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Objective Perinatal mood and anxiety disorders (PMADs) affect many neonatal intensive care unit (NICU) parents and are a significant risk factor for maternal suicide. Lack of screening and treatment interferes with infant development and bonding, compounding risks in fragile infants. We aim to describe PMAD screening in level IV NICUs across the Children's Hospitals Neonatal Consortium (CHNC) and to determine the relationship between standardized screening and mental health professionals (MHPs) presence. Study Design We surveyed experts at 44 CHNC NICUs about PMADs screening practices and presence of NICU-specific MHPs. Kruskal–Wallis test was used to examine relationships. Results Of 44 centers, 34 (77%) responded. Fourteen centers (41%) perform screening with validated tools. Thirteen (38%) centers have NICU-dedicated psychologists. Formally screening centers tend to have higher cumulative MHPs (p = 0.089) than informally screening centers. Repeat screening practices were highly variable with no difference in the number of cumulative MHPs. Conclusion Screening practices for PMADs vary across CHNC centers; less than half have additional MHPs beyond social workers. Creating a sustainable model to detect PMADs likely requires more MHPs in NICUs. Key Points PMADs affect many NICU parents. Systematic screening for PMADs is limited in level IV children's hospital NICUs. Additional MHPs may contribute to enhanced screening and support of parents. Hospitals should prioritize funds for NICU-specific MHPs to optimize outcomes. [ABSTRACT FROM AUTHOR]

Sexual abuse has increased in Nigeria. In certain circumstances, relatives molest children. However, a stable marriage shields children against sexual abuse. It remains uncertain whether a stable marriage protects children from child sexual abuse when other relatives or domestic workers join the family. Using Dahrendorf's conflict theory, we argue that relatives or domestic workers living with the family increase the risk of child sexual abuse. We also claim that sexual abuse worsens victim's health.We employed a cross-sectional survey of 419 young people (16–24 years) across eight selected local governments in Lagos State through simple random and cluster sampling techniques. We analyzed the data using descriptive statistics, Chi-Square, and Logistic Regression. The study showed that living with parents compared to guardians reduced the odds of improper touch (OR: 0.23), and fingering (OR: 0.19). Also, having relatives live with the family compared to those who are not, reduced the odds of improper touch (OR: 0.22), but more likely to experience fingering (OR: 38.17). However, in a stable marriage, when other relatives live with the family young people are more likely to experience improper touch (OR: 3.46), fondling (OR: 18.53), and fingering (OR: 32.52). Child sexual abuse increases the odds of negative health outcomes like withdrawal from groups (OR: 3.10), pregnancy (OR: 6.99), hatred for the opposite sex (OR: 2.24), and suicidal thoughts (OR: 7.19), among others. Families with temporary or long-term relatives should be vigilant. Also, society formulates and implements policy frameworks to reduce child sexual abuse in the familiar cycles. [ABSTRACT FROM AUTHOR]

Most older adults aspire to age in their homes and communities; they often face challenges due to functional limitations. The demand for home and community-based services (HCBS) has steadily increased to address these challenges. This scoping review explores the relationship between HCBS and the health outcomes of older adults. A total of 11,317 peer-reviewed articles published between January 1, 2005, and August 1, 2023, were identified from major electronic databases, with 12 articles selected for the final sample. The findings indicate that HCBS are consistently associated with better health outcomes, including improvements in physical and mental health and reduced hospitalizations. However, Black and Asian older adults reported lower accessibility to HCBS and poorer self-rated health compared to their White counterparts. Additionally, low density and lack of HCBS in neighborhoods were linked to poorer health outcomes among older adults. Policymakers should prioritize improving HCBS accessibility in neighborhoods, consider the demographic characteristics of older adults, and address their diverse needs to tailor HCBS effectively. [ABSTRACT FROM AUTHOR]

Aims: To provide an updated comprehensive evaluation of the quality and evidence association of existing studies on health outcomes related to intermittent fasting (IF). Materials and Methods: We conducted a systematic search of PubMed, Web of Science, Cochrane Library, and Embase databases, covering literature up to June 2024. Meta‐analyses and systematic reviews that include adult populations and quantitatively analyse health outcomes related to IF interventional studies are included. For evidence with complete data, we reanalyzed health evidence effect sizes and 95% confidence intervals using random‐effects models. Article quality and the certainty of the evidence were graded using A Measurement Tool to Assess Systematic Reviews (AMSTAR‐2), Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, and a standardized credibility grading system. Results: Twelve meta‐analysis studies and 122 health outcome associations with IF were identified. High‐quality evidence indicated significant associations between time‐restricted eating (TRE) and weight loss, fat mass reduction, decreased fasting insulin and glycosylated haemoglobin levels in overweight or obese adults, as well as between the 5:2 diet and reduced low‐density lipoprotein cholesterol levels. Moderate‐to‐low‐quality evidence suggested associations between modified alternate‐day fasting and improvements in body weight, lipid profile and blood pressure. Additionally, high‐to‐low‐quality evidence showed that IF regimens effectively improved liver health in non‐alcoholic fatty liver disease. Conclusions: This umbrella review highlights IF, especially TRE, as a promising intervention for weight and metabolic health, particularly beneficial for overweight or obese adults. We also highlight the need for further extensive research to understand the long‐term effects, individualized IF plans and potential adverse effects of IF in different populations. [ABSTRACT FROM AUTHOR]

