Period poverty, reuse needs, and depressive symptoms among refugee menstruators in Jordan's camps: a cross-sectional study.

BACKGROUND: Period poverty is a significant issue that impacts the physical and psychological well-being of menstruators worldwide which can further contribute to poor mental health outcomes. For menstruators living in refugee camps, access to menstrual hygiene products is often limited or non-existent, leading to increased anxiety, shame, and embarrassment. Therefore, this study aimed to assess the prevalence of the period poverty and to comprehensively analyze the association between period poverty, reusing menstrual products, and depressive symptoms among menstruators living in refugee camps in Jordan. METHODS: A cross-sectional study surveyed refugee menstruators living in camps in Jordan, aged post-menarche to pre-menopause. Data collection included socio-demographics, menstrual practices, and depressive symptoms using the Patient Health Questionnaire (PHQ-9). Period poverty was assessed through affordability and frequency of struggles with menstrual products. Chi-squared test, independent sample t-test, One Way Analysis of variance (ANOVA) followed by Post hoc, and logistic regression models were used in the analysis. RESULTS: The study included a diverse sample of 386 refugee menstruators living in camps in Jordan (mean age 32.43 ± 9.95, age range 13-55). Period poverty was highly prevalent, with 42.0% reporting monthly struggles to afford menstrual products, and 71.5% reusing menstrual products. Univariate analysis revealed that experiencing period poverty was significantly associated with a younger age of marriage, increased number of children, lower education level, lower mother and father education levels, unemployment, decreased monthly income, absence of health insurance, lower reuse need score, and increased PHQ-9 score (p < 0.05). Menstruators experiencing monthly period poverty were 2.224 times more likely to report moderate to severe depression compared to those without period poverty (95% CI 1.069-4.631, P = 0.033). CONCLUSION: This study highlights a significant association between period poverty and depressive symptoms among refugee menstruators in living in camps in Jordan, as high rates of period poverty were associated with a 2.2-fold increased likelihood of reporting moderate to severe depression. Addressing period poverty in refugee settings is crucial for mitigating depression risks and enhancing overall well-being.

Chronic illness experience in the context of resource-limited settings: a concept analysis.

AIM: This review describes the ways in which individuals experience chronic illnesses in resource-limited settings; to define the concept and understand its attributes, antecedents and consequences. METHODS: A comprehensive analysis of the databases CINAHL, PubMed and Google Scholar was conducted. During literature search the following limits were applied: articles published in English with available full-text; articles that focused on living with chronic illness in adults from the patient's perspective. RESULTS: The following three attributes of chronic illness experience were identified: transformational experience, acceptance and self-management. Prominent predisposing factors (antecedents) were: genetic inheritance, malnutrition and poverty, high levels of stress and unhealthy lifestyle. The most dominant consequences were as follows: impact on quality of life; self-management burden; burden to others and economic stressors. CONCLUSIONS: The findings underscore the need for health-care professionals to understand the chronic illness experience in the context of resource-limited settings and its consequences. The greater insights into the concept of chronic illness experience in resource-limited settings will guide nurses to support people in the realities of chronic illness experience in resource-limited settings in developing countries. This knowledge can guide nurses in providing competent care to chronically ill individuals, including meeting their individual needs with such illnesses.

Poverty and neighborhood opportunity effects on neonate DNAm developmental age.

