Poor Health Research Articles

Implementing and Delivering Culturally Centred Pharmacy Services Tailored to Ethnically Minoritised Populations: A Qualitative Systematic Review and Meta-Ethnography.

Health inequities disproportionately affect people from ethnic minority communities and require a comprehensive effort across healthcare disciplines to tackle them. Ethnically minoritised populations continue to be underserved, despite the growing awareness of the detrimental link between ethnicity and poorer health- and medication-outcomes. Pharmacy has been recognised as an accessible and inclusive healthcare setting, with the ability to meet diverse patient needs. Yet, there still remain distinct gaps in knowledge of how to best design, implement and deliver culturally centred pharmacy services for members of ethnic minority communities. A systematic literature search was undertaken in November 2023, across four databases: MEDLINE, Embase, CINAHL and PsycINFO. Qualitative studies were included if they addressed barriers, enablers and interventions aimed at tackling medicines- and health service inequalities affecting people from ethnic minority communities. Study quality was assessed using the Joanna Briggs Institute critical appraisal checklist. Data were synthesised using a meta-ethnographic approach, according to Noblit and Hare, forming a qualitative evidence synthesis to further understanding. This meta-ethnographic systematic review synthesised data from 13 international studies eligible for inclusion. Four overarching third-order constructs (termed 'themes') were developed through reciprocal translation and focused on: (i) navigating pharmacy systems across the globe; (ii) understanding cultural needs and beliefs that may influence medicine use; (iii) strengthening relationships with pharmacists and other healthcare providers and (iv) addressing possible language and communication barriers. Pharmacists and policymakers should aim to raise awareness of pharmacy services, increase the provision of cultural competency training within the profession, build stronger relationships with minority communities, and facilitate access to interpretation services. A template of recommendations has been developed to further implement and deliver such services on an individual pharmacy-, community- and profession-basis. Future research should seek to utilise lived-experience narratives and participatory co-design methods to further explore ways to address wider healthcare accessibility inequalities for this minoritised population. Public contributors and authors (inequity research champions, G.K. and T.G.) informed and shaped this project during study design and conceptualisation; they helped to ensure that the study was conducted, and the findings were reported, with sensitivity.

Valeriana jatamansi jones improves depressive behavior in CUMS mice by modulating vitamin B12-related ileal homeostasis.

Valeriana jatamansi Jones (V. jatamansi) is a traditional Chinese medicine (TCM). It was recorded in Diannan Bencao, Compendium of Materia Medica and some local medical books and was described as useful in treating insomnia, distraction, poor mental health, vomiting and diarrhea. To investigate whether the antidepressant effect of V. jatamansi may operate through modulating vitamin B12-related ileal homeostasis using a chronic unpredictable mild stress (CUMS) mouse model. A CUMS-induced depression model was established in mice for five weeks, after which V. jatamansi extracts were administered for three weeks. At week eight, the forced swimming test and novelty-suppressed feeding test were conducted. H&E staining assessed ileal pathology, while 16S rDNA sequencing analyzed changes in ileal microbiota. Additionally, B12 in serum, cubilin (CUBN) and amnionless (AMN) in ileal tissue, methionine synthase (MS) and homocysteine (Hcy) in the hippocampus were measured using ELISA, and the correlations between them and ileal microbiota were explored. Mice in the model group exhibited significant depressive behavior. However, after treatment with V. jatamansi, immobility time and feeding latency were improved. H&E staining demonstrated the repairing effect of V. jatamansi on the ileum regarding tissue damage. The alpha and beta diversity of the ileal microbiota were regulated and converged to the normal group. Additionally, V. jatamansi modulated B12, CUBN, AMN, MS, and Hcy levels. Correlation analysis showed that there are certain correlations between a variety of microorganisms and B12-related factors. These findings suggest that the mechanism of V. jatamansi in treating depression may be through repairing depression-associated intestinal damage. This repair process may affect the intestinal absorption and microbial production of B12. By reversing the reduction of serum B12, V. jatamansi ultimately reduces the infiltration of Hcy into the CNS.

