Geospatial and Socioeconomic Disparities Influencing the Management of Craniosynostosis.

BACKGROUND: Various social determinants of health have been described as predictors of clinical outcomes for the craniosynostosis population. However, literature lacks a granular depiction of socioeconomic factors that impact these outcomes, and little is known about the relationship between patients' proximity to the care center and management of the condition. METHODS/DESIGN: This study retrospectively evaluated patients with craniosynostosis who presented to a tertiary children's hospital between 2000 and 2019. Outcomes of interest included age at presentation for surgery, incidence of reoperation, and length of follow-up. Patient addresses were geocoded and plotted on two separate shapefiles containing block group information within San Diego County. The shapefiles included percent parental educational attainment (bachelor's degree or higher) and median household income from 2010. The year 2010 was chosen for the shapefiles because it is the median year of data collection for this study. Multivariate linear, logistic, and polynomial regression models were used to analyze the relationship between geospatial and socioeconomic predictors and clinical outcomes. RESULTS: There were 574 patients with craniosynostosis included in this study. The mean ± SD Haversine distance from the patient's home coordinates to the hospital coordinates was 107.2 ± 321.2 miles. After adjusting for the suture fused and insurance coverage, there was a significant positive correlation between distance to the hospital and age at index surgery (P = 0.018). There was no correlation between distance and incidence of reoperation (P = 0.266) or distance and duration of follow-up (P = 0.369). Using the same statistical adjustments, lower parental percent educational attainment and lower median household income correlated with older age at index surgery (P = 0.008 and P = 0.0066, respectively) but were not correlated with reoperation (P = 0.986 and P = 0.813, respectively) or duration of follow-up (P = 0.107 and P = 0.984, respectively). CONCLUSIONS: The results offer evidence that living a greater distance from the hospital and socioeconomic disparities including parental education and median household income may serve as barriers to prompt recognition of diagnosis and timely care in this population. However, the geospatial and socioeconomic factors studied do not seem to hinder incidence of reoperation or length of follow-up, suggesting that, once care has been initiated, longitudinal outcomes may be less impacted.

Nexus of green energy, financial inclusion, militarization, and environmental sustainability: A global perspective.

This article investigates the dynamic impact of green energy consumption (GE), financial inclusion (FI), and military spending (MS) on environmental sustainability (ES) by utilizing a sample of 121 countries from 2003 to 2022. The dataset is divided into high-income, upper-middle income and low and lower-middle-income countries. We employed a two-step system GMM approach, which was further robust through panel Quantile and Driscoll-Kraay (D-K) regressions. The findings divulged that green energy resources benefit ES at global and all income levels because of having a significant negative impact of 5.9% on ecological footprints. At the same time, FI and MS significantly enhance ecological footprints by 7% and 6.9%, respectively, proving these factors detrimental to ES. Moreover, conflicts (CON), terrorism (TM), institutional quality (IQ), and socioeconomic conditions (SEC) also have a significantly positive association with global ecological footprints and most of the income level groups. Dissimilarly, financial inclusion and armed conflicts have a non-significant influence on ecological footprints in low-income and high-income countries, respectively. Furthermore, institutional quality enhances ES in upper-middle and low and lower-middle-income countries by negatively affecting ecological footprints. At the same time, terrorism significantly reduces ecological footprints in high-income countries. This research also provides the imperative policy inferences to accomplish various SDGs.

Modeling determinants of time-to-premarital cohabitation among Ethiopian women using parametric shared frailty models.

