Due to the widespread use of screening methods and the increase in advanced age pregnancies, interest in prenatal screening tests is increasing day by day. In Türkiye, the Ministry of Health recommends that pregnant women be informed about prenatal screening tests and ultrasonographic examinations for fetal anomalies and chromosomal aneuploidy. Although these tests are not mandatory, it is important for pregnant women to understand their purpose and scope before making a decision. This requires having sufficient health literacy (HL). This study aimed to examine the HL levels of pregnant women and their perspectives on prenatal screening tests. This cross-sectional study was conducted with 477 pregnant women in the pregnancy follow-up clinic of a university hospital in Turkey. Data were obtained through the Descriptive Information Form-comprising items on sociodemographic characteristics, pregnancy, and prenatal screening-and the Health Literacy Scale (adaptation from HLS-EU-47). The average age of pregnant women was 27.55 ± 5.56. Pregnant women were most familiar with the double screening test (25.3%). Pregnant women most frequently received information or counseling on prenatal screening tests from obstetricians (44.2%) and the internet/social media (26.3%). The mean HL score was 116.11 ± 11.47, with higher levels observed among those without consanguinity with their spouses and without a family history of hereditary diseases. HL also differed significantly by regular antenatal follow-up, screening practices, and certain sociodemographic factors (p < 0.05). Higher HL was associated with greater uptake of screening. Pregnant women who underwent screening tests and those who wanted to undergo screening tests had higher HL levels. Findings suggest that strategies to improve pregnant women's HL should focus on those with low socioeconomic status and advanced age. Integrating HL assessment into routine primary care monitoring and providing visually supported, simplified education on prenatal screening may be beneficial. Midwives should strengthen communication skills suited to pregnant women's HL levels. Further research is recommended on the links between HL, screening tests, and related counseling and interventions among different groups.
In the context of modern socio-economic transformations and global challenges to systemic healthcare, the problem of an objective assessment of the quality of life of the population is of paramount importance. Traditional economic indicators (for example, GDP per capita) do not fully reflect the state of public health and social well-being. In this regard, the development of integrated assessment tools synthesizing heterogeneous data is becoming a key task for substantiating management decisions in the field of social and demographic policy. A special role in such systems is played by medical and demographic indicators, which act as objective markers of the quality of human potential. The study is based on data from Rosstat and the Ministry of Health of the Russian Federation for the period 2015-2024 for 85 regions of the Federation. The purpose of the study is to theoretically substantiate and test in practice the methodology of integrated assessment of the quality of life of the population of the subjects of the Russian Federation using a system of key medical and demographic indicators, to determine their structural contribution to the final index. В условиях современных социально-экономических трансформаций и глобальных вызовов системному здравоохранению проблема объективной оценки качества жизни населения приобретает первостепенное значение. Традиционные экономические индикаторы (например, ВВП на душу населения) не отражают в полной мере состояние общественного здоровья и социального благополучия. В этой связи разработка интегральных инструментов оценки, синтезирующих разнородные данные, становится ключевой задачей для обоснования управленческих решений в сфере социальной и демографической политики. Особую роль в таких системах играют медико-демографические показатели, выступающие объективными маркерами качества человеческого потенциала. Исследование основано на данных Росстата и Министерства здравоохранения России за 2015—2024 гг. по 85 субъектам РФ. Цель исследования: теоретически обосновать и апробировать на практике методику интегральной оценки качества жизни населения субъектов РФ с использованием системы ключевых медико-демографических индикаторов, определить их структурный вклад в итоговый индекс.
