Higher Income Research Articles

Food Insecurity and Depressive Symptoms Among Persons With Diabetes in the United States: Findings From the 2022 National Health Interview Survey (NHIS).

The purpose of this study is to examine whether food insecurity increases risk for depressive symptoms among adults with diabetes. Food insecurity is associated with depression in the general population. However, minimal research has examined this relationship among persons with diabetes. Adults with diabetes were identified from the 2022 National Health Interview Survey. Depressive symptoms were assessed by the 8-item Patient Health Questionnaire. Food insecurity status was measured with the USDA 10-item food insecurity scale. Participants were categorized as food secure, low food security, and very low food security. The association between food insecurity and depressive symptoms was examined using weighted logistic regression, adjusting for potentially influential covariates (age, sex, ethnicity, poverty to income ratio, education, diabetes type, body mass index, region, and general health). Among 2595 persons with diabetes, nearly one third (29.8%) reported symptoms of depression. Over one tenth (11.7%) had low or very low food security. Persons who had low or very low food security were more than twice as likely to report depressive symptoms (adjusted odds ratio [AOR] = 2.15, 95% CI, 1.39-3.32; AOR = 3.84, 95% CI, 2.28-6.45, respectively). Persons who were older, had higher income, and better general health were less likely to report depressive symptoms. Among adults with diabetes, low or very low food security was associated with increased risk for depressive symptoms. Further research is needed to evaluate the relationship between food insecurity and depressive symptoms among persons with diabetes.

Utilization of early therapeutic supports by autistic preschoolers in Australia: A cross-sectional study following implementation of the National Disability Insurance Scheme.

There are many types of support for young autistic children and their families, but service use in this population is not well understood. In this study, primary caregivers of autistic preschoolers were surveyed (n = 95) and a selection were then interviewed (n = 19) to understand how early, therapeutic supports were accessed by families in Australia following the establishment of a National Disability Insurance Scheme (NDIS). This article presents the quantitative data from surveys and interviews. Families usually accessed at least two types of support. The most accessed supports were occupational therapy, speech pathology and psychology, with 43% of the sample accessing some other form of support. Multiple linear regression indicated that children's higher level of support need, living in less remote or less socio-economically disadvantaged areas, and high household income were associated with higher numbers of supports accessed. Services tended to follow an individual, clinic-based model and little use of alternative service delivery was reported. The findings indicate that Australian families are accessing a wider range of support types than before the NDIS and children with more substantial autism-related support needs are likely to access a greater number of types of supports. Socio-economic inequities continue to exist and should be addressed.

Local food procurement behavior and overall diet quality among adults in Québec: results from the NutriQuébec project.

Consumption of locally produced foods is generally perceived as being part of a healthy dietary pattern. Accordingly, in 2020, the provincial government of Québec (Canada) promoted the purchase of local foods for economic and health benefits. The present cross-sectional study aimed to document the association between the behavior of local food procurement and overall diet quality in a sample of adults from the province of Québec. Data were collected in a sample of 834 adults (86.6% females) from the NutriQuébec project, a web-based longitudinal population study that aims to document the lifestyle and eating habits of adults in Québec, Canada. Dietary intakes were measured using a validated web-based 24-h recall tool and diet quality was assessed using the Healthy Eating Food Index (HEFI-2019), which measures adherence to the 2019-Canada's Food Guide recommendations on healthy food choices. Local food procurement behavior was measured using the Locavore-I-SF score, which assesses the frequency of short food supply chain use as well as the geographical origin of three locally produced foods. The Locavore-I-SF score was weakly correlated with the HEFI-2019 score (r = 0.08, p < 0.02). Positive correlations were observed for the Vegetables and fruits (r = 0.09, p = 0.005), Beverages (r = 0.08, p = 0.04) and Free sugars (r = 0.14, p < 0.001) components of the HEFI-2019. Associations between the Locavore-I-SF and the HEFI-2019 scores were found in specific subgroups of participants: males (r = 0.33, p < 0.001), participants aged between 50 and 70 years (r = 0.16, p = 0.003), participants with a greater education level (r = 0.13, p = 0.003) and higher income (r = 0.12, p = 0.02), non-vegetarian participants (r = 0.10, p = 0.008) and participants living in Census Metropolitan Areas (r = 0.11, p = 0.004). These results suggest that the behavior of local food procurement is only weakly associated with better overall diet quality among a sample of adults from Québec, raising doubts on the relevance of promoting local food procurement as an effective public health measure for improving diet quality in Québec. NCT04140071.

