Poor Socioeconomic Status Research Articles

Livelihood vulnerability assessment among the agrarian indigenous communities of Sundarban Biosphere Reserve in India for building resilience and adaptation.

Indian Sundarban Biosphere Reserve (ISBR) is a vulnerable Southeast Asian region. The negative effects of climate change were putting tremendous pressure on this region. However, a dearth of literature focused on the vulnerability and adaptation to climate change among the tribal agrarian community in ISBR. Against this backdrop, this study aims to ascertain different tribal community's perceptions of vulnerability and adaptation preferences through a mixed-method approach and measure the determinants of agricultural livelihood vulnerability. Using a multi-stage random sampling technique and with the help of a pre-structured survey schedule in ISBR, this study involved 300 randomly selected respondents in the interview and focus group discussion. This study applied the IPCC framework to evaluate the integrated livelihood vulnerability to climate change in the ISBR. This study measured the determinant factors underlying vulnerability using ordered probit regression and focus group discussions. This study measures vulnerability as a function of adaptive capacity, sensitivity, and exposure. For the integrated livelihood vulnerability index, 44 indicators under 9 main categories were chosen. 36.52% of rural livelihoods in the southern and southeastern part of Indian SBR were highly vulnerable due to high exposure to flood, riverbank erosion, frequent cyclone, high sensitivity to inadequate access to basic amenities, and low adaptive capacities due to poor livelihood security and poor socio-economic condition. On the other hand, the northern portion of the region exhibits low to moderate vulnerability because of low exposure, low sensitivity, and strong adaptive capacity. Results suggest that the limited adaptation capacities of the tribal household, such as inadequate infrastructure and low-income opportunities, are the primary reasons for livelihood vulnerabilities. This approach can be applied at different scales in other regions of India and other developing countries.

Racial and Socioeconomic Disparities in Traumatic Brain Injury Outcomes: Insights From a Nationwide Analysis

BACKGROUND AND OBJECTIVES: To examine the effects of racial and socioeconomic disparities on clinical outcomes: in-hospital mortality, discharge dispositions, and hospital length of stay (LOS) among patients with traumatic brain injury (TBI) stratified by race and socioeconomic status (SES). METHODS: We conducted a retrospective analysis by analyzing the 1995-2015 Nationwide Inpatient Sample database. Adjusted logistic regressions and multinomial logistic regression models with and without propensity score matching were applied to investigate the effects of disparities on clinical outcomes. RESULTS: African American and Hispanic patients with TBI had a lower risk of in-hospital mortality, longer hospital LOS, and lower likelihood of being discharged to rehabilitation compared with White patients. The TBI patients with poor SES (pSES) had lower in-hospital mortality and were more likely to leave against medical advice compared with non-pSES TBI patients. CONCLUSION: Racial and socioeconomic disparities had significant influences on in-hospital mortality, discharge dispositions, and hospital LOS among the TBI population. Our study observed pSES TBI patients had a lower likelihood of in-hospital mortality than non-pSES patients, which may be partially attributed to the fact that most of the pSES TBI patients were hospitalized in urban teaching hospitals and hospitals with large bed size. In effect, our data suggest that the Social Safety Net of the United States is effective in preventing mortality in patients with TBI.

STUDY OF HUMAN LEPTOSPIROSIS IN A TERTIARY CARE HOSPITAL, VISAKHAPATNAM

Objective: Prevalence of leptospirosis in humans is found in an alarming number in recent times. This endemic zoonotic disease is widespread and potentially fatal. It is usually seen in areas with poor socioeconomic conditions, water stagnation, garbage accumulation, which becomes breeding sites for the rodents. Infection may turn epidemic during monsoon. Reservoir of infection is rat scientifically named as Rattus rattus and infection results from direct or indirect exposure to host animals that carry the pathogen in their renal tubules and shed pathogenic leptospires in their urine. The main objective of this study was to estimate the seropositivity of leptospirosis in patients presenting with undifferentiated acute febrile illness for 5 to 7 days during one year period from February 2023 to February 2024 in a tertiary care hospital, Visakhapatnam, India. Methods: A total of 279 blood samples received from suspected cases of leptospirosis were subjected to IgM ELISA. Results: Out of total 279 cases, 20 were positive for leptospirosis (OD ratio ≥1.00). All the positive cases presented with a fever more than 99.5°F, chills and headache with elevated serum procalcitonin levels. Peak incidence of cases was recorded during July and August 2023. Conclusion: Seroprevalence of human leptospirosis in this study was found to be 7.2%.

