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Urinary tract infections (UTIs) make up a significant proportion of the global burden of disease in vulnerable groups and tend to substantially impair the quality of life of those affected, making timely detection of UTIs a priority for public health. However, economic and societal barriers drastically reduce accessibility of traditional lab-based testing methods for critical patient groups in low-resource areas, negatively affecting their overall healthcare outcomes. As a result, cellulose-based materials such as paper and thread have garnered significant interest among researchers as substrates for so-called frugal analytical devices which leverage the material's portability and adaptability for facile and reproducible diagnoses of UTIs. Although the field may be only in its infancy, strategies aimed at commercial penetration can appreciably increase access to more healthcare options for at-risk people. In this review, we catalogue recent advances in devices that use cellulose-based materials as the primary housing or medium for UTI detection and chart out trends in the field. We also explore different modalities employed for detection, with particular emphasis on their ability to be ported onto discreet casings such as sanitary products. [ABSTRACT FROM AUTHOR]

The discharge of older people from hospital at night is a topical and emotive issue that has recently gained media attention in New Zealand and the United Kingdom, including calls to prevent it occurring. With growing pressures on hospital capacity and ageing populations, normative aspects of hospital discharge are increasingly relevant. This paper therefore addresses the question: Should older people (say, over eighty years old) ever be discharged home from hospital during the night? Or given safety concerns, should regulation against the night-time discharge of older people be put in place? Employing a principlist lens to bioethics, this paper considers key principles or values involved, including discharge safety concerns, personal preference and consent, the risk of remaining in hospital, and broader considerations around discharge policy. These points act as a possible framework for further research and discussion of normative aspects of hospital discharge. Overall, this paper argues that while discharge safety concerns must be properly acknowledged and addressed, it can still sometimes be appropriate for an older person to leave hospital at night. The option of night-time discharge should therefore remain open to people of all ages. [ABSTRACT FROM AUTHOR]

Long COVID, also known as "post-acute sequelae of COVID-19," affects at least 65 million individuals worldwide with a wide spectrum of symptoms that may last weeks, months, or permanently. Its epidemiology and burden in Africa are unclear. This meta-analysis examines long-term COVID-19 effects in the WHO African Region. A systematic search in several databases was carried out up to 12 February 2023 including observational studies from African countries reporting the cumulative incidence of long COVID signs and symptoms. Only studies conducted in African countries were included. Several sensitivity and meta-regression analyses were performed. Among 1547 papers initially screened, 25 were included, consisting of 29,213 participants. The incidence of any long COVID symptomatology was 48.6% (95% CI 37.4–59.8) as psychiatric conditions were the most frequent, particularly post-traumatic stress disorder reaching a cumulative incidence of 25% (95% CI 21.1–30.4). Higher age (p = 0.027) and hospitalization (p = 0.05) were associated with a higher frequency of long COVID. Long COVID poses a significant burden in Africa, particularly concerning psychiatric conditions. The study recommends identifying at-risk people and defining treatment strategies and recommendations for African long-COVID patients. High-quality studies addressing this condition in African setting are urgently needed. [ABSTRACT FROM AUTHOR]

Public health officials promoted COVID-19 vaccines to limit burdens placed on the U.S. healthcare system and end the pandemic. People in some closed religious communities refused to vaccinate and likely acquired temporary immunity through infection. This paper compares the death rates in Amish, Old Order Mennonites, and conservative Mennonite groups to a rate estimated for the U.S. population. Approximately two-thirds of the U.S. population was immunized against COVID-19, while few in the Amish/Mennonite community were. We find divergent patterns. Once vaccines became available, excess deaths declined in the general population and remained elevated among Amish and Mennonites. Vaccination campaigns must consider and value the cultural beliefs of closed religious communities to be effective. [ABSTRACT FROM AUTHOR]

Stress fractures likely have a 1–2% incidence in athletes in general. In runners, a more vulnerable population, incidence rates likely range between 3.2 and 21% with female runners having greater susceptibility. The incidence of femoral shaft stress fractures is less well known. New basic and translational science research may impact the way clinicians diagnose and treat femoral stress fractures. By using a fictitious case study, this paper applies bone science to suggest new approaches to evaluating and treating femoral shaft stress fractures in the running population. [ABSTRACT FROM AUTHOR]

This paper explores how Western medicine may not fully understand and address post-traumatic stress disorder (PTSD) and other trauma-induced illnesses in a culturally appropriate manner in marginalized communities and offers a theoretical framework to develop comprehensive, effective, and sustainable solutions that comprehensively address and treat the trauma on both a collective and individual level. Focused on Palestinians, this paper discusses the collective trauma Palestinians experienced and how it manifests in transgenerational effects on the body and mind that may be post-traumatic stress disorder (PTSD) or perhaps another distinct condition that is yet to be codified in the Western medical lexicon. It describes local alternatives to Western medical diagnostic tools like the "ease to disease" diagnostic scale and the sociopolitical context—in this case, the Palestinian fight for karamah, or dignity—from which such alternatives arise. Based on these findings, a novel theoretical framework, the comprehensive communal trauma intervention model (CCTIM), a truly transdisciplinary population-level model for treating mental health in vulnerable communities globally, is proposed. It articulates the need to address the root cause of collective trauma, make modifications to the healthcare system, and cultivate strategic equity-oriented and research-based partnerships. [ABSTRACT FROM AUTHOR]