BACKGROUND: Children from families with low socioeconomic status (SES), as determined by income, experience several negative outcomes, such as higher rates of newborn mortality and behavioral issues. Moreover, associations between DNA methylation and low income or poverty status are evident beginning at birth, suggesting prenatal influences on offspring development. Recent evidence suggests neighborhood opportunities may protect against some of the health consequences of living in low income households. The goal of this study was to assess whether neighborhood opportunities moderate associations between household income (HI) and neonate developmental maturity as measured with DNA methylation. METHODS: Umbilical cord blood DNA methylation data was available in 198 mother-neonate pairs from the larger CANDLE cohort. Gestational age acceleration was calculated using an epigenetic clock designed for neonates. Prenatal HI and neighborhood opportunities measured with the Childhood Opportunity Index (COI) were regressed on gestational age acceleration controlling for sex, race, and cellular composition. RESULTS: Higher HI was associated with higher gestational age acceleration (B = .145, t = 4.969, p = 1.56x10-6, 95% CI [.087, .202]). Contrary to expectation, an interaction emerged showing higher neighborhood educational opportunity was associated with lower gestational age acceleration at birth for neonates with mothers living in moderate to high HI (B = -.048, t = -2.08, p = .03, 95% CI [-.092, -.002]). Female neonates showed higher gestational age acceleration at birth compared to males. However, within males, being born into neighborhoods with higher social and economic opportunity was associated with higher gestational age acceleration. CONCLUSION: Prenatal HI and neighborhood qualities may affect gestational age acceleration at birth. Therefore, policy makers should consider neighborhood qualities as one opportunity to mitigate prenatal developmental effects of HI.

Financial Incentives for Smoking Cessation Among Socioeconomically Disadvantaged Adults: A Randomized Clinical Trial.

Importance: Socioeconomically disadvantaged individuals (ie, those with low socioeconomic status [SES]) have difficulty quitting smoking and may benefit from incentive-based cessation interventions. Objectives: To evaluate the impact of incentivizing smoking abstinence on smoking cessation among adults with low SES. Design, Setting, and Participants: This study used a 2-group randomized clinical trial design. Data collection occurred between January 30, 2017, and February 7, 2022. Participants included adults with low SES who were willing to undergo smoking cessation treatment. Data were analyzed from April 18, 2023, to April 19, 2024. Interventions: Participants were randomized to usual care (UC) for smoking cessation (counseling plus pharmacotherapy) or UC plus abstinence-contingent financial incentives (UC plus FI). Main Outcomes and Measures: The primary outcome was biochemically verified 7-day point prevalence smoking abstinence (PPA) at 26 weeks after the quit date. Secondary outcomes included biochemically verified 7-day PPA at earlier follow-ups, 30-day PPA at 12 and 26 weeks, repeated 7-day PPA, and continuous abstinence. Multiple approaches were employed to handle missing outcomes at follow-up, including categorizing missing data as smoking (primary), complete case analysis, and multiple imputation. Results: The 320 participants had a mean (SD) age of 48.9 (11.6) and were predominantly female (202 [63.1%]); 82 (25.6%) were Black, 15 (4.7%) were Hispanic, and 200 (62.5%) were White; and 146 (45.6%) participated during the COVID-19 pandemic. Overall, 161 were randomized to UC and 159 were randomized to UC plus FI. After covariate adjustment with missing data treated as smoking, assignment to UC plus FI was associated with a greater likelihood of 7-day PPA at the 4-week (adjusted odds ratio [AOR], 3.11 [95% CI, 1.81-5.34]), 8-week (AOR, 2.93 [95% CI, 1.62-5.31]), and 12-week (AOR, 3.18 [95% CI, 1.70-5.95]) follow-ups, but not at the 26-week follow-up (22 [13.8%] vs 14 [8.7%] abstinent; AOR, 1.79 [95% CI, 0.85-3.80]). However, the association of group assignment with smoking cessation reached statistical significance at all follow-ups, including 26 weeks, with multiple imputation (37.37 [23.5%] in the UC plus FI group vs 19.48 [12.1%] in the UC group were abstinent; AOR, 2.29 [95% CI, 1.14-4.63]). Repeated-measures analyses indicated that participants in the UC plus FI group were significantly more likely to achieve PPA across assessments through 26 weeks with all missing data estimation methods. Other secondary cessation outcomes also showed comparable patterns across estimation methods. Participants earned a mean (SD) of $72 ($90) (of $250 possible) in abstinence-contingent incentives. Participation during the COVID-19 pandemic reduced the likelihood of cessation across assessments. Conclusions and Relevance: In this randomized clinical trial, incentivizing smoking cessation did not increase cessation at 26 weeks when missing data were treated as smoking; however, the UC plus FI group had greater odds of quitting at follow-ups through 12 weeks. Cessation rates were higher for the UC plus FI group at all follow-ups through 26 weeks when multiple imputation was used to estimate missing outcomes. Trial Registration: ClinicalTrials.gov Identifier: NCT02737566.

