Search Results (506)

Background: Excessive alcohol consumption is among the leading causes of hospitalisation in high-income countries and contributes to over 200 medical conditions. We aimed to determine the prevalence and characteristics of alcohol use disorder (AUD), describe the distribution of AUD in ICD-10 discharge diagnosis groups and ascertain any relationship between them in secondary care. Methods: The study group was a retrospective cohort of adult patients admitted to Nottingham University Hospital (NUH) between 4 April 2009 and 31 March 2020. Uni- and multivariable analysis was performed to determine the relationship between AUD and covariable high-risk characteristics and describe the distribution of AUD in ICD-10 discharge diagnosis groups defined by an alcohol-attributable fraction. Results: A total of 44,804 patients (66,440 admissions) were included, with a mean age of 63.1 years (SD ± 19.9); of these, 48.0% (n = 20,863) were male and 71.2% were (n = 30,994) white. AUDIT-C was completed in 97.1% (n = 43,514) of patients, and identified 16.5% (n = 7164) as having AUD, while 2.1% (n = 900) were found to be alcohol-dependent. In patients with AUD, 4.0% (n = 283) had an ICD-10 diagnosis that was alcohol-specific and 17.5% (n = 1255) were diagnosed with alcohol-related disorders; the remainder were not diagnosed with either disorder. Two-thirds (64.7%) of the patients with AUD had associated mental and behavioural disorders. Multivariable logistic regression analysis revealed that patients aged 60–69 had the highest risk of AUD (OR 4.19, 95% CI 3.53–4.99). Being single (OR 1.18, 95% CI 1.11–1.26) and a history of emergency admission (OR 1.21, 95% CI 1.14–1.29) were associated with increased odds of AUD. Conversely, females compared to males (OR 0.34, 95% CI 0.35–0.39), individuals from minority ethnic backgrounds compared to white Caucasians (OR 0.39, 95% CI 0.35–0.45), and those from more deprived areas (IMD quintile 1: OR 0.79, 95% CI 0.74–0.86) had lower odds of AUD. Conclusions: One in six admitted patients had AUD, with a higher risk in males, ages 60–69, and emergency admissions. Mental disorders are highly prevalent among hospitalised patients with AUD. The performance of the AUDIT-C score varied among hospitalised patients based on their ICD-10 diagnosis, which should be considered when implementing universal alcohol screening in these settings. Full article

Electrification of private cars is a key mechanism for reducing transport emissions and achieving net zero. Simultaneously, the development of public electric vehicle (EV) charging networks is essential for an equitable transition to EVs. This paper develops and analyses an extensive, nationally representative dataset of EV-charging sessions taking place on a key public charging network in Scotland between 2022 and 2024 to gain insights that can support the development of public charging infrastructure. Data were collated from 2786 chargers and analysed to establish a detailed characterisation of the network’s organisation and utilisation. The network considered is government-owned and was fundamental to the Scottish rollout of public chargers. Key insights from our analysis of the developed dataset include quantified disparities between urban and rural charger use-time behaviours, with the most rural areas tending to have charging activity more concentrated towards the middle of the day; an analysis of the numbers of deployed chargers in areas of greater/lesser deprivation; utilisation disparities between charger technologies, with 35% of slower chargers being used at least once daily compared to 86% of rapid/ultra-rapid chargers; and demonstration that charging tariff introductions resulted in a 51.3% average decrease in sessions. The implications of our findings for policy and practice are also discussed. Full article

Background: Non-melanoma skin cancers (NMSCs) are the most common cancers in the United States. Image-guided superficial radiation therapy (IGSRT) is an effective treatment for NMSCs. Patient comorbidities and socioeconomic status (SES) are known contributors to health disparities. However, the impact of comorbidities or SES on the outcomes of IGSRT-treated NMSCs has not yet been studied. This study evaluated freedom from recurrence in IGSRT-treated NMSCs stratified by SES and the number of comorbidities. Methods: This large retrospective cohort study evaluated associations between SES (via Area Deprivation Index (ADI)) or comorbidity (via Charlson Comorbidity Index (CCI)) and 2-, 4-, and 6-year year freedom from recurrence in patients with IGSRT-treated NMSC (n = 19,988 lesions). Results: Freedom from recurrence in less (ADI ≤ 50) vs. more (ADI > 50) deprived neighborhoods was 99.47% vs. 99.61% at 6 years, respectively (p = 0.2). Freedom from recurrence in patients with a CCI of 0 (low comorbidity burden) vs. a CCI of ≥7 (high comorbidity burden) was 99.67% vs. 99.27% at 6 years, respectively (p = 0.9). Conclusions: This study demonstrates that there are no significant effects of SES or comorbidity burden on freedom from recurrence in patients with IGSRT-treated NMSC. This supports the expansion of IGSRT in deprived neighborhoods to increase access to care, and IGSRT should be a consideration even in patients with a complex comorbidity status. Full article

