This article focuses on the economic dimensions of maternal health, highlighting the benefits of investing in maternal healthcare and the policy implications for sustainable development. Through a comprehensive review of the literature, the article explores the economic impact of maternal health, including its effects on human capital, productivity, and healthcare costs. It emphasizes the importance of addressing social determinants such as access to healthcare services, education, employment, income, and geographical disparities. By prioritizing maternal health, societies can unlock the economic potential of women, promote inclusive growth, and reduce gender disparities. The article discusses policy interventions, including the importance of healthcare infrastructure, financial support for maternal healthcare, and promoting gender equality. It also emphasizes the need for future research to quantify the economic benefits and evaluate the cost-effectiveness of different interventions. Overall, the article underscores the economic imperative of investing in maternal health and provides valuable insights for policymakers and researchers seeking to enhance maternal health outcomes and promote sustainable economic development.

Sepsis, a syndrome characterized by systemic inflammation during infection, continues to be one of the most common causes of patient mortality in hospitals across the United States. While standardized treatment protocols have been implemented, wide variability in clinical outcomes persist across racial groups. Specifically, Black and Hispanic populations are frequently associated with higher rates of morbidity and mortality in sepsis compared to the Caucasian population. While this is often attributed to systemic bias against minority groups, a growing body of literature has found patient, community, and hospital-based factors to be driving racial differences. In this article, we provide a focused review on some of the factors driving racial disparities in sepsis. We also suggest potential interventions aimed at reducing health disparities in the prevention, early identification, and clinical management of sepsis.

Smoking is a pervasive global health concern associated with a myriad of diseases, but its impact on cellular aging, particularly in relation to telomeres, is increasingly recognized. Telomeres, protective caps at the ends of chromosomes, play a crucial role in maintaining genomic integrity. This review critically examines the existing evidence on the association between smoking and telomere atrophy, exploring the molecular mechanisms involved and the implications for accelerated aging and heightened disease risk. The comprehensive analysis encompasses both cross-sectional and longitudinal studies, elucidating potential gender and age disparities. Insights into the molecular pathways linking smoking to telomere shortening are discussed, along with the broader implications for public health. The review concludes by outlining potential interventions and suggesting future research directions in this critical area.

Language barriers exacerbate health disparities among minorities. This study highlights the efficacy of simple interventions in mitigating language barriers, optimizing clinic efficiency, and enhancing preparedness for surgical procedures in Spanish-speaking (SS) females diagnosed with breast cancer in a safety net community hospital. A bilingual questionnaire was given to English and SS patients during their initial clinic visit. Additionally, a bilingual handout on surgical options and postoperative care was provided to selected surgical patients. Among the 41 patients studied, those who completed the questionnaire had an average encounter time of 27.06 minutes, compared to 45.26 minutes for those who did not. For SS patients, the average encounter time with the questionnaire was 34.07 minutes versus 46.54 minutes without it. The average cost of a medical interpreter was $17.04 with the questionnaire, versus $23.27 without. All SS patients who received the educational handout expressed greater satisfaction and understanding of their treatment plans and were less likely to require additional pre-surgery visits. This study demonstrated how the simple implementation of a translated questionnaire can reduce interpretation cost, encounter time, and improve clinic flow. Furthermore, utilizing a bilingual surgical educational handout enhances patient understanding, surgery readiness and reduces unnecessary additional visits.

Telecommunication infrastructure, as a technology-intensive industry, provides fundamental support for informatization construction. This paper empirically studies the impact of telecommunication infrastructure construction on economic and social innovative development using provincial panel data from China spanning from 2009 to 2022. The research findings indicate the following: (1) Telecommunication infrastructure significantly promotes innovation in terms of R&D investment, knowledge output, and application output. (2)At various stages of telecommunication technology development, the impact on innovative development varies. Iterative updates in telecommunication technology drive higher R&D expenditures, facilitating better utilization of innovation outcomes in industries. (3) There are regional disparities in the influence of telecommunication infrastructure on economic and social innovative development. In the eastern regions, telecommunication infrastructure construction primarily promotes mobile communication, with clear spillover effects. In contrast, in western regions, it mainly facilitates fixed communication networks. Therefore, in the new development stage of China, further strengthening telecommunication infrastructure construction provides a new impetus and space for economic and social innovative development. It is essential to persistently advance the coordinated construction of mobile and fixed communication infrastructure to achieve regional development coordination.

Abstract: Background: The birthrate of Black preterm (BPT) infant is 65% higher than White preterm (WPT) infants with BPT mortality 2.3 times higher. The incidence of culture positive sepsis is as high as 41% in preterms. This study aimed to examine infections and mortality in BPTs and WPTs. Methods: We enrolled 362 preterms born < 32 weeks gestational age (GA) between 2019-2023 in 5 neonatal intensive care unit (NICU)s to study onset of infections, and dispositions; RedCap data were analyzed for descriptive statistics. Results: 226 BPTs (63.5%) and 107 WPTs (30.8%) enrolled, with 29 other than White or Black, 50.5% female, mean GA of 27.67 weeks and 986.74 grams birthweight. Of 426 suspected infections evaluated in enrolled infants, there were 7 infants with early onset sepsis (EOS) and 39 infants with late onset sepsis (LOS). The incidence of EOS was 1.9% overall, 2.2% in BPTs vs 0.9% in WPTs. LOS incidence was 10.8% overall, 11.9% in BPTs and 9.3% in WPTs. Both BPT and WPT infants had ~ 8% gram-positive LOS events and 3% gram-negative LOS events; however, 82% of all gram-negative LOS episodes occurred in BPTs. There were 27 urinary tract infections and 78% were in BPTs. Two cerebral spinal fluid cultures were positive in BPTs. Necrotizing enterocolitis was diagnosed in 5.8% of the sample, with an incidence of 6.1% in BPTs versus 4.7% in WPTs. Death occurred in 6.0% of the enrolled infants with the rate of death being slightly higher in BPTs (7.0%) versus WPTs (5.6%). Conclusions: BPTs had a higher rate of positive cultures, double the gram-negative infections, a much higher rate of urinary tract infec-tions and a higher rate of mortality than their WPT counterparts. This study emphasizes higher risk of morbidity and mortality for BPTs.

COVID-19 has proven to be detrimental across the globe, most notably affecting the United States at an alarming rate compared to comparable countries. The pandemic has had multifactorial implications on the way communities in the United States prevent, prepare for, and address the virus; however, the impact of the pandemic on rural health is less well understood. Historically, rural communities have faced a unique set of challenges regarding accessing and receiving adequate healthcare, addressing chronic illness, and eliminating health disparities closely associated with the population’s socioeconomic status; the pandemic has exacerbated these challenges. The purpose of the current study was to conduct a systematic review of the literature to evaluate the effect of the COVID-19 pandemic on rural populations both at the individual and community level. Results indicated that rural health disparities increased both at the individual and system-wide levels as a direct result of the pandemic. Budget cuts significantly affected the infrastructure of rural hospitals resulting in them being unequipped to handle such high volumes of COVID-19 cases. The lack of infectious disease specialists, access to larger medical centers with substantial numbers of ICU beds and ventilators, and an overall lack of preparedness overwhelmed rural communities. Although comorbidities such as diabetes and heart disease were associated with poorer health outcomes for a multitude of reasons, the lack of clinic and physician availability for routine care during the pandemic further exacerbated the clinical link from COVID-19 positivity to comorbidities. Furthermore, mental health deteriorated as substance use increased to a greater extent in rural communities compared to urban, during the pandemic. This study shows that health comorbidities, mental health, substance use, health literacy, access to healthcare, among others can serve as key indicators for improving healthcare in rural communities. Future studies should seek to identify key issues that disproportionately affected rural communities in comparison to their urban counterparts considering the pandemic, as well as identify gaps in the availability of rural health resources that can improve the lives of millions of Americans now and during the next pandemic.

There is a disproportionate increase in the incidence of diet-related cardiometabolic disorders in racial and ethnic minority groups. This systematic review examines the extent to which diet-induced changes in health outcomes have been discussed by race or ethnicity in randomized controlled trials recruiting both minority and non-Hispanic White groups. Databases i.e. PubMed, Cochrane library and Web of Science were searched up to November 2019. Studies that discussed effects of defined dietary interventions on health outcomes by racial or ethnic minority group vs. non-Hispanic Whites (n=29) were included in the review. Most studies were conducted in Black vs. White people testing effects of energy restriction, macronutrient modification, sodium reduction, or variations of the Dietary Approaches to Stop Hypertension (DASH) diet on cardiometabolic outcomes. There was limited focus on other minority groups. Evidence suggests greater blood pressure reduction for Black people compared to Whites particularly on DASH (or similar) diets. Overall, there was limited consideration for group-specific eating patterns and diet acceptability in most studies. Adequately powered studies are needed for accurate interpretation of race by diet effects. With emerging precision nutrition initiatives, it is imperative to ensure adequate representation of racial and ethnic subgroups for addressing nutrition-related health disparities.

