Socioeconomic Status and Access to Healthcare: Interrelated Drivers for Healthy Aging

Profiles and predictors of access to human and veterinary healthcare in multispecies households

This study extends a behavioral-ecological framework for healthcare access and utilization to explore patterns of healthcare and veterinary care access within pet-owning households in the United States. Using Latent Class Analysis, a person-centered analytic approach, we identified five subgroups of pet owners in a diverse national sample (n = 750), each characterized by unique patterns of perceived access and actual usage of both human and veterinary healthcare. The first subgroup, "Good access/unfair system" (27%) and the second subgroup, "Good access/fair system" (30%) reported high probabilities of good healthcare and veterinary care access and limited financial burden but differed in their perceptions of healthcare fairness. The third subgroup, "Good access/Medicare" (14%), primarily comprised of older adults with Medicare, reported good access to both human and veterinary care and limited financial burden, underscoring Medicare's role in stable healthcare access. The fourth subgroup, "Moderate access" (11%), characterized by financial barriers despite non-employer health insurance, showed a lower likelihood of recent dental and veterinary visits. The fifth subgroup, "Poor access" (18%), with the poorest healthcare access and highest probability of Medicaid or no insurance, highlighted significant inequalities in healthcare and veterinary care access. Sociodemographic and social environmental factors were associated with subgroup membership. For example, the groups with better access were likely to have low financial fragility (Good access/unfair system OR = 4.61, p < 0.001), and those with poorer access were unlikely (Poor access OR = 0.14). Additionally, the groups with better access were less likely to experience discrimination (Good access/fair system OR = 0.58, p < 0.001) and those with poorer access were more likely (Moderate and Poor access both ORs = 1.37, p < 0.001). These findings emphasize the need for policies addressing factors such as economic inequality and discrimination to improve healthcare and veterinary care access and utilization. Tailored interventions at individual and systemic levels are also suggested (i.e., the Colorado "Peticaid" proposal and the Seattle One Health Clinic) to mitigate disparities and enhance healthcare and veterinary care access for vulnerable populations.

Sociodemographic characteristics and outcomes of surgically managed central cord syndrome patients

Introduction

Undiagnosed cervical spine stenosis is a risk factor for central cord syndrome (CCS), especially in vulnerable individuals. Social determinants of health (SDOH) are correlated with health outcomes. The aim of this study was to characterize the sociodemographic characteristics and outcomes in surgically-treated central cord syndrome (CCS) patients, and explore potential associations between them.

Methods

This is a retrospective cohort study of surgically-treated CCS patients at a Level-1 trauma center between 2015 and 2021. Patient demographics, radiological findings, and clinical outcomes were collected. SDOH were estimated using the Social Deprivation Index (SDI) and Area Deprivation Index (ADI). Descriptive statistics and regression analyses assessed associations between SDI/ADI, demographics and clinical outcomes.

Results

Of 56 patients, 75 % were insured by Medicare/Medicaid and 70 % were discharged to care facilities. Mean SDI was 66.4 ± 24.4, and mean ADI was 7.4 ± 2.2. Three patients required reoperation for post-operative complications. Post-operative neurologic outcomes varied, with 60.7 % stable, 30.4 % improved, and 8.9 % declined. While SDI/ADI did not correlate with outcomes, higher ADI quartiles were associated with decreased likelihood of home discharge (p = 0.048). Decline in neurologic function was associated with Medicare/Medicaid or Military insurance (p = 0.011).

Conclusions

The results of this study indicated that CCS patients typically come from lower socioeconomic backgrounds, as indicated by high SDI and ADI scores. Despite this, we did not find significant correlations between SDI or ADI with post-operative outcomes, and most patients had stable or improved neurological function post-surgery in our cohort. Future studies with larger sample sizes will provide a more comprehensive understanding of these findings.

The relationship between trajectories of intrinsic capacity and differences in the risk of functional ability decline in community-dwelling older adults: A socio-ecological approach

BACKGROUND

Functional ability (FA), a key determinant of healthy aging, is determined by intrinsic capacity (IC), environmental factors, and their interactions. IC is a composite of physical and mental capacities that undergo constant change. Therefore, understanding the factors that influence IC requires a multi-level analysis of individuals to optimize its trajectory.

METHODS

Individuals aged ≥ 65 were included in the Korean Longitudinal Study of Aging (2012-2020). Impaired IC (IIC) scores were tracked over eight years using latent class growth modeling to classify trajectory patterns. Determinants were identified through multinomial logistic regression. The relationship between IIC trajectory and FA decline was assessed using Kaplan-Meier analysis and the Cox proportional hazards model.

RESULTS

Of the 7486 subjects, 2268 (mean age 72.26 [SD 5.31] years; female 56.4 %) were included after excluding those who were underage, had lost independence, or were missing baseline data. The IIC trajectories were categorized into four classes: low-persistent (Class 1, 48.46 %); low-increasing (Class 2, 17.46 %); high-decreasing (Class 3, 20.37 %); and high-stable (Class 4, 13.71 %). Over a mean follow-up of 7.21 years, 536 individuals experienced a decline in FA. After adjusting for confounders, the hazard ratios (HRs) were 1.95 (95 % CI 1.51-2.50) for class 2, 1.93 (1.50-2.46) for class 3, and 3.41 (2.64-4.39) for class 4 compared to class 1. Additionally, age, gender, marital status, employment, social participation, and living status had overlapping effects on both IC and FA.

CONCLUSIONS

Understanding the heterogeneity of IC, combined with multidomain interventions, can enable FA maintenance and promote healthy aging.

The effect of social exclusion on the cognitive health of middle-aged and older adults: A systematic review

This systematic review aimed to evaluate the independent and joint effects of social exclusion in three specific domains-economic, social relations, and civic participation-on the cognitive health of middle-aged and older adults. Longitudinal studies from January 2000 to October 2023 were identified via Web of Science, Scopus, and PubMed, with sixty-five studies meeting inclusion criteria. The quality of the studies was assessed with Newcastle-Otawa Scale. Analysis revealed a strong association between economic exclusion and cognitive decline, with most studies indicating a significant negative impact. Ten studies found a positive link between volunteering and cognitive health for civic participation, while eight did not, showing mixed evidence. In social relations, most studies connected loneliness, social isolation, smaller social networks, reduced contact with family and friends, lower engagement in activities, and negative social interactions with cognitive decline. Notably, one study found that older adults experiencing social exclusion in multiple domains simultaneously face even greater cognitive decline. In summary, this review shows that social exclusion in economic, social relations, and civic participation and all together domains is associated with greater cognitive decline in older adults.

Trends in Alzheimer's-Related Mortality Among Type 2 Diabetes Patients in the United States: 1999-2019

BACKGROUND

Recent research has shown that type 2 diabetes mellitus (T2DM) has increased the burden of Alzheimer's disease (AD) in the US aging population. However, trends in mortality from this comorbidity among adults aged ≥ 65 years have not been investigated.

OBJECTIVES

This study examined trends and disparities in AD-related mortality among older US adults with T2DM from 1999 to 2019.

METHODS

Data from the CDC WONDER database were analysed to assess AD-related mortality in patients with T2DM aged ≥ 65 between 1999 and 2019. Age-adjusted mortality rates (AAMRs) per 100,000 people and annual percent change (APC) were calculated and stratified by year, sex, race/ethnicity, age, urbanisation and geographical region.

RESULTS

From 1999 to 2019, there were 71,550 deaths with T2DM and AD among adults aged ≥ 65. AAMRs rose from 4.12 in 1999 to 11.65 in 2019, with the sharpest increase between 2014 and 2017 (APC: 10.81; 95% CI: -3.20 to 13.43). Women had slightly higher AAMRs than men, with rates increasing from 4.71 in 1999 to 11.61 in 2019 for women, and from 4.08 to 11.70 for men. Hispanic individuals saw the highest increase in AAMR (11.15), followed by non-Hispanic Black (9.30) and White populations (7.92). AAMRs were highest in the West (10.91) and the Midwest (9.62), while the Northeast (4.70) had the lowest. Nonmetropolitan areas had consistently higher AAMRs (10.74) than large metropolitan areas (6.68) and small/medium metropolitan areas (9.25). States in the top 90th percentile for T2DM-AD mortality included California, South Dakota and Kentucky, where rates were approximately eight times higher than in states in the lowest 10th percentile.

CONCLUSIONS

This study reveals a significant rise in T2DM-AD comorbidity-related mortality among older adults, especially among Hispanics, women and rural residents. These findings underscore the need for targeted interventions to reduce the burden in vulnerable populations.

Social Mobility and Health-Related Quality of Life Trajectory Classes Among Older Women and Men

OBJECTIVES

Changes in socioeconomic status (SES) during life may impact health in old age. We investigated whether social mobility and childhood and adulthood SES are associated with trajectories of health-related quality of life (HrQoL) over a 17-year period.

METHODS

We used data from the Helsinki Birth Cohort Study (n = 2003, 46% men, mean age 61.5 years). Social mobility was derived from childhood SES, obtained from healthcare records, and register-based adulthood SES.

RESULTS

Logistic regression models showed that lower adulthood SES was associated with lower physical HrQoL trajectories. Among men low (OR 3.95, p < .001), middle (OR 2.20, p = .006), and declining lifetime SES (OR 2.41, p = .001) were associated with lower physical HrQoL trajectories compared to men with high SES. Socioeconomic status was not associated with mental HrQoL trajectories.

DISCUSSION

Declining SES during life course may have negative health consequences, while improving SES is potentially as beneficial as high SES to later-life health among men.

Chest pain in a multi-ethnic population: A community-based study on sex differences in chest pain prevalence and care contacts

Objective

While chest pain is a common symptom, its prevalence among women and men across ethnic groups is unknown. Moreover, how chest pain is associated with general practitioner (GP) and cardiologist visits in women and men across ethnic groups, remains to be determined.

