Low Socioeconomic Areas Research Articles

Global, regional, and national burden of ovarian cancer among young women during 1990-2019.

Ovarian cancer, the most devastating tumor in women globally, significantly impacts young women, compromising their daily lives and overall well-being. Ovarian cancer represents a significant public health concern due to its extensive physical and psychological consequences. Data from the Global Burden of Disease were used to assess the global, regional, and national burden of ovarian cancer in young women aged 20-39 from 1990 to 2019. This analysis focused on trends measured by the estimated annual percentage change and explored the socioeconomic impacts via the socio-demographic index (SDI). During 1990-2019, the incidence and prevalence of ovarian cancer among young women increased globally, with annual rates of 0.74% and 0.89%, respectively. The mortality rate and disability-adjusted life years also rose annually by 0.20% and 0.23%, respectively. A significant burden shift was observed toward regions with lower SDI, with high fasting plasma glucose, BMI, and asbestos exposure identified as prominent risk factors, particularly in lower SDI regions. Our findings underscore ovarian cancer in young women as an escalating global health challenge, with the burden increasingly shifting toward lower socioeconomic areas. This underscores the necessity for targeted prevention and control strategies for ovarian cancer, focusing on reducing the identified risk factors and ensuring equitable health resource distribution.

Impact of an educational intervention on water, sanitation and hygiene knowledge, attitudes, and practices in early childhood development centres in low-socio-economic areas in the Nelson Mandela Bay, South Africa.

Good water, sanitation, and hygiene (WASH) enhance healthy living and safe environments for child development. The study aimed to evaluate the impact of an educational intervention on WASH status, knowledge, attitudes and practices in early child development (ECD) centres in low socio-economic areas in the Nelson Mandela Bay in 2021. This quasi-experimental, one group, pre-post-test study elicited responses from 51 ECD practitioners (1 per ECD centre). Telephonic structured knowledge, attitude and practices (KAP) questionnaires were used. KAP was good among participants. The educational intervention significantly improved mean knowledge (p<0.001, 95% CI: 0.58-1.11) attitudes (p<0.001, 95% CI: 0.39-0.67) and practices (p = 0.001, 95% CI: 0.20-0.74). WASH knowledge was significantly impacted by toilet facilities ventilation status (p = 0.083) while WASH attitudes scores were significantly impacted by ventilation where the potties are kept (p = 0.041). WASH practice scores were significantly impacted by across the bush/field (no facility) (p = 0.021) and plastic potties usage (p = 0.057). The educational intervention significantly improved WASH-related knowledge, attitudes, and practices among ECD practitioners. WASH conditions in the ECD centres in the study area require additional interventions targeted to sustainable strategies to enhance behavioural modifications for acceptability and sustainability of intervention strategies.

Metabolomic and Physiological Effects of a Cardiorenal Protective Diet Intervention in African American Adults with Chronic Kidney Disease.

Chronic kidney disease (CKD) impacts 14% of adults in the United States, and African American (AA) individuals are disproportionately affected, with more than 3 times higher risk of kidney failure as compared to White individuals. This study evaluated the effects of base-producing fruit and vegetables (FVs) on cardiorenal outcomes in AA persons with CKD and hypertension (HTN) in a low socioeconomic area. The "Cardiorenal Protective Diet" prospective randomized trial evaluated the effects of a 6-week, community-based FV intervention compared to a waitlist control (WL) in 91 AA adults (age = 58.3 ± 10.1 years, 66% female, 48% income ≤ USD 25K). Biometric and metabolomic variables were collected at baseline and 6 weeks post-intervention. The change in health outcomes for both groups was statistically insignificant (p > 0.05), though small reductions in albumin to creatinine ratio, body mass index, total cholesterol, and systolic blood pressure were observed in the FV group. Metabolomic profiling identified key markers (p < 0.05), including C3, C5, 1-Met-His, kynurenine, PC ae 38:5, and choline, indicating kidney function decline in the WL group. Overall, delivering a directed cardiorenal protective diet intervention improved cardiorenal outcomes in AA adults with CKD and HTN. Additionally, metabolomic profiling may serve as a prognostic technique for the early identification of biomarkers as indicators for worsening CKD and increased CVD risk.

Attitudes and Exposure to Illicit Tobacco in England, 2022.

