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Song SN, Dong WP, Dong XX, Guo F, Ren L, Li CX, Wang JM. Cerebral endothelial cells mediated enhancement of brain pericyte number and migration in oxygen-glucose deprivation involves the HIF-1α/PDGF-β signaling. Brain Res 2024; 1832:148849. [PMID: 38452844 DOI: 10.1016/j.brainres.2024.148849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
The present study focused on whether hypoxia-inducible factor-1alpha (HIF-1α) and platelet-derived factor-beta (PDGF-β) are involved in the crosstalk between brain microvascular endothelial cells (BMECs) and brain vascular pericytes (BVPs) under ischaemic-hypoxic conditions. Mono-cultures or co-cultures of BVPs and BMECs were made for the construction of the blood-brain barrier (BBB) model in vitro and then exposed to control and oxygen-glucose deprivation (OGD) conditions. BBB injury was determined by assessing the ability, apoptosis, and migration of BVPs and the transendothelial electrical resistance and horseradish peroxidase permeation of BMECs. Relative mRNA and protein levels of HIF-1α and PDGF-β, as well as tight junction proteins ZO-1 and claudin-5 were analyzed by western blotting, reverse transcription quantitative PCR, and/or immunofluorescence staining. Dual-luciferase reporter assays assessed the relationship between PDGF-β and HIF-1α. Co-culturing with BMECs alleviated OGD-induced reduction in BVP viability, elevation in BVP apoptosis, and repression in BVP migration. Co-culturing with BVPs protected against OGD-induced impairment on BMEC permeability. OGD-induced HIF-1α upregulation enhanced PDGF-β expression in mono-cultured BMECs and co-cultured BMECs with BVPs. Knockdown of HIF-1α impaired the effect of BMECs on BVPs under OGD conditions, and PDGFR-β silencing in BVPs blocked the crosstalk between BMECs and BVPs under OGD conditions. The crosstalk between BMECs and BVPs was implicated in OGD-induced BBB injury through the HIF-1α/PDGF-β signaling.
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Affiliation(s)
- Shi-Na Song
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, 030001, China; Department of Geriatrics, General Hospital of TISCO, Taiyuan, 030001, China
| | - Wen-Ping Dong
- Department of Geriatrics, General Hospital of TISCO, Taiyuan, 030001, China
| | - Xin-Xin Dong
- Department of Geriatrics, General Hospital of TISCO, Taiyuan, 030001, China.
| | - Fang Guo
- Department of Geriatrics, General Hospital of TISCO, Taiyuan, 030001, China
| | - Lin Ren
- Department of Geriatrics, General Hospital of TISCO, Taiyuan, 030001, China.
| | - Chang-Xin Li
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, 030001, China.
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Patil N, Ma N, Mair M, Nazareth J, Sim A, Reynolds C, Freeman N, Chauhan M, Howells L, Peel D, Ahmad S, Sridhar T, Walter HS. Oral Cavity Cancers: Ethnic Differences in Radiotherapy Outcomes in a Majority South Asian Leicester Community. Clin Oncol (R Coll Radiol) 2024; 36:300-306. [PMID: 38388251 DOI: 10.1016/j.clon.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/15/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024]
Abstract
AIMS Squamous cell carcinoma oral cavity cancers (SCCOCCs) have a higher reported incidence in South Asian countries. We sought to compare presenting stage and outcome by ethnicity in patients with SCCOCC treated with radical radiotherapy in a single centre in the UK. MATERIALS AND METHODS All patients with SCCOCC treated with radical radiotherapy at an oncology department in Leicester (UK) between 2011 and 2017 were identified. Baseline demographic, clinical data and 2-year treatment outcomes were reported. RESULTS Of the 109 patients included, 40 were South Asian and 59 were non-South Asian. South Asians had significantly poorer 2-year disease-free survival compared with non-South Asians (54.6% versus 73%, P = 0.01). CONCLUSION Our analysis suggests that South Asians with SCCOCC have poorer outcomes despite a younger age and similar disease characteristics. Environmental, social factors and differing biology of disease may be responsible and further research is required to inform targeted interventions.
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Affiliation(s)
- N Patil
- University Hospitals of Leicester, Leicester, UK.
| | - N Ma
- University Hospitals of Leicester, Leicester, UK
| | - M Mair
- University Hospitals of Leicester, Leicester, UK
| | - J Nazareth
- University Hospitals of Leicester, Leicester, UK
| | - A Sim
- University Hospitals of Leicester, Leicester, UK
| | - C Reynolds
- University Hospitals of Leicester, Leicester, UK
| | - N Freeman
- University Hospitals of Leicester, Leicester, UK
| | - M Chauhan
- University Hospitals of Leicester, Leicester, UK
| | - L Howells
- Institute for Precision Health, University of Leicester, Leicester, UK
| | - D Peel
- Department of Radiation Oncology, Regional Cancer Treatment Services, Midcentral District Health Board, Palmerston North, New Zealand
| | - S Ahmad
- University Hospitals of Leicester, Leicester, UK
| | - T Sridhar
- University Hospitals of Leicester, Leicester, UK
| | - H S Walter
- University Hospitals of Leicester, Leicester, UK; Leicester Cancer Research Centre, University of Leicester, Leicester, UK
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Gao Y, Liu J, Liu X, Wang Y, Qiu S. Dimensions of family stress and repetitive nonsuicidal self-injury in adolescence: Examining the interactive effects of impulsivity and emotion dysregulation. Child Abuse Negl 2024; 152:106804. [PMID: 38636157 DOI: 10.1016/j.chiabu.2024.106804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/16/2023] [Accepted: 04/12/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Repetitive non-suicidal self-injury (R-NSSI) in adolescence represents a significant risk factor for suicide. Although exposure to family stress is robustly associated with the risk of non-suicidal self-injury (NSSI), studies have not examined the potential mechanisms linking different forms of family stress and R-NSSI. OBJECTIVE This study examined how unique dimensions of family stress (threat and deprivation) relate to R-NSSI via interactions between impulsivity and emotion dysregulation. PARTICIPANTS AND SETTING The current sample included 3801 middle-school adolescents (42.2 % girls, Mage = 13.21 years). METHODS We conducted a two-wave study with 6-month intervals. Participants completed self-report measures assessing family stress, impulsivity, emotion dysregulation, and NSSI. RESULTS Moderate mediation analyses showed that threat was indirectly associated with NSSI frequency through the interaction of impulsivity and emotion dysregulation in the R-NSSI group and indirectly through impulsivity in the occasional NSSI (O-NSSI) group. Deprivation did not predict subsequent NSSI frequency in either group. CONCLUSIONS These findings lend empirical support to dimensional models of adversity and suggest that adolescents who experience threat-related family stress may have greater impulsivity and are more likely to report R-NSSI in the context of emotion dysregulation.
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Affiliation(s)
- Yemiao Gao
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Jinmeng Liu
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Xia Liu
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China.
| | - Yumeng Wang
- Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Shaojie Qiu
- Faculty of Psychology, Beijing Normal University, Beijing, China
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Wende D, Karmann A, Weinhold I. Deprivation as a fundamental cause of morbidity and reduced life expectancy: an observational study using German statutory health insurance data. Int J Health Econ Manag 2024:10.1007/s10754-024-09374-3. [PMID: 38580883 DOI: 10.1007/s10754-024-09374-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/11/2024] [Indexed: 04/07/2024]
Abstract
Across all developed countries, there is a steep life expectancy gradient with respect to deprivation. This paper provides a theoretical underpinning for this gradient in line with the Grossman model, indicating that deprivation affects morbidity and, consequently, life expectancy in three ways: directly from deprivation to morbidity, and indirectly through lower income and a trade-off between investments in health and social status. Using rich German claims data covering 6.3 million insured people over four years, this paper illustrates that deprivation increases morbidity and reduces life expectancy. It was estimated that highly deprived individuals had approximately two more chronic diseases and a life expectancy reduced by 15 years compared to the least deprived individuals. This mechanism of deprivation is identified as fundamental, as deprived people remain trapped in their social status, and this status results in health investment decisions that affect long-term morbidity. However, in the German setting, the income and investment paths of the effects of deprivation were of minor relevance due to the broad national coverage of its SHI system. The most important aspects of deprivation were direct effects on morbidity, which accumulate over the lifespan. In this respect, personal aspects, such as social status, were found to be three times more important than spatial aspects, such as area deprivation.
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Affiliation(s)
- Danny Wende
- BARMER Institute for Health Systems Research, Berlin, Germany.
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Brachimi E, Sooby P, Slim MAM, Kontorinis G. The impact of multiple deprivation on the management of vestibular schwannomas. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08570-8. [PMID: 38573514 DOI: 10.1007/s00405-024-08570-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 02/18/2024] [Indexed: 04/05/2024]
Abstract
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.
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Affiliation(s)
| | - Paul Sooby
- Department of Otorhinolaryngology-Head and Neck Surgery, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - M Afiq M Slim
- Department of Otorhinolaryngology-Head and Neck Surgery, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Georgios Kontorinis
- Medical School, University of Glasgow, Glasgow, UK.
- Department of Otorhinolaryngology-Head and Neck Surgery, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK.
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Novillo-Del-Álamo B, Martínez-Varea A, Nieto-Tous M, Morales-Roselló J. Deprived areas and adverse perinatal outcome: a systematic review. Arch Gynecol Obstet 2024; 309:1205-1218. [PMID: 38063892 DOI: 10.1007/s00404-023-07300-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/10/2023] [Indexed: 02/25/2024]
Abstract
PURPOSE This systematic review aimed to assess if women living in deprived areas have worse perinatal outcomes than those residing in high-income areas. METHODS Datasets of PubMed, ScienceDirect, CENTRAL, Embase, and Google Scholar were searched for studies comparing perinatal outcomes (preterm birth, small-for-gestational age, and stillbirth) in deprived and non-deprive areas. RESULTS A total of 46 studies were included. The systematic review of the literature revealed a higher risk for adverse perinatal outcomes such as preterm birth, small for gestational age, and stillbirth in deprived areas. CONCLUSION Deprived areas are associated with adverse perinatal outcomes. More multifactorial studies are needed to assess the weight of each factor that composes the socioeconomic gradient of health in adverse perinatal outcomes.
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Affiliation(s)
- Blanca Novillo-Del-Álamo
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - Alicia Martínez-Varea
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain.
| | - Mar Nieto-Tous
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - José Morales-Roselló
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
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Dodd-Reynolds C, Griffin N, Kyle P, Scott S, Fairbrother H, Holding E, Crowder M, Woodrow N, Summerbell C. Young people's experiences of physical activity insecurity: a qualitative study highlighting intersectional disadvantage in the UK. BMC Public Health 2024; 24:813. [PMID: 38491419 PMCID: PMC10941463 DOI: 10.1186/s12889-024-18078-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 02/12/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Intersecting socioeconomic and demographic reasons for physical activity (PA) inequalities are not well understood for young people at risk of experiencing marginalisation and living with disadvantage. This study explored young people's experiences of PA in their local area, and the associated impacts on opportunities for good physical and emotional health and wellbeing. METHODS Seven local youth groups were purposefully sampled from disadvantaged areas across urban, rural and coastal areas of England, including two that were specifically for LGBTQ + young people. Each group engaged in three interlinked focus groups which explored young people's perceptions and lived experience of PA inequalities. Data were analysed using an inductive, reflexive thematic approach to allow for flexibility in coding. RESULTS Fifty five young people aged 12-21 years of different sexualities, gender and ethnicity took part. Analysis yielded four themes: PA experiences across spaces; resigned to a lack of inclusivity and 'belonging'; safety first; complexities in access and accessibility. Young people felt more comfortable to be active in spaces that were simpler to navigate, particularly outdoor locations largely based in nature. In contrast, local gyms and sports clubs, and the school environment in general, were spoken about often in negative terms and as spaces where they experienced insecurity, unsafety or discomfort. It was common for these young people to feel excluded from PA, often linked to their gender and sexuality. Lived experiences or fears of being bullied and harassed in many activity spaces was a powerful message, but in contrast, young people perceived their local youth club as a safe space. Intersecting barriers related to deprivation, gender and sexuality, accessibility, disability, Covid-19, affordability, ethnicity, and proximity of social networks. A need emerged for safe spaces in which young people can come together, within the local community and choose to be active. CONCLUSIONS The overarching concept of 'physical activity insecurity' emerged as a significant concern for the young people in this study. We posit that PA insecurity in this context can be described as a limited or restricted ability to be active, reinforced by worries and lived experiences of feeling uncomfortable, insecure, or unsafe.
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Affiliation(s)
- Caroline Dodd-Reynolds
- Department of Sport and Exercise Sciences, Fuse, Durham University, Durham, DH1 3LA, UK.
| | - Naomi Griffin
- Population Health Sciences Institute, Fuse, Newcastle University, Newcastle, NE1 4LP, UK
| | - Phillippa Kyle
- Newcastle University Business School, Fuse, Newcastle University, Newcastle, NE1 4SE, UK
| | - Steph Scott
- Population Health Sciences Institute, Fuse, Newcastle University, Newcastle, NE1 4LP, UK
| | | | | | - Mary Crowder
- ScHARR, University of Sheffield, Sheffield, S1 4DA, UK
| | | | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Fuse, Durham University, Durham, DH1 3LA, UK
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Khedmati Morasae E, Derbyshire DW, Amini P, Ebrahimi T. Social determinants of spatial inequalities in COVID-19 outcomes across England: A multiscale geographically weighted regression analysis. SSM Popul Health 2024; 25:101621. [PMID: 38420111 PMCID: PMC10899060 DOI: 10.1016/j.ssmph.2024.101621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
A variety of factors are associated with greater COVID-19 morbidity or mortality, due to how these factors influence exposure to (in the case of morbidity) or severity of (in the case of mortality) COVID-19 infections. We use multiscale geographically weighted regression to study spatial variation in the factors associated with COVID-19 morbidity and mortality rates at the local authority level across England (UK). We investigate the period between March 2020 and March 2021, prior to the rollout of the COVID-19 vaccination program. We consider a variety of factors including demographic (e.g. age, gender, and ethnicity), health (e.g. rates of smoking, obesity, and diabetes), social (e.g. Index of Multiple Deprivation), and economic (e.g. the Gini coefficient and economic complexity index) factors that have previously been found to impact COVID-19 morbidity and mortality. The Index of Multiple Deprivation has a significant impact on COVID-19 cases and deaths in all local authorities, although the effect is the strongest in the south of England. Higher proportions of ethnic minorities are associated with higher levels of COVID-19 mortality, with the strongest effect being found in the west of England. There is again a similar pattern in terms of cases, but strongest in the north of the country. Other factors including age and gender are also found to have significant effects on COVID-19 morbidity and mortality, with differential spatial effects across the country. The results provide insights into how national and local policymakers can take account of localized factors to address spatial health inequalities and address future infectious disease pandemics.
