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Dementia-friendly communities (DFCs) are a policy-endorsed approach to community engagement in England that promotes social inclusion to enable people affected by dementia to live well. Research suggests that physical activity is beneficial in encouraging social connection and improving health. A mixed method sequential study design in England involving a national survey (n = 31) and semistructured interviews (n = 65) in three DFCs was carried out. The aim was to understand how DFCs enable people affected by dementia to participate in physical activities. An evaluation framework for DFCs was used to organize and interpret the data, and analysis was informed by the inclusive (social) citizen lens. Findings showed that DFCs offered a range of adapted dementia-inclusive and dementia-specific activities; however, people were not routinely offered information at time of diagnosis. Local authorities (councils) were key to enable access to information and infrastructure change to support sustainable inclusion within their local community. [ABSTRACT FROM AUTHOR]

Drawing on a 2.5-year ethnography of first-time founders in a coworking facility, I shed light on the process by which founders ascribe self-referential meaning to entrepreneurship—that is, how they develop an entrepreneurial identity in situ. I discovered that founders' use of the coworking space occasioned distinct interaction patterns. Over time, varying interactions played a central role in whether the workspace became a community or remained a mere office space to these founders. Such emergent spatial meanings were coupled with whether founders themselves developed as entrepreneurs or not within their workspace. Founders' perceptions of the workspace as a community were generally associated with their identifying more as entrepreneurs, while their perceptions of the workspace as an office were usually linked with their identifying less, and even disidentifying, as entrepreneurs. In explaining these dynamics, I contribute to research on identity and space, research on entrepreneurial identity, and broader scholarship on space and interactions in organizations. For first-time founders, the meanings associated with being an entrepreneur can be equivocal, and where they work helps to shape their answers to the questions "What is entrepreneurship to me?" and "Who am I?" [ABSTRACT FROM AUTHOR]

An introduction to articles published within the issue is presented, including one which identified and summarized trends in how libraries have or have not considered the ethical implications of artificial intelligence (AI), another on the steps taken by an institution to develop and implement a library chatbot, and one on the developments in AI-assisted music creation as well as the resultant challenges regarding copyright and cataloging work.

Abstract: Latinx children now live in a wider array of U.S. geographic areas than in the past, including both established and new areas of Latinx settlement. This geographic heterogeneity could be consequential for Latinx children’s health care access, with prior research suggesting increased health access barriers for Latinx children in new versus established areas of settlement. Merging public-use county-level data with restricted individual-level health data from the National Health Interview Survey (2010–2014), we quantitatively examine how three health access indicators—health insurance coverage, delayed care, and usual place of care—differ among children (ages 4–17) in Latinx immigrant, Latinx U.S.-born, White U.S.-born, and Black U.S.-born families (n = 89,994) across established, fast-growing hub, new, and minor Latinx destination counties. We also examine the potential roles of local immigrant hostilities and health care resources in contributing to health access differences across destinations. In fully adjusted models, children in new destinations are less likely to have health insurance than peers in established destinations, and this disparity is even wider for Latinx children of immigrants. Adjusted model results also show that children in new destinations are more likely to have delayed care than those in established destinations, and children in these four groups in new destinations, fast-growing hubs, and minor destinations are more likely to have no usual place of care than peers in established destinations. Our results are consistent with prior work suggesting that more health care access barriers exist for children, particularly Latinx children of immigrants, in new versus established Latinx destinations.

The literature on evolution of organizational forms has remained largely silent on where the first organizational instance of a new form comes from, treating it as either a given or an outcome of random variation. We challenge this agnostic assumption by putting the first organizational founding into a specific spatiotemporal context and revealing the role of provisional spaces, defined as small-scale, easily accessible settings where market pioneers temporarily experiment with applications of an innovation before dedicated organizations emerge. We theorize that provisional spaces disseminate necessary information about an innovation and enable potential entrepreneurs to envision a new template for organizing. Therefore, geographic communities with a higher number of provisional spaces are more likely to host the first organization embodying a new form sooner than others. Using archival data on all movie-showing venues in Chicago communities, 1896–1927, we find empirical support for our theorizing. Community variance in volume and types of provisional spaces for movie projectors, such as opera houses and penny arcades, led to community-level differences in the emergence of distinct movie theater forms: nickelodeon, movie house, and movie palace. We advance scholarship on organizational form emergence by uncovering the role of provisional spaces in shaping localized opportunity structures. [ABSTRACT FROM AUTHOR]

In the article, the author discusses how public libraries can promote a vibrant local music community by citing their efforts at the New Orleans Public Library to support artists through their Crescent City Sounds streaming service. Also cited are how libraries can provide more credibility and recognition of artists to the listening public and the comment of Justin Powers of Marina Orchestra on the role of libraries in promoting the music industry.

In response to increasingly severe weather conditions, optimization of building performance and investment provides an opportunity to consider co-benefits of thermal resilience during energy efficiency retrofits. This work aims to assess thermal resilience of buildings using building performance simulation to evaluate the indoor overheating risk under nine weather scenarios, considering historical (2010s), mid-term future (2050s), and long-term future (2090s) typical meteorological years, and heat wave years. Such an analysis is based on resilience profiles that combine six integrated indicators. A case study with a district of 92 buildings in Brazil was conducted, and a combination of strategies to improve thermal resilience was identified. Results reflect the necessity of planning for resilience in the context of climate change. This is because strategies recommended under current conditions might not be ideal in the future. Therefore, an adaptable design should be prioritized. Cooling energy consumption could increase by 48 % by the 2050s, while excessive overheating issues could reach 37 % of the buildings. Simple passive strategies can significantly reduce the heat stress. A comprehensive thermal resilience analysis should ultimately be accompanied by a thorough reflection on the stakeholders’ objectives, available resources, and planning horizon, as well as the risks assumed for not being resilient.

This report aims to investigate the community engagement process so planners can more effectively work with communities and reckon with the historical trauma caused by planners in the past. Planning as an industry is responsible for the forceful removal of communities under the name of “urban decay” and is a direct cause of why some communities remain impoverished today. This history has not been long forgotten; it continues to live on in the communities directly affected, and trust when working with public agencies is low. Public agencies must understand this trauma as they work with these communities to build a better future. This report chronicles the Little Tokyo/Arts District Station joint development process by interviewing Little Tokyo residents and other stakeholders involved with the process and examining archival documents. While relatively small, Little Tokyo has a long history of asserting its autonomy in community development issues. I highlight the history of community-based organization and planning that has sustained Little Tokyo into the community it remains today. Through my findings, I recommend a history-informed planning process among public agencies. A holistic approach to planning must be taken that considers the community context in historical and contemporary terms. While the process of community engagement can be long and expensive, it is a way for public agencies to repair their relationship with communities that have been wronged in the past.

