Poor Research Articles

Lost in translation: key lessons from conducting dissemination and implementation science in Zambia

BackgroundAs the field of implementation science continues to grow, its key concepts are being transferred into new contexts globally, such as Low and Middle Income Countries (LMICs), and its use is constantly being reexamined and expanded. Theoretical and methodological positions commonly used in implementation research and practice have great utility in our work but in many cases are at odds with LMIC contexts. As a team of implementation scientists based in Zambia, we offer this commentary as a critical self-reflection on what has worked and what could limit us from fully utilizing the field’s promise for addressing health problems with contextual understanding.Main bodyWe used a ‘premortem,’ an approach used to generate potential alternatives from failed assumptions about a particular phenomenon, as a way to reflect on our experiences conducting implementation research and practice. By utilizing prospectively imagined hindsights, we were able to reflect on the past, present and possible future of the field in Zambia. Six key challenges identified were: (i) epistemic injustices; (ii) simplified conceptualizations of evidence-informed interventions; (iii) limited theorization of the complexity of low-resource contexts and it impacts on implementation; (iv) persistent lags in transforming research into practice; (v) limited focus on strategic dissemination of implementation science knowledge and (vi) existing training and capacity building initiatives’ failure to engage a broad range of actors including practitioners through diverse learning models.ConclusionImplementation science offers great promise in addressing many health problems in Zambia. Through this commentary, we hope to spur discussions on how implementation scientists can reimagine the future of the field by contemplating on lessons from our experiences in LMIC settings.

Longitudinal Association of Changes in Metabolic Syndrome with Cognitive Function: 12-Year Follow-up of the Guangzhou Biobank Cohort Study.

The association of changes in metabolic syndrome (MetS) with cognitive function remains unclear. We explored this association using prospective and Mendelian randomization (MR) studies. MetS components including high-density lipoprotein cholesterol (HDL-C), systolic blood pressure (SBP), waist circumference (WC), fasting plasma glucose (FPG), and triglycerides were measured at baseline and two follow-ups, constructing a MetS index. Immediate, delayed memory recall, and cognitive function along with its dimensions were assessed by immediate 10- word recall test (IWRT) and delayed 10-word recall test (DWRT), and mini-mental state examination (MMSE), respectively, at baseline and follow-ups. Linear mixed-effect model was used. Additionally, the genome-wide association study (GWAS) of MetS was conducted and one-sample MR was performed to assess the causality between MetS and cognitive function. Elevated MetS index was associated with decreasing annual change rates (decrease) in DWRT and MMSE scores, and with decreases in attention, calculation and recall dimensions. HDL-C was positively associated with an increase in DWRT scores, while SBP and FPG were negatively associated. HDL-C showed a positive association, whereas WC was negatively associated with increases in MMSE scores, including attention, calculation and recall dimensions. Interaction analysis indicated that the association of MetS index on cognitive decline was predominantly observed in low family income group. The GWAS of MetS identified some genetic variants. MR results showed a non-significant causality between MetS and decrease in DWRT, IWRT, nor MMSE scores. Our study indicated a significant association of MetS and its components with declines in memory and cognitive function, especially in delayed memory recall.

A Systematic Review of Digital Competence Evaluation in Higher Education

University students’ digital skills depend significantly on educators’ proficiency, necessitating regular assessments. Tools like DigComp and the TPACK model are provided in this technological context. A systematic review, following PRISMA criteria, aims to evaluate digital competencies through globally used tools. DigCompEdu is prominent, with Spain leading the research, while unvalidated instruments from Asia highlight global disparities. This review will identify key tools and expose geographical and validation gaps, stressing the need for standardized assessments. Understanding the predominance of DigCompEdu and seeing the variation that is generated in Asia highlights the poor ability to transmit self-perceived competencies to learners.

