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Breast cancer care is a costly global health issue where effective management depends on early detection and treatment. A breast cancer diagnosis can result in financial catastrophe especially in low- and middle-income countries (LMIC). Large inequities in breast cancer care are observed and represent a global challenge to caregivers and patients. Strategies to improve early diagnosis include awareness and clinical breast examination in LMIC, and screening in high-income countries (HIC). The use of clinical guidelines for the management of breast cancer is needed. Adapted guidelines from HIC can address disparities in populations with limited resources. Locally developed strategies still provide effective guidance in improving survival. Integrated practice units (IPU) with timely multidisciplinary breast care conferences and patient navigators are required to achieve high-value, personalized breast cancer management in HIC as well as LMIC. Breast cancer patient care should include a quality of life evaluation using ideally patient-reported outcomes (PROM) and experience measurements (PREM). Evaluation of breast cancer outcomes must include the financial cost of delivered care. The resulting value perspective should guide resource allocation and program priorities. The value of care must be improved by translating the findings of social and economic research into practice and resolving systemic inequity in clinical breast cancer research. Cancer survivorship programs must be put in place everywhere. The treatment of patients with metastatic breast cancer must require more attention in the future, especially in LMIC. [ABSTRACT FROM AUTHOR]

Simple Summary: Family communication in the cancer context has gained attention as a crucial factor related to the quality of life of children and adolescents. The aim of this review was to examine therapeutic parent–child communication and its impact on health outcomes in children and adolescents with cancer. This review identified an emerging body of evidence that therapeutic parent–child communication contributes to better psychological health outcomes at both the individual and family levels in the childhood cancer context. A comprehensive understanding of the impact of family communication may provide knowledge for developing interventions to improve family communication and health outcomes. Family communication has been thought to be an important area to support children's adjustment to a cancer diagnosis. However, the characteristics of therapeutic parent–child communication that contribute to better patient outcomes and the specific patient health outcomes have been less explored. This current review explored the characteristics of therapeutic parent–child communication and its physical and psychological health outcomes. A total of 5034 articles were initially identified, and only 10 articles remained for inclusion in this review after application of the exclusion criteria. Most studies used a cross-sectional design and measured verbal communication characteristics and its psychological outcomes, but no physical outcomes. The characteristics of therapeutic verbal communication (openness, maternal validation, quality of information shared, etc.) and nonverbal communication (eye contact, close physical distance, and acknowledging behaviors) were identified. The psychological health outcomes included less distress, a lower level of PTSS, less internalizing and externalizing of symptoms, increased levels of social emotional competencies, better peer relationships, and more cooperation during the procedure at the individual level. Increased family cohesion and family adaptation were family-level outcomes. Longitudinal studies are needed to identify what qualities of communication predict better psychological outcomes so that interventions can be developed and tested. In addition, physical outcomes should be evaluated. [ABSTRACT FROM AUTHOR]

Introduction: Traumatic brain injury (TBI) represents a major cause of death and disability worldwide. Brain damage is associated with physical and psychological difficulties among TBI survivors. Diverse face-to-face and telehealth programs exist to help survivors cope with these burdens. However, the effectiveness of telehealth interventions among TBI survivors remains inconclusive. Methods: A systematic review and meta-analysis of randomized control trials were conducted. Relevant full-text articles were retrieved from seven databases, from database inception to January 2022, including Academic Search Complete, CINAHL, EMBASE, Cochrane, MEDLINE, PubMed, and Web of Science. Bias was assessed with the revised Cochrane risk-of-bias tool for randomized trials. A meta-analysis was performed using a random-effects model to calculate the pooled effect size of telehealth interventions for TBI survivors. STATA 16.0 was used for statistical analysis. Results: In total, 17 studies (N = 3158) applying telehealth interventions among TBI survivors were included in the analysis. Telehealth interventions decreased neurobehavioural symptom (standardized mean difference: −0.13; 95% confidence interval [CI]: −0.36 to 0.10), reduce depression (standardized mean difference: −0.32; 95% CI: −0.79 to 0.14), and increase symptom management self-efficacy (standardized mean difference: 0.22; 95% CI: 0.02–0.42). Discussion: Telehealth interventions are promising avenues for healthcare delivery due to advances in technology and information. Telehealth programs may represent windows of opportunity, combining traditional treatment with rehabilitation to increase symptom management self-efficacy among TBI patients during recovery. Future telehealth programs can focus on developing the contents of telehealth modules based on evidence from this study. [ABSTRACT FROM AUTHOR]

We investigate how loneliness develops over the marital dissolution process in older age (i.e., transition at or after age 50) while paying close attention to heterogeneities by the dissolution pathway—widowhood and separation—and gender. Using data from over 8,000 Household, Income and Labour Dynamics in Australia survey respondents, we assess the association of interest using fixed effects regressions. Findings indicate that loneliness increased in the year before widowhood or separation among both women and men. Levels spiked in the year of dissolution, particularly for widowhood but less for separation. Widowed men were substantially more affected than widowed women, and gender differences were negligible for separation. Although loneliness levels gradually declined, widowed men remained vulnerable for remarkably long periods. Such chronic loneliness might be linked to other health disadvantages. These findings highlight the importance of long-term and gender-specific approaches to social support and integration after marital dissolution. [ABSTRACT FROM AUTHOR]

