Association of education levels with the risk of hypertension and hypertension control: a nationwide cohort study in Chinese adults

BackgroundEducation attainment can improve life expectancy and guide healthy behaviours throughout an entire lifetime. A nationwide longitudinal study of the association of education status with the risk of hypertension and its control in China is lacking.MethodsThe China Cardiometabolic Disease and Cancer Cohort Study is a multicentre, population-based, prospective cohort study. We performed the baseline survey from 2011 to 2012. A follow-up visit was conducted during 2014–2016. 101 959 subjects were included in the final data analyses. Cox proportional hazards regression was used to examine the associations of education levels with the risk of hypertension and uncontrolled hypertension.ResultsDuring follow-up, 11 189 (19.9%) participants had developed hypertension among subjects without hypertension at baseline. Among the participants with hypertension at baseline, only 40.6% had controlled hypertension. Compared with the participants’ education level at elementary school and below, the multivariable-adjusted HR for incident hypertension was 0.76 (95% CI, 0.72 to 0.80) in those with a middle school education level and 0.67 (95% CI, 0.63 to 0.70) in those with a high school degree or above. Correspondingly, multivariable-adjusted HRs associated with uncontrolled hypertension were 0.90 (95% CI, 0.87 to 0.92) in participants with a middle school education level and 0.85 (95% CI, 0.82 to 0.88) in participants with a high school degree or above level.ConclusionParticipants with education attainment at elementary school and below exhibited excess risks of newly diagnosed hypertension and worse blood pressure control compared with individuals with education attainment at middle school or above.

The Impact Of A Whole Health Model Of Care On Patient Outcomes

The FlourishCare Model (FCM) transforms primary care sites by addressing all determinants of health and focusing on helping patients to flourish. The FlourishCare Index (FCI) is a clinical measure to assess the effectiveness of the FCM to address all determinants of health. We will present data on the effectiveness of the FCM serving 159 older adults with MCCs. The sample was mostly female (77%), White (64%), retired (54%), married (30%) or widowed (20%) and living in urban areas (64%). The mean age was 69 (SD=15), with 13 years education (SD=3). Patients changed significantly over time on total FCI scores (57%-72%;□=3.80,SE=0.63). Results show significant growth over time for individual health behaviors (58%-67%;□=2.14,SE=0.84), health care access (71%-89%;□=4.43,SE=1.00) and social determinants (62%-85%;□=5.54,SE=1.02) with psychological determinants (54%-61%;□=1.74,SE=0.95) and environmental determinants (70%-81%;□=2.81,SE=1.62) showing a trend to significance. Interaction effects with time show that the FCM supported patients with lower education attainment to improve at a higher rate than those with higher education attainment, for the total FCI score (□=-0.59,SE=0.24) and health care access (□=-0.94,SE=0.38). Receiving mental health counseling resulted in more improvement in psychological determinants than those who did not receive counseling (□=3.43,SE=2.04). The FCM was able to support rural patients at a higher rate than urban patients to gain access to health care (□=4.13,SE=2.02). The FCM supported Hispanic patients the most in improving social determinants of health (□=8.40,SE=3.93). This study showed the importance of a systems approach to care using measures that focus on what matters most to older adults who value quality-of-life outcomes.

Education Attainment and Women Entrepreneurship in Uganda: A Perspective

This study examined the impact of education attainment on women's desire and capacity to venture into entrepreneurship in Bunyoro sub-region, Uganda. The study was guided by the Human Capital Theory, which emerged in the 1960s through the works of Theodre Schultz in 1962. The theory holds that education enhances an individual’s efficiency and productivity skills, which in return increases the earnings of that individual in the labor market, as well as his/her capacity to manage own business. The study adopted a descriptive correlation research design, primarily to determine the relationship between education attainment and women entrepreneurship in Bunyoro sub-region of Uganda. The mixed methods approach was used in data collection and 365 residents of Bunyoro participated in the study. Questionnaires were used to collect quantitative data, while key informants were interviewed for qualitative data. The study findings show that education attainment has a significant positive relationship with women entrepreneurship. This suggests that a high level of education attainment increases women's potentials and capacity to own and successfully manage a business.

