Usual Source Research Articles

Identifying modifiable risk factors to improve immigrant breast cancer screening in the United States.

1530 Background: Despite marked reductions in breast cancer mortality since 1990, recent data suggest that progress has slowed—owing in part to plateaus in breast cancer screening in underserved populations. Historically low rates of screening coupled with rising breast cancer incidence make immigrants an important population for targeted intervention. Herein, we (1) compare contemporary rates of breast cancer screening among immigrants versus US natives; and (2) identify modifiable risk factors to inform the development of interventions to improve screening among immigrants in the United States. Methods: Using data from the 2019 and 2021 National Health Interview Surveys, screening eligible female participants (ages 40-79 years old) were identified, then classified by immigrant status as defined by nativity (US native vs. foreign-born). Primary outcome was receipt of screening mammogram in the last two years. Logistic regression models examined associations between immigrant status and mammography, with and without adjustments for age, metropolitan residence, overall health status, and survey year. Sequential analysis was then used to assess the degree to which modifiable social risk factors influence the magnitude of the association between immigrant status and mammography. Results: Of 20,090 female participants included in the study, 20% were immigrants. Compared to US natives, immigrants were less likely to have received a mammogram in the last two years (67% vs. 72%, aOR [95%CI], 0.87 [0.78-0.96], p=0.006)—an effect that was most pronounced among immigrant noncitizens (57%; 0.55 [0.47-0.64], p<0.001) but reversed among immigrants with US citizenship (74%; 1.14 [1.01-1.29], p=0.03). Of the factors assessed, having a usual source of care (5.73 [4.77-6.87]) or insurance (4.60 [3.74-5.67]) was associated with the greatest odds of biennial mammography, followed by educational attainment (1.38 [1.19-1.60]) and employment (1.19 [1.09-1.30]; all p<0.001). While having a usual source of care or employment attenuated—but did not eliminate—the association between immigrant status and mammography (0.87 [0.78-0.96], p=0.01 and 0.89 [0.80-0.99], p=0.03, respectively), this finding was not observed upon inclusion of insurance status or education in sequential models (0.97 [0.87-1.09], p=0.6 and 1.09 [0.96-1.21], p=0.13, respectively). With respect to insurance type, Medicare Advantage (4.60 [3.74-5.67]) conferred the largest benefit, followed by private insurance (4.54 [4.00-5.26]), Medicaid (2.63 [2.20-3.14]), and Medicare (4.39 [3.53-5.46]; all p<0.001). Conclusions: Breast cancer screening remains low in noncitizen immigrant populations. Targeted interventions to improve access to health insurance coverage and primary care for noncitizens may be most effective for improving rates of screening mammography among immigrants and thus warrant further investigation.

Evaluating the Efficiency of Solar and Petrol-Powered Recirculating Aquaculture Systems for African Catfish (<i>Clarias gariepinus</i>) Fingerling Production

Accessibility of quality fingerlings is dependable on a hatchery system with the capacity to produce all year round. There are two hatchery systems operational in Nigeria namely, the flow-through and re-circulating systems. These two systems require electricity to power periodic or constant water supply and aeration. When electricity supply fails or non-existent, this will result in anxiety and hardship to hatchery operators with the subsequent low output. This paper, therefore, assessed the production efficiency of solar and petrol-powered generator recirculating aquaculture systems for African catfish <i>(Clarias gariepinus)</i> fingerlings production. The results obtained from the growth performance and survival percentage of <i>Clarias gariepnus</i> reared in the two recirculating systems (solar and generator powered recirculating systems) showed no significant difference (P> 0.05) in the initial weight, specific growth rate (SGR) and feed conversion efficiency (FCE) of <i>C. gariepnus</i> from the two-recirculating systems. However, the result showed significant differences (P<0.05) in the final mean weight, weight gained, and survival rate in the two-recirculating systems. Aligning with the guidelines outlined by the Food and Agriculture Organization (FAO), the means and range values of temperature (°C), dissolved oxygen (mg/l), pH and ammonia, observed from the two recirculating production systems indicated temperature (22.81°C - 25.11°C), dissolved pH (7.10-7.42), dissolved oxygen (6.22- 6.62mg/l), ammonia (0.04-0.08mg/l) respectively. The survival rate of fry reaching 84% for the solar group and 64% for the generator at the end of 28- 56 days. Thus, this study revealed that solar energy might become the most promising energy source that can replace the usual source of energy for hatchery operations in Nigeria. This study, therefore, recommended that Solar Powered Recirculating Systems be adopted where feasible, given their demonstrated support for increased growth rates and higher survival rates to enhance efficiency and sustainability of aquaculture production systems.