Determinants of underweight among returnee lactating mothers in Gedeb District, Southern Ethiopia: a case–control study

ObjectiveThis study aimed to assess the determinants of underweight among returnees lactating mothers in governmental health facilities of Gedeo zone, Southern Ethiopia.DesignCase–control study.SettingGedeb District governmental health facilities.ParticipantsA total of 264...

Association of low socioeconomic status with cognitive decline among older persons in underdeveloped areas in China – a data analysis of the Gansu aging study

BackgroundIndividuals with low socioeconomic status (SES) bear a disproportionate share of the cognitive impairment (CI) burden, there are growing evidence focusing on socioeconomic inequalities in CI among older persons. However, data in the underdeveloped regions is limited. This study aims to measure socioeconomic inequalities in CI among individuals aged 65 years or older in Gansu, China, and determine the contributions of socioeconomic factors to the inequalities.MethodsData from the Gansu Aging Study in 2022 including 3241 participants. Participates’ SES was assessed by using education, income, and occupation. Multivariate logistic regression was conducted to identify the associated between SES and CI, and decomposition analysis was further applied to decompose the contribution of each determinant to the observed inequalities in CI. The SES inequalities in CI were illustrated and quantified by the concentration curve index.ResultsOverall, 24.2% of participants suffered from CI in the study. The likelihood of CI was lower among those with a medium SES (OR = 0.04, 95% CI:0.03, 0.07), good SES (OR = 0.06, 95% CI: 0.04, 0.09) compared to those with lower levels of SES. Older adults with mild depression (OR = 3.66, 95% CI:2.70,4.95), moderate-severe (OR = 2.82, 95% CI:2.05,3.88) were more likely to have CI in comparison to those with no depression and regular social activities were protective factors for CI (OR = 0.28, 95% CI:0.11,0.75). The concentration index indicated that CI was more concentrated in households with poor SES. Subsequently, SES explained 34.65% of socioeconomic inequality in CI.ConclusionThis study suggested that, approximately one-quarter of older persons suffered from CI in Gansu, China. Low SES was substantially associated with risk of CI. Although interventions to modify traditional risk factors may decrease the risk of CI, disparities by SES may remain without addressing SES itself.

Multilevel Disparities of Sex-Differentiated Human Papilloma Virus-Positive Oropharyngeal Cancers in the United States.

Objectives: This study used multilevel social determinants of health (SDoH) models to determine how SDoH influence different sexes of patients diagnosed with HPV-positive oropharyngeal squamous cell cancers (OPSCC) across the US. Methods: This was a retrospective cohort study assessing HPV-confirmed patients with oropharyngeal squamous cell cancers from 2010 to 2018 using census-level Yost Index socioeconomic status (SES) score and rurality-urbanicity measures alongside individual-level race-ethnicity while stratifying by biological sex. Age-adjusted multivariate regressions were performed for survival, treatment receipt, and delay of treatment initiation (of 3+ months). Results: Across 14,076 OPSCC-HPV-positive patients, delay of treatment uniquely featured positive predictors for males of black race-ethnicity (OR, 2.07; 95% CI, 1.68-2.54) and poor Yost SES (1.43; 1.24-1.65). Five-year all-cause mortality uniquely showed positive predictors of females of black race-ethnicity (2.74; 1.84-4.71) and of males with poor Yost SES (1.98; 1.79-2.19). Three-year all-cause mortality shared positive predictors across sexes but were exacerbated in females of black race-ethnicity (2.50; 1.82-3.44) compared to males (2.23; 1.91-2.60); this was reversed for poor Yost SES (male, 1.92, 1.76-2.10; female, 1.60, 1.32-1.95). Surgery showed negative predictors of black race-ethnicity that displayed worsened effects in females (0.60, 0.44-0.79) versus males (0.75, 0.66-0.86). First-line radiation receipt uniquely featured negative predictors for males of black race-ethnicity (0.73; 0.62-0.86) with poor Yost SES (0.74; 0.68-0.82). Conclusions: Comprehensive models of multilevel SDoH displayed exacerbated disparity effects of community-level SES in males and black race-ethnicity among female HPV-positive OPSCC patients. These objective comparisons of specific SDoH factors inform providers and policy direction on how to strategically target the most pertinent SDoH factors affecting a rapidly growing cancer population.

