Disadvantaged Areas Research Articles

Integrated spatial prioritization of urban nature-based solutions for climate adaptation, mitigation, and justice

ABSTRACT In densely populated cities, people confront multiple impacts of climate change, including stormwater runoff, flooding, heat waves, and health issues. To address these impacts, nature-based solutions (NbS) have gained significant attention in recent years due to their potential to contribute to sustainability, resilience, and ecosystem services. Nevertheless, more research is required to understand the wider potential of NbS and to identify priority areas for their deployment. This study developed an analytical approach and implemented it in the Tehran Metropolitan Area (TMA) by considering factors related to NbS co-benefits. The approach included spatial prioritization, spatial correlation analysis, and suitability analysis. It combines a Geographic Information System, Integrated Valuation of Ecosystem Services and Trade-offs (InVEST) model, Zonation, Best-Worst Method, Bivariate Local Indicator of Spatial Autocorrelation analysis (BiLISA), a Fuzzy Inference System, and Boolean overlay analysis. The results include maps showing priority areas for different types of NbS and spatial co-benefits and mismatches. High-priority areas are located in disadvantaged areas. In total, 105.73 km2 (17% of the TMA) was designated as highly prioritized. We show that various NbS interventions are applicable, with green roofs and rainwater harvesting being the most feasible. This study can assist decision-makers in optimizing NbS to deliver maximum co-benefits.

Improving Behavioral Healthcare Access Disparities by Training Providers in Disadvantaged Communities - Evidence of Strategy Effectiveness.

Inadequate access to behavioral health services disproportionately impacts marginalized populations who live in disadvantaged areas. To reduce this gap, programs dedicated to optimizing behavioral health education and training must focus their efforts to enroll providers who practice in these disadvantaged areas. The Train New Trainers (TNT) fellowship program aims to enhance behavioral health knowledge, skills, and attitudes of primary care providers (PCPs) who deliver care in disadvantaged communities. We evaluate the effectiveness of the TNT recruitment strategy and the use of scholarships for targeting and recruiting PCPs who practice in disadvantaged communities. Observational study. TNT fellows from 2016 to 2023. State/federal classifications of medically underserved counties were used to establish scholarship criteria. Area Deprivation Index (ADI) was utilized to provide criterion validity for the use of state/federal criteria in the recruitment strategy, and to evaluate the effectiveness of the program in successfully recruiting PCPs practicing in disadvantaged communities. Practice location data were available for 347 fellows, 88.8% of whom received scholarships. Of the 347 practices, 300 (86.5%) primarily served communities meeting at least one state or federal criterion for medical shortage areas and/or underserved areas. According to ADI scores, 32.3% of practices served areas classified in the highest ADI (ADI decile 9 or 10), with a progressive increase in the proportion of fellows practicing in underserved areas each year; in 2023, 89.9% of practices met federal shortage criteria and 40.5% served areas with the highest deciles of ADI. The TNT program strategy for recruiting PCPs from high medical need geographical areas is associated with bringing primary care psychiatry education to areas considered underserved and disadvantaged. Equipping PCPs practicing in underserved areas with enhanced knowledge and skills in behavioral medicine has the potential to significantly improve the existing access gap in disadvantaged communities.

Ethically challenging situations in teachers’ work: role of school neighborhood socioeconomic status

Abstract Background Ethically challenging situations are common in the teaching profession and can lead to significant stress. In particular, teachers working in socially disadvantaged areas may face these kinds of situations more often due to conflicts between educational needs and available resources. We investigated the link between school neighborhood socioeconomic status (SES) and the prevalence of ethically challenging situations among teachers. Methods Data were from primary school teachers (n = 1265) participating to the Finnish Public Sector study in 2022. Experiences on ethically challenging situations were assessed with two questions: In your work how often do you feel that you have to 1) reflect on ethically challenging situations and 2) act contrary to rules, norms, or personal values (at least weekly vs. less frequently). Survey data were linked to information on school neighborhood SES obtained from national grid database. Log-binomial regression models were used to analyze the relationship between school neighborhood SES and ethically challenging situations. Results Of the respondents, 61% reported having to reflect on ethically challenging situations, and 18% felt they had to act against rules or personal values at least weekly. Teachers in schools located in the most disadvantaged areas were more likely to feel that they had to act against rules, norms, or values weekly compared to teachers in schools in the most advantaged areas (adjusted RR 1.43, 95% CI 1.01-2.02). No association was observed between reflecting on ethically challenging situations and school neighborhood (adjusted RR 0.98, 95% CI 0.87, 1.11). Conclusions School neighborhood SES appears to be associated with teachers’ possibilities to choose action in ethically challenging situations. Key messages • School neighborhood SES appears to be associated with teachers’ possibilities to choose action in ethically challenging situations. • It is essential to develop strategies to support teachers in managing ethically challenging situations in their work environments.

