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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.

Rotator cuff tears are a common orthopedic injury, and the role of social determinants of health (SDoH) in surgical outcomes remains underexplored. The goal of this study was to investigate the correlation between social deprivation, measured by the Area Deprivation Index (ADI), and outcomes following arthroscopic rotator cuff repair. We conducted a retrospective chart review on patients undergoing primary arthroscopic rotator cuff repair at a level 1 academic center between 2006 and 2019. Patient demographics (age, gender, race), comorbidities, ADIs, range of motion, visual analog pain scores, and patient-reported outcomes (Simple Shoulder Test [SST], American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES], and Quick Disabilities of the Arm, Shoulder, and Hand questionnaire [QuickDASH]) were collected. Patients were stratified into terciles based on their relative level of deprivation. Statistical analysis was performed using analysis of variance, t tests, χ2 tests, and univariate or multivariate logistic regression. A total of 322 patients were included in this study. The most deprived group had a higher prevalence of diabetes compared to the least and intermediately deprived group (P <.001). Massive tear occurrence was greater in the least deprived group (P =.003) compared to the most deprived group. There was no difference in objective outcomes between groups. Patient-reported outcomes (SST, ASES, and QuickDASH scores) were worse in the most deprived group compared with the least and intermediate deprived groups. Social deprivation significantly affects patient-reported outcomes in rotator cuff repair surgery. Although clinician-reported outcomes were consistent, patients' perceptions varied based on social determinants. Integrating SDoH considerations in orthopedic care is a promising next step in securing equitable approaches. However, more research is needed to validate and expand these findings. [ABSTRACT FROM AUTHOR]

In this paper we estimate monetary and non-monetary poverty measures at two sub-regional levels in the region of Tuscany (Italy) using data from the ad-hoc Survey on Vulnerability and Poverty held by Regional Institute from Economic Planning of Tuscany (IRPET). We estimate the percentage of households living in poverty conditions and three supplementary fuzzy measures of poverty regarding deprivation in basic needs and lifestyle, children deprivation, and financial insecurity. The key feature of the survey is that it was carried out after the COVID-19 pandemic, therefore, some of the items collected focus on the subjective perception of poverty eighteen months after the beginning of the pandemic. We assess the quality of these estimates either with initial direct estimates along with their sampling variance, and with a secondary small area estimation when the formers are not sufficiently accurate. [ABSTRACT FROM AUTHOR]

Public schools play a pivotal role in successful community development. Yet, with school closures on the rise across North America, there is limited knowledge on the outcomes of closed school properties. This study documents the afterlife of closed school properties in Ontario, Canada, identifying their potential beneficiaries, and assessing the prevalence of property vacancies. Using a dataset of over 400 schools closed between 2011 and 2021, we determined that the prevalence of certain school property reuses varied by degree of urbanicity. Fewer than one-fifth of reused properties were designed to benefit highly deprived populations, despite over half of the school closures occurring in neighborhoods with higher levels of deprivation. Furthermore, one-third of school properties remained vacant at the time of study, 36% of which closed over a decade ago. The findings reflect the need for additional consideration of the future uses of school properties prior to their closures. [ABSTRACT FROM AUTHOR]

Background: Adolescence is a crucial period for establishing healthy behaviours that can reduce the risk of noncommunicable diseases. However, limited data exist on the clustering of health-related behaviours, in adolescents from low- and middle-income countries (LMICs). This study examined how diet and physical activity behaviours cluster and how they are influenced by home and school area-level deprivation. Methods: The study surveyed 527 adolescents in Yaoundé (Cameroon), Kingston (Jamaica), and Cape Town (South Africa) and grouped them into three categories according to the socioeconomic status (SES) of their homes and school areas (low-low, low-high, and high-high). A k-median algorithm defined three clusters and measured dietary attributes including Dietary Habit Score (DHS), Healthy Food Score (HFS), Nutritional Knowledge Questionnaire (NKQ), moderate-to-vigorous physical activity (MVPA), and sedentary time using validated questionnaires. The clusters were ranked based on their physical activity levels and compared them within each city using statistical tests. Results: The scores on the NKQ and HFS indicated a poor level of both nutritional knowledge and healthy food consumption across sites. Cluster analysis revealed a consistent pattern of high screen time clustering with lower (less healthy) dietary scores across sites. This pattern was consistent regardless of SES in Kingston, and SES and school socioeconomic areas in Cape Town and Yaoundé. Conclusion: An inverse clustering of sedentary behaviour duration and eating habits remained consistent across different strata for at least two sites, suggesting that interventions to reduce sedentary time could have a ripple effect on multiple NCD risk factors in adolescence. [ABSTRACT FROM AUTHOR]

