Exploring the reasons behind nurses' intentions to leave their hospital or profession: A cross-sectional survey.

Background: Multiple factors can fuel nurses' intention to leave their employing hospital or their profession. Job dissatisfaction and burnout are contributors to this decision. Sociodemographic and work context factors can also play a role in explaining nurses' intention to leave. Objective: To investigate the role of sociodemographic and work context factors, including job resources, job demands, job dissatisfaction, depersonalization, and emotional exhaustion, on nurses' intention to leave their hospital or their profession. Design: Multicentre cross-sectional study. Settings: Eight European hospitals, two per each country, including Belgium, the Netherlands, Italy, and Poland. Participants: From May 16 to September 30, 2022, we collected 1,350 complete responses from nurses working at the selected hospitals (13 % response rate). Methods: The intention to leave was assessed through two 5-Likert scale outcomes, agreeing with the intention to leave the profession and the intention to leave the hospital. Logistic regression models were used for statistical analysis. Results: At the multivariable analysis, a higher intention to leave the hospital was observed for: younger age, having served on the frontline against COVID-19, lack of quipment, living in the Netherlands, emotional exhaustion, dissatisfaction with work prospects, and dissatisfaction with the use of professional abilities. There was a higher intention to leave the profession for: younger age, living in the Netherlands, having work-related health problems, depersonalization, emotional exhaustion, low possibilities of professional development, dissatisfaction with work prospects, lack of use of professional abilities, overall ob issatisfaction, and dissatisfaction with salary. Nurses living in Italy expressed the lowest intention to leave. Conclusion: While confirming the role of job dissatisfaction and burnout, we found higher intention to leave for young nurses, nurses with work-related health problems, and caregivers during the COVID-19 pandemic. Dissatisfaction with work prospects, professional development, and salary also increased the intention to leave. We call for educators, managers, and policymakers to address these factors to retain at-risk nursing categories, implementing strategies to mitigate intentions to leave.

Factors Related to Prevalence of Depression in Türkiye: A Population-Based Study. / Türkiye'de Depresyonun Yayginligi ile Iliskili Faktörler: Nüfusa Dayali Bir Çalisma.

OBJECTIVE: This study aims to determine the prevalence of depressive symptoms in the adult population in Türkiye and to examine the relationship of depression with socio-demographic and behavioral variables and chronic diseases. METHOD: This sturdy utilized data from the 2019 Turkey Health Survey. The Patient Health Questionnaire Depression Module (PHQ- 8) was employed to assess depressive symptoms in the survey. Based on the analysis using the diagnostic algorithm of the PHQ-8, from a total of 17084 people aged 15+ years old who were, we selected 6.4% individuals with depressive symptoms. Then, we randomly selected 1101 individuals without depressive symptoms, comprising of a total of 2202 individuals as the study sample. We assessed the factors associated with depressive symptoms using multivariate logistic regression analyses. RESULTS: The risk of developing depressive symptoms increased with age. Women were more likely to report depressive symptoms. Education, physical activity, and marital status were negatively correlated with reporting depressive symptoms. Further, social support was a protective factor to report depressive symptoms. The presence of chronic diseases was positively associated with depressive symptoms. CONCLUSION: The results showed that point and annual prevalence of depressive symptoms were high. The findings provide a basis for further studies to explore the factors associated with a higher prevalence of depressive symptoms in Türkiye. Our findings could serve as a reference to monitor depression in the country, as well as help in the planning of health resource and identify high risk segments of the population.

Understanding the Perspectives of Hail City Population on the Confidentiality and Privacy of Digital Health and Medical Information.