The United Kingdom has achieved reductions in illicit tobacco (IT) market size and share. However, there remains a 17.7% tobacco duty gap, contributing to health inequalities. In January 2024, the UK government announced a new strategy to control IT, along with provision of new funding. A representative cross-sectional survey of adults in England ran in April 2022 to evaluate attitudes and exposure to IT. Tobacco smokers were asked questions about encounters with IT, while all participants answered questions on knowledge and perspectives on IT. Of 262 tobacco smokers, 18.3% (95% CI 13.8% to 23.6%) had come across IT in the past year. Men had four times the odds of encountering IT recently than women. Among 1767 adults responding to questions on IT, two-thirds agreed IT harmed children, and more than half agreed IT was linked to organized crime. Younger adults, smokers, and those in lower socioeconomic groups were less likely to agree IT was harmful. Exposure to IT, especially among younger males, remains a concern. While most of the public acknowledge its harm, this is not universal, and some population groups are less likely to do so. The study highlights persistent exposure to IT in England, especially among younger males, and varying perceptions of IT harm across socioeconomic groups. Tackling IT requires collaboration between health and enforcement agencies, independent of the tobacco industry's influence. Strategies should include components that shift demand for IT and denormalize its presence in communities, particularly in lower socioeconomic areas with higher smoking prevalence.

Chiropractors in Multidisciplinary Teams: Enablers of Colocation Integration in GP-Led Primary Healthcare.

The aim of this study was to explore and document the enablers and barriers of chiropractic care colocation in general practice at a large-scale private primary care centre in Australia. This study focused on the perceptions of healthcare professionals regarding this integration. The research setting was a large integrated primary care centre located in an outer metro, low-socioeconomic area in the City of Moreton Bay, Queensland, Australia. Participant inclusion criteria included general medical practitioners, practice nurses, and medical managers who self-reported interactions with the physically collocated and integrated chiropractic practice. Data was collected from 22 participants using face-to-face, qualitative, semi-structured interviews with an average duration of 32 min. The data collected included perceptions of chiropractic treatment, enablers to patient referral pathways, and views of the integrated chiropractic care model. A reflexive thematic analysis was conducted on the data set. All participants reported that this was their first exposure to the colocation of a chiropractor within a general medical practice. Four key enablers of chiropractic care integration were identified: (1) the practitioner [chiropractor], (2) the organisation [general practice], (3) consumer flow, and (4) the environment [shared spaces and tenant ecosystem]. The chiropractic integration enhanced knowledge sharing and interprofessional trust among healthcare providers. The formal reporting of patient outcomes and understanding of the chiropractor's scope of practice further enabled referrals to the service. Shared administrative and business processes, including patient records, booking systems, and clinical meetings, facilitated relationship development between the chiropractor and referring health providers. Colocation as part of a larger primary care centre created proximity and convenience for health providers in terms of interprofessional communication, and for patients, in terms of access to chiropractic services. Existing governance structures supported communication, professional education, and shared values related to the delivery of patient-centred care. Identified barriers included limited public funding for chiropractic services resulting in reduced access for patients of low-socioeconomic status. Additionally, scepticism or negativity towards the discipline of chiropractic care was identified as an initial barrier to refer patients. In most cases, this view towards the chiropractor was overcome by regular patient reporting of positive treatment outcomes to their GP, the delivery of education sessions by the chiropractor for the health providers, and the development of interprofessional trust between the chiropractor and referring health providers. This study provides preliminary evidence and a conceptual framework of factors influencing the successful integration of chiropractic care within an Australian large primary care centre. The data collected indicated that integration of chiropractic care into a primary care centre serving a low-socioeconomic region can be achieved with a high degree of health provider satisfaction.

