Lower Socioeconomic Class Research Articles

Is cancer stage data missing completely at random? A report from a large population-based cohort of non-small cell lung cancer.

Population-based datasets are often used to estimate changes in utilization or outcomes of novel therapies. Inclusion or exclusion of unstaged patients may impact on interpretation of these studies. A large population-based dataset in Ontario, Canada of non-small cell lung cancer patients was examined to evaluate the characteristics and outcomes of unstaged patients compared to staged patients. Multivariable Poisson regression was used to evaluate differences in patient-level characteristics between groups. Kaplan-Meier estimates of survival and log-rank statistics were utilized. In our Ontario cohort of 51,152 patients with NSCLC, 11.2% (n=5,707) were unstaged, and there was evidence that stage data was not missing completely at random. Those without assigned stage were more likely than staged patients to be older (RR [95%CI]), (70-79 vs. 20-59: 1.51 [1.38-1.66]; 80+ vs. 20-59: 2.87 [2.62-3.15]), have a higher comorbidity index (Score 1-2 vs 0: 1.19 [1.12-1.27]; 3 vs. 0: 1.49 [1.38-1.60]), and have a lower socioeconomic class (4 vs. 1 (lowest): 0.91 [0.84-0.98]; 5 vs. 1 (lowest): 0.89 [0.83-0.97]). Overall survival of unstaged patients suggested a mixture of early and advanced stage, but with a large proportion that are probably stage IV patients with more rapid death than those with reported stage IV disease. In this case study, evaluation of stage-specific health care utilization and outcomes for staged patients with stage IV disease at the population level may have a bias as a distinct subset of stage IV patients with rapid death are likely among those without a documented stage in administrative data.

Factors Associated with Mortality and Long-Term Outcomes of Pediatric Acute Kidney Injury in a Resource Limited Setting

Introduction: Despite being a leading cause of morbidity and mortality globally, acute kidney injury (AKI) is worse in resource-limited areas. This study explores AKI incidence, inhospital mortality, and long-term outcomes in resource-limited settings. Methods: This was a prospective study of children with AKI from 2014 to 2019. KDIGO 2012 defined AKI. We assessed the etiology, inhospital mortality, and long-term outcome of AKI in a mission hospital. Results: Only 169 of 201 AKI patients had complete data. The ages ranged from 1.08 months to 17.5 years; 65.7% were male and 65.1% were from lower socioeconomic class. The incidence of AKI was 59.6 cases per 1,000 persons (95% CI: 5.42, 47.1). Most patients had stage 1 KDIGO AKI (91; 53.8%). 1–5 years old had the highest incidence of AKI (65; 38.5%); sepsis (26.6%), severe malaria (15.4%), and nephrotic syndrome (14.8%) were common AKI causes. Fever (72.8%), pallor (52.1%), and vomiting (45.6%) were the most common symptoms. Thirty-two (27.8%) patients had high blood pressure. Inhospital mortality was 14.8% (95% CI: 9.8, 21.1). The cumulative incidence of AKI-related mortality was 93.2 per 1,000 person-years. Poor outcome was associated with breathlessness, hyponatremia, and leukocytosis. Kaplan-Meier survival curve showed 81% (CI: 74–87%) survival after 5 years of AKI. On Cox proportional-hazards analysis, the absence of breathlessness (HR: 2.537, 95%: CI 1.210–5.317) and hyponatremia (HR: 2.914, 95% CI: 1.343–6.324) were associated with increased survival. Conclusion: In resource-limited settings, infectious diseases and nephrotic syndrome are common causes of AKI. Factors associated with mortality include breathlessness and hyponatremia.

