Despite multi-disciplinary team discussions the socioeconomic disparities persist in the oncological treatment of non-metastasized colorectal cancer

BACKGROUND

The introduction of national guidelines should eliminate previously observed associations between socioeconomic status (SES) and colorectal cancer treatment. The aim of the study was to investigate whether inequalities remain.

METHODS

CRCBaSe, a register-linkage originating from the Swedish Colorectal Cancer Registry, was used to identify information on patient and tumour characteristics, for 83,460 patients with stage I-III disease diagnosed 2008-2021. SES was measured as disposable income (quartiles) and the highest level of education. Outcomes of interest were emergency surgery, multidisciplinary team (MDT) conference discussion, and oncological treatment. Differences in treatment between SES groups were explored using multivariable logistic regression adjusted for year of diagnosis, age at diagnosis, sex, civil status, comorbidities, tumour location and stage.

RESULTS

Patients in the highest income quartile had a lower risk of emergency surgery (OR 0.73 95%CI 0.68-0.80), a higher chance of being discussed at the preoperative (OR 1.39 95%CI 1.28-1.51) and postoperative MDT (OR 1.41 95%CI 1.30-1.53), receiving neoadjuvant (OR 1.15 95%CI 1.06-1.25) and adjuvant treatment (OR 2.04 95%CI 1.88-2.20). Higher education level increased the odds of MDT discussion but was not associated with oncological treatment. The proportion of patients discussed at the MDT increased, with almost all patients discussed since 2016. Despite this, treatment differences remained when patients diagnosed since 2016 were analysed separately.

CONCLUSION

There were significant differences in how patients with different SES were treated for colorectal cancer. Further action is required to investigate the drivers of these differences as well as their impact on mortality and, ultimately, eliminate the inequalities.

Correlating area deprivation index with initial stage at presentation and with follow up and recurrence within an advanced practice provider-led survivorship clinic

INTRODUCTION

Living in disadvantaged neighborhoods has been shown to result in worse healthcare outcomes. The Area Deprivation Index (ADI) is a metric that ranks neighborhoods by socioeconomic disadvantage utilizing numerous factors including income, education, employment, and housing quality.

METHODS

A retrospective review of all patients who underwent surveillance in an APP-led head and neck cancer survivorship clinic from Dec 2016 to Oct 2020 at an academic tertiary care center were included. Tumor characteristics, visit frequency, recurrence, number of missed appointments, loss of follow up, and ADI scores were collected.

RESULTS

543 patients were included in the study. A majority were male (69.9 %) and white race (84.9 %) with an average age of 64.6 years old. Average ADI national percentile score was 71.6(range: 17 to 100). ADI national percentile score was not predictive of tumor characteristics at initial presentation: lymphovascular invasion (p = 0.940; OR 1.0 [95 % CI: 0.9 to 1.1]), extranodal extension (p = 0.576; OR 1.0 [95 % CI: 0.9 to 1.2]), positive margins (p = 0.069; OR 0.9 [95 % CI: 0.9 to 1.0]). ADI national percentile score was not significantly correlated with loss to follow up (p = 0.153; OR 1.2 [95 % CI: 0.9 to 1.7] or cancer recurrence (p = 0.594; OR 1.0 [95 % CI: 0.9 to 1.1]). Missing one or more clinic visits was correlated with loss to follow up (p = 0.029; OR 13.1 [95 % CI: 1.3 to 131.7].

CONCLUSION

Living in a disadvantaged neighborhood did not correlate with negative tumor characteristics, loss to follow up, or recurrence within an APP-led survivorship head and neck cancer clinic.

Prevalence and predictors of self-reported hearing aid use and benefit in Norway: the HUNT study

BACKGROUND

Knowledge on hearing aid use and benefit is important to ensure appropriate and effective treatment. We aimed to assess prevalence and predictors of hearing aid use and benefit in Norway, as well as possible birth cohort changes.

METHODS

We analyzed two large cross-sectional, population-based hearing surveys of 63,182 adults in 1996-1998 and 2017-2019 (the HUNT study). We used multivariable regression models to examine independent predictors of hearing aid use and benefit, including demography, hearing-related variables, known risk factors for hearing loss and birth cohort.

RESULTS

The nationally weighted hearing aid use in the adult population increased from 4.2% in 1997 to 5.8% in 2018. The use among individuals with disabling hearing loss (≥ 35 dB HL) increased from 46.3% to 64.4%. Most users reported some (47%) or great (48%) help from their hearing aids. In addition to the level of hearing loss and birth cohort, factors associated with hearing aid use included lower age, tinnitus, childhood-onset hearing loss, higher education, marriage, having children, being exposed to occupational noise or impulse noise, recurrent ear infections, and head injury. In addition to the level of hearing loss, factors related to hearing aid benefit included younger age, female gender, and higher income. Being bothered by tinnitus reduced the benefit.

CONCLUSION

Our study shows an increase in self-reported hearing aid usage over time in Norway, with lower adoption rates and perceived benefits observed among the elderly. The results suggest that having a spouse and children positively influences the adoption of hearing aids. These findings emphasize the necessity of customized strategies to address demographic disparities and the need for innovative enhancements in hearing rehabilitation programs.

Surviving indoor heat stress in United States: A comprehensive review exploring the impact of overheating on the thermal comfort, health, and social economic factors of occupants

In the face of escalating global climate change and the increasing frequency of extreme heat events, the mitigation of building overheating has become an urgent priority. This comprehensive review converges insights from building science and public health domains to offer a thorough understanding of the multifaceted impacts of indoor overheating on occupants. The paper addresses a significant research gap by offering a holistic exploration of indoor overheating of residential buildings and its consequences, with a specific focus on the United States, an economically diverse nation that has been underrepresented in the literature. The review illuminates the effects of overheating on thermal comfort, health, and socio-economic aspects within the built environment. It emphasizes associated repercussions, including heightened cooling energy consumption, increased peak electricity demand, and elevated vulnerability, leading to exacerbated heat-related mortality and morbidity rates, especially among disadvantaged groups. The study concludes that vulnerabilities to these impacts are intricately tied to regional climatic conditions, highlighting the inadequacy of a one-size-fits-all approach. Tailored interventions for each climate zone are deemed necessary, considering the consistent occurrence of indoor temperatures surpassing outdoor levels, known as superheating, which poses distinct challenges. The research underscores the urgency of addressing indoor overheating as a critical facet of public health, acknowledging direct socioeconomic repercussions. It advocates for further research to inform comprehensive policies that safeguard public health across diverse indoor environments.

Trends and projections of inflammatory bowel disease at the global, regional and national levels, 1990-2050: a bayesian age-period-cohort modeling study

BACKGROUND

Inflammatory bowel disease (IBD) is a global health concern with varying levels and trends across countries and regions. Understanding these differences is crucial for effective prevention and treatment strategies.

METHODS

Using data from the 2019 Global Burden of Disease study, we examine IBD incidence, mortality, and disability-adjusted life years (DALYs) rates in 198 countries from 1990 to 2019. To assess changes in the burden of IBD, estimated annual percentage changes (EAPC) were calculated, and a Bayesian age-period-cohort model was used to predict the future 30-year trends of IBD.

RESULTS

In 2019, there were 405,000 new IBD cases globally (95% uncertainty interval (UI) 361,000 to 457,000), with 41,000 deaths (95% UI 35,000 to 45,000) and 1.62million DALYs (95% UI 1.36-1.92million). The global age-standardized incidence rate in 2019 was 4.97 per 100,000 person-years (95% UI 4.43 to 5.59), with a mortality rate of 0.54 (95% UI 0.46 to 0.59) and DALYs rate of 20.15 (95% UI 16.86 to 23.71). From 1990 to 2019, EAPC values for incidence, mortality, and DALYs rates were - 0.60 (95% UI - 0.73 to - 0.48), - 0.69 (95% UI - 0.81 to - 0.57), and - 1.04 (95% UI - 1.06 to - 1.01), respectively. Overall, the burden of IBD has shown a slow decline in recent years. In SDI stratification, regions with higher initial SDI (high-income North America and Central Europe) witnessed decreasing incidence and mortality rates with increasing SDI, while regions with lower initial SDI (South Asia, Oceania, and Latin America) experienced a rapid rise in incidence but a decrease in mortality with increasing SDI. Predictions using a Bayesian model showed lower new cases and deaths from 2020 to 2050 than reference values, while the slope of the predicted incidence-time curve closely paralleled that of the 2019 data.

CONCLUSION

Increasing cases, deaths, and DALYs highlight the sustained burden of IBD on public health. Developed countries have stabilized or declining incidence rates but face high prevalence and societal burden. Emerging and developing countries experience rising incidence. Understanding these changes aids policymakers in effectively addressing IBD challenges in different regions and economic contexts.

Mediation analysis of mental health characteristics linking social needs to life satisfaction among immigrants

Background

Life satisfaction contributes to improved long and healthy lives, enhanced biological function, better mental health, and decreased mortality risks. Social needs (e.g., food security, employment, healthcare utilization) are important determinants of mental health and life satisfaction among immigrants. However, there is limited literature on how social needs influence mental health, which, in turn, affects life satisfaction among immigrants. We examined whether mental health influences the mechanisms of the relationship between social needs and life satisfaction among immigrants.