Background In the era of rapid digital advancement, the confidentiality and privacy of digital health and medical data have become paramount concerns. This study investigates the perspectives of individuals residing in Hail City regarding these critical issues, with a particular emphasis on the influence of demographic factors such as age, gender, and computer proficiency on individuals' discomfort with health professionals using computers and their trust in researchers. Gaining a deeper understanding of these factors is vital for the development of targeted interventions aimed at enhancing patient comfort and trust in digital health/medical technologies. Methodology This study employed a descriptive cross-sectional design, involving a survey of 775 individuals aged 18 and above in Hail City. The questionnaire was designed to gather information on participants' demographic characteristics, computer proficiency, experiences with digital health and medical information, and perceptions of health information safety and privacy. To examine the associations and predictive relationships between variables, chi-square tests, correlation analyses, and logistic regression were performed. Results Significant associations were found between gender and discomfort with health professionals using computers (chi-square = 60.29, p < 0.0001), and between age and trust in researchers regarding the privacy of medical information (chi-square = 50.14, p < 0.0001). Positive correlations were observed between computer proficiency and perception of health information safety (r = 0.12, p = 0.0002), while a negative correlation was found between computer ownership and avoidance of medical tests due to privacy concerns (r = -0.08, p = 0.03). Logistic regression analysis identified age, gender, and computer proficiency as significant predictors of discomfort with health professionals using computers. The findings highlight the crucial role that demographic factors play in shaping attitudes toward the privacy and security of digital health and medical information. Conclusions The findings of this study highlight the crucial role that demographic factors play in shaping attitudes toward the privacy and security of digital health and medical information. Gender and age were found to significantly influence individuals' levels of discomfort and trust, while computer proficiency was shown to enhance perceptions of safety. Based on these findings, the researchers recommend implementing targeted interventions, such as gender-sensitive training programs and initiatives, to enhance digital literacy and improve patient comfort and trust in digital health technologies.

Copy Number Variations of Plasmodium vivax DBP1, EBP/DBP2, and RBP2b in Duffy-positive and Duffy-negative Ethiopians.

Recent evidence challenges the belief that Duffy-negative individuals are resistant to Plasmodium vivax due to lacking Duffy Antigen Receptor for Chemokines (DARC). Erythrocyte Binding Protein (EBP/DBP2) has shown moderate binding to Duffy-negative erythrocytes in vitro. Reticulocyte Binding Protein 2b (RBP2b) interactions with Transferrin Receptor 1 (TfR1) suggest involvement in Duffy-negative infections. Gene copy number variations (CNVs) in PvDBP1, PvEBP/DBP2, and PvRBP2b were investigated in Duffy-positive and Duffy-negative P. vivax-infected individuals from Ethiopia. Among Duffy-positive samples, 34% displayed PvDBP1 duplications (Cambodian-type). In Duffy-negative infections, 30% showed duplications, mostly Cambodian-type. For PvEBP/DBP2 and PvRBP2b, Duffy-positive samples exhibited higher duplication rates (1-8 copies for PvEBP/DBP2, 1-5 copies for PvRBP2b 46% and 43% respectively) compared to Duffy-negatives (20.8% and 26% respectively). The range of CNVs was lower in Duffy-negative infections. Demographic and clinical factors associated with gene multiplications in both Duffy types were explored, enhancing understanding of P. vivax evolution in Duffy-negative Africans.

Socio-demographic factors and mental health trajectories in Australian children and primary carers: Implications for policy and intervention using latent class analysis.

Children's mental health status (MHS) is frequently influenced by their primary carers (PCs), underscoring the significance of monitoring disparities longitudinally. This research investigated the association between socio-demographic clusters and mental health trajectories among children and their PCs over time. Data from waves 6-9c2 of the Longitudinal Study of Australian Children (LSAC) were analyzed using Latent Class Analysis (LCA) to identify four socio-demographic classes among children aged 10-11 years at wave 6. Multinomial logistic regression and predictive marginal analysis explored associations between classes and mental health outcomes. PCs in Class 4 (disadvantaged and separated families with indigenous children) exhibited higher odds of borderline and abnormal MHS compared to Class 1 (prosperous and stable working families) across all waves. However, while MHS of PCs' impacted children consistently, the association with socio-demographic classes was significant only in wave 6. Class 4 children had elevated risks of mental illness compared to Class 1, while Class 3, characterized by educated working mothers, had lower risks. Reducing mental health risks entails addressing socio-economic disparities, supporting stable family structures, and offering tailored interventions like counseling and co-parenting support. Longitudinal monitoring and culturally sensitive approaches are crucial for promoting mental well-being across diverse groups.

Geographic information systems adoption model: A partial least square-structural equation modeling analysis approach.

