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Sexual abuse has increased in Nigeria. In certain circumstances, relatives molest children. However, a stable marriage shields children against sexual abuse. It remains uncertain whether a stable marriage protects children from child sexual abuse when other relatives or domestic workers join the family. Using Dahrendorf's conflict theory, we argue that relatives or domestic workers living with the family increase the risk of child sexual abuse. We also claim that sexual abuse worsens victim's health.We employed a cross-sectional survey of 419 young people (16–24 years) across eight selected local governments in Lagos State through simple random and cluster sampling techniques. We analyzed the data using descriptive statistics, Chi-Square, and Logistic Regression. The study showed that living with parents compared to guardians reduced the odds of improper touch (OR: 0.23), and fingering (OR: 0.19). Also, having relatives live with the family compared to those who are not, reduced the odds of improper touch (OR: 0.22), but more likely to experience fingering (OR: 38.17). However, in a stable marriage, when other relatives live with the family young people are more likely to experience improper touch (OR: 3.46), fondling (OR: 18.53), and fingering (OR: 32.52). Child sexual abuse increases the odds of negative health outcomes like withdrawal from groups (OR: 3.10), pregnancy (OR: 6.99), hatred for the opposite sex (OR: 2.24), and suicidal thoughts (OR: 7.19), among others. Families with temporary or long-term relatives should be vigilant. Also, society formulates and implements policy frameworks to reduce child sexual abuse in the familiar cycles. [ABSTRACT FROM AUTHOR]

The healthcare system in the United States (US) is complex and often fragmented across national and regional health plans which exhibit substantial variability in benefit design and formulary policies for accessing medications. We propose an access-focused value assessment framework for formulary decision-making for medications to manage immune-mediated inflammatory diseases (IMIDs), where patients are at the center of this framework. Formulary decision-making for IMID medications can be a challenging, even daunting, task with continuously evolving and enhanced treat-to-target goals. Given the complexity of the US healthcare system, patients and their caregivers need assurance from formulary decision-makers that rapid, predictable, and sustained access to both well-established treatments and innovative therapies will be a priority, with a particular emphasis on continuity of effective care. This access-focused patient-centric (APAC) value assessment approach encompasses three "value components"—higher therapeutic goals, better health-related quality of life, and improved work productivity—the monetization of which can be derived using data from clinical trials when real-world data are yet to become available. Measures and assessment approaches are outlined to serve as a pragmatic tool for decision-makers in the US to ensure timely delivery and sustained access of clinically indicated therapies aimed to improve patient outcomes, enhance equity, and increase efficiency. Plain Language Summary: Formulary decision-making for immune-mediated inflammatory diseases can be complex, as more advanced therapies are developed and approved for multiple diseases, where clinical trial endpoints may vary substantially. We introduce an access-focused patient-centric framework as a decision tool maximizing patient centricity. It focuses on improvements in three core components: therapeutic outcomes, quality of life, and work productivity. Monetization of these components provides a common metric for payers to make informed decisions, allowing timely access for patients. [ABSTRACT FROM AUTHOR]

Background: Temporal discounting, the preference for immediate over delayed rewards, affects decision-making in domains like health and finance. Understanding the differences in how people discount health outcomes compared to monetary rewards is crucial to shaping health policy and technology assessments. Aim: This systematic review and meta-analysis aimed to compare temporal discounting parameters between health outcomes and monetary rewards and evaluate their overall relationship. Method: Studies were retrieved from PubMed, Embase, Web of Science, and the Cochrane Library up to December 2023. Standardized mean differences (SMD) assessed discounting differences between statistical indicators, and correlation coefficients were transformed into Fisher's Z scores. Subgroup analyses based on population, tradability, magnitude, sign, and experimental process explored potential heterogeneity. Results: A total of 32 studies were included: 29 studies (47 pairs of health and money) for the comparative meta-analysis and 19 studies (32 pairs) for the correlation meta-analysis. No significant differences were found between health and money discounting, although the individuals were more patient with the health outcomes and more impulsive with the money. In the sign effect subgroup, health discounting for delayed losses was lower than for monetary losses (SMD: − 0.293; 95% CI: − 0.458, − 0.129). The pooled correlation coefficient (r) for all studies was 0.333 (95% CI: 0.283–0.383), indicating a moderate association. In subgroup analysis, when the indicator was the discount rate, the pooled r value for 16 studies was 0.278 (95% CI: 0.231, 0.325). Conclusion: Although no significant statistical differences were found between health and money discounting, a moderate correlation was observed, supporting consistent discount rate settings for health technology assessments. [ABSTRACT FROM AUTHOR]

Background: Better health literacy has been found to be associated with better health outcomes across varied populations. This study aimed to (1) examine the health literacy levels of individuals with respect to the extent to which they acquire, understand, appraise, and apply health information, and (2) to assess the relationship between health literacy and self-reported health in the state of Delaware. Methods: The sampling frame consisted of 60 purposively selected faith-based organizations across the state of Delaware who predominantly serve minorities. Accounting for clustering design, a sample size was determined based on a Mixed Methods test. In total, 1095 participants responded to a survey questionnaire which included a validated short version of the European Health Literacy Questionnaire (HLS-EU-Q16). The data was analyzed using descriptive statistics, reliability techniques, chi-square test of independence, and ordinal logistic regression. Results: The study found that about a quarter of the participants had inadequate level of health literacy and about another quarter had problematic level of health literacy. These results are reflected across the health domains—health care, disease prevention, and health promotion. Health literacy was predictor of self-rated health. The odds of better self-rated health are 0.360 times lower for people with inadequate health literacy levels compared to those with sufficient health literacy. Conclusion: Health literacy profoundly shapes health outcomes. The high proportion of people expressing difficulty concerning accessing, comprehending, appraising, and using health information in the health care, disease prevention, and health promotion domains in state of Delaware would require a concerted effort. [ABSTRACT FROM AUTHOR]

Guided by the bio-psycho-socio-spiritual approach, this randomized controlled trial assessed the efficacy of a self-forgiveness intervention among 60 HIV-positive individuals in Poland. Participants underwent a 90-min "Restore: The Journey Toward Self-Forgiveness" session, in contrast to a wait-list control group. The intervention significantly enhanced self-forgiveness, spirituality, mental well-being, and heart rate variability in response to a cognitive stressor (i.e., a mental arithmetic challenge). Significant effects were observed in both between-group and within-subject comparisons. These results support the incorporation of self-forgiveness into psychological rehabilitation programs for HIV to improve quality of life and health outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Low-value care is common in intensive care units (ICUs), unnecessarily exposing patients to risks and harms, incuring costs to the patient and healthcare system, and contributing to healthcare's carbon footprint. We aimed to identify, collate, and summarise published evidence on the impact of interventions to reduce low-value care in ICUs. Methods: We searched MEDLINE, Embase, and Cochrane CENTRAL from inception to 22 September 2023 for evaluations of interventions aiming to reduce low-value care, supplemented by reference lists and recently published articles. We recorded impacts on the low-value target, health outcomes, resource use, cost, and the environment. Results: From 1155 studies screened, 32 eligible studies were identified evaluating interventions to reduce: routine blood testing (n = 13), routine chest X-rays (n = 10), and other types (or multiple types) of low-value care (n = 9). All but 3 of the interventions found reductions in the immediate low-value care target (usually the primary outcome). Although the small sample size of most included studies, limited their ability to detect impacts on other outcomes, many interventions were also associated with improved health outcomes and financial savings. The only study that reported environmental impacts found the intervention was associated with reduced carbon dioxide equivalent (CO2-e) emissions. Conclusions: Interventions to reduce low-value care in ICUs may have important health, financial, and environmental co-benefits. Further research may inform wider scale-up and sustainability of successful strategies to decrease low-value healthcare. More empirical evidence on potential environmental benefits may inform policies to lower healthcare's carbon footprint. [ABSTRACT FROM AUTHOR]

