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Objective. The number of cancer survivors is increasing, and the high prevalence of frailty not only reduces quality of life but also affects the treatment of cancer patients. This study aimed to identify the prevalence and risk factors of frailty in cancer patients and to construct a nomogram to predict the probability of frailty. Methods. Nine hundred fifty‐eight cancer patients were included in this retrospective study, randomly divided into a development set (n = 680) and a validation set (n = 278). Frailty was assessed using the Tilburg frailty indicator (TFI). Social support, medical coping styles, and psychological distress were assessed by the Social Support Self‐Rating Scale (SSRS), Medical Coping Modes Questionnaire (MCMQ), and distress thermometer (DT), respectively. Results. The prevalence of frailty in cancer patients was 45.93%. Cancer patients who exercised regularly, ate a balanced diet, and actively coped with diseases were less likely to become frail. The risk factors for frailty identified by a multivariate analysis were parenteral nutrition, advanced TNM staging, vegetarian diet, unemployment, psychological distress ≥4, low physical activity, and negative coping styles. These risk factors were used to construct a nomogram, and the C‐index, calibration curve, and decision curve analysis (DCA) were used to assess the performance of the nomogram. The C‐index was 0.762, and the calibration curve showed satisfactory coherence. The net benefit of the nomogram was better between threshold probabilities of 17%–96% in DCA. Conclusion. Special focus needs to be placed on frail cancer patients due to their high prevalence and severe outcomes. Clinical medical workers could use this nomogram to identify high‐risk patients and intervene early to prevent frailty. [ABSTRACT FROM AUTHOR]

Objective: The study aims to determine the vaccination status of children and evaluate the relationship between vaccination rates, vaccine attitudes, and some parental health practices. Design and Methods: This cross‐sectional study was conducted with 674 mothers. Data were collected using a survey evaluating vaccine characteristics, some infant health practices, and The Public Attitude Toward Vaccination Scale—Health Belief Model. Chi‐square test, independent samples t‐test, and logistic regression analysis were used. Results: 80.2% of children were fully vaccinated. The rate of non or under‐vaccination was higher in the group that did not regularly undergo follow‐up for 0–2‐year‐old children, did not fully have health screenings, did not use vitamin D and iron supplements, and used alternative medicine. Moreover, the duration of breast milk feeding, the transition to supplementary food, and the duration of vitamin D use in the non‐fully vaccinated group were lower than in the fully vaccinated group (p <.05). The increase in maternal education period and severity and benefit attitude scores of vaccine attitude were the factors that decreased the rate of non‐fully vaccination. The increase in barrier scores toward vaccines increased the rate of non or under‐vaccination. Conclusion: Mothers who have negative attitudes toward vaccination have negative behaviors in health practices and screenings on infant/child health. [ABSTRACT FROM AUTHOR]

Aim: Chronic diseases are influential components of stroke, one of the dominant reasons for dementia and premature mortality. Environmental risks are risk factors for transitioning from stroke to dementia. This study addresses the transition behaviors in stroke and dementia development associated with chronic diseases and environmental risks. Methods: This study is an integrated survey of medical and environmental informatics concerning stroke patients' quality of life. A total of 10 627 stroke patients diagnosed in Taiwan were surveyed in this study. A covariate model and subgroup analysis were used to evaluate the influence of chronic diseases and environmental risk factors (i.e., divorce rate, unemployment rate, solitariness rate, temperature, and air pollution rate) on stroke and the corresponding dementia transition behaviors. Results: This study constructed a total of 98 covariate analysis models, consisting of 14 transition types [10 transitions from chronic diseases to stroke (5 metabolic risk states × 2 stroke states) and 4 transitions from stroke to dementia (2 stroke states × 2 dementia states)] by 7 covariates (i.e., sex, age, divorce rate, unemployment rate, temperature, air pollution, and solitariness rate). Among the 98 transitions, 26 were statistically significant. Conclusions: Sex, age, divorce rate, unemployment rate, temperature, and air pollution rate exerted a partially significant influence on the transition from chronic diseases to stroke. Sex, age, unemployment rate, and temperature partially influenced the transition from stroke to dementia. This study also considered high‐risk sub‐populations of stroke patients, particularly males aged 65 years and below. Geriatr Gerontol Int 2024; 24: 766–772. [ABSTRACT FROM AUTHOR]

