Low Socioeconomic Areas Research Articles

A Comparison of Pediatric Prehospital Opioid Encounters and Social Vulnerability

ABSTRACT OBJECTIVES This study explores the relationship between socioeconomic factors and pediatric opioid-related emergencies requiring naloxone administration in the prehospital setting, an escalating public health concern. METHODS A retrospective analysis of the National Emergency Medical Services Information System (NEMSIS) database was conducted, examining data from pediatric opioid-related EMS activations between January 2018 and December 2021. The Social Vulnerability Index (SVI) was used to gauge each incident's socioeconomic context and assess correlations between SVI scores and the likelihood of opioid-related activations and naloxone interventions. RESULTS A total of 7,789 pediatric opiate-related EMS activations were identified. Lower socioeconomic status (SES) areas (higher SVI scores) exhibited a decreased rate of opioid-related activations compared to lower SVI-scored areas but an increased frequency of naloxone administration. The analysis demonstrated that as socioeconomic status (SES) improves, the likelihood of opioid-related activations increases significantly supported by a significant negative linear trend (Estimate = -0.2971, SE = 0.1172, z = -2.54, p = 0.0112. On the other hand, naloxone administration was more frequently required in lower SES areas, suggesting an increased emergency response in these (Estimate = 0.05806, SE = 0.2403, z = 0.24, p = 0.8091). CONCLUSIONS The analysis highlights a statistically significant correlation between the SES of an area and pediatric opioid-related EMS activations, yet an inverse correlation with the likelihood of naloxone administration. These findings demonstrate that in lower socioeconomic areas, the total number of opiate-related EMS activations is lower; however, naloxone was more likely to be deployed during those activations. This underscores the need for further research to understand the disparities in opioid crisis management across different socioeconomic landscapes.

Correlates of food insecurity among university students in a low socioeconomic area

Abstract Background The prevalence of food insecurity (FI) is high and suggested to be growing among university students, with potential detrimental effects on their health status and academic performances. This cross-sectional study aims to identify the socioeconomic, demographic and lifestyle factors associated with FI among university students in a disadvantaged area. Methods An anonymous online survey was conducted from Nov 2022 to Jan 2023 among students enrolled at University Sorbonne Paris Nord, located in a low socioeconomic area in France. FI was assessed with one question distinguishing 2 levels of FI: quantitative (i.e. not having enough to eat) and qualitative (i.e. not having the desired food). This abstract focused on quantitative FI. To improve the representativeness of the sample compared to the total student population of the university, sample weights were used according to gender, study level and speciality, whether they were undergoing initial training or not, or obtained their baccalaureate abroad or not. Multivariable multinomial logistic regression models were used to identify factors associated with FI. Results A total of 5068 students provided valid answers (20% of the target population), 66% of whom were women, and 12% and 36% reported quantitative and qualitative FI, respectively. Being a man, an undergraduate, having obtained a baccalaureate abroad, not living in the family home, not receiving food from family, having no household food-heating facilities, reporting financial difficulties, relying on food charity and eating alone on a regular basis were positively associated with quantitative FI (P < 0.0001). Those reporting quantitative FI were more likely to report academic difficulties. Conclusions This study shows a high prevalence of FI in this student population and identifies several associated factors. Identifying students at greater risk of FI is an important first step to design and evaluate public health interventions. Key messages • The different socio-economic backgrounds of university students imply important food insecurity disparities among them. • University students present several factors associated with food insecurity, which should be considered when addressing food insecurity in this population.

