Low Socioeconomic Status Populations Research Articles

Confronting Inequalities and Bridging the Divide: A Retrospective Study Assessment of Country-Level COVID-19 Vaccine Equality with a Cox Regression Model.

COVID-19 vaccination is vital in reducing illness, hospitalization, and mortality in the face of this global pandemic. However, COVID-19 vaccination rates worldwide remain below WHO public health targets, and persistent structural inequities reduce vaccine uptake likelihood among populations of low socioeconomic status. We conducted a cross-sectional study based on publicly available data from the Our World in Data project. We included all 124 countries with available open epidemic data and a population of more than 5 million. We used a Cox Regression Model, with population, population density, median age, human development index, GDP per capita, gender inequality index, healthcare access and quality index, hospital beds per thousand people, completion rate of primary education, infection cases of COVID-19 by the end of 2022, and death rate due to COVID-19 by the end of 2022 as predictors for model hazard rates of completion of 50% population vaccination. According to our study, countries with higher populations, higher population density, higher human development index, lower gender inequality index, and lower hospital beds per 1000 people had a higher hazard rate, which means they were more likely to achieve 50% population vaccination faster. By utilizing the time to achieve vaccination rate goals as our primary endpoint, we evaluated inequity from a dual perspective, considering both the differences in vaccination rates and the duration required to attain them. Consequently, this study employed survival analysis approaches to gain a comprehensive understanding of vaccine drivers and population-level trends nationally and inform all communities from a statistical perspective to prepare for health emergencies. Development-level standing modified the effects of equal access to COVID-19 vaccination on cumulative cases and mortality, for which countries of low or medium human development tended to fare worse in outcomes than high human development countries. As COVID-19 vaccination efforts evolve, healthcare professionals, scholars, and policymakers need to identify the structural impediments to equitable vaccination awareness, access, and uptake so that future vaccination campaigns are not impeded by these barriers to immunization. Recognizing the complex nature of this significant barrier, it is evident that no single statistical analysis method can comprehensively address all intricacies.

Recruitment strategies for reaching adults aged 50 years and older with low socioeconomic status for participation in online physical activity interventions.

Generally, the health condition of those with higher socioeconomic status (SES) is better compared to those with lower SES. The application of appropriate strategies to reach low SES populations with electronic health (eHealth) interventions is thus of major importance to reduce health inequalities. eHealth-studies providing detailed information on recruitment strategies are scarce, despite the fact that this information is crucial for comparable research and implementation. To provide insight into the reach, sample characteristics and costs of three pre-planned strategies for recruiting adults aged 50 years and older with low SES for participation in an online physical activity intervention, as part of a field study. Recruitment took place via (1) invitation letters via a municipality, (2) gyms and (3) social media advertisements, aiming to include 400 participants. Additional procedures were followed to reach specifically the low SES group. Response rates, sociodemographic characteristics and costs per strategy were assessed. The highest response was shown for the municipality approach (N = 281), followed by social media (N = 71) and gyms (N = 45). Ten participants were recruited via family/friends. The most low-educated participants were reached via the municipality (N = 128) followed by social media (N = 9), gyms (N = 8) and family/friends (N = 5). Recruitment costs were with €2,142.37 the highest for the municipality compared to €96.81 for social media and no costs for gyms. Recruitment via invitation letters through a municipality has the highest potential for reaching low SES participants of the three applied strategies, although the higher recruitment costs need to be taken into account.

Associations of prenatal stress with 5-year-old children's executive function in a low socioeconomic status population.

Prenatal stress has a significant, but small, negative effect on children's executive function (EF) in middle and high socioeconomic status (SES) households. Importantly, rates and severity of prenatal stress are higher and protective factors are reduced in lower SES households, suggesting prenatal stress may be particularly detrimental for children's EF in this population. This study examined whether prenatal stress was linked to 5-year-old's EF in a predominantly low SES sample and child sex moderated this association, as males may be more vulnerable to adverse prenatal experiences. Participants were 132 mother-child dyads drawn from a prospective prenatal cohort. Mothers reported on their depression symptoms, trait anxiety, perceived stress, everyday discrimination, and sleep quality at enrollment and once each trimester, to form a composite prenatal stress measure. Children's EF was assessed at age 5 years using the parent-report Behavior Rating Inventory of Executive Function - Preschool (BRIEF-P) Global Executive Composite subscale and neuropsychological tasks completed by the children. Mixed models revealed higher prenatal stress was associated with lower BRIEF-P scores, indicating better EF, for females only. Higher prenatal stress was associated with lower performance on neuropsychological EF measures for both males and females. Results add to the limited evidence about prenatal stress effects on children's EF in low SES households.