This paper describes a case study of an Outreach and Drop-in Centre (ODIC) established under the National Action Plan for Drug Demand Reduction, Ministry of Social Justice and Empowerment, Government of India. In the quantitative part, data were gathered from the ODIC office documents and analysed using MS Excel. Linear regression analysis demonstrated a relationship between the number of in-centre clients and the number of Community Outreach Programmes (COPs). Similarly, this study examined the relationship between the number of networks established and the number of participants in COPs. Hence, two regression lines were derived accordingly. In addition, qualitative data collected through key informant interviews corroborated the quantitative results. This case study highlights the importance of networks and COPs in increasing the reach of ODIC and ensuring the quality of services. Finally, in partnership with other government agencies, this ODIC sets a model for engaging marginalised adolescents in reducing substance abuse. [ABSTRACT FROM AUTHOR]

The present project utilized a Learning Collaborative (LC) to disseminate the Behavioral Health Home Plus (BHHP) physical-behavioral health integration model to providers serving two behavioral health populations at risk for adverse health conditions: youth psychiatric residential treatment facilities (five sites) and adult opioid treatment providers (seven sites). Following the positive results of a randomized controlled trial utilizing an LC to implement two behavioral health home models in community mental health provider organizations serving adults with serious mental illness, Community Care Behavioral Health Organization facilitated integration of the models to scale health and wellness supports to additional behavioral health care delivery settings. This paper presents provider results focused on BHHP implementation training, LC implementation, physical health and wellness promotion within sites, and BHHP model sustainment plans. Provider self-reported data indicate that the LC approach is a successful tool for integrating and sustaining BHHP model components in routine care. [ABSTRACT FROM AUTHOR]

Police officers are at risk of being exposed to multiple traumas throughout their careers. Compared to the general population, police officers are also at elevated risk for the development of post-traumatic stress disorder (PTSD), increased suicidal ideation, and increased substance use. Cognitive-behavioral interventions have proven empirical validity for the prevention and treatment of PTSD and complex trauma. However, the efficacy of these interventions in police officers has not been studied. This paper will provide the practitioner with an overview of the factors that contribute to the complexity of trauma exposure in police officers, describe trauma-focused cognitive behavioral therapy as an evidence-based treatment for this population, and illustrate how this treatment can be adapted to better fit the needs of police officers. Implications of these adaptations and suggestions for future areas of intervention research with law enforcement are also described. [ABSTRACT FROM AUTHOR]

Purpose: The bond between mother and child is biological, genetic, spiritual, and unique. In times of intimate partner violence (IPV), mothering continues with efforts to protect and care for their children. The purpose of this project is to understand Indigenous mothering within the contexts of Indigenous identities, IPV, and rural, remote, and northern (RRN) places. Method: A secondary analysis of the Canadian Domestic Homicide Prevention for Vulnerable Populations Phase 3 Database revealed 16 cases identified as Indigenous mothers residing in RRN places. Grounded theory analyses explicated a preliminary theory of 'Colonial Pathways In, Indigenous Pathways Through' the social process of Indigenous mothering through IPV experiences in RRN places. Results: Indigenous mothering through IPV in RRN places is a responsive and embodied experience within a storied space, occurring through three pathways: Colonial pathways' into IPV; survival pathways during IPV; and recovery of cultural identity as providing an escape from IPV, expressed through themes of 1. comparative mothering, 2. continuous hypervigilance, protective nurturance, pursuit of safety, and 3. cultural recovery. Indigenous mothers demonstrates resilience in striving for safety while caring for their children within an IPV context. Conclusions: Indigenous mothering occurs even in the worst of times, such as during IPV. 'Colonial Pathways In, Indigenous Pathways Through' theory increases our understanding of Indigenous mothering in RRN places. Of significance is the occurrence of traumatic brain injury, pointing to the need for recognition that it is occurring and screening and treatment is required. Most of all, the study highlights the resilience, resistance, and resourcefulness of Indigenous mothers striving to keep themselves and their children safe. [ABSTRACT FROM AUTHOR]

Refugees and asylum seekers may experience challenges related to pre-arrival experiences, structural disadvantage after migration and during resettlement requiring the need for special protection when participating in research. The aim was to review if and how people with refugee and asylum seeker backgrounds have had their need for special protection addressed in national and international research ethics guidelines. A systematic search of grey literature was undertaken. The search yielded 2187 documents of which fourteen met the inclusion criteria. Few guidelines addressed specific ethical considerations for vulnerable groups much less people with refugee and asylum seeker backgrounds. One guideline explicitly addressed vulnerability for refugees and asylums seekers. To ensure members of ethics committees and researchers consider the potential challenges of conducting research with these groups, guidelines may need to be supplemented with a refugee and asylum seeker specific research ethics framework. Such a framework may be necessary to optimally protect people with refugee and asylum seeker backgrounds in research. [ABSTRACT FROM AUTHOR]

Purpose: The COVID-19 pandemic broke out at the end of 2019, and throughout 2020 there were intensive international efforts to find a vaccine for the disease, which had already led to the deaths of some five million people. In December 2020, several pharmaceutical companies announced that they had succeeded in producing an effective vaccine, and after approval by the various regulatory bodies, countries started to vaccinate their citizens. With the start of the global campaign to vaccinate the world's population against COVID-19, debates over the prioritization of different sections of the population began around the world, but the prison population has generally been absent from these discussions. Approach and Findings: This article presents the approach of Jewish ethics regarding this issue, that is, that there is a religious and a moral obligation to heal the other and to take care of his or her medical well-being and that this holds true even for a prisoner who has committed a serious crime. Hence, prisoners should be vaccinated according to the same priorities that govern the administration of the vaccine among the general public. Originality: The originality of the article is in a comprehensive and comparative reference between general ethics and Jewish ethics on a subject that has not yet received the proper attention. [ABSTRACT FROM AUTHOR]

