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Background and aims: Long pre-hospital delay substantially increases the likelihood of perforated appendicitis. This study aimed to find patient-related factors affecting this delay. Methods: A survey was conducted for patients with acute appendicitis after appendectomy. The participants were asked about their path to the surgical center and socioeconomic status. Variables affecting delays and the rate of complicated appendicitis were analyzed. Results: The study included 510 patients; 157 (31%) had complicated appendicitis with a median prehospital delay of 42 h. In patients with uncomplicated appendicitis, the delay was 21 h, p <.001. Forty-six (29%) patients with complicated appendicitis were not referred to the hospital after the first doctor's visit. The multivariate analysis discovered factors associated with long pre-hospital delay: age 40–64 years (OR 1.63 (95% CI 1.06–2.52); compared to age 18–39), age more than 64 years (OR 2.84 (95% CI 1.18–6.80); compared to age 18–39), loss of appetite (OR 2.86 (95% CI 1.64–4.98)), fever (OR 1.66 (95% CI 1.08–2.57)), non-referral by helpline nurse (OR 2.02 (95% CI 1.15–3.53)) and non-referral at first doctors visit (OR 2.16 (95% CI 1.32–3.53)). Age 40–64 years (OR 2.41 (95% CI 1.50–3.88)), age more than 64 years (OR 8.79 (95% CI 2.19–35.36)), fever (OR 1.83 (95% CI 1.15–2.89)) and non-referral at first doctors visit (OR 1.90 (95% CI 1.14–3.14)) were also risk factors for complicated appendicitis. Conclusions: Advanced age, fever and failure to suspect acute appendicitis in primary care are associated with prolonged pre-hospital delay and complicated appendicitis. [ABSTRACT FROM AUTHOR]

Objective: Many countries experience challenges in recruiting and retaining general practitioners (GPs) as supervisors for medical students in clinical placements. We aimed to investigate the opportunities, capacities and limitations of Norwegian GPs to become supervisors. Design: Web-based cross-sectional questionnaire study. Setting: Norwegian general practice. Subjects: All GPs in Norway, including locums and those on leave, both active supervisors, and GPs who are not presently supervising medical students. Main outcome measures: GPs' terms of salary, office facilities, limiting factors, capacity and needs for becoming or continuing as supervisors. Results: Among 5145 GPs, 1466 responded (29%), of whom 498 (34%) were active supervisors. Lack of a dedicated student office was the most reported limitation for both active supervisors (75%) and other GPs (81%). A high proportion (67%) of active supervisors reported that they could host more students per year, given financial support for equipped offices and higher salaries. With this kind of support, 48% (n = 461) of the GPs who were not supervisors for medical students were positive about a future supervisor role. By adjusted regression analysis, female GPs had lower likelihood of being supervisors, OR (95% CI) 0.75 (0.59–0.95) than male colleagues. GPs in the North, Mid and West regions had higher odds (OR 3.89, 3.10 and 2.42, respectively) than those in the South-East region. Teaching experience also increased the odds (2.31 (1.74–3.05). Conclusions: There seems to be capacity among both active and potential supervisors if increased salaries and financial support for office facilities are made available. KEY POINTS: Undergraduate training by clinical placements is important for the recruitment of doctors to general practice, and depends on a sufficient number of GPs as supervisors. The study shows that there is sufficient capacity among Norwegian GPs to host medical students in clinical placements. Many potential supervisors among Norwegian GPs report that they have not been approached by a university to supervise medical students. Many supervisors state that they need increased salaries and financial support for facilities and expenses in order to supervise medical students. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of diabetes retinopathy and evaluate the factors influencing its occurrence both at the onset of type 2 diabetes (T2D) and three years into its duration. Design: Retrospective population-based study. Setting: Data was retrieved from Regional Healthcare Information Platform in Region Halland 2016–2020. Subjects: Patients 35-75 years old in Region Halland receiving first-time diabetes diagnosis according to ICD-code E11-14 in 2016–17. The total cohort consisted of 1659 patients. Main outcome measures: The main outcome measure of the study was the occurrence of diabetes retinopathy at onset and within three years from the diabetes diagnosis. Multivariate logistic regression analysis was conducted for diabetes retinopathy at onset and within three years, adjusted for age, gender, comorbidities, levels of HbA1c, cholesterol, kidney functional and blood pressure. Results: At onset, there were 12% with diabetes retinopathy and after three years, 32% of the patients had developed diabetes retinopathy. In the study cohort, 71 of patients who were examined with fundus photography within three years after onset, and 8% had had dietary recommendation without pharmacotherapy. High HbA1c levels, blood pressure values and impaired renal function already at onset were associated with development of diabetes retinopathy at onset and this association persisted after three years. The odds ratio for diabetes retinopathy was increased adjusted for HbA1c elevations, renal impairment, and increased blood pressure at index and when adjusted for these variables three years from index. Conclusion: These findings indicate that the risk of developing diabetes retinopathy is present early on at onset and within the first three years of diabetes diagnosis. This highlights the importance of promptly regulating glucose- and blood-pressure levels and follow up kidney dysfunction to mitigate the risk of diabetes retinopathy. KEY POINTS: Among patients with type 2 diabetes, 12% had developed diabetes retinopathy already at onset. Among patients with type 2 diabetes, one-third had developed diabetes retinopathy after three years from onset. The presence of diabetes retinopathy already at diabetes onset, was associated with elevated HbA1c levels, renal impairment and elevated blood pressure. Diabetes retinopathy three years after the onset of the disease, was associated with increased HbA1c levels, high blood pressure, and renal dysfunction. [ABSTRACT FROM AUTHOR]

Background: the aim is to investigate the risk of short-term maternal morbidity caused by the selective clinical use of episiotomy (rate < 0.02), and to compare the risk of severe perineal tears with the statewide risk. Methods: In this retrospective cohort study, we investigated the effect of selective episiotomy on the risk of severe perineal tears and blood loss in singleton term deliveries, using propensity scores with inverse probability weighting. Results: This study included 10992 women who delivered vaginally between 2008-2018. Episiotomy was performed in 171 patients (1.55%), three of whom (1.75%) experienced severe perineal tears compared to 156 (1.44%) in the control cohort. The adjusted odds ratio of severe perineal tears was 2.06 (95% confidence interval [CI]: 0.51, 8.19 with 0.3 p value). Multivariate linear regression showed that episiotomy increased blood loss by 96.3 ml (95% CI: 6.4, 186.2 with 0.03 p value). Episiotomy was performed in 23% (95% CI: 0.228, 0.23) of vaginal deliveries in the state of Hessen, with a risk of severe perineal tears of 0.0143 (95% CI: 0.0139, 0.0147) compared to 0.0145 (95% CI: 0.0123, 0.0168) in our entire cohort. Conclusions: Selective use of episiotomy does not increase the risk of higher-grade perineal tears. However, it may be associated with maternal morbidity in terms of increased blood loss. [ABSTRACT FROM AUTHOR]

Document the impact of an outbreak of gastroenteritis on local primary health care services, compared to a control period. Controlled observational study with data from the outbreak and a control period. Data obtained from electronic medical records (EMR) of general practitioners (GPs) and the out-of-hours (OOH) service. Telephone data from the OOH service's telephone records. Campylobacteriosis outbreak in Askøy municipality, Norway in 2019. Over 2000 individuals were infected. Patients in contact with GPs and the OOH service during the outbreak and a control period. Patient contacts with GPs and the OOH service during the outbreak and a control period. There was a 36% increase in contacts during the outbreak compared to the control period (4798 vs. 3528), with the OOH service handling 78% of outbreak-related contacts. Telephone advice was the dominant method for managing the increase in contacts to primary care, both in OOH services and daytime general practice (OR 3.73 CI: [3.24–4.28]). Children aged 0–4 years had increased use of primary care during the outbreak (OR 1.51 CI: [1.28–1.78]). GPs referred 25% and OOH services referred 75% of 70 hospitalized cases. The OOH service handled most of the patients during the outbreak, with support from daytime general practice. The outbreak caused a shift towards telephone advice as a means of providing care. Young children significantly increased their use of primary care during the outbreak. [ABSTRACT FROM AUTHOR]