Educational Inequality and Its Political and Economic Consequences: A Case Study of Nigeria and Kenya

Two of the most populous and economically varied countries in Africa, Nigeria and Kenya, continue to face significant obstacles to their development: educational inequality. The article examines the various facets of educational inequality in different nations, emphasizing the effects on the political and economic spheres. Differences in educational accessibility and quality between rural and urban regions, as well as between the north and the south, have contributed to social discontent, political disenfranchisement, and economic stagnation in Nigeria. In a similar vein, while there has been improvement in Kenya regarding educational access, notable inequalities still exist, especially in disadvantaged areas, which fuels political polarization and increases the economic divide. This article highlights effective solutions meant to solve these issues while examining the effects of unequal educational resource distribution on political polarization, economic development, and national stability. This study offers important insights into the larger consequences of educational disparity for sustainable development in sub-Saharan Africa by contrasting the educational systems of Nigeria and Kenya.

Correlates of food insecurity among university students in a low socioeconomic area

Abstract Background The prevalence of food insecurity (FI) is high and suggested to be growing among university students, with potential detrimental effects on their health status and academic performances. This cross-sectional study aims to identify the socioeconomic, demographic and lifestyle factors associated with FI among university students in a disadvantaged area. Methods An anonymous online survey was conducted from Nov 2022 to Jan 2023 among students enrolled at University Sorbonne Paris Nord, located in a low socioeconomic area in France. FI was assessed with one question distinguishing 2 levels of FI: quantitative (i.e. not having enough to eat) and qualitative (i.e. not having the desired food). This abstract focused on quantitative FI. To improve the representativeness of the sample compared to the total student population of the university, sample weights were used according to gender, study level and speciality, whether they were undergoing initial training or not, or obtained their baccalaureate abroad or not. Multivariable multinomial logistic regression models were used to identify factors associated with FI. Results A total of 5068 students provided valid answers (20% of the target population), 66% of whom were women, and 12% and 36% reported quantitative and qualitative FI, respectively. Being a man, an undergraduate, having obtained a baccalaureate abroad, not living in the family home, not receiving food from family, having no household food-heating facilities, reporting financial difficulties, relying on food charity and eating alone on a regular basis were positively associated with quantitative FI (P < 0.0001). Those reporting quantitative FI were more likely to report academic difficulties. Conclusions This study shows a high prevalence of FI in this student population and identifies several associated factors. Identifying students at greater risk of FI is an important first step to design and evaluate public health interventions. Key messages • The different socio-economic backgrounds of university students imply important food insecurity disparities among them. • University students present several factors associated with food insecurity, which should be considered when addressing food insecurity in this population.

Implementation of Community-Based Development Programs in Disadvantaged Areas: Challenges and Successes

This study presents a case study on the implementation of community-based development programs in disadvantaged areas, focusing on the challenges and successes encountered during the execution of these initiatives. Utilizing a qualitative approach, the research involved in-depth interviews with various stakeholders, including community members, local government officials, and representatives from non-governmental organizations. The findings indicate that community engagement in the development process not only enhances the effectiveness of the programs but also strengthens the sense of ownership and responsibility among residents. However, the study also identifies several challenges, such as limited resources, inadequate infrastructure, and resistance to change, which can hinder progress. These findings underscore the importance of a collaborative approach and sustained support from all stakeholders to achieve success in community-based development. Furthermore, the research highlights the necessity of tailoring programs to meet the specific needs and contexts of the communities involved. This study provides valuable insights for policymakers and practitioners in designing and implementing more effective development programs in disadvantaged areas, emphasizing the critical role of community participation in fostering sustainable development.

