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Abstract Objective We aim to determine the effect of region of residence (urban vs. rural) on the odds of receiving standard of care treatment for locally advanced BCa in Louisiana and its impact on survival outcomes. Methods Using the Louisiana Tumor Registry, we identified American Joint Committee on Cancer (AJCC) stage II or III, BCa diagnoses in Louisiana residents between 2010 and 2020. Treatment received was classified as standard or non‐standard of care according to American Urological Association (AUA) guidelines and location of residence was determined using Rural Urban Commuting Area‐Tract‐level 2010 (RUCA). Multivariable logistic regression analyses and multivariate cox proportional hazard analyses were performed. Results Of 983 eligible patients, 85.6% (841/983) lived in urban areas. Overall, only 37.5% received standard‐of‐care (SOC) for the definitive management of locally advanced bladder cancer. Individuals living in rural areas (OR 0.53, 95% CI: 0.31–0.91, p = 0.02) were less likely to receive standard of care treatment. Both rural residence and receipt of non‐standard of care therapy were associated with an increased risk of bladder cancer‐specific (adj HR 1.53, 95% CI: 1.09–2.14, p = 0.01 and adj HR: 1.85, 95% CI: 1.43–2.39,

Abstract Background Currently recommended cancer screening programs address only part of the overall population cancer burden. Even populations deemed high‐risk for certain individual cancers experience a considerable potential burden of other cancers. However, few published cancer screening trials report the incidence of untargeted cancers. Methods The National Lung Screening Trial (NLST), initiated in 2002–2004, was a randomized controlled trial of lung cancer screening in adults with ≥30 pack‐years of smoking. Active follow‐up for incident invasive cancers continued through 2009. Results Among 53,229 NLST subjects (median follow‐up 6.5 years after randomization), the incidence of lung cancer was 615 per 100,000 person‐years (32% of 6142 overall first primary incident invasive cancers), and that of non‐lung cancer was 1327 per 100,000 (68%). Non‐lung cancer incidence exceeded that for lung cancer in all 5‐year age categories and all quintiles of smoking pack‐years. Besides lung cancer, the most common cancers were prostate, breast, colon/rectum, bladder, and head/neck; 23% were smoking‐related cancers, and 54% were cancer types lacking recommended population‐based screening modalities (32% excluding prostate). Non‐lung cancer comprised 48% of 1793 cancer deaths. Conclusions In the NLST, only 32% of first primary cancer incidence after study entry was lung, compared with 68% non‐lung. Even in a population at high risk for lung cancer, a single‐cancer screening test misses most cancers. Thus, in combination with existing single‐cancer screening modalities, multi‐cancer screening tests—which address many of the incident non‐lung cancers in this trial—have potential to address a currently inaccessible portion of cancer morbidity and mortality.

Abstract The COVID‐19 pandemic upended the delivery of cancer services across the care continuum. By outlining specific strategies for addressing cancer in the state, cancer control plans serve a critical role during a public health emergency. This policy analysis aims to understand how states updated their cancer control plan as a response to COVID‐19. All plans from 50 states and the District of Columbia were reviewed for language related to “COVID.” Among the 51 cancer plans analyzed, 7 plans met the inclusion criteria (Illinois [IL], Iowa [IA], Maine [ME], Nevada [NV], North Carolina [NC], Utah [UT], and Vermont [VT]). These seven plans adapted their cancer control plan in response to the COVID‐19 pandemic across three main themes: (1) improving care across the cancer care continuum, from prevention to screening and treatment; (2) improving cancer care service delivery by expanding telehealth, addressing workforce shortages, and investing in public health systems; and (3) achieving population health equity by addressing social determinants of health. Two states only adapted their plans by prioritizing future monitoring and evaluation activities as related to the COVID‐19 pandemic (ME and VT). The other five states all took different approaches to improve cancer care by adapting their service delivery and addressing social determinants of health. IL prioritized access to cancer screenings through expanding equity informed telehealth models. IA also prioritized equitable screenings as well as clinical trial participation, by addressing workforce shortages. NV focused on prevention, leveraging telehealth and specifically targeted food security and job loss resulting from the pandemic. NC‐directed cancer treatment efforts by addressing workforce shortages. UT integrated telehealth and equity initiatives to combat barriers like food insecurity and social disparities. Continued policy surveillance is needed to ensure that patients receive timely, appropriate cancer care during future public health emergencies. Research evaluating whether these plan adaptations improved outcomes or advanced equity remains warranted.

