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Aim: To describe the expectations, acceptability, and challenges identified by nurses and key healthcare stakeholders regarding the implementation of advanced practice nursing in Gabon. Background: Advanced practice nursing presents an opportunity to address the epidemiological transition and the shortage of healthcare professionals in Africa. In anticipation of establishing a master's degree program in advanced practice nursing and its subsequent implementation, it is important to understand Gabon's specific needs and characteristics. Design: This study used a multicenter cross‐sectional mixed‐method design. Methods: From April to May 2022, a total of 187 healthcare professionals were included from two hospitals and two universities in Gabon. Data were collected through questionnaires and complemented by focus group discussions, guided by the existing literature, the PEPPA framework, and Hamric's model. Results: The implementation of advanced practice nursing was generally well accepted. Factors influencing acceptability included being female, awareness of advanced practice nursing, and supporting the role of advanced practice nurses in diagnosing chronic diseases. Barriers to implementation included the absence of a legal framework for the profession and a lack of recognition of nursing skills by both nurses and doctors. Facilitators included the establishment of a master's degree program, formalization of a legal framework, raising awareness, providing training to medical doctors and other healthcare professionals about advanced practice nursing, and the development of nursing leadership. Implications for nursing: Advanced practice nursing can play a crucial role in addressing healthcare resource shortages and the dual burden of chronic and infectious diseases in Gabon, as well as in other African countries. Implications for nursing policy: To successfully implement advanced practice nursing in Gabon and French‐speaking Africa, it is essential to regulate the nursing and advanced nursing professions by creating a legal framework and establishing nursing councils. An effective implementation strategy for advanced practice nurses should be based on the specific needs of the country. Guidelines: COREQ, STROBE [ABSTRACT FROM AUTHOR]

INTRODUCTION: Our objective was to assess the incidence of kidney stones requiring acute care, trends in the surgical treatment of stones, and the demographics of stone formers in Canada. METHODS: We conducted a population-based, retrospective cohort study using administrative data from the Canadian Institute for Health Information. We included Canadian residents age >18 years, outside of Quebec, who presented between January 1, 2013, and December 31, 2018, with a kidney stone episode. This was defined as a kidney stone resulting in hospital admission, emergency department visit, or stone intervention, specifically shockwave lithotripsy (SWL), ureteroscopy (URS), or percutaneous nephrolithotomy (PCNL). RESULTS: There were 471 824 kidney stone episodes, including 184 373 interventions. The number of kidney stone episode increased from 277/100 000 in 2013 to 290/100 000 in 2018. The median age was 53 (interquartile range 41-65) years and 59.9% were male. The crude rate for stone intervention was 877/100 000. The age- and gender-standardized rate for interventions was highest in Nova Scotia and Newfoundland and Labrador, and lowest in Prince Edward Island. The most common intervention in Canada was URS (73.5%), followed by SWL (19.8%) and PCNL (6.7%). The percent utilization of SWL was highest in Manitoba, whereas for URS, it was highest in Prince Edward Island and Alberta. CONCLUSIONS: Our study provides the first population-based data on the demographics of stone formers and treatment trends across Canada. There has been a 4.7% increase in kidney stone episodes over the study period. Those presenting to hospital or requiring intervention for a kidney stone are more likely to be male, aged 41-65, and undergo URS. [ABSTRACT FROM AUTHOR]

Context: Media messaging matters for public opinion and policy, and analyzing patterns of campaign strategy can provide important windows into policy priorities. Methods: The authors used content analysis supplemented with keyword-based text analysis to assess the volume, proportion, and distribution of media attention to race-related issues in comparison to gender-related issues during the general election period of the 2022 midterm campaigns for federal office in the United States. Findings: Race-related mentions in campaign advertising were overwhelmingly focused on crime and law and order, with very little attention to racism, racial injustice, and the structural barriers that lead to widespread inequities. In stark contrast to mentions of gender, racial appeals were less identity focused and were competitively contested between the parties in their messaging, but they were much more likely to be led by Republicans. Conclusions: The results suggest that discussions of race and gender were highly polarized, with consequences for public understanding of and belief in disparities and policies important to population health. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Seclusion is a harmful and traumatising intervention for people accessing mental health services.People who are subject to seclusion in inpatient mental health services often first experience this within the first 24 h following admission.There is limited research examining how recent contact with services impacts the likelihood of seclusion when people are admitted to inpatient services. What the paper adds to existing knowledge?: Males, Māori and Pasifika experience higher rates of seclusion within the first 24 h following inpatient admission.People perceived by clinicians as overactive, aggressive, disruptive or agitated are seven times more likely to be secluded within the first 24 h.People referred from police or justice services are three times more likely to be secluded within the first 24 h.People who had frequent contact with community mental health services prior to inpatient admission were less likely to be secluded. What are the implications for practice?: The first 24 h of inpatient admission is a critical focus for eliminating the use of seclusion. Initial interactions with people recently admitted should focus on nurturing relationships and reducing distress.Mental health staff should consider the person's cultural needs, referral pathway, recent service contact and baseline ratings on the Health of the Nation Outcomes Scales (HoNOS) when working proactively to prevent the use of seclusion in the first 24 h following admission.Strengthening the focus on nurturing relationships, cultural understanding and non‐coercive de‐escalation approaches requires leadership support and strategic workforce development. Introduction: People who experience seclusion in inpatient mental health services often do so within the first 24 h following admission. There is limited research examining the potential contributing factors, particularly recent contact with services. Aim/Question: To identify factors associated with seclusion within the first 24 h following admission into acute inpatient mental health services. Method: A retrospective analysis was undertaken using routinely collected data from Aotearoa New Zealand mental health services. Results: A higher likelihood of seclusion within the first 24 h following admission was associated with: males, Māori, Pasifika, referrals from police/justice services, inpatient transfers, recent contact with crisis assessment teams and clinician perceptions of aggression, problematic substance use, cognitive problems and hallucinations or delusions. Recent contact with community mental health services was associated with a lower likelihood. Discussion: People's cultural needs, referral pathway, recent service contact and HoNOS scores should be considered when working to prevent the use of seclusion in the first 24 h following admission. Implications for Practice: The first 24 h following inpatient admission is a critical period for preventing the use of seclusion. Nurturing relationships, cultural understanding and use of non‐coercive de‐escalation approaches can support better outcomes for people recently admitted. [ABSTRACT FROM AUTHOR]

Background: A growing share of male nurses in the nursing profession in Tanzania has changed the trend of diversity of nursing gender. This might have created a divergent perspective within the communities. Therefore, the current study aimed to explore the perspective, encounters, and choices of nursing gender among licensed nurses, non-nurse healthcare providers, and clients in Tanzania. Methods: The study employed a qualitative descriptive design. The data were collected between August 2022 to January 2023 by the principal investigator and one research assistant. Twelve Focus Group Discussions (FGDs) were carried out in four different hospitals in Dar es Salaam comprised of total participants (n = 59). The participants were nurses, clients, and non-nurse healthcare providers. The data was collected through an interview guide developed by the principal investigator and validated by nurse experts. The data was analyzed using qualitative content analysis to generate themes and subthemes. Results: Eight themes and twenty-seven subthemes emerged from the study. The following are themes; ① Variations of male and female nurses in communication ② Differences of male and female nurses in carrying out leadership roles ③ Divergent clinical qualities and outcomes across nursing gender ④ Positive value of male nurses in clinical facilities from colleagues and patients ⑤ Different cooperation of male and female nurses at the clinical settings ⑥ Mixed perspective towards clinical competencies across nursing gender ⑦ Perspective towards gender diversity in nursing ⑧ Preferences of nurse's gender, reasons, and opinion towards gender preferences. Conclusion: Male nurses and female nurses differ in how they communicate, execute leadership roles, and clinical qualities. However, their variations don't mean one gender is underrated than the other, but every gender has unique communication styles, leadership styles, and clinical qualities that both lead to effective outcomes. Diversity in nursing gender is very important and should be strategized. Since preferences of nursing gender seems to enhance somebody's freedom and creates an environment where a person can discuss sensitive issues, nursing bodies and healthcare stakeholders might initiate a discussion about approaches to promote the implementation of nursing preference and perform the feasibility studies. [ABSTRACT FROM AUTHOR]

Background: Mortality rate estimation in small areas can be difficult due the low number of events/exposure (i.e. stochastic error). If the death records are not completed, it adds a systematic uncertainty on the mortality estimates. Previous studies in Brazil have combined demographic and statistical methods to partially overcome these issues. We estimated age- and sex-specific mortality rates for all 5,565 Brazilian municipalities in 2010 and forecasted probabilistic mortality rates and life expectancy between 2010 and 2030. Methods: We used a combination of the Tool for Projecting Age-Specific Rates Using Linear Splines (TOPALS), Bayesian Model, Spatial Smoothing Model and an ad-hoc procedure to estimate age- and sex-specific mortality rates for all Brazilian municipalities for 2010. Then we adapted the Lee-Carter model to forecast mortality rates by age and sex in all municipalities between 2010 and 2030. Results: The adjusted sex- and age-specific mortality rates for all Brazilian municipalities in 2010 reveal a distinct regional pattern, showcasing a decrease in life expectancy in less socioeconomically developed municipalities when compared to estimates without adjustments. The forecasted mortality rates indicate varying regional improvements, leading to a convergence in life expectancy at birth among small areas in Brazil. Consequently, a reduction in the variability of age at death across Brazil's municipalities was observed, with a persistent sex differential. Conclusion: Mortality rates at a small-area level were successfully estimated and forecasted, with associated uncertainty estimates also generated for future life tables. Our approach could be applied across countries with data quality issues to improve public policy planning. [ABSTRACT FROM AUTHOR]

