Search

To assess the association between patient primary language and route of hysterectomy. A retrospective cohort study was conducted using the Healthcare Cost and Utilization Project's State Inpatient Database (SID) and State Ambulatory Surgery and Services Database (SASD). All inpatient and outpatient hysterectomies from the most recent year of available data (2020–2021) from the six states that record patient primary language in the SID and SASD (Indiana, Iowa, Maryland, Michigan, Minnesota, and New Jersey) were queried. Patients aged 18 and over undergoing an inpatient or ambulatory hysterectomy for benign indication. Minimally invasive hysterectomy compared to abdominal hysterectomy. The association between patient primary language (English vs. non-English) and route of hysterectomy (abdominal vs minimally invasive) was evaluated. The cohort included 52,226 patients who met inclusion criteria. The majority of patients were non-Hispanic White (71%), with a median age of 46 years (IQR 40.0–53.0). 91.4% of patients spoke English as their primary language, 3.6% spoke Spanish, and 5.0% spoke another non-English language. Patients with a non-English primary language were significantly less likely to undergo minimally invasive hysterectomy compared to patients who spoke English (OR 0.60, 95% CI 0.56–0.64, p <.001). This association remained significant following adjustments for age, race, insurance, median income, state, and fibroid, abnormal uterine bleeding, prolapse or endometriosis diagnosis (aOR 0.77, 95% CI 0.71–0.84). In a sensitivity analysis of English vs Spanish vs other non-English language, the association remained significant for other non-English languages (aOR 0.67, 95% CI 0.60–0.75) but not for Spanish (aOR 0.95, 95% CI 0.83–1.09). Patients who are non-English speaking are significantly less likely to receive a minimally invasive hysterectomy. Addressing language disparities may improve access to a minimally invasive route of surgery, a possible surrogate for improved surgical outcomes, for our gynecologic patients. [ABSTRACT FROM AUTHOR]

Little is known about the relationships between demographic and economic social determinants of health and the probability of contracting COVID-19 in American Indian and Alaska Native (AI/AN) peoples. In addition, we do not know if and how tribal payments, unique to AI/AN peoples, are associated with the probability of contracting COVID-19. We surveyed 767 AI/AN patients of five geographically disparate health organizations that primarily served AI/AN peoples in urban settings between January and May of 2021. We used univariate modified Poisson regressions to estimate the influence of age, gender, household composition, education, household income, and tribal payments on risk of contracting COVID-19, with results presented as both risk and risk difference. Fifteen percent of the sample contracted COVID-19, and individuals who lived in households with two or more generations had an 11-percentage point elevated risk of contracting COVID-19 compared to those who lived alone. Twenty-seven percent of participants received tribal payments; receipt was associated with seven percentage points (change from 18% probability to 11% probability) lower risk of contracting COVID-19. Our findings showed interventions specifically designed to reduce the spread of COVID-19 in multigenerational households, and regular tribal payments may help improve health outcomes in urban AI/AN populations. [ABSTRACT FROM AUTHOR]

The caste system and resulting social exclusion are important social determinants of health inequity in India. This article critically analyzes the influence of the caste system on health inequity in India, starting with a historical perspective and moving to the current status. The article argues that the caste system has deprived Dalits and tribal people in India of achieving health equity. The programs to promote health are often disease-specific and not culturally informed, leading to poor attention at the policy level to the intersecting disadvantages that make Dalits and tribal communities vulnerable, resulting in poor health. The authors suggest strengthening and promoting primary care, improving health access for Dalit and tribal populations, and the need for pivotal changes in the medical education system, shifting the emphasis from specialized care to training family physicians to be oriented toward community health needs, keeping health equity in perspective. [ABSTRACT FROM AUTHOR]

Copyright of Eastern Mediterranean Health Journal is the property of World Health Organization and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To assess injured military veterans' experiences, beliefs, and daily physical and psychosocial functioning in relation to food and nutrition. We used a convergent mixed-methods study design and the International Classification of Functioning, Disability, and Health to operationalize the core constructs and influencing factors related to physical and psychosocial functioning, food, and nutrition. Three Veterans Affairs polytrauma rehabilitation centers. Veterans who served in the United States military on or after September 11, 2001, and whose medical diagnoses met the criteria for polytrauma; at least 1 mild traumatic brain injury and at least 1 associated comorbidity (eg, posttraumatic stress disorder, chronic musculoskeletal pain, vestibular disturbances), for a total N of 43. None. Themes from survey responses and semistructured interview data were pooled into core constructs and influencing factors. Thirty-seven veterans completed all surveys and participated in recorded interviews. Based on qualitative and quantitative data, veterans' relation to food and nutrition (ie, nutritional functioning) was found to be characterized by 5 core constructs, including food background, nutrition knowledge, meal aptitude, resource navigation, and navigation to/of food spaces. Nutritional functioning was found to be shaped by 5 influencing factors, including injuries and health conditions, ideological and cultural exposures, relations, current beliefs, and current behaviors. Nutritional functioning (food background, nutrition knowledge, meal aptitude, resource navigation, navigation to/of food spaces) among injured veterans is complex and shaped by multiple physical, psychosocial, economic, and cultural factors. [ABSTRACT FROM AUTHOR]

Introduction: Iodine is an essential mineral for fetal growth and brain development. The aim of this research was to evaluate goiter, iodine deficiency and intrauterine growth restriction in pregnant women of minority ethnic groups in Colombia. Methods: A cross-sectional study was performed in six nonmetropolitan areas of Colombia. Results: A total of 318 Indigenous and Afro-descendant pregnant women were invited to participate: 248 (83.2%) Indigenous and 50 (16.8%) Afro-descendants were studied. The mean age was 24 years (range 13-44 years). Of the women, 130 (43.5%) were from the department of Cauca, 72 (24.1%) were from Córdoba, 28 (9.4%) were from Guajira, 26 (8.8%) were from Sierra Nevada de Santa Marta, 22 (7.4%) were from Amazonas, 16 (5.4%) were from Meta and 4 (1.3%) were from the department of Cesar. A total of 244 (81.8%) were illiterate and 291 (97.7%) were of very low socioeconomic level. Goiter was observed in 69 (23.3%) pregnant women (38 (41.7%) from the department of Cauca, 10 (35.7%) from Guajira, 5 (31.2%) from Meta, 6 (27.2%) from Amazonas and 10 (13.8%) from Córdoba). Iodine deficiency (<100 µg/L) was observed in 42 (14.9%) pregnant women (16 (11.6%) mild (50-99 µg/L), 19 (13.8%) moderate (20--49 µg/L) and 7 (5.1%) severe (<20 µg/L)). Being literate was a protective factor for iodine deficiency (odds ratio (OR)=0.19, 95% confidence interval (CI) 0.04-0.84, p=0.016). Being illiterate and iodine deficient was only a risk factor for goiter (OR=6.72, 95%CI 3.9-9.5, p=0.038) in the department of Cauca. Conclusion: A high prevalence of goiter, iodine deficiency and intrauterine growth restriction was observed in minority ethnic groups of Colombia. The highest prevalence and risk was observed in the department of Cauca. [ABSTRACT FROM AUTHOR]

