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To assess the prevalence of abortion among population groups and changes in rates between 2008 and 2014.We used secondary data from the Abortion Patient Survey, the American Community Survey, and the National Survey of Family Growth to estimate abortion rates. We used information from the Abortion Patient Survey to estimate the lifetime incidence of abortion.Between 2008 and 2014, the abortion rate declined 25%, from 19.4 to 14.6 per 1000 women aged 15 to 44 years. The abortion rate for adolescents aged 15 to 19 years declined 46%, the largest of any group. Abortion rates declined for all racial and ethnic groups but were larger for non-White women than for non-Hispanic White women. Although the abortion rate decreased 26% for women with incomes less than 100% of the federal poverty level, this population had the highest abortion rate of all the groups examined: 36.6. If the 2014 age-specific abortion rates prevail, 24% of women aged 15 to 44 years in that year will have an abortion by age 45 years.The decline in abortion was not uniform across all population groups.

Life expectancy in the United States has declined since 2014 but characterization of disparities within and across metropolitan areas of the country is lacking.Using census tract-level life expectancy from the 2010 to 2015 US Small-area Life Expectancy Estimates Project, we calculate 10 measures of total and income-based disparities in life expectancy at birth, age 25, and age 65 within and across 377 metropolitan statistical areas (MSAs) of the United States.We found wide heterogeneity in disparities in life expectancy at birth across MSAs and regions: MSAs in the West show the narrowest disparities (absolute disparity: 8.7 years, relative disparity: 1.1), while MSAs in the South (absolute disparity: 9.1 years, relative disparity: 1.1) and Midwest (absolute disparity: 9.8 years, relative disparity: 1.1) have the widest life expectancy disparities. We also observed greater variability in life expectancy across MSAs for lower income census tracts (coefficient of variation [CoV] 3.7 for first vs. tenth decile of income) than for higher income census tracts (CoV 2.3). Finally, we found that a series of MSA-level variables, including larger MSAs and greater proportion college graduates, predicted wider life expectancy disparities for all age groups.Sociodemographic and policy factors likely help explain variation in life expectancy disparities within and across metro areas.

Refereed/Peer-reviewed Access to stable housing has a significant effect on the wellbeing of survivors of human trafficking and modern slavery. Safe and sustainable accommodation provides a crucial foundation for survivors beginning their recovery; however, it is often very difficult to source for support services assisting them. This paper presents the findings of research that analysed the eligibility, suitability, availability, and accessibility of short-term accommodation and long-term housing options to better understand the barriers to accommodating survivors in Australia. It demonstrates that survivors were not eligible for many options due to their immigration status or lack of income. Within the limited options, there is a shortage of suitable accommodation due to the absence of survivor-specific services, and due to rules and requirements imposed by accommodation providers that are not supportive of survivors’ unique needs. These include restrictions on survivors’ freedom of movement, on the use of alcohol and other drugs, and on accommodating men, children, and extended family, as well as requirements related to engaging in activities. These barriers negatively impact survivors’ recovery and may lead to homelessness whilst increasing the risk of re-trafficking or other harm. Collaboration and coordination between actors within anti-slavery and housing policy spheres is urgently required to mitigate these barriers and prevent such harms.

Objectives Working few hours a week, known as marginal part-time work, may increase both job and income insecurity, which have been linked to the risk of depression. This study examines the association between marginal part-time work and depression and the mediating role of job and income insecurity.Methods We included 30 523 respondents of the Danish Labor Force Survey (DLFS) between 2010 and 2017 and linked them to register-based information on weekly working hours, which was used to identify full-time workers and model group-based trajectories of marginal part-time. These data were linked with survey information on job and income insecurity, and register-based information on hospital-diagnosed depression or redeemed anti-depressant drugs in the following two years. We estimated hazard ratios (HR) by Cox proportional hazards models and conducted mediation analyses to estimate the natural direct and indirect effects using job and income insecurity as mediators.Results We identified three distinct trajectories of marginal part-time work: constant marginal part-time work, mobile towards marginal part-time work, and fluctuating in and out of marginal part-time work. Compared with full-time workers, the constant [HR 2.42, 95% confidence interval (CI) 1.83–3.20], mobile (HR 2.84, 95% CI 2.16–3.75), and fluctuating (HR 3.51, 95% CI 2.07–5.97) trajectories all had higher risks of depression. There was no evidence of mediation by either job (HR 1.02, 95% CI 0.92–1.12) or income (HR 0.98, 95% CI 0.89–1.08) insecurity.Conclusions We found a higher risk of depression following marginal part-time work. The higher risk was not mediated by job or income insecurity. OBJECTIVES: Working few hours a week, known as marginal part-time work, may increase both job and income insecurity, which have been linked to the risk of depression. This study examines the association between marginal part-time work and depression and the mediating role of job and income insecurity.METHODS: We included 30 523 respondents of the Danish Labor Force Survey (DLFS) between 2010 and 2017 and linked them to register-based information on weekly working hours, which was used to identify full-time workers and model group-based trajectories of marginal part-time. These data were linked with survey information on job and income insecurity, and register-based information on hospital-diagnosed depression or redeemed anti-depressant drugs in the following two years. We estimated hazard ratios (HR) by Cox proportional hazards models and conducted mediation analyses to estimate the natural direct and indirect effects using job and income insecurity as mediators.RESULTS: We identified three distinct trajectories of marginal part-time work: constant marginal part-time work, mobile towards marginal part-time work, and fluctuating in and out of marginal part-time work. Compared with full-time workers, the constant [HR 2.42, 95% confidence interval (CI) 1.83-3.20], mobile (HR 2.84, 95% CI 2.16-3.75), and fluctuating (HR 3.51, 95% CI 2.07-5.97) trajectories all had higher risks of depression. There was no evidence of mediation by either job (HR 1.02, 95% CI 0.92-1.12) or income (HR 0.98, 95% CI 0.89-1.08) insecurity.CONCLUSIONS: We found a higher risk of depression following marginal part-time work. The higher risk was not mediated by job or income insecurity.

International audience; Many researchers, policy makers and food activists view Short Food Supply Chains (SFSC) as attractive levers for improving farm income and the sustainability of farming systems. However, the empirical evidence documenting the association between SFSC participation and farm economic performance has been mixed. In this study, through a meta-analysis using a logistic regression, we identify key factors to explain differences between studies that find better economic performance in SFSC and those that do not. Our meta-analysis consists of 48 studies published in English and French from 2000 to 2022 that examine the economic performance of farms engaged in SFSC. Based on far more empirical evidence than previous reviews, we find that the relationship between SFSC participation and farmer income remains ambiguous. More specifically the findings indicate that the reported effect of SFSC on a farm economic performance varies depending on location and the indicator used to capture the economic performance of farms. Studies conducted in Europe are more likely to report higher farmer income as are studies that use profit satisfaction metrics rather than measures of gross or net income. We also emphasize the need to interpret the reported results cautiously because few are based on causal inference methods. Furthermore, the very few studies that account for selection bias often do so with inadequate corrections.

To examine the association between sleep disorders, employment status, and income among US adults aged 18-64 years.The 2018-2019 Medical Expenditure Panel Survey medical conditions file was queried for adults aged 18-64 years with a diagnosis of a sleep disorder (A sleep disorder was diagnosed in 4.4% ± 0.2% of the study population (approximately 8.8 ± 0.4 million adults aged 18-64 years in the United States; mean age 46.9 years, 55.8% female). Adults with sleep disorders were less likely to have wage income from employment (adjusted odds ratio 0.5, 95% confidence interval 0.4-0.6,There are significantly higher indirect costs associated with sleep disorders. This study specifically demonstrates lower employment rates, lower wages, and higher welfare income utilization among those with sleep disorders despite using a very conservative estimate of sleep disorder prevalence.Huyett P, Bhattacharyya N. The association between sleep disorders, employment, and income among adults in the United States.

