Poor Research Articles

The impact of age, sex, and gender on polypharmacy and potential prescribing cascades: Lessons from five databases.

Few studies describe how gender-related factors may contribute to polypharmacy and prescribing cascades. Describing these patterns using cross-national comparisons can improve the robustness of findings and provide lessons on the importance of considering age, sex, and gender in pharmacological research. The aim of the study was to explore the intersection of age, sex, and gender with polypharmacy and co-prescribing suggesting a potential prescribing cascade. In this cross-sectional descriptive study, we assessed polypharmacy and calcium channel blocker and diuretic co-prescribing suggesting a prescribing cascade in patients aged ≥65 years from five international secondary databases: population-level community and nursing home (ICES, Maccabi Healthcare Services), clinical trial (SENATOR), and patient registry (Report-AGE, SHELTER). The intersection of age, sex, and gender was explored. All databases provided age and sex; none included gender-identity data. Gender-related sociocultural factors, socioeconomic status (SES) measured as income and educational attainment, and marital status were not uniformly collected. Compared with males, females had lower income, has less educational attainment, and were more frequently widowed. Polypharmacy was more common in men. Co-prescribing suggesting a prescribing cascade was more frequent in females in four databases and was also more frequent in lower SES and unmarried groups (significant in ICES (community and nursing home) and Maccabi (community), with a nonsignificant trend in Maccabi (nursing home) and three remaining databases). Using two population-level databases, the prevalence of co-prescribing suggesting a prescribing cascade was highest among females 85 years and older who were also in the lower SES group (11.0% ICES and 14.6% Maccabi). Gender disparity was highest in this group (ICES Differential Prevalence = 3.0%, Maccabi Differential Prevalence = 3.8%). Older adults with lower SES experienced polypharmacy or co-prescribing suggesting a prescribing cascade more frequently than those with higher SES. Within the lower SES groups, females more frequently than males had evidence of co-prescribing suggesting a prescribing cascade. Considering the role of sex and gender-related sociocultural factors may help to better understand some contributors to polypharmacy and prescribing cascades. The research applications are highlighted in our five lessons learned.

Choosing a pediatric surgery career: affecting factors and status assessment.

This study aims to investigate the factors influencing career choices in pediatric surgery with a focus on gender and generational differences in Türkiye. A cross-sectional survey study was conducted. A questionnaire, consisting of 42 questions was developed and distributed to pediatric surgeons via email and other digital platforms. The study included 121 participants (72 males, 49 females). During clinical internships, the recognition score for pediatric surgery specialty was significantly higher among those who volunteered in clinics or participated in surgical procedures (p < 0.05). Females had higher operating room participation compared to males (51.4% vs. 69.4%, p < 0.05). For career choice reasons, Baby Boomers (1943-1960) cited "affinity towards a specific clinic" (53.6%), while Millennials (1982-2004) prioritized the "TUS score effect" (50%) and "program's geographic location" (42.5%). Job satisfaction averaged 6.8/10, with dissatisfaction related to "harsh working conditions" and "low income." Regarding marital status, 87.5% of men and 59.2% of women were married (p < 0.05). Additionally, 23.6% of men and 55.1% of women had no children (p < 0.05). Pediatric surgery faces persistent challenges across generations. mproving training conditions, creating a supportive work environment, and increasing student involvement in pediatric surgery practices are critical. Adjustments are needed for future Generation Z residents.

Low income, being without employment, and living alone: how they are associated with cognitive functioning—Results from the German national cohort (NAKO)

ABSTRACT Aim was to investigate to what extent cognitive functioning differs by three socioeconomic conditions: low income, being without employment, and living alone. A total of N = 158,144 participants of the population-based German National Cohort (NAKO) provided data on socioeconomic conditions and completed cognitive tests. Multivariable confounder-adjusted regression analyses indicated that cognitive functioning was lower in those with low income (b = −0.21) compared to not having low income, living alone (b = −0.04) compared to not living alone, and being without employment (b = −0.09) compared to being employed. An interaction with age indicated that the difference in cognitive functioning was getting larger with age between the income groups and living alone status groups. Accordingly, the three conditions appear independently associated with poorer cognitive functioning. Pathways of how cognitive health in this population group can be improved need to be explored.

