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Objective Study Setting and Design Data Sources and Analytic Sample Principal Findings Conclusions To evaluate healthcare cost and utilization changes among Medicaid and dually eligible participants of a supportive housing program implemented by a managed care organization and community‐based organization.Healthcare claims were reviewed retrospectively for 80 program participants in one urban Pennsylvania county between 1/1/2018 and 9/28/2023 who had ≥6 months of claims data in both pre‐ and post‐housing periods. Eligibility included age >18 years, Medicaid/Special Needs Plan enrollment, and housing need. Due to limited housing units, potential participants were prioritized by medical need and history of unplanned care.Healthcare cost and utilization were compared during pre‐ (i.e., 12 months before housing initiation) and post‐periods (i.e., 12 months after housing initiation).Compared to the pre‐period, significantly lower medical (−40.4%, p = 0.004), emergency department (−62.7%, p = 0.02), and total (−33.3%, p = 0.02) costs of care were observed in the post‐period. Significantly lower primary care (−50.0%, p = 0.0003), specialist (−31.3%, p = 0.02), and emergency department (−50.0%, p = 0.03) utilization were also observed.Healthcare cost and utilization among medically complex individuals were lower with supportive housing. Future evaluations with randomized designs can address the potential causal impact of supportive housing as a healthcare intervention on specific outcomes. [ABSTRACT FROM AUTHOR]

The increasing global demand for mental health services, compounded by the COVID‐19 pandemic, has spurred innovative approaches. Among these, the utilisation of paraprofessionals for delivering brief psychological interventions (BPIs) is gaining significant traction across diverse settings and populations. Paraprofessionals (individuals equipped with specialised mental health training but lacking formal qualifications) have emerged as a valuable resource. They have the potential to offer cost‐effective, culturally sensitive and readily accessible support. The integration of paraprofessionals into various healthcare settings, such as inpatient psychiatric units and primary care clinics, underscores their potential to enhance holistic well‐being and early intervention. This integration not only lightens the load on licensed therapists but also broadens access to services while reducing treatment costs. At a global scale, paraprofessionals, armed with local knowledge and community connections, play a pivotal role in improving mental health outcomes among underserved populations. Furthermore, the rise of telemental health, an increasingly crucial aspect of mental healthcare, presents new avenues for paraprofessionals to deliver psychological care. Despite their potential, paraprofessionals encounter challenges related to work‐life balance, boundary‐setting and the stigma attached to their roles. Their integration into healthcare systems requires clear roles and responsibilities, along with continuous support to ensure effective intervention and the well‐being of both providers and recipients. Further research and development are necessary to harness their full potential and meet the increasing demand for accessible mental health services. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions As aging populations shift health care from hospitals to communities, Japan has implemented policies to promote home health care. This study explored regional differences in home health care recipients among older adults and related factors.We used nationwide data from 2020 to describe the proportion of older adults receiving regular home visits and the medical institutions utilized across secondary medical areas: urban, middle and depopulated areas. We examined factors associated with the proportion of patients receiving regular home visits. Exposures included each secondary medical area's medical and long‐term‐care (LTC) resources, adjusted for the older adult population; proportion of single‐person households; and regional factors. We performed a multivariate negative binomial distribution analysis.A total of 333 secondary medical areas were included. Urban areas had more patients receiving regular home visits, primarily from enhanced home care support clinics/hospitals (HCSCs). Fewer patients received regular home visits in depopulated areas, and conventional HCSCs were more common. Multivariate analysis revealed that the number of conventional HCSCs (coefficient, 0.17 [95% confidence intervals (CI), 0.08 to 0.26]), enhanced HCSCs (coefficient, 0.21 [95% CI, 0.14 to 0.29]) and population density (coefficient, 0.10 [95% CI, 0.02 to 0.19]) were positively associated with higher home‐visit rates. Beds in LTC welfare facilities (coefficient, −0.10 [95% CI, −0.19 to −0.01]) and beds in LTC health facilities (coefficient, −0.09 [95% CI, −0.17 to 0.00]) were negatively associated.Policies to promote home health care have led to high home‐visit rates in urban areas. Medical and LTC resources and regional factors influence disparities. As Japan's population ages, it is crucial to recognize these disparities and develop medical and LTC systems tailored to each region's characteristics. Geriatr Gerontol Int 2024; ••: ••–••. [ABSTRACT FROM AUTHOR]

Background Objective Methods Results Conclusions Pakistan is a densely populated South Asian country. It is facing numerous health challenges, as well as problems of the digital divide. The government of Pakistan established e‐libraries as a pilot project in 2018. These libraries are functioning through community centers/public libraries in the largest province of the country.This paper examines the role of Pakistani e‐libraries in creating health awareness and providing health information to the public.The qualitative research design was based on focus group discussions with the head librarians of all 13 of the 20 e‐libraries contacted.The findings revealed that e‐libraries actively create health‐related awareness and connect the public to health advisors. The e‐libraries were engaged in four types of health‐related activities (seminars, awareness campaigns, open health camps, and special health day celebrations) with high attendance from the public. Attendees of these programs returned to librarians with additional health‐related queries.The study suggests a need for more liaison between the community and local healthcare institutions. This approach can make these programs more effective in helping individuals manage their health. The results of this study can serve as a useful guide for other developing nations in developing similar services. [ABSTRACT FROM AUTHOR]

Issue Addressed Methods Results Conclusions So What? This study examines Australia's Hepatitis B public health policies with a focus on the Pacific Australia Labour Mobility scheme seasonal workers as a priority population. The aim is to evaluate if Australia's Hepatitis B public health policies adequately address health disparities and equitable access to health care for seasonal workers as a priority population. We draw comparisons with the public health policies of New Zealand and Canada, to understand how these nations approach similar health concerns among their temporary seasonal workers.A health policy analysis was conducted on the public health Hepatitis B policies in Australia and then compared with those in Canada and New Zealand. Due to the nature of the study question, the review had a major focus on grey literature. The search was undertaken in two stages, including (1) Google search engine and (2) targeted websites. Basic document data was produced in descriptive summaries. Any data either explicitly or inexplicitly relating to the elimination of hepatitis B or equity towards the inclusion of seasonal workers was produced as analytical summaries through multiple revisions.Nineteen documents were identified, predominantly from Australia. Although Hepatitis B public health policies emphasised testing and awareness in priority populations, specifically mentioning seasonal workers as a priority population was absent in all three countries.The study underscores the exclusion of temporary seasonal workers in public health policies and strategies as a human rights issue, conflicting with principles of equity and equitable access to health care. Despite acknowledging challenges for temporary visa holders, policies lack specific provisions for seasonal workers. Addressing this gap is crucial for health equity and inclusive health systems.Our findings highlight the need to prioritise equity for temporary seasonal workers to achieve hepatitis B elimination goals by 2030. Exclusion from public health policies is a human rights concern, impacting access to quality health care. This study advocates for inclusive policies explicitly recognising temporary seasonal workers as a priority population, aligning with international human rights commitments to health care for all. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Discussion Immigrants and newcomers are identified by many provincial midwifery associations as “priority populations.” Recently, newcomer populations have shifted considerably, with more people coming to Canada with precarious immigration status who are increasingly ineligible for public healthcare insurance and facing barriers to accessing care. Our aims were to: (1) gain an understanding of the policies related to equitable access to midwifery care and how they may apply to migrant groups without public healthcare insurance and (2) identify existing policy themes, gaps, and regulatory barriers that limit access for this vulnerable population in Canada.We conducted a high‐level document content analysis using a health equity framework. We aimed to identify language related to equitable access in midwifery services, with particular emphasis on uninsured populations. A total of 64 documents were analyzed, including legislation and publicly available statements from midwifery regulatory bodies and associations.Midwifery regulatory authorities and associations across Canada are consistent in establishing an expectation that midwives will provide accessible care to diverse clientele. However, how these commitments are put into practice varies considerably between jurisdictions. We compared the cases of Manitoba and Ontario to illustrate the disconnect between commitments to priority populations and implementation.While there is a clearly demonstrated intention to provide equitable access to midwifery care to all people, including “priority populations” like migrants and newcomers, in practice, these commitments have not been fully realized. Equity is encumbered by broader structural issues, such as the growth in the number of newcomers without access to public health insurance. Moves toward equity within midwifery and healthcare more broadly need to meaningfully engage with other policy sectors, such as immigration, to be able to adapt to emerging issues affecting reproductive care, such as the growing precarity of newcomer populations in Canada. [ABSTRACT FROM AUTHOR]

