Health Care Survey Research Articles

Dual assurance for healthcare and future education development: normalized assistance for low-income population in rural areas-evidence from the population identification.

This study aims to explore the relationship between healthcare and future education among the rural low-income population, using J City in Guangdong Province as the focal area. Addressing both healthcare and educational concerns, this research seeks to provide insights that can guide policy and support for this demographic. Utilizing big data analysis and deep learning algorithms, a targeted intelligent identification classification model was developed to accurately detect and classify rural low-income individuals. Additionally, a questionnaire survey methodology was employed to separately investigate healthcare and future education dimensions among the identified population. The proposed model achieved a population identification accuracy of 91.93%, surpassing other baseline neural network algorithms by at least 2.65%. Survey results indicated low satisfaction levels in healthcare areas, including medical resource distribution, medication costs, and access to basic medical facilities, with satisfaction rates below 50%. Regarding future education, issues such as tuition burdens, educational opportunity disparities, and accessibility challenges highlighted the concerns of rural low-income families. The high accuracy of the model demonstrates its potential for precise identification and classification of low-income populations. Insights derived from healthcare and education surveys reveal systemic issues affecting satisfaction and accessibility. This research thus provides a valuable foundation for future studies and policy development targeting rural low-income populations in healthcare and education.

Health-related quality of life and survival of older adults in Campinas, São Paulo, Brazil: A retrospective analysis from 2008 to 2018

As the average life expectancy continues to rise, the prevalence of multimorbidity is also expected to increase, potentially leading to outcomes such as functional decline, a higher risk of premature death, and adverse effects on overall health and well-being. This study aimed to estimate the survival rates of older adults with varying levels of health-related quality of life (HRQoL) and to assess the association between the domains and components of the 36-item Short Form Health Survey and all-cause mortality over a 10-year period in Brazil. We conducted a retrospective longitudinal study using baseline data from 1,520 elders (aged 60 years and older) who participated in the Health Care Survey of the Municipality of Campinas, São Paulo, Brazil (ISACamp 2008/2009). A linkage was established between the ISACamp databases and the Mortality Information System. An active search was performed for individuals whose data could not be paired to confirm the death status. Survival functions were calculated using the Kaplan–Meier method, while hazard ratios (with 95% confidence intervals) were determined using Cox regression analysis. All HRQoL domains showed proportional hazards and statistically significant differences (p < 0.05) between survival curves, except for the bodily pain domain. In the multivariate analysis, lower scores in physical functioning and role-physical were associated with a 74% and 42% increased risk of death, respectively. In addition, impairments in role-emotional, mental health, and general health heightened the risk of mortality by approximately 36%. Notably, the lowest score in the physical component emerged as a significant predictor of mortality, increasing the probability of death by 47%, while the mental component showed no significant association. Our findings provide compelling evidence of the predictive capacity of HRQoL in evaluating mortality risk among older people in low- and middle-income countries.

Malnutrition: A Longstanding Challenge in India

Abstract: According to the World Health Organization, “malnutrition is the “deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients”. Indian population has the highest rate of adolescent malnutrition. Deficiency, Illness, Small level of education, and a range of other factors contribute to India's malnutrition crisis. Undernutrition, micronutrient deficiency conditions, and overnutrition are all forms of malnutrition. A malnourished always lags in every aspect of life which will eventually affect the productivity of the country. In the 2023 Global Hunger Index, India is positioned at 111th among 125 countries, reflecting a serious level of hunger with a score of 28.7. India is grappling with a substantial population affected by anemia, malnutrition, and obesity. Other than this Indian population is also affected by several other micronutrient deficiencies. The present article provides an overview of the triple burden of malnutrition in India by applying the literature review method and the data were collected from online sources such as government survey reports, articles, and publications related to nutrition, healthcare status, healthcare indicators, nutritional indicators, and healthcare survey reports, etc. A brief introduction of the strategies followed by the Government as well as global health organisations to combat the issue is also discussed.

