Search

Background: Integrated curriculum interventions have been suggested as an effective means to increase physical activity (PA) and health. The feasibility of such approaches in children living in deprivation is unknown. This study sought to pilot an integrated curriculum pedometer intervention in children living in deprivation on school-based PA, body fatness, resting blood pressure, motor skills, and well-being. Methods: Using a pilot cluster randomized intervention design, children (6–7 y old, n = 64) from 2 schools in central England undertook: (1) 10-week integrated curriculum intervention or (2) control (regular school-based activity). School-based PA, body fatness, resting blood pressure, motor skills, and well-being were assessed preintervention and postintervention. Results: For the intervention group, PA was higher on school days when children had physical education lessons or there were physically active integrated curriculum activities. Body fatness significantly decreased, and well-being and perceived physical competence increased, pre–post for the intervention group compared with the control group. Accelerometer-derived PA, motor skills, and resting blood pressure were not significantly different pre–post for intervention or control groups. Conclusions: A 10-week integrated curriculum PA intervention is feasible to conduct and can positively impact aspects of health in 6- to 7-year-old children in England. [ABSTRACT FROM AUTHOR]

STUDY OBJECTIVES: Sleep loss contributes to various health issues and impairs neurological function. Molecular hydrogen has recently gained popularity as a nontoxic ergogenic and health promoter. The effect of molecular hydrogen on sleep and sleep-related neural systems remains unexplored. This study investigates the impact of hydrogen-rich water (HRW) on sleep behavior and neuronal activation in sleep-deprived mice. METHODS: Adult C57BL/6J mice were implanted with electroencephalography (EEG) and electromyography (EMG) recording electrodes and given HRW (0.7-1.4 mM) or regular water for 7 days ad libitum. Sleep-wake cycles were recorded under baseline conditions and after acute sleep loss. Neuronal activation in sleep- and wake-related regions was assessed using cFos immunostaining. RESULTS: HRW increased sleep consolidation in undisturbed mice and increased non-rapid-eye movement and rapid-eye-movement sleep amount in sleep-deprived mice. HRW also decreased the average amount of time for mice to fall asleep after light onset. Neuronal activation in the lateral septum, medial septum, ventrolateral preoptic area, and median preoptic area was significantly altered in all mice treated with HRW. CONCLUSIONS: HRW improves sleep consolidation and increases neuronal activation in sleep-related brain regions. It may serve as a simple, effective treatment to improve recovery after sleep loss.

Purpose Methods Results Conclusion Socioeconomic deprivation is associated with an increased incidence of sight‐loss. To inform potential developments in eyecare, General Ophthalmic Service (GOS) sight‐testing activity was explored in relation to deprivation for GOS contractors submitting National Health Service (NHS) claims in England.Data on NHS sight‐test claims for the financial year 2022–2023 were sought from NHS England (NHSE), including number of sight‐tests by GOS contractors, their unique Organisation Data Service codes and postcodes and age‐bands of patients accessing sight‐testing. Deprivation scores were assigned to contractor practices using the Index of Multiple Deprivation (IMD) and the average number of sight‐tests for all contractors within each IMD decile calculated, allowing rate of sight‐testing per 1000 population per decile of deprivation to be estimated using Office of National Statistics (ONS) Lower Layer Super Output Area mid‐year population estimates. Inequality was examined using the Odds Ratio (OR) and slope and relative index of inequality measures (SSI and RII).Overall, 12.94 million NHS sight‐tests were provided by 5622 GOS contractors in England in 2022–2023. Most affluent decile GOS contractors undertook an average ~2200 NHS sight‐tests, while in the most deprived decile, average NHS sight‐tests per contractor was ~1100. Rate of sight‐testing per 1000 population in the most deprived decile was one quarter of that in the most affluent, with an OR of 5.29 (95% CI 5.27–5.30), indicating those in the most affluent areas were ~five times more likely to access NHS sight‐tests. Overall, SII and RII were 333.5 (95% CI 333.52–333.53) and 6.4 (95% CI 6.39–6.40), respectively, findings reflective of substantial inequality in uptake.There remains substantial unwarranted variation in uptake of NHS sight‐testing, with those in more affluent areas accessing sight‐testing substantially more than those in more deprived areas. Strategies are required to facilitate primary care optometry to provide more equitable access to eyecare. [ABSTRACT FROM AUTHOR]

Background: Māori are over-represented in Aotearoa New Zealand morbidity and mortality statistics. Other populations with high health needs include Pacific peoples and those living with material deprivation. General practice has evolved into seven models of primary care: Traditional, Corporate, Health Care Home, Māori, Pacific, Trusts / Non-governmental organisations (Trust/NGOs) and District Health Board / Primary Care Organisations (DHB/PHO). We describe nurse work in relation to these models of care, populations with high health need and patient health outcomes. Methods: We conducted a cross-sectional study (at 30 September 2018) of data from national datasets and practices at patient level. Six primary outcome measures were selected because they could be improved by primary care: polypharmacy (≥ 65 years), glucose control testing in adults with diabetes, immunisations (at 6 months), ambulatory sensitive hospitalisations (0–14, 45–64 years) and emergency department attendances. Analysis adjusted for patient and practice characteristics. Results: Nurse clinical time, and combined nurse, nurse practitioner and general practitioner clinical time, were substantially higher in Trust/NGO, Māori, and Pacific practices than in other models. Increased patient clinical complexity was associated with more clinical input and higher scores on all outcome measures. The highest rates of preventative care by nurses (cervical screening, cardiovascular risk assessment, depression screening, glucose control testing) were in Māori, Trust/NGO and Pacific practices. There was an eightfold difference, across models of care, in percentage of depression screening undertaken by nurses and a fivefold difference in cervical screening and glucose control testing. The highest rates of nurse consultations afterhours and with unenrolled patients, improving access, were in PHO/DHB, Pacific, Trust/NGO and Māori practices. Work not attributed to nurses in the practice records meant nurse work was underestimated to an unknown degree. Conclusions: Transferring work to nurses in Traditional, Health Care Home, and Corporate practices, would release general practitioner clinical time for other work. Worse patient health outcomes were associated with higher patient need and higher clinical input. It is plausible that there is insufficient clinical input to meet the degree of patient need. More practitioner clinical time is required, especially in practices with high volumes of complex patients. [ABSTRACT FROM AUTHOR]

In Pakistan, due to low per capita income and weak socio-economic policies the poverty has remained core problem in every era. Thus, as per sensitivity of the issue, the present study key objectives are to empirically address the dilemma of multidimensional poverty among agrarian and non-agrarian communities of Agro-environmental Regions of Pakistan. For assessment of comprehensive outcomes, one decade survey data (2010/11 to 2019/20) of Pakistan social and living standard measurement and globally acknowledged Alkire and Foster (Counting and multidimensional poverty measurement, 2007) indexing methodology has been adopted. Stepwise outcomes under dual cut-off K = 2 logically reveal that multidimensional poverty is purely an agrarian phenomenon at the national level and across all the nine agro-environmental regions of Pakistan. Further, at the national level in each study year, residents of the agrarian community with poverty estimates 46.40, 39.00, 34.90, and 31.90% are harshly victimized by precise menace compared to their non-agrarian counterparts with poverty measures 23.00, 20.60, 19.10, and 17.70%, respectively. Like national measure, similar trend has also been observed across each agro-environmental region where agrarian community is severely victimized of multiple attributes poverty menace compared to non-agrarian counterpart. Moreover, a comparative analysis of current valuations highlights that over time, especially in the short run, 2010/11 to 2012/13; 2012/13 to 2014/15, and 2014/15 to 2019/20, multiple aspect poverty at national level and across each zone in Pakistan presents fluctuating trend for both communities. However, in the long run, with the time gap of complete decade since to 2010–11 to 2019–20, multidimensional poverty reveals a declining trend at the national level as well as across each study zone in Pakistan. These valuations indicate a noteworthy improvement in all three attributes; education, health, and housing services specifically in longer span of time. Precise improvements are appreciable but still a strong policy like adoption of modern technology as per advance countries in all three aspect is essentially needed to achieve the UNDP agenda within the prescribed time limit. [ABSTRACT FROM AUTHOR]