Empirical evidence for a low normal or reference interval for serum prolactin (PRL) is lacking for men, while the implications of very low PRL levels for human health have never been studied. A clinical state of "PRL deficiency" has not been defined except in relation to lactation. Using data from the European Male Ageing Study (EMAS), we analyzed the distribution of PRL in 3,369 community-dwelling European men, aged 40–80 years at phase-1 and free from acute illnesses. In total, 2,948 and 2,644 PRL samples were collected during phase-1 and phase-2 (3 to 5.7 years later). All samples were analysed in the same centre with the same assay. After excluding individuals with known pituitary diseases, PRL ≥ 35 ng/ml, and PRL-altering drugs including antipsychotic agents, selective serotonin reuptake inhibitors, or dopamine agonists, 5,086 data points (2,845 in phase-1 and 2,241 in phase-2) were available for analysis. The results showed that PRL declined minimally with age (slope = -0.02) and did not correlate with BMI. The positively skewed PRL distribution was log-transformed to a symmetrical distribution (skewness reduced from 13.3 to 0.015). Using two-sigma empirical rule (2[]SD about the mean), a threshold at 2.5% of the lower end of the distribution was shown to correspond to a PRL value of 2.98ng/ml. With reference to individuals with PRL levels of 5-34.9 ng/ml (event rate = 6.3%), the adjusted risk of developing type 2 diabetes increased progressively in those with PRL levels of 3-4.9 ng/ml: event rate = 9.3%, OR (95% CI) 1.59 (0.93–2.71), and more so with PRL levels of 0.3–2.9 ng/ml: event rate = 22.7%, OR 5.45 (1.78–16.62). There was also an increasing trend in prediabetes and diabetes based on fasting blood glucose levels was observed with lower categories of PRL. However, PRL levels were not associated with cancer, cardiovascular diseases, depressive symptoms or mortality. Our findings suggest that a PRL level below 3 ng/ml (64 mlU/l) significantly identifies European men with a clinically-important outcome (of type 2 diabetes), offering a lower reference-value for research and clinical practice. [ABSTRACT FROM AUTHOR]

Childhood adversity is linked to psychological, behavioral, and physical health problems, including obesity and cardiometabolic disease. Epigenetic alterations are one pathway through which the effects of early life stress and adversity might persist into adulthood. Epigenetic mechanisms have also been proposed to explain why cardiometabolic health can vary greatly between individuals with similar Body Mass Index (BMIs). We evaluated two independent cross-sectional cohorts of adults without known medical illness, one of which explicitly recruited individuals with early life stress (ELS) and control participants (n = 195), and the other a general community sample (n = 477). In these cohorts, we examine associations between childhood adversity, epigenetic aging, and metabolic health. Childhood adversity was associated with increased GrimAge Acceleration (GAA) in both cohorts, both utilizing a dichotomous yes/no classification (both p < 0.01) as well as a continuous measure using the Childhood Trauma Questionnaire (CTQ) (both p < 0.05). Further investigation demonstrated that CTQ subscales for physical and sexual abuse (both p < 0.05) were associated with increased GAA in both cohorts, whereas physical and emotional neglect were not. In both cohorts, higher CTQ was also associated with higher BMI and increased insulin resistance (both p < 0.05). Finally, we demonstrate a moderating effect of BMI on the relationship between GAA and insulin resistance where GAA correlated with insulin resistance specifically at higher BMIs. These results, which were largely replicated between two independent cohorts, suggest that interactions between epigenetics, obesity, and metabolic health may be important mechanisms through which childhood adversity contributes to long-term physical and metabolic health effects. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: This scoping review aims to summarize recent literature exploring the associations between caregiving and resident, formal and informal caregiver health in long-term care before and during the COVID-19 pandemic. Findings: Based on the thematic analysis of 20 records out of 252 identified records, we summarized themes of biological, psychological, and social health among care givers, care workers and residents. Message: This review finds that the long-term care sector needs significant improvements in infrastructure and resources to better support caregiving, thereby enhancing the emotional, psychological, and social health of residents, formal and informal caregivers, particularly during and after crisis situations like the COVID-19 pandemic. Purpose: The COVID-19 pandemic magnified pre-existing socioeconomic, operational, and structural challenges in long-term care across the world. In Canada, the long-term care sector's dependence on caregivers as a supplement to care workers became apparent once restrictive visitation policies were employed. We conducted a scoping review to better understand the associations between caregiving and resident, formal and informal caregiver health in long-term care before and during the COVID-19 pandemic. Methods: A literature search was performed using MEDLINE, AgeLine, Google Advanced, ArXiv, PROSPERO, and OSF. Pairs of independent reviewers screened titles and abstracts followed by a review of full texts. Studies were included if they reported biological, psychological, or social health outcomes associated with caregiving (or lack thereof). Results: After screening and reviewing 252 records identified by the search strategy, a total of 20 full-text records were eligible and included in this review. According to our results, research on caregiving increased during the pandemic, and researchers noted restrictive visitation policies had an adverse impact on health outcomes for residents and formal and informal caregivers. In comparison, caregiving in long-term care prior to the pandemic, and once visitation policies became less restrictive, led to mostly beneficial health outcomes. Conclusion: Caregiver interventions, for the most part, appear to promote better health outcomes for long-term care residents and formal and informal caregivers. Suggestions to better support caregiving in long-term care settings are offered. [ABSTRACT FROM AUTHOR]

Purpose: Presenteeism, the phenomenon of employees working despite illness, is a significant issue globally, impacting individual well-being and organizational efficiency. This study examines presenteeism among Swiss employees, exploring its occurrence, primary factors, reasons, and impact on employees' health. Methods: This study used cross-sectional data from 1,521 employees in different sectors in Switzerland. Descriptive statistics and multiple linear models for influencing factors and detrimental effects, such as burnout symptoms, job satisfaction, general health, and quality of life, were calculated for data analysis. Presenteeism was measured using the Hägerbäumer multi-item scale, ranging from 1 = "Never in case of illness" – 5 = "Very often in case of illness." Results: The employees reported that in case of illness, they rarely worked in the last 12 months M = 2.04 (SD = 1.00). A positive approach to presenteeism in the team was associated with less presenteeism (β = -0.07) and problematic leadership culture in dealing with presenteeism with increased presenteeism (β = 0.10). In addition to well-known factors, presenteeism was significant for burnout symptoms (β = 1.49), general health status (β = -1.5), and quality of life (β = -0.01). Conclusion: The study offers insights into the phenomenon of presenteeism among Swiss employees in various sectors by applying a multi-item scale for presenteeism. The findings indicate that a positive team dynamic and organizational culture may significantly reduce presenteeism. Presenteeism behavior is a significant factor of adverse outcomes. This highlights the importance of acknowledging presenteeism in the context of occupational health. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the association between intuitive eating and health outcomes in patients with type 2 diabetes in a cross-sectional study. Methods: Consecutively, outpatients attending at university hospital underwent clinical, laboratory, lifestyle, and eating behavior evaluations. Intuitive eating was assessed using the Intuitive Eating Scale-2 (IES-2), and the Three Factor Eating Questionnaire-21 was adopted as a confirmatory tool for disordered eating behavior. Optimized health outcomes were considered according to the American Diabetes Association criteria for BMI, HbA1c, lipid profile, and blood pressure values, and the International Diabetes Federation criteria for waist circumference. Considering the answers of the IES-2 items, patients were grouped by latent class analysis, and their characteristics were compared by appropriate tests. Results: In total, 267 patients were evaluated: 62.2% women, with 60 (53–65) years, BMI 31.9 ± 5.4 kg/m², diabetes duration of 16 ± 9 years, HbA1c 8.5 ± 1.5%, and an IES-2 total score of 58 (50–67)%. Three intuitive eating groups were identified: higher intuitive eating, nonemotional-oriented coping, and lower intuitive eating. Patients with higher intuitive eating have higher chances of having optimized BMI and serum triglycerides values compared to patients with lower intuitive eating. Also, the 10-point increase on IES-2 was associated with a 0.62 kg/m² reduction on BMI values (95%CI -1.18;-0.06), 1.90 cm on waist circumference (95%CI -3.26;-0.54), and 23 mg/dL in serum triglycerides values (95%CI -38.27;-7.40) after adjustment for age, sex, psychotropic drug use, medication effect score, smoking, and BMI. Conclusion: Intuitive eating seems to be associated with optimized health outcomes and may contribute to better personalized interventions in nutritional treatment that promote adaptive behaviors in diabetes management, but should be tested. [ABSTRACT FROM AUTHOR]