Obesity is a common risk factor in multiple tumor types, including prostate cancer. Obesity has been associated with driving metastasis, therapeutic resistance, and increased mortality. The effect of adipose tissue on the tumor microenvironment is still poorly understood. This review aims to highlight the work conducted in the field of obesity and prostate cancer and bring attention to areas where more research is needed. In this review, we have described key differences between healthy adipose tissues and obese adipose tissues, as they relate to the tumor microenvironment, focusing on mechanisms related to metabolic changes, abnormal adipokine secretion, altered immune cell presence, and heightened oxidative stress as drivers of prostate cancer formation and progression. Interestingly, common treatment options for prostate cancer ignore the adipose tissue located near the site of the tumor. Because of this, we have outlined how excess adipose tissue potentially affects therapeutics’ efficacy, such as androgen deprivation, chemotherapy, and radiation treatment, and identified possible drug targets to increase prostate cancer responsiveness to clinical treatments. Understanding how obesity affects the tumor microenvironment will pave the way for understanding why some prostate cancers become metastatic or treatment-resistant, and why patients experience recurrence. Full article

Yak is a special free-ranging cattle breed in the plateau areas of Qinghai and Tibet. Pasture withering in cold-season pastures results in energy deficiency in yaks, which undermines the rumen epithelial barrier. However, the leading factor causing rumen epithelial injury remains unknown. Glutamine (Gln), a conditionally essential amino acid, is insufficient under pathological conditions. Glucose (GLU) is an important energy source. Thus, we explored the effects of Gln or GLU deprivation on the barrier function of yak rumen epithelial cells and investigated the underlying mechanisms, as well as the differences in rumen epithelial barrier function between Gln deprivation (Gln-D) and GLU deprivation (GLU-D). In previous work, we constructed the yak rumen epithelial cells (YRECs) line by transferring the human telomerase reverse transcriptase gene (hTERT) and simian virus 40 large T antigen (SV40T) into primary YRECs. The YRECs were exposed to normal, Gln-D, GLU-D, and serum replacement (SR) media for 6, 12, and 24 h. Our data displayed that cell viability and tight junction protein expression in the SR group were not significantly changed compared to the normal group. Whereas, compared with the SR group, Gln-D treated for more than 12 h reduced cell viability and proliferation, and GLU-D treated for more than 12 h damaged the cell morphology and reduced cell viability and proliferation. The cell proliferation and cell viability were decreased more in GLU-D than in Gln-D. In addition, Gln-D treated for more than 12 h disrupted YREC cellular partially tight junctions by inducing oxidative stress and inflammation, and GLU-D treated for more than 12 h disrupted YREC cellular tight junctions by inducing apoptosis, oxidative stress, and inflammation. Compared with Gln-D, GLU-D more significantly induced cell injury and reduced tight junction protein levels. Our results provided evidence that GLU-D induced damage through the p38 mitogen-activated protein kinase (p38 MAPK)/c-junN-terminal kinase (JNK) signaling pathway, which was more serious than Gln-D treated for more than 12 h. Full article

Lymphatic filariasis (LF) is a neglected tropical disease associated with poverty and poor environmental conditions. With the inclusion of vector control activities in LF surveillance actions, there is a need to develop simple methods to identify areas with higher mosquito density and thus a higher consequent risk of W. bancrofti transmission. An ecological study was conducted in Igarassu, which is in the metropolitan region of Recife, Pernambuco, Brazil. The mosquitoes were captured in 2060 houses distributed across 117 census tracts. The vector density index (VDI), which measures the average number of lymphatic-filariasis-transmitting mosquitoes per number of houses collected in the risk stratum, was constructed. Moreover, the social deprivation indicator (SDI) was constructed and calculated through principal component factor analysis. An average of 242 female C. quinquefasciatus were found in the high-risk stratum, while the average in the low-risk stratum was 108. The overall VDI was 6.8 mosquitoes per household. The VDI for the high-risk stratum was 13.2 mosquitoes per household, while for the low/medium-risk stratum, it was 5.2. This study offers an SDI for the density of C. quinquefasciatus mosquitoes, which can help reduce the costs associated with data collection and allows for identifying priority areas for vector control actions. Full article