Methods

We used the 2021 cross-sectional National Health Interview Survey data on U.S. immigrants (n = 4320) aged ≥18 years. We conducted weighted mediation analyses with multiple linear regression. Life satisfaction (scores 0-10; ≥1 as higher life satisfaction) was the dependent variable; independent variables were food security, employment, and healthcare utilization; and the mediator, serious psychological distress (SPD: scores 0-24; ≥1 as higher SPD).

Results

The total effect (not accounting for SPD) of food insecurity (vs. secure) on life satisfaction was negative (β = -0.61, p < 0.001); the direct effect (after accounting for SPD) was not statistically significant (β = -0.21, p = 0.153), while the indirect effect (food insecurity's effect explained by SPD) was negative (β = -0.40, p < 0.001). The total (β = 0.32, p < 0.001), direct (β = 0.24, p = 0.004), and indirect (β = 0.09, p = 0.006) effects of being employed (vs. unemployed) on life satisfaction were positive. The total (β = -0.12, p = 0.116) and direct (β = -0.03, p = 0.683) effects of healthcare utilization within the past year (vs. more than a year) on life satisfaction were not statistically significant, whereas the indirect effect was negative (β = -0.09, p < 0.001).

Conclusions

SPD mediates the effect of food security, healthcare utilization, and employment on life satisfaction, suggesting the need to improve social needs and mental health among immigrants.

Utility of Routine Preoperative Urinalysis in the Prevention of Surgical Site Infections

OBJECTIVE

Preoperative assessment is important for neurosurgical risk stratification, but the level of evidence for individual screening tests is low. In preoperative urinalysis (UA), testing may significantly increase costs and lead to inappropriate antibiotic treatment. We prospectively evaluated whether eliminating preoperative UA was noninferior to routine preoperative UA as measured by 30-day readmission for surgical site infection in adult elective neurosurgical procedures.

METHODS

A single-institution prospective, pragmatic study of patients receiving elective neurosurgical procedures from 2018 to 2020 was conducted. Patients were allocated based on same-day versus preoperative admission status. Rates of preoperative UA and subsequent wound infection were measured along with detailed demographic, surgical, and laboratory data.

RESULTS

The study included 879 patients. The most common types of surgery were cranial (54.7%), spine (17.4%), and stereotactic/functional (19.5%). No preoperative UA was performed in 315 patients, while 564 underwent UA. Of tested patients, 103 (18.3%) met criteria for suspected urinary tract infection, and 69 (12.2%) received subsequent antibiotic treatment. There were 14 patients readmitted within 30 days (7 without UA [2.2%] vs. 7 with UA [1.2%]) for subsequent wound infection with a risk difference of 0.98% (95% confidence interval -0.89% to 2.85%). The upper limit of the confidence interval exceeded the preselected noninferiority margin of 1%.

CONCLUSIONS

In this prospective study of preoperative UA for elective neurosurgical procedures using a pragmatic, real-world design, risk of readmission due to surgical site infection was very low across the study cohort, suggesting a limited role of preoperative UA for elective neurosurgical procedures.

Quantitative assessment of Land use/land cover changes in a developing region using machine learning algorithms: A case study in the Kurdistan Region, Iraq

The identification of land use/land cover (LULC) changes is important for monitoring, evaluating, and preserving natural resources. In the Kurdistan region, the utilization of remotely sensed data to assess the effectiveness of machine learning algorithms (MLAs) for LULC classification and change detection analysis has been limited. This study monitors and analyzes LULC changes in the study area from 1991 to 2021 using a quantitative approach with multi-temporal Landsat imagery. Five MLAs were applied: Support Vector Machine (SVM), Random Forest (RF), Artificial Neural Network (ANN), K-Nearest Neighbor (KNN), and Extreme Gradient Boosting (XGBoost). The results showed that the RF algorithm produced the most accurate maps of the three-decade study period, accompanied by a high kappa coefficient (0.93-0.97) compared with the SVM (0.91-0.95), ANN (0.91-0.96), KNN (0.92-0.96), and XGBoost (0.92-0.95) algorithms. Consequently, the RF classifier was implemented to categorize all obtainable satellite images. Socioeconomic changes throughout these transition periods were revealed by the change detection results. Rangeland and barren land areas decreased by 11.33 % (-402.03 km2) and 6.68 % (-236.8 km2), respectively. The transmission increases of 13.54 % (480.18 km2), 3.43 % (151.74 km2), and 0.71 % (25.22 km2) occurred in agricultural land, forest, and built-up areas, respectively. The outcomes of this study contribute significantly to LULC monitoring in developing regions, guiding stakeholders to identify vulnerable areas for better land use planning and sustainable environmental protection.

Socioeconomic determinants of racial disparities in survival outcomes among patients with renal cell carcinoma

PURPOSE

Racially driven outcomes in cancer are challenging to study. Studies evaluating the impact of race in renal cell carcinoma (RCC) outcomes are inconsistent and unable to disentangle socioeconomic disparities from inherent biological differences. We therefore seek to investigate socioeconomic determinants of racial disparities with respect to overall survival (OS) when comparing Black and White patients with RCC.

METHODS

We queried the National Cancer Database (NCDB) for patients diagnosed with RCC between 2004 and 2017 with complete clinicodemographic data. Patients were examined across various stages (all, cT1aN0M0, and cM1) and subtypes (all, clear cell, or papillary). We performed Cox proportional hazards regression with adjustment for socioeconomic and disease factors.

RESULTS

There were 386,589 patients with RCC, of whom 46,507 (12.0%) were Black. Black patients were generally younger, had more comorbid conditions, less likely to be insured, in a lower income quartile, had lower rates of high school completion, were more likely to have papillary RCC histology, and more likely to be diagnosed at a lower stage of RCC than their white counterparts. By stage, Black patients demonstrated a 16% (any stage), 22.5% (small renal mass [SRM]), and 15% (metastatic) higher risk of mortality than White patients. Survival differences were also evident in histology-specific subanalyses. Socioeconomic factors played a larger role in predicting OS among patients with SRMs than in patients with metastasis.

CONCLUSIONS

Black patients with RCC demonstrate worse survival outcomes compared to White patients across all stages. Socioeconomic disparities between races play a significant role in influencing survival in RCC.

Identifying groups of children's social mobility opportunity for public health applications using k-means clustering

Background

The Opportunity Atlas project is a pioneering effort to trace social mobility and adulthood socioeconomic outcomes back to childhood residence. Half of the variation in adulthood socioeconomic outcomes was explainable by neighborhood-level socioeconomic characteristics during childhood. Clustering census tracts by Opportunity Atlas characteristics would allow for further exploration of variance in social mobility. Our objectives here are to identify and describe spatial clustering trends within Opportunity Atlas outcomes.

Methods

We utilized a k-means clustering machine learning approach with four outcome variables (individual income, incarceration rate, employment, and percent of residents living in a neighborhood with low levels of poverty) each given at five parental income levels (1st, 25th, 50th, 75th, and 100th percentiles of the national distribution) to create clusters of census tracts across the contiguous United States (US) and within each Environmental Protection Agency region.

Results

At the national level, the algorithm identified seven distinct clusters; the highest opportunity clusters occurred in the Northern Midwest and Northeast, and the lowest opportunity clusters occurred in rural areas of the Southwest and Southeast. For regional analyses, we identified between five to nine clusters within each region. PCA loadings fluctuate across parental income levels; income and low poverty neighborhood residence explain a substantial amount of variance across all variables, but there are differences in contributions across parental income levels for many components.

Conclusions

Using data from the Opportunity Atlas, we have taken four social mobility opportunity outcome variables each stratified at five parental income levels and created nationwide and EPA region-specific clusters that group together census tracts with similar opportunity profiles. The development of clusters that can serve as a combined index of social mobility opportunity is an important contribution of this work, and this in turn can be employed in future investigations of factors associated with children's social mobility.

An asynchronous web-based intervention for neurosurgery residents to improve education on cost-effective care

OBJECTIVE

To gauge resident knowledge in the socioeconomic aspects of neurosurgery and assess the efficacy of an asynchronous, longitudinal, web-based, socioeconomics educational program tailored for neurosurgery residents.

METHODS

Trainees completed a 20-question pre- and post-intervention knowledge examination including four educational categories: billing/coding, procedure-specific concepts, material costs, and operating room protocols. Structured data from 12 index cranial neurosurgical operations were organized into 5 online, case-based modules sent to residents within a single training program via weekly e-mail. Content from each educational category was integrated into the weekly modules for resident review.

RESULTS

Twenty-seven neurosurgical residents completed the survey. Overall, there was no statistically significant difference between pre- vs post-intervention resident knowledge of billing/coding (79.2 % vs 88.2 %, p = 0.33), procedure-specific concepts (34.3 % vs 39.2 %, p = 0.11), material costs (31.7 % vs 21.6 %, p = 0.75), or operating room protocols (51.7 % vs 35.3 %, p = 0.61). However, respondents' accuracy increased significantly by 40.8 % on questions containing content presented more than 3 times during the 5-week study period, compared to an increased accuracy of only 2.2 % on questions containing content presented less often during the same time period (p = 0.05).

CONCLUSIONS

Baseline resident knowledge in socioeconomic aspects of neurosurgery is relatively lacking outside of billing/coding. Our socioeconomic educational intervention demonstrates some promise in improving socioeconomic knowledge among neurosurgery trainees, particularly when content is presented frequently. This decentralized, web-based approach to resident education may serve as a future model for self-driven learning initiatives among neurosurgical residents with minimal disruption to existing workflows.