Introduction Despite the benefits of quitting smoking for those who have cancer, including improved health outcomes and reduced therapeutic toxicities, it is unclear how many people are supported in quit attempts during this time. Variations in the availability and provision of smoking cessation (SC) services are reported, with little understanding of the challenges and solutions. This codesigned study aimed to understand the perspectives of health care professionals (HCPs) working in oncology settings to engage in SC practices and identify recommendations for developing a SC pathway. Aims and Methods This was a qualitative study. Eighteen HCPs participated in semi-structured interviews from July 2021 to May 2022. We used thematic analysis approaches to code data and present four themes and SC strategies at micro, meso, and organizational levels. Results Four themes are reported specifically: (1) timing and knowledge, (2) building a relationship, (3) frequent asking with infrequent action, and (4) removing the barriers and tailoring the system. While HCPs discuss SC, there are variations in documentation and when conversations occur. Primarily, HCPs value the time to build therapeutic relationships with patients and thus may limit SC discussions in preference to treatment in clinical interactions. The role of structural barriers, including prescriptive authority for nurses, hinders active SC processes, as it is the lack of continuity and embedding of services supported by a clinical champion for SC. Conclusions The study suggests reevaluating the status quo in SC service, highlighting service gaps, and suggesting opportunities at organizational levels to reduce structural barriers. Implications Variations in SC services exist in designated cancer centers. The data from this study can be used to inform a real-time health systems approach for SC services in oncology settings. Developing tailored SC services and interventions that are patient-centered and informed by their experiences is required. The data in this study suggest developing specialist education and training to upskill HCPs for equitable engagement if we are to meet EU and Cancer Moonshot goals for cancer reduction. [ABSTRACT FROM AUTHOR]

The healthcare system in the United States (US) is complex and often fragmented across national and regional health plans which exhibit substantial variability in benefit design and formulary policies for accessing medications. We propose an access-focused value assessment framework for formulary decision-making for medications to manage immune-mediated inflammatory diseases (IMIDs), where patients are at the center of this framework. Formulary decision-making for IMID medications can be a challenging, even daunting, task with continuously evolving and enhanced treat-to-target goals. Given the complexity of the US healthcare system, patients and their caregivers need assurance from formulary decision-makers that rapid, predictable, and sustained access to both well-established treatments and innovative therapies will be a priority, with a particular emphasis on continuity of effective care. This access-focused patient-centric (APAC) value assessment approach encompasses three "value components"—higher therapeutic goals, better health-related quality of life, and improved work productivity—the monetization of which can be derived using data from clinical trials when real-world data are yet to become available. Measures and assessment approaches are outlined to serve as a pragmatic tool for decision-makers in the US to ensure timely delivery and sustained access of clinically indicated therapies aimed to improve patient outcomes, enhance equity, and increase efficiency. Plain Language Summary: Formulary decision-making for immune-mediated inflammatory diseases can be complex, as more advanced therapies are developed and approved for multiple diseases, where clinical trial endpoints may vary substantially. We introduce an access-focused patient-centric framework as a decision tool maximizing patient centricity. It focuses on improvements in three core components: therapeutic outcomes, quality of life, and work productivity. Monetization of these components provides a common metric for payers to make informed decisions, allowing timely access for patients. [ABSTRACT FROM AUTHOR]

Background: Temporal discounting, the preference for immediate over delayed rewards, affects decision-making in domains like health and finance. Understanding the differences in how people discount health outcomes compared to monetary rewards is crucial to shaping health policy and technology assessments. Aim: This systematic review and meta-analysis aimed to compare temporal discounting parameters between health outcomes and monetary rewards and evaluate their overall relationship. Method: Studies were retrieved from PubMed, Embase, Web of Science, and the Cochrane Library up to December 2023. Standardized mean differences (SMD) assessed discounting differences between statistical indicators, and correlation coefficients were transformed into Fisher's Z scores. Subgroup analyses based on population, tradability, magnitude, sign, and experimental process explored potential heterogeneity. Results: A total of 32 studies were included: 29 studies (47 pairs of health and money) for the comparative meta-analysis and 19 studies (32 pairs) for the correlation meta-analysis. No significant differences were found between health and money discounting, although the individuals were more patient with the health outcomes and more impulsive with the money. In the sign effect subgroup, health discounting for delayed losses was lower than for monetary losses (SMD: − 0.293; 95% CI: − 0.458, − 0.129). The pooled correlation coefficient (r) for all studies was 0.333 (95% CI: 0.283–0.383), indicating a moderate association. In subgroup analysis, when the indicator was the discount rate, the pooled r value for 16 studies was 0.278 (95% CI: 0.231, 0.325). Conclusion: Although no significant statistical differences were found between health and money discounting, a moderate correlation was observed, supporting consistent discount rate settings for health technology assessments. [ABSTRACT FROM AUTHOR]

This study analyses the panel data for the 19 countries of West Africa and employed the Grossman health production function, which is estimated using the regression model with Driscoll Kraay standard error and the robustness of the result is evaluated using Common Correlated Mean Group estimator. Current health expenditure, per capita income, and C02 emissions are significantly associated with an improvement in life expectancy and a reduction in under-5 mortality. Per capita income and fossil fuel are associated with significant reductions in mortality from chronic conditions. However, while fossil fuel is significantly associated with a reduced life span, there is no significant evidence that renewable energy improves life expectancy. Moreover, renewable energy and fossil fuels are not associated with a significant reduction in under-5 mortality. Finally, though insignificant, renewable energy and public expenditure on education are associated with mortality reductions for people with chronic conditions. [ABSTRACT FROM AUTHOR]