Public health efforts to prevent expansion of alcohol retail availability in neighbourhoods with factors associated with high rates of alcohol-related harms: A case report.

This commentary illustrates a recent case study within Ontario, Canada, in which the application of sociodemographic and health data was used by public health to support a legal case to oppose a retail licence application to consume liquor at a corner store located within a neighbourhood that has experienced low socio-economic factors, including low income, high unemployment and low educational attainment levels. Communities in a similar situation may draw from this situation to prevent expansion of alcohol retail availability in neighbourhoods that have low socio-economic status populations and high unemployment and other factors associated with high rates of alcohol-related harms.

Characterization of CD4+ t cell subsets during Chlamydia muridarum genital infection

Characterization of CD4+ T cell subsets in a stressed mouse model during Chlamydia muridarum genital infection. Katrina Davis, Tesfaye Belay. Department of Applied Sciences and Mathematics. Chlamydia genital infection caused by Chlamydia trachomatis is highly prevalent in low socioeconomic status populations. Whether stress is a risk factor for the high incidence of chlamydia remains to be investigated. CD4+ T cells are the major immune cells that fight chlamydia genital infection; however, the dynamics of CD4+ T cells during stressful conditions and chlamydia infection are unclear. The profiles of CD4+ T cell signature cytokines: T helper 1 (IL-12, Interferon-gamma (IFN-γ), Thelper2 (IL-4, IL-5, IL-13), Thelper17(IL-17), and Treg (IL-10). Mice were stressed for 5 minutes daily for 21 days and infected with 1x 105 IFU/ml of Chlamydia muridarum intravaginally. Non-stressed mice were infected as controls. Mice were sacrificed 7 days post-infection, the spleen and lymph nodes were harvested, and T cells were purified and proliferated for 72 h. Determination of the levels of cytokines in culture supernatants of T cells from stressed and non-stressed mice are underway for poster presentation. Supported by the NIH grant # 1R15AI124156-01 awarded to BSU

Inequity in access to digital public primary healthcare in Sweden: a cross-sectional study of the effects of urbanicity and socioeconomic status on utilization.

Social and geographical inequity in access to primary healthcare is an ongoing concern in Sweden. Digital care can potentially decrease geographical inequity. This study aimed to evaluate how urbanicity affects the utilization of a public digital primary healthcare service - PHC Online. We performed an ecological cross-sectional study of 4,482 PHC Online visits grouped by 83 public primary healthcare centers. Multiple linear regression analysis was performed with PHC Online visits per 1,000 registered patients as the dependent variable and urbanicity (municipalities grouped by number of inhabitants), socioeconomic status (Care Need Index), and morbidity (Adjusted Clinical Groups) per primary healthcare center as independent variables. Utilization of PHC Online was more common among those of a younger age (median 32 years) and among women (65%). Urbanicity did not affect utilization. Lower socioeconomic status and higher morbidity had negative effects on utilization (B -3.289, p = 0.001, B -7.728, p = 0.045). Geographical differences based on urbanicity do not seem to affect the utilization of PHC Online. Further studies are needed to clarify a possible association to geographical barriers in access to primary healthcare, specifically accounting for factors associated with urbanicity and distance to physical clinics, and how age and sex affect such an association. Lower utilization of PHC Online in low socioeconomic status and high morbidity populations raises questions on the effect of digital primary care on equitable access to primary healthcare.

