Poor Research Articles

Modeling the potential effects of rooftop solar on household energy burden in the United States

Policymakers at the federal and state level have begun to incorporate energy burden into equity goals and program evaluations, aiming to reduce energy burden below a high level of 6% for lower income households in the United States. Pairing an empirical household-level dataset spanning United States geographies together with modeled hourly energy demand curves, we show that rooftop solar reduces energy burden across a majority of adopters during our study period from a median of 3.3% to 2.6%. For low- and moderate-income adopters (at or below 80% and 120% of area median income, respectively), solar reduces median 2021 energy burden from 7.7% to 6.2%, and 4.1% to 3.3%, respectively. Importantly, solar reduces the rate of high or severe energy burden from 67% of all low-income households before adoption to 52% of households following adoption, and correspondingly from 21% to 13% for moderate-income households. Here, we show rooftop solar can support policy goals to reduce energy burden along with strategies such as weatherization and bill assistance.

A geospatial analysis of neighborhood hot spots and socioeconomic disparities associated with high lung cancer incidence for targeted intervention in south Florida.

e22525 Background: This study aims to identify the locations as well as specific socioeconomic disparities associated with high lung cancer incidences in South Florida (SF). The information is used to develop strategies for increasing smoking cessation and lung cancer screening rates in underserved communities via community outreach and engagement (COE). Methods: Sylvester Comprehensive Cancer Center’s catchment area in SF was studied and consists of three urbanized counties (Miami-Dade, Broward, and Palm Beach) as well as one rural county (Monroe), with a total population of 6 million. Age-adjusted incidence of lung cancer was calculated (2010-2019 Florida cancer registry data) for every census tract in the study area. Geospatial hot spot analysis was then applied to identify statistically significant clusters of census tracts with high age-adjusted lung cancer incidences. Socioeconomic data (American Community Survey) and smoking rates (CDC Places data) associated with the hot spot census tracts were then analyzed for risk factor identification and potential barriers to screening. Results: Hot spots census tracts for lung cancer in SF are generally associated with lower socioeconomic status, including lower income, higher percent of people living in poverty, more households with no vehicles, lower education levels, and higher percent of active smokers. Such socioeconomic disparities are most pronounced in the two highly populated counties of Miami-Dade and Broward. Palm Beach County’s hot spots include retirement communities, while those in the rural county of Monroe have the highest smoking rates. Conclusions: Using this analysis, our COE team began targeting hot spot communities for intervention with a specific focus on those where smoking rates are high, and no lung cancer screening facilities exist. The results demonstrate the utilities of geospatial data analysis for identifying locations and population segments for which increased cancer prevention efforts are needed. Targeting neighborhoods with the identified disparities for increased intervention in smoking cessation and lung cancer screening can help a COE team reach at-risk populations with limited resources more effectively. [Table: see text]

Improving residential wood burning emission inventories with the integration of readily available data sources

Residential wood burning (RWB) is the largest anthropogenic source of PM2.5 in many North American and European cities in the winter. The current lack of information on the locations, types, and intensity of use of wood burning appliances limits the ability to accurately assess the exposure of the population to RWB emissions. In this study, we generated a high spatial resolution emission inventory for RWB in the province of Quebec, Canada using a novel data driven approach. The method first combines real estate and socioeconomic census data through machine learning models to estimate ownership rates of fireplaces and wood stoves. These ownership rates are then combined with household survey data (on wood consumption and types of appliances), emission factors and building registry data to generate the emission inventory at a 1Km2 resolution. Our proposed approach was able to capture spatial patterns in RWB appliance ownership and intensity of use, which may be overlooked by using simple urban vs rural or population based spatial proxies. The machine learning models explained 80.3 % and 63 % of the variability in wood stove and fireplace ownership rates with each appliance type exhibiting different spatial trends. Wood stoves were common in rural areas and among lower income households, whereas fireplaces were more common in urban areas. Additionally, we observed large spatial and regional variability in emissions per residence due to differences in wood consumption, appliance ownership rates, and appliance mixes (e.g. conventional vs certified). Our results suggest that using simple spatial proxies based on population, urbanization levels or residence type are not enough to explain the spatial distribution of RWB emissions as they might overlook other factors such as socioeconomic factors or regional heating preferences. Finally, our spatially distributed emissions were strongly correlated (r = 0.86) with the increase in PM2.5 concentrations during peak-RWB hours on winter weekends at 42 reference stations across the province of Quebec.

