Poor Research Articles

LOSSES OF THE WEST RUSSIAN VILLAGE DUE TO THE AXIS AGGRESSION: SCALE AND CONSEQUENCES

The article analyses the impact of human and material losses of the village of the West of the Russian Soviet Federative Socialist Republic (the RSFSR) on the peculiarities of reconstruction processes in the first post-war years in terms of the diverse sources, many of which have recently been introduced into the scientific turnover. The deficit of manpower, equipment, and capital investments in the region’s agriculture, including one due to wartime losses, significantly slowed down the agricultural production industrialisation completion, predetermined inability to solve key problems of life and labour of the population, became one of the important causes of low incomes of many collective and state farms, the reduction of arable land since the early 1950s, and the long dominance of extra-economic coercion and its supporting structures in the countryside. The consequences of the war devastation combined with the unpopular agrarian policy of the first post-war years brought to life the improvement of adaptive behaviour by the village, which the authorities spent a lot of energy and resources to combat. The losses of the war years and harsh agrarian policy were also the key reasons for the undermining of the preserved elements of traditional culture of the village of the West of the RSFSR.

Increasing support for economic freedom: responses in a representative sample of US adults

AbstractThe relationship between economic freedom and improvements in social and economic outcomes is well-documented. Yet, increasing support for government control of voluntary exchange has arisen in the US and many other countries. The present study analyzed whether videos describing human flourishing would influence support for economic freedom. In Study 1, a ‘‘brain as predictor’’ approach measured the neurologic responses of participants (N = 64) to a library of videos in order identify the videos most likely to influence people's attitudes. Study 2 then sent two videos to a representative sample of US adults (N = 1212) and assessed support for economic freedom compared to a no-video control group. The analysis first identified demographic categories that had statistically low support for economic freedom (Californians, those with low incomes, Democrats, young adults, individuals without a college education, people receiving substantial government support, and women) as targets for influence. Two different videos increased support for economic freedom between 5 and 10% among Californians and among those receiving government aid. A feature importance analysis was used to rank the demographic factors affecting support for economic freedom, identifying those receiving government aid as the group for whom future messaging would have the largest impact.

Association between preterm birth and economic and educational outcomes in adulthood: A population-based matched cohort study.

Preterm birth (PTB) affects ~10% of births worldwide; however, most literature focused on short-term clinical outcomes, with much less focus on long-term socioeconomic outcomes after PTB. We examined associations between PTB and individuals' income, employment, and educational outcomes during early adulthood. We conducted a population-level matched cohort study including all live births in Canada between 1990 and 1996, followed until 2018. Outcomes included Employment income per year in 2018 CAD and employment between ages 18 and 28 years, postsecondary education enrollment (18-22 years), and maximum educational attainment at age 22-27 years. Mean differences and risk ratios (RR) and differences (RD) were estimated using generalized estimating equation regression models for economic outcomes and multinomial logistic regression models for educational outcomes. Of 2.4 million births, 7% were born preterm (0.3%, 0.6%, 0.8%, and 5.4% born extremely preterm (24-27 weeks), very preterm (28-31 weeks), moderately preterm (32-33 weeks), and late preterm (34-36 weeks) respectively). After matching on baseline characteristics (e.g., sex, province of birth, and parental demographics) and adjusting for age and period effects, preterm-born individuals, on average, had $958 CAD less employment income per year (95% CI: $854-$1062), 6% lower income per year, than term-born individuals, and were 2.13% less likely to be employed (1.98-2.29%). PTB was also negatively associated with university enrollment (RR 0.93 (0.91-0.94) and graduation with a university degree (RR 0.95 (0.94-0.97)). Mean income differences for those born 24-27 weeks were -$5,463 CAD per year (17% lower), and adjusted RR were 0.55 for university enrollment and graduation. In this population-based study, preterm birth was associated with lower economic and educational achievements at least until the late twenties. The associations were stronger with decreasing GA at birth. Policymakers, clinicians, and parents should be aware that the socioeconomic impact of PTB is not limited to the early neonatal period but extends into adulthood.

Trends in Timely Access to High-Quality and Affordable Surgical Care in the United States.

