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Background: As part of efforts to reach the elimination target by 2030, the WHO and CDC recommend that all HCWs adhere to the three‐dose Hepatitis B vaccination schedule to protect themselves against the infection. This study assessed Hepatitis B vaccination coverage and associated factors among personnel working in health facilities in Kumasi, Ashanti Region, Ghana. Materials and Methods: A cross‐sectional study involving 530 HCWs was conducted in four hospitals in Kumasi from September to November 2023. An investigator‐administered questionnaire was employed in gathering participant demographics and other information related to vaccination coverage. IBM SPSS Version 26.0 and GraphPad Prism 8.0 were used for analysing the data. Results: Even though the majority (70.6%) reported having taken at least one dose of the vaccine, only 43.6% were fully vaccinated (≥ 3 doses). More than a quarter (29.4%) had not taken any dose of the HBV vaccine. Close to a quarter (23.6%) had not screened or tested for HBV infection in their lifetime. The statistically significant variables influencing vaccination status were age, marital status, profession, and status in the hospital. Nearly one‐half (44.9%) of the participants who have not taken the vaccine reported they do not have a reason for not taking it, and a high proportion (80.1%) were willing to take the vaccine when given for free. Conclusion: To combat the low Hepatitis B vaccination coverage among healthcare workers in Kumasi, Ghana, amidst the significant public health threat of HBV infection, comprehensive measures are necessary. These include implementing infection prevention control programmes, enhancing occupational health and safety, and conducting health promotion campaigns in healthcare facilities. Extending and intensifying Hepatitis B screening and vaccination initiatives to tertiary institutions and encouraging employers, supervisors, or team leaders to provide these services nationwide are also recommended. [ABSTRACT FROM AUTHOR]

Background: Self‐management (SM) is the gold standard of care and is the direct active participation of patients in their disease management. Condition‐specific factors, physical and social environment, individual and family, and the process of SM are factors that influence SM in people living with human immunodeficiency virus (PLHIV). Poor SM leads to high retroviral infection transmission, mortality, and morbidity. Objective: This study was aimed at assessing SM and its associated factors among PLHIV at the University of Gondar Comprehensive Specialized Hospital (UOGCSH), Northwest Ethiopia. Methods: A cross‐sectional study was conducted using a systematic random sampling technique at the UOGCSH from May 20 to July 30, 2022. The data were collected using a previously validated tool and were entered and analyzed using Statistical Package for Social Sciences Version 25. A binary logistic regression analysis was used to identify factors associated with poor SM. The statistical significance was considered at a p value < 0.05. Result: Of 419 PLHIV, the median (IQR) SM score was 39 (9), and above half (52.6%, 95% CI: 48%–57%) of them had poor SM. Being unemployed (AOR = 2.49, 95%CI = 1.19, 5.19), living alone (AOR = 2.16, 95%CI = 1.12, 4.17), unfamiliar with the management of HIV‐related symptoms (AOR = 3.59, 95%CI = 2.08, 6.20), poor social support (AOR = 3.02, 95%CI = 1.54, 5.93), poor self‐efficacy (AOR = 3.04, 95%CI = 1.83, 5.06), and unsupported by the adherence support group (AOR = 17.17, 95%CI = 8.37, 35.22) were significantly associated with poor SM. Conclusion: The majority of PLHIV had poor SM. This study supports the findings of individual family SM theory and previously published studies regarding factors affecting SM. The government, hospital, adherence support groups, and PLHIV should work on modifiable sociodemographic, condition‐specific, and process of SM to improve SM of PLHIV. [ABSTRACT FROM AUTHOR]

Purpose: To describe program characteristics and outcomes of a residential substance use recovery program serving pregnant and parenting women in a rural and urban location. Description: This assessment of administrative records from April 1, 2020 through March 31, 2022, included women in a rural (n = 140) and urban (n = 321) county in Kentucky. Assessment: This retrospective case study used descriptive and non-parametric analyses to assess the population and examine differences between locations, race, and ethnicity for women served. Logistic regression tested predictors of goal achievement by community. Of 461 women served, 65 (14.1%) delivered a baby while in treatment; 62 of which were considered healthy. 13% of the women were Black, 83.1% non-Hispanic (NH) white, and 3.7% were other races/biracial; 1.3% were Hispanic. The mean age was 30.92 years (SD 6.23) and treatment duration was 90.11 days (SD 67.70). Program goals were achieved by 312 (67.7%). There were no differences in rates of goal achievement or treatment duration by race, ethnicity, or age and no difference in the rate of achievement by location in univariate analyses. However, treatment duration was positively associated with program success in both communities. In the urban community, Black women were 8% more likely to successfully complete the program compared to NH white women (OR = 9.77 [95% CI 1.21,79.18; p = 0.033]) after controlling for confounders. Insufficient sample size for non-white women in the rural community prohibited evaluation. Conclusions: Duration of time in the program best predicted successful completion for women in recovery. These findings have policy implications. Significance: Women having difficulties with substance use are typically of childbearing age. Integrated programs are needed to address the multi-factorial needs of these women. Models suggest that optimal care involves services that are co-located or closely aligned. The current evaluation contributes to the literature by examining outcomes for women in recovery. This case study examines client outcomes at a community-based residential treatment program and found evidence that the length of stay was associated with achievement of program goals. Lastly, contrary to previous reports, Black women in an urban community had an 8% greater probability of successful completion compared to white women. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to explore the impact of the COVID-19 pandemic and associated stay-at-home orders on the breastfeeding experiences of U.S. people a identify facilitators and barriers to breastfeeding during this period, and to assess the effects of maternal stress and misinformation on breastfeeding practices. Methods: U.S. women with infants were selected through purposive and convenience sampling. An online survey, distributed during summer 2020, measured changes in infant feeding practices, maternal stress levels, use of lactation support resources, and the influence of misinformation on feeding decisions. Quantitative data were analyzed using descriptive statistics, and qualitative responses underwent thematic analysis. Results: Our sample (n = 1,861) revealed that 34% of U.S. women realized the pandemic affected their feeding practices, 544 women provided qualitative data. Major themes from qualitative analysis included ease of breastfeeding at home, bonding, increased breastfeeding duration, and challenges like limited access to lactation support. Logistic regressions highlighted demographic influences on breastfeeding practices, with no significant effects found related to the child's age or women's income on changes in feeding practices. Conclusions for Practice: The COVID-19 pandemic substantially impacted breastfeeding experiences of U.S. women, yielding insights for future policy and healthcare practices. The findings underscore the potential benefits of telehealth lactation support services and flexible remote work environments for breastfeeding people. Clear and scientifically-grounded communication regarding breastfeeding, mental health support, and policy development, are essential to promote equitable and flexible work and maternity leave options for breastfeeding people especially during global health crises. Significance: This study provides new insights into how the COVID-19 pandemic's stay-at-home orders uniquely impacted breastfeeding practices among a large and diverse sample of U.S. women across various regions, income levels, and racial/ethnic backgrounds. By capturing a wide range of experiences, we address a critical gap in understanding the effects of sudden societal changes on breastfeeding across different demographics. Our findings highlight both facilitators—such as increased time at home leading to easier breastfeeding, stronger mother-infant bonding, and extended breastfeeding duration—and barriers—including limited access to lactation support and heightened maternal stress. The diversity of our sample enhances the applicability of our results to inform maternal and child health policies and practices. We underscore the potential benefits of telehealth lactation services and flexible remote work policies in enhancing breastfeeding outcomes and reducing health inequities, emphasizing the need for supportive measures that promote breastfeeding, especially during global health crises. [ABSTRACT FROM AUTHOR]

Chronic diseases have become one of the most important factors threatening human health. Subjective life expectancy (SLE) describes an individual's expectation or subjective perception of lifespan. This article aims to explore the relationship between chronic diseases and SLE, as well as the differences among different age groups and different types of chronic diseases in this relationship. China Health and Retirement Longitudinal Study (CHARLS) is a nationwide longitudinal study that evaluates the social, economic, and health conditions of middle‐aged and older adult families and individuals aged 45 and above in China. In this study, CHARLS used probability proportional to size sampling (PPS sampling) to ensure the breadth and representativeness of the sample. This study selected cross‐sectional data from CHARLS 2018, removed missing values, and obtained a valid sample of 10,658 middle‐aged and older individuals, of whom 8564 had chronic diseases. After controlling demographic, health behavior, socioeconomic, psychological, and social security factors, an ordered logistic regression was performed to explore the relationship between chronic disease and SLE in middle‐aged and older adults. The results show that chronic diseases negatively correlate with SLE in middle‐aged and older adults. Middle‐aged and older adults with chronic diseases are 36.2% less likely to have high life expectancy than those without chronic diseases. Many different types of chronic diseases are negatively correlated with SLE. Cancer is most negatively correlated with SLE, far exceeding other chronic diseases. Chronic disease and SLE of middle‐aged and older adults have age‐heterogeneous differences. For middle‐aged people aged 45–59 and young older adults aged 60–79, there is a significant correlation between chronic diseases and SLE. However, there is no correlation between chronic diseases and subjective life expectancy in the older population aged 80 and above. The government and society should pay close attention to the prevention and treatment of chronic diseases among middle‐aged and older adults and adjust policies and measures according to the population's age structure. In addition, the government and society should pay attention to the spiritual needs of middle‐aged and older adults. The government and society should pay more attention to cancer patients. Finally, the scientific research team should also strengthen research on chronic diseases, research and development of specific drugs and vaccines, improve the cure rate of chronic diseases, promote people's health, and make people no longer afraid of diseases. [ABSTRACT FROM AUTHOR]