Rural people living around forests in Ethiopia depend on income from forest product collection as one of their livelihood activities. The forests of Sheka are threatened by unsustainable use and conversion to alternative land uses. This study was conducted to identify and quantify income from major forest products collected from the Sheka forest and examine factors that determine income from forest product collection. Quantitative and qualitative data were collected from primary and secondary sources. By stratified random sampling method, three kebeles were selected from the Masha district and 156 households were randomly selected from those kebeles and interviewed with a structured questionnaire. Descriptive and inferential statistics were determined by SPSS and STATA software. Multiple linear regression models were employed to determine the relationship between socio-economic factors and forest income. The result indicates 17 major forest product were collected and contributes an average of $1553.75 or 41.17% of their total annual income and was the highest contributor to total income. Forest income varies with agro-ecology and distance from the nearby markets in the study area. Households in the study area utilize more forest products for home consumption. Incomes from forest product collection are significantly related to the level of education of the household head, family size, and distance of home from the forest and market. Households in the study area depend to a higher degree on income from forest product collection and have an implication of sustainable management of forests in the long term. Int. J. Agril. Res. Innov. Tech. 12(2): 46-52, December 2022

This paper takes issue with the widespread claim that positional competitions are zero-sum games. It shows how the notions of ‘positional good’ and ‘positional competition’ have changed in meaning and how this has resulted in conceptual confusion in discussions amongst economists and philosophers. I argue that the Zero-Sum Claim is hardly ever true when it comes to the novel understanding of positionality that currently dominates the philosophical literature. I propose dropping the Zero-Sum Claim and construing positional competitions as win-lose. This is conceptually clearer and deepens our understanding and ethical evaluation of these important competitions in contemporary societies.

Finland is experiencing a startup boom. Startups are innovative young companies aimed at rapid revenue growth. Unfortunately, most of them fail within the first years, leaving their founders without a job and possibly in debt. Previous research did not yet establish how the founders fare after founding their company. This study explores whether founding a high-growth startup constitutes a new social risk, that is, a work situation in a postindustrial society that lowers the founder’s welfare. This study analyzes data collected in interviews with founders and experts and in participant observations. In an innovative approach, this study explores the difficulties of high-growth startup founders from the time of founding their companies on. Findings show that founders experience social isolation and financial and health problems from the moment of founding their startups. This decline in welfare is limited to founders who were not in precarious situations when founding their companies. Findings enhance our understanding of high-growth startups and of new social risks. Discussions on positive economic effects of the startup boom should also consider the negative effects on the founders’ welfare. Publishers version

Previous literature supports a disparity in income between male and female physicians across multiple specialties, even when controlling for variables such as working hours, maternity leave, and productivity.To understand if income disparity exists between male and female general dermatologists (GDs), and in dermatologists who completed a dermatologic surgical fellowship.The authors surveyed members of the American Academy of Dermatology, including 66 dermatologic surgeons (DSs) (34 male and 32 female DSs) and 252 GDs (119 male and 133 female GDs), on questions related to total annual income, demographics, current employment, and time spent providing patient care. A logarithmic ordinal regression model was used to analyze income and the effect of different variables.Male GDs were 2.46 times more likely than female GDs to be in a higher income category (95% confidence interval [CI]: 1.44-4.23). There was no significant difference between the incomes of male and female DSs (male-to-female odds ratio: 1.46, CI: -0.44 to 1.23). These findings did not change when variables of age, median patient visits, and hours worked were controlled for.Income gender inequality exists among GDs. However, this inequality does not seem to extend to DSs.

[ES] El trabajo se centra en examinar las medidas fiscales, principalmente las deducciones en la cuota íntegra del Impuesto sobre la Renta de las Personas Físicas, promulgadas para ayudar a que se impida que algunas zonas en España sigan perdiendo población. Dichas bonificaciones pueden ser aprobadas por el Estado y por las Comunidades Autónomas en España, siendo el núcleo del presente estudio las puestas en vigor por estas últimas. Para llevar a cabo el estudio de las deducciones, se ha partido de señalar de forma general las posibilidades normativas al alcance de las Regiones para modificar algunos aspectos de la regulación de la imposición personal sobre la renta y, posteriormente, se aborda con detenimiento los requisitos y posibilidades que en cada Comunidad Autónoma tienen los beneficios fiscales en vigor. [EN] The work focuses on examining the fiscal measures, mainly the deductions in the full share of the Personal Income Tax, to help prevent some areas in Spain from continuing to lose population. Said bonuses can be approved by the State and by the Autonomous Communities in Spain, being the core of this study those put into force by the latter. O carry out the study of deductions, we have started by pointing out in a general way the normative possibilities available to the Regions to modify some aspects of the regulation of personal taxation on income and, subsequently, the requirements are carefully addressed and possibilities that in each Autonomous Community have the tax benefits in force.

Финансовая грамотность является одним из ключевых факторов, определяющих финансовое благополучие человека. Тот или иной уровень финансовой грамотности, воплощаясь в повседневных финансовых практиках людей, может стать залогом их успешного поведения на финансовом рынке или, наоборот, вследствие ошибочных действий привести к потерям денежных средств, что может также сказаться на экономическом развитии страны в целом. Статья посвящена исследованию финансовых практик в области учета доходов и расходов денежных средств, а также планирования бюджета горожан. Цель работы - анализ финансовой грамотности как основания различий финансового поведения горожан. Эмпирическую базу исследования составили данные, полученные в результате проведения 20 полуформализованных интервью. Использование качественных методов сбора и анализа данных позволило представить особенности проявления различных практик текущего и долгосрочного финансового планирования, управления доходами и расходами. Изученные практики рассмотрены в тесной связи с имеющимися у респондентов знаниями в области экономики и финансов, материальными ресурсами, целями развития, а также сложившейся экономической (финансовой) культурой. Результаты: собранные материалы позволили определить совокупность финансовых практик, присущих жителям большого города, выделить мотивы и способы их использования. Были выявлены наборы финансовых знаний, навыков, установок, которые применялись в данных практиках, а также изучены каналы и способы формирования знаний и компетенций в вопросах управления личными и семейными финансами. Выводы: люди пытаются вести себя рационально при планировании и учете своих денежных средств, стремясь обеспечить необходимую экономическую безопасность для себя и своей семьи. Однако финансовые знания не всегда используются комплексно и целенаправленно. Существует три относительно условные группы людей, которые по-разному относятся к управлению своими финансами. К первой группе можно отнести тех, кто осуществляет контроль над финансами «в полной мере», отслеживая свои (индивидуальные и/или семейные) доходы и расходы. Вторая группа выбирает «одностороннюю» стратегию учета, уделяя внимание чему-то одному (мониторингу доходов или расходов). Третья группа не задумывается над вопросами управления денежными средствами. Financial literacy is one of the key factors determining a person's financial well-being. The level of financial literacy, embodied in everyday financial practices of people, can become a guarantee of their successful behavior in the financial market or, on the contrary, due to erroneous actions, lead to loss of money, which can also affect the economic development of the country as a whole. This article is devoted to the study of financial practices in the accounting of income and expenditures of money, as well as planning the budget of citizens. The aim of the work is to analyze financial literacy as the basis of differences in the financial behavior of citizens. The empirical basis of the study was the data obtained as a result of 20 semi-formalized interviews. The use of qualitative methods of data collection and analysis made it possible to present the peculiarities of various practices of current and long-term financial planning, income and expenditure management in close connection with the respondents' knowledge in the field of economics and finance, material resources, development goals, as well as the existing economic (financial) culture. Results. The collected materials made it possible to determine the set of financial practices inherent to the city residents, to highlight the motives and ways to use them. Sets of financial knowledge, skills and attitudes which were used in these practices were identified, as well as channels and ways of formation of knowledge and competences in the issues of personal and family finance management were determined. Conclusion. People try to behave rationally when planning and accounting for their money, seeking to ensure the necessary economic security for themselves and their family. However, financial knowledge is not always used comprehensively and purposefully. There are three relatively conventional groups of people who have different attitudes toward managing their finances. The first group can include those who keep track of their (individual and/or family) income and expenses «in full». The second group chooses a «one-sided» accounting strategy, focusing on one thing (monitoring income or expenses). The third group does not think about the issues of accounting and cash planning.

