Deprivation Score Research Articles

Comparative analysis of village doctors’ relative deprivation: based on two cross-sectional surveys

BackgroundVillage doctors are the main health service providers in China’s rural areas. Compared with other rural groups, they will have a sense of relative deprivation, which has an impact on their practice mentality and job stability. This study aims to analyze the changes and causes of relative deprivation among village doctors, so as to improve the stability of them.MethodsThe data were collected from two surveys conducted in Shandong Province in 2015 and 2021. In 2015, 322 village doctors were surveyed and 307 questionnaires were collected, with a recovery rate of 95.3%. In 2021, 394 village doctors were surveyed and 366 questionnaires were collected, with a recovery rate of 92.9%. Descriptive and univariate analysis were used to compare the changes before and after the survey.ResultsThe scores of vertical deprivation of village doctors increased from 2.77 ± 0.81 in 2015 to 3.04 ± 0.83 in 2021, with a statistically significant difference (P < 0.001). The reference group selected by village doctors changed from village teachers to ordinary villagers. Compared to village teachers, the horizontal deprivation score of village doctors increased from 3.47 ± 0.87 to 3.97 ± 0.77, with a statistically significant difference (P < 0.001). Compared to villagers, only the professional reputation deprivation score increased, from 2.38 ± 0.93 to 2.68 ± 0.76, with a statistically significant difference (P < 0.05).ConclusionsAs time goes by, village doctors fail to reach the expected level in terms of economic income, social status, professional reputation and living standards, resulting in a sense of relative deprivation. This may have a negative impact on village doctors’ work motivation and behavior, and will fail to guarantee the sustainability of the team. We should pay attention to this unbalanced mentality of village doctors.

Association Between Household Deprivation and Living in Informal Settlements and Incidence of Diarrhea in Children Under 5 in Eleven Latin American Cities

Diarrhea is a leading cause of death in children globally, mostly due to inadequate sanitary conditions and overcrowding. Poor housing quality and lack of tenure security that characterize informal settlements are key underlying contributors to these risk factors for childhood diarrhea deaths. The objective of this study is to better understand the physical attributes of informal settlement households in Latin American cities that are associated with childhood diarrhea. We used data from a household survey (Encuesta CAF) conducted by the Corporación Andina de Fomento (CAF), using responses from sampled individuals in eleven cities. We created a household deprivation score based on household water and sewage infrastructure, overcrowding, flooring and wall material, and security of tenure. We fitted a multivariable logistic regression model to estimate odds ratios (OR) and 95% confidence intervals (95% CI) to test the association between the deprivation score and its individual components and childhood diarrhea during the prior 2 weeks. We included a total of 4732 households with children, out of which 12.2% had diarrhea in the 2-week period prior to completing the survey. After adjusting for respondent age, gender, and city, we found a higher risk of diarrhea associated with higher household deprivation scores. Specifically, we found that the odds of diarrhea for children living in a mild and severe deprived household were 1.04 (95% CI 0.84–1.28) and 3.19 times (95% CI 1.80–5.63) higher, respectively, in comparison to households with no deprivation. These results highlight the connections between childhood health and deprived living conditions common in informal settlements.

Ethnicity and socio-economic deprivation in children with intestinal failure in New Zealand: Disparities in incidence, but not in outcomes.