To quantify recent trends in access to timely, high-quality, affordable surgical care in the US. Insufficient access to surgical care remains an ongoing concern in the US. Previous attempts to understand and quantify barriers in access to surgical care in the US lack a comprehensive, policy-relevant lens. This observational cross-sectional study evaluates multiple domains of access to surgical care across the US from 2011-2015 and 2016-2020. Our stepwise model included timeliness (<60-minute drive time), quality (surgically capable hospital with ≥3 CMS stars), and affordability (neither uninsured nor underinsured) of access to surgical care using a novel combination of data from the American Hospital Association, Medicare claims, CMS's Five-Star Quality Rating System, the American Community Survey, and the Medical Expenditure Panel Survey. The number of Americans lacking access to timely, high-quality, affordable surgical care increased from 97.7 million in 2010-2015 to 98.7 million in 2016-2020. Comparing these two periods, we found improvements in the number of Americans lacking access due to being uninsured (decrease from 38.5 to 26.5 million). However, these improvements were offset by increasing numbers of Americans for whom timeliness (increase from 9.5 to 14.1 million), quality (increase from 3.4 to 4.9 million), and underinsured status (increase from 46.3 to 53.1 million) increased as barriers to access. Multiple sensitivity analyses using alternative thresholds for each access domain demonstrated similar trends. Those with insufficient access to care tended to be more rural (6.7% vs. 2.0%, P<0.001), lower income (40.7% vs. 30.0%, P<0.001), and of Hispanic ethnicity (35.9% vs. 15.8%, P<0.001). Nearly one-in-three Americans lack access to surgical care that is timely, high-quality, and affordable. This study identifies the multiple actionable drivers of access to surgical care that notably can each be addressed with specific policy interventions.

Congruent Glass Composite Scintillator for Efficient High-Energy Ray Detection.

The scintillator is the most crucial component in the high-energy ray detection system. The available scintillators suffer from the insurmountable drawbacks including poor shaping ability for single crystal and ceramic and low efficiency for glass. Here, a glass composite scintillator is proposed from a congruent crystallization system which possesses both excellent processability and high scintillating yield. It can be fabricated into diverse shapes and sizes including the bulk and tiny fiber. Benefitting from the unique compositing combination with a high crystallization ratio, the glass composite exhibits a giant scintillating light yield of ≈26,000 photons per MeV. The practical application for X-ray imaging is demonstrated and a high spatial resolution of 12 lpmm-1 is achieved. Furthermore, the fiber derived detector is built and the remote and micro-area detection is realized. These findings not only represent a novel design concept for the development of glass composite but also suggest a great step for expanding the scope of scintillators.

L1 as a tool for providing corrective feedback

This article delves into the controversial practice of utilizing a student’s first language (L1) as a teaching resource in second language (L2) learning environments. Initially, strategies such as code-switching/code-mixing and translanguaging were considered signs of poor linguistic ability. There was a strong push towards using only the target language in foreign language education, aiming to limit the first language’s interference and foster a deeper immersion in the new language. However, later research has shown the benefits of incorporating the first language in bilingual education and language learning processes. It’s argued that a student’s knowledge in their native language can actually support their comprehension of a second language, suggesting that transferring certain linguistic or conceptual knowledge from L1 to L2 can be advantageous. This perspective encourages the strategic use of this knowledge transfer in teaching methods. Moreover, the text points to positive results from various studies on the positive impact of L1 usage in L2 classrooms. These insights pave the way for further exploration into the application of the first language in adult English as a Second Language (ESL)/English as a Foreign Language (EFL) education, particularly regarding providing corrective feedback.

Prenatal diagnosis, ultrasound findings and pregnancy outcome of 7q11.23 deletion and duplication syndromes: what are the fetal features?