Globally, vascular diseases are a leading cause of morbidity and mortality. Many of the most significant risk factors for vascular disease have a gendered dimension, and sex differences in vascular diseases incidence are apparent, worldwide. In this narrative review, we provide a contemporary picture of sex- and gender-related determinants of vascular disease. We illustrate key factors underlying sex-specific risk stratification, consider similarities and sex differences in vascular disease risk and outcomes with comparisons of data from the global North (ie, developed high-income countries in the Northern hemisphere and Australia) and the global South (ie, regions outside Europe and North America), and explore the relationship between country-level gendered inequities in vascular disease risk and the United Nation's gender inequality index. Review findings suggest that the rising incidence of vascular disease in women is partly explained by an increase in the prevalence of traditional risk factors linked to gender-related determinants such as shifting roles and relations related to the double burden of employment and caregiving responsibilities, lower educational attainment, lower socioeconomic status, and higher psychosocial stress. Social isolation partly explained the higher incidence of vascular disease in men. These patterns were apparent across the global North and South. Study findings emphasize the necessity of taking into account sex differences and gender-related factors in the determination of the vascular disease risk profiles and management strategies. As we move toward the era of precision medicine, future research is needed that identifies, validates, and measures gender-related determinants and risk factors in the global South.

Low- and middle-income countries account for over 90% of burns worldwide. Though mission trips, public health interventions and educational strategies have been introduced in recent years, a disparity remains in treatment provided between high- and low -income countries. This analysis aims to review available literature pertaining to strategies for training in burns management, with a focus on those applicable to low-income countries.Mesh terms including "burns", "burns care", "burns management", "training", "teaching" and "education" were inputted into Medline and EMBase. Studies were included on the basis that they include an educational intervention to train doctors to provide surgical burns care in low-income countries. Included literature was analysed using scoring tools then a critical appraisal was performed.Fourteen studies were included in this analysis. These describe e-learning (n = 1), video-based teaching (n = 1), lecture-based teaching (n = 1), simulation training (n = 8) and hospital-based training achieved through collaborative efforts between high and low-income countries such as mission trips and fellowship programmes (n = 3). The strategies described have been summarised and presented.Burns care training should be accessible at a global scale and so, involve training methods including simulation, courses and fellowship programmes that are affordable and accessible to surgeons in low-income countries.

Background We use the Global Multidimensional Poverty Index (MPI) to explore how different dimensions of poverty more directly linked to young people are associated with depressive symptoms among South African youth. Methods Data came from the 2017 wave of the nationally-representative National Income Dynamics Study (NIDS) in South Africa. We focused on a sample of 15-24-year-olds whose depressive symptoms were assessed using an adapted version of the 10-item Centre for Epidemiological Studies Depression Scale. We examine how individual dimensions and indicators of the MPI relate to depression, in comparison to more conventional measures, including household income, subjective social standing, overcrowding and personal assets. Cross-sectional analyses were adjusted for clustering to account for sampling design. Results The MPI index was not associated with probable depression (OR=1.02, 95%CI 0.81-1.29). Only lack of access to the labour market emerged as a key individual dimension associated with probable depression (OR=5.29, 95%CI 1.70-16.47), a relationship driven by an increased odds for those not in employment, education or training. Lack of household assets, living in an informal dwelling and lower perceived social standing were also associated with increased odds for depression. No gender differences were noted. Limitations The study is cross-sectional and not suitable to examine the causal nature of the association between multidimensional poverty and depression. Conclusions Poverty dimensions that measure youth’s access to employment or training have a strong association with depression. Further research is needed to assess whether improved access to employment or training contributes to improving mental health among young South Africans.

This study explores whether the widespread dissemination of Western-type culture and the globalization of food production and consumption that have characterized Italy for decades may have influenced red and processed meat consumption across generations. For the purpose of our study, we constructed a pseudo-panel derived from repeated cross-sections of the annual household survey, "Aspects of Daily Life," that was part of the Multipurpose Survey carried out by the Italian National Statistical Office (ISTAT) from 1997 to 2012. We adopted an APC (Age, Period, Cohort) approach that involves age, period, and cohort effects. We followed the experiences of four cohorts: the Silent Generation (born 1926-1945), the Baby Boomer 1 Generation (1946-1955), the Baby Boomer 2 Generation (1956-1965), and Generation X (1966-1980). Our results revealed that increases in disposable income, changes in women's role in society, and urbanization and globalization have had significant effects on consumption patterns. The analysis shows that the older generations have changed their diets more in favor of meat consumption than later generations, with more change in the relatively affluent north of the country compared with the south, while the youngest generations are more likely to adopt more healthful and environmentally sustainable eating patterns.

Reliable water service delivery continues to be a complex global issue that is particularly challenging in rural communities. Despite billions of dollars of infrastructure interventions, sustainable water services remain out of reach for millions of people. Professionalized maintenance services have emerged as a service provision strategy to supplement the community-based rural water management approach. This study applies system dynamics modeling to assess the potential impact of scaling up professionalized maintenance services on piped water systems in Kitui County, Kenya. The study results show that over a 10 year simulation, calibrated with 21 months of empirical data and based on a range of key assumptions, delivery of professionalized maintenance services across the county may increase countywide functionality rates from 54% to over 83%, leading to a 67% increase in water production. Furthermore, the increase in preventive maintenance activities and proactive repairs can lead to less frequent major breakdowns and reduction in county government spending on major repairs by over 60%. However, current service fee income from communities accounts for 8% of the total cost of service, necessitating substantial sustained external financing or government subsidies to be financially viable at scale.

Long-acting injectable antiretroviral therapy (LAI-ART) for the treatment and prevention of human immunodeficiency virus (HIV) holds great potential to shift treatment paradigms by offering an alternative to daily oral medication. However, significant challenges at the drug, patient, and system levels risk impeding the uptake and implementation of LAI-ART. This review aims to describe the known and anticipated barriers to uptake of LAI-ART in high-income countries, as well as the ongoing research addressing some of these barriers to improve the delivery and uptake of LAI-ART products.

OBJECTIVE There is limited evidence on the association of sustained low-income status, income changes, and all-cause mortality risk in individuals with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS Using the Korean Health Insurance Service database, we studied 1,923,854 adults with T2D (aged ≥30 years) without cardiovascular disease and cancer, who were enrolled from 2009 through 2012 and followed to the end of 2020 (median 10.8 years of follow-up). We defined income levels based on the amount of health insurance premiums and categorized them into quartiles, the first being the low-income group, and assessed the income status annually in the preceding 5 years. Cox proportional hazards models were used to quantify the association of low-income status and income changes with mortality, with adjustment for sociodemographic factors, comorbidities, and diabetes duration and treatment. RESULTS Participants who consecutively had low income showed a higher risk of mortality (hazard ratio [HR] 1.19; 95% CI 1.16–1.22), compared with those who had never been in the low-income group. This association was much stronger for consecutive recipients of Medical Aid, reflecting very-low-income status (HR 2.26; 95% CI 2.16–2.36), compared with those who had never been Medical Aid beneficiaries. Sustained low- and very-low-income status was associated with increased risk of mortality, specifically for younger adults (aged CONCLUSIONS Among Korean adults with T2D, sustained low-income status and declines in income were associated with increased risk of mortality.