Lunchbox content and dietary outcomes of Dutch primary school children explored by sociodemographics

Abstract Background Most children fail to meet recommended guidelines for a healthy diet. Children living in low socioeconomic areas are less likely to have healthy eating behaviours. In this study we investigated the food Dutch primary school children bring from home, and their dietary, health and school related outcomes explored by sociodemographics. Methods 5 primary schools, with high deprivation scores and a high percentage of overweight, have been included in this study (ClinicalTrials.gov NCT06058325). With observations in September 2023 we mapped the content of lunchboxes, including snacks, of children. Questionnaires for all parents and children in grade 5-8 focused on dietary and health outcomes of children and perceived class factors. Preliminary baseline data were analysed using descriptive statistics. Exploratory analyses will be conducted to show differences by sociodemographics (e.g. age, sex, parental financial stress). Results 297 lunchboxes were observed, 98.7% contained sandwiches, half being brown bread. Most children brought fruit from home for either lunch or morning snack, 13.8% not at all. 21.9% brought vegetables. 135 children completed the questionnaire: 43.0% boys, mean age 9.3 years old (SD 1.12). Children ate fruit and vegetables on an average of 5.9 (SD 1.69) and 4.9 (SD 2.23) days a week. Whereas 80% of children eats fruit every day at school, only 20% of children eats vegetables every day at school. Most children perceived their health as good (89.3%) and felt happy (89.6%). On a scale of 1 (low) to 5 (high), they rated concentration, social climate and comfort in class an average of 3.8 (SD 1.05), 4.3 (SD 1.07) and 4.3 (SD 0.92) respectively. Conclusions Lunchboxes of Dutch primary school children mainly contain sandwiches. Whereas most children eat fruit at school, the majority of children do not eat vegetables at school. A healthy school lunch might increase vegetable consumption of children and could affect health and school related outcomes. Key messages • Most Dutch primary school children eat sandwiches during lunch at school, but in half of the cases this is not brown bread as recommended by nutritional guidelines. • Most Dutch primary school children bring fruit to eat as snack or lunch, but no vegetables to eat at school. The majority also self-reported the lack of eating vegetables at school on a daily basis.

Cat Caring Behaviors and Ownership Status of Residents Enrolling a Cat in a Free Sterilization Program.

Most cats entering animal shelters in Australia are less than 12 months old and emanate from low socioeconomic areas. Many are unidentified and may be either owned or semi-owned cats (cats cared for by someone who does not consider themselves the owner). In Australia, approximately 33% of cats entering shelters and pounds are euthanized annually, adversely affecting the mental health of staff involved. Our study investigated cat ownership and caregiving behaviors of cats enrolled in the Australian Pet Welfare Foundation's Community Cat Program, which included free sterilization, microchipping, and preventive healthcare. The suburbs targeted in Ipswich, Australia had a high per capita cat intake into animal shelters. We surveyed 1094 cat owners and semi-owners. Most cats were under 12 months old (79%), primarily domestic short-haired (69%), and acquired through informal channels such as friends, family, or as strays. Veterinary care was limited, with only 15% of cats having visited a veterinarian and 28% being vaccinated. Prior to hearing about the free sterilization program, 88.5% of participants identified as owners, while 11.5% were semi-owners. Before completing the survey, these semi-owners transitioned from an informal caregiving relationship to becoming owner of the cat/s. Of the semi-owners, 93% indicated that their transition to ownership was driven by feelings of responsibility, emotional attachment, and access to free sterilization services. These findings suggest that targeted interventions, such as accessible veterinary care and sterilization programs, are crucial in encouraging semi-owners to take full ownership of cats, improving cat welfare, and reducing unplanned breeding. Supporting this transition helps curb overpopulation and fosters improved caregiving, benefiting both cats and communities.

Co-creating innovative and accepted legume-based dishes for school canteens with adolescents in a low socioeconomic area