The ability of Geographic Information System (GIS) to organize, analyze, visualize and integrate spatial data has been at the top of its primary uses among professional industries. However, considering the extensive adoption of Information System (IS) throughout history for government organizations' or citizens' disaster response, the implementation of geographical elements is still minimal. Previous GIS models and framework studies, particularly in developing countries, were affected by pandemic pressure, competitiveness pressure, change management, and security factors. Thus, this study aims to develop a model for the successful adoption of GIS using the Technology Acceptance Model (TAM), and De Lone and Mc Lean Information Success Model and analyze the applicability of the existing factors to enhance the performance of Public Sector Organizations (PSOs). From the study, a new conceptual framework was proposed to examine the effects of factors on GIS adoption that impact performance among PSOs from the perspective of Saudi Arabia. Quantitative methods were used to collect data through a questionnaire distributed to 350 respondents from PSO, and only 272 were found to be valid. Partial Least Square Structural Equation Modeling (PLS-SEM) validated the GIS model. The finding revealed that system quality, service quality, change management, competitiveness pressure, perceived ease of use, perceived usefulness, and security factors significantly and positively affected GIS adoption. The study also showed that GIS adoption substantially affected PSO performance. The proposed model provides insight into how GIS adoption can eventually enhance performance among PSOs. In essence, the study contributes to the running of PSO and the decisions taken by policymakers.

Evolution of Esophageal Cancer Incidence Patterns in Hong Kong, 1992-2021: An Age-Period-Cohort and Decomposition Analysis.

Objective: To elucidate the historical trends, underlying causes and future projections of esophageal cancer incidence in Hong Kong. Methods: Utilizing the Age-Period-Cohort (APC) model, we analyzed data from the Hong Kong Cancer Registry (1992-2021) and United Nations World Population Prospects 2022 Revision. Age-standardized incidence rates were computed, and APC models evaluated age, period, and cohort effects. Bayesian APC modeling, coupled with decomposition analysis, projected future trends and identified factors influencing incidence. Results: Between 1992 and 2021, both crude and age-standardized incidence rates of esophageal cancer witnessed significant declines. Net drifts exhibited pronounced downward trends for both sexes, with local drift diminishing across all age groups. Period and cohort rate ratios displayed a consistent monotonic decline for both sexes. Projections indicate a continued decline in esophageal cancer incidence. Population decomposition analysis revealed that epidemiological changes offset the increase in esophageal cancer cases due to population growth and aging. Conclusion: The declining trend of esophageal cancer in Hong Kong is influenced by a combination of age, period, and cohort. Sustaining and enhancing these positive trends requires continuous efforts in public health interventions.

Unraveling the dynamics of loneliness and cognition in late life: a cross-lagged panel model.

Introduction: Loneliness and cognitive decline are pressing concerns among older adults, yet little research has explored cognition as a predictor of loneliness. This study investigates the dynamic relationship between loneliness and cognitive function in older adults using the random intercept cross-lagged panel model (RI-CLPM). Methods: Data were drawn from Waves 9-14 of the Health and Retirement Study (HRS), encompassing 8,473 individuals aged 65 years and older. Loneliness was assessed using the UCLA Loneliness Scale, and cognitive function was measured using immediate and delayed word recall and serial 7s from the HRS RAND file. Age, gender, education, marital status, self-health report, and depression were included as covariates. Using Mplus, we computed RI-CLPMs. The first three models were conducted on loneliness and cognitive functions. Then unconditional RI-CLPMs with no exogenous predictors were computed. Results: Three conditional model results showed that age, gender, marital status, self-health report, and depression were significantly associated with loneliness in the first wave, but only age and self-health report were significantly associated with immediate and delayed word recall at the first wave, not with serial 7s. For carry-over effects, loneliness showed significant positive associations across consecutive waves, but cognitive functions showed significant positive associations just in the last two waves. Some spill-over effects were found between loneliness and cognitive functions. For within-person effects, although initially non-significant, a negative association between loneliness and immediate and delayed word recall emerged in later waves (11-12 and 13-14). The conditional models indicated that older age, not being married, male gender, low self-reported health, and high depression levels were positively associated with loneliness. However, only older age and lower self-reported health were positively linked to cognitive functions. Discussion: This study underscores the link between loneliness and cognitive function decline in older adults, emphasizing the need to address loneliness to potentially reduce cognitive decline. Insights into demographic predictors of loneliness and cognitive function could inform targeted interventions for promoting successful aging.

Hypertension among persons with type 2 diabetes and its related demographic, socioeconomic and lifestyle factors in the Fasa cohort study.

