Low Educational Level Research Articles

A scoping review of evidence on routine cervical cancer screening in South Asia: investigating factors affecting adoption and implementation.

Adopting the "Arksey and O'Malley and Levac et al." methodology, databases such as PubMed, CINAHL, Web of Science, and Scopus were scrutinized in the pursuit of relevant studies. Subsequently, the collected data were synthesized by adopting the Consolidated Framework for Implementation Research (CFIR) model. A total of 837 records were initially identified and screened for eligibility, including 55 studies. The successful adoption and implementation of cervical cancer screening in South Asia encounter numerous obstacles within the health system, including the absence of a comprehensive program protocol for screening, inadequate health infrastructure, and the presence of multiple sociocultural factors, such as social stigma, low levels of education, and concerns related to modesty. To optimize adoption and implementation, it is imperative to construct a customized policy framework that incorporates a risk communication strategy tailored to the specific contexts of these nations. Drawing insights from the experiences of South Asian countries in executing cervical cancer screening programs can inform the formulation of policies for similar healthcare initiatives aimed at facilitating the expansion of HPV vaccination efforts.

COMPARATIVE EVALUATION OF PAP SMEAR WITH HISTOPATHOLOGY IN CERVICAL LESION ACCORDING TO THE 2014 BETHESDA SYSTEM: AN INSTITUTIONAL STUDY

Objectives: The objective of this study is to evaluate the efficacy of a pap smear using The 2014 Bethesda System (TBS) for the diagnosis of premalignant and malignant lesions of the uterine cervix. Methods: A prospective study was conducted in the Department of Pathology at the institution from November 2015 to October 2017. Fifty patients with an unhealthy cervix have undergone conventional Pap smears and histopathological biopsies with the suspicion of cervical malignancy or premalignancy attending the Obstetrics and Gynecology Outpatient Department. The obtained smears were arranged according to TBS. The tissue biopsies have been processed routinely and they are stained with hematoxylin and eosin for histopathological diagnosis. Furthermore, cases such as non-neoplastic, metastatic lesions, and recurrent cases were excluded from this study. Results: The common age group has been identified as between 41 and 60 years and patients had low educational levels. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy observed in this study were 89.28%, 63.63%, 64.1%, 72.72%, and 72% respectively. Conclusion: Pap smear is a simple, effective, inexpensive procedure that can be routinely used as a screening tool for screening cervical cancer. TBSs also provide a standard approach for cytological evaluation that helps in the early detection of premalignant and malignant cervical lesions.

The predictive power of Dutch end of primary school tests for educational attainment in ninth grade

AbstractDutch secondary education is a multi‐tiered system, and many students are placed in a single track in the first year (seventh grade) of secondary education. As part of the placement procedure, all sixth‐grade students take an end of primary school test. Although these standardised attainment tests (SATs) are considered high‐stakes tests, the predictive accuracy of many of these SATs has not been studied comprehensively. In the current study, three SATs commonly used in The Netherlands (CET, IEP and R8) were compared on their predictive accuracy of educational attainment in ninth grade. The predictive accuracy was also investigated for particular track recommendations, using multiple cohorts of population data, each of around 160,000 students. For the two most recent cohorts, CET was overall a more accurate predictor of educational attainment in ninth grade than R8, which in turn was a more accurate predictor than IEP. All three attainment tests had only mediocre to acceptable predictive power overall. Furthermore, all three tests had very poor predictive power for certain single‐track recommendations. For these track recommendations, many students attained a lower or higher educational level in ninth grade. This study is the first to compare the predictive accuracy of these SATs. While statistical noise is normal when using tests, since different tests are used that vary widely in predictive accuracy, there is much more noise than is acceptable. As long as the predictive accuracy is poor to mediocre, these SATs should not have a large role to play in the Dutch placement procedure for secondary education.

