Secondary Data Analysis Research Articles

Interest in the Use of Herbal Supplements to Close the Treatment Gap for Hazardous Alcohol Use Among Men Who Have Sex With Men: Secondary Analysis of a Cross-Sectional Study.

Hazardous alcohol consumption is highly prevalent for men who have sex with men (MSM). The 4 treatments currently approved by the Food and Drug Administration for alcohol use are reaching an alarmingly low percentage of people who would benefit from a reduction in their alcohol use. There is increasing interest in alternative methods of treatment, such as herbal supplements, to address hazardous drinking. However, research on the acceptability of alternative pharmacotherapies among MSM remains limited. We examined the prevalence and correlates of expressing interest in using herbal supplements for alcohol treatment among MSM with hazardous alcohol consumption. We conducted a secondary data analysis from a cross-sectional study of MSM who use alcohol, conducted from March 2015 to July 2017 in San Francisco, California, to assess the overall prevalence of interest in using herbal supplements to help reduce alcohol consumption. Associations between expressing interest in herbal supplements and demographic, social, and clinical characteristics were examined using bivariate and multivariable logistic regression models. One-third (66/200, 33%) of the participants expressed interest in an herbal supplement for reducing alcohol consumption. In the multivariable analyses, weekly binge drinking (adjusted odds ratio [aOR] 2.85, 95% CI 1.17-6.93), interest in abstaining from alcohol use (aOR 5.04, 95% CI 1.46-17.40), higher severity of alcohol dependence score (aOR 1.22, 95% CI 1.04-1.41), and interest in naltrexone (aOR 3.22, 95% CI 2.12-4.91) were independently associated with higher odds of being interested in using an herbal supplement to reduce alcohol consumption, adjusting for age, race or ethnicity, and education. We found that MSM who have hazardous drinking habits, more severe alcohol dependence, and interest in pharmacotherapy were more likely to express interest in using an herbal supplement for reducing alcohol consumption. To our knowledge, this is the first study that has evaluated correlates of interest in herbal supplements for alcohol use among MSM. As researchers implement novel alcohol treatment studies, they should focus on recruitment efforts among MSM with a motivation to reduce their alcohol use patterns.

The Impact of Financial Inclusion on Economic Growth in Nigeria: A Secondary Data Analysis

This study investigates the impact of financial inclusion on economic growth in Nigeria, a country where a significant portion of the population remains financially excluded despite ongoing efforts to enhance access to financial services. The problem addressed is the limited understanding of how various aspects of financial inclusion, particularly mobile money, banking services, and credit availability, affect Nigeria's GDP growth. The primary objectives of the study are to assess the current level of financial inclusion, analyze its relationship with GDP growth, and provide evidence-based policy recommendations to improve financial access and support economic development. To achieve these objectives, a secondary data analysis was conducted, employing multiple linear regression, Pearson correlation, and Granger causality tests. The findings reveal a marginally significant positive relationship between Mobile Money Subscriptions (MMS) and GDP growth, while access to formal banking services and credit availability showed no significant correlation with economic growth. These results highlight the importance of mobile money as a key driver of financial inclusion, contrasting with the limited impact of traditional banking services. Based on these findings, the study recommends enhancing mobile money infrastructure, strengthening financial literacy programs, promoting inclusive banking models, and fostering collaboration with fintech firms. Implementing these recommendations could significantly improve financial inclusion in Nigeria, ultimately contributing to sustained economic growth and enhanced welfare for the population.

Characterising Long COVID in an Irish cohort: a study of symptom type, severity and determinants