COVID-19 Vaccine Hesitancy and Attitude toward Booster Doses among US Healthcare Workers

Vaccine reluctance among healthcare workers (HCW) can have widespread negative ramifications, including modeling behavior for the general population and challenges with maintaining a healthy workforce so we can respond to a resurgence of the pandemic. We previously reported that only one-third of HCW were willing to take the vaccine as soon as it became available prior to its Emergency Use Authorization (EUA). Here, we re-examine the attitude toward COVID-19 vaccines among HCW several months after the vaccines have been made widely available. In this study, only 7.9% (n = 107) of respondents were hesitant to take the first or second dose of the vaccine. Younger age (18–40 years) and lower level of education attainment (GED or less) were associated with higher vaccine hesitancy, whereas self-identified Asian racial identity was associated with greater acceptance of COVID-19 vaccination. Among the vaccine-hesitant group, more respondents noted mistrust of regulatory authorities (45.3%), government (48.6%), and pharmaceutical companies (50%) than mistrust of doctors (25.4%). Nearly two-thirds of respondents were concerned that vaccination may be ineffective against new strains and booster doses may be required; however, vaccine-hesitant respondents’ acceptance of a hypothetical booster dose was only 14.3%. Overall, vaccine hesitancy was observed to have demographic predictors similar to those previously reported; the hesitancy of some US HCW to receive booster doses may reflect a general hesitancy to receive other forms of vaccination.

The Impacts of Transportation Sustainability on Higher Education in China

Improving transportation sustainability serves as a means of reducing the perceived and real distance, thereby contributing to the city and higher education development. In this paper, the complexity of transport sustainability is measured via four different dimensions: economy, society, environment and politics. The variables are designed by the four dimensions. The higher education development is measured via the ratio of higher education degree holders, reflecting the skilled work mobility. Over the last 30 years, university students moving to cities for study and work purposes have become an important part of rural–urban transition mobility. However, few studies have explored the impacts of transportation sustainability on higher education development in China. The economic, environmental, social and political dimensions in transportation sustainability can boost China’s higher education attainment in different ways. Against this background, this study, drawing on the panel data and employing the spatial multilevel model, investigated the impacts of transportation sustainability on higher education in China, adding new empirical evidence for China’s higher education development. A panel analysis revealed that the increase in transportation sustainability induces the growth of higher education. Moreover, higher education attainment showed significant spatial dependence at the county level and had significant spatial clustering of county-level higher education attainment across provinces. Furthermore, modeled test results showed that the spatial multilevel model was more suitable for our study than traditional regression models. By identifying transport sustainability variables that have an effect on higher education, this study is the first to uncover the complexity of transportation sustainability and contributes to the latest policy implications for promoting higher education attainment through sustainable transportation.

Disrupted daily routines mediate the socioeconomic gradient of depression amid public health crises: A repeated cross-sectional study

Objective: There is a socioeconomic gradient to depression risks, with more pronounced inequality amid macroenvironmental potential traumatic events. Between mid-2019 and mid-2020, the Hong Kong population experienced drastic societal changes, including the escalating civil unrest and the COVID-19 pandemic. We examined the change of the socioeconomic gradient in depression and the potential intermediary role of daily routine disruptions. Method: We conducted repeated territory-wide telephone surveys in July 2019 and July 2020 with 1112 and 2034 population-representative Cantonese-speaking Hong Kong citizens above 15 years old, respectively. Stratified by year, we examined the association between socioeconomic indicators (education attainment, household income, employment status and marital status) and probable depression (nine-item Patient Health Questionnaire [PHQ-9] ⩾ 10) using logistic regression. Differences in the socioeconomic gradient between 2019 and 2020 were tested. Finally, we performed a path analysis to test for the mediating role of daily routine disruptions. Results: Logistic regression showed that higher education attainment in 2019 and being married in 2020 were protective against probable depression. Interaction analysis showed that the inverse association of higher education attainment with probable depression attenuated in 2020 but that of being married increased. Path analysis showed that the mediated effects through daily routine disruptions accounted for 95.9% of the socioeconomic gradient of probable depression in 2020, compared with 13.1% in 2019. Conclusion: From July 2019 to July 2020, the mediating role of daily routine disruptions in the socioeconomic gradient of depression in Hong Kong increased. It is thus implied that infection control measures should consider the relevant potential mental health impacts accordingly.