Background: Globally, early-life adversity (ELA) is linked to an increased risk of developing depression in adulthood; however, only a few studies have examined the specific effects of various types of ELA on depression in children and adolescents. This meta-analysis explores the association between the subtypes of ELA and the risk for youth-onset depression. Methods: We searched three electronic databases for reporting types of ELA, namely, emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, family conflict/violence, divorce, low socioeconomic status, and left-behind experience, associated with depression before the age of 18 years. Our meta-analysis utilized the odds ratio (OR) and relied on a random effects model. Large heterogeneous effects were detected. Some factors moderated the association between ELA and depression in youths. The homogeneity of variance test and meta-regression analysis were used to detect these relationships. Results: A total of 87 studies with 213,006 participants were ultimately identified via several strategies in this meta-analysis. Individuals who experienced ELA were more likely to develop depression before the age of 18 years old than those without a history of ELA (OR=2.14; 95% CI [1.93, 2.37]). The results of the subgroup analysis revealed a strong association between ELA and depression in youth, both in terms of specific types and dimensions. Specifically, emotional abuse (OR = 4.25, 95% CI [3.04, 5.94]) was more strongly related to depression in children and adolescents than other forms of ELA were. For both dimensions, threat (OR = 2.60, 95% CI [2.23, 3.02]) was more closely related to depression than deprivation was (OR = 1.76, 95% CI [1.55, 1.99]). Conclusion: This meta-analysis revealed that the adverse effects of a broader consideration of ELA on the risk of youth-onset depression vary according to the subtypes of ELA. [ABSTRACT FROM AUTHOR]

Introduction: In the United States (US), racial and socioeconomic disparities have been implicated in pediatric intensive care unit (PICU) admissions and outcomes, with higher rates of critical illness in more deprived areas. The degree to which this persists despite insurance coverage is unknown. We investigated whether disparities exist in PICU admission and mortality according to socioeconomic position and race in children receiving Medicaid. Methods: Using Medicaid data from 2007–2014 from 23 US states, we tested the association between area level deprivation and race on PICU admission (among hospitalized children) and mortality (among PICU admissions). Race was categorized as Black, White, other and missing. Patient-level ZIP Code was used to generate a multicomponent variable describing area-level social vulnerability index (SVI). Race and SVI were simultaneously tested for associations with PICU admission and mortality. Results: The cohort contained 8,914,347 children (23·0% Black). There was no clear trend in odds of PICU admission by SVI; however, children residing in the most vulnerable quartile had increased PICU mortality (aOR 1·12 (95%CI 1·04–1·20; p = 0·0021). Black children had higher odds of PICU admission (aOR 1·04; 95% CI 1·03–1·05; p < 0·0001) and higher mortality (aOR 1·09; 95% CI 1·02–1·16; p = 0·0109) relative to White children. Substantial state-level variation was apparent, with the odds of mortality in Black children varying from 0·62 to 1·8. Conclusion: In a Medicaid cohort from 2007–2014, children with greater socioeconomic vulnerability had increased odds of PICU mortality. Black children were at increased risk of PICU admission and mortality, with substantial state-level variation. Our work highlights the persistence of sociodemographic disparities in outcomes even among insured children. [ABSTRACT FROM AUTHOR]

As both socioeconomic deprivation and the prevalence of childhood mental health difficulties continue to increase, exploring the relationship between them is important to guide policy. We aimed to replicate the finding of a mental health gap that widened with age between those living in the most and least deprived areas among primary school pupils. We used data from 2075 children aged 4–9 years in the South West of England recruited to the STARS (Supporting Teachers and childRen in Schools) trial, which collected teacher- and parent-reported Strength and Difficulties Questionnaire (SDQ) at baseline, 18-month and 30-month follow-up. We fitted multilevel regression models to explore the relationship between Index of Multiple Deprivation (IMD) quintile and SDQ total difficulties score and an algorithm-generated "probable disorder" variable that combined SDQ data from teachers and parents. Teacher- and parent-reported SDQ total difficulties scores indicated worse mental health in children living in more deprived neighbourhoods, which was attenuated by controlling for special educational needs and disabilities but remained significant by parent report, and there was no interaction year group status (age) at baseline. We did not detect an association between probable disorder and IMD although an interaction with time was evident (p = 0.003). Analysis by study wave revealed associations at baseline (odds ratio 1.94, 95% confidence interval 0.97–3.89) and 18 months (1.96, 1.07–3.59) but not 30 months (0.94, 0.54–1.57). These findings augment the existing, highly compelling evidence demonstrating worse mental health in children exposed to socioeconomic deprivation. [ABSTRACT FROM AUTHOR]

Summary: The effect of deprivation on total bone health status has not been well defined. We examined the relationship between socioeconomic deprivation and poor bone health and falls and we found a significant association. The finding could be beneficial for current public health strategies to minimise disparities in bone health. Purpose: Socioeconomic deprivation is associated with many illnesses including increased fracture incidence in older people. However, the effect of deprivation on total bone health status has not been well defined. To examine the relationship between socioeconomic deprivation and poor bone health and falls, we conducted a cross-sectional study using baseline measures from the United Kingdom (UK) Biobank cohort comprising 502,682 participants aged 40–69 years at recruitment during 2006–2010. Method: We examined four outcomes: 1) low bone mineral density/osteopenia, 2) fall in last year, 3) fracture in the last five years, and 4) fracture from a simple fall in the last five years. To measure socioeconomic deprivation, we used the Townsend index of the participant's residential postcode. Results: At baseline, 29% of participants had low bone density (T-score of heel < -1 standard deviation), 20% reported a fall in the previous year, and 10% reported a fracture in the previous five years. Among participants experiencing a fracture, 60% reported the cause as a simple fall. In the multivariable logistic regression model after controlling for other covariates, the odds of a fall, fracture in the last five years, fractures from simple fall, and osteopenia were respectively 1.46 times (95% confidence interval [CI] 1.42–1.49), 1.26 times (95% CI 1.22–1.30), 1.31 times (95% CI 1.26–1.36) and 1.16 times (95% CI 1.13–1.19) higher for the most deprived compared with the least deprived quantile. Conclusion: Socioeconomic deprivation was significantly associated with poor bone health and falls. This research could be beneficial to minimise social disparities in bone health. [ABSTRACT FROM AUTHOR]

This note examines and tests the determinants of constituency service in the Chilean Chamber of Deputies. We argue that socio-demographic factors lead towards differences in the provision of constituency service. We use a new data set of meetings between legislators, constituents, and groups to provide evidence for two main hypotheses. First, Chilean deputies from more remote districts devote a higher proportion of their meetings to addressing local or personal issues from constituents (Centre-Periphery Hypothesis). Second, deputies from districts in worse socio-economic situations also provide relatively more constituency services of this type (Social Deprivation Hypothesis). [ABSTRACT FROM AUTHOR]

The past decade has seen the growth of Short-Term Lets (STLs) through Airbnb and other platforms. Measuring the scale of this activity is challenging as platforms appear unwilling to share data. Most research on Airbnb uses data from commercial sources but this raises issues of equity in access and transparency. Open data exist, but geographic and temporal coverage is limited. We consider whether these open data can be used to study the STLs sector, using a city in Scotland. Using 2017 data to construct: (i) property-level estimates of income; and (ii) through comparisons with rents in the long-term rental market, an area-level vulnerability index to identify neighbourhoods at greatest risk of properties switching from long-term to short-term renting. This index is strongly associated with the growth of Airbnb listings over two years. We conclude that open data can provide a valuable basis for research and policy. We discuss strategies for improving knowledge about this sector including through new data collection. [ABSTRACT FROM AUTHOR]

The measurement of deprivation for small areas in the UK has provided the basis for the development of policies and targeting of resources aimed at reducing spatial inequalities. Most measures summarise the aggregate level of deprivation across all people in a given area, and no account is taken of differences between people with differing characteristics, such as age, sex or ethnic group. In recognition of the marked inequalities between ethnic groups in the UK, and the distinctive geographies of these inequalities, this paper presents a new ethnic group‐specific neighbourhood deprivation measure—the Ethnic Group Deprivation Index (EGDI). This index, using a custom cross‐tabulated 2021 Census dataset on employment, housing tenure, education and health by ethnic group, reveals the small area geographies of ethnic inequalities that have to date received scant attention, and yet have profound impacts on life chances and well‐being. Drawing on the methodological framework of the widely used English Index of Multiple Deprivation (IMD) and for the same geographies (Lower Layer Super Output Areas), the EGDI measures deprivation for each ethnic group using data from the 2021 Census of England and Wales. The EGDI reveals the complex geographies of ethnic inequality and demonstrates that while one ethnic group in a neighbourhood may have high relative levels of deprivation, another ethnic group in that same neighbourhood may experience very low relative levels. The EGDI explores ethnic inequalities within and between neighbourhoods, complementing and augmenting existing measures by offering an important means of better understanding ethnic inequalities. The EGDI can be used to help shape locally and culturally sensitive policy development and resource allocation. [ABSTRACT FROM AUTHOR]