The promotion of sustainable diets, that valorise and give stage to plant-based foods, is beneficial for both human and environmental health. Adolescence is crucial to support healthy and sustainable eating. Despite this, adolescents remain an understudied group, especially those with a lower economic status. This study aimed to develop innovative, sustainable and healthy legume-based dishes for school canteens through co-creation with adolescents in a low socioeconomic status area with high immigration rate.Nineteen adolescents and four chefs participated in iterative sessions of focus group discussions using a combination of methods (Jobs-To-Be-Done, free association tasks, SCAMPER (Substitute-Combine-Adapt-Modify-Purpose-Eliminate-Rearrange) technique) to identify ideas of new legume-based dishes. Subsequently, 91 adolescents rated their willingness-to-try 28 dish concepts based on these ideas. Six concepts were selected and translated into prototypes that underwent further evaluation by 138 adolescents who assessed their liking, sensory and emotional responses.Results showed that all dishes were well-received, with lower acceptance among high-neophobic adolescents, yet none of the selected dishes were rejected. Exploring individual differences in liking identified two clusters with different hedonic patterns. Emotional characterization of dishes showed those that elicit positive emotional responses high in arousal and novelty in all adolescents, independently from food neophobia, increasing their likelihood of acceptance.The study shows that co-creation with adolescents, in combination with understanding individual differences, are promising strategies to develop innovative, healthy and well-received legume-based dishes for school canteens.

Are new pediatric trauma centers located close to the high-risk populations? A geolocation study.

Higher rates of injury occur in children who live in low socioeconomic areas. Since 2010, the number of verified Level I and Level II pediatric trauma centers (PTCs) has doubled. The purpose of this study is to look at the location of new verified PTC in relation to children living in high-risk areas. Historical and recent data about verified Level I and Level II PTCs were obtained from the American College of Surgeons (ACS), the American Trauma Society, and State Data where available. Census data were obtained from the US Census Bureau's American Community Survey for 2010 and 2020 for children younger than 18 years. The pediatric population was stratified by (1) poverty threshold and (2) living within 30 miles of PTC. The census data and trauma center locations were geocoded using the ArcGIS Pro program. Data analysis was performed at the census tract level. A total of 55 Level I or Level II ACS-verified PTCs were in the United States in 2010 and 116 in 2020. In 2010, there were 14.5 million children (19.6%) below the poverty threshold and 12.9 million (17.8%) in 2020. In 2010, 23 states did not have an ACS-verified PTC either in the state or in a neighboring state within 30 miles. By 2020, only nine states did not have an ACS-verified PTC or a center in a neighboring state within 30 miles. When state level data were included, this dropped to four. The 19 states who had new verified PTCs covered between 14% and 21% of children below the poverty level. The percentage of children below the poverty threshold and less than 30-mile access to a Level I or Level II PTC in 2010 was 74.56% compared with children above poverty and less than 30-mile access, which was 70.34% (p < 0.0001). In 2020, children below poverty without 30-mile access had been reduced to 52% and 45.54% for children above poverty level (p < 0.0001). Thus, there was a greater increase in 30-mile access for children above the poverty level than for those below the poverty level (24.8% vs. 22.6%, p < 0.001). On a national level, despite doubling the number of PTC, it has not improved 30-mile access for high-risk children. Alternatively, 19 states now have better access. Retrospective Cohort Study, Level III.

Moderating effects of organizational minority representation on racial and ethnic differences in early palliative care receipt among patients diagnosed with advanced cancers in 2010-2019 in the US.