Multiple Sclerosis (MS) is a progressive neurodegenerative disease that affects more than 2 million people worldwide. Increasing knowledge about MS in different populations has advanced our understanding of disease epidemiology and variation in the natural history of MS among White and minority populations. In addition to differences in incidence, African American (AA) and Hispanic patients have greater disease burden and disability in earlier stages of disease compared to White patients. To further characterize MS in AA and Hispanic populations, we conducted a retrospective chart analysis of 112 patients treated at an MS center in Houston, Texas. Here, we describe differences in clinical presentation, MRI findings, treatment regimens, disability progression, and relapse rate. We found that patients who were evaluated by a neurologist at symptom onset had significantly decreased odds of greater disability [defined as Expanded Disability Status Scale (EDSS) &gt; 4.5] at last presentation compared to patients who were not evaluated by a neurologist (OR: 0.04, 95% CI: 0.16-0.9). We also found that active smokers had significantly increased odds of greater disability both at diagnosis and at last clinical encounter compared to nonsmokers (OR: 2.44, 95% CI: 1.10-7.10, OR= 2.44, 95% CI: 1.35-6.12, p= 0.01, respectively). Assessment of the degree of brain atrophy and progression over time along with enumeration of T1, T2, and gadolinium-enhancing brain lesions did not reveal differences across groups.

The number one leading cause of death in 2017 for Americans was cardiovascular disease, and health disparities can exacerbate risks. This study evaluates the 2018 Behavioral Risk Factor Surveillance System (n=437,436) to estimate population risks for behavioral, socio-economic, psychological, and biological factors. A general linear model with a quasi-binomial link function indicated higher risks for the following groups: smokers, individuals with higher body-mass index scores, persons unable to work, individuals with depression, workers who missed more days due to mental issues, the elderly, those in race categories “indigenous Americans, Alaskan non-Hispanics” or “other, non-Hispanic,” and individuals with lower income. The results confirm previous studies and raise more questions about drinking and cardiovascular disease. Policy and ethical considerations are also discussed.

Human genetic studies have long been vastly Eurocentric, raising a key question about the generalizability of these study findings to other populations. Because humans originated in Africa, these populations retain more genetic diversity, and yet individuals of African descent have been tremendously underrepresented in genetic studies. The diversity in Africa affords ample opportunities to improve fine-mapping resolution for associated loci, discover novel genetic associations with phenotypes, build more generalizable genetic risk prediction models, and better understand the genetic architecture of complex traits and diseases subject to varying environmental pressures. Thus, it is both ethically and scientifically imperative that geneticists globally surmount challenges that have limited progress in African genetic studies to date while meaningfully including African investigators, as greater inclusivity and enhanced research capacity affords enormous opportunities to accelerate genomic discoveries that translate more effectively to all populations. We review the advantages and challenges of studying the genetic architecture of complex traits and diseases in Africa. For example, with greater genetic diversity comes greater ancestral heterogeneity; this higher level of understudied diversity can yield novel genetic findings, but some methods that assume homogeneous population structure and work well in European populations may work less well in the presence of greater diversity and heterogeneity in African populations. Consequently, we advocate for methodological development that will accelerate studies important for all populations, especially those currently underrepresented in genetics.

Purpose: The study aims to investigate racial disparities in fall-related injuries among Black and White breast cancer survivors who received chemotherapy, focusing on the risks associated with different chemotherapy regimens. Methods: This retrospective cohort study involved 11,400 breast cancer survivors (Stage 1-3) treated with chemotherapy between January 1, 2019, and December 31, 2023. Chemotherapy types studied include Doxorubicin, Cyclophosphamide, Paclitaxel, Docetaxel, and Carboplatin. Logistic regression and descriptive analyses were used to assess fall risk associated with each chemotherapy type, stratified by race. Results: The overall fall-related injury rate was higher among Black survivors (14.7%) compared to White survivors (10.0%), with a significant difference in fall risk between the two groups (p < 0.001). Fall risk was notably elevated for Black patients treated with Cyclophosphamide, Docetaxel, and Carboplatin. Conclusions: The findings highlight significant racial disparities in fall-related injuries among breast cancer survivors receiving chemotherapy. These disparities may be influenced by socioeconomic factors and healthcare access. Implications for Cancer Survivors: Interventions targeting fall prevention and equitable healthcare access are critical to reducing these disparities among Black breast cancer survivors.

Background: The aim of this study is to explore the independent and joint associations between physical activity (PA) and sleep duration with depressive symptoms. Methods: We included and analyzed 18,052 participants (age ≥ 20 years) from the cross-sectional National Health and Nutrition Examination Survey (NHANES) conducted between 2007 and 2014. Results: After adjustment, both males and females showed a significant correlation between PA, sleep duration, and depressive symptoms. In the joint association analysis, we found: 1. The interaction between PA and sleep duration was statistically significant in males but not significant in females (P=0.380). 2. Compared to individuals with the lowest PA level and not meeting the National Sleep Foundation's (NSF) guidelines, those with the highest PA level and recommended sleep duration had a 79% decrease in depression risk in males (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.14-0.32) and a 74% decrease in females (OR 0.26, 95% CI 0.20-0.35). 3. In male participants adhering to NSF guidelines, each increase in PA quartile is associated with a 19% reduction in the risk of depression (OR 0.81, 95% CI 0.71-0.92). Conversely, among male participants not adhering to NSF guidelines, there is a 23% decrease in depression risk (OR 0.77, 95% CI 0.69-0.86). For female participants, the respective reductions in depression risk are 20% (OR 0.80, 95% CI 0.73-0.89) and 14% (OR 0.86, 95% CI 0.80-0.93). Conclusion: For males, adherence to recommended sleep duration weakens the relationship between physical activity and depression, while the opposite is observed for females.

We seek to elucidate an aspirational vision for the food system and explore whether the characteristics of such a system inadvertently set unattainable standards for rural, low wealth communities. We apply discourse analysis to the following qualitative datasets: (1) interviews with food experts and advocates, (2) scholarly and grey literature, (3) industry websites, and (4) email exchanges between food advocates. The analysis revealed eight aspirational food system discourses: Production, Distribution, and Infrastructure; Healthy, Organic, Local Food; Behavioral Health and Education; Sustainability; Finance and Investment; Huger Relief; Demand Side Preferences; Romanticized, Community Led Transformations. Study findings reveal that of eight discourses only three encompass the experiences of rural, low wealth residents. This aspirational food system may result in the disempowerment of the needs of rural, low wealth groups; a perpetuation of the failure of groups who will be unable to reach the aspirational food vision; silencing of discourses that might question those that play a role in the inequitable distribution of income while sanctioning discourses that focus on personal or community solutions; and the absence of other policy-based solutions that address issues located within the food system. Further research is needed to inform policies and programs to mitigate food insecurity in rural, low wealth populations.

Chronic kidney disease (CKD) is a major non-communicable disease associated with high rates of premature morbidity and mortality. The prevalence of hypovitaminosis D (deficiency of 25(OH)D or 25D) is greater in racial/ethnic minorities and in patients with CKD than the general population. Low 25D is associated with bone and mineral disorders as well as immune, cardiometabolic and cardiovascular (CV) diseases. Thus, it has been suggested low 25D contributes to the poor outcomes in patients with CKD. The prevalence of hypovitaminosis D rises progressively with advancing severity of kidney disease with over 30% of patients with CKD stage 3 and 70% patients with CKD stage 5 estimated to have low levels of 25D. This report describes several of the abnormal physiologic and counter-regulatory actions related to low 25D in CKD such as those in oxidative stress and inflammatory systems, and some of the preclinical and clinical evidence or lack of thereof of normalizing serum 25D levels to improve outcomes in patients with CKD, and especially for the high risk subset of racial/ethnic minorities who suffer from higher rates of advanced CKD and hypovitaminosis D.

HIV early detection (CD4 counts ≥350 cells/μL) is correlated with higher life expectancy among people living with HIV (PLHIV). Several factors including physical, cultural, structural, and financial barriers have contributed to HIV late detection. This is the first-of-its-kind study on the regional differences in early detection of HIV within Tajikistan and any country in the Central Asia region. Utilizing Tajikistan Ministry of Health's national HIV data (N=10,700) spanning 2010 to 2023, we developed median regression models with median CD4 cell count as the outcome and as predictors: time (years), region, age, gender, and area (urban/rural status). Individuals younger than 19 years old are more likely to be detected early for HIV, whereas those older than 39 years are more prone to late detection. Given their active engagement in age-related and sexual activities, those older than 39 years face a higher risk of HIV transmission to others if diagnosed late. Therefore, they require further attention and targeted interventions. Females are detected earlier compared to their male counterparts, regardless of region of residence. Rural populations are detected earlier in most years compared to their urban counterparts. The COVID-19 pandemic accelerated HIV early detection in 2021 but most regions have returned to near pre-pandemic levels of detection in 2022 and 2023. These fluctuations in early detection may signify a shift in attention and resource allocation, potentially affecting efforts to address access gaps during the initial year of the COVID-19 pandemic. There are significant health inequities among different demographic and geographic groups which warrant further attention.

A striking aspect of COVID-19 is the difference in the outcome of the infection between different countries, and different ethnic groups within one country. We surveyed the literature on SARS-CoV-2 complemented with comparative publications on SARS-CoV and other coronaviruses to capture the current understanding of virus – host interactions including virus subtypes, transmission, zoonotic aspects, and potential host determinants.

