BACKGROUND: Hospitalization of patients with DKA creates a significant burden on the US healthcare system. While previous studies have identified multiple potential contributors, a comprehensive review of the factors leading to DKA readmissions within the US healthcare system has not been done. This scoping review aims to identify how access to care, treatment adherence, socioeconomic status, race, and ethnicity impact DKA readmission-related patient morbidity and mortality and contribute to the socioeconomic burden on the US healthcare system. Additionally, this study aims to integrate current recommendations to address this multifactorial issue, ultimately reducing the burden at both individual and organizational levels.
METHODS: The PRISMA-SCR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) was used as a reference checklist throughout this study. The Arksey and O\'Malley methodology was used as a framework to guide this review. The framework methodology consisted of five steps: (1) Identify research questions; (2) Search for relevant studies; (3) Selection of studies relevant to the research questions; (4) Chart the data; (5) Collate, summarize, and report the results.
RESULTS: A total of 15 articles were retained for analysis. Among the various social factors identified, those related to sex/gender (n = 9) and age (n = 9) exhibited the highest frequency. Moreover, race and ethnicity (n = 8) was another recurrent factor that appeared in half of the studies. Economic factors were also identified in this study, with patient insurance type having the highest frequency (n = 11). Patient income had the second highest frequency (n = 6). Multiple studies identified a link between patients of a specific race/ethnicity and decreased access to treatment. Insufficient patient education around DKA treatment was noted to impact treatment accessibility. Certain recommendations for future directions were highlighted as recurrent themes across included studies and encompassed patient education, early identification of DKA risk factors, and the need for a multidisciplinary approach using community partners such as social workers and dieticians to decrease DKA readmission rates in diabetic patients.
CONCLUSIONS: This study can inform future policy decisions to improve the accessibility, affordability, and quality of healthcare through evidence-based interventions for patients with DM following an episode of DKA.

BACKGROUND: In oestrogen-receptor positive breast cancer, daily oral adjuvant endocrine therapy (ET) for at least 5 years significantly reduces risks of recurrence and breast cancer-specific mortality. However, many women are poorly adherent to ET. Development of effective adherence support requires comprehensive understanding of influences on adherence. We undertook an umbrella review to identify determinants of ET adherence.
METHODS: We searched PubMed, Embase, CINAHL, PsycINFO, Cochrane and PROSPERO (inception to 08/2022) to identify systematic reviews on factors influencing ET adherence. Abstracted determinants were mapped to the World Health Organization\'s dimensions of adherence. Reviews were quality appraised and overlap assessed.
RESULTS: Of 5732 citations screened, 17 reviews were eligible (9 quantitative primary studies; 4 qualitative primary studies; 4 qualitative or quantitative studies) including 215 primary papers. All five WHO dimensions influenced ET non-adherence: The most consistently identified non-adherence determinants were patient-related factors (e.g. lower perceived ET necessity, more treatment concerns, perceptions of ET \'cons\' vs. \'pros\'). Healthcare system/healthcare professional-related factors (e.g. perceived lower quality health professional interaction/relationship) were also important and, to a somewhat lesser extent, socio-economic factors (e.g. lower levels of social/economic/material support). Evidence was more mixed for medication-related and condition-related factors, but several may be relevant (e.g. experiencing side-effects, cost). Potentially modifiable factors are more influential than non-modifiable/fixed factors (e.g. patient characteristics).
CONCLUSIONS: The evidence-base on ET adherence determinants is extensive. Future empirical studies should focus on less well-researched areas and settings. The determinants themselves are numerous and complex in indicating that adherence support should be multifaceted, addressing multiple determinants.

Disasters, whether natural or manmade, disrupt the functioning of communities, significantly impacting people\'s lives and health. To build community resilience, the Centers for Disease Control and Prevention recommends community preparedness, where multiple stakeholders work together. Disaster Preparedness Science Research (DPSR) similarly encourages the improvement of disaster relief outcomes. This literature review assesses the vulnerability of communities for prioritized intervention, summarizes disaster effects, and suggests the scope for improvement in disaster preparedness (DP). Twenty-one articles were reviewed based on disaster mitigation and economic factors from 90 studies identified through a PubMed search till September 2021. Vulnerable communities with higher hazard risks are identified by vulnerability indices (VI), including the Climate Risk Index, Environmental VI, and Socio-Economic VI. However, VI predicting one disaster may not predict another. Disaster behavioral response involves five phases. Disaster effects include medical, mental, environmental, and economic effects, as well as the unique recovery time from each domain effect. Medical effects include malnutrition, malaria, diarrhea, heat stress, exacerbations of chronic conditions, infectious disease outbreaks, trauma, and death. Mental effects are post-traumatic stress disorders, depression, anxiety, somatic complaints, psychological distress, sleep problems, and suicides. Environmental effects include isolation, migration, injury to family members, life threats, and property damage. Loss of livelihood and property are associated with worse outcomes. Disaster recovery, which is seldom measured and not clearly defined, affects measurement and comparison across settings. A uniform validated VI, including multiple indicators assessing vulnerability to various disasters, is required. Livelihood restoration is integral to mental health recovery in some disaster types. Fund diversification, prioritized to the vulnerable and to each domain effect of disaster in the immediate post-disaster phase, expedites recovery. Later recovery investments focused on helping people rebuild their community enhance psychological outcomes. Promoting job insurance in highly vulnerable labor-based communities with high VI, wherein willing-to-pay is high, could facilitate faster recovery. DPSR should be encouraged.