Background: This integrative review examined how simulation is being used to teach graduate nursing students about the social determinants of health (SDH). Methods: The literature search focused on studies that included a sample of graduate nursing students who participated in an SDH simulation-based education (SBE). The timeframe used was 2013 to 2023 as this is when SBE emerged in graduate nursing education. Databases searched included Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature, PubMed, and Web of Science. Results: Nine studies included a sample of graduate nursing students and were included in this review. Published studies ranged from 2013 to 2023. Conclusion: The findings of this review highlight the need for graduate nursing faculty to design, implement, and evaluate transformative SDH-specific SBE that prepares students to understand their role as social justice advocates for health equity. [ABSTRACT FROM AUTHOR]

• The HDP rates increased overall in Mexican municipalities in 2000–2020. • The magnitude decreased since 2008, suggesting a deceleration in HDP trends. • Structural SDH could explain the changes in HDP trends at municipal-level. • Municipalities with higher marginalization had higher HDP rates from 2005 to 2014. • Higher education and socioeconomic level were associated with lower HDP rates. To analyze the hypertensive disorders of pregnancy (HDP) trends in the 2000–2020 period and its association with social determinants of health (SDH) in Mexican municipalities. This was a retrospective longitudinal study analyzing data from routine information systems on 21,493,076 hospital discharges due to maternal causes and SDH data of 2,439–2,450 municipalities between 2000 and 2020. We used joinpoint regression models to analyze HDP trends and hybrid negative binomial regression models to examine the association between SDH and HDP rates at intra- and inter-municipality levels. HDP rate increased from 0.54 in 2000 to 2.42 cases per 100 live births in 2020 (annual average percent change of 7.7 %, 95 % CI 6.6–8.9). Municipalities with higher marginalization index had higher HDP rates (IRR 1.12, 95 % CI 1.01–1.24; 1.36, 95 % CI 1.25–1.47; 1.30, 95 % CI 1.23–1.37, and 1.06, 95 % CI 1.00–1.12, in 2000–2004, 2005–2009, 2010–2014, 2015–2020, respectively). Municipal increases in the percentage of population with high schooling were associated with decreases in HDP rates in 2000–2009. Meanwhile, the role of socioeconomic status at the state level was less consistent, yet the HDP rates were lower in most socially advantaged regions. During 21 years, HDP rates increased overall in Mexican municipalities, suggesting an increased maternal morbidity burden due to HDP. The association of municipal marginalization and socioeconomic level with HDP trends indicates a need to ensure equitable interventions to improve maternal health in Mexican municipalities. [ABSTRACT FROM AUTHOR]

Health equity enables everyone to have the best possible opportunity for good health regardless of their social circumstance. In this article we set out why it is so vital that this begins in childhood, particularly at a time when increased costs of living in many countries are exacerbating health inequities further. We examine the impact of addressing the social determinants of health at individual, population and systems levels, and why this is the business of all partners involved in the local health economy. In the UK, integrated care systems (ICS) are early in their development. In this short article, we describe the work of the Children and Young People's Health Equity Collaborative: a collaboration between children's charity Barnardo's, the Institute of Health Equity, Birmingham and Solihull ICS, Cheshire and Merseyside ICS, and South Yorkshire ICS. This details a three-year programme designed to establish enablers for this whole systems approach. This includes a Children and Young People's Health Equity Framework, a dynamic data measurement tool to direct action for longer term outcomes and supporting child health equity interventions. Children and young people's voice is central to our work, combining academic evidence with lived experience of what really matters to them. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Community disadvantage is associated with late‐life cognition. Few studies examine its contribution to racial disparities in cognition/cognitive change. METHODS: Inverse probability weighted models estimated expected mean differences in cognition/cognitive change attributed to residing in less advantaged communities, defined as cohort top quintile of Area Deprivation Indices (ADI): childhood 66–100; adulthood ADI 5‐99). Interactions by race tested. RESULTS: More Black participants resided in less advantaged communities. Semantic memory would be lower if all participants had resided in less advantaged childhood (b = ‐0.16, 95% confidence interval [CI] = ‐0.30, ‐0.03) or adulthood (b = ‐0.14, 95% CI = ‐0.22, ‐0.04) communities. Race interactions indicated that, among Black participants, less advantaged childhood communities were associated with higher verbal episodic memory (interaction p‐value = 0.007) and less advantaged adulthood communities were associated with lower semantic memory (interaction p‐value = 0.002). DISCUSSION: Examining racial differences in levels of community advantage and late‐life cognitive decline is a critical step toward unpacking community effects on cognitive disparities. [ABSTRACT FROM AUTHOR]

Copyright of Koers: Bulletin for Christian Scholarship is the property of Koers Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: COVID-19 had an impact on all sections of society, including people with disabilities. Objectives: The authors aimed to explore the needs and experiences of people with disabilities in Zambia during the COVID-19 pandemic. Method: In this hermeneutic phenomenological study, we used a semi-structured interview guide to collect data from a purposive and snowball sample of 40 people with disabilities and their caregivers. The participants were from 11 districts in 6 provinces in Zambia. The in-depth interviews were done between July 2022 and November 2022. Data were managed in NVivo and analysed using reflexive thematic analysis. Results: The three themes included: (1) awareness and experience of public health measures on COVID-19 among people with disabilities; (2) experience of othering and stigmatisation as people with disability during the COVID-19 pandemic and (3) experience of COVID-19 symptoms and having COVID-19 among people with disabilities. Conclusion: Interventions were largely unresponsive to the needs of people with disabilities, exacerbating the risk of exposure to infection. In future, adaptations like emergency risk communication in braille, audio and sign language interpretation in adapted communication formats should be made. Further studies are needed to quantify the gaps in access to health, explore policies and strategies to improve health outcomes for people with disabilities in LMICs like Zambia. Contribution: The findings may contribute to the development and enhancement of policies and interventions responsive to the needs of people with disabilities in future pandemics in the Zambian context. [ABSTRACT FROM AUTHOR]

For patients with social needs, emergency departments can be an essential bridge between the health care system and the community. Emergency nurses' knowledge of and engagement in this work need to be examined to ensure that efforts for social determinants of health screening and the resulting community connections are effective. However, there is limited research in this area of nursing practice. The purpose of this study is to describe emergency nurses' knowledge about social needs in their community, assess their knowledge of existing community resources, and examine their perceived confidence to respond to the social needs of their patients. A cross-sectional survey was conducted with 243 nurses employed in a large regional health care system. Data were collected using an adapted 81-item social determinants of health survey instrument to measure knowledge of social determinants of health, confidence, and frequency of discussing social determinants of health with emergency department patients and awareness of social resources available in the community. Survey participants were asked about barriers to incorporating social determinants of health into their emergency department workflow and to provide general demographic information. Descriptive statistics were used to analyze study results. Most of the 243 emergency nurse participants believed that addressing social determinants of health was important and that emergency nurses should be involved in issues around social determinants of health. However, most nurses reported limited knowledge about social determinants of health and had very limited knowledge about the resources available in their community to help patients with needs related to food, housing, medical care, and transportation. Nurses reported that although they know that their patients are unlikely to ask for help with social needs during an emergency department visit, they are still unlikely to ask their patients about social needs owing to low confidence about having social needs conversations, limited time, and competing care priorities. Participants advocated for greater case manager presence. Feeling connected to the community was significantly correlated to increased knowledge, confidence, and likelihood to ask about social needs (P <.05). The emergency department is a logical place for screening for social determinants of health and connecting patients with social needs to community resources. Emergency nurses included in this study acknowledged that they want to address the social needs of their patients but reported that they lack knowledge about both social determinants of health and more importantly about the resources available to help patients with social needs. In general, they did not feel confident discussing social determinants of health with their patients in the emergency department and are unlikely to ask about social needs. Barriers to screening include time, competing care priorities, and lack of knowledge and support needed from case managers. Findings from this study have implications for supporting emergency nurses employed in institutions that seek to address social influences of health for the patients in their communities. [ABSTRACT FROM AUTHOR]