Does mental health influence commuters’ mode choice? A cross-sectional assessment from the Netherlands

BackgroundPeople’s mental health may play a role in influencing their travel behaviors; however, few studies have quantified the association between mental health and commuting mode choice. ObjectiveThis study examined 1) how mental health is associated with commute mode choice and 2) whether gender differences exist. Data and methodsWe used cross-sectional data from a population-representative sample of 7,280 adults aged 18-65 from the Netherlands. We applied multilevel multinomial logit regression models to investigate the associations between commuting mode choice and self-perceived mental health controlled for multiple person-level and built environmental characteristics. We also assessed possible effect modification by gender. ResultsOur covariate-adjusted regression results based on the entire sample showed no compelling evidence for an association between self-perceived mental health and commute mode choice. While we found null associations between mental health and commute mode choice for women, stratified analyses showed that men with relatively poorer mental health were likelier to commute via bus/tram. ConclusionOur cross-sectional findings weakly support the notion that men’s mental health may be related to commute mode choice and no such relationship was found for women. However, we advocate more research before ruling out the possibility of complex interactions between mental health and commuting behavior.

Sleep and physical activity patterns in relation to daily-life symptoms in psychosis: An actigraphy and experience sampling study.

Sleep disturbances and reduced physical activity (PA) are important risk factors for poor physical and mental health outcomes in people with psychosis. However, the precise interrelations between sleep, PA and psychopathology remain unclear. This study combined experience sampling (ESM) and actigraphy in thirty-two patients with a schizophrenia spectrum disorder to investigate interrelations of day-to-day variations in actigraphic estimates of PA and sleep and psychotic and affective symptoms. Multilevel mixed-models show that subjects reported more positive affect on more physically active days. Unexpectedly, participants reported worse next-day negative affect and/or psychotic symptoms after nights with higher sleep continuity, as consistently indicated by sleep efficiency and the mean duration of bouts of wake and sleep. Lastly, PA was higher after nights with higher sleep continuity and shorter total sleep duration. These results highlight that modifiable lifestyle factors such as PA and sleep have an intricate, but clinically relevant relationship with psychotic and affective symptoms. Future studies are needed to further examine the complex effects of these behaviors in order to develop effective, targeted treatment strategies to improve clinical outcome in psychosis.

Bidirectional relationship between epigenetic age and stroke, dementia, and late-life depression

Chronological age is an imperfect estimate of molecular aging. Epigenetic age, derived from DNA methylation data, provides a more nuanced representation of aging-related biological processes. We examine the bidirectional relationship between epigenetic age and brain health events (stroke, dementia, late-life depression) using data from 4,018 participants. Participants with a prior brain health event are 4% epigenetically older (β = 0.04, SE = 0.01), indicating these conditions are associated with accelerated aging beyond that captured by chronological age. Additionally, a one standard deviation increase in epigenetic age is associated with 70% higher odds of experiencing a brain health event in the next four years (OR = 1.70, 95% CI = 1.16–2.50), suggesting epigenetic age acceleration is not just a consequence but also a predictor of poor brain health. Mendelian Randomization analyses replicate these findings, supporting their causal nature. Our results support using epigenetic age as a biomarker to evaluate interventions aimed at preventing and promoting recovery after brain health events.

Physical Health Views Among Individuals Experiencing Mental Illness: A Mixed-Methods Study of Self-Reported Health and Contributing Factors.

