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Using a qualitative methodology, 14 women experiencing food insecurity were interviewed to explore their experiences with engaging in healthy eating to manage their weight. Data was collected using semi-structured interviews and evaluated using content analysis methods. Resilience factors situated throughout the social environment altered the path from exposure to risk (food insecurity) to poor outcomes (unhealthy eating behaviors/obesity). Resilience factors included social safety net programs, transportation, stretching the food budget, nutritional knowledge, and motivation. Study results can be used to develop strength-based policies and interventions to address obesity among women with low incomes. [ABSTRACT FROM AUTHOR]

Child protection systems monitoring is key to ensuring children's wellbeing. In England, monitoring is rooted in onsite inspection, culminating in judgements ranging from 'outstanding' to 'inadequate'. But inspection may carry unintended consequences where child protection systems are weak. One potential consequence is increased child welfare intervention rates. In this longitudinal ecological study of local authorities in England, we used Poisson mixed-effects regression models to assess whether child welfare intervention rates are higher in an inspection year, whether this is driven by inspection judgement, and whether more deprived areas experience different rates for a given inspection judgement. We investigated the impact of inspection on care entry, Child Protection Plan-initiation, and child-in-need status. We found that inspection was associated with a rise in rates across the spectrum of interventions. Worse judgements yielded higher rates. Inspection may also exacerbate existing inequalities. Unlike less deprived areas, more deprived areas judged inadequate did not experience an increase in the less intrusive 'child-in-need' interventions. Our findings suggest that a narrow focus on social work practice is unlikely to address weaknesses in the child protection system. Child protection systems monitoring should be guided by a holistic model of systems improvement, encompassing the socioeconomic determinants of quality. [ABSTRACT FROM AUTHOR]

Objectives Data Sources Data Collection/Extraction Methods Study Design Principal Findings Conclusions To evaluate the quality of Arkansas All‐Payer Claims Database (APCD) for disparity research in persistent poverty areas by determining (1) its representativeness of Arkansas population, (2) variation by county, and (3) differences in coverage between persistent poverty and other counties.Cross‐sectional study using 2019 Arkansas APCD member enrollment data and county‐level data from various agencies.An alias identifier linked persons across insurance plans. County FIPS codes were used to extract county‐level variables.Cohort 1 included individuals with ≥1 day of medical coverage in 2019. Cohort 2 included individuals with medical coverage in June, 2019. Cohort 3 included individuals with continuous medical coverage in 2019. Sampling proportions of a county's population in the three cohorts were compared between persistent poverty and other counties. Inverse‐variance weighted linear regression was used to identify county‐level socioeconomic and demographic characteristics associated with inclusion in each cohort.In 2019, 73.6% of Arkansans had medical coverage for ≥1 day (Cohort 1), 66.3% had coverage in June (Cohort 2), and 58.8% had continuous coverage (Cohort 3) in APCD. Sampling proportions varied by county (median[range]: Cohort 1, 78% [58%–95%]; Cohort 2, 71% [51%–88%]; and Cohort 3, 64% [44%–80%]), and were higher among persistent poverty counties than others for all three cohorts (mean [SD], persistent poverty vs. other: Cohort 1: 80.9% [6.4%] vs. 77.1% [6.3%], p = 0.04; Cohort 2: 74.0% [6.4%] vs. 70.1% [6.2%], p = 0.03; Cohort 3: 66.4% [6.1%] vs. 62.7% [6.0%], p = 0.03). In the 2019 APCD, larger counties and those with higher proportions of females or persons 65+ years had higher coverage, whereas counties with higher per capita household income, median home value, or disproportionately more persons of other races (non‐White and non‐Black) had lower coverage (p < 0.05 for all three cohorts).The Arkansas APCD had good coverage of Arkansas population. Coverage was higher in persistent poverty counties than others. [ABSTRACT FROM AUTHOR]