Objective: We opted to study how support staff operational capacity and diabetes competences may impact the timeliness of basal insulin-initiation in general practice patients with type 2 diabetes (T2D). Design/Setting/Outcomes: This was an observational and retrospective study on Norwegian primary care patients with T2D included from the ROSA4-dataset. Exposures were (1) support staff size, (2) staff size relative to number of GPs, (3) clinic access to a diabetes nurse and (4) share of staff with diabetes course (1 and 2 both relate to staff operational capacity, whereas 3 and 4 are both indicatory of staff diabetes competences). Outcomes were 'timely basal insulin-initiation' (primary) and 'attainment of HbA1c<7%' after insulin start-up (secondary). Associations were analyzed using multiple linear regression, and directed acyclic graphs guided statistical adjustments. Subjects: Insulin naïve patients with 'timely' (N = 294), 'postponed' (N = 219) or 'no need of' (N = 3,781) basal insulin-initiation, respectively. Results: HbA1c [median (IQR)] increased to 8.8% (IQR, 8.0, 10.2) prior to basal insulin-initiation, which reduced HbA1c to 7.3 (6.8–8.1) % by which only 35% of the subjects reached HbA1c <7%. Adjusted risk of 'timely basal insulin-initiation' was more than twofold higher if access to a diabetes nurse (OR = 2.40, [95%CI, 1.68, 3.43]), but related only vaguely to staff size (OR = 1.01, [95%CI, 1.00, 1.03]). No other staff factors related significantly to neither the primary nor the secondary outcome. Conclusion: In Norwegian general practice, insulin initiation in people with T2D may be affected by therapeutic inertia but access to a diabetes nurse may help facilitating more timely insulin start-up. In patients with type 2 diabetes (T2D) cared for by their general practice physician (GP), insulin therapy was susceptible to therapeutic inertia. In Norwegian general practice, chance of timely basal insulin-initiation was found more than two-fold higher if the GP had access to a diabetes nurse. In contrast, the timeliness of basal insulin-initiation in general practice patients with T2D seemed unaffected by share of support staff with diabetes course and by factors indicatory of support staff overall operational capacity. In Norwegian general practice, a diabetes nurse seems to offer unique clinical benefits to the care of insulin treated patients with T2D. [ABSTRACT FROM AUTHOR]

The burden of symptoms is a subjective experience of distress. Little is known on the burden of feeling unwell in patients with persistent symptom diagnoses. The aim of this study was to assess the burden in primary care patients with persistent symptom diagnoses compared to other primary care patients. A cross-sectional study was performed in which an online survey was sent to random samples of 889 patients with persistent symptom diagnoses (>1 year) and 443 other primary care patients after a transactional identification in a Dutch primary care data registry. Validated questionnaires were used to assess the severity of symptoms (PHQ-15), Symptom Intensity and Symptom Interference questionnaires, depression (PHQ-9), anxiety (GAD-7), quality of life (SF-12 and EQ-5D-5L)) and social functioning (SPF-ILs). Overall, 243 patients completed the survey: 178 (73.3%) patients in the persistent symptom diagnoses group and 65 (26.7%) patients in the control group. In the persistent group, 65 (36.5%) patients did not have persistent symptom(s) anymore according to the survey response. Patients who still had persistent symptom diagnoses (n = 113, 63.5%) reported significantly more severe somatic symptoms (mean difference = 3.6, [95% CI: 0.24, 4.41]), depression (mean difference = 3.0 [95% CI: 1.24, 3.61]) and anxiety (mean difference = 2.3 [95% CI: 0.28, 3.10]) and significantly lower physical functioning (mean difference = − 6.8 [95% CI: −8.96, −3.92]). Patients with persistent symptom diagnoses suffer from high levels of symptoms burden. The burden in patient with persistent symptoms should not be underestimated as awareness of this burden may enhance person-centered care. [ABSTRACT FROM AUTHOR]

Swedish Physical Activity on Prescription (PAP) has been shown to increase physical activity levels, which is known to lead to positive health effects. PAP is being implemented in Swedish healthcare to various extents. However, there is a lack of knowledge about how Swedish general practitioners (GPs) work with PAP and what hinders and facilitates wider implementation. This study aimed to survey GPs' use and views of PAP, identify barriers and facilitators for implementing PAP, and explore associations to gender, practice location, and experience. The study was framed by the Normalization Process Theory. A survey was sent to 463 GPs at 69 different healthcare centres in Region Västra Götaland. Data were analysed using multiple logistic and linear regressions. A total of 143 GPs completed the survey (response rate 31%). Views on PAP were generally positive amongst respondents, but only 27% reported using PAP regularly. The most prominent reported barriers were insufficient training and resources. Positive views and willingness to collaborate in using PAP were identified as facilitators. Responding GPs in Gothenburg used PAP more often (OR 6.4; 95% CI 2.7–14.8) and were significantly more positive to the method than GPs in other areas of the region. GPs with more than 10 years of practice used PAP more often (OR 2.5; 95% CI 1.1–6.0) than less experienced GPs. Few of the investigated variables were associated with gender. The positive views amongst responding GPs are helpful, but more education, training and resources are needed for successful implementation of PAP in Swedish primary health care. Implementation of physical activity on prescription (PAP) in Swedish healthcare has been ongoing for many years, but is implemented to various extents across and within regions. Views on PAP are generally positive, but use is not widespread amongst general practitioners in Region Västra Götaland who responded to the survey. The method is more frequently used in Gothenburg, where the most extensive implementation work has been done, and amongst more experienced general practitioners. Education and training in using PAP need to increase for successful implementation. [ABSTRACT FROM AUTHOR]

Orphans are at higher risk of HIV infection and several important HIV risk factors than non-orphans; however, this may be due to a combination of related social, psychological, and economic factors, as well as care environment, rather than orphan status alone. Understanding these complex relationships may aid policy makers in supporting evidence-based, cost-effective programming for this vulnerable population. This longitudinal study uses a causal effect model to examine, through decomposition, the relationship between care environment and HIV risk factors in orphaned and separated adolescents and youths (OSAY) in Uasin Gishu County, Kenya; considering resilience, social, peer, or family support, volunteering, or having one’s material needs met as potential mediators. We analysed survey responses from 1105 OSAY age 10–26 living in Charitable Children’s Institutions (CCI) (orphanages) and family-based care settings (FBS). Follow-up time was 7–36 months. Care in CCIs (vs. FBS) was associated with a decreased likelihood of engaging in forced, exchange, and consensual sex. Excess relative risks (ERR) attributable to the indirect pathway, mediation, or interaction were not significant in any model. Care environment was not statistically associated with differences in substance use. Our findings support the direct, unmediated, association between institutional care and HIV risk factors. [ABSTRACT FROM AUTHOR]

Background: Human Papillomavirus (HPV), a prevalent sexually transmitted infection carrying significant risks ranging from benign lesions to various types of malignancies, represents a matter of great public health concern. Notably, most Arab countries lack public awareness campaigns or national immunization programs. This study aims at assessing the overall knowledge on HPV and HPV vaccination among the Lebanese population, exploring the prevalent attitude on the matter, and identifying barriers and misconceptions that prevent individuals from receiving the HPV vaccine. Methods: A cross-sectional study was conducted in Beirut, on 201 participants aged between 18 and 36 years old. We performed ordinal analysis to assess the trend between Knowledge levels, attitude levels and hesitancy Levels. Results: Majority of participants (77%) demonstrated a low level of knowledge on HPV vaccination, 50% held a positive attitude, with only 18.4% being already vaccinated. Negative trend was identified between levels of knowledge, attitude and hesitancy (gamma = −0.7415, p-value < 0.01; gamma= −0.58, p-value < 0.01 respectively). Unavailability or limited access to the vaccine, and misconceptions about HPV immunization were shown to be impeding vaccination. Conclusion: Analysis of our results strongly suggests that improving knowledge and attitudes is likely to foster trust and reduce hesitancy, thereby promoting higher vaccine uptake. [ABSTRACT FROM AUTHOR]

Background: Due to the different factors affecting the maintenance of a constant supply of human blood in health facilities, this study aimed at exploring the knowledge, perceptions, and practices towards blood donation among under graduate medical students at Busitema University Faculty of Health Sciences (BUFHS). Methods: Using a convergent parallel mixed methods study design, 384 students were recruited into the study. Questionnaires and focused group discussions were used to collect the data. Stata version 15.0 and thematic analysis were used to analyze quantitative and qualitative data respectively. Results: Of the respondents, 151 (39.4%) had ever donated blood and 50.4% had good knowledge about blood donation. The commonest motivating factor towards blood donation was “to save someone’s life”. Factors associated with practices towards blood donation included: religion, year 2 of study and prior blood donation history. Being Jehovah’s Witness reduced the willingness to donate blood by 88% compared to other religions. Thematic analysis revealed four themes namely; students’ experiences and thoughts, driving forces to donate blood, fears and misconceptions, and suggestions to increase blood donors. Conclusion: The proportion of undergraduate medical students who had adequate level of knowledge about blood donation was moderately high, however, some of their perceptions towards it were unconventional. To ensure safe and adequate blood supply, design of strategies and tailored programs that promote blood donation is highly recommended.. [ABSTRACT FROM AUTHOR]

Maternal depression remains under characterised in many low- and middle-income countries, especially in rural settings. We aimed to describe maternal depression and anxiety symptoms in rural and urban communities in northern Ecuador and to identify socioeconomic and demographic factors associated with these symptoms. Data from 508 mothers participating in a longitudinal cohort study were included. Depression and anxiety symptoms were assessed using the Hopkins Symptom Checklist (HSCL-25), and maternal psychological functioning was assessed using a checklist of daily activities. Tobit regression models were used to examine associations with sociodemographic variables and urbanicity. The median HSCL-25 score was 1.2 (IQR: 0.4) and 14% of women scored above the threshold for clinically relevant symptoms. Rural women reported similar food insecurity, less education, younger age of first pregnancy, and lower socio-economic status compared to their urban counterparts. After adjusting for these factors, rural women reported lower HSCL-25 scores compared to women lin urban areas (β = −0.48, 95%CI:0.65, −0.31). Rural residence was also associated with lower depression and anxiety HSCL-25 sub-scale scores, and similar levels of maternal functioning, compared to urban residence. Our results suggest that both household and community-level factors are risk factors for maternal depression and anxiety in this context. [ABSTRACT FROM AUTHOR]