Contribution of alcohol use to the global burden of cirrhosis and liver cancer from 1990 to 2019 and projections to 2044

BACKGROUND

Identifying the temporal trends of cirrhosis and liver cancer attributable to alcohol use in both the past and the future can formulate the control strategies.

METHODS

Data on cirrhosis and liver cancer attributable to alcohol use from 1990 to 2019, including mortality and disability-adjusted life year (DALY) rates were collected from the 2019 Global Burden of Disease (GBD) study. To analyze the temporal trends, the average annual percentage change (AAPC) was calculated, and the Bayesian age-period-cohort model was applied.

RESULT

Deaths and DALY of cirrhosis and liver cancer attributable to alcohol use increased year by years, but the age-standardized death rate (ASDR) and age-standardized DALY rate declined or remained stable from 1990 to 2019 in most regions of the world. The burden of cirrhosis attributable to alcohol increased in low-middle social-development index (SDI) regions, while the burden of liver cancer increased in high-SDI regions. Eastern Europe and Central Asia have the highest burden of cirrhosis and liver cancer caused by alcohol use. Deaths and DALYs are mainly distributed in people aged 40+ years, but there is an increasing trend in people aged under 40 years. New deaths from cirrhosis and liver cancer attributable to alcohol use are predicted to increase in the next 25 years, but the ASDR of cirrhosis in males will increase slightly.

CONCLUSIONS

Although the age-standardized rate of cirrhosis and liver cancer due to alcohol use have decreased, the absolute burden increased and will continue to increase. Therefore, alcohol control measures should be further strengthened and improved through effective national policies.

Epidemiology and socioeconomic consequences of work-related pelvic and acetabular fractures recorded in the German Social Accident Insurance

INTRODUCTION

Pelvic and acetabular fractures can result from work-related accidents and frequently require lengthy medical treatments. Consequently, high medical costs as well as delayed or absent return to work can be the consequence. Therefore, we aimed to study the socioeconomic consequences of work-related pelvic and acetabular fractures.

MATERIALS AND METHODS

This retrospective study investigated work-related pelvic and acetabular fractures recorded in the German Social Accident Insurance in 2011 and 2017, in terms of age, sex, type of accident, duration of incapacity to work, reductions in earning capacity, costs for outpatient and inpatient treatment and costs for pension and severance pay.

RESULTS

Among a total of 606 injuries in 2011 and 619 injuries in 2017, male patients and patients between 40 and 65 years were predominantly affected. Acetabular fractures caused higher rates of long absence from work of 6-12 months (2011: 24.7% vs. 9.5-16.9%; 2017: 26.1% vs. 6.1-11.0%) and >12 months (2011: 15.8% vs. 9.8-10.2%; 2017: 13.3% vs. 1.9-8.2%) as well as more cases with a reduction in earning capacity of at least 20% (2011: 61 vs. ≤27 cases; 2017: 39 vs. ≤12 cases) compared to pelvic ring fractures. The total costs for pelvic ring and acetabular fractures in the German social accident insurances amounted € 18,726,630 and € 9637,189 in the periods 2011-2020 and 2017-2020, respectively. The average costs per case for treatment and rehabilitation until 2020 was € 19,079 for injuries from 2011 and € 13,629 for injuries from 2017. Acetabular fractures were found to be the most cost-intensive injuries compared to anterior, posterior or complex pelvic ring fractures.

CONCLUSIONS

Work-related pelvic and especially acetabular fractures have a considerable socioeconomic impact in the German Social Accident Insurance. Measures to prevent work-related accidents and to improve treatment of pelvic injuries can help to reduce their socioeconomic burden.

Review of quantitative methods to assess impacts of changing climate and socioeconomic conditions on Arctic transportation systems

Rapid climate and socioeconomic changes are transforming Arctic human-earth systems. An integral part of these systems is mobility, which encompasses the transport of humans and goods into, out of, and between Arctic regions. Impacts of climate and socioeconomic drivers on Arctic mobility are heterogenous. Methodologies are needed to quantify these impacts in measures that can be linked with broader socioeconomic systems. This article reviews existing methods and organizes them into a conceptual framework to understand trends and gaps in the literature. We found methods quantifying impacts of a range of climate drivers on most transportation modes present in the Arctic, but few methods focused on socioeconomic drivers. In addition, underrepresented were methods explicitly considering adaptive capacity of transportation systems. We provide insight into the data and relationships relevant to understanding impacts of Arctic change on transportation systems, laying a foundation for future work that investigates how these impacts fit into broader human-arth systems.

Impact of socioeconomics and race on clinical follow-up and trial enrollment and adherence in cerebral cavernous malformation

OBJECTIVES

Cerebral cavernous malformation (CCM) affects more than a million Americans but advanced care for symptomatic lesions and access to research studies is largely limited to referral academic centers MATERIALS AND METHODS: A cohort of CCM patients screened for research studies at an accredited center of excellence for CCM was analyzed. Demographics, lesion location, history of hemorrhage, insurance type and area of deprivation index (ADI) were collected. Primary outcomes were clinical follow-up within a year from initial evaluation, and enrollment and adherence in clinical trials among eligible subjects RESULTS: A majority (52.8%) of CCM patients evaluated had a high socioeconomic status (SES) (ADI 1-3), and only 11.5% were African American. Patients who had a symptomatic bleed were more likely to follow-up (p=0.01), and those with brainstem lesion were more likely to enroll/adhere in a clinical trial (p=0.02). Rates of clinical follow-up were similar across different ADI groups, insurance coverage and race. Patients who were uninsured/self-paying, and African Americans were more likely to decline/drop from clinical trials (OR 2.4, 95% CI 0.46-10.20 and OR 2.2, 95% CI 0.33-10.75, respectively), but differences were not statistically significant CONCLUSIONS: Access of disadvantaged patients to center of excellence care and research remains limited despite geographic proximity to their community. Patients with lower SES and African Americans are as likely to follow-up clinically, but there were trends of differences in enrollment/adherence in clinical trials. Mitigation efforts should target systemic causes of low access to specialized care among uninsured and African American patients.

Driving role of climatic and socioenvironmental factors on human brucellosis in China: machine-learning-based predictive analyses

BACKGROUND

Brucellosis is a common zoonotic infectious disease in China. This study aimed to investigate the incidence trends of brucellosis in China, construct an optimal prediction model, and analyze the driving role of climatic factors for human brucellosis.

METHODS

Using brucellosis incidence, and the socioeconomic and climatic data for 2014-2020 in China, we performed spatiotemporal analyses and calculated correlations with brucellosis incidence in China, developed and compared a series of regression and Seasonal Autoregressive Integrated Moving Average X (SARIMAX) models for brucellosis prediction based on socioeconomic and climatic data, and analyzed the relationship between extreme weather conditions and brucellosis incidence using copula models.

RESULTS

In total, 327,456 brucellosis cases were reported in China in 2014-2020 (monthly average of 3898 cases). The incidence of brucellosis was distinctly seasonal, with a high incidence in spring and summer and an average annual peak in May. The incidence rate was highest in the northern regions' arid and continental climatic zones (1.88 and 0.47 per million people, respectively) and lowest in the tropics (0.003 per million people). The incidence of brucellosis showed opposite trends of decrease and increase in northern and southern China, respectively, with an overall severe epidemic in northern China. Most regression models using socioeconomic and climatic data cannot predict brucellosis incidence. The SARIMAX model was suitable for brucellosis prediction. There were significant negative correlations between the proportion of extreme weather values for both high sunshine and high humidity and the incidence of brucellosis as follows: high sunshine, [Formula: see text] = -0.59 and -0.69 in arid and temperate zones; high humidity, [Formula: see text] = -0.62, -0.64, and -0.65 in arid, temperate, and tropical zones.

CONCLUSIONS

Significant seasonal and climatic zone differences were observed for brucellosis incidence in China. Sunlight, humidity, and wind speed significantly influenced brucellosis. The SARIMAX model performed better for brucellosis prediction than did the regression model. Notably, high sunshine and humidity values in extreme weather conditions negatively affect brucellosis. Brucellosis should be managed according to the "One Health" concept.

Association between different behavioral factors and dental caries among children attending the dental clinics in a sample from Saudi Arabia

BACKGROUND

This study aimed to assess the association between different behavioral factors and the prevalence of dental caries among children attending the dental clinic in a sample from the Hail and Tabuk regions, Saudi Arabia.

METHOD

A cross-sectional study design was employed to determine the burden of dental caries in teeth and key associated factors among 6-12-year-old children who attended different dental clinics. The data was recruited from Hail and Tabuk districts, Saudi Arabia. The study included only Saudi nationals, whose parents could fill out the self-administered questionnaire and provide informed consent for their child's dental examination at clinics. Children underwent a simple dental examination based on the World Health Organization diagnostic criteria for oral health surveys. The Decayed, Missed, Filled Tooth (DMFT) index developed by the World Health Organization (WHO) was utilized to assess dental caries. Descriptive statistics were performed to describe categorical variables. The mean DMFT was compared between girls' and boys' and the children from Hail and Tabuk regions using the Mann-Whitney U-test. The chi-square test was used to examine the association between different behavioral factors and the prevalence of dental caries.