Associations between job demand-control-support and high burnout risk among physicians in Sweden: a cross-sectional study

BackgroundThe knowledge about job demands, control, and support, and their potential associations with burnout risk among physicians in Sweden, is limited. This study aimed to explore (i) factors of the JobDemand-Control-Support (J-DCS) model across different groups of physicians in Sweden, (ii) their association with high burnout risk, and (iii) the potential buffering impact of job control and support.MethodsCross-sectional data from the Swedish Longitudinal Occupational Health in Healthcare Survey (LOHHCS) study cohort was used. In 2021, a total of 2032 respondents submitted questionnaire data comprising J-DCS measures (i.e., job demands, workplace control and task-level control, and social support from peers and managers). Burnout risk was measured using the Burnout Assessment Tool. Binary logistic regression models were used to investigate the associations between the J-DCS variables and high burnout risk. Interaction analysis was performed to explore any moderation of the associations.ResultsJob demands were significantly associated with increased odds of high burnout risk (odds ratio (OR) 2.71, 95% confidence interval (CI) 1.91–3.84. Workplace control (OR 0.50, 95% CI 0.35–0.71) and peer support (OR 0.61, 95% CI 0.48–0.77) were significantly associated with reduced odds of high burnout risk. The interaction analysis showed no significant moderation of the association between job demands and high burnout risk by either peer support or workplace control, and no buffering impact was found.ConclusionJob demands were associated with high burnout risk among physicians in Sweden. Although workplace control and peer support had inverse associations with high burnout risk, no moderation or buffering impact on the association between job demands and high burnout risk was found. Longitudinal studies are needed to confirm these associations.

Unmet needs and satisfaction with healthcare in patients with multimorbidity

Abstract Background Health outcomes of patients with multimorbidity are associated with the satisfaction with the care received. The objective of this study is to describe and compare the needs, adequacy of and satisfaction with the received healthcare in patients with complex chronic diseases in Spain. Methods Data from a convenience sample of patients participating in the Access to Diagnosis and Treatment and Healthcare Survey (Spanish Patient Organizations Platform, 2022). The chronic conditions were grouped into osteoarticular, cardiovascular, neurological, respiratory, diabetes, rare diseases, digestive, vision diseases, cancer and others. The main variables included were satisfaction with the received care (0-10), perceived adequacy of care (1-5) and unmet needs (yes/no). Bivariate analyses (chi-squared and Mann-Whitney tests and correlation coefficients) were performed. Results 1133 patients answered the survey: mean age 49.5 years (standard deviation, SD: 14.8), 55.1% women, mean of 2.9 chronic health conditions (SD: 1.7). Participants showed higher levels of satisfaction with routine follow-ups and control of diseases than with access to rehabilitation and specialized care. Satisfaction with healthcare was associated with perceived adequacy of follow-ups (r= -0.79, p < 0.01). Patients with osteoarticular pathologies reported a higher number of unmet needs (57%), rated the care received as less adequate (mean 3.4; SD: 0.9) and less satisfactory (mean 4.2; SD: 2.8). Patients with cancer reported fewer unmet needs (6%), considered the care adequate (mean 2.9; SD: 0.9) and satisfactory (mean 6.8; SD: 3.1). Similar figures were also seen in patients with cardiovascular diseases. Conclusions Knowledge on patients’ perceived unmet needs and demands may lead to improving satisfaction with the health system. Comprehensive care for people with multimorbidity, including assessing patients’ perception, is a challenge that must be addressed by healthcare systems. Key messages • The analysis of the differences between pathologies in their demands will better describe the reality of patients with multimorbidity in Spain. • The perception of healthcare adequacy and satisfaction greatly varies across the type of chronic condition.

Use of a Set-up Fee to Encourage Survey Participation and Electronic Health Record Submission for a National Health Care Survey.

In 2021, the National Ambulatory Medical Care Survey Health Center (NAMCS HC) Component modernized its data collection and began collecting clinical visit data from health centers using transmission of electronic health record (EHR) data. With this redesign, there are potential cost implications for a health center to participate. Beginning in 2021, a one-time set-up fee (i.e., payment) of up to $10,000 was offered to centers who participated in the NAMCS HC Component. Starting in 2022, a Set-up Fee Questionnaire was used to capture data on the use of this money. Results show on average the fee appeared adequate in covering participation costs, with the fee most often used to cover costs of health center and EHR vendor information technology staff. Although this fee was offered only during the initial year of participation, retention rates for centers appeared high. Implications from the findings of this case study on use of a set-up fee in establishment surveys are also briefly discussed.

Neuroprotective Dietary Patterns and Longitudinal Changes in Cognitive Function in Older Adults