To analyze the distribution and factors associated with lack of knowledge about the human papillomavirus (HPV) vaccine among Brazilian adolescents.Cross‐sectional study using the 2019 National School Health Survey among 17,805 Brazilian students of public and private schools, aged 13–17 years. The outcome variable was "lack of knowledge about the HPV vaccine" and the explanatory variables were sociodemographic, behaviors, knowledge, and health conditions. Logistic regression model was used to calculate Odds Ratio (OR) and 95% confidence intervals (95%CI). Spatial analysis techniques were used to determine the formation of clusters in the federated units with similar proportions of adolescents who were unaware of the vaccine. The lack of knowledge about the HPV vaccine was reported by 45.54% of Brazilian students. There was a higher chance of lack of knowledge having had sexual intercourse (OR 1.43; 95% CI 1.20–1.70); attending public school (OR 1.72; 95%CI 1.47–2.02) and located in the Northeast Region (OR 1.35; 95%CI 1.08–1.69). The lower chance of lack of knowledge were female gender (OR 0.41; 95% CI 0.35–0.48), higher maternal education (OR 0.62; 95% CI 0.50–0.77) self‐rated health as Poor/very poor (OR 0.64; 95% CI 0.49–0.86) and receiving contraceptive counseling (OR 0.77; 95% CI 0.65–0.91). The proportion of lack of knowledge about the HPV vaccine was higher with the formation of High–High spatial clusters in the states of Maranhão, Piauí, and Pernambuco. Sociodemographic, health, and behavioral conditions and knowledge of students, as well as school characteristics, were associated with lack of knowledge about the HPV vaccine. A higher frequency of lack of knowledge about the HPV vaccine among adolescents was found in the states of the Northeastern Region. [ABSTRACT FROM AUTHOR]

Objectives: Evidence has emerged on the health dangers of electronic cigarette (e-cigarette) use among pregnant women and neonates. We examined whether rural residence is a risk factor for smoking and e-cigarette use among women during the peripartum period in the United States. Methods: This study was based on pooled cross-sectional 2015-2020 data from the Pregnancy Risk Assessment Monitoring System. The outcome was exclusive smoking, exclusive e-cigarette use, and use of both products (ie, dual use) versus use of neither tobacco product by women with live infants aged 2 to 6 months. We examined rural–urban differences in outcome by using univariate and multivariable multinomial logistic regressions with post hoc contrasts and marginal analyses, adjusting for complex survey design and nonresponse. Results: During the peripartum period, 5.0% of women were smoking combustible cigarettes, 5.0% were using e-cigarettes, and 1.9% were using both tobacco products. The crude prevalence of e-cigarette use was 1.1 percentage point higher, and the adjusted prevalence was 0.8 percentage points lower for rural versus urban women (P <.001 for both). Among rural women, 6.7% (95% CI, 6.3%-7.1%) smoked combustible cigarettes exclusively and 2.6% (95% CI, 2.3%-2.8%) used both products, as compared with 4.5% (95% CI, 4.4%-4.8%) and 1.7% (95% CI, 1.6%-1.8%) of urban women, respectively, adjusting for sociodemographic and health-related characteristics. Conclusions: Maternal sociodemographic and health-related characteristics differed by combustible smoking versus e-cigarette use during the peripartum period. The effect of residence on e-cigarette use was significantly confounded by sociodemographic and health-related characteristics, resulting in clinically comparable prevalence of e-cigarette use in rural and urban mothers with live infants aged 2 to 6 months. [ABSTRACT FROM AUTHOR]

Objective Non-Hispanic Black people (NHBP) have a three-fold higher rate of maternal mortality compared to other racial groups. Racial disparities in maternal morbidity are well-described; however, there are substantial differences in cultural, economic, and social determinants of health among racial groups. We thus sought to study the at-risk, non-Hispanic Black population as its own cohort to identify factors most associated with severe maternal morbidity (SMM). Study Design This is a population-based retrospective case–control study of all live births in the United States between 2017 and 2019 using birth records obtained from the National Center for Health Statistics. The primary outcome for this study was to determine demographic, social, medical, and obstetric factors associated with maternal morbidity among NHBP who did and did not experience an SMM event. Multivariable logistic regression was used to estimate the adjusted odds ratio between each individual factor and the outcome of SMM among NHBP. Results Of the 1,624,744 NHBP who delivered between 2017 and 2019, 1.1% experienced an SMM event defined as a composite of blood product transfusion, eclamptic seizure, intensive care unit admission, unplanned hysterectomy, and uterine rupture. The rates of these individual SMM events per 10,000 deliveries were 50, 40, 20, 5, and 4 among NHBP, respectively. Among NHBP, factors associated in multivariable regression analysis with SMM in order of strength of association included cesarean delivery, earlier gestational age at delivery, preeclampsia, induction of labor, chronic hypertension, prior preterm birth, lower educational attainment, multifetal gestation, advanced maternal age, pregestational diabetes, and cigarette smoking. The population attributable fraction for cesarean delivery, preterm birth, and pregnancy-induced hypertensive disease for the outcome of SMM were 0.46, 0.23, and 0.07, respectively. Conclusion The three factors most associated with SMM among NHBP are potentially avoidable or modifiable by aggressive screening, prevention, and treatment of preeclampsia and preterm birth as well as reducing cesarean rates in this population. Key Points The rate of SMM in NHBP may be modifiable. NHBP have a three-fold higher rate of maternal mortality. Preeclampsia, preterm birth, and cesarean sections are most associated with maternal morbidity. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to identify the prevalence and types of harm to children from others' drinking in Australia, as indicated by caregivers, and examine socio‐demographic characteristics of caregivers who indicated a child was affected by others' drinking. Design, setting, participants and measurements: A subsample of 854 adult respondents, who were caregivers of children under 18 years from the 2021 Australian Alcohol's Harm to Others study, were asked questions about whether children in their care had been negatively affected by others' drinking in the past year. Weighted prevalence estimates of overall and specific harms to children are presented. Logistic regressions were conducted to determine characteristics associated with indicating harms to children from others' drinking. Findings: Over 17% of caregivers (95% confidence interval [CI] = 13.0–19.0) indicated that one or more children in their care had been affected by others' drinking in the past 12 months. Verbal abuse (6.2%; 95% CI = 4.3–8.3) was the most common harm indicated, followed by financial harm (4.3%; 95% CI = 2.7–6.2). One percent of caregivers (95% CI = 0.4–2.3) indicated a child was physically hurt and less than 1% (95% CI = 0.2–1.4) indicated a child was the subject of a child protection call due to someone's drinking. Women and caregivers over 65 years were more likely to indicate a child had been affected compared with men and caregivers under 65 years. Caregivers who drank five or more drinks at least three times per week were four times more likely to indicate a child was affected compared with abstainers. Living in a household with someone who drinks heavily and who had negatively affected the child's caregiver was associated with an increased likelihood of child harm. Conclusions: In 2021, a weighted survey estimate for caregivers in Australia indicated that almost one in six children had been affected by others' drinking. Heavier drinking of caregivers and other household members was the most substantial predictor for indicating a child had been negatively affected by others' drinking. [ABSTRACT FROM AUTHOR]

What is the prevalence and impact of economic abuse by an intimate partner in the population? Does experience of economic abuse compound the effects of other intimate partner violence (IPV) types on women's mental health and financial wellbeing? This study used a population-based and representative sample of 1,431 ever-partnered New Zealand women to explore associations between their experience of economic abuse and a range of mental health and financial outcomes. Logistic regression was conducted, and Adjusted Odds Ratios (AORs) were reported. Overall, 15% of ever-partnered women experienced any economic abuse, with the most prevalent act "refused to give money for household expenses," reported by 8.8% of the sample. Women who experienced economic abuse presented increased risk for poor mental health (AORs ranging from 2.59 for poor mental health to 4.89 for having a diagnosed health mental health condition) and financial insecurity outcomes (AORs ranging from 3.09 for receiving government benefits to 4.72 for experiencing food insecurity) compared with women who experienced no IPV or women who had experienced any IPV (physical, sexual, psychological or controlling behavior) excluding economic abuse. Findings suggest that economic abuse may compound effects of IPV and highlight the importance of acknowledging and addressing economically abusive behaviors and their long-term detrimental impact on women's mental health and financial security. Implementing wider forms of safety planning that address issues of economic independence and security, and social support are needed to augment plans that focus on physical safety. [ABSTRACT FROM AUTHOR]

Pakistan has a significant occurrence of both consanguineous marriages and intimate partner violence (IPV), which may be interlinked. The practice of consanguineous marriages could potentially influence women to rationalize and accept instances of IPV. Such attitudes perpetuate a culture of violence against women, creating difficulties for victims to reject or escape from it. Pakistan has high prevalence rate of consanguineous marriages and IPV. However, no research has been done to explain the difference in acceptance of IPV between women in consanguineous and non-consanguineous marriages. This study used Pakistan Demographic and Health Survey data and applied association tests, logistic regression, and the Fairlie decomposition analysis. The Fairlie decomposition helps us identify the relative contribution of different socioeconomic factors in the inequalities in IPV between the two types of marriages. Five dimensions of wife-beating justification are used as outcome variables. Age, education, and empowerment of women, husband education, woman witness parental violence, region, place of residence, and household wealth status are used as independent variables. The logistic regression results indicated that women in consanguineous marriages of younger age and who witnessed parental violence are more likely to justify wife-beating than those who belong to wealthy households and enjoy more empowerment. Compared to the Punjab province, women residing in Sindh and Baluchistan are less likely and in the Khyber Pakhtunkhwa province are more likely to justify wife-beating. The Fairlie decomposition analysis shows that household wealth status, woman education, and empowerment are the main contributors in explaining the gap between the wife-beating justification of the two groups. The IPV gap can be reduced up to 77% if the distribution of women in different wealth quantiles of the consanguineous marriage group is identical to the non-consanguineous marriage group. Furthermore, woman education level is the second highest contributor. Consanguineous marriages are a prevalent cultural practice in Pakistan and are associated with several negative health and social outcomes. Addressing this issue requires a sustained and comprehensive effort by the government, civil society, and international partners, with a particular focus on women from poor households with less education. [ABSTRACT FROM AUTHOR]