This research analyses the nexus between financial inclusion, digital inclusion and health outcomes in developing countries. In comparison with earlier studies, this study demonstrates an important research gap in addressing the combined impact of these factors. Basically, this research analyses the role of traditional banking and fintech in increasing financial inclusion and ultimately, enhancing health indices in emerging markets. By developing an index based upon the Entropy Weight Method, we show unique insights into bank and fintech-based financial inclusion, health outcomes and digital inclusion in these countries. Our results also show that digital inclusion plays a moderating role on the influence of financial inclusion on health outcomes. We evidenced that well-designed policies emphasising improvement in traditional and digital financial inclusion could potentially improve health outcomes in emerging markets. We also evidenced that improvement in digital inclusion (i.e., adoption of ICT) can facilitate improvement in both digital financial inclusion and health outcomes. Based upon our study, policymakers can utilise the index that we developed to compare health outcomes between different countries as well as to develop effective strategies for improvement in financial and digital inclusion. Our study emphasises the significance of understanding the multifaceted advantages of financial and digital inclusion in the development of health policies particularly in emerging markets. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: The aim of this article is to present a systematic literature review focused on microbiome diversity in women experiencing pelvic floor dysfunction. Methods: Utilizing PubMed/MedLine and Scopus, 25 pertinent studies were meticulously selected for this review. Results: A key theme identified is the potential of microbiomes as diagnostic tools. The findings consistently highlight Lactobacillus as recurrent microbiota. Additionally, Gardnerella, Streptococcus, Prevotella, Aerococcus, Staphylococcus, Proteus, and Bifidobacterium species were frequently observed. This suggests the influential role of these microorganisms in shaping female urological and reproductive health. A deeper understanding of these predominant bacterial genera could offer invaluable insights into healthy physiological states and various disorders. The complex relationship between microbial compositions and diverse health conditions paves the way for novel diagnostic and therapeutic approaches. As we further explore the complexities of microbiomes, their role becomes increasingly crucial in transforming women's health care. Conclusions: These findings emphasize the need for personalized care, integrating the microbiome into a comprehensive health assessment and treatment framework. This review lays the groundwork for future medical strategies where the microbiome is a pivotal element in both preventive and therapeutic care. [ABSTRACT FROM AUTHOR]

Objectives: Given the escalating demand for care services, understanding the impact of informal caregiving, providing unpaid care for family members, on own health is essential. This study longitudinally analyzed the association of caregiving (and different caregiver types) with mental, physical, and self-rated health. Urban–rural, gender, and employment heterogeneity were further investigated. Method: Based on three-wave data (2011, 2013, and 2018) from the China Health and Retirement Longitudinal Study, we used growth curve models to assess the impact of informal caregiving (providing care to family members) and caregiver types (caregivers to grandchildren, parents, spouses, or multiple family members) on three health outcomes (depressive symptoms, self-rated health, and activities of daily living limitations). Results: Our study included 13,377 individuals. Results showed a negative correlation of caregiving with mental, physical, and self-rated health. Compared to noncaregivers, spousal caregivers and multiple caregivers were both associated with worsening mental, self-rated, and physical health. In contrast, adult child caregivers were only negatively associated with mental health, and grandparent caregiving did not significantly affect any health outcomes. Further heterogeneity analysis showed that gender did not moderate the relationship between caregiving and health, whereas the negative association between caregiving and health was more pronounced among the rural population and those employed in agriculture. Discussion: Findings from the present study suggest that caregiving is detrimental to health, and recommend considering caregiver type when examining caregiving and health. These findings have vital implications for policymakers in addressing the challenges of structuring and implementing a sustainable informal care system. [ABSTRACT FROM AUTHOR]

Introduction: Given the chronic nature of psoriasis (PsO), more studies are needed that directly compare the effectiveness of different biologics over long observation periods. This study compares the effectiveness and durability through 12 months of anti-interleukin (IL)-17A biologics relative to other approved biologics in patients with moderate-to-severe psoriasis in a real-world setting. Methods: The Psoriasis Study of Health Outcomes (PSoHO) is an ongoing 3-year, prospective, non-interventional cohort study of 1981 adults with chronic moderate-to-severe plaque psoriasis initiating or switching to a new biologic. The study compares the effectiveness of anti-IL-17A biologics with other approved biologics and provides pairwise comparisons of seven individual biologics versus ixekizumab. The primary outcome was defined as the proportion of patients who had at least a 90% improvement in Psoriasis Area and Severity Index score (PASI90) and/or a score of 0 or 1 in static Physician Global Assessment (sPGA). Secondary objective comparisons included the proportion of patients who achieved PASI90, PASI100, a Dermatology Life Quality Index (DLQI) score of 0 or 1, and three different measures of durability of treatment response. Unadjusted response rates are presented alongside the primary analysis, which uses frequentist model averaging (FMA) to evaluate the adjusted comparative effectiveness. Results: Compared to the other biologics cohort, the anti-IL-17A cohort had a higher response rate (68.0% vs. 65.1%) and significantly higher odds of achieving the primary outcome at month 12. The two cohorts had similar response rates for PASI100 (40.5% and 37.1%) and PASI90 (53.9% and 51.7%) at month 12, with no significant differences between the cohorts in the adjusted analyses. At month 12, the response rates across the individual biologics were 53.5–72.6% for the primary outcome, 27.6–48.3% for PASI100, and 41.7–61.4% for PASI90. Conclusions: These results show the comparative effectiveness of biologics at 6 and 12 months in the real-world setting. [ABSTRACT FROM AUTHOR]

Purpose: Advancements in medical treatments have resulted in increased medical costs for cancer patients. More than half of the patients with advanced lung cancer reported unmet financial needs. The purpose of this study is to examine the differences in the prevalence and correlates of financial hardship between middle- and older-aged patients with advanced lung cancer, and its impact on multiple health-related outcomes. Methods: This study presents a cross-sectional analysis involving 226 patients with advanced lung cancer, who were enrolled in a randomized controlled trial conducted between 2018 and 2020. Data collection was performed through self-reported questionnaires and electronic medical records. Multivariable logistic and linear regression models were adopted for analysis. Results: 58.0% reported experiencing financial hardships. Middle-aged participants who were single and had a lower education level were more likely to experience financial difficulties. However, males and higher performance status were associated with a lower likelihood of experiencing financial difficulties among older-aged participants. Financial hardship was significantly associated with anxiety (p < 0.001), depression (p < 0.001), sleep disturbances (p < 0.001), quality of life, global health status (p = 0.002), functional scale score (p < 0.001), symptom scale score (p < 0.001), and lung cancer-specific scale score (p < 0.001). Conclusions: More than half of the patients with advanced lung cancer experienced financial hardships caused by cancer or its treatment, with a higher prevalence reported in middle-aged patients. Different sociodemographic and clinical variables correlated with financial hardship in middle- and older-aged participants, respectively. More attention should be paid to middle-aged patients with advanced lung cancer, particularly during routine assessments. [ABSTRACT FROM AUTHOR]

Purpose: To examine factors of influence in diabetes management and their association with self-reported health outcomes in patients with type 2 diabetes treated at Federally Qualified Health Centers (FQHCs). Methods: This cross-sectional study examined data from the 2014 Health Center Patient Survey (HCPS). Predictor variables were categorized across three levels of the National Institute on Minority Health and Health Disparities research framework. Outcome variables retrieved from HCPS included self-reports of blood glucose levels, and diabetes-related emergency department (ED)/hospital visits during past year. Results: A total of 936 patients with diabetes were included. Most (65%) participants received a diabetes self-management plan. During the previous year, 72% received > = 2 A1C checks, 52% reported high blood glucose levels, and 12% visited an ED/hospital. Multivariable results showed that insulin use and receiving a self-management plan were associated with high blood glucose levels and ED/hospital visits. Community factors of being unable to get medications and receiving a specialist foot exam were respectively associated with high blood glucose levels and ED/hospital visits. Conclusion: Different factors were associated with health outcomes in patients with diabetes treated at FQHCs. Identifying these factors can help with targeted screening and follow-up and assessing potential interventions to improve health outcomes. [ABSTRACT FROM AUTHOR]