Design

We used baseline data on 12423 women and 9071 men from the multi-ethnic HELIUS cohort (Amsterdam, the Netherlands; 2011-2015). Using logistic regressions, we studied sex differences in chest pain prevalence across ethnic groups. Next, in those who reported chest pain in the past two years (henceforth; recent chest pain), we studied sex differences in GP, cardiologist, and any specialists visits, in total and by ethnicity. Analyses were adjusted for age, ethnicity (in the total population), socioeconomic factors, associated symptoms, clinical parameters, and lifestyle factors.

Results

Across most ethnic groups, women were more likely than men to report lifetime (33 % vs 29 %, p < .001) and recent chest pain (4.5 % vs 2.7 %, p = .001). In those with recent chest pain, women were more likely to have visited a GP, yet less likely to have visited a cardiologist, but not any specialist, compared to men. These differences were also observed in several sensitivity analyses, including in those with symptoms suggestive of typical Angina Pectoris.

Conclusion

Chest pain is more commonly reported in women than men across most ethnic groups. While men were less likely to have visited a GP than women, women were less likely to have visited a cardiologist. Combined, this suggests delays in care may occur at different points in the care trajectory for women and men.

Comprehensive evaluation of diabetes subtypes in a European cohort reveals stronger differences of lifestyle, education and psychosocial parameters compared to metabolic or inflammatory factors

BACKGROUND

The traditional binary classification of diabetes into Type 1 and Type 2 fails to capture the heterogeneity among diabetes patients. This study aims to identify and characterize diabetes subtypes within the German FoCus cohort, using the ANDIS cohort's classification framework, and to explore subtype-specific variations in metabolic markers, gut microbiota, lifestyle, social factors, and comorbidities.

METHODS

We utilized data from 416 participants (208 with diabetes and 208 matched metabolically healthy controls) from the German FoCus cohort. Participants were classified into five subtypes: severe autoimmune diabetes (SAID)-like, severe insulin-deficient diabetes (SIDD)-like, severe insulin-resistant diabetes (SIRD)-like, mild obesity-related diabetes (MOD)-like, and mild age-related diabetes (MARD)-like. Comprehensive characterization included anthropometric measurements, dietary and physical activity questionnaires, blood biomarker analysis, and gut microbiota profiling.

RESULTS

The subtype distribution in the FoCus cohort accounted to SAID-like: 2.84%, SIDD-like: 30.81%, SIRD-like: 32.23%, MOD-like: 17.54%, MARD-like: 16.59%. Of interest, inflammatory markers (C-reactive protein (CRP) and Interleukin-6 (IL-6)) and glucagon-like peptide-1 (GLP-1) levels were similarly elevated across all subtypes compared to controls, indicating common aspects in Type 2 diabetes molecular pathology despite different clinical phenotypes. While the gut microbiota and dietary patterns only showed minor differences, smoking status, sleep duration, physical activity and psychological aspects varied significantly between the subtypes. In addition, we observed a lower educational status especially for SIDD-like and SIRD-like groups, which should be considered in establishing future diabetes-related patient education programs. In respect to the development of cardio-metabolic comorbidities, we observe not only significant differences in the presence of the diseases but also for their age-of onset, highlighting the need for early preventive intervention strategies.

CONCLUSIONS

The study validates the ANDIS classification framework's applicability not only at the time point of manifestation but also in cohorts with pre-existing diabetes. While we did not find major differences regarding the classical metabolic, microbial and nutritional parameters, we identified several significant associations with lifestyle factors. Our findings underscore the importance of personalized, subtype-specific therapies not solely focusing on anthropometric and laboratory markers but comprehensively addressing the patient's own personality and situation of life.

Anti-hypertensive medication adherence, socioeconomic status, and cognitive aging in the Chinese community-dwelling middle-aged and older adults ≥ 45 years: a population-based longitudinal study

BACKGROUND

It remains unclear whether anti-hypertensive medication use is associated with cognitive aging in general Chinese middle-aged and older adults, as well as the interplay with socioeconomic status (SES). We aim to examine associations of anti-hypertensive medication adherence, SES, and cognitive aging in Chinese middle-aged and older adults.

METHODS

Our study was based on the China Health and Retirement Longitudinal Study, an ongoing longitudinal national survey recruiting community-dwelling adults aged ≥ 45 years. Baseline anti-hypertensive medication use was assessed at wave 1. Longitudinal adherence to anti-hypertensive medication was assessed during waves 1 and 2. SES was assessed using income, education, employment, and medical insurance. The annual rate of cognitive change was assessed using cognitive Z scores. Linear mixed models were used to examine longitudinal associations.

RESULTS

A total of 9229 participants were included (mean [SD] age: 57.1 [8.9] years; men: 50.8%). After controlling for blood pressure and other characteristics, participants taking anti-hypertensive medication at baseline, compared to participants not using medication, had a significantly decelerated decline in global cognition (β = 0.014; 95% confidence interval [CI], 0.003 to 0.025 SD/year; P = 0.01) and memory (β = 0.021; 95% CI, 0.008 to 0.034 SD/year; P = 0.001), respectively. Similarly, participants with high anti-hypertensive medication adherence during follow-up had slower declines in global cognition (β = 0.014; 95% CI, 0.002 to 0.027 SD/year; P = 0.02) and memory (β = 0.023; 95% CI, 0.008 to 0.038 SD/year; P = 0.003), compared to the low adherence group. There were no significant differences in cognitive decline between hypertension participants using or persistently adhering to medication and normotension participants. The SES significantly interacted with anti-hypertensive medication in associations with cognitive aging, with more evident associations observed in low SES subgroup (all P for interaction < 0.05). Several sensitivity analyses were conducted, observing consistent findings.

CONCLUSIONS

Adhering to anti-hypertensive medication was associated with decelerated cognitive aging in Chinese community-dwelling middle-aged and older adults, especially in participants with low SES. These findings indicate that promoting anti-hypertensive medication use could be important to achieve healthy and inclusive cognitive aging in general Chinese middle-aged and older adults living with hypertension.

Spatial patterns and temporal trends in stillbirth, neonatal, and infant mortality: an exploration of country-level data from 2000 to 2021

Background

Despite significant progress in improving child survival and health, substantial disparities persist and are being increasingly threatened by a complex and dynamic global environment. In this ecological study, we investigated spatial patterns, temporal trends, and key determinants of disparities in stillbirth, neonatal, and infant mortality rates across 195 countries from 2000 to 2021.

Methods

We sourced our data from two publicly available databases: the United Nations Children's Fund Data Warehouse for mortality indicators and the World Bank for World Development Indicators. We conducted spatial analysis to assess spatial autocorrelation and identify geographical clusters of countries and applied joinpoint regression to evaluate temporal trends in mortality indicators, reported as annual percentage change. We also used forward regression analysis to determine the primary indicators influencing stillbirth, neonatal, and infant mortality rates.

Results

The average stillbirth rate in 2021 was 10.9 per 1000 total births, a significant decrease from 16.3 per 1000 in 2000. Neonatal mortality also declined from 23.6 to 13.5 per 1000 live births during the same period, while infant mortality dropped from 45.0 to 22.5 per 1000 live births. Despite these improvements, spatial analysis showed notable positive spatial autocorrelations for stillbirth, neonatal, and infant mortality rates, indicating that high mortality rates were geographically clustered, particularly in African countries forming hot-spot clusters. Conversely, developed countries in Europe and Asia formed cold-spot clusters characterised by low mortality indicators. Some countries, identified as low-high or high-low clusters, stood out due to dissimilar mortality rates compared to their neighbours, warranting further investigation. Key determinants of mortality rates included the young-age dependency ratio, prevalence of undernourishment, the percentage of women aged 15 and older living with HIV, the incidence of tuberculosis, and the adolescent fertility rate - all of which showed a positive association with higher mortality rates. In contrast, factors such as the use of at least basic sanitation services, mean years of schooling, and government effectiveness had an inverse relationship, contributing to lower mortality rates.

Conclusions

By identifying hotspots and outliers, this study highlights the need for targeted health interventions and efficient resource allocation. This approach ensures that efforts are strategic and impactful, focussing on areas with the greatest need.

Promoting healthy aging using new digital solutions in Italy: A scoping review

Age-related changes can impact cognitive and physical health, reducing quality of life and independence. While technologies are increasingly used in healthcare to support older adults, their application highly depends on cultural factors. Italy, with one of Europe's highest aging populations and low digital advancement, offers an interesting scenario for discussing the digitalization of healthcare services for older adults. This study provides a state-of-the-art overview of technologies used in Italy to promote healthy aging. We systematically searched PubMed, Embase, and Scopus databases for primary studies published from 2000 to May 2024 that employed technological solutions for healthcare in healthy Italian older adults. Fifteen studies met the criteria: four assessed the impact of technological interventions on health variables like physical efficiency, nutrition, and cognition, with positive results; 13 examined usability, user experience, and expectations, overall finding good acceptance and positive attitudes. While research on technology use in promoting healthy aging in Italy is still limited, our findings suggest that digital solutions are feasible for the older population. These results are considered within the context of the Italian healthcare system, with suggestions for future directions for clinicians.

Barriers to participation in Iran's Integrated Geriatric Care Program: A qualitative study

BACKGROUND

A significant number of older adults still have unfulfilled needs related to healthcare and social services. Policymakers and health administrators can turn this challenge into a golden opportunity through proper planning and policymaking. This study aimed to identify barriers to participation in Iran's "Integrated Geriatric Care Program (IGCP)".

METHODS

A qualitative study with conventional content analysis approach was conducted in Yazd City, Iran, from January to March 2023. A purposive sampling method with maximum variation was used. Nineteen healthcare providers and community-dwelling older adults participated in the study. Data were collected using semi-structured in-depth interviews until data saturation and were concurrently analyzed.

RESULTS

Nine older persons (3 women and 6 men) with a Mean±SD age of 71.33±5.75 and ten healthcare providers (6 women and 4 men) with a Mean±SD age of 38.2±9.16 participated in the study. Two main categories, with ten sub-categories, emerged from the data analysis. The main categories were "personal challenges of older adults" and "structural defects of Integrated Geriatric Care Program".