Background: In August 2004 a series of debris flows caused significant disruption to the Scottish (strategic) Trunk Road Network. The subsequent Scottish Road Network Landslides Study identified a number of sites considered to be at highest risk. Some of these sites have been the subject of formal quantitative assessment of the risk from debris flow to mobile road users in vehicles. The A82 in Glen Coe has the added complication that two car parks have developed on debris fans exposing significant numbers of people to the risk while, they are essentially static and largely outside their vehicles. Methodology: The risk to road users is determined using a previously developed probabilistic methodology for mobile road users (mobile elements at risk) and a new and related methodology developed for static road users (static elements at risk) is described and applied. Within the latter, an entirely new metric of Annual Average Daily Visits is used to allow the temporal component of the probability of a landslide impacting a person to be determined given the occurrence of an event. Results: While Personal Individual Risk is at an acceptable level, including for frequent users, the risk presented to society as a whole presents a rather different picture; this is largely due to the number of visitors. The results assess the overall, societal risk for mobile elements at risk as As Low As reasonably Practicable, being at a similar level to other sites, albeit with a higher risk associated with higher numbers of fatalities. The results for the static elements at risk on the other hand suggest that the risks are classified as Unacceptable for higher numbers of fatalities. The assessment of the total societal risk, for mobile and static elements at risk, at the A82 Glen Coe suggests As Low As Reasonably Practicable for low numbers of fatalities but classify as Unacceptable for higher numbers of fatalities (around 20 to 250). [ABSTRACT FROM AUTHOR]

This study investigated the risk of heatwaves for people with disabilities and other socioeconomic attributes using Health Care Bigdata in South Korea. The Health Care Bigdata provides detailed information on heat-related illness (HRI) patients in 2011–2020 from seven major cities. We employed the Distributed Lag Nonlinear Model (DLNM) to measure heat waves' relative risk. Our findings are four-fold. First, the relative risk (RR) of disabled people was 5.075 (95% confidence interval 4.476–5.674), significantly surpassing that of non-disabled people, 3.296 (2.517–4.075). Second, among various personal characteristics studied, disability influenced RR the most, exceeding impacts from elderly (4.457: 3.748–5.166), low-income (3.909: 3.004–4.813), and outdoor (4.052: 2.940–5.164). Third, the disabled young group (5.305: 4.414–6.195) was more vulnerable than the non-disabled elderly group (4.287: 3.576–4.999). Lastly, no significant difference in relative risk was observed between the mild (4.413: 3.855–4.971) and severe disabled groups (4.013: 3.121–4.905). [ABSTRACT FROM AUTHOR]

Informal mentoring between youth and adults in their existing social networks can help promote positive and equitable outcomes for disadvantaged young people. Yet little published research exists examining contextual factors that may impact access to this type of beneficial relationship for under-resourced and minoritized youth. Using data from the National Survey of Children's Health (N = 32,883), a logistic regression model was run to examine the presence of an informal mentor in relation to multiple contextual factors: (1) family resources, (2) economic distress, (3) neighborhood resources, and (4) trauma. Four supplemental logistic regression models then were run testing the same relationship between informal mentorship and the identified contextual factors by race/ethnicity group. Results indicate that contextual factors matter in determining which youth have access to informal mentorship. In terms of demographic factors, there also is an indication that race/ethnicity may be more impactful than gender in determining which youth have access to informal mentorship. Several findings in the sub-sample analysis highlight the unique experiences of Black families versus families of other race/ethnicity minorities related to informal mentoring. By foregrounding a person-in-environment perspective in Critical Race Theory, the present study demonstrates how the social work perspective can be used to analyze various contextual factors of marginalization, while maintaining a focused analysis on the presence of systemic racial-inequities. In addition to these theoretical implications, identifying contextual barriers has important implications for practitioners and researchers creating interventions to expand access to informal mentoring relationships for disadvantaged youth. [ABSTRACT FROM AUTHOR]

Community health centers (CHCs) screen patients for social determinants of health (SDoH). The study's purpose was to assess the relationship between demographic factors and unmet social needs (SDoH risk) among pregnant mothers. Patient data from 345 pregnant women between January 2019-December 2020 assessed SDoH risk, using the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) tool. Chi-square analyses explored relationships between social needs and demographic factors, and a multivariate logistic regression examined associations between these variables controlling for covariates. Hispanic patients and those who preferred to speak Spanish had 2.35 and 5.39 times the odds, respectively as non-Hispanic Whites and English speakers of having moderate/high/urgent SDoH risks. Mothers who had not completed high school had increased odds (aOR = 7.38) of SDoH risk. By identifying indicators that increase social risk level, CHCs can connect patients to essential social services, improving the downstream health of mothers and children. [ABSTRACT FROM AUTHOR]

The reduced prevalence of insulin resistance and type 2 diabetes in countries with endemic parasitic worm infections suggests a protective role for worms against metabolic disorders, however clinical evidence has been non-existent. This 2-year randomised, double-blinded clinical trial in Australia of hookworm infection in 40 male and female adults at risk of type 2 diabetes assessed the safety and potential metabolic benefits of treatment with either 20 (n = 14) or 40 (n = 13) Necator americanus larvae (L3) or Placebo (n = 13) (Registration ACTRN12617000818336). Primary outcome was safety defined by adverse events and completion rate. Homoeostatic model assessment of insulin resistance, fasting blood glucose and body mass were key secondary outcomes. Adverse events were more frequent in hookworm-treated participants, where 44% experienced expected gastrointestinal symptoms, but completion rates were comparable to Placebo. Fasting glucose and insulin resistance were lowered in both hookworm-treated groups at 1 year, and body mass was reduced after L3-20 treatment at 2 years. This study suggests hookworm infection is safe in people at risk of type 2 diabetes and associated with improved insulin resistance, warranting further exploration of the benefits of hookworms on metabolic health. A beneficial effect of parasitic worms on metabolic health has been postulated based on epidemiological and animal studies. Here, the authors show in a phase I clinical trial that treatment of people at risk of type 2 diabetes with hookworms is safe and may improve key measures of metabolic health. [ABSTRACT FROM AUTHOR]