BackgroundNumerous studies have examined the association between neuroprotective diets and cognitive function during aging; however, these studies have produced divergent findings. Some studies find that greater adherence to these dietary patterns is associated with preserved cognition, whereas others find no effect. ObjectiveThe aim of this study was to examine the association of the Mediterranean, the Dietary Approach to Stop Hypertension (DASH), and Mediterranean-DASH Intervention for Neurodegeneration Delay (MIND) dietary patterns with global cognition over 4 waves of data from the Health and Retirement Study, a longitudinal panel study conducted at the University of Michigan. DesignThis is a longitudinal secondary data analysis using Health and Retirement Study data drawn from the Food Frequency Questionnaire completed as part of the Health Care and Nutrition Survey administered in 2013 to 2014, neuropsychological assessment data obtained from the Core questionnaire in 2014, 2016, 2018, and 2020, and demographic data from the Core questionnaire in 2014. Participants/settingParticipants with total daily energy intake below 600 or 800 kcal and above 6000 and 8000 kcal for women and men, respectively, were excluded based on criteria from a similar study using the same dataset. In addition, participants with a diagnosis of dementia, Alzheimer disease, or stroke as of 2014 were excluded. There were 6154 participants in the Mediterranean diet and DASH diet analyses and 5143 participants in the MIND diet analyses. Main outcome measureA global cognitive measure incorporating immediate and delayed recall, serial 7s, and backward counting scores was calculated for each participant at each wave. Statistical analysisThe primary analyses examined the association between each diet type and cognition over 4 waves using separate multilevel models that controlled for age, gender, self-rated health, years of education, total energy intake, weekly exercise, and body mass index. ResultsMediterranean and DASH diet adherence were positively and significantly associated with baseline cognition and were associated with slower cognitive decline over a 6-year period. MIND diet adherence was positively and significantly correlated with baseline cognition but was not significantly associated with slower cognitive decline over a 6-year period. Cross-level interactions for adherence to each dietary pattern and cognitive change over time, computed with standardized diet scores, were as follows: Mediterranean diet (β = .03; P = .002), DASH diet (β = .04; P = .004), and MIND diet (β = .02; P = .094). ConclusionsThe Mediterranean, DASH, and MIND dietary patterns are associated with better cognitive performance at baseline and the Mediterranean and DASH diets were associated with slower cognitive decline over time. Adherence to the DASH diet had the greatest magnitude of association with baseline cognition and rate of cognitive change.

Geographical location as a determinant of caregiver burden: a rural-urban analysis of the informal caregiving, health, and healthcare survey in Ghana

BackgroundThe caregiving scholarship widely acknowledges informal caregivers’ contributions to maintaining older adults’ health and well-being. However, informal caregivers encounter economic, physical, social, financial and psychological challenges when caring for older adults. The caregiving literature has shown variations in caregiving intensity and motivation between rural and urban informal caregivers of older adults. This situation is likely to result in rural-urban disparities in caregiver burden. However, the literature on predictors of caregiver burden is more focused on demographic, socio-economic, caregiving and health-related factors with very little attention to geographical dynamics. For this reason, the effects of demographic, socio-economic, caregiving, and health-related factors on the variations in caregiver burden between rural and urban informal caregivers of older adults are yet to be known in the sub-Saharan African context, including Ghana. Notably, the impact of geographical location on caregiver burden is mainly missing in the informal caregiving literature in Ghana. Situated within the stress process model, we determine the association between geographical location and caregiver burden among informal caregivers of older adults in Ghana.MethodsThis study employed data from a large cross-sectional survey on informal caregiving, health, and healthcare among caregivers of older adults aged 50 years or above (N = 1,853) in Ghana. We selected the World Health Organization Impact of Caregiving Scale to measure caregiver burden. Generalized multivariable linear regression models were employed to determine the association between geographical location and caregiver burden among informal caregivers of older adults. We reported beta values and standard errors with significance levels of 0.05 or less.ResultsThe results showed that rural informal caregivers of older adults significantly have a decreased caregiver burden compared to urban informal caregivers (β = -1.64; SE = 0.41). Also, participants across all the self-rated health categories (poor/very poor: β = 12.63; SE = 1.65; fair: β = 9.56; SE = 1.07; good: β = 11.00; SE = 0.61, very good: β = 7.03; SE = 0.49) have a significantly increased caregiver burden for the full sample and for both rural (poor/very poor: β = 13.88; SE = 2.4; fair: β = 6.11; SE = 1.62; good: β = 9.97; SE = 0.96, very good: β = 6.06; SE = 0.71) and urban (poor/very poor: β = 11.86; SE = 2.25; fair: β = 12.33; SE = 1.42; good: β = 11.80; SE = 0.79, very good: β = 7.90; SE = 0.67) participants. This study further revealed that participants with no financial support needs reported a decreased caregiver burden compared to those with financial support needs for the full sample (β = -2.92, p-value < 0.01) and for both rural (β = -3.20; p-value < 0.01) and urban (β =-2.70; p-value < 0.01) participants.ConclusionThe findings from this study underscore geographical location differences in caregiver burden among informal caregivers of older adults in Ghana. Given these findings, the need to consider geographical location variations in providing welfare and health support programs to lessen caregiver burden among informal caregivers of older adults is welcomed. In line with the stress process model, such welfare and health programs should consider background, context, and stressor factors that contribute to variations in caregiver burden between rural and urban informal caregivers of older adults in Ghana and other sub-Saharan African countries.