Assessing caregiver stress and resource needs in pediatric cancer care

BackgroundCaregivers of pediatric cancer patients often face significant stress and emotional strain, which can negatively impact their well-being and the quality of care provided to their children. Understanding the socio-demographic factors influencing caregiver stress and identifying the specific needs and resources required by caregivers are crucial for improving support systems in pediatric cancer care.Aim of the studyThis study aimed to analyze the levels of caregiver stress and their resource needs within pediatric cancer care.MethodsA cross-sectional descriptive design was used, and the study was conducted at El-Minia Oncology Center outpatient clinics, Egypt. The sample included 258 pediatric cancer caregivers selected based on predefined eligibility criteria. Data were collected using the Caregiver Needs and Resources Assessment (CNRA) and the King Stone Caregiver Stress Scale (KCSS), both of which demonstrated strong reliability and validity. Descriptive statistics, t-tests, ANOVA, and Pearson correlation coefficients were employed for data analysis using SPSS version 29, with a significance level set at p < 0.05.ResultsCaregivers reported moderate to high stress levels, with an average stress score of 34.59 (SD = 7.649). Age, education level, marital status, and income were significant predictors of caregiver stress (p < 0.001), with lower income and higher educational levels contributing to increased stress. The number of children, child’s age, and duration since cancer diagnosis also significantly impacted stress levels (p < 0.001). Correlation analysis revealed that psychological needs were positively related to stress (r = 0.488, p < 0.001), while spirituality was negatively associated with stress (r = -0.241, p < 0.001). Regression analysis indicated that physiological needs (ß = 0.331) and role conflict (ß = 0.294) were the strongest predictors of stress (R² = 0.636).Conclusion and implicationsThis study emphasizes the impact of socio-demographic factors on caregiver stress in pediatric cancer care. Targeted interventions that address caregivers’ psychological, social, and financial needs are essential to alleviate stress. Implementing caregiver-centered support programs in pediatric oncology can enhance the well-being of both caregivers and patients. Future research should explore sustainable strategies to further reduce caregiver burden.Clinical trial numberNot applicable.

Socioeconomic status and sleep duration among a representative, cross-sectional sample of US adults

BackgroundSleep is a crucial determinant of physical and mental health outcomes, and insufficient sleep is highly prevalent among United States adults. Although some risk factors of poor sleep have been extensively studied, including substance use, age, health behaviors, and others, the associations between socioeconomic status (SES) and sleep remain inconclusive. There is limited evidence on SES and sleep duration among the US adult population. This study analyzed the relationships between three SES indicators (poverty, education, and food security), and sleep duration.MethodsWe used responses from the 2017-March 2020 National Health and Nutrition Examination Survey (NHANES). Respondents younger than 25 years old were excluded. Sleep duration was classified using self-reported sleep time and stratified by work vs. non-workdays. SES was operationalized using three indicators: poverty-income ratio, educational attainment, and food security status. We imputed missing data for socioeconomic status and outcome variables using multiple imputation. Weighted Poisson regression models with robust standard errors were used to calculate the crude and adjusted prevalence ratios for insufficient sleep duration (< 7 h of self-reported sleep) on workdays and non-workdays separately by each of the three SES indicators.ResultsWe included a total of 8,457 individuals. In the adjusted model, participants with lower income, educational status, and food security had significantly higher prevalence of insufficient sleep duration on both workdays and non-workdays. For example, low-income individuals (poverty-income ratio < 1) had 1.22 (95% CI 1.04–1.44) and 2.08 (95% CI 1.61–2.67) higher prevalence of insufficient sleep as compared to high income individuals on workday and non-workdays, respectively. In general, we found larger differences by level of SES indicator for the non-workday than for the workday outcome. There were no major differences in gender-stratified analysis. We also found that lower SES was associated with higher prevalence of excessive sleep (≥ 9 h).ConclusionSocioeconomic status indicators are significantly associated with sleep duration in the US adult population. Lower SES correlates with increased prevalence of insufficient sleep duration, which has implications for the overall wellbeing of US adults with lower SES. Targeted interventions and further research are needed to reduce this disparity.