Background: Social constructs like race can affect how patients are perceived and impact care. This study investigated whether mentions of race in notes for critically ill patients differed according to patients' race. Methods: This retrospective cohort study included intensive care unit notes for adults (≥18 years old) admitted to any of 6 intensive care units at University of California, San Francisco, from 2012 through 2020. Notes were linked to National Provider Identifier records to obtain note writer characteristics. Logistic regression analysis with robust SEs clustered on note writers was adjusted for patient-, note- and clinician-level characteristics. Any race or ethnicity mention was the outcome of interest. Results: Among 5573 patients with 292 457 notes by 9742 unique note writers, 3225 patients (57.9%) self-reported their race as White, 997 (17.9%) as Asian, 860 (15.4%) as Latinx, and 491 (8.8%) as Black. Note writers documented race/ethnicity for 20.8% of Black, 10.9% of Latinx, 9.1% of White, and 4.4% of Asian patients. Black patients were more likely than White patients to have race mentioned in notes (adjusted odds ratio, 2.05 [95% CI, 1.49-2.82]). Conclusions: Black patients were more than twice as likely as White patients to have race mentioned in notes. Note language containing information on social constructs has consequences for clinicians and patients reading notes and for algorithms trained on clinical notes. [ABSTRACT FROM AUTHOR]

BACKGROUND: In response to the COVID-19 pandemic, educational institutions had to swiftly adapt and transition to remote teaching in order to maintain academic activities. However, these changes presented a number of challenges for professors, which could have negative effects on their health. OBJECTIVE: To analyze the association between changes in dietary and sleep habits, physical activity level, and sedentary behavior with the development of non-communicable diseases (NCDs) among Brazilian higher education professors during the pandemic period. METHODS: This is a cross-sectional and retrospective study conducted using an online form. Generalized linear models, adjusted for age, sex, and body mass index, were used to verify the difference between pre-pandemic and pandemic periods. Logistic regression models were used to predict the odds ratio (OR) for the development of NCDs according to physical activity time, sedentary behavior time, dietary and sleep patterns. RESULTS: A total of 936 professors residing across Brazil participated in the survey. The duration of sedentary behavior increased, sleep duration slightly decreased, and meal times shifted to earlier during the pandemic. A total of 22.9%of the participants reported the diagnosis of some NCDs during this period. Physical activity practice was associated with a lower risk of diseases during the pandemic, regardless of the intensity performed. On the other hand, late eating habits and excessive food consumption during the pandemic were associated with a higher risk. CONCLUSION: The results provide data that can help in the development of public policies that promote health actions to minimize the consequences associated with the pandemic period. [ABSTRACT FROM AUTHOR]

BACKGROUND: When faced with a health crisis, most people tend to seek solutions through modern or traditional medicine. However, there is a group of people who tend to take a fatalistic approach to health crises and tend not to do what is necessary. When such approaches are exhibited in disadvantaged groups, there may be a chain reaction resulting in much more important problems. OBJECTIVE: The aim of this study is to determine whether the fatalistic approach is realized during a health crisis period in people 65 years and older, pregnant women, people with chronic diseases, and healthcare workers who are considered disadvantaged. Researchers also examined whether there were sociodemographic characteristics that made a difference in these attitudes among those who were determined to have a fatalistic approach. METHODS: The research was conducted with a quantitative method. The sample calculation was performed and it was decided to reach 196 people. A self-report scale was used for fatalism. RESULTS: It was determined that the participants had a moderate level of fatalism. It was seen that there was a difference between the groups in terms of fatalistic behavior. It was observed that women, divorced people, people without alcohol and smoking habits, people who live alone, and people who think their health is poor tend to behave more fatalistic. CONCLUSION: The tendency to show fatalistic behavior was found to be higher in the group of 65 years and older. Sociodemographic characteristics are associated with fatalistic behavior. [ABSTRACT FROM AUTHOR]

Experiencing adverse childhood experiences (ACEs) may impact personal opinions, attitudes, and judgments, which can further result in HIV-related stigma. HIV-related stigma consequentially may impact HIV preventive measures such as HIV testing, pre-exposure prophylaxis uptake, and condom use. The extent to which ACEs influence HIV-related stigma perception has not been well studied. Therefore, the study aimed to examine the association between ACEs and perceived and interpersonal HIV-related stigma among Tanzanian HIV-negative men. Quantitative survey data were obtained from the Tanzania STEP (Self-Testing Education and Promotion) project established in four wards: Mabibo, Manzese, Tandale, and Mwanyanamala. A total of 507 men responded to the ACEs and HIV-related stigma questionnaires. ACEs were operationalized as types of ACEs (environmental, physical/psychological, sexual abuse) and ACE score (0 (reference) vs. 1, 2, 3, ≥ 4). Perceived HIV-related stigma was analyzed both as a binary (HIV stigma vs. no HIV stigma) and a continuous variable. Unadjusted and adjusted multinomial logistic and linear regression models were used to assess the associations between ACEs and HIV-related stigma. ACE types were associated with HIV stigma (b = 0.237, 95% CI [0.122–0.352], p = <.0001). Findings of the adjusted multinomial logistic regression model show that experiencing one ACE (aOR = 1.9; p-value = 0.023), two ACEs (aOR = 1.8; p-value = 0.044), four or more ACEs (aOR = 4.1; p-value = < 0.0001) were associated with greater perceived HIV-related stigma. Moreover, experiencing environmental (aOR = 8.6; p-value = 0.005), physical/psychological (aOR = 2.5; p-value = 0.004), and sexual abuse (aOR = 3.4; p-value = < 0.0001) were associated with higher odds of HIV-related stigma. Our study findings suggest that those who experience childhood trauma are more likely to have a higher perception of HIV-related stigma. Intervention programs targeting HIV stigma should consider addressing ACEs entailing the behavioral and psychological impact of childhood trauma. [ABSTRACT FROM AUTHOR]

Women engaged in sex work (WESW) who use drugs are a key population in Kazakhstan's HIV epidemic. Global research suggests susceptibility to HIV varies by sex work environment. This study aims to identify evidence-based typologies of WESW and examine their associations with HIV risk. We surveyed 400 WESW who use drugs in two Kazakhstani cities, including questions on sociodemographic characteristics, social, physical, and economic risk environments, and sexual risk behaviors. Latent class analysis identified four distinct typologies of sex work practice: occasional sex work (n = 61, 15%), professional sex work for money (n = 187, 47%), sex work in exchange for drugs, goods, or other services (n = 117, 29%), and managed sex work under a boss/pimp/madam (n = 35, 9%). We then used logistic regression to examine associations between typologies and risk behaviors. Compared to professional sex work, occasional sex work was associated with lower odds of multiple sexual partners (aOR:0.46[95%CI:0.24,0.90]), of multiple paid clients (aOR:0.25[0.13,0.49]), and of > 1 instance of unprotected sex with a paying partner (aOR:0.33[0.17,0.63]). Compared to professional sex work, sex work for nonmonetary items was associated with higher odds of multiple sexual partners (aOR:1.85[0.96,3.67]) and of > 1 instance of unprotected sex with a paying partner (aOR:1.71[1.01,2.93]). Results suggest heterogeneity among WESW who use drugs in Kazakhstan, and that typologies of sex work are associated with varying HIV risk environment factors and risk behaviors. Effective HIV prevention efforts must be tailored to address these varying risk environments and the resulting variety of needs. [ABSTRACT FROM AUTHOR]

Objectives: The psychological effects of the COVID-19 pandemic have been shown to include anxiety. However, the association between demographic and physiological factors in COVID-19-associated anxiety symptoms is poorly understood. Therefore, the present cross-sectional study was conducted to examine anxiety symptoms and associated factors among patients with the SARS-CoV-2 Omicron variant during the quarantine period in Shanghai. Methods: The study was conducted between April 16, 2022, and May 21, 2022, at Fangcang Shelter Hospital in Shanghai, China. Data were collected using an anonymous online questionnaire. Demographic characteristics, respiratory symptoms, vaccine dose, comorbidities (such as hypertension and diabetes), type of work, and mental health symptoms were evaluated. Logistic regression was used to examine the relationship between anxiety symptoms and risk factors. Stratified analyses were performed to investigate potential interactions. Results: A total of 2132 patients with confirmed Omicron variant SARS-CoV-2 infection were enrolled. The results demonstrated that female gender (OR = 1.47, 95% CI = 1.11-1.94), nonmanual labor (OR = 1.62, 95% CI = 1.25-2.09), respiratory symptoms (OR = 3.19, 95% CI = 2.30-4.43), and having other comorbidities (OR = 1.65, 95% = 1.09-2.50) were positively associated with anxiety symptoms. A significant interaction was found between gender and (a) nonmanual labor (OR = 1.54, 95% = 1.29-1.85), (b) respiratory symptoms (OR = 2.06, 95% = 1.72- 2.48), and (c) comorbidities (OR = 1.57, 95% = 1.16-2.12), such that the relationship with anxiety symptoms was stronger in women compared to men. There were also significant interactions between age group and (a) nonmanual labor (stronger in those ages >46) and (b) respiratory symptoms (stronger in those ages 36-45) regarding the association with anxiety symptoms. Conclusions: Alleviation of respiratory symptoms, addressing comorbidities, and implementation of both psychological and psychopharmacological treatments may help reduce anxiety symptoms following infection with the SARS-CoV-2 Omicron variant in mainland China. [ABSTRACT FROM AUTHOR]

