Disadvantaged Areas Research Articles

Impact of social determinants of health on treatment patterns and outcomes in multiple myeloma.

Evaluate treatment and outcomes by social determinants of health (SDoH) in multiple myeloma (MM), which are important for improving care and outcomes. This was a retrospective study of real-world patients enrolled in a US insurance claims database (MM diagnosis, July 2018-December 2022) with linkage to a SDoH database, supplemented with mortality, provider affiliation (academic/community), and socioeconomically disadvantaged area databases. Treatment and outcomes were evaluated across SDoH domains: race/ethnicity, education level, transportation access, food insecurity, risky health behaviors, living in disadvantaged areas, healthcare needs, and ease of healthcare-systems engagement. The study included 4768 patients (2295 and 2731 with care-setting and treatment data); median follow-up, 584 days. Patients treated in academic versus community settings were less likely to be food insecure and live in disadvantaged areas and had lower healthcare needs. Stem cell transplant was more common in White versus non-White patients, those with low versus high food insecurity and healthcare needs, and high versus low ease of healthcare-systems engagement. In multivariable analysis, high versus low disadvantaged areas (HR = 1.75) and medium versus low food insecurity (HR = 1.80) were associated with shorter overall survival. These findings indicate a need for improved access to care in the broader MM population.

A Critical Review of the Ethical Aspects of the Electronic Health Record System (SPAS in Iran)

The electronic health record system (SPAS in Iran) records information related to the health of individuals in an electronic format. It is the center for collecting health information and data on outpatients and inpatients. This system records information such as the patient's full name, marital status, gender, date of admission, level of education, occupation, type of admission, and other relevant medical data. The core values and ethical requirements of SPAS include safeguarding citizens' rights, respecting individuals, observing justice and fairness, transparency, encouraging participation, and accountability. In this study, the ethical aspects of SPAS were evaluated using the model proposed by the World Health Organization (WHO) for ethical evaluation. This model emphasizes fundamental ethical principles such as human well-being and health, respecting individuals and communities, justice, and fairness. Concerning human well-being and health, SPAS can prevent unnecessary and redundant interventions and provide physicians with quick access to an accurate patient history. Furthermore, the system ensures the confidentiality of information, which is essential to respect individuals and communities. Regarding justice and fairness, the system can improve access to health services for disadvantaged and remote areas. Moreover, SPAS adheres to procedural ethical principles such as solidarity, transparency, participation, and accountability. Therefore, by critically examining the ethical dimensions of the electronic health record system (SPAS), the findings of the present study provide valuable insights for policymakers, health professionals, and regulatory organizations to ensure the ethical and efficient performance of electronic health record systems in Iran.

Supporting parents through ECEC services: impact evaluation of a parenting support model in an area of disadvantage

ABSTRACT This study aimed to evaluate theimpact of a parenting support model, Powerful Parenting, onparents’ partnership with early years educators, the home learningenvironment, and parental stress. The unique feature of this modelinvolved locating a Parent/Carer Facilitator within each specificearly childhood education and care setting to support parents. Ithas been implemented in an economically disadvantaged areain Ireland. A total of 44 parents in the intervention group and 35in the comparison group completed questionnaires at two timepoints. No statistically significant differences were found betweenthe groups. Implemented during the COVID-19 pandemic, themodel may not have been delivered with the optimal approachto produce changes in the measured outcomes between the twoassessments. However, the intervention group parents reportedhigh satisfaction with the model. Further research into PowerfulParenting under more normal circumstances, in a post-pandemiccontext, will contribute to informing future parenting supports.