Severe mental illness is linked to poor physical health and shorter life expectancy, yet research on how individuals experiencing mental illness view and on improve their physical health is limited. This study investigates the perceptions of individuals experiencing mental illness regarding their physical health, utilising a mixed-methods approach. Phase I involved quantitative and qualitative data from an online Qualtrics survey, which included the 12-item Short Form (SF-12) survey to measure participants' quality of life and assess self-reported physical and mental health. Key findings from Phase I revealed significant relationships between lower Physical Component Summary (PCS) scores and factors such as the frequency of GP visits. Additionally, exercise preferences were found to significantly impact Mental Component Summary (MCS) scores, with individuals who preferred a mix of exercise settings reporting higher MCS scores compared to those who exercised alone or with a training partner. Phase II explored these findings further through semi-structured interviews, where participants discussed themes including physical health perceptions, the role of medication and the importance of the general practitioner relationship. Thematic analysis revealed five main barriers to improving physical health: accessibility and availability of services, motivation, staff attitudes, medication side effects and the experience of diagnostic overshadowing. Participants reported viewing physical and mental health as interconnected and expressed a desire for more collaborative care. The results suggest that strengthening the relationship with GPs and increasing awareness of medication side effects may improve physical health outcomes for individuals experiencing mental illness. Mental health nurses can play a pivotal role in enhancing physical health outcomes by monitoring, supporting health-improving strategies and facilitating access to primary care services.

The effects of socio-economic and environmental factors on Korean suicidal ideation: A Bayesian multilevel analysis.

This study investigated how socio-economic and environmental factors contribute to suicidal ideation in South Korea. This was a cross-sectional study. Using a Bayesian multilevel analysis, the study highlights the impact of housing insecurity, financial burden, and subjective health perceptions on mental health. Data from the 2018 Korea Health Panel and regional statistics were used to analyze variables at the individual, household, and regional levels. The results suggest that poor subjective health perception, depression, and a precarious financial situation increase suicidal ideation. Regions with high housing vacancies exhibit lower suicide ideation rates, implying that reduced housing competition may alleviate mental stress. Targeted mental health interventions and improved housing policies are required to help vulnerable populations.

Epidemiology of menstrual-related absenteeism in 44 low-income and middle-income countries: a cross-sectional analysis of Multiple Indicator Cluster Surveys.

Menstrual-related absenteeism from work, school, or social activities is an important functional indicator of poor menstrual health that disrupts women's and girls' daily lives and exacerbates gender inequality. We sought to estimate the prevalence of and factors contributing to menstrual-related absenteeism across low-income and middle-income countries. We analysed cross-sectional data from 47 nationally or subnationally representative Multiple Indicator Cluster Surveys from 2017 to 2023, which comprised 3 193 042 individuals from 555 869 households across 44 countries; those with available information on the outcome of interest were included in our analysis. The outcome of interest was menstrual-related absenteeism from work, school, or social activities during the respondent's last menstrual period. Independent factors included age, household wealth index, use (vs no use) of menstrual materials (eg, pads, tampons, or cloth), availability of a private place to wash at home during menstruation, and contraceptive use (hormonal and other). Univariable and multivariable associations between each factor and menstrual-related absenteeism were analysed using log-binomial models. Prevalence ratios, estimated from the log-binomial models, represent the relative prevalence of menstrual-related absenteeism across different levels of the independent variables. Prevalences and associations were pooled by geographical region and overall across all surveys using a random-effects meta-analysis. Heterogeneity was assessed using the I2 statistic, and prediction intervals generated to reflect the variation in associations. We included 673 380 women and girls aged 15-49 years in this analysis. The overall pooled prevalence of menstrual-related absenteeism was 15·0% (95% CI 12·7-17·3), with prevalence being highest in south Asia (19·7% [11·6-27·8]) and west and central Africa (18·5% [13·5-23·5]). After pooling data across surveys, girls aged 15-19 years were found to have a higher prevalence of menstrual-related absenteeism than those in older age groups, with overall pooled prevalence ratios ranging from 0·75 (0·68-0·82) in those aged 35-39 years to 0·92 (0·87-0·97) in those aged 20-24 years relative to the 15-19 years age group, with adjustment for area type (urban or rural). There was no association between menstrual-related absenteeism and household wealth or the use of menstrual materials. By contrast, having a private place to wash at home was associated with an increased prevalence of menstrual-related absenteeism (overall pooled prevalence ratio 1·25 [1·05-1·48], adjusted for wealth and area type). Menstrual-related absenteeism was less prevalent in women and girls using any contraceptives compared with those not using contraceptives (0·92 [0·87-0·96]), and for those using hormonal contraceptives compared with those using non-hormonal or no contraceptives (0·91 [0·84-0·99]), after adjusting for age, wealth, education level, parity, and area type. Menstrual-related absenteeism is prevalent, especially in Asia and Africa and among adolescent girls. The age-independent protective effect of hormonal contraceptive use suggests that symptoms such as heavy menstrual bleeding or pain contribute to absenteeism. Future studies are urgently needed to better characterise these findings to inform relevant public health interventions. National Health and Medical Research Council, Australia.