Non–extenstive statistics play a significant role in studying the dynamic behaviour of COVID-19 to assist epidemiological scientists to take appropriate decisions about pandemic planning. Generic non–extensive and modified–Tsallis statistics are used to analyze and predict the morbidity and mortality rates in future. The cumulative number of confirmed infection and death in Egypt at interval from 4 March 2020 till 12 April 2022 are analyzed using both non–extensive statistics. Also, the cumulative confirmed data of infection by gender, death by gender, and death by age in Egypt at interval from 4 March 2020 till 29 June 2021 are fitted using both statistics. The best fit parameters are estimated. Also, we study the dependence of the estimated fit parameters on the people gender and age. Using modified–Tsallis statistic, the predictions of the morbidity rate in female is more than the one in male while the mortality rate in male is greater than the one in female. But, within generic non-extensive statistic we notice that the gender has no effect on the rate of infections and deaths in Egypt. Then, we propose expressions for the dependence of the fitted parameters on the age. We conclude that the obtained fit parameters depend mostly on the age and on the type of the statistical approach applied and the mortality risk increased with people aged above 45 years. We predict - using modified–Tsallis - that the rate of infection and death in Egypt will begin to decrease till stopping during the first quarter of 2025. [ABSTRACT FROM AUTHOR]

Community health workers (CHWs), or promotores de salud, have long played a role in health promotion, but the COVID-19 pandemic has brought renewed attention to the functions, sustainability, and financing of CHW models. ¡Andale! ¿Que Esperas? was a 12-month (June 2021–May 2022) campaign that expanded the CHW workforce to increase COVID-19 vaccination rates in structurally vulnerable, Latinx communities across California. This mixed-methods evaluation aims to elucidate (1) the role of CHWs in COVID-19 response, recovery, and rebuilding and (2) the importance, needs, and perils of CHW models in the COVID-19 era and beyond. CHWs facilitated 159,074 vaccinations and vaccine appointments by countering mis/disinformation, addressing mental health and social needs, building digital competencies, and meeting people where they are, all of which expanded access and instilled confidence in the COVID-19 vaccine. CHWs' success in engaging the community lies in their shared lived experience as well as their accessibility and recognition in the community, enabling their role in both immediate response and long-term recovery. Funding instability imperils the advances made by CHWs, and efforts are needed to institutionalize the CHW workforce with sustainable funding models. While Medicaid reimbursement models exist in some states, these models are often limited to healthcare services, overlooking a critical function of the CHW model: building community resilience and mobilizing the community for social change. [ABSTRACT FROM AUTHOR]

How do we judge others' behavior when they are both seen and not seen—when we observe their behavior but not the underlying traits or history that moderate the perceived riskiness of their behavior? We investigate this question in the context of the COVID-19 pandemic: How people make sense of, and judge, vaccination-contingent behaviors—behaviors, such as going to the gym or a bar, which are considered to be more or less risky and appropriate, depending on the target's vaccination status. While decision theoretic models suggest that these judgments should depend on the probability that the target is vaccinated (e.g., the positivity of judgments should increase linearly with the probability of vaccination), in a large-scale pre-registered experiment (N = 936) we find that both riskiness and appropriateness judgments deviate substantially from such normative benchmarks. Specifically, when participants judge a stranger's behavior, without being asked to think about the stranger's vaccination status, they tend to judge these behaviors similarly positively to behaviors of others who are known to be fully vaccinated. By contrast, when participants are explicitly prompted to think about the vaccination status of others, they do so, leading them to view others more disparagingly, at times even more negatively than what a normative benchmark would imply. More broadly, these results suggest new directions for research on how people respond to risk and ambiguity. We demonstrate that even subtle cues can fundamentally alter what information is "top of mind," that is, what information is included or excluded when making judgments. [ABSTRACT FROM AUTHOR]

Background: There is no characterization of resource use in the hospital setting for immigrants in Colombia, we aimed to describe the resource use by Venezuelan immigrants, comparing those enrolled in the national health insurance system with those with and without the ability to pay. Methods: Retrospective review in the billing data system of our Hospital from 2011 to 2020. We collected information for 6,837 hospital episodes associated with 1,022 Venezuelan patients, hospital's billing information for all services rendered was extracted. Results: The mean cost per patient event were 4,595 USD for those without the ability to pay, costing 2.37 times more than a legal resident insured. Care in the ICU, inpatient days, surgery, and OB-GYN department consume most resources provided to vulnerable migrants. Discussion: Enrolment in the national health insurance may allow better access to health services by vulnerable Venezuelan migrants and thus reduce resource use for the health system. [ABSTRACT FROM AUTHOR]

This study aimed to better understand the factors driving reported trends in domestic violence during the COVID-19 pandemic, particularly the effect of the pandemic on survivors' experiences of violence and ability to seek support. We conducted semi-structured qualitative interviews with 32 DV service providers operating in organizations across 24 U.S. cities. The majority of providers described a decrease in contact volume when shelter-in-place orders were first established, which they attributed to safety concerns, competing survival priorities, and miscommunication about what resources were available. For most organizations, this decrease was followed by an increase in contacts after the lifting of shelter-in-place orders, often surpassing typical contact counts from the pre-pandemic period. Providers identified survivors' ability to return to some aspects of their pre-pandemic lives, increased stress levels, and increased lethality of cases as key factors driving this increase. In addition, providers described several unique challenges faced by DV survivors during the pandemic, such as the use of the virus as an additional tool for control by abusers and an exacerbated lack of social support. These findings provide insight into the lived experiences driving observed trends in DV rates during COVID-19. Understanding the impact of the pandemic on survivors can help to shape public health and policy interventions to better support this vulnerable population during future crises. [ABSTRACT FROM AUTHOR]