Exploring vocational outcomes, quality of life, and social inclusion in patients with spinal cord injuries following vocational rehabilitation in India

Study designWe conducted a mixed-methods sequential explanatory study. In India, most spinal cord injuries (SCI) occur within low socioeconomic status populations, typically resulting in poor vocational outcomes post-injury and difficulty reintegrating into the community. This study will increase our understanding of how vocational rehabilitation affects patients with SCI.ObjectivesThis study aims to understand the factors affecting vocational outcomes, quality of life and social inclusion for patients who have completed the Amar Seva Sangam (ASSA’s) rehabilitation program, by examining both quantitative and qualitative measures.MethodsConducted at the University of Toronto, we used self-administered questionnaires via REDCap for quantitative data collection and semi-structured interviews for qualitative data collection to capture aspects of lived SCI experience for five participants.ResultsThirty-two participants completed the quantitative phone questionnaire of which 17 were paraplegic and 15 were quadriplegic. Four themes emerged including physical barriers to employment, social inclusion of SCI patients, low income, and state of mental health.ConclusionThis study provided a detailed examination of demographic information and lived experiences of ASSA participants. The findings will be relevant and applicable to both clinical and public health sectors in SCI rehabilitation in India and other low- and middle-income countries by directing rehabilitation programs to better address areas of function that allow patients to find success following rehabilitation.

Pattern of cognitive impairment among community-dwelling elderly in Egypt and its relation to socioeconomic status

BackgroundCognitive decline is one of the aging health problems that strongly affects daily functioning and quality of life of older adults and threatens their independence. The aim of this study was to assess the prevalence and pattern of cognitive impairment (CI) among community-dwelling elderly in Egypt and the contribution of socioeconomic status to inequality in cognitive impairment.MethodsA cross-sectional study involved 470 community-dwelling elderly aged 60 years or older living in Kafr El-Sheikh Governorate, Egypt. Subjects were recruited from home visits, geriatric clubs, and outpatient clinics. The Montreal Cognitive Assessment tools (MoCA & MoCA-B) were used to assess the prevalence of cognitive impairment, Hachinski ischemic score (HIS) to investigate the type of cognitive impairment, Ain Shams Cognitive Assessment (ASCA) tool to assess the pattern of specific cognitive domain affection, and an Egyptian socioeconomic status (SES) scale to classify the SES of the study participants.ResultsThe prevalence of cognitive impairment was 50.2% distributed as 37.7% for mild cognitive impairment (MCI) and 12.5% for dementia. The most common type of cognitive impairment was the degenerative type (47.9%). Pattern of specific domain affection among cognitively impaired subjects ranged from 94% for visuospatial function to 12.7% for abstraction. Cognitive impairment was significantly higher with increasing age, female sex, marital status (single or widow), low education, higher number of comorbidities, and positive family history of cognitive impairment (p < 0.001). Also, cognitive impairment was concentrated mainly among participants with low socioeconomic score (p < 0.001).ConclusionIn Egypt, cognitive impairment is significantly prevalent and concentrated among those who are in low socioeconomic status. Patients with mild CI were more than those with dementia, and the most common type of CI was the degenerative type. Increasing educational level of low SES population and improving their access to healthcare services are highly recommended to improve the inequity of cognitive impairment.

Abstract WP112: Neighborhood Level Characteristics Associated With Adequate Transition of Stroke Care: The Transition of Care Stroke Disparities Study

Objective: Transition of Care Stroke Disparities Study is an observational prospective cohort aimed to investigate disparities in the transition of stroke care (TOSC) post-hospitalization to home and to identify factors associated with adequate TOSC and stroke outcomes. we have demonstrated that higher individual socioeconomic status is associated with adequate TOSC. The present study explores the association between neighborhood-level characteristics (NLC) and adequate TOSC in ischemic stroke patients 1 month after discharge. Methods: Data from 925 ischemic stroke patients discharged from 10 Comprehensive Stroke Centers (CSCs) was obtained from three sources: a. NLC: demographic composition, level of education, and median household income from publicly available data using participants’ Zip codes (independent variables); b. 30-day post-discharge data for 6 categories of TOSC-related behaviors (dependent variables) including medication adherence, weekly exercise, medical follow-up, rehabilitation attendance, toxic habit cessation, diet modification. c. Clinical characteristics from Get with the Guidelines-Stroke (covariates). The primary outcome was 100% adequate transition of care (ATOC), a combined index of ideal adherence to all applicable behavior modifications. Results: The sample included 46% Women, 23% Non-Hispanic Black and 22% Hispanic, the average age was 64 years. NLC ranged as follows: % Black (0-93.9, median 9.1), %Hispanic (3-99.9, median 82.3), % bachelor’s degree (6.3-77.3, median 26.2), and median household income ($18,920-159,914, median $48,816). Almost a third (34%) of participants achieved 100% ATOC. In the adjusted analysis of NLC variables, higher %Hispanic (OR=1.45, 95% CI=1.03-2.04), higher %bachelor's degree recipients (OR=1.62, 95% CI=1.21-2.18), and higher median income (OR=1.12, 95%CI=1.04-1.21) were significantly associated with achieving 100% ATOC. Conclusions: Results suggest that NLC plays a crucial role in adherence to care transition instructions, underscoring the importance of interventions targeted at lower socioeconomic status populations. Future work will determine the impacts of NLC on stroke recurrence and readmission.