The study examines the socioeconomic determinants of physical health among populations experiencing food insecurity and receiving free meals in soup kitchens in the Prefecture of Attica, Greece. Data were collected from the same six soup kitchens in 2012, 2017 and 2021, resulting in a dataset of 1533 observations. The study revealed that periods characterised by an economic recession are associated with deteriorated physical health of food‐insecure people. Moreover, the study found that physical health deteriorations among food‐insecure people are associated with older age, female gender, immigration status, disability and/or long‐term health conditions, LGBT status, unemployment, economic inactivity, homelessness, living below the poverty threshold, long‐term food dependency, illicit drug consumption and residing in lower‐ and middle‐class areas. The study proposes the Intersectional Model of Health Inequalities, which integrates multiple factors involved in shaping the health inequalities of people experiencing food insecurity, from macro‐level factors such as a country's economic performance to individual‐level factors like education, employment status and demographic characteristics. The model emphasises that low‐income populations should not be treated as a homogeneous entity. Its goal is to inform policymakers about the diverse health inequalities experienced by people with low incomes. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Safe drinking water and closed sanitation are fundamental to health and are assumed in the United States, however, gaps remain, disproportionately affecting marginalized communities. We sought to describe household sanitation access for children in rural Alabama and local health provider knowledge of sanitation related health concerns. METHODS: Data were collected from self-administered surveys obtained from children enrolled in a larger cross-sectional study to determine soil transmitted helminthiasis prevalence in Alabama, from a survey of health providers from local federally qualified health centers and from a baseline knowledge check of Alabama health providers enrolled in an online sanitation health course. RESULTS: Surveys completed on 771 children (approximately 10% of county pediatric population) revealed less than half lived in homes connected to centralized sewers; 12% reported "straight-pipes," a method of discharging untreated sewage to the ground outside the home, and 8% reported sewage contamination of their home property in the past year. Additionally, 15% of respondents were likely to use well water. The local health providers surveyed did not include routine screening for water and sanitation failures or associated infections. Regional healthcare providers have limited knowledge of soil transmitted helminthiasis. CONCLUSIONS: A significant number of children from rural counties of Alabama with high rates of poverty reside in homes with water and sanitation challenges that predominantly affect African American families. This is an under-recognized health risk by local health providers, and its contribution to well-documented health disparities in this region is poorly understood. [ABSTRACT FROM AUTHOR]

In slum environments, adolescents face unique challenges that can significantly impact their well-being. This study aimed to assess the personal well-being of adolescents living in Delhi- NCR (National Capital Region) slums. Cummins' homeostasis theory states that individuals have a natural tendency to maintain a certain level of well-being and that various psychological mechanisms work to maintain this well-being within a positive and stable range. The study's objectives were to evaluate the normative range of mean scores for PWI domains, examine demographic factors influencing subjective well-being, and to evaluate the psychometric properties of the Personal Well-being Index-School Children (PWI-SC) in the context of slum-dwelling adolescents. A total of 477 slum dwelling adolescents aged 10–19 years participated in the study. The findings revealed that the PWI-SC demonstrated strong internal consistency (Cronbach's α = 0.83) and was a one-factor solution, affirming its reliability and unidimensionality as a measure of subjective well-being. The results indicated that slum-dwelling adolescents reported moderate to high levels of subjective well-being across various PWI domains. Furthermore, the regression analysis demonstrated that various domains, such as standard of living, life achievement, personal relationships, personal safety, community connectedness, and future security, significantly contribute to adolescents' overall life satisfaction. However, the impact of health is unknown in this context. Moreover, Age, family income, household size, and living conditions in the slums were identified as factors influencing subjective well-being among adolescents. Despite confronting challenging circumstances, slum-dwelling adolescents exhibit remarkable well-being, suggesting the presence of homeostatically protected moods. The validated PWI-SC has emerged as a valuable tool for future research and interventions aimed at enhancing adolescent well-being in similar contexts. [ABSTRACT FROM AUTHOR]