A survey of patients with cancer and oncology health-care professionals about cannabis use during treatment.

This study characterizes patient and health-care professional perspectives regarding medical cannabis use at a National Cancer Institute-Designated Cancer Center. Data evaluated included the prevalence and patterns of and reasons for cannabis use. Patients with cancer undergoing treatment were recruited into a cross-sectional survey as part of a national National Cancer Institute-funded effort. Participants completed a survey about cannabis use, reasons for use, and types of cannabis. A health-care professional survey was also conducted to explore perspectives regarding patients' use of cannabis. A total of 313 patients with cancer (mean [SD] age = 60.7 [12.8] years) completed the survey (43% response rate) between 2021 and 2022. Of the respondents, 58% were female; identified as White (61%) and Black (23%); and had diverse cancer diagnoses. Nearly half of respondents (43%) had previously used cannabis, one-quarter (26%) had used cannabis since their cancer diagnosis, and almost 1 in 6 (17%) were actively using cannabis at the time of survey completion. The most common modes of ingestion were gummies (33%) and smoking (30%). The most commonly reported reasons for use were insomnia (46%), pain (41%), and mood (39%). For the 164 health-care professionals who completed the survey (25% response rate), the majority agreed that cannabis use (72%) is safe and beneficial for patients (57%). Four in 10 (39%) health-care professionals felt comfortable providing guidance to patients about cannabis use; however, only 1 in 8 (13%) felt knowledgeable about the topic of cannabis. Approximately one-sixth of patients with cancer receiving treatment actively use cannabis for management of various cancer symptoms. Perceptions about cannabis use and education varied widely among health-care professionals.

The Annual Cost of Cancer Screening in the United States.

Cancer has substantial health, quality-of-life, and economic impacts. Screening may decrease cancer mortality and treatment costs, but the cost of screening in the United States is unknown. To estimate the annual cost of initial cancer screening (that is, screening without follow-up costs) in the United States in 2021. Model using national health care survey and cost resources data. U.S. health care systems and institutions. People eligible for breast, cervical, colorectal, lung, and prostate cancer screening with available data. The number of people screened and associated health care system costs by insurance status in 2021 dollars. Total health care system costs for initial cancer screenings in the United States in 2021 were estimated at $43 billion. Approximately 88.3% of costs were attributable to private insurance; 8.5% to Medicare; and 3.2% to Medicaid, other government programs, and uninsured persons. Screening for colorectal cancer represented approximately 64% of the total cost; screening colonoscopy represented about 55% of the total. Facility costs (amounts paid to facilities where testing occurred) were major drivers of the total estimated costs of screening. All data on receipt of cancer screening are based on self-report from national health care surveys. Estimates do not include costs of follow-up for positive or abnormal screening results. Variations in costs based on geography and provider or health care organization are not fully captured. The $43 billion estimated annual cost for initial cancer screening in the United States in 2021 is less than the reported annual cost of cancer treatment in the United States in the first 12 months after diagnosis. Identification of cancer screening costs and their drivers is critical to help inform policy and develop programmatic priorities, particularly for enhancing access to recommended cancer screening services. None.

Antibiotic use by clinical presentation across all healthcare providers in rural Burkina Faso: a healthcare visit exit survey.

To guide antibiotic stewardship interventions, understanding for what indications antibiotics are used is essential. In rural Burkina Faso, we measured antibiotic dispensing across all healthcare providers. From October 2021 to February 2022, we surveyed patients in Nanoro district, Burkina Faso, following visits to health centres (3), pharmacies (2), informal medicine vendors (5) and inpatients in health centres. We estimated prevalence of antibiotic use and the proportion of Watch group antibiotics by provider type and by clinical presentation, assessing compliance with WHO's AWaRe Antibiotic Book. We estimated per capita antibiotic use by multiplying prevalence of antibiotic use, mean DDD per adult treatment course, and the rate of healthcare visits per 1000 inhabitants per day, estimated from a prior household survey. Outpatient antibiotic use was more frequent after health centre visits (54.8%, of which 16.5% Watch, n = 1249) than after visits to pharmacies (26.2%, 16.3% Watch, n = 328) and informal medicine vendors (26.9%, 50.0% Watch, n = 349). The frequency of antibiotic use was highest for bronchitis (79.9% antibiotic use, of which 12.6% Watch), malaria (31.9%, 23.1% Watch), gastroenteritis (76.0%, 31.7% Watch), rhinopharyngitis (40.4%, 8.3% Watch) and undifferentiated fever (77.0%, 44.8% Watch). Compliance with WHO AWaRe guidance could have averted at least 68.4% of all Watch antibiotic use in outpatients at health centres. Community-wide, 2.9 DDD (95% CI 1.9-3.9) were used per 1000 adult inhabitants per day. Most Watch antibiotic use at community level or primary care deviated from WHO guidance. Antibiotic stewardship should focus on key clinical presentations and include primary care and self-medication.