High-income ZIP codes in New York City demonstrate higher case rates during off-peak COVID-19 waves.

Introduction: Our study explores how New York City (NYC) communities of various socioeconomic strata were uniquely impacted by the COVID-19 pandemic. Methods: New York City ZIP codes were stratified into three bins by median income: high-income, middle-income, and low-income. Case, hospitalization, and death rates obtained from NYCHealth were compared for the period between March 2020 and April 2022. Results: COVID-19 transmission rates among high-income populations during off-peak waves were higher than transmission rates among low-income populations. Hospitalization rates among low-income populations were higher during off-peak waves despite a lower transmission rate. Death rates during both off-peak and peak waves were higher for low-income ZIP codes. Discussion: This study presents evidence that while high-income areas had higher transmission rates during off-peak periods, low-income areas suffered greater adverse outcomes in terms of hospitalization and death rates. The importance of this study is that it focuses on the social inequalities that were amplified by the pandemic.

Somos Esenciales, We are Essential: Our Mental Health is Essential. Research for, by and of the Latinx Community in the Mission District during the Pandemic.

We are Latinx immigrants and children of Latinx immigrants. We provided emergency volunteer services at the Mission Food Bank during the pandemic to provide food assistance to low-income families in the Mission District and the city of San Francisco. In March 2021, we were invited to lead a research project that we call "We are Essential". Here we share our process and a few of our findings on the mental health of San Francisco's Latinx community during the pandemic, with a focus on our children and youth. A full report of our findings will be published in 2024.

Impact of research paradigms on low-income female caregivers and their children: an oral health literacy discourse.

Objective: Despite the vast knowledge gained through research and public health surveillance, dental caries prevalence among children from low-income households remains high. The aim of this literature review is to identify assumptions made within existing empirical, constructivist, and critical paradigms to determine how those assumptions impact knowledge and if these impacts have aided in perpetuating inequity or health disparities within this target population. Method: A literature search of EBSCOhost, PubMed, and Web of Science was conducted to retrieve articles from peer-reviewed journals published in the last 10 years, including qualitative, quantitative, and mixed methods studies. Qualitative methods included narrative research via interviews; quantitative designs included cross-sectional studies using surveys and various indices to assess oral health literacy (OHL) levels and oral health status. Exclusion criteria were non-English studies and studies that did not include female caregivers. Results: Nine primary research articles were selected for analysis. The positivist paradigm was dominant in 7 of 9 articles. Oral health social processes, such as the lack of value placed on oral health as a component of overall health by the broader medical community and the public, were not discussed as influencing factors on OHL. Discussion: Assumptions identified within the dominant paradigms were determined to perpetuate inequity or health disparities, confirming a link between caregivers' OHL levels and the oral health status of their children. It is critical that all health care professionals improve their understanding of factors affecting caregivers' OHL. Conclusion: Strategies that empower and advocate for women to improve their OHL should be developed.