52 Background: Early palliative care (PC) is recommended for advanced cancers, but differential use has been documented by race and ethnicity. We examined whether racial and ethnic differences in early PC use were moderated by organization-level proportions of minority patients served. Methods: We identified patients aged ≥65.5 years diagnosed with advanced-stage breast, colorectal, non-small cell lung (NSCL), small cell lung (SCL), pancreas, and prostate cancers in 2010-2019 with ≥6 months survival and continuous fee-for-service coverage from the SEER-Medicare data. Early PC was identified by PC encounter diagnosis codes or hospice and palliative medicine (HPM) specialty codes within 90 days post-diagnosis or up to first hospice admission date. Treating physicians and organizations were assigned based on the plurality of visits within 180 days surrounding diagnosis. Using patient race and ethnicity information, organizations were classified based on the percent of racial and ethnic minorities patients (Low&lt;10%, Medium 10-19%, and High Minority-Serving ≥20%). Multivariable logistic models assessed interacting effects of organizations’ minority representation and individual race and ethnicity on early PC receipt, adjusting for patient characteristics. Results: Among 102,060 patients treated at 8,039 organizations, the percent receiving early PC increased from 1.44% in 2010 to 10.30% in 2019. High Minority-Serving organizations were larger size and more likely to employ a HPM specialist and to treat a higher proportion of patients in metropolitan but lower socioeconomic areas, and were dually Medicare-Medicaid eligible. After adjusting for patient characteristics, Hispanic patients were 1.6 percentage points (ppts, 95%CI=-3.1, -0.1) less likely to receive early PC than Non-Hispanic (NH) White patients in Low Minority-Serving organizations. In High Minority-Serving organizations, Hispanic and NH Black patients were 0.8 ppts (95%CI=0.1, 1.6) and 1.6 ppts (95%CI=1.0, 2.3) more likely to receive early PC than NH White patients. (Table). Conclusions: Racial and ethnic minorities were more likely to receive early PC than NH White at High Minority-Serving organizations but not Medium/Low Minority-Serving organizations. System-level factors may be modified to narrow racial and ethnic differences in early PC use. Adjusted difference in early palliative care by race and ethnicity. Organization Minority Representation Individual Adjusted Probability Difference (95% CI) Low NH White Ref Hispanic -1.6 (-3.1, -0.1) NH Black 0.01 (-1.7, 1.7) Other/Unknown 1.1 (-1.2, 3.4) Medium NH White Ref Hispanic -0.6 (-1.7, 0.5) NH Black -0.8 (-1.7, 0.2) Other/Unknown 0.4 (-0.9, 1.7) High Non-Hispanic White Ref Hispanic 0.8 (0.1, 1.6) NH Black 1.6 (1.0, 2.3) Other/Unknown -0.3 (-1.1, 0.4)

Estimating pneumococcal carriage dynamics in adults living with HIV in a mature infant pneumococcal conjugate vaccine programme in Malawi, a modelling study

BackgroundAdults living with human immunodeficiency virus (ALWHIV) receiving antiretroviral therapy (ART) exhibit higher pneumococcal carriage prevalence than adults without HIV (HIV-). To assess factors influencing high pneumococcal carriage in ALWHIV, we estimated pneumococcal carriage acquisition and clearance rates in a high transmission and disease-burdened setting at least 10 years after introducing infant PCV13 in routine immunisation.MethodsWe collected longitudinal nasopharyngeal swabs from individuals aged 18–45 in Blantyre, Malawi. The study group included both HIV- individuals and those living with HIV, categorised based on ART duration as either exceeding 1 year (ART > 1y) or less than 3 months (ART < 3 m). Samples were collected at baseline and then weekly for 16 visits. To detect pneumococcal carriage, we used classical culture microbiology, and to determine pneumococcal serotypes, we used latex agglutination. We modelled trajectories of serotype colonisation using multi-state Markov models to capture pneumococcal carriage dynamics, adjusting for age, sex, number of under 5 year old (< 5y) children, social economic status (SES), and seasonality.ResultsWe enrolled 195 adults, 65 adults in each of the study groups. 51.8% were females, 25.6% lived with more than one child under 5 years old, and 41.6% lived in low socioeconomic areas. The median age was 33 years (IQR 25–37 years). The baseline pneumococcal carriage prevalence of all serotypes was 31.3%, with non-PCV13 serotypes (NVT) at 26.2% and PCV13 serotypes (VT) at 5.1%. In a multivariate longitudinal analysis, pneumococcal carriage acquisition was higher in females than males (hazard ratio [HR], NVT [1.53]; VT [1.96]). It was also higher in low than high SES (NVT [1.38]; VT [2.06]), in adults living with 2 + than 1 child < 5y (VT [1.78]), and in ALWHIV on ART > 1y than HIV- adults (NVT [1.43]). Moreover, ALWHIV on ART > 1y cleared pneumococci slower than HIV- adults ([0.65]). Residual VT 19F and 3 were highly acquired, although NVT remained dominant.ConclusionsThe disproportionately high point prevalence of pneumococcal carriage in ALWHIV on ART > 1y is likely due to impaired nasopharyngeal clearance, which results in prolonged carriage. Our findings provide baseline estimates for comparing pneumococcal carriage dynamics after implementing new PCV strategies in ALWHIV.