Perceptions of multi-cancer early detection (MCED) screening tests among underrepresented populations.

e22546 Background: Cancer is the second leading cause of death, with higher death rates observed among racial and ethnic minorities and individuals of lower income. MCED tests detect a shared cancer signal in plasma cell-free DNA. Beyond clinical/direct economic benefits, MCED may offer additional benefits (emotional, social, and/or behavioral) associated with a no cancer signal detected (NCSD) result, which might differ depending on socioeconomic status. This study aimed to explore the value of a NCSD result from the perspective of underrepresented individuals from the US general population. Methods: Qualitative interviews informed a cross-sectional online survey administered to adults aged 40-80 years without a cancer diagnosis within the last 5 years and not on cancer treatment. Soft quotas ensured a sample representative of the US population by age, gender, race, and ethnicity. The survey asked about the perceived value of a NCSD result from a hypothetical MCED test and collected sociodemographic and clinical information. Results were summarized descriptively. Results: The 1073 participants were 53% female, mean age 58 years (SD = 11), 67% non-Hispanic white, 12% non-Hispanic Black/African American, 12% Hispanic, 9% other or multiple races, 32% retired and 42% had less than a college degree. Regardless of income or race/ethnicity, nearly all participants (96-98%) viewed a NCSD result as somewhat or very valuable and anticipated maintaining or improving health behaviors (98-100%) and the majority expected positive emotional impacts (66-74%). However, minority groups were more likely than white participants to anticipate making lifestyle changes after a NCSD result (44-58% vs. 28%), increasing behaviors such as: exercising (61-75% vs. 47%), seeking health-related educational material (39-52% vs. 26%), eating healthy (58-78% vs. 47%), receiving vaccines (44-49% vs. 35%), maintaining/increasing adherence to recommended cancer screenings (22-29% vs 33% / 68-74% vs. 66%), and attending doctor visits (43-65% vs. 40%). Minorities also reported being more certain they would increase these behaviors than white participants. Lower to middle household income ( < $120,000) was associated with more positive impacts to self-care and monitoring health, relief, and happiness, and less fear, concern, anxiety, and stress after a NCSD result versus those with an income ≥$120,000. Conclusions: Regardless of income level or race/ethnicity, a negative MCED test result provides additional value to the US general population beyond traditional clinical benefits, has positive impacts on psychological/emotional health, and could promote adherence to or increase preventive healthcare behaviors. Importantly, racial/ethnic minorities and those of low to mid income anticipated greater positive impacts, specifically to preventive health behaviors with a negative MCED result.

Racial and gender disparities in the incidence of thyroid cancer using Nationwide Inpatient Database.

