Ethnicity Status Research Articles

Association between perinatal and obstetric factors and early age at diagnosis of type 1 diabetes mellitus: a cohort study.

To evaluate the association between perinatal and obstetric factors as potential triggers for the early onset of T1DM. This was a retrospective cohort study enrolling 409 patients diagnosed with T1DM, in Bauru, São Paulo, Brazil, from 1981 to 2023. Data were retrieved from medical records, regarding sociodemographic parameters as age, sex, ethnicity, and socioeconomic status. Perinatal and obstetric factors as delivery type, gestational age, filiation order, length of exclusive breastfeeding, maternal age, maternal and fetal blood types, and occurrence of maternal gestational diabetes were also analyzed. An adapted survival analysis was employed to gauge the impact of each assessed variable at the age of T1DM diagnosis. The median age of T1DM diagnosis was 10.3 years with an interquartile range between 6.4 and 15.5 years. Delivery type and filiation order were the only factors statistically significantly associated with an early age at T1DM diagnosis. Patients who were born through cesarean section and who were firstborns showed a 28.6 and 18.0 % lower age at T1DM diagnosis, respectively, compared to those born through vaginal delivery and those that were nonfirstborns. Being born by cesarean section and being firstborn showed to be statistically significant factors to determine an early T1DM diagnosis.

Minority language use in teaching: ethnic minority teachers’ perspectives in Southwest China

ABSTRACT While previous research has emphasised the crucial role of multilingualism in supporting language minority students’ schooling experiences, little is known about the perspectives of teachers from minoritised backgrounds regarding their encounters with and responses to linguistic diversity in education. This article employs in-depth interviews to investigate ethnic minority teachers’ perceptions regarding minority language use in their multicultural and multilingual educational settings in southwest China. Thematic analysis was applied to identify the main themes across the narratives from 12 ethnic minority teacher participants. The findings show that teachers believed ethnic minority language use contributes to teaching ethnic minority students and interacting with ethnic minority parents. However, teachers held a deficit thinking of minority languages when it came to improving students’ Chinese proficiency and school success. Moreover, teachers believed their ethnic minority status does not necessarily play a role in teaching. Instead, sharing the same languages with ethnic minority students could benefit teaching, which is different from the prior studies concluding that sharing the same ethnic background as the students contributes to the reduction of ethnic disparities in education.

Impact of patient demographics on treatment outcomes in AML: a population-based registry in England, 2013-2020

AbstractWe report 1- and 5-year survival after acute myeloid leukemia (AML) diagnosis and early mortality within 30 days of systemic anticancer therapy (SACT) treatments, using national cancer registry data in England. Patients aged 18 to 99 years diagnosed between 2013 and 2020 were included. Overall survival (OS) was calculated using Kaplan-Meier methodology, and adjusted hazard ratios (aHRs; adjusted for intensity of treatment, age at diagnosis, sex, ethnicity, socioeconomic deprivation, comorbidity, and year of diagnosis) using Cox proportional hazards regression. Odds of 30-day mortality (adjusted odds ratios [aORs], adjusted for aforementioned characteristics), along with performance status and body mass index, were calculated using logistic regression. Among 17 107 patients identified, older age and comorbidity were associated with worse survival. Asian and Black patients had better survival than White patients: 5-year OS of 34.6%, 29.7%, and 17.8%, respectively; aHR of 0.86; (95% confidence interval [CI], 0.77-0.96) Asian vs White, and 0.84 (95% CI, 0.73-0.96) Black vs White. Socioeconomic deprivation was associated with worse survival. Overall, 7906 (46.2%) patients were documented as having received SACT. Thirty-day mortality was lower for patients receiving intensive rather than nonintensive SACT. After adjustment for cofactors, the risk was higher in those treated intensively (aOR, 0.74; 95% CI, 0.60-0.92). We show that ethnicity and socioeconomic status affects outcomes in AML. Further work is needed to understand how these effects may differ in different health care settings, and whether this because of effects on disease biology, responsiveness to treatment, or drug toxicity. Selection of intensive vs nonintensive treatment should be based on individual patient factors, balancing improved long-term survival against higher early mortality.

