Related Socioeconomic Factors Research Articles

Hypertension among persons with type 2 diabetes and its related demographic, socioeconomic and lifestyle factors in the Fasa cohort study

Hypertension is a very common comorbidity in type 2 diabetes patients, which leads to important health and treatment challenges. The present study was conducted with the aim of determining the prevalence of hypertension and its risk factors in type 2 diabetes patients. This study was conducted using cross-sectional data from 1245 participants aged between 35 and 70 years and diagnosed with type 2 diabetes at baseline in the Fasa cohort study. The prevalence hypertension was determined and multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between various risk factors and hypertension prevalence. The average age of the participants was 53.5 ± 8.7 years and 71.7% (n = 893) were female and 28.3% (n = 352) were male. The prevalence of hypertension in people with type 2 diabetes was 45.5% (n = 566). Higher age (AOR, 95% CI: 8.1, 4.6–14.3), female gender (OR, 95% CI: 1.8, 1.2–2.5), Fars (AOR, 95% CI: 1.6, 1.1–2.4) and Turk (AOR, 95% CI: 1.6, 1.1–2.5) vs. other ethnicity, and overweight (AOR, 95% CI: 1.8, 1.38–2.38) and obesity (AOR, 95% CI: 2.7, 2.0–3.8) vs. BMI < 25 was associated with a higher prevalence of hypertension, while higher physical activity (AOR, 95% CI: 0.57, 0.42–0.78) was associated with lower prevalence of hypertension in the multivariable model. The prevalence of hypertension in persons with type 2 diabetes was high and increased with greater age, in some ethnic groups, and with higher BMI and low physical activity. Further prospective studies are needed to investigate these associations in this population.

Preventable mortality, related socioeconomic, and cultural factors across European countries

Preventable mortality is a societal burden, impacting significantly on a country’s economy. The aim of this study is to identify the factors associated with the preventable mortality rate across European countries. The major contribution of this study comes from the consideration of cultural values to be related with preventable mortality. The cultural values taken into consideration are uncertainty avoidance and long-term orientation which have a strong correlation with economic preferences. For this purpose, panel data from 27 countries was collected for the period 2011–2019. Various models were applied to the dataset, including least squares dummy variable regression, AR(1) model, as well as Driscoll-Kraay, Prais-Winstein, and Hausman-Taylor models. Results show that while preventable mortality rate across European countries closely correlates with GDP per capita, social security expenditures, and air pollution, it is also associated with immigrants per capita and health expenditures. The key findings point to the relationship between cultural values and preventable mortality. These results show that designing effective policies and measures to reduce preventable mortality need to account for the cultural traits of the population.

In Patients With Rotator Cuff Tears, Female, Hispanic, African American, Asian, Socially Deprived, Federally Insured, and Uninsured Patients Are Less Commonly Treated Surgically

The purpose of the current study was to evaluate socioeconomic factors affecting whether a patient undergoes rotator cuff repair after a diagnosis of a rotator cuff tear. From 2009 through 2018, claims for adult (≥18 years of age) patients who were diagnosed with a primary rotator cuff injury were identified in the New York Statewide Planning and Research Cooperative System (SPARCS) database via International Classification of Diseases (ICD)-9th Revision-Clinical Modification (CM) and ICD-10-CM diagnostic codes. SPARCS is a comprehensive all-payer database collecting all inpatient and outpatient pre-adjudicated claims in New York. ICD-9-CM and ICD-10-CM codes were used to identify the initial diagnosis for each patient. Current Procedural Terminology codes were used to identify subsequent rotator cuff surgery. The procedures identified were linked with the initial diagnosis, and patients were noted as either having or not having rotator cuff surgery. Logistic regression analysis was performed for variables including age, sex, race, Social Deprivation Index (SDI), Charlson Comorbidity Index, and primary insurance type to determine the effect of patient factors on the likelihood of having surgery after a diagnosis of rotator cuff injury. Of the 67,584 rotator cuff patients included in the analysis, 19,770 (29.3%) of the patients underwent surgical intervention. From the logistic regression, females relative to males (odds ratio [OR]= 0.798, P < .0001), increased SDI (OR= 0.994, p < .0001), African American compared with White race (OR= 0.694, P < .0001), Asian compared with White (OR= 0.832, P < .0001), Hispanic compared with White (OR= 0.693, P < .0001), other race (OR= 0.58, P < .0001), those with Medicare (OR= 0.601, P < .0001) or Medicaid (OR= 0.614, P < .0001) relative to private insurance, and self-pay relative to private insurance (OR= 0.727, P < .0001) were all associated with decreased odds of undergoing rotator cuff surgery. Older patients (OR= 1.012, P < .0001) and Workers' Compensation relative to private insurance (OR= 1.664, P < .0001) had increased odds of undergoing surgery. The results of the current study identified disparities in the likelihood of undergoing rotator cuff repair after a diagnosis of a rotator cuff tear based on patient demographic and socioeconomic factors. Individuals with higher SDI; African American, Asian, Hispanic, or other non-White races; and those with Medicare, Medicaid, or self-pay insurance had decreased odds of surgery, whereas older age and Workers' Compensation insurance were associated with increased odds of undergoing surgery. Level IV, retrospective case series.