Abstract Long COVID (LC) is a multisystem disorder impacting 65 million people globally. This secondary analysis of data from the Follow-up After Disease Acquisition (FADA) retrospective cohort study of COVID-19 recovery, aimed to characterise the nature and severity of LC in an Irish sample. The Modified COVID-19 Yorkshire Rehabilitation Scale categorised symptoms. Data analysis employed descriptive statistics and logistic regression. Of 4,671 respondents, 2,338 (50.1%) self-reported LC. LC participants were predominantly female (1,543, 66%), White Irish (1,512, 84.9%), and highly-educated (1,174, 65.8%). 907 (51.5%), had ≥one baseline co-morbidity. Most (1,076, 59.1%) had never smoked. Only 6.9% (162) of LC cases were ever hospitalised with acute COVID-19. Recovery was reported by 979 (41.9%). Of those with persistent symptoms 306 (31.6%) were classified as “moderate/severe.” Fatigue was predominant, (1,021, 75.1%) accompanied by cognitive dysfunction (932, 68.5%) and breathlessness (870, 64.0%). Functional impairment, assessed by the EQ-5D-5L score, was evident. Factors associated with LC persistence and severity included baseline co-morbidities (aOR persistent LC 1.44 [95% CI 1.12-1.85], p = 0.005; aOR moderate/severe LC 2.90 [1.92-4.37] p < 0.001)), smoking (aOR persistent LC 1.59 [1.11-2.28] p = 0.01, aOR moderate/severe=1.65 [1.0-2.71] p = 0.05), and meeting/exceeding WHO’s physical activity guidelines (aOR persistent LC 1.49 [1.16-1.92], p = 0.002, aOR moderate/severe=1.69 [1.12-2.54], p = 0.01). LC’s diverse symptomatology and functional impairment serve as a call to action to the health service to equip itself to address this complexity. This study offers insights into LC symptom type, duration, and determinants, emphasising the need for Public Health to traverse domains, to improve all facets of population health. These findings add to the current understanding of LC, providing a foundation for the development of tailored LC services. Key messages • Long COVID causes a constellation of diverse symptoms. • The Irish Health service needs to be equipped to manage the diverse symptomatologu.

Implementation of the Lupus Low Disease Activity State in Pediatric Rheumatology Care: The Role of the Visual Analog Scale.

We compared the measurement properties of a traditional physician global assessment of disease activity (PhGA) 10-cm visual analog scale (PhGA0-10) with that of the three-point numeric scale (PhGA0-3) in childhood-onset systemic lupus erythematosus (cSLE) as part of the childhood Lupus Low Disease Activity State (cLLDAS). We used a secondary data analysis from a convenience sample of 100 patients with cSLE followed every three months for up to seven visits. Ratings of PhGA0-10, PhGA0-3, parent assessment of patient well-being (ParGA) (range: 0= very poorly, 10 = very well), disease activity as measured by the SLE disease activity index 2000 (SLEDAI-2k), Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA) SLEDAI, and the British Isles International Lupus Activity Group index (BILAG; A = 9, B = 3, C = 1, D/E = 0) were compared. After linear transformation of PhGA0-10 to a 0 to 3 range (tPhGA0-10), the frequency of PhGA0-3 ≤1 was assessed to estimate the impact of scale type on the scoring of the cLLDAS. In 600 visits, the median (range) scores of PhGA0-10, PhGA0-3, SLEDAI-2k, SELENA-SLEDAI, and BILAG were 2 (0-10), 1(0-3), 4 (0-28), 4 (0-32), and 2 (0-28), respectively. PhGA0-10 and PhGA0-3 ratings were strong to moderately correlated with (r = 0.73; P < 0.0001) and with more variability for PhGA0-3 ≥2. SELENA-SLEDAI and SLEDAI-2k scores were moderately correlated with PhGA0-10 (r = 0.56/0.54; P < 0.0001). ParGA values were weakly correlated with all other measures considered (all r = -0.19 to -0.34). There were 490 of 600 visits with PhGA0-3 ≤1 and 497 of 600 visits with tPhGA0-10 ≤1 (κ (SE) =0.59 (0.04), McNemar P = 0.4). PhGA0-3 and PhGA0-10 have comparable measurement properties and yield almost identical cLLDAS rates when used in cSLE.

Perinatal mortality in women in minority ethnic groups in Ireland (2011-2021)

