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BMC Pregnancy and Childbirth Jun 2024In the United States, maternal health inequities disproportionately affect Global Majority (e.g., Asian, Black, and Hispanic) populations. Despite a substantial body of...
In the United States, maternal health inequities disproportionately affect Global Majority (e.g., Asian, Black, and Hispanic) populations. Despite a substantial body of research underscoring the influence of racism on these inequities, little research has examined how experiences of gendered racial microaggressions during pregnancy and birth impact racially and ethnically diverse Global Majority pregnant and birthing people in obstetric hospital settings. We evaluated the psychometric properties of an adapted version of Lewis & Neville's Gendered Racial Microaggressions Scale, using data collected from 417 Global Majority birthing people. Findings from our study indicate that our adapted GRMS is a valid tool for assessing the experiences of gendered racial microaggressions in hospital-based obstetric care settings among Global Majority pregnant and birthing people whose preferred languages are English or Spanish. Item Response Theory (IRT) analysis demonstrated high construct validity of the adapted GRMS scale (Root Mean Square Error of Approximation = 0.1089 (95% CI 0.0921, 0.1263), Comparative Fit Index = 0.977, Standardized Root Mean Square Residual = 0.075, log-likelihood c2 = -85.6, df = 8). IRT analyses demonstrated that the unidimensional model was preferred to the bi-dimensional model as it was more interpretable, had lower AIC and BIC, and all items had large discrimination parameters onto a single factor (all discrimination parameters > 3.0). Given that we found similar response profiles among Black and Hispanic respondents, our Differential Item Functioning analyses support validity among Black, Hispanic, and Spanish-speaking birthing people. Inter-item correlations demonstrated adequate scale reliability, α = 0.97, and empirical reliability = 0.67. Pearsons correlations was used to assess the criterion validity of our adapted scale. Our scale's total score was significantly and positively related to postpartum depression and anxiety. Researchers and practitioners should seek to address instances of gendered racial microaggressions in obstetric settings, as they are manifestations of systemic and interpersonal racism, and impact postpartum health.
Topics: Humans; Female; Psychometrics; Racism; Pregnancy; Adult; United States; Reproducibility of Results; Surveys and Questionnaires; Hispanic or Latino; Male; Young Adult; Healthcare Disparities; Aggression; Black or African American; Delivery, Obstetric
PubMed: 38943057
DOI: 10.1186/s12884-024-06642-5 -
Scientific Reports Jun 2024Tourism carbon offsetting is a crucial pathway to achieving peak carbon and carbon neutrality in the tourism industry. Accurately grasping the collaborative evolutionary...
Tourism carbon offsetting is a crucial pathway to achieving peak carbon and carbon neutrality in the tourism industry. Accurately grasping the collaborative evolutionary mechanisms among local governments, tourism enterprises, and tourists is key to promoting the implementation of tourism carbon offsetting. By constructing an evolutionary game model involving local governments, tourism enterprises, and tourists in carbon offsetting, this study uses MATLAB to simulate the evolutionary stable strategies under various conditions. Additionally, it dynamically simulates the collaborative strategies of the three parties under the influence of local government incentive and constraint mechanisms. The results indicate that under strong governmental constraint mechanisms, there is a promotion of active participation in carbon offsetting by local governments, tourism enterprises, and tourists. Incentive policies at certain levels also play a positive guiding role. As incentives increase, local subsidies and intervention costs also rise, leading to an evolution towards less enthusiastic participation among the three parties. Appropriately balanced government incentives and penalties are beneficial in achieving an equilibrium of benefits among multiple stakeholders involved in carbon offsetting, thus helping to attain carbon neutrality goals.
PubMed: 38942938
DOI: 10.1038/s41598-024-65964-8 -
Scientific Reports Jun 2024We aimed to identify the clinical subtypes in individuals starting long-term care in Japan and examined their association with prognoses. Using linked medical insurance...