Introduction: Given the chronic nature of psoriasis (PsO), more studies are needed that directly compare the effectiveness of different biologics over long observation periods. This study compares the effectiveness and durability through 12 months of anti-interleukin (IL)-17A biologics relative to other approved biologics in patients with moderate-to-severe psoriasis in a real-world setting. Methods: The Psoriasis Study of Health Outcomes (PSoHO) is an ongoing 3-year, prospective, non-interventional cohort study of 1981 adults with chronic moderate-to-severe plaque psoriasis initiating or switching to a new biologic. The study compares the effectiveness of anti-IL-17A biologics with other approved biologics and provides pairwise comparisons of seven individual biologics versus ixekizumab. The primary outcome was defined as the proportion of patients who had at least a 90% improvement in Psoriasis Area and Severity Index score (PASI90) and/or a score of 0 or 1 in static Physician Global Assessment (sPGA). Secondary objective comparisons included the proportion of patients who achieved PASI90, PASI100, a Dermatology Life Quality Index (DLQI) score of 0 or 1, and three different measures of durability of treatment response. Unadjusted response rates are presented alongside the primary analysis, which uses frequentist model averaging (FMA) to evaluate the adjusted comparative effectiveness. Results: Compared to the other biologics cohort, the anti-IL-17A cohort had a higher response rate (68.0% vs. 65.1%) and significantly higher odds of achieving the primary outcome at month 12. The two cohorts had similar response rates for PASI100 (40.5% and 37.1%) and PASI90 (53.9% and 51.7%) at month 12, with no significant differences between the cohorts in the adjusted analyses. At month 12, the response rates across the individual biologics were 53.5–72.6% for the primary outcome, 27.6–48.3% for PASI100, and 41.7–61.4% for PASI90. Conclusions: These results show the comparative effectiveness of biologics at 6 and 12 months in the real-world setting. [ABSTRACT FROM AUTHOR]

Purpose: Advancements in medical treatments have resulted in increased medical costs for cancer patients. More than half of the patients with advanced lung cancer reported unmet financial needs. The purpose of this study is to examine the differences in the prevalence and correlates of financial hardship between middle- and older-aged patients with advanced lung cancer, and its impact on multiple health-related outcomes. Methods: This study presents a cross-sectional analysis involving 226 patients with advanced lung cancer, who were enrolled in a randomized controlled trial conducted between 2018 and 2020. Data collection was performed through self-reported questionnaires and electronic medical records. Multivariable logistic and linear regression models were adopted for analysis. Results: 58.0% reported experiencing financial hardships. Middle-aged participants who were single and had a lower education level were more likely to experience financial difficulties. However, males and higher performance status were associated with a lower likelihood of experiencing financial difficulties among older-aged participants. Financial hardship was significantly associated with anxiety (p < 0.001), depression (p < 0.001), sleep disturbances (p < 0.001), quality of life, global health status (p = 0.002), functional scale score (p < 0.001), symptom scale score (p < 0.001), and lung cancer-specific scale score (p < 0.001). Conclusions: More than half of the patients with advanced lung cancer experienced financial hardships caused by cancer or its treatment, with a higher prevalence reported in middle-aged patients. Different sociodemographic and clinical variables correlated with financial hardship in middle- and older-aged participants, respectively. More attention should be paid to middle-aged patients with advanced lung cancer, particularly during routine assessments. [ABSTRACT FROM AUTHOR]

Accelerated by the adoption of remote monitoring during the COVID-19 pandemic, interest in using digitally captured behavioral data to predict patient outcomes has grown; however, it is unclear how feasible digital phenotyping studies may be in patients with recent ischemic stroke or transient ischemic attack. In this perspective, we present participant feedback and relevant smartphone data metrics suggesting that digital phenotyping of post-stroke depression is feasible. Additionally, we proffer thoughtful considerations for designing feasible real-world study protocols tracking cerebrovascular dysfunction with smartphone sensors. [ABSTRACT FROM AUTHOR]

Objectives: Patient trust in physicians is associated with patient satisfaction with healthcare, patients engaging in follow-up care, and positive health-related outcomes. The current study investigated whether age moderated the relation between trust in physicians and four health outcome variables, including patient satisfaction, doctor visits, emergency room visits, and hospital admissions. Methods: 398 English-speaking, community-dwelling adults completed measures of physician trust and important health outcome variables via Amazon Mechanical Turk. Results: Age significantly moderated relations between trust in physicians and hospital admissions, and trust in physicians and patient satisfaction, with both positive relations becoming stronger with increasing age. Discussion: The results highlight the need for a lifespan approach to the study of physician trust and related health outcomes. They offer an avenue for increasing physician trust, engagement with the healthcare system prior to the need for hospitalization, and the reduction of healthcare costs. [ABSTRACT FROM AUTHOR]

In this study, we reviewed previous information regarding the effect of fossil fuel pricing intervention on the consumption of fossil fuels, air quality, and population health. In a rapid review, we searched and reviewed reports about the effect of fossil fuel pricing interventions on each or some of the following outcomes: fossil fuel consumption, concentrations of air pollutants, and mortalities or morbidities attributable to exposure to air pollutants. As part of our investigation, we also present the findings of an unpublished, original study that specifically estimated the effects of an elevated gasoline price in Iran's ten most populous cities. Pricing interventions were effective in reducing the consumption of fossil fuels, both in developing and developed countries. Price elasticity for transport gasoline was reported to be -0.227 and -0.715 for short- and long-term, respectively. Reductions in concentrations of air pollutants, especially NOx and particulate matter, were reported in several studies. This review study demonstrates the effects of escalating fossil fuel prices on reducing consumption, air pollution, and mortalities and morbidities attributable to air pollution. Considering the external costs of fossil fuels through environmental, climate, traffic congestions and accidents, and population health, the real costs of fossil fuels are much higher than their retail price. Pro-rich policies of subsidizing fossil fuels should be replaced by alternative policies that support clean public transport, which is suitable for population health, environment, and equity. [ABSTRACT FROM AUTHOR]