Caregivers’ perceptions of factors influencing undernutrition among under five in Ubungo, Dar es Salaam, Tanzania

BackgroundUndernutrition in children is predominantly linked to lack of a balanced diet resulting from inadequate nutrition intake. This form of malnutrition remains a leading cause of morbidity and mortality under-five children, especially prevalent in low-income countries. Understanding the specific factors contributing to undernutrition among this group, particularly those associated with caregivers, is vital yet insufficiently explored. Therefore, this study aimed to investigate and evaluate caregivers’ perceptions regarding the factors influencing under-nutrition among children under-five in Ubungo, Dar es Salaam, Tanzania.MethodsA qualitative study was conducted at Sinza Palestina Hospital in Ubungo Municipal Council, Dar es Salaam, from January 2019 to December 2019. In-depth interviews were carried out with caregivers of undernourished children to explore their thoughts, perceptions, and views on the factors contributing to under-nutrition among this demographic. A semi-structured interview guide facilitated data collection, allowing for comprehensive exploration. Recorded data underwent transcription. And thematic content analysis was utilized to identify caregivers’ perceptions and views, highlighting codes and subcategories that represented factors influencing under-nutrition. A total of 26 participants were purposefully selected among caregivers who provided consent during the study period was included.ResultsThe study revealed several primary factors contributing to under-nutrition among under-five children. Among these, poor adherences to WHO recommended feeding practices by caregivers, exacerbated by poverty resulting from low monthly income. This economic limitation impeded families’ ability to provide essential nutritious foods for their children. Additionally, limited time available for childcare emerged as main factors contributed to under-nutrition. Notably, while caregivers exhibited a good understanding of malnutrition and its causes, their perceptions did not align with WHO definition of under-nutrition.ConclusionAddressing nutrition among under five children necessitates comprehensive support for caregivers, including economic empowerment and education on WHO-recommended feeding practices. Encouraging adherence to these practices is vital. Additionally, care givers should allocate sufficient time for breastfeeding and preparing complementary food for their children.

Never tested for HIV among men who have sex with men, Hanoi, Vietnam: correlates and missed opportunities.

Introduction: Understanding levels of HIV testing among populations at risk for acquisition is essential to meeting the goal of the United Nations that 95% of individuals living with HIV know their status. This study assessed HIV testing prevalence among men who had sex with men (MSM), characteristics of MSM who have never tested for HIV, and missed testing opportunities in Hanoi, Vietnam.Methods: We measured the prevalence of never testing for HIV and missed opportunities for testing in the baseline data of a cohort study of MSM recruited in 2017-2019 in Hanoi. Logistic regression analysis characterized MSM who had never tested prior to cohort participation.Results: Of 1,893 MSM enrolled in the cohort, 39.4% had never previously tested for HIV. MSM with children (aOR 1.75, 95% CI 1.09-2.82) and those who did not know or remember having a male partner living with HIV (aOR 1.41, 95% CI 1.07-1.84) were more likely to have never tested. Older age, university education, higher income, and having a male partner living with HIV were associated with a lower likelihood of never having been tested. The most common missed testing opportunities to test MSM who had never been tested were when receiving free condoms from health educators (35.3%), testing for other sexually transmitted infections (STIs) (23.3%), reporting their MSM status to healthcare workers (16.4%), and receiving an STI diagnosis (13.0%). The most common barriers identified by MSM who had never tested were fear of seeking health care due to their sexual orientation (82.7%) and having been refused healthcare due to their sexual oreitnation (76.2%).Conclusions: Facilitating provider-initiated HIV testing in STI clinics and other healthcare services, community-based testing, and HIV self-test kits should enhance HIV testing options for young MSM, especially those with lower education and income.