Endometriosis is a chronic inflammatory disease that can have serious physical and emotional consequences for patients in terms of pain, quality of life, and infertility. Despite affecting about 10% of women, the pathophysiology and economic impact of the disease are not fully understood. This study aimed to review and summarize research articles quantifying the direct and indirect costs of endometriosis in the context of current national and international treatment guidelines. A search including the terms 'endometriosis' AND 'costs' OR 'cost of illness' OR 'cost analysis' OR 'economic burden' was performed, focusing on studies published between January 2000 and May 2022. Total costs, costs of primary and secondary care, productivity losses, and indirect costs were reported. The medical costs of endometriosis were principally registered in secondary care settings, where surgery was the main cost driver. There was considerable variability of populations and study settings, with the overall direct medical cost range of endometriosis from US$1459 to US$20,239 (2022) per patient per year. An increasing trend has been reported in secondary care costs over time; however, not enough data were available at this time to evaluate inpatient and outpatient costs versus treatment strategies. Similarly, further research is required to evaluate the costs and potential savings associated with new therapies. Numerous studies have evaluated the indirect costs of endometriosis in recent years, finding costs between US$4572 and US$14,079 (2022). Currently, limited data are available on the economic burden of the disease at the patient level.

Barriers in access to pediatric surgical care are common in low- and middle-income countries (LMICs), but also exist in high-income countries, particularly in urban and rural areas.This article describes "Disparities in Access to Care"-held within the Social Injustice Symposium at the 2020 American Pediatric Surgical Association (APSA) Annual Meeting.This symposium outlined disparities in access to care, illustrated by examples from pediatric trauma and neonatal surgery in U.S. urban, U.S. rural, and non-U.S. global locations (LMICs). Geographic and financial challenges were common to families from the rural U.S. and LMICs. In contrast, families in U.S. urban settings generally do not face geographic barriers, but are often economically and racially diverse and many face complex societal factors leading to poor outcomes. Systemic processes must be changed to improve pediatric surgical health outcomes.A comprehensive health system with an equal emphasis on supportive care and surgery is required in all settings. Global collaboration and partnerships can provide an avenue for advocacy and strategic innovation to improve quality of care.Ⅴ.

Comorbid depression and anxiety is associated with worse health outcomes compared to depression or anxiety occurring in isolation, but there is little data on its association with multimorbidity. Thus, we investigated this association across 47 low- and middle-income countries, and further explored whether having anxiety symptoms in addition to depression is associated with significant declines in health outcomes among those with multimorbidity.Cross-sectional, predominantly nationally representative, community-based data were analyzed from the World Health Survey. DSM-IV depression was assessed with the Composite International Diagnostic Interview. Anxiety symptoms referred to severe/extreme problems with worry or anxiety. Ten chronic conditions and health status across five domains (cognition, interpersonal activities, sleep/energy, self-care, pain/discomfort) were assessed. Multivariable regression analyses conducted.Data included 237,952 adults aged ≥18 years [mean age (SD) 38.4 (16.0); 50.8 % females]. Compared to no chronic conditions, 2 (OR = 6.86; 95%CI = 5.59-8.42), 3 (OR = 12.33; 95%CI = 9.72-15.63), and ≥4 (OR = 26.55; 95%CI = 20.21-35.17) chronic conditions were associated with significantly higher odds for comorbid depression/anxiety symptoms (vs. no depression or anxiety symptoms) in the multinomial logistic regression model. Among those with depression and multimorbidity, anxiety symptoms were associated with significantly worse health status across all domains.Cross-sectional design, depression and anxiety symptoms were not based on a clinical assessment.Comorbid depression/anxiety is common in people with multimorbidity, and anxiety symptoms in people with depression and multimorbidity signify worse health status. Future studies should assess the utility of screening for and treating comorbid depression/anxiety in patients with multimorbidity in terms of clinical outcomes.

Although income is an important predictor of life satisfaction, the precise forces that drive this relationship remain unclear. We propose that financial resources afford individuals a path to reducing the distressing impact of everyday hassles, thereby increasing one’s life satisfaction. More specifically, we hypothesize that financial scarcity is associated with greater distress intensity in everyday life. Furthermore, we propose that lower perceived control helps explain why financial scarcity predicts higher distress intensity and lower life satisfaction. We provide evidence for these hypotheses in a 30-day daily diary study (522 participants, 13,733 observations). A second study ( N = 376) further suggests that, although everyone relies on social support to ease stress, financial scarcity shrinks the sense one can use economic resources to reduce the adverse impact of daily hassles. Although money may not necessarily buy happiness, it reduces the intensity of stressors experienced in daily life—and thereby increases life satisfaction.

Objectives. The goal of this study was to measure unionization in the direct care workforce and the relationship between unionization and earnings, looking closely at differences across race/ethnicity and gender. Methods. Using data from the Current Population Survey from 2010 to 2020, we first used logit analyses to predict the probability of unionization among direct care workers across race/ethnicity and gender. We then measured the relationship between unionization and weekly earnings. Results. We found that male (12%) and Black (14%) direct care workers were most likely to be unionized, followed by Hispanic and other direct care workers of color. Unionized direct care workers earn wages that are about 7.8% higher than nonunionized workers, but unionized workers of color earn lower rewards for unionization compared with White direct care workers. Conclusions. Unions are a mechanism for improving job quality in direct care work, and protecting workers’ rights to unionize and participate in collective bargaining equitably may be a way to stabilize and grow the direct care workforce. (Am J Public Health. 2022;112(11):1676–1684. https://doi.org/10.2105/AJPH.2022.307022 )

Background: Macrolevel factors such as economic and climate factors can be associated with physical activity indicators. This study explored patterns and relationships between economic freedom, climate culpability, and Report Card grades on physical activity-related indicators among 57 countries/jurisdictions participating in the Global Matrix 4.0. Methods: Participating countries/jurisdictions provided Report Card grades on 10 common indicators. Information on economic freedom and climatic factors were gathered from public data sources. Correlations between the key variables were provided by income groups (ie, low- and middle-income countries/jurisdictions and high-income countries/jurisdictions [HIC]). Results: HIC were more economically neoliberal and more responsible for climate change than low- and middle-income countries. Annual temperature and precipitation were negatively correlated with behavioral/individual indicators in low- and middle-income countries but not in HIC. In HIC, correlations between climate culpability and behavioral/individual and economic indicators were more apparent. Overall, poorer grades were observed in highly culpable countries/jurisdictions in the highly free group, while in less/moderately free groups, less culpable countries/jurisdictions showed poorer grades than their counterparts in their respective group by economic freedom. Conclusions: Global-level physical activity promotion strategies should closely evaluate different areas that need interventions tailored by income groups, with careful considerations for inequities in the global political economy and climate change.