The consumption of fossil fuel significantly contributes to the growth of South Africa's economy but produces carbon dioxide (CO2), which is detrimental to environmental sustainability with overall effects on health outcomes. This study sought to (i) examine the impacts of fossil energy consumption-related CO2 emissions on the under-five mortality and infant mortality rates in South Africa and (ii) analyse the causal relationship between fossil energy consumption, CO2 emissions, and mortality rates in South Africa. Linear and nonlinear ARDL bounds and the Toda–Yamamoto causality test were used to establish the equilibrium property in the long run and the causal effects of the models' variables. Health outcome data include the under-five mortality rate (MTR1) and infant mortality rate (MTR2). Other explanatory variables include fossil energy consumption (FOC), inflation (Inf), carbon dioxide emissions (CO2), and government expenditure (GEH). It is evident from the results of linear ARDL that the first lag of the under-five mortality rate in the short run has a positive and significant impact on the under-five mortality rate in South Africa. Holding the other variables constant, the under-five mortality rate in South Africa would increase by 0.630% for every 1% increase in its lagged values. Fossil energy consumption has a positive and significant effect on the under-five mortality rate in South Africa. This significant relationship implies that a 1% increase in fossil energy consumption increases the under-five mortality rate per 1000 persons per year in South Africa by 0.418% in the short run, all things being equal. The results from the Toda–Yamamoto causality test revealed that there is no causality between the under-five mortality rate and both the consumption of fossil fuel and CO2 emissions in South Africa. The results from nonlinear ARDL presented four separate scenarios. In the short run, during increasing levels of CO2 in the initial period (lag of CO2), a 1% increase in CO2 would decrease the under-five mortality rate by 1.15%. During periods of decreasing levels of CO2 in the short run, a 1% increase in CO2 would increase the infant mortality rate by 0.66%. Again, during previous and current periods of decreasing levels of FEC, a 1% increase in FEC would increase the infant mortality rate by 0.45% and 0.32%, respectively. In the long run, during periods of increasing levels of CO2, a 1% increase in CO2 would decrease the infant mortality rate by 4.62% whereas during decreasing levels of CO2, a 1% increase in CO2 would increase the infant mortality rate by 2.3%. The risk posed by CO2 emissions and their effects on humans can then be minimised through a government expansionary policy within health programmes. [ABSTRACT FROM AUTHOR]

This paper examines the interaction between health expenditure and health outcomes with due consideration for government effectiveness across developing African economies. The rich data for this study draw from forty-five Sub-Saharan African (SSA) countries covering the period 1960 to 2022. The analysis follows a country-specific comparative manner using the Autoregressive Distributed Lag (ARDL) model as the major estimation technique. The results indicate that poor health outcomes are not due to inadequate budgetary allocations alone. Specifically, this study found a cointegrating relationship and strong adjustment of health outcomes deriving from the shocks and dynamics of not just health expenditures, but also government effectiveness. It is therefore recommended that strong institutions and safety nets be created to guard against corruption and leakages that derail the beneficial impact of public health spending. Also, government expenditures should be focused more on cottage and primary health dimensions to better mitigate adverse health conditions in SSA countries. [ABSTRACT FROM AUTHOR]

Objective: The effectiveness of out of hospital lifestyle interventions in healthcare is likely co-dependent on social support from involved one's. We sought to investigate the interrelationships between patient-partner Co-responsibility, Spousal Support, and Self-efficacy and the mechanisms through which they contribute to health behaviors and outcomes relevant to weight loss and maintenance. Methods: Co-responsibility, Spousal Support, self-efficacy, health outcomes and health behaviors like total weight loss, physical activity, OBESI-Q, and health satisfaction were assessed through a questionnaire among 868 individuals attempting to lose weight. Full and semi-partial correlations were used to understand the association between Co-responsibility, Spousal Support, Self-efficacy and health outcomes and behaviors. Results: Results showed that increased Co-responsibility was associated with improved health outcomes and that it extended the construct of Spousal Support. The underlying pathway of associations between Co-responsibility and health outcomes was found to be through Self-efficacy. Finally, it was revealed that increased Co-responsibility caused an improvement in Self-efficacy. Conclusion: Understanding Co-responsibility among patients and their involved one's could provide valuable information to health care professionals to tailor care trajectories and achieve better patient health outcomes.

Introduction: The impact of climate change on population health has been extensively studied in Australia, but no comprehensive review of the impact of climate change on health in Australia has been performed. This review summarizes the most up-to-date, high-level evidence exploring the health risks of climate change in Australia, identifies evidence gaps in the scientific literature, and lays the groundwork for an in-depth national climate change and health risk assessment in Australia. Methods: Electronic database PubMed was searched for systematic reviews of the impact of climate change on health outcomes in Australia. Narrative synthesis was conducted to summarize findings. Results: The most frequently reported climate change related risks in Australia were heat and bushfires, followed by floods and droughts, with a limited number of studies on cyclones and rising sea levels. The impacts on health included all-cause mortality and morbidity, heat-related illnesses, vector-, food- and water-borne diseases, negative mental health effects, cardiovascular, respiratory, and renal diseases, injuries and adverse birth outcomes. These impacts were unevenly distributed across Australia's geographical regions and population groups, particularly affecting young children, people with health conditions or disabilities, the elderly, and pregnant women. There were notable gaps concerning First Nations, culturally and linguistically diverse groups, ethnic minorities, and refugees in the context of climate change and health in Australia. Conclusions: Further research is needed to deepen our understanding of the associations between climate change and health outcomes in Australia, especially among disadvantaged communities and sensitive population groups. Future risk assessments using standardized methodologies to estimate exposure-response functions for specific health outcomes are warranted. At-risk populations need to be adequately supported by a national adaptation plan that will reduce their vulnerability to climate extremes and prevent adverse health impacts of climate change in Australia.

Health planning provides a structure for the application of epidemiological data to managed populations with the intention of maximising health and identifying targets for intervention. Whilst this is established practice in livestock health, such schemes are rarely applied to free-living wild animal populations. The health of wildlife is important for a variety of reasons including conservation, human health, and ecosystem health, and so it is recommended that a formalised health planning approach be adopted for wildlife, based upon advantages of livestock health schemes identified here. Six key strengths of livestock herd health plans are identified in that these plans are: (1) Outcome driven, (2) Structured and repeatable, (3) They can incorporate both health and welfare considerations and in doing so, establish multidisciplinary management teams, (4) Evidence-based allowing for the prioritisation of key risk factors, (5) Encompassing of both population and individual metrics, and (6) Offer the opportunity for accreditation schemes. The benefits highlighted have implications for both wildlife management and research agendas where the structured format of the health plans will highlight knowledge gaps. Challenges are acknowledged, and it is recognised that livestock health planning cannot simply be copied across to a wildlife context. However, the strengths identified are great enough that it is recommended that wildlife population health planning is developed for active management of individual populations, learning lessons from existing plans.