BACKGROUND: Premarital cohabitation is rampant and currently practiced worldwide, particularly in sub-Saharan Africa. It is a known cause of marital instability and divorce. It is also associated with intimate partner violence and harms the psychology of children in later life. However, in Ethiopia, there has been limited attention given to premarital cohabitation. OBJECTIVE: The main goal of this study was to identify the determinants of time-to-premarital cohabitation among Ethiopian women. METHODS: The 2016 EDHS data was used to achieve the study's goal. The survival information of 15683 women was analyzed based on their age at premarital cohabitation. The regional states of the women were used as a clustering effect in the models. Exponential, Weibull, and Log-logistic baseline models were used to identify factors associated with age at premarital cohabitation utilizing socioeconomic and demographic characteristics. RESULTS: The median age of premarital cohabitation was found to be 18 years. Surprisingly, 72.7% of participants were cohabitated in the study area. According to the Log-logistic-Gamma shared frailty model, place of residence, occupation, educational status, and being pregnant were found to be factors determining the time to premarital cohabitation. CONCLUSION: Premarital cohabitation among Ethiopian women was higher compared to women in the sub-Saharan Africa and East Africa. Place of residence, occupation, educational status, and being pregnant were found to be factors determining the time for premarital cohabitation. Therefore, we recommend the concerned bodies set out strategies to educate women about the influencing factors and dangers of premarital cohabitation.

Social Representativeness and Intervention Adherence-A Systematic Review of Clinical Physical Activity Trials in Breast Cancer Patients.

Objectives: Representativeness in physical activity randomised controlled trials (RCT) in breast cancer patients is essential to analyses of feasibility and validity considering privileged- social groups. A step-by-step exclusion of less privileged groups through the trial process could reinforce health inequality. This study aimed at examining representativeness in breast cancer (BC) physical activity trials, investigate associations between socio-economic status (SES) and intervention adherence, and explore associations between representativeness and the relationship between SES and intervention adherence. Methods: Systematic, computerised searches were performed in PubMed, CINAHL, AMED, EMBASE and PsycINFO. Additional citation-based searches retrieved 37 articles. Distributions of education level, ethnicity, and marital status in study samples were compared to national populations data to estimate representativeness in less privileged groups. Results: A preponderance of studies favoured educated, married and white patients. Only six studies reported SES-adherence associations, hampering conclusions on this relationship and possible associations between representativeness and an SES-adherence relationship. Conclusion: Less educated, unmarried and non-white individuals may be underrepresented in BC physical activity RCTs, while SES-adherence associations in such trials are inconclusive. Unintentional social misrepresentations may indicate that disguised inequity warrants revived attention.

Multilevel analysis on prevalence and associated factors of modern contraceptive uptake in Somaliland: based on The Somaliland Health and Demographic Survey 2020.

INTRODUCTION: Contraception is the deliberate prevention of unwanted pregnancy through various contraceptive methods. Its uptake is low in Sub-Saharan African countries, particularly in east Africa. This might be linked to the high prevalence of unwanted pregnancies and the high fertility rate in the area. Although studies reporting the prevalence and associated factors of modern contraceptive uptake are available in other African countries, no study has been conducted in Somaliland. Therefore, the current study aimed to assess its prevalence and associated factors in Somaliland using Somaliland Health and Demographic Survey (SLHDS) data. METHODS AND MATERIALS: The study used Somaliland Demographic Health Survey (SLDHS) 2020 data. The survey was a national-level survey using a cross-sectional study design. A total of 3656 reproductive-age women were included in the current study. To determine independent predictors of modern contraceptive uptake, a multi-level multivariable logistic regression analysis was done. Random effect analysis, standard error (SE) and intra-cluster correlation (ICC) were computed. RESULTS: The proportion of modern contraceptive uptake among reproductive age groups in Somaliland is 1%. Modern contraceptive uptake is significantly associated with the residence, educational level and wealth index of participants. Women from nomadic communities had lower odds (AOR: 0.25; 95% CI: 0.10, 0.66) of modern contraceptive uptake compared to those from urban areas. Being in the highest wealth quintiles (AOR: 17.22; 95% CI: 1.99, 155.92) and having a tertiary educational level (AOR: 2.11; 95% CI: 1.29, 9.11) had higher odds of using the modern contractive method compared to those with the lowest wealth quintiles and non-formal education, respectively. CONCLUSION: The prevalence of modern contraceptive uptake in Somaliland was very low. It is associated with the level of education, wealth index and residence of the women.