Exploring ADHD understanding and stigma: Insights from an online survey in Lebanon.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder. Public knowledge of ADHD plays a crucial role in shaping attitudes, reducing stigma, and fostering a supportive environment for individuals with this disease. This study aimed to assess the level of knowledge and stigma of the general Lebanese population regarding ADHD and identify potential factors associated with these variables. An online cross-sectional study was conducted between July and August 2023 among adults from all Lebanese regions. The questionnaire was self-administered, available in Arabic and English, and included a sociodemographic section and the validated tools Knowledge of Attention Deficit Disorders Scale (KADDS) and the ADHD Stigma Questionnaire (ASQ). A total of 647 participants were included. Most participants (n = 483 (74.7%)) lacked prior experience with individuals who have ADHD, and only 12.8% reported having good information about the condition. The participants had a mean knowledge score of 20.49 ±3.23 and a mean ADHD stigma score of 75.71 ±20.58. A significantly higher knowledge score was associated with a university level of education (B = 0.14, p < 0.001), older age (B = 0.14, p = 0.001), using the internet (B = 0.13, p = 0.001) and lecture (B = 0.09, p = 0.015) as a source of ADHD information, having a high monthly income (B = 0.13, p = 0.001), being female (B = 0.08, p = 0.030) and having a health coverage (B = 0.08, p = 0.025). Conversely, a lower knowledge was significantly associated with obtaining ADHD information from television (B = -0.13, p = 0.001) and family (B = -0.08, p = 0.043). A significantly lower score was associated with ever being diagnosed with ADHD (B = -0.18, p < 0.001), having an intermediate monthly income (B = -0.10, p = 0.005), and consuming alcohol (B = -0.11, p = 0.004), while a higher score was significantly associated with a higher KADDS total score (B = 0.12, p = 0.002) and being employed (B = 0.07, p = 0.044). The present study addressed a gap in the existing literature by examining ADHD knowledge and stigma in the Lebanese population. Surprisingly, a positive correlation between higher ADHD knowledge and increased stigma challenges common assumptions, suggesting a complex relationship between knowledge, misconceptions, and societal attitudes. The findings emphasize the need for targeted education and advocacy to improve knowledge and alleviate misconceptions and stigma within the general population.

An Overview of Medical, Surgical, and Rehabilitation Outcome Measures Used in Randomized Controlled Trials of Moderate to Severe Traumatic Brain Injury

Abstract Optimal reporting of outcomes is critical for the interpretation of research findings. This review aimed to examine the utilization of outcome measures (OMs) in randomized controlled trials (RCTs) of moderate to severe TBI (MSTBI). Systematic searches were conducted up to December 2022 in MEDLINE, PubMed, Scopus, CINAHL, EMBASE and PsycINFO, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RCTs were included if the population studied had ≥18 years and ≥ 50% had MSTBI. 662 met inclusion criteria. There was a total of 839 unique OMs across all included RCTs. Of these, only 195 (23.2%) were used in ≥4 RCTs. On average, RCTs included 1.26 OMs (range 1 to 23). A total of 495 (59%) of OMs were classified in the recovery and rehabilitation category, and 344 (41%) in the medical and surgical measures category. There was a more equal representation of OMs in high income countries (HICs) compared to low to middle income countries (LMICs), with the latter using fewer recovery and rehabilitation OMs. OMs used in RCTs of MSTBI have significant heterogeneity and variable clinical relevance, which limits the impact and generalizability of research in MSTBI, and the ability to compare across studies.