To understand the relationship between adverse childhood experiences (ACEs) and diet, sleep, and exercise in pre-adolescents.Baseline and 1-year follow-up data from the adolescent brain and cognitive development (ABCD) study were analyzed (age 10-11, n = 11,875). ACEs were measured by parent report at baseline. Three levels of ACEs were created: none, exposure to one ACE, and exposure to two or more ACEs. Health-promoting behaviors were assessed at 1 year. Diet quality was measured from parent report; sleep problems were measured by parent report, with higher scores indicating worse sleep; and amount of exercise was measured by youth report. Linear regression analyses were used to assess the relationship between ACEs and each health-promoting behavior, adjusting for family income and sex.Compared to children with no adversity, ACEs were associated with worse diet - one ACE (β = -0.30 [95% CI, -0.49 to -0.12], P = .002) and 2 or more ACEs (β = -0.56 [-0.78 to -0.34, P.001). Similarly, ACEs were associated with poor sleep - one ACE (β = 1.51 [1.00-2.03], P.001) and 2 or more ACEs (β = 2.96 [2.38-3.53], P.001). Finally, amount of exercise was not different in children with ACEs - 2 or more ACEs (β = -0.24, 95% CI, -0.51 to 0.04, P = .08).ACEs in pre-adolescents show a dose-response relationship with unhealthy diet and sleep disruption. These findings suggest potential behaviors to target to mitigate the negative impact of childhood adversity on adult health.

Funder: Medical Research Council, BACKGROUND: Access to affordable inhaled medicines for chronic respiratory diseases (CRDs) is severely limited in low- and middle-income countries (LMICs), causing avoidable morbidity and mortality. The International Union Against Tuberculosis and Lung Disease convened a stakeholder meeting on this topic in February 2022.METHODS: Focused group discussions were informed by literature and presentations summarising experiences of obtaining inhaled medicines in LMICs. The virtual meeting was moderated using a topic guide around barriers and solutions to improve access. The thematic framework approach was used for analysis.RESULTS: A total of 58 key stakeholders, including patients, healthcare practitioners, members of national and international organisations, industry and WHO representatives attended the meeting. There were 20 pre-meeting material submissions. The main barriers identified were 1) low awareness of CRDs; 2) limited data on CRD burden and treatments in LMICs; 3) ineffective procurement and distribution networks; and 4) poor communication of the needs of people with CRDs. Solutions discussed were 1) generation of data to inform policy and practice; 2) capacity building; 3) improved procurement mechanisms; 4) strengthened advocacy practices; and 5) a World Health Assembly Resolution.CONCLUSION: There are opportunities to achieve improved access to affordable, quality-assured inhaled medicines in LMICs through coordinated, multi-stakeholder, collaborative efforts.

Brazil is characterized by strong social inequalities and differences in access to quality food and sufficient quantities of it, which represent a violation of the human right to adequate food. The aim was to assess food expenditures according to the social profiles of the head of the households. Data from the cross-sectional Brazilian Household Budget Survey (2017/2018) were used with a nationally representative sample of household survey participants (n=52,917). Poisson regression was used to estimate prevalence ratios (PR) to assess the association of different social profiles with the acquisition of food. The profile characterized by woman self-classified as white, with a higher education, which characteristics were positively and significantly associated with more acquisition of fruits (PR=1.22; CI95% 1.09-1.36) and vegetables and greens (PR=1.24; CI95% 1.09-1.41). Black women with low education levels showed a negative association with the consumption of soda (PR=0.53; CI95% 0.45-0.62), and prepared food (PR=0.52; CI95% 0.37-0.74). The results reveal great inequalities in the purchase of food between the social profiles of the heads of the family. Resumo O Brasil é caracterizado por fortes desigualdades sociais e diferenças no acesso a alimentos de qualidade e em quantidade suficiente, o que representa uma violação do direito humano à alimentação adequada. O objetivo foi avaliar os gastos com alimentação de acordo com o perfil social do responsável pelo domicílio. Dados da Pesquisa de Orçamentos Familiares Brasileiros de corte transversal (2017/2018) foram usados com uma amostra nacionalmente representativa de participantes da pesquisa domiciliar (n=52.917). A regressão de Poisson foi utilizada para estimar razões de prevalência (RP) para avaliar a associação de diferentes perfis sociais com a aquisição de alimentos. O perfil caracterizado pela mulher auto classificada como branca, com maior escolaridade, cujas características estiveram positiva e significativamente associadas a maior aquisição de frutas (RP=1,22; IC95% 1,09-1,36), verduras e legumes (PR=1,24; IC95% 1,09-1,41) e queijo (RP=1,32; IC95% 1,09-1,59). Mulheres negras com baixa escolaridade apresentaram associação negativa com o consumo de refrigerantes (RP=0,53; IC95% 0,45-0,62) e alimentos preparados (RP=0,52; IC95% 0,37-0,74). Os resultados revelam grandes desigualdades na aquisição de alimentos entre os perfis sociais dos chefes de família.

Depression and low socioeconomic status have both been associated with hippocampal volume alterations. Whether these factors interact to predict neurobehavioral outcomes has not been adequately studied. The authors investigated family income as a moderator of the relationship between depression and hippocampal volume in a longitudinal sample.Longitudinal behavioral data, beginning at preschool age, and behavioral and neuroimaging data from school age to adolescence were used to assess the impact of preschool only and total preschool to adolescent depression symptoms on hippocampal volumes using family income as a moderator (N = 176).Depression severity during the preschool period interacted with family income to predict hippocampal volumes at the intercept (ie, age 13 years; B = -0.078, p = .003). Interaction decomposition revealed that only individuals with relatively high family income exhibited smaller hippocampal volume with increasing depression severity (B = -0.146, p = .005). Family income was associated with hippocampus volumes only in individuals with low to moderate preschool depression severity (B = 0.289, p = .007 and B = 0.169, p = .030, respectively).Preschool depression severity interacts with family income to predict hippocampal volume across development, such that the effects of early depression are evident only in those with higher income. These findings suggest that hippocampal volume may not be an effective marker of risk for depression at different levels of socioeconomic status, and emphasizes the importance of the environmental context when assessing risk markers for depression. Future research should explore how socioeconomic stress may eclipse the effects of depression on hippocampal development, setting alternative neurodevelopmental risk trajectories.

Resumo: O objetivo do artigo é compreender aspectos teóricos e culturais relacionados à culinária típica da fronteira Brasil-Paraguai a partir da análise da chipa como elemento alternativo à geração de renda e como potencial para indicação geográfica, no fortalecimento do turismo local. A metodologia avaliou uma amostra por adesão de 4 (quatro) Ñas tradicionais da região, vendedoras e produtoras das chipas artesanais, mapeadas a partir das observações de campo e do conhecimento tácito das pesquisadoras. Para a análise, foram consideradas as teorias econômicas, indicação geográfica e patrimônio alimentar. Os resultados evidenciaram que o nível de diferenciação e os canais de comercialização utilizados são fatores que interferem na criação e distribuição do valor agregado do produto no processo artesanal da produção da chipa. Foi possível concluir que a tipicidade da culinária regional, quando preservada e valorizada pela população local, é um elemento importante para a geração de renda, a partir do que orientam as referências sobre indicação geográfica e patrimônio cultural. Abstract: The article aims to understand theoretical and cultural aspects related to the typical cuisine of the Brazil-Paraguay border from the analysis of the “chipa” as an alternative element to income generation and as a potential for geographic indication in strengthening local tourism. The research evaluated a sample by adhesion of 4 (four) traditional Ñas in the region, sellers and producers of artisanal “chipas”, mapped from the field observations and the tacit knowledge of the researchers. For the analysis, we considered the economic theories, geographical indication, and cultural heritage. The results showed that the level of differentiation and the commercialization channels used are factors that interfere in the creation and distribution of the added value of the product in the artisanal process of “chipa” production. It was possible to conclude that the typicality of regional cuisine, when preserved and valued by the local population, is an important element for the generation of income, based on what indicate the references on geographical indication and cultural heritage. Resumen: El objetivo del articulo es comprender aspectos teóricos y culturales relacionados con la cocina típica de la frontera Brasil-Paraguay a partir del análisis del chipá como elemento alternativo a la generación de ingresos y como potencial de indicación geográfica fortaleciendo el turismo local. La metodología evaluó una muestra por adhesión de 4 (cuatro) Ñas tradicionales de la región, vendedoras y productoras de los chipás artesanales, mapeadas a partir de las observaciones de campo y el conocimiento tácito de las investigadoras. Para el análisis, se consideraron las teorías económicas, la indicación geográfica y el patrimonio alimentario. Los resultados mostraron que el nivel de diferenciación y los canales de comercialización utilizados son factores que interferen en la creación y distribución del valor agregado del producto en el proceso artesanal de producción del chipá. Fue posible concluir que la tipicidad de la cocina regional, cuando es preservada y valorada por la población local, es un elemento importante para la generación de ingresos, con base en lo que orientan las referencias sobre indicación geográfica y patrimonio cultural.

