Sociodemographic Characteristics Research Articles

Primary care physician eHealth profile and care coordination: a cross-sectional study.

Digital health holds promise for enhancing care coordination and supporting patient self-management. However, various barriers, including at the healthcare professional level, hinder its adoption. This cross-sectional study explored the eHealth profile of primary care physicians and its relationship with care coordination. As part of "The Commonwealth Fund's 2022 International Health Policy Survey of Primary Care Physicians in 10 Countries", 1114 physicians in Switzerland completed a questionnaire on their sociodemographic and workplace characteristics, digital health use and care coordination practices. Based on their responses concerning the modality, frequency and application of digital health tools, we created a digital health score. Based on responses describing the collaboration with specialists and paramedical health professionals, we created a care coordination score. The associations between both scores were assessed using stratified analyses and multiple linear regression. Among the 1114 participants (46% women, mean age 52 years), 83% used electronic patient records, 96% used teleconsultations for less than 5% of consultations, and 63% never used connected health tools to monitor patients with chronic diseases. Further, 16% allowed online appointments, 20% online medical prescriptions, 52% the possibility of electronically communicating lists of medications with other healthcare professionals, and 89% the possibility of email or web communications with the patient. The eHealth score was positively associated with the number of weekly working hours, being an internal medicine specialist or practising physician, the number of full-time equivalents in the practice and being in a group practice setting. The higher the eHealth profile score, the higher the care coordination score. Digital health and care coordination were positively associated. This could underscore the potential benefits of digital health in enhancing collaborative and interprofessional care practices.

Statistical analysis of seroprevalence and risk factors of hepatitis C in Nowshera District, Pakistan

Hepatitis C virus (HCV) transmission remains a significant public health concern. It is well documented globally, however, Nowshera district, Pakistan, is lacking such profile. This study aims to explore the relationship between HCV infection and several risk factors, including socio-demographic, clinical and personal life-style factors. This study using a cross-sectional design, examined 606 randomly selected individuals visiting the Pathology department at Qazi Hussain Medical Complex and District Headquarter (DHQ) Hospital Nowshera between May 1, 2022 and Jun 30, 2023. This research investigation employed a methodical approach involving formal interviews in conjunction with structured questionnaires to gather comprehensive information related to socio-demographic characteristics, clinical history, and personal hygiene practices. We collected 10 ml of blood samples and tested the separated serum to identify markers using the Immuno-Chromatographic Test (ICT) and the Enzyme-Linked Immunosorbent Assay (ELISA). IBM SPSS Statistics version 27 was used for data analysis. To measure the association between dependent variable and independent variables, a chi-square and risk analysis was carried out; multiple logistic regression was employed for modeling the risk factors associated with independent variable. A statistical significance level was established at a P-value of less than 0.05. In present study, which included 606 participants, 12% were found to be infected with HCV. Importantly it revealed that facial shave at barber (adjusted odds ratio, aOR = 40.65, p = 0.000) represents the most prevalent mode of HCV transmission. Additionally, a strong association was observed between HCV infection and history of past surgery (RR = 2.98, p = 0.001), HCV infected family member (aOR = 4.28, p = 0.001), workplace injuries (aOR = 6.68, p = 0.000), history of hospital admission (RR = 2.09), practicing ear and nose piercing (aOR = 5.01, p = 0.001), dental treatment (RR = 2.31) and the frequency of injections (aOR = 8.607, p = 0.000). These findings underscore the pressing need for targeted interventions. This study highlights the paramount importance of understanding the modes of HCV transmission and their associated risk factors. The results emphasize the need for educational initiatives, both within the healthcare sector and among the general public, to combat HCV transmission effectively. By implementing sterilization procedures and increasing awareness, we can make significant strides in reducing the burden of HCV infection. Moreover, proactive measures within families can help contain the spread of the virus, ultimately contributing to improved public health.