Inflammation is a key driver of age-related disease and has been associated with social conditions. We examined how cumulative community-level social and structural disadvantage is associated with inflammatory proteomic profiles in older Black adults. We employed data from the Minority Aging Research Study and the Rush Clinical Core, including the Social Vulnerability Index (SVI; global score and four domains) and 92 plasma inflammatory proteins (Olink® Target-96 Inflammation). Cross-sectional associations between each SVI metric and inflammatory proteins (principal component (PC)-derived global proteomic profile and protein-specific) were assessed using multivariable linear models (demographic, behavioral, and individual-level socioeconomic factors adjusted), with additional sex-by-SVI interaction terms. In a secondary analysis, we replaced SVI with the Index of Concentration at the Extremes (ICE) for household income (ICEincome). A total of 580 participants (mean (SD) age of 74.9 (6.50) years; 79.7% women) had global SVI and proteomics assessed. Lower household composition (SVIHHC) was associated with the primary global proteomic profile, represented by the 1st proteomic PC (beta = -0.429, p-value = 0.019). A secondary exploratory analysis using the first five proteomic PCs showed that higher minority status/language (SVIMSL) and socioeconomic status (SVISES) were associated with an inflammatory proteomic profile (SVIMSL-PC3: beta=0.160, p-value = 0.048; SVISES-PC2: beta = 0.286, p-value = 0.012). In protein-specific analyses, no SVI-protein associations were found. We found an SVIHHC-by-sex interaction for interleukin-10 receptor alpha (IL-10RA; beta = -0.258, p-value = 5.01×10-4), and among men, SVIMSL was associated with Sirtuin 2 (beta = -0.397, p-value = 8.51×10-04) and STAM binding protein (beta = -0.304, p-value = 9.87×10-04). ICEincome was inversely associated with the global proteomic profile (beta = -0.233, p-value = 0.051), and an ICEincome-by-sex interaction was found for IL-10RA (beta=0.279, p-value = 4.66×10-04). By analyzing associations between community-level factors and inflammation-related proteins, our study provides new molecular insights into how social context may relate to biological risk, identifies proteomic patterns that could inform the development of community-level interventions, and underscores the utility of integrating multi-omics approaches to investigate biological pathways relevant to health disparities research.
Peer cultures can contribute adaptive innovations, but their capacity for contribution depends on the environmental risk landscape. High-risk environments promote conservative cultural transmission, suppressing contributions from peer-driven exploration, while low-risk conditions allow peer cultures to thrive, generating, and spreading novel solutions. Socioeconomic stratification also influences these dynamics, creating cultural divides in how peer cultures operate.
The Middle East and North Africa (MENA) region presents a unique demographic, cultural, and socioeconomic profile that influence migraine burden and management. Comprehensive multicenter data on patient characteristics, treatment access, and complementary and alternative medicine (CAM) use in this region are limited. The aim of this work was to compare sociodemographic and clinical characteristics of migraine patients in low-/lower-middle-income countries (LICs/LMICs) versus high-/upper-middle-income countries (HICs/UMICs) in the MENA region, and to explore disparities in medication access, treatment adherence, patient satisfaction, and CAM use. This cross-sectional multicenter study included 676 adult migraine patients across 12 MENA countries. Data were collected via structured interviews and medical record verification, covering sociodemographic, lifestyle, clinical, and treatment-related variables, as well as knowledge, attitudes, and experiences with CAM. Patients from LICs/LMICs had significantly longer delays from headache onset to diagnosis compared with those from HICs/UMICs [6 (3-9) vs. 1 (0-3) years; effect size = 1.344, 95% CI: 1.175-1.511, P-value < 0.001]. Chronic migraine was significantly more prevalent in LICs/LMICs (44.3% vs. 20.8%; OR = 0.331, 95% CI: 0.236-0.463, P-value < 0.001), as was medication-overuse headache (38.5% vs. 15.0%; OR = 0.282, 95% CI: 0.195-0.406, P-value < 0.001). Access to medications was more restricted in LICs/LMICs, with 79.4% relying on out-of-pocket payments versus 42.1% in HICs/UMICs (OR = 0.210, 95% CI: 0.138-0.319, P-value < 0.001). Medication adherence was lower in LICs/LMICs (52.0% vs. 78.9%; OR = 3.458, 95% CI: 2.471-4.838, P-value < 0.001). Patient dissatisfaction with healthcare services was markedly higher in LICs/LMICs (35.5% vs. 7.9%, P-value < 0.001). Patients in LICs/LMICs reported greater reliance on traditional healers, religious leaders, and CAM modalities such as cupping, herbal remedies, and spiritual healing. This study highlights substantial disparities in migraine diagnosis and management between patients from LICs/LMICs and HICs/UMICs across the MENA region. Financial constraints and cultural influences may shape treatment adherence and CAM use in LICs/LMICs.