e18066 Background: This study aimed to conduct a comprehensive evaluation of the ethnic and gender disparities that exist in thyroid cancer. Despite the significant amount of research that has been conducted on the complex and multifaceted differences between races and genders in various forms of cancer, there is still a noticeable gap in the data available in patients with thyroid cancer. Therefore, this study comprehensively assessed these disparities and their potential impact on the risk of developing Thyroid cancer. Methods: Using the National Inpatient Sample 2020, we identified patients with Thyroid cancer as the primary diagnosis (local/regional and advanced metastatic). We analyzed baseline characteristics such as age, gender, insurance, and income status, and several comorbidities to assess the risk associated with Thyroid cancer. Log Binomial regression model was used to calculate the Risk ratios after adjusting for confounding variables. Results: A total of 6,471,165 patients were analyzed, and it was found that 7520 of them (0.1%) had Thyroid cancer. Among these patients, 44.8% were male, and 55.1% were female, p<0.001. Female patients demonstrated a higher risk of developing thyroid cancer as compared to males (RR= 1.41(1.27-1.57); p<0.001). Compared to white females, white males, black males and females exhibited a decreased risk of bladder cancer (RR=0.66(0.58-0.76),p<0.001; RR= 0.24(0.16-0.36),p<0.001 and RR= 0.53(0.40-0.68), p<0.001, respectively). Hispanic females (RR=2.67(2.26-3.16);p<0.001) and females of other races (RR=1.69(1.20-2.37); p=0.002) had increased risk of Thyroid cancer, while no difference in risk was noted in Asian males (RR= 0.38(0.09-1.56); p=0.18), females (RR= 0.94(0.39-2.28); p=0.90) and males of other races (RR=0.81(0.51-1.29); p=0.38). Compared to lower income group patients, patients with high incomes had an increased risk of thyroid cancer ($65,000-$85,999: RR=1.18(1.01-1.38), p=0.03 ; >$86,000: RR=1.30(1.10-1.52), p=0.001). The risk of thyroid cancer decreased with increasing age (36-45:RR=0.59(0.48-0.72),p<0.001; 46-64: RR= 0.25(0.21-0.29),p<0.001; >65: RR =0.24(0.19-0.30), p<0.001). Patients with Diabetes had decreased risk (RR= 0.31(0.27-0.36); p<0.001), while patients with Hypertension had increased risk of thyroid cancer (RR=1.30(1.16-1.47); p<0.001). Conclusions: The disparities in healthcare access and the unique challenges faced by high-risk groups have a profound impact on patients with thyroid cancer. A more comprehensive understanding of these disparities is essential to effectively support this vulnerable patient population and to identify preventive measures that can reduce the incidence of bladder cancer among high-risk demographic segments.

Surgical outcomes for non-small cell lung carcinoma by race and surgical facility types in the United States.

11167 Background: Successful outcomes of surgical treatment of cancer requires expertise and high-quality supportive services for surgical care. Previous studies have shown that case volume and availability of other in-house supportive services affect surgical outcomes. Latest studies have shown that this gap has now significantly reduced. Issues related to access, availability of funding for latest technologies and continuous medical education still exist and likely still impact the surgical outcomes. The objective of the study is to understand the impact of surgical center related factors on survival outcomes for cancer patients based on race and other demographic features. Methods: We conducted a retrospective analysis of patients diagnosed with Stage I-III Non-small cell lung cancer (NSCLC) between 2004 to 2020 using the National Cancer Database (NCDB). Patients were divided into 4 cohorts of NCDB assigned facility type (Community Cancer Program, Comprehensive Community Cancer Program, Academic/Research Program, Integrated Network Cancer Program). Racial and other demographic data was analyzed for each of the facility types. Differences in categorical variables were evaluated using a Chi-square test. Results: 298,393 adenocarcinoma and 129,144 squamous cell carcinoma patients underwent surgery for NSCLC between 2004-2020. 326,798 patients with clinical stages I-III were selected for the analysis. Most surgeries were performed at the academic/research programs and comprehensive community programs. Utilization of each facility type was uniform across all races. The 30-day mortality rate was lowest for the academic/research programs (Community Cancer Program 3.1%, Comprehensive Community Cancer Program 2.6%, Academic/Research Program 1.8%, Integrated Network Cancer Program 2.3%; p=0.000). 30-day mortality rate was higher for American Indian, Aleutian, or Eskimo racial subgroups amongst all age-groups at all the surgical facility types especially for Stage IIIB NSCLC (White: 6%, Black: 3.4%, American Indian, Aleutian, or Eskimo: 14.3%, p=0.006). For each race, the 30-day mortality rate was better at the academic/research programs. Females had lower 30-day mortality for all racial subgroups. Having private insurance was associated with the lowest 30-day mortality rate. This was noted for all races across all the facility types. Lower income status was associated with higher mortality rates across all facility types. This difference was statistically significant for white patients. Majority of patients had less than 10 days of length of stay at all the surgical facility types. Conclusions: Outcomes of NSCLC surgery are significantly better at academic/research programs where a higher number of procedures are performed and access to latest surgical technologies is available. Short-term mortality rates are higher for American Indian, Aleutian, or Eskimo racial subgroup.