Children are exposed to much more alcohol advertising when a liquor store is sited near a school

The physical location of liquor stores near schools can strongly influence the chances of youth accessing and consuming alcohol(1). As children transit to and from school, it is feasible that the presence of liquor stores near schools could also increase their exposure to alcohol advertising. Cumulative exposure to advertising influences alcohol attitudes, intentions and alcohol use(2), so reducing children’s exposure to alcohol advertising is important to delay the initiation of drinking and reduce future harms. As this has not yet been investigated in Australia, the aim of this study was to investigate whether the presence of a liquor store near a school was associated with an increased prevalence of outdoor alcohol advertising in Perth, Western Australia. We identified all outdoor alcohol advertising within a 500m radius (audit zone) of 64 randomly selected primary and secondary schools from low and high socio-economic areas across metropolitan Perth. We recorded the size, type, setting, and location of each advertisement during field data collection. Each zone was categorised by the presence or absence of at least one liquor store within the school audit zone, and results compared across these stratifications. Over half (56%) of the 64 school audit zones had at least one alcohol advertisement. On average, there were 5.9 alcohol advertisements per zone. School audit zones that contained a liquor store (59%) had over thirty times the average number of alcohol advertisements compared with audit zones that did not contain a liquor store (9.7 vs 0.3). The majority of all the alcohol advertisements identified (63%) were located outside a liquor outlet as opposed to other food businesses (2%), along the roadside (31%), on a bus shelter (3%) or on/outside another business (0.5%). Our findings that Perth schools with a liquor store nearby had more outdoor alcohol advertising within a 500m radius, compared with schools without a nearby liquor store, were independent of school type (primary or secondary) or the socio-economic status of the area. This poses significant concerns about the exposure of underage populations to outdoor alcohol advertising, and the resultant influence on alcohol use. These results underscore the necessity for policy interventions to mitigate children’s exposure to alcohol marketing, especially during the daily school commute, by regulating the location of liquor stores and alcohol promotion near schools. It will be important to incorporate the voices of children when developing future policies to assert their right to be consulted, heard and appropriately influence their environments.

Informal care and financial stress: Longitudinal evidence from Australia.

The number of people providing informal care has increased considerably in the last years while, at the same time, about one in four Australians have financial stress problems. This study uses rich longitudinal data from the Household, Income and Labour Dynamics in Australia (HILDA) survey to estimate the effect of informal care on financial stress. To establish causality, we exploit a fixed effect-instrumental variable approach to address omitted variable bias and reverse causality problems. Our findings show that informal caregiving increases financial stress between 9.9 and 14.5 percentage points. This finding is robust across a battery of quasi-experimental methods. The effect of informal caregiving on financial stress is more pronounced among males, rural residents and those living in low socioeconomic areas. Our analyses further show that financial fragility and social isolation are important channels through which informal caregiving affects financial stress.

Impact of Traditional and New Media on Smoking Intentions and Behaviors: Secondary Analysis of Tasmania's Tobacco Control Mass Media Campaign Program, 2019-2021.

Tasmania, the smallest state by population in Australia, has a comprehensive tobacco control mass media campaign program that includes traditional (eg, television) and "new" channels (eg, social media), run by Quit Tasmania. The campaign targets adult smokers, in particular men aged 18-44 years, and people from low socioeconomic areas. This study assesses the impact of the 2019-2021 campaign program on smokers' awareness of the campaign program, use of Quitline, and smoking-related intentions and behaviors. We used a tracking survey (conducted 8 times per year, immediately following a burst of campaign activity) to assess campaign recall and recognition, intentions to quit, and behavioral actions taken in response to the campaigns. The sample size was approximately 125 participants at each survey wave, giving a total sample size of 2000 participants over the 2 years. We merged these data with metrics including television target audience rating points, digital and Facebook (Meta) analytics, and Quitline activity data, and conducted regression and time-series modeling. Over the evaluation period, unprompted recall of any Quit Tasmania campaign was 18%, while prompted recognition of the most recent campaign was 50%. Over half (52%) of those who recognized a Quit Tasmania campaign reported that they had performed or considered a quitting-related behavioral action in response to the campaign. In the regression analyses, we found having different creatives within a single campaign burst was associated with higher campaign recall and recognition and an increase in the strength of behavioral actions taken. Higher target audience rating points were associated with higher campaign recall (but not recognition) and an increase in quit intentions, but not an increase in behavioral actions taken. Higher Facebook advertisement reach was associated with lower recall among survey participants, but recognition was higher when digital channels were used. The time-series analyses showed no systematic trends in Quitline activity over the evaluation period, but Quitline activity was higher when Facebook reach and advertisement spending were higher. Our evaluation suggests that a variety of creatives should be used simultaneously and supports the continued use of traditional broadcast channels, including television. However, the impact of television on awareness and behavior may be weakening. Future campaign evaluations should closely monitor the effectiveness of television as a result. We are also one of the first studies to explicitly examine the impact of digital and social media, finding some evidence that they influence quitting-related outcomes. While this evidence is promising for campaign implementation, future evaluations should consider adopting rigorous methods to further investigate this relationship.