The New Zealand National Intestinal Failure and Rehabilitation Service (NZ-NIFRS) was established in October 2015 to gather longitudinal data on the aetiology, clinical course and outcomes of children with intestinal failure (IF). One main objective is to achieve health equity for patients with IF in NZ. Clinical outcomes (enteral autonomy, parenteral nutrition (PN) dependence, death or intestinal transplantation) for IF patients diagnosed from October 2015 to 2018 were analysed; comparisons were made by ethnicity and socio-economic status (SES) using published 'prioritised-ethnicity' health data and the NZ index of deprivation, respectively. The Cox proportional-hazards model was used to assess time to enteral autonomy. Of the 208 patients (55.77% male, 43.75% preterm), 170 (81.73%) achieved enteral autonomy and 14 (6.73%) remained PN dependent. Pacific and Māori children accounted for 12.98% and 27.88% of the patient cohort, respectively, compared to 9.46% and 25.65% of the NZ paediatric population. More significantly, IF patients with a high NZ socio-economic deprivation score were overrepresented, with 35.92% in the highest deprivation quintile and 10.19% in the least deprived quintile, compared to 23.53% and 20.31%, respectively, of the NZ paediatric population. There were no significant differences in primary clinical outcomes for any patients based on ethnicity or SES. While disparities in ethnicity and social deprivation do exist in the incidence of IF in NZ children, clinical outcomes are similar for children regardless of ethnicity or SES. NZ-NIFRS has achieved one of its core objectives: to achieve health equity for all patients with IF nationwide.

Healthcare Utilization of Oral and Oropharyngeal Cancer Patients in Emergency Department and Outpatient Settings: An 8-year Population-Based Study.

This study aimed to determine trends in the healthcare utilization by Oral Cavity and Oropharyngeal cancer patients across emergency department (ED) and outpatient settings in Alberta and examine the predictors of ED visits. This is a retrospective, population-based, cohort study using administrative data collected by all healthcare facilities between 2010 and 2019 in Alberta, Canada. Trend of visits to different facilities, patients' primary diagnosis, and predictors of ED visits were analyzed. In total, 34% of patients had at least one cancer-related ED visit. With a rise of 31% in cancer incidence, there was a notable upswing in visits to outpatient clinics and community offices, while ED visits decreased. Cancer stage, rural residence, high material deprivation score, and treatments were found as predictors of ED visits. Improved symptom management and better care access for disadvantaged and rural oral cancer patients may decrease avoidable ED visits.

Individual and Geospatial Determinants of Health Associated With School-Based Human Papillomavirus Immunization in Alberta: Population-Based Cohort Study.

Human papillomavirus (HPV) infection causes nearly all cervical cancer cases and is a cause of anogenital and oropharyngeal cancers. The incidence of HPV-associated cancers is inequitable, with an increased burden on marginalized groups in high-income countries. Understanding how immunization status varies by material and social deprivation, health system, and geospatial factors is valuable for prioritizing and planning HPV immunization interventions. The objective of this study was to describe school-based HPV immunization rates by individual and geospatial determinants of health in Alberta, Canada. Health administrative data for male and female individuals born in 2004 in Alberta were used to determine HPV immunization status based on age and the number of doses administered in schools during the 2014/2015-2018/2019 school years. Immunization status and its relationship with material and social deprivation and health system factors were assessed by a logistic regression model. Geospatial clustering was assessed using Getis-Ord Gi* hot spot analysis. Mean scores of material and social deprivation and health system factors were compared between hot and cold spots without full HPV immunization using independent samples t tests. A multidisciplinary team comprising researchers and knowledge users formed a co-design team to design the study protocol and review the study results. The cohort consisted of 45,207 youths. In the adjusted model, the odds of those who did not see their general practitioner (GP) within 3 years before turning 10 years old and not being fully immunized were 1.965 times higher (95% CI 1.855-2.080) than those who did see their GP. The odds of health system users with health conditions and health system nonusers not being fully immunized were 1.092 (95% CI 1.006-1.185) and 1.831 (95% CI 1.678-1.998) times higher, respectively, than health system users without health conditions. The odds of those who lived in areas with the most material and social deprivation not being fully immunized were 1.287 (95% CI 1.200-1.381) and 1.099 (95% CI 1.029-1.174) times higher, respectively, than those who lived in areas with the least deprivation. The odds of those who lived in rural areas not being fully immunized were 1.428 times higher (95% CI 1.359-1.501) than those who lived in urban areas. Significant hot spot clusters of individuals without full HPV immunization exist in rural locations on the northern and eastern regions of Alberta. Hot spots had significantly worse mean material deprivation scores (P=.008) and fewer GP visits (P=.001) than cold spots. Findings suggest that material and social deprivation, health system access, and rural residency impact HPV immunization. Such factors should be considered by public health professionals in other jurisdictions and will be used by the Alberta co-design team when tailoring programs to increase HPV vaccine uptake in priority populations and regions.