MP21-19 THE RACIAL AND SOCIOECONOMIC CHARACTERISTICS OF A COHORT OF MEN USING AT-HOME FERTILITY TESTS IN THE UNITED STATES

You have accessJournal of UrologyCME1 Apr 2023MP21-19 THE RACIAL AND SOCIOECONOMIC CHARACTERISTICS OF A COHORT OF MEN USING AT-HOME FERTILITY TESTS IN THE UNITED STATES Jad Badreddine, Nick Sellke, Stephen Rhodes, Michael Callegari, Paul Simon, Nannan Thirumavalavan, and Ramy Abou Ghayda Jad BadreddineJad Badreddine More articles by this author , Nick SellkeNick Sellke More articles by this author , Stephen RhodesStephen Rhodes More articles by this author , Michael CallegariMichael Callegari More articles by this author , Paul Simon Paul Simon More articles by this author , Nannan ThirumavalavanNannan Thirumavalavan More articles by this author , and Ramy Abou GhaydaRamy Abou Ghayda More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003246.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Infertility is a global health concern that affects couples worldwide. Economic, racial, and geographic disparities in reproductive medicine have long affected access to fertility care. These inequalities further worsened during the COVID-19 pandemic as fertility care services were systematically paused and treatments were delayed. At-home fertility tests emerged as a seemingly convenient, affordable and accessible option for all men seeking initial semen analysis testing and screening. We aim to study the racial and socioeconomic characteristics of a cohort of men utilizing at-home sperm testing kits in the United States over 3 years. METHODS: We retrospectively reviewed the records of 5,822 men who requested semen analysis at Give Legacy, Inc. (Legacy) facilities from 2019 to 2021. The demographic characteristics of these men were collected including their age, race/ethnicity, and place of residence. Further, the weighted median household income of Legacy customers was calculated using their personal ZIP codes and corresponding median income data from the U.S. census bureau. RESULTS: The mean age (SD) of this cohort was 34.9±7.3 years. Among these 5,822 men, there were 3,936 (67.6%) normozoospermic men and 1,886 (32.3%) oligozoospermic men. The group consisted of predominantly white men (64.9%) with only 5.2% Black, 5.4% Latino, 8.9% Asian, 3.1% Arab, 2% Native Hawaiian, 2.4% Indian American, and 8.2% other groups. The geographic distribution of participants showed a majority of men from the Northeast (31.6%) and Pacific (23.4%) regions. The median household income of a Legacy customer is $108,858; significantly higher than the U.S. median household income of $70,784 (P<.01). CONCLUSIONS: Despite the fact that at-home, mail-in kits provide a better and more affordable access to initial fertility care, ethnic minorities and lower socioeconomic classes are still underrepresented in the population of men seeking fertility testing in this cohort. Further research is needed to understand the racial and socioeconomic drivers of the existing disparities in fertility care. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e293 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jad Badreddine More articles by this author Nick Sellke More articles by this author Stephen Rhodes More articles by this author Michael Callegari More articles by this author Paul Simon More articles by this author Nannan Thirumavalavan More articles by this author Ramy Abou Ghayda More articles by this author Expand All Advertisement PDF downloadLoading ...

Pattern and Predictors of Internet Addiction among Secondary School Adolescents in Enugu, Nigeria

ABSTRACT Background: Internet addiction has negative effects on adolescents. These range from psychological and social impediments to school absenteeism. Aim: To ascertain the pattern of Internet addiction and the factors that predict Internet addiction among secondary school adolescents in southeast Nigeria. Subjects and Methods: This was a cross-sectional study that involved 796 secondary school adolescents drawn from six secondary schools in Enugu, Nigeria. The data were analyzed using IBM Statistical Package for Social Sciences (SPSS) software. Results: The highest proportion of the respondents (36.3%) had a moderate level of Internet addiction, while the least proportion (2.1%) had severe dependence on the Internet. Adolescents who were less than 15 years of age have 1.1 odds of having Internet addiction when compared to those who were 20 years and above (AOR = 1.1; 95% CI: 0.4–2.8). The respondents who were of the low socioeconomic class were 1.2 times more likely to have Internet addiction when compared with those in the high socioeconomic class (AOR = 1.2; 95% CI: 0.9–1.7). About 20.1% of adolescents were always depressed when they are not using the Internet, while 16.3% of adolescents who were addicted to the Internet developed insomnia. Conclusion: There is a rising prevalence of Internet addiction among secondary school adolescents. Younger adolescents tend to be more addicted to the Internet than their older counterparts. A small number of them had severe Internet addiction. A subpopulation of adolescents who were addicted to the Internet presents with depression and sleep disorders.