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Affiliation(s)
- Esmaeil Khedmati Morasae
- Research Fellow in Operational Research, Exeter University Business School, University of Exeter, UK
| | - Daniel W. Derbyshire
- Department of Public Health and Sports Science, Faculty of Health and Life Science, University of Exeter, UK
| | - Payam Amini
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Tahera Ebrahimi
- Lecturer in Finance, Business School, Manchester Metropolitan University, UK
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Abreu TC, Mackenbach JD, Heuvelman F, Schoonmade LJ, Beulens JW. Associations between dimensions of the social environment and cardiometabolic risk factors: Systematic review and meta-analysis. SSM Popul Health 2024; 25:101559. [PMID: 38148999 PMCID: PMC10749911 DOI: 10.1016/j.ssmph.2023.101559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/27/2023] [Accepted: 11/11/2023] [Indexed: 12/28/2023] Open
Abstract
Aim The social environment (SE), including social contacts, norms and support, is an understudied element of the living environment which impacts health. We aim to comprehensively summarize the evidence on the association between the SE and risk factors of cardiometabolic disease (CMD). Methods We performed a systematic review and meta-analysis based on studies published in PubMed, Scopus and Web of Science Core Collection from inception to 16 February 2021. Studies that used a risk factor of CMD, e.g., HbA1c or blood pressure, as outcome and social environmental factors such as area-level deprivation or social network size as independent variables were included. Titles and abstracts were screened in duplicate. Study quality was assessed using the Newcastle-Ottawa Scale. Data appraisal and extraction were based on the study protocol published in PROSPERO. Data were synthesized through vote counting and meta-analyses. Results From the 7521 records screened, 168 studies reported 1050 associations were included in this review. Four meta-analyses based on 24 associations suggested that an unfavorable social environment was associated with increased risk of cardiometabolic risk factors, with three of them being statistically significant. For example, individuals that experienced more economic and social disadvantage had a higher "CVD risk scores" (OR = 1.54, 95%CI: 1.35 to 1.84). Of the 458 associations included in the vote counting, 323 (71%) pointed towards unfavorable social environments being associated with higher CMD risk. Conclusion Higher economic and social disadvantage seem to contribute to unfavorable CMD risk factor profiles, while evidence for other dimensions of the social environment is limited.
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Affiliation(s)
- Taymara C. Abreu
- Department of Epidemiology & Data Science, Amsterdam UMC - location VUmc, Amsterdam, Noord-Holland, the Netherlands
- Upstream Team, the Netherlands
| | - Joreintje D. Mackenbach
- Department of Epidemiology & Data Science, Amsterdam UMC - location VUmc, Amsterdam, Noord-Holland, the Netherlands
- Upstream Team, the Netherlands
| | - Fleur Heuvelman
- Department of Epidemiology & Data Science, Amsterdam UMC - location VUmc, Amsterdam, Noord-Holland, the Netherlands
| | - Linda J. Schoonmade
- University Library, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, the Netherlands
| | - Joline W.J. Beulens
- Department of Epidemiology & Data Science, Amsterdam UMC - location VUmc, Amsterdam, Noord-Holland, the Netherlands
- Upstream Team, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Utrecht, the Netherlands
- Amsterdam Public Health, Amsterdam Cardiovascular Sciences, Amsterdam, Noord-Holland, the Netherlands
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Sangha MS, Baker M, Baldwin AJ, Murray A. Assessing the effect of the cost-of-living crisis on hot water bottle-related burns in the United Kingdom, a single-centre retrospective observational study. JPRAS Open 2024; 39:313-320. [PMID: 38380183 PMCID: PMC10878842 DOI: 10.1016/j.jpra.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/17/2024] [Indexed: 02/22/2024] Open
Abstract
Background The cost-of-living crisis (CoLC) is an economic climate that the United Kingdom (UK) has been experiencing since late 2021, characterized by an increase in the price of essential goods faster than real-term incomes. Food and fuel poverty has ensued. This study aimed to assess whether the CoLC is associated with an increase in hot water bottle (HWB)-related burns as patients seek alternative heating sources to keep warm. Methods Records of patients treated for HWB burns between December 2019 and March 2023 were reviewed for patient demographics, burn depth and surface area, patient comorbidities, and patient index of multiple deprivation (IMD). The incidence of admissions, IMD, and severity of injury were compared prior to and during the CoLC using either independent t-test or Kruskal-Wallis H test. Results Between December 2019 and March 2023, 177 patients were treated for HWB burns, 79 prior to the CoLC, and 98 during. Of the patients, 55 patients were male and 122 females. An independent t-test comparing average monthly admissions prior and during the CoLC identified a significant difference (p = 0.042), with a mean increase of 1.85 cases (95% CI: 0.71-3.63). Additionally, a Kruskal-Wallis H test showed statistically significant difference in the number of patients treated for HWB burns between the seasons (p = 0.001). An independent t-test comparing average patient IMD prior and during the CoLC identified no difference (p = 0.33). Conclusion The increase in HWB burns coincides with the increase in energy costs and general cost of living that has occurred in the UK since October 2021.
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Affiliation(s)
- Mahaveer S. Sangha
- Corresponding author at: Foundation Year 2 Doctor, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK.
| | - Michelle Baker
- Department of Plastic & Reconstructive Surgery, Stoke Mandeville Hospital, Aylesbury, UK
| | - Alexander J. Baldwin
- Department of Plastic & Reconstructive Surgery, Stoke Mandeville Hospital, Aylesbury, UK
| | - Alexandra Murray
- Department of Plastic & Reconstructive Surgery, Stoke Mandeville Hospital, Aylesbury, UK
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Sheridan N, Jansen RM, Harwood M, Love T, Kenealy T. Hauora Māori - Māori health: a right to equal outcomes in primary care. Int J Equity Health 2024; 23:42. [PMID: 38413987 PMCID: PMC10898093 DOI: 10.1186/s12939-023-02071-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 12/01/2023] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND For more than a century, Māori have experienced poorer health than non-Māori. In 2019 an independent Tribunal found the Government had breached Te Tiriti o Waitangi by "failing to design and administer the current primary health care system to actively address persistent Māori health inequities". Many Māori (44%) have unmet needs for primary care. Seven models of primary care were identified by the funders and the research team, including Māori-owned practices. We hypothesised patient health outcomes for Māori would differ between models of care. METHODS Cross-sectional primary care data were analysed at 30 September 2018. National datasets were linked to general practices at patient level, to measure associations between practice characteristics and patient health outcomes. PRIMARY OUTCOMES polypharmacy (≥ 55 years), HbA1c testing, child immunisations, ambulatory sensitive hospitalisations (0-14, 45-64 years) and emergency department attendances. Regressions include only Māori patients, across all models of care. RESULTS A total of 660,752 Māori patients were enrolled in 924 practices with 124,854 in 65 Māori-owned practices. Māori practices had: no significant association with HbA1c testing, ambulatory sensitive hospitalisations or ED attendances, and a significant association with lower polypharmacy (3.7% points) and lower childhood immunisations (13.4% points). Māori practices had higher rates of cervical smear and cardiovascular risk assessment, lower rates of HbA1c tests, and more nurse (46%) and doctor (8%) time (FTE) with patients. The average Māori practice had 52% Māori patients compared to 12% across all practices. Māori practices enrolled a higher percentage of children and young people, five times more patients in high deprivation areas, and patients with more multimorbidity. More Māori patients lived rurally (21.5% vs 15%), with a greater distance to the nearest ED. Māori patients were more likely to be dispensed antibiotics or tramadol. CONCLUSIONS Māori practices are an expression of autonomy in the face of enduring health system failure. Apart from lower immunisation rates, health outcomes were not different from other models of care, despite patients having higher health risk profiles. Across all models, primary care need was unmet for many Māori, despite increased clinical input. Funding must support under-resourced Māori practices and ensure accountability for the health outcomes of Māori patients in all models of general practice.
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Grants
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Health Research Council of New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
- 18/788 Ministry of Health, New Zealand
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Affiliation(s)
| | | | | | - Tom Love
- Sapere Research Group, Wellington, Aotearoa New Zealand
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12
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Bladon S, Ashiru-Oredope D, Cunningham N, Pate A, Martin GP, Zhong X, Gilham EL, Brown CS, Mirfenderesky M, Palin V, van Staa TP. Rapid systematic review on risks and outcomes of sepsis: the influence of risk factors associated with health inequalities. Int J Equity Health 2024; 23:34. [PMID: 38383380 PMCID: PMC10882893 DOI: 10.1186/s12939-024-02114-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/19/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND AND AIMS Sepsis is a serious and life-threatening condition caused by a dysregulated immune response to an infection. Recent guidance issued in the UK gave recommendations around recognition and antibiotic treatment of sepsis, but did not consider factors relating to health inequalities. The aim of this study was to summarise the literature investigating associations between health inequalities and sepsis. METHODS Searches were conducted in Embase for peer-reviewed articles published since 2010 that included sepsis in combination with one of the following five areas: socioeconomic status, race/ethnicity, community factors, medical needs and pregnancy/maternity. RESULTS Five searches identified 1,402 studies, with 50 unique studies included in the review after screening (13 sociodemographic, 14 race/ethnicity, 3 community, 3 care/medical needs and 20 pregnancy/maternity; 3 papers examined multiple health inequalities). Most of the studies were conducted in the USA (31/50), with only four studies using UK data (all pregnancy related). Socioeconomic factors associated with increased sepsis incidence included lower socioeconomic status, unemployment and lower education level, although findings were not consistent across studies. For ethnicity, mixed results were reported. Living in a medically underserved area or being resident in a nursing home increased risk of sepsis. Mortality rates after sepsis were found to be higher in people living in rural areas or in those discharged to skilled nursing facilities while associations with ethnicity were mixed. Complications during delivery, caesarean-section delivery, increased deprivation and black and other ethnic minority race were associated with post-partum sepsis. CONCLUSION There are clear correlations between sepsis morbidity and mortality and the presence of factors associated with health inequalities. To inform local guidance and drive public health measures, there is a need for studies conducted across more diverse setting and countries.
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Affiliation(s)
- Siân Bladon
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK.
| | - Diane Ashiru-Oredope
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), UKHSA, London, SW1P 3JR, UK
- School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Neil Cunningham
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), UKHSA, London, SW1P 3JR, UK
| | - Alexander Pate
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Glen P Martin
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Xiaomin Zhong
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Ellie L Gilham
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), UKHSA, London, SW1P 3JR, UK
| | - Colin S Brown
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), UKHSA, London, SW1P 3JR, UK
- NIHR Health Protection Unit in Healthcare-Associated Infection & Antimicrobial Resistance, Imperial College London, London, UK
| | - Mariyam Mirfenderesky
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), UKHSA, London, SW1P 3JR, UK
| | - Victoria Palin
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, The University of Manchester, Manchester, M13 9WL, UK
| | - Tjeerd P van Staa
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
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13
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Finning K, Haeffner A, Patel S, Longdon B, Hayes R, Ukoumunne OC, Ford T. Is neighbourhood deprivation in primary school-aged children associated with their mental health and does this association change over 30 months? Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02385-y. [PMID: 38356042 DOI: 10.1007/s00787-024-02385-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/20/2024] [Indexed: 02/16/2024]
Abstract
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.
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Affiliation(s)
- Katie Finning
- Public Policy Analysis, Office for National Statistics, Newport, UK
| | - Amy Haeffner
- Exeter Medical school, University of Exeter, Exeter, UK
| | - Sohum Patel
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Bryony Longdon
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rachel Hayes
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Obioha C Ukoumunne
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK.
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Phillips-Bell GS, Mohamoud YA, Kirby RS, Parks SE, Cozier YC, Shapiro-Mendoza CK. Neighborhood Deprivation and Privilege: an Examination of Racialized-Economic Segregation and Preterm Birth, Florida 2019. J Racial Ethn Health Disparities 2024; 11:72-80. [PMID: 36652162 PMCID: PMC10352457 DOI: 10.1007/s40615-022-01498-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/08/2022] [Accepted: 12/15/2022] [Indexed: 01/19/2023]
Abstract
The Black-White disparity in preterm birth persists and is not fully explained by individual-level social, behavioral, or clinical risk factors. Consequently, there is increasing emphasis on understanding the role of structural and area-level factors. Racialized-economic segregation measured as the index of concentration at the extremes (ICE) simultaneously captures extremes of deprivation and privilege. Our objective was to examine associations between preterm birth (PTB) and the index of concentration at the extremes (ICE). In this cross-sectional study, we analyzed 193,957 Florida birth records from 2019 linked to 2015-2019 census tract data from the American Community Survey. We assessed PTB (< 37 weeks gestation) by subtypes: (1) early (< 34 weeks) and late (34-36 weeks) and (2) spontaneous and indicated (i.e., provider-initiated) deliveries. We calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for three ICE measures: (1) ICE_INC: income, (2) INC_INC + WB: income + race/ethnicity (non-Hispanic White vs. Black), and (3) INC_INC + WH: income + race/ethnicity (non-Hispanic White vs. Hispanic). Results. For ICE_INC and INC_INC + WB, aORs for residing in the worst-off vs. best-off areas were 1.25 (95% CI: 1.12, 1.46) and 1.21 (95% CI: 1.07, 1.37) for early PTB, respectively, and 1.16 (95% CI: 1.05, 1.28) to 1.22 (95% CI: 1.12, 1.34) for indicated PTB. In conclusion, deprivation captured by ICE was associated with increased odds of early or indicated PTB. Eliminating PTB disparities may require a multifaceted approach that includes addressing the interplay between income and race/ethnicity in residential areas.
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Affiliation(s)
- Ghasi S Phillips-Bell
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS S-1072, Atlanta, GA, 30341, USA.
| | - Yousra A Mohamoud
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS S-1072, Atlanta, GA, 30341, USA
| | - Russell S Kirby
- University of South Florida College of Public Health, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612, USA
| | - Sharyn E Parks
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS S-1072, Atlanta, GA, 30341, USA
| | - Yvette C Cozier
- Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
| | - Carrie K Shapiro-Mendoza
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS S-1072, Atlanta, GA, 30341, USA
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15
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Khin YP, Yamaoka Y, Abe A, Fujiwara T. Association of child-specific and household material deprivation with depression among elementary and middle school students in Japan. Soc Psychiatry Psychiatr Epidemiol 2024; 59:329-339. [PMID: 37270468 PMCID: PMC10239275 DOI: 10.1007/s00127-023-02502-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE This study aimed to investigate the association between child-specific and household material deprivation with depression among elementary and middle school students in Japan. METHODS We used cross-sectional data from 10,505 and 10,008 students for fifth-grade elementary school students (G5) and second-grade middle school students (G8), respectively, and their caregivers. The data were collected from August to September 2016 in 4 municipalities of Tokyo and from July to November 2017 in 23 municipalities of Hiroshima prefecture. Caregivers completed questionnaires including household income and material deprivation, and children completed child-specific material deprivation and depression status using the Japanese version of the Birleson depression self-rating scale for children (DSRS-C). To explore the associations, logistic regression was used after conducting multiple imputation for the missing data. RESULTS 14.2% of G5 students and 23.6% of G8 students had DSRS-C scores of more than or equal to 16, denoting the risk of depression. We found that household equivalent income was not associated with childhood depression in both G5 and G8 students when adjusted for material deprivations. While at least one item of household material deprivation was significantly associated with depression in G8 students (OR = 1.19, CI = 1.00, 1.41), but not in G5 children. Child-specific material deprivation of more than 5 items was significantly associated with depression in both age groups (G5: OR = 1.53, CI = 1.25, 1.88; G8: OR = 1.45, CI = 1.22, 1.73). CONCLUSION Future research on child mental health needs to consider children's perspectives, especially material deprivation in young children.