To identify barriers and enablers for access to and participation in rehabilitation for people with LLA in East, South, and Southeast Asian developing countries from the perspective of rehabilitation professionals. A mixed-method study involving an anonymous cross-sectional screening survey followed by in-depth interviews of rehabilitation professionals in these regions following the COREQ guidelines. Participants were surveyed online using convenience and snowball sampling techniques to inform a purposive heterogenic sample for semi-structured online interviews, between September 2021 to February 2022. Interview transcripts were analysed and thematically coded using the modified Health Care Delivery System Approach (HCDSA) framework. A total of 201 quantitative survey responses shaped the interview questions and participation of 28 participants from 13 countries for the qualitative investigation. Important factors at the patient level were sex, economics, health issues, language differences, and lack of awareness; at the care team level, peer and/or family support, referrals, and the gender of the professional; at the organizational level, service availability, resources, and quality; and at the environmental level, policies, supports, and physical and/or social accessibility. Identified interlinked factors at multiple levels of the HCDSA underpin the need for a systems approach to develop and address regional rehabilitation service provision but requires contextually adapted policy. Amputation rehabilitation practices need improvements in the developing Asian region including evaluation and redesign of, and processes and policies by, policy makers with increased support for those with lower limb amputation. The consistent factors identified in these regions as negatively impacting rehabilitation services suggest opportunities to collaborate and design common mitigation approaches between rehabilitation providers across countries. Unique local factors impacting rehabilitation in different countries suggest the necessity for customization in consultation with rehabilitation practitioners rather than the adoption of generic charitable models by external agencies. Rehabilitation professionals and others responsible for rehabilitation policy and practice should systematically target factors impacting rehabilitation outcomes for improvements at all levels within the health care systems. [ABSTRACT FROM AUTHOR]

Background: Regulatory actions are increasingly used to tackle issues such as excessive alcohol or sugar intake, but such actions to reduce sedentary behaviour remain scarce. World Health Organization (WHO) guidelines on sedentary behaviour call for system-wide policies. The Chinese government introduced the world's first nation-wide multi-setting regulation on multiple types of sedentary behaviour in children and adolescents in July 2021. This regulation restricts when (and for how long) online gaming businesses can provide access to pupils; the amount of homework teachers can assign to pupils according to their year groups; and when tutoring businesses can provide lessons to pupils. We evaluated the effect of this regulation on sedentary behaviour safeguarding pupils. Methods: With a natural experiment evaluation design, we used representative surveillance data from 9- to 18-year-old pupils before and after the introduction of the regulation, for longitudinal (n = 7,054, matched individuals, primary analysis) and repeated cross-sectional (n = 99,947, exploratory analysis) analyses. We analysed pre-post differences for self-reported sedentary behaviour outcomes (total sedentary behaviour time, screen viewing time, electronic device use time, homework time, and out-of-campus learning time) using multilevel models, and explored differences by sex, education stage, residency, and baseline weight status. Results: Longitudinal analyses indicated that pupils had reduced their mean total daily sedentary behaviour time by 13.8% (95% confidence interval [CI]: -15.9 to -11.7%, approximately 46 min) and were 1.20 times as likely to meet international daily screen time recommendations (95% CI: 1.01 to 1.32) one month after the introduction of the regulation compared to the reference group (before its introduction). They were on average 2.79 times as likely to meet the regulatory requirement on homework time (95% CI: 2.47 to 3.14) than the reference group and reduced their daily total screen-viewing time by 6.4% (95% CI: -9.6 to -3.3%, approximately 10 min). The positive effects were more pronounced among high-risk groups (secondary school and urban pupils who generally spend more time in sedentary behaviour) than in low-risk groups (primary school and rural pupils who generally spend less time in sedentary behaviour). The exploratory analyses showed comparable findings. Conclusions: This regulatory intervention has been effective in reducing total and specific types of sedentary behaviour among Chinese children and adolescents, with the potential to reduce health inequalities. International researchers and policy makers may explore the feasibility and acceptability of implementing regulatory interventions on sedentary behaviour elsewhere. [ABSTRACT FROM AUTHOR]

Objective: This research aimed to identify the fundamental and geographic characteristics of the primary healthcare personnel mobility in Nanning from 2000 to 2021 and clarify the determinants that affect their transition to non-primary healthcare institutions. Methods: Through utilizing the Primary Healthcare Personnel Database (PHPD) for 2000–2021, the study conducts descriptive statistical analysis on demographic, economic, and professional aspects of healthcare personnel mobility across healthcare reform phases. Geographic Information Systems (QGIS) were used to map mobility patterns, and R software was employed to calculate spatial autocorrelation (Moran's I). Logistic regression identified factors that influenced the transition to non-primary institutions. Results: Primary healthcare personnel mobility is divided into four phases: initial (2000–2008), turning point (2009–2011), rapid development (2012–2020), and decline (2021). The rapid development stage saw increased mobility with no spatial clustering in inflow and outflow. From 2016 to 2020, primary healthcare worker mobility reached its peak, in which the most significant movement occurred between township health centers and other institutions. Aside from their transition to primary medical institutions, the primary movement of grassroots health personnel predominantly directs towards secondary general hospitals, tertiary general hospitals, and secondary specialized hospitals. Since 2012, the number and mobility distance of primary healthcare workers have become noticeably larger and remained at a higher level from 2016 to 2020. The main migration of primary healthcare personnel occurred in their districts (counties). Key transition factors include gender, education, ethnicity, professional category, general practice registration, and administrative division. Conclusions: This study provides evidence of the features of primary healthcare personnel mobility in the less developed western regions of China, in which Nanning was taken as a case study. It uncovers the factors that impact the flow of primary healthcare personnel to non-primary healthcare institutions. These findings are helpful to policy refinement and support the retention of primary healthcare workers. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study is to assess the concordance and its association with sociocultural background of a four‐question survey with accelerometry in a multiethnic adolescent population, regarding sleep components. Based on questions from the Pittsburgh Sleep Quality Index and adapted to a school context, the questionnaire focussed on estimating sleep onset time, wake‐up time and sleep duration on both weekdays and weekends. This subjective survey was compared with accelerometry data while also considering the influence of sociocultural factors (sex, place of living, ethnic community and socio‐economic status). Methods: Adolescents aged 10.5–16 years (n = 182) in New Caledonia completed the survey and wore an accelerometer for seven consecutive days. Accelerometry was used to determine sleep onset and wake‐up time using validated algorithms. Based on response comparison, Bland–Altman plots provided agreement between subjective answers and objective measures. We categorized participants' answers to the survey into underestimated, aligned and overestimated categories based on time discrepancies with accelerometry data. Multinomial regressions highlighted the sociocultural factors associated with discrepancies. Results: Concordance between the accelerometer and self‐reported assessments was low particularly during weekends (18%, 26% and 19% aligned for onset sleep time, wake‐up time and sleep duration respectively) compared with weekdays (36%, 53% and 31% aligned, respectively). This means that the overall concordance was less than 30%. When considering the sociocultural factors, only place of living was associated with discrepancies in onset sleep time and wake‐up time primarily on weekdays. Rural adolescents were more likely to overestimate both onset sleep time (B = −1.97, p < 0.001) and wake‐up time (B = −1.69, p = 0.003). Conclusions: The study found low concordance between self‐assessment and accelerometry outputs for sleep components. This was particularly low for weekend days and for participants living in rural areas. While the adapted four‐item questionnaire was useful and easy to complete, caution should be taken when making conclusions about sleep habits based solely on this measurement. [ABSTRACT FROM AUTHOR]

Background: This study examined the proportion of Iranian children who met the World Health Organization (WHO) Guidelines for physical activity, sedentary behaviour and sleep for children under 5 years. Additionally, it investigated the feasibility and acceptability of the methods to be used in the SUNRISE study. Methods: This pilot study was conducted among 83 children aged 3 and 4 years in preschools and health care centres in Iran, in 2022. Physical activity, sedentary behaviour and sleep (ActiGraph wGT3x‐BT); fine and gross motor skills (validated activities); and executive functions (the Early Years Toolbox) were assessed. Results: Only four (4.8%) children met all recommendations of the WHO guidelines. The proportion of children who met MVPA, TPA, screen time, restrained sitting and sleep were 44.6%, 38.6%, 19.3%, 38.6% and 65.1%, respectively. Fifty‐two (62.6%) children wore the ActiGraph for at least three full days. A total of 97.6%, 95.1% and 91.5% of children completed anthropometric, EF and motor skill assessments, respectively. Conclusion: This pilot study was feasible and acceptable among Iranian children. Regarding the low proportion of children who met the WHO guidelines, it is recommended that long‐term and practical strategies be developed to promote healthier lifestyles among preschool children in Iran. [ABSTRACT FROM AUTHOR]