The Association of County-level Prostate-specific Antigen Screening with Metastatic Prostate Cancer and Prostate Cancer Mortality

Background and objectiveThere exists ongoing debate about the benefits and harms of prostate-specific antigen (PSA) screening for prostate cancer. This study sought to evaluate the association of county-level PSA screening rates with county-level incidence of metastatic prostate cancer and prostate cancer mortality in the USA. MethodsThis ecological study used data from the 2004–2012 Behavioral Risk Factor Surveillance System (BRFSS) to build a multilevel mixed-effect model with poststratification using US Census data to estimate county-level PSA screening rates for all 3143 US counties adjusted for age, race, ethnicity, and county-level poverty rates. The exposure of interest was average county-level PSA screening rate from 2004 to 2012, defined as the proportion of men aged 40–79 yr who underwent PSA screening within the prior 2 yr. The primary outcomes were county-level age-adjusted incidence of regional/distant prostate cancer during 2015–2019 and age-adjusted prostate cancer mortality during 2016–2020. Key findings and limitationsA total of 416221 male BRFSS respondents aged 40–79 yr met the inclusion criteria and were used in the multilevel mixed-effect model. The model was poststratified using 63.4 million men aged 40–79 yr from all 3143 counties in the 2010 Decennial Census. County-level estimated PSA screening rates exhibited geographic variability and were pooled at the state level for internal validation with direct BRFSS state-level estimates, showing a strong correlation with Pearson correlation coefficients 0.77–0.90. A 10% higher county-level probability of PSA screening in 2004–2012 was associated with a 14% lower county-level incidence of regional/distant prostate cancer in 2015–2019 (rate ratio 0.86, 95% confidence interval [CI] 0.85–0.87, p < 0.001) and 10% lower county-level prostate cancer mortality in 2016–2020 (rate ratio 0.90, 95% CI 0.89–0.91, p < 0.001). Conclusions and clinical implicationsIn this population-based ecological study of all US counties, higher PSA screening rates were associated with a lower incidence of regional/distant prostate cancer and lower prostate cancer mortality at extended follow-up. Patient summaryUS counties with higher rates of prostate-specific antigen (PSA) screening had significantly lower rates of metastatic prostate cancer and prostate cancer mortality in subsequent years. These data may inform shared decision-making regarding PSA screening for prostate cancer.

Assessing survival effects of persistent poverty and payer status in non-elderly adults with lung or breast cancer.

1608 Background: Persistent poverty (PP), defined as area poverty ≥20% over 30 years has been associated with increased cancer incidence and worse survival. We examined 1) whether residing in a PP area has larger survival effects than areas with similar contemporary poverty rates; 2) whether adjusting for sociodemographics and payer status reduces PP effects; and 3) whether effects differ for relatively poor (lung and bronchus, LCa) vs good prognosis (female breast; BrCa) cancers. Methods: We used Surveillance, Epidemiology, and End Results (SEER) data linked to Medicaid and Medicare enrollment records (2007-2013), with census-tract level indicators for PP and current poverty (CP) as of 2010. We selected adults aged 19-64, diagnosed with LCa or BrCa. We created a hierarchical poverty status measure (PP, CP&gt;20%, CP 10-20%, CP &lt;10%). Primary payer at diagnosis (SEER) was edited using Medicaid and Medicare enrollment records. Covariates include patient sociodemographics (including age, race, sex (LCa only), marital status), rurality, and region. We used Cox proportional hazard models to estimate effects of poverty status and payer on survival, starting with a limited Model I (poverty status, rurality, and cancer stage), adding sociodemographics, region, and diagnosis year (Model II), plus primary payer (Model III). Results: Among LCa (BrCa) 8.8% (5.3%) of 70,964 (246,405) patients lived in PP areas, with 19.1% (13.7%) in areas with CP &gt;20%; primary payers included 51.9% (75.0%) private, 28.7% (16.9%) Medicaid, and 3.1% (1.1%) uninsured. For both cancers, adjusted hazard of death increased with increasing poverty levels; PP areas showed the highest risk (table). The magnitude of the poverty gradient was smaller for LCa vs BrCa. Adjusting for sociodemographic measures and primary payer reduced the magnitude of poverty status effects, particularly for BrCa. Conclusions: We observed significant but distinct associations of poverty status, including PP, with survival for non-elderly adults with LCa and BrCa. With better prognosis, BrCa patients have longer exposure to PP, which may increase the impact on outcomes. Person-level characteristics and health insurance are also key factors affecting care access and survival. These results highlight the need to consider both area context and personal socioeconomic characteristics when targeting and evaluating interventions to enhance survival outcomes. [Table: see text]