O147: Use of the National Consultant Information Programme to evaluate surgical practice in England for rectal prolapse repair, identifying points of variation for improvement and the impact of the Covid-19 pandemic

Abstract Introduction Using the National Consultant Information Programme (NCIP) tool to extract and analyse data surrounding rectal prolapse repair procedures, to identify key trends and variation. Analysing data across a 4-year period to evaluate how the Covid-19 pandemic impacted current surgical practice. Methods NCIP compiles hospital episode statistics data gathered by NHS analysts. Data is categorised by key metrics including length of stay (LOS), procedure approach, deprivation score and pseudonymised provider. Data is for elective procedures in patients 17+ and has been contextualised by recent available literature. Results Of the 6702 procedures, 65.8% (4413) were carried out in the first time period, 1st April 2018 to 31st March 2020. Abdominal prolapse repair increased from 37.0% of procedures in the first 2 years, to 42.4% in the second period (1st April 2020 to 31st March 2022). Perineal approach decreased from 45.6% of procedures to 41.1% in the second period. 87.7% of patients were female. Most procedures were open (77.7%). Average LOS was 2.5 days and was highest in laparoscopic assisted procedures (5.38), 2.33 in open procedures. From 141 providers, the top 15 did 100-218 procedures each across the 4 years. 24 providers performed 15 or less, while 5 performed only 1 repair. Mortality within 90 days was 0.81% in the first data period and increased to 1.1% in the second. Conclusion Data suggests an impact on procedure numbers due to Covid-19, but not on approach type. Significant observed variation between provider approach and procedure count invites further research into reasons behind this.

Education to improve timeliness of shingles diagnosis in primary care: a cluster randomised study within a trial with nested qualitative study.

Herpes zoster (shingles) is normally diagnosed clinically. Timely diagnosis is important so that antiviral treatment can be started soon after rash onset. To assess whether a practice-level educational intervention, aimed at non-clinical patient-facing staff, improves the timely assessment of patients with shingles. This was a cluster randomised study within a trial (SWAT) with nested qualitative study in general practices in England. Practices were cluster randomised 1:1, stratified by centre and minimised by practice list size and Index of Multiple Deprivation score. Intervention practices were sent educational materials, highlighting the common presenting features of shingles and what action to take if suspected. The primary and secondary outcomes were the mean proportion of patients per practice seen within 72 and 144 h of rash onset, respectively. Comparison between groups was conducted using linear regression, adjusting for randomisation variables. Semi-structured interviews with practice staff in intervention practices explored views and opinions about the intervention. In total, 67 practices were enrolled; 34 randomised to the intervention and 33 to the control. The mean difference in proportion of patients seen within 72 and 144 h was -0.132 (95% confidence interval [CI] = -0.308 to 0.043) and -0.039 (95% CI = -0.158 to 0.080), respectively. In intervention practices, 90.9% reported distributing the educational materials; however, engagement with these was suboptimal. Twelve participants were interviewed, and the poster component of the intervention was said to be easiest to implement. Our educational intervention did not improve the timely assessment of patients with shingles. This may be the result of poor intervention engagement.

Determining the distance patterns in the movements of future doctors in UK between 2002 and 2015: a retrospective cohort study

ObjectiveTo determine and identify distance patterns in the movements of medical students and junior doctors between their training locations.DesignA retrospective cohort study of UK medical students from 2002 to 2015...

Adolescent Health Care Needs and Relationship to Disease in Patients With Childhood-Onset Systemic Lupus Erythematosus.