CONCLUSION

The participation of community-dwelling older adults in the Iranian IGCP is constrained by a combination of personal and structural factors. Our findings seem to be informative for health policymakers and health practitioners who aim to enhance the quality and quantity of healthcare services for older adults in developing communities.

Association of cigarette use with risk of prostate cancer among US males: a cross-sectional study from NHANES 1999-2020

BACKGROUND

Association of cigarette use with risk of prostate cancer remains unclear. We performed this study to examine whether cigarette use is associated with increased risk of prostate cancer.

METHODS

This cross-sectional study used data from the 1999 to 2020 National Health and Nutrition Examination Survey (NHANES), a population-based nationally representative survey designed to assess the health and nutritional status of US adults and children. Males were eligible if they were aged ≥ 20 years at the time of participation. Cigarette use (ever use, categorized into former use and current use) was defined as having smoked at least 100 cigarettes in life. Smoking duration, cigarettes smoked per day, and smoking pack-years were calculated in former smokers and current smokers. The primary outcome was self-reported diagnosis of prostate cancer by participants. Logistic regression was used to calculate the adjusted odd ratios (aOR) and 95% CI for the associations of cigarette use with risk of prostate cancer, adjusting for demographic characteristics. Subgroup analyses by age group were conducted. Data were analyzed from June 4 to November 30, 2023.

RESULTS

Of the 107 622 participants in 1999-2020 NHANES, 28 170 were included in the analysis. The mean (SD) age of the 28 170 participants was 46.4 (16.4) years, 68.0% were non-Hispanic White. Compared with never smokers, ever (aOR, 2.41 [95% CI, 1.15-5.06]) and former smokers (aOR, 3.56 [95% CI, 1.62-7.85]) had a higher risk of prostate cancer. This higher risk in former (aOR, 3.82 [95% CI, 1.69-8.64]) and ever smokers (aOR, 2.82 [95% CI, 1.27-6.25]) was also found in participants aged 20-59 years. Dose-response analysis showed a positive association between smoking duration (aOR, 1.07 [95% CI, 1.03-1.11]), cigarettes smoked per day (aOR, 1.03 [95% CI, 1.00-1.07]), smoking pack-years (aOR, 1.02 [95% CI, 1.01-1.03]) and risk of prostate cancer in current smokers.

CONCLUSIONS

This study suggests that cigarette use was associated with an increased risk of prostate cancer in US males, especially among those aged 20-59 years. Further research utilizing prospective study design and modeling family history is needed to confirm the findings.

Correlation of Serum Homocysteine Levels With Various Types of Coronary Syndromes (CS) and In-Hospital Mortality - A Multicenter Study

Purpose

Coronary artery disease (CAD), clinically manifested as coronary syndrome (CS), is the leading cause of death and a significant contributor to morbidity worldwide. Elevated serum homocysteine levels have been associated with an increased risk of cardiovascular diseases, including CAD. Despite extensive research, the relationship between serum homocysteine and coronary syndromes with related short-term mortality is still under-studied. The main objective of this study is to evaluate the correlation between serum homocysteine levels and various types of CS, as well as in-hospital mortality in these patients.

Patients and Methods

This multicenter study included 381 CS patients from Afghanistan, Egypt, and Pakistan tertiary care hospitals. The relation of serum homocysteine levels with different types of CS as well as with in-hospital mortality was measured and analyzed using inferential statistics (ANOVA, Kruskal-Wallis test, Tukey's post-hoc, Pearson correlation, etc.) and regression analysis (Binary regression).

Results

Among 381 patients from both genders, 160 were from Pakistan, 130 from Egypt, and 91 from Afghanistan. There was no significant difference in baseline characteristics, like age, gender, homocysteine level, CS type, and mortality, among the three countries (p > 0.05). The one-way ANOVA, the Kruskal Wallis Test, and Tukey's post hoc test showed a significant difference among different CS groups based on serum homocysteine levels, and Pearson correlation showed a strong correlation between serum homocysteine and CS (r = 0.4). Binary regression analysis showed a 10.5% increase in in-hospital mortality for each 1 µmol/L increase in homocysteine levels.

Conclusion

Serum homocysteine could serve as a valuable biomarker and mortality predictor in CS patients.

Determinants of Access to the Pentavalent 3 Vaccine Among Children Aged 0-23 months in Cameroon Based on the Demographic and Health Survey 2018

Purpose

Vaccination is one of the most effective and efficient health interventions for reducing morbidity and mortality from infectious diseases, particularly in sub-Saharan Africa. Understanding the determinants of access to vaccines can help improve immunization coverage and control vaccine-preventable diseases. The aim of this study was to explore the contribution of certain determinants to access to pentavalent 3 in children aged 0-23 months in Cameroon via demographic and health survey data.

Materials and Methods

This was a cross-sectional nested case‒control study in which children aged 0-23 months were selected via cluster random sampling in households in the 10 regions of Cameroon. Secondary data from the Demographic and Health Survey, which was conducted in Cameroon from 2017-2018, were used. Univariate and multivariate logistic models were used to analyze the determinants of access to the pentavalent 3 vaccine.

Results

The vaccination coverage of the pentavalent 3 vaccine (P3V) among children aged 0-23 months was 69.5%. The access to the P3V with Christian religion, compared with non-Christian experienced 63% of P3V (adjusted Odds ratio (AOR)=1.63, 95% CI, [1.22-2.17], p=0.001). Compared with those living in other regions in Cameron, those living in the northern regions of Cameroon were observed 37% less likely to have access to P3V (AOR=AOR=0.63, 95% CI, [0.44-0.87], p=0.006), while mother's marital status (married) compared with unmarried mothers were 37% more likely to experience access to P3V (AOR=1.37, 95% CI, [1.04-1.81], p=0.024). Relative to subjects with less education, those with at least secondary or higher education were 92% more likely to have access to P3V, (AOR=1.92, 95% CI [1.47-2.51], p<0.001), while those with cell phone experienced 44% increased access to P3V, (AOR=1.44, 95% CI, [1.17-1.78], p=0.001).

Conclusion

Access to the pentavalent 3 vaccine in Cameroon does not meet national targets and is affected by various socio-demographic factors, including region of residence, religion, educational attainment, maternal marital status, and cell phone ownership.

Burden of benign prostatic hyperplasia in the Middle East and North Africa Region, 1990-2021

OBJECTIVE

To examine the burden of benign prostatic hyperplasia (BPH) in the Middle East and North Africa (MENA) region from 1990 to 2021 by age and sociodemographic index (SDI).

METHODS

Data were sourced from the Global Burden of Disease (GBD) 2021 database. We analysed the incidence, prevalence, and years lived with disability (YLDs) attributable to BPH across the MENA region and its constituent countries.

RESULTS

In 2021, the MENA region had an estimated 4.7 million prevalent cases of BPH, with an age-standardised prevalence rate of 2168.6 per 100,000. BPH contributed to 93.6 thousand YLDs, with an age-standardised YLD rate of 42.8 per 100,000. The highest prevalence and incidence rates were observed in Jordan, Qatar, and Iran, while Egypt and Yemen recorded the lowest rates. The burden of BPH was found to increase with age, peaking in the 65-69 age range.

CONCLUSION

This study reveals an increasing burden of BPH in the MENA region, primarily due to aging populations. These findings underscore the need for tailored public health policies and strategies to enhance early detection, prevention, and management of BPH, thereby reducing its impact on healthcare systems and individuals.

[Determinants of the utilization of general health check-up among older adults in Saxony-Anhalt: What is the influence of access to health services?]

Due to the nature of demographic developmens, there is an increasing need for prevention measures in healthcare. In Germany, people with statutory health insurance have a legal right to general health check-ups for early detection of diseases that are significant in terms of population medicine. However, the older population has thus far made inadequate use of these services, resulting in significant losses of prevention potential. This paper examines the impact of objective and subjectively perceived access to health services on the use of general health check-up among citizens aged 55 years and older in the state of Saxony-Anhalt, Germany.The study uses data from a written cross-sectional survey of residents from four major and minor cities in Saxony-Anhalt. Bivariate logistic regression models were used for the statistical analysis of data to evaluate the relation between access parameters to health services and utilization.In all, 953 questionnaires were included in the analyses; 59.7% of the respondents used the general health check-up in the recommended time interval. In the multivariate analyses, the study showed that neither subjective satisfaction with access nor self-reported travel times to family doctors were significant factors affecting the utilization. On the other hand, being a member of statutory health insurance funds and the use of a private car increased the likelihood of utilization. Other determinants that had an influence on the use of general health checks were net household income and need for long-term care.The results of this study indicate potential for increasing utilization of general health check-up among older people. However, increased use of free health check-ups by this section of the population cannot be achieved primarily by improving accessibility, but must be addressed by other factors, such as attitudes towards health checks, which requires further analysis.

Exploring Multidisciplinary Approaches to Comorbid Psychiatric and Medical Disorders: A Scoping Review

Psychiatric disorders often coexist with internal medical conditions, posing significant challenges to diagnosis, treatment, and overall patient outcomes. This study examines the bidirectional relationship between these conditions, emphasizing their impact on morbidity, treatment adherence, and quality of life. Through a comprehensive review of the peer-reviewed literature, we explore the physiological, neuroinflammatory, and psychosocial mechanisms that underpin these interactions. Key psychiatric disorders, including depression, anxiety, cognitive impairments, and psychosis, are identified as critical contributors to diagnostic complexity and therapeutic hurdles. Our findings underscore the importance of integrated, multidisciplinary care models, advocating for early detection, routine mental health screening, and personalized treatment strategies. Challenges such as overlapping symptoms, diagnostic ambiguities, and potential drug interactions are critically analyzed, with practical, evidence-based recommendations proposed for clinical practice. Despite advancements, significant research gaps persist, particularly the lack of longitudinal studies and the limited application of precision medicine tailored to this population. Future directions focus on enhancing diagnostic tools, developing innovative therapeutic approaches, and integrating mental health services into routine care. This study highlights the critical need for holistic, patient-centered approaches to manage comorbid psychiatric and internal medical conditions, offering actionable insights to improve outcomes and bridge existing gaps in research and practice.