Background: In the context of an expanding syphilis epidemic, we assessed the integration of sexually transmissible infection (STI) testing within annual health assessments for Aboriginal and Torres Strait Islander young people aged 16–29 years in Aboriginal Community Controlled Health Services between 2018 and 2020. Methods: Using routinely collected electronic medical record data from a national sentinel surveillance system (ATLAS), we performed a cross-sectional analysis to calculate the proportion of assessments that integrated any or all of the tests for chlamydia, gonorrhoea, syphilis, and HIV. We used logistic regression to identify correlates of integration of any STI test. Results: Of the 13 892 assessments, 23.8% (95% CI 23.1, 24.6) integrated a test for any STI and 11.5% (95% CI 10.9, 12.0) included all four STIs. Of assessments that included a chlamydia/gonorrhoea test, 66.9% concurrently included a syphilis test. Integration of any STI test was associated with patients aged 20–24 years (OR 1.2, 95% CI 1.1–1.4) and 25–29 years (OR 1.1, 95% CI 1.0–1.2) compared to 16–19 years and patients residing in very remote (OR 4.2, 95% CI 3.7–4.8), remote (OR 2.4, 95% CI 2.1–2.8), and regional areas (OR 2.5, 95% CI 2.2–2.8) compared to metropolitan areas. There was no association with patient sex. Conclusions: Integration of STI testing into annual health assessments for Aboriginal and Torres Strait Islander young people was higher in remote areas where disease burden is greatest. Integration is similar in men and women, which contrasts with most studies that have found higher testing in women. In the context of an expanding syphilis epidemic, we assessed the integration of STI testing into Medicare Benefits Schedule Item 715, which is a comprehensive annual health assessment offered to Aboriginal and Torres Strait Islander people in Australian primary care. Guidelines recommend inclusion of STI testing for young people, but the extent to which health services nationally have integrated STI screening into health assessments is unknown. Our national, multi-centre study examined factors associated with integration of STI testing into health assessments for the first time and makes an important contribution to the evidence base supporting national guidelines. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Social determinants of health (SDOH) are linked to poor health care outcomes across the different medical specialties. We conducted a scoping review to understand the existing literature and identify further areas of research to address disparities within hand surgery. A systematic search of PubMed, Scopus, and Cochrane was conducted. Inclusion criteria were English studies examining health disparities in hand surgery. The following were assessed: the main SDOH, study design/phase/theme, and main disease/injury/procedure. A previously described health disparities research framework was used to determine study phase: detecting (identifying risk factors), understanding (analyzing risk factors), and reducing (assessing interventions). Studies were categorized according to themes outlined at the National Institute of Health and American College of Surgeons: Summit on Surgical Disparities. The initial search yielded 446 articles, with 49 articles included in final analysis. The majority were detecting-type (31/49, 63%) or understanding-type (12/49, 24%) studies, with few reducing-type studies (6/49, 12%). Patient factors (31/49, 63%) and systemic/access factors (16/49, 33%) were the most frequently studied themes, with few investigating clinical care/quality factors (4/49, 8%), clinician factors (3/49, 6%), and postoperative/rehabilitation factors (1/49, 2%). The most commonly studied SDOH include insurance status (13/49, 27%), health literacy (10/49, 20%), and social deprivation (6/49, 12%). Carpal tunnel syndrome (9/49, 18%), upper extremity trauma (9/49, 18%), and amputations (5/49, 10%) were frequently assessed. Most investigations involved retrospective or database designs (29/49, 59%), while few were prospective, cross-sectional, or mixed-methods. Despite an encouraging upward trend in health disparities research, existing studies are in the early phases of investigation. Most of the literature focuses on patient factors and systemic/access factors in regard to insurance status. Further work with prospective, cross-sectional, and mixed-method studies is needed to better understand health disparities in hand surgery, which will inform future interventions. [ABSTRACT FROM AUTHOR]

Objective: To understand the mediating effect of socioeconomic factors on the association between residential segregation and racial disparities in pancreatic cancer (PC). Background: Black patients with PC present at a later stage and have worse mortality than White patients. These disparities have been explained by the level of residential segregation. Methods: Data were obtained from Surveillance, Epidemiology, and End-Results (SEER) and included all Black and White patients who were diagnosed with PC between 2005 and 2015. The primary exposure variable was the Index of Dissimilarity, a validated measure of segregation. County-level socioeconomic variables from the US Census were assessed as mediators. The primary outcomes were advanced stage at diagnosis, surgical resection for localized disease, and overall mortality. Generalized structural equation modeling was used to assess the mediation of each of the socioeconomic variables. Results: Black patients in the highest levels of segregation saw a 12% increased risk [relative risk=1.12; 95% confidence interval (CI): 1.08, 1.15] of presenting at an advanced stage, 11% decreased likelihood of undergoing surgery (relative risk=0.89; 95% CI: 0.83, 0.94), and 8% increased hazards of death (hazard ratio=1.08; 95% CI: 1.03, 1.14) compared with White patients in the lowest levels. The Black share of the population, insurance status, and income inequality mediated 58% of the total effect on the advanced stage. Poverty and Black income immobility mediated 51% of the total effect on surgical resection. Poverty and Black income immobility mediated 50% of the total effect on overall survival. Conclusions: These socioeconomic factors serve as intervention points for legislators to address the social determinants inherent to the structural racism that mediate poor outcomes for Black patients. [ABSTRACT FROM AUTHOR]

There are well-described racial and ethnic disparities in the burden of chronic liver diseases. Hispanic persons are at highest risk for developing nonalcoholic fatty liver disease, the fastest growing cause of liver disease. Hepatitis B disproportionately affects persons of Asian or African descent. The highest rates of hepatitis C occur in American Indian and Alaskan Native populations. In addition to disparities in disease burden, there are also marked racial and ethnic disparities in access to treatments, including liver transplantation. Disparities also exist by gender and geography, especially in alcohol-related liver disease. To achieve health equity, we must address the root causes that drive these inequities. Understanding the role that social determinants of health play in the disparate health outcomes that are currently observed is critically important. We must forge and/or strengthen collaborations between patients, community members, other key stakeholders, health care providers, health care institutions, professional societies, and legislative bodies. Herein, we provide a high-level review of current disparities in chronic liver disease and describe actionable strategies that have potential to bridge gaps, improve quality, and promote equity in liver care. [ABSTRACT FROM AUTHOR]