Objectives: Hikikomori is commonly defined as a social condition in which individuals avoid social participation and relationships beyond their family members by confining themselves to a room or their house for 6 months or longer. Hikikomori has been predominantly considered a problem among young people; however, as the population is ageing, hikikomori has also emerged as a social issue among adults. Nevertheless, no comparative studies have examined the differences in the factors associated with hikikomori among teenagers/young adults and middle-aged/older adults. Thus, this phenomenon has not been thoroughly examined, and it remains unclear whether the risk factors vary between teenagers/young adults and middle-aged/older adults. Based on the Japan Cabinet Office's definition of hikikomori, this cross-sectional study evaluated the prevalence and related factors of hikikomori among the working age population (15–64 years), utilising univariate and multivariate analyses. The study also compared differences in the prevalence of and factors related to hikikomori between teenagers/young adults and middle-aged/older adults. Methods: We distributed self-administered questionnaires to individual participants and their families between 24 December 2020 and 18 January 2021. Results: Data from an anonymised sample of 3,092 individuals (split into two groups of 15–39 and 40–64 years) were subjected to analysis. The results revealed a hikikomori prevalence of 2.3% in the target population; the prevalence rate was 2.12% among individuals aged 15 to 39 years and 2.42% among those aged 40 to 64 years. The analysis demonstrated strong correlations between hikikomori and several factors, including unemployment, truancy, a history of psychiatric consultation or hospitalisation, being male and the absence of ibasho, which is defined as a place where individuals can feel peace, security, acceptance and belonging. The factors associated with hikikomori differed between teenagers/young adults and middle-aged/older adults. Conclusion: Our findings, thus, contribute to existing research by providing a comparative analysis of risk factors across different age groups. [ABSTRACT FROM AUTHOR]

Background and Objectives Advancing automation technologies are replacing certain occupations such as those involving simple food preparation more than occupations such as those in STEM fields (e.g. engineering and health care). Older workers generally face higher job automation risks in part due to their lower levels of digital skills. A better understanding of the associations between job automation risk, digital skills, and type of occupation (e.g. STEM vs non-STEM) can facilitate preparations for job automation and workforce population aging. Research Design and Methods We analyzed a nationally representative sample (N  = 1,560) of middle-aged and older U.S. workers aged 50–74 years from the 2012/2014/2017 Program for International Assessment of Adult Competencies (PIAAC) restricted-use file. The estimated job automation risks (i.e. percentage of jobs to be automated in the next decades) were derived from the previous studies. PIAAC digital problem-solving skills proficiency (measured on a scale of 0–500 points) was assessed based on a series of practical digital tasks (e.g. finding a job research website that does not require registration). Results Linear regression analysis showed that greater digital skill proficiency (b  = −0.04, p  < .05) and STEM occupations (b  = −17.78, p  < .001) each were associated with lower job automation risks, even after adjusting for a series of demographic, socioeconomic, and civic engagement characteristics. Discussion and Implications Education and labor policy interventions to promote digital skills among older workers and non-STEM workers may better prepare an aging workforce for the dynamic labor market needs in the United States. [ABSTRACT FROM AUTHOR]

Background: The concept of schizotypal personality disorder (SPD) emerged from observations of personality characteristics common in relatives of schizophrenic patients. While often studied in family designs, few studies and none with genetic measures, have examined SPD in epidemiological samples. Methods: We studied individuals born in Sweden 1940–2000 with an ICD-10 diagnosis of SPD with no prior schizophrenia (SZ) diagnosis (n = 2292). Demographic features, patterns of comorbidity, and Family Genetic Risk Scores (FGRS) were assessed from multiple Swedish registries. Prediction of progression to SZ was assessed by Cox models. Results: SPD was rare, with a prevalence of 0.044%, and had high levels of comorbidity with autism spectrum disorder (ASD), OCD, ADHD, and major depression (MD), and increased rates of being single, unemployed and in receipt of welfare. Affected individuals had elevated levels of FGRS for SZ (+0.42), ASD (+0.30), MD (+0.29), and ADHD (+0.20). Compared to cases of schizophrenia, they had significantly lower rates of FGRSSZ, but significantly elevated rates of genetic risk for ASD, MD, and ADHD. Over a mean follow-up of 8.7 years, 14.6% of SPD cases received a first diagnosis of SZ, the risk for which was significantly increased by levels of FGRSSZ, male sex, young age at SPD diagnosis and an in-patient SPD diagnosis and significantly decreased by comorbidity with MD, ASD, and ADHD. Conclusions: Our results not only support the designation of SPD as a schizophrenia spectrum disorder but also suggest potentially important etiologic links between SPD and ASD and, to a lesser extent, ADHD, OCD, and MD. [ABSTRACT FROM AUTHOR]