Our objective was to characterize adolescent health and psychosocial issues in patients with childhood-onset systemic lupus erythematosus (cSLE) and evaluate demographic and disease characteristics associated with adolescent health. We retrospectively examined adolescents aged 12 to 18 years with cSLE seen at the Hospital for Sick Children meeting the American College of Rheumatology/Systemic Lupus International Collaborating Clinics classification criteria, assessed by adolescent medicine in the cSLE clinic between 2018 and 2020. Adolescent health issues were characterized using the Home, Education/Employment, Activities, Diet/Drugs, Sexuality, Suicide/mood (HEADDSS) framework. Issues were classified as presenting and/or identified; adolescent health burden was tabulated as the number of distinct adolescent issues per patient. Multiple Poisson regression models examined associations between patient and disease characteristics (age, sex, material deprivation, disease activity, disease damage, and high-dose glucocorticoid exposure) and adolescent health issues. A total of 108 (60%) of 181 adolescents with cSLE were seen by adolescent medicine, with a median of 2 (interquartile range [IQR] 1-3) visits and a median of 2 (IQR 1-5) adolescent health issues during the study period. Common issues were mood (presenting in 21% vs identified in 50%), sleep (27% vs 2%), school and education (26% vs 1%), and nonadherence (23% vs 8%). Psychoeducation was provided by adolescent medicine to 54% of patients. High-dose glucocorticoids (risk ratio [RR] 1.82, 95% confidence interval [CI] 1.41-2.35, P < 0.001), material deprivation (RR 1.17, 95% CI 1.04-1.30, P = 0.007), and lower SLE Disease Activity Index scores (RR 0.95, 95% CI 0.92-0.98, P = 0.004) were associated with higher adolescent health burden. Adolescents with cSLE experience many adolescent issues, especially low mood. High-dose glucocorticoids and social marginalization are associated with greater adolescent health burden. This study highlights the importance of addressing adolescent health needs as part of routine care.

Race and Ethnicity, Deprivation, and Infant Mortality in England, 2019-2022

England has one of the highest infant mortality rates in Europe. Much of the variation in infant mortality rates between races and ethnicities may be due to socioeconomic factors, but how deprivation and race and ethnicity are associated with infant mortality is unclear. To investigate the association of infant race and ethnicity with the infant mortality rate in England, adjusted for preterm birth and level of deprivation. This cohort study included children who died younger than 1 year of age, born at or after 22 weeks' gestation, occurring from April 1, 2019, to March 31, 2022, in England. Characteristics of the infant were derived from death notifications. The racial and ethnic groups were derived from National Health Service data and were reported by the parents and characterized using the Office of National Statistics classification: Asian or Asian British (Bangladeshi, Chinese, Indian, Pakistani, or any other Asian background), Black or Black British (African, Caribbean, or any other Black background), multiracial (White and Asian, White and Black African, White and Black Caribbean, or any other multiracial background), White or White British (British, Irish, any other White background, or Gypsy or Irish Traveler), and other (Arab or any other racial or ethnic group). Risk of death for all racial and ethnic groups and relative risk of death compared with the reference group (White) were calcuated. Analyses were repeated, adjusting for deprivation, gestational age of infants, and region of England. A total of 5621 infants who died younger than 1 year of age were reported to the National Child Mortality Database. A total of 2842 of 5130 infants (55.4%) were male; the median gestational age was 33 weeks (IQR, 25-38 weeks); of 5149 infants, 927 (18.0%) were Asian, 448 (8.7%) were Black, 3318 (64.4%) were White, 343 (6.7%) were multiracial, and 113 (2.2%) were from other racial and ethnic groups; and the median deprivation score was 4 (IQR, 3-5). In the unadjusted analysis, the relative risk of death compared with White infants was higher for Black (1.93 [95% CI, 1.75-2.13]) and Asian (1.67 [95% CI, 1.55-1.80]) infants. The population attributable risk fraction for all mortality rates among infants who were not White was 12.0% (95% CI, 10.3%-13.8%) (unadjusted), 9.8% (95% CI, 8.0%-11.7%) (adjusted for deprivation), 7.7% (95% CI, 5.9%-9.5%) (adjusted for gestational age at birth), and 12.8% (95% CI, 11.0%-14.5%) (adjusted for region of England). This cohort study suggests that the proportion of infants who died before 1 year of age is associated with race and ethnicity, with a population attributable risk fraction of 12.0%. An overconservative adjustment for deprivation did not explain the overall patterns seen. Approximately half the population attributable risk fraction may be due to increased risk of preterm birth in Asian and Black communities. Work is needed to identify what can be done to reduce this incidence of infant mortality.