Preventing cardiovascular disease in at-risk patients: Results of a pilot behavioural health programme in general practice

Background The ‘High-Risk Prevention Programme’ (HRPP) involved a six-week health behaviour change programme based in general practices and aimed to address cardiovascular disease (CVD) risk in disadvantaged Irish communities. Objectives This pilot study aimed to establish the HRPP’s likely effectiveness and acceptability to inform the development of a future definitive trial. Methods The HRPP was conducted at six general practices in disadvantaged areas in the Ireland East region. Patients with high CVD risk were recruited by participating practices and were allocated to either a General Practice Nurse (GPN) or Health Promotion Professional (HPP) led programme focusing on positive health behavioural change. Baseline and 12-month follow-up data were collected to capture the HRPP’s likely effectiveness in promoting health outcomes and health behavioural change. Results The HRPP programme was completed by 270 patients. Out of these 270 patients, 245 (90.74%) completed baseline assessments, and 176 (65.19%) completed follow-up assessments at 12 months. Baseline data indicated a high level of CVD risk among patients and follow-up demonstrated positive change in several areas, especially weight (−1.95 kg, p < 0.001), BMI (−0.72, p < 0.001), exercise during the last week ( p <0.001), and consumption of healthy fats in the HPP group (+60%, p < 0.001). Conclusion The HRPP was a much-needed pilot intervention, and positive results were seen in both GPN and HPP arms, especially with regards to weight loss, exercise, and dietary improvements. Future definitive trials of the HRPP are likely to be effective and acceptable in terms of combatting these issues among high-risk patients.

Lessons learned from a community-based participatory research project developing a smoking cessation app in socioeconomically disadvantaged areas

Lessons learned from a community-based participatory research project developing a smoking cessation app in socioeconomically disadvantaged areas

‘There for me’: learning from young people about challenges and enablers to continuing education

ABSTRACT Young people’s perspectives are not always central to policy and practice in widening participation contexts. This article explores enablers and barriers to educational progression by considering factors that young people suggest influence how they envisage and act on their futures. The underpinning study asked students aged 12–23 in disadvantaged areas of northern England to think about their possible selves using creative methods to encourage dialogue, including an animation and board game co-designed with university students. The findings suggested that students’ perceptions of their own futures are influenced by their experiences of being categorised or labelled, both in and out of school, as well as the quality of their relationships with adults and peers. The authors discuss how these factors tended to shape the young people’s experiences of being at school, with a view to rethinking labelling and enabling participatory spaces that cultivate the intersecting relationships, influences, structures and self-belief that make a difference.

Brexit and the London housing market: An empirical contribution

This study aims to analyse the impact of Brexit on London’s housing market, exploring socio-economic and regional disparities. By examining property transaction data from 2012 to 2022, the research seeks to understand how Brexit has influenced real housing prices across different boroughs of London. The methodology involves aggregating transaction data from the Her Majesty (HM) Price Paid database and normalizing prices using the Consumer Price Index (CPI) to obtain real price variations. These data were segmented into three distinct periods: pre-Brexit (2012–2016), post-plebiscite Brexit (2016–2019), and post-implementation Brexit (2020–2022). Spatial analysis was conducted using the software Quantum Geographic Information System (QGIS), transforming point data (postcodes) into polygonal data (wards) for better visualization and comparison. The findings reveal significant socio-economic impacts, with traditionally affluent areas such as Westminster, Kensington, and Chelsea experiencing notable declines in real housing prices. Conversely, certain outer boroughs like Newham and Barnet showed resilience, with positive real price variations despite decreased sales. This geographical disparity underscores the uneven distribution of Brexit’s economic consequences, highlighting the critical role of localized economic policies and development projects in mitigating adverse effects. The results confirm existing literature on the polarization and regional inequalities exacerbated by Brexit while providing new insights into the complex interplay of local and global factors affecting housing markets. The findings emphasize the need for targeted policy interventions to address the diverse challenges posed by Brexit, ensuring both affluent and disadvantaged areas receive adequate support. This research is crucial for informing public policy, urban planning, and housing market strategies in a post-Brexit context, promoting equitable and sustainable development across London.