Simple Summary: Colorectal cancer is one of the leading causes of cancer-related deaths in the US. Lately, there has been a rise in colorectal cancer in younger patients; however, there is a paucity of data on geographical variations of early-onset colorectal cancer in the US. Thus, our study aimed to evaluate the temporal change in early-onset colorectal cancer incidence rates in different regions in the US and assess these trends by sex and histopathological subtypes. We analyzed data from 2001 to 2020 from the United States Cancer Statistics database, which encompasses nearly 98% of the US population. Our results demonstrated that early-onset colorectal cancer incidence rates and time trends increased in men and women across different regions in the US, with the steepest increase noted in the west and the least in the south. These findings persisted across both main colorectal cancer histopathological subtypes (adenocarcinoma and neuroendocrine tumors) with neuroendocrine tumors showing a more pronounced increase compared to adenocarcinoma, especially in the west and northeast. Our findings hold public health implications prompting healthcare policies and future research to investigate any disproportional exposure to region-specific risk factors over the past two decades in the US, especially in western regions. Background: Colorectal cancer remains the second leading cause of cancer-related death in the US. As early-onset colorectal cancer (EO-CRC) becomes more prevalent in the US, research attention has shifted towards identifying at-risk populations. Previous studies have highlighted the rising rate of early-onset adenocarcinoma (ADC) and neuroendocrine tumors (NET) in the US. However, data on geographical variations of EO-CRC are scarce. Hence, our study aims to analyze time trends in EO-CRC incidence rates across various US regions and to assess these trends by sex and histopathological subtypes (ADC and NET). Methods: We analyze data spanning from 2001 to 2020 from the United States Cancer Statistics (USCS) database, covering nearly 98% of the US population. Using SEER*Stat software version (8.4.2, NCI), we calculated EO-CRC incidence rates among adults aged 20–54 years, adjusting for the age standard 2000 US population. The rates were categorized by sex and US geographical regions into west, midwest, northeast, and south. Time trends, reported as annual percentage change (APC) and average APC (AAPC), were generated via Joinpoint Regression software (v.5.0.2, NCI) utilizing the weighted Bayesian Information Criteria "BIC" method to generate the best-fit trends with a two-sided p-value cutoff at 0.05. The rates were also stratified by histopathology into ADC and NET. Results: Between 2001 and 2020, a total of 514,875 individuals were diagnosed with early-onset CRC in the US, with 54.78% being men. Incidence rates and trends varied across geographical regions. In the western region (comprising 106,685 patients, 54.85% men), incidence rates significantly increased in both women (AAPC = 1.37, p < 0.001) and men (AAPC = 1.34, p < 0.001). Similarly, in the midwestern region (with 110,380 patients, 55.46% men), there were significant increases in incidence rates among women (AAPC = 1.06, p < 0.001) and men (AAPC = 1.35, p < 0.001). The northeastern region (with 94,758 patients, 54.53% men) also witnessed significant increases in incidence rates for both women (AAPC = 0.71, p < 0.001) and men (AAPC = 0.84, p < 0.001). In contrast, the southern region (with 203,052 patients, 54.48% men) experienced slower increases in incidence rates among both women and men (AAPC = 0.25, p < 0.05 in women; AAPC = 0.66, p < 0.05 in men). When stratified by histopathology, incidence rates for adenocarcinomas (ADC) increased in all regions, most notably in the west (AAPC = 1.45, p < 0.05), and least in the south (AAPC = 0.46, p < 0.05). Conversely, for neuroendocrine tumors (NET), while incidence rates increased similarly across all regions, the pace was notably faster compared to ADC, particularly in the west (AAPC = 3.26, p < 0.05) and slower in the south (AAPC = 2.24, p < 0.05) Discussion: Our analysis of nationwide US data spanning two decades and encompassing over half a million early-onset CRC patients, representing nearly 98% of the US population, highlights significant temporal variation in incidence rates across various geographical regions. The most substantial increases in incidence rates were observed in the west, while the least pronounced changes were noted in the south, affecting both men and women. These trends persisted across the main CRC histopathological subtypes, with NET exhibiting a notably swifter pace of increase compared with ADC. These findings hold important implications for public health strategies and underscore the need for targeted interventions to address the rising burden of early-onset CRC across different regions in the US. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine the association between missed CMS Star Ratings quality measures for medication adherence over 3 years for diabetes, hypertension, and hyperlipidemia medications (9 measures) and health care utilization and relative costs. STUDY DESIGN: Retrospective cohort study. METHODS: The study examined eligible patients who qualified for the diabetes, statin, and renin-angiotensin system antagonist medication adherence measures in 2018, 2019, and 2020 and were continuously enrolled in a Medicare Advantage prescription drug plan from 2017 through 2021. Atotal of 103,900 patients were divided into 4 groups based on the number of adherence measures missed (3 medication classes over 3 years): (1) missed 0 measures, (2) missed 1measure, (3) missed 2 or 3 measures, and (4) missed 4 or more measures. To achieve a quality measure, patients had to meet the Pharmacy Quality Alliance 80% threshold of proportion of days covered during the calendar year. RESULTS: The mean age of the cohort was 71.1 years, and 49.9% were female. Compared with patients who missed 0 of 9 adherence measures, those who missed 1 measure, 2 or 3 measures, and 4 or more measures experienced 12% to 26%, 22% to 42%, and 24% to 50% increased risks, respectively, of all-cause and diabetes-related inpatient stays and all-cause and diabetes-related emergency department visits (allPvalues<.01). Additionally, patients who missed 1, 2 or 3, and 4 or more adherence measures experienced 14%, 19%, and 20% higher monthly medical costs, respectively. CONCLUSIONS: Missing Star Ratings quality measures for medication adherence was associated with an increased likelihood of health care resource utilization and increased costs for patients taking medications to treat diabetes, hypertension, and hyperlipidemia. [ABSTRACT FROM AUTHOR]

Objective: The goal of this study was to provide complete, robust data on annual systemic lupus erythematosus (SLE) incidence rates over nearly two decades from the Southeast Norway area (2.9 million inhabitants) and assess accuracy of SLE‐specific International Classification of Diseases (ICD) codes for SLE diagnosis. Methods: From administrative databases, we identified all cases International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD‐10) coded as SLE during 1999 through 2017 in Southeast Norway. We manually reviewed the chart of every case ICD‐10 coded as SLE to either confirm or reject SLE diagnosis. Using SLE classification criteria, we classified all cases with confirmed SLE. We estimated annual incidence rates of classified SLE, and subsets, defined by age at diagnosis, sex, and parental country of birth. The chi‐square test was applied for linear time‐trend analyses of incidence. Results: Among the 3,488 cases ICD‐10 coded as SLE, chart reviews confirmed SLE diagnosis in 1,558 (45%), of which 797 had new‐onset disease during 1999 through 2017. Annual SLE incidence rates fell during 1999 to 2017. The fall was most pronounced in female persons 50 to 59 years old at diagnosis, in whom incidence fell from 3.4 to 1.1 per 100,000 persons (P trend < 0.001). Concurrent ecological data from the study area showed a 74% reduction in prescriptions of menopausal hormone treatment. Accuracy of ICD‐10 codes for incident SLE diagnosis was acceptable in juveniles and young adults (up to 20 years) but otherwise low. Conclusion: In a presumably complete population‐based cohort, we identified decreasing incidence of SLE, especially among female persons 50 to 59 years old. Although reasons for declining incidence are not clear, ecological data indicate a possible role of environmental factors, for example, menopausal hormone treatments. [ABSTRACT FROM AUTHOR]

Cohabitation has become more common in communities that have experienced demographic transitions, including in Taiwan, and hence it has become a research interest. However, our understanding of cohabitation in Taiwan has been limited to indirect estimations and cross-sectional analysis due to the lack of appropriate data. These analyses can provide a quick overview of the prevalence of cohabitation at specific periods, but they cannot portray the risk of cohabitation over the life course. Using recent panel data from the Taiwan Youth Project, we estimate cohabitation risk among young adults in their mid-20s to early-30s. We also examine the determinants of cohabitation. Results show that being a woman, not employed, living in emerging regions, not having varying residential locations, ever having sex (especially at an earlier age), and being more open to premarital intimacy were associated with higher odds of cohabitation. [ABSTRACT FROM AUTHOR]