Effect of COVID-19 Pandemic Lockdowns on Body Mass Index of Primary School Children from Different Socioeconomic Backgrounds

BackgroundChildhood obesity is associated with various health outcomes. Restrictive measures to contain the spread of the Coronavirus Disease 2019 (COVID-19) pandemic, like lockdowns and school closures, affected children’s daily structure, physical activity, dietary habits, and sleep quality, possibly exacerbating risk factors for childhood obesity and higher body mass index (BMI) in children. Poor socioeconomic conditions may have led to relatively higher risk for elevated BMI levels following pandemic measures. In this study, the impact of measures related to the COVID-19 pandemic on the BMI of third graders was investigated regarding children’s socioeconomic background (SEB).MethodsData from 41,728 children (8.84 ± 0.56 years, 20,431 female) were collected in the context of a cohort study. Children were tested either before the pandemic (preCOVID: Sept2017–March2020, n = 26,314), or following the first (postLDI: Aug2020–Dec2020, n = 6657) or second lockdown in Germany (postLDII: Aug2021–Jan2022, n = 8757). SEB was based on the official school type classification of the state of Berlin. Outcome was BMI standard deviation scores (SDS).ResultsSignificant effects of Time and SEB revealed elevated BMIs in postLDI (M = 0.23, p = 0.011) and postLDII (M = 0.22, p = 0.011) compared to preCOVID (M = 0.17) cohorts and higher BMIs for children with lower SEB (b = − 0.13, p < 0.001). A significant Time × SEB interaction indicated that the effect of SEB on children’s BMI increased in response to lockdowns, especially in postLDII (b = − 0.05, p = 0.006). Results suggest that the COVID-19-related measures lead to increased BMI in children, and that children of lower SEB were at particular risk for higher BMIs following lockdowns.ConclusionsThese findings highlight the dependency of children’s BMI on societal circumstances. Over the course of two lockdowns in Germany, children have experienced BMI increments, particularly in low socioeconomic areas. Authorities are called into action to counteract increasing rates of childhood weight by promoting physical activity of children and establishing related post-pandemic offers.

Prevalence and population characteristics associated with frailty in a rural low socioeconomic area in Denmark: the Lolland-Falster Health Study

BackgroundFrailty is a major geriatric syndrome that predicts increased vulnerability to minor stressor events and adverse outcomes such as falls, fractures, disability and death. The prevalence of frailty among individuals...

Investigating the walkability of primary, secondary and K-12 schools across metropolitan Perth, Western Australia

Having a walkable built environment is important to encourage active school transport. The aim of this study was to measure the walkability of all Perth, Western Australia (WA) schools and investigate whether differences in walkability exist by school type, socioeconomic status (SES) and/or subregion. Geographic Information Systems technology was used to measure walkability (i.e., traffic exposure and pedestrian connectivity) surrounding all Perth schools (n = 651) in 2021. Walkability scores and their individual components were compared using odds ratios and one-way ANOVAs with post-hoc comparisons by school type (primary, secondary and K-12; government and non-government), school SES and subregion. The majority of Perth schools (73.8%) were below the WA Planning Commission’s target for a walkable catchment area. Neighbourhoods surrounding high SES schools were significantly more walkable than neighbourhoods surrounding medium and low SES schools (mean walkability scores: 12.4, 10.5, 10.1, respectively, p < .001). Neighbourhoods surrounding schools located in the Central subregion (mean 12.3) were significantly more walkable than neighbourhoods surrounding schools located in the North-West (mean 11.0, p = .024), South Metropolitan (mean 10.0, p < .001) and North-East (mean 8.4, p < .001) subregions. No significant differences in walkability index scores were found for school type. This study found a large proportion of Perth schools were surrounded by disconnected street networks and that neighbourhoods surrounding high SES schools were, on average, more walkable than neighbourhoods surrounding medium and low SES schools. The results highlight the importance of modifying the built environment to increase opportunities for active school transport, particularly in low and medium socio-economic areas.