Abstract Women in minority ethnic groups (MEG) have been consistently overrepresented in the National Perinatal Epidemiology Centre (NPEC) Perinatal Mortality (PM) reports in Ireland (IE). International research, report similar findings. A secondary analysis of NPEC PM national clinical audit data (2011-21) examined factors associated with PM in women in MEG and differences between these and white women. Maternal sociodemographic and obstetric characteristics, maternal medical history, infant characteristics and PM outcomes of women in MEG were analysed and compared with women of white ethnicity with χ2 tests. There were 4314 PMs in IE from 2011-21; 2896 stillbirths (SB) and 1418 early neonatal deaths (ENND). Women in MEG who experienced PM were younger (p &amp;lt; 0.001) and 46% were employed (vs 75% of white women, p &amp;lt; 0.001). A greater proportion of women in MEG had previous pregnancies (77% vs 68%, p &amp;lt; 0.001), and more than twice as many had ≥3 previous completed pregnancies versus white women (26% vs. 12%, p &amp;lt; 0.001). Women in MEG also had more previous pregnancy medical issues (49% vs 38%, p = 0.001). Twice as many women in MEG had their first prenatal appointment after 20 weeks’ gestation or never received prenatal care (p &amp;lt; 0.001). Analysing by type of PM, statistically significant differences persisted for all these variables in both SB and ENND groups. Women in MEG experienced more placental conditions and obstetric factors as causes of PM, but fewer congenital anomalies compared to white women (p = 0.047). These differences only persisted in the SB group when data was analysed by type of PM. Factors highlighted in this study such as employment, parity, and prenatal care access may explain the over-representation of women in MEG in PM. These findings provide further knowledge useful to create targeted interventions (e.g. initiatives to improve maternal health literacy for women in MEG). Further studies are needed to promote change that would specifically address these systemic inequities. Key messages • Data shows systemic inequities that may contribute to the over-representation of women in minority ethic groups in perinatal mortalities. Clear and tangible changes are needed to address these issues. • Further research needs to clarify factors restricting access of women in minority ethic groups to prenatal care and promote interventions to ensure adequate prenatal care is available and accessible.

Insomnia treatment effects on negative emotionality among veterans in treatment for alcohol use disorder.

Insomnia symptoms are pervasive and persistent in alcohol use disorder (AUD), though little is known about the mechanisms that underlie this association. We previously found that cognitive behavioral therapy for insomnia (CBT-I) reduced alcohol-related problems among veterans by improving insomnia severity (NCT03806491). In this planned secondary analysis of the same clinical trial data, we tested negative emotionality as one potential mechanism to explain this effect. Specifically, we tested the change in negative emotionality as a mediator of the association between change in insomnia symptoms and alcohol-related outcomes (craving, heavy drinking frequency, and alcohol-related problems). Participants were 67 veterans in treatment for AUD who also met the criteria for insomnia disorder (91% male, 84% White, average age = 46.3 years). Participants were randomized to five sessions of CBT-I or a single-session sleep hygiene control. Assessments occurred at baseline, immediately posttreatment (~6 weeks after baseline), and at 6-week follow-up. Measures included the Insomnia Severity Index, Penn Alcohol Craving Scale, Timeline Followback, and Short Inventory of Problems. We created a latent negative emotionality indicator based on five validated and reliable measures of negative emotionality. Contrary to hypotheses, CBT-I did not improve negative emotionality relative to sleep hygiene control. However, across both treatment conditions, decreases in insomnia symptoms from baseline to posttreatment were associated with concurrent decreases in negative emotionality, which in turn predicted reductions in alcohol craving and heavy drinking. Negative emotionality may help explain links between insomnia symptoms and alcohol-related outcomes.

Vitamin C intake, psychological distress and health outcomes in patients with heart failure