RESULTS

Of the total 399 children examined, 203 (50.9%) were boys, whilst 196 (49.1%) were girls. The prevalence of dental caries was correlated with the cleaning tool, parental educational level, dental visits, and sugar consumption (p < 0.05). However, brushing frequency failed to demonstrate a correlation with the prevalence of dental caries (p > 0.05). The total mean DMFT for the studied sample was 7.81 (SD ± 1.9). Caries' experience was made up mainly of decayed teeth. Decayed teeth made up an average of 3.30 (SD ± 1.07). The total mean of missing and filling teeth was 2.51 (SD ± 0.99) and 1.99 (SD ± 1.26) respectively. There was no statistically significant difference in the mean DMFT and gender or between Hail and Tabuk (p < 0.05).

CONCLUSION

Saudi Arabia continues to have a high prevalence of dental caries compared to the global norm.

Analysis of socioeconomic and demographic factors on post-treatment outcomes for metastatic spinal tumors

OBJECTIVE

Sociodemographic factors may play a role in incidence and treatment of metastatic spinal tumors, as there is a delay in diagnosis and increased incidence of relevant primaries. There has yet to be a detailed analysis of the impact of sociodemographic factors on surgical outcomes for spinal metastases. We sought to examine the influence of socioeconomic factors on outcomes for patients with metastatic spinal tumors.

METHODS

Two hundred and sixty-three patients who underwent surgery for metastatic spinal tumors were identified. Sociodemographic characteristics were then collected and assigned to patients based on their ZIP code. The Chi-square test and the Mann-Whitney-U test were used for binary and continuous variables, respectively. Multivariate regression models were also used to control for age, smoking status, body mass index, and Charlson Comorbidity Index.

RESULTS

Males had significantly lower rates of post-treatment complication compared to females (22.7 % vs 39.3 %, p = 0.0052), and those in high educational attainment ZIP codes had significantly shorter length of stay (LOS) compared to low educational attainment ZIP codes (9.3 days vs 12.2 days, p = 0.0058). Multivariate regression revealed that living in a high percentage white ZIP code and being male significantly decreased risk of post-treatment complication by 19 % (p = 0.042) and 14 % (p = 0.032), respectively. Living in a high educational attainment ZIP code decreased LOS by 3 days (p = 0.019).

CONCLUSIONS

Males had significantly lower rates of post-treatment complication. Patients in high percentage white areas also had decreased rate of post-treatment complications. Patients living in areas with high educational attainment had shorter length of stay.

Do Patient Demographic and Socioeconomic Factors Influence Surgical Treatment Rates After ACL Injury?

INTRODUCTION

Anterior cruciate ligament (ACL) injuries may be managed nonoperatively in certain patients and injury patterns; however, complete ACL ruptures are commonly reconstructed to restore anterior and lateral rotatory stability of the knee. While ACL reconstruction is well-studied, the literature is sparse with regard to which socioeconomic patient factors are associated with patients undergoing ACL reconstruction rather than nonoperative management after diagnosis of an ACL injury. The current study seeks to evaluate this relationship between patient demographics as well as socioeconomic factors and the rate of surgery following ACL injuries.

METHODS

Patients ≤65 years of age with a primary ACL injury between 2011 and 2018 were retrospectively identified in the New York Statewide Planning and Research Cooperative System database. International Classification of Disease 9/10 and Current Procedural Terminology codes were used to identify these patients and their subsequent ACL reconstructions. Logistic regression was performed to determine the effect of patient factors on the likelihood of having surgery after the diagnosis of an ACL injury.

RESULTS

Compared to White patients, African American patients were significantly less likely to undergo ACL reconstruction following an ACL injury (OR=0.65, 95% CI, 0.573-0.726). Patients older than 35 had decreased odds of undergoing ACL reconstruction compared to younger patients, with patients 55-64 having the lowest odds (OR=0.166, 95% CI, 0.136-0.203). Patients with Medicaid (OR=0.84, 95% CI, 0.757-0.933) or self-pay insurance (OR=0.67, 95% CI, 0.565-0.793), and those with worker's compensation (OR=0.715, 95% CI, 0.621-0.823) had decreased odds of undergoing ACL reconstruction relative to patients with private insurance. Patients with higher Social Deprivation Index (SDI) were significantly more likely to be treated nonoperatively after ACL injuries compared to those with lower SDI (mean nonoperative SDI score, 61, operative SDI, 56, P<0.0001).

DISCUSSION

In patients with ACL injuries, there are socioeconomic and patient-related factors that are associated with increased odds of undergoing ACL reconstruction. These factors are important to recognize as they represent a source of potential inequality in access to care and an area with potential for improvement.

Prevalence and incidence of chronic kidney disease stage 3-5 - results from KidDiCo

BACKGROUND

Chronic kidney disease (CKD) is a global challenge. CKD prevalence estimation is central to management strategies and prevention. It is necessary to predict end stage kidney disease (ESKD) and, subsequently, the burden for healthcare systems. In this study we characterize CKD stage 3-5 prevalence and incidence in a cohort covering the majority of the Region of Southern Denmark and investigate individuals' demographic, socioeconomic, and comorbidity status.

METHODS

We used data from the Kidney Disease Cohort (KidDiCo) combining laboratory data from Southern Denmark with Danish national databases. Chronic kidney disease was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines.

RESULTS

The prevalence varied between 4.83 and 4.98% and incidence rate of CKD was 0.49%/year. The median age was 76.4 years. The proportion of individuals with CKD stage 3-5 in the entire population increased consistently with age. The percentage of women in the CKD 3-5 group was higher than in the background population. Diabetes mellitus, hypertension and cardiovascular disease were more prominent in patients with CKD. CKD stage 5 and ESKD were more frequent as incident CKD stages in the 18-49 year olds when compared to older individuals. CKD patients tended to have a lower socioeconomic status.

CONCLUSION

Chronic kidney disease stage 3-5 is common, especially in the elderly. Patients with CKD stage 3-5 are predominantly female. The KidDiCo data suggests an association between lower socioeconomic status and prevalence of CKD.

Individual and neighborhood risk factors of hospital admission and death during the COVID-19 pandemic: a population-based cohort study

BACKGROUND

The coronavirus disease 2019 (COVID-19) disproportionately affects minority populations in the USA. Sweden - like other Nordic countries - have less income and wealth inequality but lacks data on the socioeconomic impact on the risk of adverse outcomes due to COVID-19.

METHODS

This population-wide study from March 2020 to March 2022 included all adults in Stockholm, except those in nursing homes or receiving in-home care. Data sources include hospitals, primary care (individual diagnoses), the Swedish National Tax Agency (death dates), the Total Population Register "RTB" (sex, age, birth country), the Household Register (size of household), the Integrated Database For Labor Market Research "LISA" (educational level, income, and occupation), and SmiNet (COVID data). Individual exposures include education, income, type of work and ability to work from home, living area and living conditions as well as the individual country of origin and co-morbidities. Additionally, we have data on the risks associated with living areas. We used a Cox proportional hazards model and logistic regression to estimate associations. Area-level covariates were used in a principal component analysis to generate a measurement of neighborhood deprivation. As outcomes, we used hospitalization and death due to COVID-19.

RESULTS

Among the 1,782,125 persons, male sex, comorbidities, higher age, and not being born in Sweden increase the risk of hospitalization and death. So does lower education and lower income, the lowest incomes doubled the risk of death from COVID-19. Area estimates, where the model includes individual risks, show that high population density and a high percentage of foreign-born inhabitants increased the risk of hospitalization.

CONCLUSIONS

Segregation and deprivation are public health issues elucidated by COVID-19. Neighborhood deprivation, prevalent in Stockholm, adds to individual risks and is associated with hospitalization and death. This finding is paramount for governments, agencies, and healthcare institutions interested in targeted interventions.

Anthropogenic metal loads in nearshore sediment along the coast of China mainland interacting with provincial socioeconomics in the period 1980-2020

Metal pollutions have been accused of consequences of the anthropogenic activities but few quantitative delineations between environmental metal loads and socioeconomic development presented. A meta-data analysis study was carried out on metal loads in coastal sediment in the provinces of China mainland reported in literature in the period 1980-2020. Eight metals with well-recognized anthropogenic sources were selected including arsenic (As), cadmium (Cd), chromium (Cr), copper (Cu), mercury (Hg), nickel (Ni), lead (Pb), and zinc (Zn). Screened with three criteria, a total of 1173 records from 405 published studies were finalized as the metal loads dataset in coastal sediment. Evident provincial patterns were observed among the selected metals but element dependent after transformed to sample number weighted contents (C_w). Against the regional marine backgrounds, anthropogenic increment rate (R_anthrop) of metal loads in nearshore sediment presented better provincial differentiation with the extremes at 7.58 for As and 62.13 for Cu in Guangdong, 91.25 for Hg in Zhejiang, 3.19 for Ni in Tianjin, 7.72 for Pb in Fujian, and 13.51 for Zn in Liaoning. Metal loads in coastal sediment could be explained by characteristic industries in the provinces. Nearshore sediment in Guangdong had high risk to metal loads and other provinces at low-to-medium risk to the lowest thresholds of sediment quality guidelines in China and USA. Canonical correlations identified considerably interactive explanations between integrative hazard quotients (ƩHQ) of the selected metals in nearshore sediment and non-agricultural GDP per capita of non-agricultural population/urban population percentile provincially but few significant fittings by the classic environmental Kuznets Curve model quantitatively. Findings of this study explored uncertainty from both sides in explaining the interactions, i.e., data integrity of metal loads in coastal sediment in literature and appropriation of socioeconomic indicators in relation to metal emission industries.

Socioeconomic Predictors of Treatment Outcomes Among Adults With Major Depressive Disorder

OBJECTIVE

In this study, the authors sought to examine the impact of socioeconomic variables on outcomes of pharmacotherapy treatments for major depressive disorder in analyses that controlled for treatment access and level of care.

