Socioeconomic Strata Research Articles

Factors of Intergenerational Social Mobility in Lithuania: Searches of Expert Opinion Consensus

Social mobility is influenced by many factors. Studies show that Lithuania is among the countries with the same number of upward and downward social mobility. This shows that there is social inequality in the country, which especially affects people from the lower socio-economic strata. Considering the fact that previous studies of social mobility did not analyse the factors of this phenomenon based on the qualitative approach of data collection and analysis, this article, based on the Delphi method, seeks a consensus of views expressed by experts – the most important barriers and factors of social mobility. The results show that a family and neighbourhood environment that does not form positive social skills is one of the main obstacles to social mobility, moreover, opportunities are limited due to insufficient funding for social protection, high levels of inequality, the fragmentation of complex assistance and the lack of other social services.

Compound climate-pollution extremes in Santiago de Chile

Cities in the global south face dire climate impacts. It is in socioeconomically marginalized urban communities of the global south that the effects of climate change are felt most deeply. Santiago de Chile, a major mid-latitude Andean city of 7.7 million inhabitants, is already undergoing the so-called “climate penalty” as rising temperatures worsen the effects of endemic ground-level ozone pollution. As many cities in the global south, Santiago is highly segregated along socioeconomic lines, which offers an opportunity for studying the effects of concurrent heatwaves and ozone episodes on distinct zones of affluence and deprivation. Here, we combine existing datasets of social indicators and climate-sensitive health risks with weather and air quality observations to study the response to compound heat-ozone extremes of different socioeconomic strata. Attributable to spatial variations in the ground-level ozone burden (heavier for wealthy communities), we found that the mortality response to extreme heat (and the associated further ozone pollution) is stronger in affluent dwellers, regardless of comorbidities and lack of access to health care affecting disadvantaged population. These unexpected findings underline the need of a site-specific hazard assessment and a community-based risk management.

Association of glutathione-S-transferase polymorphism with genetic damage in paint workers.

Occupational exposure to toluene causes serious health problems ranging from drowsiness to lethal diseases such as cancer. Paint workers are exposed to toluene through inhalation or the dermal route, which can induce genetcic damage. The increased DNA damage could be linked to genetic polymorphism. Therefore, we evaluated the association of glutathione-S-transferase polymorphism with DNA damage in paint workers. First, we included skilled paint workers (n = 30) as exposed and healthy individuals (n = 30) as control belonging to the same socio-economic strata. The genotoxicity biomarkers, Cytokinesis-block micronucleus (CBMN), and single-cell gel electrophoresis (SCGE)/Comet assay were used to assess genotoxicity while Multiplex-PCR and PCR-RFLP were used to assess polymorphism in glutathione-s-transferase (GST) genes. Using linear curve regression analysis, we assessed the association between genetic damage and polymorphism in the glutathione-s-transferase (GST) gene in the exposed and control subjects. A significantly higher frequency of CBMN (4.43 ± 1.50) and tail moment (TM) (11.23 ± 1.0) respectively in paint workers as compared to the control(1.50 ± 0.86 and (0.54 ± 0.37) underlined significantly high genetic damage in paint workers.Regression curve analysis reveals that polymorphism in the GST gene is significantly associated with higher MN and TM in paint workers. Overall, our study provides a strong rationale for identifying a clear association between glutathione-S-transferase polymorphism and genetic damage in paint workers.

Dietary intake of polyphenols in adults and older adults residing in Chile: A population-based study

BACKGROUND: Polyphenols are a group of compounds distributed in foods of plant origin and have been considered as effective protective agents against chronic diseases. To date, there are limited data on polyphenol intakes worldwide. OBJECTIVE: The aim of the present study was to describe the intake of polyphenols and their subclasses in Chile based on data extracted from the National Food Consumption Survey 2010 –2012 (ENCA). METHODS: A total of 3658 participants were selected from whom information on food consumption frequency, anthropometric, clinical, socioeconomic and lifestyle variables were available. RESULTS: The mean intake value of total polyphenols was 979.5 + 695.5 mg/day. A higher intake was observed in men than in women. In addition, among adults, there is a higher consumption in the South macrozone. An increase in the intake of total polyphenols was evidenced when the population belonged to the high socioeconomic stratum, and the most consumed types were flavonoids and phenolic acids. CONCLUSION: Due to the growing evidence that shows a protective effect of polyphenol consumption, it is necessary to carry out more research related to the consumption of these compounds, promoting the consumption of foods that provide them and thus contributing to improve the current epidemiological.