Gender Gap in Spousal Education and Wealth After Marriage in India

This study examines gender-based disparities in spouse selection among parents in India. Our focus on studying this gender gap in low- and middle-income countries is important as arranged marriages are prevalent in many such societies, and the education and wealth of a groom can significantly impact his spouse and future generations’ long-term economic well-being. Our findings reveal that parents frequently arrange marriages for their daughters with more educated and wealthier grooms, while sons are often matched with brides of lower education. Notably, a novel finding of our study is that daughters, despite generally lower education levels, achieve higher combined educational attainment with their husbands than sons with their wives, especially in areas with lower literacy, income, and employment rates. Overall, our analysis brings to light an important facet of discriminatory societal norms that place a higher value on men’s financial success and women’s social status.

Socioeconomic status and emergency department visits in adults with a history of severe childhood asthma: a register-based study

ABSTRACT Background and Objective Our knowledge of socioeconomic status (SES) and emergency department (ED) visits in adults with a history of severe childhood asthma is limited. Our aim was, therefore, to investigate these variables in individuals with a history of severe childhood asthma compared to a control population. Methods The Kongsberg cohort comprises Danish individuals with a history of severe childhood asthma and a previous 4-month stay at an asthma care facility in Kongsberg, Norway, between 1950 and 1979. The cohort was compared 1:1 to sex and age matched controls with no previous diagnosis of or treatment for obstructive airway disease (OAD). Data from the national Danish health registries were used for comparing cases and controls. Results A total of 1394 adults from the Kongsberg cohort were alive and residing in Denmark (mean age 63 years, 43% females) at the index date (June 2022). A Charlson comorbidity index score of ≥1 was higher in the study cohort compared to controls (7% versus 3%) (p < 0.01). Cases had a 1.5-fold increased likelihood of having a high educational level (p < 0.001) compared to controls. Compared to the controls, cases had a higher risk of all-cause ED visits, with individuals having lower educational levels showing the highest proportion of ED visits. Furthermore, 31.2% and 22.9%, respectively, of cases and controls with high educational levels had had ED visits. Compared to controls, logistic regression analysis revealed a 1.7-fold higher risk of all-cause ED visits in cases (p < 0.001). Conclusions In adults with a history of severe childhood asthma, educational level, comorbidity burden, and risk of ED visit were higher compared to matched controls with no history of obstructive airway disease.

8361 Impact of Social Vulnerability on Glycemic Control in Primary Care Patients with Diabetes

Abstract Disclosure: J.N. Tich: None. S.R. MacLeod: None. V. Zhang: None. T. Love: None. R.J. Fortuna: None. Introduction: According to the CDC, 29.7 million Americans are diagnosed with diabetes (DM), contributing to morbidity, mortality and strain on the healthcare system. The impact of social determinants of health (SDOH) and social vulnerability (SV), as measured by the social vulnerability index (SVI), on DM care and control is evident. In populations with lower educational attainment levels, lower income and higher rates of poverty, prevalence of DM and rates of complications are higher. However, less is understood about how the intersectionality between SDOH/SV and race impacts diabetes control. Aims: We sought to examine the impact of SV and race on DM control in primary care patients in Upstate NY. Methods: We examined 26,010 patients with DM in Upstate NY. We defined DM control based on national HEDIS standards. SVI were calculated for each patient based on census track data. The SVI is calculated based on 16 variables in four themes: socioeconomic status, household characteristics, racial/ethnic minority status, and housing/transportation. SVI scores range from 0 (lowest vulnerability) to 1 (highest vulnerability). In addition to calculated SVI scores, we examined patient-reported SDOH, including food insecurity, housing insecurity, transportation, and social isolation. Race and ethnicity related parameters were self-reported. We report preliminary descriptive data. Results: Overall, 73.6% of patients were controlled with a HgA1c &amp;lt;8% based on the HEDIS definition. Control rates varied based on race (white 75.9% Black 66.1%; Asian 73.7%; other race 66.6%), calculated SVI, and patient reported SDOH. Within each racial category, diabetes control rates worsened with increasing SVI. Patients who expressed food insecurity had lower rates of DM control than those who had no food insecurity (68.8% vs 79.7%). Similarly, patients with housing insecurity had lower control rates (67.5%) compared to those who had greater housing security (80.0%). Patients with unmet transportation needs had lower rates of diabetic control (67.4%) compared to those with stable transportation (80.6%). Additional statistical tests and multivariate regression models are pending. Conclusions: Across a large sample of patients with diabetes, increasing SV was associated with worsening glycemic control across all racial groups studied. In preliminary analyses, both race and SVI appear to be independently associated with DM control. SVI did not fully mitigate the influence of rate on DM control. Within same SVI category, non-white participants appeared to have a more negative impact on DM control compared to white participants. While SDOH are well known influences, these findings specifically demonstrate the link between SV and glycemic control, highlighting the fact that at the same SVI quartile, non-white participants may be more vulnerable to dysglycemia. Presentation: 6/2/2024 6/2/2024