This study examined the differences in mental health service use, barriers, and service preferences among 393 low-income housing (LIH) and market-rate housing (MRH) Harlem residents in New York City. One-third (34.6%) endorsed the need for professional support for psychological issues, 27.2% and 15.8% reported using counseling services and psychotropic medication, with no differences between housing types. LIH residents (21.6–38.8%) reported significantly higher use of all types of mental health resources (e.g., websites, anonymous hotlines, self-help tools) compared with MRH residents (16.1–26.4%). Eighty-six percent reported barriers to mental health access, with LIH residents reporting more than double the barriers. Particularly, LIH residents reported greater difficulty getting time off work (34.1% vs. 14%), lack of health insurance (18.7% vs. 9.8%), lack of trust in mental health providers (14.6% vs. 4.7%), and stigma (12.2% vs. 5.1%) compared with MRH residents. Residents most preferred places of services were health clinics and houses of worship; provided by healthcare and mental health providers; and services delivered in-person and phone-based counseling. In contrast, residents least preferred getting support at mental health clinics; from family/friends; and by the Internet. No differences were found between service preferences by housing type. LIH residents reported higher use of mental health services and resources, but they face significantly more barriers to mental health care, suggesting a need to address specific barriers. Preferences for mental health services suggest a need for expanding mental health services to different settings given the low preference for services to be delivered at mental health clinics. [ABSTRACT FROM AUTHOR]

Purpose: Poverty continues to be a pervasive social problem within the United States despite a plethora of services and government assistance programs. Currently, universal and guaranteed basic income programs are being actively promoted. Method: This review incorporated universal or guaranteed basic income primary reports open to any country and in English from four academic databases including grey literature between January 1, 2013, and April 8, 2023, using randomized controlled trials or quasi-experimental study designs with no specified outcome. Results: Out of an initial 147 articles, four of the primary studies utilized a randomized controlled trial and one used a quasi-experimental design. One study occurred in the United States. Discussion: Despite the increasing implementation of such programs throughout the United States and their associated high cost, evidence is lacking based on their long-term impact and effectiveness. Further study is recommended including stronger evaluations of current and future programs. [ABSTRACT FROM AUTHOR]

As recently as the late 20th century, Schizophrenia, a category of mental illness with widely varying phenotypic symptoms, was believed by psychobiologists to be a genetically based disorder in which the environment played a limited etiological role. Yet a growing body of evidence indicates a strong correlation between schizophrenia and environmental factors. This theoretical paper explores the relationship between highly elevated rates of schizophrenia in some low-income minority communities worldwide and trauma-related dissociative symptoms that often mimic schizophrenia. Elevated rates of schizophrenia in racially and ethnically isolated, inner-city Black populations are well documented. This paper contains evidence proposing that this amplification in the rate of schizophrenia is mediated by childhood trauma, disorganized attachment, and social defeat. Further, evidence demonstrating how these three variables combine in early childhood to incubate dissociative disorders will also be conveyed. The misdiagnosis of dissociative disorders as schizophrenia is theorized to partially mediate the increased rate of schizophrenia in communities that experience high levels of racial/ethnic discrimination. It is argued that this misdiagnosis is often attributable to cultural misunderstanding and/or a lack of knowledge about dissociative disorders [ABSTRACT FROM AUTHOR]