Background: Immunization plays a significant role in global health, yet many children in Nigeria do not receive full immunization due to several influencing factors. Therefore, this study examined the trends in Nigeria's full immunization coverage and identified key predictors that influence full coverage. Methods: The data for children aged one to five years, across the six geopolitical zones of Nigeria was retrieved from the 2007, 2011, 2016/17, and 2021 national Multiple Indicator Cluster surveys We analyzed the data using univariate logistic regression. Results were presented as adjusted odds ratios (aORs), and statistical significance was set at 0.05. Results: The results showed that 12,229 children (74.2%) had been fully immunized. The trend of immunization coverage was 63.6%, 82%, 63.7%, and 76.4% in 2007, 2011, 2016/17, and 2021 respectively. Children of educated mothers (aOR: 2.6; 95% CI 1.45, 4.76) and from the richest families (aOR: 2.1; 95% CI 1.41, 3.11), were more likely to be fully immunized. Conversely, children in rural areas (aOR: 0.6; 95% CI 0.42, 0.81) and from families of more than five (aOR: 0.6; 95% CI 0.46, 0.81) were less likely to be fully immunized. Conclusion: As of 2021, the rate of full immunization coverage in Nigeria was 76.4%, an improvement from the low 2003 rate (12.3%). Maternal education and wealth index are significant sociodemographic determinants for full immunization coverage. Adopting policies that improve access to education for females nationally and access to healthcare, especially in rural areas may significantly increase full immunization coverage. [ABSTRACT FROM AUTHOR]

Objective: This study investigates the associations and mediating pathways between grip strength, cognitive function, and depression in middle-aged and elderly individuals in China. Methods: Utilizing data from the 2011 China Health and Retirement Longitudinal Study (CHARLS), we employed logistic regression and mediation analysis to examine the relationships and mediating factors between grip strength, cognitive function, and depression, while adjusting for potential confounders. Results: The study included 6,841 participants, of whom 1,734 (25.35%) exhibited symptoms of depression. Our findings indicate that weak grip strength is significantly associated with an increased risk of depression (OR: 1.57, 95% CI: 1.32-1.87) among the middle-aged and elderly population. Conversely, good cognitive function was found to be protective against depression (OR: 0.94, 95% CI: 0.93-0.95). Grip strength indirectly affected depression through cognitive function, accounting for 9.4% of the total effect (β = -0.008, 95% CI [-0.013, -0.004]). This mediating effect was 23.8% in men (β = -0.013, 95% CI [-0.020, -0.007]); and 23.2% in those aged 60 years and over (β = -0.015, 95% CI [-0.022, -0.009]). Conclusion: This study highlights that weak grip strength increases risk of depressive symptoms, and adequate cognitive function can mitigate the association between weak grip strength and an increased risk of depression among middle-aged and elderly individuals in China. Psychological care for elder adults with weak grip strength and poor cognitive function should be strengthened. [ABSTRACT FROM AUTHOR]

Background: Increased blood pressure is called a "silent killer" as it is often asymptomatic and can persist without the knowledge of the sufferer. It is one of the most prevalent and strong predictive factors for cardiovascular diseases. Methodology: This cross-sectional study was conducted to find out any association of the ABO blood group with blood pressure and includes 581 randomly selected subjects from the different organizations of district Hyderabad including Universities, colleges, Hospitals, their students, faculty members, and their employees. This study was conducted from February 2021 to January 2022. Informed consent was obtained from volunteers. A detailed history was taken followed by a thorough clinical examination. Blood pressure was recorded with a mercury sphygmomanometer in sitting position. Blood grouping was done by ABO typing. Data obtained were analyzed by SPSS version 23.0. Results: In this study, the B blood group participants were 205 (34.22%) was found more prevalent in district Hyderabad, the mean systolic blood pressure was 119.10 ± 16.57, and the mean diastolic blood pressure was 78.89 ± 29.85. and in blood group B participants systolic blood pressure was found 46.82% and diastolic blood pressure was found 43.90% also in B blood group participants followed by A, O, and AB. Conclusion: The incidence of hypertension is high in Pakistan as found in other developing countries. In this study, the evidence is suggestive of the association of the B blood group with increased blood pressure in young healthy adults of district Hyderabad Pakistan. [ABSTRACT FROM AUTHOR]

Simple Summary: The aim of this study was to assess the impact of various factors—such as age, age at menarche, age at first childbirth, number of births, body mass index (BMI), living environment (rural vs. urban), and other factors later discussed—on the likelihood of developing breast cancer. This article's original research was based on data gathered from 687 breast biopsies, which were analyzed through comparative analysis and regression analysis to identify possible predictors for malignancy and tumor size. The comparative analysis and regression models in this study provide deeper insights into the roles of various variables, particularly positive hormonal receptor status, in malignancy. Introduction: Breast cancer has become one of the most serious and widespread public health concerns globally, affecting an increasing number of women—and, in rare cases, men—across the world. It is the most common cancer among women across all countries. In this study, we aimed to evaluate the influence of demographic factors, medical and reproductive history, diagnostic techniques, and hormone receptor status on the development and progression of breast cancer. Materials and Methods: A total of 687 female patients from Romania underwent standard breast examination techniques, including clinical breast examination, mammography, ultrasonography, and, ultimately, breast biopsy. Statistical analysis was performed using the R programming language and RStudio software. The study included a comparative analysis and a prediction analysis for malignancy and tumor size (cumulative histological dimension) through logistic and linear regression models. Results: The comparative analysis identified several variables associated with malignancy: older age (p < 0.001), non-vulnerability (p = 0.04), no daily physical activity (p = 0.002), no re-biopsy (p < 0.001), immunohistochemistry use (p < 0.001), use of larger gauge needles (p < 0.001), ultrasound-guided biopsy (p < 0.001), and vacuum biopsy (p < 0.001). The hormone receptor statuses—estrogen receptor (ER), progesterone receptor (PR), and androgen receptor (AR)—showed statistically significant differences in distribution across breast cancer B classifications. Logistic regression analysis identified ER, PR, and age as significant predictors of malignancy. Linear regression analysis revealed histopathological results, living environment, geographical region, vulnerability, prior breast examination, and the number of histological fragments as significant predictors of cumulative histological dimension. Conclusions: Our predictive models demonstrate the impact of demographic factors, medical history, diagnostic techniques, and hormone receptor status on breast cancer development and progression, accounting for a significant portion of the variance in malignancy and cumulative histological dimension. [ABSTRACT FROM AUTHOR]

Background: Digital devices significantly contribute to vision-related problems. In addition, prolonged postural imbalance, owing to excessive use of digital devices, can lead to the tightening of head and neck muscles, resulting in neck pain, a common musculoskeletal discomfort that significantly affects individuals with poor vision. This study aimed to evaluate the prevalence and interrelationships of screen time, visual disorders, and neck pain among students at Majmaah University. Methods: A cross-sectional study was conducted at Majmaah University, Saudi Arabia, enrolling students aged 18 to 25 years. Exclusion criteria included neurological or musculoskeletal disorders. Demographic data and information on visual and neck pain symptoms were collected. The Neck Disability Index questionnaire was used to assess neck pain, and data were analyzed using SPSS version 24.0. Results: Among 263 participants, 53.6% were female. Nearsightedness (38.0%) and dry/itchy eyes (49.0%) were the most common visual disorders and symptoms, respectively. Visual disorders were prevalent in 62.0% of students, while neck pain was reported by 79.5%. Females and those studying for more than 5 h using electronic screens daily reported higher neck disability index scores. A significant association was found between >5 h of study duration [screen time] and neck disability (OR 3.703, 95% CI 1.500–9.144, p = 0.005). Conclusion: The study highlights a relationship between visual problems and neck pain among university students, emphasizing the need for addressing vision-related issues to reduce neck discomfort. High screen time could substantially increase the odds of developing neck disability. However, authors warrant cautious interpretation in the light of following limitations: cross-sectional study, small sample size, lack of statistical power, and self-reported data. [ABSTRACT FROM AUTHOR]

Introduction: The use of e-cigarettes or other electronic vaping products (EOEVP) has been on the rise since their introduction. Concurrently, Adverse Childhood Experiences (ACEs) have been linked to various negative behavioral health outcomes. We explore the association between ACEs and current EOEVP use, with a focus on variations across sex, race/ethnicity, and age. Methods: Utilizing data from the Behavioral Risk Factor Surveillance System (BRFSS) for 2020–2022, we analyzed responses from 202,126 adults in the United States in a cross-sectional study. Multivariable logistic regression models were used to evaluate the adjusted odds ratios (aORs) of current EOEVP use for different levels of ACEs. Stratified and interaction analyses were used to examine potential effect modification. Results: Among adults 54 years of age and younger, even a lower number of ACEs [1 (aOR 1.52), 2 (aOR 2.01), and 3 (aOR 1.51)] was associated with higher odds of current EOEVP use. Stratified analyses revealed significant differences in the odds of current EOEVP use among Non-Hispanic White adults between 1 ACE (95% CI 1.75–2.28) and 4 ACEs (2.34–3.17). Hispanic adults with ≥ 1 ACEs (p-value 0.001) and 8 ACEs (p-value 0.005) showed strong associations compared to Non-Hispanic White adults. The influence of ACEs on current EOEVP use was observed to decrease with age, particularly in older adults with fewer ACEs. The aORs did not very by sex. Conclusion: The findings emphasize the importance of considering any number of ACEs in public health strategies targeting current EOEVP use, especially among younger adults and specific minority groups. These insights are crucial for tailoring interventions and policies to address the nuanced impacts of early life adversities on health risk behaviors. [ABSTRACT FROM AUTHOR]