Aims: To explore the association between a depression diagnosis in young adulthood and risk of marginalisation at age 29 years, among those who had completed upper secondary school and those who had not completed at age 21. Methods: In a longitudinal cohort study based on nationwide registers we followed 111,558 people from age 22–29 years. Outcomes were risk of marginalisation and educational achievement at age 29. Exposure was a diagnosed depression at ages 22–26 years. Comorbid mental and somatic health conditions, gender and country of origin were covariates. Relative risks were estimated with Poisson regression models, stratified by educational level at age 21. Results: For people who had not completed upper secondary school at age 21 years, a depression diagnosis at age 22–26 increased the risk of low income (relative risk = 1.33; 95% confidence interval = 1.25–1.40), prolonged unemployment benefit (1.46; 1.38–1.55) and social security benefit (1.56; 1.41–1.74) at age 29 compared with those with no depression. Among those who had completed upper secondary school at age 21 years, depression increased the risk of low income (1.71; 1.60–1.83), prolonged unemployment benefit (2.17; 2.03–2.31), social security benefit (3.62; 2.91–4.51) and disability pension (4.43; 3.26–6.01) compared with those with no depression. Mental comorbidity had a significant impact on risk of marginalisation in both groups. Conclusions: Depression in one's mid-20s significantly increases the risk of marginalisation at age 29 years, and comorbid mental health conditions reinforce this association. Functional ability should be given priority in depression care in early adulthood to counteract marginalisation. [ABSTRACT FROM AUTHOR]

The prevalence of depression related to precarious employment (PE) has become a significant public health concern, given the declining trend of the standard employment relationship. Research has focused on the mental health detrimental effects of employment conditions, whereas there is scarce evidence concerning the burden of depression that could be prevented by targeting precariousness. This paper estimates the impact of PE on the risk of depression and the attributable fraction within the active and working salaried population in Spain. Observational cross-sectional on data drawn from the Spanish portion of European Health Survey 2020. After applying selection criteria and descriptives, binary logistic regression models stratified by sex are used to examine the associations between a 9-categories combination of employment precariousness and occupational social class, and depressive symptoms. There is a higher risk of depression among individuals in PE and among those who are unemployed, with a notable gradient based on occupational social class for women. Adjusting by sex, age and foreign-born origin, we estimate that approximately 15.0% (95% confidence interval [CI]: 1.0%–26.2%) of depression cases among the working population and 33.3% (95% CI: 23.2%-43.2) among the active population can be attributed to PE. These findings highlight the public health impact of PE on mental health, provide evidence to estimate the economic burden linked to employment-related mental health, and underscore the need for policy changes and interventions at the level of labour markets and workplaces to mitigate the detrimental effects of PE. [ABSTRACT FROM AUTHOR]

Background Young adults in Neither in Employment, Education nor Training (NEET) are at risk of adverse labour market outcomes. Earlier studies often measured NEET status at one time point or compared persistent NEETs with non-NEETs, neglecting other patterns of NEET status. Evidence on early life factors associated with NEET patterns is lacking. This study aims to (i) identify patterns of NEET status over time and (ii) examine whether factors in childhood and adolescence are associated with these patterns. Methods Data were used from 1499 participants of the TRacking Adolescents' Individual Lives Survey (TRAILS), a Dutch prospective cohort study with 15-year follow-up. NEET status was assessed at ages 19, 22 and 26. Socioeconomic status of parents (SES), intelligence and negative life events were measured at age 11, educational attainment at age 26 and mental health problems at ages 11, 13.5 and 16. Data were analyzed using multinomial logistic regression analysis. Results Four NEET patterns were identified: (i) non-NEETs (85.2%), (ii) early NEETs (4.5%), (iii) late NEETs (5.7%) and (iv) persistent NEETs (4.5%). Reporting internalizing problems at age 11 was a risk factor for early and late NEETs [odds ratio (OR) 2.77, 95% confidence interval (CI) 1.16–6.62; OR 5.00, 95% CI 2.22–11.3, respectively]. Low parental SES, lower intelligence scores and negative life events (≥3) were risk factors for persistent NEETs (OR 4.45, 95% CI 2.00–9.91; OR 0.96, 95% CI 0.94–0.98; OR 4.42, 95% CI 1.62–12.08, respectively). Conclusions The results highlight the importance of timing and duration of NEET status and emphasize the need for tailored interventions to prevent specific NEET patterns. [ABSTRACT FROM AUTHOR]

Background and Objectives Suicide rates typically increase during recessions. However, few studies have explored how recessions affect risk among older adults nearing retirement. This study used a large suicide mortality registry to characterize and quantify suicide related to retirement during the Great Recession (GR). Research Design and Methods Data come from the National Violent Death Reporting System (NVDRS, 2004–2017; N  = 53,298 suicide deaths age ≥50). We analyzed the text narratives (i.e. descriptions of the most salient circumstances to each suicide) of these decedents using natural language processing (NLP) to identify cases that were "retirement-related" (RR, e.g. anticipating, being unable to, or recently retiring). We used time-series analysis to quantify variation in RR over the GR, and compared these trends to retirees (i.e. decedents whose occupation was "retired") and all decedents aged ≥50. We used content and network analysis to characterize themes represented in the narratives. Results There were 878 RR cases (1.6% of suicides aged ≥50) identified by the NLP model; only 52% of these cases were among retirees. RR cases were younger (62 vs 75 years) and more educated (41.5% vs 24.5% college degree) than retirees. The rate of RR suicide was positively associated with indicators of the GR (e.g. short-term unemployment R 2 = 0.70, p  = .024), but economic indicators were not correlated with the suicide rate among retirees or older adults in general. Economic issues were more central to the narratives of RR cases during the GR compared to other periods. Discussion and Implications Recessions shape suicide risk related to retirement transitions. [ABSTRACT FROM AUTHOR]