Background: In African Regional Economic Communities (RECs), notable and enduring disparities exist in health outcomes. This study investigates the impact of macro-level characteristics of countries on health outcomes disparities within the African Regional Economic groupings. The study used panel data from the World Bank Development Indicators (WDI) and the Worldwide Governance Indicators (WGI), spanning 37 African countries, grouped into eight RECs between 2000 and 2019. We employed infant and under-five mortality rates and life expectancy at birth as indicators of health outcomes. Method: The study used a multilevel linear (ML) mixed-effect approach to examine the influence of country-level factors on health outcome disparities within the eight African RECs recognized by the African Union. Results: The findings show that higher unemployment rates and HIV incidence exacerbate these disparities, while a growing elderly population and improved access to basic drinking water can mitigate them. Increased internet usage correlates with higher within-regional inequalities in child mortality rates but reduces disparities in life expectant at birth. Urbanization trends contribute to lower-intra-regional inequality in infant mortality rates and life expectancy at birth. Higher domestic government health expenditure as a share of general government spending is linked to reduced disparities in under-five and infant mortality rates. Still, it increases inequalities in life expectancy at birth within the regional groupings. Moreover, a higher proportion of the population below 15 years old and trade gains positively influence regional disparities in life expectancy. Conversely, DTP immunization coverage among children aged 12–23 months is associated with higher within-regional inequality in infant mortality rates. Conclusions: Polices aimed at reducing unemployment rates and HIV incidence should be prioritized. In addition, governments should invest in elderly care programs and infrastructure development for water supply. Efforts to promote internet access should be complemented by interventions to enhance child health and healthcare accessibility. Encouraging urban planning policies that prioritize developing healthcare infrastructure and facilitating healthcare access in urban areas is crucial. Furthermore, Governments should increase their health expenditure allocation in general government spending. Promoting strategies to enhance healthcare access and quality for specific demographics, alongside leveraging trade gains to invest in healthcare infrastructure and services, is imperative. Targeted interventions ensuring equitable access to immunization services should also be emphasized. [ABSTRACT FROM AUTHOR]

Background: Better health literacy has been found to be associated with better health outcomes across varied populations. This study aimed to (1) examine the health literacy levels of individuals with respect to the extent to which they acquire, understand, appraise, and apply health information, and (2) to assess the relationship between health literacy and self-reported health in the state of Delaware. Methods: The sampling frame consisted of 60 purposively selected faith-based organizations across the state of Delaware who predominantly serve minorities. Accounting for clustering design, a sample size was determined based on a Mixed Methods test. In total, 1095 participants responded to a survey questionnaire which included a validated short version of the European Health Literacy Questionnaire (HLS-EU-Q16). The data was analyzed using descriptive statistics, reliability techniques, chi-square test of independence, and ordinal logistic regression. Results: The study found that about a quarter of the participants had inadequate level of health literacy and about another quarter had problematic level of health literacy. These results are reflected across the health domains—health care, disease prevention, and health promotion. Health literacy was predictor of self-rated health. The odds of better self-rated health are 0.360 times lower for people with inadequate health literacy levels compared to those with sufficient health literacy. Conclusion: Health literacy profoundly shapes health outcomes. The high proportion of people expressing difficulty concerning accessing, comprehending, appraising, and using health information in the health care, disease prevention, and health promotion domains in state of Delaware would require a concerted effort. [ABSTRACT FROM AUTHOR]

Evaluating the reduced-risk potential of novel tobacco and nicotine products, as compared to cigarettes, requires consideration not only of individual risk but also the impact on the population as a whole. Where the reduction in health risk for smokers who switch to the product instead of continuing to smoke, but also the product's potential effects and rate of uptake among non-smokers must be taken into account. Computational models have proven to be a valuable tool to enable evaluation of long-term population health effects, in the absence of epidemiological data. Most population health models projecting the health impact of novel tobacco and nicotine products have primarily focussed on potential population harm or benefit using premature 'all cause' mortality rates attributable to cigarette smoking as the key output indicator. This study expands on previous mortality projections for the introduction of tobacco heated products (THPs) in Japan, using an enhanced systems dynamics model including non-mortality outcomes. This enables investigation of additional projections for person-years lived with disabilities, tobacco related disease incidence, tobacco use prevalence and tobacco user behaviour, such as average smoker age, the number of years smoked and the age at which individuals ceased smoking. Disease specific projections are provided for the main smoking related diseases, lung cancer, CVD and COPD, and also for esophageal cancer and lower extremity peripheral arterial disease as examples of the potential wider application of this modelling approach. Modelling estimates based on the available data, indicate that the introduction of THPs into the Japanese marketplace will reduce future smoking prevalence, smoking-related premature deaths and the burden of smoking related disabilities, compared to a scenario where THPs had not been introduced. The resulting projections demonstrate the ability to investigate population health impacts beyond all-cause mortality to provide further insight into the harm reduction potential of alternative nicotine products such as THPs. [ABSTRACT FROM AUTHOR]

