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This study examined the effect of gaming context on young children’s prosocial behaviors. Dyads of 4- to 5-year-old children (N = 96) played the same game cooperatively, competitively, or solitarily. After playing the game for a total of ten minutes, sharing with and social inclusion of uninvolved third-parties as well as free play with previous co-players was observed. Children shared less with third-parties after playing the game competitively than after playing it cooperatively. Playing a solitary game resulted in intermediate levels of sharing. The structure of the game did not differentially impact measures of social inclusion or free play. [ABSTRACT FROM AUTHOR]

Background: Although scabies is estimated to be one of the most common skin conditions globally, prevalence data is not available in most settings. Disease mapping is required to develop and monitor successful control programs. Non-expert health workers are likely to play an important role in scabies mapping activities in endemic settings. Methodology: Four non-expert health workers were trained in the diagnosis of scabies and impetigo. The health worker diagnosis was compared to a reference consensus diagnosis of two doctors experienced in diagnosis. The study was conducted in a primary school in Gizo, Solomon Islands, in August 2018. The six examiners consecutively assessed school students, blinded to each other’s findings. Training and diagnostic procedures followed criteria for scabies diagnosis established by the International Alliance for the Control of Scabies in 2018. Principal findings: Amongst the 171 students who underwent clinical assessment the prevalence of scabies and impetigo according to the reference standard was 55% and 45% respectively. Sensitivity of the non-expert health workers’ diagnosis compared to the reference standard was 55.3% for scabies (95% confidence interval [CI], 50.1–60.4) with a specificity of 89.9% (95% CI 86–93.1) and 52.6% for impetigo (95% CI 46.9–58.3) with a specificity 97.8% (95% CI 95.7–99). Sensitivity for moderate to severe scabies was 93.5% (95% CI 86.3–97.6) with a specificity of 74% (95% CI 70.2–77.5). Conclusions: Following brief training, the diagnostic accuracy of non-expert health workers for scabies and impetigo was promising, especially for moderate to severe disease. Modifications to training and processes are recommended to further improve accuracy. The diagnosis by non-expert health workers may be acceptable for scabies and impetigo mapping in endemic areas. [ABSTRACT FROM AUTHOR]

Background: French Guiana, a French overseas department located in South America between Brazil and Surinam, is the only European territory geographically located in the Amazonian forest complex and is considered endemic for yellow fever (YF). In the context of the emergent threat of YF in Latin America, we conducted a large household cross-sectional survey from June to October 2017 to estimate vaccination coverage in the population and to determine associations with sociodemographic and geographical characteristics. Methodology/Principal findings: In total, 1,415 households and 2,697 individuals were included from the 22 municipalities of French Guiana. YF vaccination coverage was estimated at 95.0% (95% CI: 93.4–96.2) in the entire territory but was spatially heterogeneous, with the lowest levels estimated in the western part of the territory along the Surinamese cross-border region, particularly in children under 16 years who were not enrolled in school, immigrant adults and disadvantaged populations with low socioeconomic indexes. Conclusions/Significance: Despite the good vaccination coverage against YF in the general population of French Guiana resulting from the compulsory nature of YF vaccination for residents and travelers, there is an urgent need to improve vaccination coverage in vulnerable populations living in the northwestern part of the territory to limit the risk of transmission in the context of the emerging YF threat in South America. Despite the relative rarity of YF and the significant number of infectious and tropical diseases in French Guiana, clinicians should adopt a high index of suspicion for YF, particularly in vulnerable and at-risk populations. [ABSTRACT FROM AUTHOR]

Background: Active living approaches seek to promote physical activity and reduce sedentary time across different domains, including through active travel. However, there is little information on how movement behaviours in different domains relate to each other. We used compositional data analysis to explore associations between active commuting and patterns of movement behaviour during discretionary time. Methods and findings: We analysed cross-sectional and longitudinal data from the UK Biobank study. At baseline (2006–2010) and follow up (2009–2013) participants reported their mode of travel to work, dichotomised as active (walking, cycling or public transport) or inactive (car). Participants also reported activities performed during discretionary time, categorised as (i) screen time; (ii) walking for pleasure; and (iii) sport and do-it-yourself (DIY) activities, summed to produce a total. We applied compositional data analysis to test for associations between active commuting and the composition and total amount of discretionary time, using linear regression models adjusted for covariates. Adverse events were not investigated in this observational analysis. The survey response rate was 5.5%. In the cross-sectional analysis (n = 182,406; mean age = 52 years; 51% female), active commuters engaged in relatively less screen time than those who used inactive modes (coefficient -0.12, 95% confidence interval [CI] -0.13 to -0.11), equating to approximately 60 minutes less screen time per week. Similarly, in the longitudinal analysis (n = 4,323; mean age = 51 years; 49% female) there were relative reductions in screen time in those who used active modes at both time points compared with those who used inactive modes at both time points (coefficient -0.15, 95% confidence interval [CI] -0.24 to -0.06), equating to a difference between these commute groups of approximately 30 minutes per week at follow up. However, as exposures and outcomes were measured concurrently, reverse causation is possible. Conclusions: Active commuting was associated with a more favourable pattern of movement behaviour during discretionary time. Active commuters accumulated 30–60 minutes less screen time per week than those using inactive modes. Though modest, this could have a cumulative effect on health over time. [ABSTRACT FROM AUTHOR]

The increased visibility of bullying cases has led the scientific community to be more interested in analysing the factors affecting these behaviours in order to reduce bullying cases and their negative consequences. The aim of this study was to define and contrast an explanatory model that makes it possible to analyse the relationships between self-concept, empathy and violent behaviours in schoolchildren through structural equation analysis. The sample of this study is made up of 734 schoolchildren from the province of Granada (Spain), both male and female, aged between 10 and 12, and it consists of analysing self-concept (AF-5), empathy levels (TECA) and violent behaviour at schools (ECV). A structural equation model was performed and successfully adjusted (χ2 = 563.203; DF = 59; p < 0.001; CFI = 0.943; NFI = 0.937; IFI = 0.943; RMSEA = 0.076). A positive and direct relationship between self-concept and cognitive empathy has been found; manifest aggression is negatively related to self-concept. Similarly, affective empathy has a negative relationship with relational aggression. The main conclusions of this study are that the levels of self-concept and empathy represent protective factors against the development of violent and victimisation behaviours in schoolchildren. [ABSTRACT FROM AUTHOR]

Physicians currently spend as much as half of their day in front of the computer. The Electronic Health Record (EHR) has been associated with declining bedside skills and physician burnout. Medical student EHR use has not been well studied or characterized. However, student responsibilities for EHR documentation will likely increase as the Centers for Medicare and Medicaid Services (CMS) most recent provisions now allow student notes for billing which will likely increase the role of medical student use of the EHR over time. To gain a better understanding of how medical students use the EHR at our institution, we retrospectively analyzed 6,692,994 EHR interactions from 49 third-year clerkship medical students and their supervising physicians assigned to the inpatient medicine ward rotation between June 25 2015 and June 24 2016 at a tertiary academic medical center. Medical students spent 4.42 hours (37%) of each day at the on the EHR and 35 minutes logging in from home. Improved understanding of student EHR-use and the effects on well-being warrants further attention, especially as EHR use increases with early trainees. [ABSTRACT FROM AUTHOR]

In this study, we assessed the factor structure and construct validity of the parent-reported Inventory of Callous-Unemotional Traits (ICU) among school-aged children and adolescents, aged 6 to 15 years, in a community setting in Japan (n = 10,936). We investigated 15 models that have been reported in previous studies and used confirmatory factor analyses to determine a model that might actually be the best-fit among these. We then examined the correlations between the score of ICU and the Strengths and Difficulties Questionnaire (SDQ) in the best fit model and the three-factor bifactor (3FBF) model with the original ICU through cross-sectional and longitudinal analysis to determine the concurrent and predictive validity of the ICU. The results showed that the best-fit model was the two-factor bifactor (2FBF) model with a revised version of the ICU with 12 items, excluding all but one item of unemotional factors. The cross-sectional and longitudinal analysis showed that higher general callous-unemotional factor scores, callousness and uncaring specific factor scores were significantly associated with a higher level of conduct problems and a lower level of prosocial behaviors in the SDQ. These tendencies were shown both in the 2FBF model with the revised version of the ICU and the 3FBF model with the original ICU. We conclude that the 2FBF model was useful for school-aged community samples, as it predicts increases in conduct problems and decreases in prosocial behavior with fewer items than the 3FBF model. [ABSTRACT FROM AUTHOR]

