Disadvantaged Populations Research Articles

Defining the Zero Dose Child: A Comparative Analysis of Two Approaches and Their Impact on Assessing the Zero Dose Burden and Vulnerability Profiles across 82 Low- and Middle-Income Countries.

While there is a coordinated effort around reaching zero dose children and closing existing equity gaps in immunization delivery, it is important that there is agreement and clarity around how 'zero dose status' is defined and what is gained and lost by using different indicators for zero dose status. There are two popular approaches used in research, program design, and advocacy to define zero dose status: one uses a single vaccine to serve as a proxy for zero dose status, while another uses a subset of vaccines to identify children who have missed all routine vaccines. We provide a global analysis utilizing the most recent publicly available DHS and MICS data from 2010 to 2020 to compare the number, proportion, and profile of children aged 12 to 23 months who are 'penta-zero dose' (have not received the pentavalent vaccine), 'truly' zero dose (have not received any dose of BCG, polio, pentavalent, or measles vaccines), and 'misclassified' zero dose children (those who are penta-zero dose but have received at least one other vaccine). Our analysis includes 194,829 observations from 82 low- and middle-income countries. Globally, 14.2% of children are penta-zero dose and 7.5% are truly zero dose, suggesting that 46.5% of penta-zero dose children have had at least one contact with the immunization system. While there are similarities in the profile of children that are penta-zero dose and truly zero dose, there are key differences between the proportion of key characteristics among truly zero dose and misclassified zero dose children, including access to maternal and child health services. By understanding the extent of the connection zero dose children may have with the health and immunization system and contrasting it with how much the use of a more feasible definition of zero dose may underestimate the level of vulnerability in the zero dose population, we provide insights that can help immunization programs design strategies that better target the most disadvantaged populations. If the vulnerability profiles of the truly zero dose children are qualitatively different from that of the penta-zero dose children, then failing to distinguish the truly zero dose populations, and how to optimally reach them, may lead to the development of misguided or inefficient strategies for vaccinating the most disadvantaged population of children.

Socioeconomic consequences of the COVID‐19 pandemic for people who use drugs

AbstractThe COVID‐19 pandemic triggered widespread socioeconomic hardship, disproportionately impacting disadvantaged populations. People who use illicit drugs are more likely to experience unemployment, homelessness, criminal justice involvement and poorer health outcomes than the general community, yet little is known about the socioeconomic impacts of the pandemic on their lives. To address this gap in the literature, we conducted in‐depth interviews with 76 participants from two cohort studies of people who use illicit drugs (people who inject drugs and/or use methamphetamine) in Victoria, Australia. Findings support claims that pandemic‐related Social Security supplementary payments and initiatives to reduce homelessness, although not systemically transforming people's lives, produced temporary relief from chronic socioeconomic hardship. Results also indicate how temporary interruptions to drug supply chains inflated illicit drug prices and produced adverse consequences such as financial and emotional stress, which was exacerbated by drug withdrawal symptoms for many participants. Furthermore, increased community demand for emergency food and housing support during the pandemic appeared to reduce participants' access to these services. Our findings about the unintended consequences of pandemic responses on the socioeconomic lives of a group of people who use illicit drugs provide insights into and opportunities for policy reform to redress their entrenched disadvantage.

Assessing social needs among patients with cardiovascular and psychiatric comorbidities in free community health clinics.

Community-related health assessments have been shown to improve several outcomes in socioeconomically disadvantaged populations with comorbid chronic health conditions. However, while it is recognized that modifiable social determinant of health (SDH) factors might be responsible for up to 60% of preventable deaths, it is not yet standard of care to routinely screen and address these at preventive health appointments. The objective of this study was to identify the social needs of socioeconomically disadvantaged patients. We performed a retrospective review of the socioeconomic screening questionnaires distributed to under- and uninsured patients seen at a medical student-run free primary care-based community clinic. This study included participants of all ages (0 and up), genders, languages, and ethnicities who filled out the social screening questionnaire. Socioeconomic screening questionnaires assessed the need for critical resources such as food, housing, utilities, finances, transportation, childcare, employment, education, legal support, companionship, health literacy, and community assistance. The primary study outcome was to identify unmet social needs of our medical student-run free clinic patients. We secondarily sought to identify associations between these needs and chronic health conditions. We hypothesized that patients with multiple chronic health problems and financial stressors would have the highest requests for resources. Our retrospective review identified 264 uninsured participants who were evaluated for social needs using a screening questionnaire. Participants who reported unmet social needs had significantly more cardiovascular risk factors than those who did not. Cardiovascular comorbidities and a history of psychiatric illness were the two most common medical problems significantly associated with several unmet social needs. This study provides support for the preemptive identification and appropriate management of physical, mental, and social care to improve disproportionate disparities in long-term health outcomes.

