Associations of Physiological State, Cognitive Function, Sensory Function, and Biochemical Index with Frailty Status Among Patients with Schizophrenia

The literature on the prevalence and effect of the frailty status of patients with schizophrenia is limited. The interactions between frailty and psychiatric disorders warrant exploration. This study primarily aimed to explore the associations of physiological state, cognitive function, sensory function, and biochemical index with frailty status among patients with schizophrenia. A cross-sectional study design was adopted. Patients with schizophrenia were selected using purposive sampling. Frailty was revealed to be more prevalent with lower educational attainment, more hospitalization days, higher skeletal muscle percentage, higher basal metabolic rate, having fallen in the past year, use of anxiolytics or tranquilizers and sleeping pills, lower cognitive function, and use of assistive equipment. In addition, physiological state, cognitive function, and sensory function differed depending on the incidence of frailty among patients with schizophrenia. Cognitive function and the reduction of frailty incidence should be emphasized. Institutional nursing staff should regularly assess patients’ frailty risk, pay attention to changes in patients’ physiological state, monitor the cognitive function of patients, and recommend physical therapy and exercises to improve the strength, conditioning, and mobility of patients with schizophrenia for health maintenance and positive aging.

A population study on perinatal psychological distress in Mexican fathers

Introduction. The transition to parenthood can be a source of stress for fathers and, in some cases, it can be accompanied by emotional distress. This aspect has been neglected in Mexican research. Objective. To estimate the prevalence of emotional distress and the sociodemographic factors associated with it in Mexican fathers. Method. Cross-sectional study. A subsample of 997 fathers, over 18 years of age, was taken from the data of a national survey, whose partners were pregnant or had given birth in the last six months. The Kessler Emotional Distress Scale (K6) was used. Results. About 25% of the fathers experienced moderate emotional distress during their partner's pregnancy and 29.5% during the postpartum period; 1.0% and 1.9% showed serious emotional distress in those periods, respectively. Being between 18 and 29 years old (PR = .10; CI [.01, .79]), having lower educational attainment (PR = 5.59; CI [1.19, 26.21]), and going through postpartum (PR = 4.11; CI [1.00, 16.78]) were at higher risks for severe emotional distress; having one or two children (PR = .16; CI [.05, .55]) or more than three (PR = .08; CI [.01, .44]) was a higher risk than being a first-time father. Discussion and conclusion. It is necessary to continue studying paternal perinatal mental health due to the impact it has on the mother and the infant, and to design tailored interventions. Parental emotional distress needs to be better understood considering recent changes in the paternal role in developing countries.

Genetic propensity for obesity, socioeconomic position, and trajectories of body mass index in older adults

Identifying how socioeconomic positioning and genetic factors interact in the development of obesity is imperative for population-level obesity prevention strategies. The current study investigated whether social positioning, either independently or through interaction with a polygenic score for Body Mass Index (BMI-PGS), influences BMI trajectories across older adulthood. Data were analysed from 7,183 individuals from the English Longitudinal Study of Aging (ELSA). Interactions between the BMI-PGS and; lower educational attainment, self-perceived social status (SSS), and income, on BMI trajectories over 12 years across older adulthood were investigated through linear mixed effects models. Lower educational attainment, SSS and income were each associated with a higher baseline BMI for women, but not for men. There were interaction effects between BMI-PGS and social positioning such that men aged > 65 with a lower educational attainment (β = 0.62; 95%CI 0.00 – 1.24, p < 0.05), men aged ≤ 65 of a lower income (β = − 0.72, 95%CI − 1.21 - − 0.23, p < 0.01) and women aged ≤ 65 of lower SSS (β = − 1.41; 95%CI − 2.46 – 0.36, p < 0.01) showed stronger associations between the BMI-PGS and baseline BMI. There were few associations between markers of socioeconomic position and rate of change in BMI over the follow-up period. In sum, lower socioeconomic positioning showed adverse associations with women’s BMI in older adulthood. Moreover, the expression of the BMI-PGS, or extent to which it translates to a higher BMI, was subtly influenced by socioeconomic standing in both women and in men.

Educational associations with missed GP appointments for patients under 35 years old: administrative data linkage study

Background There is an evidence gap about whether levels of engagement with public services such as schools and health care affect people across the lifespan. Data on missed patient appointments from a nationally representative sample of Scottish general practices (GP) (2013–2016) were probabilistically linked to secondary school pupil data. We tested whether school attendance, exclusions (2007–2011) or lower educational attainment (2007–2016) was associated with an increased risk of missing general practice appointments. Methods School attendance data were classified into quartiles of possible days attended for years we had data. School exclusions were derived as a categorical variable of ‘ever excluded’. Attainment data were categorised via the Scottish Credit and Qualifications Framework (SCQF) level 3 or 6; a cumulative measure of attainment on leaving school. The associations between school attendance, exclusions and attainment and risk of missing medical appointments were investigated using negative binomial models, offset by number of GP appointments made and controlling for potential confounders. Results 112,534 patients (all aged under 35) had GP appointment and retrospective school attendance and exclusion data, and a subset of 66,967 also had attainment data available. Patients who had lower attendance, had been excluded from school or had lower educational attainment had an increased risk of missing GP appointments (all rate ratios > 1.40). Conclusions This study provides the first evidence from a population-representative sample in a high-income country that increased numbers of missed appointments in health care are associated with reduced school attendance, higher levels of school exclusion and lower educational attainment. Insights into the epidemiology of missingness across public services can support future research, policy and practice that aim to improve healthcare, health outcomes and engagement in services.