This study examined how labour migrations, which provide a veritable platform for nation-building, has been thwarted in Nigeria by the political elite through the politics of indigene-settler phenomenon. Though extant studies had examined the indigene-settler syndrome, the prospects of labour migration for nation-building in the country, which this entails, has been understudied. This paper, therefore, provides an insightful investigation into how the intricate web of politics of inclusion, exclusion, and deprivations between the indigenes and labour migrants or settlers in various states has tended to thwart nation-building efforts in the country. The study argues that the indigene-settler phenomenon undermines the facilitative capacity of labour migration for the actualization of the nation’s productive potentials and the construction of a common nationhood. It found that the indigene-settler syndrome is an elite construct to advance and protect their economic and political interests within the polity. It further contends that the elite’s coincidence of interests over scarce resources leads to inter-elite competition in which the indigeneity card is deployed as a potent politico-economic tool to gain advantage over contending elites. The study advocates for inclusive politics as the route to true nationhood devoid of mistrust, fears of marginalization and acrimonious competition for power. [ABSTRACT FROM AUTHOR]

Populist parties have been increasingly successful in European politics over the last decade. Although research suggests that nostalgic deprivation – a perceived loss of economic, political or social status — is linked to support for populist parties, the generalizability of this argument across voters and national contexts remains unclear. In this research note, we leverage original representative surveys across 19 European countries to demonstrate that perceptions of declining status are a consistent predictor of populist support. Decomposing nostalgic deprivation into different dimensions, we find that while social, economic and power deprivation have different antecedents, each predicts populist attitudes and voting behaviour. Moreover, we find that nostalgic deprivation predicts support for populist platforms among both left‐wing and right‐wing respondents, as well as across Eastern and Western Europe.  While the antecedents differ across contexts, these findings confirm that perceptions of downward mobility are associated with the rise of populism in Europe. [ABSTRACT FROM AUTHOR]

Mediation by multiple agents can affect the relation between neighborhood deprivation and segregation indices and ovarian cancer survival. In this paper, we examine a variety of potential clinical mediators in the association between deprivation indices (DIs) and segregation indices (SIs) with all-cause survival among women with ovarian cancer in the African American Cancer Epidemiology Study (AACES). We use novel Bayesian multiple mediation structural models to assess the joint role of mediators (stage at diagnosis, histology, diagnostic delay) combined with the DIs and SIs (Yost, ADI, Kolak's URB, ICE-income) and a set of confounders with survival. The confounder set is selected in a preliminary step, and each DI or SI is included in separate model fits. When multiple mediators are included, the total impact of DIs and SIs on survival is much reduced. Unlike the single mediator examples previously reported, the Yost, ADI and ICE-income indices do not display significant direct effects. This suggests that when important clinical mediators are included, the impact of neighborhood SES indices is significantly attenuated. It is also clear that certain behavioral and demographic measures such as physical activity, smoking, or adjusted family income do not have a significant role in survival when mediated by clinical factors. Multiple mediation via clinical and diagnostic-related measures reduces the contextual effects of neighborhood measures on ovarian cancer survival. The robust association of the Kolak URB index on survival may be due to its relevance to access to care, unlike SES-based indices whose impact was significantly reduced when important clinical mediators were included. [ABSTRACT FROM AUTHOR]