BACTERIOLOGICAL PROFILE OF URINE IN PATIENTS WITH URINARY BLADDER CALCULI

Introduction:- Urinary bladder calculi is a most commonly encountered urological problem. The association of urinary bladder calculi and urinary tract infection is well known. In this study we aim to look at the bacteriological prole of urine in patients with urinary bladder calculi. Aims:- To look for the bacteriological prole of urine in patients with urinary bladder calculi. Methods:- The present study carried out in department of surgery, Silchar Medical College and Hospital in patients with urinary bladder calculi. Diagnosis of urinary bladder calculi was conrmed and a complete assessment of patients was done. A morning mid stream urine collected in a sterile container and sent to department of microbiology at Silchar medical college &amp; hospital to look at the bacteriological ora of urine. Then, the bacteriological prole of urine studied. It is a prospective observational study for 6months (1st April, 2022 to 30th September, 2022) in the Department of surgery, Silchar Medical College and Hospital Results and Discussion :– Majority of the patients were from 51-60 age group (27.42%) and most of the patients were male (83.87%). Majority belonged to rural areas (88.71%) and to the lower socio-economic class (54.84%). Most commomly found organism in urine culture was E.coli (38.71% cases), followed by Klebsiella (20.97% cases). Burning micturation was found to be the most common presenting symptom (93.55% cases). Associated illness were found to be BPH, Phimosis, Stricture urethra, Meatal stenosis, Hypertension, Diabetes mellitus, and Anaemia. Conclusion:- Urinary bladder calculi is commonly seen in elderly males of lower socio-economic status people. Burning Micturition was the most common presenting symptom. E.coli was found to be the most common causative organism found on urine analysis.

VULVOVAGINAL CANDIDIASIS- PREVALENCE AND ANALYSIS OF ASSOCIATED RISK FACTORS AMONG WOMEN OF REPRODUCTIVE AGE GROUP IN VINDHYA REGION

Background: Although it can affect all groups, vaginitis remains one of the most common ambulatory problems to occur in women of reproductive age group. It accounts for 5-10 million office visits per year throughout world. In India prevalence of vaginitis is approximately 30%. Vaginitis has substantial impact on various aspects of female reproductive health, mental health, work ability and routine physical activity. It is also associated with various obstetrical and gynecological complications. Vulvovaginal candidiasis is common form of vaginitis. So, we aim to find out prevalence and analyze risk factors associated with vulvovaginal candidiasis at tertiary care hospital in Rewa, Madhya Pradesh India. Method: An observational cross-sectional study was conducted at Department of Obstetrics and Gynecology, Shyam Shah Medical College Rewa for 18 months from January 2021 to June 2022 on 1000 women of reproductive age group, visiting routine Gynae OPD of department of Obstetrics &amp; Gynecology. Results: Prevalence of vulvovaginal candidiasis in present study was found to be 12%. Various associated risk factors were OCP use, use of cloth during menses, douching/cleanliness habit, rural area of residence, middle and lower socioeconomic class and various occupations like factory workers and farmers. Conclusion: As it is evident that vaginitis will never be completely prevented, but incidence can be reduced. Much of the morbidity and complications can be reduced by identification and prevention of modifiable risk factors and interventional strategies directed mainly on high-risk behaviors in day-to-day life.

Predictors of Contraceptive practice in married women of Punjab, Pakistan.

Pakistan is the sixth most populous country in the world. Current contraceptive use in Pakistan is only 26% despite being one of the leading countries in Asia to launch National family planning programs. Major constraint of acceptability among women is the lack of awareness and implementation of contraceptive methods. The objective of this study was to explore the reasons behind this behavior. A cross-sectional survey was conducted with non-probability convenient sampling with sample size of 400 married women attending Fazle-Omar Hospital, Chenab Nagar, Punjab, having age between 15 to 60 years from August 2019 to February 2020. To assess the awareness of respondents about contraception, a questionnaire was made after testing its internal consistency. Data was analyzed via SPSS-21; nominal data was expressed as frequencies and percentages, quantitative as mean and standard deviation. Binary logistic regression analysis was carried out to determine predictors for contraception practice. P-value < 0.05 was considered significant. Our respondents mean age was 30.73±5.9 years. Majority of responders (65%) were educated and (61%) belonged to low socio-economic class. Mean awareness score was 65 ± 26. Out of 400 respondents, 260 (65%) were practicing contraception. Relatives and media were major sources of awareness while clinics and LHVs were contributing less. Condom was the most practiced method of contraception. Low socio-economic class, increase number of kids, responders' education and awareness score were the predictors of contraception practice. The education of women and awareness score are independent predictors of contraceptive practice in women. Hence by educating mothers and increasing awareness through various means, practice of contraception can be increased. There is much room to improve the working of family health clinics and LHV.

