Wide Disparity Research Articles

Abstract 12331: Cardiovascular Hospitalizations and Mortality Among Young Adults Aged 25 to 64 Years in the United States

Introduction: Declines in cardiovascular mortality have stagnated in the United States since 2011. There is growing concern that these patterns may reflect worsening cardiovascular health in younger populations. However, little is known about how the burden of acute cardiovascular hospitalizations and mortality have changed in young adults. Aim: To evaluate cardiovascular hospitalizations (AMI, heart failure, ischemic stroke) and in-hospital mortality among adults 25-64 years, overall and by income-level, as well as population-level cardiovascular mortality. Methods: We determined age-standardized cardiovascular hospitalization rates from 2012 to 2019, and fit quasi-Poisson and quasi-binominal regression models to compare hospitalizations and mortality between low- and higher-income young adults. Results: Between 2012 and 2019, age-standardized AMI hospitalization rates increased modestly among young adults from 162.0 (161.4, 162.6) to 163.7 (163.3, 164.2) per 100,000 (p<0.001). In contrast, there were significant increases in heart failure (163.9 [163.3, 164.5] to 231.5 [231.0, 232.0], p<0.001) and ischemic stroke hospitalizations (92.3 [91.8, 92.8] to 110.2 [109.9, 110.6], p<0.001). Across all 3 conditions, low-income adults experienced a more pronounced rise in hospitalizations, and the gap between the low- and higher-income groups widened (p-interaction<0.001), while in-hospital mortality decreased for heart failure and stroke. Population-level cardiovascular mortality rates increased in the subgroup of young adults aged 45-64 years (162.5 to 168.3 per 100,000, p<0.001), particularly in the low-income population. Conclusions: There has been an alarming increase in cardiovascular hospitalizations and population-level cardiovascular mortality among young adults over the past decade in the US, with evidence of widening disparities between low- and higher-income populations.

Drug overdose mortality rates by educational attainment and sex for adults aged 25–64 in the United States before and during the COVID-19 pandemic, 2015–2021

IntroductionDramatic increases in U.S. drug overdose deaths involving synthetic opioids, especially fentanyl, beginning around 2014 have driven a marked progression in overall drug overdose deaths in the U.S., which sharply rose to unprecedented levels amid the COVID-19 pandemic. Disparities in drug overdose deaths by educational attainment (EA) during the fentanyl era of the drug overdose epidemic and its intersection with the COVID-19 pandemic have not been widely scrutinized. MethodsUtilizing restricted-use mortality data from the National Vital Statistics System and population estimates from the American Community Survey, we estimated annual national age-adjusted mortality rates (AAMRs) from drug overdoses jointly stratified by EA and sex for adults aged 25–64 from 2015 to 2021. State-level AAMRs in 2015 and 2021 were also estimated to examine the geographic variation in the cumulative evolution of EA-related disparities over the course of the analysis period. ResultsNationally, AAMRs rose fastest among persons with at most a high school-level education, whereas little to no change was observed for bachelor’s degree holders, widening pre-existing disparities. During the analysis period, the difference in national AAMRs between persons with at most a high school-level education and bachelor’s degree holders increased from less than 8-fold (2015) to approximately 13-fold (2021). The national widening of EA-related disparities accelerated amid the COVID-19 pandemic, and they widened in nearly every state. Among non-bachelor’s degree holders, national AAMRs increased markedly faster for males. ConclusionsThe widening disparities in drug overdose deaths by EA are a likely indicator of a rapidly increasing socioeconomic divide in drug overdose mortality more broadly. Policy strategies should address upstream socioeconomic drivers of drug use and overdose, particularly among males.

Medicaid Home and Community-Based Services in the Wake of the COVID-19 Pandemic

The need to bolster Medicaid home and community-based services (HCBS) became more evident during the COVID-19 pandemic. This recognition stemmed from the challenges of keeping people safe in nursing homes and the acute workforce shortages in the HCBS sector. This article examines two major federal developments and state responses in HCBS options as a result of the pandemic. The first initiative entails a one-year increase of the federal Medicaid matching rate for HCBS included in the American Rescue Plan Act championed by the Biden administration. The second initiative encompasses administrative flexibilities that permitted states to temporarily expand and modify their existing Medicaid HCBS programs. The article concludes that the effects of the pandemic flexibilities and enhanced federal funding on most state HCBS programs will be limited without continued investment and leadership on the part of the federal government, which is a Biden administration priority. States that make the American Rescue Act and COVID-19 flexibilities initiatives permanent are states that have the fiscal resources and political commitment to expanding HCBS benefits that other states lack. States’ different approaches to bolstering Medicaid HCBS during the pandemic may contribute to widening disparities in access and quality of HCBS across states and populations who depend on Medicaid HCBS.