Assessing and Clustering Countries Based on COVID-19 and Related Indicators: Clustering and MULTIMOORA Approaches

The COVID-19 pandemic has been one of humanity's most difficult times. The pandemic spread and impact were not at the same level for all countries. Investigation of the variation of the countries is crucial for policymakers. Therefore, the study proposed to cluster countries according to the number of COVID-19 cases, deaths, vaccinations and related socioeconomic, disease, and health risk factors and rank them by using MULTIMOORA (MOORA plus the full multiplicative form) in an integrated way. The data set consists of 148 countries and 13 indicators. K-Means algorithm was used to cluster countries. Optimal cluster was found as six according to Silhouette Index. The cluster consisted of mostly developed countries ranked as best perform cluster. It had the highest number of COVID-19 vaccinations, GDP per capita, share health expenditure in GDP, life expectancy, elderly population portion, and environmental performance index values, and the least mortality of chronic diseases. Moreover, Norway, Iceland, and Denmark were the best-performing countries in this cluster. In addition to this, Turkey was located in the second-ranked cluster. It was also determined that COVID-19 indicators (cases, deaths, and vaccinations) were related to GDP per capita, environmental index, and life expectancy. As a result, policymakers can develop pandemic policies for country groups separately, and assistance can be provided in this regard according to the priority order of the countries.

Factors Influencing Adherence to Insomnia and Obstructive Sleep Apnea Treatments among Veterans with Mild Traumatic Brain Injury

ABSTRACT Objective To understand factors influencing adherence to recommended treatment for insomnia and obstructive sleep apnea (OSA) among Veterans with mild traumatic brain injury (mTBI). Method Semi-structured interviews (n = 49) with 29 clinical stakeholders and 20 Veterans were conducted. Clinical stakeholders included Veterans Health Administration providers and policymakers involved in the management of mTBI and/or sleep disorders. Veterans included those with a clinician-confirmed mTBI with a recent history of insomnia disorder and/or OSA treatment. Themes were identified using a Descriptive and Interpretive approach. Results Barriers to sleep disorder treatment adherence included factors associated with the patient (e.g., negative appraisal of treatment benefit), intervention (e.g., side effects), health conditions (e.g., cognitive challenges), health care system (e.g., limited availability of care), and socioeconomic status (e.g., economic instability). Similarly, facilitators of adherence included patient- (e.g., positive appraisal of treatment benefit), intervention- (e.g., flexible delivery format), condition- (e.g., accommodating cognitive impairments), health care system- (e.g., access to adherence support), and socioeconomic-related factors (e.g., social support). Conclusions Interviews revealed the multi-faceted nature of factors influencing adherence to sleep disorder treatment among Veterans with mTBI. Findings can inform the development of novel interventions and care delivery models that meet the complex needs of this population.

Adolescents and Psychosocial Issues: An Empirical Study

The adolescent period is a time of many upswings and downsides which requires constant support and guidance from parents, guardians and society. Moreover, adolescent girls face more psychosocial problems in contrast to boys, especially in India due to its different social and cultural environment. The psychosocial problems can have an adverse effect on the health of adolescent girls. Thus, social investment in adolescents is important not only for their well-being but also for society as a whole. The Integrated Child Development Services (ICDS) is one of the social investment programmes in India which seeks to address such problems in girls. The present research study has been carried out to explore the psychosocial issues of adolescent girl beneficiaries’ of the ICDS programme in Central Kashmir. Furthermore, the role of demographic and socio-economic factors in relation to psychosocial issues has also been examined. The research was both explorative and descriptive, and the data were analysed with quantitative techniques involving ANOVA in SPSS. The results obtained provide interesting insights into the research problems which can be beneficial for many stakeholders. The study results revealed that most of the beneficiaries had psychosocial issues such as somatic complications, adjustment problems, sleep problems, attention problems and sleep problems. However, these problems varied in relation to different demographic variables such as age, gender, education, district, economic status, etc. The research also provides interesting and valuable suggestions to different stakeholders regarding their role in solving the problems of adolescent girls.