Abstract Background Patients with heart failure (HF) have lower dietary vitamin C intake than healthy adults, which may increase oxidative stress and worsen important patient-reported health outcomes (functional status and quality of life [QOL]). Patients with HF are more likely to have higher levels of psychological distress (anxiety and depressive symptoms). However, it is not known whether psychological distress is a link in the association of dietary vitamin C with health outcomes. Objective To examine the inter-relationships among dietary vitamin C intake, psychological distress (anxiety and depressive symptoms), and health outcomes (functional status and QOL) in patients with HF. Method We performed a secondary analysis of baseline data from 206 adults with HF (female: 33%, age: 61±12, NYHA class III/IV: 44%) with complete data on dietary vitamin C intake, anxiety, depressive symptoms, functional status, and QOL. Dietary vitamin C intake was assessed using a 4-day food diary and analyzed using the Nutrition Data System for Research software program. Low dietary vitamin C intake was defined as averaged daily intake below the estimated average requirement (EAR) from the Institute of Medicine of 75 mg/day for men and 60 mg/day for women. Anxiety was assessed using the Brief Symptom Inventory Anxiety subscale. Depressive symptoms were assessed using the Beck Depression Inventory II. Functional status was measured using the Duke Activity Status Index. Quality of life was measured using the Minnesota Living with Heart Failure Questionnaire. Linear regression was conducted using the PROCESS macro in SPSS. Results Eighty-four patients (41%) had low dietary vitamin C intake based on the EAR standard. In bivariate analyses, patients with low dietary vitamin C intake had higher levels of anxiety, depressive symptoms, poorer functional status, and worse QOL (all p &amp;lt;.005). In the mediation regression model, low dietary vitamin C intake was directly associated with higher levels of anxiety, but not with depressive symptoms. Depressive symptoms were directly associated with functional status and QOL. Dietary vitamin C intake was not directly associated with functional status or QOL. Low dietary vitamin C intake was indirectly associated with poor functional status through higher levels of anxiety and depressive symptoms (Figure 1). Similarly, low dietary vitamin C intake was indirectly associated with worse QOL (Figure 2). Conclusion Anxiety and depressive symptoms link the relationship between dietary vitamin C intake and functional status and between dietary vitamin C intake and QOL. Our findings highlight the importance of including interventions to enhance diet quality and psychological well-being as part of HF treatment to improve health outcomes.Vitamin C and functional statusVitamin C and quality of life

Unmet health needs during COVID-19 pandemic in Serbia

Abstract Background The COVID-19 pandemic made health care access more difficult. This study provides insight into significant individual factors associated with unmet needs in 2021 in Serbia. Methods The study is a secondary analysis of SILC data, conducted on a sample of 13,855 respondents aged 16 + (source: Statistical Office of the Republic of Serbia). The outcome variable is self-reported unmet need for physician service in last 12 months (yes/no). Multivariate logistic regression is used to identify factors significantly related to unmet needs. Demographic, socioeconomic factors and health needs, which have been found to be significant for outcome in univariate logistic regression, are entered in final analysis. Results It was shown that age, marital, employment status, income and health needs were significant factors for unmet needs. Compared to 16-24 age group, aged 65+ were more likely to report unmet needs, OR = 3.5(CI = 2.1-5.6); for 45-64 years old OR = 3.4(CI = 2.1-5.3); for 25-44 OR = 2.0(CI = 1.3-3.1). Separated/divorced had higher odds for unmet needs than married ones, OR = 1.4(CI = 1.2-1.8); as well as unemployed, OR = 1.4(CI = 1.2-1.6), and retired, OR = 1.2(CI = 1.0-1.5), than employed. Those from the 1st quintile, based on equalized disposable household income, were more likely to report unmet need compared to the 5th quintile, OR = 1.8(CI = 1.5-2.1). A gradient across all quintiles was proven (for 2nd quintile OR = 1.6(CI = 1.3-1.9), for 3rd OR = 1.4(CI = 1.1-1.7), for 4th OR = 1.3(CI = 1.1-1.5)). Compared to participants with very good/good health, those who perceive own health as very poor/poor had 3 times higher odds (CI = 2.5-3.5) to report unmet need; for those with average health OR = 1.7(CI = 1.5-1.9). Suffering from chronic illness increases odds 2.2 times (CI = 1.9-2.5). Conclusions The highest probability for unmet needs was established across most vulnerable groups, which is significant for preparing for future public health crises and preventing increase in health inequalities during them. Key messages • During the pandemic,there was a higher probability of unmet health needs among the most vulnerable groups. • Strategies need to be put in place to prevent health inequalities deepening in a future crisis.

Differing needs for Advance Care Planning in the Veterans Health Administration: use of latent class analysis to identify subgroups to enhance Advance Care Planning via Group Visits for veterans