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Affiliation(s)
- Yu Par Khin
- Department of Global Health Promotion, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yui Yamaoka
- Department of Global Health Promotion, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Aya Abe
- School of Humanities and Social Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
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Jawad N, Hakeem FF, Sabbah W. Exploring health advice by dental professionals in USA: A secondary data analysis of NHANES (2015-2018). Patient Educ Couns 2024; 119:108038. [PMID: 37951164 DOI: 10.1016/j.pec.2023.108038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/16/2023] [Accepted: 10/26/2023] [Indexed: 11/13/2023]
Abstract
OBJECTIVES To examine socioeconomic and ethnic variations in the provision of health advice by dental professionals. METHODS Data were from the National Health and Examination Survey (NHANES) (2015-2018). Socioeconomic position (Poverty-income ratio and education) and ethnicity were the main exposures. The outcome variable of interest was whether participants received health advice regarding the "benefits of quitting cigarettes," "benefits of monitoring blood sugar levels," and "importance of oral cancer screening". Logistic regression analysis was used to examine the relationship between socioeconomic factors/ethnicity, and health advice after adjusting for covariates. RESULTS The analysis included a total of 5524 people aged eighteen and above who had complete data. Black and Hispanic individuals had higher odds of receiving advice on smoking (OR = 1.49, 95% CI: 1.04-2.12 and OR = 1.48, 95% CI: 1.05-2.07, respectively) and glucose monitoring (OR = 3.00, 95% CI: 2.03-4.43 and OR = 3.14, 95% CI: 2.04-4.82, respectively), but no significant difference for cancer screening advice.Higher poverty-income ratios (PIR) were associated with lower odds of receiving smoking advice (OR = 0.91, 95% CI: 0.84-0.98), but no significant associations were observed for glucose monitoring or cancer screening advice. The study's findings reveal a social gradient in the provision of cancer advice, with individuals having higher education levels, particularly university education (OR = 1.69, 95% CI: 1.24-2.31), showing significantly higher odds of receiving cancer screening advice CONCLUSION: The study highlights significant variations in health advice provision in dental settings, with education level, ethnicity, and smoking status playing prominent roles, emphasizing the need for targeted interventions to promote equity and cultural competence in delivering health advice in dental settings. PRACTICE IMPLICATION The results emphasize the importance of strong policies and ongoing education for dental professionals to ensure optimal treatment and prevention.
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Affiliation(s)
- Noora Jawad
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, United Kingdom
| | - Faisal F Hakeem
- College of Dentistry, Department of Preventive Dental Sciences, Taibah University Dental College & Hospital, Madinah, Saudi Arabia.
| | - Wael Sabbah
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, United Kingdom
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Khan T, Copsey B, Carder P, Johnson S, Imran M, Wang K, Alderson S. Overprescribing of potentially harmful medication: an observational study in England's general practice. BJGP Open 2024:BJGPO.2023.0156. [PMID: 38253399 DOI: 10.3399/bjgpo.2023.0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/15/2023] [Accepted: 11/24/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Overprescribing of potentially harmful medication in UK general practice has a complex association with socioeconomic deprivation. AIM To assess trends in general practice prescribing of five high-risk medications and their relationship to deprivation. DESIGN & SETTING We conducted an observational study using general practice data from three English regions with varied socio-demographic factors: West Yorkshire and Harrogate (WY), Black Country and West Birmingham (BC), and Surrey and East Sussex (SE). METHOD Practice-level prescribing data was obtained from 2016-2021 for five drug classes: opioids, hypnotics, gabapentinoids, non-steroidal anti-inflammatory drugs (NSAIDs) and antibacterials. Prescribing trends were demonstrated using a linear model. RESULTS Reduction in NSAID, Opioid, Hypnotic and Antibacterial prescriptions, and the increase in gabapentinoid prescriptions, were significant at each financial-year time period. Index of Multiple Deprivation (IMD) was positively associated with all drug classes except antibacterials, which showed a positive association when incorporating the interaction term between IMD and age.When adjusting for IMD and population, region was independently associated with prescribing rate. Compared to WY, IMD had a smaller association with prescribing in BC for NSAIDs (Coefficient -0.01578, P=0.004) and antibacterials (Coefficient -0.02769, P=0.007), whereas IMD had a greater association with prescribing in SE for NSAIDs (Coefficient 0.02443, P<.001), opioids (Coefficient 0.08919 p<.001), hypnotics (Coefficient 0.09038 p<.001), gabapentinoids (Coefficient 0.1095, P<.001) and antibacterials (Coefficient 0.01601, P=0.19). CONCLUSION The association of socioeconomic deprivation with overprescribing of high-risk medication in general practice varies by region and drug type. Geographical location is associated with overprescribing, independent of socioeconomic status.
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Affiliation(s)
- Tasneem Khan
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Bethan Copsey
- Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom
| | - Paul Carder
- NHS West Yorkshire Integrated Care Board, Leeds, United Kingdom
| | - Stella Johnson
- NHS West Yorkshire Integrated Care Board, Leeds, United Kingdom
| | - Mohammed Imran
- NHS West Yorkshire Integrated Care Board, Leeds, United Kingdom
| | | | - Sarah Alderson
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
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Jeyaparam S, Agha-Jaffar R, Mullins E, Pinho-Gomes AC, Khunti K, Robinson S. Retrospective cohort study of the association between socioeconomic deprivation and incidence of gestational diabetes and perinatal outcomes. BMC Public Health 2024; 24:184. [PMID: 38225599 PMCID: PMC10790393 DOI: 10.1186/s12889-023-17261-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 11/18/2023] [Indexed: 01/17/2024] Open
Abstract
INTRODUCTION Socioeconomic disparities have been shown to correlate with perinatal mortality and the incidence of type 2 diabetes. Few studies have explored the relationship between deprivation and the incidence of gestational diabetes (GDM). We aimed to identify the relationship between deprivation and incidence of GDM, after adjusting for age, BMI, and ethnicity. We also examined for relationships between deprivation and perinatal outcomes. METHODS A retrospective cohort analysis of 23,490 pregnancies from a major National Health Service Trust in Northwest London was conducted. The 2019 English Indices of Multiple Deprivation was used to identify the deprivation rank and decile for each postcode. Birthweight centile was calculated from absolute birthweight after adjusting for ethnicity, maternal height, maternal weight, parity, sex and outcome (live birth/stillbirth). Logistic regression and Kendall's Tau were used to identify relationships between variables. RESULTS After controlling for age, BMI & ethnicity, Index of Multiple Deprivation postcode decile was not associated with an increased risk of developing gestational diabetes. Each increase in decile of deprivation was associated with an increase in birthweight centile by 0.471 (p < 0.001). After adjusting for confounders, age was associated with a 7.1% increased GDM risk (OR: 1.076, p < 0.001); BMI increased risk by 5.81% (OR: 1.059, p < 0.001). There was no significant correlation between Index of Multiple Deprivation rank and perinatal outcomes. DISCUSSION Our analysis demonstrates that socioeconomic deprivation was not associated with incidence of GDM or adverse perinatal outcomes. Factors such as genetic predisposition and lifestyle habits may likely play a larger role in the development of GDM compared to socioeconomic deprivation alone.
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Affiliation(s)
- Srirangan Jeyaparam
- Department of Metabolism, Digestion & Reproduction, Imperial College London, London, UK.
| | - Rochan Agha-Jaffar
- Department of Metabolism, Digestion & Reproduction, Imperial College London, London, UK
- Department of Metabolic Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Edward Mullins
- Department of Obstetrics & Gynaecology, Imperial College Healthcare NHS Trust, London, UK
- The George Institute for Global Health, London, UK
| | | | | | - Stephen Robinson
- Department of Metabolic Medicine, Imperial College Healthcare NHS Trust, London, UK
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Freda MF, Scandurra C, Auriemma E, Guarino A, Lemmo D, Martino ML, Nunziata F, Maldonato NM, Continisio GI. Long-COVID in children: An exploratory case-control study from a bio-psycho-social perspective. J Psychosom Res 2024; 176:111564. [PMID: 38100898 DOI: 10.1016/j.jpsychores.2023.111564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE This study aimed to determine psychosocial differences between children with Long-COVID Syndrome (LCS) and two control groups (i.e., children who did not have COVID-19 and children who had previously had COVID-19 but did not develop LCS) from a bio-psycho-social and psychosomatic perspective. To classify children in these three groups, we examined the percentage of children meeting criteria for LCS, the type, frequency, perceived severity of symptoms, and their prevalence compared with children who never had SARS-CoV-2 infection. METHODS Data were collected from 198 Italian mothers of children aged 4 to 13 years using a cross-sectional web-based case-control survey. Of these, 105 were mothers of children who had contracted SARS-CoV-2 and 94 were mothers of children who had previously had COVID-19. Information was collected on the type and frequency of symptoms commonly referred to as "Long-COVID symptoms" and psychosocial dimensions (i.e., maternal and child health anxiety, COVID-19 anxiety, adjustment, and child deprivation). Descriptive analyses, chi-square tests, Student's T-Test, and analyses of variance were performed. RESULTS 29 children (15% of the total sample) developed LCS, mostly in the neurological/neuropsychiatric domain (59%), and of mild intensity. Regarding psychosocial and psychological dimensions, maternal health anxiety, child deprivation, and fear of SARS-CoV-2 infection differed between groups, with the first two dimensions higher in children with LCS than in controls and the latter lower in children with LCS than in controls. CONCLUSION This study sheds light on the need of integrating a psychosocial approach into the medical care of children with LCS and their caregivers.
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Affiliation(s)
- Maria Francesca Freda
- Department of Humanistic Studies, University of Naples Federico II - Via Porta di Massa 1, Napoli 80133, Italy.
| | - Cristiano Scandurra
- Department of Humanistic Studies, University of Naples Federico II - Via Porta di Massa 1, Napoli 80133, Italy.
| | - Ersilia Auriemma
- Department of Humanistic Studies, University of Naples Federico II - Via Porta di Massa 1, Napoli 80133, Italy
| | - Alfredo Guarino
- Department of Translational Medical Sciences, University of Naples Federico II - Via Sergio Pansini 5, Napoli 80131, Italy.
| | - Daniela Lemmo
- Department of Humanistic Studies, University of Naples Federico II - Via Porta di Massa 1, Napoli 80133, Italy.
| | - Maria Luisa Martino
- Department of Humanistic Studies, University of Naples Federico II - Via Porta di Massa 1, Napoli 80133, Italy.
| | - Francesco Nunziata
- Department of Translational Medical Sciences, University of Naples Federico II - Via Sergio Pansini 5, Napoli 80131, Italy
| | - Nelson Mauro Maldonato
- Department of Neuroscience, Reproductive Sciences, and Dentistry, University of Naples Federico II - Via Sergio Pansini 5, Napoli 80131, Italy.
| | - Grazia Isabella Continisio
- Department of Translational Medical Sciences, University of Naples Federico II - Via Sergio Pansini 5, Napoli 80131, Italy.
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20
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Traverso LM, Gómez-Sancho LE, De la Casa LG. Effects of food deprivation on conditioned orthonasal olfactory preferences with caloric and non-caloric reinforcers. Behav Processes 2024; 214:104974. [PMID: 38043720 DOI: 10.1016/j.beproc.2023.104974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/09/2023] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Abstract
Three experiments were conducted to investigate Conditioned Olfactory Preferences using orthonasal inhalation, which is a less explored perceptual pathway compared to retronasal inhalation. In these experiments, odors were impregnated onto plastic disks to prevent the subjects from consuming or tasting them. The reinforcers used were a sucrose solution (Caloric groups) and a saccharin solution (Non-Caloric groups). The influence of nutritional deprivation was analyzed, with unrestricted access to food throughout the procedure in Experiment 1, food restriction during the conditioning phase in Experiment 2, and limited access to food during the test phase in Experiment 3. The results revealed conditioned preferences using both sucrose and saccharin as reinforcers. Furthermore, dietary restriction reduced the conditioned preference induced by saccharin, but not the preference induced by sucrose. These findings are discussed in light of the potential differences between orthonasal and retronasal presentation of odors during conditioning.
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Affiliation(s)
- Luis M Traverso
- Laboratory of Animal Behavior and Neuroscience. Departamento de Psicología Experimental, Universidad de Sevilla, Spain
| | - Luis E Gómez-Sancho
- Laboratory of Animal Behavior and Neuroscience. Departamento de Psicología Experimental, Universidad de Sevilla, Spain
| | - Luis G De la Casa
- Laboratory of Animal Behavior and Neuroscience. Departamento de Psicología Experimental, Universidad de Sevilla, Spain.
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21
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Mahmud FH, Clarke ABM, Elia Y, Curtis J, Benitez-Aguirre P, Cameron FJ, Chiesa ST, Clarson C, Couper JJ, Craig ME, Dalton RN, Daneman D, Davis EA, Deanfield JE, Donaghue KC, Jones TW, Marshall SM, Neil A, Marcovecchio ML. Socioeconomic representativeness of Australian, Canadian and British cohorts from the paediatric diabetes AdDIT study: comparisons to regional and national data. BMC Med 2023; 21:506. [PMID: 38124088 PMCID: PMC10734126 DOI: 10.1186/s12916-023-03222-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Given limited data regarding the involvement of disadvantaged groups in paediatric diabetes clinical trials, this study aimed to evaluate the socioeconomic representativeness of participants recruited into a multinational clinical trial in relation to regional and national type 1 diabetes reference populations. METHODS Retrospective, cross-sectional evaluation of a subset of adolescent type 1 diabetes cardiorenal intervention trial (AdDIT) participants from Australia (n = 144), Canada (n = 312) and the UK (n = 173). Validated national measures of deprivation were used: the Index of Relative Socioeconomic Disadvantage (IRSD) 2016 (Australia), the Material Resources (MR) dimension of the Canadian Marginalisation index 2016 (Canada) and the Index of Multiple Deprivation (IMD) 2015 (UK). Representativeness was assessed by comparing the AdDIT cohort's distribution of deprivation quintiles with that of the local paediatric type 1 diabetes population (regional), and the broader type 1 diabetes population for which the trial's intervention was targeted (national). RESULTS Recruited study cohorts from each country had higher proportions of participants with higher SES, and significant underrepresentation of lower SES, in relation to their national references. The socioeconomic make-up in Australia mirrored that of the regional population (p = 0.99). For Canada, the 2nd least deprived (p = 0.001) and the most deprived quintiles (p < 0.001) were over- and under-represented relative to the regional reference, while the UK featured higher regional and national SES bias with over-representation and under-representation from the least-deprived and most-deprived quintiles (p < 0.0001). CONCLUSIONS Significant national differences in trial participation of low SES participants were observed, highlighting limitations in access to clinical research and the importance of reporting sociodemographic representation in diabetes clinical trials. TRIAL REGISTRATION NCT01581476. Registered on 20 April 2012.