Hypertension is a very common comorbidity in type 2 diabetes patients, which leads to important health and treatment challenges. The present study was conducted with the aim of determining the prevalence of hypertension and its risk factors in type 2 diabetes patients. This study was conducted using cross-sectional data from 1245 participants aged between 35 and 70 years and diagnosed with type 2 diabetes at baseline in the Fasa cohort study. The prevalence hypertension was determined and multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between various risk factors and hypertension prevalence. The average age of the participants was 53.5 ± 8.7 years and 71.7% (n = 893) were female and 28.3% (n = 352) were male. The prevalence of hypertension in people with type 2 diabetes was 45.5% (n = 566). Higher age (AOR, 95% CI: 8.1, 4.6-14.3), female gender (OR, 95% CI: 1.8, 1.2-2.5), Fars (AOR, 95% CI: 1.6, 1.1-2.4) and Turk (AOR, 95% CI: 1.6, 1.1-2.5) vs. other ethnicity, and overweight (AOR, 95% CI: 1.8, 1.38-2.38) and obesity (AOR, 95% CI: 2.7, 2.0-3.8) vs. BMI < 25 was associated with a higher prevalence of hypertension, while higher physical activity (AOR, 95% CI: 0.57, 0.42-0.78) was associated with lower prevalence of hypertension in the multivariable model. The prevalence of hypertension in persons with type 2 diabetes was high and increased with greater age, in some ethnic groups, and with higher BMI and low physical activity. Further prospective studies are needed to investigate these associations in this population.

Unveiling food safety knowledge and practices among pet owners in Lebanon.

Owning pets offers various potential health benefits; however, it can be associated with gastrointestinal illnesses due to poor food safety knowledge and practices. This study aimed to evaluate the level of food safety knowledge and practices among pet owners in Lebanon, exploring the association between their knowledge/practices and socio-demographic characteristics. The participants included 300 pet owners, representing various genders, ages, educational levels, educational backgrounds, and incomes. They completed a questionnaire of 72 food handling practices and knowledge questions related to preparation, cross-contamination, storage and hygiene. In parallel, 300 non-pet owners with comparable sociodemographic characteristics to pet owners (control group) completed the questionnaire. On average, food safety knowledge scores were 62.1 ± 14.9% and 58.7 ± 15.5% among pet and non-pet owners, respectively, and the difference was significant (p = 0.05). On the other hand, mean food safety practice scores were 41.3 ± 14.8% and 40.4 ± 15.3% among pet and non-pet owners, respectively, and the difference was not significant (p = 0.41). In the food safety knowledge part, non-pet owners who were young, high income, university graduate, and from health-related majors scored significantly (p < 0.05) higher, while among pet-owners, only participants with a university degree and from health-related majors scored significantly (p < 0.05) higher, in terms of knowledge. On the other hand, In the food safety practices part, non-pet owners who were young, high income, and university graduates scored significantly (p < 0.05) higher, while among pet-owners, only young and high-income participants scored significantly (p < 0.05) higher. These results highlight the need for ongoing educational initiatives to improve food safety practices among both pet owners in Lebanon. The study suggests that targeted educational programs should be developed, considering specific socio-demographic characteristics, to enhance overall food safety awareness and practices among the population.

Quality of Life of Patients Receiving Warfarin Therapy at a Tertiary Care Centre in Indonesia Using DASS (Duke Anticoagulation Satisfaction Scale).

Purpose: This study aimed to examine the quality of life of patients receiving warfarin therapy at Dr. Hasan Sadikin Central General Hospital, and its relationship with demographic factors. Patients and Methods: The procedures started with the submission of a study permit, followed by validation of the Duke Anticoagulation Satisfaction Scale (DASS) questionnaire. In addition, the validated questionnaire was completed by the participants, and significant variables were analyzed using the chi-square method for multivariate analysis. Results: The results showed that the questionnaire was valid and could be used for further analyses. Among the 88 selected participants, 52 and 36 had scoring categories <56.266 and 56.266 ≤ x ≤ 143.734, respectively, with no patients having a scoring category > 143.734. In addition, participants with low education and aged ≥ 52 years were 4.916 and 3.161 times more at risk of having quality of life score of 56.266 ≤ x ≤ 143.734, respectively. Based on the results, the average quality of life score of patients was 59.66. Participants with low educational levels and those aged ≥ 52 years were at a higher risk of having quality of life score of 56.266 ≤ x ≤ 143.734. Conclusion: In summary, a lower quality of life score was linked to increased comfort and satisfaction among patients receiving warfarin treatment. Additionally, these patients experienced fewer feelings of limitations and inconveniences related to their treatment plans.