Objective Study setting and design Data sources and analytic sample Principal findings Conclusions This study aimed to compare imputation approaches to identify the likely undocumented patient population in electronic health record (EHRs). EHR are a promising source of information on undocumented immigrants' medical needs and care utilization, but there is no verified way to identify immigration status in the data. Different approaches to approximating immigration status in EHR introduce unique biases, which in turn has major implications on our understanding of undocumented immigrant patients.We used a dataset of all emergency department (ED) visits from 2016 to 2019 in the Los Angeles Department of Health Services (LADHS) merged across patient medical records, demographic data, and claims data. We included all ED visits from our patient groups of interest and limited to patients at or over the age of 18 years at the time of their ED visit and excluded empty encounter records (n = 1,106,086 ED encounters).We created three patient groups: (1) US‐born, (2) foreign‐born documented, and (3) undocumented using two different imputation approaches: a logical approach versus statistical assignment. We compared predicted probabilities for two outcomes: an ED visit related to a behavioral health (BH) disorder and inpatient admission/transfer to another facility.Both approaches provide comparable estimates among the three patient groups for ED encounters for a BH disorder and inpatient admission/transfer to another facility. Undocumented immigrants are less likely to have a BH diagnosis in the ED and are less likely to be admitted or transferred compared to the US‐born.Researchers should consider expanding EHR with administrative data when studying the undocumented patient population and may prefer a logical approach to estimate immigration status. Researchers who rely on payer status alone (i.e., restricted Medicaid) as a proxy for undocumented immigrants in EHR should consider how this may bias their results. As Medicaid expands for undocumented immigrants, statistical assignment may become the preferred method. [ABSTRACT FROM AUTHOR]

In May 2022, the European Commission proposed the launch of a health‐specific data sharing framework called the European Health Data Space (EHDS), underpinned by legislation, for the use of electronic health data by patients and for research, innovation, policy‐making, patient safety, statistics, or regulatory purposes. In this essay, I review some of its more contentious features based on the latest version of the legislative proposal. I suggest that the EHDS is a useful case study to illustrate the need for a translational bioethics approach that shines a critical analytical light on contentious aspects of large‐scale research infrastructures. [ABSTRACT FROM AUTHOR]

Prior literature suggests that the social gradient in health is racialised such that Black individuals receive fewer health benefits from socioeconomic status than White individuals, yet scarce research studies examine whether this relationship persists in the context of Type 1 diabetes (T1D). Further, most research studies on racial health disparities in T1D outcomes focus on health during early life. We used data from the 2017–2018 wave of the T1D Exchange Registry (N = 11,963) and examined the relationship between household income, race and HbA1c in an age diverse sample of people with T1D. Results revealed that the inverse association between income and HbA1c is stronger for Black T1Ds compared to White T1Ds. Despite this, Black T1Ds with an income of $100,000 or more had higher HbA1c values compared to White individuals with an income of less than $25,000. Further, Black adolescents with T1D had particularly high HbA1c values. There is an urgent need for more research on the interpersonal and structural barriers associated with suboptimal glycaemic control among Black individuals. [ABSTRACT FROM AUTHOR]

Class‐based perspectives on the persistent social gradients in health within modern welfare states largely focus on the adverse consequences of unfettered neoliberalism and entrenched meritocratic socioeconomic selection. Namely, neoliberal‐driven economic inequality has fuelled resentment and stress among lower‐status groups, while these groups have become more homogeneous with regard to health behaviours and outcomes. We synthesise several sociological and historical literatures to argue that, in addition to these class‐based explanations, socioeconomic inequality may contribute to persistent social gradients in health due to elite class self‐interest—in particular elites' preferences for overdiagnosis, overprescription and costly high‐technology medical treatments over disease prevention, and for increased tolerance for regulatory capture. We demonstrate that this self‐interest provides parsimonious explanations for several contemporary trends in U.S. health inequality including (A) supply‐side factors in drug‐related deaths, (B) longitudinal trends in the social gradients of obesity and chronic disease mortality and (C) the immigrant health advantage. We conclude that sociological theories of elite class self‐interest usefully complement theories of the psychosocial effects of neoliberalism and of meritocratic social selection while answering recent calls for research on the role advantaged groups play in generating inequalities in health, and for research that moves beyond technological determinism in health sociology. [ABSTRACT FROM AUTHOR]

'Reflexivity', as used by Margaret Archer, means creative self‐mastery that enables individuals to evaluate their social situation and act purposively within it. People with complex health and social needs may be less able to reflect on their predicament and act to address it. Reflexivity is imperative in complex and changing social situations. The substantial widening of health inequities since the introduction of remote and digital modalities in health care has been well‐documented but inadequately theorised. In this article, we use Archer's theory of fractured reflexivity to understand digital disparities in data from a 28‐month longitudinal ethnographic study of 12 UK general practices and a sample of in‐depth clinical cases from 'Deep End' practices serving highly deprived populations. Through four composite patient cases crafted to illustrate different dimensions of disadvantage, we show how adverse past experiences and structural inequities intersect with patients' reflexive capacity to self‐advocate and act strategically. In some cases, staff were able to use creative workarounds to compensate for patients' fractured reflexivity, but such actions were limited by workforce capacity and staff awareness. Unless a more systematic safety net is introduced and resourced, people with complex needs are likely to remain multiply disadvantaged by remote and digital health care. [ABSTRACT FROM AUTHOR]

Background: Unmet need for home and community‐based services (HCBS) may disparately impact older adults from racial and ethnic minoritized groups. We examined racial and ethnic differences in unmet need for HCBS among consumers ≥65 years using publicly funded HCBS. Methods: We analyzed the National Core Indicators‐Aging and Disability survey data (2015–2019) from 21,739 community‐dwelling HCBS consumers aged ≥65 years in 23 participating states. Outcome measures included self‐reported unmet need in six service types (i.e., personal care, homemaker/chore, delivered meals, adult day services, transportation, and caregiver support). Racial and ethnic groups included non‐Hispanic Black, Asian, non‐Hispanic White, Hispanic, and multiracial groups. Logistic regression models examined associations between race and ethnicity and unmet need, adjusting for sociodemographic, health, and HCBS program (i.e., Medicaid, Older Americans Act [OAA], Program for All‐Inclusive Care for the Elderly [PACE]) characteristics, and use of specific service types. Results: Among 21,739 respondents, 23.3% were Black, 3.4% were Asian, 10.8% were Hispanic, 58.8% were non‐Hispanic White, and 3.7% were multiracial or identified with other races/ethnicities. Asian and Black consumers had higher odds of reporting unmet need in personal care than White consumers (adjusted odds ratio [aOR], 1.45, p value < 0.01; and aOR, 1.25, p < 0.001, respectively). Asian and Black consumers had significantly higher odds of unmet need in adult day services versus White consumers (aOR, 1.94, p < 0.001 and aOR, 1.39, p < 0.001, respectively). Black consumers had higher odds of unmet need versus non‐Hispanic White consumers in meal delivery and caregiver support services (aOR, 1.29; p < 0.01; and aOR 1.26, p < 0.05, respectively). Race and ethnicity were not significantly associated with experiencing unmet need for homemaker/chore or transportation services. Conclusions: Future research should identify driving forces in disparities in unmet need to develop culturally appropriate solutions. [ABSTRACT FROM AUTHOR]

Introduction: Racial and ethnic disparities in potentially inappropriate medication (PIM) use among older adults with dementia are unclear. Methods: Data were drawn from the baseline visits of participants who were ≥60 years old and diagnosed with dementia in the National Alzheimer's Coordinating Center Uniform Data Set (NACCUDS) recruited from National Institute on Aging (NIA)‐funded Alzheimer's Disease Research Centers (ADCs) throughout the United States. PIM utilization was evaluated using the 2019 American Geriatrics Society Beers Criteria for PIM Use in Older Adults. We estimated the association between race and ethnicity and the following outcomes and estimation models: (1) any PIM use, any PIM in each drug class, and any PIM best avoided in dementia patients using logistic regression models, (2) total number of medications, total number of PIMs, and anticholinergic burden scale (ACBS) using Poisson or negative binomial regression models, and (3) proportion of total medications that were PIMs using generalized linear models (GLM). Results: Compared to White participants, Black, Hispanic, and Asian participants reported taking fewer total medications (incidence rate ratio [IRR] ± standard error[SE] = 0.903 ± 0.017, 0.875 ± 0.021, and 0.912 ± 0.041, respectively, all p < 0.01). Asian participants were less likely to be exposed to any PIM (odds ratio [OR] ± SE = 0.619 ± 0.118, p < 0.05). Compared to White participants, Black participants were less likely to be exposed to benzodiazepine (OR ± SE = 0.609 ± 0.094, p < 0.01) and antidepressant (OR ± SE = 0.416 ± 0.103, p < 0.001) PIMs, but greater antipsychotic (OR ± SE = 1.496 ± 0.204, p < 0.01), cardiovascular (OR ± SE = 2.193 ± 0.255, p < 0.001), and skeletal muscle relaxant (OR ± SE = 2.977 ± 0.860, p < 0.001) PIMs. Hispanic participants were exposed to greater skeletal muscle relaxant PIMs and had lower anticholinergic burden. Asian participants were exposed to fewer benzodiazepine PIMs. Discussion: Significant racial and ethnic disparities in exposure to PIMs and PIMs by medication category in dementia research participants who have access to dementia experts found in the study suggest that disparities may be wider in the larger community. [ABSTRACT FROM AUTHOR]