Objective: This study investigated rates and predictors of mental health issues (e.g., depression and anxiety) in a sample of college students currently attending a historically Black college/university (HBCU) during the COVID-19 pandemic. Participants/Methods: 98 undergraduate students (81 female and 17 male) completed an online survey containing questions about demographics, socioeconomic status (SES), academic characteristics, and pandemic-related concerns. The survey also included PHQ-9 and GAD-7 questionnaires to evaluate depression and anxiety, respectively. Results: 49% of the students met the clinical cutoff for depression, 39% for anxiety, and 52% for depression and/or anxiety. Significant predictors of meeting the cutoffs included parental job loss/hour reduction, being a senior, and feeling that the pandemic negatively impacted daily life, among other factors. Demographic variables (age, gender, etc.) had no effect. Conclusion: HBCU students show high rates of depression and anxiety during the COVID-19 pandemic, which may be predicted based on the student's academic, socioeconomic, and pandemic-related concerns. [ABSTRACT FROM AUTHOR]

Patients with bipolar disorder have higher rates of type 2 diabetes (T2D) compared to the general population. Neighbourhood deprivation is associated with T2D and bipolar disorder. The aim of this study was to explore the potential effect of neighbourhood deprivation on incident T2D in patients with bipolar disorder. This nationwide open cohort study (1997–2018) included adults in Sweden ≥20 years with bipolar disorder (90,780 patients) to examine the subsequent risk of T2D. The association between neighbourhood deprivation and T2D was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (95% CIs). All models were conducted in both men and women and adjusted for individual‐level sociodemographic factors and comorbidities. Neighbourhood deprivation was significantly associated with T2D in patients with bipolar disorder. The HRs were 1.61 (95% CI 1.40–1.86) for men and 1.83 (1.60–2.10) for women living in high deprivation neighbourhoods compared to those from low deprivation neighbourhoods. After adjustment, these results remained significant: 1.35 (1.17–1.56) in men and 1.39 (1.20–1.60) in women living in high deprivation neighbourhoods. The suggested graded association of higher incident T2D among patients with bipolar disorder, observed when levels of neighbourhood deprivation increased, raises important clinical and public health concerns. The results may help develop a contextual approach to prevention of T2D in patients with bipolar disorder that includes the neighbourhood environment. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the sexual behaviors among working children and the associated factors. This cross-sectional study was conducted on a sample of 1937 working children in the 10–18 age range in 15 provincial capitals in 2019–20 (Feb–May); the Response rate was 94.9%. Univariate and multivariable logistic regression was used to examine the variable of sexual behaviors. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) are reported. The prevalence of sexual behaviors in working children was 4.2%. The results showed a significant difference between those who reported sexual behaviors and those who did not in terms of age, identity document (ID), running away from home, alcohol use, and substance use. There was a statistically significant relationship between fathers' unemployment and sexual behaviors among working children. Furthermore, we found that having divorced parents could increase the odds of sexual behaviors by 3.74 times. The findings showed that related welfare and support organizations should design and implement effective and continuous training and interventions to raise awareness and reduce the prevalence of high-risk sexual behaviors in working children. They should also provide family counseling and promote parental supervision of children. [ABSTRACT FROM AUTHOR]

Background: With increasing urbanization, number of urban slums is also rising. The health facilities and indicators in urban slums are poor as compared to other urban population. The present study presents an analysis of the health problems, utilization of health services and vulnerability of urban slums. Aims & Objectives: To map the slums in urban areas and assess the vulnerability of households. Methodology: The study was conducted in all urban slums of five cities of Nainital and Udham Singh Nagar districts namely Haldwani, Ramnagar, Rudrapur, Jaspur and Kashipur. Group discussions involving community members, ward surveys by ASHA workers and household level vulnerability assessment were done using standard format according to "Guidelines and Tools for Vulnerability Mapping and Assessment of Urban Health, 2017". Results: Most urban slum dwellers are daily wage laborers with major population suffering mainly from diabetes, hypertension, respiratory infection. Lack of drugs and diagnostic facilities are the major concerns. Infrastructure needs strengthening in most of the slums. Around three fourth of population belonged to vulnerable group with remaining in highly vulnerable group. Conclusion: There are social problems in urban slums like illiteracy, lack of awareness, unemployment which worsen the health problems. So, a holistic approach is needed for the solution. [ABSTRACT FROM AUTHOR]