Hospitalisations for non-specific low back pain in people presenting to South Australian public hospital emergency departments.

The present study sought to investigate predictors of hospitalisation in adults diagnosed with non-specific low back pain (LBP) and/or sciatica from an ED. A 5-year, multicentre retrospective observational study was conducted across six public hospitals (metropolitan and regional) using data from electronic medical records. Patient presentations were identified using LBP diagnostic codes and key data extracted (patient demographics, clinical activity, discharge destination). Descriptive statistics and logistic regression were used to measure associations between identified variables and hospitalisation. There were 11 709 ED presentations across the study period. People aged ≥65 years (odds ratio [OR] 2.84, 95% confidence interval [CI] 2.61-3.10) and those who arrived at the ED via ambulance (age-adjusted OR 2.68, 95% CI 2.44-2.95) were more likely to be hospitalised. People were also more likely to be hospitalised when triaged as more urgent, when blood tests or advanced spinal imaging were ordered, and when i.v./subcutaneous opioids or oral benzodiazepines were administered. Hospitalisation rates for LBP were lower in regional hospitals, in people residing in lower socioeconomic areas and in Indigenous Australians. Certain patient characteristics and ED clinical activity are associated with hospitalisations for LBP. Understanding these factors will better inform the design and delivery of appropriate high-quality care.

Colorectal cancer prevalence in faecal immunochemical test non-returners: potential for health inequality in symptomatic referral pathways.

This study aimed to describe the faecal immunochemical test non-return rate of those referred with high-risk symptoms of colorectal cancer from primary care, and the clinical outcomes of the 'non-returners'. From January 2019 to July 2021, patients referred to secondary care with symptoms suspicious of colorectal cancer and a referral priority of urgent or urgent suspicion of cancer were sent a faecal immunochemical test. All patients were investigated regardless of faecal immunochemical test return or result. Demographics and clinical outcomes such as colorectal cancer prevalence were compared between those who returned a faecal immunochemical test and non-returners. Of 7345 patients included in the study, 874 (11.9%) did not return a faecal immunochemical test. Non-returner characteristics included male sex (P = 0.040), younger age (median age 57 versus 65 years, P < 0.001), per rectal bleeding (P < 0.001) and lower socioeconomic status (median Scottish Index of Multiple Deprivation, 6 versus 7, P < 0.001) compared with those who returned a faecal immunochemical test. Of 6294 patients undergoing colorectal investigation, there was a greater prevalence of colorectal cancer (5.4% versus 3.6% P = 0.032) and significant bowel pathology than in the non-returners (15.3% versus 9.8%, P < 0.001). With a median follow-up of 25 months, the colorectal cancer prevalence for the entire 7345 cohort was equal between those who returned and did not return a faecal immunochemical test (3.2% versus 3.8%, P = 0.108). Of note, the non-returners diagnosed with colorectal cancer were younger (median age 64 versus 73 years, P < 0.001) and from a lower socioeconomic area (median Scottish Index of Multiple Deprivation 4 versus 7, P = 0.015) than faecal immunochemical test returners. Patients referred to secondary care, with symptoms suspicious of colorectal cancer, that did not return a faecal immunochemical test had a similar colorectal cancer prevalence to those that returned the test.

Association of socioeconomic status with prognosis in hypertensive patients over age 65: a cohort study in the community setting

ObjectiveTo examine whether socioeconomic status is associated with prognosis after the diagnosis of hypertension (HTN), in a population older than 65 years, in the community setting.DesignRetrospective cohort study.SettingAll the primary...