Background and objectiveSocial determinants of health (SDOH) broadly influence health levels. Research on health and its influencing factors can help improve health status. There is limited research on the spatial stratified heterogeneity of health status and the interactions between the factors influencing it. This study aimed to analyze the spatial characteristics of health outcomes in Beijing and identify its influencing factors.MethodsBased on the Healthy Beijing Initiative (2020–2030), we constructed health outcomes and five dimensions of the SDOH evaluation system. Our study measured the health outcomes and SDOH based on the latest data from 16 districts in Beijing in 2020–2022. We explored the spatial characteristics of health outcomes through descriptive and spatial autocorrelation analyses. Moreover, the Geographical Detector (GeoDetector) technique has been used to reveal the effect of SDOH and its interactions on health outcomes.ResultsA significant spatial stratified heterogeneity of health outcomes was observed, with the health outcomes mainly exhibiting two clustering types (high–high and low–low) with positive autocorrelation. The results of the geodetector showed that social and economic factors (q = 0.85), healthy lifestyle (q = 0.68) and health service (q = 0.53) could mainly explain the heterogeneity of health outcomes. Social and economic factors, healthy lifestyle and healthy environment gradually became the main influential factor in health outcomes over time. Furthermore, the interaction of any two factors on health outcomes was found to be more pronounced than the impact of a single factor.ConclusionThere existed obvious spatial stratified heterogeneity of health outcomes in Beijing, which could be primarily explained by social and economic factors, and healthy lifestyle and health service.

Objectives: We aimed to examine the association between population aging and the prevalence of non-communicable diseases and risk factors in the Brazilian population. Study design: An ecological study using secondary data from 2010 to 2023 of the Surveillance System of Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL). Methods: We estimated the aging rate in 2010 and 2022 as the ratio of people aged 65 or older to those younger than 15 using the 2010 and 2022 Brazilian censuses. We calculated the absolute differences in the prevalence of non-communicable diseases (hypertension, diabetes) and their risk factors (smoking, excessive alcohol consumption, physical inactivity, obesity) and negative health perceptions in 2010 and 2023 for the 26 Brazilian states and the Federal District. Linear regression assessed the relationship between aging rate and health outcomes. We stratified the analyses to explore the differences by sex. Results: Brazil's aging rate was higher among women than men (average of 0.20 and 0.31, respectively). The increased number of older adults was associated with a higher prevalence of excess weight and diabetes in men. In women, the aging rate was associated with a higher prevalence of smoking, excessive alcohol consumption, obesity, hypertension, and diabetes. Conclusions: Our findings show a sex-specific association between population aging and the prevalence of health conditions in the Brazilian population. By discerning the sex-specific nuances and untangling the multifactorial influences, this research aspires to contribute valuable insights to the burgeoning field of public health in the face of evolving demographic landscapes.

Background: Traditional medicine (TM) plays a significant role in healthcare either as part of the primary healthcare system or as an adjunct to conventional medicine. This study aimed to map systematic reviews (SRs) of TM modalities across health conditions and identify gaps in the research literature to facilitate priority setting in future TM research. Methods: We searched 17 databases from January 2018 to December 2022. Reviewers in pairs independently performed the database search, screened each record for inclusion, extracted data, and performed quality assessments using the AMSTAR 2 - A Measurement Tool to Assess systematic Reviews. To be included in this evidence map, the studies had to be SRs of clinical studies that evaluated the effectiveness of a TM modalities. The included SRs were analyzed according to TM modality, ICD-11 disease classification, and health outcomes, and visualized using graphical plots. Results: We retrieved 241,509 records. After excluding duplicate records, 181,616 titles and abstracts were screened and 20,856 records were selected for full-text assessment, of which 18,137 records were further excluded. The final 2719 included SRs were primarily in adults (2591) with only 128 SRs in the pediatric population. The most commonly evaluated health conditions were diseases of the digestive system, circulatory system, and genitourinary system, with herbal medicine (n = 1867) and acupuncture (n = 471) being the most investigated TM modalities in treating these illnesses. Based on AMSTAR 2 criteria, the methodology quality of the included SRs is considerably low. Conclusion: This evidence map provides a comprehensive overview of the extent and nature of the available research onTM modalities across health conditions. It provides an initial step towards characterizing the global evidence base and outlining gaps in the existing evidence. We regard this study as laying the basis for future research of TM modalities. Registration: The protocol of this map is registered in PROSPERO (CRD42023416355).

Summary: Background: Variation in thyroid function parameters within the normal range has been observationally associated with adverse health outcomes. Whether those associations reflect causal effects is largely unknown. Methods: We systematically tested associations between genetic differences in thyrotropin (TSH) and free thyroxine (FT4) within the normal range and more than 1100 diseases and more than 6000 molecular traits (metabolites and proteins) in three large population-based cohorts. This was performed by combining individual and summary level genetic data and using polygenic scores and Mendelian randomization (MR) methods. We performed a phenome-wide MR study in the OpenGWAS database covering thousands of complex phenotypes and diseases. Findings: Genetically predicted TSH or FT4 levels within the normal range were predominately associated with thyroid-related outcomes, like goitre. The few extra-thyroidal outcomes that were found to be associated with genetic liability towards high but normal TSH levels included atrial fibrillation (odds ratio = 0.92, p-value = 2.13 × 10−3), thyroid cancer (odds ratio = 0.57, p-value = 2.97 × 10−4), and specific biomarkers, such as sex hormone binding globulin (β = −0.046, p-value = 1.33 × 10−6) and total cholesterol (β = 0.027, p-value = 5.80 × 10−3). Interpretation: In contrast to previous studies that have described the association with thyroid hormone levels and disease outcomes, our genetic approach finds little evidence of an association between genetic differences in thyroid function within the normal range and non-thyroidal phenotypes. The association described in previous studies may be explained by reverse causation and confounding. Funding: This research was funded by the Swiss National Science Foundation (P1BEP3_200041). The Fenland study (DOI 10.22025/2017.10.101.00001) is funded by the Medical Research Council (MC_UU_12015/1, MC_PC_13046 and MC_UU_00006/1). The EPIC-Norfolk study (DOI 10.22025/2019.10.105.00004) has received funding from the Medical Research Council (MR/N003284/1, MC-UU_12015/1, MC_PC_13048 and MC_UU_00006/1).

