Higher Income Research Articles

Association between sleep duration and sleep quality with pre-sarcopenia in the 20–59-year-old population: evidence from the National Health and Nutrition Examination Surveys 2005–2014

BackgroundSarcopenia is a musculoskeletal disease characterized by a significant reduction in muscle mass, strength, and performance. As it mostly affects older adults, it is often recognized as a disease of old age. However, sleep is also closely related to its development. Hence, it becomes critical to explore the relationship between sleep and sarcopenia in populations under 60 years of age to develop strategies for preventing sarcopenia. We here aim to explore the specific association between sleep duration and sleep quality with pre-sarcopenia in the non-elderly population using large population samples.MethodsThis study involved 7,187 participants aged 20–59 years from the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2014. Pre-sarcopenia is defined based on the appendicular skeletal muscle mass (ASM) adjusted for body mass index (BMI). Self-reported sleep duration was categorized into three groups: <6 h (short sleep), 6–8 h (normal sleep), and > 8 h (long sleep). Sleep quality was assessed based on the Sleep Disorder and Trouble Sleeping Questionnaire. Univariate analysis and multivariate logistic regression were used to examine the relationship between sleep duration and sleep quality with pre-sarcopenia.ResultsSleep quality was significantly linked with the risk of pre-sarcopenia (OR 1.72, 95% CI 1.36–2.18, P < 0.01). Longer or shorter sleep duration did not affect the risk of pre-sarcopenia, in contrast to normal sleep duration. Subgroup analysis demonstrated a more pronounced association in individuals who are > 40 years old (P < 0.01), non-Hispanic (P ≤ 0.01), overweight (P < 0.01), have a higher income (P < 0.01), and are more educated (P ≤ 0.01). Moreover, this association was noted in populations with or without smoking (P < 0.01) and alcohol consumption (P < 0.01), hypertension (P < 0.01) and diabetes (P ≤ 0.02).ConclusionSleep quality is associated with an increased risk of pre-sarcopenia, while sleep duration is not in the population aged 20–59 years. Further prospective cohort studies with a large sample size are needed to determine causality and develop effective interventions for preventing sarcopenia in the population aged 20–59 years.

Health disparities and inequalities in prevalence of diabetes in the Kingdom of Saudi Arabia

BackgroundOver time, global health systems have witnessed significant improvements in the delivery and coverage of healthcare services. Nevertheless, the increasing prominence of non-communicable diseases remains a persistent challenge. Diabetes is one such non-communicable chronic disease that poses a threat with respect to both mortality and morbidity. This study investigated the socio-economic determinants and inequalities in the prevalence of diabetes in the Kingdom of Saudi Arabia according to data collected from the 2018 Saudi Family Health Survey conducted by the General Authority for Statistics.MethodsThe analysis was limited to a sample of 11,528 respondents aged ≥ 18 years, selected across all 13 regions of Saudi Arabia, with complete responses for all variables of interest. Socio-economic determinants in diabetes prevalence were explored with univariate, bivariate, and multivariate logistic regression analyses. Furthermore, inequalities were visualised and quantitatively estimated according to construction of a concentration curve and calculation of the concentration index.ResultsThe prevalence of diabetes among the 11,528 respondents was 11.20%. Age, education, income, and residence area were significant determinants of diabetes prevalence, with a greater risk of diabetes found in older participants (odds ratio [OR]: 12.262, 95% confidence interval [CI]: 9.820–15.313, p < 0.01) compared to younger participants. Inequality analysis showed a negative education-based concentration index (–0.235, p < 0.01), indicating that diabetes prevalence is concentrated among people with relatively less formal education. For males, the income-based concentration index was significantly positive, whereas the education-based concentration index was significantly negative, indicating a greater concentration of diabetes among Saudi men with higher incomes and less education.ConclusionThese findings emphasize the need to prioritize policies and strategies for diabetes prevention and control with considerations of the socio-economic inequalities in prevalence. Key areas of focus should include improving education levels across all regions, raising awareness about diabetes and implementing nutritional interventions.

Dementia risk prediction modelling in low- and middle-income countries: current state of evidence.