Background and aims: Problematic pornography use (PPU) is a common manifestation of the newly introduced Compulsive Sexual Behavior Disorder diagnosis in the 11th edition of the International Statistical Classification of Diseases and Related Health Problems. Although cultural, gender‐ and sexual orientation‐related differences in sexual behaviors are well documented, there is a relative absence of data on PPU outside Western countries and among women as well as gender‐ and sexually‐diverse individuals. We addressed these gaps by (a) validating the long and short versions of the Problematic Pornography Consumption Scale (PPCS and PPCS‐6, respectively) and the Brief Pornography Screen (BPS) and (b) measuring PPU risk across diverse populations. Methods: Using data from the pre‐registered International Sex Survey [n = 82 243; mean age (Mage) = 32.4 years, standard deviation = 12.5], a study across 42 countries from five continents, we evaluated the psychometric properties (i.e. factor structure, measurement invariance, and reliability) of the PPCS, PPCS‐6, and BPS and examined their associations with relevant correlates (e.g. treatment‐seeking). We also compared PPU risk among diverse groups (e.g. three genders). Results: The PPCS, PPCS‐6, and BPS demonstrated excellent psychometric properties [for example, comparative fit index = 0.985, Tucker–Lewis Index = 0.981, root mean square error of approximation = 0.060 (90% confidence interval = 0.059–0.060)] in the confirmatory factor analysis, with all PPCS' inter‐factor correlations positive and strong (rs = 0.72–0.96). A total of 3.2% of participants were at risk of experiencing PPU (PPU+) based on the PPCS, with significant country‐ and gender‐based differences (e.g. men reported the highest levels of PPU). No sexual orientation‐based differences were observed. Only 4–10% of individuals in the PPU+ group had ever sought treatment for PPU, while an additional 21–37% wanted to, but did not do so for specific reasons (e.g. unaffordability). Conclusions: This study validated three measures to assess the severity of problematic pornography use across languages, countries, genders, and sexual orientations in 26 languages: the Problematic Pornography Consumption Scale (PPCS, and PPCS‐6, respectively), and the Brief Pornography Screen (BPS). The problematic pornography use risk is estimated to be 3.2–16.6% of the population of 42 countries, and varies among different groups (e.g. genders) and based on the measure used. [ABSTRACT FROM AUTHOR]

This meta-analysis aimed to evaluate the relation between posttraumatic stress symptoms and quality of life in samples of participants exposed to childhood traumatic experiences. To test these relations, we conducted a systematic review of the literature on PTSD symptoms and quality of life. We identified 16 eligible studies that we included in the meta-analysis. Based on previous literature, we hypothesized that: (1) there is a negative relation between PTSD symptoms and quality of life; (2) the relation between PTSD symptoms and quality of life differs based on the type of childhood trauma and the type of trauma exposure; (3) the relation between PTSD symptoms and quality of life differs based on the dimensions of quality of life; (4) the relation between PTSD symptoms and quality of life vary according to gender, age, the region where the studies were conducted, the type of PTSD symptomatology measurement, and quality of life. The quantitative analysis was conducted using meta-analytic techniques. Results sustained the fact that there is a negative relation between PTSD symptoms and quality of life. Moreover, the relation between PTSD symptoms and quality of life depends on the type of trauma, gender, age, region where the studies were conducted, type of measure for PTSD symptoms, and quality of life. The theoretical and practical implications of these results are discussed. [ABSTRACT FROM AUTHOR]

Background: Social and geographical inequity in access to primary healthcare is an ongoing concern in Sweden. Digital care can potentially decrease geographical inequity. This study aimed to evaluate how urbanicity affects the utilization of a public digital primary healthcare service - PHC Online. Methods: We performed an ecological cross-sectional study of 4,482 PHC Online visits grouped by 83 public primary healthcare centers. Multiple linear regression analysis was performed with PHC Online visits per 1,000 registered patients as the dependent variable and urbanicity (municipalities grouped by number of inhabitants), socioeconomic status (Care Need Index), and morbidity (Adjusted Clinical Groups) per primary healthcare center as independent variables. Results: Utilization of PHC Online was more common among those of a younger age (median 32 years) and among women (65%). Urbanicity did not affect utilization. Lower socioeconomic status and higher morbidity had negative effects on utilization (B -3.289, p = 0.001, B -7.728, p = 0.045). Conclusions: Geographical differences based on urbanicity do not seem to affect the utilization of PHC Online. Further studies are needed to clarify a possible association to geographical barriers in access to primary healthcare, specifically accounting for factors associated with urbanicity and distance to physical clinics, and how age and sex affect such an association. Lower utilization of PHC Online in low socioeconomic status and high morbidity populations raises questions on the effect of digital primary care on equitable access to primary healthcare. [ABSTRACT FROM AUTHOR]

Current research suggests that women students may increasingly turn to sex work to help finance their education due to increased economic demands and its glamourization in the media. To date, no research has empirically examined the influence of societal factors, such as the proliferation of digital technology, as factors increasing positive attitudes toward sex work. Addressing this gap, this exploratory study investigated whether women's attitudes varied based on the context and venue of sex work. Additionally, the authors sought to enhance the understanding of established factors linked to attitudes toward sex work. One hundred fifty women-identified students completed an online survey with a within-subjects design to measure their attitudes toward five different types of sex work varying in level and type of contact from street level (in person/full contact) to webcamming (internet-mediated/no contact). In general, women students had negative attitudes toward sex work but held mildly positive attitudes regarding the activity/potency of sex work and, potentially, the women who engage in it. More positive attitudes were held toward sex work when women could maintain a "distance" between themselves and the client, either through a lack of direct genital contact or through digital technology. This research offers a detailed examination of university women's attitudes toward various forms of sex work, uncovering valuable insights into societal perceptions and how these attitudes vary depending on the context and location of sex work. [ABSTRACT FROM AUTHOR]

The purpose of this analysis is to describe HIV tests and associated outcomes for Asian people reached by the Centers for Disease Control and Prevention (CDC) HIV testing program. We analyzed CDC-funded HIV tests among Asian individuals in the United States, Puerto Rico, and the U.S. Virgin Islands (2014-2020). Of the 415,560 tests, the positivity of new diagnoses was higher among males (0.49%, aPR = 7.64) than females (0.06%), and in the West (0.42%, aPR = 1.15) than in the South (0.25%). In non-health care settings, positivity was highest among men who have sex with men (MSM; 0.87%) and transgender people (0.46%). Linkage to HIV medical care among Asian people was 87.5%, and 70.7% were interviewed for partner services. Our findings suggest that improvements are crucial, particularly for Asian MSM, in linkage to care and interview for partner services. [ABSTRACT FROM AUTHOR]

Introduction: There is a long standing and worsening shortage of psychiatrists in Australia particularly in rural areas. The majority of psychiatrists work in major cities. Objective: To identify recent trends in the Australian rural psychiatrist workforce compared with the metropolitan workforce. Design: We descriptively analysed population‐level data from the National Health Workforce Data Set (NHWDS), the Australian Institute of Health and Welfare (AIHW) and the Australian Bureau of Statistics (ABS). A descriptive analysis of the numbers (count) and gender of psychiatrists from 1995 to 2022 working in Australia was conducted. For the period 2013 to 2022, we analysed for rurality, gender, years' experience, hours worked, Medicare‐subsidised services provided and proportions of Specialist International Medical Graduates (SIMG) by sex, with a focus on the rural workforce. For international comparison, psychiatrist numbers were obtained for other OECD countries. The number of psychiatrists working in Australia, as per NHWDS and AIHW, was quantified. We analysed trends in demographics, hours worked and rurality of psychiatrists working in Australia in a serial cross‐sectional design. Findings: Most psychiatrists are maldistributed to major cities, while outer regional and remote areas have few resident psychiatrists. Outer regional New South Wales (NSW) and South Australia (SA) have the lowest numbers of psychiatrists per capita. The full‐time equivalent (FTE) of psychiatrists per 100 000 has increased from 12.6 in 2000 to 15.2 in 2022. However, the average hours worked by psychiatrists has declined. In total, available psychiatrist hours worked per 100 000 population has increased by 6.1% since the beginning of the millennium. Discussion: Rural areas in NSW and SA have the greatest shortage of psychiatrists. Specialist International Medical Graduates and females (43% of the overall workforce) are the predominant workforce in rural areas. Although Medicare‐subsidised services per 1000 people have increased in rural areas, they remain lower than for those living in major cities. Conclusion: There remains an acute shortage of psychiatrists in many regional and remote areas of Australia, with an increasing proportion of SIMGs and females working in these areas, in the context of future increased demand. [ABSTRACT FROM AUTHOR]

We compare the impact of the first two waves of the COVID-19 pandemic on risk of age-standardized mortality by sex, UK country, and English region. Each wave is defined as lasting 26weeks and are consecutive beginning in 2020week 11. The expected rate is estimated from 2015 to 2019 mean and the projected mortality trend from the same period are used to estimate excess mortality. By both measures, excess mortality was highest and lowest in regions of England, London and the South-West, respectively. Excess mortality was consistently higher for males than females. [ABSTRACT FROM AUTHOR]

Asthma is the most common chronic disease in children, disproportionately affects families with lower incomes, and is a leading reason for acute care visits and hospitalizations. This retrospective cohort study used the Massachusetts All Payer Claims Database (2014–2018) to examine differences in acute care utilization and quality of care for asthma between Medicaid- and privately insured children in Massachusetts. Outcomes included acute care use (emergency department [ED] or hospitalization), ED visits with asthma, routine asthma visits, and filled prescriptions for asthma medications. Multivariable logistic regression was used to account for differences in demographics, ZIP codes, health status, and asthma severity. Overall, 10.0% of Medicaid-insured children and 5.6% of privately insured were classified as having asthma. Among 317,596 child-year observations for children with asthma, 64.4% were insured by Medicaid. Medicaid-insured children had higher rates of any acute care use (50.4% vs. 30.0%) and ED visits with an asthma diagnosis (27.2% vs. 13.3%) compared to privately insured children. Only 65.4% of Medicaid enrollees had at least one routine asthma visit compared to 74.3% of privately insured children. Most children received at least one asthma medication (88.6% Medicaid vs. 83.3% privately insured), but a higher percentage of Medicaid-insured children received at least one rescue medication (84.0% vs. 73.7%), and a lower percentage of Medicaid-insured (46.1% vs. 49.2%) received a controller medication. These results suggest that opportunities for improvement in childhood asthma persist, particularly for children insured by Medicaid. [ABSTRACT FROM AUTHOR]