Tuberculosis is a global health concern n impacting communities, health systems, and economies This study assessed the TB treatment outcomes among individuals aged 15+ at Chawama first level hospital in Lusaka, Zambia, using a retrospective design focussing on individuals notified in 2020. The sample was described using descriptive statistics. The Pearson Chi-square test and logistics regression were used to analyse the characteristics of the patients influencing the treatment outcomes at 5% significant level. Out of 404 participants, 83.4% of them had successful treatment outcomes. Varied outcomes were noted in sex, patient type, TB type, HIV status, and DOT plan, but lacked significance. Odds of success were lower by 72.4% for those aged 65+ compared to those aged 15–24 years (OR (95% CI): 0.276 (0.086–0.881), p = .030). Similarly, after adjusting for other variables, the odds of success were lower by 72.9% (AOR (95% CI): 0.271 (0.083–0.882), p = .030). This study yielded an encouraging 83.4% TB success rate highlighting the potential for improvement to meet WHO targets. Notably, individuals aged 65+ showed a distinct pattern with lower treatment success odds, suggesting a need for focussed interventions. Special attention to elderly patients and targeted TB program interventions are recommended. [ABSTRACT FROM AUTHOR]

This paper examines the relationship between child labour and educational attainment and explores the distinction between harmful and non-harmful agricultural cocoa work. We conduct a secondary analysis of data on 3,338 children who reported attending school in 2018 across cocoa growing regions of Ghana and Côte d’Ivoire. To address differences between harmful and non-harmful child labour, we differentiated work completed by a child by hazardous activity engagement. These groups of child labour were then modelled against educational attainment, defined by a whether or not the child needed to repeat a class. We then conducted mediation analysis to assess whether injury mediates this relationship. Our results show that hazardous child labour increases the odds of repeating a class and work-related injury compared to non-hazardous labour. The effect of hazardous child labour on academic attainment was also found to be mediated by work-related injuries by 14%. Educational attainment is associated with hazardous labour activities and the odds of injury and not the act of participation in agricultural labour alone. Programmes based on strong measures of harmful work will foster better protection for children who are most at risk and may inform global debates around the benefits versus the risks of child labour. [ABSTRACT FROM AUTHOR]

Objective: There have been few studies predicting institutionalization or death in home care settings. We examined risk factors for nursing home placement (NHP) and death among home care patients. Design: A prospective one-year follow-up study. Settings and subjects: Persons aged =65years living in Eastern Finland and receiving regular home care services (n=293). Main outcome measures: Risk factors for NHP or death were investigated using Cox proportional hazards model. Explanatory variables included demographics, health status (Charlson Comorbidity Index, CCI), physical (Timed Up and Go, TUG), and cognitive (Mini-Mental State Examination, MMSE) functioning, Basic and Instrumental Activities of Daily Living (BADL, IADL) and mood (Geriatric Depression Scale, GDS-15). Results: Of the 293 patients (mean age 82.6years, 70.6% women), 27 (9.2%) moved to a nursing home and 25 (6.9%) died during the follow-up (mean 350days). The combined outcome of NHP or death was predicted by BADL (HR 0.73, CI 95% 0.62-0.86), IADL (0.75, 0.65-0.87) MMSE (0.92, 0.87-0.96), and TUG (1.02, 1.01-1.03). NHP alone was predicted by BADL (0.62, 0.50-0.78), IADL (0.57, 0.45-0.73), and MMSE (0.88, 0.82-0.94) and mortality by TUG (1.02, 1.01-1.03). Conclusion: Basic measures of functioning can be used to identify high-risk patients in home care. Decreasing BADL, IADL and MMSE predict NHP and longer TUG-times death within a year. [ABSTRACT FROM AUTHOR]

Objective: Patient education based on the patient's individual needs and circumstances is known to be associated with positive changes in clinical outcomes in chronic obstructive pulmonary disease (COPD). We aimed to assess the levels of patients' subjective needs for information about COPD before and after their general practitioners had taken part in a COPD education. Design: A secondary analysis of a cluster randomized controlled trial Setting: 22 PHCCs in Stockholm, Sweden Subjects: Randomly selected primary care patients with COPD in GOLD stages 2 and 3 (n=293) Outcome measures: Scores in the Lung Information Needs Questionnaire (LINQ) at baseline and 18months, spirometry results, and self-reported, descriptive patient data. Results: GPs' improved skills in COPD did not affect patients' self-management skills over time. In general, patients' information needs remained great in issues concerning diet, exercise and self-management. However, 43% of the patients reported reduced and 57% increased or unchanged information needs, over time. Reduced information needs were mainly associated with a high level of information needs at baseline (OR = 3.17 [95% CI 1.93-5.23], p<.01) and establishing contact with a physiotherapist (OR = 2.26 [95% CI 1.05-4.86], p=.038). Patients in a mild or stable phase of COPD with no recent exacerbations reported greater needs than those with unstable, deteriorated COPD. Conclusion: Patients' information needs are substantial in most areas of self-management of COPD, and seem to covary with the patient's current clinical status. Care providers should thus continuously be vigilant about offering all patients with COPD support and education. [ABSTRACT FROM AUTHOR]

To investigate trends in the haemoglobin (Hb) level in middle-aged Swedish women from 1968 to 2017 and to examine the potential association between Hb and the use of hormonal contraceptives (HCs). A prospective observational population study of representative 38- and 50-year-old women of Gothenburg, Sweden. The population study of women in Gothenburg started in 1968–1969 and has continued since then with new examinations every 12 years, including both follow-ups and new recruited cohorts. The study consists of both physical examinations and questionnaires. Two thousand four hundred eighty-eight women aged 38 and 50 participated in the study from 1968 to 2017. Linear regression model analyses were used to analyse linear and non-linear trends in the level of Hb. Linear and logistic regression models were used to analyse possible associations between HC and Hb and possible associations between the use of HC and anaemia, respectively. Hb was measured in g/L. HC included any ongoing use of HC therapy. Covariates were smoking, body mass index (BMI), alcohol consumption and education. A non-linear U-shaped trend in mean Hb was seen in the two age groups, 38- and 50-years old. After adjusting for covariates, a significantly higher mean Hb was seen in the 2016–2017 examination compared to 1980–1981, 1992–1993 and 2004–2005. In 38-year-olds, using HC was associated with a reduced risk of anaemia (OR 0.35, 95% CI 0.13–0.75). In both age groups, the use of HC was significantly associated with having a higher Hb. Mean levels of Hb in middle-aged women of the general population seem to be increasing again after lower levels in the 1980s and 1990s. The use of HC was associated with having a higher Hb and a lower risk of anaemia in 38-year-old women. Studies of trends in haemoglobin (Hb) in Swedish women are scarce, although many factors associated with Hb levels have changed during the last decades. The use of hormonal contraceptives was associated with higher Hb and decreased risk of anaemia in younger middle-aged women. This study shows there is a non-linear (U-formed) trend in mean Hb, with increasing values since 1992. [ABSTRACT FROM AUTHOR]

Despite decreasing mortality from cardiovascular disease (CVD), there are persistent inequities in mortality between socioeconomic groups. Primary preventative medications reduce mortality in CVD; thus, inequitable treatments will contribute to unequal outcomes. Physicians might contribute to inequality by prescribing preventative medication for CVD to themselves in a biased manner. To determine whether primary medications for preventing CVD were prescribed inequitably between physicians and non-physicians. This retrospective study retrieved registry data on prescribed medications for all physicians in Sweden aged 45–74 years, during 2013, and for reference non-physician individuals, matched by sex, age, residence, and level of education. The outcome was any medication for preventing CVD, received at least once during 2013. Age and the sex-specific prevalence of myocardial infarction (MI) among physicians and non-physicians were used as a proxy for the need for medication. Thereafter, to limit the analysis to preventative medication, we excluded individuals that were diagnosed with CVD or diabetes. To analyse differences in medication usage between physicians and matched non-physicians, we estimated odds ratios (ORs) with conditional logistic regression and adjusted for need and household income. MI prevalences were 5.7% for men and 2.3% for women, among physicians, and 5.4% for men and 1.8% for women, among non-physicians. We included 25,105 physicians and 44,366 non-physicians. The OR for physicians receiving any CVD preventative medication, compared to non-physicians, was 1.65 (95% confidence interval 1.59–1.72). We found an inequity in prescribed preventative CVD medications, which favoured physicians over non-physicians. Groups with low socioeconomic status have lower rates of using medication that prevents cardiovascular disease, compared to groups with high socioeconomic status. Physicians are responsible for prescribing all medicines to prevent cardiovascular disease; thus, biased prescriptions could have effects on the equality of care in the population. Compared to individuals with equivalent education, physicians had higher rates of using medication that prevents cardiovascular disease. This study highlights the need for systematic population-based evaluation of CVD risk in order to promote equitable CVD outcomes. [ABSTRACT FROM AUTHOR]