Low income, being without employment, and living alone: How they are associated with cognitive functioning - Results from the German National Cohort (NAKO)

Abstract Background While people with low socioeconomic status tend to have worse cognitive functioning, little is known about the impact of specific socioeconomic conditions. Aim of the present analysis was to investigate to what extent cognitive functioning differs by three socioeconomic conditions: low income, being without employment, and living alone. Methods A total of N = 158,144 participants (age 19-75 years) of the population-based German National Cohort (NAKO) provided data on socioeconomic conditions and completed cognitive testing. Multivariable regression model including the three socioeconomic conditions, age, sex, education, occupational status, having diabetes, hypertension, myocardial infarction, stroke, and depressive symptoms was used for analysis. Results Results from fully adjusted analysis indicated that cognitive functioning (z-score) was lower among those with low income (b=-0.53, CI95%=-0.57; -0.49) compared to not having low income, living alone (b=-0.10, CI95%=-0.14; -0.07) compared to not living alone, and being without employment (b=-0.22, CI95%=-0.27; -0.17) compared to being employed. The difference in cognitive functioning between those exposed compared to not exposed to the condition was changing slightly with older age among those with low income (interaction with age b=-2.39, CI95%=-3.24; -1.55) and, to a smaller extent, among those living alone (interaction with age b=-0.76, CI95%=-1.34; -0.19). Conclusions Low income, being without employment, and living alone were independently associated with poorer cognitive functioning after adjusting for confounders. As those with low income had the poorest cognitive functioning in old age, it is important to explore pathways of how cognitive health in this population group can be improved.

The long-term impact of parenthood on women and men’s income in 26 European countries

Abstract Background Historically, women’s roles were predominantly associated with motherhood, leading to significant career interruptions and lower incomes compared to men. As gender roles have evolved, as did labor policies protecting parents, it would be expected that income penalties in women and income premiums in men would attenuate, especially in the long term. This study aims to assess the association between the number of children and the income earned by women and men in older adulthood. Methods We used data from wave 8 of the Survey of Health, Ageing, and Retirement in Europe (SHARE), which includes 43,772 participants with 50 years old or over and their partners, living in 26 European countries. Multilevel analysis was employed to estimate the association between having children and the total, employment-related, and pensions-related incomes, adjusting for sociodemographic characteristics and clustering by country. Results The highest median annual total income was identified for individuals living in Bismarkian (€19,000) and Scandinavian countries (€17,708), more than twice the income earned in the European remaining countries. Having had children was associated with lower total income (OR = 0.870 for 1-2 children, OR = 0.773 for 3-5 children, OR = 0.666 for more than 5 children; p < 0.005), and women received lower total incomes (OR = 0.694; p < 0.001). These patterns were also found for employment- and pensions-related incomes. Conclusions There is a long-term negative effect of having had children, and of the number of children, on income, both employment and pension-related, but women continue to receive about 30% lower incomes than men. The adoption of comprehensive policies stimulating a more equal gender distribution of childrearing responsibilities, while protecting parenthood, along with recognizing caregiving responsibilities in pension calculations, could mitigate these disparities and promote gender equity and better living conditions at the older ages.

Impacts of an interpretation fee on immigrants’ access to healthcare: A Danish survey study

Abstract Background In 2018, a fee for healthcare interpretation was introduced for immigrants living in Denmark for more than 3 years to incentivize learning Danish faster. The fee entails out-of-pocket costs ranging from 26-225 EUR per consultation, outpatient visit, or hospital admission. Little evidence is available on how immigrants experience impacts of the fee on their access to healthcare. The study aims to address this gap. Methods Using survey data collected among newly arrived immigrants (n = 486) at 26 cluster-randomly selected language schools in 2021, we analysed prevalence and socio-demographic background of immigrants reporting interpretation needs, and self-reports about whether the fee had caused immigrants to refrain from seeking healthcare, using ad hoc interpreters, and trying to learn Danish faster. Results In the study population, 19% (95% C.I. 14-26%, n = 95) reported interpretation needs. Refugees and their families (OR: 10.2, 95% C.I. 5.3-19.7) more often reported interpretation need compared with EU/EEA immigrants, as did immigrants with low education (OR: 1.9, C.I. 1.2-2.8), low income (OR: 2.6, C.I. 1.6-4.5) or poor self-perceived health (OR: 3.2, C.I. 1.1-9.2), adjusted for gender, age, region of residence, and length of stay. Among immigrants needing interpretation, 42% (C.I. 32-53%, n = 69) reported having refrained from seeking healthcare due to the fee, 73% (C.I. 55-86%, n = 119) using ad hoc interpreters, and 77% (C.I. 59-89%, n = 126) trying to learn Danish faster. Conclusions Findings suggest that the policy aim of incentivizing resettlement country language acquisition is partly met, but that the fee has unintended consequences in terms of hampered access to healthcare and increased use of ad hoc interpreters, raising concerns about unmet health needs and poorer quality of care, especially for vulnerable immigrants. Potential benefits of the policy should be carefully evaluated against severe negative impacts on immigrants’ access to healthcare. Key messages • Healthcare interpretation fees appear to be incentivizing acquisition of the resettlement language, but at the same time severely hamper access to care. • The fee appears to disproportionately affect vulnerable immigrants, including refugees and their families and immigrants with low education, low income, and poor health.