Universalism versus residualism: a micro-simulation of alternative income maintenance schemes in South Korea

This article examines the past, present and future of income maintenance schemes in Korea. Historically, income security schemes have been built on the idea of work-centred social insurance supplemented by social assistance. This approach was based on the premise of full employment. While current schemes have achieved institutional completeness and have contributed to alleviating poverty and inequality, they have exhibited limitations in responding to the qualitative shifts of capitalism, leading to welfare blind spots. Various alternatives have been proposed, such as universal basic income (UBI), which aims for equality, and residual Safety Income (SI), which aims for efficiency. The objective of this study is to validate the effects of basic income proposals and SI as alternative income maintenance schemes emerging in Korea. We simulated and compared the poverty alleviation and income redistribution effects of the two alternatives using data from the Survey of Household Finances and Living Conditions (2019~2021). The effects of poverty alleviation and income distribution were determined by analysing the hypothetical changes in absolute and relative poverty rates, as well as the Gini coefficient. The efficiency of benefits was assessed as the ratio of the amount used to reduce the poverty gap out of the total benefit amount. The study found that while SI appeared cost-effective in addressing absolute poverty, UBI was also effective in addressing relative poverty and income inequality.

Equity in the Setting of Heart Failure Diagnosis: An Analysis of Differences Between and Within Clinician Practices.

Timely heart failure (HF) diagnosis can lead to earlier intervention and reduced morbidity. Among historically marginalized patients, new-onset HF diagnosis is more likely to occur in acute care settings (emergency department or inpatient hospitalization) than outpatient settings. Whether inequity within outpatient clinician practices affects diagnosis settings is unknown. We determined the setting of incident HF diagnosis among Medicare fee-for-service beneficiaries between 2013 and 2017. We identified sociodemographic and medical characteristics associated with HF diagnosis in the acute care setting. Within each outpatient clinician practice, we compared acute care diagnosis rates across sociodemographic characteristics: female versus male sex, non-Hispanic White versus other racial and ethnic groups, and dual Medicare-Medicaid eligible (a surrogate for low income) versus nondual-eligible patients. Based on within-practice differences in acute diagnosis rates, we stratified clinician practices by equity (high, intermediate, and low) and compared clinician practice characteristics. Among 315 439 Medicare patients with incident HF, 173 121 (54.9%) were first diagnosed in acute care settings. Higher adjusted acute care diagnosis rates were associated with female sex (6.4% [95% CI, 6.1%-6.8%]), American Indian (3.6% [95% CI, 1.1%-6.1%]) race, and dual eligibility (4.1% [95% CI, 3.7%-4.5%]). These differences persisted within clinician practices. With clinician practice adjustment, dual-eligible patients had a 4.9% (95% CI, 4.5%-5.4%) greater acute care diagnosis rate than nondual-eligible patients. Clinician practices with greater equity across dual eligibility also had greater equity across sex and race and ethnicity and were more likely to be composed of predominantly primary care clinicians. Differences in HF diagnosis rates in the acute care setting between and within clinician practices highlight an opportunity to improve equity in diagnosing historically marginalized patients.

Urban poverty beyond ‘slums’: mapping its multidimensionality

ABSTRACT Indian urban poverty research identifies slums as pockets of poverty, but official sources in developing countries typically underestimate poverty in and overlook poverty outside slum areas. In this research, deprived areas of Bengaluru outside of officially recognised slums are identified. An Index of Multiple Deprivation (in human, financial and physical capital) is estimated and mapped at the ward level. The research finds that deprivations are mainly concentrated in the city’s periphery and that human capital deprivation is a more serious driver of poverty than financial crunch. While the spatial mapping exercise in the paper has been adapted to Bengaluru, the theoretical contribution to urban and regional studies we make is the promotion of ‘people-based policies’. We argue that, irrespective of where the poor live, assistance should be provided based on measures of capital deprivations. Such analysis will help people-based approaches to eradicate poverty.