First paragraph: Food insecurity is a significant problem in Nigeria, particularly for those living in poverty; vulnerable populations such as children, women, and the elderly are particularly at risk. This commentary explores the multifaceted issue of food insecurity in Nigeria, drawing from both global and local peculiarities in the socio-economic dimensions, and looks at the impact on vulnerable populations and the government’s response. Understanding of and ideas regarding food security have undergone numerous transformations over the past three dec­ades, which are reflected in many official policy perspectives (Clay, 2002; Heidhues et al., 2004). The concept of food security emerged in the mid-1970s, with the World Food Conference in 1974 defining it in terms of the stability and availability of food commodities at both the national and international levels (FAO, 1996, 2006; FAO & DED, 2006). The notion of food security is influ­enced by four key factors: food availability, afford­ability, utilization, and sustainability (Titus & Adetokunbo, 2007). . . .

Onjective: Climate change and environmental pollution have known health effects. The recently introduced inflation reduction act (IRA) by the United States government includes funding initiatives to curb climate change, and reduce environmental pollution, in line with the nationally determined contribution (NDC) plan (40–50 % reduction in greenhouse gas [GHG] emissions by 2030, as compared with 2005). The projected cardiovascular health benefits of the IRA driven climate actions to achieve the NDC goals are not known. Methods: We used the Energy Policy Simulator (EPS), a simulation algorithm based on systems dynamics modelling estimating the impact of various energy policies, to model the impact of achieving NDC targets in the United States on health outcomes by 2050. We further investigated race-specific impact on mortality (absolute and relative) by 2050.We estimated the projected reduction in six adverse health outcomes between 2022 and 2050: asthma attacks, non-fatal heart attacks, hospital admissions, respiratory symptoms and bronchitis, lost workdays, and deaths. Results: Achievement of NDC targets by 2050 will result in 987,415 avoided asthma attacks, 41,565 avoided nonfatal heart attacks, 18,993 avoided hospital admissions, 1,493,010 avoided respiratory symptoms and bronchitis, 3,317,250 avoided lost workdays, and 32,659 avoided deaths (22,839 among white individuals, 4993 among Black individuals, 2801 among Asian individuals, and 2026 among other/multirace individuals). By 2050, minority racial groups had higher relative change in avoided deaths (white -0.74 %, Black -1.01 %, Asian -1.24 %, and other/multirace -1.75 %). Similarly, Hispanics/latinos higher relative reductions in deaths (-1.4 %) compared with non-Hispanic/Latinos (-0.7 %) by 2050. Conclusion: The IRA facilitated achievement of NDC GHG reduction goals by 2050 would result in substantial number of avoided adverse health outcomes and death. Racial and ethnic minorities are expected to have the largest relative reductions in deaths by 2050. The current report underscores the importance of continued climate action investment irrespective of political differences. The appreciation of this aspect of the IRA may be more important to overall preservation of health, beyond the reduction in medication costs.

ObjectivesThis study aims to determine clusters of access to healthcare among adults with rare diseases in Switzerland, identify associated individual characteristics of access, and impact on health-related quality of life (HRQoL).MethodsSwiss adults (N = 341) diagnosed with a rare disease completed an online survey including the Perception of Access to Healthcare Questionnaire (PAHQ) and Short Form Health Survey (SF-12). We employed partition around medoids algorithm to identify patient clusters based on the PAHQ. Various sociodemographic/disease-related factors and HRQoL were assessed.ResultsWe identified two patient clusters: higher (n = 227) and lower access (n = 114). Significantly associated with lower access were an unstable disease course (p < 0.05), increased number of misdiagnoses (p < 0.05), and diseases affecting the nervous system (p < 0.01). Membership in the lower access cluster was significantly associated with worse HRQoL (p < 0.05).ConclusionFindings highlight the need for comprehensive assessment of healthcare access in adults with rare diseases and identifies potential targets for tailored interventions.

Background Children of consanguineous parents have a higher risk of infant and childhood mortality, morbidity and intellectual and developmental disability. Methods Using a UK based longitudinal cohort study we quantify differences according to the consanguinity status of children from birth to 10 in mortality, health care usage, two health and three educational outcomes. The cohort comprises 13727 children; 35.7% White British, 43.7% Pakistani heritage, and 20.8% are from other ethnic groups. Results Compared to children whose parents were not related children whose parents were first cousins were more likely to die by age 10 (odds ratio 2.81, 95% CI 1.82-4.35) to have higher rates of primary care appointments (incident rate ratio 1.39, 95% CI 1.34-1.45) and more prescriptions (incident rate ratio 1.61, 95% CI 1.50-1.73). Rates of hospital accident and emergency attendance (incident rate ratio 1.21,95% CI 1.12-1.30) and hospital outpatients’ appointments (incident rate ratio 2.21,95% CI 1.90-2.56) are higher. Children of first cousins have higher rates of speech/ language development difficulties (odds ratio 1.63, 95% CI 1.36-1.96) and learning difficulties (odds ratio 1.89, 95% CI 1.28-2.81). When they begin school they are less likely to reach phonics standards (odds ratio 0.73, 95% CI 0.63-0.84) and less likely to show a good level of development (odds ratio 0.61, 95% CI 0.54-0.68). At age 10 there are higher numbers with special educational needs from first cousin unions compared to all children whose parents are not blood relations (odds ratio 1.38, 95% CI 1.20-1.58). Effect sizes for consanguinity status are similar in univariable and multivariable models where a range of control variables are added. Conclusions There is higher childhood mortality and greater use of health care as well as higher rates of learning difficulties, speech and language development challenges and substantive differences in education outcomes in children whose parents are first cousins.