Social Determinants of Cancer Disparities.

Cancer is a major public health issue that is associated with significant morbidity and mortality across the globe. At its root, cancer represents a genetic aberration, but socioeconomic, environmental, and geographic factors contribute to different cancer outcomes for selected population subsets. The disparities in the delivery of healthcare affect all aspects of cancer management from early prevention to end-of-life care. In an effort to address the inequality in the delivery of healthcare among socioeconomically disadvantaged populations, the World Health Organization defined social determinants of health (SDOH) as conditions in which people are born, live, work, and age. These factors play a significant role in the disproportionate cancer burden among different population groups. SDOH are associated with disparities in risk factor burden, screening modalities, diagnostic testing, treatment options, and quality of life of patients with cancer. The purpose of this article is to describe a more holistic and integrated approach to patients with cancer and address the disparities that are derived from their socioeconomic background.

Impact of ambient temperature on disadvantaged population: focusing on persons with disabilities

Impact of ambient temperature on disadvantaged population: focusing on persons with disabilities

Health professional’s perception of a smoking cessation intervention among disadvantaged patients participating in a pragmatic randomized trial

IntroductionIndividuals who have a low socio-economic position (SEP) are more likely to smoke and face greater barriers to quitting tobacco. However, the effectiveness of tailored interventions has been limited probably due to specific challenges relative to this population. We conducted a mixed-method study to better understand health professionals’ perceptions and barriers when implementing a preference-based smoking cessation (SC) intervention among disadvantaged smokers.MethodsA self-administered online questionnaire was sent to health professionals (doctors’ and other health professionals specialized in SC) participating in “STOP” a pragmatic multicentre randomized controlled trial. Perceptions regarding patient eligibility, the doctor-patient relationship, general study organization, and satisfaction were measured.ResultsTwenty-eight STOP study investigators responded. Health professionals prioritize smoking cessation for disadvantaged patients, but face challenges in approaching and following them. A research intervention providing cessation tools based on preference was deemed useful but generally undermined by time constraints. Health professionals’ preconceptions regarding patients in low SEP having other “pressing problems” which might be exacerbated by quitting smoking were also identified. Further, participation in a research intervention was perceived as not satisfactory due to workload and lack of time.ConclusionOur results highlight general barriers inherent to implementing pragmatic trials. They also present specific challenges in smoking cessation trials among disadvantaged population, essential to advance equity in tobacco control.

O.2.2-5 Health promotion in rural areas. Findings from two German projects on physical activity promotion among disadvantaged populations

Abstract Purpose Communities play a crucial role for health promotion, especially for disadvantaged groups. At the same time, rural communities face specific challenges when planning and conducting health promotion projects. This presentation focuses on the challenges and opportunities rural communities experienced in two German projects for physical activity promotion. Methods Data were obtained from city administration staff participating in the GESTALT and the BIG projects (N = 13). Data were gathered via three storywall surveys. In addition, a real-world lab with city-administration staff, representatives of sickness funds and researchers was used to follow the communities over time and consult them on project implementation. Results The challenges and opportunities occurred can be categorized in five domains: Infrastructure/mobility: Rural areas are often not well connected to public transport. This can hinder people to attend exercise classes. Voluntarily organized transport services or neighborhood assistance might help overcoming this challenge. Networking Networking is a double-edged sword. Some staff reported to experience benefits of already existing contacts to relevant stakeholder due to closely-knit communities. Others reported that it is challenging to get in touch with the network partners in the rural areas. Durability In some cases, the project funding was seen as a window of opportunity and a starting point for developing new structures for health promotion. Range of offers A need of exercise classes in rural areas resulted in the success of the projects. However, the implementation of new programs and activities can be time-consuming. Especially in rural districts, solutions often are planned and implemented on a very small scale. Implementation Regarding implementation, there are several challenges to overcome. The communities lacked gyms and qualified instructors for the classes. Reaching the target population was another challenge. Conclusions Rural communities face unique as well as general challenges when implementing exercise programs, which can impact success of project implementation. However, rural structures can also result in opportunities for the participating communities. Support/Funding Source Funded by the German Federal Centre for Health Education (BZgA) on behalf of and with funds from the statutory health insurance companies according to § 20a SGB V.