Although empirical studies have documented associations between posttraumatic stress symptoms (PTSS) and parenting among various high-risk populations, there is a relatively limited amount of research on paternal parenting among veterans. Moreover, the understanding of possible mechanisms which may account for this effect is severely lacking. This study examined associations between military related PTSS and parenting sense of competence (PSOC) among veteran fathers. Furthermore, we examined the mediating role of experiential avoidance (EA) and parental reflective functioning (PRF) in the association between PTSS and PSOC. Participants were 189 Israel Defense Forces (IDF) male combat veterans (mean age = 30.03) who completed a set of validated self-report questionnaires in a cross-sectional design study. Results showed negative associations between PTSS and PSOC-parental satisfaction but not parental efficacy. Furthermore, EA mediated the association between PTSS and parental satisfaction and efficacy; PRF- Pre mentalizing modes mediated the association between PTSS and parental satisfaction. Our findings imply that EA and PRF may serve as mechanisms of the association between PTSS and PSOC among veteran fathers. These findings are discussed in light of a psychological trauma perspective, and clinical implications to increase fathers' mentalization and psychological flexibility are suggested. Highlights: We examined predictors of parenting sense of competence (PSOC) among veteran fathers. PTSS was negatively associated with parental satisfaction, but not parental efficacy. Experiential avoidance mediated the association between PTSS and PSOC. Pre mentalizing modes mediated the association between PTSS and parental satisfaction. [ABSTRACT FROM AUTHOR]

Automated vehicles (AVs) have garnered increasing attention since they have the potential to dramatically reshape our lives in the near future. At the same time, people are concerned about various risks associated with the new technologies. Thus, people's attitudes toward AVs pose a major challenge to the wider adoption of them. Previous studies examined the effect of benefit/risk perception on people's acceptance of AVs, but they did not address the multidimensionality of benefit/risk perception. We conducted a survey (n = 840) to reveal the underlying dimensions of how people construe the benefits and risks of conditionally/fully automated vehicles. Our results showed that there were two dimensions underlying benefit perception (i.e., the perception that AVs would increase convenience and reduce harm) and three dimensions underlying risk perception (i.e., the perception of risk to physical safety and comfort, cybersecurity, and ease of use). The perception that AVs would reduce harm positively impacted people's intention to use both fully automated vehicles and conditionally automated vehicles. The perception that AVs would increase convenience and the perception that AVs would pose a risk to ease of use had a positive and negative effect, respectively, on intention to use fully automated vehicles. This study makes theoretical contributions by questioning the assumption that benefit/risk perception is a one-dimensional factor that impacts people's acceptance of AVs. This study also has practical implications as it suggests an effective method for automobile manufacturers and policymakers to communicate with the public regarding the new technologies and diffuse them safely. [ABSTRACT FROM AUTHOR]

Objectives: Social and structural barriers drive disparities in prenatal care utilization among minoritized women in the United States. This study examined the impact of Arizona's Health Start Program, a community health worker (CHW) home visiting intervention, on prenatal care utilization among an ethno-racially and geographically diverse cohort of women. Methods: We used Health Start administrative and state birth certificate data to identify women enrolled in the program during 2006–2016 (n = 7,117). Propensity score matching was used to generate a statistically-similar comparison group (n = 53,213) of women who did not participate in the program. Odds ratios were used to compare rates of prenatal care utilization. The process was repeated for select subgroups, with post-match regression adjustments applied where necessary. Results: Health Start participants were more likely to report any (OR 1.24, 95%CI 1.02–1.50) and adequate (OR 1.08, 95%CI 1.01–1.16) prenatal care, compared to controls. Additional specific subgroups were significantly more likely to receive any prenatal care: American Indian women (OR 2.22, 95%CI 1.07–4.60), primipara women (OR 1.64, 95%CI 1.13–2.38), teens (OR 1.58, 95%CI 1.02–2.45), women in rural border counties (OR 1.45, 95%CI 1.05–1.98); and adequate prenatal care: teens (OR 1.31, 95%CI 1.11–1.55), women in rural border counties (OR 1.18, 95%CI 1.05–1.33), primipara women (OR 1.18, 95%CI 1.05–1.32), women with less than high school education (OR 1.13, 95%CI 1.00-1.27). Conclusions for Practice: A CHW-led perinatal home visiting intervention operated through a state health department can improve prenatal care utilization among demographically and socioeconomically disadvantaged women and reduce maternal and child health inequity. Significance: What is already known on this subject? Prenatal care is associated with improved maternal and child health outcomes, but significant social and structural determinants affect utilization of services among minority women in the US. Home visiting programs have contributed to early initiation of and recommended frequency of prenatal care among health disparate populations. What does this study add? Most empirical studies of prenatal home visitation programs include teams with licensed health professionals. Arizona's Health Start Program is one of few home visiting interventions associated with increased prenatal care utilization in which CHWs are the primary interventionists. Impact of a community health worker (CHW) home visiting intervention on any and adequate prenatal care among ethno-racially diverse pregnant women of the US Southwest. [ABSTRACT FROM AUTHOR]