Socioeconomic disparities in healthcare access and implications for all-cause mortality among US adults: a 2000-2019 record linkage study

The United States (US) has witnessed a notable increase in socioeconomic disparities in all-cause mortality since 2000. While this period is marked by significant macroeconomic and health policy changes, the specific drivers of these mortality trends remain poorly understood. In this study, we assessed healthcare access variables and their association with socioeconomic status (SES)-related differences (exposure) in US all-cause mortality (outcome) since 2000. Our research drew upon cross-sectional data from the National Health Interview Survey (NHIS, 2000-2018), linked to death records from the National Death Index (NDI, 2000-2019; n = 486 257). The findings reveal that the odds of a lack of health insurance and unaffordability of needed medical care were over 2-fold higher among individuals with lower education compared to those with high education, following differential time trends. Moreover, elevated mortality risk was associated with lower education (up to 77%), uninsurance (17%), unaffordability (43%), and delayed care (12%). Uninsurance and unaffordability accounted for 4%-6% of the disparities in time to mortality between low- and high-education groups. These findings were corroborated by income-based sensitivity analyses, emphasizing that inadequate healthcare access partially contributed to socioeconomic disparities in mortality. Effective policies promoting equitable healthcare access are imperative to mitigate socioeconomic disparities in mortality.

Intersecting Paths to Health: A Factor Analysis Approach to Socioeconomic and Environmental Determinants in Indiana

Public health is the basis of society's well-being and the nation's development. Despite the importance of this factor and huge investments in the health sector in the United States, public health is facing enormous challenges due to the unknown nature of the influential variables in this sector. This research aims to investigate the influential variables on public health from different sources including the demographic features, built environment, socioeconomic variables, and environmental factors impact on 30 major health issues. To achieve this goal, this study utilizes exploratory factor analysis and multiple regression methods on the data obtained from the state of Indiana. The results indicated that health issues and influential factors can be divided into five main factors. This study identifies Health Burdens and Socioeconomic Disparities as a key factor, encompassing a wide range of health issues and socioeconomic variables, highlighting a significant association between socioeconomic disparities, poor health outcomes, and environmental exposures. The analysis underscores the intricate relationship between socioeconomic status, health behaviors, chronic diseases, and environmental factors, suggesting that effective interventions must address healthcare access, quality, and broader determinants of health to improve outcomes in affected communities. The results of this study can be helpful to public health policymakers, urban planners, and future public health researchers.

Isotemporal Substitution Effect of 24-h Movement Behaviors on Well-Being, Cognition, and BMI Among Older Adults

Background: This study investigated the interdependent relationships among older adults' daily engagement in physical activity (PA), sedentary time (ST), sleep, and their well-being, cognition, and body mass index (BMI). Method: Forty healthy older adults (31 females; Mean [age] = 70.8 ± 5.58) were included in the analysis. Participants wore a Fitbit tracker for an average of 23 h a day, five days a week, over six months. The Fitbit device tracked lightly active time, active time, ST, and sleep durations. Quality of life and cognitive flexibility were assessed using validated instruments. BMI was calculated using participants' self-reported height and weight. A compositional analysis (CODA) investigated the codependent associations among these variables and model time reallocation between behaviors. Results: Regression models utilizing CODA indicated significant associations between the outcomes of BMI (p = 0.05; Adj. R2 = 0.20), while cognitive flexibility and quality of life revealed no association (p > 0.05). Shifting 10 min from ST to active time is associated with a theoretical decrease of -0.76 (95% CI, -1.49 to -0.04) units in BMI. Similarly, reallocating 10 min from active time to ST is associated with a theoretical increase of 1.17 (95% CI, 0.03 to 2.3) units in BMI. Reallocating 10 min between other movement behaviors yielded no statistical significance. Conclusions: Our study highlights the importance of promoting active time to improve BMI in this population. Encouraging 10 min bouts of PA among older adults, in place of ST, is vital for improving national PA guideline adherence.

The effect of the work-family conflict, subjective socio-economic status, and physical activity on the perceived quality of life of working women in Iran: the mediating role of quality of work life

INTRODUCTION

The conflict between work and family responsibilities has created many challenges for working women in Iran. This study aimed to examine the effect of work-family conflict (WFC), subjective socio-economic status (SSS), and physical activity (PA) and quality of working life (QWL) on the quality of life (QOL) of working women in Kermanshah, Iran.

METHODS

This cross-sectional study was conducted with 392 working women in Kermanshah, the most populous city in western Iran. The data gathering tool was a six-part questionnaire, including demographic checklist, PA scale, a question on SSS, WFC scale, QWL questionnaire, and QOL questionnaire. Data were analyzed by SPSS and AMOS software.

RESULTS

The majority of participants (69.4%) were inactive or had low levels of PA during their leisure times. The highest positive correlation was observed between QWL and QOL (r = 0.309, p-value < 0.001). The highest direct effect among the variables belonged to the SSS on QWL (β = 0.41, p-value = 0.001) and QOL (β = 0.20, p-value < 0.001). Furthermore, the analysis of indirect effects indicated that QWL played a mediating role between SSS and QOL (β = 0.092, p-value < 0.001).

CONCLUSION

The findings of this study revealed that variables such as SSS, PA, and QWL had significant direct effects on QOL. However, WFC had no significant effect on QOL. Moreover, QWL had a significant positive mediating role between SSS and QOL.

Socioeconomic Indices Are Associated With Increased Resource Utilizations, but Not 90-Day Complications Following Total Hip and Knee Arthroplasty

BACKGROUND

Socioeconomic disadvantage has been associated with negative outcomes following total hip arthroplasty (THA) and total knee arthroplasty (TKA). The area deprivation index (ADI) and distressed communities index (DCI) are composite rankings that score socioeconomic status (SES) using patients' home addresses. The purpose of this study was to examine the association of ADI and DCI with outcomes following THA and TKA while controlling for potential confounding covariates.

METHODS

A series of 4,146 consecutive patients undergoing primary THA and TKA between January 2018 and May 2023 were queried from our institutional total joint registry. The 90-day medical and surgical complications and resource utilization were collected. The ADI and DCI scores were obtained for each patient, and the association between these scores and postoperative outcomes was analyzed.

RESULTS

The ADI and DCI were both associated with patient age, sex, race, comorbidity burden, and smoking status. After controlling for these variables, higher ADI and DCI scores were associated with increased length of stay (P = 0.003 and P = 0.008, respectively), but were not associated with the occurrence of any 90-day complication, reoperation, or revision.

CONCLUSIONS

The SES, as quantified by ADI and DCI, was associated with multiple known risk factors for complications following THA and TKA, but was not independently associated with complications, reoperations, or revision surgeries at 90 days postoperatively. While convenient metrics for the quantification of SES, in some populations, ADI and DCI may not be independently associated with detrimental outcomes following THA and TKA.

Patterns and trends in burden of asthma and its attributable risk factors from 1990 to 2021 among South Asian countries: a systematic analysis for the Global Burden of Disease Study 2021

OBJECTIVE

Asthma poses a significant health burden in South Asia, with increasing incidence and mortality despite a global decline in age-standardized prevalence rates. This study aims to analyze asthma trends from 1990 to 2021, focusing on prevalence, incidence, mortality, and disability-adjusted life years (DALYs) across South Asia. The study also assesses the impact of risk factors like high body mass index (BMI), smoking, and occupational exposures on asthma outcomes.

METHOD

We extracted asthma data from the Global Burden of Disease database for South Asia (1990-2021). Joinpoint regression analysis was used to assess temporal trends in asthma burden. Total Percentage change (TPC) in age-standardized rates of incidence, mortality, and DALYs were calculated. Data were stratified by gender, and the contribution of risk factors was evaluated.

RESULTS

Asthma-related mortality in South Asia decreased by 37%, from 27.78 per 100,000 (1990) to 17.54 per 100,000 (2021). The Maldives showed the most significant reduction in mortality (78.31%), while Bangladesh recorded a 47.44% reduction in prevalence and a 62.64% decrease in DALYs. High BMI, smoking, and environmental risks contributed significantly to DALYs, with environmental factors playing a major role in countries like Afghanistan (20.73%) and Bhutan (18.58%). Females, particularly those over 20, experienced higher asthma-related DALYs than males.

CONCLUSION

Asthma burden in South Asia has reduced over the past three decades, yet the absolute number of cases continues to rise, driven by population growth and environmental risk factors. Targeted interventions addressing risk factors and healthcare disparities are essential for further reducing asthma burden.

Why is low educational attainment linked to worse pain and function in fibromyalgia?

Lower educational attainment has been linked to worse pain in individuals with chronic pain, but the mechanisms of this relationship are not fully elucidated. This observational study analyzed the relationship between educational attainment and pain in patients with fibromyalgia (FM) and the potential psychological mechanisms driving this relationship. We hypothesized that (1) lower educational attainment would be associated with greater pain intensity and interference, and that (2) concerns about pain (CAP), anxiety, and depression would mediate the relationship between educational attainment and pain. A total of 119 adults (93.3% female, 79.7% White, Mage=50.4) with FM completed questionnaires including demographics, Brief Pain Inventory (BPI), Pain Catastrophizing Scale (PCS), and Hospital Anxiety and Depression Scales (HADS). Pearson correlations and bootstrapped mediation analyses were conducted to examine the relationships among education, psychological variables, and pain variables. Education was inversely correlated with pain intensity and interference, CAP, anxiety, and depression (p<.05). CAP significantly mediated the relationship between education and pain intensity (95% CI [0.151, 0.026]), while both CAP and depression mediated the effects of education on pain interference (95% CI [0.195, -0.025]; 95% CI [-0.163, -0.004]). However, anxiety did not mediate either relationship. These findings suggest that greater CAP, and in part depression, may be possible mechanisms in the relationships between lower educational attainment and worse pain intensity and interference. This work has important implications in reducing pain disparities and provides direction for psychological treatment, suggesting that both depression and CAP may be critical targets especially for people with lower education attainment. PERSPECTIVES: This study examined the relationship between educational attainment, psychological variables, and pain. Results have implications for psychological intervention aimed at concerns about pain and depression, especially among individuals with low educational attainment.