Background: Individuals of Mexican ancestry in the United States experience substantial socioeconomic disadvantages compared with non-Hispanic white individuals; however, some studies show these groups have similar dementia risk. Evaluating whether migration selection factors (e.g., education) associated with risk of Alzheimer disease and related dementia (ADRD) explain this paradoxical finding presents statistical challenges. Intercorrelation of risk factors, common with social determinants, could make certain covariate patterns very likely or unlikely to occur for particular groups, which complicates their comparison. Propensity score (PS) methods could be leveraged here to diagnose nonoverlap and help balance exposure groups. Methods: We compare conventional and PS-based methods to examine differences in cognitive trajectories between foreign-born Mexican American, US-born Mexican American, and US-born non-Hispanic white individuals in the Health and Retirement Study (1994-2018). We examined cognition using a global measure. We estimated trajectories of cognitive decline from linear mixed models adjusted for migration selection factors also associated with ADRD risk conventionally or with inverse probability weighting. We also employed PS trimming and match weighting. Results: In the full sample, where PS overlap was poor, unadjusted analyses showed both Mexican ancestry groups had worse baseline cognitive scores but similar or slower rates of decline compared with non-Hispanic white adults; adjusted findings were similar, regardless of method. Focusing analyses on populations where PS overlap was improved (PS trimming and match weighting) did not alter conclusions. Conclusions: Attempting to equalize groups on migration selection and ADRD risk factors did not explain paradoxical findings for Mexican ancestry groups in our study. [ABSTRACT FROM AUTHOR]

There are well-described racial and ethnic disparities in the burden of chronic liver diseases. Hispanic persons are at highest risk for developing nonalcoholic fatty liver disease, the fastest growing cause of liver disease. Hepatitis B disproportionately affects persons of Asian or African descent. The highest rates of hepatitis C occur in American Indian and Alaskan Native populations. In addition to disparities in disease burden, there are also marked racial and ethnic disparities in access to treatments, including liver transplantation. Disparities also exist by gender and geography, especially in alcohol-related liver disease. To achieve health equity, we must address the root causes that drive these inequities. Understanding the role that social determinants of health play in the disparate health outcomes that are currently observed is critically important. We must forge and/or strengthen collaborations between patients, community members, other key stakeholders, health care providers, health care institutions, professional societies, and legislative bodies. Herein, we provide a high-level review of current disparities in chronic liver disease and describe actionable strategies that have potential to bridge gaps, improve quality, and promote equity in liver care. [ABSTRACT FROM AUTHOR]

The erosion of strategic geopolitical stability in all parts of the world is definitely having a strong negative impact on the social sustainability of our planet. Lack of clear rules of political and economic behavior and the growth of confrontation in international relations lead to a total disorientation of global modern social system. Dominant in this direction are not only current wars and permanent threats of local and global conflict situations, but also the non-conventional (information) technologies, methods and means of changing the political regimes. Despite the terminological diversity in this field, in the last few years there has been a need to fill the "blank space" in understanding their nature and metrics. The need for a new meaningful definition of the specific political and economic, technological, social and information solutions and implications appeared mostly in social practice. In the present analysis, our attempt is to give a new interpretation to this specific measuring mechanism of the relations between individual states, which has an extraordinary degree of influence on contemporary social, economic and political relations and processes. In our opinion, the appropriate linguistic construction of this “benchmarkˮ is “Saltation diffusion penetrationˮ (SDP). SDP is a “phenomenonˮ that is becoming a dangerous tool for exerting and realizing socio-political and economic tension. Its real manifestations strike the determinants of a social system, its basic (democratic) state principles, and last but not least are a direct threat to its security. [ABSTRACT FROM AUTHOR]

It is increasingly recognised that social determinants of health such as socioeconomic inequalities, parental education level, addiction behaviors, mental health difficulties and breast-feeding rates all influence immediate and long-term outcomes in neonatal intensive care unit (NICU) graduates. Awareness, recognition and appropriate management of these risks may help alleviate some of these effects. This review looks at various social determinants and their effects on patients and families in the NICU. [ABSTRACT FROM AUTHOR]

This article is the first half of a 2-part essay on the Social Determinants of Health (SDOH) as a field of scientific inquiry and theoretical framework, exploring its historical roots, current applications, and the controversies that surround it. Part 1 (this article) discusses the background and rationale of the SDOH framework, whilst part 2 (forthcoming) will analyze the current alternatives to this framework. The authors analyze the debate surrounding the contested term "social" in the field of health equity, through a clarification of the terms "social" and "social systems" and providing an alternative model through realist semantics and ethics. Despite the misunderstandings of the term "social," the authors argue that SDOH remains a useful umbrella term to capture the political, economic, cultural, and ecological determinants of health. Through this essay, the authors outline the reasons behind our decision to change this journal's title from International Journal of Health Services to International Journal of Social Determinants of Health and Health Services. [ABSTRACT FROM AUTHOR]

Objective: To examine a resource provision program for individuals living with moderate-to-severe traumatic brain injury (TBI), using a comparison of the resources provided across social differences of language, nativity, and neighborhood. Setting: The Rusk Rehabilitation TBI Model System (RRTBIMS) collects data longitudinally on individuals from their associated private and public hospitals, located in New York City. Participants: A total of 143 individuals with TBI or their family members. Design: An observational study of relative frequency of resource provision across variables of language, nativity, and neighborhood, using related-samples nonparametric analyses via Cochran's Q test. Main Measures: Variables examined were language, place of birth, residence classification as medically underserved area/population (MUA), and resource categories. Results: Results indicate that US-born persons with TBI and those living in medically underserved communities are provided more resources than those who are born outside the United States or reside in communities identified as adequately medically served. Language was not found to be a factor. Conclusion: Lessons learned from this research support the development of this resource provision program, as well as guide future programs addressing the gaps in health information resources for groups negatively impacted by social determinants of health (SDoH). An approach with immigrant participants should take steps to elicit questions and requests, or offer resources explicitly. We recommend research looking at what interpreter strategies are most effective and research on SDoH in relation to the dynamic interaction of variables in the neighborhood setting. [ABSTRACT FROM AUTHOR]