We aimed to identify the clinical subtypes in individuals starting long-term care in Japan and examined their association with prognoses. Using linked medical insurance claims data and survey data for care-need certification in a large city, we identified participants who started long-term care. Grouping them based on 22 diseases recorded in the past 6 months using fuzzy c-means clustering, we examined the longitudinal association between clusters and death or care-need level deterioration within 2 years. We analyzed 4,648 participants (median age 83 [interquartile range 78-88] years, female 60.4%) between October 2014 and March 2019 and categorized them into (i) musculoskeletal and sensory, (ii) cardiac, (iii) neurological, (iv) respiratory and cancer, (v) insulin-dependent diabetes, and (vi) unspecified subtypes. The results of clustering were replicated in another city. Compared with the musculoskeletal and sensory subtype, the adjusted hazard ratio (95% confidence interval) for death was 1.22 (1.05-1.42), 1.81 (1.54-2.13), and 1.21 (1.00-1.46) for the cardiac, respiratory and cancer, and insulin-dependent diabetes subtypes, respectively. The care-need levels more likely worsened in the cardiac, respiratory and cancer, and unspecified subtypes than in the musculoskeletal and sensory subtype. In conclusion, distinct clinical subtypes exist among individuals initiating long-term care.
Topics: Humans; Female; Aged; Male; Japan; Cluster Analysis; Aged, 80 and over; Long-Term Care; Prognosis; Neoplasms
PubMed: 38942898
DOI: 10.1038/s41598-024-65699-6 -
Nature Communications Jun 2024Heat pumps (HPs) have emerged as a key technology for reducing energy use and greenhouse gas emissions. This study evaluates the potential switch to air-to-air HPs...
Heat pumps (HPs) have emerged as a key technology for reducing energy use and greenhouse gas emissions. This study evaluates the potential switch to air-to-air HPs (AAHPs) in Toulouse, France, where conventional space heating is split between electric and gas sources. In this context, we find that AAHPs reduce heating energy consumption by 57% to 76%, with electric heating energy consumption decreasing by 6% to 47%, resulting in virtually no local heating-related CO emissions. We observe a slight reduction in near-surface air temperature of up to 0.5 °C during cold spells, attributable to a reduction in sensible heat flux, which is unlikely to compromise AAHPs operational efficiency. While Toulouse's heating energy mix facilitates large energy savings, electric energy consumption may increase in cities where gas or other fossil fuel sources prevail. Furthermore, as AAHPs efficiency varies with internal and external conditions, their impact on the electrical grid is more complex than conventional heating systems. The results underscore the importance of matching heating system transitions with sustainable electricity generation to maximize environmental benefits. The study highlights the intricate balance between technological advancements in heating and their broader environmental and policy implications, offering key insights for urban energy policy and sustainability efforts.
PubMed: 38942764
DOI: 10.1038/s41467-024-49836-3 -
The International Journal on Drug Policy Jun 2024There is limited empirical work assessing the effectiveness of treatment as prevention (TasP) in reducing HCV prevalence among people who inject drugs (PWID). Here, we...
BACKGROUND
There is limited empirical work assessing the effectiveness of treatment as prevention (TasP) in reducing HCV prevalence among people who inject drugs (PWID). Here, we used survey data from the UK during 2010-2020, to evaluate the impact of direct-acting antiviral agent (DAA) treatment scale-up, which started in 2015, on HCV prevalence among PWID.
METHODS
We fitted a logistic regression to time/location specific data on prevalence from the Needle Exchange Surveillance Initiative in Scotland and Unlinked Anonymous Monitoring programme in England. For each post-intervention year and location, we quantified the effect of TasP as the difference between estimated prevalence and its counterfactual (prevalence in the absence of scale-up). Progress to elimination was assessed by comparing most recent prevalence against one in 2015.
