Clinical and socioeconomic determinants of survival in biliary tract adenocarcinomas

BACKGROUND Despite advances in detection and treatments,biliary tract cancers continue to have poor survival outcomes.Currently,there is limited data investigating the significance of socioeconomic status,race/ethnicity,and environmental factors in biliary tract cancer survival.Data from the Surveillance,Epidemiology,and End Results database for biliary and gallbladder adenocarcinomas were extracted from 1975 to 2016.Socioe-conomic data included smoking,poverty level,education,adjusted household income,and percentage of foreign-born persons and urban population.Survival was calculated with Cox proportional hazards models for death in the 5-year period following diagnosis.RESULTS Our study included 15883 gallbladder,11466 intrahepatic biliary,12869 extrahepatic biliary and 7268 ampulla of Vater adenocarcinoma cases.When analyzing county-specific demographics,patients from counties with higher incomes were associated with higher survival rates[hazard ratio(HR)=0.97,P<0.05].Similarly,counties with a higher percentage of patients with a college level education and counties with a higher urban population had higher 5-year survival rates(HR=0.96,P=0.002 and HR=0.97,P=0.004,respectively).CONCLUSION Worse survival outcomes were observed in lower income counties while higher income and education level were associated with higher 5-year overall survival among gallbladder and biliary malignancies.

Overcoming geographical and socioeconomic limitations in colorectal cancer screening

Despite colorectal cancer’s(CRC)high global incidence,residents of low-and middle-income countries,as well as low-income minorities in advanced economies have low screening rates.Observational studies demonstrate that in these groups higher incidence of CRC is observed,yet screening rates remain low for consistent reasons.Low income,low educational background,and lack of awareness in combination with inadequate social security of certain population groups impede access and compliance rates to CRC screening.On the other hand,despite the global availability of multiple screening approaches(colonoscopy,sigmoidoscopy,faecal occult blood test,faecal immunochemical test,computed tomography-colonography,etc.)with proven diagnostic validity,many low-income countries still lack established screening programs.The absence of screening guidelines in these countries along with the heterogeneity of guidelines in the rest of the world,demonstrate the need for global measures to tackle this issue comprehensively.An essential step forward is to develop a global approach that will link specific elements of screening with the incidence and available resources in each country,to ensure the achievement of at least a minimum screening program in low-income countries.Utilizing cheaper,cost-effective techniques,which can be carried out by less specialized healthcare providers,might not be equivalent to endoscopy for CRC screening but seems more realistic for areas with fewer resources.Awareness has been highlighted as the most pivotal element for the effective implementation of any screening program concerning CRC.Moreover,multiple studies have demonstrated that outreach strategies and community-based educational programs are associated with encouraging outcomes,yet a centrally coordinated expansion of these programs could provide more consistent results.Additionally,patient navigator programs,wherever implemented,have increased CRC screening and improved follow-up.Therefore,global coordination and patient education seem to be the main areas on which policy making needs to focus.

Socioeconomic traits and the risk of Barrett’s esophagus and gastroesophageal reflux disease: A Mendelian randomization study

BACKGROUND Previous observational studies have shown that the prevalence of gastroesophageal reflux disease(GERD)and Barrett’s esophagus(BE)is associated with socioeconomic status.However,due to the methodological limitations of traditional observational studies,it is challenging to definitively establish causality.AIM To explore the causal relationship between the prevalence of these conditions and socioeconomic status using Mendelian randomization(MR).METHODS We initially screened single nucleotide polymorphisms(SNPs)to serve as proxies for eight socioeconomic status phenotypes for univariate MR analysis.The inverse variance weighted(IVW)method was used as the primary analytical method to estimate the causal relationship between the eight socioeconomic status phenotypes and the risk of GERD and BE.We then collected combinations of SNPs as composite proxies for the eight socioeconomic phenotypes to perform multivariate MR(MVMR)analyses based on the IVW MVMR model.Furthermore,a two-step MR mediation analysis was used to examine the potential mediation of the associations by body mass index,major depressive disorder(MDD),smoking,alcohol consumption,and sleep duration.RESULTS The study identified three socioeconomic statuses that had a significant impact on GERD.These included household income[odds ratio(OR):0.46;95% confidence interval(95%CI):0.31-0.70],education attainment(OR:0.23;95%CI:0.18-0.29),and the Townsend Deprivation Index at recruitment(OR:1.57;95%CI:1.04-2.37).These factors were found to independently and predominantly influence the genetic causal effect of GERD.Furthermore,the mediating effect of educational attainment on GERD was found to be mediated by MDD(proportion mediated:10.83%).Similarly,the effect of educational attainment on BE was mediated by MDD(proportion mediated:10.58%)and the number of cigarettes smoked per day(proportion mediated:3.50%).Additionally,the mediating effect of household income on GERD was observed to be mediated by sleep duration(proportion mediated:9.75%)CONCLUSION This MR study shed light on the link between socioeconomic status and GERD or BE,providing insights for the prevention of esophageal cancer and precancerous lesions.

