, country of birth, smoking, residential location, residential area of socioeconomic disadvantage and birth year.ResultsOf 676 762 women who gave birth during the study period, 66 606 (10%) had GDM; of these, 34799 met the inclusion criteria. Compared with expectant management, those in 38‐ (adjusted odds ratio (aOR) 1.11; 95% CI, 1.04–1.18), 39‐ (aOR 1.21; 95% CI, 1.14–1.28) and 40‐ (aOR 1.50; 95% CI, 1.40–1.60) induction groups had increased risk of caesarean section. Women in the 38‐induction group also had an increased risk of composite neonatal morbidity (aOR 1.10; 95% CI, 1.01–1.21), which was not observed at 39‐ and 40‐induction groups. We found no difference between groups in perinatal death or neonatal intensive care unit admission for births at any gestational age.ConclusionIn women with GDM but without specific medical conditions and eligible for vaginal birth, IOL at 38, 39, 40 weeks gestation is associated with an increased risk of caesarean section.

Mapping disadvantage: identifying inequities in functional outcomes for prostate cancer survivors based on geography

BackgroundProstate cancer is the most common internal malignancy in Australian men, and although most patients have good survival outcomes, treatment toxicities can impair function, leading to diminished quality of life for prostate cancer survivors. Socioeconomic disadvantage and geographical remoteness have been shown to be related to worse oncologic outcomes, and it is expected that they would similarly influence functional outcomes in prostate cancer.MethodsUsing data from the Victorian Prostate Cancer Outcomes Registry (n = 10,924), we investigated functional outcomes as measured by the Expanded Prostate Cancer Index Composite-26 (EPIC-26) following prostate cancer treatment, focusing on associations with socioeconomic status and geographical remoteness and controlling for clinicopathologic characteristics. A single composite score was developed from the five separate EPIC-26 domains for use in geo-mapping.ResultsA total of 7690 patients had complete EPIC-26 data, allowing mapping hotspots of poor function using our composite score. These hotspots were observed to relate to areas of socioeconomic disadvantage. Significant heterogeneity in outcomes was seen in urban areas, with hotspots of good and poor function. Both socioeconomic disadvantage and geographical remoteness were found to predict for worse functional outcomes, although only the former is significant on multivariate analysis.ConclusionsGeo-mapping of functional outcomes in prostate cancer has the potential to guide health care service provision and planning. A nuanced policy approach is required so as not to miss disadvantaged patients who live in urban areas. We have demonstrated the potential of geo-mapping to visualise population-level outcomes, potentially allowing targeted interventions to address inequities in quality of care.

Affordability of Heathy, Equitable and More Sustainable Diets in Low-Income Households in Brisbane before and during the COVID-19 Pandemic.

The COVID-19 pandemic has increased food insecurity worldwide, yet there has been limited assessment of shifts in the cost and affordability of healthy, equitable and sustainable diets. This study explores the impact of the COVID-19 pandemic and income supplements provided by the Australian government on diet cost and affordability for low-income households in an Australian urban area. The Healthy Diets ASAP method protocol was applied to assess the cost and cost differential of current and recommended diets before (in 2019) and during the COVID-19 pandemic (late 2020) for households with a minimum-wage and welfare-only disposable household income, by area of socioeconomic disadvantage, in Greater Brisbane, Queensland, Australia. Data were collected between August and October, 2020, from 78 food outlets and compared with data collected in the same locations between May and October, 2019, in an earlier study. The price of most healthy food groups increased significantly during the pandemic—with the exception of vegetables and legumes, which decreased. Conversely, the price of discretionary foods and drinks did not increase during the pandemic. The cost of the current and recommended diets significantly increased throughout this period, but the latter continued to be less expensive than the former. Due to income supplements provided between May and September 2020, the affordability of the recommended diet improved greatly, by 27% and 42%, for households with minimum-wage and welfare-only disposable household income, respectively. This improvement in the affordability of the recommended diet highlights the need to permanently increase welfare support for low-income families to ensure food security.

Peer-Delivery of a Gender-Specific Smoking Cessation Intervention for Women Living in Disadvantaged Communities in Ireland We Can Quit2 (WCQ2)—A Pilot Cluster Randomized Controlled Trial

IntroductionWe Can Quit” (WCQ) is community-based stop-smoking program delivered by trained community facilitators, based on the socio-ecological framework and developed using a Community-based Participatory Research approach, targeting women living in socioeconomically disadvantaged (SED) areas of Ireland.Aims and MethodsThe We Can Quit2 (WCQ2) pilot trial assessed the feasibility of WCQ. A pragmatic cluster randomized controlled trial with a process evaluation WCQ2, was conducted in four matched pairs of SED districts (8–10 000 women per district). Districts were independently randomized to WCQ (group support + nicotine replacement therapy), or to individual support delivered by health professionals. Participants were adult women smokers interested in quitting, who were living or working in trial districts. Recruitment of districts and 194 women in four waves (49 women per wave); retention at 12 weeks and 6 months; fidelity to intervention delivery and acceptability of trial-related processes were assessed. Validated smoking abstinence at 12-week and 6-month post-intervention was recorded, missing data assumed as continued smoking.ResultsEight districts were recruited. 125/188 (66.5%) eligible women consented. The 49 women target was reached in wave4. Retention at 12 weeks was (Intervention [I]: 55.4%; Control [C]: 51.7%), at 6 months (I: 47.7%; C: 46.7%). Smoking abstinence at 12 weeks was (I: 23.1%, [95% CI: 14.5 to 34.7]; C: 13%, [95% CI: 6.9 to 24.1]). 83.8% of session activities were delivered. Trial-related processes were acceptable to facilitators. Low literacy was highlighted as a barrier for participants’ acceptability.ConclusionsWCQ was feasible to deliver by trained facilitators and indicated a positive direction in abstinence rates. Low literacy will need to be addressed in a future trial design.ImplicationsThis pilot trial showed that a stop-smoking intervention tailored to a group of women smokers living in SED areas which was delivered by trained local women within their local communities was feasible. Furthermore, although not formally compared, more WCQ women were abstinent from smoking at the end of treatment. The results are relevant to enhance the design of a fully powered effectiveness trial, and provide important evidence on the barriers to deliver a tailored smoking cessation service to SED women smokers in Ireland.