Objective: Our objectives with this study were to describe the frequency of selected cooccurring health conditions and individualized education program (IEP) services and post-high school transition planning for adolescents with autism spectrum disorder and identify disparities by sex, intellectual ability, race or ethnicity, and geographic area. Methods: The study sample included 1787 adolescents born in 2004 who were identified as having autism through a health and education record review through age 16 years in 2020. These adolescents were part of a longitudinal population-based surveillance birth cohort from the Autism and Developmental Disabilities Monitoring Network from 2004 to 2020 in 5 US catchment areas. Results: Attention deficit hyperactivity disorder (47%) and anxiety (39%) were the most common cooccurring health conditions. Anxiety was less commonly identified for those with intellectual disability than those without. It was also less commonly identified among Black adolescents compared with White or Hispanic adolescents. There was wide variation across Autism and Developmental Disabilities Monitoring Network sites in the provision of school-based IEP services. Students with intellectual disability were less likely to receive school-based mental health services and more likely to have a goal for postsecondary independent living skills compared with those without intellectual disability. A total of 37% of students did not participate in standardized testing. Conclusions: We identified disparities in the identification of cooccurring conditions and school-based IEP services, practices, and transition planning. Working with pediatric health and education providers, families, and adolescents with autism will be important to identify contributing factors and to focus efforts to reduce disparities in the supports and services adolescents with autism have access to and receive. [ABSTRACT FROM AUTHOR]

Summary: Awareness of the prevalence of osteoporosis and fractures across jurisdictions can guide the development of local preventive programs and healthcare policies. We observed geographical variations in total hip bone mineral density and in the prevalence of major osteoporotic fractures across Canadian provinces, which persisted after adjusting for important covariates. Purpose: We aimed to describe sex-specific total hip bone mineral density (aBMD) and prevalent major osteoporotic fractures (MOF) variation between Canadian provinces. Methods: We used baseline data from 21,227 Canadians (10,716 women, 10,511 men) aged 50–85 years in the Canadian Longitudinal Study on Aging (CLSA; baseline: 2012–2015). Linear and logistic regression models were used to examine associations between province of residence and total hip aBMD and self-reported MOF, stratified by sex. CLSA sampling weights were used to generate the prevalence and regression estimates. Results: The mean (SD) age of participants was 63.9 (9.1) years. The mean body mass index (kg/m2) was lowest in British Columbia (27.4 [5.0]) and highest in Newfoundland and Labrador (28.8 [5.3]). Women and men from British Columbia had the lowest mean total hip aBMD and the lowest prevalence of MOF. Alberta had the highest proportion of participants reporting recent falls (12.0%), and Manitoba (8.4%) the fewest (p-value=0.002). Linear regression analyses demonstrated significant differences in total hip aBMD: women and men from British Columbia and Alberta, and women from Manitoba and Nova Scotia had lower adjusted total hip aBMD than Ontario (p-values<0.02). Adjusted odds ratios (95% confidence intervals, CI) for prevalent MOF were significantly lower in women from British Columbia (0.47 [95% CI: 0.32; 0.69]) and Quebec (0.68 [95% CI: 0.48; 0.97]) and in men from British Columbia (0.40 [95% CI:0.22; 0.71]) compared to Ontario (p-values<0.03). Results were similar when adjusting for physical performance measures and when restricting the analyses to participants who reported White race/ethnicity. Conclusion: Geographical variations in total hip aBMD and in the prevalence of MOF between provinces persisted after adjusting for important covariates which suggests an association with unmeasured individual and environmental factors. [ABSTRACT FROM AUTHOR]

Objective: To map Greek academic otolaryngologists, and assess gender, age and location-related differences in their rank and academic productivity. Methods: A pre-established database of local and diaspora scientists was used, after adjustment and updating for otolaryngology. The following data were recorded: age, gender, academic rank, country of work, total citations and h-index of December 2022. Results: A total of 276 Greek academic otolaryngologists were identified in the Scopus database. Of Greek otolaryngologists, 15.9 per cent are women. Of all academic otolaryngologists, 27.1 per cent have a university post, but only 4 per cent of them are women. There is an almost linear correlation between university post ranking and citations. Otolaryngologists based in Greece accounted for 3 out of the 10 most cited Greek otolaryngologists. Conclusion: There are significant age, gender and location-related differences in academic output. The representation of women and the full use of their potential in medicine require proactive measures, to lift the burdens limiting their participation. [ABSTRACT FROM AUTHOR]

High-risk sexual behavior is the primary risk factor for the acquisition and persistence of human papillomavirus (HPV) infection and the development of HPV-associated diseases including cancer. Incidence of HPV infection is high among individuals in their late teens and early 20s. Thus, college students represent a historically high-risk group for HPV infection yet are also a group with the ability to independently access HPV vaccination for HPV prevention. To inform future interventions, we examined factors associated with HPV-associated risky sexual behaviors among sexually active college students. Data (N = 741) were from an anonymous online survey distributed to students at a public Midwestern university in 2021. The outcomes were HPV-associated sexual risk behaviors—number of oral or vaginal sexual partners [high (≥ 5) or low (< 5)] and age of oral or vaginal sexual debut [early (< 18 years) or late (≥ 18 years)]. Multivariable logistic regression models estimated the association between HPV-associated risky sexual behaviors and several predictors including age, gender, relationship status, academic level, country of birth, and rural–urban status. Among sexually active students, approximately 47% and 41% had a high number of lifetime vaginal and oral partners, respectively. Among the same group, 60% and 64% had early vaginal and oral sexual debut. Students who were single and dating (aOR = 1.93; 95% CI = 1.21, 3.08) or single and not dating (2.11; 1.28, 3.48) were more likely to have a high number of vaginal lifetime partners compared with married students. Single (vs. married) students were also about twice as likely to have a high number of oral lifetime partners. Relative to graduate students, freshmen/sophomores were more likely to have an early vaginal (2.44; 1.45, 4.11) and oral (2.14; 1.26, 3.63) sexual debut. Interventions tailored to college freshmen/sophomores and unmarried students should encourage students to receive the HPV vaccine for prevention of future HPV-associated diseases. [ABSTRACT FROM AUTHOR]

Protective factors have been established as moderators in the association among adverse experiences and future outcomes as suicidality in adulthood, performing child-to-parent violence or exhibiting trauma-related responses, therefore establishing the need to explore protective factors and their characteristics. The aim of this study is to identify profiles among protective factors in children and adolescents at risk, and to relate these profiles to several sociodemographic variables such as age, gender, country of origin (native as opposed to immigrant) and the type of family structure (being a single parent family or a bi-parent family). Data was collected from professionals involved in the Children Protective Services (CPS). Sample was composed by 635 children and adolescents involved in the CPS. Protective factors were assessed by the Adolescents and Children Risk of Abuse and Maltreatment Protective Factors Scale (ACRAM-PFS). A Latent Profile Analysis (LPA) was estimated. Six profiles were retained. Membership to these profiles was associated to gender, age, family structure and country of origin. Country of origin showed significant association to several profiles. Information provided in this study is novel and can help to improve quality of interventions from an ecological perspective. Highlights: Person-centered approach adds new light in the children maltreatment literature. This study is the first to analyze the latent profiles of protective factors against child maltreatment. We obtained six conceptually meaningful profiles. This information should be utilized to tailor more effective intervention programs. We also found significant differences in the proportion native and foreigner children. [ABSTRACT FROM AUTHOR]

Background: By 2030, the UN expects 1.4 billion older adults and 2.1 billion by 2050. By 2050, 80 percent of older persons will live in developing nations. This demographic shift will present new challenges and opportunities in several areas, including health, migration, employment, and social safety nets. This study's aims were to: (1) present novel evidence on the trends and determinants of well‐being and well‐being inequality among older people around the world; and (2) highlight variation across World Bank development groups. Methods: The study utilizes individual‐level survey data from nine waves of the Gallup World Poll (2009–2017), which is representative of about 99.5% of the global population. First, we report country‐level panel evidence on well‐being and well‐being inequality for adults over 60 years of age. Second, we estimate regressions to identify the individual‐level determinants of well‐being and well‐being inequality. Results: Our results indicate that average levels of happiness vary little over time. This holds for all World Bank development groups. In contrast, we show that inequality in well‐being increases for all categories except in high‐income countries. Examining the factors that influence well‐being and well‐being inequality reveals the particular importance of income, social ties, and health. We also reveal gender differences in global well‐being; women tend to be happier than men. Lastly, whereas variations in inequity‐causing factors are minimal when comparing older to younger individuals, they vary substantially when comparing across development groups. Conclusions: Our findings suggest that rather than focusing on the average level of well‐being among older people, governments should consider the full distribution of well‐being. This requires a special emphasis on health, social networks, and education, as well as the assessment of distributional impacts in policy proposals. [ABSTRACT FROM AUTHOR]