METHODS

The authors used data from the Combining Medications to Enhance Depression Outcomes study, a prospective clinical trial conducted from March 2008 to April 2014 with 665 adults who had major depressive disorder and were randomly assigned to three pharmacotherapeutic treatments, to develop Bayesian hierarchical models of treatment trajectories for change in Quick Inventory of Depressive Symptomatology-Self-Report ratings. Posterior tail probabilities were used to evaluate the effects of education, income, race-ethnicity, and employment on treatment outcomes.

RESULTS

After sex, age, and treatment type were controlled for in the analyses, not having a college education (<16 years of schooling), being unemployed, or being non-White were each associated with slower and less improvement. At the end of treatment (week 12), not having a college degree reduced treatment responses by 9.6% (p=0.045), being unemployed by 6.6% (p=0.007), and being non-White by 11.3% (p<0.001). Treatment response was significantly related to income; having an income at the 25th percentile of the income distribution decreased improvement by 4.8% compared with having an income at the 75th percentile (p=0.018).

CONCLUSIONS

Within a short-term, randomized controlled trial, socioeconomic factors had a critical role in the acute response of patients to pharmacotherapy for major depression.

The oral microbiome, pancreatic cancer and human diversity in the age of precision medicine

Pancreatic cancer is a deadly disease with limited diagnostic and treatment options. Not all populations are affected equally, as disparities exist in pancreatic cancer prevalence, treatment and outcomes. Recently, next-generation sequencing has facilitated a more comprehensive analysis of the human oral microbiome creating opportunity for its application in precision medicine. Oral microbial shifts occur in patients with pancreatic cancer, which may be appreciated years prior to their diagnosis. In addition, pathogenic bacteria common in the oral cavity have been found within pancreatic tumors. Despite these findings, much remains unknown about how or why the oral microbiome differs in patients with pancreatic cancer. As individuals develop, their oral microbiome reflects both their genotype and environmental influences. Genetics, race/ethnicity, smoking, socioeconomics and age affect the composition of the oral microbiota, which may ultimately play a role in pancreatic carcinogenesis. Multiple mechanisms have been proposed to explain the oral dysbiosis found in patients with pancreatic cancer though they have yet to be confirmed. With a better understanding of the interplay between the oral microbiome and pancreatic cancer, improved diagnostic and therapeutic approaches may be implemented to reduce healthcare disparities. Video Abstract.

Socioeconomics and attributable etiology of primary liver cancer, 1990-2019

BACKGROUND

Primary liver cancer (PLC) is a major contributor to cancer-related deaths. Data on global and country-specific levels and trends of PLC are essential for understanding the effects of this disease and helping policymakers to allocate resources.

AIM

To investigate the association between the burden of PLC and socioeconomic development status.

METHODS

Cancer mortality and incidence rates were obtained from the Global Burden of Disease (GBD) 2019, and the data were stratified by country and territory, sex, and the Socio-demographic Index (SDI) level. The association between the attributable etiology of PLC and socioeconomic development status, represented using the SDI, was described. The attributable etiology of PLC included hepatitis B, hepatitis C, alcohol use, and nonalcoholic steatohepatitis. The association between the attributable etiology of PLC and SDI was further stratified by sex and geographical location. A confidence analysis was also performed based on bootstrap draw.

RESULTS

The age-standardized incidence rate of PLC was 6.5 [95% confidence intervals (CI): 5.9-7.2] per 100000 person-years, which decreased by -27.5% (-37.0 to -16.6) from 1990 to 2019. Several countries located in East Asia, South Asia, West Africa, and North Africa shouldered the heaviest burden of PLC in 2019. In terms of incidence rates, the first leading underlying cause of PLC identified was hepatitis B, followed by hepatitis C, alcohol use, and nonalcoholic steatohepatitis. Regarding stratification using the SDI, the incidence rate of PLC was the highest for high and middle SDI locations. Further, the leading attributable etiologies of PLC were hepatitis B for the middle and high middle SDI locations while hepatitis C and nonalcoholic steatohepatitis for the high SDI locations.

CONCLUSION

The pronounced association between socioeconomic development status and PLC burden indicates socioeconomic development status affects attributable etiologies for PLC. GBD 2019 data are valuable for policymakers implementing PLC cost-effective interventions.

Perceptions and risk behaviors regarding biological invasions in inland aquatic ecosystems

Public engagement is vital to effectively manage Invasive Alien Species (IAS) and biosecurity campaigns directed to stakeholders are decisive to raise awareness regarding IAS regulations and problems. To design and implement adequate communication plans, stakeholders' perceptions and risk behaviors regarding IAS need to be monitored by surveys. IAS do not recognize borders and most countries are not biogeographically isolated. Therefore, international information and consensus are necessary when applying measures at a biogeographic scale. Our bilingual survey was performed at the Iberian Peninsula, targeting the general public, decision-makers and other stakeholders, covering all taxa associated to inland aquatic ecosystems. We found differences in IAS' awareness between countries, and between different stakeholder groups. Results showed that the awareness of socioeconomic and human health impacts is substantially lower when compared with impacts on biodiversity. We found that the perception regarding the predation impacts is consistent across groups and countries, while other perceptions differ. The negative socioeconomic impact on angling due to IAS introductions is widely recognized. However, angling is also the activity most referred as positively impacted by IAS due to fish introductions. Most responders knew what IAS are, providing correct species examples. For all three awareness types (Biodiversity, Socio-economic and Human health) the model regressions showed that the most important predictor was the country of provenance of the respondent, followed by Education level for the socio-economic and biodiversity regressions and the stakeholder group in the Human health regression. We can conclude that in Portugal and Spain the general public and other key target-groups have reduced understanding of some threats posed by IAS. We highlight that raising awareness about IAS impacts on humans, namely on socio-economic aspects and human health, may be more effective and it is certainly needed in education campaigns towards IAS.

On the development of a regional climate change adaptation plan: Integrating model-assisted projections and stakeholders' perceptions

Climate change is expected to have strong social-ecological implications, with global but especially regional and local challenges. To assess the climatic vulnerability of a given territory, it is necessary to evaluate its exposure to climate change and its adaptive capacity. This study describes the development of an Action Plan for Adapting to Climate Change in the Tâmega and Sousa Region, a mountainous inter-municipal community in the North of Portugal. The goals were to identify the main impacts of climate change on water resources, agriculture, forests, biodiversity, and socioeconomic sectors, as well as to develop a plan, merging local and scientific knowledge through a transdisciplinary lens. This study describes an approach that combines modelling methods, applied in the different sectors, and participatory methods, based on the analysis of the perceptions of local actors. Results indicate that the target region will experience a generalized increase in temperature and a decrease in precipitation, which will negatively impact all studied social-ecological dimensions. Overall, local business and institutional agents perceive the primary and tourism sectors as the most vulnerable in the region. The described framework demonstrates the engagement process between relevant scientific experts and local practitioners, as well as how it is critical to understand the impacts of climate change and to support the co-design of an adaptation plan, which in turn can guide political and economic decision-making towards effective implementation of the plan. In addition, the difficulties and challenges encountered during this process are discussed to support future plans and strategies for local adaptation.

Cardiorespiratory fitness and lifestyle on severe COVID-19 risk in 279,455 adults: a case control study

Background

The impact of cardiorespiratory fitness (CRF) and other lifestyle-related factors on severe COVID-19 risk is understudied. The present study aims to investigate lifestyle-related and socioeconomic factors as possible predictors of COVID-19, with special focus on CRF, and to further study whether these factors may attenuate obesity- and hypertension-related risks, as well as mediate associations between socioeconomic factors and severe COVID-19 risk.

Methods

Out of initially 407,131 participants who participated in nationwide occupational health service screening between 1992 and 2020, n = 857 cases (70% men, mean age 49.9 years) of severe COVID-19 were identified. CRF was estimated using a sub-maximum cycle test, and other lifestyle variables were self-reported. Analyses were performed including both unmatched, n = 278,598, and sex-and age-matched, n = 3426, controls. Severe COVID-19 included hospitalization, intensive care or death due to COVID-19.

Results

Patients with more severe COVID-19 had significantly lower CRF, higher BMI, a greater presence of comorbidities and were more often daily smokers. In matched analyses, there was a graded decrease in odds for severe COVID-19 with each ml in CRF (OR = 0.98, 95% CI 0.970 to 0.998), and a two-fold increase in odds between the lowest and highest (< 32 vs. ≥ 46 ml·min⁻¹·kg⁻¹) CRF group. Higher BMI (per unit increase, OR = 1.09, 1.06 to 1.12), larger waist circumference (per cm, OR = 1.04, 1.02 to 1.06), daily smoking (OR = 0.60, 0.41 to 0.89) and high overall stress (OR = 1.36, 1.001 to 1.84) also remained significantly associated with severe COVID-19 risk. Obesity- and blood pressure-related risks were attenuated by adjustment for CRF and lifestyle variables. Mediation through CRF, BMI and smoking accounted for 9% to 54% of the associations between low education, low income and blue collar/low skilled occupations and severe COVID-19 risk. The results were consistent using either matched or unmatched controls.

Conclusions

Both lifestyle-related and socioeconomic factors were associated with risk of severe COVID-19. However, higher CRF attenuated the risk associated with obesity and high blood pressure, and mediated the risk associated with various socioeconomic factors. This emphasises the importance of interventions to maintain or increase CRF in the general population to strengthen the resilience to severe COVID-19, especially in high-risk individuals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01198-5.