Spinal pain (SP) remains the leading cause of disability worldwide. The present study aimed to establish a current prevalence of SP and associated determinants in Wales by retrospectively analyzing data from the National Survey for Wales Dataset (NSWD). The NSWD is a large‐scale cross‐sectional, representative sample of adults across Wales, UK. A univariable and multivariable regression analysis was carried out on self‐reported answers to health and well‐being questions contained within the NSWD (2016–2020) to determine the strength of association of various determinants and comorbidities related to spinal pain. A total population of 38,954 of adults were included in the analysis. The study population included interview responses of 21,735 females and 17,219 males. The prevalence of SP in Wales was 4.95% (95% CI: 4.74%–5.15%) with a total of 847 males (4.92%, CI: 4.60%–5.24%) and 1082 females (4.98%, CI: 4.69%–5.27%) reporting spinal pain. The age group with the highest prevalence of SP was in the 70+ years age group for both males (5.44%, CI: 4.82%–6.07%) and females (5.95%, CI: 5.37%–6.54%). The strength of association between age and SP reaches its peak at 50–59 years with an adjusted Odds Ratio (aOR) of 3.74 (p = <0.001), that decreases slightly at 60–69 years and 70+ years. For various comorbidities included in the NSWD, significant associations with SP were confirmed for: mental illness (aOR = 1.42, p = <0.001), migraine (aOR = 2.73, p = <0.001), nervous system issues (aOR = 1.61, p = <0.001), arthritis (aOR = 1.30, p = <0.001) and issues with bones/joints/muscles (aOR = 1.93, p = <0.001). For lifestyle factors, associations were confirmed for current smokers (aOR = 1.41, p = <0.001) and ex‐smokers (aOR = 1.23, p = 0.003). This study demonstrates a low prevalence of SP in Wales when compared to global estimates and strong associations to a variety of determinants. This still represents a significant societal burden and these findings may help inform public health initiatives to encourage prevention and evidence‐based interventional strategies and ultimately, improve the quality of life for those suffering with SP in Wales. [ABSTRACT FROM AUTHOR]

Background Despite conflicting findings on the association between socioeconomic status and drinking, little is known about the impact of deprivation as a measure of inequality on alcohol use disorders (AUDs). Methods We used the Korea Welfare Panel Study, a longitudinal survey conducted from 2012 to 2022, and included 1569 Korean adult participants. Deprivation (at least one including food, housing, medical, educational, and credit deprivation) was measured by self-report and divided into four categories according to the change in deprivation experience from the previous year to the following year. AUD was measured using the Korean version of the Alcohol Use Disorders Identification Test scale. Multivariable logistic regression was used to estimate odds ratios and 95% confidence intervals and adjusted for confounders. Results Among 1569 participants, worsened deprivation and consistent deprivation were positively associated with AUD compared to non-deprivation. In particular, worsened deprivation was more likely to be associated with AUD in participants with low household income, high school education level, and economic activity. Conclusion We found that worsened deprivation and consistent deprivation were associated with AUD. Deprivation should be considered as a health policy intervention to improve drinking problems. [ABSTRACT FROM AUTHOR]

Background: Major trauma is a leading cause of death and disability in younger individuals and poses a significant public health concern. There is a growing interest in understanding the complex relationships between socioeconomic deprivation and major trauma. Anecdotal evidence suggests that deprivation is associated with more violent and debilitating injuries. There remains a paucity in literature evaluating major trauma outcomes in relation to socioeconomic deprivation. Methods: A comprehensive search of MEDLINE, Embase, and CENTRAL databases was performed to identify studies from 1947 to March 2024. The primary outcome was to establish the distribution of injuries based on deprivation, with secondary outcomes evaluating surgical intervention rates, length of stay, and mortality. Quantitative pooling of data was based on the random‐effects model. Results: Fourteen studies and 878,872 trauma patients were included. A substantial proportion (28%) of trauma incidents occurred in the most deprived group. Patients from the lowest socioeconomic group were considerably younger (weighted mean difference [WMD] −9.85 years and 95% confidence intervals [CI] −9.99 to −9.70) and more likely to be male (odds ratio [OR] 1.36 and 95% CI 1.14–1.63). There were no differences in surgical intervention (OR 1.74 and 95% CI 0.97–3.13), length of stay (WMD 1.15 days and 95% CI −0.32−2.62), and mortality (OR 1.04 and 95% CI 0.95–1.14) regardless of background. Conclusion: Major trauma is prevalent in deprived areas and in younger individuals, with an increasing trend of deprivation in male patients. Although the rates of surgery, length of stay, and mortality did not differ between groups, planning of public health interventions should target areas of higher deprivation. [ABSTRACT FROM AUTHOR]