Many children globally do not meet government guidelines for daily fruit and vegetable intake, and in New Zealand, adherence to the vegetable intake recommendation is declining. This study aimed to identify systemic barriers to children meeting fruit and vegetable (FV) guidelines and generate sustainable actions within a local community to improve children’s FV intake. A qualitative system dynamics method of community group model building was used. The research team partnered with Healthy Families Waitākere, a Ministry of Health funded prevention initiative, to recruit 17 participants (including students, parents, teachers, community leaders, local retailers and health promoters) from a low-income, ethnically-diverse community in West Auckland, New Zealand. Three group model building workshops were held during which a systems map was created and used to identify actions by considering causal pathways and reinforcing loops in the system. Barriers to children’s FV intake identified by participants were the saturation of fast-food outlets in the community and ubiquitous marketing of these products, the high cost of fresh produce compared to fast food, and parents having little time for food preparation plus declining cooking skills and knowledge. Several actions to improve children’s FV intake by improving the local food environment were identified, which will be co-designed further and tested by a collaborative group involving community leaders. This project highlights the effectiveness of group model building for engaging a local community in systems change to improve child nutrition, and supplies a blueprint for future qualitative system dynamics research. [ABSTRACT FROM AUTHOR]

Physical inactivity has been identified as a leading risk factor for premature mortality globally, and adolescents, in particular, have low physical activity levels. Schools have been identified as a setting to tackle physical inactivity. Economic evidence of school-based physical activity programmes is limited, and the costs of these programmes are not always collected in full. This paper describes a micro-costing and cost-consequence analysis of the ‘Girls Active’ secondary school-based programme as part of a cluster randomised controlled trial (RCT). Micro-costing and cost-consequence analyses were conducted using bespoke cost diaries and questionnaires to collect programme delivery information. Outcomes for the cost-consequence analysis included health-related quality of life measured by the Child Health Utility-9D (CHU-9D), primary care General Practitioner (GP) and school-based (school nurse and school counsellor) service use as part of a cluster RCT of the ‘Girls Active’ programme. Overall, 1,752 secondary pupils were recruited and a complete case sample of 997 participants (Intervention n = 570, Control n = 427) was used for the cost-consequence analysis. The micro-costing analysis demonstrated that, depending upon how the programme was delivered, ‘Girls Active’ costs ranged from £1,054 (£2 per pupil, per school year) to £3,489 (£7 per pupil, per school year). The least costly option was to absorb ‘Girls Active’ strictly within curriculum hours. The analysis demonstrated no effect for the programme for the three main outcomes of interest (health-related quality of life, physical activity and service use).Micro-costing analyses demonstrated the costs of delivering the ‘Girls Active’ programme, addressing a gap in the United Kingdom (UK) literature regarding economic evidence from school-based physical activity programmes. This paper provides recommendations for those gathering cost and service use data in school settings to supplement validated and objective measures, furthering economic research in this field. Trial registration: -ISRCTN, . [ABSTRACT FROM AUTHOR]

While diaspora communities have become more critical of Female Genital Cutting (FGC), there are also trends of continuity. To explore the interplay between continuity and change, I designed a study among Somali migrants in Norway. A team of six Somali research assistants collected data from 72 male and female research participants between 16 and 57 years of age through in-depth interviews and focus group discussions. The aim of the study was to gather knowledge that could improve interventions among migrant populations. The study findings indicate that the experience of FGC as a practice in transition implies that people have to maneuver between different and partly contradictory social norms. The paper first discusses the contradiction between a strong negative attitude toward FGC and very low engagement. The lack of engagement is explained by the increased privatization of FGC and insecurities due to the transition and disempowerment with regard to challenging the FGC practices of relatives based in countries of origin. Second, the paper explores the contradiction between perceptions of FGC as a disappearing practice and the recognition of trends of continuation. Trends of continuation include those related to perceptions of risk during travel to countries of origin, resistance to defibulation, support for sunna circumcision and insecurities regarding the significance of FGC for marriageability. Thus, despite an almost universally negative attitude toward FGC in the form of infibulation, ongoing changes can, to some extent, hamper further change. This suggests that to ensure further progress in the abandonment of the practice, these complex and interconnected expectations must be addressed. [ABSTRACT FROM AUTHOR]

Design: This study surveyed patients with stored frozen embryos and developed and tested an intervention through a randomized trial to support subjects to consider embryo disposition options (EDOs), especially donation for family building. Methods: Based on a review of literature on EDOs, the authors developed and mailed a 2-page anonymous survey to 1,053 patients in Massachusetts (USA) to elicit their feelings about their stored embryos. Target patients had embryos cryopreserved for ≥1 year and had not indicated an EDO. Survey respondents were next randomized between usual care (control arm) or an offer of complimentary counseling and educational support regarding EDOs. These counseling sessions were conducted by a licensed mental health professional specializing in infertility treatment. Results: Despite telephone reminders, only 21.3% of patients responded, likely reflecting most patients’ reluctance to address EDOs. Respondents endorsed an average of 2 of the 5 EDOs, with the following percentages supporting each option: store for future attempts (82%), continue storage (79%), donate to research (29%), discard (14%), and donate for family building (13%). When asked their opinions towards embryo donation to another couple, 78% of patients agreed that donation is a way to help another couple, 48% would consider embryo donation to another family if they had a better understanding of the process, and 38% would be willing to consider donation if they were not going to use the embryos themselves, but 73% expressed discomfort with donation. In the randomized trial, 7.8% of intervention subjects (n = 8) obtained counseling sessions compared to 0.0% (none) of usual care subjects (p = 0.0069). Counseling participants valued not only discussing EDOs, but also assistance in expressing their feelings and differences with their partners. Conclusion: Improvement in counseling rates over the control arm suggests that free professional counseling is a small, but likely effective, step towards deciding on an EDO. ClinicalTrials.gov Identifier: (Frozen embryo donation study). [ABSTRACT FROM AUTHOR]

Background: Indonesia has one of the fastest growing HIV epidemics in Asia, which mainly concentrates within risk groups. Several strategies are available to combat this epidemic, like outreach to Men who have Sex with Men (MSM) and transgender, Harm Reduction Community Meetings (HRCMs) for Injecting Drug Users (IDUs), and Information, Education and Communication (IEC) programs at Maternal & Child Health Posts (MCHPs). Reliable cost data are currently not present, hampering HIV/AIDS priority setting. The aim of this study thus is to assess the societal costs of outreach programs to MSM and transgender, HRCMs for IDUs and IEC at MCHPs in Bandung, Indonesia in 2016. Methods: The societal costs were collected in Bandung from April until May 2017. Health care costs were collected by interviewing stakeholders, using a micro-costing approach. Non-health care costs were determined by conducting surveys within the target groups of the interventions. Results: The societal costs of the outreach program were US$ 347,199.03 in 2016 and US$ 73.72 per reached individual. Moreover, the cost of HRCM for IDUs were US$ 48,618.31 in 2016 and US$ 365.55 per community meeting. For the IEC program at MCHPs, US$ 337.13 was paid in 2016 and the cost per visitor were US$ 0.51. Conclusion: This study provides valuable insights in the costs of outreach to MSM and transgender, HRCMs for IDUs and IEC at MCHPs. Policy makers can use these results in setting priorities within Indonesia. Data on effectiveness of interventions is necessary to make conclusive statements regarding cost-effectiveness and priority of interventions. [ABSTRACT FROM AUTHOR]