Objectives: To assess the effect of Community Water Fluoridation (CWF) in the prevalence of dental caries and dental fluorosis in 12-year-old children living in Israel. Considering that CWF is important in the prevention of dental caries. Between 2002 and 2014, the water in communities of at least 5,000 individuals was fluoridated. In 2014, CWF in Israel stopped. Method and materials: Data on 12-year-old children from all areas in Israel from the national cross-sectional epidemiological survey conducted in 2011 to 2012 were stratified by city water fluoridation and by city and school socioeconomic status. Two dependent variables were defined: (1) DMFT index of caries experience in the permanent dentition; (2) dental fluorosis in central incisors using the Thylstrup-Fejerskov classification of fluorosis. Results: Data from 2,181 12-year-olds were analyzed. The average DMFT was 1.17 ± 1.72, and 49% were caries-free. Based on DMFT, the caries experience was significantly higher in nonfluoridated cities (1.38 vs 0.98 in fluoridated cities) and there were more caries-free children in fluoridated cities (56.4% vs 40.6% in nonfluoridated). DMFT was higher in cities with lower socioeconomic status than high socioeconomic status (1.29 vs 1.05, respectively, P < .001) and there were fewer caries-free children in low socioeconomic status cities (44.5% vs 53.0% in high socioeconomic status cities, P < .0001). Almost all the 10.3% of children with signs of fluorosis (scoring at least 1 in the Thylstrup-Fejerskov index), had questionable to mild fluorosis (9.3%). Conclusions: CWF is a cheap, simple method of dental health protection that reaches all socioeconomic levels, and cessation of water fluoridation reduced the health of Israel's children. Clinical significance: Water fluoridation provides substantial caries prevention, by reaching a substantial number of people. The relevance of this work is for policymakers to consider CWF as clinically proven method for reducing health inequalities. [ABSTRACT FROM AUTHOR]

Thoracic hyperkyphosis could affect mobility and independence of older adults. However, there was no clear evidence on the use of the seventh cervical vertebra wall distance (C7WD), a practical measure for thoracic hyperkyphosis, to indicate mobility deficits relating to independence of these individuals. This study explored the ability of C7WD to determine mobility impairments in 104 older adults. Participants (average age of 74.1 ± 7.4 years) with various degree of thoracic kyphosis were cross-sectionally measured for their C7WD, mobility, and Cobb angle. The findings indicate that participants with thoracic hyperkyphosis (Cobb angle = 46.1 ± 5.2°) had significantly poorer mobility than those without thoracic hyperkyphosis (Cobb angle = 32.8 ± 5.9°, p <.05). A C7WD of ≥7.8 cm could indicate mobility deficits of the participants (sensitivity = 71%–92%, specificity = 75%–94%, and area under the curve >0.80). The findings confirm the ability of C7WD that could be clinically measured using rulers to indicate mobility deficits of older adults. [ABSTRACT FROM AUTHOR]

Large collections of freely available food webs are commonly reused by researchers to infer how biological or environmental factors influence the structure of ecological communities. Although reusing food webs expands sample sizes for community analysis, this practice also has significant drawbacks. As food webs are meticulously crafted by researchers for their own specific research endeavors and resulting publications (i.e., books and scientific articles), the structure of these webs inherently reflects the unique methodologies and protocols of their source publications. Consequently, combining food webs sourced from different publications without accounting for discrepancies that influence network structure may be problematic. Here, we investigate the determinants of structure in freely available food webs sourced from different publications, examining potential disparities that could hinder their effective comparison. Specifically, we quantify structural similarity across 274 commonly reused webs sourced from 105 publications using a subgraph technique. Surprisingly, we found no increased structural similarity between webs from the same ecosystem nor webs built using similar network construction methodologies. Yet, webs sourced from the same publication were very structurally similar with this degree of similarity increasing over time. As webs sourced from the same publication are typically sampled, constructed, and/or exposed to similar biological and environmental factors, publications likely holistically drive their own webs' structure to be similar. Our findings demonstrate the large effect that publications have on the structure of their own webs, which stymies inference when comparing the structure of webs sourced from different publications. We conclude by proposing different approaches that may be useful for reducing these publication‐related structural issues. [ABSTRACT FROM AUTHOR]

“Replenishing Geographical Thinking on Depletion through and of Social Reproduction” contributes to the growing interdisciplinary debates on depletion. It does so through analyses of the everyday rhythms of life by investigating the relationship between production and reproduction to understand the labour that goes into the maintenance of life and experiences of depletion, as well as strategies to measure and reverse it. I reflect on the different papers and suggest that this excellent Symposium is an important contribution to the study of depletion and opens up avenues for further explorations of the concept. [ABSTRACT FROM AUTHOR]

With the rapid development of e-health and telemedicine, previous studies have explored the relationship between physician-patient communication and patient satisfaction; however, there is a paucity of research on the influence of the characteristics of patient communication on the characteristics of physician feedback. Based on the communication accommodation theory, as well as the computer-mediated communication theory and media richness theory, this study aimed to explore how characteristics of patient communication influence characteristics of physician feedback in online health communities. We employed a crawler software to download the communication data between 1652 physicians and 105,325 patients from the Good Doctor platform, the biggest online health community in China. We built an empirical model using this data and employed a multilevel model to test our hypotheses using Stata and Python software. The results indicate that the amount of patients' rendered information positively influences the physicians' text (α = 0.123, t = 33.147, P <.001) and voice feedback (β = 0.201, t = 40.011, P <.001). Patients' hope for help signals and the provision of their electronic health records weaken the effect of the amount of patients' rendered information on physicians' text feedback (α = –0.040, t = –24.857, P <.001; α = –0.048, t = –15.784, P <.001), whereas, it strengthened the effect of the amount of patients' rendered information on physicians' voice feedback (β = 0.033, t = 14.789, P <.001; β = 0.017, t = 4.208, P <.001). Moreover, the occurrence of high-privacy diseases strengthened the effect of the amount of patients' presented information on physicians' text and voice feedback (α = 0.023, t = 4.870, P <.001; β = 0.028, t = 4.282, P <.001). This research contributes to the development of computer-mediated communication theories and sheds light on service delivery in the online health community. [ABSTRACT FROM AUTHOR]