Decreasing incidence of hepatocellular carcinoma among most racial groups: SEER-22, 2000-2019.

Hepatocellular carcinoma (HCC) incidence was rising in the United States. Previously, using data collected by the Surveillance, Epidemiology, and End Results (SEER) Program through 2017, we found that overall incidence had begun to decline, although not in Black and American Indian/Alaska Native (AI/AN) populations. Utilizing expanded SEER data encompassing ~50% of the population, we examined secular trends and demographic differences in HCC incidence through 2019. We included cases of HCC diagnosed in adults aged ≥20 years residing in SEER-22 registry areas. We examined case counts, incidence rates (per 100,000 person-years), annual percent changes (APCs), and calendar years when APCs changed significantly. HCC incidence increased from 5.56 in 2000 to 8.89 in 2009 (APC, 5.17%), then rose more slowly during 2009-2015 (APC, 2.28%). After peaking at 10.03 in 2015, incidence fell to 9.20 in 2019 (APC, -2.26%). In Asian/Pacific Islanders (A/PI), the decline began in 2007 and accelerated in 2015 (APCs: 2007-2015, -1.84%; 2015-2019, -5.80%). In 2014, incidence began to fall in the White (APC: 2014-2019, -1.11%) and Hispanic populations (APC: 2014-2019, -1.72%). In 2016, rates began to fall in Black individuals (APC: 2016-2019, -6.05%). In the AI/AN population, incidence was highest in 2017, although the subsequent decline was not statistically significant. In 2019, population-specific rates were: White, 6.94; Black, 10.74; A/PI, 12.11; AI/AN, 14.56; Hispanic, 15.48. HCC incidence is now decreasing in most US racial/ethnic populations, including among Black individuals. The onset of decline differed among racial/ethnic groups and wide disparities in HCC rates remain.

Spatio-temporal analysis of childhood vaccine uptake in Nigeria: a hierarchical Bayesian Zero-inflated Poisson approach

BackgroundGlobally, child mortality and morbidity remain a serious health challenge and infectious diseases are the leading causes. The use of count models together with spatial analysis of the number of doses of childhood vaccines taken is limited in the literature. We used a Bayesian zero-inflated Poisson regression model with spatio-temporal components to assess the number of doses of childhood vaccines taken among children aged 12–23 months and their associated factors.MethodsData of 19,564 children from 2003, 2008, 2013 and 2018 population-based cross-sectional Nigeria Demographic and Health Survey were used. The childhood vaccines include one dose of Bacillus-Calmette-Guérin; three doses of Diphtheria-Pertussis-Tetanus; three doses of Polio and one dose of Measles. Uptake of all nine vaccines was regarded as full vaccination. We examined the multilevel factors associated with the number of doses of childhood vaccines taken using descriptive, bivariable and multivariable Bayesian models. Analysis was conducted in Stata version 16 and R statistical packages, and visualization in ArcGIS.ResultsThe prevalence of full vaccination was 6.5% in 2003, 14.8% in 2008, 21.8% in 2013 and 23.3% in 2018. Full vaccination coverage ranged from 1.7% in Sokoto to 51.9% in Anambra. Factors associated with the number of doses of childhood vaccines taken include maternal age (adjusted Incidence “risk” Ratio (aIRR) = 1.05; 95% Credible Interval (CrI) = 1.03–1.07) for 25–34 years and (aIRR = 1.07; 95% CrI = 1.05–1.10) for 35–49 years and education: (aIRR = 1.11, 95% CrI = 1.09–1.14) for primary and (aIRR = 1.16; 95% CrI = 1.13–1.19) for secondary/tertiary education. Other significant factors are wealth status, antenatal care attendance, working status, use of skilled birth attendants, religion, mother’s desire for the child, community poverty rate, community illiteracy, and community unemployment.ConclusionAlthough full vaccination has remained low, there have been improvements over the years with wide disparities across the states. Improving the uptake of vaccines by educating women on the benefits of hospital delivery and vaccines through radio jingles and posters should be embraced, and state-specific efforts should be made to address inequality in access to routine vaccination in Nigeria.