Innovative Dual-Decoupling CNN With Layer-Wise Temporal-Spatial Attention for Sensor-Based Human Activity Recognition

Human Activity Recognition (HAR) is essential for monitoring and analyzing human behavior, particularly in health applications such as fall detection and chronic disease management. Traditional methods, even those incorporating attention mechanisms, often oversimplify the complex temporal and spatial dependencies in sensor data by processing features uniformly, leading to inadequate modeling of high-dimensional interactions. To address these limitations, we propose a novel framework: the Temporal-Spatial Feature Decoupling Unit with Layer-wise Training Convolutional Neural Network (CNN-TSFDU-LW). Our model enhances HAR accuracy by decoupling temporal and spatial dependencies, facilitating more precise feature extraction and reducing computational overhead. The TSFDU mechanism enables parallel processing of temporal and spatial features, thereby enriching the learned representations. Furthermore, layer-wise training with a local error function allows for independent updates of each CNN layer, reducing the number of parameters and improving memory efficiency without compromising performance. Experiments on four benchmark datasets (UCI-HAR, PAMAP2, UNIMIB-SHAR, and USC-HAD) demonstrate accuracy improvements ranging from 0.9% to 4.19% over state-of-the-art methods while simultaneously reducing computational complexity. Specifically, our framework achieves accuracy rates of 97.90% on UCI-HAR, 94.34% on PAMAP2, 78.90% on UNIMIB-SHAR, and 94.71% on USC-HAD, underscoring its effectiveness in complex HAR tasks. In conclusion, the CNN-TSFDU-LW framework represents a significant advancement in sensor-based HAR, delivering both improved accuracy and computational efficiency, with promising potential for enhancing health monitoring applications.

The impact of digital literacy in enhancing individuals' health in China

BACKGROUND

Health is the cornerstone of individual well-being and a vital factor in socioeconomic development. In an increasingly digitalized world, digital literacy has emerged as one of the indispensable abilities, which not only pertains to an individual's capacity to acquire, analyze, evaluate, and utilize information but also profoundly influences their health behaviours, health decisions, and overall well-being. This paper uses the 2020 China Family Panel Studies (CFPS) data to explore digital literacy's impact on individuals' health.

METHODS

By using the Entropy-TOPSIS method, this paper calculates digital literacy as a three-dimensional construct and adopts Ordered Probit and OLS models to analyze the impact of digital literacy on physical and mental health. Additionally, this paper employs the Two-Stage Least Squares (2SLS) to address endogeneity issues. The indirect effects of income, employment quality, and informal social support on individual's digital literacy and health nexus are also examined by the mediation effect model.

RESULTS

The results indicate that digital literacy positively impacts individuals' physical and mental health, which was confirmed by several robustness tests. The heterogeneity analysis shows that digital literacy is more effective in enhancing the health of middle-aged and older groups as well as rural individuals in China. According to mechanism analysis, digital literacy can enhance individuals' health by boosting income, improving employment quality, and expanding informal social support; however, the effects vary on physical and mental health.

CONCLUSION

Several policy suggestions emanate from the findings. To enhance the positive impact of digital literacy on individuals' health, the policy makers should emphasize on enhancing digital literacy particularly in rural areas and older age groups, bridging the digital divide, refining employment services and embracing a healthy concept of online social networking.

Adherence to multi-target stool DNA testing for colorectal cancer screening in the United States

PURPOSE

Colorectal cancer (CRC) is the second leading cause of cancer mortality in the USA and is highly preventable, with early screening vital for improving outcomes. This study aimed to evaluate adherence rates of multi-target stool DNA (mt-sDNA) testing, following updated guidelines recommending screening starting at age 45.

METHODS

This retrospective cohort study used aggregated data from Exact Sciences Laboratories LLC, examining new users (first-time testers) aged 45-85 with commercial, Medicare, or Medicaid insurance who received mt-sDNA test kits (point-of-care) between January 1, 2023, and June 1, 2023. Adherence was defined as the percentage of eligible participants returning a valid non-empty test kit within 365 days of initial shipment date. Descriptive statistics and logistic regression were used to analyze adherence.

RESULTS

Among 1,557,915 patients, the overall adherence rate to mt-sDNA testing was 71.3% (commercial insurance 72.3%, Medicare Advantage 70.2%, Medicare 69.9%, Medicaid 52.0%) (p < 0.001). Females had slightly higher adherence than males, except for commercial insurance (72.2% vs. 72.6%, p < 0.001). Adherence was highest in commercial insurance for individuals aged 76-85 (79.2%, p < 0.001), gastroenterology patients (82.5%, p < 0.001), and rural residents (73.2%, p < 0.001), along with those in Medicare Advantage earning $200 K + (78.5%, p < 0.001).

CONCLUSIONS

Adherence to mt-sDNA testing was robust, particularly among individuals with commercial insurance, older adults, gastroenterology patients, higher income groups, and rural residents. With a 71% adherence rate, the test demonstrates substantial engagement and value in colorectal cancer screening. Future research should assess its long-term impact and address disparities to optimize its benefits.

Assessing the financial burden of multimorbidity among patients aged 30 and above in India

BACKGROUND

Multimorbidity is associated with significant out-of-pocket expenditures (OOPE) and catastrophic health expenditure (CHE), especially in low- and middle-income countries like India. Despite this, there is limited research on the financial burden of multimorbidity in outpatient and inpatient care, and cross-state comparisons of CHE are underexplored.

METHODS

We conducted a cross-sectional analysis using nationally representative data from the National Sample Survey 75th Round 'Social Consumption in India: Health (2017-18)', focusing on patients aged 30 and above in outpatient and inpatient care in India. We assessed multimorbidity prevalence, OOPE, CHE incidence, and CHE intensity. Statistical models, including linear, log-linear, and logistic regressions, were used to examine the financial risk, with a focus on non-communicable diseases (NCDs), healthcare facility choice, and socioeconomic status and Epidemiological Transition Levels (ETLs).

RESULTS

Multimorbidity prevalence in outpatient care (6.1%) was six times higher than in inpatient care (1.1%). It was most prevalent among older adults, higher MPCE quintiles, urban patients, and those with NCDs. Multimorbidity was associated with higher OOPE, particularly in the rich quintile, patients seeking care from private providers, low ETL states, and rural areas. CHE incidence was highest in low ETL states, private healthcare users, poorest quintile, males, and patients aged 70 + years. CHE intensity, measured by mean positive overshoot, was greatest among the poorest quintile, low ETL states, rural, and male patients. Log-linear and logistic regressions indicated that multimorbidity patients with NCDs, those seeking private care, and those in low ETL states had higher OOPE and CHE risk. The poorest rural multimorbidity patients had the greatest likelihood of experiencing CHE. Furthermore, CHE intensity was significantly elevated among multimorbidity patients with NCDs (95% CI: 19.29-45.79), patients seeking care in private, poorest, and from low ETL states (95% CI: 7.36-35.79).

CONCLUSIONS

The high financial burden of OOPE and CHE among multimorbidity patients, particularly those with NCDs, highlight the urgent need for comprehensive health policies that address financial risk at the primary care level. To alleviate the financial burden among multimorbidity patients, especially in low-resource settings, it is crucial to expand public healthcare coverage, incorporate outpatient care into financial protection schemes, advocate for integrated care models and preventive strategies, establish standardized treatment protocols for reducing unnecessary medications linked to polypharmacy, and leverage the support of digital health technologies.

A Novel Point-of-Care Prediction Model for Steatotic Liver Disease: Expected Role of Mass Screening in the Global Obesity Crisis

Background/Aims

The incidence of steatotic liver disease (SLD) is increasing across all age groups as the incidence of obesity increases worldwide. The existing noninvasive prediction models for SLD require laboratory tests or imaging and perform poorly in the early diagnosis of infrequently screened populations such as young adults and individuals with healthcare disparities. We developed a machine learning-based point-of-care prediction model for SLD that is readily available to the broader population with the aim of facilitating early detection and timely intervention and ultimately reducing the burden of SLD.

Methods

We retrospectively analyzed the clinical data of 28,506 adults who had routine health check-ups in South Korea from January to December 2022. A total of 229,162 individuals were included in the external validation study. Data were analyzed and predictions were made using a logistic regression model with machine learning algorithms.

Results

A total of 20,094 individuals were categorized into SLD and non-SLD groups on the basis of the presence of fatty liver disease. We developed three prediction models: SLD model 1, which included age and body mass index (BMI); SLD model 2, which included BMI and body fat per muscle mass; and SLD model 3, which included BMI and visceral fat per muscle mass. In the derivation cohort, the area under the receiver operating characteristic curve (AUROC) was 0.817 for model 1, 0.821 for model 2, and 0.820 for model 3. In the internal validation cohort, 86.9% of individuals were correctly classified by the SLD models. The external validation study revealed an AUROC above 0.84 for all the models.

Conclusions

As our three novel SLD prediction models are cost-effective, noninvasive, and accessible, they could serve as validated clinical tools for mass screening of SLD.

Evaluation of Older People's Presentations to the Emergency Department With Pain During and Before the COVID-19 Pandemic

BACKGROUND

This study aimed to determine the tendency of older adults to present to the emergency department with pain complaints during the COVID-19 pandemic compared to the prepandemic period.

METHODS

A cross-sectional, retrospective study design was used. Data were collected from the electronic medical records of older people who presented to emergency departments with pain before (March 2019-March 2020) and during the COVID-19 pandemic (April 2020-July 2021). We identified 10 pain diagnosis groups using ICD-10 codes. Patient data were grouped and cleaned using SQL scripts on the Oracle database.