Background The implementation of preventive therapies among patients with stroke remains inadequately explored, especially when compared with patients with myocardial infarction (MI), despite sharing similar vascular risk profiles. We tested the hypothesis that participants with a history of stroke have a worse cardiovascular prevention profile in comparison to participants with MI. Methods and Results In cross‐sectional analyses within the UK Biobank and All of Us Research Program, involving 14 760 (9193 strokes, 5567 MIs) and 7315 (2948 strokes, 4367 MIs) participants, respectively, we evaluated cardiovascular prevention profiles assessing low‐density lipoprotein (

Abstract Introduction Asthma is characterized by preventable morbidity, cost, and inequity. We sought to build an Asthma Learning Health System (ALHS) to coordinate regional pediatric asthma improvement activities. Methods We generated quantitative and qualitative insights pertinent to a better, more equitable care delivery system. We used electronic health record data to calculate asthma hospitalization rates for youth in our region. We completed an “environmental scan” to catalog the breadth of asthma‐related efforts occurring in our children's hospital and across the region. We supplemented the scan with group‐level assessments and focus groups with parents, clinicians, and community partners. We used insights from this descriptive epidemiology to inform the definition of shared aims, drivers, measures, and prototype interventions. Results Greater Cincinnati's youth are hospitalized for asthma at a rate three times greater than the U.S. average. Black youth are hospitalized at a rate five times greater than non‐Black youth. Certain neighborhoods bear the disproportionate burden of asthma morbidity. Across Cincinnati, there are many asthma‐relevant activities that seek to confront this morbidity; however, efforts are largely disconnected. Qualitative insights highlighted the importance of cross‐sector coordination, evidence‐based acute and preventive care, healthy homes and neighborhoods, and accountability. These insights also led to a shared, regional aim: to equitably reduce asthma‐related hospitalizations. Early interventions have included population‐level pattern recognition, multidisciplinary asthma action huddles, and enhanced social needs screening and response. Conclusion Learning health system methods are uniquely suited to asthma's complexity. Our nascent ALHS provides a scaffold atop which we can pursue better, more equitable regional asthma outcomes.

Abstract Chronic kidney disease has now attained epidemic proportions, placing a significant strain on Sri Lanka's healthcare system. The North Central Province of Sri Lanka has been afflicted by this disease for decades, confronting multiple challenges. Hemodialysis is the primary form of renal replacement therapy available to end‐stage renal disease patients in Sri Lanka. Providing hemodialysis sessions free of cost in the government health sector comes with major costs on the healthcare system. As a country with a low‐to‐middle income status undergoing through reeling economic crisis, providing free healthcare in government hospitals and increasing the capacity and quality of treatment facilities for the growing number of patients with chronic kidney disease will remain a major challenge for the coming decade. The high cost for a single dialysis session, lack of resources and workforce to meet demand, occupational barriers of patients, and the economic burdens including out‐of‐pocket expenditures significant barriers in achieving quality treatment sessions and the quality of life of patients. In addition, the absence of a consistent screening program has contributed to the progression of the disease ending up requiring renal replacement therapy. This article suggests potential strategies that can be implemented to mitigate the aforementioned problems and enhance the overall health, quality of life, and survival of patients with chronic kidney disease and those who receive hemodialysis.

Abstract Background Noncommunicable diseases (NCDs) are rising in developing countries, posing substantial health, social, and economic consequences. Targeted action to address NCDs is difficult without data on the prevalence and social distribution of the risk factors. Methods A cross‐sectional survey was conducted among randomly sampled adults in Bahir Dar, Northwest Ethiopia. Sociodemographic, lifestyle risk factors, knowledge, and anthropometric measurements were collected. Chi‐square and logistic regression analyses were conducted to identify predictors for NCD risk factors and cardiovascular risk. Results This study involved 417 participants, with a mean age of 35.6 ± 12.6 years, in which 54.7% were females. The prevalence of inadequate fruit/vegetable intake was 95.7%, alcohol consumption 53.0%, physical inactivity 37.9%, tobacco use 1.9%, khat use 5.1%, hypertension 20.7%, overweight/obesity 29.6%, and abdominal obesity 67.4%. Overall, 55% of adults have clusters of three or more risk factors, and 14.6% have a moderate (10%–20%) 10‐year cardiovascular risk. Factors associated with NCD risk factors are sex, age, religion, marital status, occupation, and income. Ten‐year cardiovascular risk is higher in men (adjusted odd ratio (OR) 4.2, 95% CI 1.5–11.4), in adults with abdominal obesity (adjusted OR 5.8, 95% CI 1.4–24.2), and in those with clustered risk factors (adjusted OR 4.0, 95% CI 1.6–10.3). Conclusion This study shows that adults in Northwest Ethiopia are at high risk of developing NCDs. Coordinated, multisectoral interventions at all levels of the socio‐ecological model are needed to reduce the risk factors.