COVID-19 has disproportionately impacted marginalized groups, including transgender populations, reproducing and exacerbating inequalities and vulnerabilities that existed in those groups prior to the pandemic. This study aimed to assess the prevalence of transgender-specific COVID-19-related stressors and their association with depressive symptoms among South Korean transgender adults. We conducted a nationwide cross-sectional study of 564 South Korean transgender adults (trans women, trans men, and nonbinary people) from October 7 to October 31, 2020. We measured four transgender-specific COVID-19-related stressors as follows: (A) had difficulty receiving gender-affirming healthcare due to economic hardship related to COVID-19, (B) had difficulty receiving gender-affirming healthcare due to limited access to hospitals under the COVID-19 situation, (C) had difficulty purchasing a public face mask due to gender information on an identification card, and (D) avoided getting a COVID-19 test in fear of unfair treatment and dirty looks due to gender identity, despite having COVID-19 symptoms. Past-week depressive symptoms were assessed using the Center for Epidemiologic Studies-Depression Scale. Of the total participants, 30.7% experienced any of the four transgender-specific COVID-19-related stressors, and 70.2% were classified as having depressive symptoms during the past week. We found statistically significant associations with depressive symptoms among participants who reported that they had difficulty receiving gender-affirming healthcare due to either economic hardship (adjusted prevalence ratio [aPR] = 1.20, 95% Confidence Interval [CI] = 1.05–1.37) or limited access to hospitals (aPR = 1.15, 95% CI = 1.00–1.32), respectively. Furthermore, those who had two or more of the four transgender-specific COVID-19-related stressors were 1.21 times (95% CI = 1.05–1.40) more likely to report depressive symptoms, compared to those who did not report any stressor. Transgender-specific COVID-19-related stressors may negatively influence depressive symptoms among South Korean transgender adults. Given these findings, transgender-inclusive interventions should be implemented at the policy level during the COVID-19 pandemic in South Korea. [ABSTRACT FROM AUTHOR]

Trans and gender diverse individuals (people who identify with a gender different to what was presumed for them at birth) are one of the most medically and socially marginalized groups in our community. The COVID-19 pandemic may compound preexisting depression and thoughts of self-harm or suicide. We aimed to explore the impact of the COVID-19 pandemic on the Australian trans community. An online cross-sectional survey was conducted between 1st May 2020 and 30th June 2020, amidst strict Australia-wide social restrictions. Australian trans people aged ≥16 years were eligible to participate. Survey questions explored the impact of the COVID-19 pandemic on living situation, employment, financial situation, and healthcare. Logistic regression to assess negative impacts due to COVID-19 on depression and thoughts of self-harm or suicide (measured by Patient Health Questionnaire-9 (PHQ-9) are presented as odds ratios (95% confidence interval)). Of 1019 participants, 49.6% reported experiencing financial strain, 22% had reduced working hours, and 22.4% were unemployed (three times the national rate). Concerningly, 61.1% experienced clinically significant symptoms of depression (Patient Health Questionnaire-9 score ≥10), considerably higher than pre-COVID rates for the trans community and over twice the national rate. Moreover, 49% reported thoughts of self-harm or suicide (over three times the national rate) which was more likely if a person experienced cancelation or postponement of gender-affirming surgery (OR 1.56 (1.04, 2.35)), financial strain (OR 1.80 (1.36, 2.38)), or felt unsafe or afraid in their household (OR 1.96 (1.23, 3.08)). Given rates of clinically significant depression and thoughts of self-harm or suicide are far higher in trans people than the general population, specific strategies to improve mental health in the trans community during the COVID-19 pandemic must be made a priority for policymakers, researchers, and health service providers to prevent suicide. Supplemental data for this article is available online at [ABSTRACT FROM AUTHOR]

Objective: Transition from school to early adulthood incurs many changes and may be associated with deterioration in general health in youth with autism. We aimed to investigate this. Method: The National Longitudinal Transitions Study-2 is a USA nationally representative sample of youth receiving special education services, aged 13–17 at wave 1, followed-up over 10 years in five data collection waves. We conducted random-effects ordered logistic regressions to determine the odds ratios (OR) with 95% confidence intervals of wave, age, sex, ethnicity/race, additional intellectual disabilities, parental/guardian relationship status, and household income being associated with general health status in youth with autism. Results: Across waves, only between 74.3%–69.6% had excellent/very good health (71.7%–58.8% in those with co-occurring intellectual disabilities), but wave was not associated with health status. Associations were with age OR = 1.18 (1.04, 1.33), co-occurring intellectual disabilities OR = 1.56 (1.00, 2.44), and household income OR = 0.61 (0.40, 0.94) at $30,001–$50,000, OR = 0.44 (0.27, 0.72) at $50,001–$70,000, and OR = 0.34 (0.20, 0.56) at $70,001+. Sex, ethnicity/race, and parental/guardian relationship status were not associated with health status. Conclusion: There was little change in general health status longitudinally across the transitional period, but the proportion with excellent/very good health was low at each wave. Transitional planning should consider co-occurring intellectual disabilities, and the wider socioeconomic context in which children/youth with autism are raised. Lack of other longitudinal studies indicates a need for replication. [ABSTRACT FROM AUTHOR]

Prior studies have reported that heart failure typically affects elderly, multimorbid and socioeconomically deprived men. Women with heart failure are generally older, have a higher EF (ejection fraction) and have more heart failure-related symptoms than men. This study explored the disparities in the prevalence of heart failure between men and women in relation to age, multimorbidity level and socioeconomic status of the population in southern Sweden. A register-based, cross-sectional cohort study. Setting and subjects: The inhabitants from 20 years of age onwards (N = 981,383) living in southern Sweden in 2015. Main outcome measure: Prevalence and mean probability of having heart failure in both genders. CNI (Care Need Index) percentiles depend on the socioeconomic status of their listed primary healthcare centres. Men had a higher OR for HF − 1.70 (95% CI 1.65–1.75) - than women. The probability of men having heart failure increased significantly compared to women with advancing age and multimorbidity levels. At all CNI levels, the multimorbid patients had a higher prevalence of heart failure in men than in women. The disparity in the mean probability of heart failure between the most affluent and deprived CNI percentile was more apparent in women compared to men, especially from 80 years. The prevalence of heart failure differs significantly between the genders. Men had an increasing mean probability of heart failure with advancing age and multimorbidity level compared to women. Socioeconomic deprivation was more strongly associated with heart failure in women than in men. The probability of having heart failure differs between the genders in several aspects. Independently of socioeconomic status, men had a higher prevalence of heart failure than women among the multimorbid patients. The mean probability of men having heart failure increased significantly compared to women with advancing age and multimorbidity level. Socioeconomic status was more strongly associated with heart failure in women than in men. [ABSTRACT FROM AUTHOR]

Women are reported to consult general practitioners (GPs) more frequently than men. However, previous studies on sex differences in help-seeking behavior for somatic symptoms do not distinguish between sex and gender, do not account for sex differences in presented symptoms, and are frequently conducted in clinical settings, automatically excluding non-help seekers. Therefore, we aim to assess the independent associations of sex and gender with primary care help-seeking for somatic symptoms in the general population. Records from the longitudinal population-based Lifelines Cohort Study were linked to routine electronic health records from GPs. Participants reporting new-onset common somatic symptoms. Associations between sex and gender, operationalized via a novel gender-index, with primary care help-seeking for somatic symptoms and differences in the strength of the association between gender and help-seeking for somatic symptoms between women and men. Of 20,187 individuals with linked data, 8325 participants (67.5% female; mean age = 44.5 years [SD = 12.9]) reported at least one new-onset somatic symptom. Hereof, 255 (3.1%) consulted the GP within 6 weeks of symptom onset. Female sex was positively associated with consulting the GP (OR = 1.78; 95%CI = 1.13–2.80), whereas feminine gender was not (OR = 0.67; 95%CI = 0.39–1.16). The latter association did not differ in strength between men and women. More paid working days are negatively associated with help-seeking (OR = 0.95; 95%CI = 0.91–0.98). The results suggest that female sex rather than feminine gender is associated with primary care help-seeking behavior for somatic symptoms. Nevertheless, clinicians should be aware that gender-related variables, such as mean paid working days, may be associated with help-seeking behavior. [ABSTRACT FROM AUTHOR]

The objective of this study was to examine sexual orientation-based disparities in six self-reported health outcomes among millennial aged military veterans. We collected data using The Millennial Veteran Health Study, a cross-sectional internet-based survey with extensive quality control measures. The survey was fielded April through December 2020 and targeted millennial aged veterans across the United States. A total of 680 eligible respondents completed the survey. We assessed six binary health outcomes: alcohol use, marijuana use, frequent chronic pain, opioid misuse, high psychological distress, and fair or poor health status. Using logistic regression adjusted for a range of demographic, socioeconomic, and military-based covariates, we find that bisexual veterans consistently report worse health than straight veterans for all six health outcomes tested. Results for gay or lesbian, compared to straight veterans, were less consistent. Sensitivity models with continuous outcomes, and stratified by gender, found similar results. These results have implications for improving the health of bisexual individuals, including addressing discrimination, belonging, and social identity, particularly in institutional settings that have traditionally heteronormative and masculine cultures such as the military. [ABSTRACT FROM AUTHOR]