Análisis preliminares sobre la participación y la estratificación social en Paraguay

This article examines the level of participation of the Paraguayan population in associations and civil society organizations, according to their social stratification. The analysis is raised from the approach of the social dimension of exclusion that includes the indicator of “associationism”. The types of organizations that register the highest level of participation of the population are also identified. The methodology used was predominantly quantitative. Information on the living conditions of the Paraguayan population was collected through surveys in 4,000 homes in Asunción and the departments of Central, Alto Paraná, Itapúa, Caaguazú and San Pedro. The results showed that the highest level of participation of the population is registered in the middle socioeconomic stratum, specifically in political parties, religious associations and neighborhood commissions. In general terms, the percentage of participants in the various associations in the country does not exceed 10% of the population surveyed, including the three strata (low, medium and high).

Head & neck cancer. Its impact on the history of mankind.

Squamous cell carcinoma is the most common head & neck malignancy, and its first descriptions date from the pharaonic era. It has impacted humanity by affecting labor, scientific and cultural productivity and, sometimes, it has influenced the course of history. Head & neck cancer is more common in economically impoverished countries and individuals; however, it can affect any socioeconomic stratum; it has been suffered by known, famous, economically powerful celebrities, intellectuals and artists. Head & neck cancer treatment has been controversial since its initial description up to the present day. Therapeutic decisions have been influenced not only by the stage but by the patient's environment and, sometimes, in an effort to reduce the morbidity resulting from the various oncological treatments, erroneous decisions have been made that have implied the loss of the patient's life. Unfortunately, currently we continue to see these behaviors. A synthesis of cases of renowned celebrities that suffered from this cancer is presented, and the impact this implied in the society of their times is described.

Spatial variation of cardiovascular mortality in Cali, Colombia, between 2010 and 2017

BackgroundCardiovascular disease (CVD) is the leading cause of mortality worldwide and in Colombia. The analysis of CVD mortality has been mainly relied on individual factors and rates, but occurrence is also related to contextual conditions. Understanding the distribution of CVD in a region will contribute to implement more focused-preventive and care interventions.MethodsUsing the national mortality register established by the Department of National Statistics, standardized rates and spatial distribution of CVD mortality were estimated for Cali, Colombia, between 2010–2017. Global and local spatial aggregation was assessed using the Geary’s C test and for each district standardized mortality ratios smoothed by the Bayesian empirical were estimated.ResultsOver the period, CVD was the main cause of mortality with 28,804 deaths accounting for 23,8% of total deaths. The global CVD mortality rate varied from 235.9 to 257.4 per 100.000 habitants, with an average increase of 9.1% in the percentage change. The main cause of mortality were hypertensive diseases following by ischemic heart diseases and stroke. The standardized mortality ratios smoothed by the Bayesian empirical method showed that the districts 7, 13, 14, 15 and 16 located at the eastern area with the lowest socio-economic strata and the district 22 at the south of the city with the highest socio-economic strata had the high risks of CVD mortality. All these areas were at the boundary of the city. The the lowest risk was observed in districts 1 and 2 at the northwest area with the upper socio-economic strata. Over the study period, a spatial autocorrelation was found in the districts 1,9 10, 11, 12, 13, 14, 15, 19, and 21 by using the Geary’s C test. The highest significant spatial association was found in the districts 1 and 21.ConclusionOf 22 districts in Cali, the highest risk of CVD mortality was found in three at the lowest and one in the upper socio-economic strata between 2013 and 2017. Over the period a global spatial aggregation was identified due mainly to districts peripherical located suggesting that there could be contextual conditions influencing the risk. Therefore, there is a need for considering local conditions to prevent CVD mortality.