DAMPAK TELEMEDIS TERHADAP AKSES PELAYANAN KESEHATAN DI MASYARAKAT PEDESAAN

Telemedicine has emerged as a pivotal solution for addressing healthcare disparities in rural communities, where access to medical services is often limited. This study aims to evaluate the impact of telemedicine on healthcare access in rural areas, focusing on how residents perceive and utilize telemedicine, the effect on healthcare outcomes, and the barriers to its implementation. Using qualitative research methods, secondary data were collected from academic journal articles, government reports, and healthcare surveys. Findings reveal that rural residents generally perceive telemedicine positively, appreciating its convenience and accessibility, although technological literacy and trust in technology remain concerns. The impact on healthcare outcomes is significant, with improvements noted in chronic disease management, patient satisfaction, and cost savings. However, several barriers impede the widespread adoption of telemedicine, including technological infrastructure limitations, regulatory complexities, reimbursement issues, and the need for provider and patient education. The study concludes that while telemedicine has the potential to transform rural healthcare, addressing these barriers is crucial for optimizing its effectiveness and sustainability.

The role of gender in health insurance enrollment among geriatric caregivers: results from the 2022 informal caregiving, health, and healthcare survey in Ghana

BackgroundFemale informal caregivers of older adults experience a higher burden of physical and mental health problems compared to their male counterparts due to the greater intensity of care they provide. This is likely to result in an imbalance in health needs, including health insurance enrollment, between male and female informal caregivers of older adults. However, to date, no study is available on the role of gender in health insurance enrollment among informal caregivers of older adults in Ghana. This study examines the association between gender and health insurance enrollment among informal caregivers of older adults in Ghana.MethodsCross-sectional data from the Informal Caregiving, Health, and Healthcare Survey among caregivers of older adults aged 50 years or above (N = 1,853 and mean ages = 39.15 years and 75.08 years of informal caregivers and their care recipients, respectively) in Ghana were analyzed. A binary logit regression model was used to estimate the association between gender and health insurance enrollment. All statistical inferences were made at the 5% significance level.ResultsThe final Model (3) showed that female informal caregivers were 2.70 times significantly more likely to enrol in a health insurance scheme than their male counterparts (AOR: 2.70, 95% CI: 2.09–3.48, p-value = 0.001). Apart from gender, the results revealed that participants aged 55–64 years (AOR = 2.38, 95%CI: 1.29–4.41, p-value = 0.006), with tertiary education (AOR: 3.62, 95% CI: 2.32–5.66, p-value = 0.001) and living with the care recipients (AOR: 1.50, 95% CI: 1.14–1.98, p-value = 0.003) were significantly more likely to enrol in a health insurance scheme than their counterparts. The findings further showed that those who earned between GH¢1000 and 1999 (US$99.50-198.50) monthly (AOR: 0.70, 95% CI: 0.52–0.95, p-value = 0.022) and were affiliated with African traditional religion (AOR: 0.30, 95%CI: 0.09–0.99, p-value = 0.048) were significantly less likely to enrol in a health insurance scheme than their counterparts.ConclusionGender was a significant predictor of health insurance enrollment among informal caregivers of older adults. This finding contributes to the empirical debates on the role of gender in health insurance enrollment among informal caregivers of older adults. Policymakers need to develop gender-specific measures to address gender gaps in health insurance enrollment among informal caregivers of older adults in Ghana. Such health policies and programs should consider other significant demographic and socioeconomic factors associated with health insurance enrolment among informal caregivers of older adults in Ghana.

The annual cost of cancer screening in the U.S.