How do people estimate the income that is needed to be rich? Two correlative survey studies (Study 1 and 2, N = 568) and one registered experimental study (Study 3, N = 500) examined the cognitive mechanisms that are used to derive an answer to this question. We tested whether individuals use their personal income (PI) as a self-generated anchor to derive an estimate of the income needed to be rich (= income wealth threshold estimation, IWTE). On a bivariate level, we found the expected positive relationship between one's PI and IWTE and, in line with previous findings, we found that people do not consider themselves rich. Furthermore, we predicted that individuals additionally use information about their social status within their social circles to make an IWTE. The findings from study 2 support this notion and show that only self-reported high-income individuals show different IWTEs depending on relative social status: Individuals in this group who self-reported a high status produced higher IWTEs than individuals who self-reported low status. The registered experimental study could not replicate this pattern robustly, although the results trended non-significantly in the same direction. Together, the findings revealed that the income of individuals as well as the social environment are used as sources of information to make IWTE judgements, although they are likely not the only important predictors.

Aiming at the integrated evaluation problem of financial risk in coal industry restructuring, a model of linear regression and PCA is put forward. This paper studies the univariate correlation and multivariable mixed correlation between the main business income and the book value of fixed assets and nonfixed assets in the statements of coal listed companies and gives the correlation function between the variables by using a variety of univariate linear, univariate nonlinear, and binary linear regression methods. It also points out that the coal enterprises in China are basically in the stage of increasing scale income at the present stage and can continue to achieve rapid increase in profits through mergers and acquisitions and other expansion methods. At the same time, it is also concluded that nonfixed assets, namely, intangible assets and human capital, contribute more to the main business income of coal enterprises in China, which objectively proves the correctness of our thinking of developing knowledge economy.

In this paper, we examine the relationship between professional financial advice (PFA) and subjective well-being (SWB). Utilizing the Dutch Household Survey 1995–2018, we find that regarding a professional financial advisor as most important source of financial advice is associated with higher levels of SWB. This association is stronger for households that experienced an increase in income, individuals who do not consider themselves financially knowledgeable, and individuals that have a weaker internal locus of control and have a lower degree of conscientiousness.

The association between socioeconomic status (SES) and depressive symptoms is well documented, yet less attention has been paid to the methodological factors contributing to between-study variability. We examined the moderating role of range restriction and the depressive-symptom measurement instrument used in estimating the correlation between components of SES and depressive symptoms.We conducted an individual participant data meta-analysis of nationally-representative, public-access datasets in the United States. We identified 123 individual datasets with a total of 1,655,991 participants (56.8 % female, mean age = 40.33).The presence of range restriction was associated with larger correlations between income and depressive symptoms and with smaller correlations between years of education and depressive symptoms. The measurement instrument of depressive symptoms moderated the association for income, years of education, and occupational status/prestige. The Center for Epidemiological Studies-Depression scale consistently produced larger correlations. Higher measurement reliability was also associated with larger correlations.This study was not a comprehensive review of all measurement instruments of depressive symptoms, focused on datasets from the United States, and did not examine the moderating role of sample characteristics.Methodological characteristics, including range restriction of SES and instrument of depressive symptoms, meaningfully influence the observed magnitude of association between SES and depressive symptoms. Clinicians and researchers designing future studies should consider which instrument of depressive symptoms is suitable for their purpose and population.

The full potential of data analysis is crippled by imbalanced and high-dimensional data, which makes these topics significantly important. Consequently, substantial research efforts have been directed to obtain dimension reduction and resolve data imbalance, especially in the context of fraud detection analysis. This work aims to investigate the effectiveness of hybrid learning methods for alleviating the class imbalance and integrating dimensionality reduction techniques. In this regard, the current study examines different classification combinations to achieve optimal savings and improve classification performance. Against this background, several well-known machine learning models are selected such as logistic regression, random forest, CatBoost (CB), and XGBoost. These models are constructed and optimized based on Bayes minimum risk (BMR) associated with the oversampling method synthetic minority oversampling technique (SMOTE) and different feature selection (FS) techniques, both univariate and multivariate. To investigate the performance of the proposed approach, different possible scenarios are analyzed both with and without balancing, with and without FS, and optimization using BMR. With a major insight about the best method to use, BMR shows a good optimization when used with SMOTE, symmetrical uncertainty for FS, and CB as a boosted classifier, principally in terms of F1 score and savings metrics.

The objective of this study is to assess the determinants of willingness to pay to enhance pandemic preparedness in Mauritius.A contingent valuation method is used to estimate willingness to pay to pay for enhancing pandemic preparedness using a sample of working people in Mauritius.A two-phase decision process analysis is carried out to model the willingness to pay to enhance pandemic preparedness. The first phase is to analyse the respondents' decision of whether or not to pay for enhancing pandemic preparedness using a Probit model. The second phase is to estimate the determinants of the amount of money respondents are willing to pay using a Tobit model.Income earners are willing to pay an average of Rs. 1,900 (approximately USD 50) per annum to enhance pandemic preparedness. 'Perceived Response Efficacy', 'Awareness of the Need and Responsibility for Paying', 'Subjective Obligation to Pay' and the 'Theory of Planned Behaviour' are found to affect both stages of of the decision-making process. Knowledge on COVID-19 is found to have a positive impact on the decision to pay and health responsibility attitude is found to have a negative impact on the amount people are willing to pay.On average, the government can potentially expect to mobilise an additional Rs. 1,047,470,000 (USD 27,565,000) from taxpayers to spend on enhancing pandemic preparedness in Mauritius. To increase willingness to pay for enhanced pandemic preparedness, the government can focus on improving knowledge on a pandemic, perceived response efficacy and awareness on need and responsibility of paying.

BACKGROUND: Major depressive disorder (MDD) onset varies by socioeconomic position (SEP), this could be explained by lifestyle factors, but little is known about this pathway. Our study aims to disentangle the interplay between SEP measures (i.e., education, income and occupational prestige) and MDD onset and to examine to what extent these associations are mediated by lifestyle (i.e., occupational- and leisure time physical activity, smoking, alcohol intake, diet quality, sleep and central adiposity).METHODS: A subsample (n = 76,045) of the Lifelines Cohort Study without MDD at baseline was included. MDD onset was measured after a median follow-up time of 3.8 years with the Mini International Neuropsychiatric Interview (MINI). Direct associations between SEP, lifestyle and MDD onset were estimated using logistic regression analyses. Mediating percentages were estimated using the Karlson-Holm-Breen method.RESULTS: 1864 participants (2.5 %) showed MDD at follow-up. SEP was inversely associated with MDD onset, with education showing the strongest association. Educational- and income differences in MDD onset were for 18.7 % and 5.9 % explained by lifestyle factors (mainly smoking, alcohol intake and central adiposity). Occupational prestige differences in MDD onset were not explained by lifestyle factors.LIMITATIONS: SEP and lifestyle factors were measured simultaneously at baseline. MDD status (only based on a screening tool) was only measured at baseline and 3.8 years later.CONCLUSIONS: Compared to their lower SEP counterparts, higher SEP individuals had a lower risk of MDD onset. This was partially explained by a healthier lifestyle (mainly less smoking, alcohol intake and central adiposity) of the higher SEP individuals.