MANAGEMENT OF DIABETIC FOOT ULCERS AND RELATED COMPLICATIONS: A PROSPECTIVE OBSERVATIONAL STUDY

Introduction Foot ulceration and its complications are one of the major complications attributing to the hospital admission, with overall prevalence of about 4 -10% and even higher in geriatric population (5-10%).With the lifetime risk of 15%,it contributes as a major factor of morbidity and not infrequently leading to severe adverse outcomes, such as amputation and life threatening sepsis.The study was aimed at analyzing the prevalence of diabetic foot infection,its complications and outcomes of different treatment modalities available in a tertiary care center.Material and Methods A prospective observational study of 12 month duration was conducted among 100 patients having a history of diabetes and diagnosed with diabetic foot ulcer undergoing treatment in the surgery department of a tertiary care center in Jammu.The period of study was Feb 2022 to Feb 2023.Prior to the study an informed written consent and approval of the ethics committee was obtained. Results The incidence of diabetic foot ulcers peaks at the 5th decade of life with the mean age in our study being 53.17±10.2 years.A predominance in the male population (m:f ratio=2.57:1) and higher risk in the lower socio-economic strata was also noticed. The most common presenting complaint being ulcer (96%) and discharge (67%).Culture positivity was seen in 80% of the patients with Staph.Aureus being the most common causative organism. The main stray of treatment involved debridement and amputation (31%) followed by Split thickness skin grafting (30%). No adverse events were noted during the course of study. Conclusion Being a menace in developing countries,diabetes mellitus,a disease with life threatening and physically incapacitating consequences which not only increases the patient morbidity but also substantially increases the economic burden. Provision of precise counseling and a multidisciplinary line of action can lessen the complication and amputation rate, and is therefore recommended, along with the incorporation of diabetic foot management guidelines into the routine practice and teaching

Factors influencing the adoption of HIV prevention measures in low socio-economic communities of inner-city Durban, South Africa

ABSTRACT South Africa is the epicentre of the HIV pandemic. Although there have been health promotion education campaigns to reduce HIV incidence, these have not achieved the desired outcomes. When exploring the effectiveness of these campaigns, it is useful not only to examine HIV knowledge, but also to explore the relationship between that knowledge and health-related behaviour. This study aimed to determine the (1) level of knowledge of HIV prevention, (2) relationship between the level of knowledge and the adoption of these behaviours and (3) barriers to sexual behaviour change of vulnerable women in Durban’s city centre, KwaZulu-Natal, South Africa. A mixed methods approach was used to collect information from a marginalised population of women (n = 109) attending a non-governmental organisation, which provides for the needs of people from low socio-economic strata. Data were collected during September 2018 at a wellness day programme at the centre. A total of 109 women, over the age of 18 years answered the questionnaire. Knowledge of HIV transmission was high, with majority of participants correctly identifying modes of transmission. Almost all the participants (91.2%) had been tested for HIV, with 68.8% tested a minimum of three times. Despite this, sexual risk behaviour was high. Despite the high level of knowledge of HIV transmission, there was no relationship between HIV knowledge and adoption of behaviours for the prevention of HIV transmission (p = .457). However, bivariate analysis showed an association between transactional sex and living in informal housing (OR = 31.94, 95% CI: 5.65–180.63, p < .001). Living in informal housing was also associated with having multiple current sexual partners (OR = 6.30, 95% CI: 1.39–28.42, p = .02). Multivariate analysis, after adjusting for all other factors, indicated that the odds of having transactional sex was increased by 23 times in those who did not have formal housing (OR = 23.306, 95% CI: 3.97–144.59, p = .001). Qualitative responses showed that women perceived poverty as the overarching factor determining the lifestyle choices which impacted their health. They indicated a need for employment opportunities and provision of housing to alleviate both poverty as well as transactional sex. Although, participants from this study understood the benefits of the protective behaviours to prevent HIV transmission, economic and social factors do not afford this vulnerable group the opportunity nor the motivation to adopt such behaviours. In the current climate of increasing unemployment and escalating GBV, urgent interventions are needed in terms of employment opportunities and empowerment drives to prevent an increase in HIV transmission.

Examining non-linearity in the association between age and reported opioid use in different socioeconomic strata: cohort study using Health Survey for England waves from 1997 to 2014

BackgroundAge and socioeconomic status (SES) predict several health-related outcomes, including prescription opioid use. Contrasting findings from previous literature found higher prevalence of opioid use in both people over 65 years...