Dementia is a leading cause of death and disability with over 60% of cases residing in low- and middle-income countries (LMICs). Therefore, new strategies to mitigate risk are urgently needed. However, despite the high burden of disease associated with dementia in LMICs, research into dementia risk profiling and risk prediction modelling is limited. Further, dementia risk prediction models developed in high income countries generally do not transport well to LMICs suggesting that context-specific models are instead needed. New prediction models have been developed, in China and Mexico only, with varying predictive accuracy. However, none has been externally validated or incorporated variables that may be important for predicting dementia risk in LMIC settings such as socio-economic status, literacy, healthcare access, nutrition, stress, pollutants, and occupational hazards. Since there is not yet any curative treatment for dementia, developing a context-specific dementia prediction model is urgently needed for planning early interventions for vulnerable groups, particularly for resource constrained LMIC settings.

Knowledge, attitudes, and barriers: Palliative Care services for women with HIV in resource-limited settings

BackgroundWomen living with HIV (WLWH) in low- middle-income countries (LMICs) face increased mortality risks from comorbidities despite progress in antiretroviral therapy. Palliative care (PC) is vital for these patients, yet its integration in LMICs, such as Nigeria, is suboptimal due to unique challenges.ObjectiveThis study investigated the knowledge, perceived barriers, and facilitators influencing PC integration into routine HIV care within healthcare (HC) settings.MethodologyA cross-sectional survey was conducted among WLWH in twelve HC facilities throughout Nigeria. Data collection involved surveys focused on PC knowledge, attitudes, facilitators, and barriers. Logistic regression analyses were employed to examine the data.ResultsThis study revealed significant gaps in knowledge and attitudes towards PC among HIV + women at NISA-MIRCs. Over 90% were unaware of PC services, but many saw its potential to offer hope (55%) and improve quality of life (56.5%). The key predictors of PC knowledge included education, occupation, religion, having fewer children, urban residence, type of residence, and having a high income (p < .05). Despite the willingness to access PC, barriers such as negative HC worker attitudes, perceived high cost, and limited decision autonomy could hinder integration. Facilitators included low-cost services, positive HCW attitudes, physician recommendations, and perceived necessity for personal well-being.ConclusionKnowledge gaps, diverse attitudes, and significant barriers highlight the need for targeted PC interventions for WLWH. Tailoring educational programs, addressing cost barriers, and improving healthcare infrastructure are crucial to enhancing PC accessibility and quality. These findings can guide policymakers and HC practitioners toward more effective and inclusive care strategies.

Bridging the Digital Disability Divide: Determinants of Internet Use among Visually Impaired Individuals in Thailand

This study investigates the sociodemographic and contextual determinants influencing Internet usage among individuals with visual impairments in Thailand, contributing to the literature on the digital disability divide. Data from the “Disability Survey 2022” conducted by the National Statistical Office of Thailand were used. Descriptive statistics, chi-square tests, and logistic regression analysis were performed on data from 5621 visually impaired respondents. The findings indicate that approximately 26.88% of individuals with visual impairments use the Internet. The logistic regression analysis highlights several critical disparities. Males exhibit lower odds of Internet use compared with females (adjusted odds ratio [AOR] = 0.850, p = 0.034). Younger individuals are more likely to use the Internet; a decline in use was observed with increasing age (AOR for 60+ years = 0.052, p &lt; 0.001). Regional disparities are evident. Individuals from the northeastern (AOR = 2.044, p &lt; 0.001), central (AOR = 1.356, p &lt; 0.008), and southern (AOR = 1.992, p &lt; 0.001) regions showed higher odds of Internet use compared with those from the northern region. Higher income (AOR for 5000–9999 THB = 1.798, p = 0.001), educational attainment (AOR for bachelor’s degree = 14.915, p &lt; 0.001), and wealth index (AOR for wealthy = 5.034, p &lt; 0.001) increase the likelihood of Internet use. Employed individuals are more likely to use the Internet (AOR = 3.159, p &lt; 0.001) compared with unemployed individuals. Additionally, the severity of the visual impairment is crucial, with those having low vision in both eyes more likely to engage online than those who are completely blind in both eyes (AOR = 5.935, p &lt; 0.001). These findings highlight the need for comprehensive digital inclusion initiatives that address various factors, including age-inclusive digital literacy programs, targeted regional infrastructure development, economic support to improve digital access, and advancements in assistive technologies. This study provides valuable insights for policymakers in Thailand and other developing countries, enhancing the understanding of the digital disability divide and informing strategies to foster greater digital equity.