Universal healthy school start intervention reduced the body mass index of young children with obesity.

To evaluate the effect of a universal, school-based family support programme on body mass index (BMI) of children aged 5-7 years, using pooled data from three trials. The programme has three to four components and is delivered during the first school year. It aims to promote healthy dietary and physical activity behaviours, and secondarily prevent unhealthy weight gain. Three cluster-randomised controlled trials were conducted between 2010 and 2018 in low and mixed socioeconomic status areas in Sweden. Weight and height were measured. Multiple mixed linear regression analysis was performed on the pooled data. In total, 961 children were included (50% girls, mean age 6.3 years). The post-intervention effect on BMI z-score in all children was small, but in those with obesity at baseline, we observed a significant, clinically relevant, decrease in BMI z-score (-0.21). This was most pronounced in children with a non-Nordic born parent (-0.24). Five to six months after the intervention, decreases were no longer statistically significant. The intervention resulted in changes in BMI comparable to obesity treatment programmes focusing on behaviour change. However, the effect attenuated with time suggesting the programme should be sustained and evaluated for a longer time.

Temperature affects viral kinetics and vectorial capacity of Aedes aegypti mosquitoes co-infected with Mayaro and Dengue viruses

BackgroundIncreasing global temperatures and unpredictable climatic extremes have contributed to the spread of vector-borne diseases. The mosquito Aedes aegypti is the main vector of multiple arboviruses that negatively impact human health, mostly in low socioeconomic areas of the world. Co-circulation and co-infection of these viruses in humans have been increasingly reported; however, how vectors contribute to this alarming trend remains unclear.MethodsHere, we examine single and co-infection of Mayaro virus (D strain, Alphavirus) and dengue virus (serotype 2, Flavivirus) in Ae. aegypti adults and cell lines at two constant temperatures, moderate (27 °C) and hot (32 °C), to quantify vector competence and the effect of temperature on infection, dissemination and transmission, including on the degree of interaction between the two viruses.ResultsBoth viruses were primarily affected by temperature but there was a partial interaction with co-infection. Dengue virus quickly replicates in adult mosquitoes with a tendency for higher titers in co-infected mosquitoes at both temperatures, and mosquito mortality was more severe at higher temperatures in all conditions. For dengue, and to a lesser extent Mayaro, vector competence and vectorial capacity were higher at hotter temperature in co- vs. single infections and was more evident at earlier time points (7 vs. 14 days post infection) for Mayaro. The temperature-dependent phenotype was confirmed in vitro by faster cellular infection and initial replication at higher temperatures for dengue but not for Mayaro virus.ConclusionsOur study suggests that contrasting kinetics of the two viruses could be related to their intrinsic thermal requirements, where alphaviruses thrive better at lower temperatures compared to flaviviruses. However, more studies are necessary to clarify the role of co-infection at different temperature regimes, including under more natural temperature settings.Graphical

Physical activity and diet for Type 2 Diabetes reduction among older people living with HIV in Harare.

People living with HIV (PLWH) are ageing, and face increased risk for developing Type 2 Diabetes. Physical activity and diet are effective in reducing Type 2 Diabetes risk. However, there is variation in how older PLWH engage in physical activity and healthy eating. To describe older PLWHs' engagement in physical activity and diet for Type 2 Diabetes risk reduction in Harare. The study was conducted in five polyclinics in Harare urban district from low socio-economic areas. A qualitative approach and an exploratory descriptive design was used. Twenty-three participants were selected purposively based on the researchers' judgement of age among PLWH. Data were collected using a semi-structured interview schedule and analysed using Braun and Clark's six steps of thematic content analysis. Ethical approval was obtained, and each participant provided informed consent. The mean age of participants was 62 years. Participants performed varied physical activities through; economic activities, walking, exercise, and domestic chores. Diet included indigenous, unrefined grains, vegetables and fruit, influenced by rural background. Diet consisted of larger proportions of carbohydrates with lesser varying portions of protein and vegetables and fruit. Healthy eating among participants was facilitated by the proximity of markets and family. Health education to reduce Type 2 Diabetes risk should focus on fostering current physical activities to meet prescribed standards and increasing fruit and vegetable consumption. The physical activity and diet self-care practices among older PLWH are inadequate in reducing Type 2 Diabetes risk, emphasising the need for appropriate health education.