Comparative Study of the Socioeconomic Characteristics and Digital Literacy Level of Agricultural Extension Personnel in Imo and Ebonyi States, South-East, Nigeria

The study comparatively analysed the socioeconomic characteristics and digital literacy level of Agricultural Extension personnel (AEP) in Ebonyi and Imo States, South-East, Nigeria. The specific objectives were to describe the socioeconomic characteristics of agricultural extension personnel in Ebonyi and Imo States, and to ascertain the digital literacy level of AEP in the studied states. Purposive sampling technique was used to select 312 Agricultural Extension personnel (132 from Ebonyi State Agricultural Development Program and 180 from Imo State Agricultural Development Program) for the study. Data were collected through the use of validated and structured questionnaire, and administered through the help of well-trained enumerators. Data were analysed using simple descriptive statistical tools such as percentages mean score, standard deviation and weighted mean. Findings indicated that they were more male in the both States (55.3% and 57.8%) for Ebonyi and Imo State respectively and that the average age of AEP in Ebonyi and Imo States were 44.7 years and 49.2 years respectively. It was further revealed that the majority (77.3% and 82.8%) had B.Sc./HND as their highest academic qualifications, belonged to professional organisations (62.1% and 75%), and were earning an average monthly income of N58,798 and N62,648 for Ebonyi and Imo State respectively. Also, it was revealed that their mean years of service were 12.4 years and 13.4 years for Ebonyi and Imo State respectively. Almost all of them (87.9% and 95.0%) own a smartphone, had access to the internet (80.3% and 90.0%), but do not own a laptop/ipad (82.6% and 72.8%) for Ebon-yi and Imo State respectively. Results further revealed that Agricultural extension personnel in both Ebonyi and Imo State respectively had low digital literacy level ( = 2.41 and 2.32). The study concluded that AEP in Ebonyi and Imo State respectively had similar socioeconomic characteristics and low level of digital literacy. The study recommended that the management of ADPs in both Ebonyi and Imo State should ensure the training of AEP in digital skills to enhance their digital literacy level to enable them use digital technologies in their work.

A socioeconomic approach to the profile of microcredit holders from the Hispanic minority in the USA

The subject of this study is the microcredit market in the USA,more specifically in Florida.The justification for choosing this specific state is the massive presence of the Hispanic population.This will facilitate a generalization of the obtained results to the microcredit market in Latin American countries.Thus,the objective of this study is to analyze the profile of microcredit holders and their companies from socioeconomic and financial points of view.As our data also consider the degree of repayment of the microloans included in the sample,the clients’profile is related to the punctuality or default of their corresponding loan repayments using the methodology of multi-nomial logit regression.The variables used in this study refer to personal information concerning borrowers(gender,age,education level,and marital status),the economic situation of their respective companies(closeness to the lender,number of workers,and revenues),and the characteristics of granted loans(principal,term,and purpose).However,the results of the regression show that only two variables are significant at the 5%significance level:the borrower’s age,which has a positive effect on repay-ment punctuality,and the loan term,which exhibits a negative effect.The findings of this study have clear implications,as they can help lenders design suitable microloans adjusted to customer profiles.Finally,future research should include other demograph-ics and characteristics of affected companies.

