Facilitating equitable access to hospice care in socially deprived areas: A mixed methods multiple case study

Public Awareness and Perceptions of Palliative and Comfort Care

Vaccination against SARS-CoV-2 infection among vulnerable and marginalised population groups in Denmark: A nationwide population-based study.

Social deprivation may have a deleterious influence on post-stroke outcomes, but available data in the literature are mixed. The aim of this cohort study was to evaluate the impact of social deprivation on 1-year survival in patients with first-ever stroke. Social deprivation was assessed at individual level with the EPICES score, a validated multidimensional questionnaire, in 1312 patients with ischemic stroke and 228 patients with spontaneous intracerebral hemorrhage, who were prospectively enrolled in six French study centers. Baseline characteristics including stroke severity and pre-stroke functional status were collected. Multivariable Cox models were generated to evaluate the associations between social deprivation and survival at 12months in ischemic stroke and intracerebral hemorrhage separately. A total of 819 patients (53.2%) were socially deprived (EPICES score≥30.17). In ischemic stroke, mortality at 12months was higher in deprived than in non-deprived patients (16% vs. 11%, p=0.006). In multivariable analyses, there was no association between deprivation and death occurring within the first 90days following ischemic stroke (adjusted hazard ratio [aHR]0.81, 95% CI 0.54-1.22, p=0.32). In contrast, an excess in mortality was observed between 90days and 12months in deprived compared with non-deprived patients (aHR1.97, 95% CI 1.14-3.42, p=0.016). In patients with intracerebral hemorrhage, mortality at 12months did not significantly differ according to deprivation status. Social deprivation was associated with delayed mortality in ischemic stroke patients only and, although the exact underlying mechanisms are still to be identified, our findings suggest that deprived patients in particular may benefit from an optimization of post-stroke care.

The social environment early in life is a key determinant of developmental, physiological and behavioural trajectories across vertebrate and invertebrate animals. One crucial variable is the presence/absence of conspecifics. For animals usually reared in groups, social isolation after birth or hatching can be a highly stressful circumstance, with potentially long-lasting consequences. Here, we assessed the effects of social deprivation (isolation) early in life, that is, absence of conspecifics, versus social enrichment, that is, presence of conspecifics, on developmental time, body size at maturity, mating behaviour and group-living in the plant-inhabiting predatory mite Phytoseiulus persimilis. Socially deprived protonymphs developed more slowly and were less socially competent in grouping behaviour than socially enriched protonymphs. Compromised social competence in grouping behaviour was evident in decreased activity, fewer mutual encounters and larger interindividual distances, all of which may entail severe fitness costs. In female choice/male competition, socially deprived males mated earlier than socially enriched males; in male choice/female competition, socially deprived females were more likely to mate than socially enriched females. In neither mate choice situation did mating duration or body size at maturity differ between socially deprived and enriched mating opponents. Social isolation-induced shifts in mating behaviour may be interpreted as increased attractiveness or competitiveness or, more likely, as hastiness and reduced ability to assess mate quality. Overall, many of the social isolation-induced behavioural changes in P. persimilis are analogous to those observed in other animals such as cockroaches, fruit flies, fishes or rodents. We argue that, due to their profound and persistent effects, early social deprivation or enrichment may be important determinants in shaping animal personalities.

Social deprivation and prognosis in Scottish patients with pulmonary arterial hypertension.