The devolution of public services from central to local government can increase sensitivity to local population needs but might also reduce the expertise and resources available. Little evidence is available on the impact of devolution on population health. We evaluated the effect of devolution affecting health services and wider determinants of health on life expectancy in Greater Manchester, England.We estimated changes in life expectancy in Greater Manchester relative to a control group from the rest of England (excluding London), using a generalised synthetic control method. Using local district-level data collected between Jan 1, 2006 and Dec 31, 2019, we estimated the effect of devolution on the whole population and stratified by sex, district, income deprivation, and baseline life expectancy.After devolution, from November, 2014, life expectancy in Greater Manchester was 0·196 years (95% CI 0·182-0·210) higher than expected when compared with the synthetic control group with similar pre-devolution trends. Life expectancy was protected from the decline observed in comparable areas in the 2 years after devolution and increased in the longer term. Increases in life expectancy were observed in eight of ten local authorities, were larger among men than women (0·338 years [0·315-0·362] for men; 0·057 years [0·040-0·074] for women), and were larger in areas with high income deprivation (0·390 years [0·369-0·412]) and lower life expectancy before devolution (0·291 years [0·271-0·311]).Greater Manchester had better life expectancy than expected after devolution. The benefits of devolution were apparent in the areas with the highest income deprivation and lowest life expectancy, suggesting a narrowing of inequalities. Improvements were likely to be due to a coordinated devolution across sectors, affecting wider determinants of health and the organisation of care services.The Health Foundation and the National Institute for Health and Care Research.

We aimed to analyze recent infant and neonatal mortality from congenital heart defects (CHD) in Costa Rica, a middle-income country where CHD mortality was above expectations.A descriptive analysis of infant and neonatal mortality rates from CHD (IMR-CHD and NMR-CHD) during 2000-2019 was performed, according to province, sex, specific CHD, and sub-period, using data from the National Institute of Statistics and Censuses. We used joinpoint regression to identify any calendar-year where a significant change in trend occurred; the average annual percent change (AAPC) was determined. Using Poisson regression, marginal means and mortality ratios (MR) for IMR-CHD and NMR-CHD by sub-period (2000-2006-referent-, 2007-2013, 2014-2019) were estimated and compared using Wald's chi-square tests (α ≤ .05).During 2000-2019, CHD accounted for 12% of overall infant mortality. IMR-CHD and NMR-CHD decreased linearly over the study period (AAPC = -3.4; p .01). IMR-CHD decreased by 41%, from 13.6 per 10,000 in 2000-2006 (13.4% of infant mortality) to 8.1 per 10,000 in 2014-2019 (10% of infant mortality) (MR = 0.59; 95% confidence intervals [CI] = 0.52-0.68). NMR-CHD decreased by 38%, from 7.9 per 10,000 in 2000-2006 (11.1% of neonatal mortality) to 4.9 per 10,000 in 2014-2019 (7.9% of infant mortality) (MR = 0.59; 95% CI = 0.52-0.68). Male presented significantly higher NMR-CHD. The main causes of mortality (2014-2019) were total anomalous pulmonary venous connections, hypoplastic left heart syndrome, and double inlet ventricle.IMR-CHD, NMR-CHD, and their proportional contribution to mortality by all causes and by birth defects decreased significantly, demonstrating that all improvements implemented in the last decades have yielded favorable results.

Are individuals of higher socio-economic status less ethical than those of lower status? Highly popularised research findings claim that this is the case. This paper provides evidence against this claim, based on data from two large survey experiments with more than 11,000 participants. We prime social status in two heterogeneous samples of the German population and then elicit ethical behaviour in an incentivised experimental task. Thus, our data allows us to study both correlation (using demographic data) and causality (using the priming). Our study rejects the claim that higher social status individuals are less ethical on both accounts.

Nonsmall-cell lung cancer (NSCLC) is a common diagnosis among patients living in rural areas and small towns who face unique challenges accessing care. We examined differences in survival for surgically treated rural and small-town patients compared to those from urban and metropolitan areas.The National Cancer Database was used to identify surgically treated NSCLC patients from 2004 to 2016. Patients from rural/small-town counties were compared to urban/metro counties. Differences in patient clinical, sociodemographic, hospital, and travel characteristics were described. Survival differences were examined with Kaplan-Meier curves and Cox proportional hazards models.The study included 366 373 surgically treated NSCLC patients with 12.4% (n = 45 304) categorized as rural/small-town. Rural/small-town patients traveled farther for treatment and were from areas characterized by lower income and education(all p 0.001). Survival probabilities for rural/small-town patients were worse at 1 year (85% vs. 87%), 5 years (48% vs. 54%), and 10 years (26% vs. 31%) (p 0.001). Travel distance100 miles (hazard ratio [HR] = 1.11, 95% confidence interval [CI]: 1.07-1.16, vs.25 miles) and living in a rural/small-town county (HR = 1.04, 95% CI: 1.01-1.07) were associated with increased risk for death.Rural and small-town patients with surgically treated NSCLC had worse survival outcomes compared to urban and metropolitan patients.

Shocks to health have been shown to reduce labor supply for the individual affected. Less is known about household self-insurance through a partner's response. Previous studies have presented inconclusive empirical evidence on the existence of a health-related Added Worker Effect, and results limited to labor and income responses. We use UK longitudinal data to investigate within households both the labor supply and informal care responses of an individual to the event of an acute health shock to their partner. Relying on the unanticipated timing of shocks, we combine Coarsened Exact Matching and Entropy Balancing algorithms with parametric analysis and exploit lagged outcomes to remove bias from observed confounders and time-invariant unobservables. We find no evidence of a health-related Added Worker Effect but a significant and sizable Informal Carer Effect. This holds irrespective of spousal labor market position or household financial status and ability to purchase formal care provision, suggesting that partners' substitute informal care provision for time devoted to leisure activities.

Lower socioeconomic status is associated with significantly poorer outcomes in weight, lung function, and pulmonary exacerbation rates in people with cystic fibrosis (PwCF).We aim to reduce health disparities and inequities faced by PwCF by screening for and addressing unmet social needs.We aimed to increase routine social determinants of health (SDoH) screening of eligible PwCF from 0% to 95% and follow-up within 2 weeks for those PwCF who screened positive and requested assistance from 0% to 95% by December 31, 2021.The Model for Improvement methodology was used. A process map and a simplified failure mode effects analysis chart were created for the screening and SDoH follow-up process. For those who screened positive for SDoH and requested assistance, follow-up contact was made to offer intervention.Adult PwCF who had at least one UVA Clinic encounter in 2021 were screened for SDoH. The SDoH screening tool included eight domains: housing, food, transportation, utilities, health-care access, medication access, income/employment, and education. Follow-up was completed with all PwCF who screened positive for SDoH.A total of 132 of 142 (93.0%) PwCF eligible for screening completed the SDoH screening. Of the PwCF who completed screening, 56 (42.4%) screened positive for SDoH. A follow-up rate of 100% was achieved in June 2021 and maintained through December 2021.Implementing screening for SDOH and follow-up to mitigate social difficulties in adult PwCF at UVA was successful and could be reproduced at other CF care centers.