Exploring Maternal Socio-Demographic Factors Shaping Children's Dietary Patterns in Brazil: Results from the 2019 National Health Survey.

This study aimed to identify the dietary patterns of Brazilian children aged 6-23 months and to investigate their association with maternal socio-demographic factors. Data from the 2019 Brazilian National Health Survey were used in this cross-sectional study. Mothers of 1616 children aged 6-23 months reported on their children's dietary intake. Dietary patterns were identified using principal component analysis, and their associations with maternal socio-demographic characteristics were assessed using linear regression models. The first consisted of healthy patterns and the second, unhealthy ones. Linear regression showed that adherence to a healthy dietary pattern was higher among children of mothers who were older (ß = 0.02, p = 0.01), had more years of education (ß = 0.49, p = 0.04), reported living with a partner (ß = 0.29, p = 0.01), and resided in an urban area (ß = 0.35, p = 0.01). Conversely, adherence to the unhealthy pattern was positively associated with mothers who declared themselves as black or brown (ß = 0.25, p = 0.03). Our results show that older mothers with higher levels of education and paid work and who live with a partner are more likely to contribute to their children's healthy eating patterns. We conclude that socio-demographic factors may influence the quality of the food offered to children. Nevertheless, advocating for public policies promoting nutritious complementary diets emphasising fresh and minimally processed foods remains crucial for children whose mothers do not possess these favourable socio-demographic characteristics.

Eating Behaviors during Pregnancy: A Cross-Sectional Study.

BACKGROUND: Eating disorders are complex illnesses with serious long-term consequences. They are linked to negative outcomes such as miscarriage, low birth weight, and other obstetric and postpartum difficulties. Our study in Muscat, Oman, examines the eating habits of pregnant women who consult primary care physicians. In this study, our aim is to identify key sociodemographic factors linked with eating disorders in Oman. METHOD: We used the Eating Disorder Examination Questionnaire to assess the potential for the presence of eating disorders. Chi-Square and Fisher's Exact tests were used to analyze relationships between improper eating behavior and independent variables. RESULTS: The study showed that 1.6% of participants had a potential diagnosis of an eating disorder, with the most common inappropriate behavior being binge eating at a prevalence of 18.8%. A pre-gestational low Body Mass Index (BMI) was associated with a higher prevalence of binge eating during pregnancy. Additionally, we found that pregnant women who were working were more prone to self-induced vomiting. High BMI before pregnancy was significantly associated with various inappropriate eating behaviors, such as restraint behavior (p = 0.000), shape concern (p = 0.000), weight concern (p = 0.040), eating (p = 0.045), laxative use (p = 0.020), and excessive exercise (p = 0.043). CONCLUSION: The study reveals a high prevalence of eating disorders in pregnancy. Less educated women exhibit higher laxative use, while working women show more instances of binge eating and self-induced vomiting. These findings emphasize the critical need to prioritize targeted interventions and support for vulnerable pregnant women.

Severity and Clinical Outcomes of Pediatric Burns-A Comprehensive Analysis of Influencing Factors.

(1) Background: Burn injuries in children present a significant public health concern due to their potential for severe physical and psychological impact. (2) Methods: This study investigates the determinants of pediatric burn severity by analyzing the interplay of demographic and environmental factors. Through a retrospective analysis of pediatric burn cases over five years, encompassing patient demographics, burn causative agents, and clinical outcomes, this research aims to identify significant predictors of burn severity. (3) Results: This study presents a comprehensive analysis of pediatric burn injuries, focusing on the severity, clinical outcomes, and multifactorial aspects influencing recovery. We reviewed 1498 pediatric burn cases from January 2015 to December 2020. The mean age of patients was 5.8 years, with a slight male predominance (54%). Scalds (45%), flame burns (30%), and contact burns (15%) were the most common burn types. Our findings indicate significant differences in burn severity based on TBSA, with 32.5% of cases having TBSA greater than 20%. Multivariate logistic regression identified rural residence, male gender, flame burns, and lower socioeconomic status as significant predictors of severe burn outcomes. The overall mortality rate was 2.5%, with higher rates among patients with TBSA greater than 40%. These results highlight the need for targeted prevention strategies and improved access to specialized burn care. (4) Conclusions: Understanding these factors can inform targeted prevention strategies and improve treatment protocols.