The objective of this article is to identify the factors that influence the choice of contraceptive methods in the postpartum period.
We conducted a qualitative systematic review including articles published between 2000 and 2021 on postpartum contraception and its related influential factors. Relying on Preferred Reporting Items for Systematic Reviews and Meta-Analyses and synthesis without meta-analysis checklists, the search strategy relied on a combination of 2 lists of keywords applied to 9 databases. A bias assessment was carried out with the help of the Cochrane\'s randomized controlled trial tool, the checklist from Downs and Black, and Consolidated criteria for reporting qualitative research (CoreQ). A thematic analysis was performed to identify categories of influential factors.
A total of 34 studies met our inclusion criteria and enabled us to isolate 4 categories of factors: (1) demographic and economic factors (geographic and ethnic origin, age, living environment, education/wealth), (2) clinical elements (parity, evolution of pregnancy, childbirth and afterwards, contraception used previously and its mechanism, pregnancy planning), (3) health care delivery (pregnancy monitoring, sessions about contraception, health care system, place of delivery), and (4) sociocultural factors (knowledge and beliefs about contraception, religion, the influence of family and society). The decision process related to postpartum contraception is influenced by a combination of socioenvironmental factors and clinical elements.
The main influential factors (parity, level of education, knowledge and beliefs about contraception, and influence of family) need to be addressed by clinicians during consultations. Further multivariate research should provide quantitative data on this topic.

BACKGROUND: Little is known about what impact the use of different spatial methodological approaches may have on understanding the relationship between area-level socio-economic factors and suicide.
METHODS: In this systematic review, we searched PubMed, Embase, CINAHL and PsycInfo for original empirical studies examining the relationship between socio-economic factors and suicide with a spatial lens, published up to January 22, 2022. Data on applied spatial methods, indicators of socio-economic factors, and risk of suicide related to socio-economic factors were extracted. The protocol for this systematic review was registered with PROSPERO (CRD42021251387).
RESULTS: A systematic search yielded 6290 potentially relevant results; 58 studies met the inclusion criteria for review. Of the 58 included studies, more than half of the studies (n = 34; 58.6%) used methods that accounted for spatial effects in analyses of the association between socio-economic factors and suicide or examined spatial autocorrelation, while 24 (41.4%) studies applied univariate and multivariate models without considering spatial effects. Bayesian hierarchical models and spatial regression models were commonly used approaches to correct for spatial effects. The risk of suicide relating to socio-economic factors varied greatly by local areas and between studies using various socio-economic indicators. Areas with higher deprivation, higher unemployment, lower income, and lower education level were more likely to have higher suicide risk. There was no significant difference in results between studies using conventional versus spatial statistic methods.
CONCLUSIONS: An increasing number of studies have applied spatial methods, including Bayesian spatial models and spatial regression models, to explore the relationship between area-level socio-economic factors and suicide. This review of spatial studies provided further evidence that area-level socio-economic factors are generally inversely associated with suicide risk, with or without accounting for spatial autocorrelation.

Climate change has a significant effect on the productivity of livestock including milk, meat, and reproduction. This could be attributed to the internal diversion of energy resources towards adaptive mechanisms. Among the climate change variables, thermal stress seems to be the major limiting factor in animal agriculture. A better understanding of the effects of climate change-influenced ecological factors on the genetic diversity of livestock species is warranted. Sheep is an ideal livestock species to be used in investigating environmental adaptation due to its wide range of agroecological habitats, genetic and phenotypic variability. There is a heavy reliance on sheep genetic diversity for future animal protein security, but the implications of climate change on their genetic diversity receive less attention. Here, the potential environmental factors influencing natural selection in sheep populations are presented. We argue that prolonged exposure to these factors plays a major role in influencing the development of adaptation traits in indigenous sheep breeds, consequently leading to the alteration of genetic diversity at specific loci. The factors discussed include hot temperatures (heat stress), insufficient water, low quantity and quality of forage, and prevalence of parasites, pests, and diseases. In addition, genetic diversity, some signatures of selection for adaptation and economic angles of selection are also briefly discussed. A better understanding of environmental factors influencing the genetic diversity of sheep populations will inform breeding and management programs and may offer an opportunity for greater production efficiency with low input costs.

