Higher Levels Of Educational Attainment Research Articles

Enhancing Operations for Sustainability in Indonesian SMEs through Climate Change Awareness and Business Orientation

This study aims to identify the level of climate change awareness among small-medium scale entrepreneurs (SMEs) and to investigate its impact on future business orientation, with individual self-perception acting as a mediating variable. Addressing a significant gap in the literature, this research explores the reciprocal influence between SMEs and climate change—an area previously underexplored. Conducted in West Sumatra, Indonesia, this study employs a quantitative causal analysis approach using Structural Equation Modelling-Partial Least Squares (SEM-PLS) for robust analysis. The findings indicate that while awareness and self-perception of climate change among SMEs are low, they significantly influence potential changes in business orientation. The study reveals that although many SMEs possess a high level of educational attainment, this does not necessarily translate into heightened awareness or self-perception regarding climate change. This disconnect underscores the critical role of tailored educational initiatives and support systems to bridge the gap between knowledge and action. Additionally, the study finds that SMEs often prioritize immediate financial stability over long-term environmental sustainability, driven by the necessity to meet daily operational demands. These results underscore the urgent need for pre-emptive government policies to guide SMEs toward sustainable practices. Effective interventions should include financial incentives, technical assistance, and educational programs designed to enhance climate change awareness and capabilities among SMEs. Furthermore, this study contributes to the field of industrial engineering by identifying opportunities to optimize SME operations. By integrating environmental sustainability into business strategies, SMEs can enhance their resilience and competitiveness while contributing to broader environmental goals. This research advances the understanding of the dynamic interplay between SMEs and climate change, providing a foundation for future studies aimed at promoting sustainable industrial practices.

Proximity to public green spaces and depressive symptoms among South African residents: a population-based study

BackgroundExposure to green spaces has been suggested to improve mental health and may reduce the risk of depression. However, there is generally limited evidence on the association between green spaces and depression originating from low-and middle-income countries and Africa in particular. Here, we investigate the association between proximity to public green spaces and depressive symptoms among residents of Gauteng Province, South Africa.MethodsWe used data from the 2017/2018 Gauteng quality of life survey. We included all individuals aged 18 years or older residing in the nine municipalities of Gauteng Province that completed the survey (n = 24,341). Depressive symptoms were assessed using the Patient Health Questionnaire-2. Proximity to public green spaces was defined as self-reported walking time (either less or greater than 15 min) from individuals’ homes to the nearest public green space. To assess the association between access to public green spaces and depressive symptoms, we used mixed-effects models, adjusted for age, sex, population group (African, Indian/Asian, Coloured (mixed race), and White), educational attainment, and municipality. We additionally performed stratified analyses by age, sex, educational attainment, and population group to evaluate whether associations differed within subgroups. Associations are expressed as prevalence ratios (PR) and their 95% confidence intervals (95% CI).ResultsWe observed a 6% (PR = 0.94, 95%CI = 0.92–0.96) prevalence reduction in depressive symptoms for individuals who reported that the nearest public green space was less than 15 min from their homes as compared to those who reported > 15 min. After stratification, this inverse association was stronger among females, individuals aged 35–59 years,those with higher levels of educational attainment, and Coloured individuals as compared to their counterparts.ConclusionOur findings suggest that public green spaces close to residential homes may be associated with a reduction in the occurrence of depressive symptoms among urban populations in resource-constrained settings like South Africa.

Knowledge, attitudes and practices of pregnant women regarding urinary tract infections living in peripheral areas of Pakistan: A questionnaire-based cross-sectional study