As the proportion of the geriatric population has increased worldwide, increases in mortality and morbidity are inevitable. To ensure healthy aging, preventive measures must be taken at the earliest stage. SDG 2.2 aims to overcome malnutrition, including malnutrition, among the older population. Thus, this study was designed to assess the prevalence of malnutrition among older people who visit hospitals for various ailments so that suggestive measures can be advised. The study was conducted after approval from the Institutional Ethics Committee (IEC) and permissions from the administration of the institution. Older people aged above 60 years who provided consent to participate were considered for the study, while those who were not in a position to provide responses were excluded from the study. A sample of 117 participants was interviewed using a semistructured validated questionnaire consisting of sociodemographic details and the MNA-SF questionnaire. The collected data were entered and then analysed using IBM SPSS (ver 29). A total of 69 (59%) patients received health care from government hospitals, whereas 48 (41%) patients sought health care from private hospitals, with almost equal participation from both genders. One-third of them had hypertension and diabetes mellitus. Upon screening, 40.2% of the older people had a normal nutritional status, whereas the rest of them were either at risk or already having malnutrition. With 58.1% of the participants being malnourished or at risk of malnourishment in the 60-69 age group, among the participants in the lower/upper lower socioeconomic status category, 62.9% were malnourished or at risk of malnutrition, while 56.4% were in the lower middle/upper middle socioeconomic status category. The present study highlights the substantial burden of malnutrition among older individuals. Two-thirds of the individuals were either at risk of developing malnutrition or had already developed malnutrition. As none of the sociodemographic factors were found to be associated, qualitative studies are needed to explore the various other reasons for developing malnutrition.
Innovation does not occur in all environments. Rather, it is a cultural product of particular socioecological conditions, for example, schooling and commercial activity. Tool innovation is a product of cognitive development. It requires a developmental process that enables concrete cognition around age eight and abstract cognition in the teenage years. These conclusions arise from long-term study of textile production in a Maya community.
The Prevention Department represents the technical and functional structure of the Italian National Health Service responsible for implementing collective prevention and public health activities. Ensuring the appropriate allocation of qualified healthcare workers (HCWs) within this setting is fundamental to guarantee the delivery of essential services, maintain system efficiency, and address emerging public health challenges. This study proposes a methodological framework for estimating the annual workable hourly rate of Environmental Health Officers operating within Prevention Departments. The model integrates multiple parameters including, for the workplace safety topic, the size of the working population subject to territorial control activities, the number of companies intended for checks according to national and regional planning, contributing to the calculation of effective working time based on Full-Time Equivalent (FTE) hours. Additional corrective factors are incorporated to account for absenteeism, indirect activities, travel time related to territorial characteristics, and specific targeted prevention programs. The approach was informed by institutional standards, European policy recommendations, and data derived from a Local Health Authority located in the Veneto Region. The proposed model combines two main reference indicators: one Environmental Health Officer per 10,000 workers in the sector within the territorial jurisdiction and an additional professional per 400 companies. The calculation of effective workforce availability considers an estimated average of 1,408 working hours per year per FTE, adjusted for absenteeism and indirect activities. These parameters allow for a more realistic estimation of programmable activities based on standard average times to ensure adequate inspection, surveillance, and other prevention activities. The investigated methodology could provide a structured approach to workforce planning within Prevention Departments, supporting evidence-based staffing decisions and improving the alignment between service demand and human resources. In a context characterized by evolving public health needs, workforce shortages, organizational transformation, and flexible allocation of HCWs, useful policies for effectively managing human capital will be essential to ensure the sustainability and effectiveness of prevention services within the public health system.