Examining rehabilitation access disparities: an integrated analysis of electronic health record data and population characteristics through bivariate choropleth mapping.

Despite efforts to view electronic health records (EHR) data through an equity lens, crucial contextual information regarding patients' social environments remains limited. Integrating EHR data and Geographic Information Systems (GIS) technology can give deeper insights into the relationships between patients' social environments, health outcomes, and geographic factors. This study aims to identify regions with the fastest and slowest access to outpatient physical therapy services using bivariate choropleth maps to provide contextual insights that may contribute to health disparity in access. This was a retrospective cohort study of patients' access timelines for the first visit to outpatient physical therapy services (n = 10,363). The three timelines evaluated were (1) referral-to-scheduled appointment time, (2) scheduled appointment to first visit time, and (3) referral to first visit time. Hot and coldspot analyses (CI 95%) determined the fastest and slowest access times with patient-level characteristics and bivariate choropleth maps that were developed to visualize associations between access patterns and disadvantaged areas using Area Deprivation Index scores. Data were collected between January 1, 2016 and January 1, 2020. EHR data were geocoded via GIS technology to calculate geospatial statistics (Gi∗ statistic from ArcGIS Pro) in an urban area. Statistically significant differences were found for all three access timelines between coldspot (i.e., fast access group) and hotspot (i.e., slow access group) comparisons (p < .05). The hotspot regions had higher deprivation scores; higher proportions of residents who were older, privately insured, female, lived further from clinics; and a higher proportion of Black patients with orthopaedic diagnoses compared to the coldspot regions. Our study identified and described local areas with higher densities of patients that experienced longer access times to outpatient physical therapy services. Integration of EHR and GIS data is a more robust method to identify health disparities in access to care. With this approach, we can better understand the intricate interplay between social, economic, and environmental factors contributing to health disparities in access to care.

Racial Disparities in Pelvic Floor Disorders.

To investigate the impact of racial disparities and Socioeconomic Status (SES) on pelvic floor disorder (PFD) care. Racial disparities in colorectal PFD remain uninvestigated, despite prior research in urogynecology. This retrospective study was conducted at Guy's and St. Thomas' Hospital of London in 2023. Patients with colorectal PFD from 2013 to 2018 were evaluated. Patients were classified according to the Index of Multiple Deprivation (IMD) scores and divided into quintiles. The lowest quintile represents the most deprived, whereas the higher quintile represents the least deprived. Assessed variables: patient complaint, symptoms, consultant and biofeedback referrals, investigations, multidisciplinary meeting (MDM) discussions, treatment, and follow-up appointments. 2001 patients were considered. A total of 1126 patients were initially analyzed, and 875 patients were excluded owing to incomplete data. Eight ethnic groups were identified in this study. Constipation was the most common compliant across ethnic groups (P=0,03). Diagnostics, MDM discussions, and conservative treatment did not vary between ethnicities. White British and Asian patients were significantly more likely to be seen by a consultant (P=0.001) and undergo surgery (P=0.002). In the second part of the study, the IMD was calculated for 1992 patients who were categorized into quintiles. Diagnostic tests, discussion in MDM, Consultant review, and surgical treatments were significantly lower in the two lowest quintiles (P<0.001, P<0.001, P=0.02, and P=0.02, respectively). Conservative treatment did not vary between the IMD groups. Disparities in the diagnosis and treatment of colorectal PFD exist among ethnic minorities and patients of low SES. This study allows for the replication of service provision frameworks in other affected areas to minimize inequalities.