Papillary thyroid carcinoma (PTC) presents a significant health concern, particularly among Hispanic women in the United States, who exhibit a disproportionately higher chance of developing an advanced disease when compared to the non-Hispanic population. Emerging evidence suggests coagulation factor X, encoded by F10 gene, has a potential role in inhibiting cancer cell migration. However, comprehensive investigations into the differential expression patterns of F10 in Hispanic versus non-Hispanic females remain limited. RNA-sequencing data was acquired from the TCGA database for white female patients, 166 non-Hispanic and 25 Hispanic. A statistically significant (p &lt; 0.05) 2.06-fold increase in F10 expression levels was detected in disease-free tumors compared to recurrent PTC tumors. Furthermore, an increase in F10 gene expression levels was also observed corresponding to approximately a 1.74-fold increase in non-Hispanic patients compared to Hispanic patients. The probability of tumor recurrence was 1.82 times higher in the cohort with low expression of F10 compared to the high expression cohort, correlating with the lower disease-free rates observed in Hispanic patients’ cohort when compared to non-Hispanics. This finding underscores the relevance of ethnic disparities in molecular profiles for understanding cancer susceptibility. Identifying F10 as a potential prognostic biomarker highlights avenues for targeted interventions and contributes to improving diagnostic and treatment strategies for diverse patient populations.

This article addresses the socioeconomic gradient in immigrant health by exploring immigration status and social capital as key considerations in measurement and development of health-promoting research and practice. This paper also seeks to draw attention to the importance of understanding how researchers approach the study of health disparities affecting minoritized and immigrant populations. A critical examination of the measures used in comparative health research challenges scholars to consider the different pathways through which socio-economic factors impact health and underscores the ethical commitment of health disparities researchers to consider the relevance and implications of their work. Given the reliance on existing data from national population health surveys to test the assumptions of the immigrant paradox, any immigrant-specific measure of SES with limited application to a large, representative sample of immigrants would likely hold little appeal to both researchers and practitioners. Understanding the mechanisms through which socioeconomic status influences immigrant health can allow scholars to address the needs of immigrant populations and advocate more effectively for programs and policies that seek to advance the health of all people.

Abstract: Objective: We aimed to look for the mortality of Black and White Neonates and compare the Black and White neonates' mortalities after stratifying the population by many significant epidemiologic and hospital factors. We utilized the National Inpatient Sample (NIS) dataset over seven years from 2012 through 2018 for all neonates ≤ 28 days of age in all hospitals in the USA. Design/Method: We utilized the National Inpatient Sample (NIS) dataset over seven years from 2012 through 2018 for all neonates ≤ 28 days of age in all hospitals in the USA. Neonatal characteristics used in the analysis included ethnicity, sex, household income, and type of healthcare insurance. Hospital characteristics were urban teaching, urban non-teaching, and rural. Hospital location was classified according to the 9 U.S. Census Division regions. Results: Neonatal mortality continues to be higher in Black: 21,975 (0.63%) and in White was: 35495 (0.28%), Government-supported health insurance was significantly more among Black populations when compared to White (68.8% vs. 35.3% p<0.001). Household income differed significantly; almost half (49.8%) of the Black population has income ≤ 25th percentile vs. 22.1% in White. There was a significant variation in mortality in different U.S. locations. In the Black population, the highest mortality was in the West North Central division (0.72%), and the lower mortality was in the New England division (0.51%), whereas in the White population, the highest mortality was in the East South-Central division (0.36%), and the lowest mortality was in the New England division (0.21%). Trend analysis showed a significant decrease in mortality in Black and White populations over the years, but when stratifying the population by sex, types of insurance, the household income, the type of hospitals, the mortality was consistently higher in Black groups throughout the study years, Conclusions: Disparities in neonatal mortality continue to be higher in Black; There was a significant variation in mortality in different U.S. locations. In the Black population, the highest mortality was in the West North Central division, and the lower mortality was in the New England division, whereas in the White population, the highest mortality was in the East South-Central division, and the lowest mortality was in the New England division. There has been a significant decrease in mortality in Black and White populations over the years, but when stratifying the population by many significant epidemiologic and hospital factors, the mortality was consistently higher in Black groups throughout the study years.

The aim of innovations in road safety is to contribute to better protection of road users and to minimize damage to their property. The main objective of the article is to identify disparities in the perception of an innovation element in road safety by road users based on their type of employment and the number of kilometers driven per year. The research will evaluate the attitudes of selected groups of road users based on the number of kilometers driven in a calendar year and whether driving a motor vehicle is their main job duty. The analysis involved 239 respondents using a paper questionnaire. Disparities in the perception of innovations in road safety were evaluated using contingency tables, chi-square tests, non-parametric tests, and Cramer's V. Road users feel much safer with a front braking light when crossing traffic of vehicles and pedestrians (71%); at pedestrian crossings (74%); when turning left (63.4%); as well as when crossing traffic of multiple vehicles (62.5%). Disparities among respondents based on the type of employment of the road user were not confirmed. Conversely, road users with a higher number of kilometers driven per year have a more positive perception of the innovation element at pedestrian crossings.

Introduction Prostate Cancer (PCa) exhibits one of the widest racial and socioeconomic disparities. PCa disparities have also been widely linked to location as living in more deprived regions was associated with lower healthcare access and worse outcomes. This study aims to examine PCa survival across various US counties in function of different socioeconomic profiles and discuss the role of potential intermediary factors. Methods The SEER database linked to county-level SES was utilized. Five-year PCa-specific survival using the Kaplan Meier method was performed for 5 racial/ethnic categories in function of SES quintiles. Multilevel Cox proportional hazards regression was performed to assess the relationship between county-level SES and PCa survival. Multivariate regression analysis was performed to examine the role of healthcare utilization and severity. Results 279,000 PCa records were extracted, 5-year PCa-specific survival was 94%. Overall, living in counties with worst poverty/income quintile and highest proportions of foreign-born/language-isolated increased PCa mortality by 23% each. No association was observed with county-level High-School education, while Bachelor’s-level education decreased mortality risk by 23%. Associations varied considerably upon racial/ethnic stratification. Multilevel analyses showed varying contributions of individual and area-level factors to survival within minorities. The relationship between SES and PCa survival appeared to be influenced by healthcare utilization and disease stage/grade. Discussion Racial/ethnic categories responded differently under similar county-level SES and individual-level factors to the point where disparities reversed in Hispanics. The inclusion of Healthcare utilization and severity factors may provide partial early support for their role as intermediaries. Healthcare access (insurance) might not necessarily be associated with better PCa survival, through performing biopsy and or/surgery. County-level education plays an important role in PCa decision-making as it might elucidate discussions of other non-invasive management options. Conclusion Findings of this study demonstrate that interventions need to be tailored according to each group's needs. This potentially informs the focus of public health efforts in terms of planning and prioritizing. This study could also direct further research delving into pathways between area-level characteristics with PCa survival.

COVID-19 is a potentially fatal viral infection. This study investigates geography, demography, socioeconomics, health conditions, hospital characteristics, and politics as potential explanatory variables for death rates at the state and county levels. Data from the Centers for Disease Control and Prevention, the Census Bureau, Centers for Medicare and Medicaid, Definitive Healthcare, and USAfacts.org were used to evaluate regression models. Yearly pneumonia and flu death rates (state level, 2014-2018) were evaluated as a function of the governors’ political party using repeated measures analysis. At the state and county level, spatial regression models were evaluated. At the county level, we discovered a statistically significant model that included geography, population density, racial and ethnic status, three health status variables along with a political factor. State level analysis identified health status, minority status, and the interaction between governors’ parties and health status as important variables. The political factor, however, did not appear in a subsequent analysis of 2014-2018 pneumonia and flu death rates. The pathogenesis of COVID-19 has greater and disproportionate effect within racial and ethnic minority groups, and the political influence on the reporting of COVID-19 mortality was statistically relevant at the county level and as an interaction term only at the state level.

In response to the National Institutes of Health (NIH) All of Us Medicine Research Initiative, the Precision Medicine Research (PreMeR) Diversity Consortium was formed by four institutions from the Research Centers in Minority Institutions (RCMI) Translational Research Network (RTRN). This synergistic approach proposed evidence-based, best practices used by experienced researchers to engage, recruit and retain diverse populations in the All of Us initiative. Conceptualization of the proposed approach was aided by social influence theories to better understand how people’s beliefs and opinions should be modified to affect change leading to action [1]. The Social-Ecological Model (SEM), for Health Promotion [2], from Stokols [1] and Community-Based Participatory (CBPR) Models[3],[4] guided proposed engagement, recruitment, and retention strategies contextualized with the individual, interpersonal, organizational, community, and policy spheres of influence. The PreMeR produced a partnership to evaluate and improve the effectiveness of current engagement, recruitment, and retention strategies for minority participation in scientific studies. This approach illustrates the need to incorporate multiple methods of engagement to reach a diverse audience to participate in scientific research. Engagement, recruitment, and retention strategies in community and biomedical research must be viewed as community engaged public health interventions, utilizing the same theoretical principles and approaches.

This article examines the application of Keynesian theory in economic geography, focusing on regional development and reducing inequalities. The objective is to highlight the relevance and benefits of applying Keynesian principles in addressing spatial economic challenges. The novelty lies in examining the intersection of Keynesian economics and geography, which offers insights into regional planning, infrastructure development, and cluster formation. The results show how policymakers and researchers can use Keynesian theory to promote balanced growth and improve living standards. The keywords for this article are Keynesian theory, economic geography, regional development, disparities, and policy interventions.