Level and Trend of Child Health and Nutrition Status in Nepal: Evidence from Demographic and Health Survey (1996-2016).

Child health and nutrition are key indicators of the country's socioeconomic development and quality of life. The purpose of the paper was to examine the level, trend, and socio-demographic differences of selected child health and nutrition indicators and to provide policy recommendations for improvement. Desk review was conducted to compile secondary information on child health and nutrition status published in the Nepal Demographic and Health Survey reports prepared by Ministry of Health and Population from 1996 to 2016. Trend lines, bar diagram, and GIS maps were prepared to study and present the findings. A substantial decrease in under-five mortality, from 118 to 39 (67% point decline) and neonatal mortality, from 50 to 21 (58% point decline) deaths per 1000 live births, was noted between 1996 and 2016. Full immunization coverage decreased from 87% in 2011 to 78% in 2016. 36% of children under the age of five were stunted, 25% were underweight, and 10% were wasted in 2016. Boys were more likely to receive treatment for diarrhoea (72%), compared to girls (56%). The majority of the children (74%) had their acute respiratory infections managed at private medical centers. Child health and nutritional status differed by geographic regions, being better in Gandaki and Bagmati and poor in Karnali and Madesh. Overall health and nutrition status of children were better among educated, and wealthier families. To further reduce childhood mortality and reach the targets for the Sustainable Development Goal, targeted interventions must be implemented to improve immunization coverage plus health and nutritional status among disadvantaged populations.

Developing Family Nurse Practitioner Student Competencies: A Two-Part Mental Health-Focused Telehealth Education Activity

Telehealth is becoming a vital option for increasing access to health care. Family Nurse Practitioners (FNPs) are often the primary providers for rural and disadvantaged populations. They may be the first to encounter patients experiencing depression and other psychiatric problems. This article describes a two-part simulated telehealth education initiative to build FNP student competencies in the use of telehealth technology to interview clients with depressive symptoms.In Part 1, students completed didactic modules that introduced them to telehealth concepts. In Part 2, they participated in a simulated telehealth encounter with a standardized patient experiencing depression. Preparation included a review of care of patients with depression and focused content on telehealth etiquette. After the encounter, they received feedback from the standardized patient, debriefed with faculty, and documented their simulated telehealth visit. The activity was evaluated through post-education surveys and a one-time focus group.Students were overwhelmingly positive regarding the relevance of the educational activity to their graduate preparation and future practice. Many shared suggestions for refinement of the activity. Integration into the current curriculum and use of existing resources increased the feasibility, cost-effectiveness, and potential for long-term sustainability of the educational initiative.

Demographic Profile and Survival of Cancer Patients in a Tertiary Hospital, Bangladesh- A Cross-Sectional Study

Introduction: Cancer is the second leading cause of death and disability around the world. In developing countries, the problem of cancer is a substantial issue. Cancers like lung, stomach, breast, cervix etc. are more prevalent among socially disadvantaged populations. Globally, cancers in all forms are causing about 12% of all deaths. The aim of this study was to determine the demographic profile and survival of cancer patients in a tertiary care hospital. Methods: This was a cross-sectional study and was conducted in the Department of Oncology of North East Cancer Institute (NECI), Sylhet, Bangladesh during the period from January 2023 to June 2023. Age and sex related data of 1594 patients were collected by reviewing hospital records of diagnosed and treated cancer patient in North East Cancer Institute (NECI) from January 2016 to December 2020. Results: Majority of our patients were aged ≥ 45 years old and most of our participants were male (57.15%). The number of patients was decreased in 2020, and among 1594 registered patients only 1073 (67.31%) patients responded to our phone calls. And among the patients who responded (1073) to our phone call out of them 336 (31.31%) patients were survived and 737(68.69%) patients died. The patient who survived 336 (31.31%) among them majority were suffering from Head & Neck (14.35%), Breast (5.87%), Cervix (2.89%) cancer and patients of other type of cancer survived (8.02%). Conclusion: An increased trend of cancer is found in the older people of Bangladesh and it is more prevalent leading among the male. Though Head & Neck cancer is more prevalent in our study this result cannot be extrapolated to the entire nation.