BACKGROUND: Socioeconomic disadvantage is associated with greater risks of hospital readmission and mortality among patients with heart failure (HF). However, it is less clear whether socioeconomic disadvantage has an immediate and lasting impact on the risk of admissions after the diagnosis of HF. METHODS: We used electronic health record data of patients aged 65 years and older with newly diagnosed HF between January 2015 and July 2018 in the Duke University Health System, with up to 8 years of follow-up. We assessed the association between neighborhood-level disadvantage, measured by the area deprivation index (lower, moderate, or higher) and hospital admissions within 30, 90, and 180 days after HF diagnosis using multivariable logistic regression models. We also assessed the risk of recurrent admissions over follow-up using Prentice, Williams, and Peterson models with total time. RESULTS: In our cohort of 5889 patients (mean [SD] age, 75 (6) years; 51% women; 67% non-Hispanic White), 71% of patients had at least one admission, and ≈50% of patients died over a median follow-up of 5.6 years. Unadjusted models showed that patients residing in higher disadvantaged neighborhoods had incrementally increasing risks for admissions within 30 days (odds ratio [OR], 1.17 [95% CI, 0.99–1.38]), 90 days (OR, 1.18 [95% CI, 1.03–1.35]), and 180 days (OR, 1.23 [95% CI, 1.08–1.40]) after diagnosis compared with patients in lower disadvantaged areas. These risks were no longer significant after adjusting for patients' clinical and nonclinical characteristics at 30 days (OR, 1.09 [95% CI, 0.90–1.31]), 90 days (OR, 1.07 [95% CI, 0.92–1.25]), and 180 days (OR, 1.10 [95% CI, 0.96–1.27]). However, patients living in higher disadvantaged areas had significantly greater risks of recurrent admissions over follow-up (hazard ratio, 1.11 [95% CI, 1.05–1.16]; P <0.001) compared with patients in lower disadvantaged areas. CONCLUSIONS: Our findings suggest that patients with HF residing in areas of socioeconomic disadvantage are at higher risk for recurrent admissions and thus should be considered for targeted intervention strategies. [ABSTRACT FROM AUTHOR]

Heightened sleep disturbances occur in adolescence, yet existing research has predominantly focused on individual factors linked to poor sleep and a limited set of sleep outcomes, such as sleep duration and timing. This scoping review aimed to identify the multilevel social determinants of adolescent sleep health across domains, including regularity, satisfaction/quality, alertness/sleepiness, timing, efficiency/continuity, duration, and behavior. Social determinants of health (SDoH) were categorized through a socio-ecological lens, while sleep health domains were aligned with the RU-SATED and Peds B-SATED sleep health frameworks. A systematic database search resulted in 57 studies of non-clinical adolescent and young adult populations (age 10–24 y) in North America, published between 2014 and 2022. Research gaps include 1) absence of other sleep health domains other than duration which is predicated on the included studies using a limited set of sleep outcome measures rather than a more comprehensive measurement strategy that align with the multifaceted domains of sleep health, and 2) inconsistent terminology and/or absent conceptual and operational definitions of subjective sleep reports. The findings highlight the multilevel SDoH that influence adolescent sleep health, underscoring the need for more comprehensive research. Such efforts will facilitate the development of interventions focused on fostering optimal adolescent sleep health this populations. [ABSTRACT FROM AUTHOR]

• Patients of marginalized racial groups experience lower odds of being electively admitted compared to White patients. • Black patients have an increased likelihood of poorer outcomes and increased length of stay for UIA compared to White patients. • Rates of in-hospital complications were not significantly different between races. Strong evidence demonstrates that race is associated with health outcomes. Previous neurosurgical research has focused predominantly on subjective data, such as patient satisfaction. Our objective was to assess whether racial disparities are present in primary objective outcomes for treatment of intracranial, unruptured aneurysms in the United States. Data from the 2012–2015 National Inpatient Sample (NIS) database was analyzed. Patients who underwent either open or endovascular treatment of unruptured intracranial aneurysms were included (n = 11663). Patients were stratified by race, and those of unknown race or whose race sample size was too underpowered for analysis were excluded (n = 1202), along with those who experienced head trauma (n = 110) or concurrent AVM (n = 71). Poor outcome was defined as in-hospital mortality, discharge to a nursing facility or hospice, placement of a tracheostomy tube, or placement of a gastrostomy tube. The associations between race and adverse outcomes were determined through multivariate logistic regression, corrected for potentially confounding variables such as age, sex, procedural type, elective procedure, obesity, diabetes, tobacco, severity of illness, and hospital type. 7478 White, 1460 Black, 1086 Hispanic, and 279 Asian patients were included in the final analysis. Complication rates were not significantly different between races, however Black patients experienced the highest proportion of complications (24 %). After adjusting for confounders, the odds of poor outcomes were significantly higher for Black patients (OR = 1.32 95 % CI: 1.07–1.62; p = 0.008) when compared to White patients. Black and Hispanic patients demonstrated a longer length of stay (Black, B: 0.04; 95 % CI: 0.03, 0.06; p < 0.001; Hispanic, B: 0.04; 95 % CI: 0.02, 0.05; p < 0.001) when compared to White patients. Our nationwide analysis using the NIS suggests that Black patients treated for unruptured intracranial aneurysms experience worse outcomes and longer lengths of stay when compared to White patients. Recognizing the differences in objective outcomes and the presence of neurosurgical healthcare disparities is an important first step in providing equitable care to all patients. Future studies that carefully follow the social determinants of health and consider more confounding factors in the association between outcomes and determinants are needed. [ABSTRACT FROM AUTHOR]

Using data from a large-scale screening program (N = 19634), we aimed to prospectively identify factors predicting uptake (i.e. acceptance of the invitation) and engagement (i.e. participation in at least two sessions) in a multi-component-intensive-behavioral-intervention for obesity-management (MBIOM) intervention targeting adolescents (n = 2862; 12–14 years; BMI ≥90th percentile). Approximately one third of adolescents most in need of weight management declined the initial invitation to enter the MBIOM. Poor diet, sedentary behavior, and parental education predicted willingness to enter and stay in the intervention, however measured body mass index did not matter. Perceived family support, instead of initial motivation, facilitated engagement. Our results provide new insights on the importance of regional socio-geographical factors including trust in local authorities. • Determinants of uptake of obesity management interventions are unknown due to non-participation. • 34 % of adolescents with morbid obesity declined uptake in this obesity management intervention. • Neither measured body mass index (BMI) nor readiness for change impacted uptake or engagement. • Living in a region of trust in local authorities was related to uptake. • Poor diet and low physical activity were determinants of uptake and engagement. [ABSTRACT FROM AUTHOR]

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Existing frameworks seek to elucidate the social, political, and commercial determinants of health in order to inform practice, policy, and research that can improve health and reduce health inequities. Each approach has widened the scope of public health practice and research and identified new partners and targets for intervention. But as the public health crises of the past decade have shown, these frameworks have not yet yielded insights that have enabled the public health profession and movement to prevent or overcome dominant threats to global health and health equity. This report explores the value of an integrated framework that combines insights from previous scholarship and practice using the social, political, and commercial determinants of health. It proposes the questions such an integration would need to answer and suggests processes and tasks that could lead to the creation of a blended framework. [ABSTRACT FROM AUTHOR]