Despite the development of targeted therapeutics, immunotherapy, and strategies for early detection, lung cancer carries a high mortality. Further, significant racial disparities in outcomes exist for which the molecular drivers have yet to be fully elucidated. The growing field of Epitranscriptomics has introduced a new layer of complexity to the molecular pathogenesis of cancer. RNA modifications can occur in coding and non-coding RNAs, such as miRNAs, possibly altering their gene regulatory function. The potential role for such modifications as clinically informative biomarkers remains largely unknown. Here, we concurrently profiled canonical miRNAs, shifted isomiRs (templated and non-templated), miRNAs with single-point modification events (RNA and DNA) in White American (W) and Black or African American (B/AA) lung adenocarcinoma (LUAD) patients. We found that while most deregulated miRNA isoforms were similar in W and B/AA LUAD tissues compared to normal adjacent tissues, there was a subgroup of isoforms with deregulation according to race. We specifically investigated an edited miRNA, miR-151a-3p with an A-to-I editing event at position 3, to determine how its altered expression may be associated with activation of divergent biological pathways between W and B/AA LUAD patients. Finally, we identified distinct race-specific miRNA isoforms that correlated with prognosis for both Ws and B/AAs. Our results suggest that concurrently profiling canonical and non-canonical miRNAs may have potential as a strategy for identifying additional distinct biological pathways and biomarkers in lung cancer.

Previous research suggests that the economic crisis can affect mental health. The purpose of this study was to analyse the association of risk of poor mental health with various socioeconomic, demographic, health, quality of life and social support variables; and to evaluate the contribution of socioeconomic variables most affected by the beginning of the economic crisis (employment situation and income) on the changes in the prevalence of the risk of poor mental health between 2005 and 2010. A study of prevalence evolution in adult population residents of the Valencian Community in the Spanish Mediterranean was conducted. We studied 5781 subjects in 2005 and 3479 in 2010. Logistic regression models have been adjusted to analyse the association between variables. A standardization procedure was carried out to evaluate which part of the changes in overall prevalence could be attributed to variations in the population structure by age, sex, employment status and income between the years under study. The prevalence of GHQ + increased from 2005 to 2010, in both men and women. Several variables were closely associated with the risk of poor mental health (sex, age, country of birth, number of non-mental chronic diseases, social support, disability, cohabitation in couple, employment status, and income). The changes produced as a result of the onset of the economic crisis in income and unemployment (increase in low income and in unemployment rates) contributed to the increase of poor mental health risk. This could confirm the sensitivity of mental health to the economic deterioration caused by the crisis.

Background: Historically, in the United States and globally, women have supported other women before, during, and after childbirth. Birth doulas are considered an important component to eliminating racial disparities in maternal morbidity and mortality. To address disparities in birth outcomes, Healthy Women Healthy Futures (HWHF) provides free birth and postpartum doula services to low-income women and communities of color in New York City. Methods: Secondary analysis of program data (n=364) collected between 2020 and 2021 was conducted. Univariate and multivariable analyses focused on: method of delivery, preterm birth, low-birthweight birth, breastfeeding, maternal-infant skin contact. The key exposure variable was total doula hours. Results: Clients who received prenatal doula support had low rates of preterm birth (8.8%) and low birthweight (7.1%), and high rates of vaginal delivery (69.1%), breastfeeding in the hospital (90.9%), and maternal-infant skin contact (78.2%). Multivariable analysis did not identify an association between number of doula hours and any of the five outcomes examined. Conclusion: While descriptive results point to positive birth outcomes, these effects did not persist in multivariable analyses. Data quality concerns from this intervention likely hindered the ability to detect a program impact, emphasizing the importance of funding to support data collection and management activities.

Abstract Introduction PCa is one of the cancers that exhibits the widest disparity gaps. Geographical place of residence has been shown to be associated with healthcare access/utilization and PCa outcomes. Geographical Information Systems (GIS) are widely being utilized for PCa disparities research, however, inconsistencies in their application exist. This systematic review will summarize GIS application within PCa disparities research, highlight gaps in the literature and propose alternative approaches. Methods This paper followed the methods of the Cochrane Collaboration and the criteria set of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles published in peer-reviewed journals were searched through the PubMed, Embase, and Web of Science databases till December 2022. The main inclusion criteria were employing a GIS approach and examining a relationship between geographical components and PCa disparities. The main exclusion criteria were studies conducted outside the US and those that were not published in English. Results A total of 25 articles were included, 23 focused on PCa measures as outcomes: incidence, survival, and mortality while only two examined PCa management. GIS application in PCa disparities research was grouped into three main categories: mapping, processing, and analysis. GIS mapping allowed for the visualization of quantitative, qualitative, and temporal trends of PCa factors. GIS processing was mainly used for geocoding and smoothing of PCa rates. GIS analysis mainly served to evaluate global spatial autocorrelation and distribution of PCa cases, while local cluster identification techniques were mainly employed to identify locations with poorer PCa outcomes, soliciting public health interventions. Discussion Varied GIS applications and methodologies have been used in researching PCa disparities. Multiple geographical scales were adopted leading to variation in associations and outcomes. Geocoding quality varied considerably leading to less robust findings. Limitations in cluster-detection approaches were identified especially when variations were captured using the Spatial Scan Statistic. GIS approaches utilized in other diseases might be applied within PCa disparities research for more accurate inferences. A novel approach for GIS research in PCa disparities could be focusing more on geospatial disparities in procedure utilization especially when it comes to PCa screening techniques. Conclusion This systematic review summarized and described the current state and trend of GIS application in PCa disparities research. Although GIS is of crucial importance when it comes to PCa disparities research, future studies should rely on more robust GIS techniques, carefully select the geographical scale studied, and partner with GIS scientists for more accurate inferences. Such interdisciplinary approaches have the potential to bridge the gaps between GIS and cancer prevention and control to further advance cancer equity.

Cirrhosis is a critical global health issue, responsible for 2.4% of deaths worldwide in 2019. The Global Burden of Disease Study reported a near doubling of decompensated cirrhosis cases from 1990 to 2017. In the U.S., cirrhosis is the 12th leading cause of death and often requires hospitali-zation and procedural interventions for severe complications such as hepatocellular carcinoma, ascites, hepatic encephalopathy, and variceal bleeding. This study aims to identify racial, ethnic, and socioeconomic disparities in receiving critical interventions among U.S. patients with de-compensated cirrhosis during 2020-2021. We conducted a retrospective cross-sectional analysis using 2020-2021 National Inpatient Sample data of adult patients (≥18 years) with cirrhosis-related and cirrhosis complication-related ICD-10 codes and who underwent procedures for cirrhosis-related indications such as esophagogastroduodenoscopy (EGD) for variceal hemor-rhage, transjugular intrahepatic portosystemic shunt (TIPS) for variceal hemorrhage or refractory ascites, hemodialysis for acute kidney failure or hepatorenal syndrome, and liver transplantation We collected data on patient baseline clinicodemographic and procedural outcomes. Statistical analyses included multivariable logistic regression to assess for associations with outcomes. There were significant disparities in procedure utilization: White and Hispanic patients more likely than Black patients to receive EGD and TIPS, while Black and Hispanic patients had higher odds of receiving hemodialysis. Insurance type also influenced access, with Private/HMO insurance holders having higher odds of undergoing procedures. These findings underscore the need for targeted interventions to address healthcare inequities.

Physical activity (PA) benefits are well-established, yet many US adults fail to meet PA guidelines. This is especially true for minorities facing social inequities. This study explored barriers and facilitators to PA among urban Midwestern minorities using a mixed-methods approach framed on the socio-ecological model. A cross-sectional survey was conducted among community-dwelling minorities. Participants were grouped as completing low (LLPA) or high (HLPA) weekly leisure-time PA for comparison. Quantitative analysis included MANOVA, follow-up ANOVAs, and calculation of effect sizes. Qualitative data were assessed using inductive thematic analysis. Twenty-nine adults (44.83% Black, 41.37% Latino) participated in the study. The HLPA group (n = 18) reported higher leisure-time PA (p = 0.001, d = 2.21) and total PA (p = 0.02, d = 1.00) compared to the LLPA group (n = 11). LLPA participants faced more personal barriers to PA (p = 0.02, d = -0.92). Common barriers identified in the interviews included a lack of time and financial costs. Facilitators included social support and available PA facilities. Both groups achieved USPA guidelines through different PA domains. Increasing social support and lowering PA-related costs could enhance participation. Addressing barriers and leveraging existing facilitators are crucial to increasing PA among minorities.

Background: This qualitative systematic review protocol aims to explore the experiences of African customers in white-owned restaurants and hotels in post-apartheid South Africa, focusing on the dynamics of service interactions and their implications for racial relations within the hospitality industry. Despite the end of apartheid in 1994, the echoes of historical racial disparities and power imbalances persist, potentially influencing customer experiences in this sector, particularly in establishments owned by individuals of European descent. In view of above, the research question for this study is “How do African customers in white-owned restaurants and hotels in post-apartheid South Africa perceive and experience service interactions, and what are the underlying factors influencing these perceptions, considering historical power imbalances, societal perceptions, lingering effects of apartheid, inclusive practices, and the varied experiences across different hospitality establishments? Study Objectives: Objectives include examining the dynamics of service interactions, identifying factors influencing perceptions and experiences, evaluating alignment with inclusive practices and post-apartheid ideals, and describing African customers' experiences regarding service. Methods: The study will employ the SPIDER Framework to craft a nuanced research question that seeks to understand how African customers perceive and experience service interactions in these settings, considering historical power imbalances, societal perceptions, the lingering effects of apartheid, inclusive practices, and varied experiences across different types of hospitality establishments. This approach aims to dissect the intricate interplay of historical, societal, and economic factors that shape these experiences, providing insights into the complexities of achieving a truly inclusive and equitable hospitality landscape in post-apartheid South Africa. Expected Contribution to knowledge and practice: This review will contribute to a deeper understanding of the challenges and opportunities facing the hospitality industry in fostering environments that reflect the nation's diversity and commitment to reconciliation and social cohesion. By highlighting the lived experiences of African customers and examining the extent to which white-owned establishments embody post-apartheid ideals, this study aims to offer valuable recommendations for industry practitioners and policymakers to promote cultural sensitivity, equity, and inclusivity, thus enhancing the role of the hospitality industry in South Africa's broader societal transformation.