Introduction: Unmet need for contraception is defined as the proportion of fertile individuals who do not use contraceptives despite wanting to space or limit their childbearing. Studies show that immigrant women in Europe, have higher rates of unintended pregnancies and abortion than native born women. Somali women, have the highest fertility rate in Norway which is much higher than the total fertility rate in Norway (4.0 vs. 1.7). This study investigates the unmet need for contraception among Somali immigrant women in Oslo, Norway, compared to their original population in Mogadishu, Somalia. Methods: A community based, cross sectional study was carried out among Somali women in Oslo (N = 228) and Mogadishu (N = 229) from May to December 2018. Pre-structured questionnaires were given to women who were recruited through snow-ball sampling. Data was analyzed using SPSS version 25. We performed a chi-square test for the analyses of categorical variables, a t-test for continuous variables and multivariate logistic analysis to determine the association between exposure and outcome variable. Results: The unmet needs for contraception among Somali women in Oslo was 20.2%, which is similar to unmet needs for contraception of women in many sub-Saharan African countries. The unmet needs for Somali immigrant women in Oslo (20.2) is two times lower than that of their original population in Somalia (48.5). The odds of having unmet needs for contraception was nearly, three times higher among Somali women in Mogadishu compared to those in Oslo (OR: 2.6, CI: 2.56–7.68). The mean intended fertility was 4 among the women in Oslo and 10.8 in Mogadishu. About 13.4% of study participants in Oslo and 86.6% of those in Mogadishu consider modern contraception irrelevant for women’s health. Nearly 50% of women in both places had unintended childbirth on one or more occasion. Conclusion: The study results show the prevalence of unmet needs for contraception among Somali immigrant women Oslo, is 4 fold higher than that of Norway (20.2 vs 5.5). Information Education Communication to both men and women, may reduce the high unmet need for contraception and also improve partner communication on family planning among Somali immigrants in Oslo. Training primary health providers for provision of tailored information about the modern contraception to immigrant women, which includes an individualized counselling may improve partners’ knowledge, demand and uptake of modern contraception. [ABSTRACT FROM AUTHOR]

Palliative care aims to improve quality of life for people with serious illness and their families. One potential barrier to palliative care uptake is inaccurate knowledge and/or negative beliefs among the general population, which may inhibit early interest in, communication about, and integration of palliative care following subsequent illness diagnosis. We explored knowledge and beliefs about palliative care among the general public using nationally-representative data collected in 2018 as part of the cross-sectional Health Information National Trends Survey. Only individuals who had heard of palliative care (n = 1,162, Mage = 51.8, 64% female) were queried on knowledge and beliefs. We examined whether self-assessed level of awareness of palliative care (i.e., knowing a little vs. enough to explain it) was associated with the relative likelihood of having accurate/positive beliefs, inaccurate/negative beliefs, or responding “don’t know” to questions about palliative care. Respondents who indicated knowing a lot about palliative care had more accurate versus inaccurate knowledge than those who knew a little on only two of six items and more positive attitudes on only one of three items. In particular, respondents with greater awareness were equally likely to report that palliative care is the same as hospice and requires stopping other treatments, and equally likely to believe that palliative care means giving up and to associate palliative care with death. Those with higher awareness were less likely than those with lower awareness to respond “don’t know,” but greater awareness was not necessarily associated with having accurate or positive beliefs about palliative care as opposed to inaccurate or negative beliefs. Thus, even members of the general public who perceived themselves to know a lot about palliative care were often no less likely to report inaccurate knowledge or negative beliefs (versus accurate and positive, respectively). Findings suggest a need to improve awareness and attitudes about palliative care. [ABSTRACT FROM AUTHOR]

Background: Culture influences personal health habits and behavior, and healthcare personnel possess different views of cultural perspectives. Currently, an appropriate instrument to assess cultural competence in clinical practice is limited. The present study aimed to develop and examine the psychometric properties of the Nursing Cultural Competence Scale (NCCS) for clinical nurses. Methods: Developing and assessing the scale was carried out in two phases: Phase I involved a qualitative research to explore the themes of nurses’ cultural competence and instrument development; Phase II established construct validity of the scale using a sample of 246 nurses in Taiwan. Data from the questionnaire were analyzed using exploratory factor analysis, confirmatory factor analysis, internal consistency and test-retest reliability. Analysis results were used to determine the reliability and validity of the developed scale. Results: The results showed four factors including cultural awareness ability, cultural action ability, cultural resources application ability, and self-learning cultural ability were generated by exploratory factor analysis, and these factors explained 62.0% of total variance. Cronbach’s α of the Nursing Cultural Competence Scale was .88, and test-retest reliability correlation was .70. Conclusions: The establishment of the tool will facilitate accurate monitoring of the cultural competence among nurses and nursing managers, which can inform the construction of nursing policies aimed at pledge cultural competence expansion. [ABSTRACT FROM AUTHOR]

Background: Older individuals receiving home assistance are at high risk for emergency visits and unplanned hospitalization. Anticipating their health difficulties could prevent these events. This study investigated the effectiveness of an at-home monitoring method using social workers’ observations to predict risk for 7- and 14-day emergency department (ED) visits. Methods: This was a prospective cohort study of persons ≥75 years, living at home and receiving assistance from home care aides (HCA) at 6 French facilities. After each home visit, HCAs reported on participants’ functional status using a smartphone application that recorded 27 functional items about each participant (e.g., ability to stand, move, eat, mood, loneliness). We recorded ED visits. Finally, we used machine learning techniques (i.e., leveraging random forest predictors) to develop a 7- and 14-day predictive algorithm for the risk of ED visit. Results: The study included 301 participants, and the HCA made 9,987 observations. Over the mean 10-month follow-up, 97 participants (32%) had at least one ED visit. Modeling techniques identified 9 contributory factors from the longitudinal records of the HCA and developed a predictive algorithm for the risk of ED visit. The predictive performance (i.e., the area under the ROC curve) was 0.70 at 7 days and 0.67 at 14 days. Interpretation: For frail elders receiving in-home care, information on functional status collected by HCA helps predict the risk of ED visits 7 to 14 days in advance. A survey system for real-time identification of risks could be developed using this exploratory work. [ABSTRACT FROM AUTHOR]

Background: Despite the universal iodization of salt in Ethiopia, iodine deficiency disorder remains a major public health problem and continued to affect a large segment of the population. It is thus essential to assess factors contributing to the unacceptably high endemic goiter rate in the country and avail evidence for further additional interventions. In line with this, we examined the association of dietary pattern and iodine deficiency among school-age children in Ethiopia. Method: We conducted a school-based cross-sectional study among 767 children aged 6 to 12 in southwest Ethiopia. We collected socio-demographic and other important health related information using a pre-tested structured questionnaire through the interview. Dietary pattern of children was measured using modified Hellen Keller’s food frequency questionnaire. We measured iodine deficiency using urinary iodine concentration level and total goiter rate, according to the World Health Organization threshold criteria. We used a multivariate linear regression model to identify dietary and sociodemographic factors that affect urinary iodine level among children. Result: Out of the 767 children included in the study, 12% and 4% of children have grade 1 and grade 2 goiter respectively, making the total goiter rate 16%. While the prevalence of iodine deficiency based on urinary iodine concentration is 58.8% of which 13.7% had severe, 18.6% had moderate and 26.5% had mild form. The proportion of children who consumed godere/taro root/, banana, corn, Abyssinian cabbage, and potato, respectively at daily basis 57.8%, 53.1%, 37.9%, and 31.2%, respectively. Age (β = -0.7, 95%CI = -1.1, -0.4), sex (β = -22.3, 95%CI = -33.8, -10.8), consumption of taro root (β = -27.4, 95%CI = -22.9, -31.8), cabbage (β = -11.7, 95%CI = -5.7, -17.6), Abyssinian cabbage (β = 12.4, 95%CI = 6.7, 18.2), and banana (β = 5.6, 95%CI = 0.01, 11.2) significantly associated with urinary iodine level. Conclusion: Iodine deficiency remains an important public health problem in southwest Ethiopia. Over-consumption of goitrogenic foods and under-consumption of iodine-rich foods were prevalent and associated with lower urinary iodine level. Therefore, dietary counseling apart from universal salt iodization is recommended. [ABSTRACT FROM AUTHOR]

Study objective: The aim of the study was to investigate factors that best predict patient’s satisfaction with their ED visit, as well as examine whether patients and their families perceived the factors related to satisfaction similarly. Methods: This is a retrospective study where secondary data analysis was done on patient satisfaction data collected over three quarters for quality improvement purposes. Exploratory factor analysis (EFA) was conducted on the data from the first quarter to identify the factor structure, followed by confirmatory factor analysis (CFA) on the rest of the data to confirm the EFA factor structure. A structural equation model (SEM) was fitted where the factors predicted overall satisfaction with the ED visit. Finally, measurement invariance was conducted to examine if patients and families perceived the factors related to ED services alike. Results: Two factors were found to be predictive of satisfaction: clinical team and system processes. The SEM showed that system process was a statistically significant predictor of overall satisfaction, while clinical team predicted overall satisfaction to a smaller extent. Multi-group CFA showed that the factor structure fitted neither family nor patient groups adequately. The instrument did not exhibit partial invariance. Conclusion: This study found that system process was the best predictor of overall satisfaction. Furthermore, this study showed that the same instrument might not reliably compare the perceptions of patients and families. [ABSTRACT FROM AUTHOR]