P518 Dietary and non-dietary predictors of treatment response to adalimumab in anti-TNFα-naïve adults with Crohn’s disease

Abstract Background Biologics, such as anti-TNFα agents, are commonly used in the management of Crohn’s disease (CD). A significant proportion of patients do not respond to treatment, necessitating the exploration of pre-treatment predictors of treatment response. Methods Anti-TNFα-naïve adults with active CD (Crohn’s Disease Activity Index; CDAI≥150) participating in an RCT (NCT04859088) were randomised to receive adalimumab monotherapy or adalimumab combination therapy with 50% partial enteral nutrition (PEN). Treatment response (CDAI&amp;lt;150) was assessed after 6 weeks, baseline diet was assessed with EPIC-Norfolk FFQ, alternative Mediterranean diet scores (aMED), and principal component analysis (PCA) with orthogonal (varimax) rotation was used to identify data-derived dietary patterns. Baseline predictors evaluated included PEN use, steroid use, immunomodulator use, age, disease duration, CDAI, C-Reactive protein (CRP), albumin, haemoglobin, Scottish Index of Multiple Deprivation (SIMD) score, adherence to dietary patterns identified, aMED score, smoking status, alcohol consumption, physical activity level, body mass index (BMI), fat mass (kg/m2), fat-free mass (kg/m2), and handgrip strength. Differential analysis between responders and non-responders was carried out with general linear model or chi-square test when appropriate. Random forest model with recursive feature elimination (RF-RFE) was used to identify the most predictive factors of treatment response. Results Of 42 participants recruited to the study, 62% (26) responded to treatment. PCA revealed four dietary patterns (Figure 1A). Responders to adalimumab were younger (mean (SD): 36.0 (17.1) vs 50.8 (10.0), P=0.004), had lower baseline CDAI (mean (SD): 228 (62) vs 286 (78), P=0.018), higher CRP (14.5 (19.2) vs 4.6 (5.8) mg/L, P=0.036), were less likely to smoke (31% (5 of 16) vs 8% (2 of 26), and less likely to adhere to a dietary pattern characterised by high consumption of animal products (PC2) (P=0.030). Adherence to PC2 also correlated positively with age (r=0.327, P=0.035). The RF-RFE algorithm highlighted young age, low baseline CDAI and low PC2 adherence as key factors (Sensitivity: 77%, Specificity: 63%, PPV: 77%, NPV: 63%, OOB: 29%, P=0.012) (Figure 1B). Interestingly, exclusion of dietary factors improved diagnostic performance of the model (Sensitivity: 77%, Specificity: 75%, PPV: 83%, NPV: 67%, OOB: 24%, P=0.003) (Figure 1C), indicating potential interactions by other factors like age. Conclusion Young age, non-smoking, low baseline CDAI and elevated CRP predict adalimumab response in anti-TNFα-naïve adults. While dietary factors may also play a role, their impact seems confounded by other non-dietary factors. Further research is warranted in this area.

Sleep disorders during the COVID-19 pandemic: Results from the second phase of web-based EPICOVID19 study.

The COVID-19 pandemic has induced significant impairments, including sleep disturbances. The present study aimed to explore the impact of fear in relation to stress on sleep disorders among Italian adults and older participants in the second phase of the EPICOVID19 web-based survey (January-February 2021). Sleep disturbances during the pandemic were evaluated using the Jenkins Sleep Scale, perceived stress through the 10-item Perceived Stress Scale and fear of contagion and about economic and job situation with four ad hoc items. The strength of the pathways between stress, sleep disturbances and fear was explored using structural equation modelling, hypothesising that stress was related to sleep disturbances and that fear was associated with both stress and sleep problems. Out of 41,473 participants (74.7% women; mean age 49.7±13.1years), 8.1% reported sleep disturbances and were more frequently women, employed in a work category at risk of infection or unemployed, and showed higher deprivation scores. Considering an a priori hypotheses model defining sleep and stress scores as endogenous variables and fear as an exogenous variable, we found that fear was associated with sleep problems and stress, and stress was associated with sleep problems; almost half of the total impact of fear on sleep quality was mediated by stress. The impact of stress on sleep quality was more evident in the younger age group, among individuals with a lower socioeconomic status and healthcare workers. Fear related to COVID-19 seem to be associated with sleep disturbances directly and indirectly through stress.