Objectif: Malgré les vastes connaissances acquises par le biais de la recherche et des activités de surveillance de la santé publique, la prévalence des caries dentaires chez les enfants vivant dans des ménages à faible revenu demeure élevée. La présente revue de la littérature vise à cerner les suppositions des paradigmes empiriques, constructivistes et critiques existants afin de déterminer comment elles influent sur les connaissances, et si ces effets ont contribué à perpétuer les iniquités ou les disparités en matière de santé au sein de cette population cible. Méthodes: On a procédé à une recherche documentaire sur EBSCOhost, PubMed et Web of Science pour trouver des articles publiés au cours des 10 dernières années dans des revues à comité de lecture, y compris des études par cohortes qualitatives, quantitatives et mixtes. Les méthodes qualitatives comprenaient des recherches narratives réalisées au moyen d'entrevues. Les méthodes quantitatives comprenaient des études transversales faisant appel à des sondages, ainsi que divers indices visant à évaluer les niveaux de littératie en santé buccodentaire et la situation en matière de santé buccodentaire. Les critères d'exclusion s'appliquaient aux études non anglophones et aux études qui n'incluaient pas de femmes soignantes. Résultats: Neuf articles présentant des études originales ont été sélectionnés aux fins d'analyse. Le paradigme positiviste était dominant dans 7 des 9 articles. L'influence de certains processus sociaux de santé buccodentaire, tel que le manque de valeur accordée à la santé buccodentaire en tant qu'élément de la santé globale par la communauté médicale en général et par le public, sur la littératie en santé buccodentaire n'a pas été discutée. Discussion: On a établi que les suppositions définies dans les paradigmes dominants perpétuaient l'iniquité ou des disparités en matière de santé, ce qui confirme l'existence d'un lien entre le niveau de littératie en santé buccodentaire parmi les soignants et l'état de santé buccodentaire de leurs enfants. Il est essentiel que tous les professionnels de la santé renforcent leur compréhension des facteurs qui influent sur cette littératie chez les soignants. Conclusion: Il est nécessaire d'élaborer des stratégies propres à défendre les femmes et à leur donner les moyens d'améliorer leur littératie en santé buccodentaire.

PlanoUp!: A pilot program for the identification and treatment of depression for youth in low-income secondary schools.

Rates of depression in youth are continuing to increase at a steady rate, yet these youth often do not receive mental health services (Bertha & Balázs, 2013; Thomas et al., 2011). Schools are an ideal setting to connect youth to mental health services; however, many barriers exist with respect to schools having adequate resources and access to the appropriate levels of services (Duong et al., 2021; Owens & Peltier, 2002). Schools may collaborate with local community providers with available resources to address these gaps. The current article describes the pilot of a school-based mental health promotion program intended to reduce depression in youth by promoting access to care through referrals to community providers. Data were collected, via self-report measures, every 3 months for 12 months from students from three middle and high schools in North Texas. The students (N = 88) enrolled in this program experienced significant reductions in their depression symptoms at the end of 12 months. This program highlights the importance of school-community partnerships to promote access to care to address mental health concerns. The results from our pilot study demonstrate the feasibility and the potential of school-based programs in improving the mental health of youth in schools through community partnership. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Incidence and intensity of catastrophic health expenditure and impoverishment among the elderly: an empirical evidence from India.

World health statistics (2022) report that about 1.4 billion people have incurred catastrophic health expenditure (CHE), and half of its population have pushed into extreme poverty due to healthcare payments. The elderly population faces a higher risk of ill health, and seeking treatment reflects in high out-of-pocket health spending (OOPHS) that results in CHE and further impoverishment. This study aims to investigate the incidence and intensity of OOPHS, CHE, and impoverishment among the older adults in India. Data utilizes from the 75th round of the national sample survey (NSS) based on household social consumption: health (schedule 25.0), 2018. The incidence and intensity of CHE and impoverishment among older adults in India estimated by using standard measures. The older adults spend about 17.4% of household consumption expenditure on healthcare services. The poorest older adults are spending the highest share of consumption expenditure (24.8%) on healthcare among economic quantiles. Similarly, the elderly from rural (20.3%), male (18.4%), scheduled castes (21.5%), and Hinduism (17.9%) show a larger share of consumption expenditure on healthcare services. The incidence and intensity of CHE among older adults are 46.5% and 16.1% at 10% threshold level of household consumption expenditure, respectively. However, as the threshold level rises the incidence and intensity of CHE decline. The estimates of normalized poverty gap using the poverty line of Tendulkar committee as well as Rangarajan committee show that the intensity of impoverishment among older adults are 56.4% and 57.9% respectively, which is quite high. Financial protection along with vision might mitigate the risk of CHE and impoverishment among older adults in India.