Barriers to Exclusive Breastfeeding in Mothers Belonging to Low, Middle, and High Socio-Economic Families in Pakistan

Introduction: Exclusive breastfeeding (EBF) for the first six months of life improves health and increases infant survival. In Asia, Pakistan ranks second in child mortality. Socioeconomic status (SES) is an important predictor of healthy behaviors. The study aims to understand the barriers to exclusive breastfeeding faced by mothers from different socioeconomic classes in Pakistan.&#x0D; Method: The cross-sectional study was done in the Pediatric outpatient department (OPD) of Shifa International hospital and community health center from November 2020 to 1 March 2021. Mothers and their children 1 to 3 years of age were included in the study.&#x0D; Results: A total of 175 mothers and their children were included. EBF for the first six months was done by 120 (68.6%). However, by one year of age, only 99 (56%) continued breastfeeding. Out of these 175 mothers, 79 (45%) were from the lower class, 69 (39.4%) were from the middle class, and 27 (15.4%) were from upper SES. Among the lower, middle, and high socioeconomic classes frequency of EBF practiced by mothers was 51, 54, and 15 (p 0.03), respectively. Pre-lacteals were given to 102 (58.2%). This practice was more frequent in lower SES families (0.03). The majority of working women belonged to upper SES (0.04). Mothers in the upper class are least likely to EBF their children (OR 0.5 CI 0.2-1.3). The adjusted odds ratio for EBF is highest for lower SES mothers, followed by the middle class.&#x0D; Conclusion: Support from family, place and mode of delivery, working mothers, and high socioeconomic class are important factors affecting exclusive breastfeeding in Pakistan.

National Trends in Complications of Vascular Access for Hemodialysis and Analysis of Racial Disparities Among Patients With End-Stage Renal Disease in the Inpatient Setting

The aim of this study is to assess the trends in access-related complications, as well as the impact of race on these complications, among admitted patients with end-stage kidney disease (ESKD) receiving hemodialysis. A retrospective cohort study between 2005 and 2018 was performed using the National Inpatient Sample (NIS). Hospitalizations involving ESKD and hemodialysis were identified. There were 9,246,553 total admissions involving ESKD and hemodialysis, of which 1,167,886 (12.6%) had complications. Trends in complications were assessed and compared among races. There was a decreasing trend in rates of mechanical (trend:-0.05% per year; P< 0.001), inflammatory or infectious (-0.48%; P< 0.001), and other (-0.19%; P< 0.001) complications from 2005 to 2018. Non-White patients had a greater magnitude in the decrease in trends in rates of complications compared to White patients (-0.69% per year vs.-0.57%; P< 0.001). Compared to the White patients, Black patients (odds ratio [OR]: 1.26; P< 0.001) and those of the other races (OR: 1.11; P< 0.001) had higher odds of complications. These differences were also statistically significant among lower socioeconomic classes (75 percentile vs. 0-25 percentile: P= 0.009) and within southern states (vs. Northeast: P< 0.001). Although there was an overall decrease in the trends of dialysis-associated complications requiring hospitalization among ESKD patients receiving hemodialysis, non-White patients have higher odds of complications compared to White patients. The findings in this study emphasize the need for more equitable care for hemodialysis patients.