Analyze the ultrasound findings, single nucleotide polymorphism array (SNP-array) results, and pregnancy outcomes of fetuses with 7q11.23 deletions and duplications in the second and third trimesters. Investigate the prenatal ultrasound characteristics and follow up information of these fetuses. Seven fetuses were diagnosed with 7q11.23 deletion and six with 7q11.23 duplication via SNP-array at the prenatal diagnosis center of a single Chinese tertiary medical center from January 2017 to May 2024. Maternal demographics, ultrasound findings, SNP-array results, pregnancy outcomes, and follow-up information were comprehensively reviewed and analyzed. The copy number variations (CNVs) ranged from 1.43Mb to 1.78Mb in cases of 7q11.23 deletions and from 1.42Mb to 1.68Mb in cases of 7q11.23 duplications. These CNVs encompassed 29 OMIM-listed genes, including ELN, DNAJC30, GTF2IRD1, and GTF2I. Among the seven cases of 7q11.23 deletion syndrome, six exhibited ultrasound abnormalities. The main clinical phenotypes included three cases of intrauterine growth restriction and four cases of cardiovascular system abnormalities, specifically two cases with ventricular septal defects, one case with aortic narrowing, and one case with supravalvular pulmonary stenosis. One case was particularly notable, exhibiting complex multi-organ structural malformations. Out of six cases of 7q11.23 duplication syndrome, five exhibited ultrasound abnormalities. These included two cases of cardiovascular abnormalities: one case with a widened left ventricle and another case with a shortened fetal humerus length. One case revealed complex multi-organ structural malformations, including hydronephrosis, a microgallbladder, and a cleft lip and palate. All seven cases of 7q11.23 deletions and three cases of 7q11.23 duplications opted for termination of the pregnancy. The remaining three cases of 7q11.23 duplications chose to continue the pregnancy. One case underwent surgical treatment for a ventricular septal defect after birth, and the prognosis was favorable. Another case involved a full-term delivery, this child was followed up at the age of 4 and exhibited a phenotype of poor language expression ability. Our study broadened the clinical phenotype spectrum of fetuses with 7q11.23 deletions and duplications. Additionally, it conducted a preliminary evaluation of prenatal ultrasound findings and postnatal clinical phenotypes in follow-up cases. The clinical phenotype of fetuses with 7q11.23 deletion and duplication syndromes involves multiple systems and is relatively complex. Cardiovascular abnormalities and intrauterine growth restriction are the most common clinical manifestations observed in prenatal 7q11.23 deletion syndrome. Fetuses with 7q11.23 duplications exhibit a wide range of clinical phenotypes that lack specificity.

Global burden of zoonotic infectious diseases of poverty, 1990-2021.

The zoonotic infectious diseases of poverty (zIDPs) are a group of diseases contributing to global poverty, with significant impacts on a substantial population. This study aims to describe the global, regional, and national burden of zIDPs-schistosomiasis, cystic echinococcosis, cysticercosis, and food-borne trematodiases (FBTs)-to support policy making and resource allocation for their control and elimination. Data of zIDPs from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 were retrieved from 1990 to 2021. The age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life-year (DALY) rate were described and the estimated annual percentage changes (EAPCs) were calculated to quantify their burden and temporal trends. Spearman correlation analysis was conducted to examine the relationship between age-standardized rates and Socio-demographic Index (SDI). In 2021, these zIDPs exhibited a certain level of ASPRs and age-standardized DALY rates, while maintaining relatively low ASMRs. Noticeably, schistosomiasis presented the highest ASPR of 1914.299 (95% UI: 1378.920, 2510.853 per 100,000 population) and an age-standardized DALY rate of 21.895 (95% UI: 12.937, 37.278 per 100,000 population) among the zIDPs. The tapestry of burden-woven predominantly through low and lower-middle SDI regions-stretched across Africa, Latin America, and parts of Asia. From 1990 to 2021, a kaleidoscopic shift was observed globally as ASPRs, ASMRs, and age-standardized DALY rates declined significantly, as reflected by the EAPC values. Negative correlations were observed between the ASPRs, ASMRs, age-standardized DALY rates of schistosomiasis (r value = - 0.610,- 0.622and- 0.610), cystic echinococcosis (- 0.676 of ASMR, - 0.550 of age-standardized DALYs), cysticercosis (- 0.420,- 0.797and- 0.591) and the SDI. In contrast, a slight positive correlation was noted between the ASPR, age-standardized DALY rates of FBTs and SDI with r value of 0.221 and 0.213, respectively. The burden of zIDPs declined across almost all endemic regions from 1990 to 2021, yet still predominated in low and low-middle SDI regions. Substantial challenges exist to achieve the goal of control and elimination of zIDPs, and integrated approaches based on One Health need to be strengthened to improve health outcomes.