This study investigates the impact of the economic downturn induced by the COVID-19 pandemic on nutritional health disparities among women. The research aimed to understand how economic challenges have influenced dietary choices, access to nutritious food, and overall nutritional well-being in different socioeconomic groups of women.Utilizing a mixed-methods approach, the study combined quantitative data from national health and economic databases with qualitative insights from interviews conducted with a diverse group of women. The quantitative analysis focused on trends in nutritional health indicators and economic variables pre- and post-pandemic. Simultaneously, the qualitative component explored personal experiences and perceptions related to nutrition and economic hardships during the pandemic.The findings revealed a significant correlation between the economic downturn and worsening nutritional health among women, especially in low-income and marginalized communities. Women in these groups reported reduced access to healthy food options, increased reliance on less nutritious food due to budget constraints, and a general decline in dietary quality. This decline was less pronounced in higher-income groups, highlighting a clear disparity.Moreover, the study observed that the pandemic exacerbated pre-existing nutritional inequalities, with vulnerable groups experiencing a more pronounced impact. The research also noted that community support systems and public health interventions played a crucial role in mitigating some of these effects.In conclusion, the COVID-19 pandemic has not only posed a direct health challenge but has also indirectly affected women's nutritional health through economic strain. The study underscores the need for targeted nutritional support and economic policies that prioritize the health of women, particularly those from socioeconomically disadvantaged backgrounds.

China is a traditional agricultural country, and the integration of rural industries has become an essential policy direction for the current strategy of agricultural modernization in China. In recent years, the agricultural industrial chains across various regions of China have consistently expanded and extended. The multifunctionality of agriculture is continuously unearthed, and the principal entities managing agriculture have become increasingly diversified and have grown significantly. New industries and forms in agriculture emerge incessantly. Accurately and profoundly understanding the inherent features of the integration of industries in rural China, establishing a scientific and rational measurement index system in line with the current status and development goals of rural China, and employing appropriate measurement methods to assess its development level and process, is instrumental in comprehending the level of integrated development in various regions. This aids in identifying challenges in the developmental process and proposing targeted developmental strategies. Hence, this paper, rooted in the integration of rural industries, cross-industry, industry extension, industry agglomeration, and industry penetration, sets up an measurement index system. Using provincial panel data from 2011 to 2020, the paper measures the level of integrated development in rural industries across China and its 31 provinces. Based on the measurement results, further techniques such as kernel density estimation and Gini coefficient decomposition have been used to analyze the spatial distribution characteristics and dynamic trends of the integrated development of rural industries in China. Research indicates that during the sample period, the overall level of integrated development in rural industries in various provinces in China has shown an upward trend. Development among the eastern, central, and western regions is highly uneven, but this disparity has been gradually narrowing in recent years. Furthermore, the levels of integrated development in different provinces exhibit significant spatial agglomeration effects. The development level of neighboring regions significantly impacts the province's development status. In the process of integrated development of rural industries in China, there's a trend where "it's easier to downgrade than to upgrade," with very few regions achieving leapfrog development.

On 17 June 2022, the U.S. FDA authorized the Pfizer-BioNTech and Moderna COVID-19 (SARS-CoV-2) vaccines for emergency use in children ages 6 months – 4 years. Seroprevalence has increased during the current Omicron variant wave for children under 5 years and the burden of hospitalization for this age group is similar or exceeds other pediatric vaccine preventable diseases. Research following the October 2021 approval of vaccines for children 5 – 11 indicates high prevalence of parental vaccine hesitancy and low uptake, underscoring the urgency of understanding attitudes and beliefs driving parental COVID-19 vaccine rejection and acceptance for younger children. One month prior to FDA approval, in the present study 411 U.S. female guardians of children 1 – 4 years from diverse racial/ethnic, economic, and geographic backgrounds participated in a mixed method online survey assessing determinants of COVID-19 pediatric vaccine hesitancy. Only 31.3% of parents intended to vaccinate their child, 22.6% were unsure, and 46.2% intended not to vaccinate. Logistic regression indicated significant barriers to vaccination uptake including: Concerns about immediate and long-term vaccination side effects for young children, the rushed nature of FDA approval and distrust in government and pharmaceutical companies, lack of community and family support for pediatric vaccination, conflicting media messaging, and lower socioeconomic status. Vaccine-resistant and unsure parents were also more likely to believe children were not susceptible to infection and that the vaccine no longer worked against new variants. Findings underscore the need for improved public health messaging and transparency regarding vaccine development and approval, the importance of community outreach, and increased pediatrician attention to parental concerns to better improve COVID vaccine uptake for young children.

Background: As the only place in a store where all customers must pass through and wait, the checkout lane may be particularly influential over consumer purchases. Because most foods and beverages sold at checkout are unhealthy (e.g., candy/sweets, sugar-sweetened beverages, and salty snacks), policymakers and advocates have expressed growing interest in healthy checkout policies. To understand the extent to which such policies could improve nutrition equity, we as-sessed the prevalence and sociodemographic correlates of purchasing items from checkout. Methods: We assessed self-reported checkout purchasing and sociodemographic characteristics in a national convenience sample of adults (n=10,348) completing an online survey in 2021. Re-sults: Over one-third (36%) of participants reported purchasing foods or drinks from checkout during their last grocery shopping trip. Purchasing items from checkout was more common among men; adults <55 years of age; low-income consumers; Hispanic, non-Hispanic American Indian and Alaska Native, and non-Hispanic Black consumers; those with at least a bachelor’s degree; parents; and consumers diagnosed with type 2 diabetes or pre-diabetes (p-values<0.05). Conclusions: Purchasing foods or beverages from store checkouts is common and more prevalent among low-income and racial and ethnic minority groups. These results suggest that healthy checkout policies have the potential to improve nutrition equity.

Objective: (1) Describe the current literature on the relationship between EDS and SEP and (2) provide recommendations for consideration of SEP in sleep medicine and biomedical research. Methods: Databases Medline/Pubmed, Web of Science, Google scholar and Scopus were screened using PRISMA guidelines and 19 articles were included in the final synthesis. Results: All studies were cross-sectional. Among these studies, 21.05% (n = 4) are focused on children and adolescent and the lasting 88.95% (n = 15) focused on adults and old people. Age ranged between 8 and 17 years old for children/adolescent and ranged from 18 until 102 years old for adults. Main SEP measures presented in these studies were education, income, perceived socioeconomic status and employment. Sample size in these studies varied from N = 90 participants until N = 33865 participants. Overall, a lower educational level, a lower income and full-time employment were associated with EDS. EDS symptoms are prevalent in women, especially those with a low income or no job; and children and adolescents with difficult living conditions or people working part-time reported more sleep disturbances. Conclusions: SEP is already considered as an important determinant for many health outcomes, but if SEP is embedded in experimental design in psychosomatic research, biomedical research and clinical practice as a constant variable regardless of outcome; it will move forward future investigations.

The vegan diet excludes animal-derived product consumption and health advantages had been reported when followed. However, heterogeneous eating habits, food availability, and sociocultural characteristics among regions could lead to different physiological results. The objective of this case-control cross-sectional pilot study was to analyze body composition, daily nutrients consumption, and basic serum biomarkers as a general overview of the health status of Mexican adults with a vegan diet for ≥3 years, randomly paired with omnivores. Body composition was assessed through bioelectric impedance analysis. Eating patterns were evaluated and daily nutrients intake was calculated. A complete blood count, glycated hemoglobin, cobalamin, and creatinine serum concentrations were analyzed. We hypothesized certain nutrient deficits and specific biomarker impairments originated from cultural particularities driving food selection in Mexicans following a plant-based diet. Body composition did not differ among groups. Lower protein, niacin, pantothenic acid, pyridoxine, cobalamin, calciferol, fluoride, iodine, and selenium intake yet greater fiber, folic acid, vitamin E, copper, and molybdenum were observed in the plant-based group when compared with controls. Vegans presented lower cobalamin and creatinine serum concentrations. Hematologic abnormalities were prevalent in vegans. Insufficient consumption of several nutriments was identified in both dietary groups, suggesting that the local diet may be unbalanced, affecting both vegans and non-vegan individuals. However, vegans might present additional deficiencies, especially vitamin B₁₂, with potential repercussions. Clinical and nutritional guidance is required in this particular population to avoid possible health adverse events.