Associations between fears related to safety during sleep and self-reported sleep in men and women living in a low-socioeconomic status setting

South Africans living in low socioeconomic areas have self-reported unusually long sleep durations (approximately 9–10 h). One hypothesis is that these long durations may be a compensatory response to poor sleep quality as a result of stressful environments. This study aimed to investigate whether fear of not being safe during sleep is associated with markers of sleep quality or duration in men and women. South Africans (n = 411, 25–50 y, 57% women) of African-origin living in an urban township, characterised by high crime and poverty rates, participated in this study. Participants are part of a larger longitudinal cohort study: Modelling the Epidemiologic Transition Study (METS)–Microbiome. Customised questions were used to assess the presence or absence of fears related to feeling safe during sleep, and the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index were used to assess daytime sleepiness, sleep quality and insomnia symptom severity respectively. Adjusted logistic regression models indicated that participants who reported fears related to safety during sleep were more likely to report poor sleep quality (PSQI > 5) compared to participants not reporting such fears and that this relationship was stronger among men than women. This is one of the first studies outside American or European populations to suggest that poor quality sleep is associated with fear of personal safety in low-SES South African adults.

Realized impact of COVID-19 related disruptions on the National Bowel Cancer Screening Program.

Colorectal cancer is the second most common cause of cancer mortality in Australia (1). The National Bowel Cancer Screening Program (NBCSP) aims to reduce mortality through early detection with a biennial faecal occult blood test for Australians aged 50-74 years (2). Modelling predicted COVID-19 would reduce participation and delay colonoscopies despite the NBCSP continuing during the pandemic (3). This study analyses the realized impact of COVID-19 related disruptions on the NBCSP and the effect on mortality. NBCSP participation, time to colonoscopy and annualized mortality were compared before and during COVID-19. The effect on mortality was determined using a validated microsimulation model (4, 5). From 1 January 2018 to 31 December 2019, 2 497 317 people participated in the NBCSP and 168 390 received a colonoscopy, compared to 2 490 265 and 162 573 from 1 January 2020 to 31 December 2021. Relative participation decreased 6 % and the proportion of colonoscopies performed within the recommended 120 days increased 14.5%. A disproportionally greater impact was observed outside major cities and in lower socioeconomic areas. An estimated 98-111 additional colorectal cancer deaths resulted from 3 % fewer colonoscopies performed during the pandemic. This study presents the most comprehensive analysis of the realized impact of COVID-19 on the NBCSP. Catch-up screening would be best targeted at Australians from rural and lower socioeconomic areas where participation remains low. Streamlined referral pathways and additional colonoscopy provisioning is required as less than two thirds of screen positive patients receive a colonoscopy within the recommended 120 days.

School principals’ practices and their facing barriers to sustainable development in Turkish K12 schools

ABSTRACT This research aimed to determine school principals’ practices and barriers to sustainable development in Turkish K-12 schools governed by centralized management. The present research focused on sustainable school buildings (energy saving, water saving, natural school gardens), clean drinking water, healthy nutrition, recycling, centralized management system, local governments, and the education of students and families for sustainable development. The research was designed using a case study approach. The semi-structured interview technique was used. The data were analyzed deductively according to literature and research questions. The results indicated leadership skills especially distributed and transformational leadership skills for sustainable development, the collaboration of universities, colleagues, and municipalities, the education of the school public, the necessity of rewards and accreditation systems, and the importance of methods for the education of students. Also, this research emphasizes clean drinking water in low socioeconomic areas, the need for healthy nutrition, the climate condition of the region and the need for a school budget under a centralized management approach.

From flare to care: Dermatologists' impact on pediatric atopic dermatitis hospital admissions.