Poverty, childcare responsibilities, and stigma hinder adolescent mothers from returning to school in a low-income urban informal settlement in Kenya.

BACKGROUND: While a few studies have examined barriers to school re-entry among adolescent mothers, studies focusing on the experiences of girls in low-income informal settlements are scarce. We examined the factors that hindered parenting girls living in a resource-constrained urban setting from re-enrolling in school. STUDY SETTING: We conducted the study in Korogocho, a low-income urban informal settlement in Nairobi, Kenya. METHODS: Barriers to school re-entry were documented through inductive thematic analysis of 32 in-depth interviews with pregnant and parenting adolescent girls aged 15 to 19 years (N = 22), parents/guardians (N = 10), and 10 key informant interviews with teachers (N = 4), and community leaders (N = 6). RESULTS: Interviewed girls blamed their being out of school on their childcare responsibilities, poverty, stigmatizing and discriminatory attitudes from students and teachers, and withdrawal of parental support. While parents, teachers, and community leaders agreed that poverty and lack of childcare support hindered parenting girls from returning to school, they contended that robust support systems encompassing childcare and financial support, and less hostile school environments constituted facilitators of school re-entry among parenting adolescents. CONCLUSION: While the 2020 National Guidelines for School Re-entry in Kenya seek to deter the exclusion of adolescent mothers from education thereby ensuring retention, transition and completion at all basic education levels, the findings underscore the need for programs that ensure that pregnant and parenting adolescents have the requisite financial, material, and childcare support to facilitate their retention or re-enrollment in school in line with the Guidelines. School administrators and the Ministry of Education should develop and implement interventions that make the school environment less hostile for parenting girls.

Equality of healthcare resource allocation between impoverished counties and non-impoverished counties in Northwest China: a longitudinal study.

BACKGROUND: The Health and Medical Assistance Program for Poverty Alleviation is part of China's targeted poverty elimination strategy, which aims to protect poor people's right to health and prevent them from becoming trapped in or returning to poverty because of illness. Many tasks have been defined in this program, including raising the medical insurance level, providing a triage system, improving medical and health services, and enhancing people's health. One pivotal aspect of this initiative involves equitable health resource allocation, a key measure aimed at bolstering medical and health services. This study aimed to analyze and compare health resource allocations in different counties in Northwest China after the implementation of the program. METHODS: The Gini coefficient quantifies the level of distributional equality, the Theil index assesses the sources of inequality, and the Health Resource Agglomeration Degree gauges the accessibility of health resources. RESULTS: 1) The health resource allocation distributed based on population(Gini Coefficient < 0.45) was more equitable than that distributed based on area(Gini Coefficient > 0.35) among counties in Northwest China. 2) The contribution rate within non-impoverished counties is higher than that of impoverished counties, which means the inequality within non-impoverished counties. 3) The allocation of beds in medical institutions by area in non-impoverished counties was better than that in impoverished counties, and accessibility to health services for residents in non-impoverished counties was better than that in impoverished counties. CONCLUSION: The analysis of health resource allocation among the five provinces in Northwest China revealed significant differences in equality among the five provinces in Northwest China, and the differences were mainly derived from the non-impoverished counties. Although the equality is gradually improving, the number of health resources in impoverished counties remain lower than that in non-impoverished counties.Subsequently, it is essential to ensure equitable distribution of healthcare resources while also taking into account their utilization and quality.

Comparing Sleep Quality, Duration, and Efficiency Among Low-Income Community-Dwelling Older Adults With and Without Physical Disabilities.