Simple Summary: This cross-sectional study analyzed how multilevel social factors affect patient-reported outcomes in children under 18 who survived cancer. Study participants include 293 pairs of these survivors who received survivorship care at a U.S.-based comprehensive cancer center between 2017 and 2018 and their primary caregivers. Findings indicate that higher caregiver anxiety is linked to worse depression, stress, fatigue, sleep problems, and lower positive affect in survivors of pediatric cancer. The study also found that family conflicts are associated with sleep issues in childhood cancer survivors. Furthermore, survivors living in socioeconomically deprived areas experience poorer sleep quality, and those residing in environments with high physical deprivation experience more psychological stress and fatigue, alongside reduced positivity and mobility. These results highlight the significant impact of parental, familial, and neighborhood factors on a range of patient-reported outcomes among young cancer survivors, suggesting these social factors as crucial targets for intervention. In this study, the social determinants of patient-reported outcomes (PROs) in young survivors of childhood cancer aged <18 years are researched. This cross-sectional study investigated social determinants associated with poor PROs among young childhood cancer survivors. We included 293 dyads of survivors receiving treatment at St. Jude Children's Research Hospital who were <18 years of age during follow-up from 2017 to 2018 and their primary caregivers. Social determinants included family factors (caregiver-reported PROs, family dynamics) and county-level deprivation (socioeconomic status, physical environment via the County Health Rankings & Roadmaps). PROMIS measures assessed survivors' and caregivers' PROs. General linear regression tested associations of social determinants with survivors' PROs. We found that caregivers' higher anxiety was significantly associated with survivors' poorer depression, stress, fatigue, sleep issues, and reduced positive affect (p < 0.05); caregivers' sleep disturbances were significantly associated with lower mobility in survivors (p < 0.05). Family conflicts were associated with survivors' sleep problems (p < 0.05). Residing in socioeconomically deprived areas was significantly associated with survivors' poorer sleep quality (p < 0.05), while higher physical environment deprivation was associated with survivors' higher psychological stress and fatigue and lower positive affect and mobility (p < 0.05). Parental, family, and neighborhood factors are critical influences on young survivors' quality of life and well-being and represent new intervention targets. [ABSTRACT FROM AUTHOR]

Background: Existing research on the impacts of adversity on young children's psychological well‐being has largely focused on household‐level risk factors using observational methods in high‐income countries. This study leverages natural variation in the timing and location of community homicides to estimate their acute effects on the regulatory, behavioral, and developmental outcomes of Brazilian 3‐year‐olds. Methods: We compared the outcomes of children who were assessed soon after a recent neighborhood homicide to those of children from the same residential neighborhoods who had not recently experienced community violence. Our sample included 3,241 3‐year‐olds (Mage = 41.05 months; 53% female; 45% caregiver education less than middle school; 26% receiving a public assistance program) from seven neighborhoods in São Paulo, Brazil. Child outcome measures included parent reports of effortful control and behavior problems as well as direct assessments of children's developmental (cognitive, language, and motor) skills. Community homicides were measured using police records. Results: Recent exposure to community homicides was associated with lower effortful control, higher behavior problems, and lower overall developmental performance for children (d =.05–.20 standard deviations; p = ns – <.001). Effects were consistent across subgroups based on sociodemographic characteristics and environmental supports, but generally largest when community violence exposure was geographically proximal (within 600 m of home) and recent (within 2 weeks prior to assessment). Conclusions: Results highlight the pervasive effects that community violence can have on young children as well as the need to expand support to mitigate these effects and prevent inequities early in life. [ABSTRACT FROM AUTHOR]

Objective To explore the vitamin D nutritional status and influencing factors of primary and middle school students in poverty areas of Guizhou Province, and to provide scientific basis for the development of targeted nutritional improvement measures. Methods A total of 2,519 students from 4 primary and4 middle schools in 9 key monitoring counties (districts) in Guizhou Province, where the Nutrition Improvement Program for Rural Compulsory Education Students was implemented in 2023, were selected for questionnaire surveys, physical examinations, and blood biochemistry tests using multistage cluster sampling methods. Multifactorial logistic regression was used to analyze the current status of vitamin D nutrition and its influencing factors. Results The average vitamin D level of primary and middle school students in poverty areas of Guizhou Province was (22. 59 ± 6. 66) ng/ml, and the rate of low vitamin D was 37. 51%. The prevalence of low vitamin D among female students (46. 17%) was higher than that of male students (29. 11%), and the difference was statistically significant 仗2 = 78. 213, P < 0. 001). There was a significant difference in the rate of low vitamin D among students in different regions 仗2 二 23. 454, P <0. 001), and the rate of low vitamin D tended to increase with age = 44. 905, P <0. 001). The results of multifactorial logistic regression analysis showed that, compared with the corresponding reference group, ethnic minorities (OR = 0. 706, 95% CI: 0. 590 - 0. 844), physical activity M60 min/d (OR = 0. 791, 95% CI: 0. 663 - 0. 943), and living in the countryside (OR - 0. 747, 95% CI: 0. 616 -0.906) were protective factors for low vitamin D levels; obesity (OR =2. 133, 95% C/: 1.390 - 3.272), female students (OR 二2. 238, 95% CI: 1.882 -2.662), the 11-13 years old group (OR =1. 849, 95% CI: 1. 521 - 2. 248) and the 14 - 17 years old group (OR = 2. 000, 95% CI: 1. 576 - 2. 539) were risk factors for low vitamin D levels. Conclusion High rates of low vitamin D among primary and middle school students in poverty areas of Guizhou Province require the development of personalized nutritional interventions to improve vitamin D nutritional status. [ABSTRACT FROM AUTHOR]