Introduction: The intersection of ageism and racism is underexplored in geriatric emergency medicine (GEM) research. Methods: We performed a scoping review of research published between January 2016 and December 2021. We included original emergency department‐based research focused on falls, delirium/dementia, medication safety, and elder abuse. We excluded manuscripts that did not include (1) original research data pertaining to the four core topics, (2) older adults, (3) subjects from the United States, and (4) for which full text publication could not be obtained. The primary objective was to qualitatively describe reporting about older adults' social identities in GEM research. Secondary objectives were to describe (1) the extent of inclusion of minoritized older adults in GEM research, (2) GEM research about health equity, and (3) feasible approaches to improve the status quo of GEM research reporting. Results: After duplicates were removed, 3277 citations remained and 883 full‐text articles were reviewed, of which 222 met inclusion criteria. Four findings emerged. First, race and ethnicity reporting was inconsistent. Second, research rarely provided a rationale for an age threshold used to define geriatric patients. Third, GEM research more commonly reported sex than gender. Fourth, research commonly excluded older adults with cognitive impairment and speakers of non‐English primary languages. Conclusion: Meaningful assessment of GEM research inclusivity is limited by inconsistent reporting of sociodemographic characteristics, specifically race and ethnicity. Reporting of sociodemographic characteristics should be standardized across different study designs. Strategies are needed to include in GEM research older adults with cognitive impairment and non‐English primary languages. [ABSTRACT FROM AUTHOR]

Background: Bradford Hill (BH) viewpoints are widely used to assess causality in systematic reviews, but their application has often lacked reproducibility. We describe an approach for assessing causality within systematic reviews ('causal' reviews), illustrating its application to the topic of income inequality and health. Our approach draws on principles of process tracing, a method used for case study research, to harness BH viewpoints to judge evidence for causal claims. Methods: In process tracing, a hypothesis may be confirmed by observing highly unique evidence and disconfirmed by observing highly definitive evidence. We drew on these principles to consider the value of finding supportive or contradictory evidence for each BH viewpoint characterised by its uniqueness and definitiveness. Results: In our exemplar systematic review, we hypothesised that income inequality adversely affects self‐rated health and all‐cause mortality. BH viewpoints 'analogy' and 'coherence' were excluded from the causal assessment because of their low uniqueness and low definitiveness. The 'experiment' viewpoint was considered highly unique and highly definitive, and thus could be particularly valuable. We propose five steps for using BH viewpoints in a 'causal' review: (1) define the hypothesis; (2) characterise each viewpoint; (3) specify the evidence expected for each BH viewpoint for a true or untrue hypothesis; (4) gather evidence for each viewpoint (e.g., systematic review meta‐analyses, critical appraisal, background knowledge); (5) consider if each viewpoint was met (supportive evidence) or unmet (contradictory evidence). Conclusions: Incorporating process tracing has the potential to provide transparency and structure when using BH viewpoints in 'causal' reviews. [ABSTRACT FROM AUTHOR]

Introduction: The impact of alcohol‐free and low‐alcohol (no/lo) drinks on public health and health inequalities depends on who consumes them and how they are consumed. This study aimed to estimate: (i) the proportions of adults in Great Britain who consume no/lo drinks at different frequencies and in different settings; and (ii) the associations between no/lo drink consumption and individual characteristics. Method: Pooled data (N = 7691) from four waves of a repeat cross‐sectional survey on alcohol use completed in 2022–2023 by adults (16+) resident in Great Britain were analysed using descriptive statistics and logistic regression models. Results: In all, 31.3% of adults reported ever consuming no/lo drinks and 9.8% reported drinking them weekly. Ever consumption of no/lo drinks was associated with: being an increasing risk drinker of alcohol relative to not drinking (ORadj: 3.96, 95% CI 3.27–4.80), being aged 16–24 compared with 65+ (ORadj:1.29, 95% CI 1.07–1.57), having previously smoked compared with having never smoked (ORadj:1.19, 95% CI 1.05–1.34) and living in a rural rather than urban area (ORadj:1.14, 95% CI 1.00–1.29). It was less likely among those in lower social grades or with lower educational qualifications; those living in Yorkshire and the Humber, and Scotland, compared with the South‐East of England; and those using nicotine products. Discussion and Conclusions: A third of adults in Great Britain have consumed no/lo drinks and approximately one in 10 do so weekly. Consumption is more common among riskier drinkers of alcohol and among more advantaged social groups, which may contribute to the sustaining or widening of health inequalities. [ABSTRACT FROM AUTHOR]

Background: Minority populations are utilizing mobile health applications more frequently to access health information. One group that may benefit from using mHealth technology is underserved women, specifically those on community supervision. Objective: Discuss methodological approaches for navigating digital health strategies to address underserved women's health disparities. Description of the innovative method: Using an intersectional lens, we identified strategies for conducting research using digital health technology and artificial intelligence amongst the underserved, particularly those with community supervision. Description of its effectiveness: We explore (1) methodological approaches that combine traditional research methods with precision medicine, digital phenotyping, and ecological momentary assessment; (2) implications for artificial intelligence; and (3) ethical considerations with data collection, storage, and engagement. Discussion: Researchers must address gendered differences related to health, social, and economic disparities concurrently with an unwavering focus on the protection of human subjects when addressing the unique needs of underserved women while utilizing digital health methodologies. Public contribution: Women on community supervision in South Central Texas helped inform the design of JUN, the mHealth app we reported in the case exemplar. JUN is named after the Junonia shell, a native shell to South Texas, which means strength, power, and self‐sufficiency, like the participants in our preliminary studies. [ABSTRACT FROM AUTHOR]

Aim: Adults with intellectual and developmental disabilities (IDD) have a significantly higher prevalence of Type 2 diabetes than the general population. Evidence that lifestyle and/or behavioural interventions, such as participation in Special Olympics, decreases the risk of developing diabetes in adults with IDD could help minimize health disparities and promote overall health in this population. Methods: This was a 20‐year retrospective cohort study of adults with IDD (30–39 years) in the province of Ontario, Canada, that compared hazard rates of diabetes among Special Olympics participants (n = 4145) to non‐participants (n = 31,009) using administrative health databases housed at ICES. Using cox proportional hazard models, crude and adjusted hazard ratios were calculated for the association between the primary independent variable (Special Olympics participation status) and the dependent variable (incident diabetes cases). Results: After controlling for other variables, the hazard ratio comparing rates for developing diabetes between Special Olympics participants and non‐participants was 0.85. This represents a 15% reduction in the hazard among Special Olympics participants when followed for up to 20 years. This result was statistically significant and represents a small effect size. Conclusions: Special Olympics could be considered a complex intervention that promotes physical activity engagement through sport participation, health screenings, and the promotion of healthy eating habits through educational initiatives. This study provides evidence that Special Olympics participation decreases the rate for developing diabetes. [ABSTRACT FROM AUTHOR]

Aims: There are marked inequities in clinical outcomes and rates of diabetes technology use among youth with type 1 diabetes (T1D). The quantitative data from our mixed methods cohort study identified significant improvements in glycaemia and quality of life in participants. We aimed to use qualitative methods to provide further insight into our quantitative findings in the setting of underlying health disparities. Methods: Fifteen publicly insured, insulin pump‐naïve non‐Hispanic Black youth aged 6–21 years with T1D and baseline haemoglobin A1c (HbA1c) ≥86 mmol/mol (10%) and their parents participated in a mixed methods cohort study. Semi‐structured interviews were conducted separately with parents and youth after completion of 6 months of HCL use. Three topic areas were explored: (1) Experience using HCL, (2) barriers to HCL and (3) facilitators to accessing HCL. Semantic content analysis and consensus coding involving two team members were used to generate themes. Thematic saturation was achieved. Results: Youth (Medianage 14.9 years, 67% female) and parents (92% female) were interviewed. Youth and their parents reported that access to HCL provides a new outlook on living with T1D, although managing T1D is still hard. They felt that diabetes technology is most helpful for those struggling with management. Participants experienced barriers to access including misconceptions of HCL systems, clinician bias and systemic racism. They suggested these barriers can be overcome by offering diabetes technology education for all people with T1D, increasing awareness of HCL in the community and providing resources to overcome barriers created by social determinants of health. Conclusions: The voices of historically minoritised youth with suboptimal T1D control and their parents provide important, previously unreported experiences and perspectives on barriers and facilitators to using HCL that will shape interventions to improve equity in access to diabetes technology. [ABSTRACT FROM AUTHOR]

In single‐molecule microscopy, a big question is how precisely we can estimate the location of a single molecule. Our research shows that by using iterative localisation microscopy and factoring in the prior information, we can boost precision and reduce the number of photons needed. Leveraging the Van Trees inequality aids in determining the optimal precision achievable. Our approach holds promise for wider application in discerning the optimal precision across diverse imaging scenarios, encompassing various illumination strategies, point spread functions and overarching control methodologies. [ABSTRACT FROM AUTHOR]