Prevalence and Correlates of Suspected and Diagnosed Traumatic Brain Injuries among US School-Aged Children

ObjectiveTo (1) estimate the lifetime prevalence of suspected and diagnosed TBI based on parent report overall and select sociodemographic characteristics; and (2) describe differences in prevalence of health conditions and health-related risk factors by whether a child had a lifetime history of diagnosed TBI. Study DesignWe analyzed data from the 2020 National Survey of Children’s Health, a cross-sectional address-based survey of U.S. households. A categorical variable was created based on parent responses to 3 questions inquiring about their suspicion of their child having a brain injury, if they sought medical care, and if the healthcare provider provided a diagnosis. Parents were also asked to report on their child’s additional health conditions, functional indicators, school and social factors, and healthcare access and service utilization. ResultsThe prevalence of lifetime diagnosed TBI was 4.2% (95% CI: 3.8, 4.5). Children with a parent-reported lifetime history of diagnosed TBI were more likely to have a variety of health conditions, special healthcare needs, disabilities, activity limitations, missed days of school, and unmet care coordination needs, compared to those without a history. However, they were more likely to have a usual source of sick care and to receive more health-related services. Conclusions and RelevanceFor school-aged children, a history of TBI is associated with parent reported health needs and conditions, as well as missed days from school. It is particularly important for parents to seek care when they suspect their child has experienced a TBI to receive a diagnosis and monitor the impacts of the TBI.

Relationship Between Primary Care Physician Capacity and Usual Source of Care.

The NASEM Primary Care Report and Primary Care scorecard highlighted the importance of primary care physician (PCP) capacity and having a usual source of care (USC). However, research has found that PCP capacity and USC do not always correlate. This exploratory study compares geographic patterns and the characteristics of counties with similar rates of PCP capacity but varying rates of USC. Our county-level, cross-sectional approach includes estimates from the Robert Graham Center and data from the Robert Wood Johnson County Health Rankings (CHR). We utilized conditional mapping methods to first identify US counties with the highest rates of social deprivation (SDI). Next, counties were stratified based on primary care physician (PCP) capacity and usual source of care (USC) terciles, allowing us to identify 4 types of counties: (1) High-Low (high PCP capacity, low USC); (2) High-High (high PCP capacity, high USC); (3) Low-High (low PCP capacity, high USC); and (4) Low-Low (low PCP capacity, low USC). We use t test to explore differences in the characteristics of counties with similar rates of primary care capacity. The results show clear geographic patterns: High-High counties are located primarily in the northern and northeastern US; High-Low counties are located primarily in the southwestern and southern US. Low-High counties are concentrated in the Appalachian and Great Lakes regions; Low-Low counties are concentrated in the southeastern US and Texas. Descriptive results reveal that rates of racial and ethnic minorities, the uninsured, and social deprivation are highest in counties with low rates of USC for both high PCP and low PCP areas. Recognizing PCP shortages and improving rates of USC are key strategies for increasing access to high-quality, primary care. Targeting strategies by geographic region will allow for tailored models to improve access to and continuity of primary care. For example, we found that many of the counties with the lowest rates of USC are found in non-Medicaid expansion states (Texas, Georgia, and Florida) with high rates of uninsured populations, suggesting that expanding Medicaid and improving access to health insurance are key strategies for increasing USC in these states.

Health system inequities in Lao People's Democratic Republic: Evidence from a nationally representative phone survey.