RESULTS

It was determined that 13.3% of 405,404 older people had presented to the emergency department with pain between March 2019 and July 2021. There was a 14.2% decrease in such admissions during the pandemic period. In the study, an increase was observed in the rates of older adults presenting to the emergency department with myalgia and joint pain. In contrast, the rates of those presenting with low back and neck pain, headache, eye pain, dysuria, and acute pain decreased during the pandemic. In the regression analysis, predictors for older adults' presentation to the emergency department with pain included age over 85 years (OR: 1.403), female gender (OR: 1.053), and myalgia (OR: 2.471).

CONCLUSIONS

During the COVID-19 pandemic, our study revealed fewer presentations to the emergency department for pain-related complaints. To prevent severe health problems from delayed care, we recommend expanding telemedicine, remote pain management, and home-based care. Further research is needed to examine the long-term effects of increased myalgia and joint pain.

Prevalence and associated factors of self-reported oral health problems among adults in the Fanteakwa districts in Ghana

BACKGROUND

There is a paucity of data on oral health problems among the residents of Fanteakwa districts (South and North) in the Eastern region of Ghana. Therefore, this study assessed the prevalence and factors associated with self-reported oral health problems in the Fanteakwa districts of Ghana.

METHODS

This community-based cross-sectional study targeted residents of the towns of the Fanteakwa districts, who have not had any dental care visit in the past six months preceding the study. The participants were enrolled from July - October, 2023. Socio-demographic study variables collected were sex, age, educational level, income level, ethnicity, area of residence, household size and frequency of brushing teeth in a day. Whereas the self-reported oral health problems were tooth ache, swollen gum, bleeding gum, sensitive tooth/teeth, hole in tooth/teeth, discoloured tooth/teeth and mouth odour. The chi-square statistical test was used to test the association between the presence of oral health problem(s) and other independent variables. Whereas, Modified Poisson regression was used to test the relationships among the variables.

RESULTS

In total, 400 community members were interviewed. The mean age of respondents was 31 years (SD ± 12.4, Min = 19, Max = 81). The majority were females (55.2%) and more than 96% had some form of formal education. The Akan ethnic group accounted for as much as 47% of the respondents. The overall prevalence of self-reported oral health problems was 58.5% (95% CI 53.5% - 63.4%). The commonly reported oral health problems were toothache (51.7%), swollen gum (38.5%), difficulty in chewing (33.3%), bleeding gum (32.1%), and mobile teeth (17.1%). About 98% (229/234) of the study participants who self-reported oral health problems, reported up to four different problems. Self-reported oral health problems associated with participants' age (χ2 = 7.2, p = 0.027), income level (χ2 = 19.3, p < 0.001), ethnicity (χ2 = 21.2, p < 0.001), area of residence (χ2 = 26.9, p < 0.001), religious affiliation (χ2 = 15.7, p < 0.001) and frequency of brushing teeth in a day (χ2 = 6.85, p < 0.032). Despite the observed relationships, Modified Poisson regression identified that compared to the rural dwellers, the urban dwellers had lower odds of self-reporting oral health problems (aOR = 0.718, p = 0.032, CI: 0.531-0.971), after controlling for age and frequency of teeth brushing in a day.

CONCLUSION

High rate of self-reported oral health problems was observed in the study site. Participants from rural residence were disproportionately affected. Therefore, local health authorities are encouraged to leverage on the identified risk groups for enhanced oral health education towards reduction in the reported oral health problems.

Market integration and resident health in China

This paper uses data from the China Health and Nutrition Survey (CHNS) to study the impact of market integration on residents' health. The empirical results based on the probit model show that market integration has a significant dampening effect on resident incidence. For every one-unit increase in the degree of market integration, the probability of residents becoming sick decreases by approximately 1.45%. Moreover, after a series of robustness tests, the conclusion is still valid. This study further analyses the potential mechanism and finds that the promotion of market integration can improve the medical conditions available to residents, optimize the nutritional indices of residents, and reduce labor load of residents, thus improving their health. The results of the heterogeneity test show that there are certain differences in the impact of market integration on the health level of residents of different genders, ages and income classes. At the same time, this study also verifies that there is a synergistic effect between internet penetration and market integration.

Trends in tuberculosis mortality among older adults in China, 2004-2021: a Joinpoint regression and age-period-cohort analysis

Background

Tuberculosis (TB) remains a major public health problem in China and globally, particularly among older adults. This study aimed to examine secular trends in TB mortality among older adults in China and the net effects of age, period, and cohort.

Methods

Data from the National Disease Surveillance Points (DSPs) system were analyzed using Joinpoint regression to determine annual changes in TB mortality among individuals aged 60 years and older from 2004 to 2021. An age-period-cohort (APC) analysis using the intrinsic estimator (IE) method was conducted to estimate the independent effects of age, period, and cohort.

Results

The age-standardized TB mortality rate was 5.68 per 100,000, with higher rates observed in men, rural areas, and western regions. TB mortality among older adults declined overall from 2004 to 2021, although the rate of decline has slowed in recent years. The APC analysis revealed increased TB mortality with age, with the relative risk (RR) rising from 0.57 in the 60-64 age group to 1.53 in the 80-84 age group. The period effect decreased from 2007 to 2021, showing a higher risk effect in rural areas (RR = 1.51) than in urban areas (RR = 1.16) during 2007-2011, but this trend reversed in the period 2017-2021. The cohort effect generally declined, with the exception of certain demographic groups that showed an increase in the 1952-1956 and 1957-1961 birth cohorts.

Conclusion

TB mortality among older adults in China decreased from 2004 to 2021, although the decline has slowed in recent years. Variations in age, period, and cohort effects highlight differences by gender, urban and rural areas, and regions, providing insights for targeted intervention strategies.

Association of socioeconomic status and physical therapy compliance after arthroscopic shoulder labrum repair

BACKGROUND

Socioeconomic status has been shown to impact a patient's access to orthopedic care, but outcomes such as compliance with physical therapy and time to return to full activities has not been established. The aim of this study is to investigate the impact of socioeconomic status on physical therapy compliance and return to play time specifically in patients with shoulder instability. The area deprivation index (ADI) is a validated tool using factors from the US Census that measures socioeconomic deprivation in neighborhoods. Our hypothesis is that patients with higher socioeconomic deprivation are more likely to have more missed scheduled physical therapy appointments and a longer return to play after arthroscopic shoulder labrum repair for instability.

METHODS

This study included patients who underwent arthroscopic shoulder labrum repair between 2019 and 2023 at a single orthopedic hospital by a single surgeon. Demographic information (race, age, and sex), insurance type, ADI, physical therapy no-show visit rates, and return to play times were recorded.

RESULTS

The cohort included 73 patients, 14 of whom did not have return to play times. A total of 82.2% of the patients were male, 63.0% were White, and the mean age was 24 years. Patients with increasing ADI were significantly more likely not to attend a scheduled physical therapy session (P = .035). No association between ADI and return to play time was found (P = .165). No significant association between insurance type (private vs. Medicaid) and missed scheduled physical therapy appointments (P = .139) and return to play times was found (P = .741).

CONCLUSION

Increasing socioeconomic deprivation is associated with increased likelihood to miss scheduled physical therapy visits after shoulder instability surgery. These findings elucidate gaps in orthopedic care as postoperative physical therapy is a crucial part in the comprehensive care of shoulder instability.

Predictive value and weight of factors associated with cognitive performance in Hispanics/Latinos enrolled in the Health and Aging Brain Study: Health Disparities

INTRODUCTION

In this analysis of cognitively unimpaired (CU) Hispanic participants from the Health and Aging Brain Study: Health Disparities (HABS-HD), we aimed to identify the main predictor factors for cognitive performance and their relative importance (weight).

METHODS

The HABS-HD is a community-based longitudinal cohort study. Data from 952 CU Hispanics, enrolled from 2017 to February 2024, were analyzed. Random forest, an assembly learning method based on decision trees, was used to cross-sectionally forecast the predictive value of 42 risk factors (4 demographic variables, 4 socioeconomic variables, 6 psychosocial variables, 17 health variables, and 11 plasma and magnetic resonance imaging biomarkers) together, and the weighting of each factor for different cognitive domains (global cognition, memory, language, executive function, attention, and processing speed).

RESULTS

Participants included in the analyses had a mean age of 61.3 years (9.14), 69.4% were female, and had a mean of 10.52 (4.61) years of education. Income, glucose levels, plasma amyloid beta (Aβ)42, total tau, and neurofilament light chain were in the top 10 predictors in six cognitive domains. Age, education years, Penn State Worry Questionnaire, body mass index, and C-reactive protein were the main predictors in four cognitive domains, while plasma Aβ40 was in the top 10 list for five cognitive domains.

DISCUSSION

Results support the notion that cognitive performance depends on interactions among social, economic, biological, and functional factors. The effects of factors together, and the weight of each factor in various cognitive domains may be different in Hispanics. More studies comparing different ethnic groups are necessary to help in the development of tailored interventions to prevent cognitive decline.

Highlights

Numerous factors have been associated with cognitive decline and dementia.Research on these factors has relied on a meta-analysis of their individual association with cognition, consolidating data from different non-Hispanic White populations.Hispanics are the largest minority group in the United States, and only a few studies have analyzed the overall impact of these factors together, and their individual relative effect in different cognitive domains.We found that cognitive performance in Hispanics may be a result of interactions among social, economic, biological, and functional factors.

Associations of socioeconomic status and chronic stress with incident atrial fibrillation among older adults: A prospective cohort study from the UK biobank

BACKGROUND

This study aimed to assess the relationship between socioeconomic status (SES) and chronic stress on the incidence of atrial fibrillation (AF) in older adults, and the potential role of chronic stress in the association.

METHODS

This study included 122,494 UK Biobank participants aged ≥60 years without AF at baseline. Latent class analysis was used to define the SES of participants. Chronic stress was measured using allostatic load (AL), and participants were categorized into low, medium and high AL groups. The Cox proportional hazards model, mediation, and interaction analyses were conducted to investigate the associations between SES, AL, and AF risk.