5099 Capturing the Patient Voice for Diabetes Eye Exams

Abstract Disclosure: S. Du: None. S. Lambrechts: None. M. Freeby: None. M. Han: None. Background: Diabetic retinopathy (DR) is a leading cause of blindness among adults 20-74 years old. Ophthalmic exams are recommended every 1-2 years for type 2 diabetes patients with minimal to no DR. The 50th percentile Integrated Healthcare Association benchmark for DR screening is 49%, but at our academic medical center, the completion rate is 30%. Potential barriers to screening noted in the literature include lower levels of education, lack of knowledge about DR, and financial barriers. Objective: To understand motivating factors and barriers to DR screening among patients in our health system. Methods: We utilized the Patient Voice qualitative research method to uncover themes and identify interventions to improve care delivery. The literature was synthesized to develop a structured interview guide. From our urban academic health system, 15 patients were randomly selected for interview, six of whom had completed the “Diabetes Eye Exam” care gap and nine that had not. Interviews were transcribed and coded for thematic analysis. Results: Six opportunity areas were identified. 1) There are currently only six retinal cameras located across primary and specialty care clinics serving more than 38,000 diabetes patients. 67% of patients felt the current clinic locations were inconvenient, with distant locations and long travel times. 2) 20% of patients expressed that they would like increased flexibility of appointments offered, such as evening, weekend, and same day appointments. 3) Patients were motivated by automated diabetes eye exam specific reminder messages and appreciated the ability to self-schedule within the patient portal. 47% of patients wanted yearly reminder messages, while 40% had no preference. 4) 53% of patients expressed that they did not fully understand DR or were confused about the difference between an optometrist exam and diabetes eye exam. 5) 40% of patients completed their eye exam with their local optometrist and found this to be a more convenient option. One patient expressed that she wished her doctor had informed her that she could complete her diabetes eye exam at a local optometry clinic. 6) If patients do choose to complete their exam with their local optometrist, they would like reminders to send their records to their primary care physician or endocrinologist. A more streamlined processes to upload outside records through the patient portal would decrease this barrier. Conclusion: It is important to engage patient stakeholders and understand their needs to improve overall experience and close care gaps. Through the Patient Voice, we learned that factors such as driving distance, traffic, scheduling, and issues with uploading records are major barriers to care gap completion. Convenient clinic locations, education, and reminder messages are motivating factors. Future work will focus on developing and implementing solutions in each opportunity area. Presentation: 6/1/2024

Perceived discrimination and refraining from seeking physician’s care in Sweden: an intersectional analysis of individual heterogeneity and discriminatory accuracy (AIHDA)