Background: Prostate cancer (PCa) ranks high in terms of morbidity and mortality, especially in Africa. Prostate-specific antigen (PSA) screening remains a practical method of screening for and thereby detecting PCa early, especially among African men who are more negatively affected. Modifiable risk factors for PCa are mostly behavioural and lifestyle. Understanding community-specific determinants is important when developing health promotion interventions. Objective: This study aimed to determine the profile of African men with PCa in the Free State, South Africa. Method: A cross-sectional descriptive study was conducted using case record information and self-administered questionnaires among 341 African men with PCa attending the oncology and urology clinics of a tertiary hospital. Result: Participants' median age at diagnosis was 66 years. Only 76 (22.3%) participants had ever heard of PCa prior to being diagnosed with the disease, 36 (47.4%) of whom had ever had screening performed. The majority (n = 298, 87.4%) were symptomatic; < 50% sought medical help within six months. At diagnosis, 133 (39.0%) men presented with stage T3 or T4 disease, 75 (22.0%) with metastatic disease and 84 (24.6%) with Gleason score ≥ 8. Factors associated with advanced and high-grade disease included smoking, decreased sunlight exposure and physical activity, relatively increased ingestion of dairy products and red meat. Factors associated with early stage and low-grade disease included relatively increased ingestion of fruits, vegetables and fish. Conclusion: Advanced and high-grade PCa disease is not uncommon among men ≥ 60 years in this study setting. Certain modifiable risk factors associated with advanced disease were established in this study. The majority had lower urinary tract symptoms (LUTS) prior to PCa diagnosis, but they were of poor health-seeking behaviour. Although there seems not to be a systematic delay in the definitive diagnosis and initiation of treatment for PCa, there is a need to improve on health education and awareness in the study setting. [ABSTRACT FROM AUTHOR]

Little is known about the association between structural gender inequality and health in patriarchal China. This study employed a sample from the Chinese Women's Social Status, consisting of 26,139 participants aged 18 and 70 years (13,494 women and 12,645 men). Structural gender inequality was assessed at the macro-, meso-, and micro-levels. Mental health was measured by the summed scores of eight questions on depressive symptoms. Multilevel linear regression was applied for analysis. Results showed that total sex ratio at birth was associated with poorer mental health among women and men but sex ratio at birth of the second-born child predicted better mental health. Gender inequality at meso-level resulted in poorer mental health and gender inequality at microlevel was associated with poorer mental health both for men and women. Eliminating structural gender inequality promotes populations' mental health in China. [ABSTRACT FROM AUTHOR]

Introduction: Some evidence suggests that neighborhood socioeconomic disadvantage is associated with dementia‐related outcomes. However, prior research is predominantly among non‐Latino Whites. Methods: We evaluated the association between neighborhood disadvantage (Area Deprivation Index [ADI]) and dementia incidence in Asian American (n = 18,103) and non‐Latino White (n = 149,385) members of a Northern California integrated health care delivery system aged 60 to 89 at baseline. Race/ethnicity‐specific Cox proportional hazards models adjusted for individual‐level age, sex, socioeconomic measures, and block group population density estimated hazard ratios (HRs) for dementia. Results: Among non‐Latino Whites, ADI was associated with dementia incidence (most vs. least disadvantaged ADI quintile HR = 1.09, 95% confidence interval [CI] = 1.02–1.15). Among Asian Americans, associations were close to null (e.g., most vs. least disadvantaged ADI quintile HR = 1.01, 95% CI = 0.85–1.21). Discussion: ADI was associated with dementia incidence among non‐Latino Whites but not Asian Americans. Understanding the potentially different mechanisms driving dementia incidence in these groups could inform dementia prevention efforts. [ABSTRACT FROM AUTHOR]

Although it is widely accepted that acculturative processes are influenced by social systems, most studies focus on individual level determinants of acculturation (e.g., behaviours, psychological mechanisms, interpersonal/intergroup processes) in isolation from the social conditions of people's lives. In this article, first I provide a critical analysis of individualizing perspectives using the example of ageing and life course accumulation of disadvantage among migrants. Following this, I offer an alternative approach to studying the determinants of acculturative processes and adaptation. Borrowing from the public health literature, I introduce social determinants of health, also known as the causes of the causes. I highlight that deeply entrenched inequities in societies create the conditions for acculturation. Social structures pattern how migrants acculturate, whether they achieve positive outcomes, and the relationship between acculturative processes and cross-cultural adaptation. Finally, I offer some thoughts on advancing our empirical approach to acculturation by incorporating social determinants, such as inequities in socioeconomic position, along with individual level determinants into our models and interpretations. [ABSTRACT FROM AUTHOR]

• Forced Sexual Intercourse Victimization is strongly associated with depressive symptoms in both male and female adolescents, but the effect is larger in females. • Forced sex is also strongly associated with suicidal ideation and suicide attempts in both male and female adolescents, but the effect is larger in males. • Both male and female adolescents who attempt suicide requiring treatment have an extremely high probability—approximately 40%–of having a history of forced sexual victimization, which highlights the importance of screening adolescents for both sexual victimization and suicidality. Adolescents who have been forced to have sexual intercourse have higher rates of depressive symptoms and suicidality. This research investigated whether the association between adolescent forced sexual intercourse victimization and depressive symptoms or suicidality varies significantly by sex. This secondary analysis pooled cross-sectional data from the Youth Risk Behavior Survey 2001 through 2017 (N = 132,580) using R to estimate adjusted risk differences and additive interactions. Results show an extremely high prevalence of depressive symptoms and suicidality among adolescents who experience forced sexual victimization. This association is significantly higher among females for depressive symptoms, but significantly higher among males for suicide attempt or suicide attempt requiring treatment. also showed that approximately 40% of both males and females who attempted suicide requiring treatment also had a history of forced sexual intercourse victimization. These findings highlight the importance of screening for sexual victimization, depression and suicidality among adolescents. [ABSTRACT FROM AUTHOR]

OBJECTIVES: A children's hospital explored the feasibility and utility of social network analysis as a tool for system building in community child health, to identify gaps and opportunities in community partnerships, and to assess its role as a contributor to collective impact. METHODS: We employed social network analysis with the PARTNER survey to assess relationships among community-based organizations and a children's hospital's community-oriented programs. We utilized a two-stage, snowball sampling strategy to identify community partners. We analyzed social capital, network density, degree centralization, perceived trust, and perceived value. Network mapping depicted the hospital programs' relationships with community partners. RESULTS: Of the 153 contacted potential respondents, 76 responded for a response rate of 50%. Respondents reported a total of 1116 ties, ranging in strength from awareness and cooperation to coordination and integration. Approximately 60% of network members could reach 100 or more members in 2 steps or less. The overall network trust score was 74%. Network mapping indicated that hospital programs enhance bonding relationships within sectors, bridge gaps between partners from different sectors, and provide linkages to resources such as funders. Deficits in bonding, bridging, and access to funding are evident when the hospital's programs are omitted from network maps. CONCLUSIONS: Findings support the feasibility and utility of social network analysis as a tool for system building in community child health. The study demonstrates the potential of a children's hospital's programs to provide social capital in the form of bonding, bridging, and linking relationships. [ABSTRACT FROM AUTHOR]