Inequalities in maternal and perinatal outcomes related to ethnicity and socioeconomic deprivation are widening. Being of Black and Asian ethnicity independently increases the risk of maternal mortality and severe morbidity, as does living in the most deprived areas. Since a higher proportion of women of Asian and Black ethnicity live in the most deprived areas, this effect is compounded. Individual risks, such as obesity, are influenced by health and cultural beliefs and behaviour, social networks and norms, the environments in which we live, and access to and experience of healthcare, which are all intertwined with ethnicity and socioeconomic status. Clinicians can listen to women's and communities needs around ethnicity, race, and social determinants of health. Clinicians can also identify and use networks of community support and promote awareness within their practice and teams. Institutions can employ and retain diverse teams, measure health equity of services and develop an anti-discriminatory institutional culture. [ABSTRACT FROM AUTHOR]

Studies have observed a tight spatial coupling of elevated violent crime rates, structural deprivation, and cardiometabolic disease prevalence across geographic areas. Conceptual perspectives in the health sciences provide a framework to explain this geographic concentration of poor health and crime, which differs from perspectives derived from macro-level criminology. Drawing on these different conceptual approaches, the current study uses administrative and survey data aggregated to Census tracts to examine whether violent crime and structural deprivation are factors for cardiometabolic disease prevalence. Drawing on the racial invariance thesis, the study also tests whether these patterns are invariant across neighborhoods of different racial and ethnic compositions. Multivariate results reveal that cardiometabolic disease varies directly with levels of violent crime but not structural deprivation. Furthermore, the results do not provide consistent support for the racial and ethnic invariance hypothesis. We discuss the implications of the findings for prevention models focused on modifiable risk factors of poor health in local geographic areas. [ABSTRACT FROM AUTHOR]

Simple Summary: Socioeconomic inequalities in cancer incidence and mortality have been studied extensively, but there has been no investigation of the spatial distribution of incidence and mortality within a country to see if they are consistent with each other and with deprivation. To fill this gap, we examined the spatial distribution of cancer incidence and mortality and their association with each other and with socioeconomic deprivation at the municipal level in Hungary, one of the countries with the most unfavourable cancer burden in the world. For different types of cancer, while mortality always showed positive associations with deprivation, there was only partial overlap between areas of high incidence and mortality across the country, with clusters often independent of deprivation. Even where incidence and mortality overlapped geographically, there were often significant differences in mortality risk. Discrepancies in the spatial distribution of cancer incidence and mortality are indicators of an unmet need for cancer prevention and/or treatment. There is a rich body of literature on the distribution of cancer incidence and mortality in socioeconomically different world regions, but none of the studies has compared the spatial distribution of mortality and incidence to see if they are consistent with each other. All malignant neoplasms combined and cervical, colorectal, breast, pancreatic, lung, and oral cancers separately were studied in the Hungarian population aged 25–64 years for 2007–2018 at the municipality level by sex. In each case, the spatial distribution of incidence and mortality were compared with each other and with the level of deprivation using disease mapping, spatial regression, risk analysis, and spatial scan statistics. A positive association between deprivation and mortality was found for each type of cancer, but there was no significant association for male colorectal cancer (relative risk (RR) 1.00; 95% credible interval (CI) 0.99–1.02), pancreatic cancer (RR: 1.01; 95%CI 0.98–1.04), and female colorectal cancer incidence (RR: 1.01; 95%CI 0.99–1.03), whereas a negative association for breast cancer (RR: 0.98; 95%CI 0.96–0.99) was found. Disease mapping analyses showed only partial overlap between areas of high incidence and mortality, often independent of deprivation. Our results highlight not only the diverse relationship between cancer burden and deprivation, but also the inconsistent relationship between cancer incidence and mortality, pointing to areas with populations that require special public health attention. [ABSTRACT FROM AUTHOR]

Purpose: While some factors have been well-shown to affect the decision-making in treating patients with vestibular schwannomas (VS), little is known on the role of deprivation. Our objective was to assess the effect of socioeconomic background on the management of patients with VS. Methods: This retrospective cohort study included 460 patients with sporadic VS from West of Scotland. The postcode-based, multifactorial Scottish Index of Multiple Deprivation (SIMD) was used to assess the socioeconomic background of each patient. We performed a multivariate analysis including tumour size, growth and patient age with management modality (observation, stereotactic radiotherapy, microsurgery) being the main outcome measure and outcome (need for additional treatment) an additional measure. Results: We found no significant difference in the demographics, tumour characteristics and primary treatment choice between patients with different SIMD scores. In addition, there was no statistically significant difference in the growth occurrence rates following first-line treatment (p = 0.964) and in the second-line treatment choice (p = 0.460). Conclusions: Multiple deprivation does not affect decision making in patients with VS in the examined cohort. This is probably linked to the centralisation and uniformity of the service and might not necessarily be applicable to other health services without centralisation. [ABSTRACT FROM AUTHOR]

Introduction: To contribute to addressing diagnostic health inequalities in the United Kingdom, this review aimed to investigate determinants of diagnostic service use amongst people experiencing high deprivation in the United Kingdom. Methods: A systematic review was conducted using three databases (EBSCO, Web of Science and SCOPUS) to search studies pertaining to diagnostic service use amongst people experiencing high deprivation. Search terms related to diagnostics, barriers and facilitators to access and deprivation. Articles were included if they discussed facilitators and/or barriers to diagnostic service access, contained participants' direct perspectives and focussed on individuals experiencing high deprivation in the United Kingdom. Articles were excluded if the full text was unretrievable, only abstracts were available, the research did not focus on adults experiencing high deprivation in the United Kingdom, those not including participants' direct perspectives (e.g., quantitative studies) and papers unavailable in English. Results: Of 14,717 initial papers, 18 were included in the final review. Determinants were grouped into three themes (Beliefs and Behaviours, Emotional and Psychological Factors and Practical Factors), made up of 15 sub‐themes. These were mapped to a conceptual model, which illustrates that Beliefs and Behaviours interact with Emotional and Psychological Factors to influence Motivation to access diagnostic services. Motivation then influences and is influenced by Practical Factors, resulting in a Decision to Access or Not. This decision influences Beliefs and Behaviours and/or Emotional and Psychological Factors such that the cycle begins again. Conclusion: Decision‐making regarding diagnostic service use for people experiencing high deprivation in the United Kingdom is complex. The conceptual model illustrates this complexity, as well as the mediative, interactive and iterative nature of the process. The model should be applied in policy and practice to enable understanding of the factors influencing access to diagnostic services and to design interventions that address identified determinants. Patient or Public Contribution: Consulting lived experience experts was imperative in understanding whether and how the existing literature captures the lived experience of those experiencing high deprivation in South England. The model was presented to lived experience experts, who corroborated findings, highlighted significant factors for them and introduced issues that were not identified in the review. [ABSTRACT FROM AUTHOR]

Purpose: Sepsis is a life-threatening organ dysfunction caused by dysregulated host response to infection. The purpose of the study was to measure the associations of specific exposures (deprivation, ethnicity, and clinical characteristics) with incident sepsis and case fatality. Methods: Two research databases in England were used including anonymized patient-level records from primary care linked to hospital admission, death certificate, and small-area deprivation. Sepsis cases aged 65–100 years were matched to up to six controls. Predictors for sepsis (including 60 clinical conditions) were evaluated using logistic and random forest models; case fatality rates were analyzed using logistic models. Results: 108,317 community-acquired sepsis cases were analyzed. Severe frailty was strongly associated with the risk of developing sepsis (crude odds ratio [OR] 14.93; 95% confidence interval [CI] 14.37–15.52). The quintile with most deprived patients showed an increased sepsis risk (crude OR 1.48; 95% CI 1.45–1.51) compared to least deprived quintile. Strong predictors for sepsis included antibiotic exposure in prior 2 months, being house bound, having cancer, learning disability, and diabetes mellitus. Severely frail patients had a case fatality rate of 42.0% compared to 24.0% in non-frail patients (adjusted OR 1.53; 95% CI 1.41–1.65). Sepsis cases with recent prior antibiotic exposure died less frequently compared to non-users (adjusted OR 0.7; 95% CI 0.72–0.76). Case fatality strongly decreased over calendar time. Conclusion: Given the variety of predictors and their level of associations for developing sepsis, there is a need for prediction models for risk of developing sepsis that can help to target preventative antibiotic therapy. [ABSTRACT FROM AUTHOR]