Relationship between self-rated health, physical frailty, and incidence of disability among Japanese community-dwelling older adults: A longitudinal prospective cohort study.

Poor self-rated health (SRH) and physical frailty are both significant predictors of disability in older adults, but their joint association on health outcomes remain unclear. This study aimed to examine the relationship between SRH, physical frailty, and incidence of disability among community-dwelling older adults. This longitudinal cohort study included 2838 older adults aged 65years or older (mean age, 73.1±5.9years) living in Takahama, Japan, who participated in the baseline assessment from September 2015 to February 2017. Participants were followed prospectively until June 2021. SRH was assessed on a four-point scale, and frailty was evaluated using the Japanese version of the Cardiovascular Health Study criteria. Participants were categorized into four groups based on SRH (Good or Poor) and frailty status (Robust or Frail). Cox proportional hazard models were used to assess the association between these categories and the incidence of disability over a 5-year follow-up. During the median follow-up of 60months, 349 of the 2838 participants developed a disability. The risk of disability was significantly higher in the Poor/Robust (HR 1.64, 95% CI 1.20-2.25), Good/Frail (HR 2.58, 95% CI 1.91-3.49), and Poor/Frail (HR 2.03, 95% CI 1.37-3.01) groups than in the Good/Robust reference group. Frail older adults who report good health were associated with the risk of disability, suggesting that discrepancies between subjective and objective health assessments may lead to adverse outcomes. Recognizing and addressing these discrepancies is crucial to promote successful aging.

Control of Mycobacterium tuberculosis infection in the elderly: Is there a role for epigenetic reprogramming reversal?

With the increase in the elderly population worldwide, the number of subjects suffering from tuberculosis (TB) has shown an increased prevalence in this group. Immunosenescence is essential in this phenomenon because it may reactivate the lesions and render their adaptive immunity dysfunctional. In addition, inflammation in the lungs of the elderly subjects is also dysfunctional. Although effective drugs are available, they are often tolerated inadequately, reducing adherence to the therapy and leading to therapeutic failure. Comorbidities, poor general health status, and other medications may lead to increased drug adverse reactions and reduced adherence to treatment in the elderly. Hence, older adults require an individualized approach for better outcomes. Trained immunity, which involves epigenetic reprogramming, may contribute to balancing the dysfunction of innate and adaptive immunity in older people. This review analyzes the relationship between inflammation, age, and Mycobacterium tuberculosis. Moreover, we hypothesize that immunomodulation using trained immunity activators will help reduce inflammation while enhancing antimicrobial responses in the elderly. Understanding immunomodulation's molecular and physiological effects will lead to informed decisions about TB prevention and treatment strategies uniquely designed for the elderly.

Implementing an Adverse Childhood Experiences Screening Tool With Migrant Children: A Quality Improvement Project Using the PEARLS Screening Tool

BackgroundImmigrants, asylum seekers, and refugees live with extreme stress, consistent vulnerability, and life-long health consequences. Children in these populations face increased risk of poor mental health due to adverse childhood experiences (ACEs) and related healthcare barriers, such as lack of screening, that limit their ability to receive appropriate mental health care. AimTo implement an ACEs screening questionnaire for all migrant children 19 and under in a community shelter. MethodsThe Model for Improvement. InterventionThe Pediatric ACES and Related Life Events Screener (PEARLS) was implemented over a 10-week period in a community shelter. ResultsAll children screened had at least 1 ACE. Initiation of PEARLS screening led to recognition of adverse experiences thus allowing for mental health support and referrals to mental health specialists. ConclusionsThis QI project supports implementation of screening for adverse childhood experiences within populations of migrant children in order to uncover potential mental health concerns and provide targeted support, recognizing the long-term effects of trauma on their wellbeing.