BackgroundDiscrimination may further impede access to medical care for individuals in socially disadvantaged positions. Sociodemographic information and perceived discrimination intersect and define multiple contexts or strata that condition the risk of refraining from seeking physician’s care. By applying analysis of individual heterogeneity and discriminatory accuracy (AIHDA) we aimed to improve the mapping of risk by considering both strata average risk differences and the accuracy of such strata risks for distinguishing between individuals who did or did not refrain from seeking physician’s care.MethodsWe analysed nine annual National Public Health Surveys (2004, 2007–2014) in Sweden including 73,815 participants. We investigated the risk of refraining from seeking physician’s care across 64 intersectional strata defined by sex, education, age, country of birth, and perceived discrimination. We calculated strata-specific prevalences and prevalence ratios (PR) with 95% confidence intervals (CI), and the area under the receiver operating characteristic curve (AUC) to evaluate the discriminatory accuracy (DA).ResultsDiscriminated foreign-born women aged 35–49 with a low educational level show a six times higher risk (PR = 6.07, 95% CI 5.05–7.30) than non-discriminated native men with a high educational level aged 35–49. However, the DA of the intersectional strata was small (AUC = 0.64). Overall, discrimination increased the absolute risk of refraining from seeking physician’s care, over and above age, sex, and educational level.ConclusionsAIHDA disclosed complex intersectional inequalities in the average risk of refraining from seeking physician’s care. This risk was rather high in some strata, which is relevant from an individual perspective. However, from a population perspective, the low DA of the intersectional strata suggests that potential interventions to reduce such inequalities should be universal but tailored to the specific contextual characteristics of the strata. Discrimination impairs access to healthcare.

Understanding Vaccine Hesitancy: A Comparison of Sociodemographic and Socioeconomic Predictors with Health Literacy Dimensions.

Vaccine hesitancy represents a global public health challenge that can diminish the effectiveness of vaccination programs. Research indicates that various sociodemographic and socioeconomic factors, along with health literacy, predict vaccine hesitancy. In this study, we analyzed data from a Slovenian health literacy survey that included 3360 adult participants. We examined the effects of sociodemographic (gender and age) and socioeconomic factors (education, economic deprivation, and self-assessed socioeconomic status), as well as different dimensions of health literacy (general, communicative, and navigational), on vaccine hesitancy. The results show that age, education, and economic deprivation are statistically significant predictors of vaccine hesitancy; younger individuals, those with lower education levels, and those experiencing greater economic deprivation express increased vaccine hesitancy. Higher levels of general and communicative health literacy are associated with lower vaccine hesitancy, while navigational health literacy was not found to be a statistically significant predictor of vaccine hesitancy.

RISIKO USAHATANI TOMAT (LYCOPERSICUM ESCULENTUMMILL) DI KECAMATAN LEMBAH GUMANTI KABUPATEN SOLOK (Risks of Tomato (Lycopersicum Esculentum) Farming in Lembah Gumanti District Solok Regency)

This study aims to determine analyze the characteristics of tomato farmers, analyze the income of tomato farmers and analyze the risk level of tomato farming in Lembah Gumanti District, Solok Regency. The method used in this study is quantitative descriptive The analysis used is income, variety, standard deviation, coefficient of variation, and lower limit. The respondents who were sampled were 40 farmers with a population of 423 farmers and were selected randomly (proportional random sampling). The results showed that the characteristics of tomato farmers have a productive age of 25 to 48 years, a low level of education, farmers who already have long farming experience. The amount of cash costs incurred by farmers is IDR 6,456,733.33 / MT and the calculated costs are IDR. 4,919,309.63/MT with revenue of Rp 23,608,331.25/MT so that cash income is Rp 17,209,386.82/MT and total income is Rp 12,290,077.19/MT. Tomato farming has a production risk level with a KV value of 10.39, price risk with a KV value of 18.56, and income risk with a KV value of 13.36 with a lower income limit of Rp 10,450,763.47 where this figure will indicate the amount of loss that will be experienced by tomato farmer