PURPOSE: Physical disabilities may exacerbate the natural decline in sleep quality that occurs with aging. In the current study, we assessed sleep quality and medicinal sleep aid use among 87 community-dwelling older adults with (n = 24) and without (n = 63) physical disabilities. METHOD: Sleep quality, duration, and efficiency were assessed subjectively with the Pittsburgh Sleep Quality Index. Sleep duration and efficiency were objectively measured with actigraphy. Participants self-reported medicinal sleep aid use. RESULTS: Significant group differences were observed in sleep duration measured objectively (p = 0.01) and subjectively (p = 0.04). No other group differences were observed for sleep factors (p > 0.05) or medicinal sleep aid use (p = 0.41). CONCLUSION: Findings show that physical disability may be a factor in sleep duration; however, physical disability was not found to be associated with worsened sleep perception or greater reliance on medicinal sleep aids. Future research should consider longer objective actigraphy assessment windows and explore potential subgroup differences in sex and race/ethnicity. [Journal of Gerontological Nursing, 50(7), 12-18.].

Intersectional analysis of the experiences of women who fail to conceive in low and middle income neighbourhoods of Delhi, India: Findings from a qualitative study.

BACKGROUND: Experiences of delayed conception and infertility have been reported among women. However, the concept of intersectionality is rarely utilised in studies of infertility, and it is particularly uncommon in research from low- and middle- income countries. RESEARCH QUESTION: What are the lived experiences of women with delayed conception in low to -middle income neighbourhoods of Delhi, India? METHODS: This was a qualitative study (n = 35) that recruited women who had failed to conceive after 18 months of regular unprotected sexual intercourse. Data were collected between February and July 2021. Data were collected through focus group discussions in low income to middle income neighbourhoods of Delhi, India. Analysis identified themes related to intersecting axes of inequality. RESULTS: The results showed that gender intersected with economics, masculinity, patriarchal norms and class to influence the experiences of women. The intersection of gender, economics and patriarchal norms compromised women's agency to be active generators of family income, and this dynamic was exacerbated by patrilocal residence. In addition, masculinity contributed to stigmatisation and blaming of women, due to the inaccurate perception that men did not contribute to a couple's infertility. The intersection of gender and social class in medical settings created barriers to women's access to medical information. CONCLUSION: Findings from this study provide representative examples of the variety of axes of inequality that shape women's experiences in the study setting. Although these findings may not be generalisable to all women who are experiencing delayed conception, they highlight a need for improved awareness and education on infertility, as well as a need to ensure the availability and accessibility of fertility care for couples in need.

The protective measure for institutional care of children and adolescents from the perspective of national studies. / A medida protetiva de acolhimento institucional de crianças e adolescentes na perspectiva dos estudos nacionais.

This article aims to analyze the national scientific production on protective measures aimed at institutional care for at-risk children and adolescents in Brazil. By carrying out an integrative review, we seek to reflect on the main trends, themes, institutional actors, methodologies, and objectives of studies on the aforementioned measure and to analyze how the conditions and the right to health are presented and articulated in these references. Six thematic units were identified in the collection: Perceptions and roles of different actors in institutional reception processes; Processes of autonomy, dismissal, and causes of institutional care; Legislative aspects, evaluation of services, and identification of profiles; Family and community coexistence; Education and professional training; and Physical and mental health of sheltered children and adolescents. In Brazil, specifically, few studies investigate the concepts of the children and adolescents placed in shelters concerning protective measure processes or access to education. The link between poverty and institutionalization appears prominently and the scarcity of activities aimed primarily at family reintegration is evident. A large number of surveys point to the difficulties in implementing legislation.