The impact of social determinants on health outcomes in a region in the North of England: a structural equation modelling analysis.

OBJECTIVES: The aim of this study was to identify the impact of social determinants of health on physical and mental health outcomes in a UK population. STUDY DESIGN: Structural equation modelling was used to hypothesise a model of relationships between health determinants and outcomes within a region in the North of England using large-scale population survey data (6208 responses). METHODS: We analysed responses from a population survey to assess the influence of a deprivation-based index at the environmental level, education and income on a behaviour index (smoking, alcohol consumption, physical activity, and dietary habits) and the influence of all these factors on self-reported physical health and the influence of the behaviour index and income on mental wellbeing. RESULTS: The proposed model was well supported by the data. Goodness-of-fit statistics, most notably a low value of the root mean square error of approximation (RMSEA), supported the validity of the proposed relationships (RMSEA = 0.054). The model revealed all examined paths to be statistically significant. Income and education were influential in determining an individual's behaviour index score, which, with income was the most important predictor of both the correlated outcomes of physical health and mental wellbeing (P < 0.001 in all cases). CONCLUSIONS: Findings challenge the traditional view of singular causal pathways, emphasising that interventions should consider the underlying influencing socio-economic conditions, which would influence behaviour and therefore physical and mental wellbeing. The extent to which the model is supported by the data, and the statistical significance of individual relationships accentuates the imperative for comprehensive public health strategies that integrate multiple socio-economic factors.

Share of food group expenditure in Mexican households according to the gender of the head of household and size of the locality.

OBJECTIVE: To evaluate differences in the percentage of expenditure on food groups in Mexican households according to the gender of the household head and the size of the locality. DESIGN: Analysis of secondary data from the National Household Income and Expenditure Survey (ENIGH) 2018. We estimated the percentage of expenditure on fifteen food groups according to the gender of the head of household and locality size and evaluated the differences using a two-part model approach. SETTING: Mexico, 2018. PARTICIPANTS: A nationally representative sample of 74 647 Mexican households. RESULTS: Female-headed households allocated a lower share of expenditure to the purchase of sweetened beverages and alcoholic beverages and higher percentages to milk and dairy, fruits and water. In comparison with metropolitan households, households in rural and urban localities spent more on cereals and tubers, sugar and honey, oil and fat and less on food away from home. CONCLUSIONS: Households allocate different percentages of expenditure to diverse food groups according to the gender of the head of the household and the size of the locality where they are located. Future research should focus on understanding the economic and social disparities related to differences in food expenditure, including the gender perspective.

Seroprevalence and sociodemographic characteristics of Toxoplasma gondii infection in patients with psychiatric disorders in Malaysia.

Toxoplasma gondii is a neurotropic protozoan parasite that affects neuronal processing in the brain. This study aimed to investigate the prevalence of T. gondii infection in psychiatric disorder patients. We also investigated the potential association between sociodemographic, clinical manifestation, and behavior of Toxoplasma-seropositive patients with psychiatric disorders. Commercial ELISAs (IgG, IgM, and IgG avidity) using serum and PCR using buffy coat were performed on samples from 54 individuals in each of the following groups: patients diagnosed with depressive disorder, bipolar disorder, and schizophrenia, as well as psychiatrically healthy subjects (control group). They were recruited from the Hospital Universiti Sains Malaysia in Kelantan, Malaysia. Of 54 patients with depressive disorder, 24/54 (44.4 %) were seropositive for IgG, and four (16.7 %) were IgG+/IgM+. Among the latter, a high avidity index indicating a past infection was observed in half of the samples (50.0 %), and the other half (50.0 %) showed a low avidity index, indicating a possible recent infection. Meanwhile, 30/54 (55.6 %) patients with bipolar disorder were seropositive for IgG+, five (16.7 %) were IgG+/IgM+, and four of them had a high avidity index, and one had a low avidity index. Patients with schizophrenia showed 29/54 (53.7 %) seropositive for IgG, two of them (6.9 %) were IgG+/IgM+; one of latter had a high avidity index, and one had a low avidity index. Of 54 people in the control group, 37.0 % (20/54) were seropositive for T. gondii IgG antibodies. However, no significant difference was observed in seroprevalence between the control group and each patient group. No PCR-positive results were documented. A Chi-Square and multiple logistic regression showed that age (p = 0.031), close contact with cats/pets (p = 0.033) and contact with soil (p = 0.012) were significantly associated with Toxoplasma seropositivity in patients with psychiatric disorders. Additional research is needed to elucidate the causal relationships and underlying mechanisms.