Background: Socioeconomic deprivation has been associated with higher lung cancer risk and mortality in non-Veteran populations. However, the impact of socioeconomic deprivation on outcomes for non-small cell lung cancer (NSCLC) in an integrated and equal-access healthcare system, such as the Veterans Health Administration (VHA), remains unclear. Hence, we investigated the impact of area-level socioeconomic deprivation on access to care and postoperative outcomes for early-stage NSCLC in United States Veterans. Methods: We conducted a retrospective cohort study of patients with clinical stage I NSCLC receiving surgical treatment in the VHA between 1 October 2006 and 30 September 2016. A total of 9704 Veterans were included in the study and assigned an area deprivation index (ADI) score, a measure of socioeconomic deprivation incorporating multiple poverty, education, housing, and employment indicators. We used multivariable analyses to evaluate the relationship between ADI and postoperative outcomes as well as adherence to guideline-concordant care quality measures (QMs) for stage I NSCLC in the preoperative (positron emission tomography [PET] imaging, appropriate smoking management, pulmonary function testing [PFT], and timely surgery [≤12 weeks after diagnosis]) and postoperative periods (appropriate surveillance imaging, smoking management, and oncology referral). Results: Compared to Veterans with low socioeconomic deprivation (ADI ≤ 50), those residing in areas with high socioeconomic deprivation (ADI > 75) were less likely to have timely surgery (multivariable-adjusted odds ratio [aOR] 0.832, 95% confidence interval [CI] 0.732–0.945) and receive PET imaging (aOR 0.592, 95% CI 0.502–0.698) and PFT (aOR 0.816, 95% CI 0.694–0.959) prior to surgery. In the postoperative period, Veterans with high socioeconomic deprivation had an increased risk of 30-day readmission (aOR 1.380, 95% CI 1.103–1.726) and decreased odds of meeting all postoperative care QMs (aOR 0.856, 95% CI 0.750–0.978) compared to those with low socioeconomic deprivation. There was no association between ADI and overall survival (adjusted hazard ratio [aHR] 0.984, 95% CI 0.911–1.062) or cumulative incidence of cancer recurrence (aHR 1.047, 95% CI 0.930–1.179). Conclusions: Our results suggest that Veterans with high socioeconomic deprivation have suboptimal adherence to care QMs for stage I NSCLC yet do not have inferior long-term outcomes after curative-intent resection. Collectively, these findings demonstrate the efficacy of an integrated, equal-access healthcare system in mitigating disparities in lung cancer survival that are frequently present in other populations. Future VHA policies should continue to target increasing adherence to QMs and reducing postoperative readmission for socioeconomically disadvantaged Veterans with early-stage NSCLC. Full article

Inertial Motor sensors (IMUs) are valid instruments for measuring postural sway but their ability to detect changes derived from visual deprivation in healthy older adults requires further investigations. We examined the validity and relationship of IMU sensor-derived postural sway measures compared to force plates for different eye conditions in healthy older adults (32 females, 33 males). We compared the relationship of the center of mass and center of pressure (CoM and CoP)-derived total length, root means square (RMS) distance, mean velocity, and 95% confidence interval ellipse area (95% CI ellipse area). In addition, we examined the relationship of the IMU sensor in discriminating between open- (EO) and closed-eye (EC) conditions compared to the force plate. A significant effect of the instruments and eye conditions was found for almost all the variables. Overall, EO and EC variables within (force plate r, from 0.38 to 0.78; IMU sensor r, from 0.36 to 0.69) as well as between (r from 0.50 to 0.88) instruments were moderately to strongly correlated. The EC:EO ratios of RMS distance and 95% CI ellipse area were not different between instruments, while there were significant differences between total length (p = 0.973) and mean velocity (p = 0.703). The ratios’ correlation coefficients between instruments ranged from moderate (r = 0.65) to strong (r = 0.87). The IMU sensor offers an affordable, valid alternative to a force plate for objective, postural sway assessment. Full article