Accuracy of body weight perception: The Case of Türkiye

Abstract Background Accuracy of body weight perception is defined as the extent to which an individual’s self-assessment of their body weight aligns with their actual body weight. Our study evaluates the accuracy of body weight perception, an important factor in preventing and managing obesity and overweight, according to sociodemographic factors. Methods This study utilizes data from the nationwide cross-sectional ‘Nutrition and Health Survey 2017’. The survey includes 12,266 participants who were interviewed face-to-face. Factors influencing the accuracy of body weight perception were evaluated using the chi-square test. Subsequently, the logistic regression models were constructed to assess factors that were statistically significant (p < 0.05). Results The prevalence of obesity and overweight was found to be 36.3% and 71.5%, respectively. The accuracy of body weight perception was 39.2%, underestimation was 57.0%, and overestimation was 3.8%. There was no significant difference in accuracy of body weight perception between sexes (p = 0.94). According to logistic regression analysis (n = 12.168), accuracy of body weight perception was higher among individuals who were not overweight compared to those who were overweight (p < 0.001, OR: 4.56, CI: 4.16-4.98), among those aged 15-44 compared to those aged 45 and over (p < 0.001, OR: 1.47, CI: 1.35-1.60), among those with high school and higher education compared to those with middle school education or less (p < 0.001, OR: 1.43, CI: 1.31-1.56), among unmarried individuals compared to married ones (p = 0.011, OR: 1.12, CI: 1.03-1.23), and in individuals with poor income status compared to good (p = 0.005, OR: 1.13, CI: 1.04-1.22). Conclusions In health promotion programs aiming to perceive body weight accurately, priority should be given to people with overweight, those with low education levels, married individuals, people aged 45 and over, and individuals with low income. Key messages • Accuracy of body weight perception is important in fighting obesity. • Individuals with overweight, have a low level of education, are married, aged 45 and over, and have low income are misperceive their body weight to a greater extent.

Prevalence and social determinants of anxiety and depression among adults in Ghana systematic review

Abstract Background Anxiety and depression are major public health concerns, yet their prevalence and social determinants contributing to mental health disparities remain underexplored. This review, to our knowledge, is the first of its kind, aiming to examine the prevalence of anxiety and depression symptoms and disorders among adults in Ghana, along with social determinants associated with their occurrence. Methods A search of nine electronic databases and seven grey literature sources was conducted up to September 25, 2023. Two reviewers independently screened and appraised the studies. Forty-six studies were included. Prevalence estimates were pooled using a random-effects model. Subgroup analysis and meta-regression explored potential moderators. A narrative synthesis explored social determinants associated with anxiety and depression. Results Preliminary results showed a high prevalence of anxiety (43.7%, 95% CI: 35.6-54.4%) and depression (37.8%, 95% CI; 32.5% to 46%), with regional variations. There were significant differences in the prevalence of anxiety and depression across chronic physical conditions and method of condition assessment. Meta-regression showed significant association between average age and anxiety prevalence. Social determinants associated with anxiety included being female, non-Christian, low income, self-employed, limited social support, and basic education, while that for depression included being young (< 25yr), low income, government employed, childhood physical and sexual abuse, gender-based violence and urban residence. Protective factors for both were male gender, strong social support and higher education. Conclusions Preliminary results indicate a high prevalence of anxiety and depression linked to social determinants. While methodological limitations exist (eg, study heterogeneity), findings highlight a need for evidence-based interventions targeting social determinants to reduce the burden of anxiety and depression among adults in Ghana. Key messages • Our review suggests addressing the social determinants of mental health, aligned with sustainable developmental goals, may reduce the burden of anxiety and depression. • While Ghana is working towards improving mental health via its revised 12year Mental Health Policy launched in 2021, this review can facilitate planning and resource allocation for mental healthcare.