RESULTS
In 2015, prevalence ranged from 0.44 to 0.71 across the 23 locations (3 Scottish, 20 English). Compared to counterfactuals, there was an absolute reduction of 46% (95% credible interval [32%,59%]) in Tayside in 2020, 35% ([24%,44%]) in Glasgow in 2019, and 25% ([10%,39%]) in the Rest of Scotland in 2020. The English sites with highest estimated absolute reductions in 2021 were South Yorkshire (45%, [29%,58%]), Thames Valley (49%, [34%,59%]) and West London (41%, [14%,59%]). Compared to 2015, there was 80% probability that prevalence had fallen by 65% in Tayside, 53% in Glasgow and 36% in the Rest of Scotland. The English sites with highest % prevalence decrease compared to 2015, achieved with probability 80%, were Chesire & Merseyside (70%), South Yorkshire (65%) and Thames Valley (71%). Higher treatment intensity was associated with higher reductions in prevalence.
CONCLUSION
Conclusion. Real-world evidence showing substantial reductions in chronic HCV associated with increase of HCV treatment scale-up in the community thus supporting the effectiveness of HCV treatmen as prevention in people who inject drugs.
PubMed: 38942687
DOI: 10.1016/j.drugpo.2024.104429 -
Diagnostic and Interventional Imaging Jun 2024Radiology in Canada is advancing through innovations in clinical practices and research methodologies. Recent developments focus on refining evidence-based practice... (Review)
Review
Radiology in Canada is advancing through innovations in clinical practices and research methodologies. Recent developments focus on refining evidence-based practice guidelines, exploring innovative imaging techniques and enhancing diagnostic processes through artificial intelligence. Within the global radiology community, Canadian institutions play an important role by engaging in international collaborations, such as with the American College of Radiology to refine implementation of the Ovarian-Adnexal Reporting and Data System for ultrasound and magnetic resonance imaging. Additionally, researchers have participated in multidisciplinary collaborations to evaluate the performance of artificial intelligence-driven diagnostic tools for chronic liver disease and pediatric brain tumors. Beyond clinical radiology, efforts extend to addressing gender disparities in the field, improving educational practices, and enhancing the environmental sustainability of radiology departments. These advancements highlight Canada's role in the global radiology community, showcasing a commitment to improving patient outcomes and advancing the field through research and innovation. This update underscores the importance of continued collaboration and innovation to address emerging challenges and further enhance the quality and efficacy of radiology practices worldwide.
PubMed: 38942638
DOI: 10.1016/j.diii.2024.06.004 -
BMJ Paediatrics Open Jun 2024Limited evidence exists regarding children receiving home healthcare devices (HHDs). This study aimed to describe the range and type of HHD use by children with chronic...
BACKGROUND
Limited evidence exists regarding children receiving home healthcare devices (HHDs). This study aimed to describe the range and type of HHD use by children with chronic medical conditions in Japan and explore factors leading to increased use of these devices.
METHODS
This retrospective cohort study was conducted using data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Children receiving HHD aged ≤18 years between April 2011 and March 2019 were included. Children newly administered HHD between 2011 and 2013 were followed up for 5 years, and logistic regression analysis was performed to assess the relationship between increased HHD use and each selected risk factor (comorbidity or types of HHD). The models were adjusted for age category at home device introduction, sex and region.
RESULTS
Overall, 52 375 children receiving HHD were identified. The number (proportion) of children receiving HHD increased during the study period (11 556 [0.05%] in 2010 and 25 593 [0.13%] in 2018). The most commonly administered HHD was oxygen (51.0% in 2018). Among the 12 205 children receiving HHD followed up for 5 years, 70.4% and 68.3% who used oxygen or continuous positive airway pressure, respectively, were released from the devices, while only 25.8% who used mechanical ventilation were released from the device. The following diagnosis/comorbidities were associated with increased HHD use: other neurological diseases (OR): 2.85, 95% CI): 2.54-3.19), cerebral palsy (OR: 2.16, 95% CI: 1.87 to 2.49), congenital malformations of the nervous system (OR: 1.70, 95% CI: 1.34 to 2.13) and low birth weight (OR: 1.68, 95% CI: 1.41 to 2.00).
CONCLUSIONS
This study provides nationwide population-based empirical data to clarify the detailed information regarding children receiving HHD in Japan. This information could assist healthcare professionals in improving the quality of life of these children and their families and help health policymakers consider measures.