Muscle-strengthening activity is associated with total alcohol consumption and binge drinking among U.S. college students

Objective: To examine the association of muscle-strengthening activity with total alcohol consumption (AC) and binge drinking (BD). Participants: College students (n = 1623) from a large United States university. Methods: Students self-reported their physical activity (PA), AC, and socio-demographic characteristics via an online survey. Hierarchical regression models were computed to examine the association of aerobic PA, and muscle-strengthening activity with total AC and BD. Results: After adjusting for socio-demographic characteristics and aerobic PA, muscle-strengthening activity and achieving muscle strengthening activity recommendations explained a significant proportion of unique variance in total AC (β = .16, p < .001 and β = .16, p < .001, respectively). Similarly, with each additional day of muscle-strengthening activity the odds of reporting BD were 20.9% higher, and individuals who met muscle-strengthening activity recommendations had 93.2% higher odds of reporting BD. Conclusions: Muscle-strengthening activity should be accounted for when examining the relationship between PA and AC.

Determinants of Length of Stay for Medical Inpatients Using Survival Analysis

With the increase in insured patients and an aging population, managing the length of stay (LOS) for inpatients has become crucial for controlling medical costs. Analyzing the factors influencing LOS is necessary for effective management. Previous studies often used multiple or logistic regression analyses, which have limitations such as unmet assumptions and the inability to handle time-dependent variables. To address these issues, this study applied survival analysis to examine the factors affecting LOS using the National Health Insurance Service (NHIS) sample cohort data from 2016 to 2019, covering over 4 million records. We used Kaplan–Meier survival estimation to assess LOS probabilities based on sociodemographic, patient, health checkup, and institutional characteristics. Additionally, the Cox proportional hazards model controlled for confounding factors, providing more robust validation. Key findings include the influence of age, gender, type of insurance, and hospital type on LOS. For instance, older patients and medical aid recipients had longer LOS, while general hospitals showed shorter stays. This study is the first in Korea to use survival analysis with a large cohort database to identify LOS determinants. The results provide valuable insights for shaping healthcare policies aimed at optimizing inpatient care and managing hospital resources more efficiently.

How Psychophysical Stress Can Mediate the Effects of Anxiety and Depression on the Overall Quality of Life and Well-Being in Women Undergoing Hereditary Breast Cancer Screening.

Background: Women undergoing genetic counseling for hereditary breast cancer often experience a high emotional burden. Distress and stress in the initial phases of genetic counseling can be significant predictors of long-term psychological health, influencing quality of life and well-being. Objectives: This study aimed to evaluate the mediating role of psychophysical stress in the relationship of anxiety and depression with quality of life and well-being in women undergoing genetic counseling for BRCA1/2 mutations. Methods: A sample of 193 women from two genetic counseling clinics was assessed using validated questionnaires measuring the psychological variables under study. Sociodemographic and clinical characteristics were also considered. Results: The results of path analyses indicated a mediating role of psychophysical stress on the relationship between emotional distress and mental quality of life and well-being: higher levels of anxiety and depression were associated with increased psychophysical stress, which, in turn, was linked to a reduced perceived mental quality of life and well-being. Depression was the only significant psychological predictor of physical quality of life. Conclusions: These findings indicate that addressing both anxiety and depression in genetic counseling is crucial for enhancing mental and overall well-being. Interventions should focus on stress management to improve the quality of life, emphasizing depression treatment to enhance physical health outcomes.

Ensemble of hybrid model based technique for early detecting of depression based on SVM and neural networks

The prevalence of depression has increased dramatically over the last several decades: it is frequently overlooked and can have a significant impact on both physical and mental health. Therefore, it is crucial to develop an automated detection system that can instantly identify whether a person is depressed. Currently, machine learning (ML) and artificial neural networks (ANNs) are among the most promising approaches for developing automated computer-based systems to predict several mental health issues, such as depression. This study propose an ensemble of hybrid model-based techniques that aims to build a strong detection model that considers many psychological and sociodemographic characteristics of an individual to detect whether a person is depressed. Support vector machines (SVM) and multilayer perceptrons (MLP) are the two fundamental methods used to construct the suggested ensemble approach. The hybrid DeprMVM served as a meta-learner. In this study, the hybrid DeprMVM is a level-1 learner, whereas the SVM and MLP networks are level-0 learners. After the classifiers are trained and tested at level 0, their outputs are based on both the independent and dependent variables in the new data set that was used to train the meta-classifier. The training data class imbalance was reduced by applying the synthetic minority oversampling technique (SMOTE) and cluster sampling together, which improved the accuracy for detecting depression. Additionally, it can effectively reduce the risk of over-fitting from simply duplicating data points. To further confirm the effectiveness of the proposed method, various performance evaluation metrics were calculated and compared with previous studies conducted on this specific dataset. In conclusion, among all the techniques for identifying depression, the suggested ensemble approach had the best accuracy, at 99.39%, and an F1-score of 99.51%.