A Public Health, Whole-of-Government Approach to National Suicide Prevention Strategies

A Public Health, Whole-of-Government Approach to National Suicide Prevention Strategies

Abstract P642: Assessment of Health Literacy in Colombia: A First Step for a Cardiovascular Education Program for the Community

Introduction: Adequate health literacy enables patients and caregivers to make appropriate decisions and achieve better health outcomes. However, much information about health literacy comes from developed and English-speaking countries. There is very little information about health literacy levels in countries such as Colombia and these data, therefore, cannot be used as an input in the development of cardiovascular education programs for the community. Our objective was to optimize and adapt the Spanish validation of the short version of the Test of Functional Health Literacy in adults (s-TOFHLA) to the context of the Colombian health system. This test was chosen because its multiple questions and sections can guide the skills that should be emphasized in a health education course for patients and caregivers (i.e. navigation in the health care system, interpretation of medical instructions, understanding of doses and forms of drug dispensing). This test consists of two parts: numerical and reading comprehension (Readings A and B). The TOFHLA is graded using a score between 1 and 100 points, which classifies the participant into categories of adequate, marginal or inadequate health literacy. Methods: The validation process was carried out in the following steps 1) cultural and language adaptation, 2) expert consensus (n=7), 3) a cognitive survey (n=10), 4) piloting (n=40), and 5) application in the community (n=148). The study was conducted in 6 cities, from 5 departments (equivalent to an state) in Colombia. Results: In the piloting (n=40) Cronbach's α was 0.76 for numerical comprehension, 0.58 for reading A, and 0.95 for reading B. In the broader sample (n=148) the Cronbach's α for numerical comprehension, reading A and reading B was 0.84, 0.89, and 0.95, respectively. Most of the sample had an adequate level of literacy (77.1%), however, the percentages in the marginal (6%) and inadequate (16.7%) categories can still be considered high. Health literacy levels are lower in people with the lowest level of schooling and socioeconomic strata. In addition, there seem to be differences between urban and rural populations. No differences have been observed according to the sex of the participants. Conclusions: It is critical to assess health literacy with instruments that have been adequately validated and adapted to the conditions of each health system. This process requires the participation of health and language experts. The piloting and cognitive surveys provide a good idea of how communities interpret psychometric tests. Our results confirm differences in health literacy among populations with different levels of income and schooling. Health literacy assessment can guide the instructional design of community-directed health education programs.

Nontuberculous Mycobacterial Infection in Wisconsin Adults and Its Relationship to Race and Social Disadvantage.

Rationale: Population-based data on the epidemiology of nontuberculosis mycobacterial (NTM) infections are limited, particularly with respect to variation in NTM infection among racial groups and socioeconomic strata. Wisconsin is one of a handful of states where mycobacterial disease is notifiable, allowing large, population-based analyses of the epidemiology of NTM infection in this state. Objectives: To estimate the incidence of NTM infection in Wisconsin adults, describe the geographic distribution of NTM infection across the state, identify the frequency and type of infection caused by different NTM species, and investigate associations between NTM infection and demographics and socioeconomic status. Methods: We conducted a retrospective cohort study using laboratory reports of all NTM isolates from Wisconsin residents submitted to the Wisconsin Electronic Disease Surveillance System from 2011 to 2018. For the analyses of NTM frequency, multiple reports from the same individual were enumerated as separate isolates when nonidentical, collected from different sites or collected more than one year apart. Results: A total of 8,135 NTM isolates from 6,811 adults were analyzed. Mycobacterium avium complex accounted for 76.4% of respiratory isolates. The M. chelonae-abscessus group was the most common species isolated from skin and soft tissue. The annual incidence of NTM infection was stable over the study period (from 22.1 per 100,000 to 22.4 per 100,000). The cumulative incidence of NTM infection among Black (224 per 100,000) and Asian (244 per 100,000) individuals was significantly higher compared with that among their White counterparts (97 per 100,000). Total NTM infections were significantly more frequent (P < 0.001) in individuals from disadvantaged neighborhoods, and racial disparities in the incidence of NTM infection generally remained consistent when stratified by measures of neighborhood disadvantage. Conclusions: More than 90% of NTM infections were from respiratory sites, with the vast majority caused by M. avium complex. Rapidly growing mycobacteria predominated as skin and soft tissue pathogens and were important minor respiratory pathogens. We found a stable annual incidence of NTM infection in Wisconsin between 2011 and 2018. NTM infection occurred more frequently in non-White racial groups and in individuals experiencing social disadvantage, suggesting that NTM disease may be more frequent in these groups as well.