Does Patient's Metabolic and Bariatric Surgery Knowledge Predict Optimal Clinical Outcomes?

PURPOSE: Preoperative evaluation and educational training are required before metabolic and bariatric surgery. This study evaluates patient's comprehension prior to the operation and identifies the relationship between certain sociodemographic parameters and surgery outcomes. MATERIALS AND METHODS: An analysis of patients who completed a preoperative questionnaire and underwent metabolic and bariatric surgery between 2019 and 2021 was performed. The questionnaire evaluated surgery preparation and factors influencing weight loss after surgery. RESULTS: In total, 81 patients completed the preoperative questionnaire. Mean age was 44 ± 11.69 years, 63 females (77%). Mean BMI was 42.85 ± 5.72 kg/m2. Roux-en-Y gastric bypass, sleeve gastrectomy, and one anastomosis gastric bypass was performed in 10 (12.3%), 28 (34%), and 43 (53%) patients respectively. Out of the patients, 38 (47%) were Israeli born Jews, 14 (17.3%) were Russian born Jews, and 29 (35.8%) were Israeli born Arabs. Mean follow-up was 30.71 ± 8.66 months. Questionnaire scores average was 67.7 ± 16.15. Based on univariate analysis, younger, single, higher educated, fewer offspring, and Israeli born Jews significantly scored higher in the questionnaire (p = 0.03, 0.05, 0.01, 0.0002, 0.02 respectively). Postoperational weight loss was significantly inferior among older patients, revisional procedures, and patients with lower educational levels (p = 0.02, 0.006, 0.05 respectively). Patients with a higher BMI, and fewer offspring had a significantly higher weight loss postoperatively (p = 0.0001, 0.02 respectively). CONCLUSION: The number of factors can influence optimal weight loss following metabolic and bariatric surgery. Identifying groups with certain characteristics and addressing their weaknesses may improve weight loss outcomes.

Association of socio-demographic factors with clinical outcome among hospitalized patients in first and second waves of COVID-19 pandemic: Study from the developing world.

Background: Recent disease resurgence in China indicates that corona virus infectious disease is still a pertinent public health problem. We stand at a juncture where we are still unsure about the initial dilemmas regarding its birth, therapies, and the emerging novel strains. Medical literature has focused on the clinical, laboratory, radiological, and therapeutic aspects of disease management. There is paucity of literature on the association between socio-demographic variables on disease severity and clinical outcome. Materials and Methods: This retrospective observational study analyzing the socio-demographic variables was performed at a dedicated COVID care center in western Maharashtra, India. Electronic records of all individuals who were admitted to this hospital from July 29 2020, to June 14, 2021, and diagnosed COVID-19 positive by reverse transcriptase polymerase chain reaction (RT-PCR) were identified after due institutional ethical clearance. Patients admitted from July 29, 2020, to February 27, 2021, were categorized as patients presenting during the 'first wave of viral pandemic'. Those admitted from March 01, 2021, to June 14, 2021, have been included as patients admitted during 'second wave of viral pandemic'. The following outcome parameters were collected (presenting symptoms, duration of symptoms before the individual presented for diagnostic RT-PCR, total duration of symptoms, severity of disease at onset, duration of hospital stay, the final outcome (discharge/death) and Charlson's comorbidity index). The linear regression model was used to establish association between socio-demographic factors and disease severity at onset (mild/moderate/severe/critical). Results: A total of 37033 patients were screened, and the positivity rate with RT-PCR was 16.99% (n = 6275) during the study period. Out of which 45% (n = 2824) of the patients had mild disease requiring home isolation and the remaining 55% of patients required admission. 1590 patients from the first wave and 910 from the second wave of COVID-19 were hospitalized and included in the study after exclusion. The mean age of patients in first wave was 49 years and that in second wave was 54 years with 77.6% and 70.6% males in two waves, respectively. The burden of critical cases was higher in second wave as computed to first wave (10% vs 8%). The second wave had more outreach in the rural population as compared to second one (17.8% vs 12.2%). The mean duration from the onset of symptoms to hospitalization was 03 and 04 days, respectively, in two waves. Mortality associated in two waves was 11.9% and 24%, respectively (P < 0.05). Higher Charlson's comorbidity index was associated with higher mortality, and the cumulative survival from urban area was more as compared to the rural population (log rank - 9.148, P = 0.0002). Conclusion: The second COVID-19 wave had significantly higher case mortality. It affected elderly patients and those with rural background. The factors associated with higher mortality during COVID-19 pandemic were rural background, higher Charlson's comorbidity index and late presentation to the hospital. Ongoing vaccine campaigns, thus, should focus on rural areas and individuals with comorbidities especially in developing and least developed countries.