Unveiling the failure: a comprehensive analysis of Bangladesh’s war on drugs

PurposeThis study aims to evaluate public perceptions of illegal drug availability in Bangladesh amid the ongoing war on drugs while comparing the efficacy of crackdowns with traditional law enforcement strategies.Design/methodology/approachUsing a quantitative approach, the research analyzes data gathered from 400 participants, including law enforcement officials, students, politicians, community leaders and journalists.FindingsThe findings reveal that illegal drugs continue to be widely accessible in Bangladesh, with 50.15% of respondents acknowledging this despite the government's intensified efforts against drug dealers since 2015. Perceptions of availability are notably higher among those identifying as “other” (66.67%), younger individuals aged 18–28 (55.26%), participants with lower educational levels (76.67% for those with less than SSC education), unmarried respondents (58.86%) and students (60.55%). When assessing enforcement methods, a substantial majority (65.6%) prefer regular law enforcement over violent crackdowns. The survey indicates that all respondents identifying as “other,” along with 73.23% of females, 65.6% of males, 81.82% of participants aged 58–68 and individuals from Khulna (92.65%), Rangpur (96.92%) and Dhaka (51.43%), overwhelmingly favor regular law enforcement compared to crackdowns.Practical implicationsThe study emphasizes the urgent need to address the shortcomings of violent anti-drug measures and advocates for a more holistic approach that considers the complex interplay of social, economic and health factors in combating drug abuse in Bangladesh.Originality/valueThis study offers a comprehensive analysis of the relationship between demographic factors and perceptions of drug availability and the effectiveness of violent crackdowns vs regular law enforcement, revealing new insights into this complex sociocultural issue.

Comparing health-related quality of life and utility scores of patients undergoing hemodialysis and continuous ambulatory peritoneal dialysis in Indonesia.

Although both hemodialysis and continuous ambulatory peritoneal dialysis (CAPD) are covered by national healthcare insurance, 98% of kidney failure disease patients are treated with hemodialysis. This study compared the health-related quality of life (HRQoL) and utility scores of patients receiving hemodialysis and CAPD in Indonesia and determined factors associated with HRQoL and utility scores. A cross-sectional study was performed using the Kidney Disease Quality of Life-36 and EQ-5D-5L instruments at six hospitals. Utility scores were presented as SF-6D and EQ-5D scores. Factors associated with the EQ-5D were evaluated using Tobit regressions due to ceiling effects, while the SF-6D and HRQoL were assessed using generalized linear models since the data were not normally distributed. Among the 613 patients, 76% were treated with hemodialysis. After adjusting for sociodemographic characteristics and clinical parameters, CAPD patients reported better HRQoL compared to hemodialysis patients in terms of the SF-6D (p = .038), mental component summary (p = .020), symptoms (p = .005), and effects of kidney disease (p<.001), but no significant differences were reported in EQ-5D (p = .083), physical component summary (p = .323), burden of kidney disease (p = .111), and kidney summary scores (p = .068). Poorer HRQoL and utility scores were likely experienced by older patients who were male, married, with diabetes, treated in Class A hospitals, and with lower education, hemoglobin, and albumin levels. In Indonesia, patients treated with CAPD had better HRQoL and utility scores compared to patients undergoing hemodialysis. Therefore, CAPD should be promoted by healthcare professionals as the first treatment option for patients who are eligible for both hemodialysis and CAPD.

Global prevalence of fatigue in patients with multiple sclerosis: a systematic review and meta-analysis.

Fatigue is one of the most common and burdensome symptoms for patients with multiple sclerosis (PwMS), considerably impacting their quality of life and employment. Numerous reports have described the prevalence of MS-related fatigue, but there is no global consensus on this matter. To examine the global prevalence of MS-related fatigue and identify sources of heterogeneity in the published literature. A systematic review and meta-analysis were conducted. A comprehensive search of the PubMed, EMBASE, Cochrane Library, Web of Science, PsycINFO, CINAHL, China National Knowledge Infrastructure (CNKI), and Wanfang database for potential literature from 2000 to January 31, 2024. A random effects model was used to calculate the prevalence of MS-related fatigue. Subgroup analyses and a meta-regression were used to explore the sources of heterogeneity. Sixty-nine studies from 27 countries were included. The global prevalence of MS-related fatigue was 59.1%, and it has decreased every decade since 2000. Fatigue was prevalent among females, those with lower education levels, those who were older, those with greater disability, and those with longer MS durations. The meta-regression revealed that fatigue measurement instruments were the largest source of heterogeneity. The prevalence of MS-related fatigue is quite high. Healthcare professionals should screen for and manage fatigue for PwMS as early as possible and pay attention to populations with a high prevalence of fatigue. The high heterogeneity among the prevalence rates due to differences in the fatigue scales suggests the importance of reaching a consensus on the best screening tools for MS-related fatigue.