Summary: Obesity represents a major public health emergency worldwide, and its etiology is shaped by a complex interplay of environmental and genetic factors. Over the last decade, polygenic risk scores (PRS) have emerged as a promising tool to quantify an individual's genetic risk of obesity. The field of PRS in obesity genetics is rapidly evolving, shedding new lights on obesity mechanisms and holding promise for contributing to personalized prevention and treatment. Challenges persist in terms of its clinical integration, including the need for further validation in large‐scale prospective cohorts, ethical considerations, and implications for health disparities. In this review, we provide a comprehensive overview of PRS for studying the genetics of obesity, spanning from methodological nuances to clinical applications and challenges. We summarize the latest developments in the generation and refinement of PRS for obesity, including advances in methodologies for aggregating genome‐wide association study data and improving PRS predictive accuracy, and discuss limitations that need to be overcome to fully realize its potential benefits of PRS in both medicine and public health. [ABSTRACT FROM AUTHOR]

Objectives: The workplace is an important setting for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) exposure and transmission. Using data from a large case–control study in Colorado during 2021 and 2022, we aimed to evaluate working outside the home and SARS‐CoV‐2 infection, the racial and ethnic distribution of workers in occupations associated with infection, and workplace face mask use. Methods: Cases were Colorado adults with a positive SARS‐CoV‐2 test by reverse transcription‐polymerase chain reaction (RT‐PCR) reported to Colorado's COVID‐19 surveillance system selected from surveillance data ≤12 days after their specimen collection date. Control participants were randomly selected adult Coloradans with a RT‐PCR‐confirmed negative SARS‐CoV‐2 test result reported to the same surveillance system. Results: Working outside the home was associated with infection (odds ratio [OR] = 1.46, 95% confidence interval [CI]: 1.39–1.54). Among participants working outside the home, "Food Preparation and Serving Related" (aOR = 2.35, 95% CI: 1.80–3.06), "Transportation and Material Moving" (aOR = 2.09, 95% CI: 1.62–2.69), "Construction and Extraction" (aOR = 1.88, 95% CI: 1.36–2.59), "Protective Service" (aOR = 1.60, 95% CI: 1.15–2.24), and "Sales and Related" (aOR = 1.44, 95% CI: 1.22–1.69) were occupational categories most strongly associated with infection. American Indian/Alaskan Native, Black, and Hispanic/Latino participants were more likely than others to work in occupational categories with the highest odds of infection (p < 0.05). Cases were less likely than controls to report always wearing a mask (31.9% vs. 41.5%) and wearing a KN95/N95/KF94 mask (16.8% vs. 27.2%) at work. Conclusions: These findings emphasize the importance of occupation and workplace mask use in the COVID‐19 pandemic and its disproportionate racial/ethnic impact on workers. [ABSTRACT FROM AUTHOR]

Objective: Initiating postoperative radiotherapy (PORT) within 6 weeks of surgery for head and neck squamous cell carcinoma (HNSCC) is included in the National Comprehensive Cancer Network Clincal Practice Guidelines and is a Commission on Cancer quality metric. Factors associated with delays in starting PORT have not been systematically described nor synthesized. Data Sources: PubMed, Scopus, and CINAHL. Review Methods: We included studies describing demographic characteristics, clinical factors, or social determinants of health associated with PORT delay (>6 weeks) in patients with HNSCC treated in the United States after 2003. Meta‐analysis of odds ratios (ORs) was performed on nonoverlapping datasets. Results: Of 716 unique abstracts reviewed, 21 studies were included in the systematic review and 15 in the meta‐analysis. Study sample size ranged from 19 to 60,776 patients. In the meta‐analysis, factors associated with PORT delay included black race (OR, 1.46, 95% confidence interval [CI]: 1.28‐1.67), Hispanic ethnicity (OR, 1.37, 95% CI, 1.17‐1.60), Medicaid or no health insurance (OR, 2.01, 95% CI, 1.90‐2.13), lower income (OR, 1.38, 95% CI, 1.20‐1.59), postoperative admission >7 days (OR, 2.92, 95% CI, 2.31‐3.67), and 30‐day hospital readmission (OR, 1.37, 95% CI, 1.29‐1.47). Conclusion: Patients at greatest risk for a delay in initiating guideline‐adherent PORT include those who are from minoritized communities, of lower socioeconomic status, and experience postoperative challenges. These findings provide the foundational evidence needed to deliver targeted interventions to enhance equity and quality in HNSCC care delivery. [ABSTRACT FROM AUTHOR]

Objectives Design Methods Results Conclusions Lesbian and Gay people (LGP) experience higher rates of mental health difficulties, including self‐harm, suicidal behaviours, as well as inequalities in health care, than their heterosexual peers. Dialectical Behaviour Therapy (DBT) is an evidence‐based treatment for self‐harm and suicidal behaviours, though there is little research on LGP's experiences of DBT. This research aims to explore LGP's experiences of completing a full DBT programme.A qualitative design with semi‐structured individual interviews was utilised. The results were analysed using Interpretative Phenomenological Analysis.Six lesbian and two gay adults, aged between 22 and 47 years, living in the United Kingdom took part. All participants had completed a full programme of DBT within the 2 years prior to the interview.Four superordinate themes emerged from the data: (1) The DBT journey; (2) Connections and Sense of Community during DBT; (3) Sexuality both visible and invisible in DBT and (4) A Gender, Sexuality and Relationship Diverse (GSRD) affirmative future for DBT.Several clinical implications are suggested to improve DBT for LGP, for example to consider having other LGP within DBT groups, to create a more GSRD‐affirming DBT (changes to the DBT manual, DBT therapists, DBT programme and physical DBT space), to adapt DBT techniques to manage sexuality‐related difficulties and to adopt a GSRD‐centric framework. Overall, DBT appears to be beneficial for LGP. [ABSTRACT FROM AUTHOR]

Background Aim Study design Results Conclusion Relevance to Clinical practice Parents of infants admitted to neonatal intensive care require support to minimize the impact on their mental health and to encourage engagement with their infants to support infant neurodevelopment. Many interventions aim to address this need, but there is a lack of research considering the accessibility of these for a multicultural population.To systematically identify sources of psychotherapeutic support available for parents with infants admitted to neonatal care (NNU, neonatal intensive care unit [NICU] and special care units), assess their accessibility and acceptability and identify challenges and facilitators.Six electronic databases with no restrictions on language or date were used to identify relevant studies following Preferred Items for Systematic Reviews and Meta‐analysis (PRISMA) guidelines. Publications were included in the review if they reviewed parent experience of an intervention actively in place to support parent experience during the neonatal unit stay. Any studies where the intervention's primary aim was infant focused, such as developmental care, were excluded. All publications were quality‐assessed using quality appraisal tools appropriate for their design type. Data were extracted line by line using Sekhon et al.'s theoretical acceptability framework and questionnaire.A total of 3309 studies were found, of which 36 studies met the inclusion criteria. Included studies were published worldwide between 2000 and 2023 and explored 15 different interventions. Challenges for parental engagement were due to preconceived ideas about intervention requirements and parents' ability to participate in them. Timely information and providers' experience in delivering the intervention were reported to support engagement and as being valuable for enhancing participant knowledge. The emotional content of interventions was found to be challenging by parents across most studies. This was prominent in interventions designed to be carried out in a group format and where keepsakes were created. However, the value of these interventions was in reducing parents' feelings of isolation through increased social support and providing a starting point for conversations with wider family and friends about the family's neonatal experience. Participant demographics were poorly reported, with only two studies taking into consideration the ethicality of the intervention.Poor reporting of participant demographics, and a focus on mothers as participants, means findings are not transferrable to the wider population of parents in neonatal units. Future studies should consider how to ensure that research and interventions are accessible to multicultural populations to improve the understanding of the acceptability of interventions. Better knowledge of neonates and the NNU setting amongst intervention providers could increase the accessibility of psychotherapeutic support for parents. Training for providers on how to manage sensitive conversations may also be beneficial to support parents during interventions.The impact of neonatal admission on parental mental health is increasingly recognized and reported. Interventions have been developed to reduce the negative impact on the mental health of parents. There continue to be significant health inequalities as a result of many services not taking into account the acceptability and accessibility of interventions in this setting for their multicultural populations. This review highlights the need for better reporting of participant demographics in research and the inclusion of those seldom heard to ensure interventions are culturally, religiously and linguistically appropriate for multicultural populations. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion This study aimed to describe the epidemiology of kidney replacement therapy (KRT) in Aotearoa New Zealand and assess the impact of residential location on access to kidney transplantation.AcceSS and Equity in Transplantation (ASSET), a health‐linked data platform, was used to identify people commencing KRT in New Zealand from 2006 to 2019 and analyse regional epidemiology. Health services were classified as ‘transplanting’, ‘intermediate’ or ‘remote’ depending on their degree of separation from a transplant centre. Multiple logistic regression modelling was used to assess the predictors of deceased donor waitlisting or living donor transplantation within 6 months after starting KRT. Web‐based mapping software was used to develop interactive geospatial maps.The cohort was 7704 people newly starting KRT. Living in an intermediate [odds ratio (OR): 0.73 (95% confidence interval (CI): 0.61–0.88)] or remote [OR: 0.38 (95% CI: 0.27–0.54)) region and Māori (OR: 0.35 (95% CI: 0.28–0.44)], Pacific [OR: 0.32 (95% CI: 0.24–0.42)) and Asian (OR: 0.66 (95% CI: 0.50–0.87)] ethnicity were associated with a decreased likelihood of timely waitlisting or transplantation. Regional maps can be explored here.There is marked geospatial and ethnic variation in the epidemiology of kidney failure and access to kidney transplantation across New Zealand. Geospatial mapping of kidney failure epidemiology and transplantation outcomes can provide opportunities to direct resources towards populations at greatest need. [ABSTRACT FROM AUTHOR]