From transthyretin cardiac amyloidosis diagnosis to tafamidis treatment: Association of drop-off with patient sociodemographic characteristics.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: Compared to estimated population prevalence rates, relatively few patients at risk are diagnosed with and treated for transthyretin cardiac amyloidosis (ATTR-CA). Where along the clinical pathway patient drop-off occurs, as well as the association of drop-off with patient sociodemographic characteristics, remains unknown. METHODS: Using data from a healthcare system-wide cardiovascular imaging repository and specialty pharmacy, we characterized the clinical pathway from diagnosis with pyrophosphate scintigraphy (PYP) to tafamidis prescription, initiation, and adherence. Standardized differences (d values of ≥0.20, indicating at least a small effect size) were used to compare sociodemographics (age, sex, race, Area Deprivation Index) among patients with PYP-identified ATTR-CA by tafamidis prescription status and among patients prescribed tafamidis by initiation status. Tafamidis adherence was measured with the proportion of days covered (PDC). RESULTS: Of 97 patients with ATTR-CA, 58.8% were prescribed tafamidis, with 80.7% of those initiating therapy. Patients with ATTR-CA prescribed tafamidis were younger than those not prescribed tafamidis (d = -0.30). Utilization of a specialty pharmacy resulted in enrichment of treatment in subgroups traditionally undertreated in cardiovascular medicine, with higher rates of tafamidis initiation among women (100% initiation), patients of Black/African American race (d = 0.40), and those living in more economically disadvantaged areas (d ≥ 0.30). Adherence was high (PDC of >80%) in 88.4% of those initiating tafamidis. CONCLUSION: These findings highlight the tremendous opportunity for more robust ATTR-CA clinical programs, identifying potential patient subgroups that should be targeted to reduce disparities. For patients diagnosed with ATTR-CA, utilization of a specialty pharmacy process appears to ensure equitable provision of tafamidis therapy.

Skin Carotenoid Levels Are Associated with Demographic Factors, Body Size, and Fruit and Vegetable Intake in the Japanese Population.

This study aimed to determine the association between demographic factors, body size, and fruit and vegetable intake in the general population, focusing on individuals with both low and high skin carotenoid levels. This cross-sectional study was conducted during the 14th National Convention on the Promotion of Food and Nutrition Education (2019) in Yamanashi, Japan (a rural area) and the Open House 2019 at the National Institute of Biomedical Innovation, Health, and Nutrition in Tokyo, Japan (an urban area). Skin carotenoid measurements were conducted, and the participants were asked to fill out a self-administered questionnaire. The study population consisted of 492 Japanese individuals aged ≥16 years. The odds ratios (ORs) for low skin carotenoid levels were elevated in males, those who were overweight, and those who almost never consumed or consumed only one vegetable dish/day. Conversely, the ORs were lower in those living in Yamanashi, aged 30-39 and ≥70 years, and those who consumed fruit ≥1 time/week. For high skin carotenoid levels, the ORs were higher among those aged ≥70 years, living in Yamanashi, and those who consumed fruit ≥1 time/day or ≥5 vegetable dishes/day. Demographic factors, body size, and habitual fruit and vegetable intake may serve as indicators of skin carotenoid levels.

Determinants of Parental Attitudes towards Children's Vaccination in Lithuania: An Online Survey.