Prevalence and Correlates of Behavioral Risk Factors of Non-Communicable Diseases Among Undergraduates in University of Nigeria: A Cross-Sectional Study

Background: There is an increasing prevalence of behavioral risk factors of non-communicable diseases (NCDs) among the youths in low- and middle-income countries. These may later in life lead to chronic diseases with high morbidity, mortality, and undesirable economic impact. Aim: To assess and compare the prevalence of major behavioral risk factors of NCDs between medical and non-medical university students in Enugu, Nigeria. Methods: A questionnaire-based comparative cross-sectional study was carried out among 620 undergraduates of the University of Nigeria using the modified WHO STEPS questionnaire for chronic disease surveillance and the International Physical Activity Questionnaire (IPAQ). Data were analyzed with descriptive and inferential statistics at the significance level of P &lt; 0.05. Logistic regression analysis was carried out to predict the behavioral risk factors of NCDs. Results: The mean age of all the students was 22.5 ± 2.9 years. A greater proportion were females (54.8%). Physical inactivity was the most common behavioral risk factor of NCDs and was more prevalent in the medical students (91.0%) compared to 87.4% in the non-medical students. Overall, 95.0% of all respondents had at least one behavioral risk factor. For the medical students, younger age (AOR = 1.80 CI = 1.00 – 3.22, P = 0.049) and parents’ lower educational level (AOR = 3.49, CI = 1.29 – 9.40, P = 0.014) predicted the presence of risk factors. For the non-medical students, single marital status (AOR = 3.66, CI = 1.20 –11.19, P = 0.022), lower level of study (AOR =2.92, CI = 1.13– 7.57, P = 0.027) and parents’ lower level of education (AOR =6.48, CI = 1.41 – 29.85, P = 0.017) predicted the risk factors of NCDs. Conclusion: Behavioral risk factors were highly prevalent in both groups. There is an urgent need to introduce evidence-based intervention to curb the situation.

Trends and Factors Affecting Functional Limitations on Activities of Daily Living Performance Among Korean Adults With Disabilities, 2008-2020: A Longitudinal Study.

Loss of the ability to perform activities of daily living (ADLs) leads to negative health outcomes such as reduced quality of life, institutionalization, and mortality. In Korea, the proportion of older adults with disabilities is increasing along with rapid population aging. Therefore, providing a comprehensive approach to the prevention and management of ADL limitations in people with disabilities is necessary. This can be accomplished by understanding the trends and factors affecting these limitations over time. This study was developed to examine the longitudinal trend and factors affecting ADL limitations over time among people with disabilities in Korea. Data from 346 people with disabilities in the 2008-2020 Korean Welfare Panel Study were used. Bivariate analysis and a Kendall trend test were performed to determine the longitudinal trends for ADL limitations, and multiple logistic regression was used to evaluate whether relevant variables could predict these limitations. The prevalence of ADL limitations among people with disabilities increased by 16.5% over the 12 years of the study. The highest rate of increase in these limitations over time was found in people with mental disorders (27.8%), those over 65 years of age (27.3%), and those with depression (25.6%). In multiple logistic regression, the odds ratios of the variables were slightly different at each survey wave. However, severe disability and low educational level were consistently found to be associated with ADL limitations over time. The findings provide evidence of a significant relationship between level of disability and/or educational status and ADL limitations in people with disabilities in Korea. To prevent the development of ADL limitations in people with disabilities, comprehensive identification of longitudinal trends and factors affecting ADL limitations is necessary. Early intervention, including integrated services such as home rehabilitation services to prevent ADL limitations, especially for disabled people with severe disabilities and low educational levels, has the potential to delay ADL limitations.