Assessing the Performance of a Nutrition Knowledge Questionnaire With a Low Socioeconomic Status Population Using Rasch Analysis.

Parents and preschool teachers play a key role in shaping children's dietary behaviors. Knowledge of nutrition and healthy dietary choices is a key component to improve dietary habits and reduce the prevalence of obesity and associated co-morbidities. Using valid and reliable instruments is necessary for accurate assessment of knowledge to tailor interventions and measure effectiveness specific to the population of interest. The objectives of this paper are to (1) identify potential gaps in the baseline nutrition knowledge among parents and teachers using a previously validated questionnaire prior to a preschool obesity prevention intervention; and (2) assess the instrument's reliability and construct validity for a low socioeconomic status population using a post hoc Rasch analysis. Participants included 177 parents and 75 teachers who participated in a Head Start intervention study. Knowledge scores, instrument reliability, and item fit and difficulty were assessed using a Rasch analysis; t-tests were used to determine differences in scores between parents and teachers. Parents answered 38% of questions correctly while teachers correctly answered 46% of the questions. Adequate item fit and reliability were indicated for Sections 1 and 2 of the Nutrition Knowledge Questionnaire (NKQ). Section 3 demonstrated less adequate reliability. The items were found to adequately and reliably define the unidimensional measures of the three components of knowledge represented in this instrument, providing evidence of construct validity. However, Rasch measures indicated the NKQ overall was difficult for participants. Recommendations for improving the instrument for nutrition education/intervention and research practice areas related to obesity and obesity-related conditions are addressed.

Association between linear enamel hypoplasia, cribra orbitalia and porotic hyperostosis in a South African skeletal sample

Background: Linear enamel hypoplasia (LEH) and porous cranial lesions such as cribra orbitalia (CO) and porotic hyperostosis (PH) are considered nonspecific indicators of early childhood metabolic stress. Objectives: The study aims to describe the association of LEH with CO and PH in a sample of the Kirsten Skeletal Collection (KSC) rep- resenting a cohort in the Western Cape, South Africa. This will be used to determine if one or more of these lesions can be used as an indicator of adult mortality. Sample and Methods: Skulls (n = 412) of both sexes with known demo- graphics from the KSC were macroscopically scored for LEH, CO and PH lesions using a ring light. This study was ethically approved by the Health Research and Ethics Committee of Stellenbosch Uni- versity (S13/05/100).Statistical chi-square tests were used to deter- mine the association between lesions and student’s t-tests to deter- mine if there was a significant difference in mean age-of-death be- tween groups. Results: There was no association when comparing LEH with CO and PH in the cohort, although an association was found between CO and PH. Individuals who exhibited the pathological lesions for LEH, CO or PH (or a combination thereof) were observed to have a younger mean age-at-death than the individuals without any of the three disease lesions. Conclusions: The lesions may potentially be used as an indicator of adult mortality. However, the results of this study might represent a biased population of low socio-economic status in the Western Cape as represented in the KSC, rather than the general population of the region.

Abstract 13937: Socioeconomic Status in Pediatric Patients With Anomalous Aortic Origins of Coronary Arteries: An Individual- and Zip Code-Level Analysis