Disparities in Testicular Cancer: A Review of the Literature.

Background: Testicular cancer is the most common malignancy diagnosed in adolescents and young adults, and evidence has emerged regarding disparities that affect different groups of patients. Methods: In this article, we conducted a thorough review of this area and summarized the existing literature. Results: Some of the pertinent findings from our review include poorer outcomes for various groups including the native Māori population of New Zealand, those who live in the United States-Mexico border region, those who live in Eastern Europe, those who are uninsured and those with poorer socioeconomic status, amongst others. In the United States specifically, there is significant evidence showing that racial/ethnic minorities, compared to white patients, tend to fare worse with later presentation at higher stages and worse survival rates. Hispanic patients in particular appear to have the potential for more aggressive tumor biology than other groups and are projected to have the highest incidence rates in the US by 2026. Conclusions: Overall, disparities exist in many aspects of testicular cancer and are striking in some instances, and further research is needed in this arena and in potential solutions.

Influences of Widowhood Cultural Practices, Values, and Beliefs on the Health and Well-being of Nigerian Women: An Integrative Review.

Widowhood cultural practices are detrimental to the health and well-being of widows in Nigeria. They are associated with a higher rate of morbidity and mortality than for single and married individuals. To explore and synthesize the literature on widowhood cultural practices and their effects on the health and well-being of Nigerian women in Nigeria and in the US to inform future research. A comprehensive search of CINAHL, PubMed, Google Scholar, and Embase databases was performed using the Whittmore and Knafl Integrative Review Model. Critical appraisal was used to select the final 20 studies that met the inclusion criteria. Seven themes were identified: Inhumane treatment of widows, poor socio-economic status, support for detrimental widowhood cultural practices driven by culture, physiological well-being, psychosocial issues, support, and empowerment. Further research is needed to explore the practice and its impact in the Nigerian American population in the US.

Practitioners’ Experiences of School Readiness in Rural Early Childhood Centres in QwaQwa Free State, South Africa

The analysis of the school preparation experiences of rural early childhood practitioners. Multiple complex issues exist regarding school preparedness in South Africa. Research has found that many South African children are unprepared for formal schooling. Some of the challenges experienced by these young learners were low reading strength, learning setbacks and complications, and sluggish general development. As a result of these issues, young children face long-term repercussions. These include the inability to escape the cycle of poverty, lack of educational support, and poor socioeconomic conditions within their environment. Therefore, it can be argued that teaching within the South African public schooling context is marred with difficulties and unforeseen challenges. It is difficult to imagine how to modify South African infrastructure so all children can reach their full potential. Given that our ancient past is still rife with historical and power changes, the government must consider several factors while developing ways to aid transformation. This study investigated the perspectives of practitioners on school preparedness. At the same time, it investigates the significant learning at the grass-roots level that emerged from participation in a critical paradigm-based participatory action research project. The study is anchored in a philosophical methodology that leverages Practitioners’ idea that early childhood learners are ready for formal school. They do not emphasize play as a pedagogy for learning in preparation for school readiness. This paper is grounded in constructivism, which helps comprehend how school readiness knowledge improves formal education for young students. The author used the qualitative research approach with an interpretive paradigm to explore practitioners’ school readiness experiences. The author developed a semi-structured interview schedule to collect data from six practitioners in the Thabo-Mofutsanyana district in the Free State Province. The findings revealed practitioners lacked appropriate training and support in preparing young learners in ECD centres. Furthermore, practitioners lacked appropriate pedagogical skills to strengthen teaching and learning. The study recommended that practitioners receive ongoing professional teacher development in school readiness and use various teaching and learning strategies such as play pedagogy.

Long-Lasting Insecticidal Net Campaigns for Malaria Control Considering Prioritization and Equity