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Affiliation(s)
- Farid H Mahmud
- Division of Endocrinology, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, 555 University Avenue, RM 5446 Black Wing, Toronto, ON, M5G 1X8, Canada.
| | - Antoine B M Clarke
- Division of Endocrinology, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, 555 University Avenue, RM 5446 Black Wing, Toronto, ON, M5G 1X8, Canada
| | - Yesmino Elia
- Division of Endocrinology, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, 555 University Avenue, RM 5446 Black Wing, Toronto, ON, M5G 1X8, Canada
| | - Jacqueline Curtis
- Division of Endocrinology, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, 555 University Avenue, RM 5446 Black Wing, Toronto, ON, M5G 1X8, Canada
| | - Paul Benitez-Aguirre
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, University of Sydney, Sydney, Australia
| | - Fergus J Cameron
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Scott T Chiesa
- Institute of Cardiovascular Science, University College London, London, UK
| | | | - Jennifer J Couper
- Departments of Endocrinology and Diabetes and Medical Imaging, Women's and Children's Hospital, Adelaide, Australia
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, University of Sydney, Sydney, Australia
- Discipline of Paediatrics & Child Health, School of Clinical Medicine, University of New South Wales Medicine & Health, Sydney, Australia
| | - R Neil Dalton
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Denis Daneman
- Division of Endocrinology, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, 555 University Avenue, RM 5446 Black Wing, Toronto, ON, M5G 1X8, Canada
| | - Elizabeth A Davis
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - John E Deanfield
- Institute of Cardiovascular Science, University College London, London, UK
| | - Kim C Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, University of Sydney, Sydney, Australia
| | - Timothy W Jones
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Sally M Marshall
- Faculty of Clinical Medical Sciences, Diabetes Research Group, Translational and Clinical Research Institute, Newcastle University, 4Th Floor William Leech Building, Framlington Place, Newcastle Upon Tyne, UK
| | - Andrew Neil
- Oxford Centre for Diabetes, Endocrinology & Metabolism, University of Oxford, Oxford, UK
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22
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Siersbaek R, O'Donnell C, Parker S, Ford J, Burke S, Ní Cheallaigh C. Social exclusion and its impact on health over the life course: A realist review protocol. HRB Open Res 2023; 6:34. [PMID: 38357513 PMCID: PMC10864819 DOI: 10.12688/hrbopenres.13746.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 02/16/2024] Open
Abstract
Background Social exclusion is a process whereby certain individuals are born into or pushed to the margins of society and prevented from participating in social, cultural, economic, and political life. People who experience social exclusion are not afforded the same rights and privileges as other population groups. Socially excluded people often experience poorer outcomes in a variety of domains including health, education, employment, and housing than people with socio-economic privilege. People experiencing social exclusion frequently have higher and more complex health needs and poorer access to healthcare than the general population. The aim of this study is to better understand and explain how social exclusion occurs and how it impacts health over the life course. Methods A realist review will be undertaken. Data will be collected via a systematic search of databases of peer-reviewed literature and further iterative searches of peer-reviewed and other literatures as needed. The following data bases will be searched: MEDLINE, Embase, CINAHL, and ASSIA, using both indexed subject headings in each database and relevant key words. Grey literature will be searched via Google Scholar and relevant websites of organisations that work with populations affected by social exclusion. Conclusion A realist review will be conducted to explain the underlying societal mechanisms which produce social exclusion and related health outcomes in particular contexts affecting excluded population groups across the life course. The study has the potential to inform policy makers and service managers of how and why social exclusion occurs and potential key intervention points to prevent exclusion from happening.
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Affiliation(s)
- Rikke Siersbaek
- Clinical Medicine, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, D08 W9RT, Ireland
| | - Chris O'Donnell
- Safetynet Primary Care, Catherine Mc Auley Education & Research Centre, Dublin 7, D07 A8NN, Ireland
| | - Sarah Parker
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland
| | - John Ford
- Wolfson Institute of Population Health, Queen Mary University of London, London, England, EC1M 6BQ, UK
| | - Sara Burke
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland
| | - Clíona Ní Cheallaigh
- Clinical Medicine, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, D08 W9RT, Ireland
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23
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McLaughlin KA, Weissman DG, Flournoy J. Challenges with Latent Variable Approaches to Operationalizing Dimensions of Childhood adversity - a Commentary on Sisitsky et al. (2023). Res Child Adolesc Psychopathol 2023; 51:1809-1811. [PMID: 37581854 DOI: 10.1007/s10802-023-01114-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 08/16/2023]
Abstract
Childhood adversity is a common, powerful risk factor for future mental and physical health problems. Appropriately aggregating and categorizing discrete adverse experiences into cumulative indices remains an active area of research and debate in the field of developmental psychopathology. In a recent article by Sisitsky et al. (2013), they report using confirmatory factor analysis and latent profile analysis to categorize participants into "profiles" of childhood adversity. In this commentary, we argue that categorizing dimensions or profiles of childhood adversity based on the tendency of adversities to co-occur is misaligned with dimensional models of adversity, which derive underlying dimensions from their tendency to cumulatively predict certain outcomes rather than adversity co-occurrence. We summarize the history of theories and methods of operationalizing childhood adversity that led to the development of the dimensional model of adversity and psychopathology. We then explain why latent variable approaches, which simply reflect the tendency of adverse experiences to co-occur, are inappropriate for validating any given approach.
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Affiliation(s)
- Katie A McLaughlin
- Department of Psychology, Harvard University, 33 Kirkland Street, 02138, Cambridge, MA, USA
| | - David G Weissman
- Department of Psychology, Harvard University, 33 Kirkland Street, 02138, Cambridge, MA, USA.
| | - John Flournoy
- Department of Psychology, Harvard University, 33 Kirkland Street, 02138, Cambridge, MA, USA
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24
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Cecil CAM, Schuurmans IK. On Navigating Analytical Choices in Research on Early Life Adversity: A Commentary on Sisitsky et al. (2023). Res Child Adolesc Psychopathol 2023; 51:1805-1808. [PMID: 37535226 PMCID: PMC10661763 DOI: 10.1007/s10802-023-01103-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 08/04/2023]
Abstract
Early life adversities (ELA), including exposure to childhood maltreatment, deprivation or community violence, rarely occur in isolation. This co-occurrence poses several conceptual and methodological challenges for researchers, who must decide how best to model ELA and its association with outcomes. In this commentary, we discuss how different analytical choices come with their own - often complementary - sets of assumptions, strengths and limitations, which should be carefully considered when designing research on ELA. We then summarize work published in this issue by Sisitsky et al. (Research on Child and Adolescent Psychopathology, 2023), which serves as an important example of how different approaches can be incorporated in research in order to capture ELA as a complex phenomenon, while generating actionable results. Ultimately, such integration can enhance the quality and relevance of research, contributing to a more comprehensive understanding of ELA and its effects on health outcomes, paving the way for more targeted prevention and intervention strategies to promote children's wellbeing.
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Affiliation(s)
- Charlotte A M Cecil
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
| | - Isabel K Schuurmans
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
- The Generation R Study Group, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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25
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Milcent C. The sorting effect in healthcare access: Those left behind. Econ Hum Biol 2023; 51:101282. [PMID: 37531910 DOI: 10.1016/j.ehb.2023.101282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 05/08/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023]
Abstract
Many governments have sought to enhance patient choice in hospital by intensifying competitive pressure on hospital administrations that is expected to improve efficiency, quality, and innovation. However, there is mixed evidence on whether patients travel past their local hospitals to seek better quality care and whether higher-income patients are those most sensitive to respond to competitive pressures. Using detailed data from 17 million inpatient stays admitted in France during 2019, this paper explores patients' choice of provider where for-profit, non-profit, research hospital and local hospitals are allowed to compete with each other. We estimate the extent to which deprivation gradient plays on patient's choice of provider. We found that, in general, patients travel for their care, with just one-quarter of them going to the nearest hospital. In fact, the most vulnerable patients (i.e., those socio-economically deprived, and very aged) are mostly treated in local public hospitals with the lowest quality service level, and with large variability in quality as well, while those with less socio-economic deprivation seek care at higher-quality for-profit hospitals. Our counterfactual simulations show that admission to university hospitals attenuates existing inequalities. However, whether it delays the healthcare access sought by this population remains an open question.
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Affiliation(s)
- Carine Milcent
- Paris School of Economics (PSE), France; Center for National Scientific Research, CNRS at Paris Jourdan Sciences Economics (UMR8545), France.
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26
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Zhong X, Ashiru-Oredope D, Pate A, Martin GP, Sharma A, Dark P, Felton T, Lake C, MacKenna B, Mehrkar A, Bacon SC, Massey J, Inglesby P, Goldacre B, Hand K, Bladon S, Cunningham N, Gilham E, Brown CS, Mirfenderesky M, Palin V, van Staa TP. Clinical and health inequality risk factors for non-COVID-related sepsis during the global COVID-19 pandemic: a national case-control and cohort study. EClinicalMedicine 2023; 66:102321. [PMID: 38192590 PMCID: PMC10772239 DOI: 10.1016/j.eclinm.2023.102321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 01/10/2024] Open
Abstract
Background Sepsis, characterised by significant morbidity and mortality, is intricately linked to socioeconomic disparities and pre-admission clinical histories. This study aspires to elucidate the association between non-COVID-19 related sepsis and health inequality risk factors amidst the pandemic in England, with a secondary focus on their association with 30-day sepsis mortality. Methods With the approval of NHS England, we harnessed the OpenSAFELY platform to execute a cohort study and a 1:6 matched case-control study. A sepsis diagnosis was identified from the incident hospital admissions record using ICD-10 codes. This encompassed 248,767 cases with non-COVID-19 sepsis from a cohort of 22.0 million individuals spanning January 1, 2019, to June 31, 2022. Socioeconomic deprivation was gauged using the Index of Multiple Deprivation score, reflecting indicators like income, employment, and education. Hospitalisation-related sepsis diagnoses were categorised as community-acquired or hospital-acquired. Cases were matched to controls who had no recorded diagnosis of sepsis, based on age (stepwise), sex, and calendar month. The eligibility criteria for controls were established primarily on the absence of a recorded sepsis diagnosis. Associations between potential predictors and odds of developing non-COVID-19 sepsis underwent assessment through conditional logistic regression models, with multivariable regression determining odds ratios (ORs) for 30-day mortality. Findings The study included 224,361 (10.2%) cases with non-COVID-19 sepsis and 1,346,166 matched controls. The most socioeconomic deprived quintile was associated with higher odds of developing non-COVID-19 sepsis than the least deprived quintile (crude OR 1.80 [95% CI 1.77-1.83]). Other risk factors (after adjusting comorbidities) such as learning disability (adjusted OR 3.53 [3.35-3.73]), chronic liver disease (adjusted OR 3.08 [2.97-3.19]), chronic kidney disease (stage 4: adjusted OR 2.62 [2.55-2.70], stage 5: adjusted OR 6.23 [5.81-6.69]), cancer, neurological disease, immunosuppressive conditions were also associated with developing non-COVID-19 sepsis. The incidence rate of non-COVID-19 sepsis decreased during the COVID-19 pandemic and rebounded to pre-pandemic levels (April 2021) after national lockdowns had been lifted. The 30-day mortality risk in cases with non-COVID-19 sepsis was higher for the most deprived quintile across all periods. Interpretation Socioeconomic deprivation, comorbidity and learning disabilities were associated with an increased odds of developing non-COVID-19 related sepsis and 30-day mortality in England. This study highlights the need to improve the prevention of sepsis, including more precise targeting of antimicrobials to higher-risk patients. Funding The UK Health Security Agency, Health Data Research UK, and National Institute for Health Research.
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Affiliation(s)
- Xiaomin Zhong
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, M13 9PL, UK
| | - Diane Ashiru-Oredope
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, United Kingdom Health Security Agency (UKHSA), London SW1P 3JR, UK
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK
| | - Alexander Pate
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, M13 9PL, UK
| | - Glen P. Martin
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, M13 9PL, UK
| | - Anita Sharma
- Chadderton South Health Centre, Eaves Lane, Chadderton, Oldham OL9 8RG, UK
| | - Paul Dark
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Tim Felton
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Intensive Care Unit, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Claire Lake
- Maples Medical Centre, 2 Scout Dr, Baguley, Manchester M23 2SY, UK
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
- NHS England, Wellington House, Waterloo Road, London SE1 8UG, UK
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Sebastian C.J. Bacon
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Jon Massey
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Peter Inglesby
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Ben Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Kieran Hand
- Pharmacy Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Sian Bladon
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, M13 9PL, UK
| | - Neil Cunningham
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, United Kingdom Health Security Agency (UKHSA), London SW1P 3JR, UK
| | - Ellie Gilham
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, United Kingdom Health Security Agency (UKHSA), London SW1P 3JR, UK
| | - Colin S. Brown
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, United Kingdom Health Security Agency (UKHSA), London SW1P 3JR, UK
- NIHR Health Protection Unit in Healthcare-Associated Infection & Antimicrobial Resistance, Imperial College London, London, UK
| | - Mariyam Mirfenderesky
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, United Kingdom Health Security Agency (UKHSA), London SW1P 3JR, UK
| | - Victoria Palin
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, M13 9PL, UK
- Division of Developmental Biology and Medicine, Maternal and Fetal Research Centre, The University of Manchester, St Marys Hospital, Oxford Road, Manchester M13 9WL, UK
| | - Tjeerd Pieter van Staa
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, M13 9PL, UK
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27
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Fernandes M, Milla C, Gubran A, Barrazueta S, Altonen B, DiVittis A, Kuperberg S. Assessing the impact of socioeconomic status on incidental lung nodules at an urban safety net hospital. BMC Pulm Med 2023; 23:469. [PMID: 37996867 PMCID: PMC10668357 DOI: 10.1186/s12890-023-02726-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Lower socioeconomic status has been identified as an emerging risk factor for health disparities, including lung cancer outcomes. Most research investigating these outcomes includes patients from formal lung cancer screening programs. There is a paucity of studies assessing the relationship between socioeconomic status and incidental lung nodules. This study aimed to investigate the association between socioeconomic status and the size of incidental lung nodules on initial presentation at an urban safety net hospital, which did not have a formal lung cancer screening program or incidental lung nodule program. METHODS A retrospective chart review was conducted on patients with incidental lung nodules on CT chest imaging who were referred from primary care to a pulmonology clinic at a safety net hospital. Patients with incomplete nodule characteristics information were excluded. Data on demographics, comorbidities, smoking history, insurance type, immigration status, and geographical factors were collected. Less commonly studied determinants such as crime index, cost of living, and air quality index were also assessed. Logistic regression analysis was performed to assess relationships between nodule size and socioeconomic determinants. RESULTS Out of 3,490 patients with chest CT scans, 268 patients with ILNs were included in the study. 84.7% of patients represented racial or ethnic minorities, and most patients (67.8%) had federal insurance. Patients with non-commercial insurance were more likely to have larger, inherently higher-risk nodules (> 8 mm) compared to those with commercial insurance (OR 2.18, p 0.01). Patients from areas with higher unemployment rates were also less likely (OR 0.75, p 0.04) to have smaller nodules (< 6 mm). Patients representing racial or ethnic minorities were also more likely to have nodules > 8 mm (OR 1.6, p 0.24), and less likely to have nodules < 6 mm (OR 0.6, p 0.32), however, these relationships were not statistically significant. CONCLUSION This study found that lower socioeconomic status, indicated by having non-commercial insurance, was associated with larger incidental lung nodule size on initial presentation. While it is established that socioeconomic status is associated with disparities in lung cancer screening, these findings suggest that inequalities may also be present in those with incidental lung nodules. Further research is needed to understand the underlying mechanisms and develop interventions to address these disparities in incidental lung nodule evaluation and improve outcomes.