Socio-Behavioral Changes in Dava Village: The Influence of the Gunung Botak Gold Mine

This study aims to describe the influence of the Gunung Botak gold mine on behavioral changes and identify the factors driving socio-economic shifts within the community of Dava Village, Buru Regency. A qualitative descriptive approach was employed, with purposive sampling used to select informants based on predetermined criteria aligned with the research objectives. Data collection was carried out through observations, interviews, and documentation. The data were analyzed through stages of reduction, presentation, verification, and conclusion drawing. The findings reveal significant social and economic impacts of the mining activities. Socially, the mine has disrupted social structures, triggering tension and conflict due to shifts in roles and inequitable distribution of mining benefits. These changes have led to polarization, distrust, altered communication patterns, and increased violence and aggression. Economically, many residents have shifted their livelihoods to mining, resulting in higher incomes that influence consumption patterns, lifestyle changes, and the emergence of new social status symbols. Several factors contribute to these socio-economic changes, including economic pressures from the mine, migration and urbanization, environmental impacts, and cultural and value shifts. Collectively, these factors reflect a complex and multidimensional socio-economic phenomenon caused by the presence of the gold mine.

A Spatial Mapping for Profitability Consideration of Rental Houses in South Jakarta

Abstract: The population of South Jakarta reached 2.235.606 people as of 2023 (BPS, 2024), with a percentage of occupying owned residential buildings of 51,36% (BPS, 2022). Estimates indicate that only approximately 1,148,207 people currently reside in private assets. Rental prices need to be considered based on the strategic location to minimize the risk of rental house business owners suffering losses. The imbalance in the supply and demand of the residential market will cause the availability of land in productive areas to be increasingly limited. The existence of an imbalance in market supply and demand can be an opportunity for prospective property entrepreneurs in the field of rental houses. The analysis was carried out by calculating income predictions using multiple linear regression methods and spatial analysis between rental houses and the accessibility of public facilities in South Jakarta City. The results obtained indicate that the accessibility of public facilities in Setia Budi Sub-district provides an opportunity for high income. Keywords: Boarding House, Income Rediction, Multiple Linear Regression, Spatial Analysis

Abstract 4141487: Social Determinants of Health and Outcomes in Patients with Hypertrophic Cardiomyopathy in the Sarcomeric Human Cardiomyopathy Registry (SHaRe)

Introduction: Area-based social determinants of health (SDOH) are associated with higher risk for acquired heart disease. However, the impact of area-based SDOH on clinical outcomes in patients with hypertrophic cardiomyopathy (HCM) has not been previously studied. Hypothesis: Residing in an area with lower median household income and a higher social deprivation index (SDI) are independently associated with adverse outcomes in patients with HCM. Methods: This study included 4,483 adult patients with HCM from five Sarcomeric Human Cardiomyopathy Registry (a multi-center prospective registry of patients with HCM) sites in the US followed for a median [IQR] of 4.0 [1.0-8.5] years. The patients’ residential address was geocoded at the zip code level to characterize median household income and SDI. SDI is based on various social factors (such as income and education), with a higher score reflecting more deprivation. Multivariate models, adjusting for sex, age, hypertension and body mass index were used to determine the independent association of household income and SDI on ventricular arrhythmias (VA), heart failure (HF), and an overall composite outcome (VA, HF, atrial fibrillation, death, and stroke). Results: Median age at diagnosis was 48.3 [32.0-60.4] years with 42.0% female. Median household income was $90,000 [60,000-110,000] and median SDI was 25 [10-55]. Adjusted hazard ratios per $10,000 higher income were 0.96 (95% CI 0.93-1.00, p=0.03) for VA, 0.91 (95% CI 0.90-0.93, p &lt;0.01) for HF, and 0.95 (95% CI 0.94-0.96, p &lt;0.01) for the composite outcome. Adjusted hazard ratios per 10 units higher SDI (more deprived) were 1.07 (95% CI 1.03-1.12, p&lt;0.01) for VA, 1.06 (95% CI 1.04-1.08, p &lt;0.01) for HF, and 1.05 (95% CI 1.03-1.06, p &lt;0.01) for the composite outcome. The associations of SDI and income on clinical outcomes were similar regardless of sarcomere gene variant status. Conclusions: Residing in an area with lower median household income and higher SDI were independently associated with adverse outcomes in patients with HCM. These findings extend observations from acquired cardiovascular disease and highlight the need to address adverse SDOH to reduce health disparities and improve outcomes in patients with HCM.