ABSTRACT Invasive biological samples collected during clinical care represent a valuable yet underutilized source of information about human biology. However, the challenges of working with clinical personnel and the invasive nature of sample collection in biomedical studies can hinder the acquisition of sufficiently large sample sizes for robust statistical analyses. In addition, the incorporation of demographic data from participants is crucial for ensuring the inclusiveness of representative populations, identifying at‐risk groups, and addressing healthcare disparities. Drawing on both research experiences and the existing literature, this article provides recommendations for researchers aiming to undertake efficient and impactful projects involving invasive human samples. The suggested strategies include: (1) establishing productive collaborations with clinicians; (2) optimizing sample quality through meticulous collection and handling procedures; and (3) strategically implementing a retrospective model to capitalize on existing invasive sample repositories. When established, cooperative work between clinical health care workers and biological anthropologists can yield insights into human biology that have the potential to improve human health and wellbeing. [ABSTRACT FROM AUTHOR]

The persisting life‐expectancy ‘gap’ between First Nations and non‐First Nations Australians is fundamentally driven by the social determinants of health. These include income and social protection, access to adequate housing and food security, among others. These factors are particularly prominent in Central Australia. Inadequate housing has led to some of the highest rates of Streptococcus pyogenes infection in the world, which in turn drives an extremely high prevalence of rheumatic heart disease. Food insecurity and inadequate social protection manifesting as energy insecurity result in inadequate nutrition and have resulted in a huge burden of diabetes in Central Australia. These factors, combined with social exclusion, racism and the pervasive effect of colonisation, also drive a high rate of alcohol misuse. Only by prioritising equity in these ‘social determinants’ and emphasising the importance of First Nations leadership in formulating and implementing solutions will health inequity be addressed. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions In older adults, pressure injuries (PIs) are common and, despite advancements in PI care, are associated with increased complications in patients with dementia for whom standardized treatments are unavailable. Herein, we aimed to examine the influence of dementia status on the care practice pattern and healing outcomes for PI on discharge.This retrospective cohort study used data from the Diagnosis Procedure Combination database for 2014–2015 and the Annual Report for Functions of Medical Institutions and included patients aged ≥65 years. The DESIGN‐R (depth, exudates, size, inflammation/infection, granulation, necrosis and rating) classification system was used to determine PI severity, and the Dementia Scale was used to assess dementia status. The measured outcomes included advanced PI care and healing upon discharge. Multivariable logistic regression, accounting for hospital‐related clustering, was used to examine the association of dementia with these outcomes.Among 20 386 patients from 1198 hospitals included in the analysis, 32.5%, 20.1% and 47.3% had no, mild and severe dementia, respectively. After adjustment for patients' and hospital characteristics, compared with those without dementia, patients with severe dementia were significantly less likely to undergo advanced treatments, such as skin grafts (adjusted odds ratio [aOR], 0.62 [95% confidential interval [CI], 0.40–0.97]; P = 0.034) and flap surgeries (aOR, 0.57 [95% CI, 0.42–0.77]; P < 0.001), and had a reduced likelihood of PI healing (aOR, 0.80 [95% CI, 0.72–0.90]; P < 0.001).Severe dementia was associated with poor PI healing outcomes, indicating potential treatment disparities. Thus, PI treatment should be provided according to the severity of dementia. Geriatr Gerontol Int 2024; ••: ••–••. [ABSTRACT FROM AUTHOR]

Context Methods Findings Conclusions Policy Points What are the facilitators and barriers of physician group participation in a performance‐based financial incentive program aimed at improving equity of care by patient race and ethnicity? Launching financial incentives to improve racial equity has required extensive organizational change management for participating physician groups, including major investments to improve quality management systems. Carefully designing financial incentives to encourage equity improvement while managing unintended consequences, and considering physician groups’ populations served, baseline maturity of quality management systems, and efforts to assess and address patients’ social risk factors have been central to prepare physician groups for financial incentives to improve equity of care. Given the major investments required of physician groups to prepare for financial incentives that reward equity improvement, alignment of equity of care measure specifications and reporting requirements across payers could facilitate physician group engagement. Evidence about how baseline physician group capabilities, including the maturity of their quality management systems, impact equity improvement may help health plans prioritize and target their investments to advance equity of care by patient race and ethnicity. What are the facilitators and barriers of physician group participation in a performance‐based financial incentive program aimed at improving equity of care by patient race and ethnicity? Launching financial incentives to improve racial equity has required extensive organizational change management for participating physician groups, including major investments to improve quality management systems. Carefully designing financial incentives to encourage equity improvement while managing unintended consequences, and considering physician groups’ populations served, baseline maturity of quality management systems, and efforts to assess and address patients’ social risk factors have been central to prepare physician groups for financial incentives to improve equity of care. Given the major investments required of physician groups to prepare for financial incentives that reward equity improvement, alignment of equity of care measure specifications and reporting requirements across payers could facilitate physician group engagement. Evidence about how baseline physician group capabilities, including the maturity of their quality management systems, impact equity improvement may help health plans prioritize and target their investments to advance equity of care by patient race and ethnicity. Blue Cross Blue Shield of Massachusetts (BCBSMA), a large commercial health insurer, is using financial incentives to advance equity of care by patient race and ethnicity. Understanding experiences of this payer and its contracted physician groups can inform efforts elsewhere. We qualitatively assess physician groups’ barriers and facilitators of planning and implementing BCBSMA's financial incentives to improve equity of ambulatory care quality by patient race and ethnicity.Key informant interviews (n = 44) of the physician group, BCBSMA, and external stakeholders were conducted, equity initiative meetings were observed, and documents were analyzed to identify barriers and facilitators of designing and preparing for financial incentives to advance racial equity. Physician group experiences of preparing for and responding to financial incentives for equity improvement were assessed.Analyses revealed 1) the central importance of valid and reliable equity performance measurement and carefully designed equity improvement incentives for physician group buy‐in, 2) that prior to implementing financial incentives for equity improvement, physician groups needed to improve their quality management systems and the accuracy and completeness of patient race and ethnicity data, and 3) physician groups’ populations served, baseline maturity of quality management systems, and efforts to assess and address patients’ social risk factors were central to consider to plan for physician group financial incentives to improve racial equity.Given the major infrastructure investments and organizational change management resources required of physician groups to participate in a financial incentive program designed to reward equity improvement, alignment of equity measurement and performance requirements across payers would facilitate physician groups’ engagement in efforts to improve quality of care for racial and ethnic minority patients. [ABSTRACT FROM AUTHOR]

Background and Aims Design Setting Participants Measurements Findings Conclusions During the COVID‐19 pandemic, there was a surge in opioid overdose deaths (OODs) in Massachusetts, USA, particularly among Black and Hispanic/Latinx populations. Despite the increasing racial and ethnic disparities in OODs, there was no compensatory increase in naloxone distributed to these groups. We aimed to evaluate two community‐based naloxone expansion strategies, with the objective of identifying approaches that could mitigate mortality and racial and ethnic disparities in OODs.Individual‐based simulation model. We measured naloxone availability using naloxone kits per OOD and evaluated scenarios of achieving higher benchmarks for naloxone availability (i.e. 40, 60 and 80 kits per OOD) from 2022 levels (overall: 26.0, White: 28.8, Black: 17.3, Hispanic/Latinx: 18.9). We compared two naloxone distribution strategies: (1) proportional distribution: achieving the benchmark ratio at the overall population level while distributing additional kits proportional to the 2022 level for each racial/ethnic group (at 40 kits per OOD benchmark: overall: 40, White: 44.3, Black: 26.6, Hispanic/Latinx: 29.1), and (2) equity‐focused distribution: achieving the benchmark ratio among each racial/ethnic group (at 40 kits per OOD benchmark: 40 for all groups).Massachusetts, United States.People at risk of OOD.Annual number and rate of OODs, total healthcare costs of increasing naloxone availability.Both naloxone distribution strategies yielded comparable predicted reductions in total OODs in 2025 and incurred similar incremental costs. However, the relative reduction in the rate of OODs differed across groups. For achieving an 80 kits per OOD benchmark, proportional distribution resulted in a projected 6.7%, 6.5% and 7.1% reduction in annual OODs in 2025 among White, Black and Hispanic/Latinx populations, respectively. In contrast, equity‐focused distribution achieved a reduction of 5.7%, 11.3% and 10.2% in the respective groups. In all scenarios, the cost per OOD averted was lower than the generally accepted thresholds for cost per life saved.An equity‐focused naloxone distribution strategy designed to reduce racial and ethnic disparities in naloxone availability could improve health equity among racial and ethnic groups while potentially improving overall population health at lower healthcare costs per opioid overdose death averted than a proportional distribution strategy. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions This scoping review aims to expansively review the reporting of Indigenous status, ethnicity, culture, language and country of birth in Australian paediatric clinical studies.Scoping review of Australian clinical studies, including randomised controlled trials, non‐randomised controlled trials, cluster randomised controlled trials and quasi‐experimental studies, with paediatric participants (<18 years) or mixed adult and paediatric participants. PubMed, Cumulated Index to Nursing and Allied Health Literature and Embase databases were searched for clinical studies published 1 January 2018 to 28 November 2022.Of the 2717 studies identified in the search, 209 clinical studies were included. Overall, 131 (62.7%) clinical studies captured in this review did not report any of the variables of interest. When reported, terms used by study authors varied extensively and subsequently five study‐defined categories emerged ‘Indigenous status’, ‘race’, ‘race and ethnicity’, ‘ethnicity’, or ‘natural skin colour’. ‘Indigenous status’ was most reported (n = 37, 17.7%), followed by ‘ethnicity and/or cultural background’ (n = 15, 7.2%), ‘race and ethnicity’ (n = 4, 1.9%), race (n = 1, 0.5%) and ‘natural skin colour’ (n = 1, 0.5%). Furthermore, language used at home was reported in 27 studies (12.9%) and country of birth in 23 studies (11.0%).This review demonstrated very low reporting of Indigenous status, ethnicity, culture, language and country of birth in Australian paediatric clinical studies. Poor reporting has raised concerns surrounding generalisability of findings from these trials in addition to equity. The recent international shift encompassing improved clinical trial reporting requirements, for ethnicity and race, require prompt establishment in the Australian clinical trial domain. [ABSTRACT FROM AUTHOR]