Declining trends in telehealth utilization in the ongoing COVID-19 pandemic.

Telehealth is an important complement to in-person healthcare, with opportunities to overcome barriers to healthcare and improve health equity. Telehealth utilization increased sharply at the onset of the COVID-19 pandemic. This study assessed trends in telehealth utilization for the years 2020 through 2022, both overall and in subgroups. We gathered data from the 2020-2022 National Health Interview Survey. The rates of telehealth utilization were calculated overall and within subgroups based on demographic factors, health conditions, healthcare utilization, challenges of ability, and social needs. Adjusted multivariable logistic regression models of telehealth utilization assessed the yearly trends. We also analyzed the ratios of subgroup utilization relative to the overall rates. A total of 69,581 patients were identified with complete information. The overall rates of telehealth utilization were 36.2% for 2020, 38.9% for 2021, and 31.3% for 2022. The reduction in telehealth utilization for 2022 was large and statistically significant (OR: 0.64 (95% CI: 0.62-0.67), p < 0.001). Subgroup analyses showed corresponding reductions in 2022 for essentially all patient subgroups. Telehealth was utilized at higher rates by patients with chronic conditions, challenges of ability, and other kinds of medical utilization. Ratio analyses showed evidence of widening disparities for patients of older age, in rural areas, and by geographic region, limited education, and of low income. The study demonstrates declining rates of telehealth utilization are occurring with widening gaps among patient subgroups. Addressing these disparities may be critical to improving equity in telehealth and healthcare overall.

The Intersection Between Meritocracy and Diversity, Equity, and Inclusion.

Embracing meritocracy and diversity, equity, and inclusion is critical to the future of otolaryngology-head and neck surgery. Understanding the intersection of these twoconcepts is particularly important. Meritocracy, a key principle utilized in academic medicine and surgery, rewards individual achievement. However, it can inadvertently result in a widening disparity between individuals who have access to environments promoting and facilitating meritocracy and those facing systemic structural barriers. Navigating the intersection of meritocracy and diversity, equity, and inclusion is a complex endeavor. However, it is crucial to understand that these concepts can coexist. With a balanced approach, we can appreciate individual merit while fostering diversity, equity, and inclusion. It requires a commitment to systemic change, ongoing evaluation, and collaboration to create environments where everyone has an equal opportunity to succeed and contribute unique talents and perspectives. Through these efforts, our specialty of otolaryngology-head and neck surgery will be stronger.

Neonatal, Infant, and Child Mortality in India: Progress and Future Directions.

In India, considerable progress has been made in reducing child mortality rates. Despite this achievement, wide disparities persist across and socio-economic strata, and persistent challenges, such as malnutrition, poor sanitation, and lack of clean water. This paper provides a comprehensive review of the state of child health in India, examining key risk factors and causes of child mortality, assessing the coverage of child health interventions, and highlighting critical public health programs and policies. The authors also discuss future directions and recommendations for bolstering ongoing efforts to improve child health. These include state- and region-specific interventions, prioritizing social determinants of health, strengthening data systems, leveraging existing programs like the National Health Mission (NHM) and Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), and the proposed Public Health Management Cadre (PHMC). The authors argue that reducing child mortality requires not only scaled-up interventions but a comprehensive approach that addresses all dimensions of health, from social determinants to system strengthening.

XIII International Conference on Kangaroo Mother Care - Different opinions, experiences and related KMC issues: Good practices, stabilisation concept, nutrition and basic respiratory support.