Abstract 4112775: Demographics and Cardiovascular Mortality Among Kaposi Sarcoma Patients in the United States: An Analysis of the SEER Database

Aims and Background: Kaposi sarcoma (KS) is a vascular neoplasm caused by human herpesvirus. Despite its significance, there is limited data regarding the causes and mortality factors associated with KS, particularly concerning cardiovascular mortality rates and specific influencing factors. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to gather data from 2000 to 2020. The primary endpoint was overall survival, assessed via log-rank analysis and Kaplan-Meier plots. Hazard ratios (HR) with 95% confidence intervals (CIs) were calculated using SAS v9.4, with significance set at p&lt;0.05. Results: We identified 8,247 patients with KS. Most were male (90.6%) and aged 40-59 years old (38.5%). Mortality data from KS showed that 56.3% of diagnosed patients were alive. Among those who died, 49.8% died of infectious causes, 11.4% died of cardiac causes, and the remaining died of other causes, such as leukemias and complications. Advanced age (&gt;80 years) vs. 0-19 year age group (HR: 2.263; 95% CI: 1.068-4.795; p=0.033), non-Hispanic Black race vs. non-Hispanic White race (HR 1.492; 95% CI: 1.369-1.627; p=0.001), and visceral involvement vs. cutaneous KS (HR 1.709; 95% CI: 1.487-1.963; p=0.001) were factors associated with increased mortality. Females had a slightly lower long-term survival than males (p&lt;0.001). Married individuals, higher incomes (≥$75,000), and urban areas of living had higher survival rates compared to widowed patients, lower-income patients (&lt;$75,000), and those in rural locations, respectively (p&lt;0.001, for all). In the subgroup analysis, females (24.3%; n=112) had significantly higher cardiac-related deaths than males (9.5%; n=297) (p&lt;0.0001). Cardiac-related deaths were highest in White patients (16.1%; n=279), followed by Hispanics (10.4%; n=79). Conclusions: Cardiac causes accounted for 11.4% of deaths. Various factors are associated with an increased mortality risk.

Income-Related Disparities in Mortality Among Young Adults With Type 2 Diabetes.

Previous studies have indicated an inverse association between income and mortality. However, differences in health outcomes according to the income level of young adults with type 2 diabetes (T2D) compared with older adults with T2D have not been elucidated. To estimate the overall and cause-specific mortality risks among patients with T2D according to income and age. This retrospective nationwide cohort study in South Korea included adults aged 20 to 79 years who were diagnosed with T2D between January 1, 2008, and December 31, 2013, and followed up until December 31, 2019, and age- and sex-matched controls without diabetes. Data were analyzed between January 1, 2023, and August 27, 2024. Risks of all-cause, cardiovascular, and cancer mortality were estimated according to participants' income, which was categorized into 3 levels (low, middle, and high) based on the health insurance premium. Logistic regression analyses and Cox proportional hazard regression analyses were performed according to age groups (20-39, 40-59, and 60-79 years). A total of 1 240 780 adults (604 975 patients with T2D and 635 805 age- and sex-matched controls without diabetes) were included in the analyses. Their mean (SD) age was 56.9 (11.8) years, and 626 176 (50.5%) were men. Overall, the risk of mortality increased with lower income among patients with T2D, as well as in comparison with controls without diabetes. There was an inverse association between income and mortality risk in younger individuals (adjusted hazard ratios of all-cause mortality in the low income vs high income subgroups with T2D were 2.88 [95% CI, 2.25-3.69] in those aged 20 to 39 years, 1.90 [95% CI, 1.81-2.00] in those aged 40 to 59 years, and 1.26 [95% CI, 1.23-1.29] in those aged 60 to 79 years; P < .001 for comparing risk ratios between age groups). The pattern of income-related disparities in younger individuals was observed in cardiovascular mortality but less in cancer mortality. In this cohort study of 1 240 780 individuals aged 20 to 79 years, the risk of mortality with low income was most prominent among individuals with T2D aged 20 to 39 years. These findings highlight the need for socioeconomic support to reduce income-related health disparities in younger individuals.