Despite substantial economic growth in Lao People's Democratic Republic (PDR) over the past 20 years, high levels of income inequality and poverty persist and have likely been exacerbated by the COVID-19 pandemic. In this article, we use novel survey data to assess the extent to which socioeconomic status is associated with access to quality care in Lao PDR. We utilised data from the Lao People's Voice Survey (PVS), which was designed to measure health system performance from the perspective of the population. The survey was conducted between May and August 2022. Primary outcomes of interest were having a usual source of healthcare, using a government health centre (rather than a hospital or private clinic) as the usual source for care, receiving preventive health services, experiencing unmet healthcare needs, the quality of recent healthcare visit, and confidence in accessing and affording healthcare when needed. Poverty was measured using household asset ownership. We used logit models to assess the associations between poverty and health system performance measures, and additionally assessed differences between these associations in urban vs. rural areas by interacting urban residence with poverty. Poverty was negatively associated with having a regular provider for care (adjusted odds ratio (aOR) 0.45, 95% CI 0.26-0.78), receiving preventive health services (aOR 0.54, 95% CI 0.37-0.80), and confidence in the ability to receive care (aOR 0.50, 95% CI 0.34-0.72) and afford care (aOR 0.50, 95% CI 0.34-0.73) when needed. Poverty was positively associated with using government managed health centres as a usual source or for care (aOR 2.16, 95% CI 1.35-3.48). Poverty was not significantly associated with user experience or perceived quality of care in the last visit to the health facility. No differences in the associations between poverty and access to quality care were found between rural and urban settings. The results presented in this article suggest socioeconomic disparities in health care access in Lao PDR despite major national efforts to provide universal access to care. Universal health care policies may not be reaching the poor and additional targeted efforts may be needed to meet their healthcare needs.

Effect of social capital on enrolment of informal sector occupational groups in the national health insurance scheme in Ghana: a cross-sectional survey

BackgroundEnrolment of informal sector workers in Ghana’s National Health Insurance Scheme (NHIS) is critical to achieving increased risk-pooling and attainment of Universal Health Coverage. However, the NHIS has struggled over the years to improve enrolment of this subpopulation. This study analysed effect of social capital on enrolment of informal sector workers in the NHIS.MethodsA cross-sectional survey was conducted among 528 members of hairdressers and beauticians, farmers, and commercial road transport drivers’ groups. Descriptive statistics, principal component analysis, and multinomial logit regression model were used to analyse the data.ResultsSocial capital including membership in occupational group, trust, and collective action were significantly associated with enrolment in the NHIS, overall. Other factors such as household size, education, ethnicity, and usual source of health care were, however, correlated with both enrolment and dropout. Notwithstanding these factors, the chance of enrolling in the NHIS and staying active was 44.6% higher for the hairdressers and beauticians; the probability of dropping out of the scheme was 62.9% higher for the farmers; and the chance of never enrolling in the scheme was 22.3% higher for the commercial road transport drivers.ConclusionsSocial capital particularly collective action and predominantly female occupational groups are key determinants of informal sector workers’ participation in the NHIS. Policy interventions to improve enrolment of this subpopulation should consider group enrolment, targeting female dominated informal sector occupational groups. Further studies should consider inclusion of mediating and moderating variables to provide a clearer picture of the relationship between occupational group social capital and enrolment in health insurance schemes.

Alzheimer's Disease and Related Dementias Diagnosis in the United States Among US-Born and Foreign-Born White, Black, Hispanic, and Asian Older Adults.

Timely clinical diagnosis of Alzheimer's disease and related dementias (ADRD) is important for resource allocation, mitigating safety concerns, and improving quality of life. While studies have examined ADRD diagnosis disparities by race/ethnicity, few include its intersection with nativity. Our aims were to (1) estimate the odds of diagnosed ADRD among US- and foreign-born racial/ethnic groups compared to US-born White older adults and (2) make comparisons by nativity within each racial/ethnic group. We linked 2000-2017 National Health Interview Survey (NHIS) and 2001-2018 Medical Expenditure Panel Survey (MEPS) data (65 + years; n = 38,033). Race/ethnicity and nativity were measured using NHIS data. Diagnosed ADRD was determined using ICD-9 (290/294/331/797) or ICD-10 (F01/F03/G30/G31) billing codes created from self-reports during MEPS household interviews. Bivariate and multivariable analyses were adjusted for covariates based on Anderson's behavioral model of health services use. US-born Black (OR = 1.74; 95% CI = 1.48-2.05), Hispanic (OR = 1.62; 95% CI = 1.14-2.29), and foreign-born Hispanic (OR = 1.63; 95% CI = 1.24-2.15) older adults, but not foreign-born Black or Asian older adults, had higher odds of diagnosed ADRD compared to US-born White older adults after adjusting for age and sex. After additional adjustment for education, health insurance, usual source of care, and chronic conditions, only US-born Black older adults continued to show higher odds (OR = 1.54; 95% CI = 1.27-1.87) of diagnosed ADRD compared to US-born White older adults. There were no differences in ADRD diagnosis by nativity within each racial/ethnic group. Findings highlight the need for including nativity in studies comparing racial/ethnic groups to Whites to fully capture the ADRD burden among US-born Black older adults.