Health dialogue intervention versus opportunistic screening in primary care for type 2 diabetes and cardiovascular disease prevention in settings with low socioeconomic status (DETECT): study protocol for a pragmatic cluster-randomized trial

BackgroundMeta-analyses of randomized trials suggest that health checks and health promotion interventions targeting behavior change in primary care do not prevent cardiovascular morbidity and mortality in the general population. However, whether such interventions are more effective in high-risk populations, such as people living in low socioeconomic settings, remains unclear, as they have been poorly represented in previous trials. Therefore, we aim to evaluate the effectiveness, cost-effectiveness, and implementation of systematic screening followed by an individually oriented, lifestyle-focused, health dialogue intervention for prevention of type 2 diabetes and cardiovascular disease, as compared to opportunistic screening, in primary care in socioeconomically disadvantaged areas.MethodsUsing an overall pragmatic approach and a cluster-randomized design with two arms, we aim to enroll 3000 participants aged 50–59 years from 30 primary care centers (PCCs) with an above-average level of Care Need Index in Stockholm Region, Sweden. PCCs will be randomized (1:1) either to a health dialogue intervention, which includes inviting enlisted patients to a systematic screening of risk factors followed by an individually oriented lifestyle-focused health dialogue, or to opportunistic screening, which includes screening patients for a smaller set of risk factors during an appointment at their PCC taking place for other reasons. The main outcome will be change in systolic blood pressure during 6- and 12-month follow-ups. Additional short-term outcomes will be changes in other biological risk factors, health-related quality-of-life, and lifestyle habits, as well as process and implementation outcomes, and unintended side effects. The long-term effect on type 2 diabetes and cardiovascular disease incidence and mortality will be examined using regional and nationwide registers. Changes in systolic blood pressure and other health outcomes will be analyzed using mixed-effect generalized linear modeling and mixed-effect Cox regression to capture variability between and within PCCs. A health economic evaluation will assess resource use and costs in the short- and long-term.DiscussionThis trial of lifestyle-focused health dialogues and opportunistic screening in primary care in socioeconomically disadvantaged areas in the largest region of Sweden has the potential to yield valuable insights that could support evidence-based policymaking.Trial registrationClinicalTrials.gov (NCT06067178). Prospectively registered September 27, 2023.

Psychological wellbeing among carers of children and adolescents with physical disabilities in North-Eastern Tanzania-a cross-sectional survey study.

Caring for physically disabled children, particularly in contexts where resources are often insufficient or absent, exposes primary carers to significant psychological strain. The lack of structured mechanisms to address this psychological burden poses a considerable threat to the wellbeing of both carers and the children with disabilities under their care. However, research on the psychological wellbeing of carers in Tanzania is scarce. This study aimed to evaluate the psychological wellbeing and symptoms of anxiety and depression, along with associated factors, of carers of children, and adolescents with physical disabilities in the Kilimanjaro region. A cross-sectional survey was conducted from November 2020 to June 2021 in the Kilimanjaro region, involving 212 carers. The Swahili versions of the WHO-5 Wellbeing Index and Hopkins Symptoms Check List-25 were used to assess psychological wellbeing and symptoms of anxiety and depression. Data were analysed using IBM SPSS Statistics V.28. Multivariable linear and binary logistic regression were used to assess the associations. More than four fifths (81%) of the carers were parents, and most of these parents were mothers (92%). Of the 212 carers, more than half (51%) exhibited poor psychological wellbeing, 42% had symptoms of anxiety, and 38% symptoms of depression. Notably, poor psychological wellbeing was significantly associated with symptoms of anxiety and depression. Results of a multivariable regression analysis indicated that extended family support was associated with better psychological wellbeing and lower odds of symptoms of anxiety and depression. A higher estimated monthly income was associated with better psychological wellbeing, and lower odds of symptoms of depression. Access to rehabilitation for the child was associated with improved psychological wellbeing and decreased likelihood of symptoms of anxiety. Many carers of children, and adolescents with physical disabilities in Tanzania are at high risk of having poor psychological wellbeing, and symptoms of anxiety and depression. Support from extended-family networks is crucial in promoting good psychological wellbeing. The government in Tanzania should improve rehabilitation services, especially in disadvantaged rural areas, and integrate mental-health screening for carers in both rehabilitation programmes and primary healthcare.

Evaluating a targeted selective speech, language, and communication intervention at scale – Protocol for the Happy Talk cluster randomised controlled trial.