Food Consumption of People with Sickle Cell Anemia in a Middle-Income Country

Sickle cell anemia (SCA) is a genetic and hemolytic disease globally characterized by social vulnerability. Food consumption has been insufficiently analyzed in SCA. Secondary iron overload is often observed. This leads to unreliable recommendations for dietary iron restriction. We assessed food consumption and iron intake among adults with SCA. Considering the guidelines for healthy eating, foods were grouped according to the NOVA classification. This transversal study included 74.4% of eligible patients who were registered in the reference center for SCA treatment in Rio de Janeiro, Brazil, in 2019. Data on food consumption were collected through 24 h recall. The monthly household income of 82.3% of patients was less than $770. The consumption of fresh or minimally processed foods was directly associated with monthly household income (p < 0.0001; η2 = 0.87). Ultra-processed foods provided more than one-third of the total energy intake (35.2%). The prevalence of inadequate iron intake was about 40% among women, while that of iron intake above the tolerable upper limit was 0.8%. People from lower socioeconomic classes had the lowest iron intake. Strategies to encourage the consumption of fresh or minimally processed foods are needed considering the requirement of an antioxidant diet in SCA. These findings highlight the need for health equity to ensure food security and healthy eating in SCA.

The Use of Whatsapp Social Media Group for Nutrition Counselling among Parents with Children of Congenital Heart Defects

Background: Ignorance about appropriate Infant and Young Child Feeding (IYCF) Practices among parents of children with Congenital Heart Defects (CHD) can exacerbate malnutrition in these children leading to significant morbidity and mortality. Use of novel methods for Intensive Nutrition Counselling such as Whatsapp social media group can lead to considerable improvement in nutritional status of the child.&#x0D; Objectives: To assess the efficacy of Whatsapp group for Intensive Nutritional Counselling to parents of children with CHD. &#x0D; Methods: This is a two-year prospective interventional study, one-group before-after study design. Here, intervention is in the form of specialised focussed nutrition counselling for parents of children with CHD through Whatsapp social media group.&#x0D; Results: Majority of the patients 16 (30.0%) were in the age group of 7-12 months, predominant diagnosis (25 patients i.e. 48.9%) was Ventricular Septal Defect (VSD). Sixty-eight percent patient-families belonged to lower socio-economic class. Before intervention, 71.1% of children (37 of 52) were found to be underweight, 35.5% children were stunted and 65.6% children were wasted. Post intervention there was significant improvement in all the 3 anthropometric indicators. This intervention particularly helped improve IYCF habits for the age group of 7-12 months. Post intervention all parents included the 8 food groups in their children’s diet thus providing them wholesome nutrition whereas earlier only 2-3 food groups were given to children on a daily basis.&#x0D; Conclusion: This is the first study to explore use of Whatsapp group to educate parents of children with CHD about specific nutrition counselling, resulting in improvement in child anthropometric indices.

Factors associated with common mental disorders among breastfeeding mothers in tertiary hospital nurseries in Nigeria.

Several studies have shown that the impact of maternal mental health disorders on newborns' well-being in low and middle-income countries (LMIC) are underreported, multi-dimensional and varies over time and differs from what is reported in high-income countries. We present the prevalence and risk factors associated with common mental disorders (CMDs) among breastfeeding mothers whose infants were admitted to Nigerian tertiary care facilities. This was a national cross-sectional study involving mothers of hospitalised babies from eleven Nigerian tertiary hospitals. We used the WHO self-reporting Questionnaire 20 and an adapted WHO/UNICEF ten-step breastfeeding support package to assess mothers' mental health and breastfeeding support. Only 895 of the 1,120 mothers recruited from eleven tertiary healthcare nurseries in six geopolitical zones of Nigeria had complete datasets for analysis. The participants' mean age was 29.9 ± 6.2 years. One in four had CMDs; 24.0% (95% CI: 21.235, 26.937%). The ages of mothers, parity, gestational age at delivery, and length of hospital stay were comparable between mothers with and those without CMDs. Antenatal care at primary healthcare facilities (adjusted odds ratio [aOR:13], primary education [aOR:3.255] living in the south-southern region of the country [aOR 2.207], poor breastfeeding support [aOR:1.467], polygamous family settings [aOR:2.182], and a previous history of mental health disorders [aOR:4.684] were significantly associated with CMDs. In contrast, those from the middle and lower socioeconomic classes were less likely to develop CMDs, with [aOR:0.532] and [aOR:0.493], respectively. In Nigeria, the prevalence of CMDs is relatively high among breastfeeding mothers with infants admitted to a tertiary care facility. Prior history of mental illness, polygamous households, mothers living in the southern region and low or no educational attainment have a greater risk of developing CMDs. This study provides evidence for assessing and tailoring interventions to CMDs among breastfeeding mothers in neonatal nurseries in LMIC.