Reducing multidimensional relative poverty is one of the important issues in the current global poverty governance field. This article takes 12 ethnic regions in China as the research object and constructs a multidimensional relative poverty measurement system. The calculated multidimensional relative poverty index is decomposed according to provinces, cities, dimensions, and indicators. Then, the Dagum Gini coefficient and convergence analysis are used to analyze spatiotemporal heterogeneity and convergence characteristics. The results show that the multi-dimensional relative poverty situation of various provinces in ethnic minority areas has improved from 2012 to 2021, among which Tibet province is the most serious and Shaanxi is the best. According to the analysis of convergence, it was observed that there is no σ-convergence of multidimensional relative poverty in ethnic areas in general, and there is absolute β-convergence in general and in the southwest and northwest regions, and there is no absolute β-convergence in the northeast region. Based on this, policy recommendations for reducing multidimensional relative poverty are proposed at the end of the article. Compared with previous studies, this article focuses on ethnic regions that are easily overlooked. Starting from the dimensions of economy, social development, and ecological environment, the poverty measurement system has been enriched. [ABSTRACT FROM AUTHOR]

BACKGROUND: Districts with federal nutrition programs must have an updated local school wellness policy (LSWP) to promote nutrition, physical activity, and student wellness. This study evaluates factors associated with LSWP quality among low‐income districts. METHODS: In 2018, we collected LSWPs from websites of 200 randomly selected, county‐stratified, low‐income‐serving California public districts. Multivariable linear regression assessed associations between district characteristics, model LSWP use (national, state, none), and adoption date on policy quality. RESULTS: On the WellSAT 3.0 scale of 0‐100, mean (95% CI) comprehensiveness was 65.0 (63.2‐66.7) and strength was 37.3 (35.3‐39.2). Nearly verbatim adoption of model LSWPs was high (68.5% state model, 13.0% a national model). Half were adopted before mandated updates. District size (≥1000 students) and national model LSWP adoption were associated with higher comprehensive scores. National model LSWP adoption was associated with higher strength scores in updated policies compared with those not updated. IMPLICATIONS: LSWPs have improved school food and activity environments, but district engagement in LSWP is low. Integration into education frameworks that reduce learning barriers could provide synergy for re‐engagement. CONCLUSIONS: High adoption of model policies and low update compliance indicate little district engagement in LSWP. Mixed methods studies of districts with high‐quality LSWP are needed. [ABSTRACT FROM AUTHOR]

Background: Economic violence prevails to be one of the unexplored domains of intimate partner violence. Objective: To explore the perceived forms of economic violence and its health impacts among married women in Puducherry. Methodology: A community-based exploratory study was conducted in urban slums in Puducherry. All married women aged 18 to 65 years belonging to low socio-economic status residing in two selected slums were included by purposive sampling. A total of seven focus group discussions were conducted till the point of saturation and manual content analysis done. Results: Four major themes emerged, namely: experiences of economic abuse, health impacts of economic abuse, perceived factors influencing economic abuse, and suggested preventive measures for economic abuse. Conclusion: Economic abuse against women in India exists in multiple dimensions. It has profound consequences on the physical and psychological health of women. [ABSTRACT FROM AUTHOR]