Background: Medical interns’ quality of life (QOL) are related to patient care quality, but the specific factors responsible for interns’ QOL have not been well studied. Herein we presented this nationwide, prospective study to examine the impact of working hours restrictions on the QOL among medical interns. Methods: The study recruited 295 medical interns (age: 25.3 ± 2.1, male: 68.1%) from all the 8 medical colleges in Taiwan during the 2012–2013 academic years. Subjects were assessed for QOL by brief version of the World Health Organization Quality of Life Assessment (WHOQOL-BREF) and the 9-item Patient Health Questionnaire (PHQ-9) before and every 3 months during their internship. We also investigated their demographic data, working hours, workload characteristics, such as specialties of internship rotation, acceptance of new patients after 24-hour, and no 24-hour off within 7 days, and self-reported patient related burnout. We used generalized estimation equation to delineate the change of WHOQOL-BREF and PHQ-9 scores during internship. We used multivariate regression analysis to examine the associated factors of QOL. Results: WHOQOL-BREF score significantly decreased during internship (baseline: 60.0 ± 9.7, 53.7 ± 9.3 at 3 months, then remained at 55 after 9 months). Acceptance of new patients after 24 hours of continuous duty (β = -2.089), no 24-hour off within 7 days (β = -1.748), score of patient related burnout (β = -2.50), and PHQ-9 depression score (β = -1.02) were associated with lower WHOQOL-BREF score. Working hours was not significantly associated with the QOL (p = .6268). Conclusions: Our findings revealed interns’ QOL significantly decreased during internship. Acceptance of new patients after 24-hour of continuous duty and patient related burnout predominantly impacted interns’ QOL and depression more than working hours did. [ABSTRACT FROM AUTHOR]

Background: Millions of children and others across the world are being dangerously exposed to tobacco smoke and toxins in their own homes. Whilst there is limited interest in laws and interventions controlling tobacco use in public places in Bangladesh, no attention has been given to preventing tobacco-use inside homes. This study explores the familial and socio-cultural factors that provide obstacles for ensuring tobacco-free homes in Bangladesh. Materials and methods: A mixed-method design was adopted and from among the 1,436 tobacco users identified in a population of 11,853, 400 (tobacco users) were selected for cross-sectional survey. This survey involved a probability proportional sampling procedure, and 24 In-Depth Interviews. Multivariate logistic regression was performed to explore the association of familial and socio-cultural factors with tobacco-use at home adjusted by other demographic characteristics. Thematic content analysis was done on the qualitative data, and then inferences were drawn out collectively. Results: This study revealed that the prevalence of tobacco-use in the home was 25.7% in urban residential areas in Bangladesh. Multivariate logistic regression analysis identified that familial and socio-cultural factors were significantly associated with tobacco-use at home: marital status (OR 3.23, 95% CI: 1.37–6.61), education (OR 2.14, 95% CI: 1.15–3.99), smoking habits of older family members (OR 1.81 95% CI: 0.91–2.89), tobacco being offered as hospitality and for entertainment (OR 1.85, 95% CI: .94–2.95) and lack of religiosity practice (OR 2.39, 95% CI: 1.27–4.54). Qualitative findings indicated that social customs, lack of religious practice, tobacco-use of older family members, and lack of family guidance were key obstacles for enabling tobacco-free homes in urban areas. Conclusion: Use of tobacco at home is continuing as part of established familial and socio-cultural traditions. If tobacco-use at home is not addressed seriously by the authorities then the emerging threat of second-hand smoke exposure and harmful consequences of tobacco- use will be exacerbated. [ABSTRACT FROM AUTHOR]

Citation metrics are widely used and misused. We have created a publicly available database of 100,000 top scientists that provides standardized information on citations, h-index, coauthorship-adjusted hm-index, citations to papers in different authorship positions, and a composite indicator. Separate data are shown for career-long and single-year impact. Metrics with and without self-citations and ratio of citations to citing papers are given. Scientists are classified into 22 scientific fields and 176 subfields. Field- and subfield-specific percentiles are also provided for all scientists who have published at least five papers. Career-long data are updated to end of 2017 and to end of 2018 for comparison. [ABSTRACT FROM AUTHOR]

Background and objective: Health status in childhood is correlated with educational outcomes. Emergency hospital admissions during childhood are common but it is not known how these unplanned breaks from schooling impact on education outcomes. We hypothesised that children who had emergency hospital admissions had an increased risk of lower educational attainment, in addition to the increased risks associated with other health, social and school factors. Methods: This record-linked electronic birth cohort, included children born in Wales between 1 January 1998 and 31 August 2001. We fitted multilevel logistic regression models grouped by schools, to determine whether emergency hospital inpatient admission before age 7 years was associated with the educational outcome of not attaining the expected level in a teacher-based assessment at age 7 years (KS1). We adjusted for pregnancy, perinatal, socio-economic, neighbourhood, pupil mobility and school-level factors. Results: The cohort comprised 64 934 children. Overall, 4680 (7.2%) did not attain the expected educational level. Emergency admission to hospital was associated with poor educational attainment (OR 1.12 95% Credible Interval (CI) 1.05, 1.20 for all causes during childhood, OR 1.19 95%CI 1.07, 1.32 for injuries and external causes and OR 1.31 95%CI 1.04, 1.22 for admissions during infancy), after adjusting for known determinants of education outcomes such as extreme prematurity, being small for gestational age and socio-economic indicators, such as eligibility for free school meals. Conclusion: Emergency inpatient hospital admission during childhood, particularly during infancy or for injuries and external causes was associated with an increased risk of lower education attainment at age 7 years, in addition to the effects of pregnancy factors (gestational age, birthweight) and social deprivation. These findings support the need for injury prevention measures and additional support in school for affected children to help them to achieve their potential. [ABSTRACT FROM AUTHOR]

Background: Perceived as a minor transportation mode mainly for recreation, cycling and its related safety issues have not been treated as a citywide concern in Hong Kong and have thus received inadequate research efforts. Our study aimed to illuminate the safety challenges faced by cyclists in Hong Kong. Methods: We examined the police crash records from 1998 to 2017 and developed a Bayesian Poisson state space model to evaluate the longitudinal change in traffic injuries to cyclists. We then used quasi-induced exposure to measure the annual relative risk of crash involvement for cycling. Based on an officially published travel characteristics survey, we further measured the risk of injury for cycling per minutes cycled. Results: Between 1998 and 2017, Hong Kong witnessed a more than twofold increase in the number of cyclist injuries, with an average annual increase rate of 5.18% (95% CI: 0.53%–12.77%). By 2017, cyclists were 2.21 (1.82–2.69) times more likely to be involved in traffic crashes than in 1998. Per 10 million minutes, the injury rates for cycling were 28.64 (27.43–29.70) and 42.54 (41.07–44.02) on weekdays during 2001–2003 and 2010–2012. After adjusting for sex and age groups, cyclists were 1.95 (1.43–2.61) times more likely to be injured in 2010–2012 than in 2001–2003. Per minutes traveled, cyclists also sustained significantly higher risks of fatality and injury than pedestrians, private car drivers and passengers, taxi passengers, public bus passengers, and minibus passengers. A comparison of Hong Kong with other regions suggests that Hong Kong is among the most dangerous areas for cycling in terms of fatality rate per minutes cycled. Conclusions: Cyclist injuries have become a substantial public health burden in Hong Kong. A range of countermeasures with proven effectiveness should be promptly implemented to improve the safety of these vulnerable road users. [ABSTRACT FROM AUTHOR]