Introduction: Anomalous aortic origin of a coronary artery (AAOCA) is the second leading cause of sudden cardiac death in the young. Limited data is available on potential disparities on access to care and whether socioeconomic status is associated with AAOCA. Hypothesis: AAOCA occurrence, severity, and treatment relate to socioeconomic status and may unfold inequities to care. Methods: Single-center retrospective study of 553 pediatric patients with AAOCA residing in Texas. Zip code socioeconomic characteristics were extracted from American Community Survey 2021 5-year estimates. All Texas zip codes were ordered into quartiles by characteristic. Age at diagnosis, signs of ischemia, and surgery status were compared by race and zip code parameters. Mann-Whitney U test was for non-parametric variables and χ 2 test, Fisher’s test, or one-way ANOVA for categorical variables. Results: Table 1 depicts patients’ demographics. AAOCA patients tended to reside in zip codes at the 4 th quartile of income (39%, p=&lt;0.001), education (29%, p=0.003), and employment (42%, p=&lt;0.001) (Table 2). There was no difference in age at diagnosis, signs of ischemia, or occurrence of coronary surgery by individual race or zip code socioeconomic parameters. Conclusions: AAOCA pediatric patients tend to live in zip codes with higher socioeconomic status (SES). These differences may reflect disparities in access to diagnosis and care. Further studies are needed to determine the burden of AAOCA in low SES populations.

Associations between the Gut Microbiota, Race, and Ethnicity of Patients with Colorectal Cancer: A Pilot and Feasibility Study.

Colorectal cancer (CRC) is more prevalent among some racial and ethnic minority and low socioeconomic status populations. Although the gut microbiota is a risk factor for CRC and varies with race and ethnicity, its role in CRC disparities remains poorly understood. We examined the feasibility of recruiting sociodemographically diverse CRC patients for a microbiome study involving a home stool collection. We also explored whether race and ethnicity were associated with gut microbiome composition. We recruited Black/African American, Hispanic/Latino, and non-Hispanic White patients who were receiving care for active CRC to complete a comprehensive dietary and lifestyle survey, self-collect a stool sample, and complete an exit interview. Gut microbial diversity and composition were analyzed using 16S rRNA gene sequencing. 30 individuals consented (of 35 who were eligible and contacted) with 5 (17%) Black/African American, 11 (37%) Hispanic/Latino, and 14 (46%) non-Hispanic White. A total of 22 (73%) completed the dietary and lifestyle survey; 18 (63%) returned a stool sample. Even after controlling for socioeconomic, dietary, or treatment-related covariates, microbiome composition was associated with race and ethnicity. Fusobacteriota (a phylum associated with the development and progression of CRC) was significantly higher in the Black/African American group compared to others, and microbial diversity was higher in samples from non-Hispanic White individuals compared to Hispanic/Latino individuals. Our study shows that it is feasible to recruit and collect stool samples from diverse individuals with CRC and found significant associations in gut microbial structure with race and ethnicity.

Prevalence and risk factors of anemia in the mother–child population from a region of the Colombian Caribbean

BackgroundDespite Colombia's robust well-child visits program, Colombian children and mothers still suffer from anemia, especially in populations of lower socioeconomic status. In this study, we aimed to quantify the prevalence and risk factors among mothers and their children attending their well-child visits in Apartadó, a municipality in the Urabá region of the Colombian Caribbean.MethodsThere were 100 mother–child pairs enrolled in this secondary data-analysis study from a health facility in the municipality of Apartadó, Urabá, Colombia, during well-child visits. Self-reported data included child illnesses in the past two weeks (diarrheal, fever, or respiratory symptoms), child feeding practices (breastfeeding, complementary feeding), child vaccinations, and demographic characteristics (mother’s and child’s age, mother’s education, marital status, race, and child sex) and socioeconomic status. Mother and child anthropometry data were collected via standardized weight and height measurements. Mother or child anemia status was collected via a blood test. Chi-squared tests and multivariable logistic regression were used to assess associations between risk factors and anemia.ResultThe anemia prevalence in children (74%) and mothers (47%) was higher than the Colombian national prevalence. Reported child comorbidities in the preceding two weeks were not significantly associated with child anemia and included respiratory illnesses (60%), fever (46%), and diarrhea (30%). Stunting (8%) was not significantly associated with anemia. Wasting (0%) was not observed in this study. Reported child breastfeeding and complementary feeding were also not significantly associated with child anemia. In adjusted models, the child's significant risk factors for anemia included the mother's "Mestiza" race (OR: 4.681; 95% CI: 1.258, 17.421) versus the Afro-Colombian race. Older children (25–60 months) were less likely to develop anemia than younger (6–24 months) children (OR: 0.073; 95% CI: 0.015, 0.360).ConclusionsThe finding of high anemia prevalence in this study advances our understanding of child and maternal anemia in populations of low socioeconomic status where health care is regularly accessed through well-child programs.