Genetic ancestry is related to potential sources of breast cancer health disparities among Colombian women.

Breast cancer health disparities are linked to clinical-pathological determinants, socioeconomic inequities, and biological factors such as genetic ancestry. These factors collectively interact in complex ways, influencing disease behavior, especially among highly admixed populations like Colombians. In this study, we assessed contributing factors to breast cancer health disparities according to genetic ancestry in Colombian patients from a national cancer reference center. We collected non-tumoral paraffin embedded (FFPE) blocks from 361 women diagnosed with breast cancer at the National Cancer Institute (NCI) to estimate genetic ancestry using a 106-ancestry informative marker (AIM) panel. Differences in European, Indigenous American (IA) and African ancestry fractions were analyzed according to potential sources of breast cancer health disparities, like etiology, tumor-biology, treatment administration, and socioeconomic-related factors using a Kruskal-Wallis test. Our analysis revealed a significantly higher IA ancestry among overweight patients with larger tumors and those covered by a subsidized health insurance. Conversely, we found a significantly higher European ancestry among patients with smaller tumors, residing in middle-income households, and affiliated to the contributory health regime, whereas a higher median of African ancestry was observed among patients with either a clinical, pathological, or stable response to neoadjuvant treatment. Altogether, our results suggest that the genetic legacy among Colombian patients, measured as genetic ancestry fractions, may be reflected in many of the clinical-pathological variables and socioeconomic factors that end up contributing to health disparities for this disease.

Geospatial Associations between Female Breast Cancer Mortality Rates and Environmental Socioeconomic Indicators for North Carolina.

In North Carolina, over 6000 women will be diagnosed with breast cancer yearly, and over 1000 will die. It is well known that environmental conditions contribute greatly to health outcomes, and many of these factors include a geographic component. Using death data records from 2003-2019 extracted from North Carolina Vital Statistics Dataverse, a spatial database was developed to map and analyze female breast cancer mortality rates at the ZIP code scale in North Carolina. Thirty-nine hot spots and thirty cold spots of age-adjusted death rates were identified using the Getis-Ord analysis. Two-tailed t-tests were run between each cohort for environmental socioeconomic-related factors associated with breast cancer progression and mortality. The median age and household income of individuals who resided in ZIP codes with the highest breast cancer mortality were significantly lower than those who lived in ZIP codes with lower breast cancer mortality. The poverty rate, percentage of SNAP benefits, and the percentage of minorities were all significantly higher (p < 0.05, p < 0.001, and p < 0.001) in ZIP codes with high breast cancer rates. High-quality (ZIP code) granular cancer data were developed for which detailed analysis can be performed for future studies.

Relationship between Demographic, Socioeconomic Factors, and Psychological Responses of Health Care Providers during COVID–19 Pandemic, Kenya