Adolescents' dietary patterns, their drivers and association with double burden of malnutrition in adolescents: a cross-sectional study in Kenya's urban slums.

The double burden of malnutrition (DBM) during adolescence is associated with growth and developmental impairment and risk of non-communicable diseases. There is limited evidence on adolescent's dietary patterns (DPs), and how they contribute to DBM in urban low income contexts in sub Saharan Africa. This study assessed DPs of adolescents, their drivers and association with DBM in Kenya's urban slums. Anthropometric, socio-demographic and dietary-intake data were collected through a cross-sectional survey of 621 adolescents from three major urban slums in Nairobi, Kenya. DPs were derived using principal component analysis. Multinomial-logistic-regression was used to assess the association between the DPs, individual and environmental factors and DBM. Two DPs were identified: traditional DP (whole grains/cereals,rice, fruits, legumes/nuts, and water) and transitioning DP (refined cereals (maize/wheat), vegetables, meat, tea/coffee, sweet ultra-processed/deep fried snacks). Adolescents from Mathare (the largest slum) were more likely to adhere to the traditional DP (RRR = 3.43; 95% CI 1.85-6.37). Cultural background (Luo) had a positive association (RRR = 4.28; 95% CI 1.97-9.32), while longer residency in the slum (> 10years) had a negative association (RRR = 0.47; 95% CI0.25-0.90) with transitioning DP. The transitioning DP had a positive (non-linear) association with overweight/obesity in girls (RRR = 2.79; 95% CI 1.16-6.71). The DPs were not associated with thinness or stunting. The DPs indicate various stages of nutrition transition of adolescent diets, which are influenced by cultural background, neighbourhood and duration of stay in the slum. Transitioning DP may expose adolescents to the risks of overweight/obesity in the long-term.

Sociodemographic Predictors of Keratoconus (Severity, Treatment, and Progression) in a Tertiary Center in New York City.

To identify sociodemographic factors as predictors of keratoconus severity, progression, disease outcomes, and appropriate management in a tertiary care ophthalmology institute in the New York City metropolitan area. This is a retrospective chart review. Patients with keratoconus presenting at a tertiary eye institute in an urban setting seen between 2015 and 2022 were included. Sociodemographic data including age, sex, race, ethnicity, income derived from zip code, insurance coverage, and preferred language were recorded. These sociodemographic factors were analyzed as possible predictors of keratoconus severity at presentation (Amsler-Krumeich grades III and IV): patients presenting with acute hydrops, patients receiving corneal cross-linking or corneal transplant, patients showing 1 or more diopters of increase of Kmax during their follow-up, and patients having longer time between the provider's recommendation of corneal cross-linking and the time of the procedure. The retrospective review included 634 patients with a clinical diagnosis of keratoconus. Factors associated with severe keratoconus at presentation in the multivariate analysis were non-White (P < 0.001), lowest income (Q1) (P = 0.018), Q2 income (P = 0.012), and having Medicaid/Medicare coverage (P = 0.021). Medicaid/Medicare coverage was the only factor associated with acute hydrops (P < 0.001), and younger age was the only factor associated with disease progression (P < 0.001). Younger patients and patients with commercial insurance coverage were more likely to receive corneal collagen cross-linking (P < 0.001 and P < 0.001, respectively), whereas patients with Medicaid/Medicare coverage, lowest income, and non-White race were more likely to receive corneal transplantation (P = 0.012, P = 0.062, and P = 0.028, respectively). Medicaid/Medicare was the only factor associated with delay in receiving corneal collagen cross-linking (P = 0.013). Our study demonstrates that there are sociodemographic predictors of keratoconus disease severity, progression, and the type and the time of treatment the patients received. This confirms eye health disparities among patients with keratoconus.

When the Bough Breaks: The Financial Burden of Childbirth and Postpartum Care by Insurance Type.