Category: Ankle; Arthroscopy Introduction/Purpose: The relationship between socio-economic factors and health outcomes is of considerable interest. Social deprivation can be defined as lack of access to resources and opportunities considered essential for modern living. Several studies have investigated the impact of social deprivation on surgical outcomes. Patients who experience more social deprivation may have an initial presentation that is objectively worse compared to patients with a higher socioeconomic status. For example, socially deprived scoliosis patients may initially present with larger Cobb angles. Limited literature on the impact of social deprivation on initial presentation of patients who require surgical intervention for an osteochondral lesion (OCL) of the talus exists. This study aimed to investigate the association between social deprivation and preoperative patient-reported outcomes. Methods: Institutional review board approval was obtained (IRB 20020136). An institution-based registry was created with foot and ankle patient data from three surgeons that were prospectively collected and retrospectively analyzed. The database was queried for patients who underwent talar dome OCL microfracture and completed preoperative Foot and Ankle Ability Measure Activities of Daily Living (FAAM ADL) questionnaires between September 2013 and February 2024. Home addresses were used to determine Area Deprivation Index (ADI) state and national levels to capture social deprivation. Inclusion criteria were patients with an OCL diagnosed with advanced imaging and patients with completed preoperative FAAM ADL scores. Patients with prior ipsilateral foot or ankle surgeries or no recorded home address were excluded. Linear regression and correlation analyses were performed to investigate the relationship between ADI and preoperative FAAM ADL scores. Secondary analyses on the impact of ADI on other clinical variables were performed. Results: Sixty patients met inclusion criteria. The mean age was 32.5±15.2 years with a mean body mass index (BMI) of 29.8±7.58, evenly split between sexes. The mean preoperative FAAM ADL score as 62.4±23.5. Differences between female and male preoperative FAAM ADL scores reached significance (55.7 vs. 69.2, p = 0.026). The regression coefficient for ADI and preoperative FAAM ADL scores at the national (adjusted R2 = 0.005, p = 0.262) and state (adjusted R2 = 0.017, p = 0.160) levels failed to reach significance. Mean national ADI was 53.4±26.2 and state ADI was 4.97±2.87. Correlation analysis of other clinical variables studied, such as OCL size (p = 0.668) and BMI (p = 0.1316), did not demonstrate a statistically significant correlation with ADI. Conclusion: These findings contribute to the data regarding the interplay between socio-economic factors and health outcomes, particularly in the context of patients who underwent microfracture for a talus OCL. Larger sample sizes and including patients who opted for nonoperative treatment should be explored.

PurposeThe purpose of this paper is to determine the cost effectiveness of palliative care on patients in a home health and hospice setting. Secondary data set was utilized to test the hypotheses of this study. Home health care and hospice care services have the potential to avert hospital admissions in patients requiring palliative care, which significantly affects medicare spending. With the aging population, it has become evident that demand of palliative care will increase four-fold. It was determined that current spending on end-of-life care is radically emptying medicare funds and fiscally weakening numerous families who have patients under palliative care during life-threatening illnesses. The study found that a majority of people registering for palliative and hospice care settings are above the age group of 55 years old.Design/methodology/approachDifferent variables like length of stay, mode of payment and disease diagnosis were used to filter the available data set. Secondary data were utilized to test the hypothesis of this study. There are very few studies on hospice and palliative care services and no study focuses on the cost associated with this care. Since a very large number of the USA, population is turning 65 and over, it is very important to analyze the cost of care for palliative and hospice care. For the purpose of this analysis, data were utilized from the National Home and Hospice Care Survey (NHHCS), which has been conducted periodically by the Centers for Disease Control and Prevention’s National Center for Health Statistics. Descriptive statistics, χ2 tests and t-tests were used to test for statistical significance at the p<0.05 level.FindingsThe Statistical Package for Social Sciences (SPSS) was utilized for this result. H1 predicted that patients in the age group of 65 years and up have the highest utilization of home and hospice care. This study examined various demographic variables in hospice and home health care which may help to evaluate the cost of care and the modes of payments. This section of the result presents the descriptive analysis of dependent, independent and covariate variables that provide the overall national estimates on differences in use of home and hospice care in various age groups and sex.Research limitations/implicationsThe data set used was from the 2007 NHHCS survey, no data have been collected thereafter, and therefore, gap in data analysis may give inaccurate findings. To compensate for this gap in the data set, recent studies were reviewed which analyzed cost in palliative care in the USA. There has been a lack of evidence to prove the cost savings and improved quality of life in palliative/hospice care. There is a need for new research on the various cost factors affecting palliative care services as well as considering the quality of life. Although, it is evident that palliative care treatment is less expensive as compared to the regular care, since it eliminates the direct hospitalization cost, but there is inadequate research to prove that it improves the quality of life. A detailed research is required considering the additional cost incurred in palliative/hospice care services and a cost-benefit analysis of the same.Practical implicationsWhile various studies reporting information applicable to the expenses and effect of family caregiving toward the end-of-life were distinguished, none of the previous research discussed this issue as their central focus. Most studies addressed more extensive financial effect of palliative and end-of-life care, including expenses borne by the patients themselves, the medicinal services framework and safety net providers or beneficent/willful suppliers. This shows a significant hole in the current writing.Social implicationsWith the aging population, it has become evident that demand of palliative/hospice care will increase four-fold. The NHHCS have stopped keeping track of the palliative care requirements after 2007, which has a negative impact on the growing needs. Cost analysis can only be performed by analyzing existing data. This review has recognized a huge niche in the evidence base with respect to the cost cares of giving care and supporting a relative inside a palliative/hospice care setting.Originality/valueThe study exhibited that cost diminishments in aggressive medications can take care of the expenses of palliative/hospice care services. The issue of evaluating result in such a physically measurable way is complicated by the impalpable nature of large portions of the individual components of outcome. Although physical and mental well-being can be evaluated to a certain degree, it is significantly more difficult to gauge in a quantifiable way, the social and profound measurements of care that help fundamentally to general quality of care.