Development and validation of a measure for father involvement during early childhood in a resource-limited context

BackgroundGlobally, there is mounting evidence about the importance of father involvement for improving child and family wellbeing. However, there are limited measurement tools available for assessing father involvement in low-resource settings globally. The objective of this study was to develop and validate a scale for measuring fathers’ engagement in caregiving activities for young children and families in rural Kenya.MethodsWe used baseline data collected in February–March 2023 from a cluster-randomized controlled trial of a parenting intervention aimed at improving early child development in Nyamira and Vihiga counties in Western Kenya. The analytic sample comprised 460 primary caregivers of children under 18 months of age (91.3% mothers) who were in a relationship with a male caregiver of the young child (i.e., father). The primary caregiver reported on the 25-item father involvement scale. We conducted exploratory and confirmatory factor analyses to determine the dimensionality of the measure and estimated latent variable regression models to assess construct and predictive validity in terms of associations with sociodemographic factors, other paternal and maternal psychosocial measures, and early child development outcomes.ResultsThe scale had a four-factor structure representing father involvement in (1) childcare activities, (2) play and affection, (3) household chores, and (4) early learning activities. Each factor showed good internal consistency reliability and evidence of multiple forms of validity. The four factors were associated with child and household sociodemographic characteristics and more positive paternal and maternal psychosocial outcomes. Father involvement across all four domains was associated with higher early child cognitive, language, motor, and socioemotional development scores.ConclusionsOur findings highlight the multidimensional nature of fathers’ caregiving roles in the lives of young children and their families. We establish a valid tool for assessing father involvement in rural Western Kenya that has potential for use in other similar contexts.

Monitoring of urinary nickel and chromium in metal industries workers in Alborz, Iran

Heavy metal contamination from occupational sources is a cause for concern due to its potential accumulation in the environment and the body of living organisms, which leads to long-term toxic effects. There is limited evidence on the concentration of heavy metals in the body fluids of welding workers. This study aimed to measure the concentration of nickel (Ni) and chromium (Cr) as two main toxic heavy metals in the urine samples of welders and determine the potential relationship of various environmental factors on their concentration levels. This study was conducted in Iran in 2022–2023. Eighty-five urine samples were collected from the studied welding workers. Inductively coupled plasma optical emission spectrometry (ICP-OES) was used to measure the concentration of Ni and Cr. Data related to socio-demographic characteristics (education level, income, work experience, age, and body mass index (BMI)), lifestyle profile (consumption of seafood and canned food, smoking, physical activity), type of ventilation and preventive devices at work, and suffering from underlying diseases (cardiovascular and high blood pressure) were collected using valid questionnaires. Ni and Cr were present in 100% of urine samples with mean concentrations of (1.09 ± 0.294) and (11.45 ± 16.751) µg/g creatinine, respectively. A significant correlation was observed between the mean concentration of Ni and Cr with the level of education, income, work experience, age, consumption of seafood and canned food, smoking, type of ventilation and preventive devices, and underlying diseases (p-value < 0.05). Also, there was no significant difference between Ni concentration and physical activity and Cr concentration with BMI. Lifestyle determinants and not using preventive devices are important predictors of urinary heavy metals in welding workers. Therefore, more research is required to determine the adverse effects of long-term exposure to these heavy metals.