Out-of-pocket (OOP) costs related to childbirth and postpartum care may cause financial hardship, depending on type of insurance and income. We estimated OOP spending on childbirth and postpartum care and financial strain 1 year after birth, comparing Medicaid-insured births with commercially insured births. The Postpartum Assessment of Health Survey followed up with respondents to the Centers for Disease Control and Prevention (CDC) Pregnancy Risk Assessment Monitoring System after a 2020 birth in six states and New York City. The survey included questions on health care costs and financial well-being. Our analytic sample consisted of 4,453 postpartum people, 1,544 with a Medicaid-insured birth and 2,909 with a commercially insured birth. We observe significant financial hardship from childbirth that persists into the postpartum year, with significant differences by insurance and income. We find Medicaid is highly financially protective relative to commercial insurance; 81.4% of Medicaid-insured births were free to the patient, compared with 15.7% of commercially insured births (p < 0.001). Six of ten commercially insured births (59%) cost over $1,000 OOP. Among respondents reporting OOP costs for childbirth, we found that Medicaid enrollees are more likely to have borrowed money from friends or family to pay for childbirth (8% vs. 1%, p < 0.001) and one in five had not made any payments 1 year postpartum (26% vs. 5% of commercially insured births, p < 0.001). Among the commercially insured, those with incomes under 200% of the federal poverty level (FPL) fared worse financially than those above 200% FPL on a number of indicators, including debt in collection (33% vs. 13%, p < 0.001) and financial worry (55% vs. 34%, p < 0.001). The cost of childbirth and postpartum health care results in significant and persistent financial hardship, particularly for families with lower income with commercial insurance. Medicaid offers greater protection for families with low income by offering reduced cost sharing for childbirth and postpartum health care, but even minimal cost sharing in Medicaid causes financial strain.

Utilization of home-based care and its buffering effects between dementia caregiving intensity and caregiver burden in China.

Home-based care (HBC) services have gained global attention for their potential to reduce caregiver burden among informal caregivers of persons with dementia (PwDs), who experience high caregiving intensity. However, research on HBC and its effects on dementia caregiving in China remains limited. Data were collected from primary caregivers of PwDs in Jiangsu Province, China. Caregiving intensity and HBC utilization were measured using self-developed instruments. Caregiver burden was assessed by The Burden Scale for Family Caregivers-short. Factor analysis was employed to decompose HBC services. Hierarchical multiple regression analysed the moderating effects of HBC on the relationship between caregiving intensity and burden. A community sample of 318 caregiver and PwDs dyads was included. Caregivers averagely aged 62.16 years, with 61% being female, 84% not employed, and 66.2% having low income. PwDs aged 77.45 years averagely, with 52.8% being female and an average behavioural problems score of 42.27. Caregivers averaged 15.19 on response measures. The number and time spent on ADL-based tasks were positively associated with caregiver burden (β = 0.26, p < .001; β = 0.16, p < .01). However, attendance and time of supervision tasks were not significant predictors of burden. HBC services in China comprised four dimensions: Referral service, Household care, Skilled care, and Mental health service. While these did not directly predict caregiver burden, they moderated the associations between ADL-based tasks and caregiver burden (β=-0.25, p < .001; β=-0.24, p < .001; β=-0.23, p < .001; β=-0.20, p < .001), between time of ADL-based tasks and caregiver burden (β=-0.17, p < .001; β=-0.18, p < .001; β=-0.17, p < .001; β=-0.15, p < .01), and between the attendance at supervision tasks and caregiver burden (β=-0.11, p < .05; β=-0.20, p < .001; β=-0.17, p < .001; β=-0.17, p < .001). Only Referral service buffered the relationship between supervision time and caregiver burden (β = -0.13, p < .01). Informal caregivers of PwDs face high caregiving intensity and burden. HBC services may moderate this relationship, with different services playing varying roles. Further research is essential to explore the impact of supervision levels and develop effective strategies to enhance HBC services for dementia caregiving in China.