This study presented a radically different approach to efficiency evaluation based on the impact of the Socioeconomic and Behavioral health determinants framework on health outcomes for the countries of Middle-East region. The level of education, employment, and the percentage of the population living in the rural area constitutes the socioeconomic framework. The prevalence of tobacco smoking and alcohol consumption formed the behavioral framework. The model considers life expectancy at birth and mortality rate from non-communicable diseases as health outcomes. The econometric models of the PLS-SEM, the DEA, and the Malmquist TFP index are used to analyze the data. The DEA results highlight differences in the impact of socioeconomic and behavioral health determinants on health outcomes across the countries of the Middle-East region. Finally, evidence from the Malmquist TFP index shows an improvement in health production between the periods 2006–2017. Moreover, a substantial gap in efficiency is observed between economically prosperous countries and others who are less well-off. Furthermore, socioeconomic and behavioral frameworks positively impact life expectancy at birth. Similarly, the two frameworks have a negative impact on the mortality rate from chronic non-communicable diseases. A higher impact on health outcomes is observed in the socioeconomic as a behavioral framework in the model. The study's results have contributed to the policymakers, citizens, and the country's government to compare the health system efficiencies across the middle-east region, which would help achieve the health outcome more efficiently. [ABSTRACT FROM AUTHOR]

Previous studies have suggested the impact of intervention fidelity on the management and prevention of chronic diseases; however, little is known about the effect of the contributing determinants (at multiple levels of influence) that can impact health-related interventions intending to improve the health status of Hispanic adolescents with overweight or obesity. The current study aimed to assess whether fidelity (i.e., dosage and quality of the program delivery), acculturation (i.e., orientation to the American culture, retention of Hispanic cultural values), and individual-level socio-demographic characteristics (i.e., income, education) predict changes in family processes (e.g., parent control), which in turn may affect adolescent health-related outcomes including body mass index (BMI), physical activity, dietary intake, and adolescents' health-related quality of life. A pathway analysis model was utilized to explore the study variables among 140 Hispanic parent-adolescent dyads randomized to Familias Unidas Health and Wellness (FUHW) intervention. Results indicated that fidelity was significantly associated with changes in parent-adolescent communication, parent monitoring, limit-setting, and control. Parents' education was associated with changes in parent limit-setting, and parent Hispanicism was associated with changes in parent limit-setting and discipline. The examination between family processes and adolescent health outcomes revealed that parents' higher discipline and improved communication with their adolescents were significantly associated with improved adolescents' quality of life, and parent control was positively associated with physical activity and negatively associated with BMI in adolescents. Our findings demonstrated the significant contribution of intervention fidelity and participants' characteristics in parenting strategies leading to adolescents' health outcomes to prevent obesity-related chronic diseases. Future research is needed to investigate the effect of environmental and organizational factors on the delivery of the intervention materials. [ABSTRACT FROM AUTHOR]

Background: There is a lack of studies examining the influence of programmed cell death protein 1 (PD-1) inhibitors on the health outcomes of cancer patients in China. Aim: This study aimed to evaluate prospective health outcomes associated with introducing PD-1 inhibitor treatment in China over five years. Method: We constructed a partitioned survival model to assess disparities in health outcomes over a 5-year time frame between two scenarios: one involving the availability of PD-1 inhibitor class with standard of care and the other involving standard of care alone. The impact on various health outcomes were assessed, including life years (LYs) gained, quality-adjusted life years (QALYs) gained, progression-free survival (PFS) years gained, the reduction in the number of grade 3–5 adverse events (AEs), and the improvement in objective remission rates (ORR). A sensitivity analysis was conducted to assess the robustness and reliability of the model. Results: From 2023 to 2027, the incorporation of PD-1 inhibitor class treatments was anticipated to yield substantial improvements in health outcomes, with an estimated increase of 1,336,332 LYs (+ 24.7%), 1,065,359 QALYs (+ 30.3%), and 1,177,564 PFS years (+ 57.4%) compared to standard of care alone. Simultaneously, the number of grade 3–5 AEs decreased by 334,976 (− 13.0%), and the ORR saw a 19.1% increase (+ 105.6%) relative to standard of care treatment alone. Conclusion: This study provides a analysis of the potential beneficial effects on health outcomes in the Chinese population after introducing PD-1 inhibitor class treatment. The findings suggest the PD-1 inhibitor class will significantly improve patient survival. [ABSTRACT FROM AUTHOR]

Background: Since 2010, most tertiary care hospitals in Australia have changed how they care for extremely premature infants. However, in-hospital and longer-term outcome data have suggested unchanged or even worse health outcomes in later epochs, especially respiratory outcomes. This study examined the trend in outcomes since these changes were introduced, particularly the prevalence of chronic neonatal lung disease (CLD). Methods: This is a retrospective cross-sectional analysis of data from the Neonatal Intensive Care Units' (NICUS) database of all perinatal intensive care units in New South Wales and the Australian Capital Territory, including infants born at ≥ 24 and ≤ 28 weeks of gestational age in tertiary perinatal units between January 1, 2010, and December 31, 2020. Temporal trends and changes in primary outcome were examined by linear and adjusted multivariable logistic regression models. Results: This study included 3258 infants. We saw significant changes in antenatal magnesium sulfate (75% increase), delayed cord clamping (66% increase), delivery room intubations (30% decrease), any time (20% decrease), duration on mechanical ventilation (100-hour decrease), and hours on noninvasive ventilation (200-hour increase). Mortality decreased from 17% to 6%. The incidence of CLD increased significantly even when adjusted for confounders (15% increase). Any time and mean hours spent on mechanical ventilation significantly increased the odds of CLD. This study could not find a significant association of any of the protective antenatal treatments on CLD. Conclusions: The last decade saw a significant improvement in survival and survival to discharge without major morbidity. There was increased use of magnesium sulfate, delayed cord clamping, and less invasive respiratory management of extremely preterm infants. The avoidance of mechanical ventilation may impact the incidence of CLD. [ABSTRACT FROM AUTHOR]

Purpose of Review: Although pervasive inequities in the health outcomes of youth and young adults with type 1 diabetes (T1D) exist, the role of provider bias in these inequities is not well-understood. The purpose of this review is to synthesize evidence from existing studies on the associations between patient characteristics, provider bias, and patient health. Recent Findings: Fourteen articles were included. Determining the extent of the effects of provider bias on patient health is limited by a lack of consensus on its definition. Experiences of provider bias (e.g., shaming, criticism) negatively affects self-esteem, relationships with medical providers, and depressive symptoms. Provider bias also impacts diabetes technology recommendations, insulin regimen intensity, and risk for life-threatening T1D complications. Summary: Future studies are needed to develop questionnaires and interviews that better account for diverse experiences and interpretations of bias in T1D healthcare. More research is also needed to investigate mitigating factors to reduce provider bias as a way to improve psychological and physical health in individuals with T1D. [ABSTRACT FROM AUTHOR]

Coping skills have been shown to contribute significantly to law enforcement officers' ability to manage a variety of personal and professional stressors. Research has identified various coping styles without a consensus as to which styles are most beneficial. The objective of this study was to examine US law enforcement officers' coping styles and to determine if a particular coping style was equated with the best health outcomes. In a national representative sample of 1517 law enforcement officers, latent class analysis was applied to determine heterogeneity of coping styles. Subsequent classes were modeled as predictors of both behavioral and mental health challenges and constructive health behaviors. Results indicate that coping styles predict officers' perceived stress, anxiety and depression, suicidality, alcohol abuse, and diet. Specifically, a task-oriented, problem-focused coping style was most effective. These findings highlight the importance of training officers to manage adversity with the most effective coping strategies. [ABSTRACT FROM AUTHOR]