Barriers in Seeking Dental Health Care Facilities by the Patients in Pakistan: A Cross-Sectional Study

Background: Patientsin Pakistan face considerable obstacles due to limited accessto oral health care services, which are exacerbated by socioeconomic factors such as income and education. Gaining an understanding of these obstacles is essential to improve the oral health system. Objective: To determine the factors related to barriers to seeking dental health care facilities among patients in Pakistan and their association with education and monthly income. Methods: A cross-sectional study with 400 patients used a non-probability convenience sampling method. Patientsofbothgenderswhowere25yearsof age andolderwere included, andallparticipantsgavewrittenconsent. The chi-square test found relationships between income, education, and obstacles to accessing dental care (p &lt; 0.05).Results: A total of 400 patients aged 25 and older participated in the data collection. Patients encountered various barriers when seeking dental healthcare facilities, including costly treatment (23.1%), fear of pain (13.7%), and time constraints (13.7%). Educated patients predominantly faced issues such as time shortages and appointment-related challenges, whereas illiterate individuals cited treatment costs and fear of pain as their primary barriers.Conclusion: Costly treatment, time constraints, and dental procedure fears pose significant barriers to dental service utilization. These challenges are particularly acute among individuals with lower educational attainment and income levels.

Dietary patterns of Chinese children and adolescents and their associations with family characteristics and functioning: a multicenter cross-sectional study

BackgroundDietary patterns influence children and adolescents’ health not only in the present but also in their adulthood. Family characteristics and functioning play a crucial role in food choices and are important modifiable factors for early interventions aimed at preventing unhealthy diets.ObjectiveThe study aimed to analyze the dietary patterns of Chinese children and adolescents and explore their associations with family characteristics and functioning.Methods6276 participants aged 6 to 17 years were recruited for the multicenter cross-sectional study through cluster sampling. Food intake, family characteristics, and family function were assessed. Dietary patterns were identified through factor analysis based on food intake data, and a multiple logistic regression model was used to investigate the associations between dietary patterns, family characteristics, and family functioning.ResultsThree distinct dietary patterns were identified: the “Diverse dietary pattern” (characterized by a rich diet and balanced nutrition), the “Fast food concentrated dietary pattern” (primarily consisting of fried foods, sugary drinks, processed meats, and other junk food), and the “Traditional dietary pattern” (mainly vegetables and grains). Girls, those living in rural areas, and those with better family functioning were more likely to adhere to the “Diverse dietary pattern” (p < 0.01). Girls, primary school students, and those with lower educated mothers tended to have higher adherence to the “Traditional dietary pattern” (p < 0.01). High adherence to the “Fast food concentrated dietary pattern” were associated with boys, older age, Han ethnicity, family dysfunction, living with both parents, being an only-child, having a better educated father, lower family income, and higher pocket money (p < 0.01).ConclusionChildren and adolescents from different family backgrounds exhibit distinct dietary patterns, highlighting the importance of early screening and intervention tailored to these varying family characteristics. Among the modifiable family factors, better family functioning stands out as a key area of focus for promoting and sustaining healthy dietary patterns in Chinese children and adolescents.

A benchmarking and evidence-informed gap analysis of the hemodialysis care provision in Iran

