Poor Research Articles

All-cause and cause-specific mortality risks in individuals with diabetes living alone: A large-scale population-based cohort study

AimsThe rise in one-person households is a global trend. We aimed to investigate mortality risk in individuals with diabetes living alone (IDLA) using a large-scale population-based database. MethodsA total of 2,447,557 adults with type 2 diabetes were identified from the Korean National Health Information Database. One-person households were defined based on the number of registered family members. The risks of all-cause and cause-specific mortalities were estimated using a multivariable Cox proportional hazards regression model. ResultsDuring a median follow-up period of 6.0 years, 191,084 deaths (7.8 %) occurred. IDLA had a higher risk of mortality compared to those not living alone after adjusting for potential confounders (HR 1.20, 95 % CI: 1.18–1.22). This association was more prominent in younger individuals, men, and those with low income, and it was dependent on the duration of living alone. The risks of cause-specific mortality were all significantly higher in the IDLA group compared with the non-IDLA group. Adherence to favorable lifestyle behaviors was associated with a significant reduction in all-cause mortality, particularly in IDLA. ConclusionsThe elevated risk of mortality in IDLA highlights the need for tailored medical interventions and social assistance, particularly for those with unhealthy lifestyles or low income.

Trends in socioeconomic disparities in urban heat exposure and adaptation options in mid-size U.S. cities

There is ample evidence that Environmental Justice communities experience high levels of extreme heat. However, it is unknown how disparities in urban heat exposure and adaptation options change over time. This study investigates socioeconomic disparities over time in urban heat exposure and adaptation options in eight mid-sized Northeastern cities. We ask: How were socioeconomic factors associated with heat exposure and adaptation options over time? We analyzed disparities at the census block group level and census block level, respectively. At the census block group level, we ran spatial regression models between socioeconomic variables, including race, income, gender, and age, and heat exposure and adaptation variables, including land surface temperature, normalized different vegetation index (NDVI), tree cover, and air conditioning ownership rate. We found that: Low median household income is always associated with high LST and low NDVI from 1990 to 2020; Low percentage of females is always associated with high LST and low NDVI from 1990 to 2020. High percentage of POC is associated with high LST in 2010 and 2020, but not in 1990 and 2000; Low median household income and low percentage of elderly are associated with lower tree cover; High percentage of POC, low percentage of elderly, and low median household income are associated with lower AC rates. In analysis at the census block level by city, we found that disparities in urban heat exposure between predominantly POC and predominantly white communities increased in most cities during 1990-2020. Predominantly POC communities consistently have lower vegetation cover over time in most cities. Disparities in vegetation cover per unit area increased in most cities, whereas disparities in vegetation cover per capita decreased in most cities. Our findings of the trends in disparities in heat exposure and adaptation are useful for forecasting disparities in the future. These findings also suggest that interventions should prioritize cities with increasing disparities in heat exposure and adaptation.

Health Care Delivery Site- and Patient-Level Factors Associated With COVID-19 Primary Vaccine Series Completion in a National Network of Community Health Centers.

Objectives. To assess multilevel factors associated with variation in COVID-19 vaccination rates in a US network of community health centers. Methods. Using multilevel logistic regression with electronic health record data from ADVANCE (Accelerating Data Value Across a National Community Health Center Network; January 1, 2022-December 31, 2022), we assessed associations between health care delivery site-level (n = 1219) and patient-level (n = 1 864 007) characteristics and COVID-19 primary vaccine series uptake. Results. A total of 1 337 440 patients completed the COVID-19 primary vaccine series. Health care delivery site characteristics were significantly associated with lower series completion rates, including being located in non-Medicaid expansion states and isolated or rural communities and serving fewer patients. Patient characteristics associated with significantly lower likelihood of completing the vaccine series included being Black/African American or American Indian/Alaska Native (vs White), younger age, lower income, being uninsured or publicly insured (vs using private insurance), and having fewer visits. Conclusions. Both health care delivery site- and patient-level factors were significantly associated with lower COVID-19 vaccine uptake. Community health centers have been a critical resource for vaccination during the pandemic. (Am J Public Health. 2024;114(11):1242-1251. https://doi.org/10.2105/AJPH.2024.307773).