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Affiliation(s)
- Mateus Fernandes
- Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health, New York, USA
| | - Cristian Milla
- Department of Medicine, NYC Health + Hospitals/Woodhull, New York City Health and Hospitals, 760 Broadway, Brooklyn, NY, 11206, USA
- Division of Nephrology, SUNY Downstate/Health Sciences Center at Brooklyn, NY, Brooklyn, USA
| | - Ahmed Gubran
- Department of Medicine, NYC Health + Hospitals/Woodhull, New York City Health and Hospitals, 760 Broadway, Brooklyn, NY, 11206, USA
| | - Sandra Barrazueta
- Department of Medicine, NYC Health + Hospitals/Woodhull, New York City Health and Hospitals, 760 Broadway, Brooklyn, NY, 11206, USA
| | - Brian Altonen
- Department of Medicine, NYC Health + Hospitals/Woodhull, New York City Health and Hospitals, 760 Broadway, Brooklyn, NY, 11206, USA
- Research and Administration, New York City Health and Hospitals, NY, New York, USA
| | - Anthony DiVittis
- Department of Medicine, NYC Health + Hospitals/Woodhull, New York City Health and Hospitals, 760 Broadway, Brooklyn, NY, 11206, USA
| | - Stephen Kuperberg
- Department of Medicine, NYC Health + Hospitals/Woodhull, New York City Health and Hospitals, 760 Broadway, Brooklyn, NY, 11206, USA.
- Pulmonary and Critical Care Medicine, New York University Grossman School of Medicine, NY, New York, USA.
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28
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Liao YA, Larose MP, Barker ED. Latent Transitions of Census-level Deprivation and Network Analysis of Conduct Problem Behaviours. Res Child Adolesc Psychopathol 2023; 51:1595-1610. [PMID: 37318738 DOI: 10.1007/s10802-023-01081-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/16/2023]
Abstract
Conduct problems are more prevalent in neighbourhoods that have a vulnerable structure (e.g., high neighbourhood-level deprivation) and disarranged interpersonal characteristics (e.g., low social cohesion and informal social control at the neighbourhood level). However, as an indicator of neighbourhood structure, neighbourhood deprivation has typically not been assessed longitudinally and solely based on neighbourhood-level socioeconomic status rather than a wide variety of census-level deprivation indicators. Also, few studies have examined which CD behaviours (e.g., stealing) interplay with neighbourhood risks (e.g., low social cohesion). In this study, latent transitions of neighbourhood-level deprivation patterns, based on census-level information, were estimated between age 12.5 and 15.5 using the Avon Longitudinal Study of Parents and Children (ALSPAC). In network models, we employed multi-informant variables and estimated interplays between mother-reported CD behaviours and child-reported social cohesion, informal social control and deviant peer affiliations within different patterns of the latent neighbourhood-level deprivation transitions. We identified three constant deprivation patterns: deprived, intermediate and low pattern. In the deprived pattern, the CD behaviour "bullying" had the highest interplay with lack of social cohesions, social control, and high deviant peer affiliation. In contrast, non-violent CD behaviours: "lying" and "staying after dark ", showed importance in the intermediate and low patterns, respectively. Regardless of deprivation patterns, social cohesion played a protective role, whereas affiliation with deviant peers involved in property crime was a risk factor for CD behaviours. The identified CD behaviours can serve as a screening tool, and interventions increasing social cohesion might mitigate CD development.
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Affiliation(s)
- Yi-An Liao
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany.
- Munich Medical Research School (MMRS), Ludwig Maximilian University of Munich, Munich, Germany.
- Department of Psychiatry, National Taiwan University Hospital, No. 7, Zhongshan S Rd, Taipei City, Taiwan.
| | - Marie-Pier Larose
- INVEST Flagship Research Center/Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
| | - Edward D Barker
- Department of Psychology, Institute of Psychiatry, King's College London, Psychology & Neuroscience16 De Crespigny Park, London, SE5 8AF, UK.
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29
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Crozes F, Demeulemeester R, Mounie M, Derumeaux H, Fabre D, Petiot D, Pouget AM, Molinier L, Delpierre C, Costa N. Influence of deprivation on hospital care pathways and costs for people with ischaemic stroke: A trajectory modelling study. Ann Phys Rehabil Med 2023; 66:101775. [PMID: 37890427 DOI: 10.1016/j.rehab.2023.101775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 05/22/2023] [Accepted: 05/29/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Socioeconomic characteristics have a strong impact on the incidence of stroke. The highest levels of morbidity and mortality are associated with the lowest socioeconomic positions. Moreover, the health insurance budget for stroke is significant. OBJECTIVES To describe typical Hospital Care Pathways (HCPs) and their costs 1 year after acute stroke and to assess the impact of individuals' socioeconomic characteristics on HCPs and costs. METHODS This retrospective observational study used hospital data on people with primary ischaemic stroke in a region of France (Haute-Garonne). HCPs were identified by sequential analysis. Multinomial logistic regression was used to analyse the impact of socioeconomic characteristics on HCPs as measured using an ecological index of deprivation, and a gamma regression model was used to analyse costs. RESULTS The analysis identified 4 typical HCPs. The first HCP consisted exclusively of consultations, the second was composed of consultations and hospitalisations, the third included hospitalisations during the first 2 months after stroke followed by consultations, and the fourth included long-term hospitalisations. After adjustment, deprivation was associated with HCPs and determined its costs: a high level of social disadvantage determined the type of pathway and increased the costs. CONCLUSIONS This study is one of the first to assess the impact of social inequalities in health on post-stroke HCPs in France and their corresponding costs. Our results confirm the hypothesis that healthcare costs differ according to the level of deprivation.
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Affiliation(s)
- Fanny Crozes
- Medical Information Department, University of Toulouse Hospital Centre, Toulouse, France; UMR 1295, University of Toulouse. UPS, Inserm, Toulouse, France; General Care Coordination, University of Toulouse Hospital Centre, Toulouse, France.
| | - Romain Demeulemeester
- Medical Information Department, University of Toulouse Hospital Centre, Toulouse, France; UMR 1295, University of Toulouse. UPS, Inserm, Toulouse, France
| | - Michael Mounie
- Medical Information Department, University of Toulouse Hospital Centre, Toulouse, France; UMR 1295, University of Toulouse. UPS, Inserm, Toulouse, France
| | - Hélène Derumeaux
- Medical Information Department, University of Toulouse Hospital Centre, Toulouse, France
| | - Didier Fabre
- Medical Information Department, University of Toulouse Hospital Centre, Toulouse, France
| | - Dominique Petiot
- Medical Information Department, University of Toulouse Hospital Centre, Toulouse, France
| | - Alix-Marie Pouget
- Medical Information Department, University of Toulouse Hospital Centre, Toulouse, France
| | - Laurent Molinier
- Medical Information Department, University of Toulouse Hospital Centre, Toulouse, France
| | | | - Nadège Costa
- Medical Information Department, University of Toulouse Hospital Centre, Toulouse, France; UMR 1295, University of Toulouse. UPS, Inserm, Toulouse, France
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Scopazzini MS, Cave RNR, Mutch CP, Ross DA, Bularga A, Chase-Topping M, Woolhouse M, Koch O, Perry MR, Mackintosh CL. Scottish Index of Multiple Deprivation (SIMD) indicators as predictors of mortality among patients hospitalised with COVID-19 disease in the Lothian Region, Scotland during the first wave: a cohort study. Int J Equity Health 2023; 22:205. [PMID: 37794428 PMCID: PMC10552319 DOI: 10.1186/s12939-023-02017-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 09/18/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Sars-CoV-2, the causative agent of COVID-19, has led to more than 226,000 deaths in the UK and multiple risk factors for mortality including age, sex and deprivation have been identified. This study aimed to identify which individual indicators of the Scottish Index of Multiple Deprivation (SIMD), an area-based deprivation index, were predictive of mortality. METHODS This was a prospective cohort study of anonymised electronic health records of 710 consecutive patients hospitalised with Covid-19 disease between March and June 2020 in the Lothian Region of Southeast Scotland. Data sources included automatically extracted data from national electronic platforms and manually extracted data from individual admission records. Exposure variables of interest were SIMD quintiles and 12 indicators of deprivation deemed clinically relevant selected from the SIMD. Our primary outcome was mortality. Age and sex adjusted univariable and multivariable analyses were used to determine measures of association between exposures of interest and the primary outcome. RESULTS After adjusting for age and sex, we found an increased risk of mortality in the more deprived SIMD quintiles 1 and 3 (OR 1.75, CI 0.99-3.08, p = 0.053 and OR 2.17, CI 1.22-3.86, p = 0.009, respectively), but this association was not upheld in our multivariable model containing age, sex, Performance Status and clinical parameters of severity at admission. Of the 12 pre-selected indicators of deprivation, two were associated with greater mortality in our multivariable analysis: income deprivation rate categorised by quartile (Q4 (most deprived): 2.11 (1.20-3.77) p = 0.011)) and greater than expected hospitalisations due to alcohol per SIMD data zone (1.96 (1.28-3.00) p = 0.002)). CONCLUSIONS SIMD as an aggregate measure of deprivation was not predictive of mortality in our cohort when other exposure measures were accounted for. However, we identified a two-fold increased risk of mortality in patients residing in areas with greater income-deprivation and/or number of hospitalisations due to alcohol. In areas where aggregate measures fail to capture pockets of deprivation, exploring the impact of specific SIMD indicators may be helpful in targeting resources to residents at risk of poorer outcomes from Covid-19.
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Affiliation(s)
- Marcello S Scopazzini
- Clinical Infection Research Group, NHS Lothian Infection Service, Western General Hospital, Edinburgh, UK.
- London School of Hygiene and Tropical Medicine, London, UK.
| | | | - Callum P Mutch
- Clinical Infection Research Group, NHS Lothian Infection Service, Western General Hospital, Edinburgh, UK
| | - Daniella A Ross
- Clinical Infection Research Group, NHS Lothian Infection Service, Western General Hospital, Edinburgh, UK
| | - Anda Bularga
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Margo Chase-Topping
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | | | - Oliver Koch
- Clinical Infection Research Group, NHS Lothian Infection Service, Western General Hospital, Edinburgh, UK
| | - Meghan R Perry
- Clinical Infection Research Group, NHS Lothian Infection Service, Western General Hospital, Edinburgh, UK
| | - Claire L Mackintosh
- Clinical Infection Research Group, NHS Lothian Infection Service, Western General Hospital, Edinburgh, UK
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Lee SC, DelPozo-Banos M, Lloyd K, Jones I, Walters JTR, John A. Trends in socioeconomic inequalities in incidence of severe mental illness - A population-based linkage study using primary and secondary care routinely collected data between 2000 and 2017. Schizophr Res 2023; 260:113-122. [PMID: 37634386 DOI: 10.1016/j.schres.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/30/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE In 2008, the UK entered a period of economic recession followed by sustained austerity measures. We investigate changes in inequalities by area deprivation and urbanicity in incidence of severe mental illness (SMI, including schizophrenia-related disorders and bipolar disorder) between 2000 and 2017. METHODS We analysed 4.4 million individuals from primary and secondary care routinely collected datasets (2000-2017) in Wales and estimated the incidence of SMI by deprivation and urbanicity measured by the Welsh Index of Multiple Deprivation (WIMD) and urban/rural indicator respectively. Using linear modelling and joinpoint regression approaches, we examined time trends of the incidence and incidence rate ratios (IRR) of SMI by the WIMD and urban/rural indicator adjusted for available confounders. RESULTS We observed a turning point of time trends of incidence of SMI at 2008/2009 where slope changes of time trends were significantly increasing. IRRs by deprivation/urbanicity remained stable or significantly decreased over the study period except for those with bipolar disorder sourced from secondary care settings, with increasing trend of IRRs (increase in IRR by deprivation after 2010: 1.6 % per year, 95 % CI: 1.0 %-2.2 %; increase in IRR by urbanicity 1.0 % per year, 95 % CI: 0.6 %-1.3 %). CONCLUSIONS There was an association between recession/austerity and an increase in the incidence of SMI over time. There were variations in the effects of deprivation/urbanicity on incidence of SMI associated with short- and long-term socioeconomic change. These findings may support targeted interventions and social protection systems to reduce incidence of SMI.
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Affiliation(s)
- Sze Chim Lee
- DATAMIND at HDRUK, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK,; National Centre for Mental Health. Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Marcos DelPozo-Banos
- DATAMIND at HDRUK, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK,; National Centre for Mental Health. Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Keith Lloyd
- DATAMIND at HDRUK, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK,; National Centre for Mental Health. Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Ian Jones
- National Centre for Mental Health. Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK; MRC Centre for Neuropsychiatric Genetics and Genomics. School of Medicine, Cardiff University, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ, UK
| | - James T R Walters
- DATAMIND at HDRUK, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK,; National Centre for Mental Health. Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK; MRC Centre for Neuropsychiatric Genetics and Genomics. School of Medicine, Cardiff University, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ, UK
| | - Ann John
- DATAMIND at HDRUK, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK,; National Centre for Mental Health. Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK.
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Declercq PL, Fournel I, Demeyere M, Berraies A, Ksiazek E, Nyunga M, Daubin C, Ampere A, Sauneuf B, Badie J, Delbove A, Nseir S, Artaud-Macari E, Bironneau V, Ramakers M, Maizel J, Miailhe AF, Lacombe B, Delberghe N, Oulehri W, Georges H, Tchenio X, Clarot C, Redureau E, Bourdin G, Federici L, Adda M, Schnell D, Bousta M, Salmon-Gandonnière C, Vanderlinden T, Plantefeve G, Delacour D, Delpierre C, Le Bouar G, Sedillot N, Beduneau G, Rivière A, Meunier-Beillard N, Gélinotte S, Rigaud JP, Labruyère M, Georges M, Binquet C, Quenot JP. Influence of socio-economic status on functional recovery after ARDS caused by SARS-CoV-2: the multicentre, observational RECOVIDS study. Intensive Care Med 2023; 49:1168-1180. [PMID: 37620561 PMCID: PMC10556111 DOI: 10.1007/s00134-023-07180-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE Survivors after acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) are at high risk of developing respiratory sequelae and functional impairment. The healthcare crisis caused by the pandemic hit socially disadvantaged populations. We aimed to evaluate the influence of socio-economic status on respiratory sequelae after COVID-19 ARDS. METHODS We carried out a prospective multicenter study in 30 French intensive care units (ICUs), where ARDS survivors were pre-enrolled if they fulfilled the Berlin ARDS criteria. For patients receiving high flow oxygen therapy, a flow ≥ 50 l/min and an FiO2 ≥ 50% were required for enrollment. Socio-economic deprivation was defined by an EPICES (Evaluation de la Précarité et des Inégalités de santé dans les Centres d'Examens de Santé - Evaluation of Deprivation and Inequalities in Health Examination Centres) score ≥ 30.17 and patients were included if they performed the 6-month evaluation. The primary outcome was respiratory sequelae 6 months after ICU discharge, defined by at least one of the following criteria: forced vital capacity < 80% of theoretical value, diffusing capacity of the lung for carbon monoxide < 80% of theoretical value, oxygen desaturation during a 6-min walk test and fibrotic-like findings on chest computed tomography. RESULTS Among 401 analyzable patients, 160 (40%) were socio-economically deprived and 241 (60%) non-deprived; 319 (80%) patients had respiratory sequelae 6 months after ICU discharge (81% vs 78%, deprived vs non-deprived, respectively). No significant effect of socio-economic status was identified on lung sequelae (odds ratio (OR), 1.19 [95% confidence interval (CI), 0.72-1.97]), even after adjustment for age, sex, most invasive respiratory support, obesity, most severe P/F ratio (adjusted OR, 1.02 [95% CI 0.57-1.83]). CONCLUSIONS In COVID-19 ARDS survivors, socio-economic status had no significant influence on respiratory sequelae 6 months after ICU discharge.