Healthiness of food products promoted through placement strategies in Australian online supermarkets: a cross-sectional study

BackgroundProminent product placement is a core promotional tactic in retail food environments. How this practice has been adapted for online supermarkets, and the extent to which it is applied to healthier and less healthy food products in this setting, is largely unknown. We aimed to investigate placement-type promotions of food products in Australian online supermarkets.MethodsWe developed a new method to assess placement promotions and applied it to the online stores of the two largest supermarket retailers in Australia. Each online store was audited across six ‘locations’ (input prior to data collection), including a randomly selected high socio-economic position area and low socio-economic position area from each of the three largest Australian cities. The names, page locations and type of placement strategy of promoted food products were captured, with product healthiness assessed using the Health Star Rating (HSR) nutrient profiling system. Descriptive statistics summarised the page locations of promoted products and the placement strategies used to promote them, and chi-squared tests applied to compare product healthiness by retailer and socio-economic position.ResultsWe recorded 12,152 food products promoted through placement strategies, 99% of which were eligible for a HSR. Overall, 44% of products promoted through placement strategies were unhealthy. Cross-promotions and recommendations was the most common strategy recorded overall (55.9% of all strategies), and advertisements and site content was the strategy most likely to promote unhealthy products (53.7% of products unhealthy). One retailer was more likely to promote unhealthy products (46% v 43%, p = 0.004) and unhealthy products were more likely to be promoted in more disadvantaged than less disadvantaged locations (45% vs 43%, p = 0.05), though the magnitudes of difference were small.ConclusionsA considerable number of unhealthy products are likely presented to online grocery shoppers in Australia. Public health policies targeting unhealthy food promotions may need to be updated, including with consideration of the different ways that products can be prominently displayed online, to avoid exacerbating risks of diet-related disease and health inequalities. Our novel methodology could be used for ongoing monitoring of online supermarkets in Australia and elsewhere to inform such policies.

A public health campaign to increase awareness of the risk of dog bites in South Australia

Dog bites are a serious public health problem. A campaign by the Dog and Cat Management Board of South Australia was launched to increase awareness that any dog can bite as a first step in reducing the incidence of dog bites. The aims of this study were to 1) evaluate changes in attitudes to dog bites following the media campaign, and 2) provide baseline data on dog bites and attitudes to interactions with dogs to help target future campaigns. The media campaign ‘Good Dogs Have Bad Days’ was run from July to October, 2023, using TV, radio, billboards and social media. A cross-sectional survey was conducted pre- and post-campaign, including demographics and questions relating to interactions and attitudes to dogs. A total of n = 402 to the pre- and n = 404 responses to the post-campaign surveys were received, with most having owned a dog, living in metropolitan areas, and an equal split of males and females. Over one third (36–37 %) of dog owners and 25–29 % of non-dog owners had been previously bitten by a dog, although most did not require medical attention. Respondents were more likely to agree that any dog can bite if they recalled seeing the campaign, and less likely if they were male and had poor knowledge of the scenarios in which a dog might bite. Older respondents and those from lower socioeconomic areas believed dog bites were a more serious community issue than younger respondents from higher socioeconomic areas. Approximately 70 % of dog owners believed it was safe for strangers to approach their dog, 34–37 % allowed children or other people to pat their dog without permission and less than half separated their dog from visitors or delivery people. In contrast few of the non-dog owners allowed their children to pat a dog without the owner’s permission and only 2 % allowed them to play with dogs without supervision. The results demonstrate a relatively short campaign was associated with increased agreement any dog can bite. The proportion of respondents who had been bitten by a dog affirms the importance of public health campaigns targeting dog attacks. Some behaviours, such as supervising dogs around children and keeping dogs separate from delivery people, had relatively low agreement from dog owners and may be targeted in future campaigns. Public awareness campaigns and ongoing education will help to increase safer interactions with dogs, but it will take time and commitment to achieve a result.

Opioid prescribing in the Netherlands during the COVID-19 pandemic: a national register-based study

ObjectivesThe COVID-19 pandemic and related lockdown measures disrupted global healthcare provision, including opioid prescribing. In North America, opioid sales declined while opioid-related deaths increased. In Europe, the effect of the...