Purpose Methods Findings Conclusions Implications for nursing practice This study describes the design, integration, and semantic interoperability process of a minimum data set using standardized nursing language in the caring module of the TEC‐MED care platform.The caring module was developed in three phases (2020–2022): platform concept, functional design and construction, and testing and evaluation. Phases involved collaboration among academics, information technology developers, and social/healthcare professionals. Nursing taxonomies (NANDA‐I, NOC, NIC) were integrated to support the nursing process. The platform was piloted in six Mediterranean countries.The final platform features an assessment module with eight dimensions for data collection on older adults and their caregivers. A clinical decision support system links assessment data with nursing diagnoses, outcomes, and interventions. The platform is available in six languages (English, Spanish, French, Italian, Greek, and Arabic). Usability testing identified the need for improved Arabic language support.The TEC‐MED platform is a pioneering tool using standardized nursing language to improve care for older adults in the Mediterranean. The platform's multilingualism promotes accessibility. Limitations include offline use and mobile app functionality. Pilot testing is underway to evaluate effectiveness and facilitate cross‐cultural validation of nursing taxonomies.The TEC‐MED platform offers standardized nursing care for older adults across the Mediterranean, promoting consistent communication and evidence‐based practice. This approach has the potential to improve care quality and accessibility for a vulnerable population. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Purpose Method Results Conclusion Extant literature on transgender and gender‐diverse (TGD) people living in the United States is centered on bicoastal metropolitan cities. Little is known about the health status and health‐related barriers among TGD people living in the middle of the country. Minority Stress Theory (MST) provides a framework for understanding how TGD people experience stressors that shape their health‐related experiences.To describe health‐related experiences of TGD people living in Colorado using the MST framework.The scoping review was limited to peer‐reviewed, English‐language studies published between January 2018 and November 2023. Data abstraction and synthesis were performed using Thomas and Harden's approach to thematic synthesis.Twenty‐one articles were included in the review. Seventeen (80.9%) articles were quantitative studies, two (9.5%) were qualitative, and two (9.5%) were mixed methods. Most of the participants were transfeminine and 18 years old or younger. Three themes emerged (1) TGD Coloradans experience multiple health‐related stressors, (2) these stressors contribute to poor health outcomes, and (3) overcome with coping strategies and/or social support.TGD Coloradans experience multiple stressors related to their TGD identity that shape their health‐related experiences. Nurses play a critical role in intervening in these stressors and addressing care disparities. [ABSTRACT FROM AUTHOR]

Young people coming of age amidst widespread socioeconomic uncertainty have a unique vantage from which to interpret how social, economic and environmental factors might influence health and the generation of health inequalities. Despite this, only a small number of existing studies of ‘lay’ understandings of health inequalities have focused on young people. This arts‐based qualitative study builds on that body of research, in the context of the UK, to explore how young people make sense of health inequalities. Across two sites, Glasgow and Leeds, six groups of young people (39 in total) took part in online workshops to explore their perspectives. Throughout they engaged with population health research evidence; contributed to group discussions and responded creatively, via visual and performance art and by articulating their own views and experiences. In this paper, we explore how individual and structural explanations for health inequalities emerged, employing concepts from sociological studies of youth to shed light on these accounts. In particular, we argue that the concept of ‘austere meritocracy’, the persistence of narratives of aspiration and hard work as key to success against an increasingly hostile socio‐economic backdrop, helps explain young people’s perspectives on health inequalities in the UK. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Accurate and timely diagnosis of dementia is necessary to allow affected individuals to make informed decisions and access appropriate resources. When dementia goes undetected until a hospitalization or nursing home stay, this could reflect delayed diagnosis or misdiagnosis, and may reflect underlying disparities in healthcare access.In this retrospective cohort study, we used 2012–2020 Medicare claims and other administrative data to examine variation in setting of dementia diagnosis among fee‐for‐service Medicare beneficiaries with an initial claims‐based dementia diagnosis in 2016. We used multinomial logistic regression to evaluate the association of person and geographic factors with diagnosis location, and Cox proportional hazards regression to examine 4‐year survival relative to diagnosis location.Among 754,204 Medicare beneficiaries newly diagnosed with dementia in 2016, 60.3% were diagnosed in the community, 17.2% in hospitals, and 22.5% in nursing homes. Adjusted 4‐year survival rates were significantly lower among those diagnosed in hospitals [−16.1 percentage points (95% CI: −17.0, −15.1)] and nursing homes [−16.8 percentage points (95% CI: −17.7, −15.9)], compared to those diagnosed in the community. Community‐diagnosed beneficiaries were more often female, younger, Asian or Pacific Islander, Native American or Alaskan Native, Hispanic, had fewer baseline hospitalizations and higher homecare use, and resided in wealthier ZIP codes. Rural beneficiaries were more likely to be diagnosed in hospitals.Many older adults are diagnosed with dementia in a hospital or nursing home. These individuals have significantly lower survival than those diagnosed in the community, which may indicate diagnosis during an acute illness or care transition, or at a later disease stage, all of which are suboptimal. These results highlight the need for improved dementia screening in the general population, particularly for individuals in rural areas and communities with higher social deprivation. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Objective Methods Results Conclusion Nursing is historically, ethically, and theoretically mandated to champion social justice.To investigate how the concept of “social justice” has been explored in nursing research regarding extent, range, and nature.The five‐stage framework by Arksey and O'Malley was adopted, and JBI and PRISMA guidelines further informed the study. The search strategy comprised three steps: an initial search, a systematic search in several databases, and finally, a reference, citation, and gray literature search. A total of 55 studies meeting the inclusion criteria were included in the analysis.Almost all the included studies were authored in the English‐speaking world. Most studies were published from 2014 onward, and qualitative methods were by far the most prominent. A total of 13 specific definitions or understandings of social justice were identified. Five themes were identified across the included studies: (1) education, (2) concept, (3) theory, (4) public health and community nursing, and (5) maternal and child health.The literature on social justice and nursing is limited, albeit growing. The conceptualization of social justice within nursing is becoming broader and more nuanced. Only a few studies have focused on specific patient groups or specialties. [ABSTRACT FROM AUTHOR]

ABSTRACT Growing awareness of poor maternal health outcomes and maternal health disparities in the United States has heightened urgency around the need to promote Respectful Maternity Care (RMC) as a fundamental tenet of obstetric/midwifery care and standardize efforts to improve safety, eliminate obstetric violence and racism, and optimize health outcomes for all birthing people. The historical context of prior and contemporary perspectives around childbirth influences our understanding of RMC and are shaped by varying scholarly, clinical, and community standards (e.g., religion, human rights, government, public health, midwifery, ethics, activism, and the law), which have changed significantly since the mid‐19th century. In this commentary, we share results of a contextual question scoped as part of a larger systematic review of RMC to help inform consensus around a shared definition and development of a metric to standardize delivery and evaluation of RMC. Synthesis of this literature identified landmark historical influences on RMC over the past 100 years, highlighting the multidisciplinary scholarship and historical context influencing the progress toward RMC. Further understanding of this history may also inform policies and guidance for ongoing efforts to center respect and accountability in all aspects of maternity care, with particular attention to populations who are disproportionally impacted by disrespectful care. [ABSTRACT FROM AUTHOR]