Background: Māori have three times the mortality from lung cancer compared with non‐Māori. The Te Manawa Taki region has a population of 900 000, of whom 30% are Māori. We have little understanding of the factors associated with developing and diagnosing lung cancer and ethnic differences in these characteristics. Aims: To explore the differences in the incidence and characteristics of patients with newly diagnosed lung cancer between Māori and non‐Māori. Methods: Patients were identified from the regional register. Incidence rates were calculated based on population data from the 2013 and 2018 censuses. The patient and tumour characteristics of Māori and non‐Māori were compared. The analysis used Χ2 tests and logistic models for categorical variables and Student t tests for continuous variables. Results: A total of 4933 patients were included, with 1575 Māori and 3358 non‐Māori. The age‐standardised incidence of Māori (236 per 100 000) was 3.3 times higher than that of non‐Māori. Māori were 1.3 times more likely to have an advanced stage of disease and 1.97 times more likely to have small cell lung cancer. Māori were more likely to have comorbidities, chronic obstructive pulmonary disease, cardiovascular disease and diabetes. They also had higher levels of social deprivation and tended to be younger, female and current smokers. Conclusions: The findings point to the need to address barriers to early diagnosis and the need for system change including the need to introduce a lung cancer screening focussing on Māori. There is also the need for preventive programmes to address comorbidities that impact lung cancer outcomes as well as a continued emphasis on creating a smoke‐free New Zealand. [ABSTRACT FROM AUTHOR]

The article assesses differences in lifetime losses caused by premature deaths from cardiopulmonary disease in populations living in areas with different environmental burdens. The results provide different perspectives on data on total years lost and lifetime losses attributable to air pollution. Such lifetime losses in the industrial area related to cardiovascular causes of death are 7.6 or 5.1 years per male or female deceased, representing an average lifetime loss of 0.01907 years (i.e. 7 days) per 1 male or 0.01273 years (i.e. 4.6 days) per 1 female in the entire population. Losses related to cerebrovascular or respiratory causes of death are about 5.4 or 5.9 years per 1 deceased male or 3.9 or 5 years per 1 deceased female, respectively, which represents a loss of 0.00481 (1.8 days), or 0.00148 years (0.5 days) per 1 male or 0.00466 (1.7 days), or 0.00058 years (0.2 days) per 1 female. [ABSTRACT FROM AUTHOR]

Objectives. To examine whether a previously reported association between airborne lead exposure and children's cognitive function replicates across a geographically diverse sample of the United States. Methods. Residential addresses of children (< 5 years) were spatially joined to the Risk-Screening Environmental Indicators model of relative airborne lead toxicity. Cognitive outcomes for children younger than 8 years were available for 1629 children with IQ data and 1476 with measures of executive function (EF; inhibitory control, cognitive flexibility). We used generalized linear models using generalized estimating equations to examine the associations of lead, scaled by interquartile range (IQR), accounting for individual- and area-level confounders. Results. An IQR increase in airborne lead was associated with a 0.74-point lower mean IQ score (b = −0.74; 95% confidence interval = −1.00, −0.48). The association between lead and EF was nonlinear and was modeled with a knot at the 97.5th percentile of lead in our sample. Lead was significantly associated with lower mean inhibitory control but not with cognitive flexibility. This effect was stronger among males for both IQ and inhibitory control. Conclusions. Early-life exposure to airborne lead is associated with lower cognitive functioning. (Am J Public Health. 2024;114(3):309–318. https://doi.org/10.2105/AJPH.2023.307519) [ABSTRACT FROM AUTHOR]

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

Objective. To characterise cancer diagnosis in Scottish primary care in 2018/19 and draw comparisons with diagnostic activity in 2014. Methods. A national audit of cancer diagnosis undertaken in Scottish general practices. Participating GPs collected diagnostic pathway data on patients diagnosed with cancer in 2018/19 from medical records. These data were supplemented by linkage to the Scottish Cancer Registry and previous audit data from 2014. Analyses explored and compared patient demographics, presentation, diagnostic routes, and intervals. Results. Seventy-three practices submitted data on 2,014 cases in 2014 and 90 practices submitted data on 2,318 cases in 2018/2019. Individual demographics and types of cancer were similar. There was a higher proportion of USC (urgent suspected cancer) referrals in 2019 than 2014 (42.9% vs 38.1%, p = 0.008) but a similar proportion of emergency presentations (19.2% vs 20.4%). Primary care (median 4 (IQR 0–22) vs 5 (0–23)) and diagnostic intervals (27 (10–59) vs 30 (13–68)) were similar in both periods. Significantly fewer (24.5% vs 28.3, p = 0.015) had a diagnostic interval >60 days in 2019 than 2014. Harder to diagnose cancers were more likely to present as emergencies and be subject to prolonged delays in both cohorts. Conclusions. The 2014 and 2018/19 cohorts were broadly similar. There is limited evidence that USC use had increased between 2014 and 2018/19. Harder to diagnose cancers are still most likely to present as emergencies and be subject to delays. Overall, it seems there were small improvements in cancer diagnosis prepandemic and a further audit could examine evidence for a postpandemic recovery. [ABSTRACT FROM AUTHOR]

INTRODUCTION Despite that the smoking prevalence has considerably declined in Australia after successful public health strategies over many decades, smoking is still the leading cause of preventable diseases and death in Australia. These declines have not occurred consistently across all geographical-demographic domains. In order to provide an evidence base for monitoring the trend towards the goal of reducing smoking across all domains in Australia, this study aims to estimate trends of smoking prevalence for small domains cross-classified by seven age groups (18-24, 25-29, 30-39, 40-49, 50-59, 60-69, and ≥70 years), two genders, and eight states and territories over twenty years (2001-2021). METHODS Direct estimates of smoking prevalence for the target small domains were calculated from the micro-data of the Australian National Health Surveys conducted in seven rounds during 2001-2021. The obtained direct estimates were then used as input for developing time-series models expressed in a hierarchical Bayesian structure as a form of small-area estimation. The developed models borrow cross-sectional, temporal, and spatial strength in such a way that they can interpolate smoking levels in the non-survey years for all detailed level small domains. Smoothed trends of smoking prevalence for higher aggregation levels are obtained by aggregation of the detailed level trend predictions. RESULTS Model-based small area estimators provide consistent and reasonable smoothed trends at both detailed and higher aggregation levels. Results show that the national-level trend exhibits a steeper linear decline over the study period, from 24% in 2001 to 12% in 2021, with a considerable gender difference of around 5% over the period, with males reporting a higher prevalence. Improved model-based estimates at the state level and by age also show steady declines in trends except for the Northern Territory (still above 20%) and older age groups 60-69 and ≥70 years (declining trends remain stable after 2012). CONCLUSIONS The findings of the study identify the geographical-demographic groups that had poor improvement over the period 2001-2021, and are still behind the target of achieving lower smoking prevalence. These, in turn, will help health researchers and policymakers deliver targeted programs to the most vulnerable, enabling the nation to meet its health goals in a timely way. [ABSTRACT FROM AUTHOR]

Flashbulb memories (FBMs) refer to vivid and long-lasting autobiographical memories for the circumstances in which people learned of a shocking and consequential public event. A cross-national study across eleven countries aimed to investigate FBM formation following the first COVID-19 case news in each country and test the effect of pandemic-related variables on FBM. Participants had detailed memories of the date and others present when they heard the news, and had partially detailed memories of the place, activity, and news source. China had the highest FBM specificity. All countries considered the COVID-19 emergency as highly significant at both the individual and global level. The Classification and Regression Tree Analysis revealed that FBM specificity might be influenced by participants' age, subjective severity (assessment of COVID-19 impact in each country and relative to others), residing in an area with stringent COVID-19 protection measures, and expecting the pandemic effects. Hierarchical regression models demonstrated that age and subjective severity negatively predicted FBM specificity, whereas sex, pandemic impact expectedness, and rehearsal showed positive associations in the total sample. Subjective severity negatively affected FBM specificity in Turkey, whereas pandemic impact expectedness positively influenced FBM specificity in China and negatively in Denmark. [ABSTRACT FROM AUTHOR]

Few studies have investigated the association between PM2.5 and hypertension among floating populations. We therefore examined the relationship using binary logistic regression. Each grade of increment in the annual average PM2.5 (grade one: ≤15 µg/m3; grade two: 15–25 µg/m3; grade three: 25–35 µg/m3 [Excluding 25]; grade four: ≥35 µg/m3) was associated with an increased risk of hypertension (odds ratio [OR] = 1.081, 95% confidence interval (CI): 1.034–1.129). Among the female floating population (OR = 1.114, 95% CI: 1.030–1.204), those with education level of primary school and below (OR = 1.140, 95% CI: 1.058–1.229), construction workers (OR = 1.228, 95% CI: 1.058–1.426), and those living in the eastern region of China (OR = 1.241, 95% CI: 1.145–1.346) were more vulnerable to PM2.5. These results indicate that PM2.5 is positively associated with hypertension in floating populations. Floating populations who are female, less educated, construction workers, and living in the eastern region of China are more vulnerable to the adverse impacts of PM2.5. [ABSTRACT FROM AUTHOR]