Atopic dermatitis (AD) is a common chronic skin disease in the pediatric population; however, rates of admissions for flares in patients established with dermatology compared to those that are not established have not been fully assessed in prior studies. We reviewed electronic medical records of patients hospitalized (billing codes 99221-99223, 99217) with diagnoses encompassing AD, eczema, and dermatitis (ICD-10 codes L20.8-L20.9, L30.8-L30.9) between January 1, 2011, and December 31, 2021, at University Hospitals (UH) in Cleveland, Ohio. Patients were considered established with dermatology if they had been seen by a dermatology provider within 6 months prior to admission. Statistical analysis was performed using chi-square goodness of fit. A total of 95 patient encounters met criteria for inclusion. Fifteen (15.8%) patients were established with dermatology at the time of admission and 80 (84.2%) were not. The chi-square value (x2 = 44.74) was greater than the critical value of 10.828 at one degree of freedom (p < .001). There were 8 patients who had more than one admission for atopic dermatitis flares; 2 of these patients were established with dermatology prior to their first admission, and 4 were established at the time of the second admission. The majority of patients admitted with AD flare were not established with dermatology. Many of these patients lived in a low socioeconomic area and missed follow-up appointments. Increasing access to dermatologic care for patients with atopic dermatitis, especially in lower-income areas, could aid in decreasing atopic dermatitis-related hospitalizations.

Patterns and Correlates of Participation in a Weekly Mass Participation Physical Activity Event, parkrun, in Australia, 2011-2020.

Studying effective interventions already operating at scale is critical to improving physical activity intervention research translation. The free, weekly, timed 5-km run or walk parkrun represents a unique opportunity to examine successful organic dissemination. We conducted an ecological analysis to identify patterns of growth in Australian parkrun participation and their correlates from 2011 to 2020. Outcome variables were (1)weekly counts of walkers/runners and (2)monthly number of new parkrun registrants. We used latent class analysis to characterize growth trajectories followed by logistic regression on class membership. Covariates included parkrun course characteristics (eg,surface type and route), site-level aggregate participant profile (eg,proportion women and mean age), and surrounding area characteristics (eg,population density and physical activity norm). Three hundred and sixty-three parkruns were included (n = 8,388,695 participation instances). Sixty-nine percent followed a low-growth and 31% a high-growth participation pattern. High growth was associated with greater participation by women, concrete/bitumen surface type, lower area socioeconomic status, and greater volunteer heterogeneity. Odds of being in the slow-growth class were higher if the course contained >1km of repetition, higher average age of participants, better average parkrun performance, and higher running group membership. Two patterns of new registration were identified: high start followed by steep decline; and low start, slow decline with similar correlates to participation. Parkruns with a less competitive social milieu may have more rapid dissemination. As a free and regular event, parkruns in low socioeconomic areas have the potential to improve the activity levels of those with fewer resources.

Healthy diets positively associated with health-related quality of life in children and adolescents from low socioeconomic areas: Findings from the Greek Food Aid Program, DIATROFI

ObjectivesTo assess the relationship of diet with health-related quality of life (HRQoL) in vulnerable children and adolescents. MethodsData included 6583 children and adolescents (aged 3–18 years old) from the Greek Food-Aid DIATROFI Program in the 2015 to 2016 and 2017 to 2018 school years. HRQoL was measured with the Pediatric Quality of Life Inventory questionnaire and diet with food frequency questionnaires. The healthy plant-based diet index (hPDI), animal score, and dietary patterns were investigated. ResultsThe hPDI and animal score were associated with good HRQoL (odds ratio [OR] [95% confidence interval], 10-unit increase: ORhPDI = 1.28 [1.05, 1.57], ORanimal = 1.51 [1.14, 2.00]) and physical (ORanimal = 1.62 [1.23, 2.13]), emotional (ORhPDI = 1.30 [1.07, 1.58], ORanimal = 1.41 [1.08, 1.85]) and school function (ORhPDI = 1.32 [1.09, 1.59], ORanimal = 1.46 [1.12, 1.89]). Dietary patterns of fruits, raw vegetables, and cheese were associated with good HRQoL (OR of 1-unit increase: 1.22 [1.13, 1.32]), and physical OR = 1.18 [1.09, 1.27]) and emotional function (OR = 1.09 [1.02, 1.18]). Starchy foods and sweetened beverages were associated with poor HRQoL (OR = 0.75 [0.63, 0.90]), and emotional (OR = 0.80 [0.68, 0.95]) and school function (OR = 0.72 [0.61, 0.85]). ConclusionHealthy diets and dietary patterns were positively associated with the HRQoL of vulnerable children and adolescents, which may offer opportunities for prevention.