Heat or Eat: Exploring the Impact of the Cost-Of-Living Crisis on Single parents’ Mental Wellbeing in the United Kingdom

ABSTRACT The cost-of-living crisis in the United Kingdom has profoundly affected the mental wellbeing of single parents, compounding economic and psychosocial challenges. This study, through semi-structured online interviews with four female single parents, used thematic analysis to explore how financial burdens, mood fluctuations, sacrifices for children’s needs, and intensified social isolation impacted their mental health. The application of Social Identity Theory demonstrates the exacerbating effects of societal stigmas. The results highlight the need for targeted policies and interventions to alleviate these strains and recommend further research into the intersectionality of gender, ethnicity, and socioeconomic status among single parents.

Experience of living with psoriasis in Brazil: a Global Psoriasis Atlas online survey.

Psoriasis significantly burdens patients' lives, but there is limited data on this in Brazil. Between May 2022 and January 2023, we conducted a cross-sectional online survey of 563 Brazilian residents aged ≥18 years who had been diagnosed with psoriasis. Spearman's correlation (r) was used to test the correlation between self-assessed disease severity (Simplified Psoriasis Index [saSPI] extent score; range 0 [clear/minor] to 40 [widespread/severe]) and health-related quality of life (QoL, score of 1 means perfect health) and capability (ICECAP-A: score of 1 means full capability) measures. Multivariable linear regression was used to identify predictors of QoL and capability. A thematic analysis examined the free-text responses and identified common themes. The mean age of participants was 42.1 ± 12.4 years, and over half had at least one other long-term condition. The mean QoL score was 0.59 ± 0.25, and the mean capability score was 0.71 ± 0.21. At the time of survey completion, over 80% of respondents reported some level of pain and/or discomfort, and 86% reported feeling anxious and/or depressed. The mean self-assessed saSPI was 7.8 ± 8.6, which negatively correlated with health-related QoL (r = -0.49, P < 0.05) and capability (r = -0.44, P < 0.05). Significant predictors of poorer QoL and reduced capability included high saSPI, number of psoriasis flares and comorbidities, female gender, Black ethnicity, and employment status (unemployed, long-term sick). Frequently reported areas that impacted patients were social stigma/prejudice, powerlessness, lack of education and public awareness, and difficulty obtaining appropriate care/treatment. We found that the clinical manifestations, severity, and associated comorbidities of psoriasis negatively impacted health-related QoL and capability, along with feelings of stigmatization and barriers to specialist treatment. This highlights the need for better access to care and awareness of the disease to improve the lives of people living with psoriasis in Brazil.

Exploring the impact of social identity and team dynamics on mental health help-seeking behavior among collegiate athletes: a qualitative study

This study explores the influence of social identity and team dynamics on the mental health help-seeking behaviors of collegiate athletes. The research aims to understand how factors such as gender, ethnicity, and social status shape athletes' attitudes and actions regarding mental health assistance. Method: Using a mixed-method approach that included focus group discussions (FGDs) and in-depth interviews, data were collected from 30 athletes representing various sports disciplines, ensuring balanced representation in terms of gender, ethnicity, and social status.Result: Thematic analysis revealed significant themes: male athletes faced substantial stigma in seeking mental health assistance, viewing it as a sign of weakness, while female athletes were more open and supported by a culture of emotional expression. Minority athletes encountered additional barriers due to cultural stigma and a lack of culturally competent services, whereas majority athletes had better access to mental health resources. High-status athletes experienced pressure to maintain their image, leading to reluctance in seeking help, while low-status athletes faced challenges in accessing resources despite their willingness to seek help. Positive team dynamics, characterized by support and open communication, facilitated help-seeking behavior, while negative dynamics, such as bullying and lack of trust, created barriers. Conclusion: The study highlights the need for targeted interventions that address specific needs based on gender, ethnicity, and social status, promote mental health literacy, and foster supportive team environments. Future research should focus on the long-term effects of stigma-reduction interventions, culturally tailored mental health services, and the impact of team dynamics over time. These findings provide valuable insights for developing effective mental health support systems for collegiate athletes. Keywords: Cultural Competency, Ethnicity, Health Literacy, Social Identification, Athletes, Bullying

Bilateral Oophorectomy Prevalence Among U.S. Women.