Analysis of the Influence of Parental Attention, Teacher Pedagogical Interaction and Learning Facilities on the Motivation of Madrasah Tsanawiyah Students’ in South Bolaang Mongondow Regency, Indonesia

This study aims to analyze the influence of parental attention, teacher pedagogical interaction, and learning facilities on student learning motivation at Madrasah Tsanawiyah (MTs) in South Bolaang Mongondow Regency. Using a quantitative approach, data were collected from 63 students through a Likert scale questionnaire that had been tested for validity and reliability. The results showed that the third variable, including parental attention, teacher pedagogical interaction, and learning facilities, partially and simultaneously significantly influenced student learning motivation. These results strengthen the Self-Determination Theory approach, which states that adequate external support can meet students' basic psychological needs and increase intrinsic motivation. These findings emphasize the importance of synergy between the roles of parents, teachers, and school institutions in creating a learning ecosystem that supports student learning motivation. This study recommends the need for community-based education policies and sectoral collaboration to strengthen student learning motivation sustainably, especially in disadvantaged areas.

Health Care Disparities in Ocular Pathology and Oncology Lorenz Zimmerman Lecture

This manuscript is a publication of the Lorenz Zimmerman Lecture given by Paul Bryar, MD at the American Academy of Ophthalmology - American Association of Ocular Oncologists and Pathologists symposium at the 2024 American Academy of Ophthalmology annual meeting. Health care disparities exist in all areas of medicine, with certain groups of people in the same health system having more severe disease and worse outcomes than the general population. This is evident in life expectancy studies that demonstrated significant differences in life expectancy in different ZIP Codes within the same city. One of the largest expectancy gaps was in Chicago, with a 30-year difference in life expectancy between affluent neighborhoods versus those with higher Black and socioeconomically disadvantaged areas. Analysis of Chicago area ZIP Codes found that neighborhoods with higher rates of poverty and higher minority populations had significantly higher rates of diabetes and diabetic eye disease. The reasons for this disparity are multifactorial and include prior city planning decisions that led to distinct areas with very high concentration of minorities and poverty. These areas are often located adjacent to highways, railways, and industrial areas with higher pollution. These disparities also exist in ocular cancers, with minority populations and economically disadvantaged persons having more advanced stage of cancers compared to the general population in retinoblastoma, uveal melanoma, conjunctival melanoma and ocular surface neoplasia. In addition to more advanced disease, there is evidence that certain minorities and those with lower socioeconomic status receive different treatments, such as more likelihood to have an enucleation, than others with the exact same stage of disease. From this data, it is clear that the Social Determinants of Health play an important role in severity and outcomes of disease on both the individual and population level. While our health care system must continue to develop better treatments, in many diseases the opportunity for the greatest amount improvement lies in addressing these social determinants. Health care providers and medical educators need to modify our approach to disease to include addressing the SDOH to improve both individual and population health outcomes.

Impact of COVID-19 on Prenatal Diagnosis and Surgical Outcomes of Congenital Heart Disease: Fetal Heart Society and Society of Thoracic Surgeons Collaborative Study.

Fetal echocardiography is the mainstay of prenatal diagnosis of congenital heart disease. The COVID-19 pandemic led to shifts in triage of prenatal services. Our objective was to evaluate the impact of COVID-19 restrictions on prenatal diagnosis, surgical outcomes, and disparities in neonatal critical congenital heart disease (CCHD) management in the United States during the pandemic's first year. A multi-institutional retrospective cohort study compared neonatal CCHD outcomes (requiring surgery within 60 days of birth) 1 year prior (prepandemic era) and during the peak pandemic era, supplemented by a Fetal Heart Society survey assessing regional practice changes. Data on prenatal diagnosis, demographics, outcomes, and 2020 state Area Deprivation Index were analyzed using Wilcoxon rank sum and χ2 tests. The survey, completed by 72 fetal cardiologists from 9 US census regions, showed 75% of institutions implemented restrictions by March 2020, affecting triage, referrals, and number of prenatal cardiology visits. Compared with CCHD neonates born prepandemic (n=4637), those born during the pandemic (n=1806) had a higher proportion of prenatal diagnosis (66% versus 63%, P<0.05). There were no significant differences in complications or mortality, but pandemic-era neonates had longer hospital stays. During the pandemic, CCHD neonates had a more disadvantaged Area Deprivation Index and had surgery at hospitals located in more advantaged regions. Although pandemic-driven care delivery adjustments affected perinatal cardiology referrals and triage, prenatal diagnosis, perioperative outcomes, and survival remained robust. The management of CCHD demonstrates health care resilience, maintaining core prenatal and perioperative care. Regional variations highlight the need for targeted strategies to address disparities during health care crises.