Has socioeconomic inequality in perceived access to health services narrowed among older adults in China?

ObjectiveTo analyze the degree, evolution and causes of socioeconomic inequality in perceived access to health services among the older adults in China.MethodsThe data used in this study were drawn from the 4 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2008, 2011, 2014, 2018. Erreygers index (EI) was used to measure socioeconomic inequality in perceived access to health services in each survey wave. A panel logit regression model was used to examine the impact of socioeconomic status on perceived access to health services. The recentered influence function (RIF) regression decomposition method was used to explore the causes of socioeconomic inequality in perceived access to health services. Inverse probability weighting (IPW) was employed to adjust estimates for missing responses and loss to follow-up.Results“Pro-rich” socioeconomic inequality in perceived access to health services in China was found with inequality falling through time. The older adults with higher incomes, who had adequate financial support, and those who were wealthier compared with other residents reported lower socioeconomic inequality in perceived access to health services. Having basic health insurance and access to care resources when ill can help alleviate such inequalities.ConclusionsSocioeconomic inequality in perceived access to health services was shown to be responsive to policies that enhance health insurance coverage and support the provision of (paid and unpaid) caregiving for the older adults.

Understanding parental preference for childcare: a cross-sectional study in Chongqing, China.

This study analyzed the factors influencing childcare preference and the relationship between childcare preference and childcare service demand scale, using data collected from a questionnaire survey of 3,921 parents of infants and toddlers in Chongqing, China. The results indicate that parents with higher incomes, higher education levels, older ages, multiple infants, and dual-career living in urban areas have a stronger preference for childcare. In the shared or grandparent care model, the childcare preference is not obvious. Parents of infants tend to choose childcare institutions that provide reception services, early education, and convenience services. Higher quality environmental facilities tend to reduce the preference of parents for childcare.

Sex-Specific and Long-Term Trends of Asthma, Allergic Rhinitis, and Atopic Dermatitis in South Korea, 2007–2022: A Nationwide Representative Study

Introduction: Although sex differences in allergic diseases such as atopic dermatitis (AD), allergic rhinitis (AR), and asthma are considered important, a limited number of studies during the COVID-19 pandemic investigated this aspect. Therefore, this study aimed to analyze sex-specific and long-term trends and risk factors for allergic diseases before and during the pandemic. Methods: This study utilized data from the Korea National Health and Nutrition Examination Survey, 2007–2022, including 92,135 participants aged 19 years and older. This study used weighted multivariate regression analysis to examine the estimates of related factors and assessed weighted odds ratios or β-coefficients for these factors across multiple categories. Results: During the study period (2007–2022), the prevalence of AR was more common in females than in males. Particularly in 2022, the prevalence among females was 19.3% (95% confidence interval, 17.3–21.3), while among males, it was 15.6% (13.8–17.4). The prevalence of AD and asthma showed a slight disparity between males and females. Before and during the pandemic, the prevalence of AD and AR showed a continuous increase (AD: from 2.8% [2.5–3.2] in 2007–2009 to 4.7% [3.9–5.4] in 2022; AR: from 11.7% [11.1–12.4] in 2007–2009 to 17.4% [16.0–18.9] in 2022), while asthma maintained a relatively stable trend. Moreover, this study identified several sex-specific factors that seem to be associated with a higher prevalence of allergic diseases in females, such as high household income, smoking, and being overweight or obese. Conclusions: Throughout all the periods examined, females consistently exhibited a higher prevalence of AR compared to males. Moreover, the risk factors for males and females varied depending on the disease, with females generally facing a greater number of risk factors. Consequently, this study highlights the necessity for sex-specific health interventions and further research to comprehend the complex influence of socioeconomic factors and lifestyle choices on the prevalence and risk of AD, AR, and asthma.