Willingness to join community-based health insurance and its associated factors among households in Nekemte City, Ethiopia. A community-based cross-sectional study.

INTRODUCTION: Ethiopia has been implementing community-based health insurance programs since 2011 to improve health care financing system. However, the prevalence of household willingness to join the community-based health insurance (CBHI) program and its associated factors are less explored in urban area. Therefore, this study was aimed to assess the prevalence of willingness to join community-based health insurance program and its associated factors among households in Nekemte City, Ethiopia. METHODS: A community-based cross-sectional study was conducted on 422 randomly selected households in Nekemte City, Ethiopia. Bivariate and multivariable analyses were performed to see the association between the independent and outcome variables using binary logistic regression model. Association was described using an adjusted odd ratio (AOR) and a 95% confidence interval (CI). Finally, p-value < 0.05 was considered the cut-off point for declaring a significant. RESULTS: Among 422 study participants, 320 (75.83%) [95% CI = 71.5-79.8%)] of the households were willing to join community-based health insurance program. The willingness to join for community-based health insurance was 3.11 times more likely among households who were in the richest quintile (AOR = 3.11; 95% CI = 1.08-8.93), 3.4 times more likely among those who were merchants (AOR = 3.40;1.33, 8.69), 2.52 times more likely among those who had history of chronic illness in the household (AOR = 2.52; 95% CI = 1.43-4.45), 4.09 times more likely among those who had the awareness about the scheme (AOR = 4.09; 95% CI = 1.97-8.47) and 3.29 times more likely among those who had the experience of borrow for medical care (AOR = 3.29; 95% CI = 1.48-7.30). CONCLUSION: Nearly three fourth of the households were willing to join community-based health insurance program, however, about one fourth of households were not willing, which is a significant public health problem. Being merchant, having awareness about the scheme, being in the richest wealth quintile, having experience of borrowing for medical care, and having history of chronic illness in the household were factors found to be significantly associated with willingness to join community based health insurance in the study area. Therefore, strengthening awareness creation at community level about the benefit package and principle of the program would increase their demand for the community-based health insurance scheme.

Socioeconomic determinants of early childhood development: evidence from Pakistan.

This study investigates the socioeconomic determinants of early childhood development (ECD) in Pakistan by utilizing the data of sixth wave of the Multiple Indicator Cluster Survey (MICS) conducted in the four provinces of the country. The findings of the study reveal that mother's education, father's education, economic status of the household as measured by household's wealth index quintile, region of residence (province), child's gender, disability, nutrition and the practices used by the adult members of the household to discipline child are important determinants of ECD. The study highlights the crucial role of family background and importance of addressing the issue of malnutrition to foster child development.

Impacts of socioeconomic and environmental factors on neoplasms incidence rates using machine learning and GIS: a cross-sectional study in Iran.