RESULTS

Low SES (hazard ratio [HR]: 1.10; 95 % confidence interval [CI]: 1.04-1.15) and high AL (HR: 1.37; 95 % CI: 1.30-1.45) were associated with an increased risk of AF, respectively. Individuals in the low SES and high AL groups exhibited the highest risk of AF compared to those in the high SES and low AL groups (HR: 1.46; 95 % CI: 1.32-1.61). We identified additive and multiplicative interactions in the low SES and high AL groups (relative risk due to interaction: 0.12 (95 % CI: 0.02-0.22); P for interaction = 0.0385). AL also exerted a partial mediating effect on the association between SES and the incidence of AF (mediation proportion: 17.3 %; 95 % CI: 5.9-28.7 %).

CONCLUSIONS

Our study revealed significant associations between SES, chronic stress, and the incidence of AF in older adults. Chronic stress was also shown to partially mediate the association.

Healthcare inequity arising from unequal response to need in the older (45+ years) population of India: Analysis of nationally representative data

Given the large and growing number of older (45+ years) people in India, inequitable access to healthcare in this population would slow global progress toward universal health coverage. We used a 2017-18 nationally representative sample of this population (n = 53,687) to estimate healthcare inequality and inequity by economic status. We used an extensive battery of indicators in nine health domains, plus age and sex, to adjust for need. We measured economic status by monthly per capita consumption expenditure and used a concentration index to measure inequalities in probabilities of any doctor visit and any hospitalisation within 12 months. We decomposed inequality with a regression method that allowed for economic and urban/rural heterogeneity in partial associations between healthcare and both need and non-need covariates. We used the associations achieved by the richest fifth of urban dwellers to predict a need-justified distribution of healthcare and compared the actual distribution with that benchmark to identify inequity. We found pro-rich inequalities in doctor visits and hospitalisations, which were driven by use of private healthcare. Adjustment for the greater need of poorer individuals revealed pro-rich inequity that exceeded inequality by about 65% and 39% for doctor visits and hospitalisations, respectively. These adjustments would have been substantially smaller, and inequity underestimated, without allowing for use-need heterogeneity, which accounted for 11% of the inequity in doctor visits and was 373% of inequity in hospitalisations. Targeting service coverage on poorer and rural groups, and increasing their access to private providers, would both reduce inequity and raise average coverage in the older population of India.

Exploring social determinants of healthcare and cognition levels among diverse older adults

BACKGROUND

The purpose was to investigate the impact of social determinants of health on healthcare utilization among older adults in two cognition groups: normal and dementia/impaired cognition.

METHODS

We used cross-sectional data from the Health and Retirement Study (N = 16,339) to assess healthcare utilization: hospital stay, nursing home stay, hospice care, and doctor visits. The respondents were classified into two cognition groups using the Langa-Weir approach.

RESULTS

A cohort comparison between normal (mean age = 66.1) and dementia/impaired cognition (mean age = 71.9) groups revealed dementia/impaired group included more individuals from racial and ethnic minorities (42.7 % Black/Other, 20.8 % Hispanic) compared to the normal cognition (24.7 % Black/Other, 12.1 % Hispanic). They experienced longer hospital, nursing home, and hospice stays and varied doctor visit frequencies. These differences were influenced by race, age, marital status, education, and rurality.

CONCLUSION

Social determinants of health play an important role in predicting disparities in healthcare utilization among older adults across cognition levels.

Facilitators and barriers for the implementation of a transmural fall-prevention care pathway for older adults in the emergency department

BACKGROUND

Older adults at the emergency department (ED) with fall-related injuries are at risk of repeated falls. National guidelines state that the ED is responsible for initiating fall preventive care. A transmural fall-prevention care pathway (TFCP) at the ED can guide patients to tailored interventions. In this study, we investigated the facilitators and barriers for the implementation of the TFCP for older adults following a fall-related ED visit from the perspectives of patients and healthcare professionals.

METHODS

In this qualitative study, we used semi-structured interviews with ten older adults who had a recent ED visit due to a fall. Furthermore, we organised focus groups with 13 healthcare professionals involved in TFCP. Two researchers independently coded the transcripts using inductive thematic analysis.

RESULTS

We revealed facilitators and barriers on three key themes: 1) Communication, 2) organisation & execution, and 3) personal factors, and thereunder 12 subthemes. Our specific finding were 1a) communication between healthcare professionals and patients, 1b) interprofessional communication and 1c) communication between patients and their family or friends can have both positive and negative impact on the implementation of a TFCP. For the organisation & execution, facilitators and barriers were mentioned for 2a) processes at the ED, 2b) the fall risk assessment, 2c) patient engagement, 2d) finances, 2e) time, and 2f) responsibilities. Personal factors such as 3a) emotions and behaviour, 3b) knowledge, and 3c) motivation play a crucial role in the success of patient participation. The competence of healthcare professionals in geriatric care facilitate the process of tailoring of care to patients' needs.

CONCLUSION

When implementing a TFCP, it is crucial to be aware that facilitators and barriers from the perspective of patients and healthcare professionals exist in the processes of communication, organisation & execution, and personal factors. These factors guide the development of tailored implementation strategies in ED and primary care settings.

Incidence of Total Knee Arthroplasty in Older Females with Knee Osteoarthritis and Osteoporosis Treated with Denosumab Compared with Those Treated Using Bisphosphonates: A Population-Based Cohort Study

This study aimed to evaluate the incidence of total knee arthroplasty (TKA), a marker of severe knee osteoarthritis (OA), among older females with concurrent knee OA and osteoporosis (OP) who were treated with denosumab or bisphosphonates. By analyzing a large population-based cohort, we sought to clarify how these treatments influence the progression of knee OA to the point of requiring surgical intervention. We used data from the Taiwan National Health Insurance Research Database, including data from females aged ≥ 50 years diagnosed with knee OA and OP who initiated treatment between 2012 and 2019. Propensity score matching (1:1) resulted in the selection of 13,774 patients (6897 per group). The TKA incidence was analyzed using Cox proportional hazards models. Patients treated with denosumab had a lower TKA incidence than those treated with bisphosphonates (6.9 vs. 8.5 per 1000 person-years). The adjusted hazard ratio (aHR) for TKA in the denosumab group was 0.77 (95% CI: 0.62-0.97; p = 0.024), with the most pronounced effect observed in patients aged ≥ 80 years (aHR = 0.39, 95% CI: 0.20-0.77; p = 0.007). These findings suggest that denosumab reduces TKA risk more effectively than bisphosphonates and may serve as a superior treatment option for mitigating severe knee OA progression, especially in older adults.

Planning for the Future: Advance Care Planning Knowledge, Discussion and Decision-Making Among Older, Sexual Minority Adults

Background: Prior research has shown that advance care planning (ACP) knowledge and discussion varies among racial and ethnic groups. However, little is known if similar disparities exist within the sexual minority (SM) population. Objectives: To investigate racial disparities in ACP knowledge, discussion, and decision making within the SM population. Methods: Data from an online survey (N = 281) asked Black and White SM adults ages 50+ about their knowledge and actions about future healthcare wishes and their healthcare experiences. A series of multivariable logistic regressions were conducted to examine the association between ACP knowledge, discussion, and medical decision-making and race, while adjusting for other demographic and health-related variables. Results: On average, respondents were 57 years old (SD = 6.04) and just over half identified as being White (52%) and as men (55%). Most participants had heard of ACP (74%) and had an ACP discussion with someone (65%). Sixty-six percent of participants were very comfortable with medical decision-making. White SM adults had higher odds of having ACP knowledge (aOR = 3.56; 95% CI = 1.78, 7.07) and discussions (aOR = 2.43; 95% CI = 1.28, 4.61). While no racial differences were found in comfort with medical decision-making, other sociodemographics were significantly associated with comfort with medical decision-making. Conclusion: Outcomes from this work indicate persistent racial disparities in ACP within the SM population in addition to highlighting other factors that influence ACP. These findings emphasize the need for resources to address this systemic issues and to ensure that SM adults have access to and engage in ACP.

Availability and affordability of diabetes healthcare services associated with the frequency of diabetes-related complications

AIMS

Understanding the healthcare access challenges facing diabetic patients in low- and middle-income countries is very important. The present study investigated the association between availability (physical access) and affordability (economic access) to diabetes healthcare services and the frequency of diabetes-related complications.

METHODS

A cross-sectional survey study was conducted between February and May 2023 in Qazvin, Iran. Using convenience sampling, 373 type 2 diabetic patients (mean age = 57.99 years; SD = 11.71) referred to diabetic specialists' clinics were surveyed. Demographic characteristics, physical access to diabetes healthcare services, economic access to diabetes healthcare services, and frequency of diabetes-related complications (FDRCs) were assessed. Data were assessed using linear regression analysis.

RESULTS

The mean total access score to healthcare services was 17.71 (out of 30; SD ± 4.21; range 6-30). Patients who had more access to healthcare services had less diabetes-related complications (p < 0.005). There was a significant negative correlation (p < 0.01) between FDRCs and (i) physical access to diabetes-related healthcare services (r = -0.166) and (ii) economic access to diabetes-related healthcare services (r = -0.153). Linear regression analysis showed that with each unit increase in participants' economic, physical and total access to diabetes-related healthcare services, the FDRCs among participants decreased by 8.7%, 13.5%, and 8.8% respectively.

CONCLUSION

The results indicate that increased physical accessibility (availability) and economic accessibility (affordability) of healthcare services are associated with fewer diabetes-related complications. Therefore, policymakers and healthcare managers need to reduce diabetes-related complications by implementing schemes to increase patient access to diabetes treatment services.

COVID-Related Discrimination and Health Care Access among a Nationally Representative, Diverse Sample of US Adults

BACKGROUND

In the United States, COVID-related discrimination towards racial and ethnic minority populations is well documented; however, its impact on healthcare access during the pandemic has not been assessed.