Choices under risk often have consequences for ourselves and others. Yet, it is unclear how the other's identity (stranger, close friend, etc.) influences risky choices made on their behalf. In a mixed within and between subjects design, two participant groups made three series of risky economic decisions: for themselves, another person, or for both themselves and another person (i.e., shared outcomes). One group made choices involving a same-sex stranger (n = 29), the other made choices involving a same-sex close friend (n = 28). Hierarchical Bayesian estimation of computations underlying risky decision-making revealed that relative to choosing for themselves, people were more risk averse, loss averse, and consistent when choices involved another person. Partner identity was additionally crucial: people became risk neutral and more consistent when choosing for friends relative to strangers. These findings establish that the complexity of the social world is mirrored in its nuanced consequences for our choices. [ABSTRACT FROM AUTHOR]

For children the consequences of the COVID-19 public health measures may have long-term effects into adulthood. By exploring children's reactions more broadly, we are better placed to understanding the breadth of implications of home school and social isolation under COVID-19. The present study explored how COVID-19 related variables, namely, home school experience, child perceived family stress and instability, screen time use, missing friends and worry about virus infection are associated with children's emotional, somatic/cognitive and worry reactions, respectively. A total of 442 children (M = 11.43 years, SD = 2.59) from the longitudinal FamilieForSK-study participated and a series of hierarchical linear regression models were applied controlling for background variables including children's psychological vulnerability. Results showed significant associations between all COVID-19 related predictors, except screen time use, and the three outcomes. Family stress and instability had the strongest effects with standardised betas ranging from.356 to.555 and collectively, predictors explained between 20.7 and 44.1% of variance in outcomes. Furthermore, several associations were moderated by age and older children were more negatively impacted (i.e., higher level of reported reactions). The present study provides more conclusive evidence of the effects of home school and social isolation under COVID-19 on children. It also exemplifies the importance of focusing on children's reactions more broadly, as there was evidence that children on average had fewer emotional reactions compared to before the pandemic. [ABSTRACT FROM AUTHOR]

Engagement in lifelong HIV care is critical for both patient and public health, yet there are limited resources to invest in improving HIV outcomes. We systematically reviewed evidence on the cost-effectiveness of retention and re-engagement interventions. We searched five databases for peer-reviewed studies published between 2010 and 2020. We assessed reporting and methods quality, extracted data on target populations, interventions, and cost-effectiveness, and evaluated overall strength of evidence. Eleven studies met inclusion criteria, and eight had moderate-high quality. Cost-effectiveness estimates ranged from cost-saving to over $1,000,000/quality-adjusted life year (QALY) gained. Of the 73 cost-effectiveness ratios reported, 64% were < $100,000/QALY gained. Interventions were more likely to be cost-effective when targeted to high-risk groups, implemented in locations where baseline retention levels were low, and when used in combination with other high-impact HIV interventions (such as prevention). Overall, existing evidence is moderately strong that retention and/or re-engagement interventions can be cost-effective in high-income countries. [ABSTRACT FROM AUTHOR]

We aimed to conduct a head-to-head comparison of the five-level version of the EuroQol five-dimensional questionnaire (EQ-5D-5L) and the Assessment of Quality of Life-6D (AQoL-6D) in measuring health-related quality of life (HRQoL) of older people at risk of osteoporotic fracture. Participants (n = 291) were recruited from the Third Affiliated Hospital of Sun Yat-Sen University. Study participants were asked to complete the EQ-5D-5L and the AQoL-6D and the results were converted to health-state utilities (HSUs) using population-specific scoring algorithms. The agreement among HSUs was evaluated using the intraclass correlation coefficient and illustrated using Bland–Altman plots. The minimally important difference (MID) for the EQ-5D and AQoL was set at 0.074 and 0.06. Information on socio-demographic background, socio-economic status and clinical risk factors in FRAX® was collected. Nonparametric statistics were used to explore the known-group validity measured by fracture risk. Mean (median) EQ-5D-5L and AQoL-6D HSUs were 0.73(0.83) and 0.74(0.79) for the study population. The EQ-5D-5L and the AQoL-6D HSUs strongly agreed and the HSU difference reached the MID level in both instruments. While a decreasing trend of AQoL-6D utilities was observed with worsening bone mineral density, EQ-5D-5L HSUs were similar in individuals with normal and osteopenic bone mineral densities. The AQoL-6D was also effective for measuring difference in independent living, relationships, mental health, coping and pain. Both instruments showed good known-group validity. The EQ-5D-5L and AQoL-6D are all valid measures for older people at risk of osteoporotic fracture. [ABSTRACT FROM AUTHOR]

Tattoos of formerly gang-involved and incarcerated individuals can negatively impact their ability to reintegrate into society. Laser tattoo removal is essential to helping individuals obtain employment, re-cultivate positive relationships, and disengage from gangs. The objective of this study is to describe the demographics and motivations for laser tattoo removal at a large nonprofit clinic. This was a single center retrospective study conducted on patients presenting to Ya'stuvo Tattoo Removal between January 2016-December 2018 and had at least three laser tattoo removal sessions. Data was recorded on patient demographics, geographic location of residence (e.g. zipcode), comorbidities, probation/parole status, referral source, transportation mode, and motivations for receiving and removing tattoos. A representative sample of 862 patients was used to conduct our analysis. Average age at first visit was 30. 16% (n = 134) were on probation, 8% (n = 66) were on parole, and 63% (n = 544) did not report their probation/parole status. Reasons for receiving a tattoo included gangs (46%, n = 368), a current or ex-relationship (28%, n = 223), and decoration (20%, n = 159). The most common reasons for tattoo removal were employment (66%, n = 546), readiness to change life (47%, n = 392), maturity (47%, n = 392), family (43%, n = 356), and negative attention from tattoos (37%, n = 303). The current study highlights the importance of laser tattoo removal in reintegration and gang disengagement. Expanding cost efficient laser tattoo removal is paramount to meet the safety and socioeconomic needs of this population. [ABSTRACT FROM AUTHOR]