POBREZA ESTRUTURAL-URBANA NO SÉCULO XXI

This article presents a theoretical reflection on interpretations of poverty, principally contemporary urban poverty, inspired by the works of Milton Santos. It is based on Geographical critical theory and other potential dialogues that contextualize and analyze poverty, understood here as the result of structural violence in territorial formation and Brazilian metropolises. It is concluded that poverty is structural-urban and can inform a qualitative debate (not only quantitative) on the lack of human dignity seeking to recognize the legitimacy of existence in places. Keywords: Violence, Urban Poverty, Metropolises, Socio-spatial Formation.

The negative health assessment and the different consumption of dietary supplements

Abstract Background There is an insufficient level of research carried on the consumption of dietary supplements among diverse social and demographic groups, especially among those with a negative assessment of personal health. Therefore, the aim of this study was to assess the consumption of dietary supplements among working-age residents of Lithuania in the period from 2021 to 2023 with respect to social and demographic factors and the assessment of personal health. Materials and methods The data for this study were collected after conducting three independent cross-sectional surveys in 2021, in 2022, and in 2023. Each of the samples included 1600 working-age adult residents of Lithuania. Distribution of the respondents by the assessment of personal health and gender, age, marital status, education level, place of residence, employment, income, and COVID-19 cases among the respondents and members of their families was assessed. Results The consumption of dietary supplements differed each year and accounted for 78.1%, 71.6%, and 72.7% of the respondents, respectively (p < 0.05). In 2022, the prevalence of the consumption of dietary supplements was lower in the majority of social and demographic groups (p < 0.05). In 2023, it was higher among females, younger residents, and those from larger families, who suffered from COVID-19 (p < 0.05). Despite similar changes found in the consumption of dietary supplements among those who negatively assessed their health, this group showed more prevalent consumption of dietary supplements among residents with non-university education, unemployed respondents, and those with lower income (p < 0.05). Conclusions Despite a significantly lower prevalence in the consumption of dietary supplements in 2022, it was higher again in 2023. A negative assessment of personal health is associated with opposite tendencies in the prevalence of the consumption of dietary supplements in the general population. Key messages • Despite a significantly lower prevalence in the consumption of dietary supplements in 2022, it was higher again in 2023. • The negative assessment of personal health should be taken into account when planning nutritional interventions due to its association with different consumption of dietary supplements.

Correlation between vaccine hesitancy, vaccine reliability and perceptions of infectious diseases

Abstract Background Vaccine hesitancy is a delay in vaccine acceptance or refusal despite the availability of vaccination services. In recent years, the rise in vaccine hesitancy has attracted attention. This study aimed to evaluate the perception of vaccine hesitancy, vaccine safety, and infectious diseases among parents. Methods This cross-sectional study was conducted with 503 parents who applied to the pediatrics outpatient clinic of a university hospital. The questionnaire used in the study included questions on sociodemographic characteristics, factors related to vaccine hesitancy, The Vaccine Hesitancy Scale (VAS), the Vaccine Safety Scale (VSS), and the Perception Scale for Infectious Diseases (PPSID). Multivariate Linear Regression Analysis was used to find the variables associated with vaccine hesitancy. Results The mean age of the parents was 37.6±7.6 years. Parents’ scores on the ATS ranged from 17-85, with a mean score of 20.1±6.6 points. A moderate negative correlation was found between parents’ VAS and VSS scores, and between VAS and PPSID scores (r=-0.412, p < 0.001; r=-0.409, p < 0.001, respectively). According to the multivariate linear regression analysis the variables found to be associated with vaccine hesitancy, income status, maternal education level, child’s age group, having information about childhood vaccination schedule, child’s immunization status, the necessity of childhood vaccines, having sufficient information about the safety of vaccines, vaccine safety level, and infectious disease perception level were found to be significant predictors of vaccine hesitancy (F: 12,844, p ≤ 0.001, R2: 0.334). Conclusions This study determined that vaccine hesitancy was higher in families with lower income, who have not completed the schedule nor been vaccinated, doubt the necessity of vaccines to prevent infectious diseases, lack of knowledge about the reliability of vaccines, and whose children are still in primary school. Key messages • Health professionals have a critical role in reducing vaccine hesitancy. • It would be appropriate to plan face-to-face or online programs with parents.