Linking the terrestrial environmental record at Mason Spur volcanic complex with the middle Miocene–Pleistocene Ross Sea marine record, Antarctica: A history of subaerial (ice-free) eruptions and glaciovolcanism under variable ice thicknesses

Abstract Research into volcanism in southern Victoria Land, Antarctica, within the West Antarctic rift system, has focussed historically on the geochemistry and chronology of its volcanic centers. However, volcanoes in the West Antarctic rift system have also been dramatically influenced by the prevailing eruptive environment. Mason Spur is a middle Miocene to Pleistocene volcanic complex in the Erebus Volcanic Province. The deep interior of the complex is revealed and is used to assess its development under different environmental conditions. Many of the volcanic sequences erupted within ice and are thus ultraproximal compared with marine sediments, which are the usual source of environmental information. The volcanic rocks provide a unique, well-dated record of the terrestrial environmental conditions independent of the marine record, to which they are an important counterbalance. Evidence is provided for conditions varying between ice-free, alpine ice, and regional ice sheets, and direct comparisons are made with the marine record. The first contemporary ice thicknesses are also deduced for the Erebus Volcanic Province. The results significantly advance our understanding of the middle Miocene–Pleistocene Antarctic environment in the coastal Victoria Land region.

Implementation and Evaluation of a Large Community-Based Colorectal Cancer Screening Program.

Colorectal cancer (CRC) screening can significantly reduce incidence and mortality; however, screening rates are suboptimal. The lowest rates are among those with no usual source of care and the uninsured. We describe the implementation and evaluation of a community-based CRC screening program from 2012 to 2015 designed to increase screening within a predominantly Hispanic US-Mexico border population. The multicomponent, evidence-based program provided in-person, bilingual, culturally tailored health education facilitated by community health workers, no-cost primarily stool-based testing and diagnostic colonoscopy, and navigation. We recruited uninsured individuals due for CRC screening from clinics and community sites. An extensive qualitative and quantitative program process and outcome evaluation was conducted. In total, 20 118 individuals were approached, 8361 were eligible for screening; 74.8% completed screening and 74.6% completed diagnostic testing; 14 cancers were diagnosed. The mean age of participants was 56.8 years, and the majority were Hispanic, female, and of low socioeconomic status. The process evaluation gathered information that enabled effective program implementation and demonstrated effective staff training, compliance with processes, and high patient satisfaction. This program used a population-based approach focusing on uninsured individuals and proved successful at achieving high fecal immunochemical test kit return rates and colonoscopy completion rates. Key factors related to its success included tailoring the intervention to our priority population, strong partnerships with community-based sites and clinics, expertise in clinical CRC screening, and an active community advisory board. This program can serve as a model for similar populations along the border to increase CRC screening rates among the underserved.

Health Care Access and Utilization and the Latino Health Paradox.

The Latino health paradox is the phenomenon whereby recent Latino immigrants have, on average, better health outcomes on some indicators than Latino immigrants who have lived in the United States longer and US-born Latinos and non-Latino Whites. This study examined whether the paradox holds after accounting for health care access and utilization. The 2019-2020 National Health Interview Survey data were used. The main predictors included population groups of foreign-born and US-born Latinos (Mexican or non-Mexican) versus US-born non-Latino Whites. Predicted probabilities of health outcomes (self-reported poor/fair health, overweight/obesity, hypertension, coronary heart disease, diabetes, cancer, and depression) were calculated and stratified by length of residence in the United States (<15 or ≥15 years) among foreign-born Latinos and sex (female or male). Multivariable analyses adjusted for having a usual source of care other than the emergency department, health insurance, a doctor visit in the past 12 months, predisposing and enabling factors, and survey year. After adjusting for health care access, utilization, and predisposing and enabling factors, foreign-born Latinos, including those living in the United States ≥15 years, had lower predicted probabilities for most health outcomes than US-born non-Latino Whites, except overweight/obesity and diabetes. US-born Latinos had higher predicted probabilities of overweight/obesity and diabetes and a lower predicted probability of depression than US-born non-Latino Whites. In this national survey, the Latino health paradox was observed after adjusting for health care access and utilization and predisposing and enabling factors, suggesting that, although these are important factors for good health, they do not necessarily explain the paradox.