BackgroundPatients with end stage renal disease (ESRD) are increasing worldwide. This is especially paramount in low and middle income countries in which ESRD patients are struggling to access specialist services e.g. hemodialysis (HD). Benchmarking analysis of the offered healthcare packages in several countries and comparison of the utilized alternative healthcare models for ESRD patients may be auspicious for institutional capacity-building in the existing healthcare facilities. Main aim of this study was to perform a benchmarking and evidence-informed gap analysis of the ESRD care provision in Iran and recognize the gaps that cause diversification in care quality for ESRD patients that hinder efforts for care quality improvement in the Iranian National Healthcare System.MethodsDimensions of the Australian Anglicare Southern Queensland Clinical and Care Governance Framework (ASQCGF) were utilized as corner stones of a comprehensive clinical care plan that is essential in responding to HD patients’ needs in Iran. An extensive literature search was performed at the next stage to recognize the gold standard core elements. The ascertained components were assigned to the five separate dimensions of the ASQCGF and a preliminary draft (comprehensive package of care for HD patients) was prepared. A checklist was developed at a later stage which was sent to a panel of expert consisting professional healthcare providers in nephrology and hemodialysis wards for their opinions. A gap analysis was conducted to evaluate current care processes of the Iranian HD patients align with the elements of the gold standard framework.ResultsThe identified deficits were classified in five areas in accord with the elements of ASQCGF as follow: A) supply of resources, medical devices and equipment support B) recruitment and endorsement of clinics and general work force C) infection prevention and controlling procedures D) care effectiveness monitoring and quality improvement E) provision of safe environment for both HD patients and hospitals’ staff.ConclusionsThe study findings revealed considerable gaps in providing quality HD services to the Iranian HD patients that herald their therapeutic unmet needs and the shift that is needed to narrow down the widening organizational failure which fuels the current disenchantment among the both healthcare providers and HD patients.

Novel models by machine learning to predict the risk of cardiac disease-specific death in young patients with breast cancer

BackgroundWith the tremendous leap of various adjuvant therapies, breast cancer (BC)-related deaths have decreased significantly. Increasing attention was focused on the effect of cardiac disease on BC survivors, while limited existing population-based studies lay emphasis on the young age population.MethodData of BC patients aged less than 50 years was collected from the SEER database. A competing risk model was introduced to analyze the effects of clinicopathology variables on the cardiac disease-specific death (CDSD) risks of these patients. Further, an XGBoost prediction model was constructed to predict the risk of CDSD. Prediction performance was assessed using the receiver operating characteristic (ROC) analysis, area under the POC curve (AUC) values, calibration curves, decision curves, and confusion matrix, and SHapley Additive exPlanations (SHAP) were used to interpret the models.ResultsOur competing risk analysis proved that young BC patients with older age, low household income, non-metropolitan residential environment, black race, unmarried status, HR + subtype, higher T stage (T2-4), receiving chemotherapy, and non-surgery are under higher risk of CDSD. Further, five machine learning models were constructed to predict the CDSD risks of young BC patients, among which the XGBoost models showed the highest AUC value (train set: AUC = 0.846; test set: AUC = 0.836). The confusion matrix of the XGBoost model demonstrated that the sensitivity, specificity, and correction were 0.81, 0.94, and 0.94 for the train set, and 0.82, 0.95, and 0.96 for the test set, respectively. The SHAP graph indicated that median household income, marital status, race, and age at diagnosis were the top four strongest predictors.ConclusionIndependent CDSD risk factors for young BC patients were identified, and machine-learning prognostic models were constructed to predict their CDSD risks. Our validation results indicated that the predicted probability of our XGBoost model agrees well with the actual CDSD risks, and it can help recognize high-risk populations and therefore develop effective cardioprotection strategies. Hopefully, our findings can support the growth of the new field of cardio-oncology.

Socio-economic inequalities in oral health among Portuguese older adults: a cross-sectional study

BackgroundAlthough the oral health status has improved in developed countries in recent years, oral diseases are still unequally distributed across socio-economic groups. Research on the impact of socio-economic factors on oral health care among older adults in Europe, including Portugal, remains limited. The main aim of this study was to investigate the association between socio-economic factors and oral health indicators in Portuguese older adults.MethodsThis retrospective cross-sectional study analyzed data from 915 participants (aged 65 years and older) from the third wave (2015–2016) of the Epidemiology of Chronic Diseases Cohort Study (EpiDoC), a population-based study. Socio-economic and demographic information, general health-related characteristics and oral health data (prosthetic need, oral hygiene frequency, and last dental procedure) were collected by questionnaire. Multivariate logistic and multinomial regression models analyzed the associations between socio-economic factors and oral health indicators.ResultsParticipants with lower education level, perceived lower income and a fewer number of private sector appointments were more likely to have poor oral health (need for prosthetic treatment, less frequent oral hygiene, and tooth extraction as last dental procedure). Other factors found to be associated with oral health were sex, age, geographical area, smoking habits, and body mass index.ConclusionsSocio-economic factors were associated with oral health in Portuguese older adults. These findings may contribute to future national public health strategies by expanding oral health services to ensure better access and coverage for at-risk groups.