Background: Gender clinics are experiencing an increase in non-binary and/or genderqueer (NBGQ) individuals applying for gender affirming medical treatment (GAMT). GAMT is a well-established approach in reducing body dissatisfaction in binary transgender (BT) people, but knowledge on GAMT in NBGQ people is limited. Previous research shows that NBGQ individuals report different treatment needs compared to BT individuals. In attempting to address this difference, the current study examines the association between identifying as NBGQ, body dissatisfaction and their underlying motives for GAMT. The main research objectives were to describe the desires and motives for GAMT in NBGQ people and to examine how body dissatisfaction and gender identity relate to one's request for GAMT. Methods: Online self-report questionnaires were administered on 850 adults referred to a gender identity clinic (Mdn age = 23.9 years). Gender identity and desires for GAMT were surveyed at clinical entry. Body satisfaction was assessed with the Body Image Scale (BIS). Multiple linear regressions were used to examine whether BIS scores differed between NBGQ and BT individuals. Chi-square post hoc analyses were used to identify differences in treatment desires and motives between BT and NBGQ individuals. Logistic regressions were conducted to study the association between body image, gender identity and treatment desire. Results: Compared to BT persons (n = 729), NBGQ persons (n = 121) reported less body dissatisfaction, primarily with the genital area. NBGQ persons also preferred fewer GAMT interventions. If a procedure was not desired, NBGQ individuals more often motivated this on the basis of their gender identity, while BT individuals more often cited the risks of the procedure as their primary reason. The study confirms the need for more NBGQ specialized care, as they have a distinct experience of their gender incongruence, physical distress and express specific needs in GAMT. [ABSTRACT FROM AUTHOR]

This study aimed to systematically assess the impact of clinical and demographic variables on the diagnostic yield of Whole Exome Sequencing (WES) when applied to children with Autism Spectrum Disorder (ASD) from a consanguineous population. Ninety-seven children were included in the analysis, 63% were male and 37% were females. 77.3% had a suspected syndromic aetiology of which 68% had co-existent central nervous system (CNS) clinical features, while 69% had other systems involved. The diagnostic yield of WES in our cohort with ASD was 34%. Children with seizures were more likely to have positive WES results (46% vs. 31%, p = 0.042). Probands with suspected syndromic ASD aetiology showed no significant differential impact on the diagnostic yield of WES. [ABSTRACT FROM AUTHOR]

Context: A comprehensive meta-analysis was carried out to investigate the impact of orthodontics on masticatory muscles. Methods: A thorough search of various databases, including CNKI, Wan Fang, VIP, CBM, MEDLINE, PubMed, Cochrane Library, EMBASE, Web of Science, and Google Scholar, was performed to identify relevant studies on patients undergoing orthodontics or functional corrections. Six case-control studies were finally included in this analysis, which specifically examined the effect of orthodontic treatment on masticatory muscle function. Results: The results revealed that the mean masticatory muscle voltage in patients treated with orthodontics was found to be higher after treatment compared to before treatment [odds ratio (OR)=1.57, 95% confidence interval (CI) (0.57, 2.57), p = 0.002], which could potentially have an impact on masticatory muscle function, particularly in individuals with Class II Division 1 malocclusion. Conclusion: These findings contribute to our understanding of the effects of orthodontic interventions on masticatory muscles, further highlighting the importance of orthodontics in optimising masticatory function. [ABSTRACT FROM AUTHOR]

Masters athletes are endowed with high functional capacity, long-term health, and psychological outlook. However, their sexual activity and function are largely unknown. We investigated the influence of sustained moderate to vigorous exercise on sexual life using a model of masters athletes. A 55-item survey adapted from previous American Association of Retired People (AARP) sexuality study were distributed to masters athletes associations. The responses from 166 masters athletes were compared with AARP dataset that represented a general population. Both male and female masters athletes demonstrated more frequent sexual desire and greater involvements in different types of sexual activities (i.e., kissing or hugging, touching or caressing, sexual intercourse, oral sex, and self-stimulation; all p < 0.05). Sexual satisfaction was greater in female masters athletes than in female general population (p = 0.025), but no such group difference was observed in men. Male athletes had a lower degree of erectile dysfunction. No difference was observed in orgasm frequency between the two population groups. Age-associated decline in sexual activity was apparent in general population (p < 0.05) but absent in masters athletes. Females recorded lower engagements in partner-involved sexual behaviors than men in the general population, but no such gender difference was observed in women. The primary factor predicting improvement in sexual satisfaction was "better health for myself" (29.7%) in the general population, whereas master athletes identified "better health for partner" (23.5%). Masters athletes in general and female athletes in particular demonstrate superior sexual function, satisfaction, and behavior presumably due to their better overall health status. [ABSTRACT FROM AUTHOR]

We investigated how military identity (i.e., veteran identity centrality--the extent to which military service is central to an individual's sense of self) relates to substance use and mental health among U.S. Army Reserve and National Guard (USAR/NG) soldiers. Data were drawn from Operation: SAFETY, a longitudinal survey study of USAR/NG soldiers. Regression models (n = 413 soldiers) examined relationships between military identity and substance use (i.e., alcohol problems, past 3-months non-medical use of prescription drugs (NMUPD), illicit drug use, tobacco use), and mental health (i.e., generalized anxiety, anger, depression, and PTSD), controlling for sex, race, age, education, years of military service, military status (current/former), and deployment (ever/never). In adjusted models, stronger military identity was not related to alcohol, illicit drug, or tobacco use, but was associated with past 3-months NMUPD (OR: 1.40, 95% CI: 1.12, 1.75, p < .01) and greater symptoms of anger (IRR: 1.02, 95% CI: 1.01, 1.03, p < .01), generalized anxiety (IRR: 1.05, 95% CI: 1.01, 1.10, p < .01), depression (IRR: 1.06, 95% CI: 1.02, 1.10, p < .01), and PTSD (IRR: 1.07, 95% CI: 1.02, 1.12, p < .01). The findings demonstrate the importance of military identity for health-related outcomes. NMUPD suggests potential self-medication and avoidance of help-seeking, as admitting difficulties may conflict with military identity. [ABSTRACT FROM AUTHOR]

Gaps exist along the high blood pressure (HBP) diagnosis-treatment-control pathway in high, low and middle-income countries. To determine the prevalence of HBP and to describe the levels of awareness, control and treatment of HBP in the rural Peruvian Andes. This cross-sectional study is embedded into a multigenerational cohort. We analysed data of all adult participants aged ≥ 30 years (n = 2752) who answered a baseline health and lifestyle questionnaire and underwent a physical examination, which included three blood pressure readings. HBP was defined as measured systolic or diastolic blood pressure (BP) ≥140 and/or 90 mm Hg and/or self-reported physician-diagnosed hypertension and/or self-reported antihypertensive intake. The determinants of the prevalence of HBP, unawareness of HBP and uncontrolled HBP were assessed using mixed-effect logistic regressions. HBP was present in 18.9% of the participants. Of those with measured HBP, 72.2% were unaware of their HBP. Among those with a diagnosed or medically treated hypertension, 58.4% had uncontrolled HBP. The prevalence of HBP was higher in women (OR: 1.12, CI: 1.02–1.24), increased with age (OR: 1.01, CI: 1.01–1.01) and the presence of family history of hypertension (OR: 1.15, CI: 1.08–1.24), and decreased with healthier lifestyle score (OR: 0.93, CI: 0.91–0.95). Unawareness of HBP was lower among women (OR: 0.56, CI: 0.38–0.83), higher among participants living over 3000 m Above Sea Level (OR: 1.15, CI: 1.03–1.27) and decreased with age (OR: 0.99, CI: 0.98–0.99). Unawareness of HBP was high, few HTN patients received treatment and BP remained high in the presence of antihypertensive treatment. [ABSTRACT FROM AUTHOR]

The South African national cause of death validation (NCODV 2017/18) project collected a national sample of verbal autopsies (VA) with cause of death (COD) assignment by physician-coded VA (PCVA) and computer-coded VA (CCVA). The performance of three CCVA algorithms (InterVA-5, InSilicoVA and Tariff 2.0) in assigning a COD was compared with PCVA (reference standard). Seven performance metrics assessed individual and population level agreement of COD assignment by age, sex and place of death subgroups. Positive predictive value (PPV), sensitivity, overall agreement, kappa, and chance corrected concordance (CCC) assessed individual level agreement. Cause-specific mortality fraction (CSMF) accuracy and Spearman's rank correlation assessed population level agreement. A total of 5386 VA records were analysed. PCVA and CCVAs all identified HIV/AIDS as the leading COD. CCVA PPV and sensitivity, based on confidence intervals, were comparable except for HIV/AIDS, TB, maternal, diabetes mellitus, other cancers, and some injuries. CCVAs performed well for identifying perinatal deaths, road traffic accidents, suicide and homicide but poorly for pneumonia, other infectious diseases and renal failure. Overall agreement between CCVAs and PCVA for the top single cause (48.2–51.6) indicated comparable weak agreement between methods. Overall agreement, for the top three causes showed moderate agreement for InterVA (70.9) and InSilicoVA (73.8). Agreement based on kappa (−0.05–0.49)and CCC (0.06–0.43) was weak to none for all algorithms and groups. CCVAs had moderate to strong agreement for CSMF accuracy, with InterVA-5 highest for neonates (0.90), Tariff 2.0 highest for adults (0.89) and males (0.84), and InSilicoVA highest for females (0.88), elders (0.83) and out-of-facility deaths (0.85). Rank correlation indicated moderate agreement for adults (0.75–0.79). Whilst CCVAs identified HIV/AIDS as the leading COD, consistent with PCVA, there is scope for improving the algorithms for use in South Africa. [ABSTRACT FROM AUTHOR]