Context: Corona Virus Disease of 2019 (COVID-19), an infectious disease caused by Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2), spread across the globe, causing distress among various populations, including healthcare providers. This disease has had an unparalleled effect on the world's economic situation, livelihood, and mental and physical well-being across the globe.&#x0D; Aim: To assess the healthcare providers' psychological responses and related demographic and socioeconomic factors during the COVID-19 pandemic at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH).&#x0D; Methods: This was a hospital-based descriptive cross-sectional study at Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu County, Kenya. A stratified sampling method was used in the selection of 202 healthcare providers. The questionnaire used consisted of four components: demographic and socioeconomic factors. Standardized questionnaires measured the symptoms of depression and anxiety, the 9–item Patient Health Questionnaire (PHQ - 9) and the 7–item Generalized Anxiety Disorder Scale (GAD - 7), respectively.&#x0D; Results: Among 202 healthcare providers, the overall prevalence of depressive and anxiety symptoms was 57.4% and 59.9%, respectively. After using Pearson Chi-square for the relationship of GAD with demographic characteristics, it was revealed that age (OR 0.1, p = &lt;0.001), gender (OR 0.4, p = 0.002), and marital status (OR 4.2, p = &lt;0.001) were significantly associated. Also, the relationship of GAD with socioeconomic factors revealed that the level of education (OR 0.5, p = 0.019), income level (OR 4.6, p = &lt;0.001), living alone (OR 0.4, p = 0.004), living with partner and children (OR 2.4, p = 0.002), living with parent (OR 2.7, p = 0.001) and employment terms (OR 3.3, p = &lt;0.001), were related with symptoms of anxiety. Concerning depressive symptoms and demographic characteristics, age (OR 0.5, p = 0.006) and marital status (OR 3.2, p = &lt;0.001) were significantly associated. Also, the relationship of depression with socioeconomic factors revealed that living alone (OR 0.4, p = 0.002), living with a partner (OR 4, p = 0.007), living with a partner and children (OR 1.7, p = 0.045), living with parent (OR 2.5, p = 0.001) and having a chronic medical condition (OR 0.5, p = 0.048) were related with depressive symptoms.&#x0D; Conclusion: There was a relatively high prevalence of anxiety and depression among JOOTRH healthcare providers during the pandemic. Those with a partner and children, those living without parents, high-income level, level of education undergraduate and above, were married, above 30 years, female, and being on permanent employment were significantly related to anxiety. Those living with someone else, without a chronic medical condition, being over 30 years and married were more likely to have depression than their counterparts. The study recommends providing psychological support to healthcare providers to enhance their psychological resilience during pandemics.

Analysis of healthy life expectancy and related socioeconomic influencing factors among the middle-aged and elderly in China, the United States, and the European Union

Objective: To calculate and compare the healthy life expectancy (HLE) of the middle-aged and elderly in China, the United States, and developing and developed countries in the European Union(EU) and analyze the impact of socioeconomic factors on HLE in different countries or regions. Methods: Four surveys from 2010 to 2019 were brought into the research. The data were collected from the China Health and Retirement Longitudinal Study, Health and Retirement Study, and the Survey of Health, Ageing and Retirement in Europe. Developed and developing countries in the EU were divided into two groups for calculation. Education level, total family wealth, and work retirement status were selected to measure socioeconomic status, and activities of daily living were used as health status indicators. We used the multi-state life cycle table method to calculate the transition probability between different health states and estimate life expectancy and HLE. Results: A total of 69 544 samples were included in the study. In terms of age, the middle-aged and elderly in the United States and developed countries of the EU have higher HLE in all age groups. In terms of gender, only Chinese women have lower HLE than men. Regarding socioeconomic factors, the middle-aged and elderly with higher education levels and total family wealth level have higher HLE. In China, working seniors have higher HLE, while for USA women and developed countries of the EU, retired or unemployed seniors have higher HLE. Conclusions: Demographic and socioeconomic factors impact HLE in different countries or regions. China should pay more attention to the health of women and the middle-aged and elderly retired with lower education and less total family wealth.

Child health screening program in French nursery schools: Results and related socioeconomic factors.

The study aims to describe the output of routine health screening performed in French nursery schools by the maternal and child health services among children aged 3-4 years and to quantify the level of early socioeconomic health disparities. In 30 participating départements, data on screening for vision and hearing impairments, overweight and thinness, dental health, language, psychomotor development, and immunizations were collected for children born on specific dates in 2011 and enrolled in nursery school in 2014-2016. Information was collected on the children, their socioeconomic characteristics and on the school attended. Odds of abnormal screening results were compared for each socioeconomic factor by logistic regressions adjusted for age, sex, prematurity and bilingualism. Among the 9,939 children screened, prevalence of disorders was 12.3% for vision, 10.9% for hearing, 10.4% for overweight, 7.3% for untreated caries, 14.2% for language and 6.6% for psychomotricity. Newly detected visual disorders were more frequent in disadvantaged areas. Children with unemployed parents were three time more likely to have untreated caries and twice as likely to present language or psychomotor impairments; 52% were referred to a health professional following screening compared to 39% of children with employed parents. Except for children in disadvantaged areas, vaccine coverage was lower among disadvantaged groups. The prevalences of impairments, which are higher among disadvantaged children, highlight the potential preventive impact of systematic screening under the comprehensive maternal and child healthcare program. These results are important to quantify early socioeconomic inequalities in a Western country known for its generous social welfare system. A more holistic approach to child health is needed with a coherent system involving families and aligning primary care, local child health professionals, general practitioners, and specialists. Further results are needed to evaluate its impact on later child development and health.