Assessing progress towards universal health coverage in Cambodia: Evidence using survey data from 2009 to 2019

Over the past decades, many low- and middle-income countries have implemented health financing and system reforms to progress towards universal health coverage (UHC). In the case of Cambodia, out-of-pocket expenditure (OOPE) remains the main source of current health expenditure after several decades of reform, exposing households to financial risks when accessing healthcare and violating UHC's key tenet of financial protection. We use pre-pandemic data from the nationally representative Cambodia Socio-Economic Surveys of 2009 to 2019 to assess progress in financial protection to evaluate the reforms and obtain internationally comparable estimates. We find that following strong improvements in financial protection between 2009 and 2017, there was a reversal in the trend thereafter. The OOPE budget share rose, and the incidence of catastrophic spending and impoverishment increased in nearly all geographical and socioeconomic strata. For example, 17.7% of households experienced catastrophic health expenditure in 2019 at the threshold of 10% of total household consumption expenditure, and 3.9% of households were pushed into poverty by OOPE. The distribution of all financial protection indicators varied strongly across socioeconomic and geographical strata in all years. Fundamentally, the demonstrated trend reversal may jeopardize Cambodia's ability to progress towards UHC. To improve financial protection in the short term, there is a need to address the burden created by OOPE through targeted interventions to household groups that are most affected. In the medium term, our findings emphasize the importance of expanding health pre-payment schemes to currently uncovered vulnerable groups, specifically the near-poor. The government also needs to consider extending the scope of services covered and the range of providers to include the private sector under these schemes to reduce reliance on OOPE.

Public visibility of tuberculosis diagnosis and treatment facilities in rural Puducherry, mixed method design

Objectives: To study the specific issues on the diagnosis and treatment to be addressed in TB advocacy, communication and social mobilization activities. Early diagnosis and initiation of appropriate treatment is the mainstay in the prevention and control of tuberculosis (TB). We present findings from an operational research study on visibility of TB diagnosis and treatment among people in rural Puducherry. Materials and Methods: Study area and study setting: The present study was undertaken in the villages of Thirubhuvani Primary Health Center (PHC) in rural Pondicherry by the Department of Community Medicine, Sri Manakula Vinayagar Medical College. Study design: An exploratory sequential mixed method design where qualitative methods (Focus Group Discussion [FGD]) followed by quantitative methods (Community-based cross-sectional survey) were used. Sample size and sampling: Qualitative: FGD was conducted to assess the perceptions and practices of rural people related to TB. We conducted eight FGD, four each with men and women. It was held with the purposively selected men and women (8−12 members) from different socioeconomic strata. Quantitative: Probability proportional to size method was used to select 30 clusters from the villages of Thirubhuvani PHC. In each cluster, 12 households were selected by random walk method and head of the family who is assumed to act as decision maker in that household was interviewed using pre-designed and pre-tested questionnaire. However, we could study the required sample as calculated, the final sample studied was 348. Results: Qualitative: As per the responses emerged from the FGD, four categories are symptoms and mode of transmission, treatment, problems faced, and others. The 12 codes emerged are symptoms, mode of spread, risk factors, availability, effect home remedies health system related, family and community, financial, advantages at government hospitals, media for awareness, and recommendation. Quantitative: Among the 348 people studied, 203 were male and 145 were female. The major source of information of TB received by the community was from family, friends, neighbors, and colleagues. We found that majority of them have correctly responded that weight loss (97.1%) and cough that lasts longer than 2 weeks (27.5%) as the symptoms of TB. However, they have also commented wrongly that rash as one the symptom (76.1%) of TB, the measures for preventing TB are by avoiding hand shaking (26.4) avoid sharing foods (74.7). Smokers and alcoholic are at-risk for TB infection. Most of the participants expressed that they will feel fear (95.1), sadness or hopelessness (94.8), embarrassment (96.8), shame (89.6), and surprise (65.2) if they have contacted TB. The participants also reported TB diagnosis and treatment are free of cost (95.1) and will approach health facility (96.8) if they had symptoms of TB. The 95% of them have informed that TB is curable and treatment is available at government hospital (97.7) and available free of cost (92.2). Conclusion: Hence, a strategy for wide, consistent, and regular dissemination of information on TB is needed for better public visibility of TB diagnosis and treatment facilities in rural Pondicherry.