Neurosurgery perception of Enhanced Recovery After Surgery (ERAS) protocols

Enhanced Recovery After Surgery (ERAS) protocols are widespread in several fields, particularly general surgery, and attempt to deliver surgical care at a lower cost while also improving patient outcomes. However, few institutions have implemented ERAS protocols in neurosurgery. As such, a survey of neurosurgeons on the current state of ERAS in neurosurgery was conducted to provide insight on scaling the practice nationally. A 15-question survey was designed to assess the implementation of andsatisfaction with ERAS protocols at individual institutions. A total of 39 responses were collected from 38 unique institutions. 58.9%(N = 23) reported implementation of neurosurgical ERAS protocols. 52.1% (N = 12) of the responses were neurosurgeons at academic institutions withneurosurgical residency programs. Most neurosurgeons used ERAS protocolsfor spine cases (N = 23), with only 17.3% (N = 4) employing ERAS protocolsfor cranial cases. 69.5% (N = 16) of survey participants reported that thedesign and implementation of ERAS was a multidisciplinary effort acrossmany departments, including neurosurgery, anesthesia, and pharmacy.Decreased costs and intensive care unit (ICU) admission were reported tobe unanticipated benefits of ERAS implementation. Unanticipated challenges to implementation of new protocols included difficulties withelectronic medical record (EMR) integration, agreement of protocoldetails amongst stakeholders, uniform implementation of protocols by allneurosurgeons, and lack of adaptability by multidisciplinary staff. Meandepartment satisfaction with ERAS protocol implementation was 4.00 +/- 0.81 (N = 22) on a 5-point Likert scale.

Health-related quality of life among migrants and natives in Hamburg, Germany: An observational study

Purpose

The aim of this observational study was firstly, to assess the Health-related Quality of Life (HrQoL) among migrants and German natives in Hamburg, Germany, using the SF-12 mental and physical summary scores and secondly, to evaluate the contribution of selected sociodemographic and socioeconomic variables to explain the variance in mental and physical HrQoL separately for migrants and natives.

Methods

Face-to-face interviews were conducted with n=809 participants between May 2018 and July 2019 in six randomly selected statistical districts of Hamburg grouped into four levels of socioeconomic status (SES). The SF-12 questionnaire was used to measure the HrQoL. Socioeconomic (school education, income) and sociodemographic (age, gender, marital status, children) data was recorded, too.

Results

Migrants and natives scored higher in mental (migrants: M=45.77, SD=7.66; natives: M=47.60, SD=6.14) than in physical HrQoL (migrants: M=42.55, SD=5.55; natives: M=42.03, SD=4.71). Natives had a significantly higher (p<0.001) SF-12 mental summary score than migrants. There was a positive association between education and mental HrQoL (β=0.248, p=2.308) in the migrant but not in the native group. Due to limitations of the study the results of the impact of migration on the HrQoL require interpretation.

Conclusion

Differences between migrants and German natives in HrQoL were partially confirmed. Future research should differentiate more strongly between migration contexts as well as other determinants of health (e.g. early life, social support, unemployment) and their policy implications according to the WHO.

Determinants of dental caries in children in the Middle East and North Africa region: a systematic review based on literature published from 2000 to 2019

Background

Dental caries risk factors have been expanded to not only emphasize biology, dietary and oral habits but also broader social determinants such as socioeconomic factors and the utilization of health services. The aim was to review sociobehavioural/cultural and socioeconomic determinants of dental caries in children residing in the Middle East and North Africa (MENA) region.

Methods

A search was conducted in the PubMed/Medline database and Google Scholar to identify studies published from 2000 to 2019 covering children using key search terms. In the initial stages, titles, abstracts and, if needed, full articles were screened for eligibility. In the final stage, all included articles were reassessed and read, and relevant data were extracted.

Results

Out of 600 initial articles, a total of 77 were included in this review, of which 74 were cross-sectional, 2 were longitudinal and one was a case–control study. The studies included a total of 94,491 participants in 14 countries across the MENA region. A majority used the World Health Organization scoring system to assess dental caries. The caries prevalence ranged between 17.2% and 88.8%, early childhood caries between 3% and 57% and decayed missing filled teeth (dmft) varied between 0.6 and 8.5 across the various age groups. Increased age, low maternal education, low overall socioeconomic status, decreased frequency of tooth brushing, low parental involvement, poor oral habits, infant feeding practices and sugar consumption were among the most prevalent determinants for increased risk of caries in the reviewed studies.

Conclusions

Dental caries was found to be high among children in many of the studies published from MENA. The key determinants of dental caries were found to include factors related to child characteristics, family background, oral hygiene and infant feeding and eating habits. The high dental caries prevalence emphasises the need to address the prevailing modifiable sociobehavioural and socioeconomic determinants by translating them into effective oral health prevention policies and programmes.

Leveraging machine learning to characterize the role of socio-economic determinants on physical health and well-being among veterans

INTRODUCTION

We investigate the contribution of demographic, socio-economic, and geographic characteristics as determinants of physical health and well-being to guide public health policies and preventative behavior interventions (e.g., countering coronavirus).

METHODS

We use machine learning to build predictive models of overall well-being and physical health among veterans as a function of these three sets of characteristics. We link Gallup's U.S. Daily Poll between 2014 and 2017 over a range of demographic and socio-economic characteristics with zipcode characteristics from the Census Bureau to build predictive models of overall and physical well-being.

RESULTS

Although the predictive models of overall well-being have weak performance, our classification of low levels of physical well-being performed better. Gradient boosting delivered the best results (80.2% precision, 82.4% recall, and 80.4% AUROC) with perceptions of purpose in the workplace and financial anxiety as the most predictive features. Our results suggest that additional measures of socio-economic characteristics are required to better predict physical well-being, particularly among vulnerable groups, like veterans.

CONCLUSION

Socio-economic characteristics explain large differences in physical and overall well-being. Effective predictive models that incorporate socio-economic data will provide opportunities to create real-time and personalized feedback to help individuals improve their quality of life.

Real-Time Continuous Glucose Monitoring During the Coronavirus Disease 2019 Pandemic and Its Impact on Time in Range

Background: The coronavirus disease 2019 (COVID-19) pandemic disrupted the lives of people with diabetes. Use of real-time continuous glucose monitoring (rtCGM) helped manage diabetes effectively. Some of these disruptions may be reflected in population-scale changes to metrics of glycemic control, such as time-in-range (TIR). Methods: We examined data from 65,067 U.S.-based users of the G6 rtCGM System (Dexcom, Inc., San Diego, CA) who had uploaded data before and during the COVID-19 pandemic. Users associated with three counties that included the cities of Los Angeles, Chicago, and New York or with five regions designated by the Centers for Disease Control and Prevention (CDC) were compared. Public data were used to associate regions with prepandemic and intrapandemic glycemic parameters, COVID-19 mortality, and median household income. Results: Compared with an 8-week prepandemic interval before stay-at-home orders (January 6, 2020, to March 1, 2020), overall mean (standard deviation) TIR improved from 59.0 (20.1)% to 61.0 (20.4)% during the early pandemic period (April 20, 2020 to June 14, 2020, P < 0.001). TIR improvements were noted in all three counties and in all five CDC-designated regions. Higher COVID-19 mortality was associated with higher proportions of individuals experiencing TIR improvements of ≥5 percentage points. Users in economically wealthier zip codes had higher pre- and intrapandemic TIR values and greater relative improvements in TIR. TIR and pandemic-related improvements in TIR varied across CDC-designated regions. Conclusions: Population-level rtCGM data may be used to monitor changes in glycemic control with temporal and geographic specificity. The COVID-19 pandemic is associated with improvements in TIR, which were not evenly distributed across the United States.

Advocacy to Government and Stakeholders

Participation in the health care and government advocacy arena may represent new and challenging perspectives for the traditional neurosurgeon. However, those with a strong understanding of the laws, rules, regulations, and fiscal allocation process can directly influence the practice of neurosurgery in the United States. We seek to shine light on the black box of how health care laws are passed, the influence and techniques of lobbying, and the role and rules surrounding political action committees. This practical review of health care advocacy is supplemented by a blueprint for engagement in the political arena for the practicing neurosurgeon.

Is food insecurity a problem among the elderly in Sharpeville, South Africa?

The objective of this study was to determine the prevalence of food and nutrition insecurity and assess the socio-demographic factors associated with food and nutrition insecurity among 146 free-living elderly persons attending a care centre in Sharpeville, South Africa. Measurement instruments included socio-demographic-, 24-hour-recall and dietary diversity questionnaires and the validated household food insecurity access scale/score (HFIAS). Data were analysed with IBM SPSS Software, version 25.0. The prevalence of food insecurity from HFIAS was 60% (n = 87), with a variety of balanced responses being employed. Significant relationships were observed between HFIAS and age (r = 0.301; p = 0.000) and with household income (r = −0.258; p = 0.007). An association was observed between HFIAS and marital status (p = 0.005). Regression analysis showed that age and being single were predictors of food and nutrition insecurity. This study indicated a problem of household food insecurity with poor dietary intakes among these elderly people, mostly due to poverty and being single. More research on associations between food security and socio-economic variables is needed to plan and implement appropriate strategies to address food and nutrition insecurity in South Africa.