11051 Background: Cancer screening can decrease cancer incidence, mortality, and treatment costs. However, the annual cost of screening to the U.S. healthcare system is unknown. Methods: We used data from national healthcare surveys and standard costing sources to model the healthcare system cost of breast, cervical, colorectal, lung, and prostate cancer screening in the U.S. in 2021. Models projected the number of individuals in the U.S. eligible for each screening test based on current guidelines/recommendations; the number of eligible individuals screened by insurance status; and the costs associated with screening (in 2021 US dollars). Multiple sensitivity analyses were performed to examine the effects of changing model population parameters and costs on projected outcomes. Results: Total 2021 cancer screening costs to the U.S. healthcare system were estimated to be $57 billion; approximately 88% of the costs were attributable to private insurance, 9% to Medicare, and 3% to Medicaid, other government programs, and uninsured individuals. Most screened individuals had private insurance except for lung cancer screening, where a majority of individuals screened had Medicare coverage. Individuals with private insurance accounted for the majority of costs for each screening modality. Screening for colorectal cancer represented approximately two-thirds of the total cost; screening colonoscopy was approximately 60% of the total cost of cancer screening. Breast and cervical cancer screening represented the second and third largest screening costs, 15.4% and 14.7% (respectively) of total screening costs. Facility costs (amounts paid to facilities where testing occurred) were generally larger components of the total estimated costs of screening than were physician costs. Cost estimates were robust to a range of variations in eligible populations and screening costs. Conclusions: The $57 billion estimated annual cost for cancer screening in the U.S. in 2021 is similar to the estimated annual cost of cancer treatment in the U.S. in the first 12 months following diagnosis. Screening may have been suboptimal in 2021, with higher screening rates and costs in subsequent years. Identification of cancer screening costs and their drivers is critical to help inform policy and develop programmatic priorities. The model can be used to estimate the increased costs of enhanced access to recommended cancer screening services among underscreened populations, which would provide population-wide benefits.

Early prediction of the impact of public health policies on obesity and lifetime risk of type 2 diabetes: A modelling approach.

Help public health decision-making requires a better understanding of the dynamics of obesity and type 2 diabetes and an assessement of different strategies to decrease their burdens. Based on 97,848 individual data, collected in the French Health, Health Care and Insurance Survey over 1998-2014, a Markov model was developed to describe the progression of being overweight to obesity, and the onset of type 2 diabetes. This model traces and predicts 2022-2027 burdens of obesity and type 2 diabetes, and lifetime risk of diabetes, according to different scenarios aiming at minimum to stabilize obesity at 5 years. Estimated risks of type 2 diabetes increase from 0.09% (normal weight) to 1.56% (obesity II-III). Compared to the before 1995 period, progression risks are estimated to have nearly doubled for obesity and tripled for type 2 diabetes. Consequently, over 2022-2027, the prevalence of obesity and type 2 diabetes will continue to increase from 17.3% to 18.2% and from 7.3% to 8.1%, respectively. Scenarios statibilizing obesity would require a 22%-decrease in the probability of move up (scenario 1) or a 33%-increase in the probability of move down (scenario 2) one BMI class. However, this stabilization will not affect the increase of diabetes prevalence whereas lifetime risk of diabetes would decrease (30.9% to 27.0%). Combining both scenarios would decrease obesity by 9.9%. Only the prevalence of obesity III shows early change able to predict the outcome of a strategy: for example, 6.7%-decrease at one year, 13.3%-decrease at two years with scenario 1 stabilizing obesity at 5 years. Prevalences of obesity and type 2 diabetes will still increase over the next 5 years. Stabilizing obesity may decrease lifetime risks of type 2 diabetes without affecting its short-term prevalence. Our study highlights that, to early assess the effectiveness of their program, public health policy makers should rely on the change in prevalence of obesity III.

Maternal and child health service disruptions due to COVID-19: A WHO health-care worker exposure response and outcomes survey in western Kenya

Background: COVID-19 has disrupted health-care services delivery globally. Limited data exists about personal protective equipment (PPE) availability for health-care workers (HCW) and perceptions of COVID-19 service disruption in low-resource settings. Methods: We used the Healthcare Worker Exposure Response and Outcomes (HERO) Registry Protective Equipment Survey to assess PPE availability and reuse. HCW reported perceptions of client volume changes and time spent on various activities using a 5-point Likert scale ranging from large decreases to large increases. Results: Of the 99 HCW enrolled who completed the HERO survey, 32% were nurses, 21% clinical officers, 16% facility in-charges, among others. Forty percent worked in both maternal and child health and family planning clinics and HCW had an average of 5.3 years (interquartile range: 3.5–10.4) providing care to peripartum women. HCW reported problems procuring multiple forms of PPE, including respiratory masks (71%), face shield/googles (60%), gowns (58%), surgical masks (54%), hand sanitizer (45%), disinfecting products (43%), gloves (40%), and soap (31%). Re-use of N95/KN95 masks was common with 56% of HCW reporting reusing a single mask when attending to all patients and 2% reporting having sufficient masks to use one per patient. HCW reported reduced volume of women seeking services due to COVID-19; nearly two-thirds reported decreases in antenatal (62%) and postnatal clients (66%), as well as decreases in the number of pregnant and postpartum women initiating or continuing pre-exposure prophylaxis for HIV prevention (60% and 57%, respectively). HCW reported changes in how their time was spent; 79% spent more time disinfecting spaces between clients and 49% reported increases in responsibilities related to providing psychosocial care. Conclusions: HCW reported a dual burden of PPE shortages and client psychosocial needs, limiting their own protection and adding to workload during the pandemic.