Abstract Background Māori are over-represented in Aotearoa New Zealand morbidity and mortality statistics. Other populations with high health needs include Pacific peoples and those living with material deprivation. General practice has evolved into seven models of primary care: Traditional, Corporate, Health Care Home, Māori, Pacific, Trusts / Non-governmental organisations (Trust/NGOs) and District Health Board / Primary Care Organisations (DHB/PHO). We describe nurse work in relation to these models of care, populations with high health need and patient health outcomes. Methods We conducted a cross-sectional study (at 30 September 2018) of data from national datasets and practices at patient level. Six primary outcome measures were selected because they could be improved by primary care: polypharmacy (≥ 65 years), glucose control testing in adults with diabetes, immunisations (at 6 months), ambulatory sensitive hospitalisations (0–14, 45–64 years) and emergency department attendances. Analysis adjusted for patient and practice characteristics. Results Nurse clinical time, and combined nurse, nurse practitioner and general practitioner clinical time, were substantially higher in Trust/NGO, Māori, and Pacific practices than in other models. Increased patient clinical complexity was associated with more clinical input and higher scores on all outcome measures. The highest rates of preventative care by nurses (cervical screening, cardiovascular risk assessment, depression screening, glucose control testing) were in Māori, Trust/NGO and Pacific practices. There was an eightfold difference, across models of care, in percentage of depression screening undertaken by nurses and a fivefold difference in cervical screening and glucose control testing. The highest rates of nurse consultations afterhours and with unenrolled patients, improving access, were in PHO/DHB, Pacific, Trust/NGO and Māori practices. Work not attributed to nurses in the practice records meant nurse work was underestimated to an unknown degree. Conclusions Transferring work to nurses in Traditional, Health Care Home, and Corporate practices, would release general practitioner clinical time for other work. Worse patient health outcomes were associated with higher patient need and higher clinical input. It is plausible that there is insufficient clinical input to meet the degree of patient need. More practitioner clinical time is required, especially in practices with high volumes of complex patients.

The health and well-being of some residents in the United Kingdom are quite challenged, as access to some required treatments and support is limited due to some level of deprivation. This study compared the Jewish and other religious groups in England and Wales, to determine households’ deprivation in the health and disability, housing, education, and employment dimensions. This study further investigated the number of households with disabled residents, people living with non-limiting long-term physical or mental health conditions, and unpaid carers. The analysis was based on secondary data (UK 2021 Census data) from the Office for National Statistics. The findings of the study revealed that more households are deprived in the health and disability dimension. This suggests that apart from households that have at least a disabled resident, a few households have residents who are not disabled but their day-to-day activities are limited due to ill-health (bad or very bad health conditions). A high level of deprivation was also observed in the education dimension. Based on the high level of deprivation in the education dimension and the high proportion of households deprived in the health and disability dimension, the UK government needs to look into the health and well-being of these households. In addition, while focusing on larger local authorities (LAs) like Barnet (with a large number of households across LAs), targeted government interventions are needed to improve health and well-being of Jewish households in LAs such as Swansea, Southend-on-Sea, Hackney, Oxford, and Gateshead that have a higher proportion (within the LA) of deprivation in any of the tested dimensions or affected in terms of disability, non-limiting long-term health conditions, or the proportion of unpaid carers.

Abstract Introduction In the United States (US), racial and socioeconomic disparities have been implicated in pediatric intensive care unit (PICU) admissions and outcomes, with higher rates of critical illness in more deprived areas. The degree to which this persists despite insurance coverage is unknown. We investigated whether disparities exist in PICU admission and mortality according to socioeconomic position and race in children receiving Medicaid. Methods Using Medicaid data from 2007–2014 from 23 US states, we tested the association between area level deprivation and race on PICU admission (among hospitalized children) and mortality (among PICU admissions). Race was categorized as Black, White, other and missing. Patient-level ZIP Code was used to generate a multicomponent variable describing area-level social vulnerability index (SVI). Race and SVI were simultaneously tested for associations with PICU admission and mortality. Results The cohort contained 8,914,347 children (23·0% Black). There was no clear trend in odds of PICU admission by SVI; however, children residing in the most vulnerable quartile had increased PICU mortality (aOR 1·12 (95%CI 1·04–1·20; p = 0·0021). Black children had higher odds of PICU admission (aOR 1·04; 95% CI 1·03–1·05; p

Abstract Background Quality sleep is vital for well-being, especially for healthcare workers facing high risks of fatigue and burnout. Sleep deprivation impairs cognitive and motor functions, contributing to medical errors. Addressing sleep disorders among healthcare professionals is crucial for enhancing patient care. Tailored interventions are needed to support their well-being and improve healthcare outcomes. Objective To evaluate the effect of Sleep Quality and its Deprivation on Sudanese Healthcare Professionals amidst conflict in Sudan. Methods A cross-sectional online survey of Sudanese doctors was conducted using convenience sampling. The questionnaire covered sleep quality, daytime sleepiness, and psychological well-being. Pilot testing ensured questionnaire clarity. Data collection utilized Google Forms distributed through social media and professional networks. A minimum sample size of 384 was calculated. Statistical analysis included descriptive statistics and various tests for significance. Data were securely stored and analyzed using SPSS and R software. Results Among 649 participants, 404 (62.2%) were women, with a mean age of 30.34 years. Most were single (434, 66.9%). General practitioners constituted the largest professional group (267, 41.1%), followed by registrars/residents (142, 21.9%). Participants took an average of 43.70 minutes to fall asleep and slept an average of 5.90 hours per night. According to the PSQI, 300 (46.2%) reported mild sleep disturbance, 287 (44.2%) moderate, 42 (6.5%) severe, and only 20 (3.1%) normal sleep. The ESS revealed 285 (43.9%) with lower normal daytime sleepiness, 188 (29.0%) with higher normal, and various levels of excessive daytime sleepiness. Stress levels varied, with 398 (61.3%) reporting normal stress, while anxiety ranged from 248 (38.2%) normal to 148 (22.8%) extremely severe. Conclusion This study emphasizes the importance of addressing sleep quality, mental health, and performance challenges among Sudanese healthcare professionals. It highlights the need for hospitals to implement measures enabling more time off, adequate sleep, and reduced on-call service days. Healthcare workers must recognize the significance of these factors for their well-being and patient care quality. The research outcomes can raise awareness about the necessity of regulating healthcare practitioners' working hours and ensuring adequate sleep.

Abstract Background Although underserved populations— including those from ethnic minority communities and those living in poverty—have worse health and poorer healthcare experiences, most primary care research does not fairly reflect these groups. Patient and public involvement (PPI) is usually embedded within research studies in the United Kingdom (UK), but often fails to represent underserved populations. This study worked with patient and public contributors and local community leaders, situated in a socio-economically deprived and ethnically diverse urban area, to explore under-representation in primary healthcare research. Methods We undertook a focus group with a purposive sample of 6 members of a Patient and Public Involvement Group (PPIG), and interviews with 4 community leaders (representing Black, South Asian, Roma and socio-economically deprived communities). An iterative analysis process based on template analysis was used. Focus group 1 was rapidly analysed, and a template created. Findings were presented in focus group 2, and the template further developed. The Cultural Trauma concept was than applied to the template to give a wider theoretical lens. In-depth analysis of focus groups and interviews was then performed based on the template. Results Wider societal and historical influences have degraded trust in academic and healthcare institutions within underserved populations. Along with more practical considerations, trust underpins personal motivations to engage with research. Researchers need to invest time and resources in prolonged, mutually beneficial engagement with communities of importance to their research, including sharing power and influence over research priorities. Researcher reflexivity regarding differential power and cultural competencies are crucial. Utilising participatory methodologies including co-production demonstrates a commitment to inclusive study design. Conclusions Re-framing evidence-based medicine to be more useful and relevant to underserved populations with the highest burden of ill health is urgently needed. Lack of representation in primary healthcare research reflects wider societal inequalities, to which Cultural Trauma provides a useful lens. However, there are actions that researchers can take to widen representation. This will ultimately help achieve the goal of increased health equity by enhancing scientific rigour and research generalizability.

Informal settlement is the physical expression of inequalities and deprivations, as it indicates the failure of housing policy and the resultant gaps in living conditions. Based on the aforementioned grounds, the purpose of the paper is to analyze the physical extent and proportion of populations living in formal and informal settlements in Addis Ababa from 2011 to 2022. The study differentiated informal and formal settlement areas in Addis Ababa based on the slum ontology concept at the settlement level, a literature review, local contexts, and ground verification. Based on the morphology of formal and informal settlement areas in Addis Ababa, the study estimated the proportion of the population living in informal settlements for 2010 and 2020. The 2010 and 2020 informal settlement populations were extracted based on the 100-meter gridded spatial population data obtained from WorldPop. The study used the 2011 aerial photograph and the 2022 Google Earth image for interpretations and differentiations of formal and informal settlements. Then, the research analyzed the spatial extent, population level, and trends of formal and informal settlements. The major findings of the study indicated that informal areas constituted 61% and 59% of the residential land use in 2011 and 2022, respectively. In the intervening period (from 2011 to 2022), the informal and formal settlements of Addis Ababa have grown annually by 2.92% and 4.98%, respectively. In 2010, 67.9% of the population in Addis Ababa lived in informal settlements, while the population living in informal settlements was 53.8% in 2020. The deprivation areas versus population size study indicated the divided city pattern of urban inequality revealed by the concentration of a large deprived population in the inner-city slums and peri-urban areas. The findings also indicated appropriate area-based policy and planning interventions to reach large populations disproportionally deprived to bridge the gap in urban inequality.