More than 30 years after it was first proposed as a biodiversity conservation strategy, rewilding remains a controversial concept. There is currently little agreement about what the goals of rewilding are, and how these are best achieved, limiting the utility of rewilding in mainstream conservation. Achieving consensus about rewilding requires agreeing about what "wild" means, but many different definitions exist, reflecting the diversity of values in conservation. There are three key debates that must be addressed to find a consensual definition of "wild": (1) to which extent can people and "wild" nature co-exist?; (2) how much space does "wild" nature need? and (3) what kinds of "wild" nature do we value? Depending on the kinds of "wild" nature rewilding aims to create, rewilding policy will be faced with managing different opportunities and risks for biodiversity and people. [ABSTRACT FROM AUTHOR]

Non-migration is an adaptive strategy that has received little attention in environmental migration studies. We explore the leveraging factors of non-migration decisions of communities at risk in coastal Bangladesh, where exposure to both rapid- and slow-onset natural disasters is high. We apply the Protection Motivation Theory (PMT) to empirical data and assess how threat perception and coping appraisal influences migration decisions in farming communities suffering from salinization of cropland. This study consists of data collected through quantitative household surveys (n = 200) and semi-structured interviews from four villages in southwest coastal Bangladesh. Results indicate that most respondents are unwilling to migrate, despite better economic conditions and reduced environmental risk in other locations. Land ownership, social connectedness, and household economic strength are the strongest predictors of non-migration decisions. This study is the first to use the PMT to understand migration-related behaviour and the findings are relevant for policy planning in vulnerable regions where exposure to climate-related risks is high but populations are choosing to remain in place. [ABSTRACT FROM AUTHOR]

To analyze the impact of housing instability and social risk facts on food insecurity using resource center client information. We utilized 2-1-1 San Diego's client database to analyze the association of food insecurity and housing instability among residents from August 2017 to March 2020. 3468 clients had food or housing needs assessed by a risk rating scale. A multiple logistic regression model analyzed the associations between food insecurity and social risk factors including housing, transportation, utility bills, criminal justice, and medical debt. Multiple logistic regression indicates that those with housing instability encounter significantly greater risk of food insecurity (AOR 1.2) for homeless-sheltered, (AOR 2.1) for homeless-unsheltered. Also, utility needs (AOR 1.2) is significantly associated with food insecurity. However, those with medical debt are 48% less likely to have food insecurity. Approximately 77% of clients experienced food insecurity. Those with food insecurity also experienced higher needs in housing and other social risk factors. By further researching the association of food insecurity, housing instability, and other social needs in a population, we can better inform public health strategies that focus on proactive community and resource planning. [ABSTRACT FROM AUTHOR]

The objective of this study is to describe the longitudinal patterns of depression, anxiety, and stress symptoms from pregnancy to 5 years postpartum, in a cohort of Australian mothers experiencing adversity. Longitudinal data were drawn from the control group of a trial of nurse home visiting. Pregnant women experiencing adversity (≥ 2 of 10 adversity risk factors) were recruited from antenatal clinics across 2 Australian states (30 April 2013–29 August 2014). Women completed the Depression Anxiety and Stress Scales short-form (DASS-21) at 11 time-points from pregnancy to 5 years postpartum. DASS-21 scores were summarized at each time-point for all women and by level of adversity risk. Three hundred fifty-nine women (100%) completed the DASS-21 in pregnancy and 343 (96%) provided subsequent data. Mental health symptoms were highest in pregnancy and at 4 and 5 years postpartum. While this pattern was comparable across levels of antenatal adversity risk, women with greatest adversity risk had consistently higher mental health symptoms. In a cohort of mothers experiencing adversity, depression, anxiety, and stress symptoms were highest in pregnancy and at 4 to 5 years postpartum. The striking patterns of persistent, high, mental health symptoms, beyond the first year postpartum, can inform a more equitable and responsive health system. [ABSTRACT FROM AUTHOR]

"Street psychiatry" is an innovative model that serves people experiencing unsheltered homelessness, a vulnerable population with increased rates of mental illness and substance use disorders. Through community-based delivery of mental health and addiction treatment, street psychiatry helps the street-dwelling population overcome barriers to accessing care through traditional routes. Throughout the United States, street psychiatry programs have arisen in multiple cities, often in partnership with street medicine programs. We discuss the philosophy of street psychiatry, document operational highlights involved in the development of a street psychiatry program in New Haven, CT, suggest key ingredients to implementing a street psychiatry program, and explore challenges and future frontiers. Street psychiatry is an effective person-centered model of service delivery with the potential to be applied in a variety of urban settings to serve people experiencing street homelessness. [ABSTRACT FROM AUTHOR]

Background: Concerns exist about the ability of safety net health care organizations to participate in US health care reform. Primary care practices are key to several efforts, but little is known about how capabilities of primary care practices serving a high share of disadvantaged patients compare to other practices.Objective: To assess capabilities around access to and quality of care among primary care practices serving a high share of Medicaid and uninsured patients compared to practices serving a low share of these patients.Design: We analyzed data from the National Survey of Healthcare Organizations and Systems (response rate 46.8%), conducted 2017-2018.Participants: A total of 2190 medical practices with at least three adult primary care physicians.Main Measures: Our key exposures are payer mix and federally qualified health center (FQHC) designation. We classified practices as safety net if they reported a combined total of at least 25% of annual revenue from uninsured or Medicaid patients; we then further classified safety net practices into those that identified as an FQHC and those that did not.Key Results: FQHCs were more likely than other safety net practices and non-safety net practices to offer early or late appointments (79%, 55%, 62%; p=0.001) and weekend appointments (56%, 39%, 42%; p=0.03). FQHCs more often provided medication-assisted treatment for opioid use disorders (43%, 27%, 25%; p=0.004) and behavioral health services (82%, 50%, 36%; p<0.001). FQHCs were more likely to screen patients for social and financial needs. However, FQHCs and other safety net providers had more limited electronic health record (EHR) capabilities (61%, 71%, 80%; p<0.001).Conclusion: FQHCs were more likely than other types of primary care practices (both safety net practices and other practices) to possess capabilities related to access and quality. However, safety net practices were less likely than non-safety net practices to possess health information technology capabilities. [ABSTRACT FROM AUTHOR]