Socioeconomic Status Impacts the Prognosis of Chronic Rhinosinusitis Treated by Endoscopic Sinus Surgery:An Observational Cohort Study in Northeast China

Objective To explore the association between socioeconomic status(SES)and postoperative outcomes in patients with chronic sinusitis(CRS)after functional endoscopic sinus surgery(ESS).Methods We conducted an observational cohort study of 1,047 patients with CRS undergoing ESS.Discharged patients were followed up to 72 weeks for all-cause recurrence events.Baseline SES was established based on occupation,education level,and family income of the patients 1 year before the operation.Kaplan–Meier method was used to calculate the recovery rate after ESS,and Cox proportional hazards regression analysis was used to evaluate the relationship between SES and prognosis.Results Patients of middle SES had lower unadjusted all-cause recurrence than those of low or high SES;24-week overall recovery rate was 90.4%[95%confidence interval(CI):89.6%–91.2%]in patients of middle SES,13.5%(95%CI:12.8%–14.2%)in patients of low SES,and 31.7%(95%CI:30.7%–32.7%)in patients of high SES(both log-rank P<0.001).After adjustment for covariates,hazard ratios(HRs)were7.69(95%CI:6.17–9.71,Ptrend<0.001)for all-cause recurrence for low SES versus middle SES,and 6.19(95%CI:4.78–7.93,Ptrend<0.001)for middle SES versus high SES.Conclusion Low SES and high SES were more associated with the worse prognosis of CRS patients after ESS than middle SES.

Assessing the dynamics of human activity intensity and its natural and socioeconomic determinants in Qinghai-Tibet Plateau

Investigating the spatiotemporal variation of human activity intensity and its determinants is a crucial basis for further revealing the mechanism of human-environment interaction and optimizing the human development mode.In this study,the human activity intensity on the Qinghai-Tibet Plateau(QTP)from 1990 to 2020 was measured based on the quantitative model of land use data and the actual regional background,and the under-lying natural and socioeconomic determinants were investigated using spatial econometric methods.The results demonstrate that(1)the human activity intensity in QTP has increased by 11.96%,and there are differences in different spatial scales;the areas with high human activity intensity are distributed in the Hehuang Valley where Xining City and its surrounding areas are located,as well as the One-River and Two-River Area where Lhasa City and surrounding areas are located.(2)Human activity intensity has significant positive spatial spillover,suggesting that local changes will cause changes in the same direction in adjacent areas.(3)The human activ-ity intensity in QTP is affected by various determinants.Concerning socioeconomic factors,the economic level has no significant impact on the human activity intensity in QTP,which differs from the general regional law.Both urbanization and traffic conditions have a significant positive effect,and the impact intensity continues to increase.Concerning natural factors,topographic relief has a significant positive effect;the impacts of temper-ature and vegetation coverage have changed from insignificant to a significant positive effect;the impacts of precipitation and river network density have not been verified;there is no linear relationship between altitude and human activity intensity in the entire QTP,while it exists in local regions.Finally,this study proposes three policy implications for the realization of a more harmonious human-environment relationship in QTP.

Association and potential mediators between socioeconomic status and childhood obesity in China:findings from a national cohort study

Objective:Socioeconomic status(SES)is associated with childhood obesity,but the underlying factors remain unknown.This study aimed to identify mediators that may explain SES disparities in childhood obesity in China.Methods:Nationally representative longitudinal data from the China Education Panel Survey of 11 o019 children(13.03±0.79)collected from 2013-2014 to 2016-2017 academic years.Overweight/obesity was defined using Chinese national body mass index cut-points.Principal component analysis was used to convert the four SES indicators(maternal and paternal education,and occupation)into one comprehensive variable.Mediation analysis for SES disparities in childhood obesity was conducted using structure equation models.Results:The prevalence of overweight/obesity was 12.8%,and was higher in boys than in girls(17.8%vs.7.6%,P<0.001)at baseline.Among boys,relative risk(RR)of obesity was 1.23(95%CI:1.09 to 1.40,P<O.001)for per unit change in SES.There was no significant association between obesity and SES among girls.Mediation analyses showed that among boys,birth weight,being the only child in the family and children's selfperceived weight status mediated 70.0%of the effects of SES on obesity.No mediation effect was detected in girls.Conclusions:Chinese boys are more likely to be overweight or obese than girls.SES may impact childhood obesity through birth weight,being the only child in the family and children's self-perceived body weight status in boys,but not in girls.More attention should be made to address childhood obesity in high SES families among boys.Interventions targeting at these mediators are needed.