BackgroundSystemic lupus erythematosus is a chronic autoimmune disease associated with heightened cardiovascular risk. Data on the impact of systemic lupus erythematosus on outcomes following heart failure hospitalization remain limited. This study aimed to evaluate whether systemic lupus erythematosus is independently associated with 90-days readmission and other clinical outcomes among patients hospitalized with heart failure.MethodsWe conducted a retrospective cohort study using the 2016-2017 Nationwide Readmissions Database to evaluate the association of systemic lupus erythematosus with 90-days readmission after heart failure hospitalization. Adults ≥18 years with an index admission for heart failure were included. The primary outcome was 90-days all-cause readmission. Secondary outcomes included in-hospital mortality, median length of stay, and hospitalization costs. Multivariable Cox proportional hazards were used to identify independent predictors of outcomes.ResultsAmong 1,625,731 patients hospitalized with heart failure, 9096 had comorbid systemic lupus erythematosus. Compared with non-systemic lupus erythematosus patients, those with systemic lupus erythematosus were younger (mean age 61 vs 72 years), predominantly female, and more likely to have socioeconomic disadvantage and a higher comorbidity burden. The 90-days readmission rate was significantly higher in the systemic lupus erythematosus cohort (41%) versus the non-systemic lupus erythematosus cohort (34%) (HR: 1.07; 95% CI: 1.02-1.12; p = 0.010). In-hospital mortality did not differ significantly between groups; however, mortality during readmissions was nearly doubled compared with index admissions (5.4% vs 2.9%). SLE patients had a median length of stay of 4 days (vs 4 days in non-SLE) and incurred median hospitalization costs of USD 32,872 (13% higher than non-SLE patients). Independent predictors of readmission included Medicaid insurance, weekend admission, renal failure, myocardial infarction, and discharge to a non-home setting, whereas female sex, treatment at metropolitan teaching hospitals, and comorbid hypertension or diabetes were associated with a lower risk of readmission.ConclusionSystemic lupus erythematosus is independently associated with an increased risk of 90-days readmission following heart failure hospitalization, contributing to greater healthcare utilization and costs. These findings highlight the need for tailored strategies for transitional care, multidisciplinary follow-up, and socioeconomic support.
For older people and those with more comorbidities, kidney replacement therapy may not offer a mortality benefit. Conservative kidney management represents an alternative treatment pathway for kidney failure without dialysis. To identify the clinical and socioeconomic factors associated with choosing a non-dialysis care pathway and to explore geographical variation. MEDLINE, Embase and Web of Science databases were searched. Studies, which included patients with kidney failure choosing non-dialysis care and a comparator group of patients preparing for or receiving kidney replacement therapy, were selected. Exposures included clinical and socioeconomic factors. The outcome was a choice to have non-dialysis care. Random-effects meta-analysis was performed; with subgroup analysis by region. In total 43 studies, including 51,872 participants, were selected. Female sex was associated with choosing non-dialysis care (pooled OR 1.47, 95% CI 1.26-1.71). There was no overall association between non-white ethnicity and treatment choice in Western countries. However, in North America non-White groups had lower odds of receiving non-dialysis care compared to white patients (OR 0.70, 95% CI 0.60-0.81). Socioeconomic deprivation was associated with choosing non-dialysis care in Asia, as was low educational attainment (OR 2.85, 95% CI 1.54-5.26). There was an overall association between living alone and non-dialysis care (pooled OR 1.55, 95% CI 1.24-1.93). The geographical variation in these results highlights the importance of social and political context in understanding treatment access. We identify living alone and low socioeconomic status as possible predictors of choosing non-dialysis care. This analysis cannot ascertain if these associations arise from appropriate shared decisions, challenges to the decision making process or barriers to accessing kidney replacement therapy. Nevertheless, this review illustrates the interplay of socioeconomic, interpersonal and systemic factors at play and lays the foundation to unravelling these complexities.