School-based yoga and mindfulness interventions for young adolescents: A qualitative study in a disadvantaged area.

With raising rates of mental health problems, mind-body interventions are increasingly being integrated in schools to support children and adolescents' mental health and well-being. The aim of this study was to explore young adolescents' experiences of yoga and mindfulness and the acceptability of delivery within the school curriculum in an area of high deprivation. Qualitative group interviews with young adolescents embedded within a larger feasibility study exploring the universal (class-wide) delivery of yoga and mindfulness interventions. After participation in separate 10-week yoga or mindfulness interventions, 45 adolescents (12-13 years old; 66.7% male) took part in semi-structured group interviews exploring perceptions, acceptability, and experiences of each intervention. Data was analysed using inductive thematic analysis. Two overarching themes were identified, evident across both mindfulness and yoga groups. "Facilitators and barriers to engagement" outlined key factors impacting acceptability, including prior perceptions. Teacher qualities of non-reactivity and respect, an invitational approach to teaching, and interactive sessions were highly valued. Secondly, participants described a range of "psychosocial impacts", including increased emotional regulation, positive mindset and self-confidence, and greater focus and concentration. Physical benefits were also reported in the yoga group. This is the first study to explore the acceptability and impact of universal yoga and mindfulness interventions with an ethnically diverse sample of disadvantaged young adolescents in the United Kingdom. The findings suggest mind-body interventions can help children and adolescents develop skills to better manage challenges in their everyday lives, but they require further integration into the curriculum for optimal benefit.

Persistent Poverty, Rural Location, and Racial Segregation are Factors in Colorectal Cancer Screening in Low-Income and Uninsured Populations

Purpose: This study aimed to investigate the correlation between geographical factors, including rurality, persistent poverty counties, racial residential segregation, and adherence to colorectal cancer (CRC) screening among low-income uninsured and underinsured individuals in Texas. Methods: Utilizing retrospective survey data collected by the A&amp;M Texas Cancer Screening program from 2011 to 2022, linear mixed-effects models were employed. The models examined CRC screening adherence within the recommended time frame as the primary outcome, with geographical county-level characteristics (rurality, racial residential segregation, and persistent poverty) as the main predictors, controlling for other sociodemographic variables. Findings: The linear mixed-effects analysis revealed that individuals residing in counties characterized by high racial residential segregation (OR = 0.54, 95% CI = 0.36–0.79) or persistent poverty (OR = 0.65, 95% CI = 0.45–0.92) were less likely to self-report having undergone any type of CRC screening within the recommended time frame compared to those in counties with lower racial residential segregation and non-persistent poverty. Conversely, residents of rural counties were more likely to report being up to date with CRC screening compared to their urban counterparts (OR = 1.8, 95% CI = 1.27–2.55). Conclusions: The findings underscore the need for more targeted CRC screening promotion strategies tailored to low-income, uninsured populations residing in disadvantaged areas such as rural and persistent poverty counties, as well as those characterized by high racial residential segregation.

Patterns of intimate partner violence in Victoria, Australia: analysis using the National Ambulance Surveillance System.

Patterns of intimate partner violence in Victoria, Australia: analysis using the National Ambulance Surveillance System.