Abstract Background and Aims Given the growing utilization of critical care services by an aging population, development of population‐level risk models which predict intensive care unit (ICU) survivorship and mortality may offer advantages for researchers and health systems. Our objective was to develop a risk model for ICU survivorship and mortality among community dwelling older adults. Methods This was a population‐based cohort study of 48,127 patients who were 50 years and older with at least one primary care visit between January 1, 2017, and December 31, 2017. We used electronic health record (EHR) data to identify variables predictive of ICU survivorship. Results ICU admission and mortality within 2 years after index primary care visit date were used to divide patients into three groups of “alive without ICU admission”, “ICU survivors,” and “death.” Multinomial logistic regression was used to identify EHR predictive variables for the three patient outcomes. Cross‐validation by randomly splitting the data into derivation and validation data sets (60:40 split) was used to identify predictor variables and validate model performance using area under the receiver operating characteristics (AUC) curve. In our overall sample, 92.2% of patients were alive without ICU admission, 6.2% were admitted to the ICU at least once and survived, and 1.6% died. Greater deciles of age over 50 years, diagnoses of chronic obstructive pulmonary disorder or chronic heart failure, and laboratory abnormalities in alkaline phosphatase, hematocrit, and albumin contributed highest risk score weights for mortality. Risk scores derived from the model discriminated between patients that died versus remained alive without ICU admission (AUC = 0.858), and between ICU survivors versus alive without ICU admission (AUC = 0.765). Conclusion Our risk scores provide a feasible and scalable tool for researchers and health systems to identify patient cohorts at increased risk for ICU admission and survivorship. Further studies are needed to prospectively validate the risk scores in other patient populations.

Abstract COVID‐19 has greatly impacted the society and economy of Ethiopia, with a total of 499,493 cases confirmed and a death toll of 7572 as of February 2023. The country began COVID‐19 vaccination in March 2021 and delivered about 52 million doses as of July 2022. The government liaised with the COVAX (COVID‐19 Vaccines Global Access) facility, the African Vaccine Acquisition Trust, and other donors to acquire the vaccine doses. However, in July 2022, Ethiopia achieved only 45 persons per 100 population coverage when the global average of doses administered was 167 per 100 population. These figures grossly fall behind the requirements for achieving herd immunity. The major challenges noted are vaccine hesitancy ranging from 14.1% to 68.7%, including that among healthcare workers (HCW). There was a lack of physical infrastructure and personnel to distribute the vaccines and to administer the doses to populations who had challenges accessing healthcare services. There was heavy disinformation regarding COVID‐19 vaccines. The various government ministries including the Ministry of Health (one government approach) and the regional and zonal health offices should coordinate for efficient and equitable vaccine distribution and build community trust by working with village leaders, religious groups, and media outlets. There is a need to continue efforts on providing an awareness of the importance of COVID‐19 vaccination and herd immunity. We review and dissect the COVID‐19 vaccination efforts in Ethiopia and provide recommendations for tackling these challenges, including equity in the distribution of vaccines and proper awareness of the disease to achieve herd immunity.

Abstract The COVID‐19 pandemic has resulted in another global health crisis with millions of individuals with Long Covid experiencing disability, worse health‐related quality of life, and productivity and income losses. Despite its impact on population health outcomes, health systems, and the economy, there remains a need for a global consensus on its standard definition, diagnostic approaches, and treatment plans to manage symptoms. In many low‐ and middle‐income countries (LMICs), there are limited published estimates on Long Covid, limited studies on its diagnostics and therapeutics, and limited media and news coverage. We advocate for a global action plan and necessary investments on Long Covid research and treatment, meaningful involvement of patients and cooperation between high‐income countries and LMICs, stronger and more effective public health communication surrounding the risks of Long Covid, and support toward financial risk protection as advocated by Universal Health Care.

Abstract Aim The aim of this study is to determine the validity and reliability of the Care Vulnerability Index (CVI) as a tool to estimate the need and competence of care. Design A cross‐sectional survey including a longitudinal component. Methods Content validity ratio (CVR) was calculated by interrater agreement of a group of 11 experts in two rounds. The test–retest analysis was measured in an urban population of Colombia with 96 participants through two statistical tests: Pearson's correlation coefficient and the difference in means. Results Care Vulnerability Index turned out to be valid with a CVR of 0.879. Reliability by Pearson correlation between test–retest was 0.912 (CI95: 0.872–0.941; p‐value

Background The environment plays a large role in the health of individuals; however, more research is needed to better understand aspects of the environment that most influence health. Specifically, our study examines how the social environment influences cardiovascular health (CVH). Methods and Results The social environment was characterized using measures of belonging and life and work stress in individuals, as well as nationally derived measures of marginalization, deprivation, economic status, and community well‐being in neighborhoods. CVH was defined by the American Heart Association's Cardiovascular Health Index—a summed score of 7 clinical and behavioral components known to have the greatest impact on CVH. Data were obtained from the Canadian Community Health Survey 2015 to 2016 and multiple national data sources. Multilevel regression models were used to analyze the associations between CVH and the social environment. Overall, 27% of Canadians reported ideal CVH (6–7 score points), 68% reported intermediate CVH (3–5 score points), and 5% reported poor CVH (0–2 score points). The neighborhood environment contributed up to 7% of the differences in CVH between individuals. Findings indicated that residing in a neighborhood with greater community well‐being (odds ratio [OR], 1.33 [95% CI, 1.26–1.41]) was associated with achieving higher odds of ideal CVH, while weaker community belonging (OR, 0.67 [95% CI, 0.62–0.72]) and residing in a neighborhood with greater marginalization (OR, 0.87 [95% CI, 0.82–0.91]) and deprivation (OR, 0.67 [95% CI, 0.64–0.69]) were associated with achieving lower odds of ideal CVH. Conclusions Aspects of individual‐level social environment and residing in a neighborhood with a more favorable social environment were both independently and significantly associated with achieving ideal CVH.