Associations between child protective services workers’ attitudes toward kinship foster care placement, sociodemographic characteristics, and job characteristics

ABSTRACT When necessary to separate children from their parents, placing a child with kin leads to better outcomes. Child Protective Services (CPS) staff attitudes toward kinship foster care placements are an understudied factor that may influence decision-making and vary based on staff characteristics. Using February 2023 survey data from 2,861 CPS staff and multivariate linear regression analyses, we assessed associations between staff’s sociodemographic and occupational characteristics and attitudes toward kinship placement. Gender, race, position, work unit, and employment duration with CPS were significantly associated with staff attitudes. Understanding how staff view kinship placement is an important step toward removing barriers to its use.

Association Between Socio-Demographic Characteristics and Household Food Waste Behaviors Among University Students in Italy: The UniFoodWaste Study

Food waste is a growing environmental, economic, and social challenge worldwide. This study aimed to assess the association between various socio-demographic characteristics and household food waste behaviors among university students in Italy. A cross-sectional study was conducted using a validated, online, anonymous, and voluntary-based questionnaire distributed among university students in Milan, Italy. Linear regression analyses were performed to explore the association between socio-demographic factors and anti-household food waste behaviors (preventive practice, abilities scores, and parental guidance). A total of 2779 students participated in the survey. Students residing outside Lombardy exhibited higher preventive practice scores (β = 0.11, p = 0.030). Regular smoking was negatively associated with preventive practice (β = −0.22, p &lt; 0.001) and abilities scores (β = −0.11, p = 0.009). Cohabitation with a partner positively impacted abilities scores (β = 0.23, p = 0.007). Larger family sizes and students in scientific fields showed higher scores for parents’ guidance (β = 0.18, p &lt; 0.001). Frequent use of food delivery apps correlated with lower scores across all categories, while anti-food waste apps had a positive effect. Socio-demographic factors significantly influence food waste behaviors among university students. Tailored public health policies and educational programs addressing these factors could effectively reduce food waste.

Patient autonomy in self-managing their bronchial asthma exacerbation and its associated factors, 2024.

Asthma, a global chronic respiratory condition, varies in patient autonomy due to limited resources, health literacy, and cultural beliefs, emphasizing the importance of understanding this autonomy for improved asthma management. A cross-sectional study was conducted at Jimma University Comprehensive Specialized Hospital, involving face-to-face interviews with 175 patients. Data was collected on sociodemographic characteristics, clinical factors, and autonomy levels using a validated Patient Autonomy Preference Index. Descriptive statistics and binary logistic regression analysis were used. A total of 175 participants were recruited, out of them 41.7% (95% CI: 31.19, 40.41)) of participants were autonomous in managing their asthma exacerbation. 127 (72.6%) of study participants were female, with a mean age of 47.51 (SD ± 13.96), 101(57.7%) were live in urban areas, 54 (30.9%) had no formal education, 140 (80%) were married, 112 (64%) had health insurance, and 102(83.3%) obtained health information about their condition from healthcare workers. Reside in an urban area (AOR = 3.24; 95% CI: 1.40-7.49, p < 0.006), have health insurance (AOR = 4.30; 95% CI: 1.76-10.51, p < 0.001), those doing regular exercise (AOR = 4.79; 95% CI: 1.69-13.64, p < 0.003), have family history (AOR = 7.47; 95% CI: 1.61-34.60, p < 0.01), have a duration above five years since diagnosis (AOR = 0.44; 95% CI: 1.04-1.26, p < 0.003), and participants with a high level of health literacy (AOR = 1.10; 95% CI: 1.00-1.20, p < 0.042) become associated with being autonomous in managing asthma exacerbation. Only around forty-two percent of study participants were autonomous in managing their asthma exacerbation. Thus healthcare providers should give due attention to those who reside in rural areas, are not insured, recently diagnosed with asthma, and with low health literacy to enhance patient autonomy and self-management practices, ultimately improving health outcomes for individuals with asthma.