There is important variation in the occurrence of Paget's disease in different regions and populations. There are though few data concerning the occurrence of clinically diagnosed disease in black and ethnic minority groups in the United Kingdom (UK). We undertook an anonymised search using an integrated primary and secondary care-based database in Greater Manchester, covering a population of over 3 million people. We looked also among those with a first positive COVID test, the influence of Paget's disease on subsequent admission to hospital within 28 days. Within our database, there were 534,571 people aged 60 years and over alive on 1 January 2020. The majority were white (84%) with 4.7% identifying as Asian or Asian British, and 1.27% Black or Black British. There were 931 with clinically diagnosed Paget's disease. Overall prevalence in the greater Manchester area was 0.174%. Prevalence was higher in men than women (0.195 vs 0.155%). Compared to the prevalence of Paget's in whites (0.179%) the prevalence was lower among those identifying as Asian or Asian British (0.048%) and higher among those identifying as Black or Black British (0.344%). Prevalence increased with increasing deprivation. Clinically diagnosed Paget's disease is uncommon affecting 0.174% of men and women aged 60 or more years. Within Greater Manchester, it was more common in those identifying as Black or Black British and less common in those identifying as Asian or Asian British. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the relationship between socioeconomic deprivation and postoperative outcomes in patients who underwent colonic resection for sigmoid diverticulitis (SD). Background: The potential impact of socioeconomic inequalities on the management of SD has been scarcely studied in the literature. Considering other gastrointestinal pathologies for which lesser access to optimal treatment and poorer survival have been shown, we hypothesize that deprivation could be associated with outcomes for SD. Methods: This multicenter retrospective study was conducted at 41 French hospitals between January 1, 2010, and August 31, 2021. The main outcome was the occurrence of severe postoperative complications on postoperative day 90, according to the Clavien- Dindo scale (≥3). The European Deprivation Index was used to approximate deprivation for each patient. Multiple imputations by a chained equation were performed to consider the influence of missing data on the results. Results: Twenty percent of the 6415 patients operated on had severe postoperative complications at 90 days. In the multivariate regression analysis, increasing age, male sex, American Society of Anesthesiologists score ≥3, conversion to laparotomy or upfront open approach, surgical procedures, and perioperative transfusion were independent risk factors for severe postoperative complications. After adjusting for age, sex, body mass index, American Society of Anesthesiologists score, emergent setting, blood transfusion, indications for surgery, surgical approach, and procedures, the probability of severe postoperative complications increased with socioeconomic deprivation (P=0.026) by day 90. Conclusions: This study highlights the potential influence of socioeconomic deprivation on the surgical outcomes of SD. Socioeconomic deprivation should be considered as a risk factor for severe postoperative complications during the preoperative assessment of the patient's medical conditions. [ABSTRACT FROM AUTHOR]

This article discusses the approaches to family care for children with disabilities depicted in documentaries produced by prominent film directors in the 1960s and 1970s, the period explored as re-establishing patriarchal order in socialist Czechoslovakia. Interpreting the documentaries in the context of public campaigns on child welfare reveals mental deprivation as a central concept that brought together the biopower of institutions and patriarchal values. The success and dissemination of Deprivation Theory is shown to have resulted in multiple internal contradictions in the medicalization of public care for children that was initiated in the late 1940s. The article traces the grounding of the dichotomy of public care versus family care by re-constructing the social ideals around child development and family care. These ideals remain one of the obstacles to the deinstitutionalization of care for children with disabilities to this day. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions The mechanisms linking early‐life adversity with psychopathology over the life‐course are complex. In this prospective study, we collectively examined cognitive, affective, and developmental mediators previously found to individually link childhood threat and deprivation experiences to adolescent psychopathology to identify the most potent mechanisms.Data came from a community sample of 227 children (mean child age 11.5 ± 0.5 years, 48.5% female) from the Seattle metro area with recruitment designed to reflect diversity in family income. Candidate mechanisms included self‐rated pubertal development and task‐measured attention bias to threat, emotion regulation, theory of mind, fear learning, inhibitory control, language ability, reasoning, and reward sensitivity. Using a high‐dimensional mediation approach, we determined which mediating pathways linking threat and deprivation to psychopathology persisted after controlling for all candidate mechanisms associated with psychopathology. Models additionally controlled for the child's age, sex, early‐childhood emotional and behavioral symptoms, poverty, and maternal depression.Blunted reward sensitivity mediated the prospective relationship between threat and internalizing psychopathology, explaining 17.25% (95% CI 1.08%, 69.96%) of this association. Advanced pubertal development was associated with increases in internalizing and externalizing symptoms (standardized associations of 0.16 (95% CI 0.03, 0.29) and 0.17 (95% CI 0.05, 0.29), respectively), but not with adversity. Although deprivation was strongly related to psychopathology, no mechanisms were empirically identified.In a well‐characterized community sample, we isolated reward sensitivity as a robust mediator of the prospective association between early‐life threat and adolescent internalizing psychopathology. Interventions aimed at bolstering reward sensitivity may mitigate the impact of early‐life threat experiences on internalizing problems. [ABSTRACT FROM AUTHOR]