Topics: Humans; Japan; Retrospective Studies; Female; Male; Child; Home Care Services; Child, Preschool; Infant; Adolescent; Chronic Disease; Infant, Newborn
PubMed: 38942589
DOI: 10.1136/bmjpo-2024-002685 -
The Lancet. Public Health Jul 2024Alcohol container labels might reduce population-level alcohol-related harms, but investigations of their effectiveness have varied in approach and quality. A systematic... (Review)
Review
Alcohol container labels might reduce population-level alcohol-related harms, but investigations of their effectiveness have varied in approach and quality. A systematic synthesis is needed to adjust for these differences and to yield evidence to inform policy. Our objectives were to establish the effects of alcohol container labels bearing one or more health warnings, standard drink information, or low-risk drinking guidance on alcohol consumption behaviour, knowledge of label message, and support for labels. We completed a systematic review according to Cochrane and synthesis without meta-analysis standards. We included all peer-reviewed studies and grey literature published from Jan 1, 1989, to March 6, 2024, in English, French, German, or Spanish that investigated the effects of alcohol container labels compared with no-label or existing label control groups in any population on alcohol consumption behaviour, knowledge of label message, or support for labels. Data were synthesised narratively as impact statements and assessed for risk of bias and certainty in the evidence. A protocol was preregistered (PROSPERO CRD42020168240). We identified 40 publications that studied 31 labels and generated 17 impact statements. 24 (60%) of 40 publications focused on consumption behaviour and we had low or very low certainty in 13 (59%) of 22 outcomes. Alcohol container labels bearing health warnings might slow the rate of alcohol consumption (low certainty), reduce alcoholic beverage selection (moderate certainty), reduce consumption during pregnancy (low certainty), and reduce consumption before driving (moderate certainty). Interventions with multiple types of rotating alcohol container labels likely substantially decrease alcohol use (moderate certainty) and reduce alcohol sales (high certainty). To the best of our knowledge, this is the first systematic review on multiple types of alcohol container labels assessing their effects for certainty in the evidence. Limitations included heterogeneity in label designs and outcome measurements. Alcohol container labels probably influence some alcohol consumption behaviour, with multiple rotating messages being particularly effective, although effects might vary depending on individual health literacy or drinking behaviour. Alcohol container labels might therefore be effective components of policies designed to address population-level alcohol-related harms.
Topics: Humans; Alcohol Drinking; Alcoholic Beverages; Product Labeling; Health Knowledge, Attitudes, Practice
PubMed: 38942559
DOI: 10.1016/S2468-2667(24)00097-5 -
The Lancet. Public Health Jul 2024Alcohol health-warning labels are a policy option that can contribute to the reduction of alcohol-related harms, but their effects and public perception depend on their...
Effect of alcohol health warning labels on knowledge related to the ill effects of alcohol on cancer risk and their public perceptions in 14 European countries: an online survey experiment.
BACKGROUND
Alcohol health-warning labels are a policy option that can contribute to the reduction of alcohol-related harms, but their effects and public perception depend on their content and format. Our study aimed to investigate the effect of health warnings on knowledge that alcohol causes cancer, the perceptions of three different message topics (responsible drinking, general health harm of alcohol, and alcohol causing cancer), and the role of images included with the cancer message.
METHODS
In this online survey experiment, distributed in 14 European countries and targeting adults of the legal alcohol-purchase age who consumed alcohol, participants were randomly allocated to one of six label conditions using a pseudorandom number generator stratified by survey language before completing a questionnaire with items measuring knowledge and label perceptions. Effect on knowledge was assessed as a primary outcome by comparing participants who had increased knowledge after exposure to labels with the rest of the sample, for the six label conditions. Label perceptions were compared between label conditions as secondary outcomes.