Celiac disease care differs significantly between high- and low-middle-income countries: a global survey of celiac experts from 63 countries.

Celiac disease (CeD) is increasingly diagnosed but significant disparities exist in awareness, practices, resources, and legislation worldwide. We conducted a global online survey with CeD experts to assess this disparity internationally. A 55 questions survey encompassing nine domains relevant to CeD care (awareness, gluten-free [GF] foods availability/cost/quality, GF labeling, CeD dietician availability, insurance for CeD patients, medical training, research funding, patient support groups, and unmet needs) was generated and sent to CeD experts worldwide electronically. Countries were stratified based on per capita income as high-income (HIC) and lower-income countries (LIC) (including upper-middle-, lower-middle-, and low-income countries). Survey responses were summarized as a single score using principal component analysis. Valid responses were obtained from 131(37.4%) [HIC: 71; LIC: 60] of contacted CeD experts from 63 countries. Compared with HIC, LIC experts perceived worse availability (HIC:80% vs LIC: 47%; P<0.001), quality (52% vs 20%; P<0.001), and legislation for labeling of GF foods (82% vs 37%; P<0.001), with unfavorable reimbursement policies (27% vs 12%; P=0.002), subsidies (32% vs 13%; P<0.001), and insurance (76% vs 43%; P<0.001) for CeD patients. LIC also lacked awareness about CeD among general physicians (69% vs 32%; P<0.001), trained celiac dieticians (39% vs 12%; P=0.002), and active CeD patient support groups (93% vs 50%; P<0.001). All experts believed that GF foods were costly (94% vs 87%), frequently contaminated (27% vs 32%), and unfavorably taxed (97% and 93%). The experts agreed on key unmet needs and better research funding. Overall CeD preparedness score (median 58.3 vs 33.0; P<0.001) was also associated with income. The present survey highlights the opinion of global experts on the challenges, opportunities, and preparedness related to CeD and differences worldwide by income.

Outcomes of external versus internal fixation for traumatic lower limb fractures in low- and middle-income countries.

Lower limb fractures are common in low- and middle-income countries (LMICs) and represent a significant burden to the existing orthopaedic surgical infrastructure. In high income country (HIC) settings, internal fixation is the standard of care due to its superior outcomes. In LMICs, external fixation is often the surgical treatment of choice due to limited supplies, cost considerations, and its perceived lower complication rate. The aim of this systematic review protocol is identifying differences in rates of infection, nonunion, and malunion of extra-articular femoral and tibial shaft fractures in LMICs treated with either internal or external fixation. This systematic review protocol describes a broad search of multiple databases to identify eligible papers. Studies must be published after 2000, include at least five patients, patients must be aged > 16 years or treated as skeletally mature, and the paper must describe a fracture of interest and at least one of our primary outcomes of interest. We did not place restrictions on language or journal. All abstracts and full texts will be screened and extracted by two independent reviewers. Risk of bias and quality of evidence will be analyzed using standardized appraisal tools. A random-effects meta-analysis followed by a subgroup analysis will be performed, given the anticipated heterogeneity among studies, if sufficient data are available. The lack of easily accessible LMIC outcome data, combined with international clinical guidelines that are often developed by HIC surgeons for use in HIC environments, makes the clinical decision-making process infinitely more difficult for surgeons in LMICs. This protocol will guide research on surgical management, outcomes, and complications of lower limb shaft fractures in LMICs, and can help guide policy development for better surgical intervention delivery and improve global surgical care.