BackgroundAdvance Care Planning via Group Visits (ACP-GV) is a patient-centered intervention facilitated by a clinician using a group modality to promote healthcare decision-making among veterans. Participants in the group document a “Next Step” to use in planning for their future care needs. The next step may include documentation of preferences in an advance directive, discussing plans with family, or anything else to fulfill their ACP needs. This evaluation seeks to determine whether there are identifiable subgroups of group participants with differing needs prior to delivery of the ACP-GV program and, if so, to use information about the subgroups to enhance the program offered to veterans in United States Department of Veterans Affairs (VA) healthcare settings.MethodsWe conducted a secondary analysis of national data from a quality improvement evaluation. Patient- and provider-level data from administrative healthcare records for VA users in all 50 states, territories, and the District of Columbia provides data on veterans attending ACP-GV during federal fiscal years 2018–2022 (N = 26,857). Latent class analysis seeks to identify the various subgroups of veterans based on their level of ACP self-efficacy before attending ACP-GV and any demographic differences across the resulting subgroups of veterans attending ACP-GV. ACP self-efficacy is derived from seven items obtained from a participant worksheet used during the group.ResultsAnalysis revealed two distinct groups of veterans, distinguishable by their pre-ACP-GV levels of one aspect of ACP self-efficacy: prior knowledge of ACP. Veterans with higher prior knowledge of ACP are associated with an identified next step focused on checking their current AD status and updating it, and veterans with lower ACP prior knowledge are associated with identifying a next step to discuss ACP more fully with family. Differences in age, sex, race, ethnicity, and marital status exist across subgroups of veterans.ConclusionGreater attention must be paid to ACP and veterans’ prior knowledge of ACP to consistently encourage annual review and status updates.

Sociodemographic and lifestyle correlates of energy drinks consumption in Serbian adolescents

Abstract Background and aim Energy drinks (EDs) are non-alcoholic beverages that typically contain high levels of caffeine and sugar in combination with other ingredients known to have stimulant properties. Although there is growing evidence of the harmful physiological and psychological effects of energy drinks their popularity has increased during the past decade. While researchers point out variety of health consequences, data on prevalence and correlates of EDs consumption are scarce. Aim of the study was to determine prevalence of EDs consumption and to investigate sociodemographic and lifestyle correlates of EDs consumption among adolescents in Serbia. Study design Secondary analysis of data obtained from 2022 Health Behaviour in School-aged Children Study (HBSC) in Serbia. Study included 3962 students aged 11, 13 and 15 years. Students with missing values for one or more study variables were excluded from the analyses. Methods Multiple logistic analyses stratified by age and sex were performed to estimate the associations between consuming EDs and sociodemographic and lifestyle characteristics. Results Overall, 15.6% of students consumed EDs more than once a week (16.2% of boys and 15.5% of girls) with highest percentage among 15-year-old students (20.3%). For both genders, the percentage of adolescents consuming ED more than once a week was higher among adolescents with lowest family affluence (21.9%), those consuming soft drinks daily (39.5%) and alcohol weekly (47.6%). In boys only, consuming ED several times a week was more frequent among adolescents having at least 60 min moderate-to-vigorous physical activity (MVPA) daily than among those with lower levels of MVPA. Conclusions Different patterns of ED consumption were identified suggesting need for tailored interventions aimed at reducing ED consumption in adolescents. Key messages • Every fifth h 15-year-old student in Serbia consume EDs more than once a week. • Higher EDs consumption among physically active boys indicate need for targeting interventions that will address this issue.

Cardiometabolic multimorbidity and associated risk factors in a cohort identified through community-based screening in Eastern Nepal