Background: Studies on the in-depth documentation of wild greens use in the Mediterranean Diet (MD) are vital to understanding patterns of cross-geographical change in wild food ingredients in the Mediterranean context, their appreciated taste, and possible evolution. Our present study aims to document the leafy, wild-sourced plant portion of the MD in the unique and isolated matrifocal community of Olympos, North Karpathos Isle, Greece. Methods: An ethnobotanical field study focussing on traditionally wild-sourced edible greens (chórta) was conducted during the spring of 2023 via 42 semi-structured interviews with local people. Results: Our study documented 69 wild green taxa, along with their culinary uses and linguistic labels. Half of the gathered wild greens have a bitter taste (i.e. members of Asteraceae and Brassicaceae), while 70% of the top-quoted greens are bitter. These greens were mostly consumed cooked. Nearly half of the quoted taxa had been previously recorded as used in the food system of central Crete. In contrast, one-fourth of the folk phytonyms recorded in Olympos do not match the ones found in Crete and the rest of Greece, which may be linked to the Doric culture that the community remained attached to because of its isolation. However, the plant-human interaction kernel is similar to that of surrounding areas. Moreover, the community of Olympos seems to rely less on aromatic wild greens (compared with Crete). Conclusion: Cross-cultural foraging comparison is crucial for better understanding the circulation, exchange, and evolution of local plant knowledge under the MD umbrella. Our study assesses, in particular, how noteworthy phytolinguistic differences indicating different ancient trajectories of cultural encounters/exchanges may not necessarily be reflected in differences in terms of plant reports. As often postulated in linguistic ethnobiology, ancient linguistic labels sometimes remain as "empty shells". Given the fragile environment and the increasing over-tourism during the summer months the study site is experiencing, the presented data could contribute to a more substantial shift towards sustainable eco-tourism initiatives involving the foraging and cooking of wild greens. [ABSTRACT FROM AUTHOR]

Background: This study investigates breast cancer screening disparities among Mexican immigrant women in rural and urban U.S. communities, focusing on cultural beliefs, healthcare access, and geographical differences. Methods: A cross-sectional study of 350 Mexican immigrant women aged 40+ without prior cancer diagnosis was conducted in rural (<2000 population) and urban parts of the U.S. in 2015. Culturally tailored surveys during household visits, clinic appointments, and community meetings assessed cultural beliefs, mammography engagement, and family support. Comparative analyses t -tests and chi-square tests were conducted, with significance set at P <.05. Results: Rural women demonstrated higher adherence to spiritualismo (M = 4.31, SD = 1.13) compared to their urban counterparts (M = 3.91, SD = 1.36), marianismo (M = 3.33, SD = 0.45 vs M = 3.21, SD = 0.48), and machismo (M = 3.02, SD = 0.52 vs M = 2.80, SD = 0.61). The rural women also reported higher mammography rates (54.4% vs 45.6%), with 60.4% undergoing four or more mammograms. Despite barriers such as doctor non-recommendation (55.0% rural vs 45.0% urban) and embarrassment (67.9% rural vs 32.1% urban), rural women engaged more in family discussions about cancer screenings (61.7% vs 38.3%) and received more family assistance in finding health information (59.8% vs 40.2%). Conclusions: This study elucidates significant rural-urban disparities in cultural adherence and family support among Mexican immigrant women, underscoring the necessity for culturally tailored interventions to enhance breast cancer screening rates and health outcomes. [ABSTRACT FROM AUTHOR]

Background: In many low-income countries, enhancing the health of school-aged children is often impeded by insufficient or limited knowledge regarding their health status. Further, hands-on health promotion interventions are nearly non-existent due to the lack of designated health workers. The disconnection between schools and primary care facilities further exacerbates this issue. To address these challenges, the World Health Organization has introduced the Health Promoting School (HPS) framework, a comprehensive model designed to integrate health into all aspects of school life and promote physical, mental, and social well-being. We sought to assess the perceived health status of school-aged children, identify associated factors, and explore the role of community health workers (CHWs) in public schools in rural Rwanda. Methods: We carried out a convergent mixed methods study among teachers and community members in rural areas of Musanze, Rwanda. Data collection instruments were adapted from the World Health Organization's HPS framework and the literature. We conducted six in-depth interviews and three focus group discussions. We performed a logistic regression analysis to examine the factors associated with perceived health. Thematic analysis was used to analyze the qualitative data. Results: A total of 479 individuals participated in this survey. Of these, 425 (89%) were community members, while 54 (11%) were employed as teachers at Nyabirehe or Rwinzovu public schools. Almost half of respondents 221 (46%) described the children's health as poor. Many factors were associated with perceived children's health, including having an established leadership team for school-based health promotion (OR = 1.97, 95%CI: 1.01,3,84), and being familiar with school-based health promotion (OR = 4.77, 95%CI: 2.27,10.0). Qualitative results described the CHW as a bridge between communities, schools, and primary healthcare centers. Conclusion: This study revealed that the health of schoolchildren needs particular attention. In resource-limited settings, HPS presents a promising opportunity to address the health and well-being of children at rural public schools. However, adapted policies, the establishment of health promotion teams, and hands-on orientation for teachers and community members are necessary to ensure an effective implementation of HPS. In Rwanda and other low-income countries where public schools lack nursing staff, CHWs could play a vital role in enhancing HPS and the linkage between schools and primary healthcare facilities. [ABSTRACT FROM AUTHOR]

Evidence suggests that people experiencing inequities and who are highly marginalized (e.g., people impacted by racism, sexism, discrimination, stigma, mental illness, substance use issues, disability, and the effects of homelessness; also referred to as structurally vulnerable individuals) often die alone, in pain, and not receiving the care they need. Some research even points to highly marginalized people not feeling worthy of care. The need to consider equity in the context of palliative care has recently emerged but little attention has been paid to how ethical decision-making generally, and relational ethics, specifically, could provide guidance in the care of highly marginalized people who are on a palliative trajectory. Relational ethics offers a model of care and decision-making framework that emphasizes how clients, healthcare providers, and larger social structures are interwoven and acknowledge that structural conditions can position people to have less choice than others. Relational approaches in the context of palliative care for highly marginalized people have the potential to provide a lens to better support the delivery of equitable palliative care. This critical essay explores relational ethics as a way to approach equity in palliative care to support clients facing structural vulnerabilities. We discuss relational ethical considerations to approach collaborative partnerships between clients, healthcare providers, and the larger community with the goal of aligning care with clients' values. An ethical case for how a relational ethics approach might be used to promote equitable access to palliative care will be explored, highlighting how such approaches have the potential to better align client wishes with their needs and to ensure decision-making and care delivery is trauma-informed, harm reduction focused, and culturally respectful. Relational ethics can support social change in equity and palliative care by contributing ethically informed ways of caring for/with/about highly marginalized people. [ABSTRACT FROM AUTHOR]