Through the extensive literature review that examines the importance of children's peer cultures, Lew-Levy and Amir's paper not only succeeded in elaborating on the existing evolutionary theory of cultural learning but also contributed to the development of adjacent research domains. I would like the authors to further discuss the issues of age differences, transformation and resilience, and social justice.
Observational studies suggest an association between impaired oral health and cardiovascular disease; however, the directionality and underlying mechanisms remain unclear. In particular, whether heart failure (HF) itself adversely affects oral and periodontal health has not been systematically investigated in large populations or experimental models.We examined the association between HF and self-reported oral health indicators in 502,387 participants of the UK Biobank, including 17,356 individuals with HF defined by ICD-9/10 codes. Multivariable logistic regression models adjusted for demographic factors, cardiovascular comorbidities, systemic inflammation, lifestyle, and socioeconomic status were applied. To explore causality and mechanisms, periodontal tissue remodeling and inflammation were assessed in a murine model of pressure overload-induced HF using transverse aortic constriction (TAC). Periodontal ligament (PDL) space and alveolar bone microarchitecture were quantified by micro-computed tomography, and gingival inflammatory gene expression was analyzed by RT-PCR.HF patients exhibited a significantly higher prevalence of oral health burden compared with controls (51% vs. 40%, p<0.001). HF was associated with a 1.6-fold increased risk of impaired oral health, which remained significant after full adjustment (adjusted OR 1.18, 95% CI 1.14-1.22; p<0.001). In mice, reduced left ventricular ejection fraction following TAC was strongly associated with expansion of the maxillary PDL space (R2 = 0.63, p = 0.009) and alterations in alveolar bone microarchitecture (trabecular thickness R2 = 0.41 p = 0.061, trabecular number R2 = 0.38 p = 0.07). These structural changes were accompanied by increased gingival expression of pro-inflammatory cytokines, including Il1b (SHAM vs. TAC: 1.44 ± 1.02 vs. 3.39 ± 1.53, p = 0.06) and TNF-α (SHAM vs. TAC: 1.37 ± 0.86 vs. 5.71 ± 1.23, p = 0.002 predominantly in the maxilla.HF is independently associated with impaired oral health in a large population cohort and induces site-specific periodontal inflammation and remodelling in experimental HF. These findings support HF as an upstream driver of compromised oral-periodontal health, challenging the prevailing concept that oral disease primarily contributes to cardiovascular pathology.
To investigate how unintended pregnancy (UP) is associated with the occurrence of mental health (MH) problems one year later among womxn, while also considering pregnancy outcome (abortion/continuation), co-occurring risks and protective factors. We examine this in the Dutch context, given available abortion care up to 24 weeks gestation and high diversity in people's pregnancy intentions. We hypothesized that MH problems are more prevalent among those whose pregnancy was more unintended. Data from the Dutch BluePrInt study included both womxn who had an abortion (AB, n = 152) and who continued their UP (CT, n = 212). They filled out an online survey shortly after their abortion (AB) or around 14 weeks gestation (CT), and at follow-up one year later. Key variables included pregnancy intendedness (continuously measured), anxiety/depression symptoms (measured with a screening tool based on the CIDI), social- and partner support, abuse experiences, UP-related variables (difficulty deciding, uncertainty, pressure, and negative emotions) and socioeconomic position. 26.5% developed MH symptoms one year after their UP, with no significant differences between AB and CT groups. Pregnancy intendedness and -outcome (abortion vs. continuation), as well as their interaction, were not related to MH symptoms one year later. Previous MH was the strongest predictor of MH risks (OR: 3.54), while perceived social support from family/friends was associated with a lower risk (OR: 0.66). In a context where abortion care is available, pregnancy intendedness and -outcome do not increase people's risks of MH symptoms one year after experiencing an UP. Instead, previous MH and support from family/friends are important for MH after experiencing an UP. Positioning UP as inherently problematic is not warranted. Policy and practice should center people's lived reproductive experiences and care needs.