Background: While traditional medicine (TM) is employed by a significant portion of the global population for managing health issues, clinical guidelines and state recommendations often overlook this practice. The aim of this study was to describe the frequency of use of TM to control 3 metabolic risk factors (MRF): hypertension, hypercholesterolemia, and hyperglycaemia; and the sociodemographic, economic, and clinical characteristics associated with the use of TM. Methods: Cross-sectional descriptive study that analyses data obtained from a representative population survey in 2 health districts, one urban in the south of Quito and another in a forested rural area with diverse ethnic groups in Esmeraldas, Ecuador. We include 602 individuals with at least one MRF. We calculated the proportion of people reporting the regular use of TM (herbal or traditional remedy) to control their MRF and we assessed potential associations with sociodemographic, economic, and clinical characteristics with a multivariable logistic regression model. Results: In two very different sociocultural contexts in Ecuador we found that use of TM to control MRF was frequent (39.4% in Esmeraldas, 31.1% in Quito), frequently in combination with CM. There is a notable percentage of people, 33.9% in Esmeraldas and 39.0% in Quito, who did not take any treatment for their MRF, and the remainder used CM alone. In both settings, an individual's education lever was significantly associated with TM use. Whereas in Quito individuals with higher education more frequently treated their MRF with TM (aOR 2.04, 95% CI 1.03–3.90), in the rural, hard-to-reach context of Esmeraldas, it was more frequent among people with no formal schooling (aOR: 3.76; 95%CI 1.59–8.88), as well as those of younger age (aOR by year: 0.97; 95% CI 0.95–0.99) and afro ethnicity (aOR: 2.13; 95%CI 1.02–4.45). Conclusion: Traditional medicine is used by a significant proportion of the population in Ecuador, highlighting the need for a more accessible and intercultural healthcare approach. The health system should ensure access to the necessary information and resources for the management of their metabolic risk factors. [ABSTRACT FROM AUTHOR]

Background: Globally, oral diseases remain a major public health problem. However, there is limited information about the oral health status and factors associated with oral disease among children in Uganda. The aim of this study was to examine the oral health status and factors associated with oral health of primary school children in urban and rural areas of the Gulu district of northern Uganda. Methods: A comparative cross-sectional study was conducted among 356 school children aged 11–13 years attending six schools located in urban and rural areas. The children received a clinical oral examination and participated in a questionnaire survey that collected information on sociodemographic and oral health knowledge, attitude, and practices. All data were entered and analysed using IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp statistical software. Logistic regression analyses examined factors associated with dental caries and gingival bleeding. Results: Of the 356 children (11–13 years) included, the mean age was 12.2 years, 140 (39.3%) were male and 176 (49.4%) were from urban areas. The proportion of school children with dental caries was 33.6% (n = 119), with the mean decayed, missing due to caries, and filled teeth (DMFT) index of 0.81 (25th percentile = 0; 75th percentile = 1.00). There was no significant difference in caries prevalence between rural and urban children (31.6% versus 35.6%, p = 0.33). Of the children involved in the study, 141(39.8%) had gum bleeding. The mean oral knowledge score was 2.85 ± 1.53 (range, 0–7), while the mean attitude, hygiene practice, frequency of sweets consumption, and oral health related impact scores were 4.25 ± 1.23 (range, 1–6), 5.40 ± 1.81 (range, 0–9), 25.66 ± 4.29 (range 9–54) and 2.1 ± 1.65 (range, 0–6), respectively. Using logistic regression analyses, as oral health knowledge score increased the odds of not having dental caries increased (aOR = 1.19, 95% CI 1.02–1.39). Conclusion: The prevalence of dental caries and gum bleeding of primary school children in Gulu district is high. Children lacked knowledge on causes of oral disease, and behaviour towards oral disease prevention. In addition, oral health knowledge scores were significantly associated with dental caries. Oral health education programs in schools should emphasise providing skills-based education. [ABSTRACT FROM AUTHOR]

Background: Opioid use disorder (OUD) remains a significant public health challenge with high recurrence rates and varied long-term outcomes. Affective temperament and emotion regulation have been identified as influencing addictive behaviors and treatment outcomes in OUD. However, limited research has explored their association with reversion over an extended period. Objectives: The EDATOUD (Emotion Dysregulation and Affective Temperaments in Opioid Use Disorder) study aimed to evaluate the effects of affective temperament and emotion regulation characteristics on recurrence over a 1-year follow-up period. The study aimed to compare the baseline characteristics of patients who achieved remission versus those who did not and identify potential predictors of recurrence risk. Methods: The study included 63 patients with OUD who were assessed monthly for return-to-use through self-report, psychiatric examination, and urine analysis. Sociodemographic data, affective temperament, difficulties in emotion regulation, anxiety, and depression were measured at baseline. Statistical analyses were performed to compare the recurrent and remission groups and determine the predictive value of these clinical features on recurrence. Results: Within the one-year, 77.8% of patients returned to use. Affective temperament characteristics did not differ between the groups. However, the recurrent group patients exhibited significantly more difficulties in emotion regulation. Conclusions: Difficulties in emotion regulation are associated with an increased risk of recurrence in patients with OUD. Understanding these factors can inform the development of tailored treatment strategies to improve long-term outcomes. Further research is needed to explore additional factors contributing to reversion and enhance intervention and support systems for sustained recovery in OUD. [ABSTRACT FROM AUTHOR]

Objective: No reports on factors or Clinical prediction rules (CPRs) associated with walking independence among patients with vertebral compression fractures (VCFs) are available. Evidence regarding epidemiological walking independence rates is also sparse. Here, we sought to (i) obtain epidemiological data on the probability of inpatients with VCFs achieving walking independence, and (ii) develop and validate a CPR to determine walking independence in hospitalized patients with VCFs. Patients and Methods: We conducted a retrospective cross‐sectional observational study of patients aged ≥60 years who were hospitalized for VCF at four hospitals in Japan in 2019–2022. The outcome was walking independence at discharge. We performed a binomial logistic regression analysis to assess predictors of walking independence. Five independent variables were entered: age, American Society of Anesthesiologists physical status, cognitive function, Berg Balance Scale (BBS), and 10‐m walking test. Among the independent variables that were significant, we converted the continuous variables to binary data by calculating cut‐off values and then created the CPR. The area under the curve (AUC) was calculated as the measure of the CPR's diagnostic accuracy, and internal validation was conducted by bootstrapping. Results: Of the 240 patients, 188 (78.3%) achieved walking independence. Cognitive function and the BBS score (with a cut‐off of 45 points) were identified as significant predictors. We created a CPR using these two items (0–2 points). The CPR's AUC was 0.92 (0.874–0.967), and internal validation by bootstrapping yielded a mean AUC of 0.919 with a slope of 0.965. Conclusion: The walking independence rate of patients with a VCF during hospitalization was 78.3%, with cognitive function and BBS being predictors. The developed CPR performed well enough to retrospectively predict walking independence in VCF patients. The BBS cut‐off value and the CPR may serve as useful indicators for clinicians to predict VCF patients' walking independence. [ABSTRACT FROM AUTHOR]

Introduction: This study examined the effects of the coronavirus disease 2019 (COVID‐19) pandemic on depression and suicidal ideation in community‐dwelling elderly in Korea. Methods: Data were employed from a survey on elderly mental health in Jeollanam‐do (southwest province in Korea), conducted by the Jeollanam‐do Provincial Mental Health and Welfare Center. A total of 2423 people were recruited from all 22 cities in Jeollanam‐do from April to October, 2021. We used self‐reported questionnaires including sociodemographic factors, COVID‐19‐related stress, the Geriatric Depression Scale‐Short Form Korean Version, the Multidimensional Scale of Perceived Social Support, the Satisfaction With Life Scale and the Brief Resilience Scale. Logistic regression was performed to examine the factors of depression and suicidal ideation. Results: Of the 2423 subjects, 622 (25.7%) reported depressive symptoms and 518 (21.4%) reported suicidal ideation. The multivariate logistic regression analysis revealed that living alone, poor perceived health status, worry of COVID‐19 infection, and restriction of daily activities due to COVID‐19 pandemic are significantly associated with depression. Female gender, poor perceived health status, inability to perform household chores, and depressive symptom are risk factors of suicidal ideation. Conclusion: These findings show that old age, negative perception of health, and restriction of daily activities due to COVID‐19 are risk factors of depression in community‐dwelling elderly in the context of the COVID‐19 pandemic. Female gender, poor self‐perceived health status, and depression increase the risk of suicidal ideation among the elderly. Social support and life satisfaction are protecting factors of both depression and suicidal ideation. Resilience decreased risk of depression but not in suicidal ideation. [ABSTRACT FROM AUTHOR]