‘Honour killing’, the murder of women to preserve family reputation, is well recognised but infrequently systematically researched. This paper has three hypotheses. First, in families where women report an ‘honour killing’ there is more violence against women and girls, second these women are more likely to report more patriarchal gender attitudes than others, and third these families are exposed to higher levels of poverty. We asked (n = 1461) women enrolled in a trial in Afghanistan, and (n = 535) in a population-based sample in the occupied Palestinian Territories (oPT) if there had ever been an ‘honour killing’ in their family. In Afghanistan, 2.3% (n = 33), and the oPT 7.7% (n = 41), reported this. We built separate multivariable logistic regression models for each country, and for married and unmarried women in each country. Among Afghan married women, ‘honour killing’ was associated with borrowing because of hunger (adjusted odds ratio [aOR]8.71, 95%CI 2.27–33.40), easier access to money in emergency (aOR11.39, 95%CI 3.05–42.50), and violence within the family; intimate partner violence (IPV) (aOR3.73, 95%CI 1.12–12.36), and IPV and mother-in-law violence (aOR10.52, 2.60–42.56). For unmarried women in Afghanistan, ‘honour killing’ was associated with easier access money in an emergency (aOR4.06, 95%CI 0.85–19.37), household violence (hit by parent or sibling, or parent and sibling [aOR5.47, 95%CI 0.82–36.70; aOR7.37, 95%CI 1.24–43.86, respectively]); more childhood traumas (aOR1.24, 1.11–1.38), and more patriarchal personal gender attitudes (aOR1.24, 1.00–1.54). In the oPT experiencing IPV (aOR3.07, 1.02–9.23) and borrowing and experiencing IPV (aOR5.89, 1.84–18.79) were risks for married women. For unmarried women borrowing because of hunger was associated with higher risk (aOR2.33, 95%CI 1.18–4.85). Despite limitations–specifically the potential women were reporting the same ‘honour killing’—our analysis suggests ‘honour killings’ are associated with violence, patriarchy, and poverty. Research is needed for the prevention of ‘honour killing’, which must address the root causes. Trial Registration: ClinicalTrials.gov . [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB), a bacterial infectious disease, continues to be a public health concern in many developing countries. However, lack of data concerning the public health burden and potential risk factors for the disease hampers control programs in target areas. Therefore, the aims of present study were to determine the prevalence of TB and genetic diversity of M. tuberculosis isolates from individuals visiting health facilities in South Gondar Zone, northwest Ethiopia. Methods: A cross-sectonal study was conducted between March 2015 and April 2017. Bacteriological examination, region of difference (RD) 9 based polymerase chain reaction (PCR) and spoligotyping were used. Results: The overall prevalence of all smear positive TB was 6.3% (186/2953). Extra pulmonary TB (EPTB) was clinically characterized in about 62.4% (116/186) TB-positive cases. Some demographic characteristics, such as patients' origin (districts where patients were recruited) [patients’ origin (chi-square (χ2) value; 62.8,p<0.001) were found to be significantly associated risk factors for the occurrence of TB in the study area. All the mycobacterial isolates were found to be M. tuberculosis. Among the 35 different spoligotype patterns identified, 22 patterns were shared types.The three dominantly identified families were T, CAS and Manu, each consisting of 46.9%, 24.0% and 10.4% of the isolates, respectively. Conclusion: The present study revealed that TB continues to be a public health problem in South Gondar Zone which suggests a need of implementing effective disease control strategies. [ABSTRACT FROM AUTHOR]

Haptic sound symbolism has been found in adults, between ideophones and various textures, between words and shape, and between written words and texture. However, associations between the sound of nonwords and features other than shape and in early stages of development have been less explored. The present study investigates the haptic manifestation of sound symbolism in an early developmental stage. We examined associations between nonwords and the rough-smooth tactile dimension in 3.5-to-4.5-year-old children. Two experiments were conducted: a pointing selection task and a naming task. Sound symbolic associations were found in the naming task, but not in the pointing task. On the other hand an unexpected bias towards smoothness was found in the pointing task. We explain these results by suggesting that the articulation of nonwords may facilitate or intensify sound symbolism, and that hedonic biases are manifested in the pointing task. [ABSTRACT FROM AUTHOR]

Studies from the social and health sciences have tended to view the household as the locus of access to and distribution of care, resources, monitoring and modeling for children’s wellbeing. Obesity may present a special case for the study of investments in children, being a component of health for which more of certain inputs may not lead to better outcomes. We expanded on common measures of household structure in the child health literature by considering co-residence and relatedness of parents, grandparents, other relatives, and other children. Data were from a longitudinal sample of 6,700 children participating in the Early Childhood Longitudinal Study Kindergarten Class of 1998–99 (ECLS-K), the largest U.S. national dataset with measures of child anthropometrics and household structure at seven time-points over nine years. We used lagged survey-adjusted regressions to estimate associations between household structure and subsequent changes in children’s weight between ages 5 and 14 years in terms of BMI gain and incident obesity. Adjusting for household structure more thoroughly, children living in households with two parents rather than one parent did not experience advantages in terms of less excess weight gain or lower incidence of obesity during elementary and middle school. Children living with a grandmother gained more weight than children not living with a grandmother. Living with siblings and with non-related adults was associated with less weight gain. These findings corroborate a scenario in which, for health problems associated with caloric surplus, classic household factors have more complex associations with child wellbeing. [ABSTRACT FROM AUTHOR]

An increasing number of studies reveal crossmodal correspondences between speech sounds and perceptual features such as shape and size. In this study, we show that an interjection Koreans produce when downing a shot of liquor reliably triggers crossmodal associations in American English, German, Spanish, and Chinese listeners who do not speak Korean. Based on how this sound is used in advertising campaigns for the Korean liquor soju, we derive predictions for different crossmodal associations. Our experiments show that the same speech sound is reliably associated with various perceptual, affective, and social meanings. This demonstrates what we call the ‘pluripotentiality’ of iconicity, that is, the same speech sound is able to trigger a web of interrelated mental associations across different dimensions. We argue that the specific semantic associations evoked by iconic stimuli depend on the task, with iconic meanings having a ‘latent’ quality that becomes ‘actual’ in specific semantic contexts. We outline implications for theories of iconicity and advertising. [ABSTRACT FROM AUTHOR]

Objectives: This study investigates the protective role of ethnic-racial identity (ERI) affirmation on the longitudinal association between racism and Aboriginal Australian children’s social and emotional well-being (SEWB). Methods: 408 children from the K-Cohort of the Longitudinal Study of Indigenous Children were included in the analysis. Data were collected through questionnaire-guided interviews at 7–10 and 9–12 years of age. Children’s racism experience, SEWB (Strengths and Difficulties Questionnaire), and confounding were reported by caregivers. ERI was reported by children and dichotomized into high versus low. Generalized linear models with log-Poisson links and robust errors were used to estimate adjusted Risk Ratios (RRa) for the effect of racism on SEWB domains. Effect-measure modification analysis was used to verify differences on effect sizes per strata of ERI affirmation. The presence of modification was indicated by the Relative Excess Risk due to Interaction (RERI). Results: Slightly above half (51.4%) of the children presented high ERI affirmation. Children exposed to racism and with low ERI affirmation were at increased risk of hyperactive behavior (RRa 2.53, 95% CI 1.17, 5.48), conduct problems (RRa 2.35, 95% CI 1.07, 5.15), and total difficulties (RRa 1.73, 95% CI 0.84, 3.55). Positive RERIs indicated the joint effects of racism and low ERI affirmation surpassed the sum of their separate effects in these domains. Children with high ERI affirmation were at increased risk of peer problems (RRa 1.66, 95% CI 0.78, 3.52). Conclusions: These findings suggest that ERI may mitigate the risk of poor SEWB due to racism. Fostering affirmative ERI can be an important strategy in promoting resilience in Aboriginal Australian children. [ABSTRACT FROM AUTHOR]

Background: Against a backdrop of more than four decades of war, conflict and insecurity, Afghanistan is recognised as suffering from endemic violence and children are exposed to multiple forms of violence, including at the family and school levels. This paper presents the results of an evaluation of school-based peace education and a community-based intervention to change harmful social norms and practices related to gender and the use of violence in conflict resolution, implemented in Afghanistan with the aim of reducing violence against and between children. Methods: The evaluation consisted of a cross-sectional, interrupted time series design with three data collection points over 12 months. Data was collected from students in 11 secondary schools (seven girls’ and four boys’ schools) in Jawzjan province of Afghanistan, with a total of 361 boys and 373 girls sampled at endline. All children were interviewed with a questionnaire developed for the study. Key outcomes included children’s experience of peer violence (both perpetration and victimization) at school, corporal punishment both at home and at school, and observation of family violence. Other outcomes included children’s gender equitable attitudes, attitudes towards child punishment, depression and school performance. Results: Between baseline and endline evaluation points, there were significant reductions in various forms of violence at the school level, including both boys’ and girls’ past month experience of peer violence victimization, peer violence perpetration, and corporal punishment by teachers. There were also significant reductions in boys’ and girls’ experience of corporal punishment at home and observation of family violence, with a particularly strong effect observed among girls. Both boys and girls had significantly more equitable gender attitudes and significantly less violence-supportive attitudes in relation to children’s punishment, and significantly fewer symptoms of depression. Girls’ school attendance was also significantly higher at endline. Discussion: To our knowledge this is the first time that a peace education program has been evaluated in Afghanistan, with or without a community intervention to change harmful social norms and practices related to gender and the use of violence for conflict resolution. The evaluation suggests that the intervention may have led to a reduction in various forms of violence, including children’s peer violence, corporal punishment of children both at school and at home, and in children’s reports of domestic violence against women at the household level. [ABSTRACT FROM AUTHOR]