BackgroundUrinary tract infections (UTIs) are some of the most common infections affecting women during pregnancy, which – if left untreated – may lead to severe consequences for both mother and infant health. Low socio-economic status and educational attainment levels, inappropriate personal hygiene practices – especially in rural women – may lead to an increased risk of developing UTIs. The present study aims to assess the knowledge, attitudes and practices of pregnant women – who are living in peripheral areas of the Chakwal district, Punjab, Pakistan – regarding UTIs, according to the Health Belief Model (HBM). MethodsA descriptive, cross-sectional study was carried out using a 91-item questionnaire, including six HBM domains. Data collection was performed with convenience sampling among pregnant women in hospitals between July and September 2021. Statistical analyses (descriptive statistics, χ2-tests) were carried out using IBM SPSS 25.0. Results98.4% (n = 243) of the respondents were married, 77.7% (n = 192) were housewives, 41.7% (n = 103) attended up to an intermediate college education, while 43.7% (n = 108) were in their first trimester. Majority of women (81.8%) had positive attitudes towards UTI-related knowledge-acquisition, and most of them (94.7%) had good hygiene practices; on the other hand, only around half of the participants (55.5%) had acceptable knowledge levels. Advanced age (p = 0.005) and higher educational attainment levels (p = 0.025) were associated with better attitudes, while higher income levels were associated with better knowledge (p < 0.001). In the HBM domains, major obstacles noted by the respondents’ were finding it difficult to go for a urine/laboratory test and feelings of hesitation to refuse intimacy with their husband while having a UTI; on the other hand, good hygiene practices were not denoted as a barrier to prevent UTI occurrence. Participant age and the responses in the perceived benefits domain showed significant associations (p < 0.05). ConclusionAs attitudes towards learning were overwhelmingly positive, our results suggest that educational interventions may enhance rural women's knowledge regarding UTIs, which may helpful in the prevention of recurrent infections and the associated health risks for the mother and fetus.

Using latent class analysis to investigate enduring effects of intersectional social disadvantage on long-term vocational and financial outcomes in the 20-year prospective Chicago Longitudinal Study.

Class and social disadvantage have long been identified as significant factors in the etiology and epidemiology of psychosis. Few studies have explicitly examined the impact of intersecting social disadvantage on long-term employment and financial independence. We applied latent class analysis (LCA) to 20-year longitudinal data from participants with affective and non-affective psychosis (n = 256) within the Chicago Longitudinal Research. LCA groups were modeled using multiple indicators of pre-morbid disadvantage (parental social class, educational attainment, race, gender, and work and social functioning prior to psychosis onset). The comparative longitudinal work and financial functioning of LCA groups were then examined. We identified three distinct latent classes: one comprised entirely of White participants, with the highest parental class and highest levels of educational attainment; a second predominantly working-class group, with equal numbers of Black and White participants; and a third with the lowest parental social class, lowest levels of education and a mix of Black and White participants. The latter, our highest social disadvantage group experienced significantly poorer employment and financial outcomes at all time-points, controlling for diagnosis, symptoms, and hospitalizations prior to baseline. Contrary to our hypotheses, on most measures, the two less disadvantaged groups did not significantly differ from each other. Our analyses add to a growing literature on the impact of multiple forms of social disadvantage on long-term functional trajectories, underscoring the importance of proactive attention to sociostructural disadvantage early in treatment, and the development and evaluation of interventions designed to mitigate ongoing social stratification.

The effect of educational attainment on birthrate in Japan: an analysis using the census and the vital statistics from 2000 to 2020

BackgroundIn Japan, difference in birth rates depending on educational attainment has not been investigated. This study aimed to reveal birth rates in Japan depending on the highest level of educational attainment and their trends over the years using nationwide government statistics data.MethodsIndividual-level data from Vital Statistics and the Census from 2000, 2010, and 2020 were used for birth and population data, respectively. Data linkage was conducted for males and females in the Census and fathers and mothers in the Vital Statistics using information about gender, household, nationality, marital status, birth year, birth month, prefecture, and municipality for individuals. The birth rate was calculated by gender, a five-year age group, the highest level of educational attainment achieved, and year. In addition, the slope index of inequality (SII) and relative index of inequality (RII) were calculated to evaluate the degree of inequality in birth rates, depending on the educational attainment.ResultsBirth rates were higher in persons with lower educational attainment compared to those with a higher educational attainment among males and females in their twenties, while they tended to be higher in persons with higher educational attainment among those in their thirties and forties. Additionally, an increase in the birth rate from 2000 to 2020 was the largest in university graduates among males aged 25–49 years and women aged 30–49 years, and a decrease in the birth rate was the smallest in university graduates among males and females aged 20–24 years. As a result, SII and RII increased from 2000 to 2020 among males and females in their thirties and forties.ConclusionsIn conclusion, persons with higher educational attainment tended to have a relatively favorable trend in the birth rate compared with persons with lower educational attainment in recent decades. It suggested that enhanced administrative support for individuals with lower educational attainment or lower socioeconomic status may be required to ameliorate the declining birth rate in Japan.