This study aimed to summarise the views and experiences of the participants in the workshop of the XIII International Conference on Kangaroo Mother Care (KMC). The results of the discussions held during the workshop of the XIII International Conference on KMC were summarised. There were 152 participants from 47 countries. Four main KMC topics were discussed: good practices, immediate implementation, nutrition and basic ventilation. Several agreements were reached, namely that professional societies and governments should develop official recommendations to promote KMC as standard care for preterm and low birth weight infants and that parents should be involved as active caregivers in neonatal care units. Moreover, the criteria for referring community-born infants to KMC require standardisation. Important inequalities in resource availability among high-, middle- and low-income countries were recognised for all topics. Specific needs were identified for parenteral nutrition and fortifiers, nasal continuous positive airway pressure (nCPAP) and oxygen blenders, which are rarely available in low- and middle-income countries. Immediate implementation of KMC was discussed as a new concept. Its benefits were recognised, but its application has some variability. Adequate preterm care requires a basic neonatal package, including KMC, nCPAP, immediate management protocols and adequate nutrition and feeding strategies. The differences in resources among high-, middle- and low-income countries highlight the wide disparities in neonatal care according to the place of birth.

A study on prevalence and risk factors of depression among adolescent girls studying in government and private schools-A comparative study.

The prevalence of depression among school-going adolescent girls in India is about 40%. Adolescent girls attending private and government-run schools in South India have vastly different sociodemographic backgrounds and school environments. Assessing the associated risk factors for depression will help in designing appropriate preventive strategies. To evaluate the prevalence of depression among school-going adolescent girls and the associated risk factors among government and private school students. The cross-sectional comparative study was conducted in two private and two government-run schools in Tamil Nadu. A semi-structured questionnaire and 11-item Kutcher Adolescent Depression Scale were administered to female students belonging to grades eight, nine, and ten. Differences in the prevalence of depression and the familial, social, and behavioral risk factors between private and government school students were measured and analyzed. The prevalence of depression among our study population is 23.8%. An adolescent girl studying in a private school has a 4.67 times higher chance of being depressed as compared to her counterpart in a government school. Stress due to higher academic expectations, peer pressure, disagreement with friends, excess smartphone usage, and family discord are associated factors in private school students, and family discord and chronic illness among family members were associated risk factors for depression in government school students. There is a wide disparity in the prevalence of depression and associated factors among private and government school-going adolescent girls. The intervention program for depression has to be addressed differently according to the type of school.

Epidemiology of syphilis infections among pregnant women in Tanzania: Analysis of the 2020 national representative sentinel surveillance.

Syphilis has detrimental effects on the health of the mother and that of both fetuses and newborns exposed in utero or at delivery. Understanding its local epidemiology is essential for policies, planning, and implementation of targeted preventive interventions. Using data from the 2020 National Sentinel Surveillance of pregnant women attending antenatal clinics (ANCs) in Tanzania we determined the prevalence and determinants of syphilis among pregnant women in Tanzania mainland. The ANC surveillance was conducted in 159 ANC sites from all 26 regions of Tanzania's mainland from September to December 2020. It included all pregnant women 15 years and above on their first ANC visit in the current pregnancy during the survey period. Counseling for syphilis was done using standard guidelines at the ANC and testing was done using rapid SD Bioline HIV/Syphilis Duo test kits. Analysis was done using both descriptive statistics to determine the prevalence and characteristics of syphilis, whereas, logistic regressions were used to examine the independent association between syphilis and dependent variables. A total of 38,783 women [median age (Interquartile range (IQR)) = 25 (21-30) years] participated in the surveillance. Of them, 582 (1.4%) tested positive for syphilis. A wide regional variation was observed with the highest burden in Kagera (4.5%) to the lowest burden in Kigoma (0.3%). The odds of syphilis infections were higher among older women and those with no formal education. Compared with primigravids, women with 1-2, those with 3-4 and those with more than four previous pregnancies had 1.8 (aOR = 1.8, 95% CI: 1.2-2.5), 2.1 (aOR = 2.1, 95% CI: 1.4-3.1) and 2.6 (aOR = 2.6, 95% CI: 1.7-3.9) higher odds of syphilis infection respectively. Syphilis is still prevalent among pregnant women in Tanzania with a wide regional disparity. Efforts to prevent new infections, screen pregnant women, and treat those infected should be strategized to include all regions and renewed emphasis on regions with high burden, and importantly among women who are multipara, with a low level of education, and advanced age.