Abstract Background Cardiometabolic multimorbidity constitutes a major cause of premature mortality and morbidity in low- and middle-income countries like Nepal. Early detection of associated risk factors and timely management at primary care centres can significantly reduce the impact at individual level. Lack of quality research data in resource poor setting often pose a challenge to plan for efficient delivery of health services. Purpose This analysis of secondary data from a cohort identified through a community based NCD intervention program intends to explore the distribution of cardiometabolic multimorbidity and associated risk factors in adult population of Eastern Nepal. Methods This report is a part of integrated NCD management strategy, a KHDC (Kidney, Hypertension, Diabetes, and Cardiovascular disease) program, implemented through community-based screening and interventions focused on primary level healthcare centres. The KHDC program involved screening of 14,517 individuals aged 18 years and above at baseline during a period of 2019-2023 for selected NCDs, including, cardiovascular diseases, hypertension, diabetes, and kidney disease. Individual level data was collected through anthropometric measurements, participants’ self-report, vitals assessment, laboratory parameters and diagnostic adjuncts including ECG and Echocardiography. Outcome of cardiometabolic multimorbidity1 was defined as presence of two or more of diabetes mellitus, and cardiovascular diseases including myocardial infarction and stroke. Results About 12.8% (n=1862) of the participants had at least one cardiometabolic multimorbidity, while less than one per cent (n=47) had two or more multimorbidity. Presence of at least one multimorbidity was associated with older age ≥ 40 years [OR: 3.870 (95% CI: 3.285-4.558)], male gender [OR: 1.326 (95% CI: 1.202-1.463)], BMI ≥ 23 kg/cm2 [OR: 1.348 (95% CI: 1.208-1.503)], current tobacco consumption [OR: 1.164 (95% CI: 1.038-1.305)] and co-occurrence of hypertension [OR: 1.736 (95% CI: 1.550-1.943)]. The presence of both diabetes mellitus and cardiovascular disease was associated with age ≥ 40 years [OR: 7.612 (95% CI: 1.846-31.395)] and co-occurrence of hypertension [OR: 2.544 (95% CI: 1.401-4.620)]. Conclusion Disproportionate burden of cardiometabolic multimorbidity was apparent among adult population screened in our program. Older age and co-occurrence of hypertension was identified as contributing factors for the presence of such multimorbidity. A baseline information on the distribution and risk factors for the same among general population can provide a valuable insight into understanding the disease progression and prognostic outcomes.Table of Outcomes

Consumption and expenditure of antidepressants and anxiolitycs in 14 European countries

Abstract Background Since the burden of depressive and anxiety disorders, assessing the use and spending of drugs commonly prescribed for treating such conditions is a valuable barometer of mental health assistance and healthcare services. The current research aims to evaluate the consumption of antidepressants and anxiolytics and the relative expenditure among 14 European countries (Austria, Czech Republic, Finland, Germany, Hungary, Italy, Latvia, Luxembourg, Norway, Portugal, Slovak Republic, Slovenia, Spain and Sweden). Methods A retrospective longitudinal study was assessed based on pooled time series analysis of secondary data over ten years (2012-2021). Defined Daily Doses (DDD) per 1,000 inhabitants and health expenditure per capita (current US$, computed on purchasing power parity) were considered. Linear and quadratic trends were calculated for defining relationships between the variables of interest. Results Prevailing patterns of consumption and spending show an increase in antidepressants and a decrease in anxiolytics. Noteworthy is the growth slope of antidepressant consumption in three selected countries, Portugal, Spain, and Sweden, by over two and a half times from 2012 to 2021. In addition, for a few countries, there is a pattern contrary to most countries for anxiolytics (Latvia, Spain) and discordant between consumption and expenditure for antidepressants (Austria, Hungary). Conclusions The widespread growth of antidepressant use deserves attention. As a public health issue, the prescription and use of antidepressants should be addressed by targeted policies for integrating multifaceted strategies. Key messages • Monitoring consumption and expenditure of antidepressant and anxiolytic drugs represents a valid tool for assessing the efficacy and availability of mental healthcare services among the population. • The growth in the consumption of antidepressants represents a relevant public health issue and deserves attention for the evaluation of an integrated approach of assistance.

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.

Trends in diabetes morbi-mortality and its association with abdominal obesity among Tunisian adults

Abstract Introduction Tunisia is undergoing rapid nutritional transition, with increasing rates of abdominal obesity. Coupled with rising diabetes prevalence, it poses significant challenges to public health. This study aimed to estimate the morbi-mortality prevalence and trends of diabetes among Tunisian adults, particularly examining its association with abdominal obesity. Methods We conducted a secondary data analysis on adults aged 35 to 70 from three national surveys in Tunisia, in 1996 (n = 3513), 2005 (n = 7700), and 2016 (n = 6007) respectively. Mortality data was sourced from the Tunisian National Information System on Causes of Death in 2020. The underlying cause of death was determined using the IRIS software, following WHO guidelines for tabulating mortality statistics. Diabetes was defined according to the American Association of Diabetes criteria. Abdominal obesity was defined as a waist-to-height ratio ≥ 0.6. We performed chi-squared test for trend analysis. Results A total of 17220 participants were analyzed. We found a significant upwards trend in diabetes prevalence (p &amp;lt; 10-3): it increased from 13.1%[11.9-14.3] in 1996 to 15.1% [12.5-17.4] in 2005, then to 20.5%[18.9-22.1] in 2016. Linear trend test concluded to significant increase in diabetes prevalence estimated at 56.6% in two decades. Diabetes was significantly associated with abdominal obesity (Odds ratio (OR)=2.17[2.11-2.21]). Diabetes was the leading cause of death among Tunisian adults in 2020 (n = 22715). The proportional mortality due to diabetes was estimated at 6.2% (n = 1407) (6.4% for men and 6% for women). The age group with the highest proportional mortality due to diabetes was 65-70 years old (44.6%). Conclusions Our findings highlight the burden of diabetes on public health in Tunisia and its association with abdominal obesity. Hence the urgency to strengthen comprehensive preventive and control measures to alleviate its repercussions among the Tunisian population. Key messages • The prevalence of diabetes increased significantly amongTunisian adults in the past two decades. • Immediate implementation of targeted interventions and policy measures is imperative to effectively address this issue.