Longitudinal Pathways to Influenza Vaccination Vary With Socio-Structural Disadvantages

Background Although influenza vaccination can prevent influenza-related deaths, uptake remains low, particularly in disadvantaged populations. Purpose A theoretical model of psychological pathways to vaccination accounting for the direct and moderating role of socio-structural factors was tested. The study sought to understand the joint contributions of psychological (i.e., knowledge, attitudes, and intention) and socio-structural factors (i.e., income, education, and insurance) to influenza vaccination, prospectively. Methods A nationally representative empaneled sample of over 3,000 U.S. adults answered questions about vaccination knowledge, attitudes, and intentions, as well as actual vaccination across five timepoints from September 2018 to May 2019. Socio-structural factors were examined as moderators. Results Findings revealed strong positive associations between knowledge and attitudes, attitudes and intentions, as well as intentions and subsequent vaccination. Importantly, health insurance moderated the associations between attitudes and intentions and between intentions and vaccination, such that those without insurance had weaker associations between attitudes and intentions and between intentions and vaccination. In addition, education moderated the path from knowledge to attitude and from intentions to vaccination, such that people with lower educational attainment had weaker associations between knowledge and attitudes and between intentions and vaccination. Conclusions Socio-structural factors act as barriers to the influence of knowledge on attitudes, attitudes on intentions, and intentions on behavior. Future research needs to be mindful of the specific paths disrupted by social disadvantages and examine ways to intervene to decrease those effects.

Awareness of statin–food interactions using grapefruit as an example: a cross-sectional study in Eastern Province of Saudi Arabia

Objectives The purpose of this study is to assess patients’ knowledge regarding statin–grapefruit interactions, to identify any pertinent demographic characteristics that may influence knowledge of this drug–food interaction, and to identify preferred patient sources of health information. Methods A cross-sectional study was conducted to collect data from statins users about the awareness regarding drug interaction with foods. Self-administered questionnaires have been distributed to collect data from statins users regardless of the type and the reason they administer these medications. Respondents were statins users visiting the King Fahd Hospital’s outpatient clinic (KFHU) and community pharmacies in the Eastern province of Saudi Arabia. Key findings Our study revealed that 62% of statin users never heard about the statin–grapefruit interaction. Only 11% have correctly recognized the interaction effect. Only 11, 21 and 6% of users have reported that they often/always received information on drug–food interaction from pharmacists, physicians and nurses, respectively. Users aged above 60 years had lower awareness than those aged &lt;40 (6.0% vs. 14.1%). Similarly, the proportion was lower among users who had primary or lower educational attainment, unemployed or had income lower than 5000 SAR compared with that among the contrary groups. However, only income showed a statistically significant association (P = 0.007). Conclusions The majority of statin users have never heard about their interaction with food. Geriatrics, low-income and less educated patients had a lower level of awareness compared with their counterparts. Many patients may end up discontinuing their medications because of that interaction and the consequent side effects. Pharmacists are requested to play their expected role in providing adequate patient counselling to help improve patients’ awareness regarding safety concerns of statins medication.

The Racial Wealth Gap and Access to Opportunity Neighborhoods

Some Black households live in neighborhoods with lower incomes, as well as higher unemployment rates and lower educational attainment, than their own incomes might suggest, and this may impede their economic mobility. We investigate reasons for the neighborhood sorting patterns we observe and find that differences in financial factors such as income, wealth, or housing costs between Black and white households do not explain racial distributions across neighborhoods. Our findings suggest other factors are at work, including discrimination in the housing market, ongoing racial hostility, or preferences by Black households for the strength of social networks or other neighborhood amenities that some lower-socioeconomic locations provide.