271 Social deprivation trends in operative penile cancer

Background Weight regain is a prevalent issue following Roux-En-Y Gastric Bypass (RYGB) surgery for obesity. This study aims to assess the impact of ethnicity and social deprivation on the likelihood of weight regain post-RYGB. Method We analysed data from Luton &amp; Dunstable Hospital. Key variables included patient demographics such as sex, age, ethnicity, social deprivation (Indices of Multiple Deprivation – IMD), American Society of Anesthesiologists (ASA) classification, and weight and Body Mass Index (BMI) at the time of surgery. Weight regain was defined as the regaining of more than 25% of the Total Body Weight Loss (TBWL) achieved after RYGB. Results Out of 1,346 patients who underwent RYGB, 80% were female. The median age was 48 years (IQR: 39-55), and the median BMI was 44.7 kg/m^2 (IQR: 40.6-50.1). At a median follow-up of 39 months, 20.7% experienced weight regain. Multivariable analysis showed that patients from Black (HR: 1.63, 95% CI: 1.33-1.81, p=0.009) and Asian (HR: 1.40, 95% CI: 1.23-1.71, p=0.011) ethnic groups, as well as those from more socially deprived backgrounds (HR: 2.39, 95% CI: 1.99 – 3.13, p&amp;lt;0.001), were more likely to experience weight regain compared to their White and more affluent counterparts. Conclusion Ethnicity and social deprivation significantly influence the likelihood of weight regain following RYGB. The factors contributing to these disparities are likely multifaceted, encompassing genetic, social, and educational elements. Early identification of patients at increased risk of weight regain and the provision of tailored resources can help mitigate this risk and enhance surgical outcomes.

The impact of social deprivation on patient satisfaction in physical medicine and rehabilitation outpatient interventional spine and musculoskeletal medicine using the press Ganey® outpatient medical practice survey

An understanding of relationships between different constructs of the neighbourhood environment and diet quality is needed to inform public health interventions. This study investigated associations between material deprivation, social deprivation and population density with diet quality in a cohort of 19,973 Canadian adults aged 35 to 69 years within the Atlantic PATH cohort study. Diet quality, a metric of how well diet conforms to recommendations was determined from a 24-item food frequency questionnaire. Neighbourhood environment data were derived from dissemination area level Census data. Two deprivation indices were evaluated: material and social deprivation, which reflect access to goods and amenities and social relationships. Multi-level models were used to estimate relationships (mean differences and 95% CI) between neighbourhood environment and diet quality, adjusting for covariates. Mean diet quality was lower in the most socially deprived neighbourhoods compared to the least socially deprived: −0.56, 95% CI (−0.88, −0.25). Relationships between diet quality and population density differed between urban and rural areas (p-interaction < 0.0001). In rural areas, diet quality was higher in intermediate-density neighbourhoods: 0.54, 95% CI (0.05, 1.03). In urban areas, diet quality was lower in intermediate-density and the most-dense neighbourhoods: −0.84, 95% CI (−1.28, −0.40) and −0.72, 95% CI (−1.20, −0.25). Our findings suggest socially deprived and high-density neighbourhoods are associated with lower diet quality and possible urban-rural differences in neighbourhood environment-diet quality relationships. Additional studies are needed to determine the temporal nature of relationships and whether differences in diet quality are meaningful.