O artigo tem como objetivo analisar a produção científica nacional sobre as medidas protetivas de acolhimento institucional para crianças e adolescentes em situação de risco no Brasil. Através da realização de uma revisão integrativa, busca-se refletir sobre as principais tendências, temas, atores institucionais, metodologias e objetivos dos estudos acerca da referida medida e analisar como se apresentam e se articulam as condições e o direito à saúde nessas referências. Seis unidades temáticas foram identificadas no acervo: percepções e papéis de diferentes atores nos processos de acolhimento institucional; processos de autonomia, desligamento e causas de acolhimento institucional; aspectos legislativos, avaliação de serviços e identificação de perfis; convivência familiar e comunitária; educação e formação profissional; e saúde física e mental de crianças e adolescentes acolhidos. No Brasil, especificamente, poucos estudos investigam as concepções dos acolhidos sobre os processos de medida protetiva, assim como o acesso à educação. O vínculo entre pobreza e institucionalização aparece com destaque e fica evidenciada a escassez de atividades visando a reintegração familiar de maneira prioritária. Um número alto de pesquisas aponta para as dificuldades de implementar legislações.

Vulnerabilities mediating the Healthcare encounter: by an intersectional agency. / Vulnerabilidades mediando o encontro do Cuidado em Saúde: por uma agência interseccional.

This essay elucidates the Healthcare and Intersectionality notions to prompt reflections on the interaction between healthcare professionals and individuals referred to as Nanás: elderly, poor, and Black women who represent a historically marginalized profile throughout Brazilian history. By delving into the arguments about the concept of Intersectionality and the multifaceted Care dimensions, it becomes apparent that there is a pressing need to broaden the perspective on women who access healthcare services, as they are inherently shaped by their life experiences. Moreover, it is imperative to acknowledge how the intersecting factors inherent in their profiles can influence the approach taken by those providing Care, which underscores the essentiality of an intersectional agency on the part of the agents involved in this encounter, namely the Nanás and healthcare workers, to effectively uphold the principles of comprehensiveness and equity within the Unified Health System (SUS).

O presente ensaio articula os conceitos de Cuidado em Saúde e Interseccionalidade para suscitar reflexões sobre o encontro entre o/a trabalhador/a de saúde e aquelas que aqui denominamos uma Naná: uma mulher, negra, idosa e periférica, perfil historicamente vulnerabilizado ao longo da história brasileira. Considerando as argumentações que envolvem o conceito de Interseccionalidade e as diferentes vertentes acerca do Cuidado, observamos a necessidade de se ampliar o olhar sobre estas que buscam os serviços de saúde já atravessadas por suas histórias de vida, e ponderar sobre os atravessamentos que seu perfil pode acionar em quem exerce o Cuidado. Aponta ser primordial uma agência interseccional por parte das/os agentes deste encontro, Nanás e profissionais de saúde, para que se concretizem os princípios de integralidade e equidade no Sistema Único de Saúde (SUS).

Association of poverty-income ratio with cardiovascular disease and mortality in cancer survivors in the United States.

BACKGROUND: Lower income is associated with high incident cardiovascular disease (CVD) and mortality. CVD is an important cause of morbidity and mortality in cancer survivors. However, there is limited research on the association between income, CVD, and mortality in this population. METHODS: This study utilized nationally representative data from the National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey evaluating the health and nutritional status of the US population. Our study included NHANES participants aged ≥20 years from 2003-2014, who self-reported a history of cancer. We evaluated the association between income level, prevalence of CVD, and all-cause mortality. All-cause mortality data was obtained through public use mortality files. Income level was assessed by poverty-income ratio (PIR) that was calculated by dividing family (or individual) income by poverty guideline. We used multivariable-adjusted Cox proportional hazard models through a backward elimination method to evaluate associations between PIR, CVD, and all-cause mortality in cancer survivors. RESULTS: This cohort included 2,464 cancer survivors with a mean age of 62 (42% male) years. Compared with individuals with a higher PIR tertiles, those in the lowest PIR tertile had a higher rate of pre-existing CVD and post-acquired CVD. In participants with post-acquired CVD, the lowest PIR tertile had over two-fold increased risk mortality (Hazard Ratio (HR) = 2.17; 95% CI: 1.27-3.71) when compared to the highest PIR tertile. Additionally, we found that PIR was as strong a predictor of mortality in cancer survivors as CVD. In patients with no CVD, the lowest PIR tertile continued to have almost a two-fold increased risk of mortality (HR = 1.72; 95% CI: 1.69-4.35) when compared to a reference of the highest PIR tertile. CONCLUSIONS: In this large national study of cancer survivors, low PIR is associated with a higher prevalence of CVD. Low PIR is also associated with an increased risk of mortality in cancer survivors, showing a comparable impact to that of pre-existing and post-acquired CVD. Urgent public health resources are needed to further study and improve screening and access to care in this high-risk population.