Improving Hypertension Control in Vulnerable Populations Around the World.

This review aims to describe recent literature, guidelines, and approaches to reveal and reduce hypertension burden in disadvantaged populations. Hypertension is a major global health issue and the most potent risk factor for cardiovascular disease, morbidity, and mortality. It disproportionally affects vulnerable populations, including low-, middle-, and high-income countries. Specifically, the burden of hypertension is higher in US Black adults, and addressing social determinants of health is crucial for reducing disparities among vulnerable populations worldwide. Multifactorial approaches, including lifestyle modifications and combination drug therapy, are essential in managing hypertension. Community-based interventions, team-based care, and telehealth strategies can also improve hypertension control. Additionally, renal nerve denervation is a potential treatment for resistant hypertension. Overall, to reduce the global hypertension burden among vulnerable populations, emphasis should be placed on equitable healthcare access and application of evidence-based medicine.

Cost-effectiveness of remote robotic mechanical thrombectomy in acute ischemic stroke.

Clinical outcomes following endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) treatment are highly time sensitive. Remote robotic (RR)-EVT systems may be capable of mitigating time delays in patient transfer from a primary stroke center (PSC) to a comprehensive/thrombectomy-capable stroke center. However, health economic evidence is needed to assess the costs and benefits of an RR-EVT system. Therefore, the authors of this study aimed to determine whether performing RR-EVT in suspected AIS patients at a PSC as opposed to standard of care might translate to cost-effectiveness over a lifetime. An economic evaluation study was performed from a US healthcare perspective, combining decision analysis and Markov modeling methods over a lifetime horizon to evaluate the cost-effectiveness of RR-EVT in suspected AIS patients at a PSC compared to the standard-of-care approach. Total expected costs and quality-adjusted life-years (QALYs) were estimated. In the cost-effectiveness analysis, RR-EVT yielded greater effectiveness per patient (4.05 vs 3.88 QALYs) and lower costs (US$321,269 vs US$321,397) than the standard-of-care approach. Owing to these lower costs and greater health benefits, RR-EVT was the dominant cost-effective strategy. After initiation of an RR-EVT system, the average costs per year were similar (or slightly reduced), according to this simulation. Sensitivity analyses revealed that RR-EVT remains cost-effective in a wide variety of time delays and cost assumptions. In a one-way sensitivity analysis, RR-EVT remained the most cost-effective strategy when time delays were greater than 2.5 minutes, its complication rate did not exceed 37%, and costs were lower than $54,081. When the cost of the RR-EVT strategy ranged from $19,340 to $54,081 and its complication rate varied from 15% to 37%, the RR-EVT strategy remained the most cost-effective throughout the two ranges. RR-EVT was also the most cost-effective strategy even when its cost doubled (to approximately $40,000) and time delays exceeded 20 minutes. In a probabilistic sensitivity analysis, RR-EVT was the long-term cost-effective strategy in 89.8% of iterations at a willingness-to-pay threshold of $100,000/QALY. This analysis suggests that RR-EVT as an innovative solution to expedite EVT is cost-effective. An RR-EVT system could potentially extend access to care in underserved communities and rural areas, as well as improve care for socioeconomically disadvantaged populations affected by health inequities.