The second edition of the Czech Republic's Report Card on Physical Activity for Children and Youth was released in 2022. This paper describes the development of the Report Card and presents a comprehensive summary of the main findings. The multi-level search strategy was developed by the national expert panel to identify the available sources that provide data related to the physical activity of Czech children and adolescents. The data were used to assign grades to ten core and two additional indicators. A total of 28 sources provided data that allowed grades to be assigned to 11 out of the 12 indicators. Grade B was assigned to six indicators (School: B+, Community and Environment: B, Organized Sport and Physical Activity: B–, Active Transportation: B–, Family and Peers: B–, Sleep: B–), grade C to three indicators (Overall Physical Activity: C+, Active Play: C, Physical Literacy: C), and grade D to two indicators (Government: D+, Sedentary Behaviors: D). No grade for the "Physical Fitness" indicator could be assigned due to a lack of data collected in the reference period 2018–2019. Although the family, school, and built environment provided a variety of opportunities to be physically active, a high proportion of children and adolescents did not meet the current physical activity guideline and were exposed to excessive sedentary behavior. A multisectoral and multidisciplinary response is required to reduce the health and economic burden of physical inactivity and excessive sedentary behavior among Czech children and adolescents. [ABSTRACT FROM AUTHOR]

Improvement in the quality of life is reflected in the narrowing of the gap between health-adjusted life expectancy (HALE) and life expectancy (LE). The effect of megacity expansion on narrowing the gap is rarely reported. This study aimed to disclose this potential relationship. Annual life tables were constructed from identified death records and population counts from multiple administrative sources in Guangzhou, China, from 2010 to 2020. Joinpoint regression was used to evaluate the temporal trend. Generalized principal component analysis and multilevel models were applied to examine the county-level association between the gap and social determinants. Although LE and HALE in megacities are increasing steadily, their gap is widening. Socio-economic and health services are guaranteed to narrow this gap. Increasing personal wealth, a growing number of newborns and healthy immigrants, high urbanization, and healthy aging have helped in narrowing this gap. In megacities, parallel LE and HALE growth should be highly considered to narrow their gap. Multiple social determinants need to be integrated as a whole to formulate public health plans. [ABSTRACT FROM AUTHOR]

In the United States (US), racial and ethnic minority populations experience poorer oral health than the general population. Social and commercial determinants of health embedded in structural and institutional racism and/or discrimination generate and exacerbate oral health inequities. We provide examples of oral health disparities (including oral health status and workforce issues) among selected racial and ethnic minority groups in the US. In addition, we compiled four priority areas based on research over the last two decades to guide actions to improve oral health equity. These four priority areas aim to improve health care models, interventions, and policies to help close gaps and reduce disparities in oral health and access to dental care. [ABSTRACT FROM AUTHOR]

This study reviewed data on the mode of delivery of medical abortion care (via face-to-face or telehealth) at a Family Planning service during the coronavirus (COVID-19) pandemic; April 2020 to March 2022. This was considered over time, in the context of changing eligibility criteria for Medicare-rebated telehealth services as well as patient demographic data. The study demonstrated that when Medicare rebates for telehealth are available for all those requiring abortion care, telehealth contributes to care provision alongside face-to-face services, and is more likely to be utilised by people living in regional and remote areas. This study investigated the impact of policy changes affecting Medicare-rebated telehealth services for medical abortion care at an Australian family planning service during the coronavirus (COVID-19) pandemic. Findings from clinical records highlight the need for continued provision of Medicare-rebated telehealth to promote equitable access to abortion care. [ABSTRACT FROM AUTHOR]

Several studies have shown that social isolation and loneliness are associated with the occurrence of psychotic experiences. However, dynamics of these phenomena in people with subclinical experiences, commonly referred to as psychotic-like experiences (PLEs), remains largely unknown. Therefore, in this study we performed a temporal network analysis to model dynamic predictions between social isolation, loneliness, negative affect, social stress, and PLEs. A total of 77 drug-naïve individuals with PLEs from a transdiagnostic sample were enrolled. Data were obtained using the experience sampling method (ESM). The ESM questionnaires were delivered during 7 consecutive days (6 assessments per day). Therefore, 3234 data entries were analyzed. Social isolation predicted next-moment emergence of PLEs through the effects on loneliness and negative affect. Also, PLEs appeared to predict next-moment loneliness, but not social isolation, through the effects on negative affect. Social stress did not predict any variables in the network. However, it was predicted by previous-moment PLEs and social isolation. Negative affect had the highest in-strength and out-strength centrality. Findings from the present study indicate that social isolation might predict the emergence of PLEs through the effects of momentary loneliness and negative affect. Also, loneliness might be bidirectionally associated with PLEs. Interventions targeting negative affect and social isolation might be beneficial in people with PLEs. • Social isolation predicts the emergence of psychotic-like experiences (PLEs). • This prediction is mediated by loneliness and negative affect. • PLEs predict loneliness, but not social isolation, through negative affect. • Negative affect may play a central role in people with PLEs. • Social stress might be predicted by social isolation and PLEs. [ABSTRACT FROM AUTHOR]

The HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social, and emotional development beginning prenatally and planned through early childhood. The charge of the HBCD Social and Environmental Determinants (SED) working group is to develop and implement a battery of assessments to broadly characterize the social and physical environment during the prenatal period and early life to characterize risk and resilience exposures that can impact child growth and development. The SED battery consists largely of measures that will be repeated across the course of the HBCD Study with appropriate modifications for the age of the child and include participant demographics, indicators of socioeconomic status, stress and economic hardship, bias and discrimination (e.g., racism), acculturation, neighborhood safety, child and maternal exposures to adversity, environmental toxicants, social support, and other protective factors. Special considerations were paid to reducing participant burden, promoting diversity, equity, and inclusion, and adopting trauma-informed practices for the collection of sensitive information such as domestic violence exposure and adverse childhood experiences. Overall, the SED battery will provide essential data to advance understanding of child development and approaches to advance health equity across infant and child development. [ABSTRACT FROM AUTHOR]

Social inequities and mental health are public health and medical conditions that are inextricably linked. Perinatal mental health is influenced by social, physical, and biological factors, with additional stressors related to pregnancy. The social determinants of health (SDOH) encompasses all conditions in which people live and grow, inclusive of cultural norms that reflect the diverse populations we serve. To best understand the mechanisms by which the SDOH affects perinatal mental health, we introduce the Urban Stress Model and describe the link between urban realities to stress response and potential mechanisms that link urban living to increased risk of adverse perinatal mental health. Given the increased diversity of patient populations, cultural considerations are paramount in understanding the utility and best practices in screening and interventions among ethnically diverse communities. Building on our Urban Stress Model and a structural determinants of health framework, we present examples of interventions to address the social inequities of perinatal mental health from the policy to community levels. [ABSTRACT FROM AUTHOR]

Despite increasing socioeconomic development in Indonesia the issue of child marriages remains prevalent among teenage females. To date, there have not been any nationally representative studies examining child marriage determinants via multivariate regression modeling in Indonesia. The following study used data from the 2019 Indonesian Population and Health Survey and the Teenage Reproductive Health Survey to estimate the determinants of child marriage and marital expectations. Multivariate simulations were carried out in order to approximate the association between demographic and socioeconomic characteristics and the following early marriage outcomes: 1) often married or cohabited, 2) married or cohabited before 19 years, 3) married or cohabited before 16 years, 4) self-reported marital age preferences and 5) behaviours that approve female child marriage. Among the child marriage research group, 17 percent reported being married before the age of 19 and 6 percent before 16 years of age (n = 6578, females aged 20-24 at the time of the survey). At approximately 26 years, the average respondent supported marriage, and 5 percent approved of child marriage (n = 8779, unmarried females 15-24). Schooling, wages and media participation have beneficial effects on marriage results, whereas rural residency is a risk factor. There are significant regional differences, reflecting the locations of geographically disparate religious, racial, and social elements. The following study addresses a gap in the knowledge of the Indonesian determinants of child marriage. There seems to be little tolerance for child marriage by girls and young people, suggesting an entry point for systemic interventions that might contribute to lasting progress. Future projects should point to cost-effectiveness factors and assist the government and women activists in understanding programs and strategies that can halt child marriage in Indonesia. Society should prioritize vigorous testing of gendertransformative education and methods for economic improvement. [ABSTRACT FROM AUTHOR]