THE ROLE OF AGRICULTURAL SUBSIDIES IN SHAPING YOUNG FARMERS' DECISION-MAKING IN THE GREEK AGRICULTURAL SECTOR

The Greek agricultural sector is grappling with a dynamic environment characterized by evolving policies, global market forces, and reduced protectionism. To effectively navigate these challenges, a paradigm shift toward a new development philosophy is imperative. This philosophy seeks to address structural issues, enhance technical and economic aspects, and strategically orient production towards crops that capitalize on the Mediterranean region's comparative advantages. This study explores Greek farmers' attitudes, expectations, and satisfaction levels in this evolving landscape, with a particular emphasis on assessing the impact of the Young Farmers 2021 program and demographic factors. Utilizing a questionnaire of 18 closed-ended questions, data were collected from 144 respondents, comprising 76 participants in the Young Farmers 2021 program and 68 non-participants. The survey encompassed inquiries into demographic and social variables and delved into the assessment of attitudes, expectations, and satisfaction levels. The collected data underwent rigorous analysis involving Non-Linear Principal Component Analysis and categorical regression. The examination yielded two discernible factor axes: „Challenges and Diminished Satisfaction“ and „Favorable Perceptions and Optimistic Prospects.“ Remarkably, Young Farmers 2021 program participants exhibited fewer hurdles, higher contentment, and a more sanguine outlook compared to non-participants. These disparities were statistically significant, underscoring the program's substantial influence. Furthermore, demographic attributes emerged as pivotal determinants. A higher level of educational attainment was correlated with diminished difficulties, augmented satisfaction, and more favorable perceptions and expectations. This underscores the pivotal role of educational initiatives in equipping farmers with the necessary acumen and skills to effectively surmount obstacles and cultivate optimism within the agricultural sector. In summary, this study underscores the noteworthy impact of the Young Farmers 2021 program on Greek farmers' attitudes, expectations, and contentment levels. Program involvement was associated with reduced challenges, heightened satisfaction, and a more positive outlook regarding the future of agriculture. Additionally, educational attainment surfaced as a pivotal factor in molding farmers' experiences and outlooks. These insights offer valuable guidance to policymakers and agricultural organizations, facilitating the development of targeted interventions and policies aimed at encouraging program participation and delivering educational resources. Keywords: agricultural subsidies, decision-making, financial considerations, policymaking. JEL: Q12; Q14; O2

Enhancing quality of life and medication adherence for people living with HIV: the impact of an information system

BackgroundThe widespread availability of antiretroviral therapy has led to improvements in life expectancy and thus an increase in the number of people living with HIV/AIDS (PLWHA) worldwide. However, a similar increase in the number of newly-diagnosed patients in Cyprus suggests the need for solutions designed to improve monitoring, planning, and patient communication. In this study, we aimed to determine whether the use of an information system to manage PLWHA might contribute to improved quality of life and critical adherence to prescribed drug regimens and ongoing medical care.MethodsA randomized controlled trial study was conducted in Cyprus based on information that we collected using the highly valid and reliable Greek translation of the World Health Organization (WHO) Quality of Life (QOL) HIV-BREF questionnaire to assess sociodemographic variables and patient compliance. We distributed 200 questionnaires before implementing a Health Medical Care (HMC) information system at our clinic. Six months after implementing this system, 68 of the completed questionnaires were selected, including two groups of 34 participants who had been assigned at random to the intervention or the control group. Participants included PLWHA aged ≥ 18 years who had been receiving antiretroviral therapy for more than 12 months between July 15, 2020, and July 15, 2022.ResultsThe changes in baseline to six-month scores reported for the intervention group were significantly higher than in the control group in all six subscales assessed with the WHOQOL-HIV-BREF questionnaire, as well as in the assessment of compliance. Furthermore, compliance with treatment was associated with higher scores in the questionnaire subscales, including physical health, psychological health, degree of autonomy, social relationships, life circumstances, and spirituality/religious/personal beliefs. We also identified specific demographic factors and behaviors that were associated with better compliance with scheduled medical care and the prescribed drug regimen. Specifically, men exhibited better compliance than women and younger PLWHA exhibited better compliance than the elderly as did individuals who reported a higher level of educational attainment. Additionally, individuals who did not use addictive substances, consumed less alcohol, and were managed using the monitoring information system all exhibited better compliance compared to those in the control group.ConclusionThe results of this study suggest that management of PLWHA via the use of an information system can contribute to improved QOL and drug compliance.