Executive Function in Preschool Children with Congenital Heart Disease and Controls: The Role of a Cognitively Stimulating Home Environment

ObjectivesTo assess the relationships between (1) environmental and demographic factors and executive function (EF) in preschool children with congenital heart disease (CHD) and controls and (2) clinical and surgical risk factors and EF in preschool children with CHD. Study DesignAt 4-6 years of age, parents of children with CHD (n=51) and controls (n=124) completed the BRIEF-P questionnaire and the Cognitively Stimulating Parenting Scale (CSPS). Multivariable general linear modelling assessed the relationship between BRIEF-P composite scores (Inhibitory Self-Control Index [ISCI], Flexibility Index [FI], and Emergent Metacognition Index [EMI]) and group (CHD/control), sex, age at assessment, gestational age (GA), index of multiple deprivation (IMD) and CSPS scores. The relationships between CHD type, surgical factors and brain MRI injury rating (BIR) and ISCI, FI, and EMI scores were assessed. ResultsPresence of CHD, age at assessment, sex, and IMD were not associated with EF scores. Lower GA was associated with higher ISCI and FI scores, and age at assessment was associated with lower FI scores. Group significantly moderated the relationship between CSPS and EF, such that CSPS significantly predicted EF in children with CHD (ISCI: p=0.0004; FI: p=0.0015; EMI: p=0.0004) but not controls (ISCI: p=0.2727; FI: p=0.6185; EMI: p=0.3332). There were no significant relationships between EF scores and surgical factors, CHD type, or BIR. ConclusionsSupporting parents to provide a cognitively stimulating home environment may improve EF in children with CHD. The home and parenting environment should be considered when designing intervention studies aimed at improving EF in this patient group.

Fitness Sporcularında Kas Yoksunluğu ile Yeme Bozukluğu Arasındaki İlişkinin Araştırılması

In this study, it was aimed to investigate the relationship between muscle deprivation and eating disorder tendency in the sample of Turkish athletes and to examine them in terms of gender, years of doing sports and number of training.&#x0D; A total of 276 fitness athletes with an average age of 26.72, determined by the random sampling method based on voluntariness, participated in the questionnaire applied in the study. The data of the research were collected by google form online questionnaire using “Personal Information Form”, “Muscle Deprivation Scale” and “Orthorexia-11 Scale”. Independent Sample T Test, One-Way ANOVA test and Pearson Correlation test were used to analyze the data determined to be normally distributed. &#x0D; It was determined that the muscle deprivation scores of the athletes differed according to gender, number of training sessions and years of doing sports (p

Exploring whether primary care networks can contribute to the national goal of reducing health inequalities: a mixed-methods study.

Significant health inequalities exist in England. Primary care networks (PCNs), comprised of GP practices, were introduced in England in 2019 with funding linked to membership. PCNs have been tasked with tackling health inequalities. To consider how the design and introduction of PCNs might influence their ability to tackle health inequalities. A sequential mixed-methods study of PCNs in England. Linear regression of annual PCN-allocated funding per workload-weighted patient on income deprivation score from 2019-2023 was used. Qualitative interviews and observations of PCNs and PCN staff were undertaken across seven PCN sites in England (July 2020-March 2022). Across 1243 networks in 2019-2020, a 10% higher level of income deprivation resulted in £0.31 (95% confidence interval [CI] = £0.25 to £0.37), 4.50%, less funding per weighted patient. In 2022-2023, the same difference in deprivation resulted in £0.16 (95% CI = £0.11 to £0.21), 0.60%, more funding. Qualitative interviews highlighted that, although there were requirements for PCNs to tackle health inequalities, the policy design, and PCN internal relationships and maturity, shaped and sometimes restricted how PCNs approached this task locally. Allocated PCN funding has become more pro-poor over time, suggesting that the need to account for deprivation within funding models is understood by policymakers. The following additional approaches have been highlighted that could support PCNs to tackle inequalities: better management support; encouragement and support to redistribute funding internally to support practices serving more deprived populations; and greater specificity in service requirements.

