Do social support and community engagement act as mechanisms in the association between neighbourhood income inequality and the mental health of mothers in Calgary,Canada? A mediation analysis

PurposeAccording to the social determinants of health framework, income inequality is a potential risk factor for adverse mental health. However, few studies have explored the mechanisms suspected to mediate this relationship. The current study addresses this gap through a mediation analysis to determine if social support and community engagement act as mediators linking neighbourhood income inequality to maternal anxiety and depressive symptoms within a cohort of new mothers living in the City of Calgary, Canada.MethodsData collected at three years postpartum from mothers belonging to the All Our Families (AOF) cohort were used in the current study. Maternal data were collected between 2012 and 2015 and linked to neighbourhood socioeconomic data from the 2006 Canadian Census. Income inequality was measured using Gini coefficients derived from 2006 after-tax census data. Generalized structural equation models were used to quantify the associations between income inequality and mental health symptoms, and to assess the potential direct and indirect mediating effects of maternal social support and community engagement.ResultsIncome inequality was not significantly associated with higher depressive symptoms (β = 0.32, 95%CI = −0.067, 0.70), anxiety symptoms (β = 0.11, 95%CI = −0.39, 0.60), or lower social support. Income inequality was not associated with community engagement. For the depression models, higher social support was significantly associated with lower depressive symptoms (β = −0.13, 95%CI = −0.15, −0.097), while community engagement was not significantly associated with depressive symptoms (β = 0.059, 95%CI = −0.15, 0.27). Similarly, for the anxiety models, lower anxiety symptoms were significantly associated with higher levels of social support (β = −0.17, 95%CI = −0.20, −0.13) but not with higher levels of community engagement (β = 0.14, 95%CI = −0.14, 0.41).ConclusionThe current study did not find clear evidence for social support or community engagement mediating the relationship between neighbourhood income inequality and maternal mental health. Future investigations should employ a broader longitudinal approach to capture changes in income inequality, potential mediators, and mental health symptomatology over time.     

Out of the boxes,out of the silos: The need of interdisciplinary collaboration to reduce poor-quality medical products in the supply chain

In this paper, we argue that understanding and addressing the problem of poor-quality medical products requires a more interdisciplinary approach than has been evident to date. While prospective studies based on rigorous standardized methodologies are the gold standard for measuring the prevalence of poor-quality medical products and understanding their distribution nationally and internationally, they should be complemented by social science research to unpack the complex set of social, economic, and governance factors that underlie these patterns. In the following sections, we discuss specific examples of prospective quality surveys and of social science studies, highlighting the value of cross-sector partnerships in driving high-quality, policy-relevant research in this area.     

台州市功能性消化不良的流行病学现状调查及影响因素分析

目的 探讨台州市功能性消化不良的流行病学现状及影响因素。方法 回顾性选取2020年1月至2022年2月浙江省台州医院收治的功能性消化不良患者200例，统计患者的一般资料，分析该病的流行病学现状，对功能性消化不良的影响因素进行单因素分析，然后将差异有统计学意义的因素再进一步纳入多因素Logistic回归分析。结果 200例功能性消化不良患者中，女性发病率高于男性；30~60岁年龄段群体，患病率最高；存在暴饮暴食、喜食烫食、挑食、多食酸制品、未准时进食、常食宵夜、睡眠时间<6h、有药物过敏史、有功能性消化不良家族史、存在便秘情况者的患病率均高于未存在以上情况者，差异均有统计学意义（P<0.05）。多因素Logistic回归分析显示，性别、年龄、暴饮暴食、喜食烫食、挑食、多食酸制品、未准时进食、宵夜摄取情况、每天睡眠时间、药物过敏史、家族史、便秘是该病患病率升高的主要影响因素。结论 性别、年龄、暴饮暴食、喜食烫食、挑食、酸制品、未准时进食情况、宵夜摄取情况、每天睡眠时间、药物过敏史、家族史、便秘是功能性消化不良的主要影响因素。     