Importance of attributes and willingness to pay for oral anticoagulant therapy in patients with atrial fibrillation in China: A discrete choice experiment

Background Adherence to oral anticoagulant therapy in patients with atrial fibrillation (AF) in China is low. Patient preference, one of the main reasons for discontinuation of oral anticoagulant therapy, is an unfamiliar concept in China. Methods and findings A discrete choice experiment (DCE) was conducted to quantify patient preference on 7 attributes of oral anticoagulant therapy: antidote (yes/no), food–drug interaction (yes/no), frequency of blood monitoring (no need, every 6/3/1 month[s]), risk of nonfatal major bleeding (0.7/3.1/5.5/7.8[%]), risk of nonfatal stroke (ischemic/hemorrhagic) or systemic embolism (0.6/3.2/5.8/8.4[%]), risk of nonfatal acute myocardial infarction (AMI) (0.2/1.0/1.8/2.5[%]), and monthly out-of-pocket cost (0/120/240/360 RMB) (0 to 56 USD). A total of 16 scenarios were generated by using D-Efficient design and were randomly divided into 2 blocks. Eligible patients were recruited and interviewed from outpatient and inpatient settings of 2 public hospitals in Beijing and Shenzhen, respectively. Patients were presented with 8 scenarios and asked to select 1 of 3 options: 2 unlabeled hypothetical treatments and 1 opt-out option. Mixed logit regression model was used for estimating patients’ preferences of attributes of oral anticoagulants and willingness to pay (WTP) with adjustments for age, sex, education level, income level, city, self-evaluated health score, histories of cardiovascular disease/other vascular disease/any stroke/any bleeding, and use of anticoagulant/antiplatelet therapy. A total of 506 patients were recruited between May 2018 and December 2019 (mean age 70.3 years, 42.1% women). Patients were mainly concerned about the risks of AMI (β: −1.03; 95% CI: −1.31, −0.75; p < 0.001), stroke or systemic embolism (β: −0.81; 95% CI: −0.90, −0.73; p < 0.001), and major bleeding (β: −0.69; 95% CI: −0.78, −0.60; p < 0.001) and were willing to pay more, from up to 798 RMB to 536 RMB (124 to 83 USD) monthly. The least concerning attribute was frequency of blood monitoring (β: −0.31; 95% CI: −0.39, −0.24; p < 0.001). Patients had more concerns about food–drug interactions even exceeding preferences on the 3 risks, if they had a history of stroke or bleeding (β: −2.47; 95% CI: −3.92, −1.02; p < 0.001), recruited from Beijing (β: −1.82; 95% CI: −2.56, −1.07; p < 0.001), or men (β: −0.96; 95% CI: −1.36, −0.56; p < 0.001). Patients with lower educational attainment or lower income weighted all attributes lower, and their WTP for incremental efficacy and safety was minimal. Since the patients were recruited from 2 major hospitals from developed cities in China, further studies with better representative samples would be needed. Conclusions Patients with AF in China were mainly concerned about the safety and effectiveness of oral anticoagulant therapy. The preference weighting on food–drug interaction varied widely. Patients with lower educational attainment or income levels and less experience of bleeding or stroke had more reservations about paying for oral anticoagulant therapies with superior efficacy, safety, and convenience of use.

Genetic propensity for obesity, socioeconomic position, and trajectories of body mass index in older adults

Background Identifying how socioeconomic positioning and genetic factors interact in the development of obesity is imperative for population-level obesity prevention strategies. The current study investigated whether social positioning, either independently or through interaction with a polygenic score for Body Mass Index (BMI-PGS), influences BMI trajectories across older adulthood. Methods Data were analysed from 7,183 individuals from the English Longitudinal Study of Aging (ELSA). Interactions between the BMI-PGS and; lower educational attainment, SSS, and income, on BMI trajectories across older adulthood were investigated through linear mixed effects models. Results Lower educational attainment, SSS and income were each associated with a higher baseline BMI for women, but not for men. There were interaction effects between BMI-PGS and social positioning such that men aged > 65 with a lower educational attainment (β = 0.62; 95%CI = 0.00-1.24), men aged ≤ 65 of a lower income (β=-0.72, 95%CI=-1.21- -0.23) and women aged ≤ 65 of lower SSS (β=-1.41; 95%CI=-2.46-0.36) showed stronger associations between the BMI-PGS and baseline BMI. Conclusions Lower socioeconomic positioning showed adverse effects for women’s BMI in older adulthood. While the expression of the BMI-PGS, or extent to which it translates to a higher BMI, was subtly influenced by socioeconomic standing in both women and in men.

Socioeconomic Position and Late-Onset Dementia: A Nationwide Register-Based Study

Objectives Previous research on the association between socioeconomic position (SEP) and dementia has not sufficiently accounted for the complex relationship between education and occupation. We investigated the independent and joint effects of educational attainment and occupation-based SEP on dementia. Methods We used register-based information about educational attainment, occupation-based SEP, and dementia from 1,210,720 individuals. Information about cognitive ability at conscription was available for a subsample of men. Results When mutually adjusted, lower educational attainment and occupation-based SEP were associated with higher dementia risk in a dose–response manner. Higher occupation-based SEP partly mitigated the higher dementia risk associated with lower educational attainment. After adjusting for cognitive ability in a subgroup of men, only unskilled work was associated with higher dementia risk. Discussion Occupation-based SEP is independently associated with dementia and may mitigate the higher dementia risk associated with short education. Future research should elucidate the mechanisms underlying social inequality in dementia.