The effect of nutritional education on nutritional knowledge level and diet quality in volleyball players living in a disadvantaged area

The aim of this study is to determine the effect of nutritional education (NE) planned for volleyball players who live in a socioeconomically disadvantaged area on the level of nutritional knowledge and diet quality. The study was conducted with volleyball players between the ages of 9 and 14 who were studying in schools in disadvantaged areas of Istanbul between July 2022 and August 2022. NE was applied in 3 separate modules. As a data collection tool, the General Information and Nutritional Habits Questionnaire, from which information about the hypothesis of the study will be obtained, was used both pre- and post-NE. A 1-day (24-hour) food consumption record was taken from the study group at the beginning and end of the study. Again, at the beginning of the study, the Diet Quality Index (DQI-I) of the food consumption records was calculated to analyze the current diet quality of the players at the end. The nutritional knowledge level of 40 volleyball players participating in the study increased post NE (p0.05). There is no statistically significant difference between the total DQI-I scores (p&gt;0.05). The 3-week nutrition education given as a result of the study, which was planned to examine the effect of nutrition education on the nutritional knowledge level and diet quality of volleyball players living in disadvantaged areas, caused a significant increase in the level of nutrition knowledge, while it did not create significant changes in the DQI-I. It is thought that the reason for this situation is related to socioeconomic level, the availability of high nutritional value food, and the level of nutritional knowledge of families. There is a need for necessary practices in the dissemination of nutrition education in the adolescent period.

Epidemiological and Clinical Manifestations of Acute Rheumatic Fever in Far North Queensland, Australia

We used the Queensland acute rheumatic fever (ARF) and rheumatic heart disease (RHD) register to describe the clinical phenotype and the characteristics of individuals diagnosed with ARF in Far North Queensland, Australia, between January 2012 and December 2023. There were 830 episodes of ARF in 740 individuals during the study period; 785/830 (95%) episodes occurred in First Nations Australians and 696/824 occurred in areas of socioeconomic disadvantage. There was no significant change in the overall incidence of ARF during the study period (Spearman’s rho = 0.51, p = 0.09). The median (interquartile range) age of the cohort was 15 (10–23) years, although 276/830 (33%) episodes of ARF occurred in individuals ≥20 years. Individuals with carditis, polyarthritis, an abnormal electrocardiogram, fever and elevated inflammatory markers were more likely to have confirmed ARF. The presence of polyarthralgia, monoarthritis or skin manifestations was not associated with a diagnosis of confirmed ARF. Individuals with monoarthralgia were less likely to have confirmed ARF. At the end of the study period, 264/706 (37%) individuals who had access to echocardiography had confirmed RHD. Individuals who did not have echocardiography documented as a component of their initial episode of care were more likely to have severe RHD at the end of the study (25/339 (7%) versus 7/401 (2%), p &lt; 0.0001). ARF and RHD continue to be diagnosed in First Nations Australians in tropical Australia. It seems unlikely that Australia will achieve its stated aim of eliminating RHD by 2031.

Aboriginal and Torres Strait Islander females and survival from breast cancer.

Background Despite access to universal health care, Aboriginal and Torres Strait Islander females (hereafter respectfully referred to as Aboriginal) in Australia have higher breast cancer incidence and mortality rates. We investigated factors contributing to these survival disparities. Methods Aboriginal females (n=395; 0.7%) and non-Aboriginal females (n=57 618; 99.3%) with breast cancer were identified from Victoria, Australia. Clinical, pathological, demographic, and socioeconomic variables were analyzed. Endpoints were all-cause and breast cancer-specific mortality. Hazard ratios (HR) were estimated using Cox regression. Tumor-infiltrating lymphocytes (sTILs) were evaluated from a subset of Aboriginal females and compared to females in TCGA. Results Registry data revealed that Aboriginal females were younger (P<0.001), had more advanced stage disease (P=0.007), were more likely to live in non-metropolitan areas (P<0.001) and in areas of greater disadvantage (P<0.001) compared to other females, at diagnosis. Age-adjusted multivariate analysis revealed a higher all-cause mortality risk (HR 1.27, 95%CI 1-1.61) for Aboriginal females, but this risk diminished for breast cancer specific mortality and after adjustment for stage and grade. Breast cancers from Aboriginal females had significantly reduced sTILs in the luminal and triple-negative subtypes, compared to TCGA. Conclusions Mortality for females with breast cancer was influenced by socio-economic, geographic and clinical factors. Notably, Aboriginal females with tumour features typically associated with favourable outcomes, experienced poorer outcomes. The reduced immune infiltrate warrants further investigation. Impact These findings highlight the need to address socioeconomic inequities and ensure culturally safe cancer care. Further research should explore biological and environmental factors influencing outcomes for Australian Aboriginal females.