Investigating strategies to improve AccesS to Kidney transplantation (the ASK trial): a protocol for a feasibility randomised controlled trial with parallel process evaluation

BackgroundThe UK’s living-donor kidney transplant (LDKT) activity falls behind that of many other countries internationally, with less than 20% of those eligible receiving a LDKT each year. Certain individuals with kidney disease in the UK appear to be particularly disadvantaged in accessing a LDKT; the most socioeconomically deprived people with kidney disease are 60% less likely to receive a LDKT than the least deprived. Improving equity in living-donor kidney transplantation has been highlighted as an international research priority.MethodsThis feasibility trial was designed to determine the feasibility of delivery and acceptability of a multicomponent intervention designed to improve access to living-donor kidney transplantation. The intervention comprises three main components: (i) a meeting between a home educator and the transplant candidate for a dedicated discussion about living-donor kidney transplantation, living kidney donation and potential donors; (ii) a standardized letter from a healthcare professional to a candidate’s potential donors and (iii) a home-based education and family engagement session including two home educators, the transplant candidate and their family. The primary objectives are to establish the feasibility (i) of delivering the developed intervention in existing care pathways and (ii) of undertaking a randomised controlled trial of the intervention. A mixed-methods parallel process evaluation will investigate the acceptability, implementation and mechanisms of impact of the intervention. The trial is based at two UK hospitals: a transplanting hospital and a non-transplanting referral hospital. Individuals are eligible if they are ≥ 18 years old, are active on the kidney transplant waiting list or have been referred for transplant listing and do not have a potential living-donor undergoing surgical assessment. Randomisation will be undertaken with concealed allocation. Participants will be randomly allocated 1:1 to (i) the intervention or (ii) usual care, stratified by site to ensure a balance in terms of local differences. Minimisation will be used to ensure balance in sex, age group and socioeconomic strata, with probability weighting of 0.8 in order to reduce predictability. The primary outcomes are recruitment (% of those eligible and invited who consent to randomisation) and retention (% of participants completing follow-up).DiscussionFindings will inform the design of a future fully powered, randomised controlled trial to formally evaluate the effectiveness of the intervention at improving equitable access to living-donor kidney transplantation.Trial registrationISRCTN Registry ISRCTN10989132 Applied 30/10/20.

Canine parasitoses in north Patagonia (Argentina): comparison between different social and environmental factors.

In many countries, urban areas are commonly contaminated with canine feces that spread parasites, a situation related to the natural and social environment. Dogs having free access to public areas therefore constitutes a health risk. Because in Patagonia there are no records of city comparisons that consider the number of free-roaming dogs and the local environmental and socioeconomic characteristics, in this study we analyse and compare canine parasitoses in two cities of Rio Negro province, Argentina. Canine feces were collected from public areas of El Bolsón and Cipolletti cities and examined using enrichment methods, Kinyoun stain and immunoassay (Copro-Elisa). The total percentage of positive feces in El Bolsón was 68.95% and 16 parasite taxa being identified, whereas in Cipolletti the total positive feces was 41.1%, with 11 taxa. Both cities presented more helminth species than protozoans. The variables that explained the occurrence of all parasites were rainfall and socioeconomic stratum with the highest values being found in low-income areas.Soil moisture is conditioned by rainfall. This study highlights the presence of the zoonotic Echinococcus sp. in dogs in urban areas of the Rio Negro province. The occurrence of this parasite in Cipolletti is unexpected, given that this city is not considered an endemic zone for this disease, which is not included in local monitoring and control plans.

Breaking Barriers: Understanding and Overcoming Societal, Institutional, and Cultural Health Challenges for Women in STEM Fields