Citizens' access to health care and the delivery of the healthcare services is significantly affected by the spatiality of the regions and the connectedness of the elements of the healthcare system. This network of healthcare system, region and delivery of services faces myriad challenges in the borderland geography, which is characterised by accentuated military presence, poor physical infrastructure, disinterest of habitation near the border, lack of adequate, necessary and allied services such as schools and industry, social seclusion, migration etc. All these factors amalgamate to create an effect of gender-blind phenomenon as well as border-blind phenomenon. This is particularly acute for women and children. A phenomenology research design has been used for the study. It encapsulates qualitative aspects of the views of those who experience marginalisation inclusive of gender-blind experiences. Marginalised women and frontline healthcare workers at the borderland were considered for the inquiry in this study. The study is a composite description of the phenomenon. The border districts of Rajasthan from the Radcliffe line of Rajasthan have been identified for the purpose of the study. Using narrative ethnography along with interviews, an examination was executed from health professionals and marginalised women to comprehend health care access and equity from the service provider's perspective as well as the beneficiary's perspective. The study provides a range of attributions based on which it could be established that health inequities exist in bordering rural areas. The study realises the geopolitical influence of the Radcliffe line, where borderlands are commonly vital to the continuum struggle between the centre and state. Yet, there remains a gap towards implementing various schemes and services due to varied reasons for access from main to far-off border areas, making the situation vulnerable from a resource deficiency point of view. The Health Equity Framework cannot meet Social Determinants of Health in borderland areas of Rajasthan. • Using narrative ethnography along with interviews in four border districts of Rajasthan, an examination was executed from health professionals and marginalised women to comprehend health care access and equity from the service provider's perspective as well as the beneficiary's perspective. • A significant observation is that the network of healthcare system, region and delivery of services faces myriad challenges in the borderland geography. • The accessibility of efficient health care to women is compromised by poor physical infrastructure, disinterest of habitation near the border, lack of adequate necessary and allied services such as schools and industry, social seclusion, migration etc. • The Health Equity Framework is unable to meet Social Determinants of Health in borderland areas of Rajasthan as the inaccessibility of healthcare workers and resources can pointedly distress an individual's utilisation of healthcare services, resulting in considerable variance in health outcomes, which was observed in a realistic sense among all the four regions undertaken in the study. • The inequalities are apparent concerning the accessibility, availability and consumption of healthcare services among the population of the borderland. [ABSTRACT FROM AUTHOR]

Background: While the COVID-19 pandemic's total impact on global mortality is uncertain, an estimated 15 million excess deaths occurred during the first two pandemic years, suggesting that a broad impact, since several causes of death showed a substantial rise. Aims: To estimate excess suicides in Brazil and evaluate differences within and between subgroups during the first 2 years of the COVID-19 pandemic. Method: Based on suicide data from the mortality information system of the Brazilian Ministry of Health, the expected number of suicides was estimated by age group, gender, 4-month periods and regions through quasi-Poisson generalized additive models. Analyses were performed in R software and RStudio. Results: Between March 2020 and February 2022, 29,295 suicides were reported in Brazil, close to what would be expected (30,116; 95% Confidence Interval (95% CI): [28,009, 32,224]), albeit in males and females aged 30 to 59 years and 60 years and over, there were excess suicides in at least one of the six 4-month periods evaluated, especially in the second pandemic year. In the Southeast region, a 28% increase was observed in women 60 years and older during the second year. In the North region, suicide increased 23% and 32% among women aged 30 to 59 years during the first and second pandemic years, respectively. The Northeast region had a 16% excess in suicides among men aged 30 to 59 years and 61% among women 60 years old and older during the second pandemic year, reaching 83% in July to October 2021. Conclusions: During the first 2 pandemic years, the pattern of suicides was not homogeneous in Brazil. There were substantial excess suicides in women aged 30 to 59 years from the North and Northeast, while among the elderly and men there was a consistent pattern in several four-month periods throughout Brazil. [ABSTRACT FROM AUTHOR]

This study identifies and analyzes barriers to sexual and gynecological health care Black women face at a Historically Black College or University (HBCU) and a Predominantly White Institution (PWI) in southeastern America. Participants identified as Black women who were sexually active, age 18–25, and undergraduate students. The research team conducted in-depth interviews across two campuses via Zoom. Interviews were coded using inductive thematic analysis. We derived six specific themes that summarize Black female college students' barriers to care: Patient–provider Interactions, Economic Determinants of Health, Social Support, Access to Care, Lack of Primary Care, and No Challenges. Reproductive and sexual health disparities can be mitigated with attention to diversity in medical school, affordable care, and teaching young women to prioritize their care for long-term reproductive health. [ABSTRACT FROM AUTHOR]

Aims and Objectives: (i) To estimate the national incidence of unplanned removal of peripherally inserted central catheters (PICCs) in China. (ii) To explore the associated risk factors to provide evidence for the prevention. Design: A multi‐centre prospective cohort study. Methods: A representative sample of 3222 Chinese adult patients with successful PICC insertion was recruited for the PICC Safety Management Research (PATH) using a two‐stage cluster sampling method from December 2020 to June 2022. Sixty hospitals from seven Chinese provinces representing all geographical regions were selected. Demographic information and PICC characteristics were collected using a standard online case report form. Risk factors for the unplanned removal of PICCs were assessed using a cause‐specific hazard model and verified using a sub‐distribution hazard model. STROBE guidelines were followed in reporting this study. Results: Three thousand one hundred and sixty‐six patients were included in the final analysis with a mean age of 59 years and a total of 344,247 catheter days. The incidence of unplanned removal was 10.04%. Female, with thrombosis history, PICC insertion due to infusion failure, valved catheter and double‐lumen catheter were risk factors, whereas longer insertion and exposure length were protective factors in the cause‐specific hazard model. Higher BMI became an independent risk factor in the sub‐distribution hazard model. Conclusions: Unplanned removal of PICCs is a serious clinical challenge in China. Our findings call for prevention strategies targeting the identified risk factors. Relevance to Clinical Practice: Our study characterised the epidemiology of unplanned removal of PICCs among Chinese adult inpatients, highlighting the need for prevention among this population and providing a basis for the formulation of relevant prevention strategies. Patient or Public Contribution: Patients contributed through sharing their information required for the case report form. Healthcare professionals who provide direct care to the patient at each medical centre contributed by completing the online case report form. [ABSTRACT FROM AUTHOR]

BACKGROUND: Income inequality is theorized to impact health. However, evidence among adolescents is limited. This study examined the association between income inequality and health‐related school absenteeism (HRSA) in adolescents. METHODS: Participants were adolescents (n = 74,501) attending secondary schools (n = 136) that participated in the 2018‐2019 wave of the COMPASS study. Chronic (missing ≥3 days of school in the previous 4 weeks) and problematic (missing ≥11 days of school in the previous 4 weeks) HRSA was self‐reported. Income inequality was assessed via the Gini coefficient at the census division (CD) level. Multilevel modeling was used. RESULTS: Greater income inequality was associated with a higher likelihood of chronic and problematic HRSA (chronic: OR = 1.17, 95% CI: 1.06, 1.30; problematic: OR = 1.29, 95% CI 1.11 to 1.50). Increased predicted probabilities for Problematic HRSA were observed at greater degrees of income inequality among students who identified as either white, black, Latinx, or mixed, while protective associations were observed among students who identified as Asian or other. No associations were modified by gender. CONCLUSION: Income inequality demonstrated unfavorable associations with HRSA, which was modified by racial identity. [ABSTRACT FROM AUTHOR]

Open Access (OA) publishing has progressed from an initial fringe idea to a still‐growing, major component of modern academic communication. The proliferation of OA publishing presents a context to examine how new innovations and institutions develop. Based on analyses of 1,296,304 articles published in 83 OA journals, we analyze changes in the institutional status, gender, age, citedness, and geographical locations of authors over time. Generally, OA journals tended towards core‐to‐periphery diffusion patterns. Specifically, journal authors tended to decrease in high‐status institutional affiliations, male and highly cited authors over time. Despite these general tendencies, there was substantial variation in the diffusion patterns of OA journals. Some journals exhibited no significant demographic changes, and a few exhibited periphery‐to‐core diffusion patterns. We find that although both highly and less‐legitimate journals generally exhibit core‐to‐periphery diffusion patterns, there are still demographic differences between such journals. Institutional and cultural legitimacy—or lack thereof—affects the social and intellectual diffusion of new OA journals. [ABSTRACT FROM AUTHOR]

Background: Hypothyroidism is a major manifestation of autoimmune thyroid diseases (AITD). We previously reported that a low selenium (Se) status was linked to an elevated prevalence of thyroid diseases. We hypothesized that Se status may also influence the restoration of thyroid function. Thus, this study aimed to investigate the factors affecting the recovery of thyroid function in patients with (sub-)clinical hypothyroidism, with a specific focus on Se status. Methods: We conducted a 6-year prospective cohort study comparing two counties with different Se concentrations. Demographic and disease data were collected from 1,190 individuals (549 Se-adequate and 641 Se-deficient) who completed a follow-up study in 2019. In addition, urinary iodine (I) levels, thyroid function, and serum and nail Se levels were measured. Logistic regression was used to investigate the relationship between Se deficiency and recovery of thyroid function. Results: Sex and smoking status was similar between the two counties studied. Thyroid function recovery rate was significantly higher in Se-deficient counties (46.0% vs. 30.6%, P = 0.008). In the multivariate analysis, our results show that female sex (odds ratio [OR] (95% confidence interval [CI]) = 1.875 (1.080–3.257), P = 0.026] and increasing age [OR (95%CI) = 1.028(1.007–1.049), P = 0.009] were associated with the recovery rate. Additionally, our study revealed that while Se status was significant in the univariate analysis, this association appeared to disappear in the multivariate analysis. Conclusions: Female sex and increasing age have unfavorable effects on the recovery of thyroid function in patients over 30 years of age with (sub-) clinical hypothyroidism. [ABSTRACT FROM AUTHOR]