ED visits, hospital admissions and treatment breaks in head/neck cancer patients undergoing radiotherapy.

Radiation therapy (RT) is an integral part of treatment of head/neck cancer (HNC) but is associated with many toxicities. We sought to evaluate sociodemographic, pathologic, and clinical factors associated with emergency department (ED) visits, hospital admissions (HA), and RT breaks in HNC patients undergoing curative-intent RT. We completed a Level 3 (Oxford criteria for evidence-based medicine) analysis of a cohort of HNC patients who underwent curative-intent RT at our institution from 2013 to 2017. We collected demographic characteristics and retrospectively assessed for heavy opioid use, ED visits or HA during RT as well as RT breaks. Treatment breaks were defined as total days to RT fractions ratio ≥1.6. Multivariable stepwise logistic regression analyses were done to determine the association of various sociodemographic, pathologic, and clinical characteristics with ED visits, HA and RT treatment breaks. The cohort included 376 HNC patients (294 male, 82 female, median age 61). On multivariable analysis, significant factors associated with ED visits during RT were heavy opioid use and black race. Receipt of concomitant chemotherapy was the only factor associated with hospital admissions during RT. Advanced age, lower socioeconomic class, glandular site, and receipt of chemotherapy were all independently associated with RT breaks. Lower cancer stage and lack of substance abuse history were independently associated with lack of treatment breaks. HNC patients with factors such as heavy opioid use, Black race, receipt of concomitant chemotherapy, and lower socioeconomic class may require closer monitoring during RT.

Co-occurrence of familial Mediterranean fever with systemic lupus erythematosus in South Asian population

Background and objectiveFamilial Mediterranean fever (FMF) and systemic lupus erythematosus (SLE) are autosomal recessive auto-inflammatory diseases, triggered by FMF-associated gene mutations and auto-antigens. The literature on the co-occurrence of these two disorders is limited to case reports and their correlation is considered rare. We investigated the proportion of FMF among SLE patients when compared with a healthy adult cohort in South Asia. MethodsFor this observational study, data from our institutional database were collected for the patients diagnosed with SLE. The control group was randomly selected from the database and were age- matched for SLE. The overall proportion of FMF among patients with and without SLE was considered. Student's t-test, Chi-square, and ANOVA were used for univariate analysis. ResultsThe study population included 3623 SLE patients and 14,492 controls. In the SLE group, there was a significantly higher proportion of FMF patients compared with the non-SLE group (1.29% vs. 0.79% respectively; p=0.015). SLE was prevalent in Pashtun's (50%) in the middle socioeconomic group while FMF was dominant in Punjabi's and Sindhi's (53%) in the low socioeconomic class. ConclusionThis investigation demonstrates that FMF is more prevalent in a South-Asian population cohort of SLE patients.

Prevalence and Correlates of Polypharmacy, and Drug Utilization Pattern in a Semi-urban Population: Results from the Pars Cohort Study.

Although polypharmacy is considered a major predictor of irrational use of drugs, little is known about polypharmacy in developing regions. We aimed to indicate the prevalence and correlates of polypharmacy and to determine the medication profile at the population level in southern Iran. In this cross-sectional study, we analyzed data from participants of the Pars Cohort Study (PCS) (aged above 40 years, N=9269). Polypharmacy was defined as using five or more medications concurrently. A Poisson multivariable model was applied to estimate the adjusted prevalence ratios (APRs) of various risk factors. The Anatomical Therapeutic Chemical (ATC) classification system was used for classifying medications. Prevalence of polypharmacy was 10.4%, (95% CI: 9.75; 11.08) and it was higher among females (15.0%), older adults (age≥65 years) (16.0%), and individuals with more than two chronic conditions (31%). Being female, educated, married, and not having a low socio-economic class were independently associated with a higher likelihood of polypharmacy. The most prevalent medications among female participants were sex hormones and modulators of the genital system (58.4%), drugs for acid-related disorders (14.6%), and anti-anemic preparations (13.6%,). On the other hand, males were using acid-related disorders (14.6%), anti-inflammatory and anti-rheumatic products (7.8%), and beta-blocking agents (6.3%). The prevalence of polypharmacy in our sample was relatively low, especially among males. Cardiovascular drugs, acid suppressants, hormonal contraceptives, and anti-anemic preparations are drug classes with the highest contribution to polypharmacy.