Background: Glioblastoma is the most common and aggressive primary brain tumour, characterised by its invasive nature and complex metabolic profile. Emerging research highlights the role of amino acids (AAs) in glioblastoma metabolism, influencing tumour growth and the surrounding microenvironment. Methods: This narrative review synthesises recent pre-clinical studies focusing on the metabolic functions of AAs in glioblastoma. Key areas include the effects of AA deprivation on tumour growth, adaptive mechanisms, and the tumour microenvironment. Results: The effects related to arginine, glutamine, methionine, and cysteine deprivation have been more extensively reported. Arginine deprivation in arginine-auxotrophic glioblastomas induces apoptosis and affects cell adhesion, while glutamine deprivation disrupts metabolic pathways and enhances autophagy. Methionine and cysteine deprivation impact lipid metabolism and ferroptosis. Tumour adaptive mechanisms present challenges, and potential compensatory responses have been identified. The response of the microenvironment to AA deprivation, including immune modulation, is critical to determining therapeutic outcomes. Conclusions: Targeting AA metabolism offers a promising approach for glioblastoma treatment, with potential targeted drugs showing clinical promise. However, the complexity of tumour adaptive mechanisms and their impact on the microenvironment necessitates further research to optimise combination therapies and improve therapeutic efficacy. Full article

Background: Ethnic and socioeconomic disparities in cancer outcomes are exacerbated by clinical trial underrepresentation. This study aims to identify inequalities in ethnicity and socioeconomic features among ovarian cancer clinical trial participants in two London cancer centres. Methods: All ovarian cancer patients treated between 2017 and 2022 were included. Patients participating in clinical trials were classified as the trial population (TP); the remainder were considered the non-trial population (NTP). Data on disease characteristics and sociodemographic features, including ethnicity and Indices of Multiple Deprivation (IMD) deciles, were accessed from electronic patient records. Results: Of the 892 patients, 212 (24%) were enrolled in trials: 87 in Phase II, 103 in Phase III, and 21 in prospective, non-investigational medicinal product trials. The TP were more likely to be of White ethnicity (72.6% vs. 57.5%; p < 0.001), younger (mean age 58 vs. 60; p = 0.003), living in less deprived areas (most deprived tercile: 21.2% vs. 34.0%; p = 0.004), and English-speaking (95.8% vs. 90.9%; p = 0.041). In the multivariate analysis, White ethnicity (p < 0.0001), age (p = 0.003), IMD decile (p = 0.007), and interpreter requirement (p = 0.037) were independent predictors of trial participation. Conclusions: Ethnic and socioeconomic inequalities affect trial participation, potentially worsening health disparities in ovarian cancer patients. Strategies to overcome trial recruitment barriers for underserved groups are needed to improve the equity of care. Full article

The sustainable development of rural tourism requires not only active participation from the government and enterprises but is also closely tied to the attitudes of local residents. This study, grounded in the theories of relative deprivation and social comparison, focuses on the residents living near the Jinshi Gorge Scenic Area in Shangluo City. We constructed a structural equation model to explore how residents’ perceptions of the social environment in rural tourism influence their sense of relative deprivation, enhance their happiness, and ultimately promote the sustainable development of rural tourism. The study’s findings reveal the following: (1) that demographic characteristics, including age, education level, and annual income, significantly influence residents’ perceptions of their social environment, particularly their sense of group identity, social support, and feelings of inequality. (2) Levels of relative deprivation vary significantly across different demographic groups. (3) There is a strong positive correlation between individual cognitive relative deprivation and individual emotional relative deprivation. Similarly, group cognitive relative deprivation positively predicts group emotional relative deprivation. (4) Experiences of discrimination, feelings of inequality, and strength of group identity emerge as significant predictors of both individual and group-level cognitive and emotional relative deprivation. (5) Social support has a significant negative effect on individual cognition, individual emotions, group cognition, and group emotional relative deprivation. Full article

This article presents the correlation between the Multidimensional Poverty Index (MPI) and the area planted, production in tons, and productive yield for various crops in Colombia from 2018 to 2021. The aim of this study is to determine the relationship between agricultural productivity and multidimensional poverty in Colombia, focusing on the cultivation of coffee, plantain, and corn. The methodology employed included a literature review through a bibliometric analysis to understand the relationships between the MPI and agricultural production. In the second stage, the agricultural sector statistics for the years 2018 to 2021 and the MPI by regions and departments of Colombia during the same period was systematized. Finally, a quantitative statistical analysis was conducted to establish the correlation of the MPI with the area planted, production in tons, and productive yield for coffee, plantain, and corn crops in Colombia. The MPI identifies those who are deprived in 50% or more of the index’s dimensions as living in extreme poverty. The results show that higher productive yields in the crops analyzed correspond to a lower MPI. Coffee crops have an MPI below 50%; plantain crops have an MPI between 20% and 50%, and for mechanized corn crops, the data show an MPI between 20% and 30%. This demonstrates that coffee, plantain, and corn crops represent an alternative for reducing the MPI in Colombia. Full article