Abstract P232: Toxic Stress is Associated With Greater Odds of Cardiovascular Disease Among Younger but Not Older Women in the Go Red for Research Dataset

Introduction: The incidence of certain cardiovascular diseases (CVD) such as heart attack and stroke have been increasing among younger women (ages 35-54 years). Psychosocial stress may be an important risk factor for CVD among this group of women. We examined whether toxic stress was associated with an increased odds CVD and whether this association was greater among younger women (&lt; 55 years of age) compared to older women (≥ 55 years of age). Hypothesis: Toxic stress would only be associated with CVD among younger women. Methods: We utilized data from participants enrolled in the American Heart Association Research Goes Red Registry, an online research platform powered by Verily. Women were asked if they had been diagnosed with any of the following heart related conditions (heart attack, hemorrhagic stroke, prior revascularization, or blocked arteries). Women were also asked whether they had experienced toxic stress defined as a significant life-defining stressful activity over a prolonged period unaccompanied by sufficient social resources or support such as loss of a child, racial discrimination, or job loss. Logistic regression models were used to estimate odds ratios between toxic stress and CVD as well as differences by age (&lt; 55 versus ≥ 55 years of age) using an interaction term. Results: The analytic dataset included 1,354 women who completed both the RGR Survey and the Healthcare and Experience Survey. The mean age of participants was 47.8 (SD: 12.6), 70% were less than 55 years of age, 83% were Non-Hispanic White, 59% indicated that they had experienced toxic stress, and 12% had CVD. In final multivariable models, there were significant differences in the association between toxic stress and CVD by age group (toxic stress-by-age interaction = 0.05) such that toxic stress was only significantly associated with an increased odds of CVD among women &lt; 55 years of age (OR: 2.00; 95% CI: 1.17, 3.44; p-value: 0.0119). In contrast, toxic stress was not significantly associated with an increased odds of CVD among older women ≥ 55 years of age (OR: 0.97; 95% CI: 0.59, 1.61; p-value: 0.9052). Conclusions: Toxic stress was associated with an increased odds of cardiovascular disease among younger, but not older women in this cross-sectional study. Stress may be an underrecognized risk factor for CVD, especially among younger women who may benefit from interventions to mitigate and prevent stress. These findings should be corroborated in future longitudinal or other study designs that can establish temporality and stronger inferences of causality.

Outpatient Visits and Antibiotic Use Due to Higher-Valency Pneumococcal Vaccine Serotypes.

In 2022-2023, 15- and 20-valent pneumococcal conjugate vaccines (PCV15/PCV20) were recommended for infants. We aimed to estimate the incidence of outpatient visits and antibiotic prescriptions in US children (≤17 years) from 2016-2019 for acute otitis media, pneumonia, and sinusitis associated with PCV15- and PCV20-additional (non-PCV13) serotypes to quantify PCV15/20 potential impacts. We estimated the incidence of PCV15/20-additional serotype-attributable visits and antibiotic prescriptions as the product of all-cause incidence rates, derived from national health care surveys and MarketScan databases, and PCV15/20-additional serotype-attributable fractions. We estimated serotype-specific attributable fractions using modified vaccine-probe approaches incorporating incidence changes post-PCV13 and ratios of PCV13 versus PCV15/20 serotype frequencies, estimated through meta-analyses. Per 1000 children annually, PCV15-additional serotypes accounted for an estimated 2.7 (95% confidence interval, 1.8-3.9) visits and 2.4 (95% CI, 1.6-3.4) antibiotic prescriptions. PCV20-additional serotypes resulted in 15.0 (95% CI, 11.2-20.4) visits and 13.2 (95% CI, 9.9-18.0) antibiotic prescriptions annually per 1000 children. PCV15/20-additional serotypes account for 0.4% (95% CI, 0.2%-0.6%) and 2.1% (95% CI, 1.5%-3.0%) of pediatric outpatient antibiotic use. Compared with PCV15-additional serotypes, PCV20-additional serotypes account for > 5 times the burden of visits and antibiotic prescriptions. Higher-valency PCVs, especially PCV20, may contribute to preventing pediatric pneumococcal respiratory infections and antibiotic use.