Background: Poor self-rated health (SRH) is a well-established risk factor for premature employment exit through unemployment, work disability, and early retirement. However, it is unclear whether the premature employment exit risk associated with underlying cardio-metabolic health conditions is fully captured by poor SRH. This study examines the metabolic syndrome (MetS), an early-stage risk factor for cardiovascular disease and type two diabetes mellitus, as a risk factor for premature employment exit while controlling for poor SRH. Methods: We analyzed data from N=55 016 Dutch workers (40-64 years) from five waves of the Lifelines Cohort Study and Biobank. MetS components were based on physical measures, blood markers, and medication use. SRH and employment states were self-reported. The associations between MetS, SRH, and premature employment exit types were analyzed using competing risk regression analysis. Results: During 4.3 years of follow-up, MetS remained an independent risk factor for unemployment [adjusted subdistribution hazard ratio (SHR): 1.14, 95% CI: 1.03, 1.25] and work disability (adjusted SHR: 1.33, 95% CI: 1.11, 1.58) when adjusted for poor SRH, common chronic diseases related to labor market participation (i.e., cancer, musculoskeletal-, pulmonary-, and psychiatric diseases), and sociodemographic factors. MetS was not associated with early retirement. Conclusions: Poor SRH did not fully capture the risk for unemployment and work disability associated with MetS. More awareness about MetS as a 'hidden' cardio-metabolic risk factor for premature employment exit is needed among workers, employers, and occupational health professionals. Regular health check-ups including MetS assessment and MetS prevention might help to prolong healthy working lives. [ABSTRACT FROM AUTHOR]

Background: The risk of suicide is complex and often a result of multiple interacting factors. Understanding which groups of the population are most at risk of suicide is important to inform the development of targeted public health interventions. Methods: We used a novel linked dataset that combined the 2011 Census with the population-level mortality data in England and Wales. We fitted generalized linear models with a Poisson link function to estimate the rates of suicide across different sociodemographic groups and to identify which characteristics are independent predictors of suicide. Results: Overall, the highest rates of suicide were among men aged 40-50 years, individuals who reported having a disability or long-term health problem, those who were unemployed long term or never had worked, and those who were single or separated. After adjusting for other characteristics such as employment status, having a disability or long-term health problem, was still found to increase the incidence of suicide relative to those without impairment [incidence rate ratio minimally adjusted (women) = 3.5, 95% confidence interval (CI)=3.3-3.6; fully adjusted (women) 3.1, 95% CI=3.0-3.3]. Additionally, while the absolute rate of suicide was lower in women compared with men, the relative risk in people reporting impairments compared with those who do not was higher in women compared with men. Conclusions: The findings of this work provide novel population-level insights into the risk of suicide by sociodemographic characteristics in England and Wales. Our results highlight several sociodemographic groups who may benefit from more targeted suicide prevention policies and practices. [ABSTRACT FROM AUTHOR]

Aim: To reveal the prevalence of frailty and factors that strongly affected the frailty condition among older adults in East Java, Indonesia. Method: We conducted a cross‐sectional study carried out among 400 older adults aged ≥60 years without any acute illness. Data were collected from rural area in two locations in Malang and Pasuruan, East Java, Indonesia, in 2019–2020. For data collection, we used the sociodemographic profile assessment, Fried frailty phenotype, Geriatric Depression Scale, Mini Mental State assessment, sun exposure, handgrip strength, International Physical Activity Questionnaire, walk score, and body mass index. We used logistic regression statistics for data analysis. Results: The result showed that 2.5% were robust, 83% were prefrail, and 14.5% were frail. A higher proportion of subjects were aged 60–74 years (83.3%), women (70.3%), with lower educational status (84.5%). Multivariate analysis showed that the intrinsic factors low cognitive status (odds ratio [OR], 3.052 [95% confidence interval (CI), 1.691–5.508]) and older age (OR, 3.073 [95% CI, 1.637–5.767]) were associated with frailty among the older adults in a rural area. Depression was also associated with frailty (OR, 2.458 [95% CI, 0.465–12.985]). From extrinsic factors, we also found that low sun exposure (OR, 2.931 [95% CI, 1.650–5.204]) and unemployment (OR, 1.997 [95% CI, 1.112–3.588]) were associated with frailty. Conclusion: For the Indonesian elderly in this study, low cognitive status, older age, depression, low sun exposure, and unemployment were associated with frailty. Understanding the modifiable risk factors of frailty can provide a valuable reference for future prevention and intervention. Geriatr Gerontol Int 2024; 24: 170–175. [ABSTRACT FROM AUTHOR]