Introduction: Rural Americans face significant health disparities due to limited access to healthcare services. Telehealth has emerged as a promising solution to mitigate these disparities by facilitating remote access to medical care. This paper comprehensively reviews the advantages, challenges, and implementation strategies of telehealth in rural areas.Method: A narrative review methodology was employed to synthesize existing literature and case studies on telehealth in rural settings. Databases such as PubMed, Google Scholar, and JSTOR were searched for relevant studies published in the last three decades. Keywords such as "telehealth," "rural health," and "healthcare disparities" guided the search process. The review focused on studies assessing the impact of telehealth on healthcare access, cost-effectiveness, and quality of care in rural areas.Results: The review findings indicate that telehealth significantly enhances healthcare access by reducing travel distances, increasing availability of specialist consultations, and promoting patient engagement. It improves chronic disease management and patient satisfaction by enabling convenient access to healthcare services at home. Despite initial setup costs and challenges such as broadband access and regulatory issues, telehealth demonstrates long-term cost savings through reduced travel expenses and improved healthcare efficiency. Quality of care is enhanced through improved communication between healthcare providers and patients, leading to better treatment adherence and health outcomes.Conclusion: Telehealth represents a transformative approach to address healthcare disparities in rural areas. It offers a cost-effective solution to improve access to healthcare services, enhance patient outcomes, and reduce healthcare costs in the long run. However, successful implementation requires addressing infrastructure challenges, refining reimbursement policies, and ensuring regulatory support. Future efforts should focus on expanding broadband infrastructure, refining policy frameworks, and conducting further research to optimize telehealth's impact on rural healthcare delivery.

Mitochondrial DNA copy number (mtDNAcn) is associated with mitochondrial function contributing various diseases. Understanding of the association between mtDNAcn and infant neurodevelopment, as well as the role of racial disparities, remains unknown. A cohort study was conducted with 55 preterm infants and a single blood sample was collected from each infant during their NICU stay to measure mtDNAcn. NICU Network Neurobehavioral Scale (NNNS) and Bayley Scale of Infant Developmental testing Edition III was assessed during NICU until 2 years of corrected age (CA). Linear regression models were performed to investigate the relationship between the clinical characteristics, neurobehavioral outcomes and mtDNAcn. Majority of our subjects were male, White, non-Hispanic, had C-section, and without preterm premature rupture of membrane (PPROM). Increased mtDNAcn was found associated with younger birth gestational age (GA), nonoptimal neurodevelopment. However, the opposite associations between mtDNAcn and neurodevelopmental outcomes were observed between Black and White infants up to 1 year of CA. Adverse early life experience, together with increased mtDNAcn in White infants, and decreased mtDNAcn in Black infants may be considered as significant positive predictors of poor early life neurodevelopmental outcomes in infants.

Type 2 diabetes (T2D) is associated with increased cardiovascular morbidity, mortality, and hospital admissions. There is variability in clinical practice. The objectives are to analyze the variability in the control of Blood Pressure (BP), HbA1c, and LDL-C in T2D patients and its influence on admissions due to cardiovascular events (CVE) Methods: We analyzed the electronic records in Primary Care Health centers in Navarra (Spain) and hospital admission for CVE. We follow 480637 people from 2012 to 2016. We calculated indicators of control of patients with T2D for each year, percentage with: HbA1c &lt; 7%; HbA1c &gt;= 9%; BP &lt;140/90 mmHg; LDL-C &lt;100 mg/dl. We used logistic and Cox regression. Results: Patients in the best control GP practices cluster are 2.5 times more likely to have HbA1c &lt;7% [OR: 2.46 (95% CI: 2.29-3.64)]. Poor HbA1c control ≥ 9% is more likely in the worst control cluster [OR: 1.73 (95% CI:1.63-1.83)]. The probability of admission for CVE increases with age, being male, low income, obesity, history of CVE, having HbA1c ≥ 9%, and belonging to a GP practice in the cluster of HbA1C ≥ 9% worst control. In contrast, it decreases in patients with HbA1c &lt;7%, BP&lt;140/90 mmHg and LDL &lt;100 mg/dl.

Shelter-in-place aimed at slowing COVID-19 transmission has altered nature accessibility patterns, creating quasi-experimental conditions to assess if retracted nature contact and perceived nature deprivation influences physical and emotional wellbeing. We measure through survey methods how pandemic mandates limiting personal movement and outdoor nature access effect self-assessed nature exposure, perceived nature deprivation, and subsequent flourishing as measured by the Harvard Flourishing Index. Results indicate that perceived nature deprivation strongly associates with neighborhood nature contact, time in nature and access to municipal nature during the pandemic, after controlling for shelter-in-place mandates, job status, household composition, and sociodemographic variables. Our hypothesis that individuals with strong perceived nature deprivation under COVID-19 leads to diminished wellbeing proved true. Interaction models of flourishing showed positive modification of nature affinity with age and qualitative modification of nature deprivation with race. Our results demonstrate the potential of local nature contact to support individual wellbeing in a background context of emotional distress and social isolation, important in guiding public health policies beyond pandemics.

Recent clinical SARS-CoV-2 studies link diabetes, cardiovascular disease, and hypertension to increased disease severity. In the US, racial and ethnic minorities and low socioeconomic status (SES) individuals are more likely to have increased rates of these comorbidities, lower baseline health, limited access to care, increased perceived discrimination, and limited resources, all of which increase their vulnerability to severe disease and poor health outcomes from SARS-CoV-2. Previous studies demonstrated the disproportionate impact of pandemic and seasonal influenza on these populations, due to these risk factors. This paper reviews increased health risks and documented health disparities of racial and ethnic minorities and low SES individuals in the US. Pandemic response must prioritize these marginalized communities to minimize the negative, disproportionate impacts of SARS-CoV-2 on them and manage spread throughout the entire population. This paper concludes with recommendations applicable to healthcare facilities and public officials at various government levels.

Purpose of review: In this review, we discuss the importance of digital health equity and how social determinants of health (and intersectionality with race, ethnicity, and gender) affect cardiovascular health-related outcomes in digital health trials. We propose strategies to improve digital health equity as we move to a digitally-connected world for healthcare applications and beyond.Recent findings: Digital health has immense promise to improve population health by reaching individuals in their homes, at their preferred times. However, initial data demonstrate decreased patient engagement and worse cardiovascular outcomes for racial and ethnic minorities, leading to unequal uptake of digital health technologies. In addition, while women generally have higher uptake of technology, they are less likely to be referred by clinicians for digital health interventions. We highlight several exemplar trials and analyze their methodology for replication in future digital health research.Summary: The promise of digital health equity has not been reached due to exclusionary practices. Specific focus must be placed on societal/governmental policies that enable digital inclusion, particularly of racial and ethnic minority populations and women, to ensure that the expansion of digital health technologies does not exacerbate existing health disparities.

The Gulf of Mannar, a UNESCO World Biosphere Reserve, faces severe overfishing and habitat degradation threats. In this study, we investigate the pivotal role of ecosystem services in sustaining local livelihoods and overall well-being. By conducting a comprehensive survey of 480 respondents across two districts, we gathered extensive data on demographics, livelihoods, fishing practices, reliance on ecosystem services, and community management participation. The analysis reveals a critical dependence on the Gulf's resources (income, food security, traditions) with gender disparities (men fish, women in pre/post-harvest), but fishing is only allowed in the 10km buffer zone (not the core zone). The findings emphasize the promise of community-based strategies, such as Marine Protected Areas and reviving co-management committees, for achieving sustainable fisheries management. However, we also identify gaps, including the need for more nuanced well-being indicators and improved models for community management participation. To address these challenges, we advocate for sustainable fishing practices, tackling social inequities, especially gender disparities in resource access and decision-making, and investing in healthcare, education, and social safety nets for fishing communities. Promoting alternative livelihoods can alleviate pressure on fish stocks, and empowering local communities through capacity building and community-based management initiatives is crucial for ensuring the long-term sustainability of both the Gulf of Mannar ecosystem and the well-being of its dependent communities. This multifaceted approach holds significant promise for balancing ecological health with human prosperity.

Breast cancer mortality rates vary across ethnic groups in Israel, where protective factors such as high fertility and breastfeeding rates may be moderated by socioeconomic factors and mammography rates. We aim to investigate disparities in breast cancer mortality between Jewish and Muslim Arab women in Israel and examine how sociodemographic variables and number of children are associated with mortality. Our retrospective follow-up study uses data from the Israeli Central Bureau of Statistics and multivariable Cox regression models, adjusting for age, number of children, country of origin, locality size, and socioeconomic status. Compared to Jewish women, Muslim Arab women exhibited lower breast cancer mortality rates. However, after adjusting for multiple sociodemographic variables, no significant differences persisted between Jewish and Muslim Arab women. Having more than three children was associated with lower mortality among Muslim Arab women, but not among Jewish women. European/American origin, larger localities, and medium socioeconomic status were associated with higher mortality. Sociodemographic factors may therefore explain the disparities in breast cancer mortality between Jewish and Muslim Arab women in Israel. Targeted intervention programs considering unique characteristics and risk factors of different ethnic groups are needed to reduce disparities and improve outcomes.

In the last decade, readily available electronic devices have created unprecedented opportunities for teens to access a wide variety of information and media – both positive and negative – on the internet. Despite the increasing number of initiatives taking place worldwide intended to assess and mitigate the online risks encountered by children and adolescents, there is still a need for a better understanding of how adolescents use the internet and what consequences they may face. We conducted a cross sectional online survey of a convenience sample of 733 8th and 9th grade students in Utah. The survey contained eight questions regarding students’ exposure to three types of online risk scenarios: content risk, contact risk, and commercial risk. Independent variables included students’ online behaviors, use of social media and private messaging apps, and adult supervision of online activities. Logistic and negative binomial regression models indicated that female gender, social media use, and chatting with strangers were associated with exposure to multiple unsafe online scenarios. Our results provide critical information to practitioners involved in the development of educational initiatives by building a profile of potentially risky online behaviors and allow them to tailor their initiatives to meet the needs of more vulnerable populations.