Objective: To compare maternal demographics based on occupation coding status and evaluate potential bias by excluding manually coded occupations. Methods: This case-control study assessed cases with clefts obtained from the Texas Birth Defects Registry. The NIOSH Industry and Occupation Computerized Coding Systemautomatically coded occupations, withmanual coding for unclassified cases. Maternal demographics were tabulated by occupation coding status (manual vs. automatic). Logistic regression examined associations between major occupation groups and clefts. Results: Automatic coding covered over 90% of all mothers. Building, grounds cleaning, and maintenance occupations, and office and administrative support occupations were significantly associated with cleft lip with or without cleft palate, even after excluding manually coded occupations. Conclusion: We found consistent associations before and after excluding manually coded data for most comparisons, suggesting that machine learning can facilitate occupation-related birth defects research. [ABSTRACT FROM AUTHOR]

While research has shown that the prevalence of ADHD in the general population has increased over time, there have been no studies focused on ADHD prevalence in patients with borderline personality disorder (BPD). This study compares two cohorts of adults with rigorously diagnosed BPD recruited nearly three decades apart (1992 vs. 2020). Participants from the 1992 McLean Study of Adult Development (MSAD) (N = 290) and the 2020 Flourishing study (N = 147) were assessed for ADHD using DSM-III-R and DSM-5 criteria respectively. Compared to MSAD subjects, the prevalence of ADHD among Flourishing subjects was significantly higher overall, and in female (but not male) subjects. This increased prevalence, which is likely due to the broadening of the DSM criteria over time, highlights what many observers believe to be a problematic expansion of the diagnostic criteria for ADHD that may have decoupled this criteria set from capturing a neurodevelopmental disorder that typically begins in childhood. [ABSTRACT FROM AUTHOR]

This study aimed to examine the risk and protective factors associated with depression in middle-aged and older Chinese adults with activity limitations. Data were obtained from the 2018 Wave 4 Survey of the China Health and Retirement Longitudinal Study. In the logistic regression analysis, health and functioning, losing a child, and a perceived lack of future assistance with daily activities increased the odds of depression. Conversely, receiving adequate assistance with daily activities lessened the depressive impacts of activity limitations, as indicated by a significant interaction effect. Enhanced long-term support for individuals with disabilities is necessary to improve mental health. [ABSTRACT FROM AUTHOR]

Numerous studies suggest that subjects suffering from a mental health condition before the COVID‐19 pandemic were at higher risk of contagion, but mostly are cross‐sectional or retrospective. The BIOVAL‐D‐COVID‐19 is a longitudinal cohort study design with 922 subjects who full filled two evaluations from an online survey of Spanish residents before and during the pandemic. Mental health conditions assessed were: Major Depressive Episode (MDE), Generalised Anxiety Disorder (GAD), Suicidal Thoughts and Behaviours (STB) and subthreshold of panic and bipolar disorder (BD). Mental health screening instruments used were: the Spanish version of the Composite International Diagnostic Interview (CIDI) version 3.0 for the evaluation of MDE, the GAD‐7 scale to evaluate GAD; STB was evaluated with four items from the CIDI questionnaire. Panic Disorder and BD were screened from a modified and self‐reported version of the CIDI. A bivariate plus five logistic regression models were developed for each mental health condition adjusted by socio‐demographic variables; employment status; general and physical health; comorbidity; and including all previous variables and the other mental health conditions. We found in bivariate model that MDE; GAD and STB were statistically significant risk factors of contagion of COVID‐19. The logistic regression models developed reveal that having a previous GAD (aOR 3.30 1.31–8.31) or STB (aOR 2.16 CI 95% 1.01–4.62) was statistically significant associated with COVID‐19 contagion, independently of all variables included. MDE was not a risk factor of contagion when it was adjusted by comorbidity (aOR 0.99 CI 95% 0.47–2.09). It is recommended to detect those subjects with previous GAD or STB as vulnerable groups of infection to reduce contagion rates. [ABSTRACT FROM AUTHOR]

Background: Ethnic minority women in the United States continue to experience racial disparities. Immigrant Arab women (IAW) underutilize mammography screening (MS) even compared with other ethnic minorities. This population still has gaps in knowledge regarding breast cancer (BC) and screening methods and encounters social barriers, highlighting the imperative role of the male figure and the family, which hinders screening. Materials and Methods: A cross-sectional design with an exploratory and predictive approach was employed to examine knowledge gaps and perceived social barriers associated with MS and to identify predictive factors of MS among IAW in California. The analysis included 316 women that met the eligibility criteria. Results: Familiarity with MS and awareness of screening recommendations were the specific areas of knowledge significantly associated with mammography uptake (odds ratio [OR] 15.4, 95% confidence interval [CI]: 5.6–40.8, p < 0.001) and (OR 12.07, 95% CI: 7–21, p < 0.001), respectively. Logistic regression revealed three MS predictors, the two knowledge areas and age. Perceived social barriers were significantly associated with age [F (3,312) = 4.684, p = 0.003]. There was a significant difference in social barriers between women in their 40s and those in their 60s (p = 0.002) and between women in their 50s and those in their 60s (p = 0.003), suggesting lower barriers among women in their 60s (M = 14.3). Living status was significantly associated with perceived social barriers [F (1,314) = 8.83, p = 0.003]. Conclusions: This study offered valuable insights for health care professionals, policymakers, and community organizations working to improve BC early detection in immigrant and ethnic women to reduce social disparities and reinforce social justice. Knowledge-deficit areas and social barriers must be analyzed and incorporated in awareness programs to improve screening practices of IAW. [ABSTRACT FROM AUTHOR]

Objectives Advance care planning (ACP), which comprises a living will, durable power of attorney for healthcare (DPAHC), and end-of-life discussions, is an inherently relational process. However, it is unclear how marital status affects men's and women's ACP over the life course. Drawing on social control and gender-as-relational frameworks, we examine marital status differences in ACP and how these patterns differ by gender and age. Methods Data are from the 2020 Health and Retirement Study (HRS), a representative sample of U.S. older adults (N  = 7,074). We estimate logistic regression models to evaluate whether marital status differences in ACP are moderated by age and gender, and multinomial logistic regressions to examine age and gender differences in DPAHC designations among married parents. Analyses are adjusted for sociodemographic and health covariates. Results Multivariable analyses revealed significant moderation effects for discussions only. Among married/cohabiting persons, women are more likely than men to have end-of-life discussions, with gender differences diminishing slightly at oldest ages. Among divorced persons in their 60s and 70s, women are much more likely than men to have had discussions, although this gap converges among the oldest-old. Conversely, young-old widowed men and women are equally likely to have discussions, although women are increasingly likely to do so with advancing age. Men are more likely than women to name their spouse as DPAHC, yet this gap diminishes with age. Discussion Healthcare providers can better guide end-of-life consultations if they understand how men's and women's family relationships change with advancing age. [ABSTRACT FROM AUTHOR]

Background and Objective Work discrimination is an important public health problem with consequences for health. This study examined the effect of chronic work discrimination on 4-year changes in HbA1c, as a reflection of glucose control and type 2 diabetes risk in older workers and assessed whether allostatic load (AL) affected the strength of this association. Research Design and Methods We used Health and Retirement Study data (2010–2016, n  = 3,246). Conditional change multinomial logistic regression examined the association between chronic work discrimination, high AL (4 or more out of 8 high-risk biomarkers), and HbA1c, while accounting for relevant covariates. Results Black participants had the highest rates of baseline (22.7%) and follow-up (28%) HbA1c levels, AL (38%), and chronic work discrimination (39%; p  < .01). Severe chronic work discrimination was associated with elevated HbA1c (relative risk ratio [RRR] = 1.61, 95% confidence interval [CI] = 1.07, 2.43). AL was associated with elevated HbA1c (RRR = 1.49, 95% CI = 1.04, 2.14). Relative to White participants, Hispanic (RRR = 1.52, 95% CI = 1.07, 2.16, RRR = 1.81, 95% CI = 1.051, 3.12), and Black (RRR = 2.42, 95% CI = 1.82, 3.23; RRR = 3.00, 95% CI = 1.97, 4.56) participants had an increased risk of intermediate and elevated HbA1c, respectively. Among those with long job tenure (≥5 years), both moderate (RRR = 1.81, 95% CI = 1.11, 2.96) and severe (RRR = 1.90, 95% CI = 1.15, 3.12) chronic work discrimination was associated with elevated HbA1c. Discussion and Implications Chronic work discrimination was associated with HbA1c; however, no moderating effects of AL were observed. Findings underscore a need for organizational and public health measures to establish strong anti-discrimination laws in the workplace to improve the work environment of older workers and reduce diabetes risk. [ABSTRACT FROM AUTHOR]

Background: Government programs—targeting chronic disease patients with high health care costs—focus on clinical conditions, factors internal to the health care system, and individual patient education, not on addressing modifiable social determinants of health to reduce health care utilization. Objective: To evaluate differences in sociodemographic variables and health care utilization between patients with chronic obstructive pulmonary disease (COPD) who reported food insecurity and those who did not. Methods: This descriptive retrospective cross-sectional study used data from the electronic health records of a convenience sample of 854 participants with a discharge diagnosis of COPD or COPD with acute exacerbation, admitted via the emergency department of participating hospitals in Southern California. Chi-square (or Fisher's exact) tests and t tests were used to evaluate group differences, and multivariate (or Firth) logistic regression to identify factors that increased the odds of emergency department visits and hospitalizations. Results: Significant differences between groups were identified for food insecurity (sometimes or often vs never insecure) and age (P <.001), race (P =.022), medical insurance (P <.001), zip code (P =.022), homeless status (P <.001), smoking status (P <.001), and emergency department visits (P =.033). No significant differences were found for food insecurity and hospitalizations (P =.592). Conclusion: This study contributes to the growing body of research supporting the association of upstream social factors (food insecurity, homelessness, zip code) and downstream health outcomes (repeated emergency room visits), and how existing programs can be effectively utilized to impact downstream health outcomes such as health care utilization. [ABSTRACT FROM AUTHOR]