The issue of food security amongst older people is a growing concern, as ageing populations face unique challenges that impact their access to adequate nutrition. This scoping review aims to explore and synthesise existing literature on food security in later life, identifying key factors contributing to food insecurity amongst seniors and highlighting interventions that can enhance food access. By employing a systematic approach based on Arksey and O'Malley's framework, this study examines research from multiple databases, focussing on studies published in the past decade. The findings reveal a multifaceted problem influenced by socio-economic status, health limitations, social isolation and geographic barriers. Elderly individuals often encounter mobility issues that hinder their ability to procure food, while fixed incomes and rising costs exacerbate their access to nutritious options. In addition, the review identifies successful community-based programmes and policy initiatives that have shown promise in addressing these challenges, emphasising the importance of tailored interventions that consider the specific needs of older people. The analysis highlights significant gaps in the current literature, particularly in the areas of culturally sensitive programmes and the long-term effects of food insecurity on mental health. Furthermore, the role of technology in mitigating food insecurity presents a promising yet underexplored avenue for future research. The review underscores the critical need for comprehensive strategies integrating policy, community support and technological innovations to effectively combat food insecurity amongst seniors. By addressing these issues, stakeholders can improve the overall quality of life and health outcomes for the elderly population, ensuring their nutritional needs are met sustainably. [ABSTRACT FROM AUTHOR]

This study examines the intensity of grieving experienced by volunteers from animal protection organizations in southern Spain. A total of 130 volunteers (86% female; M = 42.0 years) reported on their reactions to loss following the death of animals under their care, levels of empathy, anthropomorphism, and attachment experienced toward these animals, received social support, and overall health status. The results showed that 65.5% of participants displayed signs of general complicated grieving (83% on the grief scale; 40% on the anger scale; 47% on the guilt scale). The intensity of grief was associated with higher symptomatology (linear polynomial ANOVA, **p <.01). The linear regression analysis revealed a relationship between attachment levels, anthropomorphism, empathy, family support (inverse), and the intensity of grieving experienced (*p <.05). Taken together, these findings indicate the existence of complicated mourning reactions among volunteer staff in animal protection organizations, justifying the development of specific prevention programs. [ABSTRACT FROM AUTHOR]

Background: Individuals with dementia are particularly vulnerable during emergency situations due to challenges with cognition, mobility, and daily functioning. However, little is known about how disruptive events may specifically impact the health of those with dementia. Objective: To evaluate changes in health outcomes for individuals with and without dementia surrounding the Israel-Gaza war in October 2023. Specifically, we analyzed and compared changes in mental health status, medication adherence, healthcare service utilization, and associated costs between individuals with dementia (Study Group) and those without dementia (Control Group) during the period surrounding the Israel-Gaza war in October 2023. Method: A prospective cohort study compared outcomes between individuals with dementia (Study Group, n = 24,178) and without (Control Group, n = 250,652) before and after the crisis onset. The conflict precipitously threw national systems into disarray, recruited healthcare personnel to the war effort, and disrupted supply chains. Results: Compared to baseline, analysis revealed alterations in patterns of dementia diagnoses, healthcare service utilization, medication adherence, and associated costs during the crisis period for both groups. However, the Study Group experienced comparatively larger declines. Conclusions: Findings provide insights into how humanitarian emergencies, through disruption of health systems and care networks, differentially impact continuity of dementia care. This underscores the need for tailored crisis response strategies to address the heightened vulnerabilities of patients with dementia. [ABSTRACT FROM AUTHOR]

Introduction Human milk is associated with positive short- and long-term health outcomes. Women's choice to breastfeed is influenced by personal, social, health, and economic factors. The COVID-19 pandemic impacted health care delivery, non-emergent health care services, and family lifestyles, primarily in the early months of 2020. The aim of this study was to determine if breastfeeding initiation rates differed during a global pandemic among women in the military health care system. Materials and Methods This was a cross-sectional chart review study. We compiled all birthing event health records from March to August in 2019 and 2020 from a single military medical center. Of the 2,737 maternal-infant dyads available, 1,463 met complete inclusion criteria and were analyzed to determine associations between delivery year, maternal and infant characteristics, and initial feeding methods. Institutional research approvals were obtained from the university and medical center institutional review boards. Results There was no significant association between breastfeeding initiation rates and delivery year (X 2(1) = 2.898, P  = .089). Some maternal and infant characteristics significantly associated with the feeding method in the logistic regression model and differed by delivery year. Black women were 1.9 times less likely to initiate breastfeeding compared to White women; this disparity became more pronounced in 2020. Multiparous mothers, those who gave birth via cesarean section, and those at earlier gestational ages (32–37 weeks) were less likely to initiate breastfeeding. Models differed by delivery year, with only Black race and cesarean birth significantly impacting the overall model in 2020. Maternal age, military status, military rank, marital status, birth complications, and infant gender were not associated with the feeding method. Conclusions Overall breastfeeding initiation rates did not differ during the COVID-19 pandemic when rates in 2020 were compared to those in the year prior. Race, birth method, parity, and gestational age were associated with breastfeeding initiation rates in women cared for at military centers. [ABSTRACT FROM AUTHOR]