Gulf War Illness (GWI), a chronic multisymptom illness with a complex and uncertain etiology and pathophysiology, is highly prevalent among veterans deployed to the 1990-1991 GW. We examined how GWI phenotypes varied by demographic and military characteristics among GW-era veterans. Data were from the VA's Cooperative Studies Program 2006/Million Veteran Program (MVP) 029 cohort, Genomics of GWI. From June 2018 to March 2019, 109,976 MVP enrollees (out of a total of over 676,000) were contacted to participate in the 1990-1991 GW-era Survey. Of 109,976 eligible participants, 45,169 (41.1%) responded to the 2018-2019 survey, 35,902 respondents met study inclusion criteria, 13,107 deployed to the GW theater. GWI phenotypes were derived from Kansas (KS) and Centers for Disease Control and Prevention (CDC) GWI definitions: (a) KS Symptoms (KS Sym+), (b) KS GWI (met symptom criteria and without exclusionary health conditions) [KS GWI: Sym+/Dx-], (c) CDC GWI and (d) CDC GWI Severe. The prevalence of each phenotype was 67.1% KS Sym+, 21.5% KS Sym+/Dx-, 81.1% CDC GWI, and 18.6% CDC GWI severe. These findings affirm the persistent presence of GWI among GW veterans providing a foundation for further exploration of biological and environmental underpinnings of this condition.

Introduction: Telehealth may address deficiencies in care provision for older adults, but potential downsides when used in place of in-person care are unclear. The use of subsequent care may be informative in a comprehensive evaluation of telehealth. Methods: We used administrative claims data from Optum?s de-identified Clinformatics? Data Mart Database to explore telehealth use in outpatient care and subsequent emergency department (ED) utilization before and during the COVID-19 pandemic. Results: We found evidence that telehealth use is associated with a higher likelihood of subsequent ED visits within six months relative to in-person care, but estimated differences vary across years and by age group. In 2021, estimated differences are statistically significant and increasing by age group. Conclusion: Telehealth may be associated with more frequent subsequent use of ED care compared with in-person care; however, more work is needed to understand healthcare quality differentials by visit modality and whether the results are causal.

Abstract Background Nursing incivility, defined as disrespectful behaviour toward nurses, is increasingly recognized as a pressing issue that affects nurses’ well-being and quality of care. However, research on the pathways linking incivility to outcomes is limited, especially in Saudi hospitals. Methods: This cross-sectional study examined relationships between perceived nursing incivility, nurse stress, patient engagement, and health outcomes in four Saudi hospitals. Using validated scales, 289 nurses and 512 patients completed surveys on exposure to incivility, stress levels, activation, and medication adherence. The outcomes included readmissions at 30 days and satisfaction. Results: More than two-thirds of nurses reported experiencing moderate to severe workplace incivility. Correlation and regression analyzes revealed that nursing incivility was positively associated with nursing stress. An inverse relationship was found between stress and patient participation. Serial mediation analysis illuminated a detrimental cascade, incivility contributing to increased nurse stress, subsequently diminishing patient engagement, ultimately worsening care quality. Conclusions The findings present robust evidence that nursing incivility has adverse ripple effects, directly impacting nurse well-being while indirectly affecting patient outcomes through reduced care involvement. Practical implications advocate for systemic interventions focused on constructive nursing cultures and patient empowerment to improve both healthcare provider conditions and quality of care. This study provides compelling information to inform policies and strategies to mitigate workplace mistreatment and encourage participation among nurses and patients to improve health outcomes.

Abstract Background Transportation plays a significant role in health, community resilience, and access to basic needs such as healthcare, social services, education, and job opportunities. Health and community resilience are, however, impacted by a multitude of complex and unequal factors, such as transportation restrictions exacerbated by the Israeli occupation. The goal of the research was to examine the intricate relationships that exist in Palestine between movement restrictions imposed by occupation, health outcomes, and community resilience. Method A self-structured questionnaire, devised based on expert conversations and previous literature, was used in this descriptive, quantitative study to explore health and resilience outcomes. Age, gender, marital status, place of residence, and means of transportation were among the various factors that were utilized to describe the socio-demographics of the study sample (n = 202). The researchers employed stepwise multiple regression and descriptive statistics for the data analysis. Results Study findings indicated that transportation restrictions have significant direct and indirect health consequences. A significant direct effect is observed, signifying a negative correlation between restrictions and health; increased transportation restrictions are consistently correlated with a decline in health. The study emphasized how place of residence affects health outcomes, with higher scores for campers and people living in green line areas. It also underscores that public means of transportation are found to be better for health outcomes than private cars. Conclusion This study emphasized that roadblocks, checkpoints, and military incursions make it difficult for Palestinians to receive medical care, which has a detrimental impact on their health and well-being. It also underscores the need for significant reforms in Palestinian health and transportation systems to enhance infrastructure and healthcare access. The Palestinian Authority should invest in public transportation and community resilience programs to address transportation-related health issues, especially in villages, due to frequent settler attacks.