Physical education professionals aim to develop quality programmes for physical education. This study aimed to develop and validate a scale using professionals’ perceptions of Quality Physical Education QPE in Asia using twenty-four items regarding QPE quality issues. The items covered status and roles, development of educational elements and supportive features in physical education. A sample of N = 799 sport and physical education professionals from eleven Asian cities participated in this questionnaire survey. Twenty-four items relating to QPE were examined via exploratory factor analysis (EFA) using maximum likelihood extraction and direct oblimin rotation methods. Nevertheless, only 20 items were extracted following the EFA examination. Items 1, 9, 14 and 18 were excluded because of low factor loadings. The remaining items were clustered into four subscales: Development and Supportive Elements for Quality Physical Education in Schools (DSFQPE; α = .918), Core Values of Quality Physical Education (CVPE; α = .908), Curriculum Arrangement of Physical Activities (CAPA; α = .884) and Provision and Norms in Physical Education (PNPE; α = .865). The Cronbach’s alpha coefficient (α = .875) indicated excellent internal consistency for the overall measure. Furthermore, the 4 retained factors from the EFA were assessed via robust confirmatory factor analysis (CFA). The 4-factor model demonstrated a good fit with the data (CMIN/DF = 3.450, CFI = .928, TLI = .916, PCFI = .801, RMSEA = .078). The study identified a 4-factor structure with internal consistency and acceptable interfactor correlations. The structure seemed to be applicable, including the twenty items identified as useful and necessary tools for the framework of analysis in the investigation of diverse settings for the study of quality physical education. [ABSTRACT FROM AUTHOR]

Introduction: The National Rural Health Mission (NRHM) was launched in India in 2005 to address the health needs of under-served populations in rural areas, and to support universal access to care. Despite this initiative, unaccredited informal providers (IPs) often remain patients’ first point of contact, which has led to inconsistencies in treatment, and has compromised the quality of care. Aim: To explore the factors that influence patients’ decisions about healthcare providers in rural areas of central India. Methods: Nine focus group discussions (FGDs) were held in nine villages in central India. Framework analysis using an inductive approach was used to analyse the data. Results: The crosscutting theme across the discussions was not choice but need—the need for affordable and accessible health care regardless of the provider’s qualification. Results highlighted that IPs play a pivotal role in villagers’ lives. Formal healthcare services were accessed infrequently, and mainly when a condition was judged severe or possibly even fatal. Even then, affordability was carefully weighed. Villagers’ distance from formal providers contributed to high cost and low preference of formal providers. When opting for IPs, familiarity and trust were more important to villagers than qualifications. IPs have operated in rural communities in India for a long time and have adapted their services to meet the needs, preferences, social norms, and economic conditions of villagers. Conclusion: IPs have captured a niche and are often the first contact point in rural settings even when patients ultimately are diagnosed and treated by trained doctors. Merely tackling the undersupply of qualified doctors is not effective or sufficient to impact on the rural healthcare system: the strong and prevalent influence of IPs needs to be addressed also. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether implementation of comprehensive in-school eyecare results in measurable benefits for children and young people in terms of visual status, classroom behaviours and how well their visual needs are met. Design: School-based observational study. Participants & Methods: 200 pupils [mean age 10 years 9 months, 70% male, majority moderate (40%) or severe (35%) learning difficulty] of a special education school in the UK. A sector-agreed in-school eyecare framework including full eye examination and cycloplegic refraction, dispensing of spectacles (as appropriate) and written reporting of outcomes to parents/teachers was applied. Classroom behaviours were observed and recorded prior to, and after, the in-school eyecare. Surveys were employed to obtain visual histories from parents/teachers. School records and statutory documents were reviewed for diagnostic and learning disability classifications. Visual function and ocular health were profiled at baseline and significant visual deficits identified. Where such deficits were previously unrecognised, untreated or not compensated for (e.g. correction of refractive error, enlargement of educational material) they were recorded as ‘unmet visual need’. At follow-up, 2–5 months after initial (baseline) measures, eye examinations, parent/teacher surveys and behaviour observations were repeated. Follow-up measures were used to determine if measurable improvements were evident in visual function, ocular health, the level of unmet need and classroom behaviour following implementation of in-school eyecare. Results: 199 participants completed baseline and follow-up measures. 122 (61%) participants presented with at least one significant visual or ocular health deficit and 90 (45%) participants had at least one unmet visual need. Younger pupils and those with no previous history of eyecare were more likely to demonstrate unmet visual needs at baseline (OR 1.12 95% CI 1.03 to 1.21) p = 0.012; (OR 4.44 95% CI 1.38 to 14.29 p = 0.007 respectively). On follow-up, the number of pupils with unmet visual needs dropped significantly to 36 (18%) (McNemar’s test p<0.001). Visual and behavioural metrics of participants without significant visual deficits or whose visual needs were adequately addressed at baseline remained relatively unchanged between baseline and follow-up (Wilcoxon signed rank p>0.05). Where significant refractive deficits were corrected at follow-up, near visual acuity improved significantly (Wilcoxon signed rank p = 0.013), however, poor spectacle compliance was a persistent cause of unmet visual need. Off-task behaviour reduced significantly after actions to address unmet visual needs were communicated to parents and teachers (Wilcoxon signed rank p = 0.035). Conclusions: The present study demonstrates for the first time measurable visual and behaviour benefits to children in special education settings when they receive comprehensive in-school eye examinations, on-site spectacle dispensing and jargon-free reporting of outcomes to teachers and parents. [ABSTRACT FROM AUTHOR]

Background: People with multimorbidity have reduced functional capacity, lower quality of life, higher mortality rates and use healthcare resources more intensively than healthy people or those with a single chronic condition. Multimorbidity was defined as the coexistence of two or more chronic conditions in the same person. The aim of this study was to explore associations between multimorbidity and use of healthcare services and the impact of socioeconomic status on utilization of hospitalizations and bed days. Methods: The study population included all individuals aged 16 years and older who lived in the Capital Region of Denmark on January 1st, 2012. Data on chronic conditions, use of healthcare services and demographics were obtained from Danish national administrative and health registries. Zero-inflated models were used to calculate anticipated annual use of hospitalizations and bed days. Findings: The study population comprised 1,397,173 individuals; the prevalence of multimorbidity was 22%. Prevalence was inversely related to educational attainment. For people with multimorbidity, utilization of hospitalizations and bed days increased approximately linearly with the number of chronic conditions. However, a steep increase in utilization of bed days was observed between five and six or more chronic conditions. An educational gradient in hospitalization rates and use of bed days was observed regardless of the number of chronic conditions. Educational attainment was strongly associated with healthcare utilization. Conclusion: Multimorbidity was associated with a significant increase in utilization of all healthcare services in Denmark. In addition, a socioeconomic gradient was observed in utilization of hospitalizations and bed days. [ABSTRACT FROM AUTHOR]

Many scientific researchers aspire to engage policy in their writing, but translating scientific research and findings into policy discussion often requires an understanding of the institutional complexities of legal and policy processes and actors. To examine how researchers have undertaken that challenge, we developed a set of metrics and applied them to articles published in one of the principal academic publication venues for science and policy—Science magazine’s Policy Forum. We reviewed each Policy Forum article published over a five-year period (2011–15), 220 in all. For each article, we assessed the level of policy content based on presence of a stated policy proposal or position and identification of the relevant policy actors and actions, and recorded attributes such as field of science, field of policy, number of references to legal and policy sources, number of authors from law and policy institutions, and number of citations. We find that a handful of science fields dominate publication frequency, but that all fields have produced publications with high policy engagement. Of the attributes, number of references to law and policy sources is correlated positively with level of engagement, whereas number of law and policy authors was fairly constant across all depths of engagement. Surprisingly, level of policy engagement was negatively correlated with the number of citations an article subsequently received. We offer possible explanations for these results and thoughts for authors, editors, and research institutions interested in facilitating robust engagement of policy in scientific writing. [ABSTRACT FROM AUTHOR]