Enhancing community potential to boost grassroots economy through value-added pickled bamboo shoots, Thailand

The objectives of this research article were: 1) to examine the community context, problems, and needs, 2) to enhance the community's capacity through the process of upgrading and adding value to fermented bamboo shoot products, and 3) to assess the capacity development of the Ban Sang Thor community, Phon Mueang Subdistrict, Lao Suea Kok District, Ubon Ratchathani Province. This study employed a mixed-methods research design. The key informants were 12 experts, 50 workshop participants selected through purposive sampling, and ten experts, 50 producers (selected through purposive sampling), and 100 consumers selected through accidental sampling for product development satisfaction evaluation. Data were analyzed using descriptive statistics, including percentages, frequencies, means, and standard deviations. Qualitative data were analyzed using content analysis and descriptive explanations. The Ban Sang Thor community, characterized by a rich historical background and traditional Heet Sip Song Kong Sip Si customs, addressed socioeconomic challenges such as poverty, household indebtedness, and low income through the enhancement of fermented bamboo shoot products. The community engages in educational initiatives regarding hygienic production practices and participates in packaging design processes. The resulting products exhibit durability, aesthetic appeal, and consumer acceptance. High levels of satisfaction from experts and consumers culminate in the production of safe sanitary products with a distinct community-branded identity. Sustainable economic development contributes to the preservation of a community's cultural heritage.

Electrochemical Synthesis of Metasequoia-Like Reduced Graphene Oxide Coated Cobalt-Silver Catalyst for Stable and Efficient Electrocatalytic Nitrate Reduction to Ammonia.

Electrocatalytic nitrate (NO3 -) reduction to ammonia (NH3) is a green and efficient NH3synthesis technology. Metallic silver (Ag) is one of the well-known electrocatalysts for NO3 - reduction. However, under alkaline conditions, its poor water-splitting ability fails to provide sufficient protonic hydrogen required for NH3 synthesis, resulting in low NH3 selectivity. Additionally, metal catalysts are prone to leaching and oxidation during electrocatalysis, resulting in poor stability. Herein, cobalt (Co) into Ag (CoAg) catalyst is doped, which not only increases the NH3 selectivity by 34.4%, but also reduces the reduction potential by 0.1V. Meanwhile, reduced graphene oxide (rGO) as a protective "armor" is used to encapsulate the CoAg catalyst (rGO2.92@CoAg). The rGO2.92@CoAg catalyst shows excellent stability for over 300 hours (h) of continuous reaction. The Co and Ag contents in the rGO2.92@CoAg catalyst after continuous tests decreases by only 4.3% and 3.1%, respectively, which are much lower than those of the CoAg catalyst without the rGO (90.8%, 52.6%). Moreover, the rGO2.92@CoAg catalyst shows high Faradaic efficiency (99.3%) and NH3 yield rate (1.47mmol h-1 cm-2). Therefore, a high performance and strong stability rGO2.92@CoAg catalyst is obtained by Co doping and rGO coating, which provides theoretical basis for practical industrial application.

AI-Driven Education, Careers, and Entrepreneurship for a Transformed Tomorrow

In this in-depth exploratory case study of artificial intelligence (AI), the researchers applied a scaled, reactive, and parallel approach relating to education, employment, and entrepreneurship, wherein the data from the previous case study was used to inform the next of three case studies. Dissimilar to what was supposed from extant literature, the results revealed that AI may support learning without escalating biases or inequities. Increased and continued learning occurred within two weeks of the first pilot.The findings contribute to the resourcing literature by unveiling the capability to apply AI-driven data to boost an increase in behavioral learning, whether classical, operant, or observational. Specifically, the data shows that underperforming students, those lagging on standardized tests, and those of lower income levels can increase their learning when offered individualized and adaptive learning tailored to distinct needs, preferences, and abilities. The change is due to increased purposive attention that is AI-driven and maintains learners' interests through an avatar. This study shows how AI progress, particularly scaled, reactive, and parallel AI, can lead to new tools and services for advancements that impact performance support, employment trends, corporate learning, and professional development. Also, the study shows that AI-driven education can improve job prospects and career growth, benefiting learners, academics, and practitioners. This exploratory research results inform widespread AI implementation, fostering educational and career synergies.