Malaria remains a significant public health concern in several developing countries. Tropical weather, coupled with poor environmental and socioeconomic conditions, increases mosquito activity and disease transmission in impoverished nations. The most effective strategy to prevent and control malaria is the use of long-lasting insecticidal nets, or LLINs. Ensuring that LLINs are effectively and equitably distributed to those who need them most is crucial yet challenging, especially since financial and health resources are scarce in endemic countries. Through a real-world case study conducted in the Brazilian Amazon, which accounts for 99% of malaria cases in Brazil, we propose a Malaria Vulnerability Index (MVI). This composite index encompasses epidemiological, socioeconomic, and environmental factors. Using the MVI, we developed a prioritization-based location-allocation model to maximize the benefits of targeting the most vulnerable municipalities for malaria interventions. Our mathematical model relies on discrete coverage levels, which makes the allocation of LLINs more flexible while ensuring community-wide protection. We also explore the theoretical relationship between our proposed model and classical demand covering problems. Finally, we discuss some approaches to delivering more equitable solutions by minimizing the number of underserved areas. Our results include comparisons between various malaria interventions and provide practical insights. In particular, we show that we can drastically reduce the number of underserved areas without compromising the effectiveness of the LLINs allocation through lexicographic optimization. The results also reveal that with investment levels up to 50% of the ideal, we can fully protect the endemic area after 2 years of successive interventions.

Clinical Profile and Outcomes of Late Preterm Neonates in Relation to Gestational Age and Maternal Psychosocial Factors in a Tertiary Care Centre

The relationship between maternal psychosocial factors and outcomes among LPN remains unexplored. Objectives: To determine the morbidity profile of LPN with respect to gestational age and study its association with maternal psychosocial, lifestyle and demographic factors. Methodology: Cross-sectional study on LPNs in a tertiary care centre over one year. Results: Total sample: 263. LPN incidence: 94/1000 live births; Maternal age 20-30 years (p=0.03), high screen time (p=0.02), Caesarean section (p=0.02), moderate Maternal Stress (MS) (p=0.014) was associated with (a/w) births at 35 0/6 to 6/7 weeks of gestation (WOG).Low Birth Weight (LBW) LPN: 66.5% incidence, highest at 35 0/6 to 6/7 WOG; a/w maternal age 20-30 (p=0.002), nulliparity (p=0.02), moderate to severe MS (p=0.012), and Pregnancy Induced Hypertension (PIH) (p=0.04).Small for Gestational Age (SGA): 35%, peaking at 35 0/6 to 6/7 WOG; a/w nulliparity and severe MS. Sepsis 12.2%, highest at 34-35 0/6 to 6/7 WOG (p=0.001); a/w lower-middle socioeconomic status (p=0.05) and multiparity (p=0.02). Respiratory Distress Syndrome (RDS) 5.3%, peaked at 34 0/6 to 6/7 WOG (p=0.044); a/w poor socioeconomic status (p= 0.00). Transient tachypnoea of Newborn (TTN) 49.4%, a/w nulliparity (p=0.02). Neonatal hyperbilirubinemia (NNH) 57.8%, peaking at 34-35 0/6 to 6/7 WOG (p=0.01); a/w nulliparity (p=0.03). Perinatal asphyxia (PA) 6.5%, highest at 35 WOG. Conclusion: NNH and TTN were common in LPN. 35 WOG related to various risk factors and morbidities. LPN born to mothers with moderate MS, PIH, nulliparity, and age 20-30 were LBW. Mother’s screen time > 4 hours/day a/w LPNs born at 35 WOG.

Peripheral neuropathy and associated factors among children living with HIV on antiretroviral therapy in Gamo zone, Southern Ethiopia: an institution-based cross-sectional study

BackgroundPeripheral neuropathy (PN) is a common neurological complication of HIV (Human Immunodeficiency Virus) that can significantly affect patients’ quality of life. In Ethiopia, children living with HIV are at an increased risk of developing peripheral neuropathy due to comorbidities such as anemia, tuberculosis, malnutrition, and poor socio-economic status. Our study aims to evaluate the prevalence of peripheral neuropathy among children living with HIV in Ethiopia using a simple clinical screening tool.MethodsA health institution-based cross-sectional study was conducted among 148 children aged 5 to 18 years living with HIV who are receiving treatment at the antiretroviral therapy (ART) clinic of the randomly selected public health institutions in the Gamo zone. An interview and neurologic examination were conducted. A binary logistic regression model was used to identify factors associated with the outcome variable. Variables with p-value < 0.25 in the bi-variable logistic regression analysis were entered and checked for association in a multivariable logistic regression model. The level of statistical significance was declared at the p-value < 0.05.ResultIn this study, 148 children participated, making a response rate of 97.5%. The mean ± standard deviation (SD) age of the respondents was 15.03 ± 2.99 years, and 81(54.7%) were male. The magnitude of PN was 20.9% (31/148). Children in the age category of 15–18 (adjusted odds ratio (AOR) = 1.88, 95%CI; 1.24–4.60), low BMI for age (AOR = 1.66, 95%CI; 1.12–4.15), last exposure to isoniazid within 1 year (AOR = 2.31, 95%CI; 1.12–8.53). Longer duration of HIV illness (AOR = 2.17, 95%CI; 1.54–4.64), and past tuberculosis (TB) treatment (AOR = 2.11, 95%CI; 1.08–7.48) were significantly associated factors with peripheral neuropathy.ConclusionOur analysis revealed that being in the age category of 15–18 years, low BMI for age, Isoniazid exposure, longer Duration of HIV illness, and past TB treatment were significantly associated with peripheral neuropathy in children living with HIV. These disease-related factors may contribute to the development and progression of peripheral neuropathy in this population.Clinical trial numberNot applicable.