Gender norms and the gender gap in higher education

Cross-country differences in the gender gap of higher education attainment are large. In this paper, we study the role of gender norms for this particular gender gap. To isolate the effect of gender norms from institutional and economic factors, we investigate the decisions of second-generation immigrants in the United States to achieve at least a bachelor’s degree. We measure gender norms using economic outcomes as well as beliefs prevailing in the migrants’ parents’ country of origin. We find that gender norms explain part of the observed differences in the gender gap in attaining at least a bachelor’s degree. There is also a sizable effect of gender norms on gender gaps in higher educational attainment levels, such as a master’s degree or a Ph.D. We confirm the gender norms effect using a sample of siblings, which allows us to hold unobservable and observable household characteristics constant.

Characteristics and cognition of older adults engaged in lifelong learning

ABSTRACT Lifelong learning programs for older adults are suggested as a promising strategy to promote successful and active aging. This observational study utilized cross-sectional data from a nationwide survey administered to adults aged 65 and older who were recruited through nine Osher Lifelong Learning Institutes (OLLI). Data collected included general demographics, and measures of physical and mental health, cognitive ability, meaning and purpose, cognitive reserve, and successful aging. Descriptive characteristics of the population revealed a predominantly White, female population, the majority of whom were married, retired, and reported high levels of educational attainment. Participants reported high levels of physical and mental health, and meaning and purpose as measured by PROMIS® measures. High levels of cognitive reserve, self-reported cognitive ability, and successful aging were also found in this sample. Using references to the general aging adult population comparative analyses found OLLI participants reported significantly higher physical health and mental health, and cognitive reserve scores. This study provides additional context for understanding characteristics of older adults who are cognitively aging well.

Perceptions of the COVID-19 Vaccination Within a Convenience Sample of Sudanese Americans.

Sudanese American and other immigrant and refugee communities are at greater risk for exposure to COVID-19. This survey sought to better characterize COVID-19 vaccination practices, motivators, and drivers for hesitancy among Sudanese Americans. We developed an online, cross-sectional survey in English and Arabic distributed by Sudanese American community leaders in April 2022 with data stored anonymously in REDCap. Inclusion criteria were self-reporting being born within Sudan and living in the US within the last 2 years. Descriptive analysis tested survey responses for possible associations between the primary outcome, self-reported vaccination status, and questions regarding vaccination history, perspectives on vaccination, and demographic characteristics using Fishers Exact and Chi Squared Tests. Of 111 survey responses received, 107 met inclusion criteria. 93% of respondents reported COVID-19 vaccine uptake with the primary motivation to protect oneself from disease. The most cited reason for vaccine hesitancy was belief it had not been studied enough. The group that reported vaccination had higher levels of education (.032) and were more likely to perceive that COVID-19 vaccinations were able to reduce spread (.001), decrease severe outcomes (.004), and benefits outweighing their risks (.004). This survey population of Sudanese Americans demonstrated high levels of vaccine uptake (93%), far greater than either the corresponding US (78%) or Sudanese population (15%). It is likely that high levels of educational attainment moderated vaccine uptake, though our survey may not have had the power to fully evaluate vaccine hesitancy.

Differences in College Lecturers’ Ratings of Principals Instructional Leadership: A Jamaican Perspective.