Impact of the presence of a family member with dementia on the prevalence of depression: a comparison based on household income level

BackgroundFamilies caring for patients with dementia are more vulnerable to depression. This cross-sectional study compared differences in socioeconomic status and gender related to depression among families of patients with dementia and identified associated factors.MethodsInequality in depression according to household income level among families of patients with dementia was assessed using the Korean Community Health Survey, which included a sample of over 200,000 participants. Depression prevalence was assessed using the Patient Health Questionnaire-9 (PHQ-9) and each independent variable was calculated. Significant differences were analyzed using the chi-square test. Complex-sample multivariate logistic regression was performed to examine the association between the income levels of families of patients with dementia and depression. Additionally, an analysis of depression, stratified by income level and gender, was conducted.ResultsThe prevalence of depression among families of patients with dementia was 4.41%. The odds ratio (OR) for depression among families of patients with dementia compared to the population of families without patients with dementia was 1.49. Depression was significantly more likely in families with lower income levels (adjusted OR [aOR]: 2.17, 95% confidence interval [CI]: 2.16–2.18). The magnitude of the impact of having a family member with dementia on depression varied by income level, being highest in the lowest income group (aOR: 1.64, 95% CI: 1.63–1.66) and lowest in the highest income group (aOR: 1.26, 95% CI: 1.24–1.27). Stratification by gender showed that both men and women in families of patients with dementia were more likely to experience depression than those in families without patients with dementia. Women had a higher likelihood of depression across all income levels than men; however, the impact of having a family member with dementia was more pronounced among men, especially those from lower-income groups.ConclusionsOur findings suggest the necessity for support policies tailored to low-income groups and women among families of patients with dementia. This is crucial given the higher prevalence of depression among families of patients with dementia than among families without patients with dementia.

Paranormalism, Voting Intention, and Other Conspiracy Mentality Predictors in Sweden

This article explores conspiracy mentality occurrence in Sweden as part of a 2020 survey of paranormal beliefs, practices, and experiences. Using the idea of a shared sociocultural milieu of alternative views and practices of knowledge as a departure point, the relationship between conspiracy mentality and paranormalism, viewed as instances of cultic, rejected, and stigmatized knowledge, is tested through multivariate regression. As part of the regression model, the effects of other social predictors (e.g. gender, income, and cultural values) are also assessed. A nonparametric analysis further explores the relationship between conspiracy mentality and voting intention. The results of multivariate regression show that the dependent variables only predict conspiracy mentality to a limited extent. Predictors that significantly contribute to predicting conspiracy mentality are gender (being male), higher levels of paranormalism, lower income, conservation as opposed to openness-to-change values, and self-transcendence as opposed to self-enhancement values. Meanwhile, the nonparametric test pointed to distinctly higher conspiracy mentality levels among sympathizers with the right-wing populist party the Sweden Democrats and those who favoured political parties not represented in parliament.

Examining socio-economic disparities among e-cigarette users and cigarette smokers in three Canadian jurisdictions.