Occupational asthma (OA) is a significant public health concern due to its high prevalence and socioeconomic burden. In Tunisia, direct costs of OA have not been previously evaluated, highlighting an important knowledge gap for health policy planning. This study aimed to assess the direct cost of OA in the private sector of central Tunisia and identify factors influencing this cost. A retrospective claims-based cohort study was conducted using data from the National Health Insurance Fund (CNAM) on OA cases recognised between 2015 and 2017 in the governorates of Sousse, Monastir, Mahdia and Kairouan, central Tunisia. Direct costs were estimated from the CNAM payer perspective. The costs were tracked from the date of recognition until 31 December 2020 and expressed in 2020 Tunisian dinars (TND). Statistical analyses included univariate tests and generalized linear models (GLM) with gamma family and log link for right-skewed cost data, reporting adjusted incidence rate ratios (aIRR) with Huber-White (HC1) robust standard errors. A total of 157 cases of OA were analyzed, predominantly female (75.8%), with a mean age of 43.41 ± 7.29 years. The textile sector represented 72% of cases. High-molecular weight allergens, particularly vegetable textile dust (70.7%), were the agents most frequently implicated. The median total direct cost was 4,593.52 TND (€1,467.24) per case [IQR: 3,408.00-6,871.72]. The median annualized cost was 1,114.03 TND (€355.94) per person-year. Cash benefits (96.8% of patients) dominated over in-kind benefits (22.9%). In multivariate analysis, age ≥ 40 years was the only significant independent predictor of medical costs (adjusted incidence rate ratio [aIRR] = 2.84, 95% CI: 1.59-5.07; p < 0.001), whereas no clinical or demographic factor predicted indemnity costs. Univariate analysis additionally identified male sex (p = 0.04), higher PPD rate (p < 0.001), and absence of prior occupational disease history (p = 0.001) as factors associated with higher total direct costs. This study highlights the considerable direct costs associated with occupational asthma in central Tunisia's private sector, and the resulting burden placed on the healthcare system and the affected workforce. These findings underscore the need to strengthen primary prevention strategies, particularly in the textile industry, to reduce both the health and economic impact of this disease.
Unhealthy and ultra-processed food (UPF) consumption leads to dietary pattern changes, a deterioration of diet quality, and increases the risk of chronic diseases. Marketing of UPF on government-owned assets, such as public transport infrastructure, contributes to their repeated exposure to the public, increasing consumption. To quantify food and beverage marketing on public transport infrastructure in Western Melbourne, assess the proportion of advertising for unhealthy and ultra-processed food, and explore the relationship between unhealthy advertising and socioeconomic disadvantage. We performed a cross-sectional study at all bus stops, tram stops and train stations in three local government areas (LGAs) in Western Melbourne. We grouped food advertisements using a modified classification from existing protocols and performed descriptive analysis by LGA and transport type. We evaluated the relationship between the proportion of unhealthy advertisements in each area and the index of relative socioeconomic disadvantage using Spearman's correlation. Of 693 total advertisements, 229 promoted food or drinks. Three-quarters (174/229) advertised unhealthy products, most commonly sugar-sweetened beverages (49%) and unhealthy meals (28%). Overall, 73% of food advertisements promoted ultra-processed foods. Vending machines on train platforms accounted for 40% of all unhealthy advertisements. We found no statistically significant relationship between the proportion of unhealthy advertisements and socioeconomic disadvantage. Unhealthy and ultra-processed food marketing dominates public transport food advertising in Western Melbourne. Advertising on public transport has a meaningful impact on communities' exposure to unhealthy foods and the risk of obesity and chronic disease.