Neighborhood Disadvantage Predicts Delay in Care in Bilateral Breast Reduction.

The Area Deprivation Index (ADI) is a validated quantifiable measure of neighborhood disadvantage and social determinants of health (SDoH). Higher percentiles in ADI correlate with the most disadvantaged neighborhoods: lower income, lower education, and less access to transportation. Using ADI, we aimed to investigate the impact of SDoH on bilateral breast reduction (BBR) complication rates. A retrospective study of BBR patients from 2015 to 2021 was conducted. Patient addresses were matched to ADI percentiles and grouped into most (top 80% ADI) and least disadvantaged. Multivariable regressions were used to compare postoperative treatment between groups and adjust for confounders. In total, 568 patients were analyzed and 47% were high ADI. Time-to-event analysis revealed a 155% (β = 2.55; CI, 1.87-3.48; P < 0.001) increase in time to presentation for treatment of wound-related complications among higher-deprivation patients compared to their lower-deprivation counterparts. This difference in time to presentation equated to approximately 3 days overall when comparing higher to lower deprivation patients; however, this difference between the groups increased to 12 days when comparing those who experienced wound-related complications beyond day 30. High deprivation was associated with increased delays to treatment after complications. More research is needed to determine the factors that impact postoperative courses among high ADI patients.

The effect of sociodemographic characteristics and polypharmacy on loneliness and social isolation in community-dwelling older adults

The aim of this study was to assess the impact of sociodemographic factors and polypharmacy on loneliness and social isolation in older adults. This cross-sectional study included 370 older adults with and without polypharmacy. The data were gathered via the Personal Information Form, Loneliness Scale for Elderly, and Lubben Social Network Scale-Revised. A multivariate ANOVA (MANOVA) was conducted to assess the impact of independent variables on the combined dependent variables. Loneliness and social isolation were found higher in older adults with polypharmacy. In addition, loneliness and social isolation are more common in women, individuals with low educational attainment, single individuals, individuals with low income, individuals living in rural areas, individuals with poor family relationships, individuals not living with their families and individuals with chronic diseases. It is thought that the findings of this study will be guiding for all health professionals working in the field of elderly health in interventions to be planned for the elderly population.

Depression is associated with unintended pregnancy among fathers during the first 3 years after childbirth

BackgroundThe aim of the present study is to estimate the prevalence of unintended pregnancy in fathers with children aged less than or equal to 36 months and evaluate whether unintended pregnancy is associated with depression after controlling for covariates. MethodsWe used data from the Brazilian National Health Survey (PNS) of 2019, a cross-sectional study that comprised a representative sample of residents in private households in Brazil. For the analysis of this study, we selected 30,579 men (> 14 years old) who answered to the Selected Resident questionnaire of the PNS and reported having a biological child (son). Among these 4806 had a child with less than 4 years of age and were used in our analysis. ResultsThe prevalence of unintended pregnancy in this group of fathers with a child ≤ 3 years was 35.0 % (95 % CI 32.6–37.5). In the final adjusted model, the variables associated with depression were: PHQ-9 total score (OR: 1.07, 95 % CI 1.03–1.11, p ≤0.001), a higher father's age (OR 1.01, 95 % CI 1.01–1.02), a higher father's age at birth (OR: 0.92, 95 % CI 0.90–0.94), self-reported black (OR: 3.00, 95 % CI 1.94–4.66), brown (OR: 1.63, 95 % CI 1.25–2.13) or indigenous (OR: 0.22, 95 % CI 0.07–0.69) skin color, lower per capita family income >1 to 2 MW (OR: 1.54, 95 % CI 1.01–2.35), ½ to 1 MW (OR: 2.22, 95 % CI 1.46–3.38) and up to 1 MW (OR: 1.76, 95 % CI 1.19–2.59) and not participating in the partner's prenatal appointments (OR: 2.04, 95 % CI 1.55–2.68). DiscussionIn our study, the prevalence of unplanned pregnancy among fathers of child less than 4 years of age is high, and it is associated with depression. Black and brown self-reported skin color, lower family income and higher father's age are associated with increased risk of unintended pregnancy.