Access to health services can differ greatly based on ethno-racial identity and immigration status. We examined the reporting of ethno-racial data and immigration status in published literature on the health of newcomer children. An integrative scoping review was performed using the methodological framework outlined by Arksey and O'Malley (2005). 4147 articles were identified and 75 studies included in the final analysis. 67% (50/75) did not describe the participants immigration status at all. Most studies (65%, 49/75) also did not report participants' ethno-racial identities. Of those that did, 65% (17/26) reported participant ethnicity alone, and 15% (4/26) reported race alone, while 19% (5/26) reported both race and ethnicity. We found that most studies on newcomer children did not report immigration status or ethno-racial identity. In doing so, studies may ignore the specific impacts of racism and xenophobia on health and access to care. [ABSTRACT FROM AUTHOR]

In the last four decades, advances in assisted reproductive technology (ART) have offered hope to individuals with fertility problems to conceive. However, a closer examination of the clinical outcomes of ART shows a stark contrast in Asian women compared to Caucasians, with majority of studies reporting lower reproductive success among Asian women. We performed a systematic review to elucidate the genes associated with ART clinical outcomes, with a focus on Asian ethnicities. We completed a database search to identify all studies associated with reproductive outcomes in women of different ethnic backgrounds. Following PRISMA, 128 studies were analyzed. Pathway analysis of gene sets was done using Cytoscapev3.4.0. We observed that age at menarche (AAM) was correlated with the timing of the first pregnancy, with Hawaiians having the lowest age (22.2 years) and Japanese the highest age (25.0 years). LIN28 mutations were associated with AAM and prevalent in both Chinese and American populations. FMR1 was most associated with ovarian reserve. Network analysis highlighted a close association between FMR1, FSHR, ESR1, BMP15, and INHA, through biological functions affecting menstrual cycle and hypothalamic-pituitary axis and therefore ovarian follicle development. Leveraging these findings, we propose the development of a personalized, ethnic-specific biomarker panel which would enhance patient stratification to address every woman's unique reproductive potential. [ABSTRACT FROM AUTHOR]

While there has been a proliferation in gay dating app (GDA) use in China, research into their potential effects on health outcomes, particularly mental health outcomes, among gay and bisexual men is lacking. The motivations for GDA use are diverse, and understanding users' motivation profiles may provide a necessary starting point for exploring the heterogeneous effects of GDA use on health outcomes. A cross-sectional survey of the motivations for GDA use and other health outcome variables (i.e., condom use frequency, self-stigma, and subjective emptiness) was conducted among 366 Chinese gay and bisexual men. The results of exploration structure equation modeling indicate that the GDA Use Motivation Scale, with a four-factor first-order model, had strong psychometric properties. Then, latent profile analysis (LPA) based on the mean scores of four aspects of motivation was performed. The results of the LPA revealed the existence of four profiles: "Weak motivations" (30.9%), "Differentiated motivations" (17.8%), "Moderate motivations" (30.3%), and "Strong motivations" (21.0%). Differences in health outcomes among the motivation profiles were found by using the Bolck–Croon–Hagenaars approach. Overall, most participants (60.1%) tended to use condoms consistently, regardless of how strong their GDA use motivation was; however, stronger GDA use motivations were associated with higher levels of self-stigma and subjective emptiness. We call for more research to focus on the real needs behind and motivations for GDA use so that all such app users' voices can be heard, as well as to raise awareness about the potential health risks associated with GDA use among Chinese gay and bisexual men. [ABSTRACT FROM AUTHOR]

Considering advances in HIV prevention and treatment, jurisdictional efforts to end the HIV/AIDS epidemic, and reduced stigma towards people living with HIV infection and mental health conditions, the authors systematically reviewed studies published between 2016 and 2021 and identified 45 studies that met the eligibility criteria. The review found that stigma towards mental health conditions still acts as a barrier to accessing HIV treatment, which impacts treatment outcomes. Additionally, social determinants of health, such as housing instability and poverty, appear to impact mental health and, therefore, HIV-related outcomes. The review also highlighted the mutually reinforcing effects of HIV, mental health, and substance use conditions, providing valuable insights into the syndemic effects of these co-occurring conditions. Overall, the review highlights the need to address stigma and social determinants of health in HIV prevention and treatment efforts and to integrate mental health services into HIV care to improve outcomes for people living with both HIV and mental health conditions. [ABSTRACT FROM AUTHOR]

Introduction: Technical variation exists when performing the gastrojejunostomy during Roux-en-Y gastric bypass (RYGB). However, it is unclear whether changing technique results in improved outcomes or patient harm. Methods: Surgeons participating in a state-wide bariatric surgery quality collaborative who completed a survey on how they perform a typical RYGB in 2011 and again in 2021 were included in the analysis (n = 31). Risk-adjusted 30-day complication rates and case characteristics for cases in 2011 were compared to those in 2021 among surgeons who changed their gastrojejunostomy technique from end-to-end anastomosis (EEA) to either a linear staple or handsewn anastomosis (LSA/HSA). In addition, case characteristics and outcomes among surgeons who maintained an EEA technique throughout the study period were assessed. Results: A total of 15 surgeons (48.3%) changed their technique from EEA to LSA/HSA while 7 surgeons (22.3%) did not. Nine surgeons did LSA or HSA the entire period and therefore were not included. Surgeons who changed their technique had significantly lower rates of surgical complications in 2021 when compared to 2011 (1.9% vs 5.1%, p = 0.0015), including lower rates of wound complications (0.5% vs 2.1%, p = 0.0030) and stricture (0.1% vs 0.5%, p = 0.0533). Likewise, surgeons who did not change their EEA technique, also experienced a decrease in surgical complications (1.8% vs 5.8%, p < 0.0001), wound complications (0.7% vs 2.1%, p < 0.0001) and strictures (0.2% vs 1.2%, p = 0.0006). Surgeons who changed their technique had a significantly higher mean annual robotic bariatric volume in 2021 (30.0 cases vs 4.9 cases, p < 0.0001) when compared to those who did not. Conclusions: Surgeons who changed their gastrojejunostomy technique from circular stapled to handsewn demonstrated greater utilization of the robotic platform than those who did not and experienced a similar decrease in adverse events during the study period, despite altering their technique. Surgeons who chose to modify their operative technique may be more likely to adopt newer technologies. [ABSTRACT FROM AUTHOR]

Recent studies have linked driving licensure, delay in driving licensure, and driving exposure to alcohol and drug use, parental monitoring, and peer influence. Early licensure and increased driving exposure were linked to higher alcohol and drug use, while parental monitoring knowledge may be associated with lower use. Health, education, and employment also may be affected, with early licensure and increased driving exposure linked to better outcomes. To reduce use among emerging adults, parents must equip them with effective prevention knowledge and be mindful of driving exposure and delay. Investing in programs to promote licensure and driving may help emerging adults obtain better health and prosperity, although the potential advantages of driving privileges must be balanced against earlier and greater driving exposure to alcohol and drug use. [ABSTRACT FROM AUTHOR]