Glaucoma poses a serious public health concern as it is the second leading cause of blindness after cataracts, while also being the leading cause of irreversible blindness worldwide. Glaucoma is more prevalent among Black, Latino, and Asian populations and it is essential to examine both racial and ethnic disparities that exist in treatment and prevention. As the number of people with glaucoma continues to grow, it is important to review aspects of this condition in order to better care for those affected. This article will review significant forms of glaucoma and what differentiates them in a diagnosis, treatment options, and recommendations on prevention and improving awareness

Esophagogastric cancers are among the most common and deadly cancers worldwide. This review traces their chronology from 3000 BCE to the present. The first several thousand years were devoted to palliation, before advances in operative technique and technology led to the first curative surgery in 1913. Systemic therapies were introduced in 1910, and radiotherapy shortly thereafter. Operative technique improved massively over the 20th century, with operative mortality rates reducing from over 50% in 1933 to less than 5% by 1981. In addition to important roles in palliation, endoscopy became a key non-surgical curative option for patients with limited-stage disease by the 1990s. The first nonrandomized studies on combination therapies (chemotherapy +/- radiation +/- surgery) were reported in the early 1980s, with survival benefit only for subsets of patients. Randomized trials over the next decades had similar overall results, with increasing nuance. Disparate conclusions led to regional variation in global practice. Starting with the first FDA approval in 2017, multiple immunotherapies now encompass more indications and earlier lines of therapy. As standards of care incorporate these effective yet expensive therapies, care must be given to disparities and methods for increasing access.

This analysis investigates health outcomes by cause and income group across European and African countries, highlighting significant disparities tied to economic status. Low and lower-middle-income countries in Africa face a greater burden of disease, particularly in acute lower respiratory infections, diarrheal diseases, bacterial infections, HIV/AIDS, and maternal conditions. This is primarily due to limited access to clean water, sanitation, and healthcare services. In contrast, high-income African countries exhibit better health outcomes. European countries show variations: lower-middle-income nations suffer more fro4m acute respiratory infections and HIV/AIDS, while high-income countries report higher incidences of cancer and bacterial infections. These differences reflect disparities in healthcare quality and social determinants. The study emphasizes the need for targeted policy initiatives to address these disparities by focusing on socioeconomic factors and improving healthcare access and quality across all income groups.

This research explores how regional socioeconomic variables affect the perception of social trust and support networks (PYCC) in Italian regions, and examines the implications for public policy designed to strengthen social cohesion. This study examines the variable "People You Can Count On" (PYCC) from the ISTAT-BES dataset, focusing on its distribution across Italian regions between 2013 and 2022. Using clustering through a k-Means algorithm optimized with the Silhouette coefficient and the Elbow method, three distinct clusters of regions emerged, highlighting significant differences in social support networks. An econometric model was employed to estimate the PYCC variable, factoring in socioeconomic indicators such as employment rates, income inequality, and social participation. The results indicate a complex interplay between socioeconomic conditions and social trust, with regions in the South and Islands showing increased community support, while many Northern regions experienced declines. The study suggests that areas with lower economic conditions often foster stronger social networks, driven by necessity. These findings underline the importance of targeted public policies aimed at fostering social cohesion, particularly in regions facing economic challenges. Policy implications include enhancing education, supporting small enterprises, and promoting social housing and welfare initiatives. Strengthening community participation and volunteering are also highlighted as critical strategies to build resilient support networks. Overall, the research provides valuable insights into the regional disparities of social trust and the role of socioeconomic factors in shaping community support across Italy.

The COVID-19 pandemic has revealed significant disparities in disease severity and mortality across various population groups and regions. These disparities cannot be attributed solely to healthcare systems, socioeconomic factors, living conditions, or individual immune landscapes; environmental factors also play a crucial role. This work explores how variations in nasal morphology related to age, gender, and race can affect the respiratory system's ability to filter, warm, and humidify inhaled air. These variations may contribute to differences in how cold, dry, polluted, and infected air impact the respiratory system, thus influencing the observed patterns of disparities in COVID-19 outcomes. The analysis suggests that individuals with genetically determined wider nasal cavities, often found in populations originating from warmer climates, have decreased filtration and air conditioning efficiency, leading to increased susceptibility to respiratory infections and disproportionately high mortality rates from COVID-19. Moreover, age-related changes in nasal morphology, such as increased nasal volume and involution atrophy of the mucosa, contribute to impaired air conditioning and filtration, thereby increasing the risk of severe outcomes in the elderly. Gender differences in nasal morphology, with men typically having larger nasal passages compared to women, are linked to poorer air conditioning and filtration, potentially contributing to the higher risk of severe COVID-19 in men. Preliminary statistical analyses of the U.S. population suggest that men with favorable nasal structures may have a longer life expectancy than those with less optimal nasal anatomy; however, this should be regarded as a hypothesis. The findings underscore significant gaps in our understanding and highlight the urgent need for further research to unravel the complex interplay between nasal morphology, respiratory system dynamics, and environmental factors in shaping disease susceptibility and outcomes.

Food insecurity is a pervasive issue for Allegheny County as one in five residents experience food insecurity. Food insecurity is linked to chronic health conditions like heart disease and hypertension and disproportionately affects women in the United States, particularly women who are head of household. There are multiple dimensions used to measure regional food insecurity, one of which is food accessibility. Prior research has examined the linkages between food access and food insecurity, and this study aims to further explore the relationship between equitable access to sustainable food and levels of regional food insecurity. This study examines food outlets in Allegheny County to determine if there is a significant relationship between food outlet availability and food insecurity. Both the presence and accessibility of these food outlets were examined. To measure accessibility, the walking distance to the nearest public transportation stop was calculated for each public transportation stop. The minimum distance to each food outlet was compared to food insecurity rates on a Census Tract level. Results showed that communities without grocery stores did, on average, have higher rates of food insecurity. Also, communities with a higher proportion of female-headed households experienced greater food insecurity, regardless of access to food outlets. However, there was no statistically significant relationship between the distance from public transportation stops to grocery stores and rates of food insecurity. Based on these findings, we suggest that sole reliance on distance as an indicator of food insecurity can be misleading, and there should be a greater focus on walkability within the community as using opposed to physical distance alone.

Work disparities experienced by nurses in long-term care (LTC) can impact the retention, well-being, and health of this workforce. Despite the significant impact disparities experienced by nurses have on the workforce and LTC sector, a review of the available literature on work disparities has not been conducted on work disparities experienced by nurses in LTC. Consequently, this scoping review aimed to explore the nature and extent of research on meso-level work disparities experienced by nurses in LTC and how such disparities are linked with nurse health and well-being. Five databases were searched: MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), and CINAHL (EBSCO host). Of the 5,652 articles retrieved, 16 studies published between 1997 and 2024 met the inclusion criteria. The average number of work disparities within each study was 3.06 (minimum = 1, maximum = 6, SD = 1.62). Types of work disparities across the 16 studies were work opportunities (n = 19), work treatment (n = 18), job security (n = 8), and work compensation (n = 8). Only four articles investigated the association of a work disparity with a variable of health and well-being. Future research on how macro-level disparities intersect with meso-level work disparities may inform a contextual understanding of how disparities transpire in the work of nurses in LTC. Studies are required to address the gaps in knowledge regarding how work disparities negatively influence the health of nurses to inform better retention, well-being, and health of nurses in LTC.

Urban environments play a crucial role in shaping the lived experiences of women, yet traditional urban design practices often neglect the diverse needs and identities of women, perpetuating social barriers and gender inequalities. This review paper seeks to explore the existing research on how urban design influences women's social challenges in cities. By synthesizing literature from urban planning, architecture, gender studies, and sociology, this review provides a comprehensive overview of the impact of urban design on women's experiences and opportunities in urban spaces. The review highlights gender disparities in urban design, inclusivity in urban planning, and the need for gender-sensitive approaches to address these disparities. Key scholars, including Susan S. Fainstein, Leslie Kern, Sharon Zukin, Daphne Spain, and Vandana Shiva, have contributed significantly to understanding gender disparities in urban spaces and advocating for more inclusive and equitable urban environments. The discussion emphasizes the importance of community engagement, participatory planning processes, and an intersectional lens in urban design to ensure that women's voices and needs are effectively incorporated into decision-making processes. Future research directions include exploring the role of technology, smart city initiatives, and addressing the impacts of gentrification and urban redevelopment on women's access to housing and resources. By advancing research on gender equity in city planning, we can work towards creating more inclusive, equitable, and sustainable urban environments that benefit all residents.