Introduction: Recent research has identified social capital as an essential element of social context that influences the healthy aging experience. Since social capital is a resource that is context and culture relative, this study builds on and extends the existing literature on social capital among older adults by investigating different dimensions of social capital in later life and related individual and environmental characteristics in the Chinese context. Materials & Methods: Using the China Family Panel Study (CFPS) 2016 wave, 8097 individuals aged 60 years and older were included in the sample. Factor analysis was used to explore the dimensions that comprise the social capital of Chinese older adults. Multiple indicators, multiple cause (MIMIC) structural equation models were used to identify influential individual and environmental characteristics. Results: The findings of this study showed that as an interaction between the actor and the multiple levels of the social environment, the social capital of Chinese older adults derived from three levels of social environment—family, community, and macro society. Rural older adults had higher levels of social capital across all three levels. While demographic factors and functioning, including female, age, marital status, education, and functional limitations, had a significant relationship with family‐based social capital, having higher income and better self‐rated health were related to higher level of community‐ and society‐based social capital. Additionally, the physical community environment was a key determinant across all three levels of social capital. Discussion and Conclusion: Findings from this study demonstrate the important roles of neighborhood environment in shaping older adults' all levels of social capital. The findings also identified the unique role of family social capital and the need for policies and practices to reduce the vulnerability associated with a limited ability to adapt to the broader environment. [ABSTRACT FROM AUTHOR]

Background: Hypertension (HTN) is a major global health concern, affecting approximately 1.28 billion adults worldwide. In Rwanda, hypertension contribute to 2.81 of the disability adjusted life years (DALYs) and 1.87% of hypertensive heart disease mortality. Traditional medicine remains popular in Africa with some herbal remedies which have shown antihypertensive properties. However, no study was done to explore traditional Practitioners' approach to hypertension in Rwanda. Objective: To explore the experience of traditional Practitioners while managing hypertension in Rwanda. Methodology: This qualitative study utilized an ethnographic approach to explore the experience of traditional Practitioners (TPs) while managing HTN in Rwanda. Semi- structure interviews were conducted with 20 traditional Practitioners from three districts known for their popular use of traditional medicine in Rwanda. Participants were purposively selected, and interviews were guided by a pretested semi-structured interview guide in local language. Thematic analysis was used to generate the key themes. Results: Three main themes emerged from analysis: first, traditional medicine is often undervalued by modern medical providers, resulting in limited collaboration and communication between traditional Practitioners and modern medical providers. Despite this, TPs are trusted by the community, often receiving referrals from patients dissatisfied with modern treatment. Second, TPs face challenges in diagnosing HTN due to lack of diagnostic tools, often relying on their observation, patients' description of symptoms and patient's response to treatment. TPs expressed desire for collaboration with modern medicine and access to diagnostic tools. Third, lack of legal framework and standardized practices for traditional medicine remains a challenge. Conclusion: The study highlights the need to promote collaboration between traditional and modern medicine in Rwanda. To enhance HTN management, we recommend training of traditional Practitioners, setting standardized practice and legal framework to guide traditional Practitioners in Rwanda as well as improving their access to HTN diagnostic tools. [ABSTRACT FROM AUTHOR]

Few studies have focused on off‐reserve Indigenous children and families. This nationally representative, cross‐sectional study (data collected from 2006 to 2007) examined Indigenous‐ and non‐Indigenous‐specific determinants associated with positive socioemotional and behavioral well‐being among First Nations children living off‐reserve in Canada. The parents or other caregivers of 2990 two‐to‐five‐year‐old children (M = 3.65; 50.6% male) reported on their children's socioemotional and behavioral well‐being and a range of child, parent, and housing characteristics. Being taught an Indigenous culture, greater community cohesion, caregiver nurturance, good parental/other caregiver health, and fewer household members were associated with better socioemotional and behavioral well‐being. These results highlight the importance of leveraging Indigenous‐specific determinants and acknowledging non‐Indigenous‐specific factors, to promote the well‐being of First Nations children living off‐reserve. [ABSTRACT FROM AUTHOR]

Healthy Indigenous child development is grounded in Indigenous ways of knowing and being. Attachment theory has been influential in understanding the significance of parenting for infant development in Western science but has focused on child–caregiver bonds predominantly within the parent–child dyad. To bring forth Indigenous perspectives regarding understandings of parenting, the attachment bond, and the well‐being of Indigenous children, we conducted semi‐structured interviews with 28 members of a Northwest tribal community (21 female) in spring and summer 2020. Themes included Community caregiving, Family value systems, Bonding, Traditional teachings, and Historical trauma. The need to expand the lens of attachment theory beyond the dyad is clear. Implications for improving the child welfare system and prevention programs within Indigenous communities are discussed. [ABSTRACT FROM AUTHOR]

Background: Community connectedness, outness, and internalized phobia are potential protective and risk factors for mental health in lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals. However, these interrelated factors have generally been examined in isolation and for the LGBTQ community in aggregate. As such, there may be undetected effects of factors on mental health for each LGBTQ group. Objectives: We examined the associations between mental health (i.e., depression and anxiety) and risk/protective factors (i.e., internalized phobia, community connectedness, outness) in each LGBTQ subgroup separately. Method: A large national U.S. sample (N = 1,030) of individuals who identified as LGBTQ completed an anonymous Internet survey during fall 2019. Participants answered questionnaires about community connectedness, outness, internalized homophobia or transphobia, anxiety, and depression. Results: On average, most subgroups reported symptoms of depression and anxiety above clinical cutoffs. Less outness and greater internalized phobia were associated with more severe depression and anxiety, but this pattern was not consistent across LGBTQ subgroups. Greater community connectedness was generally associated with more severe anxiety and depression. Discussion: LGBTQ subgroups vary in how risk and protective factors relate tomental health outcomes. Our findings highlight the importance of examining LGBTQ subgroups separately and examining risk/protective factors simultaneously to identify the unique contribution of each factor. More research is needed to understand potential LGBTQ mental health risks and protective factors, and future researchers should examine the unique roles of risk and protective factors in separate LGBTQ subgroups. [ABSTRACT FROM AUTHOR]