Drug-Related Violence, Substance Abuse, and Mental Health Challenges in a Southeastern American Indian Tribe: A Qualitative Study

ABSTRACT Background Drug-related violence [DRV] and substance abuse impact the mental health of economically challenged minority community members. DRV challenges to mental health promotion are exacerbated in American Indian [AI] communities. Purpose To investigate psycho-social and environmental factors influencing DRV, substance abuse, and mental health challenges within the Lumbee, a southeastern American Indian Tribe. Methods In-depth, one-on-one interviews with 37 Lumbee Tribal Members and Key Leaders were conducted. Results Findings align with existing research, revealing the influence of poor socioeconomic conditions, poor coping strategies, broken family structures, and failed federal policy. The substantial influence of local Christian churches on beliefs, attitudes, and practices of the Lumbee community vis-à-vis DRV and mental health was recognized. Discussion Findings indicated that social-environmental factors, seemingly independent of drug use/violence prevention and treatment, play important roles in the Lumbee community’s ability to recover from mental health consequences of DRV. Identifying barriers to, and facilitators of, prevention and treatment are critical to improving the welfare of tribal communities. Translation to Health Education Practice Major competencies associated with this research apply to Areas I & II, Assessment of Needs/Capacity and Planning. Identification of DRV and mental health education, prevention and treatment barriers are critical to quality-of-life improvement in tribal communities.

Impact of Geopolitical Unrest on Surgical Delays and Outcomes in Immigrant Populations With Cleft Lip and Palate

Background: Geopolitical conflicts in the Middle East have led to mass migrations, with Turkey becoming a major host country. This influx has strained the health care system, particularly regarding specialized care for conditions like cleft lip and palate (CLP). Timely intervention is crucial for optimal outcomes, but cultural, socioeconomic, and logistical barriers often cause delays, impacting physical, functional, and psychosocial development. Methods: This retrospective study analyzed 72 immigrant pediatric CLP patients treated in Turkey between 2012 and 2022. Data on demographics, medical history, surgical interventions, complications, and treatment delays were collected. Surgical timing was compared with American Cleft Palate Craniofacial Association guidelines, and the impact of socioeconomic status on delays was assessed. Results: Seventy-two patients underwent a total of 91 surgical interventions, including 29 cleft lip repairs, 22 cleft palate repairs, 6 pharyngeal flaps, 15 fistula closures, 8 corrections of secondary lip scars and whistling deformities, and 11 alveolar bone graftings. A majority (73.6%) had poor socioeconomic status. The average delays for cleft lip, cleft palate, and alveolar bone grafting surgeries were 5.3±4, 7.3±6.1, and 34.1±23.5 months, respectively, and were significantly longer for patients with poor socioeconomic status (P=0.00502, 0.030741, and 0.041878). The average delay for pharyngeal flap surgery, performed in patients with poor socioeconomic status (except for one), was 43.7±14.1 months. Conclusions: This study highlights the challenges and disparities in CLP care for immigrant children in Turkey due to geopolitical conflict. While surgical complication rates are similar to established data, delays in treatment, especially among those with lower socioeconomic status, are a significant concern. The findings emphasize the need for comprehensive, culturally sensitive care and systemic interventions to improve access and outcomes for this vulnerable population.