Background: Bilateral oophorectomy has been linked to numerous health outcomes, some of which can have a long latency period. Limited data are available on bilateral oophorectomy prevalence among U.S. women. Methods: The National Health Interview Survey fielded measures of bilateral oophorectomy most recently in 2010 and 2015. We pooled these 2 data years to present bilateral oophorectomy prevalence estimates by age-group, race, ethnicity, geographic region, and hysterectomy status. Results: Our study found bilateral oophorectomy was common among older women. Among women aged 70-79 years, 29% reported a bilateral oophorectomy, compared with <1% for women aged 20-29 years. By geographic region, bilateral oophorectomy prevalence among women 20-84 years was 12.3% in the South, 10.8% in the Midwest, 9.4% in the West, and 8.0% in the Northeast. Small numbers limited our ability to generate age-specific estimates for American Indian and Alaska Native women and subgroups of Asian and Hispanic women. Nearly half of women who had a bilateral oophorectomy reported their procedure occurred more than 20 years ago. Among women aged 20-84 years who reported a hysterectomy, 57% reported they also had both of their ovaries removed. Conclusion: Standard measures of incidence rates for ovarian cancer are not adjusted for oophorectomy status. These findings suggest that ovarian cancer incidence rates may be underestimated among older women. Continued monitoring of bilateral oophorectomy prevalence will be needed to track its potential impact on ovarian cancer incidence and numerous other chronic health outcomes.

Cognitive and Psychological Mediators of the Social Gradient in Tobacco Use Initiation Among Adolescents: Evidence from the ABCD Study.

Tobacco use among adolescents is a significant public health concern, with early initiation leading to long-term health risks. Understanding the factors that contribute to the initiation of tobacco use is crucial for developing effective prevention strategies. This study investigates the roles of substance use harm knowledge and tobacco susceptibility in mediating the relationship between social gradients (race, ethnicity, and socioeconomic status) and tobacco use initiation among adolescents. Data from the Adolescent Brain Cognitive Development (ABCD) study, comprising a racially, ethnically, and economically diverse sample of tobacco-naive adolescents aged 9 to 16, were analyzed. Structural equation modeling (SEM) was used to test whether substance use harm knowledge and tobacco susceptibility mediate the effects of socioeconomic status (SES) on the initiation of tobacco use. Findings indicated that both substance use harm knowledge and tobacco susceptibility partially mediate the relationship between SES and tobacco use initiation. Adolescents from lower SES backgrounds exhibited lower levels of harm knowledge and higher levels of tobacco susceptibility, which increased their likelihood of initiating tobacco use. This study highlights the complex interplay between social determinants and individual cognitive and psychological factors in influencing tobacco use initiation among adolescents. Public health interventions that enhance harm knowledge and reduce susceptibility to tobacco use are crucial for preventing initiation, particularly among racially, ethnically, and economically diverse adolescents. These efforts can help reduce health disparities and promote health equity.

Implementation of an Approach to Equitable Allocation of SARS-CoV-2 Monoclonal Antibodies for Preexposure Prophylaxis: Experience From a Single Medical Center.

During the COVID-19 pandemic, SARS-CoV-2 monoclonal antibodies for preexposure prophylaxis (SMA-PrEP) offered patients who were immunocompromised another option for protection. However, SMA-PrEP posed administrative, operational, and ethical challenges for health care facilities, resulting in few patients receiving them. Although the first SMA-PrEP medication, tixagevimab and cilgavimab, had its authorization revoked due to compromised in vitro efficacy, new SMA-PrEP medications are currently completing clinical trials. This article provides an operational framework for administrative organization, patient identification and prioritization, equitable medication allocation, medication ordering and administration, and patient tracking. A retrospective cohort study evaluating our hospital's SMA-PrEP administration strategy was performed. Multivariable logistic regression was used to examine factors associated with receipt of SMA-PrEP. Despite the barriers in administering this medication and the scarcity of resources, our hospital was able to administer at least 1 dose of SMA-PrEP to 1359 of 5902 (23.0%) eligible patients. Even with the steps taken to promote equitable allocation, multivariable logistic regression demonstrated that there were still differences by race, ethnicity, and socioeconomic status. As compared with patients who identified as Black, patients who identified as White (odds ratio [OR], 1.85; 95% CI, 1.46-2.33), Asian (OR, 1.59; 95% CI, 1.03-2.46), and Hispanic (OR, 1.53; 95% CI, 1.02-2.44) were more likely to receive SMA-PrEP. When compared with patients with low socioeconomic status, patients with high socioeconomic status (OR, 1.37; 95% CI, 1.05-1.78) were more likely to be allocated SMA-PrEP. Despite efforts to mitigate health care disparities, differences by race/ethnicity and socioeconomic status still arose in patients receiving SMA-PrEP.