Persistent effects of legal status on healthcare access and outcomes: findings from a state-wide representative cross-sectional survey in California

BackgroundTo examine how legal status and past undocumented status are associated with healthcare access and health outcomes.MethodsData were collected between 2018 and 2020 as a follow-on, cross-sectional survey to the...

Prevalence of self-medication practices among pregnant women in India: A systematic review and meta-analysis.

Self-medication practice among pregnant women is a global concern. However, its understanding in the Indian context is limited due to a lack of comprehensive studies. This study aimed to comprehensively assess the prevalence of self-medication, the medications used for self-medication, diseases/conditions associated with self-medication, and the reasons for self-medication among Indian pregnant women. This study was carried out following the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A thorough search was done in PubMed, Embase, and Google Scholar to find articles that were published up until May 2023. Inclusion criteria comprised observational studies reporting self-medication prevalence among pregnant women in India. Data were extracted using a standardized sheet, and a random-effects model was applied to determine the overall prevalence of self-medication using R software. The I2 statistic was employed to assess the heterogeneity among the studies. This study analyzed eight studies with a collective sample size of 2208 pregnant women. The pooled prevalence of self-medication among pregnant Indian women was 19.3% (95% CI: 7.5%-41.3%; I2 = 99%; p < 0.01). Common self-treated conditions were cold, cough, fever, headache, and stomach disorders. Antipyretics, analgesics, antihistamines, and antacids were frequently used for self-medication. The perception of mild ailment, immediate alleviation, convenience, time savings, and advice from family, friends, or the media were all reasons for self-medication. Local pharmacies were the most usual source for obtaining drugs, and pharmacists, family, friends, and past prescriptions were common sources of medicine information. A low yet substantial number of pregnant women in India are engaged in self-medication practices. Appropriate strategies need to be planned to reduce self-medication practices to attain sustainable developmental goals for maternal health in India.

The development of laboratory‐based high energy sources for XPS

Over the last fifty years, a number of higher energy X‐ray sources have been suggested as alternatives for the usual AlKα source found in the first commercial XPS systems and still the standard anode material for XPS today. This paper reviews the development of a number of such sources, predominantly in the authors' laboratory, and the rationale behind the desire to extend the binding energy range of the technique. The achromatic sources SiKα, ZrLα and TiKα are described along with monochromatic sources AgLα and CrKβ, both based on the standard quartz monochromator geometry but taking higher orders of diffraction. The driving force for much of this development was the desire to probe deeper core levels and CCC Auger transitions. These could be combined into initial or final state Auger parameters as described in much of the work cited in this review. The highest energy source considered is the CuKα source based around an external X‐ray tube, which provides much insight into the electronic structure of steels by measurement of the Fe1s and FeKLL peaks. The last decade or so has seen a significant increase of interest in HAXPES, and all manufacturers of turn‐key XPS instruments offer HAXPES options of one form or another, there are three dedicated HAXPES systems commercially available, which are very briefly described.

Sociodemographic inequities in COVID-19 vaccination among adults in the United States, 2022