Understanding a woman's future contraceptive needs and enhancing her chances of putting those needs into action depend heavily on her intentions to use contraceptive methods. However, there is little information about global perspectives of intention to utilise contraceptives among fecund sexually active women. This study examines the patterns and determinants of contraception intention of fecund sexually active women. The most recent Demographic and Health Surveys (DHS) from 59 countries were used for secondary data analysis. The DHSs applied a cross-sectional survey design to collect data from women between the ages of 15 and 49. The study comprises a sample of 697,590 fecund sexually active women in the reproductive ages. The desire to utilise contraceptive methods was examined using a multivariable binary logistic regression analysis. All analyses were weighted to allow for a complex survey design. A pooled prevalence of intention to utilise contraception was 42.8% (95% CI: 42.5, 43.1) at the global level. Eastern and Southern Europe had the lowest prevalence, 17.3% (95% CI: 16.4, 18.2), and the highest prevalence was observed in countries from Latin America and the Caribbean, 68.0% (95% CI: 67.5, 69.9). Attaining secondary-level education (adjusted odds ratio (aOR) = 1.68; 95% CI: 1.62–1.72) or higher (aOR = 1.71; 95% CI: 1.63–1.80), working (aOR = 1.21; 95% CI: 1.18–1.24), experience of a pregnancy loss (aOR = 1.06; 95% CI: 1.03–1.09), or being exposed to media family planning messages (aOR = 1.51; 95% CI: 1.48–1.55) were factors associated with an increased likelihood of intent to use contraceptives. The study has established that contraceptive use intention was low in many developing countries. Education, age, employment status, fertility preference, and exposure to family planning messages influenced contraceptive use intention. Health policy-makers ought to consider these factors when designing sexual and reproductive health strategies in developing countries. [ABSTRACT FROM AUTHOR]

HIV risk reduction counselling may reduce risk-taking behaviours. Yet, concerns remain about risk compensation among individuals initiating pre-exposure prophylaxis (PrEP). We assessed changes in risky sexual behaviour indicators among HIV vaccine preparedness study participants who received regular risk reduction counselling and referral for PrEP in Masaka, Uganda. Adults (18–39 years) at high risk of HIV infection were enrolled in the study between July 2018 and December 2021. Data were collected on socio-demographic factors (baseline) and self-reported sexual risk behaviours (baseline, six monthly). HIV testing and risk-reduction counselling and referral for PrEP were done quarterly. Participants who had completed at least 1 year of follow-up were included in the analysis. Proportional differences and McNemar chi-square tests were used to assess changes in the prevalence of self-reported risky sexual behaviour indicators between baseline and 1 year. Logistic regression was used to assess the predictors of unchanged/increased HIV risk at 1 year. Three hundred participants [132 (44%) females, 152 (51%) aged ≤24 years] were included in this analysis. Eighty-one (27%) participants initiated PrEP at 1 year. Compared to baseline, there were significant reductions in the prevalence of the following self-reported HIV risk indicators at 1 year (overall, among non-PrEP initiators, and among PrEP initiators): transactional sex, ≥6 sexual partners, unprotected sex with ≥3 partners, sex while drunk, and sexually transmitted infection diagnosis/treatment. Percentage differences ranged from 10% for individuals reporting at least six sexual partners to 30% for those reporting unprotected sex with three or fewer sexual partners. There was weak evidence of association between female gender and unchanged/increased HIV risk at 1 year (adjusted OR: 1.35, 95% CI (0.84–2.17)). No other indicators, including PrEP use, were associated with unchanged/increased HIV risk at 1 year. Regular risk-reduction counselling may reduce risky sexual behaviour, while PrEP initiation may not lead to risk compensation. [ABSTRACT FROM AUTHOR]

Undernutrition remains a major public health issue in low- and middle-income countries. Objective Our aim for this study was to identify the factors contributing to undernutrition in children under five years old in North Africa. We searched five electronic bibliographic databases (Ovid MEDLINE, Web of Science, Embase (Ovid), ProQuest, and CINAHL) for eligible observational studies published after 2006. STATA version 17 software was used to calculate the odds ratios between associated factors and indicators of undernutrition, with 95% confidence intervals. For each factor, the overall odds were pooled using a forest plot. Due to the significant heterogeneity among the studies (I2 > 50%), a random-effects model was used, and sensitivity analysis was conducted to examine the effect of outliers. Out of 1093 initially identified studies, 14 met the selection criteria. Our meta-analysis revealed that uneducated mothers were the most common factor associated with undernutrition in North African children. Children aged 0–23 months were significantly associated with stunting (odds ratios (OR) = 1.27; 95% CI: 1.18; 1.37) and wasting (OR = 1.68; 95% CI: 1.42; 1.99). Children living in rural areas were also at higher odds of being stunted (OR = 1.74; 95% CI: 1.64; 1.84) and underweight (OR = 1.59; 95% CI: 1.35; 1.88). These analyses also indicated that a lower wealth index, mothers' nutritional health, uneducated fathers, and low birth weight were other factors significantly associated with stunting. Addressing undernutrition in Northern Africa requires a multidisciplinary approach prioritising mothers and young children, especially families in underprivileged areas. [ABSTRACT FROM AUTHOR]

HIV/AIDS remains the leading cause of morbidity and mortality worldwide. Moreover, sub-Saharan countries, including Ethiopia, are highly affected by HIV/AIDS pandemic. Ethiopia's government has been working on a comprehensive HIV care and treatment programme, including antiretroviral therapy. However, evaluating client satisfaction with antiretroviral treatment services is not well studied. This study aimed to assess client satisfaction and associated factors with antiretroviral treatment services provided at public health facilities of Wolaita zone, South Ethiopia. A facility-based cross-sectional study involved 605 randomly selected clients using ART services from six public health facilities in Southern Ethiopia. A multivariate regression model was used to see an association between independent variables and the outcome variable. The odds ratio with 95% CI was computed to determine the presence and strength of the association. Four hundred twenty-eight (70.7%) clients were satisfied with an overall antiretroviral treatment service, which included significant variations ranging from 21.1% to 90.0% among health facilities. Sex [AOR = 1.91; 95% CI = 1.10–3.29], employment [AOR = 13.04; 95% CI = 4.34–39.22], clients' perception of the availability of prescribed laboratory services [AOR = 2.56; 95% CI = 1.42–4.63], availability of prescribed drugs [AOR = 6.26; 95% CI = 3.40–11.52] and cleanliness of toilet in the facility [AOR = 2.83; 95% CI = 1.56–5.14] were factors associated with client satisfaction with antiretroviral treatment services. The overall client satisfaction with antiretroviral treatment service was lower than the national target of 85%, with a marked difference among facilities. Sex, occupational status, availability of comprehensive laboratory services, standard drugs, and cleanliness toilets in the facility were factors associated with client satisfaction with antiretroviral treatment services. Sex-sensitive services needed to address and sustained availability of laboratory services and medicine recommended. [ABSTRACT FROM AUTHOR]

In a critical obstetric situation, the time interval between the decision of performing a caesarean section (CS) and delivery can influence maternal and newborn outcomes. In Somaliland, consent for surgical procedures, such as CS needs to be sought from family members. To determine the association between a delay in performing a CS and severe maternal and newborn outcomes in a national referral hospital in Somaliland. The type of barriers leading to delayed performance of CS after a doctor's decision were also explored. Women were followed from the time of decision to perform CS until discharge from the hospital between 15 April 2019 and 30 March 2020. No delay was defined as < 1 hour and delayed CS was defined as 1–3 hours and >3 hours from decision of CS to delivery. Information was collected on barriers leading to delayed CS and maternal and newborn outcomes. Data was analysed using binary and multivariate logistic regression. Overall, 1255 women were recruited from a larger cohort of 6658 women. A delay in CS >3 hours was associated with higher odds of severe maternal outcomes (aOR 1.58, 95% CI [1.13–2.21]). On the contrary, delay in performing a CS >3 hours was associated with lower odds of stillbirth (aOR 0.48, 95% CI [0.32–0.71]) compared to women without delay. Further, family decision-making for consent was the most important barrier leading to delays of >3 hours as compared to financial factors and barriers related to healthcare providers (48% vs 26% and 15%, respectively, p < 0.001). In this setting, delay in performing CS >3 hours was associated with higher risk of severe maternal outcomes. A standardised system of performing a CS by primarily addressing the barriers associated with family decision-making, financial aspects and healthcare providers is needed. [ABSTRACT FROM AUTHOR]