Abstract Aim Families from socioeconomically deprived backgrounds appear to have been greatly impacted and face worsening inequalities as a result of the COVID-19 pandemic. With more than half of children in Newham, East London, living in poverty, this study aimed to investigate the impact of the COVID-19 lockdowns on families with a child under 5 years-old in Newham and identify their immediate needs to inform recovery efforts. Subjects and methods This was a qualitative study. Semi-structured interviews were conducted with 13 participants (2 fathers; 11 mothers) exploring the impact of the COVID-19 lockdowns on family life, neighbourhood and community and important relationships in the child’s world. Results All parents experienced significant impacts on family life and well-being because of the pandemic. Families were placed under increased stress and were concerned about the impacts on child development. Low-income families were most disadvantaged, experiencing lack of professional support, community engagement and inadequate housing. Conclusion Families were placed under increasing pressure during the pandemic and recovery efforts need to target those most affected, such as families from low-income households. Recovery efforts should target child social and language development, family mental health, professional service engagement and community involvement.

Stressors are directly related to major events throughout the beef cattle production cycle. Understanding the impact stressors have on productive outcomes is critical for the efficient implementation of management strategies. Such stressors include environmental extremes, nutritional deprivation, and common management procedures. Environmental extremes such as thermal stress can disturb gestating cows’ normal physiological responses, hindering reproductive efficiency. Thermal stress during the breeding season can affect embryo development causing a decrease in conception rates, although adjusting the scheduling of breeding activities can minimize losses. Additionally, suboptimal nutrition may negatively impact reproductive performance if management strategies including modifying seasonal grazing practices are not implemented. As gestation progresses, nutrient requirements increase; thus, without appropriate dietary management, poor calf performance, the loss of the body condition score, and reduced reproductive performance may result. While weaning is a common management procedure, this event is another major stress within the production system. Applying efficient strategies such as creep feeding or two-step weaning to mitigate weaning stress can maximize production efficiency. This review will explore in-depth the stressors associated with production events in the beef cattle industry and give insight into researched management strategies targeting these stressors that will improve the sustainability of the production system.

Aims: The overall aim of this study was to determine the impact of deprivation with regard to quality of life, demographics, joint-specific function, attendances for unscheduled care, opioid and antidepressant use, having surgery elsewhere, and waiting times for surgery on patients awaiting total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods: Postal surveys were sent to 1,001 patients on the waiting list for THA or TKA in a single Northern Ireland NHS Trust, which consisted of the EuroQol five-dimension five-level questionnaire (EQ-5D-5L), visual analogue scores (EQ-VAS), and Oxford Hip and Knee Scores. Electronic records determined prescriptions since addition to the waiting list and out-of-hour GP and emergency department attendances. Deprivation quintiles were determined by the Northern Ireland Multiple Deprivation Measure 2017 using postcodes of home addresses. Results: Overall, 707 postal surveys were returned, of which 277 (39.2%) reported negative “worse than death” EQ-5D scores and 219 (21.9%) reported the consumption of strong opioids. Those from the least deprived quintile 5 had a significantly better EQ-5D index (median 0.223 (interquartile range (IQR) -0.080 to 0.503) compared to those in the most deprived quintiles 1 (median 0.049 (IQR -0.199 to 0.242), p = 0.004), 2 (median 0.076 (IQR -0.160 to 0.277; p = 0.010), and 3 (median 0.076 (IQR-0.153 to 0.301; p = 0.010). Opioid use was significantly greater in the most deprived quintile 1 compared to all other quintiles (45/146 (30.8%) vs 174/809 (21.5%); odds ratio 1.74 (95% confidence interval 1.18 to 2.57; p = 0.005). Conclusion: More deprived patients have worse health-related quality of life and greater opioid use while waiting for THA and TKA than more affluent patients. For patients awaiting surgery, more information and alternative treatment options should be available. Cite this article: Bone Jt Open 2024;5(5):444–451.

Abstract Background Women who live with disadvantages such as socioeconomic deprivation, substance misuse, poor mental health, or domestic abuse face inequalities in health before, during, and after pregnancy and for their infants through to childhood. Women do not experience these factors alone; they accumulate and interact. Therefore, there is a need for an overview of interventions that work across health and social care and target women at risk of inequalities in maternal or child health. Methods Systematic review methodology will be used to identify systematic reviews from high-income countries that describe interventions aiming to reduce inequalities for women who experience social disadvantage during pregnancy. We will describe the range of interventions and their effectiveness in reducing inequalities in maternal or child health. Any individual, hospital, or community-level activity specific to women during the pre-conception, antenatal, or postpartum period up to 1 year after birth will be included, regardless of the setting in which they are delivered. We will search eight electronic databases with the pre-determined search strategy and supplement them with extensive grey literature searches. We will present a narrative synthesis, taking into account the quality assessment and coverage of included studies. Discussion Inequalities in maternal and child health are a key priority area for national policymakers. Understanding the range and effectiveness of interventions across the perinatal period will inform policy and practice. Identifying gaps in the evidence will inform future research. Systematic review registration PROSPERO CRD42023455502.

Coronavirus disease-19 (COVID-19) has disproportionately affected certain demographics in England, exacerbating existing health disparities. Effective therapeutics are a critical line of defence against COVID-19, particularly for patients at elevated risk for severe disease. Surveillance systems were established to monitor the usage of COVID-19 therapeutics in hospital and community settings and to inform stewardship. Three antiviral therapies—nirmatrelvir plus ritonavir (Paxlovid®), remdesivir (Veklury®), and molnupiravir (Lagevrio®)—and two neutralising monoclonal antibody therapies (nMAbs)—sotrovimab (Xevudy®) and casirivimab with imdevimab (Ronapreve®)—were in use in England between July 2020 and April 2023. This paper aims to illuminate trends in the utilisation of COVID-19 therapeutics treatment in both hospital and community settings, stratified by the Index of Multiple Deprivation (IMD) in England. Chapter 3 of the English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report 2022 to 2023 also discusses the epidemiological surveillance of these five directly acting antiviral COVID-19 therapeutics’ use in England between 2022 and 2023.

Abstract Background The choice of a hospital should be based on individual need and accessibility. For maternity hospitals, this includes known or expected risk factors, the geographic accessibility and level of care provided by the hospital. This study aims to identify factors influencing hospital choice with the aim to analyze if and how many deliveries are conducted in a risk-appropriate and accessible setting in Bavaria, Germany. Methods This is a cross-sectional secondary data analysis based on all first births in Bavaria (2015-18) provided by the Bavarian Quality Assurance Institute for Medical Care. Information on the mother and on the hospital were included. The Bavarian Index of Multiple Deprivation 2010 was used to account for area-level socioeconomic differences. Multiple logistic regression models were used to estimate the strength of association of the predicting factors and to adjust for confounding. Results We included 195,087 births. Distances to perinatal centers were longer than to other hospitals (16 km vs. 12 km). 10% of women with documented risk pregnancies did not deliver in a perinatal center. Regressions showed that higher age (OR 1.03; 1.02–1.03 95%-CI) and risk pregnancy (OR 1.44; 1.41–1.47 95%-CI) were associated with choosing a perinatal center. The distances travelled show high regional variation with a strong urban-rural divide. Conclusion In a health system with free choice of hospitals, many women chose a hospital close to home and/or according to their risks. However, this is not the case for 10% of mothers, a group that would benefit from more coordinated care.