Medication non-adherence is a major challenge in stroke prevention in atrial fibrillation (AF), yet no validated tool exists to identify patients at risk of non-adherence at the time of oral anticoagulation (OAC) initiation. In this retrospective cohort study at a large tertiary centre in New York City (2015-2023), adults with AF and a CHA₂DS₂-VASc score ≥ 2 initiating OAC were included. Predicted medication adherence was quantified using the Medication Adherence Score (MAS), a validated algorithm incorporating demographic, socioeconomic, and geographic attributes, dichotomised as high (MAS ≥80) or low (MAS <80). The primary outcome was ischaemic stroke within 12 months, analysed using Fine-Gray competing-risk regression. Of 11,233 eligible patients, 4035 (35.9%) had high and 7198 (64.1%) had low predicted adherence. Most patients received a direct oral anticoagulant (DOAC, 70.3%), 10.7% received warfarin, and 19.0% switched agents. Ischaemic stroke occurred in 6.2% of patients. High predicted adherence was associated with significantly lower stroke risk (sHR 0.67; 95% CI 0.56-0.80), with 12-month cumulative incidences of 5.08% vs. 7.97%. Continuously modelled MAS confirmed a dose-response relationship (HR 0.98 per unit increase; 95% CI 0.97-0.99). Results were consistent after excluding patients with prior stroke (sHR 0.66; 95% CI 0.53-0.83). In AF patients initiating OAC, low predicted medication adherence is independently associated with increased ischaemic stroke risk. The MAS may support early identification of high-risk patients, enabling targeted adherence interventions at OAC initiation.
Childhood leukemia is the leading cause of cancerrelated death among children. In Brazil, limited data on pediatric leukemia trends hinder public health strategies. This study analyzed leukemia mortality in individuals aged 0-19years in São Paulo State, Brazil, from 2000 to 2019. An ecological time-series design was applied using official Mortality Information System (SIM/ DATASUS) microdata, identifying leukemia cases through ICD-10 codes C91-C96. Mortality trends were assessed using the Prais- Winsten regression model and Durbin-Watson test, estimating annual percent change (APC) and 95% confidence intervals. Between 2000 and 2019, 3687 deaths occurred (24.34/100,000), with a decreasing trend (APC: -0.017), from 1.69/100,000 in 2000 to 1.21/100,000 in 2019. Mortality was higher among males (56%), white individuals (71%), and adolescents aged 15-19years (30.8%). Acute lymphoblastic leukemia (C910) accounted for 50.8% of deaths, and unspecified septicemia (A419) was the most frequent associated cause (25.8%). SIGNIFICANCE STATEMENT Analyzing pediatric leukemia mortality trends in São Paulo state provides valuable epidemiological evidence to support surveillance, guide public health policies, and identify regional disparities. As one of Brazil's main referral centers, São Paulo offers important insights into the impact of demographic, socioeconomic, and healthcare factors on mortality, contributing to improved prevention and management strategies nationwide. The study of pediatric leukemia mortality helps understand the disease’s epidemiology and trends in São Paulo state, a national reference. Analyzing temporal evolution supports epidemiological surveillance and the development of prevention strategies to reduce mortality. The scarcity of studies on leukemia trends in Brazilian children challenges the creation of effective public health policies and the allocation of resources. Demographic and socioeconomic factors, along with advances in personalized medicine and early detection, influence mortality outcomes. Mortality data analysis reveals patterns and disparities, guiding more effective, targeted strategies to improve outcomes and quality of life for affected children. Understanding São Paulo’s reality is essential to grasp the complexities of pediatric leukemia and foster continued progress in prevention, treatment, and control across Brazil.