Geospatial Variations and Neighborhood Deprivation in Drug-Related Admissions and Overdoses

Drug overdoses are a national and global epidemic. However, while overdoses are inextricably linked to social, demographic, and geographical determinants, geospatial patterns of drug-related admissions and overdoses at the neighborhood level remain poorly studied. The objective of this paper is to investigate spatial distributions of patients admitted for drug-related admissions and overdoses from a large, urban, tertiary care center using electronic health record data. Additionally, these spatial distributions were adjusted for a validated socioeconomic index called the Area Deprivation Index (ADI). We showed spatial heterogeneity in patients admitted for opioid, amphetamine, and psychostimulant-related diagnoses and overdoses. While ADI was associated with drug-related admissions, it did not correct for spatial variations and could not account alone for this spatial heterogeneity.

Avoidable hospitalisation for diabetes mellitus among immigrants and natives: Results from the Italian Network for Longitudinal Metropolitan Studies

BACKGROUND AND AIMS

Italy has experienced a relevant increase in migration inflow over the last 20 years. Although the Italian Health Service is widely accessible, immigrants can face many barriers that limit their use of health services. Diabetes mellitus (DM) has a different prevalence across ethnic groups, but studies focusing on DM care among immigrants in Europe are scarce. This study aimed to compare the rates of avoidable hospitalisation (AH) between native and immigrant adults in Italy.

METHODS AND RESULTS

A multi-centre open cohort study including all 18- to 64-year-old residents in Turin, Venice, Reggio-Emilia, Modena, Bologna and Rome between 01/01/2001 and 31/12/2013-14 was conducted. Italian citizens were compared with immigrants from high migratory pressure countries who were further divided by their area of origin. We calculated age-, sex- and calendar year-adjusted rate ratios (RRs) and 95% confidence intervals (95% CIs) of AH for DM by citizenship using negative binomial regression models. The RRs were summarized using a random effects meta-analysis. The results showed higher AH rates among immigrant males (RR: 1.63, 95% CI: 1.16-2.23), whereas no significant difference was found for females (RR: 1.14, 95% CI: 0.65-1.99). Immigrants from Asia and Africa showed a higher risk than Italians, whereas those from Central-Eastern Europe and Central-Southern America did not show any increased risk.

CONCLUSION

Adult male immigrants were at higher risk of experiencing AH for DM than Italians, with differences by area of origin, suggesting that they may experience lower access to and lower quality of primary care for DM. These services should be improved to reduce disparities.

Will legal international rhino horn trade save wild rhino populations?

Wild vertebrate populations all over the globe are in decline, with poaching being the second-most-important cause. The high poaching rate of rhinoceros may drive these species into extinction within the coming decades. Some stakeholders argue to lift the ban on international rhino horn trade to potentially benefit rhino conservation, as current interventions appear to be insufficient. We reviewed scientific and grey literature to scrutinize the validity of reasoning behind the potential benefit of legal horn trade for wild rhino populations. We identified four mechanisms through which legal trade would impact wild rhino populations, of which only the increased revenue for rhino farmers could potentially benefit rhino conservation. Conversely, the global demand for rhino horn is likely to increase to a level that cannot be met solely by legal supply. Moreover, corruption is omnipresent in countries along the trade routes, which has the potential to negatively affect rhino conservation. Finally, programmes aimed at reducing rhino horn demand will be counteracted through trade legalization by removing the stigma on consuming rhino horn. Combining these insights and comparing them with criteria for sustainable wildlife farming, we conclude that legalizing rhino horn trade will likely negatively impact the remaining wild rhino populations. To preserve rhino species, we suggest to prioritize reducing corruption within rhino horn trade, increasing the rhino population within well-protected 'safe havens' and implementing educational programmes and law enforcement targeted at rhino horn consumers.

Do Narrow Networks Affect the Delivery of Outpatient Care in Neurosurgery?: A Statewide Analysis of Marketplace Plans in New Jersey

BACKGROUND

The aftermath of the Affordable Care Act (ACA) witnessed the rise of narrow networks, which feature fewer providers in exchange for lower premiums. Debate still continues on whether narrow networks provide adequate access to health care, especially in specialty care services such as neurosurgery. The objective of this article was to analyze the 2019 Marketplace plans' impact on delivering outpatient neurosurgical care in New Jersey.

METHODS

The 2019 Marketplace Public Use Files were queried for "silver" plans, identifying a total of 11 plans across 3 insurance companies. Online search engines were used to identify the number of in-network neurosurgeons within 20-25 miles of ZIP codes at the center of each county. The primary outcome was the number of neurosurgeon-deficient plans, defined as those having no in-network neurosurgeons within the assigned mile radius.

RESULTS

Of all individuals who purchased an insurance plan, 73% (185,797/255,246) opted for a silver plan. Out of 111 active neurosurgeons in New Jersey, 25% (28/111) did not participate in any of the silver plans. Analysis showed 8 plans as neurosurgeon-deficient in Sussex and Warren. Meanwhile, most of the silver plans provided access to >5 neurosurgeons within 20-25 miles of most (17/21) county centers.

CONCLUSIONS

In more densely populated states such as New Jersey, the impact of narrow networks on neurosurgical coverage is less apparent. However, frustrations regarding access to care still exist because nearly 25% of neurosurgeons do not participate in the standard ACA insurance product. Furthermore, guidelines that define network adequacy in neurosurgery remain elusive, which calls for more robust parameters to monitor and ensure adequate access to health care.

Longer shared parental leave is associated with longer duration of breastfeeding: a cross-sectional study among Swedish mothers and their partners

BACKGROUND

Breastfeeding is associated with health benefits for both the mother and infant and is therefore important to support; moreover, parental leave is a beneficial factor for breastfeeding. The Swedish parental leave is generous, allowing each parent to take 90 days; additionally, a further 300 days can be taken by either parent. Generally, mothers take 70% of the parental leave days, mainly during the first year. However, breastfeeding duration has declined in the last decade, and it is not known how shared parental leave is associated with the duration of breastfeeding.

AIM

To investigate how parental leave is associated with the duration of exclusive and partial breastfeeding of the infant during the first 12 months after birth. An additional aim was to describe infants' and parents' characteristics and mode of birth in association with the duration of exclusive and partial breastfeeding.

METHODS

This cross-sectional study was part of the Swedish Pregnancy Planning Study, conducted in Sweden in 2012-2015. The parents were recruited at 153 antenatal clinics in nine counties. In total, 813 couples completed a follow-up questionnaire 1 year after birth. Linear regression models were used to analyse the association between parental leave and the duration of breastfeeding.

RESULTS

Infants were exclusively breastfed for, on average, 2.5 months (range 0-12 months) and partially breastfed, on average, 7 months (range 0-12 months). Most of the parental leave was taken by the mother (mean = 10.9 months) during the infant's first 12 months, while the partner took 3 months, on average. The parental leave (used and planned) during the infant's first 24 months were, on average, 21 months. In the multivariate linear regression analysis, mothers' and partners' high level of education (p < 0.001, p = 0.044, respectively), mothers' higher age (p = 0.049), non-instrumental vaginal birth (p = 0.004) and longer parental leave for the first 24 months (p < 0.001) were associated with longer duration of partial breastfeeding.

CONCLUSION

The duration of partial breastfeeding was associated with higher parental educational level, higher age, non-instrumental vaginal birth and longer parental leave.

Data for understanding the risk perception of COVID-19 from Vietnamese sample

This data article describes the risk perception of COVID-190 from 391 Vietnamese respondents aged from 15 to 47 years. These data have been used in Huynh (2020). These data include the socioeconomics, media attention, and risk perception of COVID-19 in Vietnam through a survey conducted on February 1, 2020. In addition, our data might serve as a reference source for further in-depth surveys to understand the risk perception and social media communication across countries.

Geographic Variation in Costs of Transsphenoidal Pituitary Surgery in the United States

BACKGROUND

Geographic variations in health care costs have been reported for many surgical specialties.

OBJECTIVE

In this study, we sought to describe national and regional costs associated with transsphenoidal pituitary surgery (TPS).

METHODS

Data from the Truven-MarketScan 2010-2014 were analyzed. We examined overall total, hospital/facility, physician, and out-of-pocket payments in patients undergoing TPS including technique-specific costs. Mean payments were obtained after risk adjustment for patient-level and system-level confounders and estimated differences across regions.

RESULTS

The estimated overall annual burden was $43 million/year in our cohort. The average overall total payment associated with TPS was $35,602.30, hospital/facility payment was $26,980.45, physician payment was $4685.95, and out-of-pocket payment was $2330.78. Overall total and hospital/facility costs were highest in the West and lowest in the South (both P < 0.001), whereas physician reimbursements were highest in the North-east and lowest in the South (P < 0.001). There were no differences in out-of-pocket expenses across regions. On a national level, there were significantly higher overall total and hospital/facility payments associated with endoscopic compared with microscopic procedures (both P < 0.001); there were no significant differences in physician payments or out-of-pocket expenses between techniques. There were also significant within-region cost differences in overall total, hospital/facility, and physician payments in both techniques as well as in out-of-pocket expenses associated with microsurgery. There were no significant regional differences in out-of-pocket expenses associated with endoscopic surgery.

CONCLUSIONS

Our results show significant geographic cost disparities associated with TPS. Understanding factors behind disparate costs is important for developing cost containment strategies.