We compare children according to whether and to what extent they are deprived using the data from the German family survey “Growing up in Germany (in short: AID:A)” 2019. We classify the children into different types of relative deprivation using a Ward cluster analysis and use multinomial logistic regression models to estimate each child’s probability of being assigned to each type. Our results indicate the prevalence of relative deprivation of children covaries with economic and non-economic resources available to the children’s households. Further, we find only marginal differences between children within the same household. [ABSTRACT FROM AUTHOR]

Background: A methodology for determining the appropriate balance between medical access and combating poverty remains undetermined. To address the boundary conditions for exceedingly good medical access, this study examined whether the impact of deprivation on cancer stage distribution could be eliminated in Japan, which has the highest hospital bed density in the world. Methods: A nationwide medical claims‐based database was used to evaluate the influence of municipality‐level hospital bed density and the postal code‐level areal deprivation index on cancer stage at diagnosis. Given the limited number of similar studies in Japan, we focused on colorectal cancer (CRC), for which disparities have been reported in a prefecture‐level study. Multilevel multivariate logistic regression models were used, with odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for baseline and socioeconomic factors. Results: Regardless of the early/advanced‐stage definitions, CRC consistently tended to be detected at more advanced stages in more deprived areas. In the analysis of stages 0–I/II–IV, the OR (95% CI) was 1.09 (1.05, 1.14) (p < 0.001). In the analyses of stages 0–I/II–IV and 0–II/III–IV, gradients were observed, and later detections were observed for more deprived segments. Hospital bed density was not significantly associated with the stage distribution. Conclusion: The results indicate that inequalities in CRC detection due to deprivation persist even in the country with the highest hospital bed density worldwide, suggesting that poverty measures remain indispensable regardless of hospital bed access. Further investigation of various regions and cancers is required to develop a practical framework. [ABSTRACT FROM AUTHOR]

INTRODUCTION: England has seen an increase in deaths due to alcohol-related liver disease (ALD) since 2001. We studied the influence of socioeconomic position on the incidence of ALD and the mortality after ALD diagnosis in England in 2001-2018. METHODS: This was an observational cohort study based on health records contained within the UK Clinical Practice Research Datalink covering primary care, secondary care, cause of death registration, and deprivation of neighborhood areas in 18.8 million residents. We estimated incidence rate and incidence rate ratios of ALD and hazard ratios of mortality. RESULTS: ALD was diagnosed in 57,784 individuals with a median age of 54 years and of whom 43% had cirrhosis. The ALD incidence rate increased by 65%between 2001 and 2018 in England to reach 56.1 per 100,000 person-years in 2018. The ALD incidence was 3-fold higher in those from the most deprived quintile vs those from the least deprived quintile (incidence rate ratio 3.30,95%confidence interval 3.21-3.38), with reducing inequality at older than at younger ages. For 55- to 74-year-olds, there was a notable increase in the incidence rate between 2001 and 2018, from 96.1 to 158 per 100,000 person-years in the most deprived quintile and from 32.5 to 70.0 in the least deprived quintile. AfterALDdiagnosis, the mortality risk was higher for patients from the most deprived quintile vs those from the least deprived quintile (hazard ratio 1.22, 95% confidence interval 1.18-1.27), and this ratio did not change during 2001-2018. DISCUSSION: The increasing ALD incidence in England is a greater burden on individuals of low economic position compared with that on those of high socioeconomic position. This finding highlights ALD as a contributor to inequality in health. [ABSTRACT FROM AUTHOR]

Purpose: Upper gastrointestinal (GI) cancers contribute to 16.7% of UK cancer deaths. These patients make high use of acute hospital services, but detail about palliative care use is lacking. We aimed to determine the patterns of use of acute hospital and hospital specialist palliative care services in patients with advanced non-curative upper GI cancer. Methods: We conducted a service evaluation of hospital use and palliative care for all patients with non-curative upper GI cancer seen in one large hospital, using routinely collected data (2019–2022). We report and characterise hospital admissions and palliative care within the study time period, using descriptive statistics, and multivariable Poisson regression to estimate the unadjusted and adjusted incidence rate ratio of hospital admissions. Results: The total with non-curative upper GI cancer was 960. 86.7% had at least one hospital admission, with 1239 admissions in total. Patients had a higher risk of admission to hospital if: aged ≤ 65 (IRR for 66–75 years 0.71, IRR 76–85 years 0.68; IRR > 85 years 0.53; p < 0.05), or lived in an area of lower socioeconomic status (IMD Deciles 1–5) (IRR 0.90; p < 0.05). Over the 4-year period, the rate of re-admission was higher in patients not referred to palliative care (rate 0.52 readmissions/patient versus rate 1.47 readmissions/patient). Conclusion: People with advanced non-curative gastrointestinal cancer have frequent hospital admissions, especially if younger or from areas of lower socioeconomic status. There is clear association between specialist palliative care referral and reduced risk of hospitalisation. This evidence supports referral to specialist palliative care. [ABSTRACT FROM AUTHOR]

Background Due to the high correlation of chronic kidney disease (CKD) with other comorbidities, the sole effect of CKD on deprived people is not clear. In addition, there is a paucity of evidence in the literature linking isolated domains of deprivation to outcomes. This study aimed to examine whether deprivation was associated with adverse outcomes in patients with CKD, independent of cardiometabolic morbidities. Individual domains of deprivation were also evaluated. Methods A retrospective study of patients with non-dialysis-dependent CKD (ND-CKD) in the Salford Kidney Study to investigate the association of deprivation with outcomes. The English Indices of Deprivation was used for the comparative analysis of the five quintiles of deprivation. Two propensity score methods were used to attenuate the confounding effect of cardiometabolic morbidities between the least and the most deprived groups. Results People living in the least deprived areas (n  = 319) had a lower risk of combined outcomes (all-cause mortality and renal replacement therapy) when compared with the most deprived group (n  = 813) [hazard ratio (HR) 0.83; 95% confidence interval (CI) 0.71–0.98]. The negative association of deprivation remained after matching but with mixed statistical significance when using different propensity methods (HR 0.85; 95% CI 0.70–1.03 for propensity score matching and HR 0.77; 95% CI 0.61–0.98 for inverse probability weighting). The association of combined outcomes varied across component index of multiple deprivation domains with wide CIs. However, areas with lower scores for education, income and employment were significantly associated with a higher risk. Conclusions This study has identified that in people with ND-CKD, unemployment, poor educational attainment and lower household income were associated with poor outcomes. The association of deprivation with adverse outcomes persists despite adjustment for cardiometabolic morbidities. [ABSTRACT FROM AUTHOR]

Background: Although underserved populations— including those from ethnic minority communities and those living in poverty—have worse health and poorer healthcare experiences, most primary care research does not fairly reflect these groups. Patient and public involvement (PPI) is usually embedded within research studies in the United Kingdom (UK), but often fails to represent underserved populations. This study worked with patient and public contributors and local community leaders, situated in a socio-economically deprived and ethnically diverse urban area, to explore under-representation in primary healthcare research. Methods: We undertook a focus group with a purposive sample of 6 members of a Patient and Public Involvement Group (PPIG), and interviews with 4 community leaders (representing Black, South Asian, Roma and socio-economically deprived communities). An iterative analysis process based on template analysis was used. Focus group 1 was rapidly analysed, and a template created. Findings were presented in focus group 2, and the template further developed. The Cultural Trauma concept was than applied to the template to give a wider theoretical lens. In-depth analysis of focus groups and interviews was then performed based on the template. Results: Wider societal and historical influences have degraded trust in academic and healthcare institutions within underserved populations. Along with more practical considerations, trust underpins personal motivations to engage with research. Researchers need to invest time and resources in prolonged, mutually beneficial engagement with communities of importance to their research, including sharing power and influence over research priorities. Researcher reflexivity regarding differential power and cultural competencies are crucial. Utilising participatory methodologies including co-production demonstrates a commitment to inclusive study design. Conclusions: Re-framing evidence-based medicine to be more useful and relevant to underserved populations with the highest burden of ill health is urgently needed. Lack of representation in primary healthcare research reflects wider societal inequalities, to which Cultural Trauma provides a useful lens. However, there are actions that researchers can take to widen representation. This will ultimately help achieve the goal of increased health equity by enhancing scientific rigour and research generalizability. Plain English summary: The problem: People living in poverty, and people from ethnic minority communities may be referred to as 'underserved'. Underserved communities benefit less from health services, and along with other factors, this leads to health inequalities. Primary care research does not include enough people from these communities. This makes the health inequalities worse. What we did: This study looks at why people from underserved communities are not included in research. It also looks at what might help. We had focus group discussions with members of a Patient and Public Involvement Group (PPIG). These are individuals who do not have research expertise, but use their lived experience as patients to influence the research process. This group was formed in 2017, from areas where more people live with social disadvantage. We also interviewed local community leaders. Interviews and focus groups ask open questions, so are a good way to explore what people think about an issue. We found a useful theory about how cultural history affects what people can do. We used this to help us to understand how our findings could improve and widen participation in research within underserved communities. What we found: We found that trust is very important. There needs to be trust between people and organisations. There are also practical reasons people from underserved communities might not be able to get involved in research. Researchers need to be aware of these things, and work with people from these communities throughout all stages of research. Long term relationships need to develop between institutions and people doing research. Understanding each other's culture and history makes it easier to work together. [ABSTRACT FROM AUTHOR]