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]

Water insecurity is a global concern likely to be compounded by increases in population and climate change. Existing water insecurity measurement methods capture multidimensional deprivation only at regional or sub-regional levels. Such estimates do not capture heterogeneous household experiences of water supply, proximity to water sources and affordability, which can vary substantially from regional averages. Accurate measurement requires a method that captures the incidence and intensity of a household's simultaneous deprivation in dimensions of water accessibility, affordability, sufficiency and safety. We propose such a method and assess related inequalities using an approach analogous to the Alkire–Foster methodology for multidimensional poverty. Using household-level data from the Kenya Integrated Household Budget Survey 2015/16, we find that 63% of the Kenyan population experience multiple deprivation in water access. The dimensions of water affordability and sufficiency contribute most to multidimensional water insecurity, highlighting the need to ensure an adequate supply of affordable water. Disparities by household place of residence, dwelling type, and socio-economic status are evident. The estimates of multidimensional water insecurity are robust to different deprivation and poverty cutoffs. Our analysis is an invitation to rethink water insecurity metrics, allowing water deprivation to be measured more frequently and with greater precision to understand its impact clearly. [ABSTRACT FROM AUTHOR]

Background Access to kidney transplantation (KT) remains challenging for patients with end-stage kidney disease. This study assessed women's access to KT in France by considering comorbidities and neighbourhood social deprivation. Methods All incident patients 18–85 years old starting dialysis in France between 1 January 2017 and 31 December 2019 were included. Three outcomes were assessed: access to the KT waiting list after dialysis start, KT access after waitlisting and KT access after dialysis start. Cox and Fine–Gray models were used. Gender–European Deprivation Index and gender–age interactions were tested and analyses were performed among strata if required. Results A total of 29 395 patients were included (35% of women). After adjusting for social deprivation and comorbidities, women were less likely to be waitlisted at 1 year {adjusted hazard ratio [adjHR] 0.91 [95% confidence interval (CI) 0.87–0.96]} and 3 years [adjHR 0.87 (95% CI 0.84–0.91)] after dialysis initiation. This disparity concerned mainly women ≥60 years of age [adjHR 0.76 (95% CI 0.71–0.82) at 1 year and 0.75 (0.71–0.81) at 3 years]. Access to KT after 2 years of waitlisting was similar between genders. Access to KT was similar between genders at 3 years after dialysis start but decreased for women after 4 years [adjHR 0.93 (95% CI 0.88–0.99)] and longer [adjHR 0.90 (95% CI 0.85–0.96)] follow-up. Conclusions In France, women are less likely to be waitlisted and undergo KT. This is driven by the ≥60-year-old group and is not explained by comorbidities or social deprivation level. [ABSTRACT FROM AUTHOR]

Aim: To develop the 'Stronger Towns Index': a deprivation index that took into account characteristics of areas encompassing towns that may be eligible for redevelopment funding and explore how this index was associated with self-rated health and migration within England between 2001 and 2011. Subject and methods: All members of the ONS Longitudinal Study in England aged 16 and over in 2001 whose records included a self-rated health response and a valid local authority code. Local authorities in England were ranked using a composite index developed using the five metrics set out in the Stronger Towns Funding: productivity, income, skills, deprivation measures, and the proportion of people living in towns. The index was split into deciles, and logistic regression carried out on the association between decile and self-rated health in 2001 in the main sample (n = 407,878) and decile change and self-rated health in 2011 in a subsample also present in 2011, with migration information (n = 299,008). Results: There were areas in the lowest deciles of Town Strength who did not receive funding. After multiple adjustment, LS members living in areas with higher deciles were significantly more likely (7% to 38%) to report good health than those in the lowest decile in 2001. Remaining in the same decile between 2001 and 2011 was associated with 7% lower odds of good self-rated health in 2011. Conclusion: It is important to consider health in towns when allocating funding. Areas in the Midlands may have missed out on funding which might help mitigate poor health. [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]