Islet Isolation Outcomes in Patients Undergoing Total Pancreatectomy With Islet Autotransplantation in the POST Consortium.

In total pancreatectomy with islet autotransplantation (TPIAT), a greater number of islets transplanted produces more favorable outcomes. We aimed to determine predictors of islet isolation outcomes. We investigated factors associated with islet isolation outcomes expressed as islet number (IN), islet equivalents (IEQ; standardized to an islet with 150 μm diameter), IN/kg, or IEQ/kg using data from the multicenter Prospective Observational Study of TPIAT. Single-predictor linear regression was used to estimate the association of individual patient and disease characteristics with islet isolation outcomes, and augmented backward elimination was used to select variables to include in multivariable analyses. In multivariable analyses, only elevated hemoglobin A1c was associated with worse outcomes for all measures (P < 0.001 for all). Total IEQ obtained for transplant was higher for participants with Hispanic ethnicity (P = 0.002) or overweight status pre-TPIAT (P < 0.001) and lower with non-White race (P = 0.03), genetic pancreatitis (P = 0.02), history of lateral pancreaticojejunostomy (P = 0.03), and presence of atrophy (P = 0.006) or ductal changes (P = 0.014) on imaging. IEQ/kg was higher in females (P = 0.01) and Hispanic participants (P = 0.046) and generally lower with older age (nonlinear association, P < 0.001) and pancreatic atrophy (P < 0.001) on imaging. Total IN and IN/kg showed trends similar, but not identical, to IEQ and IEQ/kg, respectively. Patient demographics and certain pancreatic disease features were associated with outcomes from islet isolation. Hemoglobin A1c before TPIAT was the metabolic testing measure most strongly associated with islet isolation results.

Emergent inequity of glycaemic metrics for Māori children with type 1 diabetes is negated by early use of continuous glucose monitoring.

We investigated if continuous glucose monitoring (CGM) in children with type 1 diabetes (T1D) within 12 months of being diagnosed modifies the development of glycaemic outcome inequity on the basis of either ethnicity or socio-economic status (SES). De-identified clinical and SES data from the KIWIDIAB data network were collected 12 months after diagnosis in children under 15 years diagnosed with T1D between 1 October 2020 and 1 October 2021. There were 206 children with new onset T1D: CGM use was 56.7% for Māori and 77.2% for Europeans. Mean (SD) HbA1c was 62.4 (14.2) mmol/mol at 12 months post diagnosis, but Māori were 9.4mmol/mol higher compared to Europeans (p<0.001). For those without CGM, Māori had an HbA1c 10.8 (95% CI 2.3 to 19.4, p=0.013) mmol/mol higher than Europeans, whereas there was no evidence of a difference between Māori and Europeans using CGM (62.1 [9.3] mmol/mol vs 58.5 [12.4] mmol/mol p=0.53 respectively). Comparing quintiles of SES, HbA1c was 10.8 (95% CI 4.7 to 16.9, p<0.001) mmol/mol higher in the lowest quintile of SES compared to the highest. These observational data suggest CGM use ameliorates the ethnic disparity in HbA1c at 12 months in new onset T1D.