The effects of pregnancy on oral health, salivary ph and flow rate

BackgroundThe frequent occurrence of dental caries and periodontal diseases in women during pregnancy may be due to many factors, such as salivary variables. The aim of this study was to evaluate the effects of pregnancy on salivary pH, flow rate, the DMFT index, and CPI sores.MethodsA total of 198 volunteers (pregnant in different trimesters and non- pregnant) were included for the present observational cross-sectional study. Data about sociodemographic characteristics and dental and systemic health conditions were recorded. Unstimulated saliva samples were collected for 5 min via the spitting method. The pH of the saliva was measured by a portable pH meter. The salivary flow rate was determined by the weight measurement method. The DMFT index and CPI were determined. The statistical evaluation was performed using Robust ve Poisson Regression analyses (p < 0.05).ResultsIt was determined that there was a gradually significant decrease in the Ph value from the first trimester to the third trimester during pregnancy, which was lower than the control group. (p < 0.001) The flow rate of pregnants in their third trimester was lower than that of first trimester (p = 0.017). The CPI scores of pregnant women were significantly greater than that of non-pregnants (p = 0.042), while the DMFTs were similar among all groups.ConclusionOur findings indicate that pregnancy leads to a notable reduction in unstimulated salivary pH and flow rate, which also has a detrimental impact on periodontal health.Trial registrationClinical Trials-ID: NCT06343337; Registration Date: 04.01.2024.

Who is sufficient, and why? A mixed-methods approach to the social determinants of sufficiency lifestyles in the pursuit of decarbonisation

Sufficiency consists of less materially intensive consumption patterns that focus on wellbeing rather than material wealth. Such consumption patterns are commonly referred to as sufficiency lifestyles and are increasingly seen as a key driver for achieving decarbonisation. However, while research finds that sustainable consumption and environmental behaviour are often associated with high social status, lower carbon footprints and lower consumption more broadly are associated in the literature with poverty and deprivation. This article aims to investigate whether a combination of low carbon footprint and high wellbeing exists, what socio-demographic characteristics are associated with it, and to explore the actual experiences of people engaged in sufficiency lifestyles through initiatives and their characteristics. We use a mixed-methods design with data from demographically representative surveys in Denmark, Germany, Italy and Latvia (N=5,080), and in-depth interviews with participants from sufficiency-oriented intentional communities (N=90). We find that sufficiency lifestyles are linked to a stronger inclination towards sufficiency orientation or a heightened stronger environmental identity, accompanied by a negative correlation with social deprivation aspects. Drawing on the interviews, we find that individuals engaged in sufficiency-oriented practices tend to benefit from economic, social and cultural resources that allow them to overcome energy dependency and constraints, and that their motivations are not limited to pro-environmental behaviour. Based on these empirical findings, we explore potential avenues for the diffusion of sufficiency-oriented lifestyles, including the establishment of binding rules through a democratic process that curb overconsumption while providing attractive low-carbon lifestyles for all.

Exposure to secondhand smoke among school-going adolescents in Malaysia: Results from the National Health and Morbidity Survey (NHMS) 2022: Adolescent Health Survey (AHS).

The adverse effects of secondhand smoke (SHS) exposure on health have been well established. Using the NHMS 2002: Adolescent Health Survey (AHS), this study attempts to evaluate the extent and factors associated with SHS exposure among Malaysian school-going adolescents. We conducted the NHMS 2022: AHS to gather a representative sample of school-age teenagers. We employed a cross-sectional study design and a multi-stage sampling procedure. We utilized a pre-validated self-administered questionnaire to collect data from the selected respondents. The data analysis included adjusted odds ratios (AORs) with 95% confidence intervals (95% CIs). Additionally, we investigated the possible two-way interactions between the independent variables. The SHS prevalence was 42.0%. Exposure to secondhand smoke (SHS) was associated with male gender (AOR=1.28; 95 CI: 1.20-1.38), older age (AOR=1.46; 95% CI: 1.33-1.60), Malay (AOR=1.88; 95% CI: 1.49-2.37), Bumiputra Sabah (AOR=2.23; 95% CI: 1.67-2.99), Bumiputra Sarawak (AOR=2.43; 95% CI: 1.80-3.28), and Chinese ethnicity (AOR=2.89; 95 CI: % 2.30-3.64), as well as current smoking (AOR=2.78; 95% CI: 2.50-3.09), having separated or divorced parents (AOR=1.12; 95% CI: 1.02-1.23), and parental tobacco product use (AOR=4.75; 95% CI: 4.44-5.08). We found significant interactions between: 1) Age group with gender and ethnicity; 2) Gender and ethnicity; and 3) Parental smoking status with gender, response to tobacco use, parents' marital status, and ethnicity. Parental characteristics, sociodemographic characteristics, and SHS exposure are strongly correlated. In addition, there is evidence of smoking displacement to the house from other areas by parents/guardians. This study offers a fresh perspective on how these variables influence the likelihood of SHS exposure for Malaysian school-age teenagers. More efforts should focus on parental variables and sociodemographic traits, especially parental smoking cessation support.