Background: Generalized Joint Hypermobility (GJH) offers flexibility that could enhance motor activities. However, if it leads to injury and pain, it increases functional difficulties and activity limitations. The far-reaching consequences of activity limitations and restricted participation include poor physical fitness and diminished quality of life. This study investigated whether variations in joint mobility are associated with physical activity levels, physical fitness, and overall quality of life (QoL) among children and whether these factors change over a 2-year period. Method: One hundred and sixty-five school-aged children were recruited at the beginning of a two-year longitudinal study. One hundred and eleven children were measured three times at one-year intervals. Joint mobility was classified as normal mobile, mobile, or hypermobile. The children were administered the FACES pain scale, the child activity limitation interview, a physical activity questionnaire, and the pediatric quality of life inventory questionnaire. Additionally, the 20-meter shuttle run was used to estimate aerobic fitness. Results: In this study, pain was unrelated to joint mobility. The activity limitations of our study population were not different at baseline or at the end of the study, irrespective of joint mobility. Children with GJH had significantly lower physical activity levels at the end of the study. Overall, QoL increased over time, and aerobic capacity decreased. However, changes in children with GJH were not significantly different from those in children with normal mobility in this respect. Conclusion: Children with GJH were moderately active, however significantly less than children with normal mobility. Joint mobility had no significant effect on activity limitations, physical fitness or QoL. Significance: What is known? • Increased joint mobility reduces physical activity levels. What is new? • Children with GJH were not more limited in their activities than those with normal mobility, as measured by the activity limitation interview. • Children with GJH do not have a greater risk of developing pain-related activity limitations. • The quality of life did not differ between children with and without GJH. [ABSTRACT FROM AUTHOR]

Background: Place matters for health. In Texas, growing rural populations face a variety of structural, social, and economic disparities that position them for potentially worse health outcomes. The current study contributes to understanding rural health disparities in a state-specific context. Methods: Using 2023 County Health Rankings data from the University of Wisconsin Population Health Institute, the study analyzes rural/non-rural county differences in Texas across six composite indexed domains of health outcomes (length of life, quality of life) and health factors (health behavior, clinical care, socioeconomic factors, physical environment) with a chi-square test of significance and logistic regression. Results: Quartile ranking distributions of the six domains differed between rural and non-rural counties. Rural Texas counties were significantly more likely to fall into the bottom quartile(s) in the domains of length of life and clinical care and less likely to fall into the bottom quartile(s) in the domains of quality of life and physical environment. No differences were found in the domains of health behavior and socioeconomic factors. Findings regarding disparities in length of life and clinical care align with other studies examining disease prevalence and the unavailability of many health services in rural Texas. The lack of significant differences in other domains may relate to indicators that are not present in the dataset, given studies that find disparities relating to other underlying factors. Conclusions: Texas County Health Rankings data show differences in health outcomes and factors between rural and non-rural counties. Limitations of findings relate to the study's cross-sectional design and parameters of the secondary data source. Ultimately, results can help state health stakeholders, especially those in community or operational contexts with limited resources or access to more detailed health statistics, to use the CHR dataset to consider more relevant local interventions to address rural health disparities. [ABSTRACT FROM AUTHOR]

Introduction E-cigarettes (ECs) may be an effective harm reduction strategy for individuals with conditions like chronic obstructive pulmonary disease (COPD), asthma, coronary artery disease (CAD), and peripheral arterial disease who smoke combustible cigarettes (CCs). Our aim was to examine how individuals with chronic conditions transition from CCs to ECs and its impact on health outcomes. Aims and Methods In a pilot randomized controlled trial (RCT), patients with COPD, asthma, and CAD/PAD who currently smoke CCs and have not used nicotine replacement therapy (NRT) or ECs in the past 14 days were randomized to receive ECs or combination NRT with behavioral counseling. Disease symptoms, acceptability/satisfaction (TSQM-9) and feasibility, and cigarettes per day (CPD), and/or EC use were collected at baseline, 3-, and 6 months. Descriptive statistics and a linear regression were conducted to explore changes in CPD and chronic condition-specific assessments (CAT, SAQ-7, and ACT) that assess COPD, asthma, and CAD/PAD symptom change. Results At 3 months, the EC group (n  = 63, mean CPD = 9 ± 11) reduced their CPD by 54% versus 60% in the NRT group (n  = 58, mean CPD = 7 ± 6), p  = .56. At 6 months, 17.5% had switched completely to ECs while 23% quit smoking in the NRT arm. CAT scores showed a significant 6-point reduction in the EC arm (p  = .03). Participants scored an average of 69 ± 27 for EC effectiveness, 87 ± 23 for convenience, and 75 ± 27 for overall satisfaction. Conclusions This pilot study suggests that ECs may be a safer alternative for chronic condition patients using CCs and warrants further research on expected smoking cessation/reduction among individuals who use ECs. Implications The findings from this pilot RCT hold significant implications for chronic conditions such as COPD, asthma, CAD, and peripheral arterial disease who smoke CCs. The observed reduction in CPD and improvement in respiratory symptoms suggest that switching to ECs appears feasible and acceptable among those with chronic diseases. These results suggest that ECs may offer an alternative for individuals struggling to quit CC smoking through existing pharmacotherapies. This study supports further exploration of switching to ECs as a harm reduction strategy among CC users who have been unsuccessful at quitting by other means. [ABSTRACT FROM AUTHOR]

Stress and HIV disproportionately affect Latinx adults in the United States, contributing to numerous health inequities. Among people living with HIV (PLWH), increased stress is associated with decreased medication adherence, effectiveness, and higher rates of immunosuppression and comorbidities. Our study (N = 126) examined the relationship between perceived stress and HIV-related health among Latinx (n = 83) and non-Latinx White (n = 43) PLWH. Latinx PLWH reported better HIV-related health outcomes than non-Latinx White PLWH, despite higher viral load (all p 's <.05). An interaction effect showed that higher perceived distress was associated with worse health outcomes and lower CD4+ T cell count only in Latinx PLWH (p 's <.05). Our findings highlight the consequences of stress on HIV-related health. Notably, higher stress may be especially detrimental among Latinx PLWH, underscoring the need for more culturally tailored interventions in HIV-related care. Future research should include additional sociocultural factors and longitudinal assessment in a larger sample. [ABSTRACT FROM AUTHOR]