The effects of alcohol on recovery from musculoskeletal trauma and injuries

Introduction: This study aimed to investigate the association between alcohol misuse (abuse and dependence) and clinical outcomes including infection, length of stay (LOS), and in-hospital mortality (IHM) among patients with musculoskeletal injuries. Methods: A retrospective analysis was conducted using California Hospital Discharge Data for 2018. The study included patients aged 18 years or older with musculoskeletal injuries categorized by injury sites (head/neck, trunk, and extremities) and alcohol misuse (abuse or dependence). Multivariate logistic regression analysis was used to assess the independent association of alcohol misuse with the outcome variables, controlling for age, gender, ethnicity, and insurance status. Results: Among 3.7 million discharges, 207623 (40.2%) had alcohol abuse, and 58.8% had alcohol dependence. The findings revealed that among musculoskeletal injury discharges, those with alcohol abuse, compared to alcohol dependence, had higher odds of infection (OR=1.25; CI=1.07-1.45). However, they had lower odds of LOS of≥4 days (OR=0.78; CI=0.77-0.79), and lower odds of IHM (OR=0.91; CI=0.86-0.96). Extremity injuries were associated with higher odds of infection, longer hospital stays, and lower IHM compared to head/neck and trunk injuries. Males compared to females and patients aged 67 or older compared to their 18-34 age group encounters were more likely to experience infection, LOS of≥4 days, and IHM. Hispanic and Asian patients experienced less infection and fewer days in the hospital but presented with higher odds of IHM. Conclusion: Our results reveal the burden of alcohol misuse in treatment outcomes among patients undergoing hospitalization for treatment of musculoskeletal injuries as they related to infection, length of hospital stay, and IHM. These findings also highlight the potential economic implications of alcohol-related musculoskeletal injuries. Our findings emphasize the necessity for an approach that goes beyond treating immediate physical injury, but considering a patient’s history of alcohol abuse and providing appropriate support and interventions to improve treatment outcomes for individuals affected by musculoskeletal injuries and alcohol misuse.

Mental health in secondary school-aged children with epilepsy and their primary caregivers: A case control study

PurposeTo describe the prevalence and associated factors of mental health problems in secondary school-aged (11–16 years) children with epilepsy and their primary caregivers compared to a control group without epilepsy. MethodsChildren with epilepsy (n = 60), controls (n = 49), and caregivers (n = 60 epilepsy and n = 49 control group) completed a measure of the child's mental health (Strengths and Difficulties Questionnaire; SDQ). Primary caregivers in both groups completed a measure of their own mental health (Depression, Anxiety, and Stress Scale-21; DASS-21). Factors associated with child and caregiver mental health in the epilepsy group were explored using linear regression. ResultsThere were no significant differences between the epilepsy and control group regarding age, gender, ethnicity and socioeconomic status. A higher proportion of children with epilepsy scored in the at-risk range on the SDQ indicating more mental health problems than the control group, as reported by the children (45% vs. 24 %) (p = 0.026) and caregivers (52% vs. 14 %) (p < 0.001). Primary caregivers of children with epilepsy had more symptoms of depression (p = 0.001), anxiety (p = 0.028) and stress (p = 0.019) than caregivers in the control group. Children with epilepsy with greater motor coordination problems had greater mental health difficulties. Children with epilepsy with more mental health difficulties had caregivers with more difficulties and caregivers of children with earlier onset of seizures had more mental health difficulties. ConclusionsEpilepsy confers a high risk for mental health problems in adolescents and their primary caregivers. There is a need to better understand the relationship between caregiver and child mental health difficulties in epilepsy.

Experiences of Self-Sampling and Future Screening Preferences in Non-Attenders Who Returned an HPV Vaginal Self-Sample in the YouScreen Study: Findings From a Cross-Sectional Questionnaire.