Virtual Medicine Wards and Hospital-at-Home Programs

What Is the Issue? In 2021, the occupancy rate of acute care hospital beds in Canada was 86.7%. High occupancy rates without turnover to accommodate all hospitalization needs is an indicator of potential bed shortages and health system pressure. Patients have historically remained in hospital beds until their treatment or recovery is complete. Some patients may be well enough to continue their treatment or recovery at home sooner if provided with the right supports. What Are the Technologies? Virtual wards, also known as hospital-at-home programs, support the provision of inpatient-level acute medical care in a patient’s home. There are 2 main models of these programs: admission avoidance and supported early discharge. This report focuses on the latter type. Many of these programs are technology-enabled and incorporate remote monitoring devices to record the patient’s vital signs and tablets or web portals to facilitate data sharing. Video calls with the clinical team are also used in combination with in-person visits by health care providers. What Is the Potential Impact? Hospital beds can be freed up more quickly to provide space for newly admitted patients with more acute care needs. The safety and effectiveness of virtual ward programs have been examined in several systematic reviews in the existing clinical literature. Factors evaluated include mortality, length of stay, hospital readmissions, and costs as outcomes. Both admission avoidance and early supported discharge via hospital-at-home programs had lower or similar mortality and hospital admission outcomes as inpatient care after completion of care. Patients, caregivers, and health care providers appear to be generally satisfied with their participation in virtual ward programs. Comfort and satisfaction can be improved by allowing patients to receive treatment in a familiar and comfortable environment without compromising patient outcomes. However, increased caregiver burden, lack of sufficient training for participants and staff, and difficulties recruiting health care providers were identified as challenges associated with virtual ward programs. What Else Do We Need to Know? The level of technological support required by patients, caregivers, and staff participating in these programs should be considered when developing a program. Adequate training about how to use provided equipment and other tasks needed to manage care in the home (e.g., drug administration, symptom monitoring, communication with health care professionals) is required for patients and caregivers. There should also be provision of all necessary equipment with supports to overcome any barriers (e.g., visual impairment, physical limitations) to ensure comfort and proficiency. Care coordination and communication among the multidisciplinary care team, the patient, and their caregivers is important. Canadian cost data were not identified, but it is generally accepted that virtual ward programs are associated with reduced costs when compared with traditional in-hospital care. The inclusion of digital monitoring and record keeping technologies as part of virtual ward programs may disproportionately exclude people from some groups, including older people, people living in social housing or without housing, people with lower incomes, people who are unemployed, people living with disabilities, and people who live in rural areas without access to such programs. Key recommendations for development of virtual ward programs in Canada include using a single remote patient-monitoring platform that connects with the hospital’s electronic health record system, choosing a technology to connect patients and providers that best fits the needs of the virtual ward program, and ensuring data security, confidentiality, and data management protocols are in place.

Using explainable machine learning and fitbit data to investigate predictors of adolescent obesity

Sociodemographic and lifestyle factors (sleep, physical activity, and sedentary behavior) may predict obesity risk in early adolescence; a critical period during the life course. Analyzing data from 2971 participants (M = 11.94, SD = 0.64 years) wearing Fitbit Charge HR 2 devices in the Adolescent Brain Cognitive Development (ABCD) Study, glass box machine learning models identified obesity predictors from Fitbit-derived measures of sleep, cardiovascular fitness, and sociodemographic status. Key predictors of obesity include identifying as Non-White race, low household income, later bedtime, short sleep duration, variable sleep timing, low daily step counts, and high heart rates (AUCMean = 0.726). Findings highlight the importance of inadequate sleep, physical inactivity, and socioeconomic disparities, for obesity risk. Results also show the clinical applicability of wearables for continuous monitoring of sleep and cardiovascular fitness in adolescents. Identifying the tipping points in the predictors of obesity risk can inform interventions and treatment strategies to reduce obesity rates in adolescents.