Objective Data Sources and Study Setting Study Design Data Collection/Extraction Methods Principal Findings Conclusions To decompose the mental health disparities between breast cancer patients and survivors (hereafter survivors) of racial and ethnic minority groups and non‐Hispanic White survivors into the contributions of individual‐, interpersonal‐, community‐, and societal‐level determinants.We used data from the 2010–2020 Medical Expenditure Panel Survey Household Component (MEPS‐HC). Our primary outcome was whether the person had mental health conditions or not.We employed the Kitagawa–Oaxaca–Blinder (KOB) method to understand to what extent the differences in outcomes were explained by the differences in the determinants between non‐Hispanic Black or Hispanic breast cancer survivors and non‐Hispanic White survivors. We also bifurcated the Hispanic sample analysis by the US‐born status (and county of origin).Confidential geographic identifiers are utilized to supplement the MEPS‐HC data with information on community characteristics and local healthcare resources.The prevalence of mental health conditions among non‐Hispanic Black and Hispanic breast cancer survivors was 26.1% (95% CI: 20.4, 31.7) and 28.3% (95% CI: 21.9, 34.6), respectively. These rates were higher than those for their non‐Hispanic White counterparts, 19.7% (95% CI: 17.4, 21.9). In our KOB model, the disparity between non‐Hispanic Black and White survivors was fully explained by differences in education, health, and family structure, with community‐ and societal‐level determinants playing no significant role. Conversely, our KOB model did not explain any of the overall differences between Hispanic and non‐Hispanic White survivors. However, for foreign‐born Hispanic survivors, the disparity was fully explained by a combination of individual‐ and societal‐level determinants.Our findings, which identify specific individual‐, interpersonal‐, and societal‐ determinants that were associated with racial and ethnic differences in mental health, can be used by clinicians and policymakers to proactively address racial and ethnic disparities in health. [ABSTRACT FROM AUTHOR]

Background: Despite mandated insurance coverage since 2006 and robust health infrastructure in urban settings with high concentrations of minority patients, race‐based disparities in prostate cancer (PCa) treatment persist in Massachusetts. In this qualitative study, the authors sought to identify factors driving inequities in PCa treatment in Massachusetts. Methods: Four hospitals offering PCa treatment in Massachusetts were selected using a case‐mix approach. Purposive sampling was used to conduct semistructured interviews with hospital stakeholders. Additional interviews were conducted with representatives from grassroots organizations providing PCa education. Two study staff coded the interviews to identify major themes and recurrent patterns. Results: Of the 35 informants invited, 25 participated in the study. Although national disparities in PCa outcomes were readily discussed, one half of the informants were unaware that PCa disparities existed in Massachusetts. Informants and grassroots organization representatives acknowledged that patients with PCa are willing to face transportation barriers to receive treatment from trusted and accommodating institutions. Except for chief equity officers, most health care providers lacked knowledge on accessing or using metrics regarding racial disparities in cancer outcomes. Although community outreach was recognized as a potential strategy to reduce treatment disparities and engender trust, informants were often unable to provide a clear implementation plan. Conclusions: This statewide qualitative study builds on existing quantitative data on the nature and extent of disparities. It highlights knowledge gaps in recognizing and addressing racial disparities in PCa treatment in Massachusetts. Improved provider awareness, the use of disparity metrics, and strategic community engagement may ensure equitable access to PCa treatment. Plain Language Summary: Despite mandated insurance and urban health care access, racial disparities in prostate cancer treatment persist in Massachusetts.This qualitative study revealed that, although national disparities were acknowledged, awareness about local disparities are lacking.Stakeholders highlighted the importance of ancillary services, including translators, rideshares, and navigators, in the delivery of care.In addition, whereas hospital stakeholders were aware of collected equity outcomes, they were unsure whether and who is monitoring equity metrics.Furthermore, stakeholders agreed that community outreach showed promise in ensuring equitable access to prostate cancer treatment.Nevertheless, most interviewed stakeholders lacked clear implementation plans. To understand the drivers of racial disparities in prostate cancer treatment in Massachusetts, this statewide qualitative study was conducted through interviews with stakeholders at treating hospitals. Abstracted themes highlight the significance of provider awareness, the importance of overcoming transportation barriers, the accommodation of care through translators and navigators, and strategic community engagement for ensuring equitable access to care. [ABSTRACT FROM AUTHOR]

Background: This study examines patients' understanding of health insurance terms and concepts and quantifies health insurance literacy (HIL) levels by key sociodemographic factors. Methods: This study included 393 adult patients with cancer (>18 years old) receiving treatment in two ambulatory infusion centers: Mayo Clinic in Phoenix, Arizona and the University of Mississippi Medical Center in Jackson, Mississippi. Respondents' perceptions of their HIL were assessed using the Health Insurance Literacy Measure (HILM), a validated 21‐item measure of a consumer's ability to select and use health insurance (HIL self‐efficacy). Respondents' knowledge of health insurance concepts (HIL knowledge) was measured using 10 items created by the Kaiser Family Foundation. The number of correct answers was categorized into three levels: 0–4 (low knowledge), 5–6 (moderate knowledge), and 7–10 (high knowledge). Multivariable logistic regressions were used to compare correct answers to HIL knowledge questions by HIL self‐efficacy. Results: Nearly three‐quarters of patients had high HIL self‐efficacy and high HIL knowledge (70.5%), understanding basic insurance terms, such as premiums and deductibles. Relatively low percentages of patients correctly answered questions about the meaning of provider networks, health insurance formularies, and calculating out‐of‐pocket spending in scenarios when insurers pay a portion of allowed charges. Lower HIL knowledge was more common among patients with less educational attainment (

ABSTRACT Background Methods Results Conclusion Metabolic dysfunction‐associated steatotic liver disease is a significant driver of the increasing global burden of chronic liver disease. This study aimed to describe the temporal trends and inequalities of liver complications related to metabolic dysfunction‐associated steatotic liver disease (LC‐MASLD) by geographical region, age and sex during 1990–2021.Global Burden of Diseases Study 2021 data were analysed to assess LC‐MASLD incidence, prevalence, mortality and disability‐adjusted life years (DALYs). Temporal trends during 1990–2021 were measured by ‘estimated annual percentage change’ (EAPC). Inequalities of LC‐MASLD burden across countries were evaluated by the slope index of inequality (SII) and the relative concentration index (RCI).During 1990–2021, LC‐MASLD rose annually by 0.73% in incidence and prevalence, 0.19% in mortality and 0.16% in DALYs. In 2021, the Middle East and North Africa had the highest incidence and prevalence and Andean and Central Latin America had the highest mortality and DALY rates. While LC‐MASLD incidence was earliest in the 15–19 age group, both prevalence and DALY rates peaked at 75–79 years for both sexes. Inequalities in mortality and DALYs by countries' socioeconomic development index increased during 1990–2021, demonstrated by a decline in SII from −0.09 to −0.56 per 100 000 for mortality and from 1.41 to −7.74 per 100 000 for DALYs. RCI demonstrated similar findings.The LC‐MASLD burden is increasing globally, especially in economically disadvantaged countries, with widening disease inequalities during 1990–2021. Effective prevention and subregional interventions are crucial, with a specific focus on resource optimisation for disadvantaged populations. [ABSTRACT FROM AUTHOR]

Background Aim Study Design Results Conclusions Relevance to Clinical Practice The intensive care unit has structural complexities, and critically ill patients are exposed to disparities. Thus, the intensive care unit can be a potential health disparity setting.This study explored cultural knowledge associated with health disparities in the intensive care unit.This critical ethnographic study was conducted using Carspecken's approach. It was carried out in intensive care units in Western Iran from 2022 to 2023. Data collection and analysis were conducted in three interconnected stages. The initial stage involved over 300 h of field observation. In the subsequent stage, a horizon analysis was performed. Conversations with 17 informants were recorded in the final stage to enrich the dataset further. Then, the analysis process was carried out as in the previous step to uncover an implicit culture of health disparity.This research revealed the following themes: (a) extension of the impact of political, social, and cultural powers, (b) being influenced by individual diversity, (c) balancing services based on the consideration of benefits and consequences, (d) departure from professional behaviour and (e) insufficient organizational discipline.The findings of this study showed that individual diversity, political, social and cultural powers within a context of insufficient organizational discipline, and departure from professional behaviour influence the service delivery culture in the intensive care unit. Moreover, the benefits and consequences of service delivery impact its execution. These stereotypes have the potential to contribute to the emergence of health disparities. Cultural transformation is challenging because of deep‐rooted stereotypes, but the reduction of disparities is possible through awareness, critical self‐reflection and cultural competence.The findings of this research can prompt staff self‐reflection in situations prone to disparities. Health leaders can use these findings to shape health policies at both macro and micro levels. [ABSTRACT FROM AUTHOR]