Impact of a school-based food assistance program on household food insecurity in Greece, 2012–2019: a multi-year evaluation of the DIATROFI program

BackgroundChildhood food insecurity can persist among low socioeconomic areas in high-income countries. Universal Free School Meal (UFSM) programs are designed to respond to this pressing issue. This study aimed to conduct a multi-year evaluation of the DIATROFI Program’s impact on household food insecurity in Greece. MethodsThis study utilized data from 18,716 students (618 kindergarten to high schools), from low socioeconomic areas participating in the school-level UFSM Program DIATROFI between 2012 and 2019. Parents of students completed annual baseline and follow-up paper-based self-completed questionnaires. The primary outcome was household food insecurity, measured using the Food Security Survey Module (FSSM) at both questionnaires, and evaluated through mixed linear and logistic regression models with repeated measurements. FindingsStudents’ median age was 9 years old (Interquartile range (IQR): 6·5, 12·0), 51·6% (n=9,658) were girls, and 82·2% (n=15,382) lived in low/medium socioeconomic affluence households. Households with food insecurity reduced from 51·5% (n=9,630) to 47·6% (n=8,901) after one school year. Food insecurity score declined steadily for four years of consecutive participation, compared to baseline score (one-year b:–0·26; 95% Confidence Interval (CI):–0·30, –0·22, and four-year –1·28; –1·53, –1·03). The likelihood of retaining food insecure status reduced from 17% after one-year participation (Odds Ratio (OR): 0·83; 95% CI: 0·79, 0·87) to 36% after four-year participation (0·64; 0·49, 0·82). The Program’s impact on household food insecurity alleviation was greater among households with low parental education and low socioeconomic affluence. InterpretationThe DIATROFI Program effectively improved household food security during and after the Greek socioeconomic crisis. School-level UFSM programs targeting underprivileged students can improve household food insecurity, with a more pronounced effect with increased years of participation, and among economically disadvantaged households. FundingThe DIATROFI Program was funded through various national and private organizations, including national prefecture authorities, Greek payment authorities, philanthropic/charitable organizations, and private companies.

Breast cancer burden among young women from 1990 to 2021: a global, regional, and national perspective.

Breast cancer, the most prevalent tumor in women globally, significantly impacts young women, compromising their daily lives and overall well-being. Breast cancer represents a significant public health concern due to its extensive physical and psychological consequences. Data from the Global Burden of Disease (GBD) were used to assess the global, regional, and national burden of breast cancer in young women aged 20-39 from 1990 to 2021. This analysis focused on trends measured by the estimated annual percentage change (EAPC) and explored the socioeconomic impacts via the sociodemographic index (SDI). During 1990-2021, the incidence and prevalence of breast cancer among young women increased globally, with annual rates of 0.82 and 0.87%, respectively. The mortality rate and disability-adjusted life years (DALYs) also rose annually by -0.12% and -0.05, respectively. A significant burden shift was observed towards regions with lower SDI, with diet high in red meat, alcohol use, and high fasting plasma glucose identified as prominent risk factors, particularly in lower SDI regions. Our findings underscore breast cancer in young women as an escalating global health challenge, with the burden increasingly shifting towards lower socioeconomic areas. This underscores the necessity for targeted prevention and control strategies for breast cancer, focusing on reducing the identified risk factors and ensuring equitable health resource distribution.

The Caring Life Course Theory: Opening new frontiers in care-A cardiac rehabilitation example.