Association of active commuting with incidence of depression and anxiety: prospective cohort study.

Evidence is limited on the incidence of depression and anxiety in relation to active commuting. Our study aimed to explore their association and examine the mediating role of inflammatory. This study included 240,547 workers in the UK Biobank. The exposure variable was the mode of transport used to get to and from work including active (walking, cycling, mixed mode) and non-active commuting (car or public transport). The incidence of depression and anxiety was defined using ICD-10 codes. Cox proportional hazard regression models were used to explore the hazard ratios (HRs) of active commuting with depression and anxiety, and mediation analyses were used to test the mediating role of inflammatory in this association. There were 10,862 depression and 9407 anxiety events. Active commuting was associated with lower risk of depression [cycling: HR 0.775, 95% confidence interval (0.674-0.890); mixed mode walking: 0.858 (0.800-0.919); mixed mode cycling: 0.821 (0.744-0.907)] and anxiety [cycling: 0.781 (0.675-0.904); mixed mode walking: 0.867 (0.805-0.934); mixed mode cycling 0.810 (0.728-0.902)], and there were distinct dose-response trends between commuting distance and incidence of depression or anxiety. Inflammatory explained 19.75% of the association between cycling with depression, and 18.05% with anxiety. There were interactions between commuting and occupation type. Cycle and mix mode commuting were associated with lower risk of depression and anxiety, and inflammation partially mediated these association. Implementing initiatives that facilitate active commuting may help alleviate the poor mental health.

An Innovative Clinic-Based Intervention to Improve Adolescent Access to Sexual and Mental Health Services: The Total Teen Program.

Adolescents encounter numerous healthcare access barriers, leading to poor health outcomes. Researchers developed the Total Teen (TT) program to improve access to sexual and reproductive health (SRH) and mental health (MH) services in settings providing adolescents and young adults (12-25) health services. This pilot study assessed the TT's impact on care across three settings: school-based health clinics, a federally qualified health center, and an adolescent health clinic for 12 weeks. Sociodemographic data, including age, race/ethnicity, gender, and insurance status, were collected. MH was assessed using patient health questionnaire (PHQ)-9 and generalized anxiety disorder (GAD)-2 scales, and sexual health was evaluated based on CDC guidelines and additional evidence-based questions. One-on-one time, confidential consultations, SRH and MH micro visits, and referrals measured access. Descriptive statistics, Pearson Chi-square tests, and Kruskal-Wallis tests compared site outcomes, while logistic regression models adjusted for age, gender, race, and site. Four hundred and fifty-one participated in the TT program across the three sites. Concerning micro visits and referrals, being male was associated with lower depression rates (P = .0003) and generalized anxiety disorder (P = .0099). Being males also predicted micro visit receipt (P = .0199). Concerning SRH micro visits, higher sexual behavior scores (P < .0001) were significantly associated with a greater likelihood of utilizing SRH micro visits. Results indicate that TT improves access to SRH and MH services and referrals for at-risk adolescents. Findings underscore the importance of integrating SRH and MH services into routine adolescent care and involving health organizations and providers as key stakeholders in enhancing preventive healthcare access.

Abstract TMP113: Sex differences in the effects of social isolation on behavioral and metabolic parameters in a model of cerebral amyloid angiopathy