Objectives: To assess the prevalence of delirium (DEL) among older patients living at home and periodically visited by their General Practitioners (GPs). Design: Observational study. Setting: In Italy, programmed home visits by the GPs are regularly scheduled for their vulnerable and frail patients who are often on poly-drug regimens and suffering from dementia. Participants: N = 102 patients among those receiving programmed home visits by n = 6 GP based in the Brianza area (Lombardy). Measurements: Patients were screened for delirium with the Italian version of the 4AT, with a score ≥ 4 considered as a positive indicator for DEL. The Charlson Comorbidity Index (CCI), the Short Physical Performance Battery (SPPB), the presence of dementia, and benzodiazepine (BZD) use were recorded. Results: DEL+ was detected in almost half of the recruited sample (44.1%), and it was clearly associated with increased comorbidity and decreased motor abilities. Pre-existing dementia was documented in most of DEL+ patients (71.1%), while this was the case for only a minority of DEL- (5.2%, p < 0.00001). Analogously, BZD use was over-represented in the DEL+ group with respect to the DEL− one (73.3% vs. 22.8%, p < 0.00001). Conclusions: DEL prevalence as detected by GP during programmed home visits is surprisingly high, and related to motor impairment, comorbidities (among which dementia), and BZD use. DEL prompt recognition should be one of the goals of GP-programmed home visits, since this treatable and preventable condition is associated to an elevated burden of frailty and risk of death. [ABSTRACT FROM AUTHOR]

The SAVA syndemic is frequently used to describe the co-occurrence of HIV, gender-based violence (GBV), and substance use. In this study we determine the extent to which the typologies of the SAVA syndemic can be described and utilized for intervention strategies among youth living in the slums of Kampala, Uganda. We analyzed the "Kampala Youth Survey 2014," a cross-sectional survey conducted in the spring of 2014, consisting of a convenience sample (N = 1134) of urban youth (12–18 years of age). Descriptive statistics were computed for hypothesized risk factors and demographic variables among the 8 typologies of GBV, HIV, and alcohol use. Multinomial logistic regression was conducted to determine statistically significant correlates with each typology. The overall prevalence of GBV was 31.7%, whereas the overall prevalence of alcohol use in the past 12 months was 31.2%. HIV-Positive youth comprised 10.5% of the total sample. Females comprised the majority of the typology with no SAVA components compared to males (55% vs. 45%, respectively), as well as the SAVA syndemic typology (GBV + HIV + ALC +) (58% vs. 42%, respectively). Engaging in commercial sex work (36%), witnessing parental abuse (61%), and depression/suicidality (81%) were all highly prevalent among youth in the SAVA syndemic typology (GBV, HIV, and alcohol use). Sex work and observing parental abuse were associated with the SAVA syndemic typology in the multivariable model. In our study, alcohol rarely coexisted without GBV among the typologies. Therefore, prevention efforts including structural interventions may be particularly warranted in vulnerable populations to address alcohol use, which may directly or indirectly impact GBV and HIV. [ABSTRACT FROM AUTHOR]

This study was designed to examine the effectiveness of an evidence-based parenting program—Triple P Positive Parenting Program—in shelter settings for families experiencing homelessness. The intervention has not previously been evaluated in a shelter setting, where there is a critical need for evidence-based parenting programs. Using a within-group pre- and post-intervention with 3-month follow-up design, 39 mothers residing in a shelter with a child ages 2–6 years participated. Results of this preliminary study showed positive effects of Triple P Discussion Groups. There were significant improvements in mother-reported parenting practices and child behavior across time, but no change in child maltreatment risk as measured by the Brief Child Abuse Potential Inventory. Mothers rated satisfaction with the program high immediately after the group and again three weeks later. Results showed Triple P Discussion Groups are acceptable and have some positive effects for this vulnerable population in need of parenting support. We discuss implications of findings, limitations of the study (including a 33% attrition rate), and recommendations for further study. Highlights: Evaluated Triple P Discussion Groups delivered in shelters for homeless families. Parenting improved; child problem behaviors reduced; no effects on abuse risk. Mothers were highly satisfied with all aspects of the intervention. [ABSTRACT FROM AUTHOR]

Aim: To analyze the effects that the reform of the public health model of Ecuador has had on the deployment of a comprehensive health care system, taking into special consideration its capacity to respond to social inequalities in health. Methods: We carried out a systematic review of the literature following the PRISMA checklist in the Scopus and Google Scholar databases. Screening identified 20 documents for inclusion in the review. Results: Health reform in Ecuador has promoted the creation of a primary care model with a special focus on vulnerable groups and health inequities. However, a history of a dispersed and fragmented health care system, the geographical distribution of health professionals, the tradition of biomedical models of health practices, and structural inequities remain important challenges. Conclusions: We found evidence of substantial improvements in the structure and coverage of the health system towards a model of unified health care that prioritizes comprehensive primary care. The political and social changes of the last decade and the reform of the health model in Ecuador have provided a framework for the construction of a socially committed health caresystem. However, there are significant shortcomings and challenges that need to be resolved in order to reduce the conditions of notorious social inequality in health still found in Ecuador. [ABSTRACT FROM AUTHOR]