Influence of Socioeconomic Profile on Uptake of Immunohistochemistry Services among Women with Breast Cancer Attending Tertiary Health Facilities

Background: Breast cancer is the leading cause of death from cancer in women worldwide. It can be stratified by histological and immunopathological analysis as well as by molecular subtypes. Socioeconomic and cultural-mediated factors contribute to breast cancer heterogeneity and overall survivability. Objective: The aim of this study was to determine the influence of socioeconomic profile on the uptake of immunohistochemistry (IHC) services among women with breast cancer attending tertiary health facilities in Imo State. Methodology: This descriptive cross-sectional study was carried out among women with breast cancer in Imo State. The instrument for data collection used was a structured questionnaire constructed in line with the objectives of the study. A total of 121 respondents were selected randomly from a target study population of 891 using a systematic sampling technique. The software Statistical Package for Social Sciences (SPSS) version 21 was used for data analysis. Results: The mean age of the 121 respondents in this study was 45.2 ± 0.7 years. Age and education levels of the respondents were found to significantly influence the utilization of IHC services (P Conclusion: In our study, the consumption of IHC services was influenced significantly by the respondents’ age and level of education. Consequently, public health awareness programmes centred on the importance of IHC services in the management of breast cancer should be encouraged, so as to reach the less educationally endowed and older women in order to save more lives.

The Association of Socioeconomic Status with the Burden of Cataract-related Blindness and the Effect of Ultraviolet Radiation Exposure: An Ecological Study

Objective To assess the association of socioeconomic status with the burden of cataract blindness in terms of year lived with disability(YLD) rates and to determine whether ultraviolet radiation(UVR) levels modify the effect of socioeconomic status on this health burden.Methods National and subnational age-standardized YLD rates associated with cataract-related blindness were derived from the Global Burden of Disease(GBD) study 2017. The human development index(HDI) from the Human Development Report was used as a measure of socioeconomic status.Estimated ground-level UVR exposure was obtained from the Ozone Monitoring Instrument(OMI)dataset of the National Aeronautics and Space Administration(NASA).Results Across 185 countries, socioeconomic status was inversely associated with the burden of cataract blindness. Countries with a very high HDI had an 84% lower age-standardized YLD rate [95%confidence interval(CI): 60%–93%, P < 0.001] than countries with a low HDI;for high-HDI countries, the proportion was 76%(95% CI: 53%–88%, P < 0.001), and for medium-HDI countries, the proportion was48%(95% CI: 15%–68%, P = 0.010;P for trend < 0.001). The interaction analysis showed that UVR exposure played an interactive role in the association between socioeconomic status and cataract blindness burden(P value for interaction = 0.047).Conclusion Long-term high-UVR exposure amplifies the association of poor socioeconomic status with the burden of cataract-related blindness. The findings emphasize the need for strengthening UVR exposure protection interventions in developing countries with high-UVR exposure.

The association between socioeconomic status and visual disability among older adults in China