Complication profile in a cochlear implantation- surgical audit in a large study population of low socio-economic status in a developing country

Objectives To audit surgical complications and their management in cochlear implant (CI) recipients in a tertiary care referral otorhinolaryngology center in South India. Materials and methods Hospital data on 1,250 CI surgeries performed from June 2013 to December 2020 was reviewed. This is an analytical study with data collected from medical records. The demographic details, complications, management protocols and relevant literature were reviewed. Patients were divided into the following five age groups: 0–3 years, 3–6 years, 6–13 years, 13–18 years and above 18 years. Complications were divided into major and minor and complication occurrence was divided into peri-operative, early post-operative, and late post-operative, and the results were analyzed. Results The overall major complication rate was 9.04% (including 6.0% due to device failure). If the device failure rate was excluded, the major complication rate was 3.04%. The minor complication rate was 6%. Discussion CI is the gold standard in the management of patients with severe to profound hearing loss with minimal benefit from conventional hearing aids. Experienced tertiary care CI referral and teaching centers manage complicated implantation cases. Such centers typically audit their surgical complications, providing important reference data for young implant surgeons and newer centers. Conclusion Although not bereft of complications, the list of complications and its prevalence is sufficiently low to warrant the advocacy of CI worldwide, including developing countries with low socio-economic status.

Socioeconomic deprivation and prognostic outcomes in acute coronary syndrome: A meta-analysis using multidimensional socioeconomic status indices

BackgroundLow socioeconomic status (SES) is an important prognosticator amongst patients with acute coronary syndrome (ACS). This paper analysed the effects of SES on ACS outcomes. MethodsMedline and Embase were searched for articles reporting outcomes of ACS patients stratified by SES using a multidimensional index, comprising at least 2 of the following components: Income, Education and Employment. A comparative meta-analysis was conducted using random-effects models to estimate the risk ratio of all-cause mortality in low SES vs high SES populations, stratified according to geographical region, study year, follow-up duration and SES index. ResultsA total of 29 studies comprising of 301,340 individuals were included, of whom 43.7% were classified as low SES. While patients of both SES groups had similar cardiovascular risk profiles, ACS patients of low SES had significantly higher risk of all-cause mortality (adjusted HR:1.19, 95%CI: 1.10–1.1.29, p < 0.001) compared to patients of high SES, with higher 1-year mortality (RR:1.08, 95%CI:1.03–1.13, p = 0.0057) but not 30-day mortality (RR:1.07, 95%CI:0.98–1.16, p = 0.1003). Despite having similar rates of ST-elevation myocardial infarction and non-ST-elevation ACS, individuals with low SES had lower rates of coronary revascularisation (RR:0.95, 95%CI:0.91–0.99, p = 0.0115) and had higher cerebrovascular accident risk (RR:1.25, 95%CI:1.01–1.55, p = 0.0469). Excess mortality risk was independent of region (p = 0.2636), study year (p = 0.7271) and duration of follow-up (p = 0.0604) but was dependent on the SES index used (p < 0.0001). ConclusionLow SES is associated with increased mortality post-ACS, with suboptimal coronary revascularisation rates compared to those of high SES. Concerted efforts are needed to address the global ACS-related socioeconomic inequity. Registration and protocolThe current study was registered with PROSPERO, ID: CRD42022347987.

Roles of dendritic cells and macrophages during Chlamydia muridarum genital infection in stressed mice

It is well known that stress has a significant impact on public health and more evidence shows that stressors generally are greater in populations of lower socioeconomic status. Cold-induced stress inhibits immune cell activity and has been shown to cause different expressions of cytokine profiles during Chlamydia muridarum genital infection. Dendritic cells (DCs) and macrophages(MØ) are immune cells that express beta2-adrenergic receptor (β2-AR) and with key roles during chlamydia genital infection. This study is aimed to investigate the role of β2-AR by using a β2-AR knockout mouse. Wildtype (WT) and β2-AR knockout(KO) mice were stressed for five minutes daily and infected with C. muridarum intravaginally. Non-stressed infected mice of the groups were used as controls. Bone-marrow-derived DCs and MØ were tested isolated, counted differentiated, and proliferated for cytokine production. The proliferation of DCs and macrophages in the presence/absence of β2-AR agonists and antagonists was tested. Data show that non-stressed mice had a higher production of cytokines than stressed mice. Increased production of TNF-α in LPS-treated DCs and MØ of WT and β2-AR KO was observed. The effect of fenoterol and ICI118,55 antagonist showed no significant difference in cytokine production. The data indicate that β2-AR KO and WT had a similar pattern of cytokine production suggesting that deficiency in β2-AR restores the function of immune cells during genital infection. Experiments are undergoing to fully understand the mechanisms involved in modulating the function of DC and MØ during chlamydia genital infection.