Marleen Temmerman and colleagues describe a model of care for people who have experienced sexual violence, set in Kenya. [ABSTRACT FROM AUTHOR]

Previous studies have reported an association between family relationships and suicidal behavior, and found that people with high suicidal ideation are not likely to consult with others about their distress. An effective consulting service is therefore necessary for such individuals. Crisis hotlines are effective for reducing suicide risk, but their associated suicide ideation rate and odds ratio of family problems children remain unclear. The present study investigated the suicidal ideation rate and odds ratio of callers under 20 years of age (N = 24,333) with family problems to the Japanese crisis hotline in 2012. There were 5,242 (21.5%), 18,061 (74.2%), and 1,030 (4.2%) calls related to family problems, other problems, and both, respectively. The suicidal ideation rate and odds ratio of callers with family problems were 2.2% and 0.426, respectively. This result suggested that callers with family problems have a significantly lower rate and odds ratio for suicidal ideation compared with others. However, some associations with a high suicide ideation rate were found for individual items among callers with family problems such as abuse (20.4%), family breakdown (16.1%), and domestic violence (10.6%). Further studies are needed to understand the suicidal ideation of callers with family problems and develop more effective preventive strategies. [ABSTRACT FROM AUTHOR]

The field of paleontology, which is based principally on observations of the natural world, includes an active community that is engaged across multiple social media platforms, consisting of museums, academic researchers, amateur fossil collectors, paleontological artists, and commercial fossil dealers. As such, it represents an ideal environment for examining the people, interactions, and flow of scientific information. Using interactions involving the four most popular Twitter hashtags for paleontology, this embedded mixed methods study defined the members of this social world and investigated how they influenced and controlled the flow of information, as well as how their expression of scientific practice was related to their identity. Results provide further evidence for the diversity of people and practice involved in this domain of science and indicate that the magnitude and breadth of the public’s impact may be larger than previously projected. Certain types of messages were shown to be effective for different segments of the community, but news posts, essentially media outlet stories, were ineffective for generating any form of engagement. This study adds to our understanding of the important scientific contribution being made by members of the public as they interact with professional scientists and educators as peers in an open social media platform that supports a diverse and active community. [ABSTRACT FROM AUTHOR]

Social judgments of faces predict important social outcomes, including leadership decisions. Previous work suggests that facial cues associated with perceptions of dominance and trustworthiness have context-specific effects on leadership decisions. Facial cues linked to perceived dominance have been found to be preferred in leaders for hypothetical wartime contexts and facial cues linked to perceived trustworthiness have been found to be preferred in leaders for hypothetical peacetime contexts. Here we sought to replicate these effects using images of women’s faces, as previous studies have primarily focused on perceptions of leadership abilities from male faces, with only a handful of these including female faces. Consistent with previous work, a linear mixed effects model demonstrated that more trustworthy-looking faces were preferred in leaders during times of peace and more dominant-looking faces were preferred in leaders during times of war. These results provide converging evidence for context-specific effects of facial cues on hypothetical leadership judgments. [ABSTRACT FROM AUTHOR]

Objective: The aim of using the game-based tool Kahoot! was to evaluate and reinforce the contents taught in the subject of Management and Administration of Nursing, Ethics and Health Legislation Services included in the Degree in Nursing, during the 2016–2017 academic year. Methods: A prospective quasi-experimental study was carried out on a sample of 116 students. 10 multiple-choice questions were designed, with only one possible correct answer and a 20-second-limited response time for each of the questions. Four of these questions previously answered in the classroom using this game were chosen (20% of the exam). Each one of them corresponded to one unit of the topics taught in the subject. In order to participate in the educational game, students needed their smartphones or electronic devices. After completing the game, the students’ satisfaction level derived from its use was assessed. Results: The correct answer rate in the educational game was greater than 50% for all questions except for one, in which the rate was 28.8% (P<0.05). Response time as related to score presented statistically significant differences, and higher scores for those questions with lower response time (P<0.001). The questions included in the final test which had been previously answered using Kahoot! showed a significantly higher difficulty index than the rest of the final exam questions (P<0.05). Question 3 was the easiest, while being the one in which the highest-scoring students obtained more wrong answers. For the students this tool was easy to use (89.6%) and they positively valued the content acquisition and comprehension, as well as the teacher-student interaction (P<0.05). Conclusion: The implementation of educational games which consider response time and correct answers favors competitiveness and motivates students to actively participate in their learning process. [ABSTRACT FROM AUTHOR]

Background: Recent trends in sexual behavior, demonstrated in most countries, continue to indicate that more people are adopting safer sexual behaviors. However, there are signs of an increase in risky sexual behaviors in several countries. This study aimed to assess sexual behaviors and associated factors among youths in Nekemte town, East Wollega, Ethiopia in 2017. Methods: A community-based cross sectional study was conducted using a self-administered questionnaire. Then, the collected data were analysed using logistic regressions with 95% confidence interval (CI). Besides, the results of data analysis were `presented using appropriate descriptive measures and tables. Findings: Almost half of the respondents, 144(48.6%) had practiced sexual intercourse. Factors associated with ever had sexual intercourse include: being in age group 20-24(AOR = 2.322, 95% CI (1.258, 4.284)), having pocket money (AOR = 1.938, 95% CI (1.057, 3.556)), not attending school (AOR = 2.539, 95% CI (1.182, 5.456)), watching pornography (AOR = 4.314, 95% CI (2.265, 8.216)) and drinking alcohol (AOR = 7.725, 95% CI (3.077, 19.393)). Conclusion: High proportions of youths were practicing sexual intercourse. Targeting those identified associated factors in future intervention plan would improve the sexual behaviors of youths. [ABSTRACT FROM AUTHOR]

Introduction: Some studies in developing countries have shown that infant mortality is highly associated with maternal education, implying that maternal education might play an important role in the reduction of infant mortality. However, other research has shown that lower levels of maternal education does not have any significant contribution to infant survival. In this systematic review, we focus on the effect of different levels of maternal education on infant mortality in Ethiopia. Methods: MEDLINE, EMBASE, CINAHL, Scopus, and Maternity and Infant Care databases were searched between November 15, 2017 and February 20, 2018. All articles published until February 20, 2018 were included in the study. The data extraction was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA 2009) guidelines. An I2 test was used to assess heterogeneity and a funnel plot was used to check publication bias. Findings: We retrieved 441 records after removing duplications. During screening, 31 articles were fully accessed for data extraction. Finally, five articles were included for analysis. The overall pooled estimate indicated that attending primary education was associated with a 28% reduction in the odds of infant mortality compared to those infants born to mothers who were illiterate, OR: 0.72 (95% CI = 0.66, 0.78). Another pooled estimate indicated that attending secondary education and above was associated with a 45% reduction in the odds of infant mortality compared to those infants born to mothers who were illiterate, OR: 0.55 (95% CI = 0.47, 0.64). Conclusion: From this study, understanding the long-term impact of maternal education may contribute to reduce infant mortality. Therefore, policy makers should give more attention in promoting the role of women through removing institutional and cultural barriers, which hinder women from access to education in order to reduce infant mortality in Ethiopia. [ABSTRACT FROM AUTHOR]

Stress and mental health problems impede social functioning and may also complicate relationship formation with peers. The aim was to investigate whether high perceived stress among young adults is associated with social interaction behaviour both via face-to-face interaction and via smartphone interaction. The data was derived from the Copenhagen Network Study, where 535 first-year students (mean age 21.3, 77% male) self-reported on perceived stress at baseline and were subsequently followed for three months with continuous Bluetooth recordings of face-to-face interactions and smartphone interactions (calls and texts) measuring the network size, frequency, and duration of interactions. Logistic regression was used to assess associations between perceived stress (high/low) and social interactions adjusting for sex, age, and personality traits. Participants with high perceived stress were more likely to engage in a larger call and text network and have a higher call and text frequency compared to individuals with low perceived stress. We found a non-statistically significant tendency that participants with a high perceived stress level spend less time meeting face to face with peers. Stressed students engage in frequent smartphone interaction which may be explained by a social support seeking behaviour, or it may be that accommodating a large network via the smartphone is stress-inducing. [ABSTRACT FROM AUTHOR]