Abstract Background and Aims Covid‐19 vaccines were disseminated across Europe from the end of 2020. Malta had one of the fastest vaccination rollouts in Europe and by March 2022 most adults had their booster dose. The aim was to investigate adult's perspectives, experiences, and attitudes regarding vaccination in Malta. Methods An anonymous online survey targeting adult social media users living in Malta was disseminated through social media, with a snowball technique. Demographic information, vaccination uptake, side‐effects, perceptions, and experiences were gathered through quantitative and qualitative means. Participants were sub‐grouped according to their vaccination status and descriptive analysis through frequency was performed. χ2/Fisher test testing followed by logistic regressions were performed to assess the vaccination perspectives according to vaccination status. Results Out of 611 participants 79.87% had the booster, 4.91% had two doses awaiting booster, 6.55% refused booster while, 8.67% refused any dose. Booster sub‐group when compared to vaccine hesitant sub‐group exhibited an association with the perception for the need to “continue wearing masks, maintaining physical distance and hand washing following vaccination” (odds ratio [OR]: 5.97 confidence interval [CI] 95%: 1.09–32.36 p = 0.04). Those waiting for the booster dose when compared to those refusing booster, exhibited an association with the perspective that “COVID‐19 vaccine is the solution to returning to normality” (OR: 5.00 CI 95%: 1.12–22.35 p = 0.04). The commonest reason for inoculation was to protect against severe disease (63.08% CI 95%: 58.91–67.07). More pronounced booster adverse effects raised concern about future booster doses uptake. Unwillingness among anti‐booster and vaccine hesitant arose among high socioeconomic background participants, with concern for vaccine safety and adverse effects. Conclusion Vaccine hesitancy is low yet, vaccination unwillingness even among highly educated may act as a barrier to control the pandemic. Clear, transparent public health communication which targets concerns is crucial, with unified messages from governing bodies optimizing population safety.

Abstract Social determinants of health (SDoH) can impact the vulnerable pulmonary arterial hypertension (PAH) population, especially during the COVID‐19 pandemic. Providers' understanding of SDoH at the point of care and their impact is unknown. We conducted semi‐structured virtual interviews with US clinicians at 17 pulmonary hypertension (PH) centers and one patient advocate from the Pulmonary Hypertension Association. We sought participants' perspective on SDoH in PAH and their impact. Transcripts were developed and analyzed for key themes to assess potential policy implications. Participants served a large PAH population and demonstrated high awareness of SDoH and its impact on treatment and outcomes. They reported that patients' SDoH, including socioeconomic status, health insurance, access to health care, education levels, health literacy, employment status, and insecurities associated with housing, food, transportation, and family support, impacted health and well‐being. COVID‐19‐related social isolation, mental health, and substance abuse contributed to significant inequities in care provision and outcomes. While telemedicine helped clinicians manage patients remotely during the pandemic, there was a concern for patients with limited access to this medium. Participants reported no formal screening for SDoH at the point of care. With the recognition and the desire to act upon health inequities associated with SDoH, participants felt that it was vital for their centers to have a dedicated PH social worker and support staff to optimize care and outcomes. An approach that integrates SDoH in PAH care management, streamlined through institutional policy, could address health disparities leading to improved healthcare access, outcomes, and quality of care.

Abstract Background Depression is more prevalent in breast cancer (BC) survivors than in the general population. However, little is known about depression in long‐term survivors. Study objectives were: (1) to compare the age‐specific prevalence of depressive symptoms (a) in BC survivors vs female population controls, (b) in disease‐free BC survivors vs BC survivors with self‐reported recurrence vs controls, and (2) to explore determinants of depression in BC survivors. Methods About 3010 BC survivors (stage I‐III, 5‐16 years post‐diagnosis), and 1005 population controls were recruited in German multi‐regional population‐based studies. Depression was assessed by the Geriatric Depression Scale‐15. Prevalence of mild/severe and severe depression only were estimated via logistic regression, controlling for age and education. Multinomial logistic regression was used to explore determinants of mild and severe depression. Results Compared with population controls, BC survivors were more likely to report mild/severe depression (30.4% vs 23.8%, p = .0003), adjusted for age and education. At all age groups