It is well established that a gradient exists among cigarette smokers, such that smoking is more prevalent among individuals who are of lower socio-economic status (SES). In this study, we examined whether a similar SES gradient exists among electronic cigarette (e-cigarette) using youth and adults in three Canadian jurisdictions. A secondary analysis of data from Ontario, Quebec and Yukon respondents (n = 58,592) to the 2017-2018 Canadian Community Health Survey was conducted. Unadjusted and adjusted logistic regression models explored SES measures: total and relative household income, and education level, separately on use of e-cigarettes or cigarettes in the past 30 days. Models adjusted for additional socio-demographic and psychosocial covariates. A significant inverse SES gradient existed for cigarette smoking based on education and income variables, with higher education and income associated with decreasing consumption in a stepwise manner. No SES gradient was observed for e-cigarettes. While a robust SES gradient was observed among cigarette smokers, no gradient for e-cigarette use was observed. Explanations for these findings may be linked to perceptions that e-cigarettes are healthier, have convenient designs and appealing flavours, and less stigmatised. As more becomes known about potential harms from e-cigarettes, effective interventions may be needed to prevent the emergence of a gradient that disproportionately affects those at lowest income and education levels. Continued monitoring of e-cigarette use patterns across SES groups is necessary for public health.

Analisis Marketing Mix 7P terhadap Minat Kunjungan Ulang Pasien di Klinik Khasanah Medika dan Baitul Syifa Tahun 2024

Number of repeat visits from old patients in 2023 at the Baitul Syifa Clinic is 74%, while at the Khasanah Medika Clinic ber of patient visits has an impact on low clinic income, so that Marketing Mix 7P can be used as an appropriate marketing strategy to increase patient interest in repeat visits. The purpose of this research analyze influence Marketing Mix 7P on interest in re-visiting patients at the Baitul Syifa Clinic and Khasanah Medika Clinic and analyzing the variabels that have the most dominant influence on interest in re-visiting patients. This type of research is quantitative research by design cross sectional. Sampling technique with Purposive sampling. The subjects of this research were outpatients at the Baitul Syifa Clinic and Khasanah Medika Clinic. The number of samples in this study was 100 patients from each clinic. The research instrument uses a questionnaire with statistical tests chi square. The research results stated that Marketing Mix 7P has a significant effect on interest in repeat visits by Baitul Syifa clinic patients, including variabels Product with a value of 81% (p=0,000), Price with a value of 79% (p=0,000), Promotion with a value of 78% (p=0,000), Place with a value of 80% (p=0,000), People (p=0,000), Process with a value of 80% (p=0,000), and Physical Evidence with a value of 78% (p=0.000), whereas Marketing Mix at the Khasanah Medika clinic which consists of Product with a value of 80% (p=0,000), Price with a value of 80% (p=0,000), and Place with a value of 78% (p=0.000) has a significant effect on patient interest in repeat visits, other variabels, namely Promotion with a value of 43% (p=0,909), People with a value of 67% (p=0,970), Process with a value of 68% (p=0,268), and Physical Evidence with a value of 48% (p=0.983).

Healthcare debts in USA: a silent fight

Healthcare debt in the United States is a significant problem, affecting millions of Americans. Many people struggle to pay for healthcare, and approximately 9% owe over $250 due to health costs. Nearly half of US adults find it difficult to afford healthcare, with uninsured individuals and those with lower incomes facing the most significant challenges. Healthcare debt in the United States is a problem with profound consequences. This debt encompasses expenses incurred for various medical services, from hospital stays and surgeries to doctor visits and medications. Healthcare debt casts a long shadow, adversely affecting physical and mental well-being and increasing stress, anxiety, and depression. Unpaid bills lead to the avoidance of necessary care, perpetuating health issues and straining the healthcare system. Beyond health implications, it affects credit history, limits access to credit facilities, and hampers employment opportunities. So, comprehensive healthcare reform emerges as a potential remedy, by expanding access to affordable health insurance, regulating healthcare costs, and addressing coverage gaps could alleviate the impact of healthcare debts. Therefore, exploring the feasibility of transitioning towards a universal healthcare system becomes crucial, offering equitable access to essential medical services and mitigating financial burdens on individuals. As healthcare debts continue to profoundly influence health, economic stability, and social well-being, a holistic approach is imperative for a healthier and economically sound future for all Americans.