Abortion and Women’s Future Socioeconomic Attainment

Abortion is a safe and common medical procedure. Roughly one in four women in the United States will have an abortion before the end of her reproductive years. Because of how common this experience is and how rapidly abortion policy is shifting, understanding the relationship between abortion and women’s socioeconomic futures is well worth exploring. Extant research has demonstrated that the transition to parenthood is a critical inflection point in women’s socioeconomic trajectories, often leading to poorer outcomes. In this article, we connect previous sociological work elucidating mechanisms of socioeconomic stratification and gender by considering the relationship between abortion use and access and future socioeconomic outcomes such as education, income, and financial stability—as measured by several measures, including evictions, debt, ability to pay bills, and a separate index of economic instability. We use national longitudinal survey data to assess socioeconomic outcomes associated with abortion using two statistical approaches. We find that women who lived in a location with fewer abortion restrictions in adolescence, and women who had an abortion, compared to a live birth, in adolescence, are more likely to have graduated from college, have higher incomes, and have greater financial stability at two time-points over an almost 25-year period. Our results provide evidence that policy environments allowing access to abortion, and teenagers having the option to use abortion to avoid early parenthood, are important axes along which women’s economic lives are shaped. Our research implies that the widespread abortion bans and restrictions in the United States are likely to lead to lower educational attainment and adult economic stability among women living under such restrictions, as compared to women in locations with better access to abortion.

How to combat stigma surrounding mental health disorders: a scoping review of the experiences of different stakeholders

BackgroundThe stigma associated with mental health disorders (MHDs) results in delayed help-seeking, limited access to health services, suboptimal treatment, poor treatment outcomes, and an increased risk of human rights violations. This scoping review summarizes qualitative research on the lived experiences of different stakeholders regarding strategies and interventions to combat stigma for people with MHDs.MethodsThis study was a six-step scoping review using the Arksey and O’Malley framework. A comprehensive search of the following electronic databases was conducted to identify relevant records: PubMed, Scopus, Web of Science (WoS) and Google Scholar, as well as a manual search of the reference lists. All steps, including screening of eligible studies, data extraction, and analysis, were performed independently by multiple reviewers, with disagreements resolved by discussion. The data were synthesized based on the for-content synthesis guidelines.ResultsA total of 25 studies were included in this review of the 32,976 initial identified citations. The included studies were from all countries (low, middle, and high income), stigmatized disorders (e.g., schizophrenia, bipolar disorder, etc.) and target populations (e.g., people with MHDs and their families, health care providers, the general community, and students and school members). The thematic synthesis revealed six types of interventions and strategies and 17 themes related to reducing stigma in patients on MHDs. Strategies and interventions were classified by patient (self-stigma), family (family stigma), healthcare professionals’ stigma, workplace stigma, public/societal stigma, and structural type of stigma (institutional stigma).ConclusionsThis review contributes new evidence that should be considered in future interventions and policies to reduce stigma against MHDs. Multilevel and multistakeholder strategies and interventions are needed to reduce the stigmatization of MHDs.

The impact of internet medical service on rural gender inequality in health opportunity: a cross-sectional study

BackgroundThe increasing popularity of Internet medical service may have alleviated the gender inequality in health opportunity faced by rural women. However, research to ascertain the association between Internet medical service and gender inequality in health opportunity is scarce. This study explored the impact of Internet medical service on gender inequality in health opportunity among rural women and the underlying mechanisms involved.MethodsA multistage stratified cross-sectional survey was conducted across six counties in three provinces in China, yielding 3,108 responses for a 97.13% response rate. The questionnaire was used to collect information on Internet healthcare use, health status, health behaviors, social activities and personal exercise, chronic disease status, and demographic and socio-economic characteristics of the participants. Based on Roemer's theory of equality of opportunity (EOP), we established a decomposition strategy for the fairness gap between genders, which we used for the measurement of the gender inequality in health opportunity Fixed effects models, propensity score matching (PSM), and least absolute shrinkage and selection operator (LASSO) regression were utilized to explore the impact of Internet medical service on rural gender inequality in health opportunity.ResultsOn average, rural women experienced a gender health fairness gap of 1.63. Internet medical service significantly mitigated this inequality (β = -0.0602, P = 0.0002), and this finding remained significant across propensity score matching (PSM) and LASSO regression analyses. Mechanistic analysis revealed that human capital positively moderates this effect (β = -0.0510, P < 0.01), while income (β = 0.0370, P < 0.001) and marital status (β = 0.2039, P < 0.001) have negative moderating effects.ConclusionsBy focusing on gender inequality in the digital era, this study highlights the mitigating role of Internet medical service on gender inequality in health opportunity in rural areas. This study proposes and validates the mechanisms through which Internet medical service alleviates gender inequality in health opportunity, suggesting that human capital amplifies this effect, while high personal income and marital status attenuate this effect. These findings contribute to understanding how the digital age can narrow gender health opportunity equality, providing support for future interventions aimed at promoting health equity and gender equality.