Identifying the zero-dose and under-immunized children in Bangladesh: Approaches and experiences.

This paper presents and elaborates on empirical methods and approaches used to identify Zero-Dose (ZD) and Under-immunized (UI) children as well as the communities that these children reside in within Bangladesh. This paper also describes demand- and supply side-barriers that lead to children being ZD and UI in the country. Time period for the study was December 2022-May 2023. The study methodology encompassed secondary data analysis using data from national surveys, primary data collection and analysis via a lot quality assurance sampling (LQAS) survey and also, qualitative data collection and analysis. Study population included caregivers of children aged 4.5 months (4 months 15 days) to 23 months for the LQAS survey. The qualitative component included policymakers, program managers and service providers working in immunization as well as mothers in the selected study areas who had a living child aged less than 2 years as the study population. Our data analysis confirms existence of ZD and UI children in areas which were categorized into haor (wetlands), hilly, char (sandy/silty land surrounded by water), coastal, plain land and urban slums. Determinant analysis showed that the mother's level of education, antenatal visits made, and access to media were significantly associated with children being ZD or UI. Reproductive autonomy emerged as a key factor that had prominent impact on a child being ZD. The qualitative analysis indicated the importance of population migration, health workforce shortages and lack of access to transportation as prominent barriers to immunization. Notably, the methods and approaches used in this study are both effective and easily replicable to identify ZD and UI children. The drivers of ZD and UI along with the barriers to immunization provide potential areas for intervention by policy-makers and can apprise about interventions to be tested in future implementation research.

The cost burden of adolescent and young adult pregnancy: real-world evidence from the Brazilian public health care system

Background In low- and middle-income countries, pregnancy in adolescence represents an important public health issue. Rates of early pregnancy have significant social and economic consequences that extend beyond the individual sphere, impacting public/governmental budgets. Aim To estimate the cost implications of early pregnancies from the perspective of the Brazilian Unified Public Health System. Methods This retrospective secondary data analysis focuses on assessing direct hospital costs. The study cohort comprises adolescents and young adults who underwent prenatal care at a reference maternity hospital between January and December 2021. Individual procedure costs were extracted from hospital records and converted into monetary values using the Brazilian Federal Fee. The sample size for each group was determined based on preliminary data collected during a pilot study. Descriptive analyses presented costs stratified by age groups. To estimate budgetary impacts and sensitivity we used national live birth incidence rates. Results The mean cost per case of adolescent pregnancy was US$ 704.92 (SD: 1,707.74) and for adult pregnancy was US$ 592.40 (SD: 941.43). The cost of hospital admission accounted for 61% of the total cost of adolescent pregnancies. The annual budget impact of pregnancies among women under 30 years was estimated at US$ 1 billion, with 239 million coming from women under 20 years old. Conclusion Pregnancy in adolescence may lead to a significant annual budget impact, representing 24% of costs attributed to pregnancies among women under 30 years. Costs related to hospital admissions and complications represent a substantial share of the total costs of adolescent pregnancy.