Patient-, Provider-, and Facility-Level Contributors to the Use of Cardiology Telehealth Care in the Veterans Health Administration: Retrospective Cohort Study.

Telehealth (care delivered by phone or video) comprises a substantial proportion of cardiology care delivered in the Veterans Health Administration (VHA). Little is known about how factors specific to patients, clinicians, and facilities contribute to variation in cardiology telehealth use. The aim of this study is to estimate the relative extent to which patient-, clinician-, and facility-level factors affect cardiology telehealth use in VHA. This was a retrospective, nation-wide cohort study of veterans' use of VHA cardiology telehealth care during the first 2 years of the COVID-19 pandemic (March 11, 2020, to March 10, 2022). We constructed multilevel, multivariable, logistic regression models of patient-level cardiology telehealth use (telephone or video-based care). Models included random effects for the patient, the patient's main cardiology provider, and the patient's primary facility (ie, VHA medical center) for specialty care and fixed effects for patient sociodemographic and clinical characteristics. Our analytic cohort comprised 223,809 veterans with 989,271 encounters among 2235 unique clinicians. The veterans' average age was 70.2 years, and 3.4% (n=7616) were women. Of the 989,271 encounters, 4.2% (n=41,480) were video based and 34.3% (n=338,834) were phone based. Adjusted odds of telehealth use were slightly higher for women versus men (adjusted odds ratio [AOR] 1.08, 95% CI 1.05-1.10), individuals identifying as Hispanic or Latino versus not Hispanic or Latino (AOR 1.46, 95% CI 1.43-1.49), and those with medium and long drive times versus short drive time (AOR 1.11, 95% CI 1.10-1.12 and AOR 1.09, 95% CI 1.07-1.10, respectively). Further, 40.5% of the variation in a veteran's likelihood of using cardiology telehealth care was found at the patient level, 30.8% at the clinician level, and 7% at the facility level. The largest share of the attributable variability in VHA cardiology telehealth use in this cohort was explained by the patient, followed closely by the clinician. Little variability was attributed to the primary facility through which the veteran received their cardiology care. These results suggest that policy solutions intended to improve equity of cardiology telehealth care use in VHA may be most impactful when directed at patients and clinicians.

Antipsychotic prescribing practices and their association with rehospitalization in a forensic psychiatric sample.

While there is extensive literature examining the effectiveness of antipsychotic prescribing to patients with schizophrenia spectrum or other psychotic disorders in general psychiatric services, there is a dearth of studies examining antipsychotic prescribing practices and their effectiveness in forensic psychiatric services. Forensic psychiatric patients have unique challenges often due to their high-profile offences, public scrutiny, and legal requirements. This longitudinal, retrospective study aimed to examine antipsychotic prescribing and rehospitalization rates in a forensic psychiatric sample, along with relevant socio-demographic, clinical, and forensic characteristics. All patients had a psychotic illness and were prescribed antipsychotic medication. The sample included 153 patients, of which the majority were male (85.6%), Caucasian (71.2%), middle aged (30s to 50s), had schizophrenia or schizoaffective disorder (76.5%), had a substance use disorder (62.1%), and had a most serious index offence against the person (80.4%). Atypical antipsychotics accounted for the majority of antipsychotic prescriptions (75.9%) and the sample had an antipsychotic polypharmacy rate of 39.9%. The sample was divided into four primary antipsychotic formulation types, which were oral (34.0%), injection (39.2%), clozapine (19.0%), and subtherapeutic (7.8%). Regarding rehospitalization, 52.9% of the sample was rehospitalized, with the average number of rehospitalizations being 1.2 (SD = 1.7) and proportion of the follow up period rehospitalized being 16.4% (SD = 27.7%). Patients prescribed clozapine had numerically lower rates of rehospitalization than those prescribed oral and injection formulation types, but it was not statistically significant. With a 19.0% prescription rate, clozapine may be underutilized in this sample. Further research is needed to demonstrate the potential benefits of clozapine regarding rehospitalization in forensic psychiatric patients, as has already been done in general psychiatry. Advancing treatment of the high-profile forensic population can reduce stigma toward people with mental illness and criminal justice involvement.