The rate of medication nonadherence and influencing factors: A systematic Review

Lack of adherence to recommended therapy will reduce its effectiveness and can subsequently lead to disease progression, disabilities or even death. A vast number of research studies have emphasized the magnitude of medication nonadherence and its effect on treatment outcomes, patient’s health, healthcare providers and the associated costs; medication nonadherence remains a major concern that is believed to be widely practiced amongst medication taking patients. The current systemic review aims to cohere the available evidence regarding medication nonadherence rate, practices, and potential affecting factors and predictors. A search through different databases was conducted, including PubMed, Medline, and CINHAL for recently published research articles, within five years. The terms used for the search include medication nonadherence, medication nonadherence, factors affecting medication nonadherence and predictors of medication nonadherence. The search was limited to human subjects, English language journal articles and exclusion of review articles, case studies, and data from clinical trials as patient adherence is closely observed.&lt;br /&gt; The search resulted in 667 articles and only 65 articles were included and further screened. However, according to our exclusion criteria, 15 articles only were included in this review. The three most reported practices of medication nonadherence are prescription abandonment, nonconforming, and non-persistence. There are five reported factors that may lead to nonadherence practices such as socioeconomic-related factors, healthcare system-related factors, patient-related factors, disease-related factors, and therapy-related factors. In conclusion, medication nonadherence practice is a multi-dimensional phenomenon that requires a multi-targeted solution.

Ultrasound aspects and risk factors associated with urogenital schistosomiasis among primary school children in Mali

BackgroundUrogenital schistosomiasis is endemic in Mali and is a major cause of serious morbidity in large parts of the world. This disease is responsible for many socio-economic and public health issues. The aim of this study was to investigate the impact of the disease on morbidity and to describe demographic and socioeconomic factors in relation to the status of children with urogenital schistosomiasis in Mali.MethodsWe conducted a cross-sectional study in November 2021 of 971 children aged 6 to 14 years selected at random from six schools in three districts in the Kayes Region of Mali. Demographic and socioeconomic data were collected on survey forms. Clinical data were collected following a medical consultation. Hematuria was systematically searched for through the use of strips. The search for Schistosoma haematobium eggs in urine was done via the filtration method. The urinary tract was examined by ultrasound. Associations between each of these variables and disease infection were tested using multivariate logistic regression.ResultsThe overall prevalence of urinary schistosomiasis detected was 50.2%. The average intensity of infection was 36 eggs/10 ml of urine. The associated risk factors for urogenital schistosomiasis showed that children who bathed, used the river/pond as a domestic water source, and who habitually urinated in the river/pond were more affected (P < 0.05). Children with farming parents were most affected (P = 0.032). The collection of clinical signs revealed that boys had more pollakiuria (58.6%) and dysuria (46.4%) than girls. Ultrasound data showed that focal lesion rates were recorded in all villages with the lowest rate in Diakalel (56.1%). Ultrasound and parasitological findings showed that irregularity and thickening were strongly associated with urinary schistosomiasis (P < 0.0001).ConclusionsSchistosoma haematobium infection was still endemic in the study site despite more than a decade of mass treatment with praziquantel. However, the high percentage of symptoms associated with high intensity reinforces the idea that further studies in terms of schistosomiasis-related morbidity are still needed.

Refugee Population and Environmental Quality in Sweden and Lebanon: Is Fertility Rate Changing the Dynamics?

Arising from the arrays of man-made factors (including political- and socioeconomic-related factors) and natural disasters across the globe, population displacement, as one of the consequences of the above-mentioned factors, has continued to trigger refugee populations. This is the reason Lebanon (with the highest number of refugees per total population in the world) and Sweden (with the highest number of refugees per total population in Europe) are considered in a comparative investigation. Importantly, this study examines the environmental effect of greenhouse gas (GHG) emissions via the refugee population and fertility rate, alongside the roles of income and natural resource abundance, from 1990 to 2021. The results reveal that fertility rates spur GHG emissions, thereby hampering environmental sustainability in both countries. While the refugee population mitigates GHG emissions in Sweden, the effect is contrary and environmentally damaging in Lebanon. The disparity in the countries’ environmental proactiveness, which has supposedly permeated societal values, especially in Sweden, could have influenced the above result. Meanwhile, in both countries, the refugee populations moderate the effect of the fertility rate, increasing the environmental demerit of the increase in the fertility rate. However, the Swedish income level improvement helps mitigate GHG emissions, thus validating the environmental Kuznets curve (EKC) hypothesis in the long run. In Sweden, the natural resource abundance also promotes environmental benefit. Contrarily, in Lebanon, increases in both the natural resource abundance and income per person increase GHG emissions, thus worsening the environmental quality. Finally, this study offers policy recommendations for improving refugee programs.