IntroductionMultimorbidity — having 2 or more chronic diseases — is a national public health concern that entails burdensome and costly care for patients, their families, and public health programs. Adults residing in socially deprived areas often have limited access to social and material resources. They also experience a greater multimorbidity burden.MethodsWe conducted a retrospective cohort analysis of electronic health record (EHR) data from 678 community-based health centers (CHCs) in 27 states from the Accelerating Data Value Across a National Community Health Center (ADVANCE) Network, a clinical research network, from 2012–2019. We used mixed-effects Poisson regression to examine the relationship of area-level social deprivation (eg, educational attainment, household income, unemployment) to chronic disease accumulation among a sample of patients aged 45 years or older (N = 816,921) residing across 9,362 zip code tabulation areas and receiving care in safety-net health organizations.ResultsWe observed high rates of chronic disease among this national sample. Prevalence of multimorbidity varied considerably by geographic location, both within and between states. People in more socially deprived areas with Social Deprivation Index (SDI) scores in quartiles 2, 3, and 4 had greater initial chronic disease counts — 17.1%, 17.7%, and 18.0%, respectively — but a slower rate of accumulation compared with people in the least-deprived quartile. Our findings were consistent for models of the composite SDI and those evaluating disaggregated measures of area-level educational attainment, household income, and unemployment.ConclusionSocial factors play an important role in the development and progression of multimorbidity, which suggests that an assessment and understanding of area-level social deprivation is necessary for developing public health strategies to address multimorbidity.

In a nationwide study, we aimed to study the association of neighborhood deprivation with child and adolescent mental health problems. We used data from the Canadian Health Survey on Children and Youth (N = 47,871; age range: 1-17years) and linked these to Neighborhood Material and Social Deprivation data calculated using Canada's Census of Population. Using a series of logistic regressions, we studied the association between living in deprived areas and mental health problems among children and youth. We used bootstrap replicate weights for all analyses and adjusted them for individual sociodemographic characteristics. In the adjusted model, the parent-reported developmental disorder was associated with more socially deprived neighborhoods (OR 1.29; 95% CI 1.07, 1.57 for most vs. least deprived quintiles). However, mental health service need or use was associated with living in less materially deprived areas (OR 0.78; 95% CI 0.63, 0.96 for most vs. least deprived quintiles). Among mental health problemsreported by the youth (12-17years old), poor/fair general mental health, alcohol drinking, and cannabis use were associated with neighborhood social deprivation in the adjusted models. In contrast, poor/fair general mental health, suicide ideas, alcohol drinking, and cannabis use were all negatively associated with higher materially deprived quintiles. Our study provides further support for the existing evidence on the association between neighborhood deprivation, particularly social deprivation, and the mental health of children and adolescents. The findings can help public health policymakers and service providers better understand and address children's mental health needs in their neighborhoods.

Background UK National Institute for Health and Care Excellence (NICE) clinical guidelines (CG) 168, published in July 2013, aimed to improve the management of lower limb venous disease by newly recommending interventional treatment for all people affected by symptomatic varicose veins (VV) and specialist vascular referral for all people suffering from a leg ulcer (LU) that had been present for ≥2 weeks. This study aims to determine if CG168 has increased access to vascular services, particularly for the socially deprived, who might be expected to have greater need for such services. Methods The study was performed in a highly multi-cultural, socio-economically diverse, mixed urban/suburban population of approximately 1.2 million people living in and around East Birmingham, UK. Index of multiple deprivation quintile (IMD-Q) was used as a measure of social deprivation to compare levels of social deprivation of people undergoing interventions for symptomatic VV or referred with an LU during 18-month periods before and after the publication of CG168. The referring general practitioner practices (GPPs) were also recorded. Results There was no change in overall IMD-Q distribution before and after CG168 in terms of VV interventions. However, there was a non-significant increase in proportions of people classified as IMD-Q5 (the most deprived quintile). After CG168, fewer IMD-Q5 people with LU were referred, with a shift in referrals towards those from less socially deprived areas. More GPP referred people with both VV and LU after CG168, and those that referred patients before and after CG168 tended to refer more after CG168. Conclusions CG168 has increased VV interventions as well as the number referred with LU. However, this improvement in access to treatment and referral may have disproportionately favoured the more socio-economic privileged. Professional and public education is required to ensure that the beneficial impact of the CG168 recommendations are maximised and that those with the greatest health needs have equal access to evidence-based management of their venous disease.

Effects of social deprivation in prepubescent rhesus monkeys: immunohistochemical analysis of the neurofilament protein triplet in the hippocampal formation