AIM: To investigate the association between socioeconomic status(SES) and visual disability(VD) among older Chinese adults. METHODS: We obtained data from the Second National Sample Survey on Disability, conducted in China in 2006. A total number of 192 375 older adults(aged≥65 y) were screened for suspected VD via interviews with trained examiners. Those who screened positively for VD were referred to ophthalmologists to obtain a final diagnosis. RESULTS: VD was prevalent among 7.29% of Chinese adults aged 65 and older, and was higher in rural areas(8.71%) than in urban areas(4.82%). After adjusting for SES indicators and covariates, we found that lesseducated older adults were more likely to suffer from VD, with an odds ratio(OR) of 2.50(95%CI: 2.26-2.82) for illiterates, compared with those who graduated from senior high school or above. Older adults who were in the lowest income quintile were more at risk of VD, with an OR of 1.81(95%CI: 1.68-2.95), compared with adults in the highest income quintile. In urban areas, when compared with adults who graduated from senior high school or above, those who did not continue their education after junior high school, primary school, or those who were illiterate, were more likely to suffer from VD, with an OR of 1.35(95%CI: 1.51-1.59), 1.84(95%CI: 1.60-2.12), and 2.63(95%CI: 2.27-3.04), respectively. Lower levels of income were statistically significant when associated with VD. In rural areas, adults who were illiterate had an OR of 2.21(95%CI:1.75-2.79) when compared to adults with senior high school or above education level. Per capita, household income remained significantly associated with VD. Older adults who were ≥85, female, single, and residing in rural areas were associated with higher risks of VD. CONCLUSION: Individual-level SES among the elderly, in the form of education and income, is associated with VD among elderly Chinese adults in both urban and rural areas; however, the association is stronger in rural areas. Further studies are still required to explore the mechanism behind the relationships.

Epidemiologic and socioeconomic factors impacting hepatitis B virus and related hepatocellular carcinoma

Chronic Hepatitis B is a highly prevalent disease worldwide and is estimated to cause more than 800000 annual deaths from complications such as cirrhosis and hepatocellular carcinoma(HCC).Although universal hepatitis B vaccination programs may have reduced the incidence and prevalence of chronic hepatitis B and related HCC,the disease still imposes a significant healthcare burden in many endemic regions such as Africa and the Asia-Pacific region.This is especially concerning given the global underdiagnosis of hepatitis B and the limited availability of vaccination,screening,and treatment in low-resource regions.Demographics including male gender,older age,ethnicity,and geographic location as well as low socioeconomic status are more heavily impacted by chronic hepatitis B and related HCC.Methods to mitigate this impact include increasing screening in high-risk groups according to national guidelines,increasing awareness and health literacy in vulnerable populations,and developing more robust vaccination programs in under-served regions.

Socioeconomics and attributable etiology of primary liver cancer,1990-2019

BACKGROUND Primary liver cancer(PLC)is a major contributor to cancer-related deaths.Data on global and country-specific levels and trends of PLC are essential for understanding the effects of this disease and helping policymakers to allocate resources.AIM To investigate the association between the burden of PLC and socioeconomic development status.METHODS Cancer mortality and incidence rates were obtained from the Global Burden of Disease(GBD)2019,and the data were stratified by country and territory,sex,and the Socio-demographic Index(SDI)level.The association between the attributable etiology of PLC and socioeconomic development status,represented using the SDI,was described.The attributable etiology of PLC included hepatitis B,hepatitis C,alcohol use,and nonalcoholic steatohepatitis.The association between the attributable etiology of PLC and SDI was further stratified by sex and geographical location.A confidence analysis was also performed based on bootstrap draw.RESULTS The age-standardized incidence rate of PLC was 6.5[95%confidence intervals(CI):5.9-7.2]per 100000 person-years,which decreased by-27.5%(-37.0 to-16.6)from 1990 to 2019.Several countries located in East Asia,South Asia,West Africa,and North Africa shouldered the heaviest burden of PLC in 2019.In terms of incidence rates,the first leading underlying cause of PLC identified was hepatitis B,followed by hepatitis C,alcohol use,and nonalcoholic steatohepatitis.Regarding stratification using the SDI,the incidence rate of PLC was the highest for high and middle SDI locations.Further,the leading attributable etiologies of PLC were hepatitis B for the middle and high middle SDI locations while hepatitis C and nonalcoholic steatohepatitis for the high SDI locations.CONCLUSION The pronounced association between socioeconomic development status and PLC burden indicates socioeconomic development status affects attributable etiologies for PLC.GBD 2019 data are valuable for policymakers implementing PLC cost-effective interventions.