Background: With increasing urbanization, number of urban slums is also rising. The health facilities and indicators in urban slums are poor as compared to other urban population. The present study presents an analysis of the health problems, utilization of health services and vulnerability of urban slums. Aims & Objectives: To map the slums in urban areas and assess the vulnerability of households. Methodology: The study was conducted in all urban slums of five cities of Nainital and Udham Singh Nagar districts namely Haldwani, Ramnagar, Rudrapur, Jaspur and Kashipur. Group discussions involving community members, ward surveys by ASHA workers and household level vulnerability assessment were done using standard format according to "Guidelines and Tools for Vulnerability Mapping and Assessment of Urban Health, 2017". Results: Most urban slum dwellers are daily wage laborers with major population suffering mainly from diabetes, hypertension, respiratory infection. Lack of drugs and diagnostic facilities are the major concerns. Infrastructure needs strengthening in most of the slums. Around three fourth of population belonged to vulnerable group with remaining in highly vulnerable group. Conclusion: There are social problems in urban slums like illiteracy, lack of awareness, unemployment which worsen the health problems. So, a holistic approach is needed for the solution. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine, via testimonial data, resistance strategies used to thwart a sexual assault among slum-dwelling Kenyan adolescent girls (N = 678) following their participation in an empowerment self-defense program (IMpower). The majority (58.2%) of perpetrators were strangers; there were no differences in resistance strategies used between strangers versus known perpetrators (83.8% used verbal strategies, 33.2% used resistance strategies, 16.7% ran away, and 7.9% used distraction). Associations between resistance strategies and perpetrator tactics, number of assailants, location of the assault, and the presence of a bystander were also examined. [ABSTRACT FROM AUTHOR]

Multilevel models with nested errors are widely used in poverty estimation. An important application in this context is estimating the distribution of poverty as defined by the distribution of income within a set of domains that cover the population of interest. Since unit-level values of income are usually heteroskedastic, the standard homoskedasticity assumptions implicit in popular multilevel models may not be appropriate and can lead to bias, particularly when used to estimate domain-specific income distributions. This article addresses this problem when the income values in the population of interest can be characterized by a two-level mixed linear model with independent and identically distributed domain effects and with independent but not identically distributed individual effects. Estimation of poverty indicators that are functionals of domain-level income distributions is also addressed, and a nonparametric bootstrap procedure is used to estimate mean squared errors and confidence intervals. The proposed methodology is compared with the well-known World Bank poverty mapping methodology for this situation, using model-based simulation experiments as well as an empirical study based on Bangladesh poverty data. [ABSTRACT FROM AUTHOR]

To get a rich description of the barriers to using assistive technology (AT) among men and women ≥65 years living in poor and disadvantaged communities in Puerto Rico, an issue not well described among older people. We conducted qualitative interviews assisted by videos of AT and guided by the Matching Person and Technology Model and the Gender Analysis Framework with a purposive sample of 23 men and women. Participants were asked questions regarding reasons for not using AT, willingness for using AT, their identified gender roles and gender-related activities, and bargaining positions. They were also asked about their access to resources to acquire AT, bargaining positions, the stigma associated with AT use, and the characteristics of AT. Directed content analysis with input from a Community Advisory Board was used for the interpretation of the results. The predominant barrier (for both men and women) to using AT devices were: lack of information about AT s and access to money for their purchase, lack of availability and cost of such devices, and (self)-stigma. More women than men experienced limited access to AT services, limited access to and control of money, limited skills for using AT, and less bargaining power for making independent decisions. More men than women expressed a lack of functional need and personal preferences other than using AT devices for managing difficulties in activities. There are gender differences concerning the multilevel barriers to using AT devices among older Hispanics residing in low-income communities. Older Hispanic men and women in this study experienced different obstacles to using assistive technology (AT) they need for compensating their functional disabilities in daily living activities. Women in this study reported having less access to money and AT services, diminished skills for using AT devices, and less power to make independent decisions to access AT devices compared to men. To ensure the equitable provision of AT, cultural as well as gender-related factors concerning AT use need to be considered. Future research should focus on women's functional health, also should focus on the development of gender-sensitive and culturally competent AT interventions to improve older Hispanics from poor communities function and opportunities for ageing at their homes and in their communities. [ABSTRACT FROM AUTHOR]