Die Bevölkerungsperspektive in der Bewertung der Leistungsfähigkeit des deutschen Gesundheitssystems: Ergebnisse einer Querschnittsbefragung GKV-Versicherter

IntroductionSince the World Health Report in 2000, Health System Performance Assessment (HSPA) has been established as a tool for the evaluation and evidence-informed governance of health systems. So far, the population perspective has not been integrated into HSPA in a systematic manner, although people's experiences and expectations are of great importance to improve health systems and especially to strengthen patient-centered care. Therefore, this study aims to conduct an HSPA of Germany's health system from the population's perspective covering all eight goals of WHO’s Health Systems Framework, and to identify strengths and needs for improvement. MethodsIn 2018, 32,000 people insured with the German sickness fund ‘AOK Nordost’ were invited by mail to participate in the survey. The questionnaire contained a total of 43 items covering the eight goals of WHO's Health Systems Framework (e.g., access, quality, safety) plus socioeconomics and other characteristics of the insured persons. The data on the health system goals were analyzed descriptively and by subgroups (age, sex, income, chronic conditions, health literacy). ResultsThe sample (n=1,481; response rate 4.6%) was 54.8% female and had a mean age of 59.1 years (±18.5). Altogether, the participants saw several needs for improvement within the German health system. For instance, 60.0% found quality differences between hospitals to be big, and between 3.9% and 8.5% reported mistakes related to their treatment or prescription medication in the previous two years. A big need for reform was especially seen regarding out-of-pocket payments (51.5%) and the coordination of ambulatory care physicians among each other (44.2%) and with hospitals (41.9%). In addition, big subgroup differences were seen, especially for income and health literacy. Of the participants in the lower income group, 37.2% reported a (very) strong financial burden due to out-of-pocket payments (vs. 20.7%). People with limited health literacy (52.1%) assessed the access to care generally as not being good, and they perceived greater quality differences and needs for reform, compared to their counterparts. For instance, 36.6% had experienced discrimination in the previous year (vs. 19.9%). DiscussionThe survey results provide a comprehensive picture of Germany's health system from the population perspective. In some areas, previous findings were confirmed (e.g., a lack of coordination between providers). Other results expand existing knowledge (e.g., the role of health literacy in health care provision) or raise new questions (e.g., the difference between the subjectively assessed burden from out-of-pocket payments and the objective measures currently used). The great differences between subgroups are a call to action on the level of both politics and practice to better consider the individual's needs in order to make health better for everyone. Further research could provide deeper insights in this regard. ConclusionStrengthening the population perspective in HSPA allows for a better understanding and evaluation of health systems and, in particular, helps to identify areas for improvement in patient-centered care.

Digitalization and the Emerging Risk of Delinquency Among Emerging Adults Raised in a Wired World

Globally, the digital age has immensely contributed to the evolution and emergence of delinquency and social problems among emerging adults. As excellent as the tremendous benefits that technology has afforded these generations of youths raised in a wired world, some have decided to engage in the dark side of computer technology. The main aim of the study is to explore the how problematic internet use can influence development of delinquent behaviour among emerging adults in higher school of learning. It also explored the role of household financial capabilities of the emerging adults. The study adopted convenient sampling method to select n=386; (50.5% males and 49.5% females) who were aged between 16-27 years from University of Lagos. This cross-sectional study administered standardized instruments to examine the variables (Problematic internet use questionnaire, Disciplinary and delinquent behaviour survey) Result showed no significant difference between problematic internet use and emerging adult delinquency (t(384) = -1.29 P&gt; .05), also, no significant difference between the delinquency of participants from high or low income earners, t(373) = -1.93, P&gt; .05). Therefore, it is expedient to develop safety guidelines that will serve as interplay between digitalization and delinquency in which emerging adults must exercise restraint and broader range of delinquency can be confirmed among other samples.

The distributional effects of oil supply news shocks

This paper uses high frequency data on the distribution of US income to investigate the heterogeneous effects of oil supply news shocks. Using a FAVAR with an external instrument, We show that these shocks have large negative effects on the left and right tail of the distribution. For low income individuals, the effect is driven by a decline in wages and proprietor’s income, while a fall in corporate profits and interest income drives the effect for affluent individuals.