The purpose of this quantitative study is to determine how lecturers rated their principals as instructional leaders and to examine the differences in lecturers’ ratings of principals’ instructional leadership based on the demographic characteristics of gender, age range, lecturing status, number of years current principals have been employed to the colleges. and the highest level of educational attainment of the current principals. A survey that adopted the Principal Instructional Management Rating Scale (PIMRS) was used to collect data from 170 participants purposively. Overall, lecturers had moderately high ratings of principals’ instructional leadership within the colleges. There were no statistically significant differences in the ratings of lecturers based on age range and the number of years the current principal has been employed within the colleges. Male lecturers rated their principal higher than female lecturers on the dimension of creating a positive college climate. Adjunct lecturers gave their principals a higher rating than full-time lecturers on the dimension of managing instructional programs. Principals that had a master’s degree as their highest educational attainment were rated higher by the lecturers on the dimension of defining the college mission. This study contributes to the body of knowledge by filling the gap at the college level.

Large-scale genome-wide association study to identify causal relationships and potential mediators between education and autoimmune diseases.

Epidemiological studies suggested a potential connection between education and autoimmune disorders. This study investigated the possible cause-and-effect relationship using a Mendelian randomization approach. We explored the causality between four education traits (n = 257,841~1,131,881) and 22 autoimmune diseases. The mediating role of smoking (632,802 individuals), BMI (681,275 individuals), alcohol (335,394 individuals), and income (397,751 individuals) was also investigated. Transcriptome-wide association study (TWAS) and enriched signaling pathways analysis were used to investigate the underlying biological mechanisms. Especially, higher cognitive performance was protective for psoriasis (odds ratio (OR) = 0.69, 95% confidence interval (CI) = 0.60-0.79, p = 6.12×10-8), rheumatoid arthritis (RA) (OR = 0.75, 95% CI = 0.67-0.83, p = 4.62×10-6), and hypothyroidism (OR = 0.83, 95% CI = 0.77-0.90, p = 9.82×10-6). Higher levels of educational attainment decreased risks of psoriasis (OR = 0.61, 95% CI = 0.52-0.72, p = 1.12×10-9), RA (OR = 0.68, 95% CI = 0.59-0.79, p = 1.56×10-7), and hypothyroidism (OR = 0.80, 95% CI = 0.72-0.88, p = 5.00×10-6). The completion of highest-level math class genetically downregulates the incidence of psoriasis (OR = 0.66, 95% CI = 0.58-0.76, p = 2.47×10-9), RA (OR = 0.71, 95% CI = 0.63-0.81, p = 5.28×10-8), and hypothyroidism (OR = 0.85, 95% CI = 0.79-0.92, p = 8.88×10-5). Higher self-reported math ability showed protective effects on Crohn's disease (CD) (OR = 0.67, 95% CI = 0.55-0.81, p = 4.96×10-5), RA (OR = 0.76, 95% CI = 0.67-0.87, p = 5.21×10-5), and psoriasis (OR = 0.76, 95% CI = 0.65-0.88, p = 4.08×10-4). Protein modification and localization, response to arsenic-containing substances may participate in the genetic association of cognitive performance on UC, RA, psoriasis, and hypothyroidism. According to mediation analyses, BMI, smoking, and income served as significant mediators in the causal connection between educational traits and autoimmune diseases. Higher levels of education-related factors have a protective effect on the risk of several autoimmune disorders. Reducing smoking and BMI and promoting income equality can mitigate health risks associated with low education levels.

A study on the sample representativeness of the Wisconsin Alzheimer’s Disease Research Center Clinical Core participants versus the Wisconsin state population