Context Methods Findings Conclusions Policy Points A large population of incarcerated people may be eligible for prerelease and transition services under the new Medicaid Reentry Section 1115 Demonstration Opportunity. We estimated the largest relative population increases in Medicaid coverage from the opportunity may be expected in smaller and more rural states. We found that mental illness, hepatitis C, and chronic kidney disease prevalence rates were sufficiently high among incarcerated populations to likely skew overall Medicaid population prevalence of these diseases when prerelease and transition services are expanded, implying the need for planning of additional data exchange and service delivery infrastructure by state Medicaid plans. A large population of incarcerated people may be eligible for prerelease and transition services under the new Medicaid Reentry Section 1115 Demonstration Opportunity. We estimated the largest relative population increases in Medicaid coverage from the opportunity may be expected in smaller and more rural states. We found that mental illness, hepatitis C, and chronic kidney disease prevalence rates were sufficiently high among incarcerated populations to likely skew overall Medicaid population prevalence of these diseases when prerelease and transition services are expanded, implying the need for planning of additional data exchange and service delivery infrastructure by state Medicaid plans. As states expand prerelease and transition services for incarcerated individuals under the Medicaid Reentry Section 1115 Demonstration Opportunity, we sought to systematically inform Medicaid state and plan administrators regarding the population size and burden of disease data available on incarcerated populations in both jails and prisons in the United States.We analyzed data on eligibility criteria for new Medicaid prerelease and transition services based on incarceration length and health conditions across states. We estimated the potentially eligible populations in prisons and jails, considering various incarceration lengths and health status requirements. We also compared disease prevalence in the incarcerated population with that of the existing civilian Medicaid population.We found that rural and smaller states would experience a disproportionately large proportion of their Medicaid populations to be eligible for prerelease and transition services if new Medicaid eligibility rules were broadly applied. Self‐reported psychological distress was notably higher among incarcerated individuals compared with those currently on Medicaid. The prevalence rates of previously diagnosed chronic hepatitis C and kidney disease were also much higher in the incarcerated population than the existing civilian Medicaid population.We estimated large volumes of potentially Medicaid‐eligible entrants as coverage policy changes take effect over the coming years, particularly impacting smaller and more rural states. Our findings reveal very high disease prevalence rates among the incarcerated population subject to new Medicaid coverage, including specific chronic, infectious, and behavioral health conditions that state Medicaid programs, health plans, and providers may benefit from advanced planning to address. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Methods Results Conclusion Trial Registration This qualitative study aimed to explore the experience and perception of the mouth, oral health, functioning and the social environment amongst adults with disabilities and complex health conditions.Purposive sampling using the maximum variation strategy was performed to select participants with a wide range of experiences in terms of demographics, disability and health conditions. Consent was sought, and semi‐structured interviews were conducted, recorded and transcribed verbatim. Within the interpretivist tradition, a phenomenological approach was used to describe the lived, contextualised experience of people in relation to their mouths, as described by participants. Thematic analysis was undertaken.Eighteen participants with disabilities and complex health conditions were interviewed. Twelve individuals had an intellectual disability. Three main themes were identified: perception of the mouth and oral health; symptomatic perceptions and responses to oral health problems; and inter‐relationships between the mouth, oral health and the socio‐medical environment. The mouth had a central place in the lives of the participants, but its importance was only recognised when oral health problems interfered with daily life, function, social relationships, family life or autonomy. Certain social determinants of health were identified: social exclusion, financial insecurity, lack of autonomy, nutrition and negotiation of services. Oral problems were perceived as an additional burden to those with disabilities or complex health conditions.This study provided insight into the daily lives of adults with disabilities and complex health conditions. It helps to fill the gaps in the existing literature regarding the perceptions of the mouth and oral health, connecting oral function, general health and social environment for this population.This study was registered into ClinicalTrials.gov (NCT04815434) [ABSTRACT FROM AUTHOR]

Objective Study Setting and Design Data Sources and Analytic Sample Principal Findings Conclusion To understand why American Indian and Alaskan Native (AIAN) populations have had exceptionally high COVID‐19 mortality, we compare patterns of healthcare utilization and outcomes for two serious infectious respiratory diseases—Influenza‐like‐illness (ILI) and coronavirus disease 2019 (COVID‐19)—between American Indian and Alaskan Native (AIAN) populations (as identified in Medicaid data) and non‐Hispanic Whites over the 2009–2021 period.We select all people under the age of 65 years identified as non‐Hispanic White or AIAN in the New York State Medicaid claims data between 2009 and 2021. We analyze data across 10 ILI cohorts (between September 2009 and August 2020) and 4 COVID‐19 cohorts (March–June 2020, July–September 2020, October–December 2020, and January–June 2021). We examine mortality and utilization rates using logistic regressions, adjusting for demographic characteristics, prior chronic conditions, and geographic location (including residence near a reservation). We stratify the analysis by rural vs. nonrural counties.We use the New York State Medicaid claims data for the analysis.We find that even among Medicaid beneficiaries, who are similar in socioeconomic status and identical in health insurance coverage, AIAN populations have much lower rates of use of outpatient services and much higher rates of acute (inpatient and emergency room) service utilization for both ILI and COVID‐19 than non‐Hispanic Whites. Prior to COVID‐19, demographic and health status‐adjusted all‐cause mortality rates, including from ILI, were lower among American Indians than among non‐Hispanic Whites on New York State Medicaid, but this pattern reversed during the COVID‐19 pandemic. Both findings are driven by nonrural counties. We did not observe significant differences in all‐cause mortality and acute service utilization comparing AIAN to non‐Hispanic Whites in rural areas.The utilization and mortality disparities we identify within the Medicaid population highlight the need to move beyond insurance in addressing poor health outcomes in the American Indian population. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion Lov'U'r Teeth is a French oral health prevention programme targeting children. The programme offers an appointment with a dentist for oral examination and individual oral health advice. It covers any necessary primary dental care resulting from that examination. Despite being free, it was under‐utilised at its previous evaluation 10 years ago. The study aims to identify the determinants of participation and their evolution since 2009.We worked on the General Beneficiary Sample, a medico‐administrative database representative of the French population, including health‐care consumption data. We selected individuals aged 6 to 15. We performed descriptive statistics and multivariate logistic regressions to analyse and compare the determinants of participation between 2009 and 2019. The final sample included 26 288 children.Lov'U'r Teeth participation rate increased by 4.2 percentage points from 2009 to 2019. Participation was highest at age 6 and declined as age increased. Children from households facing financial difficulties have a 72% lower probability of participating than other children. Over the study period, increasing poverty rates were consistently associated with lower participation. Children living in the areas with the highest poverty rates were up to 46% less likely to participate than those in areas with the lowest poverty rates.Participation in Lov'U'r Teeth has improved over the past 10 years, but the programme continues to reproduce social inequalities, as the determinants of using free preventive dental care mirror those of non‐preventive care. Lov'U'r Teeth should enhance communication strategies to reach those in need and clarify the programme's benefits. [ABSTRACT FROM AUTHOR]

Increasing socioeconomic challenges and their impacts on mental health support the importance of assessing clients' social determinants of mental health (SDMH) challenges. We examined counseling clients' (N = 390) experiences with SDMH assessment in counseling using the Client Perceptions of SDMH Assessment Scale (CP‐SDMH). Confirmatory factor analysis confirmed a three‐factor structure for the CP‐SDMH. Results suggest potential biases in SDMH assessment practices. Clients reported that SDMH assessment most often occurred verbally and in relation to health and economic issues. Disparities emerged, indicating higher assessment frequency for Black/African American clients compared to White clients, and lower SDMH assessment rates for clients in specific settings, such as private practices. Furthermore, results indicate a significant positive correlation between assessment of SDMH challenges and client satisfaction. Implications for counseling and future research are discussed. [ABSTRACT FROM AUTHOR]

Background: Emergency departments serve as the front line for individuals facing acute health needs, often compounded by social determinants of health (SDoH). Integrating SDoH into emergency medicine care is vital for promptly addressing health concerns and averting future crises. This curriculum adopts a team‐based approach to train emergency medicine residents in identifying and addressing SDoH, thereby delivering comprehensive and equitable care. Methods: The curriculum employs various educational strategies, including presession readings, SDoH introductions, case simulations, debriefing sessions, panel discussions, and collaboration with other health care professionals. Evaluation via pre‐ and postcurriculum surveys revealed substantial enhancements in residents' comprehension, identification, and familiarity with local resources related to SDoH. Results: Findings indicated an uptick in residents' grasp and acknowledgment of SDoH, alongside their capacity to address these factors. Posttraining Likert scores exhibited notable improvements across all domains, underscoring an augmented ability to manage SDoH in clinical practice. This curriculum amplifies residents' capability to deliver patient‐centric care and advocate for health equity. Conclusions: Continuous refinement and assessment are paramount for ensuring residents' readiness to navigate the intricate social determinants affecting patients' well‐being. Ultimately, this curriculum heralds a pivotal stride toward fostering health equity and refining patient care standards within emergency medicine. [ABSTRACT FROM AUTHOR]

Social theory plays an important role in the nursing discipline and nursing inquiry as it helps conceptually embed nursing in the larger picture of the social world. For example, a broad category of critical theory provides a unique lens for uncovering social conditions of inequity and oppression. Among the sociological theories, actor‐network theory (ANT) is an approach to research and analysis that has recently gained interest among nurse philosophers and researchers. Studies guided by ANT seek to understand phenomena of interest as constituted within the relationships between human and nonhuman actors to understand how care practices are co‐created/enacted and how they can be made more humane. In this paper, we describe the benefits of ANT for examining healthcare access for incarcerated individuals with life‐limiting illnesses accessing palliative care and for people using illicit drugs. We argue that attention to the materiality of care practices can contribute to efforts of advancing health equity for these groups. [ABSTRACT FROM AUTHOR]