Background: The achievement of the global agenda on universal health coverage (UHC) is pivotal in ensuring healthy lives and promoting the well-being of all. However, achieving healthy lives and wellbeing of all has been hampered by the challenge of health care financing. As such, healthcare financing, through health insurance is gaining popularity in developing countries such as Kenya, in their pursuit to achieve universal health coverage. The primary purpose of health insurance and delivery is to improve health. However, there is a paucity of evidence on the effectiveness of health insurance in improving the health outcomes and health status of the Kenyan population. Therefore, this study aimed to analyze the impact of health insurance on health outcomes in Kenya. Methods: The study utilized the most recent nationally representative Kenya Integrated Household Budget Survey (KIHBS) 2015/16 dataset in order to analyze the impact of health insurance on health outcomes. The instrumental variable 2-stage least squares (IV 2SLS) and control function approach (CFA) estimation techniques were used to cater for potential endogeneity and heterogeneity biases present in ordinary least squares (OLS) estimators. Results: Health insurance enrolment leads to a reduction in mortality, thereby improving the health status of the Kenyan population, despite low levels of insurance uptake. However, the insured population experienced higher chronic illnesses and out-of-pocket (OOP) expenditures raising concerns about financial risk protection. The fact that health insurance is linked to chronic illnesses not only reinforces the reverse causality of health insurance and health status, but also that the effects of potential adverse selection strongly drive the strength and direction of this impact. Conclusions: We conclude that health insurance enrolment reduces mortality and hence has a beneficial impact in promoting health. Health insurance coverage therefore, should be promoted through the restructuring of the National Hospital Insurance Fund (NHIF) fragmented schemes and by consolidating the different insurance schemes to serve different population groups more effectively and equitably. The government should revisit the implementation of a universal social health insurance scheme, as a necessary step towards UHC, while continuing to offer subsidies in the form of health insurance to the marginalized, vulnerable and poor populations. [ABSTRACT FROM AUTHOR]

Introduction: As recent analyses have indicated that low-volume hospitals experience higher rates of complications following total knee arthroplasty (TKA), it remains important to evaluate how area deprivation index (ADI) of hospitals impacts the quantity of TKA performed. Our analysis sought to evaluate how the ADI of orthopedic surgeon's place of service influences TKA utilization. Materials and methods: The Medicare Provider Utilization and Payment Data Public Use File (MPUP-PUF) was queried to identify claims between 2013 and 2019 associated with Healthcare Common Procedure Coding System (HCPCS) code 27447 (TKA). The MPUP-PUF file was linked with publicly available ADI information as well as information regarding each provider's practice location. The Mann–Kendall trend test was used to analyze significant differences in TKA volume between ADI quintiles and differences in TKA volume overall between the years 2013 and 2019. An adjusted multivariable linear regression analysis was conducted to evaluate how ADI, and practice-specific characteristics, influenced TKA utilization volume. Results: When isolating by ADI quintiles, no significant changes in TKA volume were demonstrated for Quintile 4 (Kendall's τ = 0.524; p = 0.13) and Quintile 5 (Kendall's τ = 0.524; p = 0.13) between 2013 and 2019. However, a significant increase in TKA volume over the study period was observed in Quintile 1 (Kendall's τ = 0.714 p = 0.034), Quintile 2 (Kendall's τ = 0.714 p = 0.034), and Quintile 3 (Kendall's τ = 0.905 p = 0.007). The adjusted multivariable linear regression model demonstrated that each increase in ADI quintile was associated with significantly lower TKA utilization (β-estimate − 1.16; 95% CI − 2.04 to − 0.29; p = 0.009). Conclusions: Our findings suggest that resource deprivation contributes to disparities in TKA utilization. With the ongoing recognition of how social and neighborhood-level deprivation may influence access to end-stage osteoarthritis care and related perioperative outcomes, the present study serves to encourage continued efforts at ensuring equity in orthopedic care. [ABSTRACT FROM AUTHOR]

The study investigates women who experience the chronic illness of endometriosis, their communication about sexual activity and physical, emotional and relational health outcomes. In an examination of data posted on Reddit over a one year period, 90 posts and responses, results indicate that women experience negative physical and emotional health outcomes more frequently than positive outcomes related to their chronic health condition and sexual activity. Further, women experience neutral outcomes as related to physical health, but no neutral outcomes are reported related to emotional or relational health. Finally, regarding relational health, women most frequently shared positive health outcomes related to sexual activity, suggesting the importance of positive and supportive partners and healthy relational communication. Discussion and implications follow. [ABSTRACT FROM AUTHOR]

We investigate the impact of the migration of a household member who is potentially a caregiver on child health and schooling outcomes in Pakistan. We use micro-level cross-sectional data on more than 600,000 children from multiple rounds of the UN's Multiple Indicator Cluster Survey (MICS) dataset from 2008–2018 for Punjab province. We implement a new instrumental variable to address the endogeneity of the migration decision, comprising a triple interaction of nighttime light intensity of the major destination countries, historic migration rates at the district level, and the number of adult males in a household. The absence of the migrating member of the household negatively (positively) affects younger (older) children: the short-term nutritional status of children under age five is harmed, while children aged 5–17 are more likely to be enrolled in school. These results are robust to the inclusion of controls for mother, child, and household characteristics, in addition to location and survey year fixed effects. The negative impact on nutritional status for children under five years is smaller for boys in urban areas, in wealthier households, and in households with more educated mothers. However, the positive impact of migration on schooling outcomes is driven by girls, families in rural areas, and wealthier households. [ABSTRACT FROM AUTHOR]

As work constitutes a central part of an individual’s life and people tend to define themselves by their career or job, our working lives hold a critical key to our happiness and health. Using the National Longitudinal Survey of Youth-1979 cohort (N = 7273) and building upon the cumulative advantages and disadvantages theory with a lifecourse perspective, this paper examines how work schedule patterns, together with social position, are associated with our health at age 50. Results indicate that engaging in work schedule patterns that were anything but mostly or only standard hours was associated with poorer health outcomes at age 50 measured by SF-12 physical and mental functions and clinical-risk depressive symptoms. These adverse health consequences might be particularly true for those with the most disadvantaged social positions: females, those with low educational attainment (e.g., high school or below), and those who experienced economic hardship in early life (exposure to poverty or welfare). In addition, the associations between work schedule patterns and health at age 50 might differ by the age period during which one works a particular schedule (i.e., between ages 22–29, 30–39, and 40–49). These results speak to how cumulative advantages and disadvantages via the intersectionality of work and social position throughout a lifetime may shape not only our opportunities and constraints brought about by our work but also our long-term well-being. [ABSTRACT FROM AUTHOR]

While studies have demonstrated that air pollution can be catastrophic to the population's health, few empirical studies are found in the economic literature because a considerable proportion of the evidence comes from epidemiological studies. Because of the crucial role of governance in the health community, good governance has been a contentious issue in public sector management in recent years. Therefore, the aim of this study is to examine the effects of air pollution and the role of governance on health outcomes. This study employed the generalized method of moment (GMM) estimation techniques to analyse panel data for 72 developing countries from 2010 to 2017. The empirical results confirm that higher PM2.5 and CO2 levels have a detrimental influence on life expectancy and healthy life expectancy, whereas the role of governance has a positive impact on life expectancy and healthy life expectancy. Furthermore, the findings show governance quality plays a role in moderating the negative effect of PM2.5 on health outcomes. The ongoing rise in air pollution has had a significant impact on the health of developing countries. It appears that governance quality has improved health outcomes. The findings have important policy implications, such that strengthening governance can reduce air pollution emissions in developing countries. However, to reduce the health effects of air pollution, developing countries must implement effective environmental development policies and track the implementation and enforcement of such policies. [ABSTRACT FROM AUTHOR]

Adult siblings are potentially important sources of care, support, advocacy, and friendship for their brothers and sisters with intellectual and developmental disabilities (IDD). Drawing on data about 851 adult siblings who completed an online national survey, we examined predictors and potential key moderators of siblings' mental distress, wellbeing, quality of life, and health outcomes. Moderated regression analyses indicated that siblings experiencing higher levels of subjective poverty; siblings with brothers and sisters with lower levels of independence; and siblings who are carers and also experiencing low levels of subjective poverty, had worse outcomes and may be in need of specific supports. Compared to normative samples, adult siblings of people with IDD had worse outcomes across the measures. [ABSTRACT FROM AUTHOR]