Nulliparous (pregnant women who are giving birth for the first time) and multiparous (women who have multiple children) may have different concerns, which may be associated with risk of antenatal depression. This study aims to examine the role of social support and stressful life events as risk factors for antenatal depression in nulliparous and multiparous women. The sample included 1,524 pregnant women recruited from an obstetrics setting at the end of the first trimester of pregnancy from two Spanish tertiary-care public hospitals. The sample completed the Patient Health Questionnaire (PHQ-9), and the "social support" and "stressful life events" subscales of the Postpartum Depression Predictor Inventory-Revised (PDPI-R). Nulliparous women reported a lower prevalence of depressive symptoms (15.6 percent) compared to multiparous mothers (20.1 percent). In both groups, marriage/partner problems (NP: β = 0.178, p <.01 vs MP: β = 0.164, p <.01) and a perceived lack of instrumental support from friends (NP: β = -0.154, p <.01 vs MP: β = −0.154, p <.01) were significant risk factors for antenatal depression. However, nulliparous women have more risk factors such as unemployment (β = 0.096, p <.05), job change (β = 0.127, p <.01), financial problems (β = 0.145, p <.01) and lack of instrumental support from partner (β = −0187, p <.01). For multiparous women, moving (β = 0.080, p <.05) and lack of instrumental support from family (β = −0.151, p <.01) were risk factors. These results suggest the critical need for screening and designing preventive interventions adapted and taking into consideration parity to provide more effective health care during pregnancy. [ABSTRACT FROM AUTHOR]

Background and aims: Sepsis is a serious and life-threatening condition caused by a dysregulated immune response to an infection. Recent guidance issued in the UK gave recommendations around recognition and antibiotic treatment of sepsis, but did not consider factors relating to health inequalities. The aim of this study was to summarise the literature investigating associations between health inequalities and sepsis. Methods: Searches were conducted in Embase for peer-reviewed articles published since 2010 that included sepsis in combination with one of the following five areas: socioeconomic status, race/ethnicity, community factors, medical needs and pregnancy/maternity. Results: Five searches identified 1,402 studies, with 50 unique studies included in the review after screening (13 sociodemographic, 14 race/ethnicity, 3 community, 3 care/medical needs and 20 pregnancy/maternity; 3 papers examined multiple health inequalities). Most of the studies were conducted in the USA (31/50), with only four studies using UK data (all pregnancy related). Socioeconomic factors associated with increased sepsis incidence included lower socioeconomic status, unemployment and lower education level, although findings were not consistent across studies. For ethnicity, mixed results were reported. Living in a medically underserved area or being resident in a nursing home increased risk of sepsis. Mortality rates after sepsis were found to be higher in people living in rural areas or in those discharged to skilled nursing facilities while associations with ethnicity were mixed. Complications during delivery, caesarean-section delivery, increased deprivation and black and other ethnic minority race were associated with post-partum sepsis. Conclusion: There are clear correlations between sepsis morbidity and mortality and the presence of factors associated with health inequalities. To inform local guidance and drive public health measures, there is a need for studies conducted across more diverse setting and countries. [ABSTRACT FROM AUTHOR]

This study was conducted to determine the prevalence of fear of childbirth and affecting factors in pregnant women in Turkey. This was a cross-sectional study and included a total of 2025. Pregnant Women Assessment, some variables related to previous and current perinatal processes and Wijma Delivery Expectancy/Experience Questionnaire (version A) were used for data collection. In this sample, 42.4% of the women reported fear of childbirth. What the women were afraid of most was the development of unwanted conditions at childbirth, obscurity/uncertainty, and negative attitudes of health professionals. The factors causing fear of childbirth were the low education level, unemployment status, low financial status, stillbirth, unplanned pregnancy, indecisiveness about the type of delivery, not attending prenatal education programs, negative effects of other people, insufficient social support, confiding in the healthcare centre and health professional, negative, and indecisive birth perceptions, prior negative birth experiences and not feeling ready for childbirth (p < 0.001). The prevalence of fear of childbirth in this Turkish sample, especially in the multipara is higher than in Western countries. Causes of fear of childbirth can vary with countries and even with each region of a country. [ABSTRACT FROM AUTHOR]

Introduction: Existing literature suggests that transgender women (TW) may be at high risk for adverse mental health due to stress attributed to combined experiences of stigma and complex social and structural vulnerabilities. Little research has examined how these co‐occurring experiences relate to mental health. We aimed to test a theoretically driven conceptual model of relationships between stigma, social and structural vulnerabilities, and mental health to inform future intervention tailoring. Design/Methods: Partial least square path modeling followed by response‐based unit segmentation was used to identify homogenous clusters in a diverse community sample of United States (US)‐based TW (N = 1418; 46.2% White non‐Hispanic). This approach examined associations between latent constructs of stigma (polyvictimization and discrimination), social and structural vulnerabilities (housing and food insecurity, unemployment, sex work, social support, and substance use), and mental health (post‐traumatic stress and psychological distress). Results: The final conceptual model defined the structural relationship between the variables of interest within stigma, vulnerability, and mental health. Six clusters were identified within this structural framework which suggests that racism, ethnicism, and geography may be related to mental health inequities among TW. Conclusion: Our findings around the impact of racism, ethnicism, and geography reflect the existing literature, which unfortunately shows us that little change has occurred in the last decade for TW of color in the Southern US; however, the strength of our evidence (related to sampling structure and sample size) and type of analyses (accounting for co‐occurring predictors of health, i.e., stigma and complex vulnerabilities, reflecting that of real‐world patients) is a novel and necessary addition to the literature. Findings suggest that health interventions designed to offset the negative effects of stigma must include anti‐racist approaches with components to reduce or eliminate barriers to resources that contribute to social and structural vulnerabilities among TW. Herein we provide detailed recommendations to guide primary, secondary, and tertiary prevention efforts. Clinical Relevance: This study demonstrated the importance of considering stigma and complex social and structural vulnerabilities during clinical care and design of mental health interventions for transgender women who are experiencing post‐traumatic stress disorder and psychological distress. Specifically, interventions should take an anti‐racist approach and would benefit from incorporating social support‐building activities. [ABSTRACT FROM AUTHOR]