Introduction: The prevalence of social isolation (SI) increases with aging and contributes to poor health outcomes and increased risk of cognitive impairment, especially in Aβ-related diseases. Cerebral amyloid angiopathy (CAA) is characterized by amyloid β (Aβ) deposition in the cortical and leptomeningeal vessels, and is a leading cause of hemorrhagic stroke and age-related cognitive impairment. How social isolation affects vascular amyloid deposition, cognitive decline and social behavior in CAA is unknown. Methods: TgSwDI mice carrying Swedish, Dutch, and Iowa mutations of human amyloid precursor protein were used as a CAA model. Male and female C57BL/6 wildtype (WT) and CAA mice were randomly assigned to pair housing (PH) or SI at 3 months of age. Affective and social behaviors were assessed at baseline and every 3 months thereafter using the tail suspension test (TST) and three-chamber social interaction test. At 9 months post-SI, cognitive behaviors and general well-being were measured using fear conditioning (FC) and the nesting test, respectively. Body weights were recorded, and white adipocyte size was measured using immunostaining. Results: SI led to increased immobility in the TST at 3- and 6-months post-SI in both male and female WT and CAA mice, suggesting depressive-like behavior (n=5-8/grp, p&lt;0.05). Isolated CAA mice displayed greater cognitive deficits in FC, while only male WT SI mice showed impaired cognition (n=5-12/grp, p&lt;0.005). Sex differences in social behavior were observed in isolated CAA mice. Specifically, at 6 months post-SI, female CAA mice displayed deficits in sociability and social novelty (n=4-9/grp, p&lt;0.05), which was not seen in male CAA mice. SI negatively impacts the general well-being in both male WT and CAA SI animals (n=5-12/grp, p&lt;0.005). Preliminary findings showed increased white adipocyte size in male WT SI mice with a similar trend in male CAA SI animals, pointing to potential metabolic effects of isolation. Conclusion: SI induced cognitive decline in both male and female CAA mice. Behavioral differences between sexes were noted in CAA mice including nesting ability, sociability, and depressive-like behaviors. Further research is needed to determine the cellular and molecular mechanism underlying SI-induced metabolic changes in CAA.

Molecular detection and occurrence of contagious ecthyma in goat.

Contagious ecthyma or Orf is a common, contagious and zoonotic disease of small ruminants caused by orf virus. The present research was conducted to study the occurrence of Orf in goats in and around Parbhani district. Overall occurrence of Orf in goats was recorded 38.83% on the basis of PCR results. The higher occurrence of Orf recorded in the kids below 4 months of age, male, poor health status and non-descript goats. The clinical signs observed in Contagious Ecthyma affected goats were pyrexia, severe proliferative ulcerated cauliflower-like lesions around lips and scabby lesions were observed on the lips, muzzles, mucocutaneous junctions, nostrils, ear, inner aspect of thigh and gums. The hematological parameters revealed erythrocytopenia, anemia, leukocytosis, neutrophilia and lymphopenia. For molecular confirmation, DNA extraction of all scab samples collected from suspected goats and showed amplification of partial B2L gene at 592 bp by PCR. Analysis of DNA sequence revealed that three Parbhani sequences were positive for CEV. The obtained 3 sequences of orf virus got accession numbers PP235095, PP235096 and PP235097 were closely related with each other and with other strains obtained from GenBank for the Parbhani district, Maharashtra and strains of other states of India mainly with Meghalaya, Assam and Goa.

Development of Machine Learning Algorithms for Identifying Patients With Limited Health Literacy.

Limited health literacy (HL) leads to poor health outcomes, psychological stress, and misutilization of medical resources. Although interventions aimed at improving HL may be effective, identifying patients at risk of limited HL in the clinical workflow is challenging. With machine learning (ML) algorithms based on readily available data, healthcare professionals would be enabled to incorporate HL screening without the need for administering in-person HL screening tools. Develop ML algorithms to identify patients at risk for limited HL in spine patients. Between December 2021 and February 2023, consecutive English-speaking patients over the age of 18 and new to an urban academic outpatient spine clinic were approached for participation in a cross-sectional survey study. HL was assessed using the Newest Vital Sign and the scores were divided into limited (0-3) and adequate (4-6) HL. Additional patient characteristics were extracted through a sociodemographic survey and electronic health records. Subsequently, feature selection was performed by random forest algorithms with recursive feature selection and five ML models (stochastic gradient boosting, random forest, Bayes point machine, elastic-net penalized logistic regression, support vector machine) were developed to predict limited HL. Seven hundred and fifty-three patients were included for model development, of whom 259 (34.4%) had limited HL. Variables identified for predicting limited HL were age, Area Deprivation Index-national, Social Vulnerability Index, insurance category, Body Mass Index, race, college education, and employment status. The Elastic-Net Penalized Logistic Regression algorithm achieved the best performance with a c-statistic of 0.766, calibration slope/intercept of 1.044/-0.037, and Brier score of 0.179. Elastic-Net Penalized Logistic Regression had the best performance when compared with other ML algorithms with a c-statistic of 0.766, calibration slope/intercept of 1.044/-0.037, and a Brier score of 0.179. Over one-third of patients presenting to an outpatient spine center were found to have limited HL. While this algorithm is far from being used in clinical practice, ML algorithms offer a potential opportunity for identifying patients at risk for limited HL without administering in-person HL assessments. This could possibly enable screening and early intervention to mitigate the potential negative consequences of limited HL without taxing the existing clinical workflow.