Impact of marginalization on characteristics and healthcare utilization among people with substance use disorder in Ontario, Canada, before and during the COVID-19 pandemic: A cross-sectional study.

To describe and compare the characteristics of people with SUD and their use of healthcare services in two ways: 1) across varying levels of marginalization and 2) before and during the pandemic. We conducted a population-based cross-sectional study using administrative data from Ontario, Canada. We included individuals age 16+ with a recorded diagnosis of SUD between June 2018-2019 (pre-pandemic) and June 2021-2022 (during-pandemic). Baseline sociodemographic and clinical characteristics and use of healthcare services were enumerated across the five quintiles of the Ontario Marginalization Index. 259,497 pre-pandemic and 276,459 during-pandemic people with SUD were identified. Over 40% belonged to the two highest marginalization quintiles (Q4/Q5). Most had an outpatient visit with similar percentages across quintiles, however the number of visits increased with increasing marginalization (pre-pandemic: mean 8.5 visits in Q1 vs 13.0 visits in Q5; during-pandemic: mean 9.5 in Q1 vs 13.4 in Q5). There was no consistent pattern in percent of people who sought alcohol-related outpatient care, however more marginalized people sought drug-related outpatient care (pre-pandemic: 19.1% in Q1 vs 31.7% in Q5; during-pandemic: 18.7% in Q1 vs 32.5% in Q5). Almost half of people with SUD had an emergency department (ED) visit, of which more belonged to higher marginalization quintiles (pre-pandemic: 43.5% in Q1 vs 49.8% in Q5; during-pandemic: 41.4% in Q1 vs 49.3% in Q5). SUD prevalence and most health service utilization remained similar from pre- to during-pandemic. Increasing marginalization was associated with increased use of healthcare among people with SUD. Future research should aim to further explore the complex relationship between marginalization and substance use.

Anxiety, depression, stress, and resilience among undergraduate nursing students at Al-Quds university: the impact of war started on October 7 in Palestine

BackgroundThe current outbreak of war in Palestine on the 7th of October 2023, heightened concerns about mental health and well-being of individuals, particularly undergraduate students in Palestine. Such traumatic experiences and political conflict did affect the social, economic, psychological, and academic status of university students in Palestine, in particular, nursing students. However, resilience is one of the moderators which may positively decrease the severity of those negative war-related symptoms.AimThe study aimed to examine the moderation effect of resilience on the relationship between sociodemographic and personal characteristics and depression, anxiety, and stress among undergraduate nursing students in Palestine.Design and methodsA quantitative, descriptive-correlational design utilized to investigate anxiety, depression, stress, and resilience among nursing students. A convenience sample of 325 nursing students recruited from Al-Quds University were asked to respond to a self-administered questionnaire.ResultsA total of 325 nursing students participated in this study. The analysis showed that the majority of the participants were experiencing extremely severe anxiety levels (43.7%, n = 142), while 25.5% (n = 83) were experiencing extremely severe depression and 14.5% (n = 47) were experiencing high-stress levels compared to 60% (n = 195) of the students were at their normal resilience level. There were statistically significant differences in the resilience based on sex (t323 = 2.994, p = .003). Knowing that males have higher resilience mean scores (M = 3.06, SD = 0.35) than females (M = 2.93, SD = 0.41) indicates higher resilience in males than females. After performing two steps of hierarchical regression, the results revealed that resilience negatively moderated the relationship between sociodemographics and depression, and anxiety.ConclusionThis study offers valuable insights into the mental health status of undergraduate nursing students in Palestine during the war. The results indicated that resilience is one of the pivotal moderators that may buffer anxiety and depression. The findings underscore the need for targeted interventions to address the diverse mental health needs of this population, considering the complex interplay of individual, demographic, and contextual factors. Future research should continue to explore these dynamics and evaluate the effectiveness of interventions promoting mental well-being during conflict.