Background In areas of social disadvantage up to 40–50% of children enter preschool with speech and language skills significantly poorer than would be expected for their age. The Happy Talk trial tests if a community embedded, targeted selective speech and language programme that simultaneously engages with parents and early childhood educators, (1) improves language outcomes in children aged between 2 years 10 months and 6 years and (2) is cost effective for the health care system. Method The Happy Talk trial is a large scale cluster randomised trial of a 12-week manualised intervention delivered in pre/school settings serving socially disadvantaged communities, in Ireland. Seventy-two clusters will receive the intervention (12 participants per cluster). Parents and pre/school staff engage in group training and coaching in the form of 12 1-hour sessions for parents and four staff workshops, over the course of the pre/school year. Training/coaching includes core interaction skills (modelling, expanding, balancing questions and comments), early literacy and phonological awareness. Blinded assessments pre- and immediately post-intervention and at 6 months follow up, will measure the primary outcomes of children’s receptive and expressive language and functional impact, and secondary outcomes of quality of life. Parental responsiveness and educator-child interactions will also be evaluated. Discussion This robust study evaluates a public health approach to the delivery of speech language and communication intervention in the ‘real world’ in the community, which focuses on prevention and equity of access. Pilot work indicates that the programme is feasible, acceptable to parents and staff, cost effective, and suitable for implementation at scale. The trial includes a process evaluation, a well-developed economic evaluation and the outcomes are directly relevant to children, families and educators. This work has the potential to improve the long-term outcomes and life chances of people living in social disadvantage. Trial registration clinicaltrials.gov NCT06460090 Trial Management There is a formal governance structure to oversee the conduct and running of the trial, consisting of a trial management group and a steering committee. More details on the composition, roles and responsibilities of each committee can be found in the supplemental material.

A time-series analysis examining implementation strategies to increase use of an early-supported discharge hospital at home model.

Early-supported discharge (ESD) hospital-at-home (HaH) programs facilitate hospitalized patients to receive ongoing acute-level care at home, thereby promoting patient-centeredness while improving hospital throughput. The current study aimed to test multiple implementation strategies to increase and sustain HaH ESD utilization. We conducted interrupted time series analyses to evaluate the effectiveness of implementation strategies on weekly HaH ESD referrals and capacity utilization at five hospitals. Intervention 1 included provider-focused education and HaH nurse navigator support (July 2021 to May 2022). Intervention 2 added provider-level referral performance feedback and daily electronic health record-based eligibility reports (May 2022 to December 2022). During postintervention (January 2023 to June 2023), implementation strategies were no longer supported by the study team. Clinical outcomes were assessed over time and between patient subgroups. There were 5951 HaH ESD patients overall. After Intervention 2, we observed immediate increases in weekly HaH ESD referrals (level change mean difference [MD, 95% confidence interval]: 14.8, 5.9-23.6) and capacity utilization (level change MD: 13.9%, 6.2%-21.5%) and additional week-to-week increases in capacity utilization (slope change MD: 0.6%, 0.2%-0.9%), compared to Intervention 1 trends. HaH ESD referrals and capacity utilization were sustained postintervention. The proportion of provider-initiated referrals increased over time (Intervention 1: 79.4%, Intervention 2: 90.9%, postintervention: 95.2%). As HaH ESD utilization increased, we observed shorter inpatient length of stay and fewer HaH ESD encounters per visit (p < 0.01). There were small, statistically significant differences in 30-day mortality and readmission for residents of rural and socioeconomically disadvantaged areas. Applying referral-focused provider feedback and daily eligibility reports were effective within a multicomponent approach to increase and sustain HaH ESD utilization.

Are Cooked Nutritious School Lunches Associated with Improved Attendance? Findings from the 2022-2023 Tasmanian School Lunch Project.

Background/Objectives: During 2022-2023, the School Lunch Project (SLP) provided free nutritious cooked lunches 1-4 days per week to Kinder to Grade 10 students attending 30 schools in areas of high disadvantage in Tasmania, Australia. This analysis examined if the SLP was associated with student attendance. Methods: Staff (teachers, support staff, and principals) from 12 schools completed an online survey and/or participated in focus groups/interviews. Government-held, objectively measured, grade-level attendance data were provided for 17 SLP and 11 matched comparison schools for 2018-2023. Linear mixed models compared attendance on school lunch and non-school lunch days in SLP schools. Difference-in-difference regression compared attendance between SLP and comparison schools. Qualitative data were analysed thematically. Results: Sixty-five staff completed surveys, where 22% reported that increased attendance was a benefit of the SLP. Similar findings were observed in the staff focus groups/interviews (N = 51). Mean attendance was similar on school lunch and non-school lunch days among the SLP schools during 2022 (difference: 0.04, 95% CI: -0.5, 0.6) and 2023 (difference 0.1, 95% CI: -0.2, 0.4) and similar between SLP and comparison schools (average treatment effect in the treated: 1.2, 95% CI: -0.7, 3.0). Conclusions: The SLP was perceived by some staff to improve attendance but was not associated with objectively measured attendance examined at the grade level.