A scoping review on sociodemographic inequalities in breast cancer screening attendance in Germany

Abstract Background Organized breast cancer screening (BCS) programs are effective measures among women aged 50-69 for preventing the fifth cause of death in Germany. However, still participation rates have not yet reached EU standards. It is unclear which and how sociodemographic factors are related to BCS attendance. This scoping review aims to identify sociodemographic inequalities in BCS attendance among 50-69-year-old women following implementing the Organized Screening Program in Germany. Methods Following PRISMA guidelines, we searched the Web of Science, Scopus, MEDLINE, PsycINFO, and CINAHL. We included primary studies with a quantitative study design and reviews examining BCS attendance among women aged 50-69 with data from 2005 onwards in Germany. Harvest plots depicting effect size direction for the different identified sociodemographic inequalities were developed. Results We screened 476 titles and abstracts and 33 full texts. In total, 27 records were analysed, 14 were national reports, and 13 peer-reviewed articles. Eight sociodemographic variables were identified and summarised in the harvest plots: age, education, income, migration status, type of district, employment status, partnership cohabitation and health insurance. Older women, women with lower incomes and migration backgrounds who live in rural areas and lack private insurance, respond more favourably to BCS invitations. However, from a lifetime perspective, these associations only hold for migration background, are reversed for income and urban residency, and are complemented by partner cohabitation. Finally, women living in the federal states of Lower Saxony, Saxony, Mecklenburg-Western Pomerania, Saxony-Anhalt, and Thuringia showed higher attendance rates in the last two years. Conclusions High-quality research is needed to identify women at higher risk of not attending BCS in Germany, particularly as the overall attendance rate still falls below European standards. Key messages • High-quality research is needed to identify women at higher risk of not attending BCS in Germany, particularly as the overall attendance rate still falls below European standards. • Women without migration background, high income, living in rural areas, and not cohabitating with their partners are at higher risk of never attending BCS in Germany.

Population trends and demographic disparities in sexual identity in Stockholm County, 2010 to 2021

Abstract Background Sexual identity, linked to experiences of disadvantage and discrimination, is crucial in equality monitoring. Sweden’s gender-neutral marriage laws, introduced in 2009, provide a unique context. This study examines the population trends and demographic disparities in sexual identity over time. Methods We analyzed three population surveys (2010, 2014, 2021) from the Stockholm Public Health Cohort, including around 50,000 individuals per survey. Sexual identity was assessed via self-administered questionnaires. Demographic data were sourced from Swedish national registers. Weighted multivariate Poisson regression with robust variance estimators was used to identify demographic disparities in sexual identity. Results were presented as proportion ratio (PR) with 95% confidence interval (CI). Results Overall, 29,607 (2010), 20,249 (2014), and 22,558 (2021) individuals reported sexual identity. Heterosexual identity decreased from 95.7% (95% CI 95.4-96.0%) in 2010 to 89.0% (88.5-89.4%) in 2021, while bisexual identity increased from 1.4% (1.2-1.6%) in 2010 to 2.0% (1.8-2.3%) in 2014, and further up to 2.7% (2.4-2.9%) in 2021. Homosexual identity increased slightly from 1.5% (1.4-1.7%) in 2010 to 1.8% (1.6-2.0%) in 2021. Multivariate analyses showed that female, older age, and lower education were inversely associated, while never-married status and living alone were positively associated, with homosexual identity. In contrast, female, younger age, lower income (100 SEK/year) ( < =2,500 vs > 4,500: 2010: PR 3.32 [95% CI 1.92-5.75]; 2014: 1.83 [1.28-2.60]; 2021: 1.51 [1.14-2.01]), and never-married status (never vs currently married: 2010: 2.03 [1.47-2.80]; 2014: 1.92 [1.39-2.65]; 2021: 1.50 [1.15-1.95]) were positively associated with bisexual identity. Conclusions Heterosexual identity decreased while homosexual/bisexual identities increased in Stockholm County during 2010-2021. Socioeconomic disparities persist in sexual minorities and vary by sexual identity. Key messages • Marked socioeconomic disparities persist in sexual minorities and vary by sexual identity in Stockholm County, although income and marital status disparities in bisexual group seem narrowing. • Future studies are warranted to investigate the social dynamics that continue to produce sexual minority disadvantages.