Background: Loneliness and social isolation coexist, making it difficult to study each separately. The COVID-19 lockdown provided an unprecedented and ethically viable opportunity to study loneliness in seriously ill nursing home residents under uniformly imposed social isolation conditions. Objective: To understand the phenomenon of loneliness of the seriously ill nursing home patients under a uniform social isolation condition imposed by the COVID-19 pandemic lockdown. Design: Cross-sectional, semi-structured interviews were tape-recorded, transcribed verbatim, and analyzed qualitatively using an inductive thematic analysis. The University of California, Los Angeles (UCLA) Three-Item Loneliness Scale was used to measure loneliness and any relationships between self-reported loneliness and isolation were elucidated. Setting/Participants: Thirty seriously ill nursing home residents living in complete social isolation imposed by the COVID-19 pandemic lockdown. Results: Thematic analysis identified four key themes: (1) Diverse perceptions about the impact of the COVID-19 lockdown, (2) regret over the missed opportunities for spending time with friends and family, (3) using electronic communication to maintain connections with loved ones, and (4) the impact of nursing home staff. In total, 50% of the participants reported feeling socially isolated, 60% patients reported loneliness, and 70% reported being adversely impacted by the lockdown. Patients who felt socially isolated also reported experiencing loneliness (Kendall's Tau = 0.61, 95% confidence interval [CI] = 0.30, 0.89, p < 0.01, large effect size). Persons from communities of color had higher median loneliness scores compared to Non-Hispanic Whites. Participants in the last year of life also reported higher levels of loneliness. Conclusion: A study of loneliness under uniform social isolation conditions in seriously ill nursing home patients showed a high prevalence of loneliness and a strong correlation between self-reported loneliness and social isolation, especially in persons from minority communities and those in the last year of life. In-person support provided by nursing home staff and virtual support from family was helpful to patients. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to model the health indicator of functioning for persons with spinal cord injury or disorder living in Switzerland in the long-term context, considering chronological age, time since injury, and age at injury. Design: This is a longitudinal analysis of three waves of a community survey. An interval-scaled functioning metric was constructed using modern test theory. Random effects within-between mixed models were used to investigate trends in functioning over time. Results: Persons with complete injuries have lower levels of functioning than persons with incomplete injuries, and persons with complete tetraplegia have the lowest levels of functioning. The person's age when injured, the level and completeness of the injury, the presence of secondary health conditions, and various combinations of these factors significantly influenced how functioning changed over time. Conclusions: Our study shows that chronological age is not necessarily the best time variable for understanding the aging process of people with spinal cord injury in terms of changes in functioning over time and that modeling functioning over time since injury provides important insights into how functioning of people with complete or incomplete injuries declines with increasing time living with the injury. [ABSTRACT FROM AUTHOR]

Humane education fosters empathy and ethical thinking in young children, equipping them with the emotional intelligence and moral foundation needed to make compassionate choices and positively impact their communities. [ABSTRACT FROM AUTHOR]

Background: People with communication problems experience challenges in participation. Optimizing communicative participation for this population is an important outcome of speech and language therapy. Participation experiences are best assessed from the patient's perspective, using a patient‐reported outcome measure (PROM). The Communicative Participation Item Bank (CPIB) has been developed to identify perceived problems in communicative participation. However, previous research has shown that the item bank does not cover all domains and concepts of communicative participation, contains general communication items, and is not suitable for all people with communication problems. Aims: To develop a comprehensive PROM aimed at measuring communicative participation for all adults with communication problems and test its content validity. Methods & Procedures: An initial pool of 242 items was based on three sources: relevant content from an earlier literature review and concept elicitation study, and the translation of the items of the CPIB. This item pool was pilot‐tested for comprehensibility and comprehensiveness using cognitive debriefing interviews in adults with different communication problems (speech, language, voice, hearing and cognitive communication disorders). This resulted in a second version of the item bank. The content validity of this version was tested in a group of professionals. The last (third) version of 133 items was tested for content validity in a second, new group of adults with various communication problems. Outcomes & Results: The initial pool of 242 items was developed and pilot‐tested in 27 adults with different communication problems. After modifications, 161 items remained, which were tested in a content validity study with 25 people with different communication problems and five professionals (in the field of speech and language therapy and speech and language research). The professionals considered 91.9% of the item bank relevant and comprehensible, and comprehensive by adding two items. The item bank was then considered relevant, comprehensible and comprehensive by the group of adults with communication problems. A total of 133 items remained in the item bank, related to the International Classification of Functioning, Disability and Health (ICF) Activities and Participation domains 'mobility', 'self‐care', 'domestic life', 'interpersonal interactions and relationships', 'major life areas' and 'community, social and civic life'. Conclusions & Implications: MyCommunication—Adults is an item bank for measuring communicative participation in adults with communication difficulties. The next step is to test the psychometric properties of the item bank, in order to establish a final item bank. The refined description of the construct of communicative participation can already be used for participation‐focused goal‐setting between individuals with communication problems and speech and language therapists. WHAT THIS PAPER ADDS: What is already known on the subject: The CPIB was developed to measure communicative participation in community‐dwelling adults with communication problems. The item bank does not cover all domains and concepts of communicative participation, contains general communication items and not all questions seem to be relevant for specific target groups (e.g., hearing population). What this paper adds to the existing knowledge: This study presents a refined description of the construct of communicative participation and the development of a new comprehensive PROM aimed at measuring this construct for all adults with communication difficulties. The development of the PROM is based on a previously conducted literature review and concept elicitation study. This study describes the development process of this new PROM, called MyCommunication‐Adults, and the assessment of its content validity. What are the potential or actual clinical implications of this work?: The refined description of the construct of communicative participation can be used for participation‐focused goal‐setting between individuals with communication problems and speech and language therapists. [ABSTRACT FROM AUTHOR]

This study explored the manifestations of intersectional structural stigma and stigma-reducing strategies in the context of health among a diverse group of persons experiencing homelessness in the southwest United States. Purposive sampling was used to recruit youth (ages 12–17), young adults (ages 18–24), adults (ages 25 years old or older), women with children, veterans, and males over 60 years old who self-identified as homeless. Grounded theory was applied, and thematic analysis was conducted using data collected from seven focus groups (n = 76 participants). A model of intersectional stigma was adapted from the Health Stigma and Discrimination Framework. This adaptation depicts pathways for addressing intersectional stigmatization experienced by individuals with multiple intersecting identities across the interpersonal, organization, and community levels not explicitly addressed in the Health Stigma and Discrimination Framework. At the interpersonal level, participants indicated they experienced stigmatizing behaviors and practices by service providers due primarily to their identities related to economic or unhoused statuses, gender, age, and mental health. Facilitators of intersectional stigma were identified through organization practices and processes. Multiple stigmatized identities due to social beliefs also facilitated stigmatization at the community level. Health outcomes influenced by stigmatization were also identified. Despite the stigmatization they experienced, participants discussed stigma-reducing strategies related to community assets, medical care, and destigmatizing practices by service providers. [ABSTRACT FROM AUTHOR]

A 10-year review of the 2008 Council of Australian Governments' (COAG) Close the Gap Strategy identified the lack of involvement of Indigenous people in developing policies as a key reason health disparities persist. It also posits that disconnection from Country and culture have been crucial factors. Physical and mental health cannot be separated from spiritual health and well-being amongst Indigenous Australians. This article describes the co-development of a cultural enrichment research study with Indigenous Elders, health service leaders, and community members that places culture at the centre of care to augment traditional Western mental health management. The study has been overseen and nurtured from its inception by a governance board of Traditional Custodian Elders and an Advisory Group of Indigenous health workers. Qualitative data were collected through community 'zoom- yarns ' between an Indigenous research assistant and 44 community members during COVID-19 lockdowns. These yarns were analysed through an innovative, constructivist, multi-perspectival discursive grounded theory method. Findings have led to an Elder-governed adjuvant cultural therapy which is currently being trialled and will be evaluated using the same multi-perspectival discursive grounded theory research methodology. One third of all Indigenous Australians now live in capital cities, so developing models to bring culture and Country into urban health facilities are becoming increasingly important. The Indigenous-led research approach outlined in this paper suggests a model for engaging Indigenous communities that mainly distrust Western research and have been failed by Western mental health care. It has the potential to shape future policy. [ABSTRACT FROM AUTHOR]