AbstractBackgroundUnderstanding how representative a research sample is compared to the population can help inform future recruitment planning, data analysis strategies, and interpretation of the generalizability of the findings. We compared the demographics, rural residence, neighborhood socioeconomic disadvantage, and vascular risk factors between the Wisconsin Alzheimer’s Disease Research Center (ADRC) Clinical Core participants versus the Wisconsin state adult population.MethodThe ADRC participant sample (n = 678) included all active participants as of November 30, 2021. The state population statistics were estimated using multiple national and state data sources. Differences between the sample versus the population were tested using the one‐sample z‐test, the one‐sample Wilcoxon signed rank test, the exact binomial test, and the exact Monte Carlo multinomial test. Except for age, comparisons were performed for two age groups: 45‐64 years and ≥ 65 years, separately.ResultThe ADRC participants are older than the state population. For each age group, compared to the state population, the ADRC participants include more women and greater proportions of Black and American Indians, have higher levels of educational attainment, have smaller percentages living in rural areas and more disadvantaged neighborhoods, and show lower vascular risks. The sample versus population differences are greater for the ≥ 65 years group (the group at higher risk for AD) than the 45‐64 years group for most metrics, however, are smaller for sex and neighborhood disadvantage.ConclusionThe ADRC targets recruiting middle‐aged and older adults with dementia, mild cognitive impairment, or increased risk for AD. Thus, the participants are not a suitable sample for epidemiology studies on AD prevalence. Oversampling underrepresented racial groups would alleviate the lack of statistical power associated with small or unbalanced sample sizes and increase the precision in effect size estimates for studies on racial disparities. Future recruitment should endeavor to include participants from a broader range of educational backgrounds and more residents in rural areas and disadvantaged neighborhoods. These subpopulations have inequitable access to quality health care and are at greater risk. Properly representing them in research would allow conclusions to be generalizable to these subpopulations and support policy making to meet their needs.

Racial and Ethnic Discrimination and Hypertension by Educational Attainment Among a Cohort of US Women

Although understudied, there are likely within-group differences among minoritized racial and ethnic groups in associations between racial and ethnic discrimination (RED) and hypertension risk, as minoritized individuals with higher educational attainment may more frequently encounter stress-inducing environments (eg, professional workplace settings, higher-income stores and neighborhoods) characterized by, for instance, exclusion and antagonism. To investigate educational attainment as a potential effect modifier of associations between RED and hypertension risk among US women; the study hypothesis was that the magnitude of associations would be stronger among participants with higher vs lower educational attainment. This is a nested case-control study using Sister Study data collected at enrollment (2003-2009) and over follow-up visits until September 2019. Among eligible US Black or African American (hereafter Black), Latina, and non-Hispanic White women without prior hypertension diagnoses, incidence density sampling was performed to select self-reported hypertension cases that developed over a mean (SD) follow-up 11 (3) years. Data were analyzed August 2022 to February 2023. Participants reported lifetime everyday (eg, unfair treatment at a business) and major (eg, mistreatment by police) RED via a self-administered questionnaire. Adjusting for sociodemographic characteristics, conditional logistic regression was used to estimate odds ratios (ORs) and 95% CIs for associations between RED and hypertension by educational attainment category at baseline (college or higher, some college, and high school or less) within racial and ethnic groups. Among 5179 cases (338 [6.5%] Black; 200 [3.9%] Latina; and 4641 [89.6%] non-Hispanic White) and 10:1 race and ethnicity- and age-matched control participants with a mean (SD) age of 55 (9) years at enrollment, half (49.9%) of women reported attaining college or higher education, and Black women with college or greater education had the highest burden of RED (eg, 83% of case participants with college or higher education reported everyday RED compared with 64% of case participants with high school or less education). Everyday RED was associated with higher hypertension risk among Black women with college or higher education (OR, 1.56 [95% CI, 1.06-2.29]) but not among Black women with some college (OR, 0.72 [95% CI, 0.47-1.11]), with evidence of both multiplicative and additive interaction. Results for Black women with high school or less education suggested increased risk, but confidence intervals were wide, and the result was not statistically significant but may be clinically significant (OR, 1.89 [95% CI, 0.83-4.31]). Educational attainment was not a modifier among other racial and ethnic groups or for associations with major RED. In this nested case-control study of RED and hypertension risk, chronic or everyday RED-associated hypertension disproportionately affected Black women with the highest levels of educational attainment.