Everyday household costs of raising a child with cerebral palsy

Abstract Background Caring for a child with a disability can be costly in terms of time and energy, and it is also associated with lower incomes and higher direct costs, such as costs for assistive technologies, transport, food, clothing and leisure activities. However, few studies that have focused on households’ everyday costs associated with raising a child with disability. This study is based on the capability approach. The economic costs of a child with cerebral palsy are defined as the economic costs associated with achieving the same capabilities, or functionings, as a child without cerebral palsy. The purpose of this study is to explore the needs and economic costs in households raising a child with cerebral palsy. The results are important to inform, plan and justify targeted policies and interventions. Methods Digital in-depth interviews with caregivers from 15 Norwegian households raising children with cerebral palsy (aged 4-17 years, GMFCS levels 1-5). 12 women, 2 men and a couple were interviewed two times (1-2 hours each). Results The caregivers who took part in the interviews described their demanding role and that they spend a lot of time organizing daily routines, activities, health services, assistive technologies and assistants. Many of them initially reported that they do not have many daily extra costs, but when discussing the different areas of consumption, it emerged that households have extra housing costs because they need to make adaptations, remodeling and maintenance to their homes. An adapted car, which requires service, insurance and fuel, is often used for transport. The washing machine runs regularly and towels, sheets and clothes need to be frequently changed. Sometimes they also end up buying food, clothes or toys that are not used. Conclusions Households caring for children with cerebral palsy have additional costs for several types of expenses, including especially high costs for housing and transportation. Key messages • Households raising a child with cerebral palsy have needs that generate additional costs. • The costs vary and it is important to cover a broad range of cost areas.

Food insecurity is associated with poor mental health and health risk behaviors in Czechia

Abstract Background Food insecurity (FI) is one of social determinants of health and a profound public health concern because it leads to malnutrition and hence poor health. COVID-19 impacted people disproportionately and exacerbated preexisting social and health inequalities. The aim of this study was to understand how socioeconomic and health conditions affected one’s FI in Czechia during the pandemic using a representative panel of Czech adults from a longitudinal survey, Life During the Pandemic collected in October 2022 as part of a Czech longitudinal survey. Methods A study sample of 1,499 respondents was included in our multiple logistic regression models. Depressive symptoms and anxiety symptoms were assessed using validated questionnaires PHQ-2 and DAG-2. Results Approximately one third of the study sample (32.4%) reported being food insecure. In the fully-adjusted model, adults with depressive symptoms (OR 2.37, CI 1.49, 5.02), problems with sleeping (OR 2.20, CI 1.64, 2.96), smoking habit (OR 2.27, CI 1.68, 3.07), lower fruit and vegetable consumption (OR 1.50, CI 1.04, 2.17) had greater odds of experiencing FI. The lowest income group was associated with 6.2 times greater odds of reporting FI as compared to the high-income group (CI 3.96, 9.67). Lower education attainment also had higher odds of experiencing FI (OR 2.15, CI 1.40, 3.31). Anxiety was not a significant predictor for FI. Conclusions Our study highlights that food insecurity is associated with depressive symptoms, poor quality of sleep and lower consumption of fruit and vegetables among adults. Food insecurity was also evident among lower income and lower education attainment. Funding source This study was supported by The Charles University Grant Agency (GA UK). Key messages • Our study suggests that adults with poor mental health and diet quality experience food insecurity. • Given the established link between a balanced diet and mental well-being, interventions should encompass not only food security but also the quality of dietary intake.