Prevalences and causes of vision impairment in elderly Chinese: a socioeconomic perspective of a comparative report nested in Jiangsu Eye Study

AIM：To survey the prevalence and causes of visual impairment/blindness among elderly Chinese from different socioeconomic status in community-based design.METHODS：Cluster-sampling randomly selected residents from Binhu and Funing District,two areas representing different socioeconomic levels in China with Binhu in an advanced status and Funing in lessdeveloped area.The participants subjected to ophthalmic examination.The presenting visual acuity（PVA） and best-corrected visual acuity（BCVA） were recorded.Visual impairment and blindness were defined according to World Health Organization criteria.The causes of visual impairment/blindness were identified by ophthalmic examination and/or questionnaire.The socioeconomic status included the per capita gross domestic product,numbers of hospital with ophthalmic service and the number of ophthalmologists per 1 million residents.RESULTS：We successfully included 12 867 participants form 2 areas in this study.The prevalence of PVA impairment（〈20/63 to ≥20/400） in the better eye was 5.4% in Binhu and 23.6% in Funing,while the prevalence of blindness（〈20/400） was 0.9% in Binhu and 2.3% in Funing.With BCVA,the prevalence of visual impairment was 2.4% in Binhu and 6.4% in Funing,while the prevalence of blindness was 0.8% in Binhu and 1.6% in Funing.The participants with older age and female gender had higher prevalence in visual impairment and blindness.The highest prevalences of vision impairment and blindness evaluated by BCVA at 〉80y age group reached 20.4% and 6.3% respectively.The prevalences of vision impairment and blindness evaluated by BCVA were 3.5% and 1.0% in male and 5.0% and 1.3% in female.The above differences were statistically significant（P〈0.05）.The predominant causes of visual impairment and blindness were cataract,retinal disorders and uncorrected refractive error in both areas.The socioeconomic status was associated with visual impairment and blindness.CONCLUSION：This community-based study build a sufficient sample size for an ophthalmic survey.Our data show the disparities on socioeconomic development and genders in visual impairment and blindness in China.Special emphasis of ophthalmic service should be placed on females and less-developed area.

Socioeconomic inequalities in the use of delivery care services in Bangladesh: a comparative study between 2004 and 2007

The study explores inequalities in the utilization of delivery care services in different administrative divisions in Bangladesh, by key socioeconomic factors. It estimates the extent of the relationship between women’s socioeconomic inequalities and their place of delivery during 2004 and 2007. Trends in relation to place of delivery in relation to residency and education over a period of thirteen years (1993-2007) have also been measured. The study analyzed the trends and patterns in utilization of institutional delivery care among mothers, using data from the Bangladesh Demographic Health Survey (BDHS) conducted during 1993-2007. The data was disaggregated by area of residence in different divisions in Bangladesh. Bi-variate analyses, concentration curves and multivariate logistic regression were employed in the analysis of the data. The study indicated slow progress in the utilization of institutional delivery care among mothers in Bangladesh between 1993 and 2007. Large variations in outcome measures were observed among the different divisions. Multivariate analyses suggested growing inequalities in utilization of delivery care services between different economic groups and parents with different educational levels. The use of institutional delivery care remains substantially lower among poor and less educated rural mothers in Bangladesh, irrespective of age and employment. Further studies are recommended to explore the specific causes relating to the non-utilization of institutional delivery care.

Hypertension Prevalence,Awareness,Treatment,and Control and Their Associated Socioeconomic Factors in China:A Spatial Analysis of A National Representative Survey