Factors Associated with Lipoprotein(a) Testing Among Multiethnic Individuals.

Lipoprotein(a) [Lp(a)] is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and clinical guidelines recommend incorporating Lp(a) testing in routine care. Examine real-world, contemporary clinical testing patterns of Lp(a) among multiethnic populations. In this nested case-control study, we assessed the prevalence and factors associated with Lp(a) testing within a large Northern Californian health system between 2010 and 2021. Incident density matching was used to select controls matched with a case for a case:control ratio of up to 1:5. Conditional logistic regression was used to assess the relationship between Lp(a) testing, sociodemographic, and clinical characteristics. We included individuals aged 18years or older with ≥ 2 primary care visits during the study period. Lp(a) testing rates over time and factors associated with testing based on demographic, medical, and healthcare utilization variables. Of the 1,484,410 individuals in the cohort, 14,818 (1.0%) underwent Lp(a) testing. The median Lp(a) level was 35mg/dL and over a third of individuals had Lp(a) levels > 50mg/dL. After adjustment, South Asian individuals were three times more likely to have undergone Lp(a) testing, as compared to non-Hispanic White individuals [OR = 3.19, (95% CI = 2.98, 3.41)], while those identified as non-Hispanic Black and Hispanic were significantly less likely to have undergone Lp(a) testing [OR = 0.70, (95% CI = 0.62, 0.80) and 0.64 (95% CI = 0.59, 0.69), respectively]. Those with a history of ASCVD had over twice the odds of undergoing testing [OR = 2.14 (95% CI = 1.99, 2.29)], as did individuals with more frequent primary care visits [OR = 1.99 (95% CI = 1.84, 2.15)]. Lp(a) testing rates in real-world settings are low, with significant disparities by race, ethnicity, and healthcare utilization. Expanding access to Lp(a) testing may help reduce disparities within ASCVD risk assessment and treatment as new targeted therapeutic agents become available.

Self-Guided Blood Pressure Screening in the Community, Opportunities, and Challenges.

Community-based health check kiosks provide opportunities to improve the detection and long-term monitoring of hypertension. We describe the sociodemographic and cardiovascular characteristics of first-time and repeat users of these kiosks. This was an observational study. Deidentified data collected from 430 SiSU Health consumer-facing health check stations in pharmacies across Australia between January 2018 and November 2020 were analyzed. Using a logistic regression, we identified factors associated with repeat checks in the overall cohort and in those with possible hypertension presented as adjusted odds ratios (aOR) and 95% CIs. A total of 982 122 unique checks were conducted; 54% (n=530 139) of the health check users were female, and the average age of all users was 38.2 (SD, 16.0) years. Notably, 13% used the kiosks more than once. Overall, 22% met the definition of possible hypertension, 16% (n=136 345) had blood pressure (BP) ≥140/90 mm Hg, 4% (n=34 349) had BP >160/100 mm Hg, and 13% (121 282) reported taking BP medicines. In the adjusted analysis, first-time users who were aged 50 to 69 years (aOR, 0.91 [95% CI, 0.87-0.96]) or ≥70 years (aOR, 0.68 [95% CI, 0.62-0.74]) were less likely than young users (18-29 years) to return for a second health check. Those in very remote areas were 61% (aOR, 0.39 [95% CI, 0.19-0.72]), and smokers were 13% less likely to return (aOR, 0.87 [95% CI, 0.83-0.91]). People taking BP medications were more likely to return (aOR, 1.16 [95% CI, 1.09-1.22]). Community-based health checks may identify people with high BP and could provide an option for self-monitoring. Broader implementation is needed to increase the reach in rural areas and among the elderly population.