Summary Objective The purpose of this study was to model weight trajectories over a 5‐year time period (2012–2016) and their association with behavioural and psychosocial characteristics and health care–related experiences using data from the Patient Outcomes Research to Advance Learning (PORTAL) overweight/obesity cohort. Methods Weight trajectories for each eligible patient in the PORTAL overweight/obesity cohort (n = 2864) were identified first using growth modelling; trajectories were then grouped using a hierarchical cluster analysis. Weight trajectory clusters that emerged were compared on demographics, and predictors of cluster membership were examined. Clusters were also compared on responses to a survey assessing health behaviours, quality of life, and health care experience completed in 2015 by 49% of the total sample (n = 1391). Results Seven distinct weight trajectory clusters were identified: (a) significant weight loss then maintenance; (b) higher stable weight; (c) moderate stable weight; (d) steady weight loss then relapse; (e) weight gain then weight loss; (f) steady weight gain then maintenance; and (g) lower stable weight. Age, sex, race/ethnicity, and body mass index at baseline predicted patient's weight trajectory (P < .001). Over two thirds of patients maintained their weight over the 5‐year period. Significant weight loss then maintenance, weight gain then weight loss, and higher stable weight patients were more likely to report receiving weight counselling from their provider. Patients in the significant weight loss then maintenance and lower stable weight clusters were more likely to be physically active than the other clusters. Conclusion Findings suggest variability in patterns of weight change among adults with overweight or obesity who have access to health care and that these patterns differ on demographic, behavioural and psychosocial factors, and health care experience.

Abstract Pulmonary arterial hypertension (PAH) is characterized by increased resistance in the pulmonary arterioles as a result of remodeled blood vessels. We sought all available epidemiologic data on population‐based prevalence, incidence, and 1‐year survival of PAH as part of the Global Burden of Disease Study. We performed a systematic review searching Global Index Medicus (GIM) for keywords related to PAH between 1980 and 2021 and identified population‐representative sources of prevalence, incidence, and mortality for clinically diagnosed PAH. Of 6772 articles identified we found 65 with population‐level data: 17 for prevalence, 17 for incidence, and 58 reporting case fatality. Reported prevalence ranged from 0.37 cases/100,000 persons in a referral center of French children to 15 cases/100,000 persons in an Australian study. Reported incidence ranged from 0.008 cases/100,000 person‐years in Finland, to 1.4 cases/100,000 person‐years in a retrospective chart review at a clinic in Utah, United States. Reported 1‐year survival ranged from 67% to 99%. All studies with sex‐specific estimates of prevalence or incidence reported higher levels in females than males. Studies varied in their size, study design, diagnostic criteria, and sampling procedures. Reported PAH prevalence, incidence, and mortality varied by location and study. Prevalence ranged from 0.4 to 1.4 per 100,000 persons. Harmonization of methods for PAH registries would improve efforts at disease surveillance. Results of this search contribute to ongoing efforts to quantify the global burden of PAH.

Over the past decade, direct oral anticoagulants (DOACs) have contributed to a major paradigm shift in thrombosis management, replacing vitamin K antagonists as the most commonly prescribed anticoagulants in many countries. While DOACs provide distinct advantages over warfarin (eg, convenience, simplicity, and safety), they are frequently associated with inappropriate prescribing and adverse events. These events have prompted regulatory agencies to mandate oversight, which individual institutions may find difficult to comply with given limited resources. Veterans Health Administration (VHA) has leveraged technology to develop the DOAC Population Management Tool (PMT) to address these challenges. This tool has empowered VHA to update a 60‐year standard of care from one‐to‐one provider‐to‐patient anticoagulation monitoring to a population‐based management approach. The DOAC PMT allows for the oversight of all patients prescribed DOACs and leads to intervention only when clinically indicated. Using the DOAC PMT, facilities across VHA have maximized DOAC oversight while minimizing resource usage. Herein, we discuss how the DOAC PMT was conceived, developed, and implemented, along with the challenges encountered throughout the process. Additionally, we share the impact of the DOAC PMT across VHA, and the potential of this approach beyond anticoagulation and VHA.

Objective: To describe the workflow, reach, cost, and self-reported quit rates for an opt-out tobacco treatment program (TTP) for patients seen in 43 oncology outpatient clinics., Methods: Between May 25, 2021, and December 31, 2022, adult patients (≥18 years) visiting clinics affiliated with the Medical University of South Carolina Hollings Cancer Center were screened for smoking status. Those currently smoking were referred to a telehealth pharmacy-assisted TTP. An attempt was made to contact referred patients by phone. Patients reached were offered free smoking cessation counseling and a 2-week starter kit of nicotine replacement medication. A random sample of 420 patients enrolled in the TTP were selected to participate in a telephone survey to assess smoking status 4 to 12 months after enrollment., Results: During the reference period 35,756 patients were screened and 9.3% were identified as currently smoking. Among the 3319 patients referred to the TTP at least once, 2393 (72.1%) were reached by phone, of whom 426 (12.8%) were ineligible for treatment, 458 (13.8%) opted out of treatment, and 1509 (45.5%) received treatment. More than 90% of TTP enrollees smoked daily, with an average of 13.1 cigarettes per day. Follow-up surveys were completed on 167 of 420 patients, of whom 23.4% to 33.5% reported not smoking; if all nonresponders to the survey are counted as smoking, the range of quit rates is 9.3% to 13.3%., Conclusion: The findings demonstrate the feasibility of reaching and delivering smoking cessation treatments to patients from a diverse set of geographically dispersed oncology clinics., (© 2024 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)