METHODS

We used data from our nationally representative, online survey of 5,500 American Indian/Alaska Native (AIAN), Asian, Black, Native Hawaiian/Pacific Islander, Latino, White, and multiracial adults conducted between 12/2020-2/2021 (baseline) and 8/2021-9/2021 (6-month follow-up; 35.1% response rate). At baseline, participants were asked how often they experienced discriminatory behaviors "because they think you might have COVID-19" (modified Everyday Discrimination Scale). Participants were asked if they were unable to get needed health care (e.g., cancer screening), or COVID-19 testing at both time-points. Vaccine willingness was assessed at baseline and uptake at follow-up.

RESULTS

Experiencing COVID-related discrimination was associated with not being able to get health care at baseline (OR = 3.66, 95% CI = 2.91-4.59) and follow-up (OR = 1.86, 95% CI = 1.16-2.97) and not being able to get a COVID-19 test at baseline (OR = 2.11, 95% CI = 1.68-2.65) and follow-up (OR = 4.12, 95% CI = 2.20-7.72). Experiencing discrimination was also associated with being less likely to have received a COVID-19 vaccine (OR = 0.52, 95% CI = 0.30-0.90), despite individuals who experienced discrimination being more willing to vaccinate at baseline (OR = 1.56, 95% CI = 1.10-2.22).

CONCLUSIONS

COVID-related discrimination was associated with an increased likelihood of being unable to get health care across all racial and ethnic populations, although associations were strongest among Asian, AIAN, and Latino adults. Healthcare providers should be aware of the impact of discrimination on healthcare utilization, delays, and health-seeking behaviors, especially among racial and ethnic minorities.

Trends, risk factors, and outcomes of selective screening for abdominal aortic aneurysms in at-risk patients

OBJECTIVES

For men ages 65 to 75 years without a smoking history and for women ages 65 to 75 years with a smoking history, the United States Preventative Service Task Force recommends that primary care providers (PCPs) use their clinical judgement when offering abdominal aortic aneurysm (AAA) screening. This study describes the trends in screening for these cohorts, identifies factors that may influence screening rates, and compares outcomes between screened and unscreened patients.

METHODS

The TriNetX population database was queried for subjects with routine PCP visit between ages 65 to 75 from 2007 to 2023 to create cohorts of male smokers, male nonsmokers, and female smokers. Prevalence and 1- and 3-year incidences of AAA screening by ultrasound and computed tomography scans/magnetic resonance imaging (CT/MRI) were calculated. Screened and unscreened patients' demographics, diagnoses, and medications were compared. Rates of AAA diagnosis and repair were compared between unmatched screened and unscreened patients.

RESULTS

Screening for all groups peaked in 2023. Male smokers had the highest screening prevalence (21.2%), followed by male nonsmokers (3.1%) and female smokers (0.90%). The 1-year incidence of screening increased for male smokers, peaking at 8.2% in 2021. The 1-year incidence plateaued at 1.9% for male nonsmokers in 2020 and remained between 0.25% and 0.35% for female smokers for the whole observation period. By 2023, 23.6%, 14.3%, and 24.3% of male smokers, male nonsmokers, and female smokers had been screened via CT/MRI, respectively, with CT/MRI comprising the majority of screening events for all three cohorts. Hyperlipidemia and statin use were associated with screening for all groups (P < .05), whereas a personal history of coronary artery disease was associated with no screening. Screening for male nonsmokers was associated with hypertension, diabetes, and chronic pulmonary obstructive disease (P < .05). Screening in female smokers was associated with family history of coronary artery disease (odds ratio, 1.50; P < .001). For all groups, screening was associated with unruptured AAA diagnosis and endovascular aortic repair (P < .05). Screened female smokers had similar rates of AAA diagnosis as male nonsmokers (4.58% and 4.37%, respectively).

CONCLUSIONS

AAA screening in all at-risk populations increases diagnosis and treatment of AAA, but the screening rate is low for all groups, even with increasing CT/MRI use. Patients with strong risk factors for AAA are not undergoing screening. Collaboration with PCPs is necessary to increase screening rates and ensure that patients with the most clinically consequential risk factors are managed appropriately.

The mediating role of behavioural and socio-structural factors on the association between household wealth and childhood malaria in Ghana

BACKGROUND

Children under five continue to bear a disproportionate burden of malaria morbidity and mortality in endemic countries. While the link between socioeconomic position (SEP) and malaria is well established, the causal pathways remain poorly understood, hindering the design and implementation of more targeted structural interventions. This study examines the association between SEP and malaria among children in Ghana and explores the potential mediating role of behavioural and socio-structural factors.

METHODS

Data from the Ghana Demographic and Health Survey (DHS) 2022 were analysed. As part of the survey, children were tested for malaria using a rapid diagnostic test (RDT), and SEP was measured using a household asset-based wealth index. Mediation analysis (MA) using a regression-based approach was performed to assess mediated effects between SEP and malaria in children under five in Ghana through housing quality, educational attainment (EA), long-lasting insecticidal net (LLIN) use, indoor residual spraying (IRS), and healthcare-seeking behaviour (HSB). Reported are the total natural indirect effects (TNIEs) and the proportion mediated (PM).

RESULTS

Of the 3,884 children included in the survey, 19.4% (757) had malaria. Belonging to a household with high SEP was associated with a 43% lower risk of malaria (Prevalence Ratio, PR = 0.57; 95% Confidence Interval, CI 0.46-0.71). Regarding indirect (mediated) effects, maternal EA of secondary school or higher (OR = 0.68; 95% CI 0.60-0.77; PM = 17.5%), improved housing (OR = 0.80; 95% CI 0.68-0.91, PM = 9.2%), LLIN use (OR = 0.95; 95% CI 0.90-0.99, PM = 2.1%) partially mediated the association between SEP and malaria. The combined effect of all three mediators was higher than those in a single mediator or two sequential mediators (with EA as the initial mediator) (OR = 0.58; 95% CI 0.51-0.68, PM = 25.7%). No evidence of mediation was observed for HSB and IRS.

CONCLUSION

We found evidence of mediation by EA, housing, LLIN use and IRS, suggesting that current biomedical and behavioural malaria control efforts could be complemented with structural interventions, such as improved housing and education. Future studies that test the effect of different or joint effects of multiple mediators based on prospective designs are recommended to strengthen the evidence.

It is a matter of convenience: why welfare technologies have become domesticated in Swedish eldercare

BACKGROUND

The use of welfare technology is gaining ground in municipal eldercare and is increasingly being integrated into everyday routines. However, the meanings that eldercare personnel attach to welfare technology in the care of older recipients, and thus the domestication of welfare technology, remain largely underexplored. This study explores how eldercare personnel understand and ascribe meanings to welfare technologies in their daily work, with the aim of understanding their domestication.

METHODS

The empirical material comprised 181 photographs, each paired with corresponding text, from 61 participants across four municipalities in southern Sweden. The empirical material was thematically analysed, focusing on different categories of welfare technologies and their ascribed meanings. In our coding "convenience" and at times "inconvenience" were interpreted as recurrent patterns. Their repeated presence across various contexts and the meanings ascribed to different welfare technologies prompted deeper interpretive engagement, leading us to adopt it as a key theme. In the final step, the codes were synthesised through the lens of "convenience" to better understand the meanings participants attached to welfare technology in eldercare work.

RESULTS

The participants ascribed meanings to welfare technology that resonate with broader societal and cultural understandings of technological solutionism, while aligning with national policies promoting welfare technology as a means of supporting safety, activity and independence for older adults. Welfare technology was often understood as both convenient and an act of care. Our analysis uncovered different dimensions of "convenience", which we labelled as: "remote surveillance convenience", "logistics convenience", "communication convenience", "safety convenience", "comforting convenience" and "activation convenience". Yet, in some cases, welfare technology was also seen as a hindrance to care, being inconvenient due to its inflexibility, technical difficulties and the tendency to create duplicate tasks.

CONCLUSION

This paper contributes to a deeper understanding of the domestication of welfare technology in eldercare. Our study found that eldercare personnel engage with and interpret welfare technologies by ascribing meanings related to perceived convenience - a concept not widely explored in this context. Welfare technologies were often seen as convenient substitutes for physical proximity and relational care, such as "remote surveillance convenience" through cameras and "comforting convenience" via robotic pets. However, convenience, while central to the participants' experiences, should not be understood as inherently "good" or positive but as part of the domestication process, shaped by socio-technical contexts and the political economy of eldercare, which prioritises effectiveness and efficiency. By shedding light on these dynamics, our study examines how the domestication of welfare technology is shaped by and reinforces broader discourses of technological solutionism, raising questions about its long-term impact on care practices.

Gender-Specific Insights into Depression in Patients with Ischemic Heart Disease: Findings from a Pilot Study Using a Self-Developed Questionnaire

BACKGROUND/OBJECTIVES

Ischemic heart disease (IHD) significantly affects mental health, with gender-specific differences being observed in psychological responses. This pilot study aimed to explore these differences in the demographic, clinical, psychological, psychiatric, and social profile of patients diagnosed with IHD.

METHODS

A descriptive, cross-sectional design was used, recruiting 183 adult patients diagnosed with coronary artery disease and depression at the Psychiatry Department of Arad County Emergency Hospital, Romania, between May 2021 and May 2024. Data were collected using a self-developed tool, named the Depression Assessment in Ischemic Heart Disease Questionnaire (DA-IHDQ), alongside standardized assessments. Statistical analysis was performed using JASP statistical software (Version 0.19.1, University of Amsterdam, Amsterdam, Netherlands), employing binomial and multinomial tests for categorical data, and Cronbach's alpha was used to assess internal consistency.

RESULTS

This study found significant demographic differences, with female patients exhibiting higher levels of emotional distress and severe depression compared with the male subjects. Women reported greater social isolation and a stronger desire to seek for psychological or psychiatric support. Furthermore, a positive correlation between depression severity and physical symptoms was observed in both genders.

CONCLUSIONS

These findings highlight the importance of recognizing gender-specific responses to IHD, emphasizing the need for tailored interventions in mental healthcare and cardiac rehabilitation. Future research should further explore these differences to enhance the understanding of the psychosocial/psychiatric aspects of IHD and improve patient outcomes.