Socio-economic risk factors for intestinal helminthiases in selected endemic communities in Mindanao, the Philippines: a cross-sectional study

Abstract Background Parasitic neglected tropical diseases (NTDs) or ‘infectious diseases of poverty’ continue to affect the poorest communities in the world, including in the Philippines. Socio-economic conditions contribute to persisting endemicity of these infectious diseases. As such, examining these underlying factors may help identify gaps in implementation of control programs. This study aimed to determine the prevalence of schistosomiasis and soil-transmitted helminthiasis (STH) and investigate the role of socio-economic and risk factors in the persistence of these diseases in endemic communities in the Philippines. Methods This cross-sectional study involving a total of 1,152 individuals from 386 randomly-selected households was conducted in eight municipalities in Mindanao, the Philippines. Participants were asked to submit fecal samples which were processed using the Kato-Katz technique to check for intestinal helminthiases. Moreover, each household head participated in a questionnaire survey investigating household conditions and knowledge, attitude, and practices related to intestinal helminthiases. Associations between questionnaire responses and intestinal helminth infection were assessed. Results Results demonstrated an overall schistosomiasis prevalence of 5.7% and soil-transmitted helminthiasis prevalence of 18.8% in the study population. Further, the household questionnaire revealed high awareness of intestinal helminthiases, but lower understanding of routes of transmission. Potentially risky behaviors such as walking outside barefoot and bathing in rivers were common. There was a strong association between municipality and prevalence of helminth infection. Educational attainment and higher “practice” scores (relating to practices which are effective in controlling intestinal helminths) were inversely associated with soil-transmitted helminth infection. Conclusion Results of the study showed remaining high endemicity of intestinal helminthiases in the area despite ongoing control programs. Poor socio-economic conditions and low awareness about how intestinal helminthiases are transmitted may be among the factors hindering success of intestinal helminth control programs in the provinces of Agusan del Sur and Surigao del Norte. Addressing these sustainability gaps could contribute to the success of alleviating the burden of intestinal helminthiases in endemic areas.

Understanding the Relationship between Environmental Factors and Mental Health Status among Type 2 Diabetes Mellitus Patients: A Scoping Review.

Type 2 diabetes mellitus (T2DM) is associated with a wide range of health outcomes, including an increased risk of depression and anxiety and a decline in quality of life. Even though the significance of biopsychological factors in the mental health status of T2DM patients has been discussed in other studies, the role of environmental factors has been lacking. Therefore, this review aimed to identify the relationship between environmental factors and mental health status among T2DM patients. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews was utilized in this study. Using predetermined keywords, a systematic search was conducted on three electronic databases from 2005 to 2023, namely, Web of Science, Scopus, and PubMed. Articles written in English, and studies focusing on the research question are among the inclusion criteria. Ten articles were extracted that were relevant to the research question. Poor socioeconomic status, urban areas, the influence of neighborhood, greenness, and air pollution had associations with mental health status among T2DM patients. The possible implications of these factors for mental health demand further research and policy consideration.

Improving access to utilize the healthcare services facilitated by ASHAs, ANMs and medical officers of PHC among scheduled tribe pregnant women: An interventional study.

Early marriages, early childbirth, low BMI and high incidence of anaemia are known factors for high maternal mortality among tribal pregnant women. This was a mixed method study (qualitative and quantitative) undertaken to evaluate educational intervention package among tribal pregnant women in Chittoor District of Andhra Pradesh State in South India. A baseline household survey with the help of a semi-structured questionnaire was conducted in both intervention group (n = 109) and control group (n = 119) of ST habitations. An educational intervention was implemented through health education approach to bring about awareness and behavioural change among pregnant women regarding healthcare practices and utilization of health services. Qualitative data collection tool included semi-structured FGD. Quantitative data was analysed using SPSS version 26.0. Content analysis was done for qualitative data. The findings of this study show that awareness and utilization with respect to various services facilitated by ASHAs, ANMs and medical officers are improved postintervention among tribal pregnant women, and the various reasons for non-utilization of services were lack of awareness, long distance of health facility, no transportation, poor socio-economic status, inadequate facilities at PHC, etc. This study shows that intervention to improve awareness and health services utilization, and continuous health education should be imparted to all the pregnant mothers. For this healthcare providers like ASHA and ANM and medical officers should be trained and motivated to educate the community.