Education Attainment, Intelligence and COVID-19: A Mendelian Randomization Study

Background: Evidence of socioeconomic inequality in COVID-19-related outcomes is emerging, with a higher risk of infection and mortality observed among individuals with lower education attainment. We aimed to evaluate the potential interventions against COVID-19 from the socioeconomic perspective, including improvement in education and intelligence. Methods: With a two-sample Mendelian randomization approach using summary statistics from the largest genome-wide association meta-analysis, univariable analysis was adopted to evaluate the total causal effects of genetically determined education attainment and intelligence on COVID-19 outcomes. Multivariable analysis was performed to dissect the potential mechanisms. Results: Genetic predisposition to higher education attainment by 1 SD (4.2 years) was independently associated with reduced risk of COVID-19 severity (OR = 0.508 [95% CI: 0.417–0.617]; p < 0.001). Genetically higher education attainment also lowered the risk of COVID-19 hospitalization (0.685 [0.593–0.791]; p < 0.001), but the association was attenuated after adjustment for beta estimates of intelligence in multivariable analysis. Genetically higher intelligence was associated with reduced risk of COVID-19 hospitalization (0.780 [0.655–0.930]; p = 0.006), with attenuation of association after adjustment for education attainment. Null association was observed for genetically determined education attainment and intelligence with SARS-CoV-2 infection. Conclusion: Education may act independently and jointly with intelligence in improving the COVID-19 outcomes. Improving education may potentially alleviate the COVID-19-related health inequality.

A time-driven activity-based costing approach for identifying variability in costs of childbirth between and within types of delivery

Background Recently, time-driven activity-based costing (TDABC) is put forward as an alternative, more accurate costing method to calculate the cost of a medical treatment because it allows the assignment of costs directly to patients. The objective of this paper is the application of a time-driven activity-based method in order to estimate the cost of childbirth at a maternal department. Moreover, this study shows how this costing method can be used to outline how childbirth costs vary according to considered patient and disease characteristics. Through the use of process mapping, TDABC allows to exactly identify which activities and corresponding resources are impacted by these characteristics, leading to a more detailed understanding of childbirth cost. Methods A prospective cohort study design is performed in a maternity department. Process maps were developed for two types of childbirth, vaginal delivery (VD) and caesarean section (CS). Costs were obtained from the financial department and capacity cost rates were calculated accordingly. Results Overall, the cost of childbirth equals €1894,12 and is mainly driven by personnel costs (89,0%). Monitoring after birth is the most expensive activity on the pathway, costing €1149,70. Significant cost variations between type of delivery were found, with VD costing €1808,66 compared to €2463,98 for a CS. Prolonged clinical visit (+ 33,3 min) and monitoring (+ 775,2 min) in CS were the main contributors to this cost difference. Within each delivery type, age, parity, number of gestation weeks and education attainment were found to drive cost variations. In particular, for VD an age > 25 years, nulliparous, gestation weeks > 40 weeks and higher education attainment were associated with higher costs. Similar results were found within CS for age, parity and number of gestation weeks. Conclusions TDABC is a valuable approach to measure and understand the variability in costs of childbirth and its associated drivers over the full care cycle. Accordingly, these findings can inform health care providers, managers and regulators on process improvements and cost containment initiatives.