The moderating role of school culture in teacher–child interactions and child outcomes in a disadvantaged area of southwestern China

ABSTRACT The influencing factors of teacher–child interaction are multidimensional. However, there is a lack of research on the role of school organizational support in this interaction. This paper aims to examine the role of school culture (i.e. innovation orientation and formal relationships) in potentially moderating the relationship between teacher–child interactions and child outcomes in preschool settings in K County, a disadvantaged area in southwestern China. A total of 77 classrooms with a total of 872 children were recruited from 45 preschools. The results indicated that the quality of teacher–child interaction in our study was at a low level. More specifically, the quality of instructional support was at a low level, emotional support was close to mid-level, and classroom organization was also mid-level. The findings also indicated that innovation orientation and formal relationships could have a significant impact on the effectiveness of emotional support and classroom organization in promoting child outcomes.

Prenatal Urologic Consultation for Prenatal Hydronephrosis: True Equity or Hidden Disparity?

Prenatal Urologic Consultation for Prenatal Hydronephrosis: True Equity or Hidden Disparity?

Improving Literacy And Numeracy Skills With A Calistung Tutoring Work Program By Campus Teaching Students At Elementary School 1 Pungguk Lama

The Teaching Campus Program is one part of Merdeka Belajar, this program is designed to improve the quality of education in Indonesia by including students as teacher partners in schools, helping to design teaching materials, providing guidance, and supporting extracurricular activities. This program aims to overcome the challenges of low literacy and numeracy, especially in disadvantaged or disadvantaged areas. Through Bimbel Calistung activities at SD Negeri 1 Pungguk Lama. This study used a descriptive qualitative method to evaluate the impact of the program on students' basic skills. Through direct observation, interviews and documentation of activities, it was found that participation in Bimbel Calistung significantly develops students' reading and numeracy skills, and arouses their interest in learning. The purpose of this research is to understand how successful the tutoring program is in developing learners' reading, writing and arithmetic skills and what influences this success. The program not only supports academic improvement, but also builds a stronger literacy culture within the school. It can be concluded that the research shows that student-school collaboration can result in a more effective learning environment, helping to develop literacy and numeracy skills that are essential for the future of the participants.

‘Peace is a beacon of hope’: young people’s commitment to building a culture of peace in Scotland

ABSTRACT Young people are important actors in building and sustaining just and positive peace. This paper presents the conceptualisations of and commitments to a culture of peace youth would like to uphold in one of the least peaceful places in the United Kingdom, Glasgow. Fifty-nine youth participants (12–18 years old) coming from wealthy and disadvantaged areas of the city participated in arts-based workshops where they were asked to contribute to a Peace Wall by responding to peace-related prompts. We used the foundational elements of the culture of peace outlined in UN Resolution 53/243 titled Declaration and Programme of Action on a Culture of Peace for a reading of youth conceptualisations and commitments. Our findings show young people’s strong commitment to a culture of peace in their communities through upholding human rights, equity, freedoms, respectful relationships with others, and personal responsibility. However, we also identify some missing elements, such as cooperation and solidarity with others. In our discussion, we discuss these findings and point to two key contributions to research and practices, with a particular focus on how to support youth learning to become peace facilitators and peacemakers.

Impact of Hispanic Ethnicity, Geography, and Insurance Status on Cardiovascular Outcomes in Patients Undergoing Percutaneous Coronary Intervention.

Impact of Hispanic Ethnicity, Geography, and Insurance Status on Cardiovascular Outcomes in Patients Undergoing Percutaneous Coronary Intervention.