Determinants of birth registration and certification in Southwest Ethiopia: implication for a new strategy to achieve Sustainable Development Goals (SDGs)

Birth registration is a child's basic legal and social right that grants them presence and security in their lifetime. However, it was initiated very recently, and its magnitude has not been well examined in Ethiopia. Therefore, this study assessed the magnitude of birth registration of children under two years old in Southwestern Ethiopia. This community-based cross-sectional study was conducted on randomly selected 689 mothers or caregivers who had children less than 24 months from 15 April 2023 to 05 June 2023. The study was carried out in Bench Sheko Zone, located in the South West Region of Ethiopia. Face-to-face interviews were used to collect data. Multivariable logistic regression was performed to determine the factors associated with birth registration. In this study, 26.4%, 95% CI (23.2–29.6%) children were registered for birth. Mothers/caregivers who had a notification about birth registration and certification during pregnancy (AOR = 21.8, 95% CI 11.7–40.9) and information about birth registration after delivery (AOR = 3.9, 95% CI 1.4–11.3) were more likely to register for birth and certification compared to their counterparts while mothers/caregivers who had lower income and poor knowledge were less likely to register for birth and certification of their children. The region's current birth registration rate is low, with only one-fourth of all births registered. Birth notification, information about birth registration, knowledge and income level were all significant predictors of registration. Key strategies such as improving information dissemination, promoting institutional deliveries, empowering economic capacity, and increasing community engagement for improving the current birth registration level are needed to ensure that every child's birth is officially recognized. Subsequently, this will establish a foundation for achieving sustainable development goals (SDGs).

Association of childbirth experience with long–term psychological outcomes: a prospective cohort study

BackgroundThere has been limited research on the lasting impact of giving birth on both mothers and infants. This study aimed to investigate women’s memories of their childbirth experience 4 months and 4 years after giving birth. Additionally, it aimed to examine how the childbirth experience is linked to women’s mental health, sexual satisfaction, exclusive breastfeeding, and the type of subsequent birth.MethodsIn this prospective cohort study, a total of 580 women giving birth in Tabriz hospitals in 2018 were followed up for 4 years. The data were collected using a childbirth experience questionnaire, a mental health inventory, and a sexual satisfaction scale for women, and were analyzed by a Pearson correlation test, an independent samples t-test, and a general linear model.ResultsThe total scores of the childbirth experience in two short-term (4 months) and long-term (4 years) time points following the birth had a significant and strong correlation with each other (r = .51; p < .001). After adjusting for the effects of socio-demographic and obstetric characteristics, sexual satisfaction had significant relationships with childbirth experience (p < .001) and postpartum complications (p < .001). In addition, mental health had significant relationships with childbirth experience (p < .001), postpartum complications (p < .001), and low income (p = .004).ConclusionsEven 4 years after giving birth, women have a clear recall of their childbirth experience. This experience has a significant association with long-term outcomes such as sexual satisfaction, mental health, exclusive breastfeeding, and subsequent birth type.

Diabetes control in public assistance recipients and free/low-cost medical care program beneficiaries in Japan: a retrospective cross-sectional study

IntroductionPrevious research has highlighted the association between socioeconomic factors and diabetes management. This study aimed to elucidate the blood glucose control status among individuals with low income (ie, recipients of...

COVID 19 and violence in Pregnant women: A short review

Introduction: COVID 19 pandemic made pregnant women more likely to experience domestic violence due to its unique circumstances and the unpreparedness of the health care systems. Event that led to increased episodes of violence. Purpose: This review aims to investigate the relationship between COVID-19 and violence in pregnancy. Methodology: Recent articles between the period 2019 to 2023 were included after searching Medline, Pubmed and Google Scholar. Results: The results spotted out that COVID-19 increased the prevalence of domestic violence comparatively to the period before the Pandemic due to lockdown which led the couples spending more time together and the lowest incomes. It also showed that there were negative impacts in both pregnant women and fetus, such as miscarriages and psychological impacts to women. While highlighted the need of better organized health care systems and public awareness. Conclusions: Public awareness and more supportable health care systems could help in the early recognition of pregnant women at risk and reduce the phenomenal of violence during pregnancy.