We assessed experiences of human papillomavirus (HPV) vaginal self-sampling and future screening preferences in an ethnically and socio-economically diverse group of women overdue for cervical screening. A postal questionnaire was embedded in the YouScreen self-sampling trial in England: 32.5% (2712/8338) of kit completers returned the survey. Kit non-completers were encouraged to return a questionnaire, but no responses were received. Participants were ethnically diverse (40.3% came from ethnic minority backgrounds), and 59.1% came from the two most deprived quintiles. Differences in confidence in kit completion, trust in the test results and intention to attend a follow-up test if HPV-positive were evaluated using Pearson's χ2 analyses. Binary logistic regression models explored predictors of a future screening choice and preferences for urine versus vaginal self-sampling. Most kit-completers reported high confidence in self-sampling (82.6%) and high trust in the results (79.9%), but experiences varied by ethnicity and screening status. Most free-text comments were positive but some reported difficulties using the device, pain or discomfort. Most women would opt for self-sampling in the future (71.3% vs. 10.4% for a clinician-taken test) and it was more often preferred by ethnic minority groups, overdue screeners and never attenders. Urine self-tests were preferred to vaginal tests (41.9% vs. 15.4%), especially among women from Asian, Black or Other Ethnic backgrounds. Kit-completers were confident, found the test easy to complete, and trusted the self-sample results. However, experiences varied by ethnic group and some women highlighted difficulties with the kit. Most women would prefer self-sampling in the future, but it was not a universal preference, so offering a choice will be important. We did not have direct patient and public involvement and engagement (PPIE) in the questionnaire design. However, patients and public representatives did input into the design of the YouScreen trial and reviewed the wider study materials (e.g. participant information sheet). This questionnaire study was embedded in the YouScreen trial. The protocol for the YouScreen trial is available at https://www.isrctn.com/ISRCTN12759467. The National Institute for Health Research 43 Clinical Research Network (NIHR CRN) Central Portfolio Management System (CPMS) ID is 4441934.

PP01.63 A comparative analysis of plasma genotyping practices in non-small cell lung cancer by race, ethnicity, and smoking status

PP01.63 A comparative analysis of plasma genotyping practices in non-small cell lung cancer by race, ethnicity, and smoking status

The Impact of Sociodemographic Factors on Rates of Tympanostomy Tube Placement for Pediatric Otitis Media.

To identify the impact of race, ethnicity, and socioeconomic status (SES) on the rate of tympanostomy tube placement. Retrospective medical review and population-level analyses. Tertiary referral center. Demographic and population-level characteristics (age, gender, race, insurance status, and ZIP code) compared to the regional, health system, and otolaryngology clinic demographics. Among 38,461 children diagnosed with otitis media (OM) 61.4% were white, 27.4% were black, 32.7% had private insurance, and 18.2% were Hispanic. Among patients seen in the pediatric ear, nose, and throat (ENT) clinics, 70.0% were white, 20.0% were black, 46.6% had private insurance, and 14.9% were Hispanic. Further disparity was noted among those receiving tympanostomy tubes: 75.6% white, 15.6% black, 61.9% private insurance, and 11.7% Hispanic. Higher rates of tube placement were noted for those of white race [odds ratio, OR: 1.96, (95% confidence interval, CI: 1.85-2.04), <.001] and non-Hispanic ethnicity [OR: 1.67, (95% CI: 1.56-1.75), <.001]. Geographically, rates of tube placement were significantly lower in areas with higher deprivation indices, areas with lower proportions of white residents, and areas with the lowest median incomes. These markers correlate strongly with black race and Hispanic ethnicity. Lower rates of tube placement were also seen in majority white locales with higher deprivation indices and lower median incomes. Rates of access to pediatric ENT clinics, and of tube placement, are significantly lower for those of Hispanic ethnicity and black race than for non-Hispanic white children. Higher rates of tube placement were noted among white children and those with private insurance. Lower rates of tube placement were seen in areas of lower SES regardless of racial demographics.

A Machine Learning Exploration of Social Determinants of Health and Hospital-Onset Bacteremia, Northern California, 2019–2023