MSOR12 Presentation Time: 8:55 AM: Skin Brachytherapy, an Alternative Treatment for Non-Melanoma Skin Cancer: A Case Series from a Low Middle Income Country, Latin American Experience

MSOR12 Presentation Time: 8:55 AM: Skin Brachytherapy, an Alternative Treatment for Non-Melanoma Skin Cancer: A Case Series from a Low Middle Income Country, Latin American Experience

Increasing disparities in human exposure to perfluorooctanesulfonic acid: findings from per- and polyfluoroalkyl substance concentrations in 1999-2018 NHANES

The disparities in exposure to environmental hazards have fueled the environmental justice movement, which has garnered increasing attention and momentum over the past few decades. However, research addressing exposure disparities pertaining to chemicals remains notably limited. Here, leveraging data from the National Health and Nutrition Examination Survey spanning the period from 1999 to 2018, we unveiled that the perfluorooctanesulfonic acid (PFOS) exhibited the highest concentration in human biomonitoring in general U.S. population, with a mean value of 14.54 ± 19.59ng/ml. Subsequently, the mean concentrations of Perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), perfluorononanoic acid (PFNA), and perfluorodecanoic acid (PFDA) were 3.33 ± 3.19, 2.29 ± 3.13, 1.07 ± 1.30, and 0.34 ± 0.71, respectively. Meanwhile, although females or Non-hispanic White exhibited relatively higher levels for most per- and polyfluoroalkyl substances (PFASs) compared to other groups. The individuals with higher household incomes demonstrated elevated exposure to PFASs. Interestingly, despite lower exposure burdens were observed in Non-Hispanic Black individuals, females, and individuals with low family income, we identified relatively higher exposure disparities in these populations. In particular, exposure disparities for general U.S. population exposure to PFOS exhibited an approximate 50% increase from 1999 to 2018, despite a concurrent decline of 84% in biomonitoring levels. Meanwhile, the population aging has led to an exacerbation of human exposure to PFOS by 12.4%. Our findings underscore the necessity of ensuring equitable protection from PFAS exposure for all populations, although further investigation is required to understand the underlying mechanisms driving these disparities.

School Poverty Level Moderates the Effectiveness of a Physical Activity Intervention.

To explore whether school poverty level and funding modified the effectiveness of an evidence-based Comprehensive School Physical Activity Program called Health Empowers You! implemented in elementary schools in Georgia. Secondary data analysis of a multi-level, cluster-randomized controlled trial. 40 elementary schools in Georgia in 2018-2019. 4th grade students in Georgia. Intervention schools implemented the Health Empowers You! program to increase school-day physical activity. The outcome was average daily moderate-to-vigorous physical activity, school free-reduced price lunch (FRPL) percentage and per pupil expenditures were effect modifiers. Separate linear mixed regression models estimated the effect of the intervention on average daily moderate-to-vigorous physical activity, with interaction terms between intervention status and (1) school FRPL percentage or (2) per pupil expenditures. The effect of the intervention was significantly higher in schools with higher FRPL percentage (intervention*school % FRPL β (95% CI): .06 (.01, .12)), and was modestly, but not statistically significantly, higher in schools with lower per pupil expenditures. Findings support the use of the Health Empowers You! intervention, which was effective in lower income schools, and may potentially reduce disparities in students' physical activity levels.