Abstract LB138: The conception of an Oncology Neurodiversity Work Group to address cancer disparity for individuals with autism and intellectual or developmental disability (IDD) at the Sidney Kimmel Cancer Center

Abstract Studies have suggested that autistic individuals are as much as 30% more likely to receive a cancer diagnosis which may be associated with co-occurring IDD or birth defects. Following a diagnosis of cancer, outcomes have been documented to be significantly worse for autistic individuals. Autistic individuals experience numerous barriers to care across healthcare settings, including a lack of appropriate communication with providers, a lack of accommodating healthcare environments, lack of mental health support, and too few providers who are trained in working with individuals with autism or IDD. This leads to numerous negative health outcomes, including lower likelihood of having a regular source of care, lower satisfaction with healthcare, reduced screening utilization, delays in recognizing early symptoms of disease, higher ED utilization, and anxiety and stress associated with healthcare visits. We report on the results of a recent Medical Oncology provider survey conducted from 10/31/22 - 12/16/22 to evaluate for opportunities to address barriers to care facing individuals with autism and/or IDD. Of the 49 respondents comprised of physicians and nurse practitioners, 93.9% (46) noted receiving five or fewer hours of specific training or education regarding caring for populations with IDD. Additionally, providers cited the following barriers most commonly related to delivery care to patient with IDD: Lack of strategies to enhance communication on site (32, 65.3%), Inadequate time allotted for visits (28, 57.1%), Inadequate staff training and education related to this group (27, 55.1%), Limited resources to support vulnerable or lower socio-economic status populations (22, 44.9%), and Fragmentation of care (19, 38.8%). The Sidney Kimmel Cancer Center and the Jefferson Center for Autism &amp; Neurodiversity have collaborated to develop a culturally competent care design aimed at understanding the needs of our neurodiverse population through a joint research effort. The results of our Medical Oncology provider survey identified the need for training of providers and staff to optimize the patient experience, creation of accessible cancer screenings, and the adoption of an environment that supports the sensory and communication abilities and needs of neurodivergent patients. Providers that adopt best practices in the care of autistic and/or IDD individuals have noted that patients and families report marked improvement in the rating of their patient experience in the visit. The desired product is care plans, appropriate medical settings, and trained providers that will meet the needs of this population and improve overall health outcomes. Citation Format: Avnish K. Bhatia, Alexander Fossi, Brooke L. Goodspeed, Jane Tobias, Christopher McNair, Dwight McBee, Wendy Ross. The conception of an Oncology Neurodiversity Work Group to address cancer disparity for individuals with autism and intellectual or developmental disability (IDD) at the Sidney Kimmel Cancer Center [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr LB138.

Can Blockchain Help Improve Financial Inclusion? A Comparative Study

The financial inclusion of poor populations and/or refugees can be hindered by difficulties in proving or reluctance to disclose their identity. Bank accounts and mobile money services require that identities be provided. Financial digital services based on blockchain technology can provide anonymous authentication to poor/refugee populations and be a first step towards financial inclusion. We scrutinize several examples of such projects by comparing them with blockchain-based digital identity or financial inclusion programs that are not necessarily restricted to poor/migrant populations. We use social network activity as a proxy for the failure or success of such projects. We find that blockchain projects targeted to migrants and poor individuals are more likely to fail than are those targeted to all. We more closely examine one particular case to check the consistency of our proxy. We present plausible explanations for our result: the discrepancy between the needs of populations of low socioeconomic status and the proposed blockchain-backed financial services and the fact that maintaining such services is energy intensive.

Perioperative Medicine: What the Future Can Hold for Anesthesiology.

Perioperative Medicine: What the Future Can Hold for Anesthesiology.