To operationalize the Caring Life Course Theory (CLCT) as a framework for improving cardiac rehabilitation (CR) engagement and informing ways to address disparities in rural, low socio-economic areas. A secondary analysis of data collected from 15 CR programmes to identify CR patterns through the CLCT lens using a mixed-methods approach. All analytical processes were conducted in NVivo, coding qualitative data through thematic analysis based on CLCT constructs. Relationships among these constructs were quantitatively assessed using Jaccard coefficients and hierarchical clustering via dendrogram analysis to identify related clusters. A strong interconnectedness among constructs: 'care from others', 'capability', 'care network' and 'care provision' (coefficient = 1) highlights their entangled crucial role in CR. However, significant conceptual disparities between 'care biography' and 'fundamental care' (coefficient = 0.4) and between 'self-care' and 'care biography' (coefficient = 0.384615) indicate a need for more aligned and personalized care approaches within CR. The CLCT provides a comprehensive theoretical and practical framework to address disparities in CR, facilitating a personalized approach to enhance engagement in rural and underserved regions. Integrating CLCT into CR programme designs could effectively address participation challenges, demonstrating the theory's utility in developing targeted, accessible care interventions/solutions. Explored the challenge of low CR engagement in rural, low socio-economic settings. Uncovered care provision, transitions and individual care biographies' relevance for CR engagement. Demonstrated the potential of CLCT to inform/transform CR services for underserved populations, impacting practices and outcomes. EQUATOR-MMR-RHS. A consumer co-researcher contributed to all study phases.

Impact of class cancellations on parents’ and children’ adaptation following an outbreak of the Omicron variant during the COVID-19 pandemic in Taiwan in April 2022

ObjectiveTo explore the impact on Taiwanese parents and children following an outbreak of the Omicron variant during the COVID-19 pandemic.MethodsData were collected following class cancellations mandated by the Ministry of Education due to an outbreak of the Omicron variant of COVID-19 in April 2022. A national parent organization developed self-report survey questionnaire, “Impact of the Pandemic-related School Closures/Class Cancellations” (IPRSCCC), assessed parents’ perceived impact of school cancellations on their child/children’ and on their adaptation. The online survey was available between May 4 and May 9, 2022, in 20 districts throughout Taiwan.ResultsA total of 2126 parents representing 2592 children responded. Total scores on the IPRSCCC were significantly higher for parents of children whose classes were cancelled (n = 891) compared with parents whose children continued in-person classes (n = 1053). Parents perceived the class cancellations of the child/children disrupted daily routine, learning loss and impacted academic motivation. They also reported emotional stress and no time for rest, which were associated with parental burnout. However for these parents, there were no significant differences in scores between parents living in low and high socioeconomic areas. Only the subscale score for disrupted daily routine was significantly higher for fathers, and emotional stress was significantly higher for parents with two, or ≥ 3 children. When academic impacts were examined using national examination scores for 12th grade students, the percent of students with scores of ≤ 6 in English, Chinese, and mathematics was higher in 2022 than in 2020.ConclusionsHigher IPRSCCC scores for parents of children whose classes were cancelled provides additional evidence of the impact of disruptions of in-person classes due to the COVID-19 pandemic. Examination scores confirmed class cancellations impacted academic performance.

Challenges to young children’s swimming lesson participation in New South Wales, Australia

BackgroundChild swimming lessons are a key intervention for drowning prevention; however, participation has been severely affected by COVID-19 restrictions and cost-of-living challenges. To encourage re-engagement, the New South Wales government...

Socioeconomic Disparities in Urban Forest Diversity and Structure in Green Areas of Santiago de Chile.

Urban trees enhance biodiversity, provide ecosystem services, and improve quality of life in cities. Despite their benefits, trees are not distributed equitably, and many cities exhibit a "luxury effect". Given the importance of public green space for providing access to urban tree benefits, we investigated the relationship between socioeconomic level and tree diversity and structure in 60 green areas in Santiago de Chile. Species richness and total tree abundance did not significantly vary among socioeconomic levels; however, a differential effect was found according to species origin. Introduced tree species exhibited similar abundance and species richness across socioeconomic levels, but native tree species were more abundant and richer in higher socioeconomic level areas compared to lower ones. Tree cover was higher in the high and medium socioeconomic level areas than in the low socioeconomic level area. A higher average DBH was found in the medium socioeconomic level area, which may be explained by older neighborhoods and a legacy of the luxury effect. Our findings reveal that socioeconomic groups are associated with differences in tree cover, width, and the number of native species in public green areas. Consequently, urban residents have different provisions of ecosystem services and opportunities to interact with natural heritage. Increasing the amount of tree cover and native species available to vulnerable groups will reduce disparities.