Neoplasm is an umbrella term used to describe either benign or malignant conditions. The correlations between socioeconomic and environmental factors and the occurrence of new-onset of neoplasms have already been demonstrated in a body of research. Nevertheless, few studies have specifically dealt with the nature of relationship, significance of risk factors, and geographic variation of them, particularly in low- and middle-income communities. This study, thus, set out to (1) analyze spatiotemporal variations of the age-adjusted incidence rate (AAIR) of neoplasms in Iran throughout five time periods, (2) investigate relationships between a collection of environmental and socioeconomic indicators and the AAIR of neoplasms all over the country, and (3) evaluate geographical alterations in their relative importance. Our cross-sectional study design was based on county-level data from 2010 to 2020. AAIR of neoplasms data was acquired from the Institute for Health Metrics and Evaluation (IHME). HotSpot analyses and Anselin Local Moran's I indices were deployed to precisely identify AAIR of neoplasms high- and low-risk clusters. Multi-scale geographically weight regression (MGWR) analysis was worked out to evaluate the association between each explanatory variable and the AAIR of neoplasms. Utilizing random forests (RF), we also examined the relationships between environmental (e.g., UV index and PM2.5 concentration) and socioeconomic (e.g., Gini coefficient and literacy rate) factors and AAIR of neoplasms. AAIR of neoplasms displayed a significant increasing trend over the study period. According to the MGWR, the only factor that significantly varied spatially and was associated with the AAIR of neoplasms in Iran was the UV index. A good accuracy RF model was confirmed for both training and testing data with correlation coefficients R2 greater than 0.91 and 0.92, respectively. UV index and Gini coefficient ranked the highest variables in the prediction of AAIR of neoplasms, based on the relative influence of each variable. More research using machine learning approaches taking the advantages of considering all possible determinants is required to assess health strategies outcomes and properly formulate policy planning.

Distracted on duty: A theory-based exploration of influences leading to mobile phone distracted riding among food delivery workers.

Using mobile phones while riding is a form of distracted riding that significantly elevates crash risk. Regrettably, the factors contributing to mobile phone use while riding (MPUWR) among food delivery riders remain under-researched. Addressing this literature gap, the current study employs the Job Demands-Resources (JD-R) model and various socio-economic factors to examine the determinants of MPUWR. The research incorporates data from 558 delivery workers in Hanoi and Ho Chi Minh City, Vietnam. The study utilizes two analytical methods to empirically test the hypotheses, considering non-linear relationships between variables: Partial Least Square Structural Equation Modelling (PLS-SEM) and Artificial Neural Network (ANN). The results reveal mixed impacts of factors connected to job resources. Although social support appears to deter MPUWR, work autonomy and rewards seemingly encourage it. Furthermore, a predisposition towards risk-taking behaviour significantly impacts the frequency of mobile phone usage among delivery riders. Interestingly, riders with higher incomes and those who have previously been fined by the police exhibit more frequent mobile phone use. The findings of this study present valuable insights into the crucial factors to be addressed when designing interventions aimed at reducing phone use among food delivery riders.

Measurement and determinants of multidimensional urban poverty: Evidence from Shandong Province, China.

China eliminated rural poverty under current poverty standards in 2020. However, compared with rural poverty, urban poverty in China has been somewhat neglected. This paper aims to discover the changes and determinants of multidimensional urban poverty in Shandong Province, a representative province in Eastern China. Using a nationally representative panel dataset, the China Family Panel Studies, and the Dual Cutoff method, this study creates a multidimensional poverty index with four dimensions and 11 indicators to measure urban poverty in Shandong Province. This paper discovers that while the incidence of multidimensional urban poverty in Shandong Province decreased from 47.62% in 2010 to 36.45% in 2018, the intensity of multidimensional poverty only decreased from 41.27% to 37.25%, which indicates the inadequacy of urban anti-poverty efforts in Shandong Province. This paper also uses logistic regression to identify the determinants of multidimensional urban poverty. The findings suggest that income, health, drinking water, and durable goods are the main determinants of multidimensional urban poverty in Shandong Province. Based on these findings, this study provides targeted recommendations for future urban anti-poverty policies in Shandong Province.

Lifestyle and sociodemographic risk factors for stillbirth by region of residence in South Australia: a retrospective cohort study.