Pediatrics leading the way: co-enrollment as the next step in health-related social needs screening and referral.

To contextualize how pediatrics led the field in developing and implementing tools to screen for social determinants of health in clinical care as well as in creating innovative interventions to mitigate them, and to summarize where the evidence points as the next frontier. The evidence showed that health-related social needs (HRSN), like food insecurity, energy insecurity, and housing instability, continue to drive poor health outcomes across the lifespan; patients and healthcare providers are open to discussing HRSN in clinical settings, though some providers feel ill-equipped to do so; to mitigate HRSN, healthcare plays a unique role in ensuring patients' HRSN are understood, referring to effective resources through building strong, lasting relationships with community partners, embedding services in the healthcare setting across all departments, and empowering patient families to participate in programs and services; and administrative burden hinders families from getting all the benefits to which they are entitled, which streamlined co-enrollment processes can address. Pediatric providers can add a unique and credible voice to seeking changes to the safety-net, including co-enrollment, that could reduce administrative burden, address patients' HRSN, and improve health starting in the prenatal period through later adulthood.

Longitudinal associations between well-being, hair cortisol, and self-reported health.

This pre-registered study examines the longitudinal relationships between well-being, hair cortisol (a biomarker linked to poor health), and self-reported health. Accumulated cortisol output over three months was determined quarterly over the course of one year using hair samples. Well-being was assessed as affective well-being (via experience sampling), cognitive well-being (i.e., life satisfaction), and eudaimonic well-being (via the Ryff Scales of Psychological Well-Being). Self-reported health was measured using one item on the current state of health. The longitudinal analyses allowed for disentangling initial between-person differences from within-person changes and were based on a large panel study of working-age people (N = 726). The results indicate that hair cortisol levels were generally not associated with any of the examined well-being facets, regardless of the level of analysis. Further, deviations from well-being trait levels were not linked to subsequent within-person changes in hair cortisol (and vice versa), challenging the notion that cortisol output is a key physiological pathway through which well-being improves health. In contrast, self-reported health was positively correlated with affective, cognitive, and eudaimonic well-being at both the trait and within-person levels, whereas deviations from well-being trait levels were generally not associated with subsequent within-person changes in self-reported health, and vice versa.

Decrease in provider stigma is associated with improved quality health indicators among individuals receiving methadone in primary care centers in Ukraine.