Prevalence and Predictors of Depression Symptoms Among Afghan Hypertensive Patients: Secondary Analysis of a Multi-Center Cross-Sectional Study.

Although depression is a frequently occurring mental disorder in patients with hypertension, little is known about the symptoms of depression among Afghan hypertensive patients. This study aimed to analyze the prevalence and predictors of depression symptoms among Afghan hypertensive patients. This was a secondary analysis of a multi-center cross-sectional study conducted between August and December 2022 across three major provinces in Afghanistan. Socio-demographic and clinical characteristics of the eligible participants were used in the analysis. A score of ≥ 5 on the PHQ-9 (Patient Health Questionnaire) was considered the cut-off point for labeling hypertensive patients as screening positive for depressive symptoms. We performed binary logistic regression to determine the predictors of depression symptoms among hypertensive patients. Out of 853hypertensive patients, 51.8% (95% CI: 48.4-55.2%) had depressive symptoms. Binary logistic regression revealed that low monthly household income [AOR=1.42, 95% CI (1.01-1.97), low education level [2.41 (1.57-3.71)], physical inactivity [1.81 (1.22-2.71)], poor blood pressure control [2.41 (1.57-3.71)], and the presence of medical comorbidity [1.59 (1.15-2.19)] were the predictors of depression symptoms. This study showed a high prevalence of depressive symptoms among Afghan hypertensive patients. Moreover, we found that low monthly household income, physical inactivity, low education level, poor blood pressure control, and the presence of medical comorbidity were the predictors of depression symptoms. Our findings suggest that hypertensive patients should be screened for mental health symptoms, and those most at risk for depression should seek supportive counseling.

Prevalence and molecular characterization of carbapenem-resistant Enterobacterales in patients from a public referral hospital in a non-metropolitan region of Brazil during and post the SARS-CoV-2 pandemic.

Antimicrobial resistance (AMR) poses a global threat, with carbapenem-resistant Enterobacterales (CRE) representing a significant concern due to limited therapeutic options. This study investigated the prevalence of carbapenemase genes in CRE strains isolated from tracheal aspirates of patients at a Brazilian university hospital between January 2020 and August 2023. Bacterial identification was conducted using MALDI-TOF, while carbapenemase genes were detected by qPCR. Demographic and clinical data were collected, and univariate analysis was performed using the chi-square test (p < 0.05). Variables with p ≤ 0.10 were further investigated using the chi-square test for linear trend, along with stratified analysis. Out of 1,133 samples, 111 (9.79%) showed CRE growth, with 46 isolates included in the final sample, predominantly comprising Klebsiella pneumoniae (65.21%) and Serratia marcescens (19.57%). The blaKPC gene was prevalent (78.26%), while blaNDM was detected in 21.74% of cases. The identified population was predominantly male (67.39%), elderly (69.57%), white (56.52%), unmarried (63.04%), and had a low level of education (56.52%). Most patients (69.57%) were in the intensive care unit and remained hospitalized for more than 30 days (76.08%). There was a significant inverse trend between Klebsiella pneumoniae and age (p = 0.045), as well as a direct linear trend between blaNDM and the annual increase in COVID-19 cases in Brazil (p = 0.050). A high probability of finding non-Klebsiella pneumoniae bacteria was observed in patients with prolonged hospital stays, independent of COVID-19 (p = 0.006) and the type of resistance genes (p = 0.020). The persistent prevalence of CRE, especially with blaKPC, underscores the urgency of effective control measures.

Is it possible to detect women at higher risk of intrapartum stillbirth? An area-based prospective cohort study.