FINDINGS
19 110 participants completed the survey and were eligible for analysis. Our results showed that a third of the participants exposed to the cancer message increased their knowledge of alcohol causing cancer (increase for 1131 [32·5%, 95% CI 29·8 to 35·2] of 3409 participants [weighted percentage] for text-only message; increase for 1096 [33·3%, 30·4 to 36·2] of 3198 [weighted percentage] for message inlcuding pictogram; and increase for 1030 [32·5%, 29·6 to 35·4] of 3242 [weighted percentage] for message including graphic image), compared with an increase for 76 (2·4%, -1·2 to 6·0) of 3018 participants who viewed the control message. Logistic regression showed that cancer messages increased knowledge compared with the control label (odds ratio [OR] 20·20, 95% CI 15·88 to 26·12; OR 21·16, 16·62 to 27·38; OR 20·61, 16·19 to 26·68). Cancer messages had the highest perceived impact and relevance, followed by general health harm and responsibility messages. Text-only and pictogram cancer messages were seen as clear, comprehensive, and acceptable, whereas those including an image of a patient with cancer had lower acceptability and the highest avoidance rating of all the labels. The only identified interaction between perceptions and experimental conditions (with gender) indicated higher comprehensibility and acceptability ratings of cancer labels than responsibility messages and control labels by women, with the results reversed in men.
INTERPRETATION
Health warnings are an effective policy option to increase knowledge of alcohol causing cancer, with a generalisable effect across several countries. Europeans consider alcohol health-warning labels to be comprehensible and acceptable, with cancer-specific health warnings having the highest perceived impact and relevance.
FUNDING
EU4Health.
Topics: Humans; Europe; Male; Female; Health Knowledge, Attitudes, Practice; Adult; Neoplasms; Middle Aged; Product Labeling; Surveys and Questionnaires; Young Adult; Alcohol Drinking; Adolescent; Public Opinion; Alcoholic Beverages; Aged
PubMed: 38942558
DOI: 10.1016/S2468-2667(24)00102-6 -
The Lancet. Public Health Jul 2024Even though alcohol consumption is an established risk factor for cancer, evidence regarding the effect of a reduction or cessation of alcohol consumption on cancer...
BACKGROUND
Even though alcohol consumption is an established risk factor for cancer, evidence regarding the effect of a reduction or cessation of alcohol consumption on cancer incidence is scarce. Our main study aim was to assess the effect of alcohol rehabilitation and abstinence on cancer incidence in people with alcohol dependence.
METHODS
We conducted a nationwide hospital retrospective cohort study which included all adults residing in mainland France and discharged in 2018-21. Multivariable Cox proportional hazards models were used to estimate the effect of rehabilitation treatment at hospital or a history of abstinence versus alcohol dependence without rehabilitation or abstinence on the risk for incident alcohol-associated cancers by sex, controlled for potential confounding risk factors.
FINDINGS
10 260 056 men and 13 739 369 women were discharged from French hospitals in 2018-21. Alcohol dependence was identified in 645 720 (6·3%) men and 219 323 (1·6%) women. Alcohol dependence was strongly related to alcohol-associated cancer sites in both sexes (hepatocellular carcinoma and oral, pharyngeal, laryngeal, oesophageal, and colorectal cancers), except for breast cancer. Rehabilitation treatment or abstinence was associated with significantly lower risks compared with alcohol dependence without rehabilitation or abstinence (adjusted hazard ratios: 0·58, 99·89% CI 0·56-0·60 in men and 0·62, 0·57-0·66 in women). Relative risk reductions were significant for each alcohol-associated cancer site in both sexes and supported by all subgroup and sensitivity analyses.
INTERPRETATION
Our study results support the clear benefits of alcohol rehabilitation and abstinence in reducing the risk for alcohol-associated cancers. As only two in five patients with alcohol dependence were recorded with a history of rehabilitation treatment or abstinence, a large untapped potential exists for reducing cancer incidence.
FUNDING
European Union's EU4Health programme.
Topics: Humans; Male; Female; France; Neoplasms; Middle Aged; Retrospective Studies; Alcoholism; Adult; Aged; Risk Factors; Incidence
PubMed: 38942557
DOI: 10.1016/S2468-2667(24)00107-5