Trends in overall and abdominal obesity among Korean adults, 2007-2022: an Age-period-cohort analysis

Abstract Overall and abdominal obesity, often defined as having high body mass index (BMI) and waist circumference (WC), are associated with an increased risk of chronic disease. A comprehensive understanding of trends and contributing factors is necessary to reduce the disease burdens. This study investigated the nationwide trends and independent effects of age, period, and birth cohort on BMI and WC in Korean adults. We conducted hierarchical age-period-cohort (cross-classified random-effects models) analyses using measured BMI and WC data from 85,292 Korean adults (aged ≥19) in the Korea National Health and Nutrition Examination Survey 2007-2022. We also examined whether the age, period, and cohort effects varied by socioeconomic subgroups. In 2007-2022, the age-standardized mean BMI (23.6 to 24.2 kg/m2) and WC (81.7 to 83.5 cm) increased in the overall population. An upward trend was evident among men, while only a slight change was observed in women. The mean BMI was highest at age 47 (25.1 kg/m2) in men and age 60 (24.2 kg/m2) in women and it decreased at older ages. Controlling for age and period effects, mean BMI was lowest among the birth cohorts of 1960-1964 (24.15 kg/m2), with the highest mean BMI observed among the birth cohorts of 1919-1939 (24.97 kg/m2) and 1990-2003 (24.99 kg/m2). The mean WC was highest at age 55 (88.0 cm) in men and age 79 (83.4 cm) in women. Similar U-shaped birth cohort effect was observed with WC, with the lowest mean observed among the birth cohorts of 1960-1964 [82.92 (0.30)]. At most age, period, and birth cohorts, mean BMI and WC were consistently higher among adults at lower income and education. The overall period effect was consistently found in all socioeconomic subgroups, but the gap in BMI between income and education subgroups widened over time. Our findings suggest that BMI and WC slightly increased in overall Korean adults in 2007-2022, with some inequalities among age, sex, birth cohort, and socioeconomic subgroups. Key messages • The obesity indices increased from 2007 to 2022, but the cohort effect on BMI and WC showed a U-shaped pattern with the lowest mean among birth cohorts of 1960-1964. • The obesity prevalence is varied by socioeconomic status, suggesting that more intense interventions may be needed to target the susceptible groups.

Social health gradient and risk factors among patients hospitalized for COVID-19 and pre-pandemic respiratory infections. A linked national individual case-control study in Belgium

IntroductionThe literature establishes a clear social gradient in health for transmissible respiratory diseases. However, this gradient’s extent remains largely unexplored in the context of COVID-19, and it is uncertain whether the pandemic has exacerbated this gradient. The study aims to compare the socio-economic profiles and comorbidities during the COVID-19 pandemic with a control population affected by viral pneumonia/respiratory disease in 2019.MethodsThis case-control study analyzed linked data from all patients hospitalized for COVID-19 in 2020 (n = 22,087) and for respiratory diseases in 2019 (n = 7,586). Socio-economic data from the social security database were linked to clinical data from the hospital registry. We analyzed the socio-demographic and clinical factors associated with COVID-19 hospitalization (control group, wave 1, and wave 2) using multinomial regressions and logistic regression models and the length of stay during hospitalization using binomial negative regressions.ResultsA social health gradient was observed in both the COVID-19 and control groups, with a significant increase across waves for COVID-19 (p-trend < 0.0001). Men, people over the age of 45, those with comorbidities, high population density, lower income, lower socio-economic status, and people living in Brussels capital were at higher risk of COVID-19 hospitalization and longer length of stay compared to the control group. Except for sub-Saharan Africans, all patients of foreign nationality had a significantly increased risk of hospitalization (p < 0.001), but a shorter length of stay compared to Belgians.ConclusionThe socio-health gradient for COVID-19 followed the same pattern as that observed in pre-pandemic respiratory diseases, intensifying in the second wave and among the most deprived groups. This study emphasizes the importance of collecting social data alongside clinical data for a better understanding of social health inequalities and for tailoring health prevention policies.

The Impact of Parental Involvement in Preschool on Children’s Academic Performance

This study aims to examine whether there is a correlation between parental involvement in preschool and children’s academic performance. The study also investigated whether parental involvement (home-based, school-based and home-school conferencing) have an impact on pre-school children’s academic performance. In addition, this study also investigated the effects of parents’ gender, level of education and income on young learners’ academic success at school. This study employed a descriptive research design and used questionnaire to collect the data. The sample consists of 400 parents from five preschools in Henan district, China. Stratified random sampling was used in choosing the sample. The data of the study were analyzed using independent correlation, regression, independent samples t-test and one-way ANOVA. The results revealed that there is a significant positive correlation between parental involvement (home-based involvement, school-based involvement and home-school conferencing) and preschoolers' academic performance. The findings also showed that female parents were more engaged than male parents at preschool. Results of the ANOVA test revealed that parents with higher level of education and higher income were significantly more involved in preschool compared to their counterparts with lower level of education and lower income. These findings are crucial for policy makers to take the right measures in enhancing parental involvement in preschool.