The aim of the study is to perform an overview of intrapartum stillbirth (SB) at term, assessing risk factors, causes of death and quality of pregnancy care. This is an area-based, prospective cohort study on pregnant women at ≥37 weeks from 2014 to 2021. We compared intrapartum SB' information to alive birth and to antepartum deaths of the same period. Results of logistic regression are reported as the Odds Ratio (OR) with 95% confidence interval (95% CI) and the P value. A descriptive analysis about the causes of death and quality of pregnancy care is performed. The overall rate of SB at term in Emilia-Romagna was 1.06 ‰ births. Among the 260 cases, 27 (10.4%) occurred during labor, with an intrapartum SB rate of 0.11‰. This SB rate was stable during years. SGA newborn (P=0.005, 95% CI 1.47-9.04, OR 3.63), low level of education (P<0.0001, 95% CI 2.98-16.11, OR 6.93), pre pregnancy BMI ≥ 25 kg/m2 (P<0.0001, 95% CI 6.61-31.74, OR 14.50) are independent risk factors for intrapartum SB when compared to alive newborns. Compared with antepartum SB, excessive weight gain in pregnancy (RR 2.91, 1.43-3.98, P=0.001) represents a risk factor for intrapartum ones. Preventing intrapartum SB at term in developed country should be based on both the appropriate antenatal management of fetal growth and the avoidance of maternal excessive weight gain. An effort toward pre conceptional intervention of improving maternal shape could be of value.

Personal income tax reform and household savings rates: Evidence from a quasi-natural experiment in China

This study examines the effects of the 2018 personal income tax reform on household savings rates using data from the China Household Finance Survey (CHFS). Employing a quasi-natural experiment approach, our findings demonstrate that the reform has led to an increase in savings rates among Chinese households. Mechanism tests indicate that income uncertainty serves as the underlying mechanism linking the personal income tax reform to household savings rates. Heterogeneity analyses reveal that the impact of the personal income tax reform on household savings rates is particularly pronounced for households with lower income and those whose heads have lower levels of education. Additionally, the personal income tax reform has elevated the proportion of household development and enjoyment consumption in total consumption. This study provides a novel micro-perspective on the influence of Chinese fiscal policies on residents' saving behavior and offers valuable insights for promoting high-quality consumption and fostering high-quality economic development.

Complex Regional Pain Syndrome: a cross-sectional study of physical symptoms, disability, and psychological health in long term.

Knowledge about long-time residual symptoms, disabilities, and psychological health in complex regional pain syndrome (CRPS) is limited. The aim was to evaluate outcome, focusing on physical symptoms, disability, and psychological health, in individuals with CRPS through a cross-sectional survey study. Individuals with a confirmed diagnosis of CRPS were identified through medical charts and sent validated survey forms (Disabilities of the Arm, Shoulder and Hand-Quick version, Specific Hand Surgery Questionnaire-8 questions, EuroQol 5 Dimensions 3 levels, Life Satisfaction Questionnaire-11, Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, and Sense of Coherence-29) and complementary questions. Responders (response rate: 99/238, 42%; CRPS type 1: 72%; CRPS type 2: 28%; time since diagnosis median: 59 [34-94] months) reported remaining symptoms and disability (Disabilities of the Arm, Shoulder and Hand-Quick version score: 45 [20-70]) and more improvement in type 1 than in type 2. Only 9% of individuals with CRPS reported no residual pain or discomfort. Approximately 60% had problems in daily activities, 49% had sleeping problems, and 90% experienced moderate-extreme pain with 23% still on sick leave. The Hospital Anxiety and Depression Scale survey revealed significantly higher scores than a Swedish reference population. Individuals with a low Sense of Coherence and high pain catastrophizing had worse disability and were less satisfied with their lives and physical and psychological health. A lower level of education and more anxiety were associated with worsened disability over time. Individuals with CRPS suffer in the long term from pain, sleeping problems, and limitations in daily activities with occurrence of anxiety and depression, resulting in dissatisfaction with many aspects of their lives. A low Sense of Coherence and high pain catastrophizing are associated with a worse outcome. Biopsychosocial aspects should be addressed in clinical practice.