Labor market impacts of eco-development initiatives in protected areas

Eco-development seeks to balance economic development with biodiversity conservation, enhancing the effectiveness of protected area management. This paper examines the labor market impacts of eco-development initiatives implemented in the protected areas of the Western Ghats, India, a significant biodiversity hotspot facing intense socio-economic pressures. Our findings show that eco-development has substantially altered labor market outcomes in villages within and surrounding protected areas, resulting in a higher share of non-farm employment. This shift is marked by a reduction in year-round work and an increase in seasonal employment. These effects appear to stem from the specific types of jobs created by eco-development and the changes in land use patterns it promotes, such as a higher proportion of forested land and increased reliance on rainfed agriculture over irrigated farming. Descriptive evidence also suggests that, despite improvements in literacy, the affected villages experience lower consumption levels and higher poverty rates.

The effect of education level and unemployment rate on poverty in Deli Serdang regency

Poverty is a complex problem that is multidimensional and affects many people around the world, including Indonesia. In Indonesia, poverty is still high, especially in underdeveloped rural and urban areas. Low education levels and high unemployment exacerbate poverty conditions as they affect access to decent work and adequate income. In Deli Serdang Regency, North Sumatra, despite having abundant natural resources, the poverty rate is still high. Expected solutions include improved access and quality of education, increased job opportunities, entrepreneurship promotion, access to better health and social services, and effective redistribution policies. This study aims to determine the influence of education, unemployment, HDI, and income on poverty in Deli Serdang Regency and to determine the influence of wages, consumption, and poverty on income simultaneously on income in Deli Serdang Regency. The approach used in this study is a quantitative approach sourced from secondary data in a time series, namely from 2013 to 2023. The data analysis model in this study uses a simultaneous equation model. The results of the simultaneity test showed that education had a positive and significant effect on poverty, while unemployment, HDI and income had a negative and insignificant effect on poverty. And poverty has a positive and significant effect on income, while consumption and wages have a negative and insignificant effect on income.

Suicidal transition rates and their predictors in the adult general population: a repeated survey over 21years in France.

The "suicidal transition" from ideation to an act has become a specific topic of research. However, rates in the general population, variations across time and risk factors are unclear. Data were collected from the phone survey Baromètre Santé among 18-75-year-olds in France. Seven independent samples interviewed between 2000 and 2021 (total N=133,827 people; 51.3% females) were questioned about suicidal ideation and attempts over the previous 12months. Transition was calculated as the weighted ratio of attempt on ideation 12-month rates. Mean 12-month rates of suicidal ideation, attempts and transition were 4.7% (95% Confidence Interval (CI) (4.6-4.8)), 0.5% (95% CI (0.4-0.5)) and 7.7% (95% CI (6.8-8.6)), respectively. Transition rates varied between 4.5 and 11.9% across surveys. In multivariable analyses, higher transitions rates were associated with a previous suicide attempt (adjusted Odds Ratio (aOR)=11.1 95% CI (7.9-15.6)); 18-25 vs 26-55-year-olds (1.8 95% CI (1.2-2.8)); lower vs higher income (1.7 95% CI (1.0-2.7); and lower vs higher professional categories (aOR around 1.9). No significant association was found with gender, education level, employment status, living alone, urbanicity, current major depression, daily smoking, weekly heavy drinking, cannabis use, and body mass index. Most people with suicidal ideation do not attempt suicide. These findings emphasize the need to avoid generic terms such as "suicidality", and to increase research on suicidal transition to improve prevention and prediction. They may also inform the organization of suicide prevention in the general population.

Longitudinal Association of Changes in Metabolic Syndrome with Cognitive Function: 12-Year Follow-up of the Guangzhou Biobank Cohort Study.