Background: Data from recent years show that the COVID-19 pandemic has significantly reduced the scope of child immunisation worldwide. If the numbers continue to fall, we may have a vaccination crisis. In order to understand the local factors of this phenomenon, we studied parents' viewpoint towards childhood vaccination in Lithuania. Therefore, the aim of our study was to determine the impact of parental attitudes on children's vaccination. Materials and Methods: A web-based cross-sectional study was made in Lithuania from October 20th to November 3rd, 2020, using Google Forms. An anonymous questionnaire included both quantitative and qualitative questions. The questionnaire was distributed to the general population in Lithuania via social media and a snowball sampling. Only parents who have at least one child under 18 years old were involved in the study. We analysed the parents' attitudes towards vaccination by their socioeconomic and demographic determinants using MS Excel and OpenEpi tools. The respondents were considered vaccine supporters if they vaccinated all their children with state-reimbursed vaccines or only vaccinated some of their children, and vaccine sceptics if they did not vaccinate their children with state-reimbursed vaccines. Results: The population of our research consisted of 775 parents. There were more males against vaccination than females, respectively, 59.6% and 33.2%. 65.0% of all respondents stated that they vaccinated their children with the full course of vaccines, while the remaining 35.0% did not vaccinate. University-level education dominated in both pro-vaccine and anti-vaccine groups. We found that 16.9% of parents who were unvaccinated as children themselves tend not to vaccinate their children. However, in the pro-vaxx group, only 0.7% of parents were unvaccinated during childhood. 50.8% of vaccine sceptics were not fully informed by healthcare professionals about the benefits and risks of vaccination, while only 31.6% of vaccine supporters were not informed. Social environment did not have an impact on the decision whether to vaccinate or not to vaccinate a child among both vaccine advocates and vaccine deniers (accordingly, 51.2% and 42.9%). 29.3% of respondents stated that the cost of paid vaccinations was too high. Open-text survey responses gave us more in-depth insight about the parental decision-making process. Protection of children and society from infectious diseases (31.7%) was mentioned as the main reason for vaccination. Whereas vaccine-hesitant parents were mostly concerned about already-occurring side effects or their risk (43.4%). Conclusions: Our findings confirmed that vaccine hesitancy was associated with not being vaccinated in childhood themselves, lack of information from medical practitioners and male gender. The price of vaccines also had an impact on immunisation rates - more than one-third of the vaccine supporting parents indicated that the cost of paid vaccinations was too high. The main incentive for vaccine compliance was parents' desire to protect their children and society from infectious diseases. Whereas vaccine-hesitant parents were mostly concerned about already occurring side effects or their risk. There was no consensus, whether vaccination of children should be mandatory in Lithuania, as the answers to the question were almost evenly distributed. The formation of parents' attitudes towards children's vaccination is a complex process that is determined by parents' attitudes towards the health care system, lack of trust in doctors, and gaps in communication about the benefits and risks of vaccination. All of this information should be taken into account in health policy-making.

The Individual-Level and Community-Level Social Determinants of Burn Injuries: A Single-Institution Study From the Southwestern United States.

Burn injuries are a significant public health concern, causing life-threatening complications and substantial hospitalization costs for patients. It has been shown that burn injuries may affect individuals differently based on demographic factors and socioeconomic status, among other variables. In the Southwestern United States with high ambient temperatures, specific burn etiologies, such as pavement burns, may pose a disproportionately high risk for disadvantaged communities and homeless individuals. This study uniquely explores burn injuries in relation to patients' socioeconomic status in Las Vegas, Nevada by using the Distressed Community Index to quantify socioeconomic status utilizing individual-level and community-level indicators. This single-institution and retrospective study collected data from all patients admitted to a burn center located in Las Vegas. Data were analyzed through Chi-square, one-way ANOVA, and post-hoc analysis with Tukey's test. Patients residing in distressed communities contributed to the greatest number of burn injuries, however there was a lack of significant association between socioeconomic status and burn injury (p = 202). Additionally, specific burn etiologies and demographic characteristics were associated with variations in burn patient hospital course, complications, resources utilized and outcomes. Distressed patients were significantly associated with public insurance (p < 0.001), and public insurance users were associated with pavement burns-one of the most severe burn injuries (p < 0.001). This study emphasizes the importance of developing comprehensive burn prevention resources tailored to vulnerable populations, especially in regions with increased incidence of severe burn injuries, in order to reduce burn burden and mortality.