Background: Using the published survival statistics from cancer registration or population‐based studies, we aimed to describe the global pattern and trend of lung cancer survival. Methods: By searching SinoMed, PubMed, Web of Science, EMBASE, and SEER, all survival analyses from cancer registration or population‐based studies of lung cancer were collected by the end of November 2022. The survival rates were extracted by sex, period, and country. The observed, relative, and net survival rates of lung cancer were applied to describe the pattern and time changes from the late 1990s to the early 21st century. Results: Age‐standardized 5‐year relative/net survival rate of lung cancer was typically low, with 10%–20% for most regions. The highest age‐standardized relative/net survival rate was observed in Japan (32.9%, 2010–2014), and the lowest was in India (3.7%, 2010–2014). In most countries, the five‐year age‐standardized relative/net survival rates of lung cancer were higher in females and younger people. The patients with adenocarcinoma had a better prognosis than other groups. In China, the highest 5‐year overall relative/net survival rates were 27.90% and 31.62% in men and women in Jiangyin (2012–2013). Conclusion: Over the past decades, the prognosis of lung cancer has gradually improved, but significant variations were also observed globally. Worldwide, a better prognosis of lung cancer can be observed in females and younger patients. It is essential to compare and evaluate the histological or stage‐specific survival rates of lung cancer between different regions in the future. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To read about a study of adolescents' use of social media as a coping strategy during COVID-19 • To increase your knowledge of types of coping mechanisms used by adolescents during challenging situations • To enhance your understanding of the positive and negative effects of using social media as a coping mechanism Background: During the coronavirus disease 2019 (COVID-19) pandemic, adolescents used various coping strategies to manage stress and loneliness. One such strategy was to engage in active coping, social relations coping and humour coping via social media. Such coping strategies can be helpful but can also reinforce stress and loneliness. Aim: To explore adolescents' use of social media to manage stress and loneliness at a time of restricted social contacts due to the COVID-19 pandemic, including potential differences between adolescents according to gender, age, area of residence and extent of social media use. Method: A cross-sectional design and an online questionnaire were used to survey a convenience sample of adolescents aged between 12 and 18 years in Jordan. Three data collection tools were used – the modified Brief Coping Scale, the six-item Revised UCLA Loneliness Scale and the Perceived Stress Scale. Results: A total of 770 adolescents participated, half of whom were using social media more than before the pandemic. Increased use of active coping, social relations coping and humour coping was associated with decreases in stress and loneliness. Active coping contributed the most to reducing levels of stress while social relations coping contributed the most to reducing levels of loneliness. Younger participants made more use of active coping and humour coping than older participants. Conclusion: Social media use can be a positive coping strategy for adolescents to manage stress and loneliness during a crisis such as the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Aim: Healthcare workers are at risk of infections due to needle-stick and sharp injuries (NSSIs) and through contact with blood and contaminated body fluids. This study aimed to investigate NSSIs and associated factors in healthcare workers. Methods: This single-center analytical cross-sectional study included healthcare workers who were admitted to "the Hospital Infections Control Committee" following NSSIs at University of Health Sciences Turkey, Istanbul Haseki Training and Research Hospital, between January 1, 2020, and December 31, 2021. Demographic and epidemiological data, serological tests, and routine follow-up results were retrospectively collected from NSSI surveillance. Healthcare workers were divided into two groups according to the occurrence of stab wounds (injury or no injury). The age, sex, occupation, and working area of healthcare workers were compared. Results: A total of 232 (7%) experienced NSSIs among 3,312 healthcare workers. The NSSI was 35.0 [confidence interval (CI)=34.9-35.2] per 1000 person-years. Needle-stick and sharp injuries were most frequently observed in nurses (n=148, 63.8%). Nurses [odds ratio (OR)=5.97, CI=4.51-7.90, p<0.001], cleaning staff (OR=1.64, CI=1.13-2.37, p=0.009), medical waste personnel (0R=10.79, CI=2.88-40.46, p<0.001), and medical technicians/technologists (OR=1.92, CI=1.03-3.57, p=0.039) were at increased risk for NSSIs. Conclusion: This study highlights the need for assigning sufficient healthcare workers, prioritizing vaccination programs for high-risk groups, and providing regular hands-on training as crucial measures to prevent injuries. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) pandemic began in India in 2020. Despite successful vaccination, cases again started increasing from mid-December 2021. Therefore, this study was undertaken to find out the clinico-epidemiological characteristics and effectiveness of vaccination in the household transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in and around Pune. Material and Methods: All samples received from December 15, 2021, till February 15, 2022, were included in the study. Samples received in viral transport medium (VTM) were extracted by the MagMAX RNA Extraction Kit, and reverse transcriptase--polymerase chain reaction (RT--PCR) was performed by the CoviPath Kit as per kit guidelines. Values of nucleocapsid (N) gene and open reading frame (ORF) less than 37 were considered positive. Clinico-epidemiological data were analyzed from the sample referral form (SRF). Results: A total of 712 of 1032 household contacts of 271 families were positive. When geographical areas were compared, it was found that rural areas were affected more (63.76%) as compared to urban areas (36.24%). Males were more affected than females. The most commonly affected age group was 41--50 years (26.54%). Small families were found to have more household transmission. Mild symptoms were present in 97.89%. Among 271 infected individuals, seven were admitted to hospital, of which one patient died due to pneumonia. Two doses of vaccination were completed in 93.95%, and 3.79% had taken booster dose. Conclusions: Data from this study showed that a high rate of transmission was observed in household contact despite two doses of vaccination. However, these vaccinated individuals had mild symptoms, maybe due to the effect of vaccination and infecting variant omicron. [ABSTRACT FROM AUTHOR]

Background: Growing evidence shows the undisputable role of non-HDL-C and remnant cholesterol (remnant-C) in cardiovascular disease (CVD) risk assessment and treatment. However, the reference interval (RI) for these lipid parameters is not readily available. The aim of the present investigation was to determine the age and sex-specific RIs for non-HDL-C and remnant-C as well as other lipid parameters among a healthy population in southern Iran. We also report the RI of lipid parameters in rural and urban residents, smokers and post-menopausal women. Methods: Among 14 063 participants of Bandare Kong and Fasa cohort studies, 792 healthy subjects (205 men and 578 women) aged 35-70 years were selected. Fasting blood samples were used for determination of total cholesterol (TC), triglycerides (TG) and HDL-C using colorimetric methods. Non-HDL-C and remnant-C were calculated using the valid formula. The 2.5th and 97.5th percentiles were calculated and considered as RI. Results: In the total population (n = 792, age 35-70), RIs for non-HDL-C and remnant-C was 74.0-206.8 and 8.0-52.7 mg/dL, respectively. Age (35-44 and ≥ 45 years) and gender-specific RIs for serum non-HDL-C and remnant-C were determined. Remnant-C and non-HDL-C level were different between sex and age categories. The mean value of all lipid parameters except HDL-C was higher in men, urban residents, subject with age ≥ 45 years and smokers. Conclusion: This is the first study in which the RIs for non-HDL-C and remnant-C in southern Iran are reported. This may help physicians to conveniently use these lipid parameters for patient care and better cardiovascular risk assessment. [ABSTRACT FROM AUTHOR]

Background: Diabetes frequently results in the need for multiple medication therapies, known as 'Polypharmacy'. This situation can incur significant costs and increase the likelihood of medication errors. This study evaluated the prescriptions of patients with diabetes regarding polypharmacy to assess its effect on the control of hemoglobin A1c (HbA1c) levels and prescription costs. Methods: A cross-sectional national study was conducted based on data from linking the Iranians Health Insurance Service prescriptions in 2015 and 2016 with the STEPS 2016 survey in Iran. The association of the individual and sociodemographic factors, as well as polypharmacy, as independent variables, with control of HbA1c levels and the cost of the prescriptions were assessed among diabetic patients using logistic and linear regression, respectively. Results: Among 205 patients using anti-diabetic medications, 47.8% experienced polypharmacy. The HbA1c of 74 patients (36.1%) was equal to or less than 7, indicating controlled diabetes. HbA1c control showed no significant association with gender. However, prescription costs were notably lower in females (β = 0.559 [0.324-0.964], P = 0.036). No significant correlation was found between the area of residence and prescription costs, but HbA1c was significantly more controlled in urban areas (OR = 2.667 [1.132-6.282], P = 0.025). Prescription costs were significantly lower in patients without polypharmacy (β = 0.211, [0.106-0.423], P < 0.001), though there was no significant association between polypharmacy and HbA1c levels. Conclusion: Our results demonstrated that diabetics with polypharmacy paid significantly more for their prescriptions without experiencing a positive effect on the control of HbA1c levels. [ABSTRACT FROM AUTHOR]