Weighted Lottery to Equitably Allocate Scarce Supply of COVID-19 Monoclonal Antibody

Equitable allocation of scarce medications is an important health policy goal. There are few data about attempts to achieve equitable allocation in the community setting. To describe the development and use of a weighted lottery to allocate a scarce supply of tixagevimab with cilgavimab as preexposure prophylaxis to COVID-19 for immunocompromised individuals and examine whether this promoted equitable allocation to disadvantaged populations. This quality improvement study analyzed a weighted lottery process from December 8, 2021, to February 23, 2022, that assigned twice the odds of drug allocation of 450 tixagevimab with cilgavimab doses to individuals residing in highly disadvantaged neighborhoods according to the US Area Deprivation Index (ADI) in a 35-hospital system in Pennsylvania, New York, and Maryland. In all, 10 834 individuals were eligible for the lottery. Weighted lottery results were compared with 10 000 simulated unweighted lotteries in the same cohort performed after drug allocation occurred. Proportion of individuals from disadvantaged neighborhoods and Black individuals who were allocated and received tixagevimab with cilgavimab. Of the 10 834 eligible individuals, 1800 (16.6%) were from disadvantaged neighborhoods and 767 (7.1%) were Black. Mean (SD) age was 62.9 (18.8) years, and 5471 (50.5%) were women. A higher proportion of individuals from disadvantaged neighborhoods was allocated the drug in the ADI-weighted lottery compared with the unweighted lottery (29.1% vs 16.6%; P < .001). The proportion of Black individuals allocated the drug was greater in the weighted lottery (9.1% vs 7.1%; P < .001). Among the 450 individuals allocated tixagevimab with cilgavimab in the ADI-weighted lottery, similar proportions of individuals from disadvantaged neighborhoods accepted the allocation and received the drug compared with those from other neighborhoods (27.5% vs 27.9%; P = .93). However, Black individuals allocated the drug were less likely to receive it compared with White individuals (3 of 41 [7.3%] vs 118 of 402 [29.4%]; P = .003). The findings of this quality improvement study suggest an ADI-weighted lottery process to allocate scarce resources is feasible in a large health system and resulted in more drug allocation to and receipt of drug by individuals who reside in disadvantaged neighborhoods. Although the ADI-weighted lottery also resulted in more drug allocation to Black individuals compared with an unweighted process, they were less likely to accept allocation and receive it compared with White individuals. Further strategies are needed to ensure that Black individuals receive scarce medications allocated.

Oral health related knowledge in a disadvantaged population group

Oral health related knowledge in a disadvantaged population group

Dental therapist job satisfaction and intention to leave: A cross-sectional study

Dental therapy is a mid-level oral health profession that was introduced to the South African health system more than four decades ago, during the apartheid era. The purpose for the introduction of this profession was to meet the oral health needs of the underserved majority population1,2,3. However, even with the dismantling of apartheid and the creation of a democratic state, disparities in access to basic oral healthcare persist.1 Local studies have reported limited access to oral health services, especially among the disadvantaged and vulnerable population groups where the highest burden of oral diseases has been reported.4,5,6

Administrative and legal relations for the provision of administrative guardianship in the field of higher education

The state guarantees equal access to higher education. Due to the Chernobyl disaster, war, or other circumstances (death of both parents or deprivation of their parental rights, damage to health, which led to limitation of life activities and establishment of disability), we have entrants who do not have the opportunity to exercise their right to higher education on equal terms with other entrants who were not affected by these circumstances.&#x0D; We have a number of legislative acts to regulate these relations to ensure equal access to higher education for socially disadvantaged population groups, among which the Constitution of Ukraine and the Law of Ukraine «On Education» are generally declarative in national legislation. The Law «On Higher Education» already specifies the subjects of administrative guardianship in the field of higher education, as well as their right to a specific type of administrative guardianship in the field of higher education. Exercising his right to equal access to higher education, the subject of administrative guardianship in the field of higher education applies to the institution of higher education with a request to provide a specific type of administrative guardianship in the field of higher education, the institution of higher education takes measures to provide administrative guardianship in the field of higher education. Relations arise, which should be called administrative-legal relations of administrative guardianship in the field of higher education. Why precisely administrative-legal relations, because firstly, these relations are regulated by the norms of administrative law, for example, the norms regulating the procedure for admission to an institution of higher education and relating to subjects of administrative guardianship in the field of higher education are created and approved by the Ministry of Education and Science of Ukraine, that is, by the central body of the executive power, secondly, in the presence of a wide range of rights, the student is in a certain subordination to the institution of higher education, so according to Article 63 of the Law of Ukraine «On Higher Education», the student of the institution of higher education undertakes to observe the statute and internal regulations of the institution of higher education, comply with the requirements for occupational health and safety, safety technology, industrial sanitation, and fire safety provided by the relevant rules and instructions, comply with the requirements of the educational (scientific) program (individual curriculum (if available), observing academic integrity, and achieve the study results determined for the corresponding level of higher education, thirdly, administrative guardianship in the field of higher education is provided at the expense of the state budget, fourthly, administrative-legal relations regarding the provision of administrative guardianship in the field of higher education arise in the presence of administrative-legal norms , which prescribe them. Institutions of higher education under the supervision of the Ministry of Education and Science of Ukraine, as well as persons who are entrants or students of higher education and wish to receive administrative guardianship in the field of higher education, are the subjects of administrative-legal relations regarding administrative guardianship in the field of higher education. This article is dedicated to the study of the topic of administrative-legal relations for the provision of administrative guardianship in the field of higher education, subjects, objects and legal grounds for the emergence, change and termination of these relations.