Background/Aims: Glucose-6-phosphate dehydrogenase deficiency worsens the risk of anaemia and complicates gestation and birth if poorly managed. This study investigated the prevalence and factors associated with anaemia and this deficiency in pregnant women. Methods: This cross-sectional study was conducted among 369 pregnant women at the Cape Coast Metropolitan Hospital, Ghana. Multiple logistic regression was used to investigate the relationship between anaemia and various sociodemographic variables. Results: The prevalence of anaemia was 41.2% at 13 weeks' and 66.7% at 36 weeks' gestation. Overall, 29.8% of participants were glucose-6-phosphate dehydrogenase deficient. Age (P=0.024)and marital status (P=0.009) were significantly associated with anaemia at 13 weeks. Gravidity (P=0.014) and employment status (P=0.001) were significantly associated with anaemia at 36 weeks. Conclusions: There was a high prevalence of co-morbid anaemia and glucose-6-phosphate dehydrogenase deficiency at 13 and 36 weeks' gestation. Future studies should consider genetic and dietary factors that may contribute to gestational anaemia. Implications for practice: Clinicians and midwives should be aware of the factors that can affect anaemia and glucose-6-phosphate dehydrogenase deficiency, particularly in areas where deficiency is prevalent. Early detection could allow individualised treatment. [ABSTRACT FROM AUTHOR]

Summary: We found that a standardized order set after hip fracture increased initiation of anti-osteoporosis medication and increased persistence at 1 year, but did not reduce secondary fractures. Background: A treatment gap exists after osteoporosis-related fractures. Introducing standardized care can improve treatment. We evaluated the impact of a hip fracture order set (OS) on anti-osteoporosis medication (AOM) initiation, persistence, and secondary fracture prevention. Methods: In 2015, one hospital in Manitoba, Canada, introduced a hip fracture OS including recommendations for the initiation of AOM (OS group). A control group was identified from the other hospitals in the same region. A retrospective cohort study was conducted using linked administrative health data. All individuals 50 + years with surgical treatment for low-energy hip fracture between 2010 and 2019 were included and followed for AOM initiation, medication persistence at 1 year, and secondary fractures. Between-group differences for each year were assessed using chi-square tests. Logistic regression models tested the impact of socio-demographic and clinical factors on initiation, persistence of AOM. Cox regression tested the risk of secondary fracture. Results: No baseline differences between OS group (813 patients) and control group (2150 patients) were observed in demographics, socioeconomic factors, or comorbidities. An increase in post-fracture AOM initiation was seen with OS introduction (OS group year before 16.7% versus year after 48.6%, p < 0.001). No change was seen in the control group. Persistence on AOM also increased (OS group year before 17.7% versus year after 28.4%, p < 0.001). No difference in secondary fractures was observed (OS group 19.8% versus control group 18.8%, p = 0.38). Conclusion: Introduction of a hip fracture OS significantly increased AOM initiation and persistence at 1-year post-fracture. There was no significant difference in secondary fractures. [ABSTRACT FROM AUTHOR]

Purpose: The COVID-19 pandemic impacted healthcare delivery, especially for people with chronic disease. We investigated telehealth use by persons with multiple sclerosis (MS) during the COVID-19 pandemic and their suggestions to improve their telehealth experience. Methods: From persons with MS, we collected data on demographic, disease-related and social determinants of health, telehealth use during the COVID-19 pandemic, satisfaction with telehealth, and suggestions to improve telehealth. We conducted univariate log-binomial regression to establish factors associated with telehealth use versus no use, summarised experiences and suggestions for improvement with frequency tables, and conducted thematic analysis on free-text suggestions for improvement. Results: Of 1,485 participants, 69.8% used telehealth during the first phase of the COVID-19 pandemic. Only small differences were observed for demographic, disease and social health determinants between telehealth users and non-users. Most participants who used telehealth had good or very good experiences (new providers:74.3%; existing providers:78.6%). The most common suggestion for improving telehealth experience was "guidance on preparing for telehealth sessions." Participants also wanted expansion in telehealth availability and utility. Conclusion: Persons with MS in Australia commonly used telehealth during the COVID-19 pandemic and were generally satisfied with their experiences. Implementing the suggested improvements will help optimise telehealth for persons with MS. Registration: N/A. IMPLICATIONS FOR REHABILITATION: Australians with multiple sclerosis (MS) had good or very good experiences of telehealth during the first year of the pandemic. Telehealth is a useful consultation tool for many rehabilitation professions and may be appropriate for use across the whole MS population. To improve the delivery of rehabilitation through telehealth, provision of better guidance on preparing for telehealth consultations and provision of digital equipment to monitor their health is wanted by persons with MS. Rehabilitation professionals and researchers should take opportunities to identify if proficiency in the English language and cultural background may influence experiences with telehealth in persons with MS. [ABSTRACT FROM AUTHOR]

Objective: Ten states, including the District of Columbia, have laws that currently permit physical therapists (PTs) to directly order diagnostic imaging (DI) in the United States. Military and civilian PTs order DI judiciously and appropriately demonstrating optimal patient outcomes and satisfaction when compared to other medical professionals. However, no studies have explored perceived attitudes, beliefs, and barriers to PT DI referral specific to North Dakota (ND). Therefore, the purpose of this mixed-methods study was to identify ND PTs' attitudes, beliefs, and barriers toward DI referral. Methods: A total of 147 participants completed an online survey with a subset of 17 participants agreeing to an interview. Frequency counts of demographic data and perceived barriers were completed. A binary logistic regression was run on demographic data. One-on-one interviews were conducted with a thematic coding process completed within a qualitative analysis. Results: Seventy-four percent of PTs reported not currently referring for DI, although 71% felt that it would improve their patient outcomes. PTs with post-professional training (OR = 4.59), a doctorate degree (OR = 3.84), practicing in an orthopaedic or sports setting (OR = 3.55), and practicing within an urban setting of ND (OR = 3.01) were more likely to refer for DI. The main barriers identified in the survey included: (1) the logistics of performing a DI referral, (2) DI referrals only privileged to other medical providers, (3) provider/work relationship dynamics, (4) the cost of continuing education (CE), (5) and the inability to identify CE. One-on-one interviews further identified five main themes related to DI referral. Discussion/Conclusion: Several barriers identified resulted in 74.1% of PTs not directly referring for DI, although certain characteristics (post-professional training, doctorate degree, orthopaedic/sports setting, practicing in an urban area in ND) were more likely to refer for DI. This study may help improve future adoption and implementation of DI referral in current and future states. [ABSTRACT FROM AUTHOR]

Caries is an important public health concern. Dental sealants are effective in preventing caries; however, their uptake is suboptimal and little is known about second molar (2M) sealants. The authors examined the prevalence of 2M sealants among US adolescents and investigated the factors associated with their presence. The authors conducted a cross-sectional analysis of 2011-2016 National Health and Nutrition Examination Survey data on adolescents aged 12 through 19 years with complete sealant data (n = 3,636). Race and ethnicity, income, and first molar (1M) sealant were primary variables of interest. The logistic regression models were used to estimate the factors associated with 2M sealants. All analyses used survey weights and accounted for complex survey design. Only 34.6% of adolescents (95% CI, 31.2% to 38.0%) had 2M sealants. Approximately 89.0% of adolescents (95% CI, 86.1% to 92.0%) with 2M sealants and 19.6% (95% CI, 17.1% to 22.2%) without 2M sealants had 1M sealants. In the adjusted models, race and ethnicity were strongly associated with 2M sealant presence, but the association did not hold when 1M sealant was included in the model. 1M sealants were the most significant factor explaining the presence of 2M sealants (odds ratio, 0.03; 95% CI, 0.02 to 0.04). Two of 3 adolescents lacked 2M sealants, with considerable disparities in their presence. To improve adolescent oral health, clinical and community programs should increase delivery of 2M sealants. Study findings highlight the need to evaluate adolescent sealant delivery programs to improve the uptake of 2M sealants. [ABSTRACT FROM AUTHOR]

This study aimed to conduct a cross-sectional questionnaire survey of foreign patients to analyze the impact of patients' illness perceptions on their need for professional medical interpreters. From February 2022 to May 2023, an online questionnaire was distributed to 4,962 individuals aged 18 years or older who were non-native speakers of Japanese. These individuals were enrolled in organizations such as international exchange associations and Japanese language support classes and had utilized medical institutions in Japan due to their own illness or injury or that of their children. Among the 312 valid responses, international patients with a high score for illness perception were more likely to want to utilize professional medical interpreters than those with a low score for illness perception (odds ratio, 1.968; 95% confidence interval, 1.044–3.709; P = 0.036). Our findings suggest that hospitals should be better prepared to meet the potential language needs of international patients with a higher illness perception. [ABSTRACT FROM AUTHOR]