Abstract Background Despite maternal flavivirus infections’ linkage to severe maternal and fetal outcomes, surveillance during pregnancy remains limited globally. Further complicating maternal screening for these potentially teratogenic pathogens is the overwhelming subclinical nature of acute infection. This study aimed to understand perinatal and neonatal risk for poor health outcomes associated with flaviviral infection during pregnancy in El Salvador. Methods Banked serologic samples and clinical results obtained from women presenting for labor and delivery at a national referent hospital in western El Salvador March to September 2022 were used for this study. 198 samples were screened for dengue and Zika virus IgM, and statistical analyses analyzed demographic and clinical outcome associations with IgM positivity. Results This serosurvey revealed a high rate of maternal flavivirus infection—24.2% of women presenting for labor and delivery were dengue or Zika virus IgM positive, suggesting potential infection within pregnancy. Specifically, 20.2% were Zika virus IgM positive, 1.5% were dengue virus IgM positive, and 2.5% were both dengue and Zika virus IgM positive. Women whose home had received mosquito abatement assistance within the last year by the ministry of health were 70% less likely to test IgM positive (aOR = 0.30, 95%CI: 0.10, 0.83). Further, statistical geospatial clustering revealed transmission foci in six primary municipalities. Pregnancy complications and poor birth outcomes were noted among the dengue and/or Zika virus maternal infection group, although these outcomes were not statistically different than the seronegative group. None of the resulting neonates born during this study were diagnosed with congenital Zika syndrome. Conclusions The high rate of Zika virus detected among pregnant women and the lack of Zika-specific neonatal outcomes monitoring during a non-outbreak year highlights the need for continued surveillance in Central America and among immigrant mothers presenting for childbirth from these countries. As changing climatic conditions continue to expand the range of the disease vector, asymptomatic screening programs could be vital to early identification of outbreaks and clinical management of cases.

Abstract Background There is limited evidence of the associations between postural-derived sitting time, waist-worn derived sedentary time and children’s health and the moderation effect of physical activity (PA). This study examined associations of children’s device-measured sitting time with cardiometabolic health risk factors, including moderation by physical activity. Methods Cross-sectional baseline data from children (mean-age 8.2 ± 0.5 years) in Melbourne, Australia (2010) participating in the TransformUs program were used. Children simultaneously wore an activPAL to assess sitting time and an ActiGraph GT3X to assess sedentary time and physical activity intensity. Cardiometabolic health risk factors included: adiposity (body mass index [BMI], waist circumference [WC]), systolic and diastolic blood pressure (SBP, DBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), cholesterol, triglycerides, fasting plasma glucose (FPG), serum insulin, and 25-hydroxyvitaminD (25[OH]D). Linear regression models (n = 71–113) assessed associations between sitting time with each health risk factor, adjusted for different PA intensities (i.e. light [LIPA], moderate-vigorous intensities [MVPA], separately on each model), age, sex, adiposity, and clustering by school. Interaction terms examined moderation. The analyses were repeated using device-measured sedentary time (i.e. ActiGraph GT3X) for comparison. Results Sitting time was positively associated with SBP (b = 0.015; 95%CI: 0.004, 0.026), DBP (b = 0.012; 95%CI:0.004, 0.020), and FPG (b = 0.001; 95%CI: 0.000, 0.000), after adjusting for higher PA intensities. The association between sitting time and insulin (b = 0.003; 95%CI: 0.000, 0.006) was attenuated after adjusting for higher PA intensities. When the models were adjusted for LIPA and MVPA, there was a negative association with LDL (b=-0.001; 95%CI: -0.002, -0.000 and b=-0.001; 95%CI: -0.003, -0.000, respectively). There was a negative association of sedentary time with WCz (b=-0.003; 95%CI: -0.005, 0.000) and BMIz (b=-0.003; 95%CI: -0.006, -0.000) when the models were adjusted by MVPA. Sedentary time was positively associated with triglycerides (b = 0.001; 95%CI: 0.000, 0.001) but attenuated after adjusting for MVPA. No evidence of moderation effects was found. Conclusions Higher volumes of sitting and sedentary time were associated with some adverse associations on some cardiometabolic health risk factors in children. These associations were more evident when sitting time was the predictor. This suggests that reducing time spent sitting may benefit some cardiometabolic health outcomes, but future experimental research is needed to confirm causal relationships and identify the biological mechanisms that might be involved. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12609000715279.

Abstract Background This study evaluates the feasibility of a nine-month advanced quality-improvement program aimed at enhancing the quality of care provided by primary care physical therapists in the Netherlands. The evaluation is based on routinely collected health outcomes of patients with nonspecific low back pain, assessing three feasibility domains: (1) appropriateness, feasibility, and acceptability for quality-improvement purposes; (2) impact on clinical performance; and (3) impact on learning and behavioral change. Methods A mixed-methods quality-improvement study using a concurrent triangulation design was conducted in primary care physical therapist practice. Feedback reports on the processes and outcomes of care, peer assessment, and self-assessment were used in a Plan-Do-Study-Act cycle based on self-selected goals. The program’s appropriateness, feasibility, and acceptability, as well as the impact on clinical performance, were evaluated using the Intervention Appropriate Measure, Feasibility Intervention Measure, Acceptability Intervention Measure (for these three measure, possible scores range from 4 to 20), and with a self-assessment of clinical performance (scored 0–10), respectively. The impact on learning and behavioral change was evaluated qualitatively with a directed content analysis. Results Ten physical therapists from two practices participated in this study. They rated the program with a mean of 16.5 (SD 1.9) for appropriateness, 17.1 (SD 2.2) for feasibility, and 16.4 (SD 1.5) for acceptability. Participants gave their development in clinical performance a mean score of 6.7 (SD 1.8). Participants became aware of the potential value of using outcome data and gained insight into their own routines and motivations. They changed their data collection routines, implemented data in their routine practice, and explored the impact on their clinical behavior. Conclusions This explorative study demonstrated that a quality-improvement program, using health outcomes from a national registry, is judged to be feasible. Impact statement This study provides preliminary evidence on how physical therapists may use health outcomes to improve their quality, which can be further used in initiatives to improve outcome-based care in primary physical therapy.