Introduction: Social determinants of health can impact healthcare-associated infections. Hospital-onset bacteremia (HOB) may lead to poor outcomes, increased length of stay, and increased cost of care. We explored the association of social determinants of health and HOB. Methods: We retrieved blood culture data at Stanford Health Care from May 2019 to October 2023. We identified blood cultures ordered ≥4 days of admission. To evaluate the association between social determinants of health and HOB, we employed an unsupervised machine learning approach (K-Means clustering) to discern patterns in HOB rates based on the Social Vulnerability Index (SVI). The SVI indicates the relative vulnerability of every U.S. Census tract. It ranks the tracts on 16 measures of vulnerability across 4 themes: socioeconomic factors, household characteristics, racial and ethnic minority status, and housing/transportation aspects. The number of clusters was determined using the Elbow Method (Figure 1). Results: Out of 209,947 blood cultures from 23,938 unique patients with a California address, we identified 81,653 blood cultures collected after 4 days (40%). The K-Means clustering algorithm identified 3 distinct clusters within the Californian census tracts, suggesting heterogeneity in the relationship between SVI and HOB (Figure 2). Cluster 1 had a higher SVI (median 0.73, range 0.46 – 0.99), with logistic regression indicating a positive SVI-HOB association (OR 4.84, 95% CI 4.02 – 4.81, p &lt;.001). Cluster 2, had a median SVI of 0.29 (range 0.0009 – 0.78), also showed a positive association between SVI and HOB (OR 1.67, 95% CI 1.4 – 1.89, p &lt;.001), aligning with trends of higher infection risks in more vulnerable groups. In contrast, Cluster 3 had a median SVI of 0.22 (range 0.002 –0.84). In this cluster, the SVI showed a negative association with HOB (OR 0.24, 95% CI 0.18 – 0.31, p &lt;.001). Cluster 3 was the cluster with the least number of subjects (15,000, versus 21,761 for Cluster 1 and 29,762 for Cluster 2). Most subjects in Cluster 3 resided in Santa Clara County, whereas those in Clusters 1 and 2 were spread across Santa Clara, San Mateo, Alameda, Merced, and Sacramento Counties (Figure 3). Conclusions: Advanced techniques can be used to explore the complex interplay between social determinants of health and healthcare-associated infections and could guide the development of community-specific strategies to improve outcomes.

Understanding the preferences of young adults with type 2 diabetes mellitus with regard to diabetes self-management education: a qualitative study

AimYoung-onset type 2 diabetes (YOD) is associated with poorer clinical outcomes. To support the development of more effective diabetes self-management education (DSME) programmes, this study aimed to understand the preferences...

International Human Rights Law: Enforcement Mechanisms and Challenges in a Globalized World

The abstract provides an overview of international human rights law, examining its enforcement mechanisms and the challenges it faces in an increasingly interconnected and globalized world. the evolution of human rights law, the role of international organizations, and the complexities of ensuring compliance and accountability in diverse cultural, political, and legal contexts. International human rights law serves as a cornerstone of the global legal framework, promoting fundamental rights and freedoms for all individuals regardless of nationality, ethnicity, religion, or social status. The abstract delves into the origins of human rights law, tracing its development from the Universal Declaration of Human Rights to various international treaties, conventions, and customary norms.

Dementia diagnosis rates and the impact of ethnicity, rurality and deprivation

Objectives NHS England publishes monthly national and regional estimated dementia diagnosis rates (DDR) to assess the healthcare system’s effectiveness in identifying dementia cases. Previous research indicates that sociodemographic factors, such as ethnic minority status, socioeconomic deprivation, and rurality, influence both healthcare quality and dementia risk. This study aimed to examine the association between these sociodemographic factors and DDR, and to estimate an ethnicity-adjusted DDR using available ethnic group data. Method We analysed NHS Digital Primary Care Dementia Data electronic health records for July 2023. We used a linear regression model to determine the association between DDR and ethnicity, deprivation, and rurality factors using local authority region level data. We also adjusted the DDR at the level of sub-integrated care boards based on previously published odds ratios of dementia diagnosis by ethnic group. Results Regression modelling revealed that areas with higher proportions of minority ethnic groups and greater rurality had lower DDRs. Conversely, higher levels of deprivation were linked to higher DDRs. After adjusting for different odds ratios for dementia in minority ethnic groups, the national DDR decreased by 1%, with regional diagnosis rates dropping by up to 5.4%. Conclusion Higher regional proportional ethnic minority population and greater rurality were associated with a lower DDR which might reflect poorer access to diagnostic services. Higher deprivation levels were associated with a higher DDR which might reflect higher rates of dementia in more deprived populations. We discuss measures to improve the accuracy and utility of the DDR, with a specific focus on ethnicity.