The association of changes in metabolic syndrome (MetS) with cognitive function remains unclear. We explored this association using prospective and Mendelian randomization (MR) studies. MetS components including high-density lipoprotein cholesterol (HDL-C), systolic blood pressure (SBP), waist circumference (WC), fasting plasma glucose (FPG), and triglycerides were measured at baseline and two follow-ups, constructing a MetS index. Immediate, delayed memory recall, and cognitive function along with its dimensions were assessed by immediate 10- word recall test (IWRT) and delayed 10-word recall test (DWRT), and mini-mental state examination (MMSE), respectively, at baseline and follow-ups. Linear mixed-effect model was used. Additionally, the genome-wide association study (GWAS) of MetS was conducted and one-sample MR was performed to assess the causality between MetS and cognitive function. Elevated MetS index was associated with decreasing annual change rates (decrease) in DWRT and MMSE scores, and with decreases in attention, calculation and recall dimensions. HDL-C was positively associated with an increase in DWRT scores, while SBP and FPG were negatively associated. HDL-C showed a positive association, whereas WC was negatively associated with increases in MMSE scores, including attention, calculation and recall dimensions. Interaction analysis indicated that the association of MetS index on cognitive decline was predominantly observed in low family income group. The GWAS of MetS identified some genetic variants. MR results showed a non-significant causality between MetS and decrease in DWRT, IWRT, nor MMSE scores. Our study indicated a significant association of MetS and its components with declines in memory and cognitive function, especially in delayed memory recall.

A Systematic Review of Digital Competence Evaluation in Higher Education

University students’ digital skills depend significantly on educators’ proficiency, necessitating regular assessments. Tools like DigComp and the TPACK model are provided in this technological context. A systematic review, following PRISMA criteria, aims to evaluate digital competencies through globally used tools. DigCompEdu is prominent, with Spain leading the research, while unvalidated instruments from Asia highlight global disparities. This review will identify key tools and expose geographical and validation gaps, stressing the need for standardized assessments. Understanding the predominance of DigCompEdu and seeing the variation that is generated in Asia highlights the poor ability to transmit self-perceived competencies to learners.

Low income, being without employment, and living alone: How they are associated with cognitive functioning - Results from the German National Cohort (NAKO)

Abstract Background While people with low socioeconomic status tend to have worse cognitive functioning, little is known about the impact of specific socioeconomic conditions. Aim of the present analysis was to investigate to what extent cognitive functioning differs by three socioeconomic conditions: low income, being without employment, and living alone. Methods A total of N = 158,144 participants (age 19-75 years) of the population-based German National Cohort (NAKO) provided data on socioeconomic conditions and completed cognitive testing. Multivariable regression model including the three socioeconomic conditions, age, sex, education, occupational status, having diabetes, hypertension, myocardial infarction, stroke, and depressive symptoms was used for analysis. Results Results from fully adjusted analysis indicated that cognitive functioning (z-score) was lower among those with low income (b=-0.53, CI95%=-0.57; -0.49) compared to not having low income, living alone (b=-0.10, CI95%=-0.14; -0.07) compared to not living alone, and being without employment (b=-0.22, CI95%=-0.27; -0.17) compared to being employed. The difference in cognitive functioning between those exposed compared to not exposed to the condition was changing slightly with older age among those with low income (interaction with age b=-2.39, CI95%=-3.24; -1.55) and, to a smaller extent, among those living alone (interaction with age b=-0.76, CI95%=-1.34; -0.19). Conclusions Low income, being without employment, and living alone were independently associated with poorer cognitive functioning after adjusting for confounders. As those with low income had the poorest cognitive functioning in old age, it is important to explore pathways of how cognitive health in this population group can be improved.