Situational Analysis of Cat Ownership and Cat Caring Behaviors in a Community with High Shelter Admissions of Cats.

Managing stray cats in urban areas is an ongoing challenge, and in Australia, many are euthanized. Most stray cats are from disadvantaged areas and are under 1 year of age. The Australian Pet Welfare Foundation intended to assess the impact of a free cat sterilization program in an area with high shelter intake of cats in the city of Ipswich, Queensland. The aims of this pre-intervention study were to undertake a situational analysis of cat ownership, semi-ownership and cat caring behaviours, and compare those in the same demographic with dog ownership and caring behaviours relating to sterilization rates, to provide a basis against which to assess the program's effectiveness. In a sample of 343 participants from that area, 35% owned cats and 3% fed stray cats. Cats were predominantly obtained from family or friends (31%) and shelters (20%). More respondents owned dogs (53%), which were most often sourced from breeders (36%) and family acquaintances (24%). More owned cats than owned dogs were sterilized (91% versus 78%). However, only 74% of cats aged 4 to <12 months were sterilized. Cat containment practices varied, with 51% of owners containing their cat(s) at all times, and a further 18% doing so at night. These results suggest the need for community-based programs that focus on sterilizing owned and semi-owned cats, and assisting semi-owners in becoming full owners to reduce stray cat populations and associated negative impacts. This includes assistance with cat containment where vulnerable native species are present. Public understanding of the causes and effective solutions for free-roaming cats, alongside legislative changes, are required to facilitate these efforts. Assistive programs aligned with One Welfare principles are expected to benefit the wellbeing of animals, humans and their environments.

Impact of real-world remote symptom monitoring program on hospitalizations and ICU admissions.

377 Background: Previous randomized controlled trials have demonstrated benefits to patients from remote symptom monitoring (RSM) with electronic patient-reported outcomes (ePROs) including healthcare utilization. However, less is known about the impact of RSM in diverse, real-world populations. Methods: This cross-sectional analysis from a hybrid, type 2 implementation-effectiveness trial evaluated the impact of RSM on healthcare utilization amongst patients with cancer receiving chemotherapy, immunotherapy, monoclonal antibody, or targeted therapy at two academiccancer centers in the Southeastern United States. Modified Poisson regression models with robust standard error and 95% confidence interval (CI) was used to calculate the relative risk (RR) of any hospital or ICU utilization between patients receiving RSM and controls for 3 and 6 months after index date. Models were controlled for age at index, race, sex, cancer type, cancer stage, insurance, prior treatment, comorbidities, RUCA, and follow-up during COVID-19 pandemic. Additional logistic regression models were used to estimate odds ratios (OR) for subset analysis stratified by race (Black or African American, Other, or White), rurality using Rural-Urban Commuting Area Codes, and neighborhood disadvantage using Area Deprivation Index (ADI). Results: From 5/2021-2/2024, 1215 patients were enrolled in RSM; 27% were Black, 16% lived in a rural area, and 25% lived in an area with high neighborhood disadvantage. The populations receiving RSM were similar to the control population (n = 4559); 26% were Black, 22% lived in a rural area, and 28% lived in area with high neighborhood disadvantage. The unadjusted relative risk of hospitalization for patients receiving RSM and control patients were 0.70 (95% CI, 0.63-0.70) and 0.77 (95% CI, 0.71-0.85), respectively. In adjusted analyses, hospitalizations were lower amongst patients receiving RSM compared to control patients with a RR of 0.82 (95% CI 0.73-0.92). Similar patterns were observed for ICU admissions (RR 0.59; 95% CI,0.40-0.88). Analysis by patient subgroup was similar to the overall analysis. A lower odd of hospitalizations and ICU admissions at 6 months was observed across all subset analyses: Black vs. White patients (OR 0.80; OR 0.48); rural vs. urban patients (OR 0.78; OR 0.68); and patients living in areas of high vs. lower neighborhood disadvantage (OR 0.59; OR 0.33). Conclusions: The use of RSM amongst patients receiving treatment for cancer is associated with reductions in hospitalizations and ICU admissions in real-world, diverse settings. Further work to expand this intervention nationally is needed. Clinical trial information: NCT04809740 .