In-vitro and in-silico investigation of anti-obesity effect of Shorea tumbuggaia

The rising prevalence of obesity has become a significant concern in both high income and low income countries. Addressing obesity has challenges due to the limitations in current treatment options. Dietary modifications have become a common approach in managing obesity and its associated risks. The study was aimed atinvestigating the anti-obesity effects of the methanol extract of Shorea tumbuggaia, focusing specifically on its ability to inhibit pancreatic lipase activity. Shorea tumbuggaia stem bark methanolic preparation was screened for total phenolic content and subjected to phytochemical tests for presence of secondary metabolites. The pancreas of a chicken was used to extract the lipase enzyme. Lipase inhibitory activity of various methanol extract concentrations was assessed using olive oil as the substrate. Additional docking investigations of Shorea tumbuggaia components were made to investigate the role in regulating obesity and its associated issues.The study revealed that the extract has exhibited concentration dependent inhibition of pancreatic lipase activity. The study findings on Shorea tumbuggaia lipase inhibitory activity are encouraging which may be due to the existence of secondary metabolites causing the inhibitory action.

Social Markers of Differences in Fruit and/or Vegetable Consumption Among Brazilians: An Intersectional Analysis

Objective The objective of this study was to examine the differences in fruit and/or vegetable consumption (FVC) among Brazilian adults by examining various social markers, such as gender, race, income, and education level. Method A cross-sectional study of 88,531 Brazilian adults aged 18 years or older who participated in the 2019 National Health Survey was conducted. The dependent variable was irregular FVC (<5 d/wk). Individuals at the highest risk for irregular FVC include those who are men and Black and who have lower education levels and lower income. Individuals at lower risk include those who are women and White and who have higher education levels and higher income. The prevalence of irregular FVC was calculated considering the levels of the social risk index for FVC and the intersections among two, three, and four risk categories. Odds ratio (OR) and 95% confidence interval (CI) analyses were performed to compare groups at higher risk with those at lower risk. Results The prevalence of irregular FVC was 57.2% in the general population, 38.1% for individuals in the lowest risk group, 47.5% for individuals in one risk category, 57.9% for individuals in two risk categories, 67.6% for individuals in three risk categories, and 74.4% for individuals in the highest-risk group, and there were significant differences at each level. The highest risk group had a 4.36 (95% CI, 3.86–4.92) times greater chance of irregular FVC. Conclusions The complex path to promote FVC among the Brazilian population underscores the need for intersectoral policies aimed at reducing inequalities.

Fiscal Incidence of the Property Tax

We use data from Florida spanning a decade (2010–2019) to empirically revisit the topic of fiscal incidence, the difference between benefits received and taxes paid, as it applies to property taxation. We first estimate demand equations in order to calculate the Lindahl tax share, or price the median voter would be willing to pay for public goods. Our measure of fiscal incidence is the difference between the Lindahl tax share and the actual tax share. With the exception of police and fire expenditures, benefits tend to outweigh costs for those with higher incomes, a pattern we attribute to public goods being valued more by high-income residents who pay a modestly progressive property tax. Controlling for income, Hispanic and black residents have higher levels of fiscal incidence. We explore how policy reforms, including equitable property assessment, affects fiscal incidence.

Divided we abstain: Testing the effect of local income inequality on individual-level turnout using Norwegian administrative panel data

This paper investigates the relationship between income inequality and voting by utilizing exceptionally granular data that offer novel insights into local disparities. Existing research documents a larger turnout gap between rich and poor in areas characterized by high income inequality, causing concerns about further underrepresentation for low-income individuals and a larger democratic deficit. While previous studies have focused on inequality at higher aggregation levels, this paper advances the field by employing administrative data with complete income and validated voting records measuring inequality for neighborhoods hosting 1212 residents on average. The longitudinal setup allows rigorous modeling following the same individual in the same context over time. The results suggest that living in a neighborhood where the income difference between rich and poor becomes more pronounced discourages participation in national elections among low-income voters while it boosts participation among the rich, further accentuating the class-based inequality in political voice.