Impact of Nutritional Insufficiency on Nutritional Status of Adolescents in low and high Income Socio Economic Group

Background: Adolescence is the most crucial period with uplifted energy need that demands an intense nutritive care for fulfillment of complete good wellbeing in the upcoming life course and evaluation of the nutrient inadequacy as a part of their daily routine tells about diet quality which is an essential element at every stages of a human life. Aim: To assess the energy insufficiency of adolescents in low and high socioeconomic status as it has high significance in the growing stages because it affects both the physiological and psychological aspects of overall well-being. Method: This was a comparative cross-sectional study. The research was conducted on 410 adolescent girls and boys with age ranging from 10 to 14 years of Lahore from public and private sector schools selected through lottery method that basically reflects low and high socioeconomic background effects with detailed energy intake analysis and association of nutritional status to the total energy consumed per day of these groups. The data was collected on the basis of a questionnaire consisting of demographics and 24-hr recall calculated by taking an average of the last 3 days’ food intake. Results: The results revealed that adolescent groups belonging to high socioeconomic class were more in the normal health status, had less energy insufficient values and better food quality than adolescents from low socio economic class. Practical implication: The study will provide light to do in depth research should be conducted in the community in innovative ways for the better understanding of nutritional health related problems and its solutions for the children as well as adolescents as the new generation are the future of our beloved country. Conclusion: The result shows that as socioeconomic status tends to get better, diet quality improves and encourages a healthy lifestyle as compared to those living in improvised conditions. Keywords: Adolescence, Nutrient Inadequacy Energy Insufficient, 24-Hr Recall

A cross-sectional study assessing the effectiveness of hygiene related interventions and education delivered in an afterschool club in urban slums of Gurugram

Background: There is insufficient evidence about the effectiveness of hygiene related interventions and education delivered to out of school children, attending non-formal schools in urban slums. Methods: This cross sectional, interventional study was conducted from January 2022 to April 2022 in a non-formal school in an urban slum in Gurugram, Haryana. A validated questionnaire about hygiene related practices was used to record the behavioural practices of these children before and after education about hygienic practices. The children were also provided with soap, detergent, and four sets of clothes to enable them to follow the hygienic practices. The pre and post intervention status of various hygiene variables was compared. A p&lt;0.01 was considered as statistically significant. Results: Of the 97 children included in this interventional study, 54 were boys. All of them were from the lower socioeconomic class, with 93% of the mothers and 98% of the fathers being illiterate. The percentage of unhygienic practices decreased significantly post intervention. All the p values for comparison between the pre and post intervention status of various hygiene variables were highly significant statistically (p=0.001). Maximum improvement was seen in case of brushing teeth, cutting nails, using footwear and bathing (2.86). Similarly, the total mean score for pre intervention was 30.62 which decreased to 10.54, indicating a total improvement of 20.08. Conclusions: Hygiene related interventions including continuing education, and provision of clothes and detergent, can improve hygienic practises in out of school children who attend non-formal schools in slums.

A focused retrospective study on differences in IBD characteristics between Black and White patients in the south

BackgroundMost facets of Inflammatory Bowel Disease (IBD) have not been thoroughly compared among minority populations, including Black patients. Our study was designed to characterize the demographics, phenotypes, outcomes, healthcare utilization, and treatment of IBD in a large cohort with 38% Black patients. MethodsElectronic health records of 3272 IBD patients seen in a tertiary academic medical network from 2012 to July 15th, 2019 were analyzed. ResultsBlack patients with Crohn's disease were significantly more likely than White patients to suffer from perianal (p < 0.001), fistulizing (p < 0.001), and fibrostenotic phenotypes (p < 0.001). Black patients with IBD were significantly more likely to undergo IBD-related surgery (p = 0.042) and experience an IBD-related complication (p < 0.001). The proportion of patients with at least one colonoscopy, one visit to the gastroenterology clinic, one visit to the emergency department (ED), and one hospital admission were higher in Black patients (p < 0.001, p = 0.005, p < 0.001, and p < 0.001; respectively). ConclusionsBlack IBD patients had more severe disease phenotypes and worse healthcare outcomes than White patients. Black patients also used healthcare facilities and IBD medications to an equal or greater extent, despite being of a lower average socioeconomic class than their White counterparts. Our study suggests that underlying factors that do not pertain to the utilization of healthcare resources may be responsible for these worse outcomes in Black patients.