Transitional pathways through middle school for First Nations students in the Northern Territory of Australia

The middle-school years (Year 7 to Year 9) is a particular challenge for socially disadvantaged populations, with high proportions of children either repeating school years or dropping out of school. In Australia, a group of particular concern is First Nations children for whom there is a collective effort by all governments to improve education outcomes, although there have been few studies of their transition through the middle-school years. This retrospective study, using individual-level linked data, followed a cohort of 7881 First Nations students for 2 years after enrolment in Year 7 (Y7) in any Northern Territory (NT) government school in the years from 2008 to 2014 to quantify the transitional pathways through middle school and identify the factors associated with faltering progress. We used multinomial multilevel logistic regression to identify the factors associated with school dropout and repeating Y7 or Y8 (Y7/8). Two years after Y7 enrolment, eight in ten First Nations students progressed to Y9 (78.8%), more than one in ten students had dropped out of school (13.3%) before reaching Y9, and one in 12 (7.9%) repeated Y7/8. The likelihood of either dropping out of school or repeating years was higher among students who were enrolled in Y7 when aged less than 11.5 years, had a low Y7 school attendance rate, moved to either interstate or non-government schools and who lived in a remote area. Students who were not born in the NT and those with a record of substantiated child maltreatment during Y7 were more likely to repeat Y7/8. Planning interventions to improve school retention through the middle-school years should consider these factors.

Endometriosis in the era of precision medicine and impact on sexual and reproductive health across the lifespan and in diverse populations.

Endometriosis is a common estrogen-dependent disorder wherein uterine lining tissue (endometrium) is found mainly in the pelvis where it causes inflammation, chronic pelvic pain, pain with intercourse and menses, and infertility. Recent evidence also supports a systemic inflammatory component that underlies associated co-morbidities, e.g., migraines and cardiovascular and autoimmune diseases. Genetics and environment contribute significantly to disease risk, and with the explosion of omics technologies, underlying mechanisms of symptoms are increasingly being elucidated, although novel and effective therapeutics for pain and infertility have lagged behind these advances. Moreover, there are stark disparities in diagnosis, access to care, and treatment among persons of color and transgender/nonbinary identity, socioeconomically disadvantaged populations, and adolescents, and a disturbing low awareness among health care providers, policymakers, and the lay public about endometriosis, which, if left undiagnosed and under-treated can lead to significant fibrosis, infertility, depression, and markedly diminished quality of life. This review summarizes endometriosis epidemiology, compelling evidence for its pathogenesis, mechanisms underlying its pathophysiology in the age of precision medicine, recent biomarker discovery, novel therapeutic approaches, and issues around reproductive justice for marginalized populations with this disorder spanning the past 100 years. As we enter the next revolution in health care and biomedical research, with rich molecular and clinical datasets, single-cell omics, and population-level data, endometriosis is well positioned to benefit from data-driven research leveraging computational and artificial intelligence approaches integrating data and predicting disease risk, diagnosis, response to medical and surgical therapies, and prognosis for recurrence.

Influence of parental anthropometry and gestational weight gain on intrauterine growth and neonatal outcomes: Findings from the MAI cohort study in rural India.