BACKGROUND: Stillbirth rates remain a global priority and in Australia, progress has been slow. Risk factors of stillbirth are unique in Australia due to large areas of remoteness, and limited resource availability affecting the ability to identify areas of need and prevalence of factors associated with stillbirth. This retrospective cohort study describes lifestyle and sociodemographic factors associated with stillbirth in South Australia (SA), between 1998 and 2016. METHODS: All restigered births in SA between 1998 ad 2016 are included. The primary outcome was stillbirth (birth with no signs of life ≥ 20 weeks gestation or ≥ 400 g if gestational age was not reported). Associations between stillbirth and lifestyle and sociodemographic factors were evaluated using multivariable logistic regression and described using adjusted odds ratios (aORs). RESULTS: A total of 363,959 births (including 1767 stillbirths) were included. Inadequate antenatal care access (assessed against the Australian Pregnancy Care Guidelines) was associated with the highest odds of stillbirth (aOR 3.93, 95% confidence interval (CI) 3.41-4.52). Other factors with important associations with stillbirth were plant/machine operation (aOR, 1.99; 95% CI, 1.16-2.45), birthing person age ≥ 40 years (aOR, 1.92; 95% CI, 1.50-2.45), partner reported as a pensioner (aOR, 1.83; 95% CI, 1.12-2.99), Asian country of birth (aOR, 1.58; 95% CI, 1.19-2.10) and Aboriginal/Torres Strait Islander status (aOR, 1.50; 95% CI, 1.20-1.88). The odds of stillbirth were increased in regional/remote areas in association with inadequate antenatal care (aOR, 4.64; 95% CI, 2.98-7.23), birthing age 35-40 years (aOR, 1.92; 95% CI, 1.02-3.64), Aboriginal and/or Torres Strait Islander status (aOR, 1.90; 95% CI, 1.12-3.21), paternal occupations: tradesperson (aOR, 1.69; 95% CI, 1.17-6.16) and unemployment (aOR, 4.06; 95% CI, 1.41-11.73). CONCLUSION: Factors identified as independently associated with stillbirth odds include factors that could be addressed through timely access to adequate antenatal care and are likely relevant throughout Australia. The identified factors should be the target of stillbirth prevention strategies/efforts. SThe stillbirth rate in Australia is a national concern. Reducing preventable stillbirths remains a global priority.

Financial inclusion and improved water usage among households in Ghana.

BACKGROUND: In Ghana, about 76% of households are at risk of drinking water polluted with faecal matter, hence, poor sanitation and unsafe water are responsible for 80% of all diseases in the country. Given this, some studies have been carried out concerning the factors that determine access and use of improved water among households in Ghana. However, although financial inclusion can make it easy for households to afford and hence, use improved water, it has received very little attention. This study, thus, examines the effect of financial inclusion on the use of improved water among households in Ghana. METHODS: The Ghana Living Standards Survey round 7 (GLSS7) is used as the data source while the binary logit regression is employed as the main empirical estimation technique. RESULTS: The results show that households with financial inclusion (employing an indicator which has not been disaggregated into formal and informal financial inclusion) have a higher likelihood of using improved water sources relative to those without financial inclusion. The results are robust using formal financial inclusion as well as a combined index of financial inclusion. CONCLUSION: Enhancing financial inclusion, especially formal financial inclusion can be utilised as a major policy instrument towards increasing access and use of improved water sources among households in Ghana.

The effects of trade liberalization on inequality in nutrition intake: empirical evidence from Indian districts.