Parental stress interaction with environmental factors in childhood allergic asthma: Early life significance

Although stress and indoor/outdoor environments have been independently linked with asthma, their interactions on childhood physician-diagnosed allergic asthma (PDAA) remain undisclosed. We aimed to research the effect of parental stress and their interactions with indoor/outdoor environmental factors on childhood PDAA. A retrospective cohort study was undertaken of preschoolers at Changsha, a city in central China. We collected information on parental stress levels and various indoor environmental exposures, through questionnaire surveys. Outdoor air pollution exposure was obtained from ten ambient pollution monitoring stations in Changsha, and individual pollution exposure were calculated. Using logistic regression models, we assessed the individual and synergistic impacts of parental stress and indoor/outdoor factors on childhood PDAA. We found that preschoolers' PDAA showed a significant association with high parental gross annual income and psychological stress indicators including fatigue, headache, and inattention, with ORs = 2.10 (1.31–3.35), 1.38 (1.04–1.82), 1.33 (1.07–1.65), and 1.42 (1.14–1.76), respectively. Furthermore, in preschoolers with high parental economic stress, the association between indoor mold/moisture spots and PDAA was notably more pronounced. Significantly stronger association between outdoor SO2 exposure in the past year in preschoolers with socially stressed parents. Parental headache and inattention exacerbated the effects of PM2.5-10 and PM10 exposure during the 7-9th months before pregnancy and throughout the pregnancy on PDAA. Preschoolers with high parental psychological stress and high exposure to outdoor atmospheric pollutants showed an increased likelihood of developing PDAA. Our research suggests that both parental stress and its interaction with hazardous environments from indoor sources and atmospheric pollutants contribute to PDAA.

Smoking: Profile of an Elderly Sample in the City of Porto Alegre-RS/Brazil

Objective: The objective of this study is to determine the profile of smokers in a sample of elderly people served by the Family Health Strategy (ESF) in the city of Porto Alegre/RS. Theoretical Framework: Smoking is one of the main risk factors for several chronic diseases, including cardiovascular disease, cancer, chronic obstructive pulmonary disease (COPD) and several other conditions. Although the number of smokers is declining in many countries, the impact of smoking remains a significant public health concern. Method: Cross-sectional study with prospective data collection involving a sample of 567 elderly people. 30 ESF teams from different Health Districts were chosen through a stratified random draw and 36 elderly people were selected from each team. Results and Discussion: The prevalence of smoking was 21.5%, with a higher prevalence in men (26%). Widowed elderly people had less history of smoking (47.8%), as did retired elderly people (54.7%), religious practitioners (50.7%) and those with higher incomes. An increase in prevalence was observed in elderly people who stopped smoking, with an increase in age groups. Research Implications: The research can provide specific data on the profile of elderly smokers in Porto Alegre, allowing public policies to be created or adjusted to more effectively serve this population. Originality/Value: While many studies on smoking focus on younger populations or middle-aged adults, the choice to specifically study smoking among older adults is less common and therefore fills a significant gap in the literature.

Maternal immigrant status and survival among children with congenital heart disease

ObjectiveTo examine associations between maternal immigrant status and survival of children with congenital heart disease (CHD). ApproachA retrospective population-based cohort study of hospital live births between April 2002 to September 2020 in Ontario, Canada was conducted at ICES. We identified children aged 0-17 years with a diagnosis of CHD from inpatient and health services datasets. The exposure was maternal immigrant status obtained from the IRCC permanent resident database. The outcome was time-to-death from after birth to &lt;18 years olds. Multilevel Cox hazard regression models generated hazard ratios (HR) for associations between maternal immigrant status and children’s deaths while accounting for hospitals as a cluster factor and adjusting for maternal age at birth, neighbourhood income and education quantiles, comorbidities, a composite of severe maternal morbidity, gestational age at birth, birth weight, and infant sex. ResultsRelative to children born to non-immigrant mothers, the adjusted HR for death was 1.17 (95% CI:1.06-1.30) in children whose mothers were immigrants, and 1.33 (95% CI:1.07-1.65) in those from refugees. Moreover, compared to children residing in neighbourhoods with the highest income and educational levels, the adjusted HR of death for children who lived in neighbourhoods with the lowest income and educational level was 1.52 (95% CI: 1.24-1.88) and 1.47 (95% CI: 1.18-1.83) respectively. ConclusionChildren with CHD born to immigrant and refugee mothers, and those living in low socioeconomic status neighbourhoods had worse mortality. Health policy decision makers should target children with CHD from immigrant/refugee families and disadvantaged neighbourhoods to improve their survival.