Socio-demographic profile of medical students in Aotearoa, New Zealand (2016–2020): a nationwide cross-sectional study

ObjectiveTo determine the socio-demographic profile of all students enrolled to study medicine in Aotearoa New Zealand (NZ).Design and settingObservational, cross-sectional study. Data were sought from the Universities of Auckland and...

The Effects of Estrogen on the Risk of Developing Dementia using the UK Biobank Data

AbstractBackgroundThe incidence of dementia increases with postmenopausal women, which prompted the investigation of the role of estrogen in the development of dementia. We aimed to investigate the role of estrogen in the UK Biobank.MethodA total of 273,201 women were included in this study. Comprehensive interviews, medical history, body mass index (BMI), and the apolipoprotein E (APOE) genotype were obtained. Reproductive characteristics, including estrogen length and history of surgery, were used as exposure variables. The Cox Proportional Hazard model was used to estimate hazard ratios (HR) for the development of dementia, adjusting for age, education, the Townsend deprivation score, the APOE genotype, family history of dementia, BMI, smoking status, diabetes mellitus, hypertension, and hyperlipidemia.ResultThe mean estrogen length was 37.25 years (8.03 years). About 19% of women had a history of surgery. Compared to women with the lowest overall exposure to estrogen (Estrogen length ≤33), women with higher levels of cumulative estrogen had a decreased risk of dementia (34≤Estrogen length ≤37, HR = 0.79, 95% CI = 0.72‐0.89, p&lt;0.001; 38≤Estrogen length ≤42, HR = 0.72, 95% CI = 0.65‐0.79, p&lt;0.001; 43≤Estrogen length, HR = 0.77, 95% CI = 0.70‐0.85, p&lt;0.001). Compared to women without a history of surgery, women with a history of surgery had an increased risk of dementia (HR = 1.08, 95%CI = 1.00‐1.17, p = 0.038).ConclusionThis study found that longer estrogen length had a decreased risk for dementia and a history of surgery had an increased risk for dementia. The results of this study suggested that estrogen might have a protective role in women’s development of dementia. The exact biological mechanism of the protective effects of estrogen in the brain needs to be elucidated in the future.

Descriptive study of COVID-19 vaccinations and infections within an NHS workforce.

Healthcare workers were a priority group for coronavirus disease 2019 (COVID-19) vaccination during the pandemic. Occupational exposure may account for some of the increased risk faced. Describe COVID-19 vaccine uptake and infection rates in staff across a large NHS board in Scotland to better understand occupational risk during the pandemic. Descriptive cross-sectional study. Demographic data were extracted on 5 August 2021 from 26 058 members of staff. COVID-19 vaccination status and positive polymerase chain reaction (PCR) results were extracted on two separate dates to describe the timeline of staff infections between March 2020 and January 2022. There was high uptake of all three vaccine doses across all demographic groups in hospital staff. PCR positivity decreased with increasing age and Scottish Index of Multiple Deprivation score. Staff and nosocomial COVID-19 infections followed peaks in community infection rates. NHS Lothian is a typical NHS workforce with good vaccine uptake. Beyond very early cases, there seems to be minimal evidence of occupational acquisition of COVID-19. The large number of nosocomial infections at the start of the pandemic may, in fact, reflect lack of community testing at this time. Despite protection from high vaccine coverage, job type and good Infection Prevention and Control practices, it seems that staff remain at high risk of catching the highly transmissible omicron variant from the community rather than work.