BackgroundDespite the availability of COVID-19 vaccines since December 2020, sociodemographic inequities in vaccination and preventable COVID-related deaths persist. To inform efforts for equitable COVID-19 vaccination campaigns, a comprehensive national evaluation of existing inequities is necessary. ObjectiveTo examine sociodemographic inequities in COVID-19 vaccination receipt using data from the 2022 National Health Interview Survey (NHIS). MethodsThis secondary data analysis used cross-sectional nationally-representative data from the 2022 NHIS to assess vaccination inequities among 27,126 adults. Separate Poisson regressions adjusted for clinical factors (e.g., age, sex, high-risk health conditions) were used to evaluate vaccination inequities across sociographic factors (e.g., race/ethnicity, poverty, health insurance). ResultsIn 2022, 79.6% of adults received at ≥ 1 vaccine dose, 75.0% received ≥ 2 doses (“fully vaccinated”), 45.7% received ≥ 3 doses (≥ 1 booster), and 17.2% received ≥ 4 doses (≥ 2 boosters). Marked inequities were evident in COVID-19 vaccination across primary and booster doses, especially receipt of at least 1 booster dose (≥ 3 doses). Black (35.7%, prevalence ratio [PR] 0.78 [95% CI 0.74-0.83]) and Latinx (35.5%, PR 0.82 [CI 0.78-0.86]) adults were less likely to receive ≥ 3 doses than Asian (66.5%, PR 1.41 [CI 1.35-1.48]) and White (48.8%) adults. Poverty (31.1% [PR 0.65 {CI 0.61-0.69}] vs. 50.7%) and food insecurity (27.1% [PR 0.63 {CI 0.58-0.68}] vs. 47.3%) were negatively associated with receipt of ≥ 3 vaccine doses. Adults without usual source of care (24.9%, PR 0.61 [CI 0.57-0.65]) or health insurance (17.4%, PR 0.40 [CI 0.36-0.45]) had much lower rates of ≥ 3 doses than those with appropriate health care access (48.7% and 51.9%, respectively). ConclusionAs of 2022, 1-in-5 U.S. adults remain unvaccinated, and more than half have not received any recommended booster doses. Economically/socially marginalized populations—including Black and Latinx adults and those with structural barriers such as poverty, food insecurity, and poor health care access—were less likely to receive a booster. Addressing these vaccination inequities is crucial to achieve equitable COVID-19 protection and reduce preventable deaths among economically/socially marginalized populations.

Bridging the Gap: Addressing Immigrant Health Through Community-initiated Screening Events

Abstract: Background: In areas of new-immigrant population growth, medical and social infrastructure may be lagging behind the needs of those who do not identify with the majority culture or language. Subsequently, information regarding this population's health status and access to care is limited. Montana's Hispanic population is one such group. Despite its low total population, the state has experienced unprecedented growth in the number of Spanish-speaking individuals and families over the last decade. Objectives: We utilized a community based participatory research framework to emphasize equal partnership between lay community members and researchers to ensure adherence to community priorities and strengthen trust between the two parties allowing for future collaboration. Based on community request, we designed four health screening events to provide needed health prevention services to the Hispanic community. Methods: Through collaboration with a Community Advisory Board, we created four health screening events to provide basic primary care services, including height and weight, blood pressure, diabetes, and mental health screenings. We partnered with a team of dental hygienists to provide oral preventive health. We conducted a cost-effectiveness analysis, comparing our approach to traditional health services. Study variables were analyzed using analysis of variance to examine differences in health outcomes between health screening events. Results: We screened 140 persons and found that 85.7% lacked health insurance and 80.7% lacked a usual source of care. We also found overweight and obesity in 47.1% and 27.1%, respectively, and hypertension in 63.6%. Services provided by the health screening events were up to $239 less expensive than comparable services provided at local health centers. Conclusions: Working directly with the community, we designed and implemented health prevention events which served to meet a growing need and to identify and address health concerns among the Hispanic immigrant community.

Association between person-centred care quality and advance care planning participation in haemodialysis

ObjectivePerson-centred care (PCC), which incorporates patients’ preferences and values for medical care and their life, has been proposed in decision-making for promoting advance care planning (ACP) among patients with kidney...

Incarceration History and Access to and Receipt of Health Care in the US

People with a history of incarceration may experience barriers in access to and receipt of health care in the US. To examine the associations of incarceration history and access to and receipt of care and the contribution of modifiable factors (educational attainment and health insurance coverage) to these associations. Individuals with and without incarceration history were identified from the 2008 to 2018 National Longitudinal Survey of Youth 1979 cohort. Analyses were conducted from October 2022 to December 2023. Access to and receipt of health care were measured as self-reported having usual source of care and preventive service use, including physical examination, influenza shot, blood pressure check, blood cholesterol level check, blood glucose level check, dental check, and colorectal, breast, and cervical cancer screenings across multiple panels. To account for the longitudinal study design, we used the inverse probability weighting method with generalized estimating equations to evaluate associations of incarceration history and access to care. Separate multivariable models examining associations between incarceration history and receipt of each preventive service adjusted for sociodemographic factors; sequential models further adjusted for educational attainment and health insurance coverage to examine their contribution to the associations of incarceration history and access to and receipt of health care. A total of 7963 adults with 41 614 person-years of observation were included in this study; of these, 586 individuals (5.4%) had been incarcerated, with 2800 person-years of observation (4.9%). Compared with people without incarceration history, people with incarceration history had lower percentages of having a usual source of care or receiving preventive services, including physical examinations (69.6% vs 74.1%), blood pressure test (85.6% vs 91.6%), blood cholesterol level test (59.5% vs 72.2%), blood glucose level test (61.4% vs 69.4%), dental check up (51.1% vs 66.0%), and breast (55.0% vs 68.2%) and colorectal cancer screening (65.6% vs 70.3%). With additional adjustment for educational attainment and health insurance, the associations of incarceration history and access to care were attenuated for most measures and remained statistically significant for measures of having a usual source of care, blood cholesterol level test, and dental check up only. The results of this survey study suggest that incarceration history was associated with worse access to and receipt of health care. Educational attainment and health insurance may contribute to these associations. Efforts to improve access to education and health insurance coverage for people with an incarceration history might mitigate disparities in care.