Impact of the COVID-19 Pandemic Onset on the Early Careers of Pediatric Oncology Health Professionals and Researchers: A Report From the Children's Oncology Group Young Investigators Committee, Young SIOP Network, and Young SIOPE.

The COVID-19 pandemic onset had a global debilitating impact on individuals and on burgeoning careers. In 2021, the Children's Oncology Group Young Investigators Committee, Young SIOP (International Society of Paediatric Oncology) Network, and Young SIOPE (European Society for Paediatric Oncology) co-sponsored a survey to explore the impacts of the first year of the pandemic on early-career pediatric oncology professionals with respect to working practices, productivity, professional and career development, personal wellbeing, and changing childcare needs. The survey comprised demographic, multiple-choice, and free-text questions, and was distributed via email and social media with English, French, and Spanish versions available. Descriptive statistics and chi-square tests were used to compare quantitative data by self-designated gender and country of origin. Qualitative data were described using content analysis. Professionals (N = 499, 26.3% male, 77.2% MDs) in 48 countries (77.6% high income) responded in English (79.4%), Spanish (12.4%), and French (8.2%). Respondents had difficulty obtaining and keeping jobs (26.9%), worsened overall academic productivity (50.7%, with higher rates among bench scientists, p<0.01), and decreased career opportunities (40.9%). Childcare challenges impacted 56.7% of respondents and was felt more negatively among women (p = 0.008) and in high-income settings (p<0.0001). Qualitative data (n = 300) highlighted these differences were often attributable to diminished professional/personal boundaries and impacted their personal wellbeing. The COVID-19 pandemic significantly impacted early-career academic and clinical professionals working in pediatric oncology, with unique challenges noted among those with childcare responsibilities. Career disruptions that resulted from the pandemic should be considered and mitigated by governing bodies and hiring institutions.

The Perceptions of Overweight and Obese Individuals Regarding Weight-Loss Dietary Supplement Advertisements: A Pilot Cross-Sectional Survey

Introduction: The negative health consequences of overweight and obesity underscore the importance of weight loss in mitigating these issues. Weight-loss dietary supplements (DS) are highly sought-after by overweight or obese individuals, with widespread advertisements promoting their use. This study aimed to investigate the perceptions of overweight and obese individuals regarding weight-loss DS advertisements. Methods: Over a six-week period from 5th April to 17th May 2023, an online pilot cross-sectional study was conducted targeting overweight and obese individuals in Malaysia. The study utilized a convenience sampling method to recruit participants. Results: Of the 146 participants, most were female (82.9%), 53.4% were overweight, and 46.6% were obese. Most respondents believed that weight-loss DS advertisements often contained exaggerated, unverified, and misleading information. Nearly 90% acknowledged that exaggerated advertisement claims might influence consumers, and about 85% believed that people are influenced to buy frequently advertised weight-loss DS. Despite these perceptions, about 40% reported purchasing a weight-loss DS after seeing such a product in an advertisement, while less than 50% of those who purchased weight-loss DS sought information from healthcare professionals. Conclusion: The study found that almost 40% of the respondents had purchased a weight-loss DS after seeing such products being advertised. Individuals with higher income, married people, and older respondents appeared more likely to purchase a weight-loss DS. These findings underscore the necessity for stricter regulatory frameworks and comprehensive consumer education initiatives to protect consumers from misleading information and unethical marketing tactics within the weight-loss DS industry. Implementing targeted public health interventions could further safeguard consumers from the risks associated with exaggerated product claims.