Finishing the “unfinished revolution”?: College‐educated mothers' resistance to intensive mothering

AbstractIntensive mothering, a classed and gendered practice optimally performed by stay‐at‐home mothers, is a dominant parenting ideology, particularly in developed societies with wide disparities in wealth. Ironically, in these societies, women tend to be well educated and have good employment prospects that are expected to free them from domestic obligations. Facing competing expectations shaped by the institutions of work and the family, how do college‐educated mothers consider ending or limiting their participation in the workforce or holding jobs while resolving the moral dilemma of being both a worker and a mother? We compared 33 college‐educated Hong Kong mothers engaged in different professions and constructed typologies that describe how intersecting ideologies of mothering and work shape work‐family arrangements. We paid special attention to mothers with strong commitment to their work, but with different ideologies about mothering. Some espouse the ideology of intensive mothering. Their belief in gender essentialism proved exhausting for them, both at work and at home. While away from home, these mothers supervised domestic helpers from their workplaces. Other women value their professions as emblematic of their identity as the perfect mother—an integrated form of mothering, thus feeling no guilt for delegating childcare responsibilities. We argue that given the entrenched gender inequality in workplaces and men's slow progress in doing their share of domestic work, the emergence of integrated mothering both rhetorically and in practice reflects women's striving to bring the “unfinished revolution” closer to the finish line.

International Cooperation, Criminal Justice and Human Rights: The Missing Link

Abstract International society has recently witnessed the emergence of two interrelated trends: on the one hand, the significant rise in transnational crimes, which constitute a serious challenge to States’ traditional security capabilities, and the noticeable increase in the number of international instruments put in place to bring that challenge to acceptable levels, on the other hand. The great emphasis the international community has put on the principle “aut dedere aut judicare” to strengthen the universal legal regime against serious crimes and to deny safe haven to their perpetrators is challenged not only by political, legislative and practical considerations pertaining to the lack of ratification and incorporation of international conventions and the wide disparity between States as to their implementation capacity, but also by the inherent differences between States’ differing legal systems. This is an area that, despite its relevance to international cooperation and human rights, has long been ignored by criminal justice comparative studies. Based on actual cases such as the Ramda and El Guerbouzi cases, this article examines and assesses the impact of the differences between civil law and common law systems on the effectiveness of international cooperation and human rights. It argues that, unless these differences are acknowledged and properly dealt with, perpetrators of serious crime will continue to constitute a serious threat to our peace and security.

Remote Schooling During the COVID-19 Pandemic: Rural Latino Caregiver Perspectives and Experiences

ABSTRACT The COVID-19 pandemic forced more than 50 million students and their families to adapt to remote schooling. Most disrupted were communities of color, who faced multiple and overlapping inequalities in digital and equipment access, exposing and exacerbating existing disparities. Conducted in a small rural school district, this study surveyed the experiences of rural Spanish-speaking Latino caregivers. A total of 104 caregivers responded to a survey assessing caregiver digital literacy and access, school support, caregiver-teacher relationship and communication, and caregiver values, expectations, and teaching efficacy. Findings highlighted wide disparities in digital access and availability of equipment or devices compared to recent reports of more affluent White caregivers. Findings also highlighted that strong caregiver-teacher relationships were important for helping caregivers to navigate children’s instruction during remote instruction. While student learning losses have yet to be fully assessed, hints at the full impact of school closures for rural linguistically and culturally diverse families are available from other countries, and they suggest that learning losses will be much greater for children from disadvantaged families than the population at large.

Virtual care use among older immigrant adults in Ontario, Canada during the COVID-19 pandemic: A repeated cross-sectional analysis.