Predicting Poverty

Abstract Poverty prediction models are used to address missing data issues in a variety of contexts such as poverty profiling, targeting with proxy-means tests, cross-survey imputations such as poverty mapping, top and bottom income studies, or vulnerability analyses. Based on the models used by this literature, this paper conducts a study by artificially corrupting data clear of missing incomes with different patterns and shares of missing incomes. It then compares the capacity of classic econometric and machine-learning models to predict poverty under different scenarios with full information on observed and unobserved incomes, and the true counterfactual poverty rate. Random forest provides more consistent and accurate predictions under most but not all scenarios.

Supplemental Nutrition Assistance Program Work Requirements and Safety-Net Program Participation.

Work requirements are a controversial feature of US safety-net programs, with some policymakers seeking to expand their use. Little is known about the demographic, clinical, and socioeconomic characteristics of individuals most likely to be negatively impacted by work requirements. To examine the association between work requirements and safety-net program enrollment. This cohort study included Medicaid and Supplemental Nutrition Assistance Program (SNAP) enrollees in Connecticut. The impact of SNAP work requirements for able-bodied adults without dependents-the target population-was estimated using a triple-differences research design comparing outcomes before and after the policy (first difference) in affected and exempted towns (second difference) between the targeted population and untargeted parents and caregivers (third difference). SNAP and Medicaid enrollment trends were assessed for a 24-month period, and the characteristics of individuals most likely to lose coverage were examined. Data were collected from August 2015 to April 2018, and data were analyzed from August 2022 to September 2024. The reintroduction of SNAP work requirements in 2016. Proportion of enrollees disenrolled from SNAP and Medicaid. Of 81 888 Medicaid enrollees in Connecticut, 46 872 (57.2%) were female, and the mean (SD) age was 36.6 (7.0) years. Of these, 38 344 were able-bodied adults without dependents, of which 19 172 were exposed to SNAP work requirements, and 43 544 were parents or caregivers exempted from SNAP work requirements. SNAP coverage declined 5.9 percentage points (95% CI, 5.1-6.7), or 25%, following work requirements. There were no statistically significant changes in Medicaid coverage (0.2 percentage points; 95% CI, -1.4 to 1.0). Work requirements disproportionately affected individuals with more chronic illnesses, targeted beneficiaries who were older, and beneficiaries with lower incomes. Individuals with diabetes were 5 percentage points (95% CI, 0.8-9.3), or 91%, likelier to lose SNAP coverage than those with no chronic conditions; older SNAP beneficiaries (aged 40 to 49 years) with multiple comorbidities were 7.3 percentage points (95% CI, 4.3-11.3), or 553%, likelier to disenroll than younger beneficiaries (aged 25 to 29 years) without chronic conditions; and households with the lowest incomes were 18.6 percentage points (95% CI, 11.8-25.4), or 204%, likelier to lose coverage than the highest income SNAP beneficiaries. In this cohort study, SNAP work requirements led to substantial reductions in SNAP coverage, especially for the most clinically and socioeconomically vulnerable. Work requirements had little effect on Medicaid coverage, suggesting they did not lead to sufficient increases in employment to transition beneficiaries off the broader safety net.

Association between neutrophil-percentage-to-albumin ratio (NPAR) and metabolic syndrome risk: insights from a large US population-based study

Metabolic syndrome (MetS) is a cluster of conditions that increase the risk of cardiovascular disease and diabetes. This study aimed to investigate the association between Neutrophil-Percentage-to-Albumin Ratio (NPAR) and MetS in a large, nationally representative US population. We analyzed data from 28,178 participants in the National Health and Nutrition Examination Survey (NHANES) 2005–2018. Logistic regression models were used to evaluate the association between NPAR and MetS. Restricted cubic spline (RCS) models were employed to assess the dose-response relationship. Mediation analyses were conducted to explore potential mediating effects of serum uric acid and triglyceride-glucose (TyG) index. After adjusting for confounders, participants in the highest NPAR quartile had a 14% higher risk of MetS compared to those in the lowest quartile (OR 1.14, 95%CI 1.03–1.27, P = 0.010). RCS models revealed a monotonic increasing trend between NPAR and MetS risk (P for overall association = 0.002). Mediation analyses showed that serum uric acid and TyG index mediated 14.93% and 29.45% of the total effect of NPAR on MetS, respectively. Subgroup analyses indicated that the positive association between NPAR and MetS was more pronounced in Mexican Americans, individuals aged 20–65 years, those with lower income, males, current smokers, and moderate drinkers. Higher NPAR is associated with increased risk of MetS in the US adult population. This association is partially mediated by serum uric acid and TyG index. These findings suggest that NPAR may serve as a novel biomarker for MetS risk assessment and provide insights into potential mechanisms linking inflammation and metabolic disorders.