The Black population, often treated as ethnically homogenous, faces a constant challenge in accessing and utilizing healthcare services. This study examines the intragroup differences in health-seeking behavior among the multiple ethnic subgroups that comprise the Black community. A cross-sectional study was conducted among 239 adults ≥18 years who self-identified as Black in the United States and Canada. A multiple logistic regression model was fitted to evaluate the relationship between health-seeking behaviors and ethnic origin controlling for selected social and health related factors. The mean age of participants was 38.6 years, 31% were male, and 20% were unemployed. Sixty-one percent reported very good or excellent health status, and 59.7% reported not being treated for chronic disease at the time of the survey. Aging (OR=1.05, CI:1.01–1.09) and being female (OR= 0.30, CI: 0.14–0.65) were associated with favorable health-seeking behaviors. Compared with participants who had earned high school diplomas only, those who reported having earned graduate degrees were 75% less likely to have engaged in favorable health-seeking behavior (OR=0.25, 95% CI: 0.07–0.86). In the Black community of our sample, regardless of ethnic origins or country of birth, the factors associated with health-seeking behavior were age, gender, and educational attainment. Keywords: African American; African; Caribbean; Healthcare Utilization; Ethnic Disparities; Health-seeking behavior; intragroup difference, black populations, ethnic subgroups

Breakthrough COVID-19 (occurring in fully vaccinated people) has been described. Data on its characteristics among immune mediated rheumatic disesases (IMRD) patients are scarce. This study describes breakthrough COVID-19 among IMRD patients participating of SAFER-study, a Brazilian multicentric cohort evaluating safety, effectiveness and immunogenicity of SARS-Cov-2 vaccines in autoimmune diseases. Descriptive analysis and a binary logistic regression model, to evaluate predictors of COVID-19-related hospitalization, were performed. P-value < 0.05 was significant. The included 160 patients were predominantly females (83.1%), with mean (SD) age 40.23 (13.19) years. Patients received 2 (19%), 3 (70%) or 4 (11%) vaccine doses. The initial two-dose series was mainly with ChAdOx1 (Oxford/AstraZeneca) (58%) or BBIBP-CorV (Sinopharm-Beijing) (34%). The first booster (n=150) was with BNT162b2 (BioNtech/Fosun Pharma/Pfizer) (63%) or ChAdOx1 (29%). The second booster (n=112) was with BNT162b2 (40%) or ChAdOx1 (26%). COVID-19 hospitalization rate was 17.5%. IMRD moderate/high activity (OR: 5.84, CI: 1.9-18.5, p=0.002) and treatment with corticosteroids (OR: 2.94, CI: 1.02-8.49, p=0.0043) associated with higher odds of hospitalization, while the increasing number of vaccine doses was protective (OR: 0.37, CI: 0.15-0.9, p=0.032). These findings, along with previous reassuring results about the safety of the COVID-19 vaccines, argue in favour of booster vaccination in IMRD patients.

Background: The COVID-19 pandemic has exacerbated existing healthcare disparities among American Indian/Alaska Native (AI/AN) populations, rooted in historical traumas and systemic marginalization. Methods: This study conducted at a single Indian Health Service (IHS) clinic in central Michigan examines the effectiveness of educational interventions in enhancing COVID-19 knowledge and attitudes among AI/AN populations. Utilizing a pre/post prospective study design, participants received either a video or infographic educational intervention, followed by a survey assessing COVID-19 knowledge and attitudes. Results: The results indicate significant improvements in knowledge and attitudes post-intervention, with both modalities proving effective. However, specific factors such as gender, political affiliation, and place of residence influenced COVID-19 attitudes and knowledge, emphasizing the importance of tailored interventions. Conclusions: Despite limitations, this study highlights the critical role of educational interventions in addressing vaccine hesitancy and promoting health equity within AI/AN communities. Moving forward, comprehensive strategies involving increased Indian Health Service funding, culturally relevant interventions, and policy advocacy are crucial in mitigating healthcare disparities and promoting health equity within AI/AN communities.

This article explores the enduring influence of colonial legacies on the economic development of the Americas, tracing their historical roots and contemporary repercussions. By examining a comprehensive range of historical and modern research, the article analyzes how colonial institutions, policies, and labour systems have profoundly shaped the economic trajectories of countries across the region. Central to the discussion is the lasting impact of colonial-era practices, such as the mining mita in Peru, and how factor endowments have influenced inequality and development patterns. The article further investigates the broader implications of these findings for understanding the deep-seated origins of economic disparities and the formidable challenge of overcoming colonial legacies in the present day. Special attention is given to the role of inclusive institutions, regional cooperation, and the intersection of culture and identity in fostering more equitable economic and social progress. Through this analysis, the article provides valuable insights into the historical foundations of contemporary economic imbalances and offers policy recommendations for addressing these persistent legacies.

Objective: To recommend how physicians can best respond to families whose hopes for a miracle via divine intervention influence their medical decisions, like, for example, making them not want to withdraw ventilatory support in cases of poor neurologic prognosis because they are still hoping for God to intervene. Methods: Auto-ethnographic analysis of chaplaincy experience in this clinical context yields a nuanced 90-second, point-of-care spiritual intervention physicians can use to address the religious aspect of families who base medical decisions on their hopes for a miracle via divine intervention. Explanation of how spiritual intervention dovetails with existing physician communication protocol for responding to families hoping for a miracle. Results: Spiritual intervention for religious aspect of miracle-hoping families is integrated into existing physician communication protocol for responding to families hoping for a miracle with recommendations for utilization of existing communication technology when necessary. Conclusion: Properly addressing the religious dimension of families hoping for a miracle may be helpful for physicians interested in decreasing their own stress levels, improving outcomes for this clinical context, and ensuring that unintentional discrimination does not perpetuate racial disparities in end-of-life care.

The Indian educational system grapples with deep-rooted structural and systemic challenges that have hindered equitable access to quality education across all levels. Central issues include outdated curricula that fail to equip students with contemporary skills, significant socio-economic disparities limiting access and outcomes, and inadequate teacher training alongside deficient infrastructure, particularly in rural and economically disadvantaged areas. These challenges contribute to unequal educational opportunities and outcomes, with a stark divide between urban and rural, and between private and public institutions. This review delves into these pervasive issues, analyzing how they manifest from primary through tertiary education. In primary education, the focus often remains on rote learning, overlooking critical thinking and problem-solving skills. At the secondary and tertiary levels, curriculum relevance remains a concern, as courses frequently do not align with modern industry demands or technological advancements, creating a skills gap among graduates. Addressing these challenges, this review proposes a series of reforms aimed at building a more inclusive and effective system. Key reforms include curriculum modernization to incorporate skills for the 21st century, integrating digital learning tools to expand access and facilitate adaptive learning, and comprehensive teacher development programs that emphasize continuous professional growth. Together, these initiatives aim to create an educational environment that is not only inclusive but also adaptive to the evolving demands of a globalized world, thereby enhancing the quality and reach of education across India.

This study examines Brazil's complex economic journey from 1930 to 2000, exploring the interplay between historical legacies, policy choices, and global economic forces in shaping the nation's development trajectory. It argues that Brazil's economic history during this period is characterized by a series of paradoxes: rapid industrialization alongside persistent inequality, economic miracles followed by devastating crises, and modernization efforts constrained by colonial-era structures. The analysis begins with the Estado Novo of Getúlio Vargas, tracing the evolution of Brazil's economy through state-led industrialization, the "Economic Miracle" of the military regime, the debt crisis and hyperinflation of the 1980s, and the neoliberal reforms of the 1990s. Special attention is given to the enduring impact of slavery and colonial land distribution on Brazil's social and economic structures. The study highlights how these historical factors have contributed to ongoing challenges such as regional disparities, income inequality, and the "Brazil Cost." By examining these issues, the paper provides insights into the complexities of economic development in postcolonial societies and the challenges of overcoming historical constraints in the pursuit of equitable and sustainable growth.

Health services research is a multidisciplinary discipline that aims to improve population health by studying healthcare services' organization, delivery, and financing. Over time, the field has worked to define its boundaries and establish a set of core research topics and methods addressing population wellbeing, access, quality, and cost. Although the influence of health technology is significant, our literature survey on health services research showed that SCs in general—containing their management, cost, and policy—had received little attention. Importantly, our assessment also showed that the system’s readiness to handle supply policy and supply device deficiencies like those encountered during pandemic was hardly ever mentioned. Reduced open areas and water bodies, deteriorating infrastructure, and changes in the biological morphology all affect cities’ uncontrollable and unplanned growth. Urban amenities, facilities, and healthcare services were unevenly distributed due to this unchecked urban population development. In light of this, this research suggests two reliable models for site selection issues for one of Hong Kong’s main hospitals. Levels of uncertainty, infeasibility tolerance, and reliability are taken into consideration. Then, two categories of uncertainty—symmetric and bound-ed—were examined. As a result, the challenge of scheduling in uncertainty has been considered, and potential solutions have been presented using a specified probability distribution function. The paper concludes by introducing the specific justice and health problems and outlining four typical strategies. In order to ensure that medications and other healthcare supplies are produced, distributed, and given to patients, a vast network of systems, components, and procedures must be effectively managed. This research contributes in this regard. Also, its grantee fairness in health systems and the populations health locally, nationally, and globally. It highlights health inequity, advances the measurement of health inequity, and promotes public dialogues on health inequity.

Research question/problem: This comprehensive review and comparative analysis aims to investigate the significance of enhancing oxygen provision in the context of COVID-19, focusing on the implications for healthcare policies and services.Background/context: The study addresses the shift in the oxygen dissociation curve of blood in COVID-19 patients, emphasizing the impact on oxygen delivery to tissues and the challenges it poses for clinical management. It also explores the disruption of healthcare systems due to the pandemic and the integration of social determinants of health in clinical environments.Methodology: The research incorporates a thorough literature review, comparative analysis of diverse approaches to oxygen delivery, and examination of successful interventions through case studies and best practices. Data collection techniques include the review of scholarly articles, case studies, and policy documents.Results/Key findings: The study highlights the imperative for augmented oxygen supply and the significance of maintaining appropriate oxygen saturation levels, especially in the context of respiratory illnesses like COVID-19. It also emphasizes the positive correlation between increased oxygen saturation levels and life expectancy, indicating potential health benefits of enhanced oxygen availability.Conclusions/Implications: The findings underscore the need for a structured approach to oxygen therapy and the importance of equitable distribution of oxygen to underserved regions. The implications of the research extend to enhancing healthcare policies and services regarding oxygen provision during the COVID-19 pandemic, especially in rural and remote areas.