Objective We aimed to investigate and interpret the associations between socioeconomic factors and the prevalence, awareness, treatment, and control of hypertension at the provincial level in China.Methods A nationally and provincially representative sample of 179,059 adults from the China Chronic Disease and Nutrition Surveillance study in 2015–2016 was used to estimate hypertension burden. The spatial Durbin error model was fitted to investigate socioeconomic factors associated with hypertension indicators.Results Overall, it was estimated that 29.20% of the participants were hypertensive nationwide,among whom, 34.32% were aware of their condition, 27.69% had received antihypertensive treatment,and 7.81% had controlled their condition. Per capita gross domestic product(GDP) was associated with hypertension prevalence(coefficient:-2.95, 95% CI:-5.46,-0.45) and control(coefficient: 6.35, 95% CI:1.36, 11.34) among adjacent provinces and was also associated with awareness(coefficient: 2.93, 95%CI: 1.12, 4.74) and treatment(coefficient: 2.67, 95% CI: 1.21, 4.14) in local province. Beds of internal medicine(coefficient: 2.66, 95% CI: 1.08, 4.23) was associated with control in local province. Old dependency ratio(coefficient:-3.58, 95% CI:-5.35,-1.81) was associated with treatment among adjacent provinces and with control(coefficient:-1.69, 95% CI:-2.42,-0.96) in local province.Conclusion Hypertension indicators were not only directly influenced by socioeconomic factors of local area but also indirectly affected by characteristics of geographical neighbors. Population-level strategies should involve optimizing supportive socioeconomic environment by integrating clinical care and public health services to decrease hypertension burden.

Age, socioeconomic features, and clinical factors predict receipt of endoscopic retrograde cholangiopancreatography in pancreatic cancer

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP) is the recommended technique for biliary decompression in pancreatic cancer. Previous studies have suggested racial, socioeconomic and geographic differences in diagnosis,treatment and outcomes of pancreatic cancer patients.AIM To examine geographic, racial, socioeconomic and clinical factors associated with utilization of ERCP.METHODS Surveillance, Epidemiology and End Results and linked Medicare claims data were used to identify pancreatic cancer patients between 2000-2011. Claims data were used to identify patients who had ERCP and other treatments. The primary outcome was receipt of ERCP. Chi-squared analyses were used to compare demographic information. Trends in use of ERCP over time were assessed using Cochran Armitage test. Adjusted odds ratios(aORs) and 95% confidence intervals(CIs) for receipt ERCP were calculated using logistic regression,controlling for other characteristics.RESULTS Among 32510 pancreatic cancer patients, 14704(45.2%) underwent ERCP.Patients who had cancer located in the head of the pancreas(aOR 3.27, 95%CI:2.99-3.57), had jaundice(aOR 7.59, 95%CI: 7.06-8.17), cholangitis(aOR 4.22,95%CI: 3.71-4.81) or pruritus(aOR 1.42, 95%CI: 1.22-1.66) and lived in lower education zip codes(aOR 1.14, 95%CI: 1.04-1.24) were more likely to receive ERCP. In contrast, patients who were older(aOR 0.88, 95%CI: 0.83, 0.94), not married(aOR 0.92, 95%CI: 0.86, 0.98), and lived in a non-metropolitan area(aOR0.89, 95%CI: 0.82, 0.98) were less likely to receive ERCP. Compared to white patients, non-white/non-black patients(aOR 0.83, 95%CI: 0.70-0.97) were less likely to receive ERCP. Patients diagnosed later in the study period were less likely to receive ERCP(aOR 2004-2007 0.85, 95%CI: 0.78-0.92; aOR 2008-2011 0.76,95%CI: 0.70-0.83). After stratifying by indications for ERCP including jaundice,racial differences persisted(aOR black patients 0.80, 95%CI: 0.67-0.95,nonwhite/nonblack patients 0.73, 95%CI: 0.58-0.91). Among patients with jaundice, those who underwent surgery were less likely to undergo ERCP(aOR0.60, 95%CI: 0.52, 0.69).CONCLUSION ERCP utilization in pancreatic cancer varies based on patient age, marital status,and factors related to where the patient lives. Further studies are needed to guide appropriate biliary intervention for these patients.