In this systematic review, we aimed to explore the influence of sociocultural beliefs and practices on contraception and their uptake among women in low-income countries (LICs) and lower-middle-income countries (LMICs). For this purpose, a literature search was conducted using four databases, namely Scopus, Web of Science, PubMed and EBSCOhost Research Platform. Twenty-five articles were selected and analyzed out of a total of 5180 retrieved and screened articles. We used thematic analysis to identify, interpret and report patterns and themes from these records. The analysis identified six factors influencing the uptake of contraceptive methods among women aged 13 to 65-years in LICs and LMICs in relation to their sociocultural beliefs and practices. We found that women's social status and responsibility were recognized at the individual level and the unique patriarchal culture at the partner level, while community-level factors included myths and misconceptions, cultural differences and religious beliefs. Thus, the main challenges to the uptake of contraceptive methods among women in terms of sociocultural norms occur at varying levels of society. This review suggests the need for future family planning programs and health education to target specific community levels and especially to consider diverse social and cultural backgrounds.

The objective of this review is to characterize the state of literature regarding forcibly displaced persons' sexual and reproductive health in urban areas in low- and middle-income countries. Specific objectives include describing the sexual and reproductive health outcomes among forcibly displaced persons relocating in urban environments.As a result of persecution, conflict, violence, human rights violations, and disruptive events, 89.3 million people worldwide were forcibly displaced as of the end of 2021. Forcibly displaced people face a wide range of sexual and reproductive health challenges in their countries of origin, en route to final destinations, and on arrival in host communities. There is a growing urbanization of forcibly displaced persons, yet there is limited attention on sexual and reproductive health outcomes of this population.This review will consider studies that include sexual and/or reproductive health outcomes and needs of forcibly displaced persons within urban environments in low- and middle-income countries. Published and unpublished evidence, including quantitative, qualitative, mixed methods research, and gray literature, will be eligible for inclusion.MEDLINE, Embase, PsycINFO, CINAHL, IBSS, ASSIA, SSCI, and Global Medicus Index will be searched for English-language articles. Titles and abstracts will be screened against the inclusion criteria, followed by full-text review of potentially eligible studies, which will be independently assessed by 2 reviewers. Eligible articles will be extracted and charted. Results from extracted data will be tabulated and accompanied by a narrative summary to summarize and contextualize the extracted data to describe how the results relate to the review's objectives and question.

This article aims to evaluate the association between racial residential segregation and homicide mortality in the state of Minas Gerais (MG), Brazil. We conducted an ecological study in which the units of analysis were municipalities in MG. The outcome was homicide deaths between 2008 and 2012 and the exposure variable was residential segregation measured using the racial interaction index, calculated using data from the 2010 Demographic Census. The covariables were per capita family income and the Gini index. The variables were presented in tables and thematic maps and associations were measured using Bayesian hierarchical models. The results of the model adjusted for per capita family income showed a negative association between the racial interaction index and homicide mortality (coefficient=-1.787; 95%CI=-2.459; -1.119). Homicide mortality was lower in municipalities with higher levels of racial interaction.O objetivo desse artigo é avaliar a associação entre segregação residencial racial e mortalidade por homicídios em Minas Gerais (MG). Trata-se de estudo ecológico, com os municípios de MG como unidades de análise. O desfecho foi óbitos por homicídio ocorridos de 2008 a 2012 e a exposição a medida de segregação residencial índice de interação racial, estimada para 2010 a partir dos dados do censo demográfico; outras covariáveis foram renda média per capita e índice de Gini. As variáveis foram apresentadas em mapas temáticos e a associação entre elas foi investigada por modelos hierárquicos bayesianos. Houve associação negativa entre o índice de interação racial e a mortalidade por homicídios (coeficiente=-1,787; IC95%=-2,459; -1,119), em modelo ajustado pela renda per capita. Os municípios de MG com maior interação racial tiveram em média uma menor mortalidade por homicídios.

Alcohol is a leading risk factor for over 200 conditions and an important contributor to socioeconomic health inequalities. However, little is known about the associations between individuals' socioeconomic circumstances and alcohol consumption, especially heavy episodic drinking (HED; ≥5 drinks on one occasion) in low-income or middle-income countries. We investigated the association between individual and household level socioeconomic status, and alcohol drinking habits in these settings.In this pooled analysis of individual-level data, we used available nationally representative surveys-mainly WHO Stepwise Approach to Surveillance surveys-conducted in 55 low-income and middle-income countries between 2005 and 2017 reporting on alcohol use. Surveys from participants aged 15 years or older were included. Logistic regression models controlling for age, country, and survey year stratified by sex and country income groups were used to investigate associations between two indicators of socioeconomic status (individual educational attainment and household wealth) and alcohol use (current drinking and HED amongst current drinkers).Surveys from 336 287 participants were included in the analysis. Among males, the highest prevalence of both current drinking and HED was found in lower-middle-income countries (L-MICs; current drinking 49·9% [95% CI 48·7-51·2] and HED 63·3% [61·0-65·7]). Among females, the prevalence of current drinking was highest in upper-middle-income countries (U-MIC; 29·5% [26·1-33·2]), and the prevalence of HED was highest in low-income countries (LICs; 36·8% [33·6-40·2]). Clear gradients in the prevalence of current drinking were observed across all country income groups, with a higher prevalence among participants with high socioeconomic status. However, in U-MICs, current drinkers with low socioeconomic status were more likely to engage in HED than participants with high socioeconomic status; the opposite was observed in LICs, and no association between socioeconomic status and HED was found in L-MICs.The findings call for urgent alcohol control policies and interventions in LICs and L-MICs to reduce harmful HED. Moreover, alcohol control policies need to be targeted at socially disadvantaged groups in U-MICs.Deutsche Forschungsgemeinschaft and the National Center for Advancing Translational Sciences of the US National Institutes of Health.

Previous research has shown that patients who are older, less educated, or have lower income are less likely to lodge complaints about health care. This variation may reflect less wish to complain or inequitable access to complaint channels or remedies. We aimed to investigate associations between sociodemographic characteristics and health users' wish to complain.This was a randomized case vignette survey among 6756 Danish men aged 45-70 years (30% response rate).Assuming they received the care in vignettes about prostate cancer (prostate-specific antigen) testing, participants rated their wish to complain on a 5-point Likert scale. Information on sociodemographic characteristics was obtained through self-reports and municipality-level information from national registries.Lower education was associated with an increased wish to complain (mean Likert difference 0.44 [95% CI 0.36-0.51]; P .001). The wish to complain was higher among unemployed men (difference 0.16 [95% CI 0.04-0.28]; P .011) and those with a chronic illness (difference 0.06 [95% CI 0.02-0.10]; P .004). Given the same healthcare scenarios, there was no difference in wish to complain among health users who were retired, living rurally, or from lower income groups.Health users who are less educated, lower income, elderly, or from rural or minority communities appear to be as likely, or more likely, to wish to complain about health care as others. Yet, younger, well-educated, and higher income citizens are overrepresented in actual complaint statistics. The finding suggests persisting inequalities in the suitability or accessibility of complaint processes for some groups of patients.

Our study evaluated general surgery resident indebtedness and perspectives on financial compensation.In May 2020, a survey was distributed nationwide by general surgery program directors in the Association of Program Directors in Surgery on a voluntary basis to their residents.The survey was completed by 419 general surgery residents. Median salary was $60-65 K and median medical educational debt was $200-250 K. Approximately 61% of residents reported that their financial needs were not met by their income. Most residents (76%) believe that for a fair compensation, their salaries should be 30-50% higher. Proposed interventions for improvement in resident compensation included: overtime payment, redirection of GME funds to the residency programs, and compensating residents for billable services.Residents enter training with significant medical educational debt and feel unfairly compensated for their work. Therefore, comprehensive interventions with input from residents are needed to improve their financial well-being.