The role of primary care attributes in preventing loss or change of usual source of care: a nationwide cohort study.

The existence of a stable usual source of care (USC) is fundamental to the provision of quality health care. However, no longitudinal studies have examined whether core primary care attributes influence the stability of USC status. We aimed to examine the association between primary care attributes (first contact, longitudinality, coordination, comprehensiveness, and community orientation) and the loss or change of USC. This nationwide cohort study was conducted during the coronavirus disease 2019 pandemic using a representative sample of the Japanese adult population aged 40-75 years. The primary outcome measures were loss of USC and voluntary change in USC during the 12-month follow-up period. Primary care attributes were evaluated in the baseline survey using the Japanese version of Primary Care Assessment Tool (JPCAT). Data were analyzed for 725 participants who had a USC at baseline. Among them, 93 (12.8 %) lost their USC and 46 (6.3%) changed their USC during the follow-up period. Multivariable multinominal logistic regression analyses showed that the JPCAT total score was associated with decreased loss of USC and change in USC. Among the JPCAT domains, longitudinality, comprehensiveness (services available), and community orientation were associated with reductions in both USC loss and change. Our study indicates that primary care attributes play an important role in preventing the loss or change of USC and contribute to the stability of USC status. These findings provide additional rationale for policymakers, healthcare providers, and managers to seek to strengthen core attributes of primary care.

Examining Differences Among Latinos Not Adherent to Cancer Screening Guidelines: A Latent Class Analysis

Cancer screening rates are low among Hispanic individuals. We examined subgroups of Latinos not adherent to cancer screening guidelines, using latent class analyses, to identify how different facets of cultural identity and risk factors might coalesce. Analyses of 2,873 Hispanic/Latino individuals revealed six latent classes: Connected Immigrants, Bridging Locals, Rooted Locals, Bridging Immigrants, Isolated Locals, and Connected Locals. Multinomial regression analysis also was used to examine sociodemographic and health care predictors of belonging to each latent class. Results show that the Connected Immigrants group, who are highly connected with their Latin culture and Spanish language dominant, stood in stark contrast to Rooted Locals, US born and English language dominant with non-Hispanic/Latino friendship groups. Rooted Locals also were more likely to have a usual source of care and less likely to have visited a doctor in the past year. These differences could shape health messaging beyond common variables such as ethnicity and language.

Isolation and Identification of Bacterial Contamination Water Supply in Shendi City-Sudan

Background: Microbial contamination of water persists to be a significant problem; the usual source is human and animal fecal matter that has contaminated the water systems. The presence of bacteria and pathogenic organisms is of great concern when considering the safety of drinking water, as pathogenic organisms can cause watery diarrhea, cholera, typhoid fever, and other illnesses. Objective: This is a prospective tap water examination study to find groundwater microbiological fecal contamination. Materials and Methods: Water samples for laboratory examination were collected from a different area of Shendi city, which were classified as Tap water. Each sample was a collection in a sterile container and then isolated and Confirmation by biochemical test. Results: Tap water samples were found to be contaminated with E. coli about 80 (63.6%) samples, an indicator of contamination with the fecal matter of animals and humans. It was the isolation of other Gram-negative enteric bacteria such as Salmonella and pseudomonas these were not scientific indicators of water contamination by animal and human fecal matter. Conclusions: Tap Water was contaminated with feces and posed a health risk to consumers of that water and was found to be contaminated with E.coli bacteria. Future studies are needed to understand the complicated issues concerning water quality in the city. Community-led sanitation and hygiene education and better water source protection are urgently required.