Objectives: Structural racism (SR) is viewed as a root cause of racial and ethnic disparities in maternal health outcomes. However, evidence linking SR to increased odds of severe adverse maternal outcomes (SAMO) is scant. This study assessed the association between state-level indicators of SR and SAMO during childbirth. Methods: Data for non-Hispanic Black and non-Hispanic white women came from the US Natality file, 2017–2018. The exposures were state-level Black-to-white inequity ratios for lower education level, unemployment, and prison incarceration. The outcome was patient-level SAMO, including eclampsia, blood transfusion, hysterectomy, or intensive care unit admission. Adjusted odds ratios (aORs) of SAMO associated with each ratio were estimated using multilevel models adjusting for patient, hospital, and state characteristics. Results: A total of 4,804,488 birth certificates were analyzed, with 22.5% for Black women. SAMO incidence was 106.4 per 10,000 (95% CI 104.5, 108.4) for Black women, and 72.7 per 10,000 (95% CI 71.8, 73.6) for white women. Odds of SAMO increased 35% per 1-unit increase in the unemployment ratio for Black women (aOR 1.35; 95% CI 1.04, 1.73), and 16% for white women (aOR 1.16; 95% CI 1.01, 1.33). Odds of SAMO increased 6% per 1-unit increase in the incarceration ratio for Black women (aOR 1.06; 95% CI 1.03, 1.10), and 4% for white women (aOR 1.04; 95% CI 1.02, 1.06). No significant association was observed between SAMO and the lower education level ratio. Conclusions for Practice: State-level Black-to-white inequity ratios for unemployment and incarceration are associated with significantly increased odds of SAMO. Significance: What is already known on this subject? Structural racism is viewed as a root cause of racial and ethnic disparities in maternal health outcomes, independent of socioeconomic determinants of health. However, supporting evidence is scant. What this study adds? In this population-based study in 2017–2018, state-level Black-to-white inequities in unemployment and incarceration are associated with significantly increased odds of severe adverse maternal outcomes (i.e., blood transfusion, hysterectomy, and ICU admission) during childbirth for non-Hispanic Black women, and to a lesser extent, for non-Hispanic white women. Addressing structural racism in maternal care may contribute to improving maternal health equity. [ABSTRACT FROM AUTHOR]

Suicide is the ending of one's own life for economic, psychological, and social reasons. Suicide cases worldwide occur mostly in low- and middle-income countries. The aim of this study is to examine the effect of economic indicators of low and middle-income countries on suicide rates by panel data analysis method. The dependent variable is the (crude) suicide rate. The independent variables are gross domestic product, per capita income, general unemployment rate, poverty level, and Gini index value. In the study, two different econometric models were developed. In Model 1, it was predicted that a 1% increase in the poverty level of countries in the middle-income group could lead to an increase of 0.66% in the suicide rate. In Model-2, it was estimated that a 1% increase in the per capita income of low-income countries would cause a 0.52% decrease in the suicide rate. It was predicted that a possible increase of 1% in the Gini index value would cause an increase of 0.24% and 0.32% in the suicide rates of middle- and low-income countries, respectively. Although there are various factors affecting the suicide rate in society, there are often economic reasons at the root of the problem. The consequences of the unequal distribution of income in a poorer society can be more devastating. Although the results of the study are important in terms of revealing the effect of economic indicators on suicide rates more research is needed in this area. [ABSTRACT FROM AUTHOR]