This research work examines the convergence of health expenditure in Central Europe and the Baltic region. The study reveals the absolute convergence in per capita health expenditures, indicating similar health outcomes for all eleven countries of the region. However, there is a divergence in health expenditure and outcomes across the eleven countries. Notably, public health expenditure diverges in Denmark, Estonia, Finland, and Norway, while, private health expenditure converges in Poland, Russia, and Sweden. Despite an overall convergence in life expectancy at birth across the countries, mortality rates due to non-communicable diseases only converge in Estonia. [ABSTRACT FROM AUTHOR]

Forensic patients have poorer health outcomes than the general population and have specific healthcare needs. Health literacy is an emerging field that could enhance how forensic services meet the needs of this cohort. We undertook an exploratory cross-sectional survey using the Health Literacy Questionnaire (HLQ) to describe the health literacy strengths and challenges of forensic patients in a high-secure facility in Australia. Data were collected from 35 forensic patients. Males comprised 85% of the sample, 80% had a primary diagnosis of schizophrenia and 74% self-reported at least one existing health problem. Compared to the general Australian population, forensic patients had significantly lower HLQ scores for five of the nine scales. No statistical differences were found when comparing participant characteristic groups. This study has revealed differing patterns of health literacy strengths and challenges of forensic patients. Future research on a larger scale is required to enhance the health literacy of this population. [ABSTRACT FROM AUTHOR]

Background: Housing is an important social determinant of health. The objective of this study was to investigate the predictive role of homeownership in mental health outcomes. Methods: The Behavioral Risk Factor Surveillance System 2020 data (N = 401,958) were analyzed. Outcomes: Self-reported prevalence of ever depressive disorders, difficulty concentrating or remembering, difficulty doing errands alone due to poor physical/mental health, number of days not having good mental health in past 30 days, and number of days poor physical/mental health affected daily activities in past 30 days Exposure: Homeownership (own/rent). Adjusting factors: Socio-demographic and lifestyle variables. Adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) are reported. All estimates were weighted to account for the study design. Results: Of the participants, 33% resided in rental properties. The mean age for renters was 38 years, and homeowners 53. Homeownership was high among women, old age, employed, and White race. The prevalence of ever depressive disorders was18.3%, with high estimates among women, age group (18–44 years), and American-Indians/Alaskan-Natives. The study revealed a significant association between homeownership and mental health. In the adjusted models, compared to homeowners, renters experienced higher prevalence of ever depressive disorders (aOR 1.29, 95%CI: 1.16–1.44), increased difficulty concentrating/remembering (aOR 1.38, 95%CI: 1.19–1.60), were more likely to report poor physical/mental health affecting daily activities (aOR 1.24, 95%CI: 1.05–1.45), reported more days of not having good mental health in the past 30 days (aOR 1.23, 95%CI: 1.12–1.34), and had increased likelihood of poor physical/mental health affecting their daily activities (aOR 1.17, 95%CI: 1.04–1.31). Age-stratified analysis demonstrates consistent associations across various age groups. Conclusion: This study provides robust evidence supporting the positive impact of homeownership on mental health. Promoting affordable homeownership opportunities has the potential to alleviate the mental health burden in the United States. [ABSTRACT FROM AUTHOR]

Background: As envisioned by the 2010 Constitution, Kenya implemented a devolved system of government in March 2013, setting up 47 counties and a corresponding number of local governments. These counties differed in their levels of development. While counties such as Nairobi and Kiambu led in social and economic indicators, others such as Turkana, Mandera and Wajir were at the bottom of the list. Keeping the between-country disparities and the need to remedy those disparities in mind, the national government used formula-based criteria to determine counties' eligibility for the receipt of financial resources. On the basis of these criteria, counties were classified into marginalized and nonmarginalized counties. The marginalized counties were the 14 (of the 47) most socially and economically disadvantaged counties. These counties receive additional financial resources, which we call targeted intergovernmental fiscal transfers (i.e. fiscal transfers from the national government to county governments). Methods: We used the difference-in-differences (DID) technique and fixed effects models to estimate the effects of these targeted intergovernmental fiscal transfers on human immunodeficiency virus (HIV) incidence and diarrhoea incidence. Results: The results revealed that the counties receiving those transfers experienced a statistically significant decline in the incidence of diarrhoea but had no impact on the incidence of HIV. Our study fills a major gap in causal evidence linking intergovernmental fiscal transfers to health outcomes, especially in the context of low–middle-income countries in a newly decentralized setting. Conclusions: Our results imply that targeted intergovernmental fiscal transfers may be effective at improving some subnational health outcomes, and therefore in reducing within-country health inequalities. [ABSTRACT FROM AUTHOR]