Risk of low birthweight associated with the timing and frequency of antenatal care visits in Lao PDR: a retrospective cohort study

BackgroundAntenatal care (ANC) plays an important role in preventing low birthweight (LBW). Whereas the government of Lao People’s Democratic Republic (Lao PDR) has committed to increasing the usage of ANC, little attention has been given to the early initiation of ANC. The present study assessed the influence of delayed and fewer ANC visits on LBW in the country.MethodsThis is a retrospective cohort study conducted at Salavan Provincial Hospital. Study participants were all pregnant women who gave birth at the hospital between 1 August 2016 and 31 July 31 2017. Data were collected from medical records. Logistic regression analyses were performed to quantify the relationship between ANC visits and LBW. We also investigated factors associated with inadequate ANC visits: first ANC visit after the first trimester or < 4 ANC visits.ResultsThe mean birth weight was 2808.7 g [standard deviation: SD 455.6]. Among 1804 participants, 350 (19.4%) had babies with LBW, and 147 (8.2%) had inadequate ANC visits. In multivariate analyses, compared to participants with adequate ANC visits, those with ≥ 4 ANC visits and the first ANC visit after the second trimester, those with < 4 ANC visits, and those with no ANC visits had higher odds ratios (ORs) of LBW: 3.77 (95% confidence interval: CI = 1.66–8.57), 2.39 (95% CI = 1.18–4.83) and 2.22 (95% CI = 1.08–4.56), respectively. Younger maternal age (OR 1.42; 95% CI = 1.07–1.89), government subsidisation (OR 2.69; 95% CI = 1.97–3.68) and ethnic minority (OR 1.88; 95% CI = 1.50–2.34) were associated with increased risk of insufficient number of ANC visits after adjusting for covariates.ConclusionsFrequent and early initiation of ANC was associated with a reduction in LBW in Lao PDR. Encouraging childbearing-aged women to receive sufficient ANC at proper timing may lead to a reduction in LBW and improvement in short- and long-term health outcomes of neonates. Special attention will be needed for ethnic minorities and women in lower socioeconomic classes.

Social determinants of diabetic retinopathy and impact of sight-threatening diabetic retinopathy: A study from Pune, India.

Diabetes-related retinopathy is the leading cause of blindness in India. The study was carried out with the purpose of studying the association of sight-threatening diabetic retinopathy (STDR) with socioeconomic factors and demonstrating the impact of STDR on the affected individual. A mixed methods (quantitative and qualitative) research design was used. The study participants were divided into two groups for quantitative analysis. The control group consisted of non-sight-threatening diabetic retinopathy, whereas the study group consisted of sight-threatening diabetic retinopathy. Apart from demographics, data on comorbidities, type and duration of diabetes mellitus (DM), health insurance status, and socioeconomic data were collected from each individual. A statistical test (Chi-square) was performed to study the association between socioeconomic (SE) classes and STDR. For the qualitative part, a few people were chosen. Face-to-face interviews were conducted in depth. A total of 207 individuals, were recruited, of which 69 had STDR and the remaining 138 had non-STDR. The incidence of STDR was high among patients with lower socioeconomic class (SEC) (upper lower and lower), and univariate analysis revealed a strong association between STDR and SEC, the presence of comorbidities, presence of health insurance, type and duration of DM, and P value <0.05. SEC, in contrast, emerged as an independent risk factor for STDR in multivariate analysis. STDR had a devastating effect on all patients interviewed. The financial impact was most likely the most severe. People with lower SEC are more likely to suffer from STDR-related vision loss. The impact of such vision loss on individuals is multifaceted, including a negative impact on social and work life, psychological well-being, and, most importantly, a significant financial impact.