Cervical cancer remains a leading cause of cancer-related mortality among women in low- and middle-income countries, with sub-Saharan Africa bearing a disproportionate burden. Although Human papillomavirus (HPV) vaccination is an effective preventive strategy, completion of the recommended two-dose schedule remains suboptimal in many rural settings in Uganda. This study assessed demographic and individual-level predictors of low HPV vaccine uptake among adolescent girls in Rukiga District. A cross-sectional mixed-methods study was conducted between September and November 2022 among 292 caregivers of adolescent girls aged 9-14 years in Rukiga District. Quantitative data were analyzed using multivariable logistic regression to identify factors associated with completion of the HPV vaccination series. Qualitative data were collected through in-depth interviews with 11 health workers and 10 Village Health Team members and analyzed thematically to explore contextual barriers to vaccine uptake. Completion of the two-dose HPV vaccination series was low (23.49%). Maternal caregiving was positively associated with vaccine completion (AOR = 1.70, 95% CI: 1.05-2.75, p = 0.030). In contrast, lack of formal education (AOR = 0.19, p = 0.033), primary education (AOR = 0.50, p = 0.007), and peasant occupation (AOR = 0.49, p = 0.013) among caregivers were associated with lower uptake. Individual factors such as residential mobility (AOR = 0.50, p = 0.001) and school absenteeism or dropout (AOR = 0.73, p = 0.037) significantly reduced the likelihood of completing vaccination. Qualitative findings revealed key barriers including misconceptions about vaccine safety, school-based delivery limitations, frequent mobility, health system constraints (e.g., stockouts, understaffing), and community mistrust. HPV vaccine uptake in Rukiga District remains low and is influenced by caregiver education, maternal involvement, socioeconomic status, and adolescent mobility and school attendance. Addressing these barriers requires targeted community health education, strengthening school and outreach vaccination strategies, and improving health system capacity. Tailored interventions focusing on less-educated caregivers and hard-to-reach adolescents are critical to improving vaccine completion and reducing the burden of cervical cancer.
BackgroundThere is limited evidence on the relationship between educational attainment and health markers in Japan. This study examined the associations of education level with cardiometabolic markers and health behaviors in a large Japanese population.MethodsThis cross-sectional study used health-related data (medical claims and health checkup results) from public health insurance enrollees linked with national census data between April 2020 and March 2021 from 16 municipalities. Participants were categorized according to education level: low (junior high school graduates or lower), middle (high school graduates), and high (vocational school graduates or higher). The study outcomes were cardiometabolic markers (waist circumference, body mass index, systolic blood pressure, diastolic blood pressure, HbA1c, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol) and health behaviors (smoking habit, drinking habit, restful sleep, and regular exercise). Linear regression and modified Poisson regression analyses were performed to analyze the associations between education levels and the outcomes. The analyses were also conducted according to sex and age (39-64 and 65-75 years).ResultsThe study cohort comprised 61,684 participants. Higher education levels were generally associated with better cardiometabolic markers, but were also linked with higher low-density lipoprotein cholesterol levels. In addition, higher education levels were associated with better health behaviors. The magnitude of association was more pronounced in women and middle-aged persons.ConclusionsThese findings provide a broad overview of the associations between educational attainment and health markers in a large Japanese population, and deepen our understanding of health disparities.
The relationship between economic development and emotional well-being is less well understood than the corresponding relationship with life satisfaction, partly because prior cross-national studies have often relied on brief dichotomous affect measures. Using four waves of the European Social Survey (2006, 2012, 2014, and 2023), we aggregated responses from 177,948 respondents in 33 countries to 97 country-round observations and linked these observations to real GDP per capita. We found strong positive associations between GDP and both emotional well-being and life satisfaction across countries. Longitudinal mixed models showed positive associations between GDP and both well-being components over time. Supplementary checks using separate affect components, quadratic GDP specifications, demographic-composition controls, contextual adjustment for social trust and income inequality, attenuation models with perceived income adequacy and unemployment, and growth-versus-decline tests broadly supported this pattern. Overall, the findings challenge previous conclusions that economic development is only weakly related to affect. When emotional well-being is measured with graded content-valid affect items, it shows a clear positive relationship with both GDP levels and changes in GDP.