Study Design.: Retrospective cohort study. Objective.: To identify factors contributing to optimal bracing compliance in adolescent idiopathic scoliosis (AIS). Summary of Background Data.: Poor brace compliance is a key factor affecting brace treatment success in AIS. Predictive factors influencing optimal brace compliance to achieve brace treatment success remain unknown. Materials and Methods.: This study included AIS patients aged 10 to 15, with a Cobb angle of 20° to 40°. Demographics data, radiographic assessments, and patient-reported outcomes (including the SRS-22r patient questionnaire) were collected. Brace compliance was monitored using in-brace thermometers, defining optimal bracing time as >18 h/d. Multivariable logistic regression analysis was used to identify predictors of optimal bracing time from the demographic and patient-reported outcomes score before bracing. Results.: Among 122 patients, 59.0% achieved optimal bracing time by six months. The achieved group indicated higher scores in the satisfaction domain before bracing (3.3±0.7 vs. 3.1±0.6; P =0.034). Multivariable logistic regression analysis demonstrated that the satisfaction domain before bracing was an independent factor associated with the achievement of the optimal bracing time [OR 1.97 (95% CI: 1.00–3.89), P =0.049]. The model with bracing at one-month follow-up also demonstrated the bracing at 1 month was a significant factor [OR 1.52 (95% CI: 1.30–1.79), P <0.001]. Conclusions.: Optimal bracing compliance in AIS is significantly influenced by prebracing satisfaction and brace compliance at earlier time points. These findings highlight the need to address psychological factors and early compliance in AIS bracing treatment. SRS-22r can be useful to identify the need for psychological support. [ABSTRACT FROM AUTHOR]

Background: Harmful algal bloom occurrences have been increasingly reported globally and over time. Exposure to the variety of toxins and co-contaminants that may be present in harmful algal blooms can cause illness and even death. Poison control data is a valuable public health information source that has been used to characterize many types of toxin exposures, including harmful algal blooms. Prior studies have been limited by location and time, and knowledge gaps remain regarding cyanobacteria harmful algal bloom (cyanoHAB) exposure circumstances, and the breadth and severity of associated clinical effect. Methods: The objective of this study was to characterize epidemiologic and clinical features of cyanoHAB exposure cases reported to 55 US poison control centers and available in the National Poison Data System (NPDS). We identified 4260 NPDS cyanoHAB exposure cases reported from 2010 to 2022, including symptomatic exposure cases with and without clinical effects related to the exposure and asymptomatic exposure cases. We assessed demographics; exposure routes, locations, chronicity; clinical effects; and medical outcomes. We calculated case rates annually and 13-year case rates by US geographic division. Results: Over half of cyanoHAB exposure cases were children < 20 years old (n = 2175). Most cyanoHABs exposures occurred in a "public area" (n = 2902, 68.1%); most were acute (≤ 8 h) (n = 3824, 89.8%). Dermal and ingestion routes and gastrointestinal effects predominated. 2% (n = 102) of cases experienced a moderate or major medical outcome; no deaths were reported. National rates increased from 0.4 cases/1 million (1 M) person-years in 2010 to 1.4 cases/1 M person-years in 2022. The Mountain division had the highest 13-year rate (7.8 cases/1 M person-years). Conclusions: CyanoHAB exposure case rates increased 2010–2022, despite a decrease in all-cause exposure cases during the same period. NPDS data provide valuable public health information for characterization of cyanoHAB exposures, an emerging public health challenge. [ABSTRACT FROM AUTHOR]

Background: The implementation of early essential newborn care (EENC) is important to maternal and neonatal health. However, few studies have conducted a complete procedure of EENC in cesarean section. This study aimed to systematically evaluate the effects of EENC during and after cesarean section. Methods: A randomized controlled trial was conducted at a tertiary hospital in Wuhan, China. Full-term pregnant women who had no comorbidities and underwent elective cesarean section were recruited and received EENC intervention or routine health care. The Infant Breastfeeding Assessment Tool (IBFAT), the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), a questionnaire of the breastfeeding behavior, the Maternal Postnatal Attachment Scale (MPAS) and the Edinburgh Postnatal Depression Scale (EPDS) were used to collect data. The correlation between EENC implementation and breastfeeding, maternal-infant attachment, postpartum depression, and other maternal and neonatal outcomes was analyzed. Results: Mother-newborn pairs (N = 157) were enrolled in this study, 78 in the EENC group and 79 in the control group. A total of 155 (98.8%) were followed up at 14 days, 144 (91.7%) at 42 days, and 123 (78.3%) at 3 months. For the primary outcomes, generalized linear mixed model analysis showed that implementing EENC during cesarean section was beneficial for initiating breastfeeding (OR = 0.021), shortening the breastfeeding initiation time (β = − 45.321), improving the IBFAT scores (β = 2.740), and enhancing breastfeeding self-efficacy (β = 4.880). These effects were not influenced by time interaction. However, no difference was observed in the rate of exclusive breastfeeding between these two groups (P > 0.05). Implementing EENC during cesarean section significantly improved maternal-infant attachment (β = 9.668). Moreover, univariate analysis showed benefits of EENC in improving postpartum depression (P < 0.001) and decreasing maternal perinatal blood loss (P < 0.05). Conclusions: According to our small sample study, there is a trend of improvement in breastfeeding related behavior and maternal infant attachment in women who received EENC during cesarean deliveries. The effects of EENC on exclusive breastfeeding should be further explored in the future. Trial registration: Chinese Clinical Trial Register at www.chictr.org.cn, ChiCTR2300074760, retrospectively registration. Registration Date: August 15, 2023. Plain English summary: EENC has been implemented in women who give birth vaginally and has been proven to have numerous benefits in aiding maternal postpartum recovery, increasing breastfeeding rates, and reducing admission rates to NICU. For a long time, China's cesarean section rate has remained high. While EENC has been well-promoted among women undergoing vaginal deliveries, its application in cesarean sections has been limited. Therefore, we conducted a randomized controlled trial, one group received EENC intervention and the other did not receive it. We collected data before and after the intervention to explore the safety and effectiveness of implementing EENC techniques in cesarean sections. The results indicate that the application of EENC in cesarean sections is safe and feasible. It can improve breastfeeding behaviors and mother-infant attachment. This intervention is recommended to be implemented on a larger scale. [ABSTRACT FROM AUTHOR]