Poor foetal growth and subsequent low birth weight are associated with an increased risk for disease later in life. Identifying parental factors that determine foetal growth are important to curbing intergenerational malnutrition, especially among disadvantaged populations in the global south where undernutrition rates are high. The objective of this study was to assess the relationships between parental biometry, intrauterine growth and neonatal outcomes, while factoring in socioeconomic status of historically disadvantaged households in rural India. Using data from the prospective longitudinal cohort, pregnant women from rural Pune, India (n = 134) were assessed between August 2020 and November 2022. Data on socio-demography, ultrasound measurements, parental and foetal anthropometry were collected. Multiple linear regression models were run to predict determinants of foetal intrauterine and neonatal growth (p value<0.05). The dependent variables were ultrasound measurements and neonatal biometry, and independent variables were gestational weight gain, parental and mid-parental height. Mean(±SD) maternal age, maternal height, paternal height and mid-parental height were 22.8±3.7 years, 153.6±5.5cm, 165.9±6.5cm and 159.1±8.7cm, respectively. Pre-pregnancy body mass index and gestational weight gain was 20.5±4.0 kg/m2 and 9.8±3.7kg respectively. Mid-parental height and gestational weight gain were strongly correlated with neonatal growth and foetal intrauterine growth (p<0.05); however, the correlation peaked at 28 weeks of gestation (p<0.05). Gestational weight gain (B = 28.7, p = 0.001) and mid-parental height (B = 14.3, p = 0.001) were identified as strong determinants of foetal-intrauterine growth and neonatal anthropometry at birth. Maternal height was found to influence length of male neonate (B = 0.18, p = 0.001), whereas, paternal height influenced length of the female neonate (B = 0.11, p = 0.01). Parental socio-economic status, biometry and maternal gestational weight gain influence growth of the child starting from the intrauterine period. Our study underlines the need for interventions during pre-pregnancy, as well as during pregnancy, for optimal weight gain and improved foetal and neonatal outcomes.

Equity considerations in clinical practice guidelines for traumatic brain injury and homelessness: a systematic review

Clinical practice guidelines (CPGs) predominantly prioritise treatment and cost-effectiveness, which encourages a universal approach that may not address the circumstances of disadvantaged groups. We aimed to advance equity and quality of care for individuals experiencing homelessness and traumatic brain injury (TBI) by assessing the extent to which homelessness and TBI are integrated in CPGs for TBI and CPGs for homelessness, respectively, and the extent to which equity, including consideration of disadvantaged populations and the PROGRESS-Plus framework, is considered in these CPGs. For this systematic review, CPGs for TBI or homelessness were identified from electronic databases (MEDLINE, Embase, CINAHL, PsycINFO), targeted websites, Google Search, and reference lists of eligible CPGs on November 16, 2021 and March 16, 2023. The proportion of CPGs that integrated evidence regarding TBI and homelessness was identified and qualitative content analysis was conducted to understand how homelessness is integrated in CPGs for TBI and vice versa. Equity assessment tools were utilised to understand the extent to which equity was considered in these CPGs. This review is registered with PROSPERO (CRD42021287696). Fifty-eight CPGs for TBI and two CPGs for homelessness met inclusion criteria. Only three CPGs for TBI integrated evidence regarding homelessness by recognizing the prevalence of TBI in individuals experiencing homelessness and identifying housing as a consideration in the assessment and management of TBI. The two CPGs for homelessness acknowledged TBI as prevalent and recognised individuals experiencing TBI and homelessness as a disadvantaged population that should be prioritised in guideline development. Equity was rarely considered in the content and development of CPGs for TBI. Considerations for equity in CPGs for homelessness and TBI are lacking. To ensure that CPGs reflect and address the needs of individuals experiencing homelessness and TBI, we have identified several guideline development priorities. Namely, there is a need to integrate evidence regarding homelessness and TBI in CPGs for TBI and CPGs for homelessness, respectively and engage disadvantaged populations in all stages of guideline development. Further, this review highlights an urgent need to conduct research focused on and with disadvantaged populations. Canada Research Chairs Program (2019-00019) and the Ontario Ministry of Health and Long-Term Care (Grant #725A).