The long-term impact of parenthood on women and men’s income in 26 European countries

Abstract Background Historically, women’s roles were predominantly associated with motherhood, leading to significant career interruptions and lower incomes compared to men. As gender roles have evolved, as did labor policies protecting parents, it would be expected that income penalties in women and income premiums in men would attenuate, especially in the long term. This study aims to assess the association between the number of children and the income earned by women and men in older adulthood. Methods We used data from wave 8 of the Survey of Health, Ageing, and Retirement in Europe (SHARE), which includes 43,772 participants with 50 years old or over and their partners, living in 26 European countries. Multilevel analysis was employed to estimate the association between having children and the total, employment-related, and pensions-related incomes, adjusting for sociodemographic characteristics and clustering by country. Results The highest median annual total income was identified for individuals living in Bismarkian (€19,000) and Scandinavian countries (€17,708), more than twice the income earned in the European remaining countries. Having had children was associated with lower total income (OR = 0.870 for 1-2 children, OR = 0.773 for 3-5 children, OR = 0.666 for more than 5 children; p &amp;lt; 0.005), and women received lower total incomes (OR = 0.694; p &amp;lt; 0.001). These patterns were also found for employment- and pensions-related incomes. Conclusions There is a long-term negative effect of having had children, and of the number of children, on income, both employment and pension-related, but women continue to receive about 30% lower incomes than men. The adoption of comprehensive policies stimulating a more equal gender distribution of childrearing responsibilities, while protecting parenthood, along with recognizing caregiving responsibilities in pension calculations, could mitigate these disparities and promote gender equity and better living conditions at the older ages.

Accuracy of body weight perception: The Case of Türkiye

Abstract Background Accuracy of body weight perception is defined as the extent to which an individual’s self-assessment of their body weight aligns with their actual body weight. Our study evaluates the accuracy of body weight perception, an important factor in preventing and managing obesity and overweight, according to sociodemographic factors. Methods This study utilizes data from the nationwide cross-sectional ‘Nutrition and Health Survey 2017’. The survey includes 12,266 participants who were interviewed face-to-face. Factors influencing the accuracy of body weight perception were evaluated using the chi-square test. Subsequently, the logistic regression models were constructed to assess factors that were statistically significant (p &amp;lt; 0.05). Results The prevalence of obesity and overweight was found to be 36.3% and 71.5%, respectively. The accuracy of body weight perception was 39.2%, underestimation was 57.0%, and overestimation was 3.8%. There was no significant difference in accuracy of body weight perception between sexes (p = 0.94). According to logistic regression analysis (n = 12.168), accuracy of body weight perception was higher among individuals who were not overweight compared to those who were overweight (p &amp;lt; 0.001, OR: 4.56, CI: 4.16-4.98), among those aged 15-44 compared to those aged 45 and over (p &amp;lt; 0.001, OR: 1.47, CI: 1.35-1.60), among those with high school and higher education compared to those with middle school education or less (p &amp;lt; 0.001, OR: 1.43, CI: 1.31-1.56), among unmarried individuals compared to married ones (p = 0.011, OR: 1.12, CI: 1.03-1.23), and in individuals with poor income status compared to good (p = 0.005, OR: 1.13, CI: 1.04-1.22). Conclusions In health promotion programs aiming to perceive body weight accurately, priority should be given to people with overweight, those with low education levels, married individuals, people aged 45 and over, and individuals with low income. Key messages • Accuracy of body weight perception is important in fighting obesity. • Individuals with overweight, have a low level of education, are married, aged 45 and over, and have low income are misperceive their body weight to a greater extent.

Impacts of an interpretation fee on immigrants’ access to healthcare: A Danish survey study