Air pollution, greenspace and noise are interrelated environmental factors with the potential to influence human health outcomes. Research has measured these exposures in diverse ways across the globe, but no study has yet performed a country-wide analysis of air pollution, greenspace, and noise in England. This study examined cross-sectional PM_2.5, NO₂, greenness, accessible greenspace, road noise, and rail noise exposure data at all residential postcodes in England (n = 1,227,681). Restricted cubic spline models were fitted between each environmental exposure and a measure of socioeconomic status, the Index of Multiple Deprivation (IMD) rank. Population-weighted exposures by IMD deciles, urbanicity, and region were subsequently estimated. Restricted cubic spline models were also fitted between greenness and each other environmental exposure in the study. The results show some evidence of inequalities in exposure to air pollutants, greenspace, and noise across England. Notably, there is a socioeconomic gradient in greenness, NO₂, PM_2.5, and road noise in London. In addition, NO₂, PM_2.5, and road noise exposure decrease as greenness increases in urban areas. Concerningly, almost all air pollution estimates in our study exceed international health guidelines. Further research is needed to elucidate the socioeconomic patterns and health impacts of air pollution, greenspace, and noise over time. Full article

The joint involvement of family and society in elderly care is a crucial factor in improving the health status of older adults and narrowing health disparities, which are essential for achieving sustainable development goals. However, the interactions between these entities and their mechanisms of influence require further investigation. By utilizing data from the China Longitudinal Aging Social Survey (CLASS) spanning 2014 to 2016 and employing the Kakwani index of individual relative deprivation in conjunction with a two-way fixed-effects model for unbalanced panel data, in this study, we investigated the mechanisms through which social elderly care security and familial support influence health inequalities among the elderly. The findings reveal that only senior benefits (=−0.009, p < 0.05) significantly mitigate relative health deprivation in this population. Enrollment in pension insurance amplifies the sense of relative health deprivation among the elderly, but this effect becomes insignificant after controlling for temporal effects. Both economic support (=−0.002, p < 0.05) and emotional support (=−0.004, p < 0.01) from offspring significantly reduce the level of relative health deprivation among the elderly. Mechanism testing results indicate that individual attitudes towards aging serve as a mediator in the relationship between relative health deprivation and preferential treatment, economic support, and emotional support. The results of further heterogeneity tests suggest that the impact of various elderly support models on relative health deprivation differs by age, gender, and residential area.These findings confirm that support from both society and family plays a crucial role in achieving sustainable health outcomes for the elderly. Consequently, it is recommended to enhance the social elderly care security system, bolster familial support functions, cultivate positive individual attitudes towards aging, and address health inequalities among the elderly in accordance with their distinct characteristics, thereby improving their quality of life and sense of fulfillment, and contributing to the broader goals of sustainable development. Full article

Increasing tenure security is essential for promoting safe and inclusive urban development and achieving Sustainable Development Goals. However, assessment of tenure security relies on conventional census and survey statistics, which often fail to capture the dimension of perceived tenure insecurity. This perceived tenure insecurity is crucial as it influences local engagement and the effectiveness of policies. In many regions, particularly in the Global South, these conventional methods lack the necessary data to adequately measure perceived tenure insecurity. This study first used household survey data to derive variations in perceived tenure insecurity and then explored the potential of Very-High Resolution (VHR) satellite imagery and spatial data to assess these variations in urban deprived areas. Focusing on the city of Kigali, Rwanda, the study collected household survey data, which were analysed using Multiple Correspondence Analysis to capture variations of perceived tenure insecurity. In addition, VHR satellite imagery and spatial datasets were analysed to characterize urban deprivation. Finally, a Random Forest regression model was used to assess the relationship between variations of perceived tenure insecurity and the spatial characteristics of urban deprived areas. The findings highlight the potential of geospatial information to estimate variations in perceived tenure insecurity within urban deprived contexts. These insights can inform evidence-based decision-making by municipalities and stakeholders in urban development initiatives. Full article