Ideally health insurance aims to provide financial security, promote social inclusion, and ensure equitable access to quality healthcare services for all households. Community-based health insurance has been operating in Ethiopia since 2011. However, its nationwide impact on universal health coverage has not yet been evaluated despite several studies being conducted. We evaluated the impact of Ethiopia's community-based health insurance (2012–2021) on universal health coverage. On 27 August 2022, searches were conducted in Scopus, Hinari, PubMed, Google Scholar, and Semantic Scholar. Twenty-three studies were included. We used the Joana Briggs Institute checklists to assess the risk of bias. We included cross-sectional and mixed studies with low and medium risk. The data were processed in Microsoft Excel and analyzed using RevMan-5. The impact was measured first on insured households and then on insured versus uninsured households. We used a random model to measure the effect estimates (odds ratios) with a p value < 0.05 and a 95% CI. The universal health coverage provided by the scheme was 45.6% (OR = 1.92, 95% CI: 1.44–2.58). Being a member of the scheme increased universal health coverage by 24.8%. The healthcare service utilization of the beneficiaries was 64.5% (OR = 1.95, 95% CI: 1.29–2.93). The scheme reduced catastrophic health expenditure by 79.4% (OR = 4.99, 95% CI: 1.27–19.67). It yielded a 92% (OR = 11.58, 95% CI: 8.12–16.51) perception of health service quality. The health-related quality of life provided by it was 63% (OR = 1.71, 95% CI: 1.50–1.94). Its population coverage was 40.1% (OR = 0.64, 95% CI: 0.41–1.02). Although the scheme had positive impacts on health service issues by reducing catastrophic costs, the low universal health coverage on a limited population indicates that Ethiopia should move to a broader national scheme that covers the entire population. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) continues to be a public health issue of concern in South Africa. Workers in the agricultural sector are generally at increased risk of TB due to multiple interacting factors such as exposure to silica dust, co-worker infection, and occupations falling within the lower socio-economic sectors. This study investigates factors associated with TB screening uptake for agricultural workers in Limpopo Province, South Africa. This cross-sectional study targeted a study population of 16,787 agricultural workers across 96 agricultural worksites in South Africa. A two-stage cluster random sampling design identified 24 agricultural worksites and a potential 2500 participants. The outcome variable was self-reported TB screening. Descriptive statistics and unadjusted and adjusted logistic regression analyses were performed to determine factors associated with TB screening. A literature review informed the selection of covariates as possible confounders. The final study sample comprised 2144 workers across 24 sites, with 55% being women. TB screening uptake was 1155 (56.3%). Factors such as living with human immunodeficiency virus (HIV) (AOR 3.16, 95% CI: 2.44–4.09), accessing health services in the workplace (AOR 1.94, 95% CI: 1.09–3.46), and having prior TB knowledge (AOR 18.45, 95% CI: 9.8–34.74) were positively associated with TB screening. Participants in the age group 36–49 years had significantly higher odds of self-reporting TB screening, compared with those aged 18–25 years (AOR 1.37, 95% CI 1.07–1.77). Migrant workers from Mozambique (OR 0.52, 95% CI: 0.34–0.79) and Zimbabwe (OR 0.71, 95% CI 0.57–0.89) were significantly less likely to self-report TB screening compared to their South African counterparts. The findings underscore the importance of workplace health services in achieving end-TB targets. We recommend programs and interventions for preventing TB in South Africa that target the agricultural sector in general, and in particular migrant workers. [ABSTRACT FROM AUTHOR]

Emergency department-based HIV self-testing (ED-HIVST) could increase HIV-testing services to high-risk, under-reached populations. This study sought to understand the injury patient acceptability of ED-HIVST. Injury patients presenting to the Kenyatta National Hospital Accident and Emergency Department were enrolled from March to May 2021. Likert item data on HIVST assessing domains of general acceptability, personal acceptability, and acceptability to distribute to social and/or sexual networks were collected. Ordinal regression was performed yielding adjusted odds ratios (aOR) to identify characteristics associated with high HIVST acceptability across domains. Of 600 participants, 88.7% were male, and the median age was 29. Half reported having primary care providers (PCPs) and 86.2% reported prior HIV testing. For each Likert item, an average of 63.5% of the participants reported they 'Agree Completely' with positive statements about ED-HIVST in general, for themselves, and for others. In adjusted analysis for general acceptability, those <25 (aOR = 1.67, 95%CI:1.36–2.08) and with prior HIV testing (aOR = 1.68, 95%CI:1.27–2.21) had greater odds of agreeing completely. For personal acceptability, those with a PCP (aOR = 3.31, 95%CI:2.72–4.03) and prior HIV testing (aOR = 1.83, 95%CI:1.41–2.38) had greater odds of agreeing completely. For distribution acceptability, participants with a PCP (aOR = 2.42, 95%CI:2.01–2.92) and prior HIV testing (aOR = 1.79, 95%CI: 1.38–2.33) had greater odds of agreeing completely. ED-HIVST is perceived as highly acceptable, and young people with prior testing and PCPs had significantly greater favourability. These data provide a foundation for ED-HIVST programme development in Kenya. [ABSTRACT FROM AUTHOR]

Peer-led education interventions are assumed to be an effective means of increasing contraceptive utilization and demand in adolescents. However evidence is lacking on whether peer-led education is effective in promoting the demand for and use of contraceptives in adolescent girls, especially in resource-limited settings. The present study evaluated the effectiveness of peer-led education interventions in improving contraceptive use, unmet needs, and demand among sexually active secondary school adolescent girls in Gedeo Zone, South Ethiopia. A single-blinded cluster randomised controlled trial study was performed in six randomly selected secondary schools in the Gedeo Zone, southern Ethiopia. A total of 224 participants were recruited and randomly assigned to the intervention and control groups. The intervention group received peer-led education intervention for six months. A pre-tested and validated questionnaire was used to measure contraceptive use, unmet need, and contraceptive demand. A generalised estimating equation (GEE) model was used to examine the effectiveness of the intervention. After six months of intervention, the Differences-in-difference in contraceptive use, unmet need, and contraceptive demand between the intervention and control groups were 25.1%, 7.4%, and 17.7%, respectively. There was a statistically significant difference in contraceptive use [AOR = 8.7, 95% CI: (3.66, 20.83), unmet need for contraceptives [AOR = 6.2, 95% CI: (1.61, 24.36)] and contraceptive demand [AOR = 6.1, 95% CI: (2.43, 15.11)] between the intervention and control groups. School-based peer education intervention effectively improved contraceptive use and unmet needs in a low-resource setting and created demand in sexually active adolescent girls. These results support the potential utility of this approach in similar settings for the promotion of contraception use and demand. [ABSTRACT FROM AUTHOR]

Globally, anaemia prevails as a public health issue, being also a concern in Mozambique, where about two-thirds of children 6–59 months of age are affected by this condition. We carried out this study to estimate anaemia prevalence and evaluate structural determinants and haematological parameters association among children aged 6–59 months attending pediatric inpatient and outpatient services in a Quaternary Health Facility in Maputo City Province, Mozambique. We collected data from 637 inpatients or outpatients who attended pediatric consultations at the Maputo Central Hospital. The overall rate of anaemia in children aged 6–59 months was 62.2% (396/637), with 30.9% moderate anaemia (197/637), 23.9% mild anaemia (152/637), and 7.4% severe anaemia (47/637). Among our study participants, critical factors for anaemia were those concerning the age group, child´s caregiver schooling, malaria and size of the liver. [ABSTRACT FROM AUTHOR]

While there have been notable advancements in child health in Egypt, disparities in child mortality still exist. Understanding these disparities is crucial to addressing them. The objective of this study is to explore the factors linked to child mortality in Egypt, providing a comprehensive understanding of the disparities in child mortality rates. The study utilises cross-sectional data from Egypt's Demographic and Health Survey (EDHS) in 2014 to examine child mortality. The dataset consists of 15,848 observations from mothers with children born within five years prior to the survey. The choice of explanatory variables was guided by the Mosely and Chen Framework and logistic multivariate regression was used to conduct the analyses. The study finds lower education, early childbearing, insufficient birth spacing, lack of breastfeeding, and absence of improved toilet facilities (proxy for living conditions) were all significantly linked to an increased likelihood of child loss. Additionally, poorer people in rural settings experienced the worst child mortality. The findings align with the World Health Organization's Conceptual Framework for Action on the Social Determinants of Health (CSDH). Recommended policy interventions include targeting women in rural areas, improving living conditions and removing financial/other barriers to accessing care. [ABSTRACT FROM AUTHOR]