The association between the mental health disorders, substance abuse, and tobacco use with head & neck cancer stage at diagnosis.

Mental health disorders, substance abuse, and tobacco use are prevalent in the US population. However, the association between these conditions and head and neck cancer (HNC) stage is poorly understood. This research aims to uncover the relationship between pre-existing mental health disorders, substance abuse, and tobacco use and HNC stage at diagnosis in patients receiving care in an integrated, public safety-net healthcare system. This study was a secondary data analysis of linked hospital tumor registries and electronic health record (EHR) data. The study's primary independent variables were the comorbidities of mental health disorders, substance abuse, and tobacco use. The dependent variable was HNC stage at diagnosis, operationalized as early stage (i.e., stages I, II, and III) and advanced stage (stage IV, IVA, IVB, or IVC). The analysis included multivariable logistic regression adjusted for covariates of demographic variables, tumor anato RESULTS: The study population consisted of 357 patients with median age of 59years, and was primarily male (77%), diverse (Black or African American 41%; Hispanic 22%), and from neighborhoods with low income (median average annual household income $39,785). Patients with a history of mental health disorders with or without tobacco use had significantly lower odds of advanced stage HNC at diagnosis (adjusted OR = 0.35, 95% Confidence Interval [CI]: 0.17-0.72.) while patients with a history of substance abuse with or without tobacco use had significantly higher odds of advanced stage HNC at diagnosis (adjusted OR 1.41, 95% CI: 1.01-1.98) than patients with no history of mental health disorders, substance abuse, or tobacco use. The relationship between HNC stage at diagnosis and the comorbidities of mental health disorders, substance abuse, or tobacco differs depending on the type and co-occurrence of these comorbidities. These findings demonstrate the need for innovative care delivery models and education initiatives tailored to meet the needs of patients with mental health disorders, substance abuse, and tobacco use that facilitate early detection of HNC.

The relationship between health literacy level and quality of life in bariatric surgery patients

Abstract Background Today, obesity is an important public health problem. In addition to the intervention programmes developed to prevent obesity, the necessity of medical and surgical treatment is increasing with the growing population. This study was conducted to determine the relationship between health literacy and quality of life in patients undergoing bariatric surgery. Methods This cross-sectional study was conducted with the participation of 136 patients aged 18 years and older who underwent bariatric surgery in a general surgery service between January 2021 and December 2023 and whose contact information was available. The survey participation rate was 75.1%. The questionnaire used for data collection consisted of questions about the sociodemographic information of the participants, The European Health Literacy Survey Questionnaire (HLS-EU-Q16) and the Postbariatric Surgery Quality of Life Scale items. Descriptive statistics, Mann Whitney U, Kruskal Wallis H test and Spearman correlation analysis were used to analyze the data. A value of p < 0.05 was considered statistically significant. Results The mean age of the patients who participated in the study was 38.2 ± 10.8 years; mean BMI was 42.3 ± 6.4 before surgery and 29.0 ± 6.2 after surgery. In the study, 44.1% of the patients who underwent bariatric surgery were found to have inadequate/problematic health literacy level. Participants who had less than a bachelor’s degree (p = 0.009) and low income (p < 0.001) had significantly lower health literacy levels. In addition, a moderate positive correlation was found between overall health literacy score and quality of life score (r = 0.252; p = 0.003). Conclusions In conclusion, this study shows that improved health literacy positively affects quality of life in patients undergoing bariatric surgery and that health literacy education should be emphasized in this context. Key messages • The level of health literacy of bariatric surgery patients is a determining factor on quality of life, and therefore health literacy education is important, especially in identified risk groups. • Increased health literacy can have positive results in terms of psychosocial and physical health and improve quality of life after bariatric surgery.