Precarious work is increasingly prevalent in the United States and is associated with adverse health outcomes; however, precarious work and associated working conditions are generally not considered in residency training. Healthcare providers should understand the context and risk factors associated with precarious work to holistically serve worker-patients in clinical settings. Objectives: This cross-sectional survey aimed to examine employment characteristics and their associations with employment precarity in two high socioeconomic hardship Chicago neighborhoods. Methods: We used a community-based participatory approach to develop and administer a survey to residents who perceived their work situations to be precarious. Results: A total of 489 residents were surveyed. Responses were skewed toward the most precarious work situations, with the majority of respondents employed outside of a traditional arrangement. Those in the highest precarity category were most likely to identify as Latinx and born outside of the United States. Unstable, low-quality employment conditions were nearly all significantly associated with highest precarity work situations. Conclusions: Precarious employment is an important predictor of other employment conditions, and characterizing these at a hyperlocal level allows for a nuanced understanding of work as a determinant of health. [ABSTRACT FROM AUTHOR]

Background: Advance care planning empowers people by allowing them some control over certain healthcare decisions in the event they are unable. Yet, advance care planning rates in the American Indian and Alaska Native populations are low. Thus, we culturally tailored the Make Your Wishes About You (MY WAY), an intervention to improve advance care planning access and completion for American Indian peoples. Methods: In partnership with an American Indian Tribe, the project took a community-based participatory orientation and relied on a Community Advisory Board and a Professional Advisory Board. The culturally tailoring was a 15-step process. These steps allowed us to ensure that the tailoring reflects community-specific norms and preferences, greater reliance on visual images and local idioms of expression, more appropriate attention to family roles, and inclusion of spiritual elements. Results: A four-phase cultural tailoring framework emerged with each phase centering around listening, learning, and analyzing with tailoring occurring between each phase. A culturally tailored MY WAY was created, which was delivered in a manner that reflected Tribal citizenss' preferences. Materials included Tribal language, local idioms of expression, attention to family roles, and appropriate inclusion of spiritual elements. The materials were rated high on a content validity index by the advisory board members. Conclusion: There is a growing interest in tailoring existing evidence-based programs with relatively little in the literature offering guidance. By sharing our efforts and experiences in culturally tailoring an advance care planning program for an American Indian Tribe, we hope that it will serve useful for future efforts in ensuring that evidence-based programming reaches those in greatest need. While this project was rooted in the core Indigenous values of community, ceremony or spirituality, language, and place it also lends itself to broader translation across different populations. [ABSTRACT FROM AUTHOR]

Objectives: Mental health remains an unmet need among Chinese Americans. This study aims to identify specific needs and strategies that may address the needs. Design: A total of 55 Chinese Americans consented and participated in online focus groups conducted in either Chinese or English using nominal group technique. Participants discussed the following questions, achieved themes, and provided ranking of themes in importance for each: (1) In general, what do people in the Chinese American community think about mental health or emotional well-being? (2) What have you found to be helpful for accessing mental health or emotional well-being services or care in the Chinese American population? And (3) What actions would you suggest to improve mental health and emotional well-being in the Chinese American population? Results: Across the focus groups, we observed high consistency of top ranked themes including lack of knowledge and awareness, negative impression, lack of Chinese-speaking providers, and that the most helpful factor toward access to care was education and increased awareness. Seminars and trainings was the top actionable suggestion. Conclusion: The findings are consistent with previous findings and continue to show that Chinese Americans need more education and training and that providers who can speak the language and understand the culture would be very helpful to increase access to care. This study emphasizes addressing mental health disparities in the Chinese American community through awareness, tailored interventions, and barrier removal. Promoting equal access also underscores the need for ongoing assessment and responsive strategies. [ABSTRACT FROM AUTHOR]

Background and Objectives Raising dementia awareness is essential for building a dementia-friendly community. However, existing studies have underexplored the effects of virtual reality (VR) dementia educational programs for the general public on enhancing positive attitude toward dementia. This study aimed to examine the effectiveness of a VR dementia-friendly educational program called the Drive for Dementia Readiness Inside Virtual Reality (DRIVE) program to improve attitude toward dementia of the general public. Research Design and Methods A two-arm randomized controlled trial was conducted. Eligibility criteria for participants included being 16 years and older in Japan and having no professional license in healthcare and social care. We randomized individuals to attend a multielement VR dementia-friendly educational program (intervention), including simulation, VR films, short films, lectures, and discussions or a lecture-based program (control). Data were collected 3 times, including at baseline, postintervention, and 3-month follow-up. The primary outcome was attitude toward dementia. The secondary outcomes were intention of helping behavior for people living with dementia and knowledge of dementia. Results We recruited 157 community residents, among whom 130 were included in the analysis. Although the mean changes in attitude score were not significantly different between the groups (Hedge's g  = 0.26), the intention of helping behavior score was significantly higher in the intervention group (g  = 0.49). Discussion and Implication The DRIVE, a VR-based multielement dementia-friendly educational intervention, was shown as a promising tool for significantly affecting the intention of helping behavior for people living with dementia to establish dementia-friendly communities. Clinical Trials Registration Number UMIN000044901 [ABSTRACT FROM AUTHOR]

The study aimed to compare the quality of life (QoL) in two communities with different exposures to conflict and investigate the inter-relationship between posttraumatic stress disorder (PTSD), social support, and QoL. This is a cross-sectional with 413 participants. Study instruments included the PTSD module of the Composite International Diagnostic Interview (CIDI), the World Health Organization Quality of Life BREF (WHOQoL-BREF), and the Multidimensional Scale of Perceived Social Support (MSPSS). The family domain of social support was protective of both PTSD and QoL. Except for the relationship between community's location and the physical subscale of the QoL, a hierarchical regression analysis showed that all the independent variables were significantly associated with the QoL domains. Direct exposure to crises impaired QoL more than areas indirectly exposed. PTSD and the family domain of social support play a significant role in the QoL outcome. This suggests that therapeutic intervention to improve QoL should target these key variables. [ABSTRACT FROM AUTHOR]