Aims: To know the prevalence, associated factors and temporal trends of disabilities for basic and instrumental activities of daily living in older people in Spain from 2009 to 2017. Background: Disability in older people is associated with health problems, increased health costs and low quality of life. There are no updated data in Spain with a representative sample about disability. Methods: Cross-sectional study with 25,465 non-institutionalized older people who participated in the European Health Survey in 2009 and 2014 and the National Health Survey in 2011/12 and 2017 in Spain. The prevalence rates of disability were evaluated using the Katz Scale and Lawton and Brody Scale. Logistic regression was used to determine if there was an association between basic and instrumental activities of daily living and sociodemographic characteristics. Results: More individuals had disability for instrumental activities of daily living (31.9%) than disability for basic activities of daily living (11.1%). The most predominant disability for instrumental activities of daily living was performing severe housework (34%). The prevalence of disabilities decreased from 2009 to 2017. In general, disability was associated with female gender, advanced age, lower education, restricted daily activity, being bedridden and higher pain levels. Conclusion: There is a considerable prevalence of disabilities for basic and instrumental activities of daily living in older people in Spain. Although the disability prevalence has decreased slowly from 2009 to 2017, it continues to remain a health problem. Gender may influence the disabilities for basic and instrumental activities of daily living. Health policymakers should establish prevention strategies and effective interventions (e.g., physical exercise) for prevention and reduction of the disabilities for basic and instrumental activities of daily living, particularly in older females. [ABSTRACT FROM AUTHOR]

We present a lab-in-the-field experiment and surveys of marginalised Roma children in Slovakia to examine whether reminding Roma of their ethnicity reduces their performance in a cognitive task. Research on social identity and stereotypes has documented that when individuals feel that their social group is negatively stereotyped in a domain, their performance declines, which can reinforce discrimination. In an effort to break the cycle of negative stereotypes, we remind Roma subjects of either Roma or non-Roma role models. We find that the activation of a Roma’s ethnicity reduces cognitive performance. In contrast, Roma exposed to Roma role models outperform those reminded of their ethnicity and of non-Roma role models. We then attempt to understand the channels through which social identity and role models affect performance. We show that priming the identity of a Roma has a direct effect on confidence, decreasing performance. [ABSTRACT FROM AUTHOR]

Background: The provision of health care in low-income and middle-income countries (LMICs) is recognized as a significant contributor to economic growth and also impacts individual families at a microeconomic level. The primary goal of our study was to examine the relationship between surgical conditions in children and the poverty trajectories of either falling into or coming out of poverty of families across Somaliland. Methods: This work used the Surgeons OverSeas Assessment of Surgical Need (SOSAS) tool, a validated household, cross-sectional survey designed to determine the burden of surgical conditions within a community. We collected information on household demographic characteristics, including financial information, and surgical condition history on children younger than 16 years of age. To assess poverty trajectories over time, we measured household assets using the Stages of Progress framework. Results: We found there were substantial fluxes in poverty across Somaliland over the study period. We confirmed our study hypothesis and found that the presence of a surgical condition in a child itself, regardless of whether surgical care was provided, either reduced the chances of moving out of poverty or increased the chances of moving towards poverty. Conclusion: Our study shows that the presence of a surgical condition in a child is a strong singular predictor of poverty descent rather than upward mobility, suggesting that this stressor can limit the capacity of a family to improve its economic status. Our findings further support many existing macroeconomic and microeconomic analyses that surgical care in LMICs offers financial risk protection against impoverishment. [ABSTRACT FROM AUTHOR]

Background: Video games have grown in popularity since the 1970s, and tobacco imagery is present in a substantial subset of games, including those oriented to youth. Much like exposure to tobacco content in films, exposure to tobacco content in video games may influence smoking uptake and use; however, the tobacco industry’s role in facilitating or promoting the use of tobacco imagery in video games is unclear. We explored the industry’s interest in and use of video games to market their products to youth and young adults. Methods: We retrieved and analyzed archival tobacco industry documents. We supplemented information from the documents with current and archived versions of several brand and corporate websites and one website containing user-supplied information on video games. Results: Tobacco companies recognized the youth appeal and marketing potential of video games as early as 1980. Initial marketing ideas included incorporating video game themes into product packaging and design. More fully realized plans focused on incorporating video games into product promotions in bars, as a high visibility way to attract younger patrons and increase long-term marketing opportunities by generating names for tobacco company direct-marketing databases. Tobacco companies also incorporated video games into in-home product promotions, primarily as components of brand websites, in order to enhance brand image and generate repeat website traffic. A similar desire to attract and keep visitors led to discussions about the inclusion of video games on corporate youth smoking prevention websites, although only one company, Lorillard, followed through. Conclusions: Video game players are an attractive target market for tobacco companies. Video games, as used by these companies, facilitate consumer engagement with particular tobacco brands or particular corporate messages. Eliminating the use of video games as a promotional vehicle may require limiting tobacco marketing in both physical and online environments. [ABSTRACT FROM AUTHOR]

Exploiting nation-wide data from the Danish National Birth Cohort, we show that children’s emotional and behavioral problems measured by the Strengths and Difficulties Questionnaire (SDQ) are closely related to their performance in standardized academic tests for reading and mathematics in sixth grade. The relationship is remarkably linear across the entire distribution for both the total difficulties score and subscale scores of the SDQ; higher scores on the SDQ (more problems) are related to worse performance in academic tests. We assess the similarity across respondent type; parent (child age 7 and 11), teacher (child age 11) and self-reported scores (child age 11), and find that teacher and parent reported scores have very similar slopes in the SDQ–test score relationship, while the child reported SDQ in relation to the academic test performance has a flatter slope. [ABSTRACT FROM AUTHOR]

Background: Physical inactivity is a major health issue in Saudi Arabia (SA). Being physically active can improve overall health and prevent the risk of noncommunicable diseases and their consequences. The objective of this study was to assess the knowledge, attitudes, and practices of primary health care physicians in SA toward physical activity (PA) and identify the correlates of PA counseling provided by physicians. Methods: A cross-sectional study was conducted in four main cities of Eastern Province, SA (Al-Khobar, Dammam, Qatif, and Safwa). A total of 147 physicians (44%) filled out self-reported surveys that were used in the assessment of the aims. Results: Overall, 59.9% of the physicians believed that PA promotion to patients was their responsibility, and 53.7% of the physicians felt confident in their ability to provide PA counseling. However, the physicians indicated that lack of time, inadequate referral services for PA, and inadequate training in PA counseling are barriers to providing PA counseling to their patients. Only 5.4% of the physicians had excellent knowledge about PA recommendations. Female physicians were more likely to promote PA than male physicians (OR, 3.72; 95% CI, 1.10–12.58; P = .03) and more likely to assess PA in pediatric patients (OR, 2.61; 95% CI, 1.03–6.61; P = .04). Compared to other specialties, family physicians were more likely to provide general PA counseling to patients without chronic diseases (OR, 8.86; 95% CI, 1.86–42.13; P = .006). Physicians who saw fewer adult patients were more likely to systematically track/follow-up on the PA of patients (OR, 3.13; 95% CI, 1.14–8.58; P = .03) and to promote PA to pediatric patients (OR, 2.87; 95% CI, 1.37–6.00; P = .005). Conclusions: Training medical staff in PA counseling and strengthening the health care workforce and infrastructure can help physicians improve their counseling practice. [ABSTRACT FROM AUTHOR]

Introduction: La Maison Bleue is a community-based perinatal health and social centre in Montreal that provides services during pregnancy up to age five to families living in vulnerable contexts. The study aimed to describe: 1) the challenges and protective factors that affect the well-being of migrant families receiving care at La Maison Bleue; and 2) how La Maison Bleue strengthens resilience among these families. Methods: We conducted a focused ethnography. Immigrants, refugees, asylum seekers and undocumented migrants were invited to participate. We collected data from November to December 2017 via semi-structured interviews and participant observation during group activities at La Maison Bleue. Data were thematically analysed. Results: Twenty-four mothers participated (9 interviewed, 17 observed). Challenges to well-being included family separation, isolation, loss of support, the immigration process, an unfamiliar culture and environment, and language barriers. Key protective factors were women’s intrinsic drive to overcome difficulties, their positive outlook and ability to find meaning in their adversity, their faith, culture and traditions, and supportive relationships, both locally and transnationally. La Maison Bleue strengthened resilience by providing a safe space, offering holistic care that responded to both medical and psychosocial needs, and empowering women to achieve their full potential towards better health for themselves and their families. Conclusion: Migrant mothers have many strengths and centres like La Maison Bleue can offer a safe space and be an empowering community resource to assist mothers in overcoming the multiple challenges that they face while resettling and raising their young children in a new country. [ABSTRACT FROM AUTHOR]