Abstract Background Adolescence is a crucial period for establishing healthy behaviours that can reduce the risk of noncommunicable diseases. However, limited data exist on the clustering of health-related behaviours, in adolescents from low- and middle-income countries (LMICs). This study examined how diet and physical activity behaviours cluster and how they are influenced by home and school area-level deprivation. Methods The study surveyed 527 adolescents in Yaoundé (Cameroon), Kingston (Jamaica), and Cape Town (South Africa) and grouped them into three categories according to the socioeconomic status (SES) of their homes and school areas (low-low, low-high, and high-high). A k-median algorithm defined three clusters and measured dietary attributes including Dietary Habit Score (DHS), Healthy Food Score (HFS), Nutritional Knowledge Questionnaire (NKQ), moderate-to-vigorous physical activity (MVPA), and sedentary time using validated questionnaires. The clusters were ranked based on their physical activity levels and compared them within each city using statistical tests. Results The scores on the NKQ and HFS indicated a poor level of both nutritional knowledge and healthy food consumption across sites. Cluster analysis revealed a consistent pattern of high screen time clustering with lower (less healthy) dietary scores across sites. This pattern was consistent regardless of SES in Kingston, and SES and school socioeconomic areas in Cape Town and Yaoundé. Conclusion An inverse clustering of sedentary behaviour duration and eating habits remained consistent across different strata for at least two sites, suggesting that interventions to reduce sedentary time could have a ripple effect on multiple NCD risk factors in adolescence.

Over-dependence on agriculture has failed to provide adequate and sustainable livelihoods for rural households. This study assessed the impact of livelihood diversification on the poverty status of rural farming households in Kwara State, Nigeria. Cross-sectional data were collected from 152 farming households over a period of one year using well-structured questionnaires and interview schedules. Descriptive statistics, Shannon diversity index, Foster, Greer and Thorbecke poverty index, fractional logit and probit regression models were used for analysis. Findings revealed that agriculture-related livelihood activities were still the main livelihood strategy in the area. Although farmers in the study area have a wide variety of livelihood options, the different activities carried out by rural households were very similar such as crop farming, fish farming and palm wine tapping which ranked 1st, 2nd and 3rd, respectively. The main determinants of livelihood diversification were age, gender, household size and farming experience. The main determinants of household poverty were access to credit, gender, age and cooperative membership. The main constraints identified were insufficient funds (own capital) for investment, high transport costs, lack of training to acquire skills, and insufficient credit facilities. Based on these findings, it is recommended that the government should organise training courses on asset accumulation for households through extension services.

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.

BACKGROUND: COPD diagnosis is tightly linked to the fixed-ratio spirometry criteria of FEV1/FVC