Minor Ailments and Pharmacist Management in Ontario, Canada: Attachment and Primary Care

Minor ailments (MA) are health conditions that can be managed with minimal prescribed treatment and/or self-care strategies. In Ontario, Canada, pharmacists were given authority to deliver service for thirteen MAs on January 1, 2023, with an additional six MAs on October 1, 2023. This study aims to identify patterns of MA service provision and describe characteristics of recipients of MA services. A cross-sectional analysis of linked health administrative data, including pharmacist billing for MA services, patient demographics, and physician and hospital billing data, was conducted. Delivery of MA services prescribed in Ontario from January 1 to December 31, 2023 were analyzed with key demographics (age, sex, income, new arrival status, comorbidity), health care utilization (ED, hospitalization) and primary care attachment. In 2023, 547,673 (3.6%) Ontario residents received at least one MA service, with the top 5 services being urinary tract infections (199,282), conjunctivitis (153,021), herpes labialis (46,659), allergic rhinitis (41,521), and dermatitis (39,365). Compared to all Ontario residents, the MA service recipients were more likely to be people with a higher rate of ED visits (41.7% vs. 32.4%), comorbidities (17.5% vs. 9.7%), higher incomes (highest income quintile, 23.1% vs. 20.1%; lowest income quintile, 16.5% vs. 19.4%), and hospitalizations (23.6% vs. 17.6%), and less likely to be newcomers to Ontario (8.7% vs. 13.1%). They were more likely to be attached to a primary care provider (91.3% vs. 84.7%). This study provides insight into early users of this program, and sheds light on those with systemic vulnerabilities and equity deserving groups.

Associations of prenatal maternal urinary concentrations of triclosan and benzophenone-3 with cognition in 7.5-month-old infants

BackgroundEndocrine-disrupting chemicals (EDCs) have been linked to adverse health outcomes and prenatal exposure is known to impact infant and child development. However, few studies have assessed early developmental consequences of prenatal exposure to two common phenolic compounds, benzophenone-3 (BP-3) and triclosan (TCS). ObjectiveWe evaluated the relationship of prenatal exposure to BP-3 and TCS with infant cognition at 7.5 months via performance on a visual recognition memory (VRM) task. MethodsDrawing from the Illinois Kids Development Study (IKIDS) cohort, prenatal exposure to BP-3 and TCS was assessed in pools of five urine samples collected from each woman across pregnancy. Cognition was measured in 310 infants using a VRM task assessing information processing speed, attention, and recognition memory through infrared eye-tracking. Generalized linear regression estimated exposure-outcome associations, followed by stratification to investigate modification of associations by infant sex and stimulus set. ResultsSampled mothers were more likely to be white, college educated, and middle or high income relative to the US population. Mean chemical exposures were significantly higher than those of adult women in the NHANES cohort. In models adjusted for income, gestational age at birth, and testing age, prenatal BP-3 exposure was associated with an increase in run duration (average time spent looking at the stimuli before looking away) (β = 0.0011, CI -0.0001:0.0022), indicating slower information processing speed, while TCS was associated with significantly longer time to familiarization (time to accrue a total of 20 s of looking time to the stimuli) (β = 0.0686, CI 0.0203:0.1168, p < 0.01), indicating poorer attention. Stratum-specific analyses isolated both effects to male infants who viewed the second of two stimulus sets. ConclusionHigher prenatal exposure to triclosan was associated with poorer attention in infancy, while benzophenone-3 may be associated with slower information processing speed, particularly among males.

Chains of misery: surging invasive group A streptococcal disease.