Black people represent less than 13% of the population in the United States, but over 15% of COVID-19 deaths, with a mortality rate two times higher than White people. The Black Church system has historically been in a unique position to serve Black communities, particularly during times of crisis. The deep-rooted connection of the Black Church system within Black communities was largely shaped by slavery and segregation. However, there have been questions about the relevance of the Black Church system today. The objective of this commentary is to describe the intersectionality of ministry and health that has been illuminated in a profound way during this pandemic. Those in leadership had to evaluate and disseminate COVID-19 information to congregants, recognizing mistrust of the medical and public health systems still permeates throughout Black communities. Moreover, the death of George Floyd sparked international outcry, which launched church leaders to respond to a second pandemic: systemic racism. Understanding ways the Black Church responded to COVID-19, and systemic racism, is significantly important to public health and medical communities as it addresses the relevance of this system and ways to appropriately support during another public health crisis. [ABSTRACT FROM AUTHOR]

Background. By 2023, 1,080,000 cases of COVID-19 have been reported in Harris County. Systemic inequity and vaccine hesitancy have contributed to COVID-19 disparities. Community Health Workers provide health education and instrumental support to alleviate health disparities among vulnerable communities. We conducted an analysis of Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis in June 2022 among a broad coalition of Community Health Work stakeholders to better understand the local landscape in the context of the COVID-19 pandemic. Methods. We recruited 33 community health workers and industry stakeholders in Harris County, Texas, to participate in the SWOT analysis. Participants were asked to describe their opinions on the SWOT facing the Community Health Work landscape and then rank the outcomes of the analysis to prioritize action. Results. A total of 19 themes were identified. Weaknesses included lack of respect and resources for Community Health Workers and poor coordination and capacity among the workforce infrastructure. Limited funding and lack of appreciation for Community Health Workers were deemed important threats. Diversity and community connection were critical strengths, and strong education, training, and raising awareness for community health work were considered opportunities to overcome identified weaknesses and threats. Discussion. Increased funding, greater coordination, greater respect, and amplified training can improve capacity for Community Health Workers and, therefore, improve public health outcomes for respiratory illness and viral infections such as COVID-19. This analysis helps fill an important research gap on the topic Community Health Workers responding to public health crises with racially disparate outcomes. [ABSTRACT FROM AUTHOR]

Background.: Community-led health care interventions may be an effective way to tackle cardiovascular disease (CVD) risk factors, especially in materially deprived communities where health care resources are stretched and engagement with institutions is often low. To do so effectively and equitably, interventions might be developed alongside community members through community engagement. Objectives.: The aim of this project was to carry out stakeholder mapping and partnership identification and to understand the views, needs, experiences of community members who would be involved in later stages of a community-based CVD prevention intervention's development and implementation. Methods.: Stakeholder mapping was carried out to identify research participants in three communities in Sussex, United Kingdom. A qualitative descriptive approach was taken during the analysis of focus groups and interviews with 47 participants. Findings.: Three themes were highlighted related to intervention design (a) Management: the suitability of the intervention for the community, management of volunteers, and communication; (b) Logistics: the structure and design of the intervention; and (c) Sociocultural issues, the social and cultural expectations/experiences of participants and implementers. Conclusions.: Study participants were open and willing to engage in the planned community-based intervention, particularly in elements of co-design and community-led delivery. They also highlighted the importance of sociocultural factors. Based on the findings, we developed recommendations for intervention design which included (but were not limited to): (a) a focus on a bottom-up approach to intervention design, (b) the recruitment of skilled local volunteers, and (c) the importance of fun and simplicity. [ABSTRACT FROM AUTHOR]

The Duke University Clinical and Translational Science Institute Community Engaged Research Initiative (CERI) created an e-Library in 2018. This e-Library was developed in response to requests from academic researchers and the community for reliable, easily accessible information about community-engaged research approaches and concepts. It was vetted by internal and external partners. The e-Library's goal is to compile and organize nationally relevant community-engaged research resources to build bi-directional capacity between diverse community collaborators and the academic research community. Key elements of the e-Library's development included a selection of LibGuides as the platform; iterative community input; adaptation during the COVID-19 pandemic; and modification of this resource as needs grow and change. [ABSTRACT FROM AUTHOR]

Purpose: To explore health care providers' (HCP) experiences related to transitions in care from inpatient rehabilitation to the community for patients with limb loss. Materials and Methods: A qualitative study was conducted using semi-structured interviews. Participants were eligible if they were HCPs currently working in amputation rehabilitation at a rehabilitation hospital in Ontario, Canada, with at least 1-year experience in this setting, and could speak and understand English. Data were analyzed thematically using the six-step process of the DEPICT model dynamic reading, engaged codebook development, participatory coding, inclusive reviewing and summarizing of categories, collaborative analyzing and translating. Results: Fourteen HCPs from a variety of health care professions participated in this study. Five key themes describe participants' perspectives on the factors impacting patients' transition in care following limb loss. Specifically, participants emphasized patient preparedness, HCP follow-up, finances and funding, patient self-management skills, and psychosocial support as factors that could influence the transition in care. Conclusion: This study identified challenges to transitions in care for people with limb loss. Future research is needed to evaluate solutions to address these challenges in transitions in care. IMPLICATIONS FOR REHABILITATION: Suboptimal transitions in care can result in readmission to the hospital, emergency department visits, and increased health care costs. Patient preparedness, follow-up, finances and funding, patient self-management skills, and psychosocial support are perceived to influence transitions in care from inpatient rehabilitation to the community. Improved access to follow-up and supports in the community and improved communication across the continuum of care could improve transitions for people with limb loss. [ABSTRACT FROM AUTHOR]

Background: Insomnia is a prevalent condition in Australia that increases the risk of depression and anxiety symptoms. Cognitive behaviour therapy for insomnia (CBT‐i) is the recommended 'first line' treatment but is accessed by a minority of people with insomnia. Aims: To improve CBT‐i access in Australia, we aimed to develop and test a self‐guided interactive digital CBT‐i program. Methods: An online randomised controlled trial was conducted from August 2022 to August 2023 to investigate the effect of digital CBT‐i, versus digital sleep education control, on symptoms of insomnia (ISI), depression (PHQ‐9), anxiety (GAD‐7), fatigue, sleepiness and maladaptive beliefs about sleep at 8‐week follow‐up. The control group accessed the intervention after the 8‐week follow‐up. Questionnaires were additionally administered at 16 and 24 weeks. Intent‐to‐treat mixed models and complete‐case chi‐squared analyses were used. Results: Participants included 62 adults with insomnia symptoms (age M (SD) = 52.5 (16.3), 82% female, ISI = 18.6 (2.9)). There were no between‐group differences in baseline characteristics or missing 8‐week data (14.5%). After adjusting for baseline scores, CBT‐i was associated with lower insomnia (Diffadj (95% CI) = 7.32 (5.0–9.6), P < 0.001, d = 1.64), depression (3.36 (1.3–5.4), p = 0.002, d = 0.84), fatigue (5.2 (2.5–7.9), P < 0.001, d = 1.00) and maladaptive beliefs about sleep (11.0 (4.1–18.0), P = 0.002, d = 0.82), but not anxiety symptoms at 8 weeks (1.84 (−0.1 to 3.8), p = 0.060, d = 0.50). Compared to control, CBT‐i was associated with greater rates of insomnia remission (ISI <8; 0.0%, vs 40.0%, P < 0.001) and response at 8 weeks (ISI reduction ≥6; 7.1% vs 72.0%, P < 0.001). Improvements in insomnia and depression were maintained at 24 weeks in the CBT‐i group. Conclusions: This interactive digital CBT‐i program resulted in large and sustained improvements in symptoms of insomnia, depression, fatigue and maladaptive beliefs about sleep in Australian adults with insomnia symptoms. Implementation programs are required to increase digital CBT‐i access and uptake. [ABSTRACT FROM AUTHOR]