Rural versus urban healthcare through the lens of health behaviors and access to primary care: a post-hoc analysis of the Romanian health evaluation survey

BackgroundWorldwide, rural populations are recognized to be exposed to increased health challenges due to their living and working environment, socioeconomic status, and access to health services. According to the Romanian Country Health Profile 2023, approximately 46% of all deaths recorded in Romania in 2019 could be attributed to behavioral risk factors such as tobacco smoking, dietary risks, alcohol consumption and low physical activity. No data on rural versus urban areas are available to date, and research is needed to document health inequalities, identify barriers to health services, and explore solutions.MethodsThis study is an analysis of data collected during the Health Evaluation Survey carried out by the National Institute of Public Health in 2022 and aimed to reveal differences in health risk factors between rural and urban areas. The analysis was carried out under the methodological framework of the Health Evaluation Survey 2022, which is coordinated by the National Institute of Public Health.ResultsOur study’s objectively measured data revealed that the overall health profile of rural communities is characterized by lower education levels, lower incomes, and higher binge drinking rates than those of their urban counterparts. Additionally, rural inhabitants more often have high blood pressure, are more overweight and obese (per body mass index measurements) and have higher fasting plasma glucose. The health profile of the urban population revealed higher education levels and greater proportions of people with adequate monthly income, people with daily alcohol consumption, people who smoke, and people with hypercholesterolemia. Access to primary health care evaluated through proxy indicators was lower in rural areas but was relatively good overall.ConclusionsOur analysis of the health profile of rural communities revealed a greater prevalence of obesity and overweight, especially among women, and an increased prevalence of heavy drinking among men. Access to primary health care evaluated through proxy indicators is lower in rural areas but is relatively good overall. Lower education levels and the possibility of lower health literacy underpin the need for targeted health education campaigns. Sustainable strategies for rural health need to be identified, especially in the field of health promotion and disease prevention programs.Trial registrationThis study is observational research involving human participants where no interventions were applied to the study population.

Racial disparities in presenting stage and surgical management among octogenarians with breast cancer: a national cancer database analysis.

As the US faces a diverse aging population, racial disparities in breast cancer outcomes among elderly patients remain poorly understood. We evaluate the association of race with presenting stage, treatment, and survival of invasive breast cancer among octogenarians. Women (≥ 80years) with invasive breast cancer were identified in 2004-2020 NCDB. To facilitate comparison, only non-Hispanic Black and non-Hispanic White patients were included; patients of Hispanic ethnicity were excluded. Demographics, tumor characteristics, and treatments were assessed by race. Overall survival was compared using the logrank test. Multivariable logistic and Cox proportional hazard regression models were developed to evaluate the independent association of race with outcomes of interest. Of 222,897 patients, 19,059 (8.6%) were Black. Most patients had stage I ER + HER2- invasive ductal carcinoma. Black patients more frequently had greater comorbidities, low income and education, and advanced stage (p < 0.001 each; ref: White). Following adjustment, Black women had increased likelihood of Stage III/IV over time, as well as increased odds of chemotherapy (AOR 1.22, 95% CI 1.15 - 1.29) and non-operative management (AOR 1.82, 95% CI 1.72 - 1.92; ref: White). Although Black patients had lower survival rates compared to White, race was not associated with 5-year mortality following adjustment for stage, receipt of surgery, and adjuvant treatments (p = 0.34). Inferior survival among elderly Black patients appears be driven by advanced stage at presentation. While such disparities are narrowing in the present era, future work must consider upstream interventions to ensure equitable outcomes for all races.