The purpose of this project was to examine nurse anesthetists' practice and encounters with ambulatory surgery patients experiencing transportation difficulties after the provision of anesthesia. A mixed method approach was used. An eleven-item questionnaire was disseminated nationally to 2,827 Certified Registered Nurse Anesthetists (CRNAs) practicing in the outpatient setting. The survey consisted of multiple-choice questions and open text for qualitative assessment. Questions focused on frequency of encounters with patients experiencing transportation difficulties post-anesthesia and policies for rideshare options. A total of 43% of responding CRNAs work in a clinical practice setting in which patients have the option of being discharged using rideshare (Uber/Lyft) but only if accompanied by an adult. Issues emerged around patient safety when using a rideshare service for discharge postanesthesia. The proliferation of rideshare options may provide increased access to surgical services in the outpatient anesthesia care setting. Practice considerations associated with transportation policies for postanesthesia patients in the era of rideshare services are warranted. [ABSTRACT FROM AUTHOR]

Background: Participation was shown to be associative with subjective health (SH) in many different populations, including emerging adults. Objectives: This study aimed to investigate SH and associative variables in emerging adults with different levels of participation limitations. Methods: Healthy university students who were between 18–25 years of age were included. SH was assessed with the visual analog scale. The participants were grouped based on P-Scale. Multiple linear regressions were conducted to determine the associative variables of SH for each P-Scale group. Results: A total of 572 participants were included. General health-related quality of life was associated with SH in all P-Scale groups. Other prominent findings of this study showed perception of health, income, and lifestyle were among the most significant associative variables of SH. Conclusion: Variables associated with emerging adults' SH change with their participation restrictions. Therefore, different approaches are needed to improve the subjectively perceived health status of emerging adults. [ABSTRACT FROM AUTHOR]

Research suggests social connectedness may help older adults with dementia maintain cognitive functionality and quality of life. However, little is known about its specific social and biological mechanisms. This paper proposes two pathways through social bridging (i.e., cognitive enrichment through expansive social networks) and bonding (i.e., neuroendocrine benefits of integration in cohesive social networks). We provide preliminary evidence for these pathways using neuroimaging, cognitive, and egocentric social network data from the Social Networks and Alzheimer's Disease (SNAD) study (N = 280). We found that network size, density, and presence of weak ties (i.e., social bridging) moderated the association between brain atrophy and cognitive function, while marriage/cohabitation (i.e., social bonding) moderated the association between perceived stress and cognitive function. We argue that social connectedness may have downstream implications for multiple pathophysiological processes in cognitive aging, even negating existing structural damage to the brain, making it a strong candidate for clinical or policy intervention. [ABSTRACT FROM AUTHOR]

This research assessed social determinants of contraceptive use among a nationally representative sample of adolescents. This study analyzed nationally representative, publicly available data from the 2013-2015 National Survey of Family Growth (NSFG). The sample consisted of sexually active males and females between the ages of 15 and 19 (n = 775). Independent variables were social determinant questions asked on the NSFG, selected based on the Healthy People Social Determinants of Health Framework. We tested associations between adolescents' social determinants of health and 2 outcomes, use of any contraceptive at last sex, and effectiveness level of contraceptive method at last sex. Results indicated high contraceptive use at last intercourse (91.5%) and a significant association between any use of contraceptive and family structure (adjusted odds ratio [AOR] = 2.05, 95% confidence interval [CI] = 1.04-4.03), employment (AOR = 2.00, 95% CI = 1.06-3.77), and education (AOR = 3.43, 95% CI = 1.06-11.13). Few participants reported use of a highly effective method of pregnancy prevention (4.3%). In regression analyses, access to health care (AOR = 0.34, 95% CI = 0.14-0.84) and language and literacy (AOR = 2.92, 95% CI = 1.03-8.26) were found to be associated with using moderately effective contraceptive method to prevent pregnancy compared with not using any method. Although adolescents report overall high rates of contraceptive use, not all contraceptives have the same rates of effectiveness, and adolescents are often choosing those with lower effectiveness. This study found low rates of highly effective contraceptives to prevent pregnancy use (ie, intrauterine device and implant). It is also important to further explore the associations between family structure (measured in this study as intact childhood family) and distal links to contraceptive use. Future research should also further distinguish pathways to adolescent decision-making to use contraceptive methods to protect against STIs and pregnancy. [ABSTRACT FROM AUTHOR]

Objectives: Opioid use disorder (OUD) is a national epidemic, and Black and Hispanic patients are less likely to receive treatment when compared to white patients. In this study, race was used as a proxy to assess potential effects of racism on the referral process for OUD treatment. Our primary aim was to examine whether Black or Hispanic patients experienced increased barriers to inpatient OUD detoxification (detox) placement at a community-integrated, substance use disorder support program based in an emergency department (ED). Our secondary aim was to determine if Black and Hispanic patients were more likely to have >3 referrals.Methods: This retrospective cohort study was conducted at a large urban safety-net hospital and included patients seen in the ED from July 2018 to September 2019 with ICD-10 codes for an opioid-related visit and who sought placement to inpatient detox. A generalized linear mixed model controlling for multiple visits, age, sex, insurance, time, day of week, and time of year was used to assess the association between race/ethnicity and hypothesized barriers to placement. The proportion of patients with >3 visits for referral to inpatient detox was compared between Black and Hispanic patients and white patients using a chi-squared test.Results: We identified 1733 encounters from 782 unique patients seeking connection to inpatient detox for OUD. Of the 1733 encounters, 45% were among Black and Hispanic patients. Hispanic and Black men had significantly lower odds of having a barrier to inpatient OUD detox than white men (OR = 0.734, 95% CI 0.542-0.995). No significant difference was found for Hispanic and Black women (OR = 1.212, 95% CI 0.705-2.082). More Black and Hispanic patients experienced >3 referrals to inpatient detox compared to white patients (19.2% vs 12.9%, p = 0.016).Conclusions: This study suggests in the context of near-universal health insurance coverage, an ED-based OUD support program staffed by diverse community members can mitigate inequities in access to inpatient detox. However, the increased number of ED visits for OUD detox placement by Black and Hispanic patients suggests racial inequities in OUD treatment exist after linkage to care. Additional research should explore the causes, specifically structural and interpersonal racism, and determine solutions to address racial inequities in detox placement as well as maintenance in treatment programs. [ABSTRACT FROM AUTHOR]