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Affiliation(s)
| | - Isabelle Fournel
- Centre d’Investigation Clinique, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | | | | | - Eléa Ksiazek
- Centre d’Investigation Clinique, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | - Martine Nyunga
- Service de Médecine Intensive Réanimation, CH de Roubaix, Roubaix, France
| | - Cédric Daubin
- Department of Medical Intensive Care, CHU de Caen Normandie, Caen, France
| | | | - Bertrand Sauneuf
- Service de Médecine Intensive Réanimation, CH Public du Cotentin, Cherbourg-en-Cotentin, France
| | - Julio Badie
- Service de Médecine Intensive Réanimation, Hopital Nord Franche-Comte, Trevenans, France
| | - Agathe Delbove
- Service de Réanimation Polyvalente, CHBA Vannes, Vannes, France
| | - Saad Nseir
- Service de Médecine Intensive Réanimation, CHRU Roger Salengro, Lille, France
- Inserm U1285, Univ. Lille, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France
| | - Elise Artaud-Macari
- University of Normandie, UNIROUEN, EA3830, CHU Rouen, Department of Pneumology, Thoracic Oncology and Respiratory Intensive Care Unit, Rouen, France
| | - Vanessa Bironneau
- Service de Pneumologie, CHU Poitiers, Poitiers, France
- INSERM CIC 1402, ALIVES Research Group, Université de Poitiers, Poitiers, France
| | - Michel Ramakers
- Service de Médecine Intensive Réanimation, Centre Hospitalier Mémorial de Saint-Lô, Saint-Lô, France
| | - Julien Maizel
- Service de Médecine Intensive Réanimation, CHU d’Amiens, Amiens, France
| | | | - Béatrice Lacombe
- Service de Réanimation Polyvalente, Groupe Hospitalier Bretagne Sud, Lorient, France
| | | | - Walid Oulehri
- Service de Réanimation Chirurgicale, CHRU Strasbourg, Strasbourg, France
| | - Hugues Georges
- Service de Médecine Intensive Réanimation, CH de Tourcoing, Tourcoing, France
| | - Xavier Tchenio
- Service de Réanimation Polyvalente, Centre Hospitalier Fleyriat, Bourg en Bresse, France
| | | | - Elise Redureau
- Service de Pneumologie, CHD Vendée, La Roche-sur-Yon, France
| | - Gaël Bourdin
- Service de Réanimation Polyvalente, CH Saint Joseph Saint Luc, Lyon, France
| | - Laura Federici
- Service de Médecine Intensive Réanimation, AP-HP, Hôpital Louis Mourier, Colombes, France
| | - Mélanie Adda
- Service de Médecine Intensive Réanimation, Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - David Schnell
- Service de Réanimation Polyvalente et USC, CH d’Angoulême, Angoulême, France
| | - Mehdi Bousta
- Service de Réanimation Médico-Chirugicale, Groupe Hospitalier du Havre, Le Havre, France
| | | | - Thierry Vanderlinden
- Intensive Care Unit, St Philibert hospital, ETHICS EA 7446, Lille Catholic University, Lille, France
| | - Gaëtan Plantefeve
- Service de Médecine Intensive Réanimation, CH d’Argenteuil, Argenteuil, France
| | - David Delacour
- Service de radiologie, Clinique du Cèdre, Bois-Guillaume, France
| | | | - Gurvan Le Bouar
- Service de Médecine Intensive Réanimation, CHES Evreux, Evreux, France
| | - Nicholas Sedillot
- Service de Réanimation Polyvalente, Centre Hospitalier Fleyriat, Bourg en Bresse, France
| | - Gaëtan Beduneau
- Normandie Univ, UNIROUEN, UR3830, CHU Rouen, Department of Medical Intensive Care, 76000 Rouen, France
| | - Antoine Rivière
- Service de Réanimation Polyvalente, CH d’Abbeville, Abbeville, France
| | - Nicolas Meunier-Beillard
- Centre d’Investigation Clinique, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | | | - Jean-Philippe Rigaud
- Service de Médecine Intensive Réanimation, CH de Dieppe, Dieppe, France
- Espace de Réflexion Ethique de Normandie, CHU Caen, Caen, France
| | - Marie Labruyère
- Department of Intensive Care, Burgundy University Hospital, 14 rue Paul Gaffarel, B.P 77908, 21079 Dijon Cedex, France
- Lipness Team, INSERM Research Center LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Marjolaine Georges
- Department of Pulmonary Medicine and Intensive Care Unit, University Hospital, Dijon, France
| | - Christine Binquet
- Centre d’Investigation Clinique, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, Burgundy University Hospital, 14 rue Paul Gaffarel, B.P 77908, 21079 Dijon Cedex, France
- Lipness Team, INSERM Research Center LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
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Levasseur M, Dubois MF, Généreux M, Naud D, Trottier L, Menec V, Roy M, Gabaude C, Couturier Y, Raina P. Key Age-Friendly Components of Municipalities that Foster Social Participation of Aging Canadians: Results from the Canadian Longitudinal Study on Aging. J Urban Health 2023; 100:1032-1042. [PMID: 37594674 PMCID: PMC10618123 DOI: 10.1007/s11524-023-00762-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 08/19/2023]
Abstract
Municipalities can foster the social participation of aging adults. Although making municipalities age-friendly is recognized as a promising way to help aging adults stay involved in their communities, little is known about the key components (e.g., services and structures) that foster social participation. This study thus aimed to identify key age-friendly components (AFC) best associated with the social participation of older Canadians. Secondary analyses were carried out using baseline data from the Canadian Longitudinal Study on Aging (n = 25,411) in selected municipalities (m = 110 with ≥ 30 respondents), the Age-friendly Survey, and census data. Social participation was estimated based on the number of community activities outside the home per month. AFC included housing, transportation, outdoor spaces and buildings, safety, recreation, workforce participation, information, respect, health, and community services. Multilevel models were used to examine the association between individual social participation, key AFC, and environmental characteristics, while controlling for individual characteristics. Aged between 45 and 89, half of the participants were women who were engaged in 20.2±12.5 activities per month. About 2.5% of the variance in social participation was attributable to municipalities. Better outdoor spaces and buildings (p < 0.001), worse communication and information (p < 0.01), and lower material deprivation (p < 0.001) were associated with higher social participation. Age was the only individual-level variable to have a significant random effect, indicating that municipal contexts may mediate its impact with social participation. This study provides insights to help facilitate social participation and promote age-friendliness, by maintaining safe indoor and outdoor mobility, and informing older adults of available activities.
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Affiliation(s)
- Mélanie Levasseur
- CIUSSS de L'Estrie CHUS: Centre Integre Universitaire de Sante Et de Services Sociaux de L'Estrie Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada.
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada.
| | - Marie-France Dubois
- CIUSSS de L'Estrie CHUS: Centre Integre Universitaire de Sante Et de Services Sociaux de L'Estrie Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Mélissa Généreux
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Daniel Naud
- CIUSSS de L'Estrie CHUS: Centre Integre Universitaire de Sante Et de Services Sociaux de L'Estrie Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Lise Trottier
- CIUSSS de L'Estrie CHUS: Centre Integre Universitaire de Sante Et de Services Sociaux de L'Estrie Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | - Verena Menec
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Mathieu Roy
- CIUSSS de L'Estrie CHUS: Centre Integre Universitaire de Sante Et de Services Sociaux de L'Estrie Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | | | - Yves Couturier
- Department of Social Work, Université de Sherbrooke, Sherbrooke, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Labarge Centre for Mobility in Aging, McMaster University, Hamilton, Canada
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Canada
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Uong SP, Zhou J, Lovinsky-Desir S, Albrecht SS, Azan A, Chambers EC, Sheffield PE, Thompson A, Wilson J, Woo Baidal J, Stingone JA. The Creation of a Multidomain Neighborhood Environmental Vulnerability Index Across New York City. J Urban Health 2023; 100:1007-1023. [PMID: 37594675 PMCID: PMC10618140 DOI: 10.1007/s11524-023-00766-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 08/19/2023]
Abstract
Compared to previous studies commonly using a single summary score, we aimed to construct a multidomain neighborhood environmental vulnerability index (NEVI) to characterize the magnitude and variability of area-level factors with the potential to modify the association between environmental pollutants and health effects. Using the Toxicological Prioritization Index framework and data from the 2015-2019 U.S. Census American Community Survey and the 2020 CDC PLACES Project, we quantified census tract-level vulnerability overall and in 4 primary domains (demographic, economic, residential, and health status), 24 subdomains, and 54 distinct area-level features for New York City (NYC). Overall and domain-specific indices were calculated by summing standardized feature values within the subdomains and then aggregating and weighting based on the number of features within each subdomain within equally-weighted primary domains. In citywide comparisons, NEVI was correlated with multiple existing indices, including the Neighborhood Deprivation Index (r = 0.91) and Social Vulnerability Index (r = 0.87) but provided additional information on features contributing to vulnerability. Vulnerability varied spatially across NYC, and hierarchical cluster analysis using subdomain scores revealed six patterns of vulnerability across domains: 1) low in all, 2) primarily low except residential, 3) medium in all, 4) high demographic, economic, and residential 5) high economic, residential, and health status, and 6) high demographic, economic and health status. Created using methods that offer flexibility for theory-based construction, NEVI provided detailed vulnerability metrics across domains that can inform targeted research and public health interventions aimed at reducing the health impacts from environmental exposures across urban centers.
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Affiliation(s)
- Stephen P Uong
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 1608, New York, NY, 10032, USA
| | - Jiayi Zhou
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 1608, New York, NY, 10032, USA
| | - Stephanie Lovinsky-Desir
- Department of Pediatrics New York, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Sandra S Albrecht
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 1608, New York, NY, 10032, USA
| | - Alexander Azan
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Earle C Chambers
- Department of Family and Social Medicine Bronx, Albert Einstein College of Medicine, New York, NY, USA
| | - Perry E Sheffield
- Department of Environmental Medicine and Public Health New York, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Azure Thompson
- School of Public Health Brooklyn, SUNY Downstate Health Sciences University New York, New York, NY, USA
| | - Joseph Wilson
- Department of Environmental Medicine and Public Health New York, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jennifer Woo Baidal
- Department of Pediatrics New York, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Jeanette A Stingone
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 1608, New York, NY, 10032, USA.
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Gauche L, Laporte R, Bernoux D, Marquant E, Vergier J, Bonnet L, Aouchiche K, Bresson V, Zanini D, Fabre-Brue C, Reynaud R, Castets S. Assessment of a new home-based care pathway for children newly diagnosed with type 1 diabetes. Prim Care Diabetes 2023; 17:518-523. [PMID: 37391315 DOI: 10.1016/j.pcd.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 06/09/2023] [Accepted: 06/18/2023] [Indexed: 07/02/2023]
Abstract
AIM To compare the outcomes of home-based and conventional hospital-based care for children newly diagnosed with type 1 diabetes mellitus. METHODS A descriptive study was conducted of all children newly diagnosed with diabetes mellitus at the Timone Hospital in Marseille, France, between November 2017 and July 2019. The patients received either home-based or in-patient hospital care. The primary outcome was the length of initial hospital stay. The secondary outcome measures were glycemic control in the first year of treatment, families' diabetes knowledge, the effect of diabetes on quality of life, and overall quality of care. RESULTS A total of 85 patients were included, 37 in the home-based care group and 48 in the in-patient care group. The initial length of hospital stay was 6 days in the home-based care group versus 9 days in the in-patient care group. Levels of glycemic control, diabetes knowledge and quality of care were comparable in the two groups despite a higher rate of socioeconomic deprivation in the home-based care group. CONCLUSION Home-based care for children with diabetes is safe and effective. This new healthcare pathway provides good overall social care, especially for socioeconomically deprived families.
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Affiliation(s)
- Laetitia Gauche
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France
| | - Rémi Laporte
- APHM, Hôpital Nord, Permanence d'Accès aux Soins de Santé Mère-Enfant, Marseille, France, Aix Marseille Univ, Equipe de Recherche EA 3279 "Santé Publique, Maladies Chroniques et Qualité de Vie", Faculté de Médecine, Marseille, France
| | - Delphine Bernoux
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France
| | - Emeline Marquant
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France
| | - Julia Vergier
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France
| | - Laura Bonnet
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France
| | - Karine Aouchiche
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France
| | - Violaine Bresson
- Pediatric Home-based Care, Timone enfant Hospital, Marseille, France
| | - Didier Zanini
- Pediatric Home-based Care, Timone enfant Hospital, Marseille, France
| | - Catherine Fabre-Brue
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France
| | - Rachel Reynaud
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France
| | - Sarah Castets
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France.
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Phillips EM, Brock RL, James TD, Nelson JM, Mason WA, Espy KA, Nelson TD. Does preschool executive control mediate the impact of early environmental unpredictability and deprivation on the general factor of psychopathology a decade later? J Child Psychol Psychiatry 2023; 64:1505-1516. [PMID: 36872576 PMCID: PMC10911046 DOI: 10.1111/jcpp.13775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Although deprivation has been consistently shown to increase risk for psychopathology through impaired executive control, the unique effects of other dimensions of early adversity, such as unpredictability, on executive control development are poorly understood. The current study evaluated whether deprivation and/or unpredictability early in life have unique effects on the general factor of psychopathology through impaired preschool executive control. METHODS Participants included 312 children (51% female) oversampled for greater sociodemographic risk. Preschool executive control was measured using a battery of nine developmentally appropriate executive control tasks. Dimensions of adversity were measured with observational and caregiver assessments, and psychopathology was measured with caregiver and child reports. RESULTS In separate models, both deprivation and unpredictability had significant indirect effects on the adolescent general factor of psychopathology through impaired preschool executive control. However, when both dimensions of adversity were included simultaneously, early life deprivation, but not unpredictability, was uniquely associated with the general factor of psychopathology in adolescence through impaired preschool executive control. CONCLUSIONS Preschool executive control appears to be a transdiagnostic mechanism through which deprivation, but not unpredictability, increases risk for the general factor of psychopathology in adolescence. Results elucidate potential transdiagnostic targets for intervention efforts aimed at reducing the development and maintenance of psychopathology across the life span.