Abstract Background Food insecurity and environmental degradation pose significant threats to health outcomes in South Asia, necessitating effective policy interventions. Therefore, this study aims to examine the impact of food insecurity and environmental degradation on health outcome indicators amidst global inflationary shocks and institutional quality arrangements. Additionally, it aims to explore the intricate moderating role of institutional quality on the relationship between food insecurity, endogenous variables, and external shocks. Method In alignment with the study’s objectives, a set of panel data spanning from 2000 to 2021 is compiled for South Asia. The study introduces a novel variable representing inflationary shock, crafted through the integration of inflation datapoints and the application of the generalized autoregressive conditional heteroskedasticity model. Additionally, a distinctive aggregate institutional quality index is formulated, drawing from six key measures of the Worldwide Governance indicators. To scrutinize the effects of food insecurity, environmental degradation, and other explanatory variables, the study employs the two-step system generalized method of moment technique, offering a robust analytical approach to uncover complex relationships and dynamics in the region. Results The results indicate that the prevalence of undernourishment, inequality in per capita calorie intake, and CO2 emissions significantly reduce life expectancy and increase mortality rates. Additionally, it shows that per capita kilocalorie supply, per capita GDP, per capita health expenditures, and urbanization are statistically significant for increasing life expectancy and decreasing mortality rates. The findings reveal that inflationary shocks severely affect food insecurity and environmental factors, exerting further pressure on contemporary life expectancy and mortality rates. In rebuttal, the institutional quality index is found to have significant effects on increasing and decreasing life expectancy and mortality rates, respectively. Furthermore, the institutional quality index is effective in moderating the nexus between food insecurity, environmental degradation, and health outcomes while also neutralizing the negative impact of inflationary shocks on the subject. Conclusion The results verify triple health constraints such as food insecurity, environmental factors, and economic vulnerability to global shocks, which impose severe effects on life expectancy and mortality rates. Furthermore, poor institutional quality is identified as a hindrance to health outcomes in South Asia. The findings suggest specific policy implications that are explicitly discussed.

Introduction: Osteoarthritis (OA) is one of the most significant contributors to disability regarding limitation in transfer and ambulation. Extracorporeal shockwave therapy (ESWT) has recently been developed as regenerative therapy. However, its effect on daily performance is limited. This study aims to evaluate ESWT on improving daily performance in knee OA patients. Methods: Thirteen OA patients were selected in one-group pretest–posttest design. Each participant received ESWT once a week for 6 weeks. Functional performance tests such as transfer ability by 30 s chair stand test (30s-CST) and ambulation with Timed Up and Go (TUG) test were evaluated before therapy (T1), at 3 weeks (T2), and 6 weeks after completing serial intervention (T3). A paired t-test was used to assess ESWT on changes in TUG and 30s-CST results. Effect size evaluated using Cohen’s D. Pearson correlation test analyzed the correlation of other variables with TUG and 30s-CST, as well as between TUG and 30s-CST. Results: There were significant improvements with a large effect size in 30s-CST during T2 (P = 0.001, r = 1.28) and T3 (P = 0.001; r = 1.265). It also happened in TUG results with T2 (P = 0.004, r = 0.978) and T3 (P = 0.002, r = 0.855). Pearson correlation test showed that body mass index was correlated with 30s-CST. TUG has a correlation with the onset of OA, IMT, and WBS, as well as 30s-CST correlated with TUG results. Conclusions: ESWT intervention for 6 weeks was proven to be effective in improving basic daily performance in knee OA patients.

The article explores racial disparities in dermatofibrosarcoma protuberans (DFSP) patients in the United States, with Black patients facing a higher risk of disease-specific mortality and larger tumor sizes compared to White patients. Using the SEER database, the study found that non-White patients, particularly Black individuals, presented with tumors located on the trunk and required more radiation therapy. Multivariate analysis revealed that identifying as Black independently increased the risk of disease-specific mortality. The study emphasizes the need for improved screening and prevention strategies for DFSP in populations of color, especially Black patients, to address the observed poorer survival outcomes. [Extracted from the article]

PURPOSE OF REVIEW: In this review, we examine the intersection of the HIV and COVID-19 epidemics with focus on COVID-19-related health outcomes and risk factors for SARS-CoV-2 among people living with HIV (PLWH). RECENT FINDINGS: Evidence to date do not suggest a higher incidence of SARS-CoV-2 infection among PLWH compared to the general population, although-once exposed-PLWH are at greater risk of severe COVID-19 outcomes. Key risk factors for severe COVID-19 include non-HIV comorbidities known to be associated with severe disease, as well as HIV-specific risk factors such as low CD4 + T-cell count, unsuppressed viral load, and tuberculosis co-infection. The disproportionate impact of the SARS-CoV-2 pandemic among Black, Latinx, and Native American/Alaskan Native PLWH could worsen pre-existing disparities in health outcomes among PLWH. Data on SARS-CoV-2 vaccine protection among PLWH needs additional study, although some studies suggest decreased humoral responses among those with low CD4 + T-cell counts, while there is a signal of increased vaccine breakthrough rates among PLWH in two large observational cohorts. Data on post-acute sequelae of SARS-CoV-2 (PASC) among PLWH is also limited. PLWH do not have a higher susceptibility to SARS-CoV-2, but once exposed, they are at higher risk of severe COVID-19 outcomes. Additional resources will need to be dedicated to the development of interventions to improve health outcomes and address disparities among PLWH impacted by the COVID-19 pandemic.

Introduction  Race, ethnicity, and socioeconomic status (SES) are complex, interconnected social determinants of health outcomes. This study uses multivariable analysis on a combination of large national datasets to examine the effects of these factors on 5-year disease-specific survival (DSS) and conditional DSS (CDSS) for nasopharyngeal carcinoma (NPC). Methods  A retrospective study of adults with NPC between 2000 and 2017 from the Surveillance, Epidemiology, End Results (SEER) registry was performed, using the National Cancer Institute Yost Index, a census tract-level composite score of SES to categorize patients. Kaplan-Meier analysis and Coxs regression for DSS and CDSS were stratified by SES. Logistic regression was conducted to identify risk factors for advanced cancer stage at time of diagnosis and receiving multimodal therapy. Results  Our analysis included 5,632 patients. DSS was significantly associated with race and SES ( p