This paper seeks to disaggregate the relative effects of key environmental, economic, and social factors, including risk of crime, on food access in Newark, New Jersey. First, we identify environmental risk factors that contribute to the spatial distribution of aggravated assault. We then compare the results of this analysis that generates risk scores for assault in microenvironments to food access maps. The final part of the analysis assesses the relationship of these risk scores to macro level measures of social disorganization in determining their differential impact on food access. The results of this study suggest that high-risk environments for aggravated assaults and the presence of abandoned properties are strongly associated with the distribution of food access. In addition, individuals who are going to bodegas to get food within food deserts are also increasing their risks of becoming victims of aggravated assault. As such, food policy must consider how to mitigate the negative effects of multiple layers of deprivation, including crime, to better eradicate food deserts. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) are associated with later cognitive decline. However, the mechanisms underlying the effects of different types of ACEs are unclear. This study examined how ACEs impact cognitive function, specifically deprivation-related ACEs (DrACEs) and threat-related ACEs (TrACEs). Additionally, we explored the potential role of cognitive reserve (CR) and depression in these relationships. Data were taken from the China Health and Retirement Longitudinal Study (CHARLS) of 2014 and 2020. CR, depressive symptoms and cognitive function measures were collected from 2020. ACEs were assessed at the 2014 Life Course Survey. The main analyses included 7113 participants aged 45 years or older. To explore potential associations, linear regression and SPSS Macro PROCESS were employed. Among middle-aged and older adults, only exposure to DrACEs was associated with cognitive function ((β = −0.101 [95% CI : −0.150, −0.052]) for DrACEs = 1; (β = −0.250 [95% CI : −0.333, −0.167]) for DrACEs ≥ 2). The indirect effects mediated by CR and depressive symptoms were statistically significant. The use of retrospective self-reported data for ACEs may introduce recall bias. Chinese middle-aged and older adults who have experienced DrACEs exhibit poorer cognitive function, while the association between TrACEs and cognitive function was not significant. And the impact of DrACEs on cognitive function was mediated by CR and depressive symptoms. Further research is necessary to validate our findings, establish causal links, and uncover the underlying mechanisms involved. • Deprivation-related adverse childhood experiences led to lower cognitive function in later life. • Threat-related experiences had no significant impact on cognitive function in later life. • The impact of deprivation was mediated by cognitive reserve and depressive symptoms. [ABSTRACT FROM AUTHOR]

IntroductionGirls with physical and motor disabilities represent one of the most vulnerable groups in contemporary society, possessing distinct needs and challenges compared to other segments of the population (Naghdi et al., 2023). Their disabilities are often subject to societal judgment, which can exacerbate their struggles (Blandul, 2024). This complex reality is further compounded by intersections with gender, class, poverty, and other social, cultural, political, and economic factors that shape their experiences (Amjad et al., 2023). Disability incurs significant social and health costs for these girls, leading to heightened stress and vulnerability (Schofield et al., 2024). As a result, disabled girls frequently become targets of stereotypes and discriminatory attitudes. This research aimed to explore the experiences and perspectives of disabled girls in Yazd City, addressing these questions: What experiences and mentalities does disability bring to these girls? How do they perceive, feel, and reinterpret disability within the contexts of family and society? Materials & MethodsThis study utilized a qualitative approach grounded in interpretive phenomenology based on the method developed by Dikelman et al. (1989). The participants were girls with physical and motor disabilities from Yazd City with a total of 18 individuals selected through purposive and theoretical sampling techniques. Data were collected through in-depth, semi-structured interviews, which were recorded with the participants' consent. After conducting the interviews and transcribing the conversations, the data were analyzed using Dikelman's analytical method. The interview locations were chosen for the comfort of the participants. To ensure the quality and reliability of the data, the researchers collected multiple pieces of information and direct quotes. A key ethical consideration was obtaining informed consent from both the participants and their parents, with interviews conducted only as long as the participants were comfortable. The data collection process spanned 9 months. Discussion of Results & ConclusionThis article examined the experiences and perspectives of disabled girls through a qualitative lens. During the coding process, themes, such as identity stigma, leadership, marriage anxiety, forced confinement at home, educational challenges, inequality, and social restrictions emerged. The participants expressed that their disability was not the sole source of their difficulties; rather, it was the attitudes of family, peers, and society that had contributed to and exacerbated these challenges, creating a vicious cycle of limitations and exclusion. The girls reported that their families influenced by traditional and stereotypical beliefs feared social judgment and were often resistant to their pursuit of education, employment, and marriage. They perceived disability as a debilitating factor, instilling in them a sense of futility regarding their efforts. The belief that their movement difficulties and gender would render their aspirations fruitless further compounded their challenges.Participants noted that their limited mobility had prevented them from engaging in social situations. The absence of accessible facilities, such as ramps and elevators, along with inadequate transportation options and high travel costs, had created significant barriers to attending schools, universities, and workplaces. They highlighted that the partial implementation of laws and the lack of medical, educational, and employment support in organizational policies had led to their social exclusion. Moreover, the difficulties in commuting coupled with the meaningful stares, labels, and judgments from others had contributed to feelings of loneliness, depression, and a sense of being trapped at home.

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.

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]

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]

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]

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]

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]