Spatial and temporal clustering of patients hospitalized with laboratory-confirmed influenza in the United States

BACKGROUND

Timing of influenza spread across the United States is dependent on factors including local and national travel patterns and climate. Local epidemic intensity may be influenced by social, economic and demographic patterns. Data are needed to better explain how local socioeconomic factors influence both the timing and intensity of influenza seasons to result in national patterns.

METHODS

To determine the spatial and temporal impacts of socioeconomics on influenza hospitalization burden and timing, we used population-based laboratory-confirmed influenza hospitalization surveillance data from the CDC-sponsored Influenza Hospitalization Surveillance Network (FluSurv-NET) at up to 14 sites from the 2009/2010 through 2013/2014 seasons (n = 35,493 hospitalizations). We used a spatial scan statistic and spatiotemporal wavelet analysis, to compare temporal patterns of influenza spread between counties and across the country.

RESULTS

There were 56 spatial clusters identified in the unadjusted scan statistic analysis using data from the 2010/2011 through the 2013/2014 seasons, with relative risks (RRs) ranging from 0.09 to 4.20. After adjustment for socioeconomic factors, there were five clusters identified with RRs ranging from 0.21 to 1.20. In the wavelet analysis, most sites were in phase synchrony with one another for most years, except for the H1N1 pandemic year (2009-2010), wherein most sites had differential epidemic timing from the referent site in Georgia.

CONCLUSIONS

Socioeconomic factors strongly impact local influenza hospitalization burden. Influenza phase synchrony varies by year and by socioeconomics, but is less influenced by socioeconomics than is disease burden.

Socioeconomic, geographic and climatic risk factors for canine parvovirus infection and euthanasia in Australia

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11 % of Australian veterinary hospitals reported >40 canine parvovirus cases in 2016.

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Socioeconomic disadvantage was the strongest risk factor for canine parvovirus.

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Euthanasia is the leading cause of fatality for canine parvovirus related disease.

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Hottest month of the year is associated with canine parvovirus case occurrence.

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Low rainfall is associated with higher canine parvovirus cases.

Infection of canids with canine parvovirus (CPV) can result in severe, often fatal disease. This study aimed to examine climatic, socioeconomic and geographic risk factors for CPV infection and CPV-associated euthanasia in Australia. Australian veterinary hospital responses (534; 23.5 %) to a national veterinary survey of CPV case occurrences and euthanasias in 2016 were used. Severe caseloads (>40 cases per annum) were reported by 26 (11 %) hospitals (median 60 cases; IQR 50–110). Case reporting, case numbers, and without-treatment euthanasia were significantly associated with disadvantage across all Socio-Economic Index for Areas quintiles (p < 0.0001) – the greater the disadvantage, the more reports. Strong negative correlations were found between case numbers and the Index of Relative Socioeconomic Disadvantage (r_SP = –0.3357, p < 0.0001) and also between euthanasia and the Index of Education and Occupation (r_SP = –0.3762, p < 0.0001). Hospitals in more remote areas were also more likely to report cases and to euthanize without treatment (p < 0.0001). Of the climate variables, temperature of the hottest month was most strongly positively correlated with case numbers (r_SP = 0.421, p < 0.0001), and lower annual rainfall was associated with more case-reporting hospitals (p < 0.0001). These results confirm that socioeconomic disadvantage is a significant risk-factor for CPV infection and outcome, and high temperature may also contribute to risk.

Demographic and Socioeconomic Factors for Renouncing Further Active Therapy for Patients with Brain Metastasis of Non-Small Cell Lung Cancer

Background

As patients with brain metastasis (BM) of non-small cell lung cancer (NSCLC) have dismal prognosis, some of them decide to discontinue further treatment for BM. The objective of this study was to determine factors for renouncing further active therapy in patients with BM of NSCLC, focusing on their demographic and socioeconomic status.

Methods

Medical records of 105 patients with radiological diagnosis of BM of NSCLC for the recent 11 years at authors' institution were retrospectively reviewed. Clinical features as well as demographic and socioeconomic characteristics such as marriage status, cohabiting family members, religious affiliations, educational background, and economic responsibility were reviewed.

Results

Median overall survival (OS) was 13.84 (95% CI: 10.26–17.42) years in 67 patients (group A) who underwent active treatment (radiotherapy and/or chemotherapy) and 4.76 (95% CI: 3.12–6.41) years in 38 patients (group B) who renounced active treatment. Less patients were unmarried (p=0.046), more cohabitating family members (p=0.008), and economically independent (p=0.014) in group A than those in group B. Similarly, the unmarried, and none cohabitating family members had short OS (5.17 and 7.38 years, respectively). In multivariate analysis for predisposing factors of OS in these patients, the following demographic and socioeconomic factors had independent significance: marriage status and cohabitating family members.

Conclusion

This study suggests that demographic and socioeconomic status as well as clinical factors could influence the decision of further active treatment and prognosis of patients with BM of NSCLC.

Racial/ethnic differences in survival for patients with gliosarcoma: an analysis of the National cancer database

PURPOSE

Gliosarcoma is characterized by the World Health Organization as a Grade IV malignant neoplasm and a variant of glioblastoma. The association of race and ethnicity with survival has been established for numerous CNS malignancies, however, no epidemiological studies have reported these findings for patients with gliosarcoma. The aim of this study was to examine differences by race and ethnicity in overall survival, 30-day mortality, 90-day mortality, and 30-day readmission.

METHODS

Data were obtained by query of the National Cancer Database (NCDB) for years 2004-2014. Patients with gliosarcoma were identified by International Classification of Diseases for Oncology, Third Edition (ICD-O-3)-Oncology morphologic code 9442/3 and topographical codes C71.0-C71.9. Differences in survival by race/ethnicity were examined using univariable and multivariable Cox proportional hazards models. Readmission and mortality outcomes were examined with univariable and multivariable logistic regression.

RESULTS

A total of 1988 patients diagnosed with gliosarcoma were identified (White Non-Hispanic n = 1,682, Black Non-Hispanic n = 165, Asian n = 40, Hispanic n = 101). There were no differences in overall survival, 30- and 90-day mortality, or 30-day readmission between the races and ethnicities examined. Median survival was 10.4 months for White Non-Hispanics (95% CI 9.8, 11.2), 10.2 months for Black Non-Hispanics (95% CI 8.6, 13.1), 9.0 months for Asian Non-Hispanics (95% CI 5.1, 18.2), and 10.6 months for Hispanics (95% CI 8.3,16.2). 7.3% of all patients examined had an unplanned readmission within 30 days.

CONCLUSION

Race/ethnicity are not associated with differences in overall survival, 30-day mortality, 90-day mortality, or 30-day readmission following surgical intervention for gliosarcoma.

Wastewater-based epidemiology in Beijing, China: Prevalence of antibiotic use in flu season and association of pharmaceuticals and personal care products with socioeconomic characteristics

Wastewater-based epidemiology is an emerging field that has mostly been applied to investigate consumption of illicit drugs. In this study, the wastewater-based epidemiology approach was employed to study consumption of pharmaceuticals and personal care products (PPCPs) and measure their prevalence of use in eight densely populated, urban areas of Beijing, China. Ammonium loads were used to estimate the population equivalents of each sewershed. These estimates were applied to calculate population-normalized antibiotic consumption and prevalence of use during flu season, when antibiotics are frequently misused as a medical treatment. Results indicated that 21.9 g d^-1 (10⁴ people)^-1 of ten popular antibiotics were consumed across the eight sewersheds, indicating that 1.98‰ of the 12.5 million population equivalents used these antibiotics during the sampling period. A comparison of these results to calculations made using previously reported data from 2013 suggest that recent Chinese antibiotic control policies have been effective. Uncertainty analyses were conducted to identify the 95% confidence range for antibiotic prevalence of use as 1.44-3.61‰. Human excretion factors were identified as the most sensitive variable. The wastewater-based epidemiology methods were also applied to a wider range of PPCPs, and the results indicated positive relationships between consumption and socioeconomic factors, such as housing price and population density. Overall, this work provides important public health information on antibiotic use and elucidates relationships between PPCP consumption and socioeconomic characteristics.

Overweight/obesity among social network members has an inverse relationship with Baltimore public housing residents' BMI

The American Heart Association has encouraged networks research focused on cardiovascular disease and its risk factors, such as obesity. However, little network research has focused on minorities or low-income populations. Our objective was to characterize the relationship between body mass index (BMI) with social network overweight/obesity among public housing residents in Baltimore, MD - a predominantly black, low-income group. We conducted a cross-sectional survey of randomly selected public housing residences (8/2014–8/2015). Adults had their height and weight measured and reported their network members' weight statuses using pictograms. Our dependent variable was respondents' BMI, and independent variable was perceived exposure to overweight/obesity in the social network. We also explored network exposure to overweight/obesity among 1) family members and 2) friends. We used multivariable linear regression adjusted for significant covariates. Our sample included 255 adults with mean age of 44.4 years, 85.5% women, 95.7% black, and mean BMI of 33.2 kg/m². Most network members were overweight/obese (56.1%). For every 1% increase in network exposure to overweight/obesity, individuals' BMI decreased by 0.05 kg/m² (p = 0.06). As network exposure to overweight/obesity among friends increased, individuals' BMI significantly decreased by 0.06 kg/m² (p = 0.04). There was no significant relationship between BMI and network exposure to overweight/obesity among family members. In conclusion, among Baltimore public housing residents, a statistically significant, inverse association existed between individuals' BMI and overweight/obesity among friends in their social networks. Our results differ from relationships seen in prior studies of other populations, which may be due to racial and/or contextual differences between studies.