Sudden unexpected infant death (SUID) is a major contributor to infant death and a persistent public health issue. After an initial decline after the 1994 "Back to Sleep" campaign, SUID numbers plateaued. Currently, ~10 infants die suddenly and unexpectedly each day in the United States. In 2019, we established a surveillance system for SUID in Cook County, Illinois, partnering our academic medical center, the Cook County Medical Examiner's Office, and child death review to create the Cook County SUID Case Registry. Our data show that, in Cook County, including the city of Chicago, ~1 infant dies unexpectedly during sleep very week. Of these SUID, ~25% were because of suffocation/possible suffocation. SUID peaks at 30 to 60 days old. SUID rates are 15 times higher in non-Hispanic Black infants and 3 times higher in Hispanic infants, compared with white infants. Nearly all involved 1 or more unsafe sleep factors. SUID are concentrated in community areas experiencing high hardship. Through our Community Partnership Approaches for Safe Sleep--Chicago team, we have developed collaborative prevention approaches in affected communities, allowing for conversations with families and those who support them to better understand barriers to safe sleep that they experience. These partnerships and our data allow for tailoring of informed prevention approaches to address upstream factors driving disproportionate infant mortality in historically disinvested communities, as well as optimizing the immediate risks posed by the infant sleep environment. Data from our system show the number of SUID declining modestly since our prevention work began. [ABSTRACT FROM AUTHOR]

Background: In Malaysia, the unregulated use of antibiotics and lack of awareness about antimicrobial resistance (AMR) among pharmacists pose significant challenges. Implementing community-based Antimicrobial Stewardship (AMS) initiatives is crucial to address the rising AMR. Methods: We developed a bespoke AMS intervention, aligned with the World Health Organization's AMS modules, as a 2-day online educational seminar for community pharmacists. The effectiveness of the workshop was evaluated using pre- and post-seminar questionnaires, focusing on AMS knowledge and attitudes towards antimicrobial usage. Results: Among 528 participants, 489 completed both questionnaires. Pre-seminar, only 59% correctly understood the concept of antibiotic resistance reversibility, which improved to 85.9% post-seminar (p =.002). The average AMS knowledge score increased from 5/10 to 8/10 post-intervention (p <.05). A significant improvement was also noted in pharmacists' ability to select appropriate antibiotic therapies, particularly for urinary tract infections, with an increase from 78% to 90% correct responses. Conclusion: The AMS seminar was well-received and significantly improved the AMS knowledge of community pharmacists. The results underline the need for more AMS-focused interventions in this demographic in Malaysia, contributing to the development of formalized AMS programs. Such initiatives are expected to enhance antibiotic use awareness, encourage optimal antibiotic practices, and positively shift professional conduct in community settings. [ABSTRACT FROM AUTHOR]

Transgender and nonbinary (TNB) people experience elevated rates of posttraumatic stress (PTS) due to transphobic violence, discrimination, microaggressions, and minority stress. Nonbinary people in particular experience unique chronic minority stressors (e.g., misgendering, interpersonal invalidation) because of the assumption that gender is inherently binary. Such examples of oppression against TNB people could contribute to complex PTS (c-PTS) symptoms, which arise due to exposure to chronic, cumulative, and interpersonal trauma. This study aimed to examine how misgendering and invalidation may be associated with PTS and c-PTS symptoms among nonbinary people and whether this association is moderated by pride and community connectedness. Cross-sectional data from 610 nonbinary people living in the United States and Canada were analyzed using hierarchical linear regressions. Misgendering and invalidation had significant positive associations with PTS and c-PTS symptoms. However, pride and community connectedness were not significant moderators of these associations. Findings from this study contribute to the conceptualizations of traumatic stress among nonbinary people and provide considerations for more affirming trauma-informed care. Public Significance Statement: The findings of this study suggest that misgendering and invalidation are associated with trauma symptoms among nonbinary people. Results can be applied to inform nonbinary-affirming clinical practice and advocacy. [ABSTRACT FROM AUTHOR]

BACKGROUND: The school climate concept has been promising, but has long‐standing critiques that have not been adequately addressed to date. The School as a Protective Factor approach represents one attempt to offer a new approach that builds on and extends beyond the concept of school climate while addressing previously identified limitations. CONTRIBUTIONS TO THEORY: The School as a Protective Factor approach offers a new framework for conceptualizing, measuring, and establishing protective school social and learning environments that co‐promote academic achievement and student health in schools, especially student mental health and substance use/abuse prevention. This new framework includes clear definitions, explicit goals, firmly established constructs, validated measures, and an intentionally parsimonious approach that prioritizes the implementation of well‐established, high‐impact constructs. CONCLUSIONS AND IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: The School as a Protective Factor approach presents a simple, easy‐to‐use means of ensuring a school social environment that meets the developmental, academic, and health needs of all children and adolescents while maximizing protection across a range of desired outcomes. Perhaps most importantly, it does so in a manner that is manageable and easily integrated into every aspect of schooling, resonates with the practical experience of school personnel, and includes brief, effective, and free measurement tools. [ABSTRACT FROM AUTHOR]

This article concludes the special issue, Identifying and Closing the Gaps in the Prevention of Disordered Eating and Eating Disorders, by reflecting on some of the shared themes as the bases for guiding improvements, if not innovations, in future research. Overall, the articles in this collection highlight the progress achieved within eating disorders prevention in recent years, while addressing many of the existing—and sometimes glaring—gaps within the field. While these manuscripts represent important steps forward, they also offer conceptual frameworks and methodological roadmaps for future developments in the field. Based on prominent themes across those 12 articles, in this conclusion we recommend that future research within eating disorders prevention prioritize equity within research teams, participants, and research approaches. We encourage partnerships with non-academic teams and communities, as well as with multidisciplinary academic colleagues, to ensure that foundational research is directly translatable into program development and implementation, that our prevention efforts are sustainable over time, and that our research development and participating "audiences" include perspectives currently underrepresented in the literature. We also encourage action-based research in which research teams and other stakeholders consider ways to address policy and other systemic factors that lead to body- and appearance-based oppression and inequality. [ABSTRACT FROM AUTHOR]