Multiple Indicator Vulnerability to Energy Poverty: Assessing Spatial Variability Across Chile

This study investigates the multifaceted issue of energy poverty, focusing on its spatial and socioeconomic dimensions, with a particular emphasis on the case of Chile. Despite global initiatives like Sustainable Development Goal 7, which advocates for universal access to affordable and reliable energy, millions remain vulnerable to energy poverty. In Chile, this phenomenon is exacerbated by geographic and climatic variability, resulting in significant disparities in energy access, affordability, and efficiency. Using a multidimensional framework adapted from Bouzarovski and Petrova, we assessed energy poverty through factors including household income, fuel costs, energy infrastructure reliability, and regional climate needs. This analysis integrated composite indicators to map vulnerability at the regional level, highlighting high-risk areas primarily in the central and southern regions, where low incomes and dependency on biomass for heating amplified exposure occur. The findings reveal that approximately 4 million Chileans face a high risk of energy poverty, underscoring the need for regionally tailored policies that address both immediate economic constraints and structural energy inequalities. This research contributes to a comprehensive understanding of energy poverty in Chile and offers policy recommendations aimed at reducing socioeconomic disparities and achieving sustainable, equitable energy access.

Psychological conditions, social coexistence and rehabilitation of ex-prisoners under Internal Security Act in the southern border provinces of Thailand

Ex-prisoners are defined as those under the Internal Security Act who have previously committed offenses connected to the incidences of disturbance/conflicts in Thailand's southern border provinces. Additionally, certain people have a strong propensity for repeat transgressions, which could be detrimental to society. This study used qualitative research techniques and in-depth interviews to examine psychological circumstances, social coexistence, means of subsistence, occupations, and current support practices. Following a period of reintegration into society, some observations were made namely: i) 23 ex-prisoners in the southern border provinces were on insurgent charges, ii) 10 government employees with five years of experience were in care, assistance, healing, and rehabilitation process, and iii) four members of civil society with five years of experience in aid, recovery, and rehabilitation were among the informers for the sources of information. The results also revealed that most ex-prisoners experienced psychological stress and anxiety after re-entering society. This phenomenon occurs due to issues related to debt, low income, localized violence, and frequent visits by the army troops' to their houses, it was discovered that some groups were stigmatized by local residents. Nevertheless, they were found to have adjusted to living and got along well with their families. In terms of occupation and sources of income, it was found that most were merchants, general laborers, and rubber tappers. Additionally, the community networks supporting the restoration of coexistence in the community are either the responsibility from government agencies or authority both direct or indirect involvement of the civil society organizations/Non-Governmental Organisation (NGOs). The findings of this study will be helpful in establishing a framework for assisting and rehabilitating the quality of life of ex-prisoners under the Internal Security Act that is congruent with the local requirements and context.

Sexual and Intimate Partner Violence Against Women with Schizophrenia: A Scoping Review

Background: Globally, 641 million women are touched by intimate partner violence (IPV), establishing it as the most prevalent form of violence affecting women. Women, who are already disproportionately affected by sexual and IPV, face an elevated risk when dealing with severe mental illnesses (SMI) compared to the general population. Schizophrenia, classified as an SMI, poses numerous obstacles that impact women’s ability to maintain employment, good health, and sustain stable relationships. Nevertheless, limited data exists on IPV against women with schizophrenia and its impact. Aims: The objective of this scoping review was to summarize the available literature on sexual and IPV against women with schizophrenia and underlie future avenues of research. Methods: We conducted an electronic search using keywords in the following databases: APA PsychInfo, PubMed, Scopus, Google Scholar and Psychology and Behavioral Sciences Collection. The search yielded a total of 6,099 articles. Upon title and abstract review, 97 articles were retained for full-text reading, after which 7 articles were included in this review. Results: The available articles reveal an association between sexual and IPV against women with schizophrenia. Younger women diagnosed with schizophrenia, especially those with low income or unemployed, are at a higher risk of experiencing sexual and IPV. This victimization increases the likelihood of suicide and exacerbates psychopathology. Conclusion: Research should examine care-setting interventions for women with schizophrenia, who are at increased risk of sexual and IPV, aiming to prevent severe harm. Implementation of preventive measures is essential for enhancing healthcare and societal transformation.