Determinants of trajectories of informal caregiving in later life: evidence from England

Although the long-term consequences of informal care provision have been well investigated, few studies have examined the trajectories of informal care provision among older people and the socioeconomic, demographic, health, and family characteristics associated with them. We use data from four waves of the English Longitudinal Study of Ageing, with 6561 respondents followed for 6 years (2012/3–2018/9). We used group-based trajectory modelling to group people's provision of care over time into a finite number of distinct trajectories of caregiving. Using multinomial logistic regressions, we then investigated the characteristics associated with these trajectories. Four distinct trajectories of caregiving were identified: “stable intensive”, “increasing intensive”, “decreasing”, and “stable no care”. Results suggest that although there are socioeconomic, demographic, and health differences across the trajectories of caregiving (with younger women in good health and poorer socioeconomic status more likely to care intensively throughout), family characteristics are their main drivers. Respondents who live alone, with no children, and no parents alive are more likely to never provide care, whereas those with older parents and who live with adults in poor health are more likely to provide stable intensive care. Also, changes in family characteristics (e.g. death of parents, widowhood, or deterioration of the partner’s health) are associated with trajectories representing increases or decreases in caregiving over time. Overall, trajectories of informal caregiving undertaken by older people are varied and these patterns are mostly associated with both the availability and health of family members, suggesting that need factors represent the most immediate reason for caregiving commitments.

Determinants of Contraception Among Women Undergoing Cancer Treatment: A Cross-Sectional Study from Zahedan, Iran

Objectives: This study investigates the prevalence of contraceptive use among women receiving cancer treatment in Zahedan, southeast Iran. We evaluated the role of various demographic and socio-cultural factors, fertility intentions, and care providers in contraceptive use. Methods: This cross-sectional study was conducted on 133 women of reproductive age receiving cancer treatment (chemotherapy or radiotherapy) in Zahedan. Patients referred to three medical centers in Zahedan from November 2019 to May 2020 were selected via the convenience sampling method and interviewed using a questionnaire. The data were analyzed in SPSS (version 18) using multinomial logistic regression. Results: It was found that 34.6% (N = 46) of women undergoing cancer treatment were at risk of unintended pregnancy, with 23.3% (N = 31) using the withdrawal method and 11.3% (N = 15) not using any form of contraception. Additionally, 37.0% (N = 49) of women reported inadequate knowledge about emergency contraception methods. Furthermore, 46.6% (N = 62) of women stated that the physician responsible for their cancer treatment had never discussed contraceptives with them. The highest prevalence of traditional contraceptive methods and non-use of contraception was observed among illiterate women, women with primary education, women living in polygamous families, women desiring more than four children, women who did not agree with their husbands on the contraceptive method, women who did not receive any physician consultation, and women living far from health centers. The multinomial logistic regression analysis revealed that the main predictors of contraception use were physician consultation about contraception (OR = 13.64, 95% CI: 2.13-87.32, P = .006) and couple agreement on the contraception method (OR = 9.91, 95% CI: 1.69-58.15, P = .011). Conclusions: Considering that, based on new population policies in Iran, access to free family planning (FP) services has ended and access to contraceptives is limited, women of reproductive age with illnesses—especially those with poor socioeconomic status, those living in polygamous families, and those in less developed regions—should be considered as a vulnerable group by the healthcare system. Furthermore, men should be included in consultation sessions with care providers to improve their participation in FP.

Multidisciplinary team meetings improve survival in patients with esophageal cancer.

Multidisciplinary team meetings (MDTs) are recommended for patients with esophageal cancer. Improved staging, timeliness to surgery and better adherence to guidelines have been attributed to MDTs, but there are few studies published on the MDTs' effect on survival. All patients with esophageal cancer in Sweden between 2006 and 2018 were grouped according to whether they had been discussed at an MDT as part of their clinical pathway. Factors affecting group allocation were explored with multivariable logistic regression, and the impact of MDT on survival was studied with Cox-regression and the Kaplan-Meier estimator. Of 6837 included patients, 1338 patients (20%) were not discussed at an MDT. Advanced age (80-90years; odds ratio [OR] 0.25, 0.16-0.42 (95% confidence interval)) and clinical stage IVb (OR 0.65, 0.43-0.98) decreased the probability of being presented at an MDT, whereas high education level (OR 1.31, 1.02-1.67), being married (OR 1.20, 1.01-1.43), squamous histology (OR 1.50, 1.22-1.84) and later year of diagnosis (OR 1.33, 1.29-1.37 per year) increased the probability of an MDT. In multivariable adjusted analysis, MDT discussion was associated with improved survival (hazard ratios 0.72, 0.66-0.78) and median survival increased from 4.5 to 10.7months. MDTs were associated with improved survival for esophageal cancer patients. Elderly patients with advanced disease and poor socioeconomic status were less likely to be presented at an MDT, but had clear survival-benefits if they were discussed in a multidisciplinary setting.