Assessment of Adherence and Common Non-adherence Factors for Inhaled Medications in Asthma and Chronic Obstructive Pulmonary Disease (COPD) Patients

Abstract: Background: Inhaled medications are the cornerstone for the treatment of asthma and chronic obstructive pulmonary disease (COPD). Adherence of inhaled medications can be influenced by many factors such as patient preferences, education and awareness. Therefore, it is fundamental to identify and address the factors that helps to improve adherence to inhaled medications. Hence, this study aims to assess the adherence and common non-adherence factors for inhaled medications in asthma and COPD patients. Materials and Methods: A prospective observational study was conducted at the department of respiratory medicine for 6 months in a tertiary care teaching hospital. A total of 150 patients who were diagnosed with asthma and COPD, and used inhaled medications were enrolled. Patients were interviewed and administered with Inhaled Medication Adherence Questionnaire (IMAQ). The identified factors for non-adherence were classified based on the five dimensions of adherence instrumented by the World Health Organization (WHO). Results: A total of 97/150 (64.7%) patients [asthma: 42 (64.2%) and COPD: 55 (68.7%)] were found non-adherent to inhaled medications. Between them, 54% were attributable to socioeconomic reasons, 38% were patient-related, 4.6% therapy-related and 3.3% healthcare system-related. According to the study results majority of patients showed non-adherence due to socioeconomic-related factors followed by patient-related factors. Conclusion: This study concluded that non-adherence to inhaled medication was high in asthma and COPD patients. Low economic status, social stigma, lack of knowledge, inappropriate usage technique and complexity of treatment were the most common factors influencing non-adherence to inhaled medications in asthma and COPD. Keywords: Asthma, Chronic obstructive pulmonary disease (COPD), Medication adherence, Medication adherence questionnaire, Non-adherence factors.

Nighttime light data‐based analysis of spatiotemporal patterns evolution and driving forces of economic development in China at prefecture level (1992–2020)

AbstractIntercity lighting data are an important resource for studying spatial and temporal patterns in regional urban development as an indicator of the intensity of urban social and economic activity. Understanding the evolutionary characteristics of the spatial pattern of regional economic development can support decision‐making in regional economic coordination and sustainable development strategies. Based on a long time series of nighttime lighting data from 1992 to 2020, this study used the Theil index, Markoff transfer matrix, spatial autocorrelation, and spatial regression to analyze spatiotemporal evolutionary characteristics and drivers of urban economic development in China. The study found that from 1992 to 2020, China's economic development hot spots have been concentrated in highly developed urban agglomerations namely the Beijing–Tianjin–Hebei region, Shandong Peninsula, Yangtze River Delta, and Pearl River Delta. Cold spots were mainly concentrated in the central‐west and southwest of the country. The economic growth rate shows an opposite spatial pattern, which demonstrates the effectiveness of the national coordinated development strategy for regions. The Theil index for urban economic development in China shows an overall downward trend, and the overall economic disparity is mainly due to the relatively low economic development of Tibet, Xinjiang, Gansu, and other western provinces. Therefore, regional economic development remains significantly uneven. In China, the economic type of cities is relatively stable, and the probability of leapfrogging types is low; however, the level of cities with high resource dependence or a single economic structure easily downgrades. The level of economic development and the related socioeconomic factors of neighboring cities influence an obvious spatial spillover effect in the development of urban economies in China. The pattern of China's urban economic development is mainly affected by innovation capacity, financial support, capital investment, transportation infrastructure, and industrial structure.

Malnutrition and gender disparities in the Eastern Mediterranean Region: The need for action.