We describe the epidemiology of the recent global surge in invasive group A streptococcal (GAS) disease and consider its proximate and distal causes. We highlight important knowledge gaps regarding clinical management and discuss potential strategies for prevention. Rates of invasive GAS (iGAS) disease were increasing globally prior to the COVID-19 pandemic. Since mid-2022, following the worst years of the pandemic in 2020 and 2021, many countries with systems to monitor GAS syndromes have reported surges in cases of iGAS concurrent with increased scarlet fever, pharyngitis, and viral co-infections. The emergence of the hypervirulent M1UK strain as a cause of iGAS, particularly in high income countries, is concerning. New data are emerging on the transmission dynamics of GAS. GAS remains universally susceptible to penicillin but there are increasing reports of macrolide and lincosamide resistance, particularly in invasive isolates, with uncertain clinical consequences. Intravenous immunoglobulin is used widely for streptococcal toxic shock syndrome and necrotizing soft tissue infections, although there is limited clinical evidence, and none from a completed randomized controlled trial. Intensive and expensive efforts at population-level control of GAS infections and postinfectious autoimmune complications have been only partially successful. The great hope for control of GAS diseases remains vaccine development. However, all modern vaccine candidates remain in the early development stage. In many countries, iGAS rates surged from mid-2022 in the aftermath of pandemic control measures and physical distancing. The emergence of a dominant hypervirulent strain is an important but incomplete explanation for this phenomenon. Clinical management of iGAS remains highly empirical and new data has not emerged. A vaccine remains the most likely means of achieving a sustainable reduction in the burden of iGAS.

Patient Factors Associated with Access to Outpatient Pediatric General Surgical Care in a Rural State

BackgroundWe sought to understand factors impacting timely access to outpatient pediatric general surgical care in a largely rural state. MethodsWe conducted a multi-site retrospective cohort study, evaluating patients <18 years referred for outpatient pediatric general surgical evaluation from 11/1/2017–7/31/2022. Outcomes included obtaining an appointment, completing an appointment, and undergoing an operation. Time to appointment and operation were calculated. Bivariate analysis and multivariable logistic regression were performed to evaluate for associations between patient factors and the primary outcomes, as well as delay to appointment. ResultsOf 5270 patients, mean age was 7.1 years (SD = 6) with 59% male. All patients obtained an appointment; 85% (n = 4498) completed an appointment within one year. Forty percent (n = 2092) underwent an operation. Mean times from referral to appointment and operation were 22.5 (SD = 33.4) and 81.5 days (SD = 137.5), respectively. Patients who identified as African American/Black (OR = 1.94, p < 0.001), had self-pay (OR = 6.33, p < 0.001), or lived >100 miles away (OR = 1.55, p < 0.001) were more likely to not complete appointments. Patients with high household income (OR = 0.70, p = 0.009) and private insurance (OR = 0.60, p < 0.001) were less likely to not complete appointments. Delay to appointment was associated with race (p = 0.020). Patients with private insurance (p < 0.001) and higher income (p = 0.020) were more likely to undergo operation. ConclusionFifteen percent of patients referred for outpatient pediatric general surgical evaluation did not complete an appointment within one year. Race, household resources, insurance, and travel distance were associated with completing appointments. Information about groups that have disparate access to care will inform interventions to improve this access. Type of StudyRetrospective Cohort Study. Level of EvidenceIII.

Disparities in adherence to physical activity guidelines among US adults: A population-based study.

The objective of this study was to determine adherence to national guidelines for aerobic and muscle-strengthening physical activity among United States (US) adults and identify factors associated with guideline nonadherence. The 2022 National Health Interview Survey data were analyzed to evaluate self-reported physical activity among 26,494 US adults. Adherence to national guidelines was defined as engaging in ≥150 minutes moderate-intensity or ≥75 minutes vigorous-intensity aerobic activity/week, and muscle-strengthening activity ≥2 days/week. A multivariable logistic regression model evaluated associations between 24 sociodemographic and health variables with nonadherence to physical activity guidelines. Shapley Additive Explanations were used to assess the relative importance of each factor in the model. The population-weighted analysis revealed that only 24.3% of US adults met both the aerobic and muscle-strengthening activity guidelines. The regression model identified 17 factors significantly associated with nonadherence. When evaluating the relative importance of these variables, older age, lower educational attainment, and lower household income emerged as the primary determinants of nonadherence. Guideline adherence was lowest among subgroups with multiple risk factors, with only 6.5% of older adults with lower income and education meeting the guidelines. In contrast, adherence was 42.7% in younger respondents with higher incomes and educational attainment. In conclusion, physical activity rates among US adults remain below public health targets, with significant disparities among sociodemographic groups. Expanded outreach efforts targeting higher-risk populations are urgently needed to address barriers, promote physical activity engagement, and achieve health equity.