BACKGROUND: Despite the positive impact of trade liberalization on food availability in India, severe inequality in nutrition consumption at the district level persists. Empirical evidence on the relationship between trade liberalization and nutrition consumption inequality often offers a country-level perspective and generates disputed outcomes. The study aimed to explore the effects of trade liberalization on inequality in nutrition consumption at the district level in India and to examine the heterogeneity of the impact on different nutrition consumption. METHODS: Our study employed the Gini Index to measure nutrition consumption inequality of 2 macronutrients and 5 micronutrients at the district level in India during 2009-2011, utilizing the comprehensive FAO/WHO individual food consumption data. The import tariff was adopted as a proxy for trade liberalization, as its externally imposed nature facilitates a causal interpretation. We further identified the direct causal relationship between food trade liberalization and inequality in nutrition consumption using a fixed effects model. RESULTS: The results show that more than 50% of the individuals in the survey districts did not meet the dietary standards for both macronutrients and micronutrients. Food trade liberalization hindered the improvement of inequality in nutrition consumption. As import tariffs were reduced by 1%, the inequality in intake of calories, zinc, vitamin B1, and vitamin B2 increased significantly by 0.45, 0.56, 0.48, and 0.66, respectively, which might be related to food market performance. The results also highlight the positive role of the gender gap, female-headed households, and caste culture on inequality in nutrition consumption in India. CONCLUSIONS: To ease the shock of liberalization and minimize its inequality effects, complementary measures should be adopted, such as improving food logistic conditions in poor areas, and nutrition relief schemes.

Factors associated with the use of annual health checkups in Thailand: evidence from a national cross-sectional health and welfare survey.

Introduction: Thailand has provided free annual health checkups (AHC) since universal health coverage began in 2002. However, evidence regarding the equitable use of AHC is scarce. Thus, this study explored factors associated with the use of AHC in Thailand. Methods: A cross-sectional study was conducted using data from the national 2015 Health and Welfare Survey. Respondents aged 15 years or above (n = 57,343) were selected as the study sample. Descriptive statistical analysis and multivariable binary logistic regression were conducted to examine the association between the use of AHC and factors selected on the basis on Andersen's Behavioral Model of Access to Medical Care. Results: Among the study sample, approximately 4.9% (n = 2,815) had used AHC during the past year. Regarding predisposing factors, the use of AHC was positively related to age (e.g., over 61 vs. 15-30: AOR = 2.90 [95% CI = 2.40-3.52], p < 0.001) and female sex (AOR = 1.23 [95% CI = 1.12-1.35] p < 0.001). For enabling factors, the AHC use was positively associated with income (e.g., Q4 vs. Q1: AOR = 1.98 [95% CI = 1.75-2.25], p < 0.001), education (e.g., high vs. low: AOR = 3.11 [95% CI = 2.75-3.51], p < 0.001), being married (e.g., vs. single: AOR = 1.27 [95% CI = 1.11-1.46], p < 0.001), and urban residency (AOR = 1.12 [95% CI = 1.04-1.22], p = 0.006). For need-for-care factors, the AHC use was positively related to chronic disease (AOR = 1.26 [95% CI = 1.15-1.38], p < 0.001), non-smoking (e.g., vs. daily: AOR = 1.18 [95% CI = 1.03-1.36], p = 0.015), non-drinking (e.g., vs. 3-4 times per week: AOR = 1.26 [95% CI = 1.04-1.53], p = 0.016), and vegetable consumption (e.g., over 5 ladles vs. below 1 ladle: AOR = 1.86 [95% CI = 1.50-2.31], p < 0.001). Conclusion: The results indicate that health awareness could play a significant role in the use of AHC. Individuals with high socioeconomic status (e.g., high-income people) and those with low-risk health behaviors (e.g., non-smokers) generally have a high interest in health and well-being. This may have been the primary reason for the high use of AHC among these groups. Thus, the government should continue to promote the public's health awareness through various public campaigns and education programs to increase the use of AHC.

Population density and receipt of care for common mental disorders: a cross-sectional analysis of English household data from the 2014 Adult Psychiatric Morbidity Survey.