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Affiliation(s)
- Eric M Phillips
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Rebecca L Brock
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Tiffany D James
- Office of Research and Economic Development, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Jennifer Mize Nelson
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
- Office of Research and Economic Development, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - W Alex Mason
- Department of Child, Youth, & Family Studies, Nebraska Center for Research on Children, Youth, Families, and Schools, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Kimberly Andrews Espy
- Department of Neuroscience, Developmental and Regenerative Biology, University of Texas at San Antonio, San Antonio, TX, USA
- Department of Psychiatry and Behavioral Science, University of Texas Health San Antonio, Long School of Medicine, San Antonio, TX, USA
| | - Timothy D Nelson
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
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Ning K, Gondek D, Pereira SMP, Lacey RE. Mediating mechanisms of the relationship between exposure to deprivation and threat during childhood and adolescent psychopathology: evidence from the Millennium Cohort Study. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02289-3. [PMID: 37676493 DOI: 10.1007/s00787-023-02289-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
The key aim of our study was to examine pathways from exposure to childhood adversities (i.e., deprivation and threat) to adolescent psychopathology. The assessed mediating mechanisms included cognitive ability and emotion regulation, as proposed by the Dimensional Model of Adversity and Psychopathology (DMAP). The study comprised participants from the nationally representative Millennium Cohort Study. Latent scores for deprivation and threat were derived using confirmatory factor analysis from indicators collected when participants were at age of 9 months, 3 and 5 years. Cognitive ability was measured using the Verbal Similarities subscale of the British Ability Scales II at age 11, and emotion regulation was measured using emotion dysregulation subscale of the Child Social Behavioural Questionnaire at age 7. Psychopathology, defined as psychological distress, was assessed using the Kessler 6 scale at age 17. We conducted causal mediation analysis adjusting for multiple confounding factors. We did not find total effect of either exposure to deprivation or threat on psychological distress, but we did find significant indirect effects of exposure to deprivation on psychological distress via cognitive ability (- 0.11, 95% CI - 0.20 to - 0.05) and emotion regulation (0.03, 0.02 to 0.12), and exposure to threat on psychological distress via cognitive ability (- 0.04, - 0.07 to - 0.01) and emotion regulation (0.09, 0.03 to 0.15). The lack of associations between deprivation or threat and psychological distress may be due to reporting bias or developmental period of psychopathology. Results of mediation analysis partially support the DMAP but indicate limited benefits to reduce adolescent psychological distress by targeting cognitive ability or emotion regulation to those exposed to childhood adversities.
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Affiliation(s)
- Ke Ning
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Dawid Gondek
- Research Department of Epidemiology and Public Health, University College London, London, England
- Swiss Centre of Expertise in Life Course Research (LIVES), University of Lausanne, Lausanne, Switzerland
| | - Snehal M Pinto Pereira
- Division of Surgery and Interventional Science, University College London, London, England
| | - Rebecca E Lacey
- Research Department of Epidemiology and Public Health, University College London, London, England.
- Population Health Research Institute, St George's, University of London, London, England.
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Anderson A. Regional and neighbourhood-based variation in three types of vaccine attitude in Britain. Health Place 2023; 83:103098. [PMID: 37572542 DOI: 10.1016/j.healthplace.2023.103098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/14/2023]
Abstract
This study investigates the geographic patterning of attitudes towards vaccination in Britain (England, Wales, and Scotland). Using survey data from the 2018 Wellcome Monitor linked to lower super output areas and NUTS2 regions, this study provides evidence that negative attitudes regarding the risk of side-effects from vaccination and regarding the efficacy of vaccination are correlated with higher levels of local deprivation. While previous research has highlighted associations between vaccine uptake and deprivation for a variety of reasons, this study specifically contends that particular individualised types of caution about vaccines also tend to cluster in deprived areas.
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Affiliation(s)
- Alistair Anderson
- School of Sociology and Social Policy, Law and Social Sciences Building, University Park, Nottingham, NG7 2RD, UK.
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Sturley C, Norman P, Morris M, Downing A. Contrasting socio-economic influences on colorectal cancer incidence and survival in England and Wales. Soc Sci Med 2023; 333:116138. [PMID: 37579558 DOI: 10.1016/j.socscimed.2023.116138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/15/2023] [Accepted: 08/01/2023] [Indexed: 08/16/2023]
Abstract
Colorectal cancer (CRC) is the third most commonly diagnosed cancer in the world and second most common cause of cancer death. The relationship between socio-economic deprivation and CRC incidence is unclear and previous findings have been inconsistent. There is stronger evidence of an association between area-level deprivation and CRC survival; however, few studies have investigated the association between individual-level socio-economic status (SES) and CRC survival. Data from the Office for National Statistics Longitudinal Study (LS) in England and Wales was used. LS members aged 50+ were stratified by individual-level educational attainment, social class, housing tenure and area deprivation quintile, measured at the 2001 Census. Time-to-event analysis examined associations between indicators of SES and CRC incidence and survival (all-cause and CRC death), over a 15-year follow-up period. Among 178116 LS members, incidence of CRC was lower among those with a degree, compared to those with no degree and higher among those employed in manual occupations compared to non-manual occupations. No clear relationship was observed between CRC incidence and the area-based measure of deprivation. Disparities were greater for survival. Among 5016 patients diagnosed with CRC aged 50+, probability of death from all-causes was lower among those with a degree, compared to no degree and higher among those employed in manual occupations, compared to non-manual occupations and among those living in social-rented housing, compared to owner-occupiers. Individual indicators of SES were also associated with probability of death from CRC. Those living in the most deprived areas had a higher probability of death (from all-causes and CRC) compared to those in the least deprived areas. Both individual and area-based indicators of SES were associated with CRC survival, and the relationships were stronger than those observed for CRC incidence. These findings could help inform more effective targeting of public health interventions for CRC.
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Affiliation(s)
- Charlotte Sturley
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK; Leeds Institute of Medical Research, University of Leeds, Leeds, UK.
| | - Paul Norman
- School of Geography, University of Leeds, Leeds, UK
| | - Michelle Morris
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK; Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Amy Downing
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK; Leeds Institute of Medical Research, University of Leeds, Leeds, UK
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Boyd J, Hayes K, Green D, Angus C, Holmes J. The contribution of health behaviour to socioeconomic inequalities in alcohol harm: Analysis of the UK biobank, a large cohort study with linked health outcomes. SSM Popul Health 2023; 23:101443. [PMID: 37334333 PMCID: PMC10275713 DOI: 10.1016/j.ssmph.2023.101443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/02/2023] [Accepted: 06/04/2023] [Indexed: 06/20/2023] Open
Abstract
This is the first study to use the UK Biobank database to: 1) test whether participants of a low socioeconomic position (SEP) are less likely to drink, but more likely to suffer alcohol-related harm, and 2) test the contribution of behavioural factors. The database contains health-related information from 500,000 UK residents that were recruited aged 40-69 between 2006 and 2010. Our analysis focuses on participants resident in England (86% of the total sample). We obtained baseline demographics, survey data regarding alcohol consumption and other behaviours, and linked death and hospital-admission records. The primary outcome was time from study entry to experiencing an alcohol-attributable event (hospital admission or death). The relationship between alcohol-attributable harm and five measures of SEP (area-level deprivation, housing tenure, employment status, household income and qualifications) was investigated using time-to-event analysis. Average weekly alcohol consumption, other drinking behaviours (drinking history and beverage preference), and lifestyle factors (BMI and smoking status) were added incrementally as covariates in nested regression models to investigate whether they could explain the relationship between harm and SEP. 432,722 participants (197,449 men and 235,273 women) were included in the analysis with 3,496,431 person-years of follow-up. Those of a low SEP were most likely to be never/former drinkers or high-risk drinkers. However, alcohol consumption could not explain experiences of alcohol-attributable harm between SEP groups (Hazard Ratio (HR) 1.48; 95% Confidence Interval 1.45-1.51, after adjusting for alcohol consumption). Drinking history, drinking mostly spirits, an unhealthy Body Mass Index and smoking all increased the risk of alcohol-attributable harm. However, these factors only partially explain SEP differences in alcohol harm as the HR for the most deprived vs the least deprived was still 1.28 after adjustment. This suggests that improving wider health behaviour of the most deprived could reduce alcohol-related inequalities. However, a substantial proportion of the variance in alcohol harm remains unexplained.
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Affiliation(s)
- Jennifer Boyd
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kate Hayes
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Dan Green
- College of Health and Life Sciences, Aston University, B4 7ET, Birmingham, UK
| | - Colin Angus
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - John Holmes
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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Sharma R, Humphrey JL, Frueh L, Kinnee EJ, Sheffield PE, Clougherty JE. Neighborhood violence and socioeconomic deprivation influence associations between acute air pollution and temperature on childhood asthma in New York city. Environ Res 2023; 231:116235. [PMID: 37244495 PMCID: PMC10364588 DOI: 10.1016/j.envres.2023.116235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 05/29/2023]
Abstract
Ambient air pollution, temperature, and social stressor exposures are linked with asthma risk, with potential synergistic effects. We examined associations for acute pollution and temperature exposures, with modification by neighborhood violent crime and socioeconomic deprivation, on asthma morbidity among children aged 5-17 years year-round in New York City. Using conditional logistic regression in a time-stratified, case-crossover design, we quantified percent excess risk of asthma event per 10-unit increase in daily, residence-specific exposures to PM2.5, NO2, SO2, O3, and minimum daily temperature (Tmin). Data on 145,834 asthma cases presenting to NYC emergency departments from 2005 to 2011 were obtained from the New York Statewide Planning and Research Cooperative System (SPARCS). Residence- and day-specific spatiotemporal exposures were assigned using the NYC Community Air Survey (NYCCAS) spatial data and daily EPA pollution and NOAA weather data. Point-level NYPD violent crime data for 2009 (study midpoint) was aggregated, and Socioeconomic Deprivation Index (SDI) scores assigned, by census tract. Separate models were fit for each pollutant or temperature exposure for lag days 0-6, controlling for co-exposures and humidity, and mutually-adjusted interactions (modification) by quintile of violent crime and SDI were assessed. We observed stronger main effects for PM2.5 and SO2 in the cold season on lag day 1 [4.90% (95% CI: 3.77-6.04) and 8.57% (5.99-11.21), respectively]; Tmin in the cold season on lag day 0 [2.26% (1.25-3.28)]; and NO2 and O3 in the warm season on lag days 1 [7.86% (6.66-9.07)] and 2 [4.75% (3.53-5.97)], respectively. Violence and SDI modified the main effects in a non-linear manner; contrary to hypotheses, we found stronger associations in lower-violence and -deprivation quintiles. At very high stressor exposures, although asthma exacerbations were highly prevalent, pollution effects were less apparent-suggesting potential saturation effects in socio-environmental synergism.
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Affiliation(s)
- Rachit Sharma
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
| | - Jamie L Humphrey
- Center for Health Analytics, Media & Policy, RTI International, Research Triangle Park, NC, USA
| | - Lisa Frueh
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Ellen J Kinnee
- University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Perry E Sheffield
- Department of Environmental Medicine and Public Health, and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jane E Clougherty
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Fu Y, Mason AS, Song M, Ni X, Liu L, Shi J, Wang T, Xiao M, Zhang Y, Fu D, Yu H. Multi-omics strategies uncover the molecular mechanisms of nitrogen, phosphorus and potassium deficiency responses in Brassica napus. Cell Mol Biol Lett 2023; 28:63. [PMID: 37543634 PMCID: PMC10404376 DOI: 10.1186/s11658-023-00479-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/20/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Nitrogen (N), phosphorus (P) and potassium (K) are critical macronutrients in crops, such that deficiency in any of N, P or K has substantial effects on crop growth. However, the specific commonalities of plant responses to different macronutrient deficiencies remain largely unknown. METHODS Here, we assessed the phenotypic and physiological performances along with whole transcriptome and metabolomic profiles of rapeseed seedlings exposed to N, P and K deficiency stresses. RESULTS Quantities of reactive oxygen species were significantly increased by all macronutrient deficiencies. N and K deficiencies resulted in more severe root development responses than P deficiency, as well as greater chlorophyll content reduction in leaves (associated with disrupted chloroplast structure). Transcriptome and metabolome analyses validated the macronutrient-specific responses, with more pronounced effects of N and P deficiencies on mRNAs, microRNAs (miRNAs), circular RNAs (circRNAs) and metabolites relative to K deficiency. Tissue-specific responses also occurred, with greater effects of macronutrient deficiencies on roots compared with shoots. We further uncovered a set of common responders with simultaneous roles in all three macronutrient deficiencies, including 112 mRNAs and 10 miRNAs involved in hormonal signaling, ion transport and oxidative stress in the root, and 33 mRNAs and 6 miRNAs with roles in abiotic stress response and photosynthesis in the shoot. 27 and seven common miRNA-mRNA pairs with role in miRNA-mediated regulation of oxidoreduction processes and ion transmembrane transport were identified in all three macronutrient deficiencies. No circRNA was responsive to three macronutrient deficiency stresses, but two common circRNAs were identified for two macronutrient deficiencies. Combined analysis of circRNAs, miRNAs and mRNAs suggested that two circRNAs act as decoys for miR156 and participate in oxidoreduction processes and transmembrane transport in both N- and P-deprived roots. Simultaneously, dramatic alterations of metabolites also occurred. Associations of RNAs with metabolites were observed, and suggested potential positive regulatory roles for tricarboxylic acids, azoles, carbohydrates, sterols and auxins, and negative regulatory roles for aromatic and aspartate amino acids, glucosamine-containing compounds, cinnamic acid, and nicotianamine in plant adaptation to macronutrient deficiency. CONCLUSIONS Our findings revealed strategies to rescue rapeseed from macronutrient deficiency stress, including reducing the expression of non-essential genes and activating or enhancing the expression of anti-stress genes, aided by plant hormones, ion transporters and stress responders. The common responders to different macronutrient deficiencies identified could be targeted to enhance nutrient use efficiency in rapeseed.
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Affiliation(s)
- Ying Fu
- Institute of Crop and Nuclear Technology Utilization, Zhejiang Academy of Agricultural Sciences, Hangzhou, China
| | - Annaliese S Mason
- Plant Breeding Department, University of Bonn, Katzenburgweg 5, 53115, Bonn, Germany
| | - Maolin Song
- Institute of Crop and Nuclear Technology Utilization, Zhejiang Academy of Agricultural Sciences, Hangzhou, China
- College of Advanced Agricultural Sciences, Zhejiang A&F University, Hangzhou, China
| | - Xiyuan Ni
- Institute of Crop and Nuclear Technology Utilization, Zhejiang Academy of Agricultural Sciences, Hangzhou, China
| | - Lei Liu
- Institute of Crop and Nuclear Technology Utilization, Zhejiang Academy of Agricultural Sciences, Hangzhou, China
| | - Jianghua Shi
- Institute of Crop and Nuclear Technology Utilization, Zhejiang Academy of Agricultural Sciences, Hangzhou, China
| | - Tanliu Wang
- Institute of Crop and Nuclear Technology Utilization, Zhejiang Academy of Agricultural Sciences, Hangzhou, China
| | - Meili Xiao
- Key Laboratory of Crop Physiology, Ecology and Genetic Breeding, Ministry of Education, Agronomy College, Jiangxi Agricultural University, Nanchang, 330045, China
| | - Yaofeng Zhang
- Institute of Crop and Nuclear Technology Utilization, Zhejiang Academy of Agricultural Sciences, Hangzhou, China
| | - Donghui Fu
- Key Laboratory of Crop Physiology, Ecology and Genetic Breeding, Ministry of Education, Agronomy College, Jiangxi Agricultural University, Nanchang, 330045, China.
| | - Huasheng Yu
- Institute of Crop and Nuclear Technology Utilization, Zhejiang Academy of Agricultural Sciences, Hangzhou, China.