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

The current study aims to explore gaming behaviour among young adults in India and its effects on their physical and emotional health, productivity, interactions, and social life. Data were collected from 12 avid gamers through in-depth semi-structured interviews. A thematic analysis was conducted to identify the global theme and organise themes from the data. The global theme was the “exploration of contemporary gaming behaviour”. The habit theme included the origin of the game, practice, and change over time, while the effects’ theme focused on the physical and emotional health, productivity, interactions, and social life of young adults who engaged in gaming. The findings suggest that gaming behaviour has become an established habit among young adults in India, significantly affecting various aspects of their lives. The study highlights the need for increased awareness of the potential negative consequences of excessive gaming and emphasises the importance of moderation in gaming. [ABSTRACT FROM AUTHOR]

Objective: We aimed to systematically investigate the associations between racial discrimination and various health outcomes and to evaluate the certainty of evidence from existing meta-analyses of observational studies. Method: We systemically searched the associations between racial discrimination and health outcomes for PubMed/MEDLINE, Embase, WoS, and Google Scholar up until January 31, 2024. Notably, the included studies were predominantly conducted in the USA and Europe, limiting the generalizability of our findings to a global context. Results: Eight meta-analyses of observational studies involving over 1 million individuals were included, describing 15 potential health outcomes related to racial discrimination. The quality assessment revealed that most included meta-analyses were of low quality. For oncological health outcomes, significant associations were found with the mortality of hepatocellular carcinoma (HCC); black patients had a higher risk, while Asian patients had a lower risk when compared to white patients. In addition, black patients with disparities on the cancer care continuum are a protective factor for early-stage HCC diagnosis. For gastroenterological health outcomes, Hispanic patients with nonalcoholic fatty liver disease and black patients with socioeconomic status/differential access to health care, compared to white patients (reference), showed significant associations. For mental health outcomes, racial discriminations were significantly associated with increased odds of psychotic experiences, suicidal ideation, and suicidal attempts. Numerous significant associations were from weak to suggestive evidence levels, indicating variability in the evidence. Conclusion: Despite the complexity of measuring its impact, racial discrimination shows a profound influence across clinical areas, including an unexpected protective association in early-stage HCC diagnosis among black patients. [ABSTRACT FROM AUTHOR]

Background: The molecular mechanisms underlying racial disparities in schizophrenia (SCZ) illness courses and outcomes are poorly understood. While these differences are thought to arise partly through stressful social gradients, little is known about how these differences are reflected in the brain, nor how they might underlie disparate psychiatric outcomes. Methods: To better understand the neuro-molecular correlates of social gradients, SCZ, and their overlap, we analyzed post-mortem dorsolateral prefrontal cortex (DLPFC) RNAseq data from two racially diverse cohorts in the CommonMind Consortium (235 reported Black and 546 White, 322 SCZ cases and 459 controls) using differential expression and gene set variation analyses. Results: We observed differences in brain gene expression that were consistent across cohorts and reported race. A combined mega-analysis identified 1,514 genes with differential expression (DE) between reported race groups after accounting for diagnosis and other covariates. Functional enrichment analyses identified upregulation of genes involved in stress and immune response, highlighting the potential role of environmental differences between reported race groups. In a race-by-diagnosis interaction analysis, no individual genes passed statistical significance. However, 109 gene sets showed statistically significant differences, implicating metabolic and immune pathways. Conclusion: Our results suggest molecular mechanisms uniquely perturbed across reported race groups and identify several candidate pathways associated with SCZ in a reported race-dependent manner. Our results underscore the importance of diverse cohort ascertainment to better capture population-level differences in SCZ pathogenesis. [ABSTRACT FROM AUTHOR]

Background Sleep of inadequate quality, duration or regularity has potential negative physical and mental health outcomes. The impacts of poor sleep within the paramedic occupation are not well understood. Aims This review aimed to determine the prevalence of insomnia, excessive daytime sleepiness and poor sleep quality amongst paramedics, and to identify any relationships between insomnia, excessive daytime sleepiness, poor sleep quality and other health-related outcomes. Methods A systematic search identified studies that measured excessive sleepiness, insomnia or poor sleep quality using validated measures. The population was limited to paramedics in Australia, New Zealand or the UK owing to the similar nature of the workload, education standards, shift patterns and scope of practice. Results Four studies were included. All used the Pittsburgh Sleep Quality Index, two used the Epworth Sleepiness Scale and one used the Insomnia Severity Index. Sample sizes ranged between 60 and 342. The weighted mean prevalence of excessive daytime sleepiness was 30 %, and poor sleep quality reported as 71%. Only one study measured the association between sleep and other health-related outcomes; this study reported an association between sleep quality and multiple measures of mental health. Conclusions The findings of this review suggest that paramedics experience both poor-quality sleep and excessive daytime sleepiness, and further suggest that there may be an association between poor sleep quality and mental health. Given sleep impacts a variety of health outcomes, as well as impacts work performance, research on the specific components of sleep is important. [ABSTRACT FROM AUTHOR]