Menstrual poverty scale: reliability and validity study.

The tendency toward poverty in the globalizing world significantly affects women. Unlike men, women have mandatory expenses every month. Especially poor women have difficulty in accessing to the hygienic products they need during the menstrual period. That is why, this study aims to develop a measurement tool that can effectively and widely assess women's menstrual poverty. This study is a methodological study that evaluates the psychometric properties of the scale. The study included 420 women living in a middle-income province in the north of Türkiye between April - July, 2023. The data were collected using the Menstrual Poverty Scale, and the items on the scale were developed based on a review of existing literature and expert opinions (CVI = 0.85-0.95). The sample was divided into two parts. It was made exploratory factor analysis and confirmatory factor analysis. Before conducting the study, an ethics committee decision and informed consent of the women were obtained. The collected data were analyzed using the SPSS 23 and AMOS 23 programs. The EFA revealed a structure consisting of 13 items and four factors. The four factors considered were as follows; access to hygiene products, quality of life, embarrassment, and receiving information, and education about menstruation. The item factor loadings varied from 0.46 to 0.91. The Cronbach's alpha coefficient was determined to be 0.69. The corrected item-total correlations for the scale items ranged from 0.62 to 0.84. According to the confirmatory factor analysis, the structural equation modeling results of the Menstrual Poverty Scale were found to be meaningful (p = .000; RMSEA 0.64; CMIN/Df 1.70). It is suggested to conduct validity and reliability studies in different cultures by applying the scale to women from different cultural backgrounds.

Affordability and adherence gains for Medicare Part D low-income subsidy recipients when low-income subsidy benefits expanded in 2024.

BACKGROUND: The lowest-income beneficiaries enrolled in the Medicare Part D prescription drug program receive "full subsidies" that waive the premium and deductible and impose minimal copayments. Those with slightly higher incomes and assets may be eligible for "partial subsidies." Prior to 2024, individuals receiving partial subsidies faced reduced Part D premiums and deductibles and paid 15% coinsurance. Under provisions of the Inflation Reduction Act, recipients of partial subsidies were upgraded to full subsidies beginning in 2024. The objective of this pilot study was to assess whether the new policy is likely to reduce cost-related nonadherence to prescribed medications- a common problem faced by older adults even among those receiving subsidies. OBJECTIVE: To compare cost-related nonadherence among partial- vs full-subsidy recipients with similar characteristics. METHODS: We used 2019 Medicare Current Beneficiary Survey data for the study. The Medicare Current Beneficiary Survey is uniquely suited for this work because it contains administrative data on low-income subsidy enrollment plus extensive survey-based information on financial resources necessary to establish program eligibility and rates of cost-related nonadherence. Explanatory variables included sociodemographic characteristics, economic resources, work status, and health variables. RESULTS: We found that the partial-subsidy group reported significantly more cost-related nonadherence (39% vs 22%; P = 0.01) arising both from a lower propensity to fill some prescriptions (23% vs 12%; P = 0.03) and to more delays in filling others (29% vs 8%; P = 0.03). The differences were more pronounced for women and racial and ethnic minority groups in contrast to men and majority populations, respectively. Because the study samples were small, we could not conduct a detailed regression analysis. CONCLUSIONS: The magnitude of cost-related nonadherence effects associated with partial-subsidy cost sharing suggests that the Inflation Reduction Act policy to expand low-income subsidies may boost medication adherence, most notably among women and racial and ethnic minority groups.