Roles of agro-nursing in bringing health services in rural and remote areas of Indonesia

Agro-nursing is an innovative approach to health care that integrates nursing science with a contextual understanding of agricultural conditions and rural life. Rural and remote areas in Indonesia often face challenges in accessing adequate health care. This article discusses the role of agro-nursing in addressing these challenges, highlighting how nurses can act as agents of change who provide health care and empower communities through approaches appropriate to local characteristics. By utilizing local potential, community culture, and agricultural systems as an integral part of rural life, agro-nursing strengthens health care promotive, preventive, curative, and rehabilitative efforts. This study also highlights the importance of specialized training, cross-sector collaboration, and policy support to optimize the role of agro-nursing in improving the health of communities in remote and disadvantaged areas. It is hoped that agro-nursing can be a sustainable strategy for narrowing the gap in health services between urban and rural areas in Indonesia.

Electricity inaccessibility across historically redlined and present-day disadvantaged areas in New York City.

Electricity is crucial in sustaining livelihoods from turning the lights on at night, keeping the refrigerator running to avoid food spoilage, and powering electricity-dependent durable medical equipment such as nebulizers. Thus, electricity inaccessibility may result in adverse outcomes. Like other environmental burdens, electricity inaccessibility may be socially patterned, with disproportionate occurrence in racially and economically marginalized communities. To evaluate the 2017-2019 distribution of electricity inaccessibility - defined as power outages and energy insecurity - across historical and present-day measures of community racial disadvantage in New York City (NYC). We measured power outages with NYC 311 outage call reports and the System Average Interruption Frequency Index (SAIFI). We calculated energy insecurity as monthly average energy use, leveraging data from the New York State Energy Research and Development Authority. These three electricity inaccessibility metrics were estimated within both historical Home Owners' Loan Corporation (HOLC) graded areas (A, 'best' through D, 'redlined') and present-day racial and economic Index of Concentrations at the Extremes (ICE) census tracts quartiles. Our study covered 396 HOLC areas and 2218 census tracts in NYC. Historically A-graded areas had fewer 311 outage calls and lower SAIFI. Additionally, the rate of 311 outage calls in the present-day most disadvantaged census tracts was nearly six times that of the most privileged tracts. Persistently disadvantaged areas (i.e., both poor HOLC grade and high ICE) had more power outages than consistently advantaged areas. However, the present-day most disadvantaged census tracts still had more power outages than persistently disadvantaged areas. This 2017-2019 New York City (NYC) study evaluated the distribution of three electricity inaccessibility metrics in relation to community privilege and disadvantage. Uniquely, we assessed the distribution across historically redlined areas and present-day census tracts. We defined electricity inaccessibility as power outages (311 calls and power interruptions) and energy insecurity (residential energy use). We found that 311 calls and power interruptions were more common in historically redlined areas, present-day disadvantaged census tracts, and persistently disadvantaged areas. These findings indicate proxies for historical racial discrimination, such as redlining, and modern-day community disadvantages impact the access to reliable electricity in NYC.

Regulatory Approach in Addressing the Availability and Affordability of Telecommunication Services in Indonesia

Ensuring equal access to telecommunication services is a major regulatory challenge, particularly in the Frontier, Outermost, and Disadvantaged (3T) areas. This study analyzes how regulations can ensure the availability and affordability of telecommunication services in these regions based on Steven Vago’s theory of law and society. Using a normative juridical approach and qualitative analysis, this study explores pricing policies, subsidies, and incentives as instruments to create a more equitable telecommunication ecosystem. The findings indicate that Law Number 36 of 1999 on Telecommunications establishes the Universal Service Obligation (USO) to ensure equal access to telecommunication services. However, the implementation of this policy still faces obstacles, such as infrastructure limitations, high investment costs, and service prices that remain unaffordable for low-income communities. More adaptive regulations are needed to address digital access disparities and promote equitable telecommunication services. The government can optimize targeted subsidies and incentives to expand service coverage, enhance operator competitiveness, and curb monopolistic practices that hinder service affordability. This study emphasizes that telecommunication regulations must evolve in line with social changes and digitalization. With the right policy approach, telecommunication services can be accessible to all societal levels, particularly in regions experiencing digital disparities.