Malnutrition takes a heavy toll on the populations of the Eastern Mediterranean Region (EMR), with gender related socioeconomic risk factors impacting undernutrition and obesity in both women and men. This perspective article, a derivative of a report by the World Health Organization, reviews the scientific literature on the effect of gender on malnutrition related outcomes in the EMR. Results revealed that biological and gender-related socioeconomic risk factors play a role for undernutrition and obesity in both women and men. Malnutrition can be negatively influenced by gender-biased cultural standards, habits, structural determinants, differential exposures, and health system gaps. This can result, for example, in women tending to focus on familial and household related needs, at the expense of their own health and physical mobility and on suffering more food insecurity, undernutrition, micronutrient deficiencies and obesity compared to men in the EMR. Conflict and crisis situations negatively affect both genders, but generally put women at a higher risk of adverse. Women's socially limited autonomy in mobility is also an obstacle to access to health services in the EMR, including those related to nutrition. Multi-level approaches are needed to address gender issues to enable a more equitable distribution of resources and reduce the impact of malnutrition in the EMR.

Socio-demographic disparities in health-related quality of life after hip fracture in China: evidence from the China Health and Retirement Longitudinal Study.

Hip fractures cause high mortality and worsened health-related quality of life (HRQoL). This study aimed to investigate whether socio-demographic-related inequities in post-hip fracture participants' HRQoL exist in China. Data from the China Health and Retirement Longitudinal Study (waves 2013, 2015, and 2018) were used. The measurement of HRQoL in this study focused on 5 health dimensions: depression, body pain, mobility, basic activities of daily living, and instrumental activities of daily living. A difference-in-differences (DID) analysis with multiple time periods was performed to gauge the impact of hip fracture on HRQoL. A multivariate regression approach was used to explore socio-demographic-related factors associated with inequities of HRQoL. A total of 23,622 individuals were included, and 341 participants reported hip fracture events during the survey period. In participants with hip fracture, the presentation rate of body pain increased by 14% (p < 0.01) and the HRQoL of other health dimensions worsened (p ≤ 0.01) after hip fracture. The DID analysis showed that hip fracture had a negative impact on all HRQoL dimensions (p < 0.01). Socioeconomic-related factors of HRQoL inequities included school education level and location of residence. Study participants with hip fracture with greater educational attainment or living in urban areas had higher (p < 0.05) levels of HRQoL. In addition, comorbidities also correlated with a worse HRQoL (p < 0.05). Hip fracture significantly affects people's HRQoL in China, and the impact is more profound for those with lower educational attainment or living in rural areas. Targeted interventions should be designed to narrow this inequity.

Using Comic-Based Concussion Discharge Instructions to Address Caregiver Health Literacy in the Emergency Department

IntroductionThis study compared the effectiveness of comic-based with text-based concussion discharge instructions on improving caregiver knowledge. This study also examined the role of social determinants of health on comprehension instructions. MethodsThis was an observational study of the caregivers of pediatric concussion patients. Caregivers' health literacy and demographics related socioeconomic factors were obtained. After the patients’ evaluation in the emergency department, caregivers were given printed comic-based concussion discharge instructions. Caregivers were contacted 3 days later and tested overall knowledge of discharge instructions’ content. These survey results were compared with historical controls who received text-based instructions. ResultsA total of 120 participants were recruited, and 86 participants completed follow-up procedures. When comparing the caregivers’ recall ability with a comic-based vs traditional text-based instructions, caregivers with comic-based content were more likely to accurately recall overall discharge instructions (77.5% vs 44%, P < .001), particularly physical rest and activity restrictions (86.5% vs 63%, P < .001). Caregivers also were less likely to misidentify a red flag symptom (7.5% vs 19%, P < .04). Comic-based instructions did not increase recall of cognitive rest instructions or postconcussive symptoms. When examining demographic factors, caregivers who could not recall 3 postconcussive symptoms were more likely to be Hispanic or Black, less likely to be college educated, and more likely to have low health literacy. DiscussionNovel methods should be explored to adequately prepare caregivers for continuing postconcussive care at home. Discharge instructions must be tailored to address caregivers’ baseline health literacy and how caregivers digest and retain information.

ЭКОНОМИЧЕСКИЕ И СОЦИАЛЬНЫЕ АСПЕКТЫ УПОТРЕБЛЕНИЯ АЛКОГОЛЯ В РОССИЙСКОМ ОБЩЕСТВЕ

In this article the author considers the relationship of socioeconomic factors and assesses the impact of alcohol consumption on socioeconomic aspects and the general health of the nation.