Background and aim: We aimed to capture the breadth of health outcomes that have been associated with the presence of Urinary Incontinence (UI) and systematically assess the quality, strength, and credibility of these associations through an umbrella review and integrated meta-analyses. Methods: We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p-values, 95% prediction intervals, heterogeneity, small-study effects, and excess significance. We graded the evidence from convincing (Class I) to weak (Class IV). Results and discussion: From 3172 articles returned in search of the literature, 9 systematic reviews were included with a total of 41 outcomes. Overall, 37 out of the 41 outcomes reported nominally significant summary results (p < 0.05), with 22 associations surviving the application of a more stringent p-value (p < 10−6). UI was associated with worse scores than controls in female sexual function (Class II), while it was also associated with a higher prevalence of depression (odds ratio [OR] = 1.815; 95% confidence interval [CI]: 1.551–2.124), and anxiety (OR = 1.498; 95% CI: 1.273–1.762) (Class IV). UI was associated with poorer quality of life (QoL), higher rate of mortality (hazard ratio = 2.392; 95% CI: 2.053–2.787) an increase in falls, frailty, pressure ulcers, diabetes, arthritis, and fecal incontinence (Class IV). Conclusions: UI is associated with female sexual dysfunction, with highly suggestive evidence. However, the evidence of other adverse outcomes including depression, anxiety, poorer QoL, higher mortality, falls, pressure ulcers, diabetes, arthritis, fecal incontinence, and frailty is only weak. A multidimensional approach should be taken in managing UI in the clinical setting. [ABSTRACT FROM AUTHOR]

Retirement years are ideally spent in good health. We aimed to produce new information using person-oriented methods by identifying groups of statutory retirees who did or did not achieve this objective and the factors that distinguish these groups from each other. Our particular focus was on the years directly after the transition into retirement, and the pre-retirement factors that explained the development of health, using a more severe health-related outcome—hospitalization. We studied the retirement, hospitalizations, education, and work characteristics of former employees of the City of Helsinki, Finland (N = 6569), from complete registers. We used group-based trajectory models and identified groups of constant low, constant high, decreasing, and temporarily occurring hospitalizations, and one group of increasing hospitalizations among women and two groups of earlier and later increasing hospitalizations among men. Multinomial regression models showed that among women, belonging to groups with less favourable health was associated with secondary education, older age at retirement, and reduced working hours. Education and work characteristics before retirement both contribute to the development of health, as indicated by hospitalizations directly after retirement. Our findings show that socioeconomic inequalities in health are persistent and should also be addressed after transition into retirement. [ABSTRACT FROM AUTHOR]

There has been concern raised in religion/spirituality (R/S) research about the use of measures of spirituality that are contaminated by indicators of mental and/or social health. Many of these scales are used widely in published studies examining associations with health, and yet many researchers and reviewers are not aware of contamination issues. We have previously cautioned researchers to be careful in their choice of religious/spirituality (R/S) measures (Koenig and Carey in J Relig Health, 63(5):3729–3743. https://doi.org/10.1007/s10943-024-02112-6, 2024), and to avoid using measures contaminated with the health outcome being assessed, which will result in tautological findings (particularly between spirituality and mental health). However, not all is lost. There are approaches for analyzing collected data using contaminated measures that can still result in meaningful and interpretable results, which may contribute to our knowledge of the impact of R/S on health. In this brief article, we describe several approaches for analyzing such data including deleting contaminated items from the scale, analyzing subscales separately, and modeling psychosocial scales, subscales, or collections of variables as mediators in the causal pathway that leads from R/S to health. The use of path analysis or structural equation modeling to identify direct effects and indirect effects through mediating constructs may also be helpful in this regard. [ABSTRACT FROM AUTHOR]

Background: Outcomes-based agreements (OBAs) have the potential to provide more timely patient access to novel therapies, although they are not suitable for every new medication or reimbursement scenario. The authors of this paper studied how to operationalize an OBA in oncology by leveraging existing real-world data (RWD) infrastructure in the province of Alberta. Objective: The main objectives were to (1) evaluate which health outcomes in oncology are suitable for OBAs and whether they can be tracked with existing infrastructure, and (2) determine how RWD in oncology can be used to implement an OBA and the expected timing for delivery. Methods: Using the Oncology Outcomes (O2) Group infrastructure and Alberta administrative data, a review of five key oncology outcomes was performed to determine suitability to support an OBA. Results: Overall survival and time-to-next-treatment were determined as potentially suitable oncology outcomes for OBAs; progression-free survival, patient-reported outcomes, and return to work were deemed inadequate for OBAs at the current time due to data limitations. Conclusions: Results indicate that it is feasible to leverage RWD to support OBAs in oncology in Alberta, with minimal additional data, resources, and infrastructure. The operational processes and steps to collect and analyze RWD for OBAs were identified, starting with performing an RWD feasibility study. The expected timeframe to fulfill the real-world evidence (RWE) requirements for an OBA is approximately 3 years for cancers with short trajectories. [ABSTRACT FROM AUTHOR]

Purpose: Bariatric surgery has a favorable effect on fertility in women. However, due to a lack of data regarding children's outcomes, the ideal time for conception following bariatric surgery is unknown. Current guidelines advise avoiding pregnancy during the initial weight loss phase (12–24 months after surgery) as there may be potential risks to offspring. Thus, we aimed to analyze health outcomes in children born to mothers who had undergone bariatric surgery. The surgery-to-delivery interval was studied. Materials and Methods: A nationwide registry belonging to the Austrian health insurance funds and containing health-related data claims was searched. Data for all women who had bariatric surgery in Austria between 01/2010 and 12/2018 were analyzed. A total of 1057 women gave birth to 1369 children. The offspring's data were analyzed for medical health claims based on International Classification of Diseases (ICD) codes and number of days hospitalized. Three different surgery-to-delivery intervals were assessed: 12, 18, and 24 months. Results: Overall, 421 deliveries (31%) were observed in the first 2 years after surgery. Of these, 70 births (5%) occurred within 12 months after surgery. The median time from surgery to delivery was 34 months. Overall, there were no differences noted in frequency of hospitalization and diagnoses leading to hospitalization in the first year of life, regardless of the surgery-to-delivery interval. Conclusion: Pregnancies in the first 24 months after bariatric surgery were common. Importantly, the surgery-to-delivery interval had no significant impact on the health outcome of the children. [ABSTRACT FROM AUTHOR]

The urbanization of Indigenous peoples in Canada has increased substantially during recent decades, with over 44% of Indigenous peoples now residing in urban centres. Despite the urban concentration of healthcare services, Indigenous health outcomes remain significantly worse than non-Indigenous health outcomes for people living in urban centres. The historical and subsisting impacts of colonialism have had a profound negative influence on social determinants of health for Indigenous peoples, resulting in higher rates of chronic disease and mortality. Mistrust of the healthcare system, racial discrimination, and medical paternalism remain barriers to accessing care and diminish the quality of care received. This commentary explores how Indigenous-led health services can improve Indigenous health outcomes and how urban reserves could be used to improve the health of urban Indigenous residents., Competing Interests: Declarations. Ethics approval: Not applicable. Consent to participate: Not applicable. Consent for publication: Not applicable. Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s) under exclusive license to The Canadian Public Health Association.)