The critical role of virtual care during the COVID-19 pandemic has raised concerns about the widening disparities to access by vulnerable populations including older immigrants. This paper aims to describe virtual care use in older immigrant populations residing in Ontario, Canada. In this population-based, repeated cross-sectional study, we used linked administrative data to describe virtual care and healthcare utilization among immigrants aged 65 years and older before and during the COVID-19 pandemic. Visits were identified weekly from January 2018 to March 2021 among various older adult immigrant populations. Among older immigrants, over 75% were high users of virtual care (had two or more virtual visits) during the pandemic. Rates of virtual care use was low (weekly average <2 visits per 1000) prior to the pandemic, but increased for both older adult immigrant and non-immigrant populations. At the start of the pandemic, virtual care use was lower among immigrants compared to non-immigrants (weekly average of 77 vs 86 visits per 1000). As the pandemic progressed, the rates between these groups became similar (80 vs 79 visits per 1000). Virtual care use was consistently lower among immigrants in the family class (75 visits per 1000) compared to the economic (82 visits per 1000) or refugee (89 visits per 1000) classes, and was lower among those who only spoke French (69 visits per 1000) or neither French nor English (73 visits per 1000) compared to those who were fluent in English (81 visits per 1000). This study found that use of virtual care was comparable between older immigrants and non-immigrants overall, though there may have been barriers to access for older immigrants early on in the pandemic. However, within older immigrant populations, immigration category and language ability were consistent differentiators in the rates of virtual care use throughout the pandemic.

SDFA: Structure-Aware Discriminative Feature Aggregation for Efficient Human Fall Detection in Video

Older people are susceptible to fall due to instability in posture and deteriorating health. Immediate access to medical support can greatly reduce repercussions. Hence, there is an increasing interest in automated fall detection, often incorporated into a smart healthcare system to provide better monitoring. Existing systems focus on wearable devices which are inconvenient or video monitoring which has privacy concerns. Moreover, these systems provide a limited perspective of their generalization ability as they are tested on datasets containing few activities that have wide disparity in the action space and are easy to differentiate. Complex daily life scenarios pose much greater challenges with activities that overlap in action spaces due to similar posture or motion. To overcome these limitations, we propose a fall detection model, coined SDFA, based on human skeletons extracted from low-resolution videos. The use of skeleton data ensures privacy and low-resolution videos ensures low hardware and computational cost. Our model captures discriminative structural displacements and motion trends using unified joint and motion features projected onto a shared high dimensional space. Particularly, the use of separable convolution combined with a powerful GCN architecture provides improved performance. Extensive experiments on five large-scale datasets with a wide range of evaluation settings show that our model achieves competitive performance with extremely low computational complexity and runs faster than existing models.

Determinants of cervical cancer screening among women living with HIV in Zimbabwe.

In sub-Saharan Africa (SSA), cervical cancer (CC) is the second leading cause of cancer-related deaths, with human immunodeficiency virus (HIV) seropositive women being particularly vulnerable. Despite the benefits of early CC screening in reducing HIV-related CC deaths, CC screening uptake remains limited, with wide disparities in access across SSA. As part of a larger study, this paper examines the determinants of CC screening among HIV-seropositive women of reproductive age (15-49 years) in Zimbabwe. Using the 2015 Zimbabwe Demographic and Health Survey, we conducted multilevel analyses of CC screening among 1490 HIV-seropositive women, nested in 400 clusters. Our findings revealed that, even though 74% of HIV-seropositive women knew about CC, only 17.6% of them reported ever screening for it. Women who held misconceptions about HIV (OR = 0.47, p = 0.01) were less likely to screen for CC compared to those with accurate knowledge about HIV and CC. HIV-seropositive women with secondary or higher education were more likely to screen (OR = 1.39, p = 0.04) for CC compared to those with a primary or lower level of education. Age was positively associated with screening for CC. Furthermore, locational factors, including province and rural-urban residence, were associated with CC screening. Based on these findings, we call for integrated care and management of HIV and non-communicable diseases in Southern Africa, specifically, Zimbabwe due to the legacy of HIV in the region.

A Brief Overview of the Sexual and Reproductive Health Awareness of Adolescents in Kerala