This interdisciplinary investigation delves into the multifaceted analysis of barriers within the realms of socioeconomic, cultural, institutional, and mental health aspects to attain a deeper comprehension of the persisting underrepresentation of women within STEM (Science, Technology, Engineering, and Mathematics) professions. Despite regulatory efforts aimed at fostering gender equality, women remain a minority in STEM domains, constituting a mere 34% of the workforce. This disparity is glaring, with women comprising only 21% of engineering majors and 19% of computer science majors, thereby illustrating the pervasive underrepresentation across the academic spectrum. Additionally, gender pay disparities persist, accentuated by biased recruitment and advancement practices that culminate in considerably lower earnings for women in comparison to their male counterparts. Young girls and women face discouragement in pursuing STEM vocations owing to entrenched stereotypes, a dearth of female role models, and an inhospitable institutional milieu. Prevailing societal biases continue to perpetuate the notion that STEM is predominantly male- dominated, portraying scientists and STEM professionals primarily as men. The absence of female role models, particularly for Black women, compounds this challenge. Furthermore, institutional impediments within academic and research settings perpetuate gender insensitivity, mandating conformity to traditional gender norms and impeding the progression of women in their professional trajectories. Additionally, the rigorous demands of STEM education exacerbate mental health issues, notably amongst graduate women hailing from various socioeconomic strata. These issues manifest as heightened stress levels, anxiety, depressive disorders, and even suicidal ideation, dissuading young girls from embarking on STEM careers. To redress these obstacles and propel gender equality within STEM, recommendations encompass the implementation of affirmative action and equal pay policies, robust advocacy for inclusivity and diversity in STEM education and workplaces, establishment of mentorship initiatives, and proactive efforts to debunk prevalent stereotypes. Essential too is the destigmatization and establishment of comprehensive mental health support initiatives tailored to the unique needs of underrepresented groups within STEM. This study underscores the urgent call for collaborative action by governments, institutions, and stakeholders to cultivate a more hospitable and equitable STEM environment for women. It accentuates the paramount importance of comprehending and addressing the intricate interplay of factors inhibiting gender parity within STEM professions. To conduct a meticulous exploration of the intricate nexus between societal, cultural, institutional, and mental health elements contributing to gender disparities in STEM, the research methodology involved a triangulation of data from scholarly journals, surveys, and academic papers within the STEM domain

Bridging the cancer care gap and inequities in radiation treatment in India: A narrative review

Cancer is the fifth leading cause of death in India, yet India's cancer care landscape remains fragmented. In this paper, we review the current state of access to radiation therapy and the inequities involved, as well as identify potential solutions to improve access to radiation therapy in cancer. We undertook this narrative literature review, which encompassed database searches (PubMed, Embase, Scopus) and scrutiny of the grey literature (Google Scholar, OpenGrey), using the search terms: “cancer care access disparities,” “radiotherapy accessibility challenges,” “out-of-pocket expenditure in cancer treatment,” “value-based cancer care models,” “cost-effective radiotherapy strategies,”and“resource-limited cancer care solutions.” Our search strategy focused on articles addressing barriers to radiation treatment, inequities in radiation treatment equipment, and optimal radiation techniques in resource-limited settings in India, thereby identifying key challenges and potential interventions. Of the 1933 articles initially retrieved, we included 46 for the preparation of this review. Among the various modalities utilized for the management of cancer, radiation treatment is the most resource-intensive, requiring expensive and dedicated infrastructure. Scarce infrastructure, perpetuating inequities across geographical regions and socioeconomic strata, is responsible for inequities in access to radiation treatment in India. With the advent of newer radiation techniques requiring specialized equipment for the delivery of advanced radiation treatment, these inequities widen in low- and middle-income countries such as India. The challenge lies in providing affordable and equitable radiation treatment without compromising on quality within India's diverse and populous expanse. Bridging these gaps mandates the improvement of the existing infrastructure, fostering local production of quality medical equipment like linear accelerators, establishing and adhering to country-specific standardized treatment guidelines based on volumes, optimally utilizing available equipment like indigenous telecobalt machines and cost-effectiveness evidence, establishment of rural cancer care centers, optimization of private sector capacities and economic support through national insurance schemes.

National Vaccine Coverage Survey 2020: methods and operational aspects.

The national vaccination coverage survey on full vaccination at 12 and 24 months of age was carried out to investigate drops in coverage as of 2016. A sample of 37,836 live births from the 2017 or 2018 cohorts living in capital cities, the Federal District, and 12 inner cities with 100 thousand inhabitants were followed for the first 24 months through vaccine record cards. Census tracts stratified according to socioeconomic levels had the same number of children included in each stratum. Coverage for each vaccine, full vaccination at 12 and 24 months and number of doses administered, valid and timely, were calculated. Family, maternal and child factors associated with coverage were surveyed. The reasons for not vaccinating analyzed were: medical contraindications, access difficulties, problems with the program, and vaccine hesitancy. Preliminary results showed that less than 1% of children were not vaccinated, full coverage was less than 75% at all capitals and the Federal District, vaccines requiring more than one dose progressively lost coverage, and there were inequalities among socioeconomic strata, favorable to the highest level in some cities and to the lowest in others. There was an actual reduction in full vaccination in all capitals and the Federal District for children born in 2017 and 2018, showing a deteriorating implementation of the National Immunization Program from 2017 to 2019. The survey did not measure the impacts of the COVID-19 pandemic, which may have further reduced vaccination coverage.