The quality of older adults’ involvement in clinical communication with general practitioners: evidence from rural towns in Australia

ObjectiveA study was conducted about the putative links of older rural Australians’ health knowledge and preparation with their quality of involvement in patient-general practitioner (GP) communication during health intake visits. MethodsIt was a cross-sectional study between January 2021 and April 2022. The 32-item quality of involvement in communication scale was designed and incorporated into the SurveyGizmo software. This online survey was administered by sending an email request to the Renmark Rotary Club, which actively promoted this study across five rural towns in South Australia. 121 participants completed the surveys. Mean-sum scores were calculated based on the questionnaire responses to evaluate outcomes, specifically initiation of information, active participation, and emotional expression. We employed different methods including t-tests, ANOVA, and leaner regressions to analyse data. ResultsThe demographic profile of participants characterised by a female predominance (58.7%, 71/121), a majority falling within the 65‒< 70 age bracket (47.1%, 57/121), and a high level of educational attainment (58.7% had completed high school or higher, 71/121). Additionally, 35% of the participants predominantly spoke a language other than English at home. Regarding the initiation of information with GPs, the mean sum-score was (20.5 ± 3.7), indicating a marginally above-average level of engagement. Contrarily, the active participation was suboptimal, as suggested by a mean sum score of (35.9 ± 6.3). Furthermore, the emotional expression was relatively low, with a mean score of (13.9 ± 1.8). Substantial variations were discerned in the quality of patient-GP communication, contingent upon factors such as educational background, language spoken at home, health literacy, and preparatory measures for clinical visits. Participants who predominantly spoke a language other than English at home demonstrated significantly lower levels of information initiation with their GPs (P < 0.001). Higher educational attainment was positively correlated with increased active participation (P < 0.001). Enhanced health literacy and thorough visit preparation were significantly associated with increased levels of active participation (P < 0.001). ConclusionMeaningful engagement through recognition, empowerment, and support (health literacy programs) for older rural adults is suggested for improving their quality of involvement in communication with GPs.

Variations in cognition by human capital characteristics: a cross-sectional analysis of Brazilian older adults.

The productivity of individuals is assumed to decline upon reaching old age when cognitive ability is considered. This assumption is false, especially if the human development characteristics of people are analyzed, which highlights the need to recognize the heterogeneity among subpopulations. Using Wave two of the Brazilian Longitudinal Study on Aging, conducted from 2019 to 2021, this study explored the onset and speed of cognitive aging among older individuals aged at least 60 in Brazil, with reference to their education and income levels. It was observed that although higher human capital characteristics yielded results toward later cognitive decline, women benefited more from having higher educational attainment levels. Such a pattern was similar among men and increased income levels. Disparities in cognitive performance, whether from education or income, were greatest at age 60, and this advantage diminished as age progressed. Viewing the older population as homogeneous in terms of health function is restrictive. It should be recognized that variations in social status affect individuals' health status into old age and therefore their respective potential for productivity should be maximized.

Inequalities in dental services use by older adults in Chile according to eligibility for a national dental programme.

The objectives of this study were to determine the prevalence and trends in dental service use among Chilean older adults (60+ years) between 2006 and 2017; to assess the association between socioeconomic factors and dental service use and type (public/private) in 2017 and whether these differ by eligibility to a national dental programme (GES-60). This study involved secondary data analysis of five nationally representative cross-sectional surveys between 2006 and 2017. Trends were assessed for use of dental services and types of services used among 60-79-year-olds. Logistic regression models examined the association between use of dental services in 2017 and socioeconomic variables (income and education), accounting for covariates (age, gender, residence, ethnicity, cohabiting status, employment and disability). Estimated marginal means and odds ratios (ORs) were calculated to assess the association between socioeconomic variables and the outcomes by GES-60 eligibility. Across surveys, the average prevalence of use of dental services in the last 3 months was 5.0%. There was a slight increase in dental visits between 2006 and 2017. This trend was higher among GES-60 eligible individuals using public dental services. Inequalities were observed in regression analyses. Compared to the poorest quintile and those with no formal education respectively, the ORs were 2.36 (95% confidence interval (CI) 1.79-5.68) for the richest quintile and ranged from 2.91 (95% CI 1.49-5.68) to 6.43 (3.26-12.68) for each higher level of educational attainment. Inequalities were wider among GES-60 non-eligible than GES-60 eligible older adults for both outcomes. Socioeconomic inequalities were present among older adults regardless of GES-60 eligibility. However, these inequalities were more pronounced among non-eligible individuals. Our findings suggest a limited impact of GES-60 only among eligible older adults. Policies considering the needs of the whole older adult population are likely to have a stronger impact.