Interventions to improve access to cancer care in underserved populations in high income countries: a systematic review

BackgroundUnderserved populations both globally and in Canada face serious cancer inequities that result from systemic economic, environmental, and social conditions. These pose barriers in access to cancer care and lead to suboptimal cancer care experiences and outcomes. Knowledge of effective interventions to improve access to cancer care is needed to inform the design of tailored interventions for these populations.AimTo identify interventions and programs to improve access to cancer care for underserved populations in high income countries with universal health coverage (UHC) and the United States (US) throughout the cancer care continuum.MethodsWe conducted a systematic review following the PRISMA standards. We searched Medline, EMBASE, PsycINFO, CINAHL, Scopus, and the Cochrane Library. Inclusion criteria: quantitative and qualitative studies published in English in the last 10 years (2013–2023), describing interventions/programs to improve access to cancer care for underserved populations (18 years and over). We included studies in the US given the body of scholarship on equity in cancer care in that country. Screening, data extraction and analysis were undertaken by two independent reviewers.ResultsOur search yielded 7,549 articles, and 74 met the inclusion criteria. Of these, 56 were conducted in the US, 8 in Australia, 6 in Canada, and 4 in the United Kingdom. Most (90.5%) were quantitative studies and 47.3% were published between 2020–2023. Seven types of interventions were identified: patient navigation, education and counselling, virtual health, service redesign, financial support, improving geographical accessibility and multicomponent interventions. Interventions were mainly designed to mitigate language, distance, financial, lack of knowledge and cultural barriers. Most interventions focused on access to cancer screening, targeted rural populations, racialized groups and people with low socioeconomic status, and were conducted in community-based settings. The majority of interventions or programs significantly improved access to cancer care.ConclusionOur systematic review findings suggest that interventions designed to remove specific barriers faced by underserved populations can improve access to cancer care. Few studies came from countries with UHC. Research is required to understand tailored interventions for underserved populations in countries with UHC.

A systematic review and meta-analysis of heat exposure impacts on maternal, fetal and neonatal health.

Climate Change has severe and wide-ranging health impacts, especially for vulnerable groups. Despite growing evidence of heat-associated adverse maternal and neonatal health outcomes, there remains a lack of synthesis quantifying associations and identifying specific risk periods. We systematically reviewed the literature on heat impacts on maternal, fetal, and neonatal health, and quantified impacts through meta-analyses. We found 198 studies across66 countries, predominantly high income (63.3%) and temperature climate zones (40.1%), and 23 outcomes. Results showed increased odds of preterm birth of 1.04 (95%CI = 1.03, 1.06; n = 12) per 1°C increase in heat exposure and 1.26 (95%CI = 1.08, 1.47; n = 10) during heatwaves. Similarly high heat exposure increased the risk for stillbirths (OR = 1.13 (95%CI=0.95, 1.34; n = 9)), congenital anomalies (OR=1.48 (95%CI = 1.16, 1.88; n = 6)), and gestational diabetes mellitus (OR = 1.28 (95%CI = 1.05, 1.74; n = 4)). The odds of any obstetric complication increased by 1.25 (95%CI = 1.09, 1.42; n = 11) during heatwaves. Patterns in susceptibility windows varied by condition. The findings were limited by heterogeneity in exposure metrics and study designs. The systematic review demonstrated that escalating heat exposure poses a major threat to maternal and neonatal health, highlighting research priorities, guiding the selection and monitoring of heat-health indicators, and emphasising the need to prioritise maternal and neonatal health in national climate-health programmes.

Food Security Achievement through Women Empowerment: A Study of Informal Sector in Lahore

Background: Women empowerment (WE) in food security is one of the global issues faced by women in all the countries of the world. Achievement of zero-hunger goal of Sustainable Development Goals in 2030 (SDG) still seems to be unachievable because of this food insecurity. This research aims to study the achievement of food security by enhancing WE in the informal sector in Lahore, Pakistan. Moreover, the analysis goals are to determine the contribution of microcredit facilities and management skills in the enhancement of WE which improves food security. Method: This study was quantitative and descriptive. Using a primary survey questionnaire on cross-sectional data source by simple random sampling, 495 women borrowers in the informal sector of Lahore, Pakistan were investigated. Data analysis was done using SMART PLS3. Results: The results of the study revealed a positive relationship between WE and food security through the active participation of women in production decisions. The utilization of resources within the households is strengthened by familial rights, social support, and the removal of gender disparity. Conclusion: Women's capacity to contribute more to the daily household expenditure is increased by the higher income, and eventually, it increases their empowerment and food security.