The review provides a comprehensive summary of existing literature focusing on the most serious risk factors of non-communicable diseases and collects current knowledge on their distribution, determinants, clusters, psychological and socio-economic consequences. Especially, the life-course approach is stressed, early life consequences of the later onset of chronic diseases, the risk behavior and its social, socio-economic and psychosocial determination is reviewed. Potential of preventing these harmful consequences has a lifelong approach. The aim is to demonstrate the opportunity for future health system transformation in terms of public health prevention regarding the non-communicable diseases. It is concluded that personalized lifestyle medicine should address a patient\'s health by empowering them with the information they need to regain control of their health. Preventive methods should be tailored for each patient, considering such patient\'s specific genes, environment, lifestyle, early life factors and social patterns of risk factors to avoid burden of health in later age. Intervention and preventive measures should target not only to individual factors but should reflect wider social, psychosocial and socio-economic consequences. It is also crucial from the point of view of public health to consider data on exposome, which are not included in epidemiological studies as well as its impact on health in the context of non-communicable diseases. Med Pr. 2021;72(5):535-48.

BACKGROUND: Surgical disease in Low Income Countries (LIC) is common, and overall provision of surgical care is poor. A key component of surgical health systems as part of universal health coverage (UHC) is financial risk protection (FRP) - the need to protect individuals from financial hardship due to accessing healthcare. We performed a systematic review to amalgamate current understanding of the economic impact of surgery on the individual and household. Our study was registered on Research registry (www.researchregistry.com).
METHODS: We searched Pubmed and Medline for articles addressing economic aspects of surgical disease/care in low income countries. Data analysis was descriptive in light of a wide range of methodologies and reporting measures. Quality assessment and risk of bias analysis was performed using study design specific Joanna-Briggs Institute checklists. This study has been reported in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines.
RESULTS: 31 full text papers were identified for inclusion; 22 descriptive cross-sectional studies, 4 qualitative studies and 5 economic analysis studies of varying quality. Direct medical, direct non-medical and indirect costs were variably reported but were substantial, resulting in catastrophic expenditure. Costs had far reaching economic impacts on individuals and households, who used entire savings, took out loans, reduced essential expenditure and removed children from school to meet costs.
CONCLUSIONS: Seeking healthcare for surgical disease is economically devastating for individuals and households in LICs. Policies directed at strengthening surgical health systems must seek ways to reduce financial hardship on individuals and households from both direct and indirect costs and these should be monitored and measured using defined instruments from the patient perspective.

BACKGROUND: The incidence and prevalence of pressure ulcers in critically ill patients in intensive care units (ICUs) remain high, despite the wealth of knowledge on appropriate prevention strategies currently available.
METHODS: The primary objective of this systematic review was to examine the economic impact of pressure ulcers (PU) among adult intensive care patients. A systematic review was undertaken, and the following databases were searched; Medline, Embase, CINAHL, and The Cochrane Library. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was used to formulate the review. Quality appraisal was undertaken using the Consensus on Health Economic Criteria (CHEC)-list. Data were extracted using a pre-designed extraction tool, and a narrative analysis was undertaken.
RESULTS: Seven studies met the inclusion criteria. Five reported costs associated with the prevention of pressure ulcers and three explored costs of treatment strategies. Four main PU prevention cost items were identified: support surfaces, dressing materials, staff costs, and costs associated with mobilisation. Seven main PU treatment cost items were reported: dressing materials, support surfaces, drugs, surgery, lab tests, imaging, additional stays and nursing care. The overall validities of the studies varied between 37 and 79%, meaning that there is potential for bias within all the included studies.
CONCLUSIONS: There was a significant difference in the cost of PU prevention and treatment strategies between studies. This is problematic as it becomes difficult to accurately evaluate costs from the existing literature, thereby inhibiting the usefulness of the data to inform practice. Given the methodological heterogeneity among studies, future studies in this area are needed and these should use specific methodological guidelines to generate high-quality health economic studies.

India is the second country in tobacco production in the world. Smoking tobacco products included Hookah, Cohutta, Chillum, Chillum, ganja, Beedi, Mava, Cigarettes, and cigar etc. Various types of smokeless tobacco like betel quid, khaini, mishri, snuff, gutkha are used. Fifty percent of them are addicted to smokeless tobacco. Sixty eight smokeless tobacco products were available in 2010; most of them included the risk of cancer warning except for loose tobacco products. Women mostly prefer 8 out of 29 gutkha brands. Out of these 29 gutkha brands, 15 were loose tobacco packets. India is the second-largest tobacco consumer, comprises of 27.5 crore consumers which altogether greater than the population of Western Europe. From among these 27.5 crore consumers, 16.4 crore people are smokeless tobacco in takers, 6.9 crore people are exclusive smokers and 4.2 crore people are both tobacco in takers and exclusive smokers. If we take this data into consideration early mortality of 45 crore people is expected by 2050 worldwide. Female basically are prone to fewer cigarettes per day as compared to males. On the other hand, a cigarette that is consumed by females has lower nicotine content as compared to males. In developing countries, the female population has less prevalence of smoking because the level of employment is low, socio-cultural norms, and health and beauty concerns. According to the estimation by the South East Asia Region (SEAR) in the year 2000 basically from India, we encounter death of about 18% men and about 3% of women due to tobacco. Various policies have been set up to control the use of tobacco. So that threat to public health is reduced. Policies like tobacco control policy, pro-health policy are set up for this purpose. Talking about the effects on a longer-term usage of water pipe can add up to the risk of getting affected by cancers of lungs, mouth, bladders, atherosclerosis, cardiovascular and pulmonary diseases, tooth extraction, etc.