Abstract Background In 2018, a fee for healthcare interpretation was introduced for immigrants living in Denmark for more than 3 years to incentivize learning Danish faster. The fee entails out-of-pocket costs ranging from 26-225 EUR per consultation, outpatient visit, or hospital admission. Little evidence is available on how immigrants experience impacts of the fee on their access to healthcare. The study aims to address this gap. Methods Using survey data collected among newly arrived immigrants (n = 486) at 26 cluster-randomly selected language schools in 2021, we analysed prevalence and socio-demographic background of immigrants reporting interpretation needs, and self-reports about whether the fee had caused immigrants to refrain from seeking healthcare, using ad hoc interpreters, and trying to learn Danish faster. Results In the study population, 19% (95% C.I. 14-26%, n = 95) reported interpretation needs. Refugees and their families (OR: 10.2, 95% C.I. 5.3-19.7) more often reported interpretation need compared with EU/EEA immigrants, as did immigrants with low education (OR: 1.9, C.I. 1.2-2.8), low income (OR: 2.6, C.I. 1.6-4.5) or poor self-perceived health (OR: 3.2, C.I. 1.1-9.2), adjusted for gender, age, region of residence, and length of stay. Among immigrants needing interpretation, 42% (C.I. 32-53%, n = 69) reported having refrained from seeking healthcare due to the fee, 73% (C.I. 55-86%, n = 119) using ad hoc interpreters, and 77% (C.I. 59-89%, n = 126) trying to learn Danish faster. Conclusions Findings suggest that the policy aim of incentivizing resettlement country language acquisition is partly met, but that the fee has unintended consequences in terms of hampered access to healthcare and increased use of ad hoc interpreters, raising concerns about unmet health needs and poorer quality of care, especially for vulnerable immigrants. Potential benefits of the policy should be carefully evaluated against severe negative impacts on immigrants’ access to healthcare. Key messages • Healthcare interpretation fees appear to be incentivizing acquisition of the resettlement language, but at the same time severely hamper access to care. • The fee appears to disproportionately affect vulnerable immigrants, including refugees and their families and immigrants with low education, low income, and poor health.

Prevalence and social determinants of anxiety and depression among adults in Ghana systematic review

Abstract Background Anxiety and depression are major public health concerns, yet their prevalence and social determinants contributing to mental health disparities remain underexplored. This review, to our knowledge, is the first of its kind, aiming to examine the prevalence of anxiety and depression symptoms and disorders among adults in Ghana, along with social determinants associated with their occurrence. Methods A search of nine electronic databases and seven grey literature sources was conducted up to September 25, 2023. Two reviewers independently screened and appraised the studies. Forty-six studies were included. Prevalence estimates were pooled using a random-effects model. Subgroup analysis and meta-regression explored potential moderators. A narrative synthesis explored social determinants associated with anxiety and depression. Results Preliminary results showed a high prevalence of anxiety (43.7%, 95% CI: 35.6-54.4%) and depression (37.8%, 95% CI; 32.5% to 46%), with regional variations. There were significant differences in the prevalence of anxiety and depression across chronic physical conditions and method of condition assessment. Meta-regression showed significant association between average age and anxiety prevalence. Social determinants associated with anxiety included being female, non-Christian, low income, self-employed, limited social support, and basic education, while that for depression included being young (&amp;lt; 25yr), low income, government employed, childhood physical and sexual abuse, gender-based violence and urban residence. Protective factors for both were male gender, strong social support and higher education. Conclusions Preliminary results indicate a high prevalence of anxiety and depression linked to social determinants. While methodological limitations exist (eg, study heterogeneity), findings highlight a need for evidence-based interventions targeting social determinants to reduce the burden of anxiety and depression among adults in Ghana. Key messages • Our review suggests addressing the social determinants of mental health, aligned with sustainable developmental goals, may reduce the burden of anxiety and depression. • While Ghana is working towards improving mental health via its revised 12year Mental Health Policy launched in 2021, this review can facilitate planning and resource allocation for mental healthcare.

POBREZA ESTRUTURAL-URBANA NO SÉCULO XXI

This article presents a theoretical reflection on interpretations of poverty, principally contemporary urban poverty, inspired by the works of Milton Santos. It is based on Geographical critical theory and other potential dialogues that contextualize and analyze poverty, understood here as the result of structural violence in territorial formation and Brazilian metropolises. It is concluded that poverty is structural-urban and can inform a qualitative debate (not only quantitative) on the lack of human dignity seeking to recognize the legitimacy of existence in places. Keywords: Violence, Urban Poverty, Metropolises, Socio-spatial Formation.