The author tackles the topic on legal capacity in the intersection between civil law and human rights that is very important, yet neglected in the Macedonian legal theory and jurisprudence. Namely, Republic of North Macedonia has ratified the Convention on Rights of Persons with Disabilities and has an obligation to align its legal system (primarily its Family Law and Law on Non-contentious Procedure, but also other laws) with its spirit. It seems as if the concept of legal capacity does not include variations of the mental capacity in the Court’s decision when deciding to limit/deprive a person of his/her legal capacity. Instead, it is binary in terms that the legal capacity can either be limited/deprived or not, without further specification of the scope of rights and obligations encompassed therein. As a result, persons deprived of legal capacity (and sometimes persons with limited legal capacity) are limited to enjoying and acting upon most of their fundamental rights. The author concludes that persons deprived of legal capacity in the Macedonian legal system are in a state of ‘civil death’ because they are restricted from enjoying and acting upon many fundamental human rights. These include equality rights (not to be discriminated against), private and family life rights (a right to make decisions about their own body, medical treatments, reproductive choices, conclusion of marriage, recognition of parenthood etc.), procedural rights (a right to access to court and administrative institutions, a right to express legally valid opinions in such proceedings), political rights (a right to vote) etc. This should be changed as a matter of priority in the future. [ABSTRACT FROM AUTHOR]

Longitudinal research in England and Wales has identified increasing inequality in child welfare interventions, particularly with respect to children in the poorest areas coming into care. Although previous cross-sectional research has shown associations between area level deprivation and child welfare interventions to be weakest in Northern Ireland (NI), it remains unknown if this reflects wider trends over time. This study uses longitudinal administrative data to investigate the relationship between area level deprivation and the (1) referral, (2) investigation, (3) registration and (4) looked after stages of children's contact with child and family social work from 2010 to 2017 (stages 1–3) and 2020 (stage 4). Both relative and absolute measures of inequality (Ratio of Inequality, Slope Index of Inequality and Relative Index of Inequality) were calculated to examine trends. The results highlight a clear and increasing social gradient in child welfare interventions in NI over time, particularly at the higher levels of intervention and those involving children aged 0–4 years. Routine analysis of children's social care caseloads by deprivation is highlighted as a means of focusing attention on poverty and material inequality, prompting practitioners, managers and policy makers to consider the drivers of such inequality and how this might be addressed. [ABSTRACT FROM AUTHOR]

Can 'health resilience' explain international differences in COVID‐19 mortality? This paper aims to understand the significant diversity in mortality rates between countries in terms of their degree of preparedness for the crisis and the underlying health conditions of the population. We integrate COVID‐19 data from the first year of the pandemic with panel data from 2009 to 2017 for 188 countries around the world in order to investigate international variation in COVID‐19 mortality rates. Country‐level data on health, medical, social and policy variables are compared with COVID‐19 mortality rates, with further controls imposed to adjust for infection rate, population and health spending. The results show that prior health conditions, social deprivation and the demography of the country all have significant effects on the mortality rates associated with the virus. The evidence also suggests that countries with higher levels of health‐related policy targets demonstrated lower levels of mortality during the crisis. Finally, we confirm that social habits such as smoking, alcohol consumption and over‐eating create a highly vulnerable group of individuals who were exposed to a greater risk of mortality during the outbreak. [ABSTRACT FROM AUTHOR]

Though considerable work supports the Dimensional Model of Adversity and Psychopathology, prior research has not tested whether the dimensions—threat (e.g., abuse) and deprivation (e.g., neglect)—are uniquely related to salivary trait indicators of hypothalamic pituitary adrenal (HPA) axis activity. We examined the unique and interactive effects of threat and deprivation on latent trait cortisol (LTC)—and whether these effects were modified by co‐occurring adversities. Emerging adults (n = 90; Mage = 19.36 years; 99.88% cisgender women) provided salivary cortisol samples four times a day (waking, 30 min and 45 min postwaking, bedtime) over three 3‐day measurement waves over 13 weeks. Contextual life stress interviews assessed early adversity. Though the effects varied according to the conceptualization of early adversity, overall, threat—but not deprivation, nor other co‐occurring adversities—was uniquely associated with the across‐wave LTC. Specifically, the incidence and frequency of threat were each negatively related to the across‐wave LTC. Threat severity was also associated with the across‐wave LTC, but only among those with no deprivation. Finally, the effects of threat were modified by other co‐occurring adversities. Findings suggest that threat has unique implications for individual differences in HPA axis activity among emerging adults, and that co‐occurring adversities modify such effects. [ABSTRACT FROM AUTHOR]

This study aimed to determine the multidimensional poverty status of farming households in Katsina state, northwestern Nigeria. A multi-stage sampling technique was used to elicit primary data from 480 farming households. Descriptive statistics and the multidimensional poverty assessment tool (MPAT-14) were used to analyze the data. The socio-demographic analysis showed that the mean age of respondents was 43 years while the average household size was 9 persons. The majority (86%) of respondents were male, and they were mostly married (85%) and educated (51.3%). The MPAT results showed that farmers in the study area experienced a high level of deprivation according to the majority of the fundamental human needs indicators, such as food and nutrition security (27.7%), domestic water supply (28.9%), health care (22.9), sanitation and hygiene (28.1%), housing, clothing, and energy (33.9%), and education (27.7%). The results indicate that the majority (60.6%) of the households are living in multidimensional poverty and that there is a higher level of multidimensional poverty among farming households. The government should upscale appropriate healthcare delivery systems to improve the healthcare services rendered. [ABSTRACT FROM AUTHOR]

Summary: To address the lack of contemporary population‐based epidemiological studies of hepatosplenic T‐cell lymphoma (HSTCL), we undertook a population‐based study of ICD‐O‐3‐coded HSTCL in England. We used the National Cancer Registration Dataset and linked datasets on hospital admissions, Systemic Anti‐Cancer Therapy, socio‐demographics, comorbidities and death, identifying cases from 1 January 2013 to 31 December 2019 with survival data up to 5 January 2021. Crude and directly age‐standardised incidence rates per million persons per year were calculated. Crude and adjusted incidence rate ratios compared incidence between groups using Poisson regression. A Cox proportional hazards model estimated mortality risks adjusted for age, sex, ethnicity, deprivation and allogenic stem cell transplant (allo‐SCT; time varying). We identified 44 patients, mean age 42 years. Median survival was 11 months, and 1 and 5 year survivals were 48% (95% CI 29%–43%) and 22% (95% CI 12%–42%) respectively. The age‐standardised incidence was 0.1 per million/year. Incidence was higher in areas with greater deprivation (0.15 per million/year), and more cases than expected were in non‐White patients (39%). Non‐Whites had a twofold increased risk of death (adjusted hazard ratio 2.21 [95% CI 1.03–4.78]) even after adjusting for deprivation, younger age and allo‐SCT. In conclusion, ethnicity and socio‐economic status affect both the incidence and survival of HSTCL. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion The impact of the COVID‐19 pandemic on the mental health of children and young people (CYP) has been widely reported. Primary care electronic health records were utilised to examine trends in the diagnosing, recording and treating of these common mental disorders by ethnicity and social deprivation in Greater Manchester, England.Time‐series analyses conducted using Greater Manchester Care Record (GMCR) data examined all diagnosed episodes of anxiety disorders and depression and prescribing of anxiolytics and antidepressants among patients aged 6–24 years. The 41‐month observation period was split into three epochs: Pre‐pandemic (1/2019–2/2020); Pandemic Phase 1 (3/2020–6/2021); Pandemic Phase 2 (7/2021–5/2022). Rate ratios for all CYP specific to sex, age, ethnicity, and neighbourhood‐level Indices of Multiple Deprivation (IMD) quintile were modelled using negative binomial regression.Depression and anxiety disorder rates were highest in females, CYP aged 19–24, and White and ‘Other’ ethnic groups. During Pandemic Phase 1, rates for these diagnoses fell in all demographic subgroups and then rose to similar levels as those recorded pre‐pandemic. In Pandemic Phase 2, rates in Black and Mixed‐ethnicity females rose to a significantly greater degree (by 54% and 62%, respectively) than those in White females. Prescribing rates increased throughout the study period, with significantly greater rises observed in non‐White females and males. The temporal trends were mostly homogeneous across deprivation quintiles.The observed fluctuations in frequency of recorded common mental illness diagnoses likely reflect service accessibility and patients' differential propensities to consult as well as changing levels of distress and psychopathology in the population. However, psychotropic medication prescribing increased throughout the observation period, possibly indicating a sustained decline in mental health among CYP, and also clinicians' responses to problems presented. The comparatively greater increases in frequencies of diagnosis recording and medication prescribing among ethnic minority groups warrants further investigation. [ABSTRACT FROM AUTHOR]