Exploring the causality between educational attainment and gastroesophageal reflux disease: A Mendelian randomization study.

Observational studies suggest that higher educational attainment (EA) contributes to the prevention and treatment of gastroesophageal reflux disease (GERD). However, the causality of this relationship is not supported by strong evidence. We used publicly available genetic summary data, including that on EA, GERD, and the common risk of GERD, to prove this causality. Multiple methods in Mendelian randomization (MR) were employed to evaluate the causality. The leave-one-out sensitivity test, MR-Egger regression, and multivariable MR (MVMR) analysis were applied to evaluate the MR results. Higher EA was significantly associated with lower GERD risk (inverse variance weighted method, odds ratio [OR]: 0.979, 95% confidence interval [CI]: 0.975-0.984, P <0.001). Similar results were obtained when the weighted median and weighted mode were used for causal estimation. After adjusting for potential mediators, the MVMR analysis showed that body mass index (BMI) and EA were still significantly correlated and negatively correlated with GERD (OR: 0.997, 95% CI: 0.996-0.998, P =0.008 and OR: 0.981, 95% CI: 0.977-0.984, P <0.001), respectively. Higher levels of EA may have a protective effect against GERD by having a negative causal relationship. Additionally, BMI may be a crucial factor in the EA-GERD pathway.

Are relative educational inequalities in multiple health behaviors widening? A longitudinal study of middle-aged adults in Northern Norway.

Educational inequality in multiple health behaviors is rarely monitored using data from the same individuals as they age. The aim of this study is to research changes in relative educational inequality in multiple variables related to health behavior (smoking, physical activity, alcohol intake, and body mass index), separately and collectively (healthy lifestyle), among middle-aged adults living in Northern Norway. Data from adult respondents aged 32-87 in 2008 with repeated measurements in 2016 (N = 8,906) were drawn from the sixth and seventh waves of the Tromsø Study. Logistic regression was used to assess the relative educational inequality in the variables related to health behavior. The analyses were performed for the total sample and separately for women and men at both baseline and follow-up. Educational inequality was observed in all the variables related to health behavior at baseline and follow-up, in both men and women. Higher levels of educational attainment were associated with healthier categories (non-daily smoking, physical activity, normal body mass index, and a healthy lifestyle), but also with high alcohol intake. The prevalence of daily smoking and physical inactivity decreased during the surveyed period, while high alcohol intake, having a body mass index outside of the normal range and adhering to multiple health recommendations simultaneously increased. The magnitude of relative educational inequality measured at baseline increased at the follow-up in all the variables related to health behavior. Differences were larger among women when compared to men, except in physical inactivity. Persistent and increasing relative disparities in health behavior between the highest education level and lower education levels are found in countries with well-established and comprehensive welfare systems like Norway. Addressing these inequalities is essential for reducing both the chronic disease burden and educational disparities in health.

Educational attainment and anxiety in middle-aged and older Europeans

We examined the relationship between educational attainment (EA) and anxiety symptoms in a sample of 77,792 individuals (median age = 64 years, 55% female) from the Survey of Health, Ageing and Retirement in Europe. Using logistic regression, we estimated odds ratio (OR) with 95% confidence interval (CI) for the association between EA (7 educational levels based on International Standard Classification of Education) and anxiety symptoms (12 or more points from the shortened 5-item version of the Beck Anxiety Inventory), adjusting for sociodemographic and health-related factors. We further explored whether the relationship varied by region, sex and age group. Independent of sociodemographic and health-related factors, higher levels of EA were associated with lower odds of anxiety symptoms. The magnitude of this association plateaued at first stage of tertiary education (OR 0.40; 95% CI 0.35–0.47, p < 0.001). The association was stronger in females, middle-aged individuals and in Central and Eastern Europe while not apparent in Northern Europe. Our findings suggest that individuals with higher education might be protected against anxiety throughout life. The protective effect of education against anxiety symptoms is more pronounced in less egalitarian regions and in females.