Incidence of typhoid fever in Burkina Faso, Democratic Republic of the Congo, Ethiopia, Ghana, Madagascar, and Nigeria (the Severe Typhoid in Africa programme): a population-based study

Typhoid Fever remains a major cause of morbidity and mortality in low-income settings. The Severe Typhoid in Africa programme was designed to address regional gaps in typhoid burden data and identify populations eligible for interventions using novel typhoid conjugate vaccines. A hybrid design, hospital-based prospective surveillance with population-based health-care utilisation surveys, was implemented in six countries in sub-Saharan Africa. Patients presenting with fever (≥37·5°C axillary or ≥38·0°C tympanic) or reporting fever for three consecutive days within the previous 7 days were invited to participate. Typhoid fever was ascertained by culture of blood collected upon enrolment. Disease incidence at the population level was estimated using a Bayesian mixture model. 27 866 (33·8%) of 82 491 participants who met inclusion criteria were recruited. Blood cultures were performed for 27 544 (98·8%) of enrolled participants. Clinically significant organisms were detected in 2136 (7·7%) of these cultures, and 346 (16·2%) Salmonella enterica serovar Typhi were isolated. The overall adjusted incidence per 100 000 person-years of observation was highest in Kavuaya and Nkandu 1, Democratic Republic of the Congo (315, 95% credible interval 254-390). Overall, 46 (16·4%) of 280 tested isolates showed ciprofloxacin non-susceptibility. High disease incidence (ie, >100 per 100 000 person-years of observation) recorded in four countries, the prevalence of typhoid hospitalisations and complicated disease, and the threat of resistant typhoid strains strengthen the need for rapid dispatch and implementation of effective typhoid conjugate vaccines along with measures designed to improve clean water, sanitation, and hygiene practices. The Bill & Melinda Gates Foundation.

Caregiver burden and health-related quality of life: A study of informal caregivers of older adults in Ghana.

Similar to many developing countries, caregiver burden remains high in Ghana which may affect informal caregivers of older adults' health-related quality of life (HRQoL). However, no study has examined the association between caregiver burden and HRQoL among informal caregivers of older adults in Ghanato date. Understanding this association may well help to inform health and social policy measures to improve HRQoL among informal caregivers of older adults in Ghana. Situated within a conceptual model of HRQoL, the purpose of this study was to examine the relationship between caregiver burden and HRQoL among informal caregivers of older adults in Ghana. We obtained cross-sectional data from informal caregiving, health, and healthcare (N = 1853) survey conducted between July and September 2022 among caregivers (≥ 18 years) of older adults (≥ 50years)inthe Ashanti Region of Ghana. The World Health Organization Impact of Caregiving Scale was usedto measure caregiver burden. An 8-item short form Health Survey scale developed by the RAND Corporation and the Medical Outcomes Study was used to measure HRQoL. Generalized Linear Models were employed to estimate the association between caregiver burden and HRQoL. Beta values and standard errors were reported with a significance level of 0.05 or less. The mean age of the informal caregivers was 39.15years and that of the care recipients was 75.08years. In our final model, the results showed that caregiver burden was negatively associated with HRQoL (β = - .286, SE = .0123, p value = 0.001). In line with the conceptual model of HRQoL, we also found that socio-economic, cultural, demographic and healthcare factors were significantly associated with HRQoL. For instance, participants withno formal education (β = -1.204, SE=.4085, p value =0.01), those withprimary level of education (β = -2.390, SE=.5099, p value =0.001) orjunior high school education (β = -1.113, SE=.3903, p value= 0.01) hada significantly decreased HRQoLcompared to those with tertiary level of education. Participants who werebetween the ages of 18-24 (β = 2.960, SE=.6306, p value=0.001), 25-34 (β = 1.728, SE=.5794, p value=0.01) or 35-44 (β = 1.604, SE=.5764, p value= 0.01) years significantly had increased HRQoLcompared to those who were 65 years or above. Also, participants who did not utilize healthcare services in the pastyear before the survey significantly had increased HRQoLcompared to those who utilized healthcare services five or more times in the pastyear (β = 4.786, SE=. 4610, p value=0.001). Consistent with our hypothesis, this study reported asignificant negativeassociation between caregiver burden and HRQoL. Our findings partially support the conceptual model of HRQoLused in this study. We recommend that health and social policy measures to improve HRQoL among informal caregivers of older adultsshould consider caregiver burden as well as other significant socio-economic, cultural, demographic, and healthcare factors.