镇江市护士分层培训及分层进阶现况分析

目的调查镇江市各医院护士分层培训及分层进阶的方法及现状。方法2018年4—5月间采用自行设计的调查问卷,对全市医院的护理人员进行随机抽样调查。结果调查显示镇江市96.45%的护士受医院分层培训及分层进阶这一模式的管理。其中N1占16.77%,N2占29.5%,N3占41.9%,N4占8.7%,其他占3.11%。有24.53%的护士对医院目前的分层培训方式感到满意并认为无需改进,40.99%的护士表示满意,但需要改进,29.19%的护士表示基本满意,需要改进,5.28%的护士表示不满意需要较大改进。95.82%的医院科室对不用层级的护士有不同的核心能力要求并根据不同核心能力要求进行培训。结论护士分层培训几分层进阶这一管理模式在镇江各医院都有体现,但各医院实行的方式有较大差异,配套的管理方式也有待完善。     

Factors associated with provision of depot medroxyprogesterone acetate to adolescents by US health care providers

ObjectiveIdentify factors associated with healthcare providers' frequency of depot medroxyprogesterone acetate (DMPA) provision to adolescents.Study designWe analyzed data from surveys mailed to a nationally representative sample of public-sector providers and office-based physicians (n=1984). We estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of factors associated with frequent DMPA provision to adolescents in the past year.ResultsAlthough most providers (>95%) considered DMPA safe for adolescents, fewer reported frequent provision (89% of public-sector providers; 64% of office-based physicians). Among public-sector providers, factors associated with lower odds of frequent provision included working in settings without Title X funding (aOR 0.44, 95% CI 0.30–0.64), reporting primary care as their primary clinical focus versus reproductive or adolescent health (aOR 0.42, 95% CI 0.28–0.61), and providing fewer patients with family planning services. Among office-based physicians, factors associated with lower odds of frequent provision included specializing in obstetrics/gynecology (aOR 0.50, 95% CI 0.27–0.91) and family medicine (aOR 0.21, 95% CI 0.09–0.47) versus adolescent medicine, completing training ≥15 versus <5 years ago (aOR 0.27, 95% CI 0.09–0.83), and reporting that 0–24% of patients pay with Medicaid or other government healthcare assistance versus ≥50% (aOR 0.23, 95% CI 0.09–0.61). The reason most commonly reported by providers for infrequent DMPA provision was patient preference for another method.ConclusionsWhile most providers reported frequently providing DMPA to adolescents, training on evidence-based recommendations for contraception, focused on subgroups of providers with lower odds of frequent DMPA provision, may increase adolescents' access to contraception.ImplicationsAlthough >95% of providers considered depot medroxyprogesterone (DMPA) a safe contraceptive for adolescents, only 89% of public-sector providers and 64% of office-based physicians reported frequently providing DMPA to adolescents. Provider training on evidence-based recommendations for contraception counseling and provision may increase adolescents' access to DMPA and all methods of contraception.     

2009-2018年资阳市手足口病流行病学及病原学特征分析

目的 研究2009-2018年资阳市手足口病的流行病学及病原学特征，为有效防控手足口病提供理论依据。方法 从中国疾病控制中心监测信息报告管理系统获取以乡镇为单位的手足口病数据，进行三间分布描述，利用ArcGIS 10.1软件制作专题地图。结果 资阳市2009-2018年累计报告病例19195例，年平均发病率为61.72/10万，虽总体上呈升高的趋势；各乡镇均有手足口病报告；每年有两个发病高峰，分别是5-7月和9-11月，其中5-7月为主高峰，9-11月为次高峰；男女性别比为1.44[DK]∶1，5岁以下儿童共发病18209例，占比为94.9%。2015年之前优势毒株为EV71和CoxA16，2015年之后优势毒株为其他肠道病毒。结论 资阳市手足口病发病呈持续升高态势。手足口病的优势毒株近年来在改变，应增加人肠道病毒的监测种类，落实综合性防控措施，预防和控制手足口病的流行。