Aim: Families from socioeconomically deprived backgrounds appear to have been greatly impacted and face worsening inequalities as a result of the COVID-19 pandemic. With more than half of children in Newham, East London, living in poverty, this study aimed to investigate the impact of the COVID-19 lockdowns on families with a child under 5 years-old in Newham and identify their immediate needs to inform recovery efforts. Subjects and methods: This was a qualitative study. Semi-structured interviews were conducted with 13 participants (2 fathers; 11 mothers) exploring the impact of the COVID-19 lockdowns on family life, neighbourhood and community and important relationships in the child's world. Results: All parents experienced significant impacts on family life and well-being because of the pandemic. Families were placed under increased stress and were concerned about the impacts on child development. Low-income families were most disadvantaged, experiencing lack of professional support, community engagement and inadequate housing. Conclusion: Families were placed under increasing pressure during the pandemic and recovery efforts need to target those most affected, such as families from low-income households. Recovery efforts should target child social and language development, family mental health, professional service engagement and community involvement. [ABSTRACT FROM AUTHOR]

The study examines the socioeconomic determinants of physical health among populations experiencing food insecurity and receiving free meals in soup kitchens in the Prefecture of Attica, Greece. Data were collected from the same six soup kitchens in 2012, 2017 and 2021, resulting in a dataset of 1533 observations. The study revealed that periods characterised by an economic recession are associated with deteriorated physical health of food‐insecure people. Moreover, the study found that physical health deteriorations among food‐insecure people are associated with older age, female gender, immigration status, disability and/or long‐term health conditions, LGBT status, unemployment, economic inactivity, homelessness, living below the poverty threshold, long‐term food dependency, illicit drug consumption and residing in lower‐ and middle‐class areas. The study proposes the Intersectional Model of Health Inequalities, which integrates multiple factors involved in shaping the health inequalities of people experiencing food insecurity, from macro‐level factors such as a country's economic performance to individual‐level factors like education, employment status and demographic characteristics. The model emphasises that low‐income populations should not be treated as a homogeneous entity. Its goal is to inform policymakers about the diverse health inequalities experienced by people with low incomes. [ABSTRACT FROM AUTHOR]

The key aim of our study was to examine pathways from exposure to childhood adversities (i.e., deprivation and threat) to adolescent psychopathology. The assessed mediating mechanisms included cognitive ability and emotion regulation, as proposed by the Dimensional Model of Adversity and Psychopathology (DMAP). The study comprised participants from the nationally representative Millennium Cohort Study. Latent scores for deprivation and threat were derived using confirmatory factor analysis from indicators collected when participants were at age of 9 months, 3 and 5 years. Cognitive ability was measured using the Verbal Similarities subscale of the British Ability Scales II at age 11, and emotion regulation was measured using emotion dysregulation subscale of the Child Social Behavioural Questionnaire at age 7. Psychopathology, defined as psychological distress, was assessed using the Kessler 6 scale at age 17. We conducted causal mediation analysis adjusting for multiple confounding factors. We did not find total effect of either exposure to deprivation or threat on psychological distress, but we did find significant indirect effects of exposure to deprivation on psychological distress via cognitive ability (− 0.11, 95% CI − 0.20 to − 0.05) and emotion regulation (0.03, 0.02 to 0.12), and exposure to threat on psychological distress via cognitive ability (− 0.04, − 0.07 to − 0.01) and emotion regulation (0.09, 0.03 to 0.15). The lack of associations between deprivation or threat and psychological distress may be due to reporting bias or developmental period of psychopathology. Results of mediation analysis partially support the DMAP but indicate limited benefits to reduce adolescent psychological distress by targeting cognitive ability or emotion regulation to those exposed to childhood adversities. [ABSTRACT FROM AUTHOR]

There have been increasing calls in gentrification studies to examine the geography of gentrification in slums, as little is known about the patterns and processes of slum gentrification, especially in sub-Saharan African cities where slums house over 50% of the urban population. This study explored the spatiotemporal changes in slums in Lagos, Nigeria, between 1984 and 20 on the pattern and drivers of gentrification. Data were collected from 42 slums in Lagos through remote sensing (1984–2020) and a field survey (2020–2021). The study integrated geospatial analysis with quantitative and qualitative analysis to investigate the patterns and drivers of gentrification in Lagos slums. The findings show that between 1984 and 2020, all the sampled slums had undergone gentrification processes, apart from those that were completely cleared. However, many slums continue to have deprived areas as they continue to gentrify. Almost all the slum communities have experienced slum clearance in the past. Additionally, the current and new housing developments in the study have favored middle- to high-income groups, which has led to the displacement of previous slum residents. The study identified slum clearance, fires and floodings, the presence of palaces in the community, the proportion of deprived areas in 1984, government interest in the slum, and the size of the church as drivers of slum gentrification processes in Lagos. Finally, the findings show that the vulnerability of slum dwellers increases with slum gentrification. Therefore, this study recommended developing policies and programs, such as sustainable relocation and low-cost housing, to mitigate the negative consequences of slum gentrification, especially in cities with significant shares of low-income groups. [ABSTRACT FROM AUTHOR]

Background: Visits present an opportunity for prisoners to preserve family ties and reduce isolation, but not all receive visits from family or friends whilst incarcerated. Aims: To locate, appraise and synthesise qualitative data on the experiences of adult male prisoners (aged 18 years+) who do not receive prison visits from family or friends. Methods: Nine electronic databases were searched from the date of their inception until March 2023. The quality of included studies was assessed using the Critical Appraisal Skills Programme checklist for qualitative studies, and data from the studies were synthesised using the thematic synthesis method. Results: Eighteen studies from seven countries (the USA, the UK [England, Northern Ireland & Scotland], Canada, Netherlands and the Philippines) were eligible for inclusion. Three main themes emerged: (1) reasons for not receiving visits, (2) harmful effects of not receiving visits and (3) the value of volunteer visitor programmes. Practical problems were cited as interfering with visiting opportunities, but also some prisoners or families chose not to meet in prison. Loneliness and depression were extensively described as effects of not receiving visits. Qualities associated with volunteer visitors included raised self‐esteem, improved mood and personal growth. Conclusion: Narratives of the experiences of adult men in prison without visits from family or friends suggest that not only the practical difficulties of imprisonment affect visiting; barriers that prisoners themselves impose would merit further exploration, as would family and relationship dynamics during incarceration and the emotional impact of prison visits, for both prisoners and their families. There are suggestions of therapeutic as well as humanitarian benefits from volunteer visiting programmes. There is a gap in the literature about any specific effect on rebuilding family relationships. [ABSTRACT FROM AUTHOR]

This paper explores the relationship between neighbourhood level density of civil society organisations (CSOs), diversity, and deprivation. We compare the UK and Sweden, two countries with different civil society traditions and welfare state regimes. We use data on formal civil society organisations to examine whether diverse neighbourhoods have lower levels of civil society infrastructure. In the UK, contrary to what could be expected from Putnam's assertion that diversity has a negative effect on trust, thus limiting civil society activities at the neighbourhood level, we observe a positive relationship between the density of CSOs and diversity. In Sweden, we find different patterns. First, we observe a negative correlation between CSO density and diversity. Second, we find lower density of formal CSOs in areas with high diversity and high economic disadvantage and higher density in areas characterised by low diversity and high disadvantage. [ABSTRACT FROM AUTHOR]

Simple Summary: Stress in beef cattle occurs throughout all management practices. The goal of a cow–calf producer is to produce one calf per cow a year; thus, stressors in these management systems can disrupt this desire. When homeostasis is disturbed, the efficiency of a beef cow decreases, which may lead to reproductive deficiencies, reduced daily intake, and a decreased body condition score. Therefore, this decline in production efficiency may cause a loss in the profitability of the operation. The goal of this review is to address the stressors inherent in beef cattle management systems to provide producers with insight into the best ways to mitigate beef cattle stress. Stressors are directly related to major events throughout the beef cattle production cycle. Understanding the impact stressors have on productive outcomes is critical for the efficient implementation of management strategies. Such stressors include environmental extremes, nutritional deprivation, and common management procedures. Environmental extremes such as thermal stress can disturb gestating cows' normal physiological responses, hindering reproductive efficiency. Thermal stress during the breeding season can affect embryo development causing a decrease in conception rates, although adjusting the scheduling of breeding activities can minimize losses. Additionally, suboptimal nutrition may negatively impact reproductive performance if management strategies including modifying seasonal grazing practices are not implemented. As gestation progresses, nutrient requirements increase; thus, without appropriate dietary management, poor calf performance, the loss of the body condition score, and reduced reproductive performance may result. While weaning is a common management procedure, this event is another major stress within the production system. Applying efficient strategies such as creep feeding or two-step weaning to mitigate weaning stress can maximize production efficiency. This review will explore in-depth the stressors associated with production events in the beef cattle industry and give insight into researched management strategies targeting these stressors that will improve the sustainability of the production system. [ABSTRACT FROM AUTHOR]