OBJECTIVES: People living in less urban areas in the UK may have reduced access to mental healthcare compared with people in urban areas. Although this was not reported in the 2000 Adult Psychiatric Morbidity Survey (APMS) data, subsequent changes to mental health provision and economic recession may have impacted care inequalities. We re-examined this, hypothesising that those living in less urban areas of England received less antidepressant medication and psychological interventions, compared with those living in urban areas, after adjusting for covariates including common mental disorders (CMDs) and socioeconomic status. DESIGN: National cross-sectional study. SETTING: Households in England. PARTICIPANTS: We analysed data from 7455 participants aged 16 and above from the 2014 English APMS. EXPOSURES: Residence in an urban or less urban area. PRIMARY OUTCOME: Current receipt of any antidepressant medication or any psychological intervention. RESULTS: Participants living in less urban areas were half as likely to be in receipt of any psychological intervention relative to those living in urban areas (adjusted OR (aOR) 0.49; 95% CI 0.30 to 0.79; p=0.004). There was no association between urbanisation and antidepressant receipt (aOR 1.01; 95% CI 0.81 to 1.25; p=0.944). CONCLUSION: People living in less urban areas have a lower likelihood of being in receipt of psychological treatment for CMDs, which may indicate barriers to care access. Our findings differ from the results of a study using a comparable sample conducted 14 years previously. While Improving Access to Psychological Therapies services have increased therapy access nationwide, this may have had more impact in urban areas, potentially widening urban/rural inequalities. Further research is needed to understand how to address such geographical inequalities in access to mental healthcare.

Healthcare-seeking behavior and spatial variation of internal migrants with chronic diseases: a nationwide empirical study in China.

Individuals migrating with chronic diseases often face substantial health risks, and their patterns of healthcare-seeking behavior are commonly influenced by mobility. However, to our knowledge, no research has used spatial statistics to verify this phenomenon. Utilizing data from the China Migrant Dynamic Survey of 2017, we conducted a geostatistical analysis to identify clusters of chronic disease patients among China's internal migrants. Geographically weighted regressions were utilized to examine the driving factors behind the reasons why treatment was not sought by 711 individuals among a population sample of 9272 migrant people with chronic diseases. The results indicate that there is a spatial correlation in the clustering of internal migrants with chronic diseases in China. The prevalence is highly clustered in Zhejiang and Xinjiang in north-eastern China. Hotspots were found in the northeast (Jilin and Liaoning), the north (Hebei, Beijing, and Tianjin), and the east (Shandong) and also spread into surrounding provinces. The factors that affect the migrants with no treatment were found to be the number of hospital beds per thousand population, the per capita disposable income of medical care, and the number of participants receiving health education per 1000 Chinese population. To rectify this situation, the local government should "adapt measures to local conditions." Popularizing health education and coordinating the deployment of high-quality medical facilities and medical workers are effective measures to encourage migrants to seek reasonable medical treatment.

Sociodemographic and Lifestyle Characteristics Associated with Maternal Dietary Patterns in Mexico.

There is scarce evidence on sociodemographic and lifestyle characteristics that may explain adherence to different dietary patterns (DPs) during pregnancy. Our aims were to identify dietary patterns in a sample of pregnant Mexican women and to describe their association with selected sociodemographic and lifestyle characteristics. This is a secondary cross-sectional analysis of 252 mothers of children that participated as controls in a hospital-based case-control study of childhood leukemia. We obtained parents' information about selected sociodemographic characteristics, as well as alcohol and tobacco consumption. We also obtained dietary information during pregnancy. We identified DPs using cluster and factor analyses and we estimated their association with characteristics of interest. We identified two DPs using cluster analysis, which we called "Prudent" and "Non healthy", as well as three DPs through factor analysis, namely "Prudent", "Processed foods and fish", and "Chicken and vegetables". Characteristics associated with greater adherence to "Prudent" patterns were maternal education, older paternal age, not smoking, and being a government employee and/or uncovered population. Likewise, the "Processed foods and fish" pattern was associated with greater maternal and paternal education, as well as those with less household overcrowding. We did not identify sociodemographic variables related to the "Chicken and Vegetables" pattern. Our results may be useful to identify target populations that may benefit from interventions aimed to improve individual dietary decisions during pregnancy.