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Lin L, Cao B, Chen W, Li J, Zhang Y, Guo VY. Association of childhood threat and deprivation with depressive symptoms and the moderating role of current economic status among middle-aged and older adults in China. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1227-1236. [PMID: 36418644 DOI: 10.1007/s00127-022-02384-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the independent impact of threat-related and deprivation-related adverse childhood experiences (ACEs) on depressive symptoms among middle-aged and older adults, and to evaluate the moderating role of current economic status in these associations. METHODS This cross-sectional study included 11,048 participants aged ≥ 45 years from the China Health and Retirement Longitudinal Study. We captured five threat-related ACEs and five deprivation-related ACEs by questionnaires. Depressive symptoms were assessed using the 10-item Centre for Epidemiological Studies Depression Scale. Current economic status was reflected by annual per capita household consumption expenditure. We performed logistic regression analyses to evaluate the independent association of childhood threat and deprivation with depressive symptoms, and conducted stratified analyses and tests for interaction to explore the moderation effect of current economic status in such associations. RESULTS Compared with the nonexposed group, the experience of both childhood threat and deprivation were independently associated with greater risks of depressive symptoms later in life (odds ratio [OR] 1.75, 95% CI 1.49-2.05 for ≥ 2 threat-related ACEs; OR 2.02, 95% CI 1.67-2.43 for ≥ 2 deprivation-related ACEs). High current economic status significantly ameliorated the impact of childhood deprivation, but not threat, on depressive symptoms (P value for interaction 0.038). CONCLUSIONS Both threat-related and deprivation-related ACEs were associated with the risk of depressive symptoms among middle-aged and older adults, while current economic status was a significant moderator in such risks only for childhood deprivation. The findings implied that prioritising targeted interventions for individuals with ACEs, especially for childhood deprivation victims who were economically disadvantaged in adulthood, may help mitigate depressive symptoms in later life.
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Affiliation(s)
- Li Lin
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou, 510080, Guangdong, China
| | - Bing Cao
- Department of Neurosurgery, Wu Tsai Neuroscience Institute, Stanford University School of Medicine, Stanford, CA, USA.
| | - Weiqing Chen
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou, 510080, Guangdong, China
| | - Jinghua Li
- Department of Biostatistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yuying Zhang
- Department of Child Healthcare, Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Vivian Yawei Guo
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou, 510080, Guangdong, China.
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McCartney G, Hoggett R, Walsh D, Lee D. How important is it to avoid indices of deprivation that include health variables in analyses of health inequalities? Public Health 2023; 221:175-180. [PMID: 37473649 DOI: 10.1016/j.puhe.2023.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVES This study aimed to quantify the difference in mortality inequalities using the Scottish Index of Multiple Deprivation (SIMD) and the Income and Employment Index (IEI; a subindex of SIMD, which excludes health) as ranking measures in Scotland. STUDY DESIGN This ecological study was a cross-sectional analysis of routine administrative data. METHODS Data from the 2020 SIMD and the subindex using data from only the Income and Employment domains, the IEI, were obtained. The correlation between data zones, percentage of data zones that changed deprivation tenth and differences in the Slope Index of Inequality (SII) and Relative Index of Inequality (RII) for Standardised Mortality Ratios (SMRs) across tenths were compared when data zones were ranked by SIMD and IEI. RESULTS There was a close correlation between data zones ranked by SIMD and IEI (R2 = 0.96). When data zones were ranked by IEI, 18.7% of data zones moved to a lower deprivation tenth, and 20.8% of data zones moved to a higher deprivation tenth, compared with SIMD. However, only a negligible number of data zones moved two or more tenths. The SMRs across deprivation tenths were very similar between the SIMD and IEI, as were the summary health inequality measures of SII (87.3 compared with 85.7) and RII (0.88 and 0.86). CONCLUSION Although there is a logical problem in using deprivation indices that include health outcomes to rank areas to calculate the scale of health inequalities, the impact of using an alternative subindex containing only data from the income and employment domains is minimal. For population-wide analyses of health inequalities in Scotland, the SIMD does not introduce a substantial bias in the health inequalities summary measures despite substantial movement of small areas between ranked population tenths. Although not examined here, this is likely to be relevant to other similar indices across the United Kingdom.
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Affiliation(s)
- G McCartney
- College of Social Sciences, University of Glasgow, 40 Bute Gardens, Glasgow, G12 8RT, UK.
| | - R Hoggett
- NHS Education for Scotland, 89 Hydepark St, Glasgow, G3 8BW, UK
| | - D Walsh
- Glasgow Centre for Population Health, Olympia Building, Bridgeton Cross, Glasgow, UK
| | - D Lee
- School of Mathematics and Statistics, Mathematics and Statistics Building, Glasgow, G12 8SQT, UK
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Santa-Ramírez HA, Otálvaro-Castro GJ, Joost S, Melgar-Quiñonez H, Bilal U, Stringhini S. Small area vulnerability, household food insecurity and child malnutrition in Medellin, Colombia: results from a repeated cross-sectional study. Lancet Reg Health Am 2023; 23:100521. [PMID: 37275622 PMCID: PMC10238747 DOI: 10.1016/j.lana.2023.100521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/27/2023] [Accepted: 05/11/2023] [Indexed: 06/07/2023]
Abstract
Background Malnutrition and food insecurity might be driven not only by individual factors but also by contextual conditions, such as area-level deprivation or vulnerability. This study aimed to analyze the association between area-level vulnerability and i) household food insecurity and ii) malnutrition in children in Medellin, Colombia, during the years 2017 and 2018. Methods We obtained data from two different sources: the Living Standards Measurement Survey (LSMS) and the nutrition surveillance system of Medellin. The main outcomes were food insecurity in households with children and anthropometric indicators for children under five. The main predictor was area-level vulnerability. Mixed effects Poisson regression with robust standard errors models were conducted to test the association of quintiles of deprivation with each outcome. Findings Households with children living in areas with the highest deprivation had 1.9 times the prevalence of food insecurity as compared to those living in areas with the lowest deprivation (PR 1.91, 95% CI 1.42-2.57). Similar results were observed for underweight/risk of underweight (PR 1.26, 95% CI 1.11-1.42), stunting/risk of stunting (PR 1.36, 95% CI 1.22-1.53) and stunting (PR 1.93 95% CI 1.55-2.39) among children under five. We found no consistent associations with wasting/risk of wasting or excess weight/risk of overweight across quintiles of deprivation. Interpretation This study sheds light on the role of area-level vulnerability on malnutrition in children in Medellin, Colombia, showing a pattern of increasing prevalence of food insecurity, underweight and stunting by quintile of deprivation. Funding Swiss School of Public Health (SSPH+) and Centre for Global Health Inequalities Research (CHAIN).
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Affiliation(s)
- Hugo-Alejandro Santa-Ramírez
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
- Health Policy and Management Research Group, National Faculty of Public Health, University of Antioquia, Medellin, Colombia
| | - Gabriel-Jaime Otálvaro-Castro
- Health Policy and Management Research Group, National Faculty of Public Health, University of Antioquia, Medellin, Colombia
| | - Stéphane Joost
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
- Group of Geographic Information Research and Analysis in Population Health (GIRAPH), Geneva, Switzerland
- Laboratory of Geographic Information Systems (LASIG), School of Architecture, Civil and Environmental Engineering (ENAC), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Hugo Melgar-Quiñonez
- McGill Institute for Global Food Security, School of Human Nutrition, McGill University, Montreal, Canada
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- University Centre for General Medicine and Public Health (UNISANTE), University of Lausanne, Lausanne, Switzerland
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Lewis C, Johnson S, Hartwig A, Ubido J, Coleman A, Gartland N, Kamal A, Gaokar A, Armitage CJ, Fishwick D, van Tongeren M. Areas of enduring COVID-19 prevalence: drivers of prevalence and mitigating strategies. BMC Public Health 2023; 23:1203. [PMID: 37344781 DOI: 10.1186/s12889-023-15723-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 04/20/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND UK local authorities that experienced sustained high levels of COVID-19 between 1st March 2020 and 28th February 2021 were described by the UK Scientific Advisory Group for Emergencies as areas of enduring prevalence. This research was carried out in order to examine the views of local authority Directors of Public Health, who played a crucial role in the local response to COVID-19, on reasons for sustained high levels of prevalence in some areas, alongside an investigation of the mitigation strategies that they implemented during the course of the pandemic. METHODS Interviews were conducted with Directors of Public Health in 19 local authority areas across England, between July and November 2021. This included nine areas identified as areas of enduring prevalence and ten 'comparison' areas. RESULTS The outcomes of this study suggests that the geographical differences in prevalence rates are strongly influenced by health inequalities. Structural factors including deprivation, employment, and housing, due to their disproportionate impact on specific groups, converged with demographic factors, including ethnicity and age, and vaccination rates, and were identified as the main drivers of enduring prevalence. There are key differences in these drivers both within and, to a lesser extent, between local authorities. Other than these structural barriers, no major differences in facilitators or barriers to COVID-19 mitigation were identified between areas of varying prevalence. The main features of successful mitigation strategies were a locally tailored approach and partnership working involving local authority departments working with local health, community, voluntary and business organisations. CONCLUSIONS This study is the first to add the voices of Directors of Public Health, who played a crucial role in the local COVID-19 response. Areas of enduring prevalence existed during the pandemic which were caused by a complex mix of structural factors related to inequalities. Participants advised that more research is needed on the effectiveness of mitigation strategies and other measures to reduce the impact of structural inequalities, to better understand the factors that drive prevalence. This would include an assessment of how these factors combine to predict transmission and how this varies between different areas.
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Affiliation(s)
- Catherine Lewis
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England.
| | - Sheena Johnson
- Alliance Manchester Business School, University of Manchester, Manchester, England
| | - Angelique Hartwig
- Alliance Manchester Business School, University of Manchester, Manchester, England
| | - Janet Ubido
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Anna Coleman
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Nicola Gartland
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Atiya Kamal
- Birmingham City University, Birmingham, England
| | - Amit Gaokar
- Rochdale Borough Council, Manchester, England
| | | | | | - Martie van Tongeren
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
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Duke-Williams O, Stockton J, Shelton N. Levelling Up for health in towns? Development of a new deprivation index: the 'Stronger Towns Index' and its association with self-rated health and migration in England, between 2001 and 2011. Z Gesundh Wiss 2023:1-7. [PMID: 37361310 PMCID: PMC10249929 DOI: 10.1007/s10389-023-01944-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 05/11/2023] [Indexed: 06/28/2023]
Abstract
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.
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Affiliation(s)
- Oliver Duke-Williams
- Department of Information Studies, University College London (UCL), London, WC1E 6BT UK
| | - Jemima Stockton
- Centre for Longitudinal Study Information and User Support (CeLSIUS), Department of Epidemiology and Public Health, University College London (UCL), London, WC1E 6BT UK
| | - Nicola Shelton
- Centre for Longitudinal Study Information and User Support (CeLSIUS), Department of Epidemiology and Public Health, University College London (UCL), London, WC1E 6BT UK
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48
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Bandyopadhyay A, Whiffen T, Fry R, Brophy S. How does the local area deprivation influence life chances for children in poverty in Wales: A record linkage cohort study. SSM Popul Health 2023; 22:101370. [PMID: 36891499 PMCID: PMC9986621 DOI: 10.1016/j.ssmph.2023.101370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/16/2023] [Accepted: 02/18/2023] [Indexed: 02/25/2023] Open
Abstract
Objectives Children growing up in poverty are less likely to achieve in school and more likely to experience mental health problems. This study examined factors in the local area that can help a child overcome the negative impact of poverty. Design A longitudinal record linkage retrospective cohort study. Participants This study included 159,131 children who lived in Wales and completed their age 16 exams (Key Stage 4 (KS4)) between 2009 and 2016. Free School Meal (FSM) provision was used as an indicator of household-level deprivation. Area-level deprivation was measured using the Welsh Index of Multiple Deprivation (WIMD) 2011. An encrypted unique Anonymous Linking Field was used to link the children with their health- and educational records. Outcome measures The outcome variable 'Profile to Leave Poverty' (PLP) was constructed based on successful completion of age 16 exams, no mental health condition, no substance and alcohol misuse records in routine data. Logistic regression with stepwise model selection was used to investigate the association between local area deprivation and the outcome variable. Results 22% of children on FSM achieved PLP compared to 54.9% of non-FSM children. FSM Children from least deprived areas were significantly more likely to achieve PLP (adjusted odds ratio (aOR) - 2.20 (1.93, 2.51)) than FSM children from most deprived areas. FSM children, living in areas with higher community safety, higher relative income, higher access to services, were more likely to achieve PLP than their peers. Conclusion The findings indicate that community-level improvements such as increasing safety, connectivity and employment might help in child's education attainment, mental health and reduce risk taking behaviours.
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Affiliation(s)
- Amrita Bandyopadhyay
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Wales, SA2 8PP, UK.,Administrative Data Research Unit, Swansea University, Wales, SA2 8PP, UK
| | - Tony Whiffen
- Administrative Data Research Unit, Welsh Government, Wales, CF10CF10 3NQ, UK
| | - Richard Fry
- Administrative Data Research Unit, Swansea University, Wales, SA2 8PP, UK.,Health Data Research UK, Swansea University Medical School, Wales, SA2 8PP, UK
| | - Sinead Brophy
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Wales, SA2 8PP, UK.,Administrative Data Research Unit, Swansea University, Wales, SA2 8PP, UK.,Health Data Research UK, Swansea University Medical School, Wales, SA2 8PP, UK
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Crescenzi F, Neri L. Estimating fuzzy measures of deprivation at local level in Tuscany. Qual Quant 2023:1-20. [PMID: 37359972 PMCID: PMC10220345 DOI: 10.1007/s11135-023-01679-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 06/28/2023]
Abstract
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.
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Affiliation(s)
- Federico Crescenzi
- Department of Economics, Engineering, Society, Business Organization, Tuscia University, Viterbo, Italy
| | - Laura Neri
- Department of Economics and Statistics, University of Siena, Siena, Italy
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Kwon E, Fisher S, Lin HC, Kogan SM. Racial discrimination, childhood adversity, and depression among Black men: Tests of stress sensitization hypotheses. Psychiatry Res 2023; 325:115257. [PMID: 37257250 DOI: 10.1016/j.psychres.2023.115257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/29/2023] [Accepted: 05/18/2023] [Indexed: 06/02/2023]
Abstract
Racial discrimination has been linked to depression among Black American men. Racial discrimination, however, does not uniformly confer risk for depression. According to the stress sensitization theory, racial discrimination can be particularly harmful for those with histories of adversity in childhood. Existing research on stress sensitization is limited in that it has conceptualized childhood adversity as a unidimensional construct composed of a broad range of stressful experiences. To fill this gap in the literature, the current study investigated stress sensitization hypotheses, focusing on how different dimensions of adverse childhood experiences moderate the association between racial discrimination and depression. Study sample was 504 young Black men (mean age at baseline = 20.3, SD = 1.08) living in rural counties in South Georgia where childhood adversity is disproportionately high. The association between racial discrimination and increased risk for depressive symptoms varied by the degree of childhood experience of deprivation, but not threat. Our findings suggest that no or low levels of childhood deprivation, which is commonly regarded as a protective factor, can elevate the negative effects of discrimination on depression. This finding emphasizes that clinicians should consider developmental risk and protective factors that are unique to Black American men.
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Affiliation(s)
- Elizabeth Kwon
- Department of Public Health, Baylor University, Waco, TX, United States.
| | - Sycarah Fisher
- Department of Educational Psychology, University of Georgia, Athens, GA, United States
| | - Hsien-Chang Lin
- School of Public Health, Indiana University, Bloomington, IN, United States
| | - Steven M Kogan
- Department of Human Development and Family Science, University of Georgia, Athens, GA, United States
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