Interconnections between governance and socioeconomic conditions:Understanding the challenges in sub-Saharan Africa

Given that challenges on the issue of socioeconomic development faced by countries in sub-Saharan Africa(SSA)have been identified as critical to strengthening the inherent link between governance and socioeconomic conditions,this study examines the interconnections between governance and socioeconomic conditions in SSA.With a focus on 25 countries in SSA between 2005 and 2019,we conduct the analysis based on the Panel-Corrected Standard Error and System Generalized Method of Moments estimations and panel causality tests.The results show that SSA does not seem to have the means of effective governance to spur improved socioeconomic conditions.Moreover,the pervasiveness of institutional problems in many countries of SSA has been responsible for the poor socioeconomic conditions in the region.Likewise,governance quality and socioeconomic conditions are found to influence each other.An improvement in socioeconomic conditions could result in better governance quality.On the other hand,governance quality is viewed as a vital ingredient in achieving needed socioeconomic development outcomes.Thus,it is suggested that there is a need for countries in SSA to streamline governing systems toward engendering improved well-being.The introduction and implementation of transformative policies through effective governance are also necessary for ensuring critical structural changes and increasing social service provision.Overall,there should be a proactive identification of ineffective policies and procedures by policymakers to enhance meaningful impacts in the region.

Parenting preschoolers with autism: Socioeconomic influences on wellbeing and sense of competence

BACKGROUND Previous research suggests that parents raising a child with autism experience higher levels of psychological distress than parents of typically developing children and parents of children with other developmental disorders. Little is known, however, about the intersection between the effects of socioeconomic status(SES) on the wellbeing and sense of parental competency of parents of preschoolers with autism and how it relates to child symptom severity.AIM To examine the relationship between their child's symptom severity, SES, as measured by neighbourhood advantage and occupational status, on the psychological wellbeing and perceived parenting competence among parents of preschoolers with autism.METHODS Parents of 117 preschool-aged children with a diagnosis of autism spectrum disorder(ASD), 107 mothers and 54 fathers, completed questionnaires about their child's symptoms of ASD and functioning, their own perceptions of their wellbeing and parental competence on entry to an early intervention program in Sydney, Australia. Parents also provided demographic information pertaining to their occupation, level of education attained and address(postcode). All children were also assessed for their severity of symptoms using the Autism Diagnostic Observation Schedule. The Australian Socioeconomic Index of occupationalstatus as a measure of familial SES and the Index of Relative Socio-economic Advantage and Disadvantage as a measure of neighbourhood advantage were used to examine the impact of SES on parental sense of competence and wellbeing.RESULTS Compared to normative populations, both mothers and fathers in our sample reported significantly higher levels of parenting sense of efficacy but lower levels of interest in the parenting role. Mothers also displayed higher levels of satisfaction. Both mothers and fathers displayed higher levels of depression than normative populations with mothers also reporting greater levels of stress and anxiety. Child symptom severity was associated with maternal parenting competency with these relationships amplified among mothers with higher familial SES and who lived in areas of greater neighbourhood advantage.Increased adaptive functioning was associated with better maternal wellbeing,particularly among mothers who lived in areas of greater neighbourhood advantage. Contrastingly, paternal parenting competence was generally not influenced by child adaptive functioning or symptom severity, although for those in higher familial SES brackets, children's symptom severity and maladaptive symptoms were negatively related to paternal sense of parenting efficacy. There was a trend towards moderate relationships between lower familial SES and greater depression, stress and anxiety among fathers, but no relationship with their child's ASD symptom severity or functioning.CONCLUSION SES differentially impacts wellbeing and sense of parenting competence and its relationship to the impact of child symptoms for mothers and fathers of preschoolers with autism.

Changes in Land Use, Socioeconomic Indices, and the Transportation System in Gifu City and their Relevance during the Late 20th Century

History provides valuable lessons for the interplay of factors that shape urban growth and development. This study examines changes in land use, socioeconomic indices, and the transportation system of Gifu City during the late 20th century using geographical information system (GIS) methods. The data for the study were historical maps and the population census and economic statistics data from 1950 to 2000, when Japan was in a period of high economic growth. The discussion focuses on the master plan, road construction, land use, the spatial distribution of the population, and socioeconomic indices. It was possible to compare spatial distribution patterns over time using GIS. When policies were created that attached importance to construction of a road network due to the development of motorization and elimination of the city tram, the surrounding suburban area became the focus of land-use development. As a result, Gifu City is plagued by the doughnut phenomenon. It is important to identify the relationships among urban planning factors to provide for future urban and transportation planning.