Background: Adolescence is a critical and challenging period of life. Many adolescents today have patchy knowledge on SRH issues, which may lead to risky decision making concerning their health. Kerala, though one of the most literate states in India, is yet to implement comprehensive sex education. Objectives: To list the sources of information and to study the awareness of adolescents on Sexual and Reproductive Health (SRH) issues among high school students in Kerala. Materials &amp; Method: A cross sectional study was conducted among 8th, 9th, 10th class students. Multistage random sampling was conducted and a sample size of 338 was achieved. Data was collected via a self-administered questionnaire and analyzed using SPSS Version-23. Results were explained in terms of frequency, percentage, mean and standard deviation. Results: Mean age of the study population was 14.2 ±0.88 years; most of them were females (58%) and followed Christian religion (49%); belonged to urban areas. The major sources of information for adolescents regarding SRH matters like private parts, type of touch, response to sexual assault and menstruation was their mother. When it comes to puberty changes, both mother and teachers were the major sources. Media was the most common source of information regarding Masturbation, sexual contact, pregnancy, contraception, STDs, and sexual abuse. There is wide disparity in the awareness of adolescents on major SRH issues. Conclusions: India has the largest adolescent population, and it is a country known to have strict traditional values and age-old cultures and customs. Adequate information through parents may improve the knowledge on these issues. Age-appropriate comprehensive sexuality education must be incorporated into their curriculum effectively to improve their SRH.

Changes in Some Haematological Parameters of Two Breeds of Chicken Inoculated with Eimeria Oocyst

Coccidian parasites, especially those in the genus Eimeria, are intestinal parasites common in poultry. They cause coccidiosis in infected birds. The effect of the parasites on the haematology of infected chickens was studied using broilers and white-leghorns. A total of 30 day-old chicks, fifteen each from the two breeds, were procured for the experiment. They were grown to three weeks old, and confirmed to be free from any intestinal parasite, before inoculating 10 birds each, randomly selected from the two breeds, with Eimeria oocyst. The packed cell volume (PCV), thrombocyte number, leukocyte number and proportion of leukocyte types were determined from blood samples obtained from the birds within ten days after inoculation and confirmation of infection. Infected broilers (B) and white-leghorns (WL) both had packed cell volumes that were lower than the control (C) (B. 31.8±2.2, WL. 32.8±1.8, C. 34.3±2.6). However, estimates of the effect sizes suggested that coccidiosis accounted for only about 5% of the observed variance in the PCV of broilers and 2% in white-leghorns. The disease significantly affected the thrombocyte number of infected broilers only (B. 7.0±0.5, WL. 10.4±1.1, C. 10.0±0.8). A remarkable difference was found in the leukocyte numbers of infected birds (B. 13.4±2.2, WL. 21.4±3.2, C. 14.9±2.0). However, the infection increased the proportion of circulating monocytes from 1% in control to 5% in the infected birds regardless of their breed. The observation that broilers are prone to parasite induced thrombocytopaenia, supported by the wide disparity in the leukocyte numbers of the two breeds of chicken during an infection, suggest that white-leghorns are better adapted to withstand the effects of coccidiosis when compared with broilers reared under the same environmental conditions.

A national examination of suicidal ideation, planning, and attempts among United States adults: Differences by military veteran status, 2008–2019

There is a widening disparity in suicide deaths between United States (U.S.) military veterans and nonveterans. However, it is unclear if there are similar differences in suicidal ideation, planning, and attempts that often precipitate these deaths. A better understanding of trends in suicidal thoughts and behaviors could illuminate opportunities for prevention. We examined pooled cross-sectional data (N = 479,801 adults) from the 2008 to 2019 National Survey on Drug Use and Health. We examined differences in past-year suicidal ideation, suicide planning, and suicide attempts between U.S. veterans (n = 26,508) and nonveterans (n = 453,293). We conducted post hoc analyses to examine for differences in these relationships by race/ethnicity and sex. Lastly, we examined trends in these outcomes over time and tested for differences in trends by veteran status. Overall, veterans had significantly greater odds of past-year suicidal ideation (aOR = 1.33, 95% CI 1.20 to 1.47) and suicide planning (aOR = 1.52, 95% CI 1.30 to 1.78) compared to nonveterans. However, the association between veteran status and past-year suicide attempt was not statistically significant (aOR = 1.29, 95% CI 1.00 to 1.68). These relationships did not differ by race/ethnicity or sex (ps > 0.05). Among all adults, there were significant linear increases in past-year suicidal ideation, planning, and attempts (ps < 0.001). However, these trends did not differ between veterans and nonveterans (ps > 0.05). Veterans may be more likely to experience suicidal thoughts and behaviors than nonveteran adults. Upward trends in suicidal thoughts and behaviors among both veterans and nonveterans from 2008 to 2019 highlight opportunities for intervention.