While comprehensive mental health promotion inherently involves individuals, there is an ongoing need to address large-scale determinants of people's mental health and wellbeing-particularly policies and environments. To have the best possible chance of creating positive change, mental health promotion must also work throughout key mediating structures such as places of education and work. This includes universities. Yet, in their efforts to address student and staff mental health and wellbeing, Australian universities have demonstrated limited uptake of comprehensive mental health promotion approaches. In this commentary, I discuss a recent review of Australia's higher education system-the Australian Universities Accord-as a catalyst for strengthening institutional action and change through a comprehensive mental health promotion lens. I discuss key findings-and silences-made clear throughout the review process. I then advocate several urgent priorities for university-level change-across institutional assessment, institutional accountability and performance, and institutional leadership and power-if Australia's universities are genuinely committed to improving mental health and wellbeing among students and staff., (© 2024 The Author(s). Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

Abstract Introduction Despite learning health systems' focus on improvement in health outcomes, inequities in outcomes remain deep and persistent. To achieve and sustain health equity, it is critical that learning health systems (LHS) adapt and function in ways that directly prioritize equity. Methods We present guidance, including seven core practices, borne from theory, evidence, and experience, for actors within LHS pursuing equity. Results We provide a foundational definition of equity. We then offer seven core practices for how LHS may effectively pursue equity in health: establish principle, measure for equity, lead from lived experience, co‐produce, redistribute power, practice a growth mindset, and engage beyond the healthcare system. We include three use cases that illustrate ways in which we have begun to center equity in the work of our own LHS. Conclusion The achievement of equity requires real transformation at individual, institutional, and structural levels and requires sustained and persistent effort.

Abstract Problem The current coronavirus disease 2019 (COVID‐19) pandemic underscores the need for building and sustaining public health data infrastructure to support a rapid local, regional, national, and international response. Despite a historical context of public health crises, data sharing agreements and transactional standards do not uniformly exist between institutions which hamper a foundational infrastructure to meet data sharing and integration needs for the advancement of public health. Approach There is a growing need to apply population health knowledge with technological solutions to data transfer, integration, and reasoning, to improve health in a broader learning health system ecosystem. To achieve this, data must be combined from healthcare provider organizations, public health departments, and other settings. Public health entities are in a unique position to consume these data, however, most do not yet have the infrastructure required to integrate data sources and apply computable knowledge to combat this pandemic. Outcomes Herein, we describe lessons learned and a framework to address these needs, which focus on: (a) identifying and filling technology “gaps”; (b) pursuing collaborative design of data sharing requirements and transmission mechanisms; (c) facilitating cross‐domain discussions involving legal and research compliance; and (d) establishing or participating in multi‐institutional convening or coordinating activities. Next steps While by no means a comprehensive evaluation of such issues, we envision that many of our experiences are universal. We hope those elucidated can serve as the catalyst for a robust community‐wide dialogue on what steps can and should be taken to ensure that our regional and national health care systems can truly learn, in a rapid manner, so as to respond to this and future emergent public health crises.

Abstract Subjective cognitive decline (SCD) is receiving increasing attention as studies have suggested that SCD status is associated with risk of future cognitive decline and dementia. Population‐based measures of SCD can be extremely useful to the public health community, health‐care providers, researchers, and policymakers. A large population‐based SCD measure now exists through the state‐based Behavioral Risk Factor Surveillance System (BRFSS). All 50 states have included the cognitive decline module, which asks about SCD, to their BRFSS survey one or more times. Population measures of SCD can aid researchers in designing clinical studies by better estimating the populations that may be at risk for more severe cognitive decline based on their SCD status to ensure that the optimal groups are targeted. Population‐level estimates of SCD can also help to inform health‐care providers’ decisions about initiating cognitive assessments, managing other conditions among those with memory problems, and identifying the needs of caregivers.