Despite tobacco marketing diversification, limited research has examined use profiles across countries, particularly in relation to consumer values (e.g. appeal of innovation, conscientiousness). Using 2021 data, latent class analysis assessed past-month use of seven tobacco products (cigarettes, electronic cigarettes [e-cigarettes], heated tobacco products, cigars, hookah, pipe, smokeless) among adults reporting past-month use in the United States (US n = 382) and Israel (n = 561). Multivariable multinomial regression examined consumer values and sociodemographics in relation to country-specific class membership. US classes included: primarily cigarette 58.1%; e-cigarette–no cigarette 17.5%; primarily cigar 14.9%; and poly-product 9.9%. Higher innovation correlated with e-cigarette–no cigarette and poly-product (vs. primarily cigarette) use. Other correlates included being: younger with e-cigarette–no cigarette; male, Black, and more educated with primarily cigar; and Black and Asian (vs. White) with poly-product. Israel classes included: primarily cigarette 39.0%; moderate poly-product 40.3%; high poly-product 13.4%; and hookah 7.3%. Lower conscientiousness correlated with moderate poly-product (vs. primarily cigarette) use; higher innovation correlated with high poly-product; lower innovation correlated with hookah. Other correlates included being: younger, male, and more educated with moderate poly-product; male and sexual minority with high poly-product; and Arab with hookah. Tobacco consumer segments within and across countries likely reflect different consumer values and industry marketing targets. [ABSTRACT FROM AUTHOR]

South Asia bears a substantial proportion of the global maternal mortality burden, with adolescents disproportionately affected. Bangladesh has one of the highest adolescent pregnancy rates in the world, with low utilisation of maternal newborn and child health (MNCH) services. This hampers the country's efforts to achieve optimal health outcomes as envisioned by the Sustainable Development Goals. Male partner involvement is a recognised approach to optimise access to services and decision-making. In South Asia data on male involvement in MNCH service uptake is limited. Plan International's Strengthening Health Outcomes for Women and Children was implemented across four districts in Bangladesh between 2016 and 2020 and aimed to address these issues. Study results (N = 1,724) found higher maternal education levels were associated with use of MNCH services. After controlling for maternal education, service uptake was associated with male partner support level and perceived joint decision-making. The positive association between male support level and MNCH scale was robust to stratification by maternal education level, and by age group (i.e. adolescent vs. adult mothers). These findings suggest that one path for achieving optimal MNCH outcomes might be through structural-level interventions centred on women, combined with components targeting male partners or male heads of households. [ABSTRACT FROM AUTHOR]

The SARS-CoV-2 coronavirus pandemic has led to increased food insecurity levels. This cross-sectional study examines the prevalence and determinants of food insecurity during the two-month (1 April to 1 June 2022) city-wide lockdown in Shanghai. The data was collected via an online questionnaire from 3230 adult Shanghai residents during the lockdown. Food insecurity was measured using an adapted version of the Household Food Insecurity Access Scale. Nearly 70% of participants reported being exposed to food insecurity. Using multivariable logistic regressions, we examined the associations between key correlates (i.e. age, income, lockdown-related income loss, migration, employment status, social capital, preparedness, and received social support) and overall food insecurity while adjusting for ethnicity, gender, education, household size, and marital status. Results showed that compared to local Shanghai residents, migrants (i.e, permanent migrants with Hukou (OR = 2.16), permanent migrants without Hukou (OR = 2.06), temporary migrants (OR = 2.74)), and participants with less than or greather than 50% lockdown-related income loss (OR = 2.60, OR = 3.09), were associated with higher odds of overall food insecurity. Participants with greater preparedness (OR = 0.66), greater bonding social capital (OR = 0.93), and greater bridging social capital (OR = 0.94), had lower odds of overall food insecurity. Targeted interventions are needed to enhance food resilience and health equity among vulnerable populations. [ABSTRACT FROM AUTHOR]

Brazil has a historical gap regarding information on violence against women. Herein we aimed to evaluate the association of socioeconomic and demographic characteristics with physical violence against women in Brazil, as well as the possible escalation of violence to severe patterns of violence. We analysed data from the 3rd Brazilian Household Survey on Substance Use, in 2015. The main outcomes were reporting any physical violence and being stabbed/shot in the last 12-months. Logistic regressions were fitted to assess the association between socioeconomic and demographic variables with the outcomes. We estimated 3.8 million women reported any physical violence (5.52%): 3.79% reported threats to beat/ push/kick, 1.87% threats with knife/gun, 2.49% were beaten/pushed/kicked, 0.63% were spanked/ choked, and 0.21% were stabbed/shot. The higher the severity of violence, the higher the number of types of violence experienced. The likelihood of reporting any violence was higher among women 18–24 years, without a stable partner, who were at an informal job or unemployed, and who live in urban areas. The sociodemographic characteristics associated with reporting any violence reinforce the importance of addressing gender inequalities. Evidence of escalation violence reinforces the need to protect and care for women who report any type of violence. [ABSTRACT FROM AUTHOR]

The 2030 Sustainable Development Goals call for both the elimination of violence against women and girls and disability-disaggregated data. However, few population-based, multi-country studies have examined how disability impacts intimate partner violence (IPV) in fragile settings. Demographic and Health Survey data from five countries (Pakistan, Timor-Leste, Mali, Uganda, and Haiti) were pooled and analyzed to assess the relationship between disability and IPV (N = 22,984). Pooled analysis revealed an overall disability prevalence of 18.45%, with 42.35% lifetime IPV (physical, sexual and/or emotional), and 31.43% past-year IPV. Women with disabilities reported higher levels of past-year and lifetime IPV compared to those without disabilities (AOR 1.18; 95% CI 1.07, 1.30; AOR 1.31; 95% CI 1.19, 1.44, respectively). Women and girls with disabilities may be disproportionately impacted by IPV in fragile settings. More global attention is needed to address IPV and disability in these settings. [ABSTRACT FROM AUTHOR]

International evidence suggests migrants experience significant cancer inequities. In Australia, there is limited information assessing equity for Culturally and Linguistically Diverse (CALD) migrant populations, particularly in cancer prevention. Cancer inequities are often explained by individualistic, behavioural risk factors; however, scarce research has quantified or compared engagement with cancer prevention strategies. A retrospective cohort study was conducted utilising the electronic medical records at a major, quaternary hospital. Individuals were screened for inclusion in the CALD migrant or Australian born cohort. Bivariate analysis and multivariate logistic regression were used to compare the cohorts. 523 individuals were followed (22% were CALD migrants and 78% Australian born). Results displayed that CALD migrants made up a larger proportion of infection-related cancers. Compared to Australian born, CALD migrants had lower odds of having a smoking history (OR = 0.63, CI 0.401–0.972); higher odds of 'never drinking' (OR = 3.4, CI 1.473–7.905); and lower odds of having breast cancers detected via screening (OR = 6.493, CI 2.429–17.359). Findings affirm CALD migrants' low participation in screening services but refute the assertion that CALD migrants are less engaged in positive health practices, enabling cancer prevention. Future research should examine social, environmental, and institutional processes and move beyond individualistic, behavioural explanations for cancer inequities. [ABSTRACT FROM AUTHOR]

Approximately 280 million people around the world suffer from depression, and the rates are higher among women than men. For women living in informal settlements in lower – and middle-income countries (LMICs) the prevalence and associated burden of depressive symptoms may be particularly high. The purpose of this paper was to explore factors associated with possible major depressive disorder (MDD) in a probability sample of women living in Mathare informal settlement in Nairobi, Kenya and to identify potential points for intervention and/or support. Quantitative surveys were conducted with 552 women aged 18–75. Possible MDD was measured using the Patient Health Questionnaire and regressed on individual, household/familial-, and community/interpersonal-level factors. Findings highlight the potential importance of factors such as physical health, economic stress, access to water and sanitation, household and family dynamics, and neighbourhood/village differences in possible MDD among women living in informal settlements. We identify potential points for research, intervention and policy including: providing appropriate tangible assistance or interventions to reduce economic stress/strain; expanding access to water and sanitation and, in doing so, reducing potential burdens to physical health; providing and expanding healthcare to include mental healthcare; and investigating family dynamics and bolstering support for families, particularly for those experiencing conflict. [ABSTRACT FROM AUTHOR]

Exposure to tobacco marketing is positively associated with smoking initiation and behaviours. There is limited literature examining disparities among reported exposure in low- and middle-income countries. This study sought to fill this gap with a survey among 1427 adolescents and 889 adult smokers in Mexico City in 2020. Data were analysed using chi-square and hierarchical regression models. Two-thirds of adolescents noticed cigarette pack displays in stores. Participants from low- and mid-socioeconomic status (SES) neighbourhoods were more exposed to tobacco marketing than their counterparts through several channels. After addressing the shared variance among participants from the same household nested in neighbourhood SES level and controlling for gender, adolescent non-smokers and adult smokers who noticed pack displays were more likely to be susceptible to smoking (OR = 1.8, 95% CI 1.4–2.4) and to smoke more (OR = 1.7, 95% CI 1.21–2.47); adult smokers who noticed tobacco marketing at more places were less likely to be certain about smoking risks (OR = 0.9, 95% CI 0.8–0.9). The results suggest that the tobacco industry targets youth and individuals from low-SES neighbourhoods through several channels. Greater exposure to tobacco marketing was associated with increased susceptibility to smoking and decreased risk perception. These findings support a comprehensive ban on tobacco marketing in Mexico. [ABSTRACT FROM AUTHOR]