Objectives: While physical health status is known to impact social functioning, a growing literature suggests that social well‐being may affect oral health. This investigation evaluated whether self‐perceived quality of social roles, activities and relationships (social well‐being) influences gingival inflammation. Methods: Data were from the Population Assessment of Tobacco and Health Study, a nationally representative cohort of US adults, biennial waves 4 (2017) to 6 (2021). Social well‐being was derived from the validated PROMIS Global‐10 survey instrument, categorized for this longitudinal analysis as high, moderate or low. The main outcome was incident self‐reported gum bleeding (dichotomous, proxy for gingivitis). Survey‐weighted logistic regression modelling adjusted for overall health status, sociodemographic (e.g. age, sex, race/ethnicity), socioeconomic (e.g. income, education) and behavioural (e.g. tobacco, alcohol) confounders and was used to predict marginal mean gum bleeding incidence. Results: Cross‐sectionally at wave 4 (N = 23 679), gum bleeding prevalence was higher along a stepwise gradient of decreasing satisfaction with social activities and relationships (extremely satisfied: 20.4%; not at all: 40.1%). Longitudinally, among participants who had never reported gum bleeding through wave 4 (N = 9695), marginal predicted new gum bleeding at wave 6 was greater with each category of lower wave 4–5 social well‐being (high: 7.6%; moderate: 8.6%; low: 12.4%). Findings were robust to alternative model specifications. Results should be interpreted considering study limitations (e.g. potential unmeasured confounding; outcome by self‐report). Conclusions: Social functioning may affect physical health. Specifically, social roles, activities and relationships may influence inflammatory oral conditions, like gingivitis. Confirmatory research is warranted, along with policies and interventions that promote social well‐being. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the individual and community factors that contribute to dental utilization among young children on Medicaid utilizing the Anderson Model and the Socio‐Ecological Framework. Methods: This observational cross‐sectional study was conducted using baseline data (socio‐demographics, clinical dental need) from a cluster‐randomized hybrid effectiveness‐implementation trial among 1021 child–parent dyads recruited from primary care practices across northeast Ohio. The baseline data were then linked to dental Medicaid claims data (categorized as any dental visit, volume, and type in the past 12 months) and ICD‐10 codes from the child's EHR data (individual‐level) together with Dental Health Provider Shortage Area (HPSA) status and Area Deprivation Index (ADI) which were obtained at the neighbourhood‐level using home address of each dyad (community‐level). Multivariable analyses using generalized estimating equations (GEE) accounted for clustering by practice, and models included individual‐level alone, and individual + community‐level factors to evaluate their effects on dental utilization. Results: Medicaid claims data indicated that among the 1021 children (mean age: 4.3 ± 1.1 years; 54.4% males; 43.8% Black, Non‐Hispanic), a majority of children were seeing the dentist at least once a year by the age of 4 (56.1%). The mean ADI of their neighbourhoods was 109.22 (20.2) and 27.5% lived in a HPSA area. The GEE analyses revealed that individual factors such as older children, parents being married, and continuous Medicaid enrollment were associated with significantly higher dental utilization. Among community factors, being in a HPSA had an OR = 1.53 (CI: 1.03, 2.27) associated with higher dental utilization. Conclusions: Being in a HPSA was associated with higher dental utilization possibly due to dentists or safety net dental clinics in these areas accepting Medicaid‐eligible children. [ABSTRACT FROM AUTHOR]

Objectives: To describe the participants of a university-based COVID-19 contact tracing course and determine whether the course changed knowledge, attitudes, and intention to participate in contact tracing. Participants: Faculty, staff, and students were eligible. Methods: Surveys evaluated the impact of the course on participant intentions to engage in contact tracing. Logistic regression identified characteristics associated with increased likelihood of participating in contact tracing. Results: Nearly 800 individuals participated, of whom 26.2% identified as Hispanic/Latino and 14.0% as Black. Nearly half (48.8%) planned to conduct contact tracing. While attitudes did not change, knowledge improved (67.9% vs. 93.8% scores on assessments; p < 0.001). Younger participants and Black individuals were more more likely to be confident that they would participate in contact tracing. Conclusions: Course completion was associated with increased knowledge. Participants were racially and ethnically diverse, highlighting how universities can partner with health departments to develop workforces that reflect local communities. [ABSTRACT FROM AUTHOR]

This study examined associations between perceived discrimination, treatment adherence self-efficacy, and depressive symptoms among people living with HIV (PLHIV) in the Southern United States. Cross-sectional survey data were collected from 402 PLHIV who self-reported on interpersonal discrimination experiences based on HIV status, sexuality, gender, income, and living condition. Participants also reported on adherence self-efficacy and depressive symptoms. We employed K-means clustering to identify groups based on discrimination experiences, and logistic regressions to examine group differences on adherence self-efficacy and depressive symptoms. Results suggested three groups: a cluster with high perceived discrimination across all identities/conditions (n = 41; 11%; Cluster 1); a cluster with high perceived discrimination based on HIV status, income, and living condition (n = 49; 13%; Cluster 2); and a cluster with low perceived discrimination across all identities/conditions (n = 288; 76%; Cluster 3). Compared to Cluster 3, Cluster 1 and 2 had 2.22 times (p =.037) and 3.98 times (p<.001) greater odds of reporting depressive symptoms. Compared to Cluster 3, Cluster 2 had 3.40 times (p =.003) greater odds of reporting lower adherence self-efficacy. Findings demonstrate the need for individual-level support for PLHIV with discrimination histories, and broader efforts to end the stigma, discrimination, and marginalization of PLHIV based on HIV status and other characteristics. [ABSTRACT FROM AUTHOR]

We assessed the accessibility to health care services and treatment for people with noncommunicable diseases (NCDs) in Northwest Syria after more than eleven years of the worst humanitarian crisis in Syria. Included in this cross-sectional study were people with one or more of cardiovascular diseases, diabetes, cancer, or chronic obstructive pulmonary diseases; people from both Aleppo and Idleb governorates; and residents from both inside and outside the camp. Data were collected in November 2022 via face-to-face interviews. The findings were obtained from 674 respondents (52.8% female). Respondents in Idleb were 6.5 times more likely to access health care services than Aleppo (p = 0000). In-camp residents were 1.5 times more likely to access outreach health services (p = 0.020). Respondents with higher income were three times more likely to access health care services compared to respondents with lower income (p = 0.000). Having any of the surveyed NCDs made the respondents less likely to get the required services. The study findings added more evidence about the inequity in terms of accessing health care services in Northwest Syria and identified the barriers. It was clear that a perceived group of people with NCDs do not have access to the health care services, including outreach health services and free medications. [ABSTRACT FROM AUTHOR]

Social workers are recognising the increasing frequency and severity of disasters within the context of climate change, and are concerned with supporting communities in preparing, coping and building resilience. Although social workers have had positive impacts on disaster relief and recovery throughout the world, they have been less influential in impacting communities' and individuals' abilities to prepare for future disasters, which requires addressing the structural causes and impacts of disasters. While concerned with macro-level and neoliberal causes and dimensions of disasters, the focus of this research is on micro-level perspectives. Our study investigates whether past experiences of pandemics, including coronavirus disease 2019 (COVID-19), along with other disasters, translate into motivation to prepare for future disasters. We derived the sample from the 2021 US National Household Survey and analysed it using logistic regression analysis. Findings suggest that certain disaster experiences, such as COVID-19 and technological disasters, along with heightened risk perceptions of pandemics and natural disasters, increased people's motivation for disaster preparedness. Such motivation is influenced by sociodemographic characteristics, including race/ethnicity and disability. Using a transformative social work practice lens to articulate implications for social workers, we emphasise addressing root causes of disasters, community-level change work and whole-person, intersectional support and interventions. [ABSTRACT FROM AUTHOR]

Aim: To identify subtypes of job crafting among Chinese nurses and to explore the characteristics of different subtypes and their relationship with work engagement. Design: A cross‐sectional study. Methods: A survey of 350 clinical nurses was conducted between December 2022 and January 2023. Identify profile categories for nurses' job crafting using a latent profile analysis. Logistic regression and ANOVA were used to explore the characteristics of different categories of nurses' job crafting in terms of sociodemographic, work engagement variables. Results: Ultimately 3 latent profiles are identified: low job crafting (Class 1, N = 177, 50.7%), moderate job crafting (Class 2, N = 136, 38.9%), high job crafting (Class 3, N = 37, 10.5%). Nurses who are female, aged 31 to 40 and married are more likely to be grouped into Class 2. Nurses with a middle level of title are more likely to be grouped as Class 3. Nurses with high levels of work engagement are more likely to be grouped as Class 2 and Class 3 rather than Class 1. Conclusion: The job crafting has a distinctly classified character among Chinese nurses. 89.6% of nurses were at a low to medium level of job crafting, work engagement is an important predictor of nurses' job crafting. Nursing Managers should focus on the low job crafting group and develop targeted interventions to help nurses improve their job crafting and work engagement levels. Patient or Public Contribution: None. [ABSTRACT FROM AUTHOR]

Objectives: To improve our understanding of older informal caregivers' (ICs) health, this paper aimed to compare multidimensional frailty and sociodemographic and economic characteristics between (subgroups of) older ICs and non-caregivers. Methods: Using data originating from the Belgian Ageing studies (n = 6054), intergroup differences between older ICs and non-caregivers and between care-dependent and -independent older ICs/non-caregivers were conducted. In addition binary logistic regressions were carried out to determine which variables were related to caregiver status and need of assistance. Results: Among all respondents, 14.3% were ICs reporting care needs themselves. Informal and non-caregivers with care needs, relative to those without, more often only (partially) completed primary education, were significantly older, more likely to be female and widowed, found it more difficult to make ends meet, and reported higher levels of frailty in each domain. Moreover, environmental and psychological frailty were associated with an increase in the likelihood of reporting need of assistance among older non-caregivers and ICs, respectively. Conclusions: This study revealed a particular vulnerable subpopulation of older ICs with care needs. Clinical Implications: It is essential for clinicians to be observant for unrecognized frailty and care needs in older ICs and to develop targeted intervention and prevention strategies. [ABSTRACT FROM AUTHOR]