Issue Addressed: Obesity in children is one of the most significant public health issues globally. Given the high prevalence of overweight and obesity in children, there is a need to identify effective obesity prevention efforts that can be delivered at scale to improve child health. We aimed to (i) identify obesity prevention interventions targeted at children aged 0-2 that have been scaled-up, and their relative efficacy compared to their pre-scale trial, (ii) describe adaptations made, and the extent to which factors related to scalability have been reported., Methods: We conducted a rapid review of pre-scale randomised controlled trials targeting nutrition, physical activity and obesity prevention in infants, and calculated the relative effect size for relevant outcomes in the corresponding scaled up trial. We documented adaptations made to the pre-scale trial for scale up, and explored how different components of scalability had been reported according to the Intervention Scalability Assessment Tool., Results: Of the 14 identified pre-scale trials, only one formal evaluation of the scale-up trial was identified. For body mass index, <10% of the effect was retained, however for nutrition and behavioural outcomes, the proportion of effect retained varied from -11.1% to 144%. Significant adaptations to modality were made in the scaled up trial primarily to reduce cost and increase reach of the intervention. Reporting of scalability components varied across the 14 trials, with only one trial reporting information for all assessed components., Conclusions: The majority of effective interventions targeting obesity prevention in infants have not been evaluated in a scaled up form. The magnitude of effect retained for the single trial that was scaled up was variable. In general, reporting of components of scalability was sub-optimal. SO WHAT?: The findings suggest that there is substantial need for the development and rigorous evaluation of obesity prevention interventions in children aged 0-2 which are amenable for scale., (© 2023 The Authors. Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

We study the relationship between proximity to fast food restaurants and weight gain from late childhood to early adolescence. We use the Millennium Cohort Study, a UK-wide nationally representative longitudinal study, linked with granular geocoded food outlet data to measure the presence of fast food outlets around children's homes and schools from ages 7 to 14. We find that proximity to fast food outlets is associated with increased weight (body mass index, overweight, obese, body fat, weight), but only among those with maternal education below degree level. Within this sample, those with lower levels of emotional regulation are at heightened risk of weight gain., (© 2023 The Authors. Health Economics published by John Wiley & Sons Ltd.)

Background: Stronger primary health care (PHC) is critical to achieving the United Nations' Sustainable Development Goals. However, there is scarce evidence on the impact of PHC on health system performance in developing countries. Since 2009, China has implemented an ambitious health system reform, among which PHC has received unprecedented attention. This study investigates the role of PHC resource in improving health status, financial protection and health equity., Methods: We obtained province-level and individual-level data to conduct a longitudinal study across the period of China's health system reform. The dependent variables included health outcomes and financial protection. The independent variables were the number of PHC physicians and share of PHC physicians in all physicians. Mixed-effect models were used for adjusted associations., Results: From 2003 to 2017, the number of PHC physicians slightly increased by 31.75 per 100,000 persons and the share of PHC physicians in all physicians increased by 3.62 percentage points. At the province level, greater PHC physician density was positively associated with life expectancy, negatively associated with age-standardized excess mortality, infectious disease mortality, perinatal mortality low birth weight, as well as the share of health expenses in total consumption expenses. At the individual and household level, greater PHC physician density was positively associated with self-assessed health, and negatively associated with incidence of catastrophic health expenditures. Compared to other quintiles, the poorest quintile benefited more from PHC physician density., Conclusions: In China, an increased PHC physician supply was associated with improved health system performance. While China's PHC system has been strengthened in the context of China's health system reforms, further effective incentives should be developed to attract more qualified PHC workers., (© 2023 John Wiley & Sons Ltd.)

Abstract Introduction Dementia is a prevalent condition in older adults associated with decline in cognitive and functional abilities and substantial burden. This study assessed the prevalence and impact of subjective memory impairment in the United States. Methods The 2011 to 2014 National Health and Nutrition Examination Survey, a population‐based, nationally representative survey, was analyzed. Data included medical examinations, self‐reported cognitive and functional limitations, and health care utilization over 1 year. Participants were aged ≥65 years and completed both interview and medical examination components. Descriptive analyses of patient characteristics were performed, and complex survey regression models were used to test associations. Results Of 2431 survey participants included, 53.1% had no memory impairment, 40.1% had early‐stage memory impairment, and 6.6% had late‐stage memory impairment. In adjusted analyses, late‐stage versus no impairment was associated with more functional limitations (odds ratio [OR] = 7.26, P

Background Population densities of many cities are increasing rapidly, with the potential for impacts on cardiovascular health. This longitudinal study examined the potential impact of population‐density increases in urban areas (urban densification) on cardiovascular risk markers among Australian adults. Methods and Results Data were from the Australian Diabetes, Obesity and Lifestyle Study, in which adult participants’ cardiovascular risk markers were collected in 3 waves (in 1999–2000, 2004–2005, and 2011–2012). We included 2354 participants with a mean age of 51 years at baseline who did not change their residence during the study period. Outcomes were 12‐year changes in waist circumference, weight, systolic and diastolic blood pressure, fasting and 2‐hour postload plasma glucose, high‐density lipoprotein cholesterol, and triglycerides. The exposure was neighborhood population densification, defined as 12‐year change in population density within a 1‐km radius buffer around the participant’s home. Multilevel linear growth models, adjusting for potential confounders, were used to examine the relationships. Each 1% annual increase in population density was related with smaller increases in waist circumference (b=−0.043 cm/y; 95% CI, −0.065 to −0.021 [P