People who inject drugs experience poor health and social outcomes which improve with opioid agonist therapies like methadone, yet provider stigma may influence healthcare utilization. In Ukraine, integrating methadone into primary care centers (PCCs) provides an opportunity to examine provider stigma and its impact on patient outcomes. This sub-analysis included patients randomized to receive methadone in PCCs as part of an implementation trial in which the control group received methadone in specialty addiction clinics in Ukraine. Methadone integration in PCCs was supported through continuous tele-education for providers. Provider stigma towards people who inject drugs, methadone, and attitudes towards evidence-based practices were assessed at baseline, 12, and 24 months using standardized scales (range 1-10). Patient-level outcomes were measured bi-annually over 24 months using a quality health indicator (QHI) score, a percentage of guideline-concordant primary and specialty health services accessed. Linear mixed-effects models examined the changes in provider stigma and attitudes, and the association of these measures with patient outcomes. The sample included 583 patients and the 112 providers in 24 clinics. Provider fear and stereotypes toward people who inject drugs improved significantly, by 0.6 (95 % CI 0.2-1.1) and 0.4 points (95 % CI 0.1-0.8), respectively, as did preference for methadone over abstinence-based treatment (0.7 points, 95 % CI 0.2-1.1). A 1-point improvement in provider prejudice correlated with a 7.0-point increase (95 % CI: 1.1-13.0) in patient primary care QHI scores at 12 months, while improved attitudes towards evidence-based practices were associated with an 8.3-point increase (95 % CI: 1.1-13.0). Preference for methadone maintenance over abstinence was associated with a 3.7-point increase (95 % CI: 0.6-6.7) in specialty care QHI scores at 12 months, and reduced stereotypes were associated with a 10.9-point increase (95 % CI: 1.2-20.7) at 24 months. Integrating methadone into PCCs with the support of provider tele-education may reduce provider stigma, particularly fear and stereotypes, toward people who inject drugs and methadone maintenance. Reducing provider stigma has the potential to improve patient outcomes through increased access to preventive care and screenings.

Association of social deprivation and colon cancer mortality: A population-based analysis.

25 Background: Colon cancer mortality is largely influenced by social factors, with higher rates seen in deprived areas. The Social Deprivation Index (SDI) measures factors like poverty, education, and unemployment, which have been linked to poor health outcomes. This study examines the relationship between county level social deprivation and colon cancer mortality in Texas. Methods: We conducted a population-based cohort study of colon cancer deaths in Texas. We queried the National Cancer Institute Surveillance, Epidemiology and End Results Program for county level colon cancer deaths in Texas over the most recent available year, 2021. We calculated age-adjusted mortality rates (AAMRs) per 100,000 population using the direct standardization method based on the age group weights from the 2000 standard US population. Confidence intervals for AAMR were derived by estimating the standard error as the AAMR divided by square root of number of mortalities. The SDI by county was linked to mortality rate using Federal Information Processing Standards (FIPS) codes. The significance of the difference between two AAMR was evaluated by determining if the intersection of 95% confidence intervals was empty. The association between SDI and AAMR was tested using both unweighted and weighted Spearman correlation with county population as weight. Results are reported and Spearman correlation and 95% confidence interval (ρ [95% CI]). Sensitivity analysis was performed by considering only the individual components of the SDI. Subgroup analyses included age group, sex, urban counties, rural counties, and race/ethnicity groups. Results: A total of 3,800 colon cancer mortalities were identified in 2023. The statewide AAMR was 12.5 (95% CI 12.1 to 12.9). Out of 254 counties, 29 (11.4%) had an SDI ≤ 25, 61 (24.0%) had 26 ≤ SDI ≤ 50, 87 (34.3%) had SDI 51 ≤ SDI ≤ 75, and 77 (30.3%) had 76 ≤ SDI ≤ 100. Total population in counties with SDI ≥ 76 was 15,106,726 (51.1%) with AAMR 12.959 (12.379 to 13.538). In contrast, the population in counties with SDI ≤ 25 was 4,771,473 (16.1%) with significantly lower mortality (AAMR 9.752 [95% CI 8.879 to 10.625]). The population weighted Spearman correlation between county level SDI and AAMR was positive (ρ = 0.339 [95% CI 0.209 – 0.514]). The unweighted Spearman correlation between county level SDI and AAMR was also positive (ρ = 0.178 [95% CI 0.089 – 0.238]). Households with no vehicle, poverty, and unemployment were most correlated with AAMR while renter occupied housing had no association. The correlation of county level SDI and AAMR were similar for rural counties, urban counties, males, females, Whites, Hispanics and Blacks. Conclusions: This study reveals a significant positive correlation between higher SDI and increased colon cancer mortality at the county level in Texas. The findings highlight the need for targeted public health interventions in deprived areas to reduce mortality and address disparities.