Technical efficiency analysis in Italian sheep and goat farms using FADN dataset

The sheep and goat farms are one of the main breeding in many Italian regions located in mountainous and disadvantaged rural areas. One of the main Italian Protected Designation Origin cheese as Pecorino Romano is made by sheep milk from many regions. The main purpose of this research was to asses by a quantitative approach the technical efficiency in sheep and goat farms part of the Farm Accountancy Data Network (FADN) in all Italian regions since 2008 to 2020. By the Multi-direction Efficiency Analysis (MEA) it has been possible to overcome one of the main bottlenecks of the technical efficiency estimation analysing which is the excess in each input able to impact to the technical efficiency. Main results have pointed out that the Italian sheep and goat farms have a higher technical efficiency compared to other studies carried out in other European countries. Land capital, labour and assets have been the main inputs able to impact to the technical efficiency. Furthermore, an important role of subsidies to the sheep and goat Italian farms exists.

Prevalence and associated factors of chronic kidney disease among Truká Indigenous adults in Cabrobó, Brazil: a population-based study

The prevalence of chronic kidney disease (CKD) is increasing worldwide, especially in developing countries, due to factors such as lifestyle changes and the rise of non-communicable diseases. Populations living in socioeconomically disadvantaged areas are subject to a higher burden of CKD. However, the burden of CKD on Brazilian Indigenous people, especially those undergoing an advanced urbanisation process, has not yet been described. This cross-sectional study included 1715 Truká Indigenous adults from Cabrobó, Brazil. CKD was defined according to the Kidney Disease Improving Global Outcomes guidelines classification as a urinary albumin/creatinine ratio ≥30mg/g and/or an estimated glomerular filtration rate <60mL/min/1.73m2. Univariate and multiple logistic regression models were used to evaluate factors associated with CKD. Odds ratio (OR) with a 95% confidence interval (CI) was used to measure association. Out of the 1654 participants analysed (61 excluded due to missing data), the prevalence of CKD was 10% (95% CI, 8.6%-11.5%), with a higher prevalence in women compared to men (12.4% versus 6.9%, p<0.001). The mean age was 40.5 years, with 55.6% being women. In univariate analysis, female sex (OR, 1.9; 95% CI, 1.3-2.7), age ≥60 years (OR, 4.6; 95% CI, 3.2-6.6), cardiovascular disease (OR, 2.1; 95% CI, 1.1-4.1), and dyslipidemia (OR, 1.6; 95% CI, 1.1-2.4) were identified as associated factors with CKD. Multiple logistic regression analysis identified age ≥60 years, female sex, and dyslipidemia as independently associated factors with CKD. The prevalence of CKD among Truká Indigenous adults analysed is high and affects a higher proportion of women. Our study found no association between hypertension, diabetes, obesity, and CKD risk, despite their high prevalence. These findings assist in developing early CKD detection strategies in Brazilian Indigenous communities, supporting disease treatment and prevention. National Council for Scientific and Technological Development (CNPq)-Ministry of Science, Technology, and Innovation of Brazil, and the Maria Emília Foundation.

The healthcare support program and healthcare utilization of older adults in ethnic minority areas in Vietnam

Over the past few decades, Vietnam has experienced a substantial improvement in health outcomes, providing an example of a low-income country that has achieved a major success in public health despite the lack of resources. However, inequalities in access to healthcare services persist among the poor, ethnic minorities, and other vulnerable groups. To address this issue, the Vietnamese government implemented a healthcare support program in ethnic minority areas in 2013. We examine the effects of this program on healthcare utilization among older individuals aged 55–74. Employing a difference-in-differences approach and data from the Vietnam Household Living Standards Survey from 2008 to 2018, we find that the program has a positive effect on inpatient visits at public health facilities. However, the program has no impact on outpatient visits. Additional analysis reveals that the program increases outpatient visits at commune health stations and inpatient visits at district hospitals. There is also suggestive evidence of a switch from private to public facilities. Our results suggest that providing healthcare resources to disadvantaged areas can increase healthcare utilization of older people, which can, in turn, improve their health outcomes.