Introduction: COVID-19 pandemic led to significant reductions in influenza detection worldwide, fueling debates on whether influenza truly ceased circulating in communities. The number of influenza cases decreased significantly in Japan, raising concerns about the potential risk of decreased immunity to influenza in the population. Our single-center study aimed to investigate influenza trends before and during the COVID-19 pandemic in Tokyo, Japan., Materials and Methods: This cross-sectional study included patients of all ages who visited Tokyo Shinagawa Hospital between April 1, 2018, and March 31, 2023. Influenza and COVID-19 tests were conducted using Quick Navi-Flu2 and polymerase chain reaction (PCR). We analyzed data from before and during the COVID-19 epidemic, based on patient background, hospitalization, and deaths, collected from medical records., Results: A total of 12 577 influenza tests were conducted, with approximately 100 tests consistently performed each month even in the influenza off-season. Throughout the observation period, 962 positive cases were identified. However, no cases were observed for 27 months between March 2020 and November 2022. Influenza A cases were reobserved in December 2022, followed by influenza B cases in March 2023, similar to the influenza incidence reports from Tokyo. The positivity rate during the 2022-2023 winter season was lower than before the COVID-19 epidemic and decreased in elderly patients, with no hospitalizations or deaths observed., Conclusion: This single-center study provided actual trend data for influenza patients before and during COVID-19 outbreaks in Tokyo, which could offer insights into the potential impact and likelihood of influenza virus infection in Japan., Competing Interests: None to declare., (© 2024 The Authors. Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.)

Objective: To explore how gender and low-income status independently influence general health care access in patients with hearing loss., Study Design: Cross-sectional study., Setting: National database., Methods: Patients with a diagnosis of sensorineural hearing loss from the National Institutes of Health All of Us database were included. Data entered from May 2018 to November 2022 was analyzed. Patient demographics such as age, gender, educational level, and insurance status were assessed. Multivariate logistic regressions were performed for statistical evaluation., Results: A subset of 8875 patients (48.3% male, mean age 69) were evaluated. After multivariate analysis, female participants were more likely than male participants to report difficulty affording prescribed medications (odds ratio [OR]: 1.7, p < .0005) and specialists (OR: 1.4, p < 0.005). Female patients were also more likely to delay care due to elder care responsibilities (OR: 2.6, p < .0005), employment obligations (OR: 1.7, p < .0005), and feelings of apprehension in seeing a provider (OR: 1.7, p < .0005). Finally, female participants reported feeling less likely to be involved in their own medical care compared to males (OR: 1.2, p < .005). Low-income (<$25,000) participants reported less likely to feel respected (OR: 3.2, p < .0005) and delivered understandable health information (OR: 2.3, p < .0005) by providers compared to participants of higher income., Conclusion: This work suggests that patients with hearing loss, female gender, and lower socioeconomic status independently introduce barriers to health care access and utilization. These factors should be considered in efforts to promote equity in the care of patients with hearing loss., (© 2023 American Academy of Otolaryngology-Head and Neck Surgery Foundation.)

Background: Dental caries (cavities) experience is prevalent in US children, and national data show rates to be increasing among young children. Disparities are found for those in the low-income and non-Hispanic Black and Hispanic/Latinx groups. Use of caries prevention, specifically dental sealants, is low, even among school-based programs., Contributions to Theory: A population health management (PHM) framework may support targeted school-based case management to reduce oral health disparities. PHM-oriented tools were applied to a school-based oral health intervention and developed into a conceptual model. From 2014 to 2019, Chicago-based Oral Health Forum (OHF) developed a case management intervention in schools, utilizing PHM tools. Through programmatic and school-based partnerships, the PHM tools informed intervention to incorporate community-based organizations, case management staffing, oral health education, targeted community outreach, and Community Dental Health Coordinators' training., Conclusions: Through a PHM framework, school-based oral health partnerships targeting high-need children was implemented. Use of PHM tools in school-based health programs should be considered in other high caries schools., (© 2023 The Authors. Journal of School Health published by Wiley Periodicals LLC on behalf of American School Health Association.)

Nursing has a unique opportunity to address issues of structural violence that contribute to poor health outcomes. Models for designing nursing care relative to the social determinants of health can be adapted from the discipline of peace studies and the phenomenon of peacebuilding. The aim of this qualitative study was to describe the lived experience of peacebuilding from the perspective of community or public health nurses. Interviews were conducted with eight participants. Attributes of the peacebuilder included fostering human relationships that value the inherent worth and dignity of others, nurturing a character of humility and moral courage, and contemplating the personal cost of engaging in prolonged processes of peacebuilding. Practices of peacebuilding included mediating conflict through multilayered processes, accompanying others to places of empowerment, and utilizing interdisciplinary teaching and learning to build capacity for change. Increasing an understanding of the lived experience of peacebuilding by nurses is relevant to nursing research, theory, and practice, and adds to a broader understanding of peacebuilding., (© 2023 The Authors. Nursing Inquiry published by John Wiley & Sons Ltd.)