Background: Adherence to treatment recommendations is challenging in hemodialysis (HD) patients, yet it has been found to be extremely crucial in obtaining positive clinical and health outcomes. Aim: To evaluate the influence of implementing an educational process provided by the clinical pharmacist on HD patients' adherence to treatment recommendations and clinical outcomes. Method: A randomized controlled trial was conducted in which patients from three HD units in Jordan were randomly allocated to either an intervention (n = 60) or a control group (n = 60). During a three-month period, the intervention group received a monthly educational approach from a clinical pharmacist with recommendations for improving medication, nutrition, and fluid adherence, whereas the control received standard medical care. The primary outcome was patient adherence to HD-related recommendations. Quality of life (QOL), disease awareness, hospitalization, and changes in biochemicals were secondary outcomes. Results: The final analysis included 114 patients (n = 57/group). In the intervention group, there was a significant improvement in total adherence score versus control (1170.6 ± 44.1 vs. 665.8 ± 220.7, p < 0.001), and adherence to various aspects including episodes/duration of shortening HD, dietary guidelines, fluid restriction, and prescription medications. The clinical pharmacist intervention enhanced patients' QOL and improved awareness and perspective of the disease. Following the intervention, laboratory values for urea, creatinine, phosphorus, and hemoglobin were considerably improved. Additionally, the intervention group had fewer hospitalizations than the control group (0.54 ± 0.07 vs. 0.78 ± 0.26, p < 0.001). Conclusion: Providing clinical pharmacy education to HD patients improved adherence behavior and clinical outcomes. This illustrates the importance of clinical pharmacists as interdisciplinary team members in dialysis care. Trial registration This trial has been registered in ISRCTN Register (ISRCTN75517095). https://clinicaltrials.gov/ct2/show/ISRCTN75517095 [ABSTRACT FROM AUTHOR]

Purpose of Review: In this review, we examine the intersection of the HIV and COVID-19 epidemics with focus on COVID-19-related health outcomes and risk factors for SARS-CoV-2 among people living with HIV (PLWH). Recent Findings: Evidence to date do not suggest a higher incidence of SARS-CoV-2 infection among PLWH compared to the general population, although—once exposed—PLWH are at greater risk of severe COVID-19 outcomes. Key risk factors for severe COVID-19 include non-HIV comorbidities known to be associated with severe disease, as well as HIV-specific risk factors such as low CD4 + T-cell count, unsuppressed viral load, and tuberculosis co-infection. The disproportionate impact of the SARS-CoV-2 pandemic among Black, Latinx, and Native American/Alaskan Native PLWH could worsen pre-existing disparities in health outcomes among PLWH. Data on SARS-CoV-2 vaccine protection among PLWH needs additional study, although some studies suggest decreased humoral responses among those with low CD4 + T-cell counts, while there is a signal of increased vaccine breakthrough rates among PLWH in two large observational cohorts. Data on post-acute sequelae of SARS-CoV-2 (PASC) among PLWH is also limited. Summary: PLWH do not have a higher susceptibility to SARS-CoV-2, but once exposed, they are at higher risk of severe COVID-19 outcomes. Additional resources will need to be dedicated to the development of interventions to improve health outcomes and address disparities among PLWH impacted by the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

While global warming and climate change associated with increasing carbon dioxide are widely seen to be one of the most serious worldwide dangers to population health, little is known regarding "how" country alters the linkage between increasing CO2 emissions and population health outcomes. Current literature on the health effects of CO2 emissions recommends various factors that may establish a more robust link, including health expenditure and research and development. Therefore, the purpose of this inquiry is to examine the effectiveness of health expenditure and R&D in improving health outcomes through reducing CO2 emissions. Using data for Saudi Arabia over the period 2000–2018, the dynamic ordinary least squares (DOLS) technique shows that (i) health and R&D expenditures decrease infant mortality and increase life expectancy; (ii) health and R&D expenditures reduce CO2 emissions in all the estimated models; (iii) health and R&D expenditures can improve health outcomes through reducing CO2 emissions; and (iv) health and R&D expenditures have both direct and indirect effect on health outcomes. Policy implications and limitations are also discussed. [ABSTRACT FROM AUTHOR]

Obesity is linked with health and psychosocial outcomes among many populations. However, it is unclear the extent to which obesity is linked with these outcomes among autistic adults. We searched seven research databases for articles examining the association between obesity and autistic adults' health and psychosocial outcomes. Three studies found that obesity was associated with health outcomes, including: in-hospital mortality, risk of type II diabetes, cardiovascular disease, and number of co-occurring medical conditions. One study found no significant association between autism diagnosis, mental health conditions, and body mass index. Obesity increases the risk of in-hospital mortality and some chronic conditions among autistic adults, highlighting the need for clinicians trained to promote weight management among autistic adults. [ABSTRACT FROM AUTHOR]

Widespread contamination of the superficial, drinking, and groundwater by perfluoroalkyl substances (PFASs) was discovered in the Veneto Region (northeast of Italy) in 2013. Mothers from the contaminated area were concerned about the effects of PFAS on their own and their children's health. We determined the factors that influenced the perceived risk of PFAS and the presence of self-reported diseases by conducting a study with 384 mothers of children aged 1–13 years living in the contaminated area (Red Zone, Veneto, Italy). Information on demography, the sources of exposure, and the health condition of the mothers was collected through an online survey. The serum PFAS concentration was recorded for some of the participants. We determined the factors influencing the perceived risk, risk of health outcomes, and serum PFAS levels through regression analyses. The PFAS perceived risk of the mothers increased with an increase in the trust in scientific institutions and social media, and when many friends were present, trust in politics and full-time employment had a protective effect. The PFAS perceived risk increased the occurrences of self-reported and autoimmune diseases. Longer residence (> 20 years) in the most exposed area (Red Zone A) increased the frequency of some health outcomes. Serum PFAS concentrations decreased with breastfeeding, but increased with tap water consumption, residence in Red Zone A, and residence time. The PFAS perceived risk of the mothers was associated with many factors that influenced reporting of health issues. The association between PFAS exposure and health outcomes needs further investigation. [ABSTRACT FROM AUTHOR]

Results of path analysis involving sexual minority participants (N = 1317) from diverse sociopolitical contexts revealed health outcomes to be associated with internalized homonegativity and the resolution of conflict between religious and sexual minority identities. Contrary to expectations, several markers of religiousness were not directly associated with either improved or worsened health outcomes for depression or anxiety. However, religious activity moderated the influence of internalized homonegativity (IH) on depression such that IH was less strongly related to depression among individuals who frequently attended religious services than among individuals who infrequently attended religious services. These findings have special salience for advancing a more accurate understanding of conservatively religious sexual minorities and directing culturally sensitive research, clinical services, and public policy. [ABSTRACT FROM AUTHOR]

With the rapid development of Internet techniques in China, more and more Chinese middle-aged and older adults have begun to use the Internet for their daily social interactions, and the resulting online social capital may affect their health. Using data from the Chinese General Social Survey of 2017 (n = 7733, aged 45–90 years old), this study investigated the influence of online social capital on the health of middle-aged and older adults in China, and the Heckman sample selection model was used to address potential sample selection bias in Internet use. The results show that number of online contacts significantly improved the physical health of middle-aged and older adults, while the level of depression was significantly reduced by online closeness of non-specific relationships, but more online interactions may slightly increase their depression. Furthermore, more online contacts were associated with elevated physical health among male, rural, less-educated and middle-aged adults, while more online closeness of non-specific relationships was associated with less depression in almost all subgroups. Online social capital can improve the health of middle-aged and older adults in China, so we should help increase older adults' access to the Internet and improve their Internet skills to give full play to the positive health effect of online social capital. However, it should be alert to the negative health consequences caused by excessive Internet use. [ABSTRACT FROM AUTHOR]

Purpose: The aim was to summarize the current literature for the effectiveness of physical activity interventions on physical functioning, body composition, and quality of life (QOL) in pediatric, adolescent and young adult cancer survivors. Methods: We conducted systematic structured searches of PubMed and Web of Science databases. Two independent researchers selected against inclusion criteria: (1) lifestyle intervention including physical activity and/or physical activity interventions for pediatric, adolescent, and young adults with any cancer diagnosis; (2) measured QOL, physical functioning (e.g., strength, activities of daily living), or body composition (e.g., changes in weight, percent body fat); and (3) randomized controlled trials. Results: Searches identified 4770 studies. Following the removal of duplicates and title and abstract screening, 83 full-text articles were assessed, and 9 studies met the inclusion criteria. Childhood and adolescent cancer survivors encompassed n = 7 studies while young adult cancer survivors were included in n = 2 studies. Three studies reported using a theoretical framework and six did not. Interventions ranged from 1 week to 6 months. Across all studies reviewed, n = 2 reported improvements in physical activity, n = 5 studies reported partial improvements, and n = 2 reported no improvements. Conclusions: Interventions to improve physical activity behaviors reported mixed results. Only two physical activity interventions incorporated young adults with cancer; thus, physical activity interventions for young adult cancer survivors should be further explored. Future research should focus on personalized physical activity components encouraging behavior change techniques to maximize physical health and QOL improvements. [ABSTRACT FROM AUTHOR]