Using English General Practice Patient Survey data to explore Long Covid prevalence

Abstract Background High global burden of Long Covid (LC) has significant implications for population wellbeing, health/social care and the economy. We aimed to assess prevalence of LC, the level of uncertainty general practice (GP) patients felt about whether they were experiencing it and patient characteristics associated with LC. Methods This is a secondary data analysis of GP Patient Survey 2023 data (759,149 participants aged 16+yrs in England). The outcomes included self-reported LC, and being unsure about having LC. Identity and socioeconomic characteristics were explored in relation to these outcomes using univariable and multivariable regression analyses. Results 4.8% of respondents described themselves as having LC, and 9.1% were unsure whether they had it. Patient age (highest odds at 35-54 years), sex (females more than males), ethnicity (highest odds in Gypsy or Irish Traveller), sexual orientation (increased odds in gay or lesbian or bisexual compared to heterosexual), religion, smoking, carer status, parental status, having a long-term condition, and area-level index of multiple deprivation (higher odds in more deprived areas) were all significantly associated with reporting having LC in the multivariable model compared to answering that question with ‘no’. Generally, similar patterns of association to the above were observed in those who answered the Long Covid question with ‘unsure’ compared to those answering ‘no’, except for parental status and sexual orientation which were not significantly associated with the outcome in the multivariable model. Conclusions This study quantitatively highlights the high levels of uncertainty among primary care patients around experiencing LC, and the unequal distribution of LC burden among population groups. Our findings underline the need for better public health and primary care messaging to raise awareness around LC and ensure that those needing support can access services, particularly those already disadvantaged in society. Key messages • There are high levels of uncertainty about having Long Covid among people attending primary care services. • There is unequal burden of Long Covid in England underlining the need for improved awareness and access to support, particularly for minoritised groups.

ANALYSIS OF WOMEN’S SERVICE NETWORKS IN NORTHEAST BRAZIL: CHALLENGES AND PERSPECTIVES FOR THE EFFECTIVENESS OF SERVICES

This article proposes a critical analysis of women's care networks in the Northeast of Brazil, focusing on support services for victims of violence and the promotion of women's health and rights. The research aims to identify the main challenges faced by care networks in the region and explore possible strategies for improving the effectiveness of these services. The analysis will be based on a combination of literature review, secondary data analysis.

The Impact of COVID-19 Pandemic on the Banking Industry and Its Customers

, including customer demand, digital transformation, risk management methods, and overall financial performance. Focusing on shifts in client demand for loans and financial products, the rise of digital banking, and banks' reactions to increased financial risks, this study examines how the pandemic affected conventional banking operations and customer interactions. The goals of the research are to look at how banks changed their services throughout the pandemic, how they dealt with risk, and how well they did financially. The research relies on secondary data analysis that scours academic journals, government documents, business reports, and bank records. Findings highlight a sharp drop in loan demand in the early phases of the epidemic, followed by a dramatic increase in demand for mortgage refinancing and corporate loans supported by the government. Online and mobile banking saw a meteoric rise in popularity as more and more clients made the switch. Lending restrictions and provisions for non-performing loans were tightened by banks in response to financial instability, which had a detrimental impact on their profitability. Better digital banking infrastructure, more robust risk management frameworks, and more adaptable financial products that can react to crises more effectively are some of the long-term consequences that the study emphasizes for the banking sector. At its end, the paper suggests ways financial institutions might be better ready for future disruptions and urges additional investigation into how fintech will play a role and how regulations will alter in the banking industry after a pandemic.

Empowering marginalised communities: Leveraging indigenous knowledge for sustainable energy development in South Africa

AbstractAmidst South Africa's volatile energy landscape—characterised by political turbulence, economic instability and Eskom's chronic financial and operational challenges—the imperative for transformative reform is both urgent and indispensable. Municipalities are confronted with deteriorating infrastructure, recurrent power disruptions and widespread electricity theft, which collectively exacerbate the national energy crisis. This paper investigates the integration of indigenous knowledge systems within the country's energy sector as a strategic response to these persistent challenges, promoting the empowerment of marginalised communities and advancing environmental sustainability. Anchored in the theoretical frameworks of environmental justice and indigenous rights, the paper advocates for Afrocentric paradigms such as traditional resource governance and community‐driven energy solutions. Employing thematic analysis of secondary data, it evaluates the viability and prospective benefits of this paradigm shift. The paper posits that the inclusion of indigenous knowledge in energy practices not only presents tangible solutions to the energy crisis but also cultivates socio‐economic empowerment and reinforces environmental stewardship.