The MENA region has experienced extraordinary events in recent years, resulting in an influx of refugees and displaced people who are vulnerable to mental disorders. Several previous studies have examined their prevalence, but none have focused on this region. This systematic review provided an estimate of the prevalence of mental illness and associated risk factors in the MENA region, and overcame the methodological limitations of individual studies. Thorough searches of the relevant databases were carried out to locate relevant published articles. Furthermore, cross-sectional studies were conducted to assess mental disorders in refugees, asylum seekers, migrants, or internally displaced people residing in the MENA region. Only studies meeting the aforementioned criteria were considered. For this purpose, RStudio software version 2023.12.0 + 369 with netmeta package was used for measurement and data analysis. JBI used to assess study quality. The results, including 32 cross-sectional studies with a total of 21659 participants were obtained and discussed. The overall prevalence was 42% (95% CI; 30%, 54%) for depression, 43% (95% CI; 31%, 57%) for anxiety, 22% (95% CI; 11%, 39%) for stress, and 45% (95% CI; 36%, 53%) for PTSD. As a result, it was noted that being female was associated with depression, and being female and unemployed was associated with PTSD, however being married was protective against this later. Compared to the rest of the globe, MENA has a greater rate of mental illness among refugees. Nevertheless, much effort should be devoted on listing causes associated, as well as their management and prevention. • MENA has a higher prevalence of mental illness among migrant , stigma and conflict raise mental health risks. • The overall prevalence was 42% for depression, 43% for anxiety, 22% for stress, and 45% for PTSD. • Being female was connected with dissatisfaction, and unemployment with PTSD, while marriage protected against this later. [ABSTRACT FROM AUTHOR]

Divorce is often considered a major and stressful life transition. Given that divorcees are overrepresented in primary care and there is a association between individuals' physical health and psychological adjustment, potential post-divorce health problems are of concern. Yet, empirical evidence is lacking on the magnitude of the overall physical health risk after divorce, on possible differences across specific pathologies, and on factors that may increase or reduce this risk. The current meta-analysis addresses these issues. We identified 94 studies including u = 248 relevant effect sizes, based on N = 1,384,507 participants. Generally, compared to married individuals, divorcees showed significantly worse self-reported health (OR = 1.20, [1.08–1.33]), experienced more physical symptoms (OR = 1.34, [1.17–1.53]), and had a higher risk for diabetes (OR = 1.18 [1.05–1.33]), joint pathologies (OR = 1.24, [1.14–1.34]), cardiovascular (OR = 1.24, [1.09–1.41]) and cerebrovascular conditions (OR = 1.31, [1.14–1.51]), and sexually transmitted diseases (OR = 2.48, [1.32–4.64]). However, they had no increased risk of hypertension, hypercholesterolemia, cancer and cancer development, disabilities or limitations, or cognitive pathologies. Nor did divorcees significantly differ from married individuals when aggregating all pathologies to measure overall physical health problems (OR = 1.14, [0.85 to 1.54]). Yet, moderation analyses revealed that being female, unemployed, childless, or having a lower education constitutes a higher risk for overall physical health problems after divorce. The same applied to having a heavy alcohol consumption, lack of exercise, and being overweight. Our meta-analysis shows that divorcees are at heightened risk of certain pathologies, with sexually transmitted diseases as a particular post-divorce hazard. These findings call for more awareness among counsellors and physicians on divorcees' health conditions and the characteristics that make divorcees even more vulnerable to health problems. • The overall health risk was not significantly higher in divorcees compared to married people. • Divorcees showed a higher risk for some health conditions, especially sexually transmitted diseases. • Being a female, unemployed, not having children, and having a lower education increased the risk for post-divorce health problems. • Heavy alcohol consumption, lack of exercise, and being overweight also increased the risk for post-divorce health problems. [ABSTRACT FROM AUTHOR]

It is unclear whether unemployment exposure, as well as working conditions, can have sustained effects on the health of retirees who are no longer exposed. The aim of the present study is to investigate this issue in 29,281 French retirees from the CONSTANCES cohort in whom the prevalence of suboptimal self-rated health, disability for routine tasks, cardiovascular diseases and cancers is assessed according to lifetime exposure to unemployment and prior working conditions. The analyses are performed retrospectively using multivariable logistic regression models with adjustment for potential confounders such as sex, birth year, parental histories of cardiovascular disease and cancer, social position, retirement age and duration. High lifetime exposure to unemployment is associated with an increased prevalence of suboptimal self-rated health (adjusted odds ratio (95% CI), 1.39 (1.23–1.57)), disability for routine tasks (1.41 (1.26–1.57)) and several cardiovascular diseases including stroke (1.66 (1.19–2.31)), myocardial infarction (1.65 (1.18–2.31)) and peripheral arterial disease (2.38 (1.46–3.90)). Bad prior working conditions are associated with an increased prevalence of disability for routine tasks (1.17 (1.04–1.33)) and cancers (1.27 (1.04–1.54)), notably prostate cancer (1.60 (1.01–2.64)). These findings suggest that unemployment and working conditions have long-term health effects that may cumulate over lifetime, emphasizing that risk evaluation and preventive strategies in retirees, as in workers, should take into account the life-course of individuals in addition to traditional risk factors. • Lifetime unemployment exposure and prior working conditions are associated with retirees' health. • Working conditions and unemployment have long-term health effects that may cumulate over lifetime. • Risk assessment in retirees should take into account life-course events in addition to traditional risk factors. [ABSTRACT FROM AUTHOR]