By means of probabilistic graphical models, in this paper, we present a new framework for exploring relationships among indicators commonly included in the Multidimensional Poverty Index (MPI). In particular, we propose an Ising model with covariates for modeling the MPI as an undirected graph. First, we prove why Ising models are consistent with the theoretical distribution of MPI indicators. Then, a comparison between our estimates and the association measures typically used in the literature is provided. Finally, we show how undirected graphs can complement the MPI policy-relevant properties, apart from discovering further insightful patterns that can be useful for policy purposes. This novel approach is illustrated with an empirical application for the global MPI indicators of Guinea and Ecuador, taking living areas and monetary poverty as covariates, respectively. [ABSTRACT FROM AUTHOR]

Mindfulness has been shown to increase parental well-being in multi-faceted ways, yet we do not invest in broad applications of mindfulness training for those most in need. The overall aim of this qualitative study is to better understand whether and how mindful self-care instruction helps Black, low-income women assimilate the experience of birth and the transition into motherhood. Conclusions indicate that the mindfulness program impacts these women by helping them feel more connected to themselves, increasing their awareness and practice of self-care, and improving their mental health and well-being. [ABSTRACT FROM AUTHOR]

Calls for humanity to act on environmental changes are becoming increasingly critical. The growing polycrisis including the impact of ongoing conflicts in contested geopolitical spaces and the struggles for ways to sustain a livelihood in areas of precarity and poverty, are just some of the intersecting challenges which have given rise to a Code Red alarm by the United Nations surrounding issues related to climate change. Rich narratives and stories of climate actions from Africa offer examples of potential paths. This paper explores how such narratives inform local development and climate action. A key message is that stories and narratives, created by various peoples, disciplines, and systems of knowledge, can all be powerful genres and sources for agentic change that can inspire and embolden development practice and action. [ABSTRACT FROM AUTHOR]

This study aimed to (a) compute the prevalence of violence exposure types, polyvictimization, and self-reported depression, anxiety, and using substances to cope among youth ages 12–18 years living on the streets or in the slums of Kampala, Uganda, (b) examine the independent associations among orphan status, violence exposure types, and self-reported mental health concerns, and (c) explore the association between polyvictimization and mental health concerns. Data are from a 2014 cross-sectional survey of service-seeking youth ages 12–18 years (N = 1134) in Kampala, Uganda. Violence exposure types explored in this study were: witnessing family physical violence, direct physical abuse by a parent, any rape history, and physical dating violence. We used descriptive statistics and multivariable logistic regression to test study objectives. Over half of the sample (60.5%) reported experiencing at least one type of violence exposure; many youth endorsed self-reported depression (57.8%), anxiety (76.8%), and substance use to cope (37.0%). Exposure to violence was associated with higher odds for self-reported depression, anxiety, and using substances to cope. These findings underscore the urgent need to implement evidence-based interventions among this young, underserved population and their families to prevent violence, improve mental health outcomes, and promote resilience. [ABSTRACT FROM AUTHOR]

Introduction: Pregnant British Pakistani women have disproportionately poorer health than the wider population. Bradford has a strong Pakistani presence and a wide range of public health problems including high levels of gestational diabetes, high obesity rates and a high infant mortality rate, which is highest for babies of Pakistani origin. For women to be healthy, we need to know what concerns they have about their health so they can be addressed appropriately. The aim of this study, therefore, was to explore the health concerns of pregnant British Pakistani women living in deprived areas. Methods: Semi-structured qualitative interviews were conducted with 21 pregnant Pakistani women in a hospital setting. Data were analysed using thematic analysis. Results: Pakistani women identified safety issues, barriers to undertaking physical activity in the areas where they live, concerns surrounding exercising during pregnancy and cultural and religious constraints that prevented them from engaging in physical activity. They reported issues around food, concerns around a lack of culturally appropriate diet information, the cost of unhealthy food locally, and the lack of healthy food options in their residences. Women were unsure on where to obtain health promotion information and reported a lack of access in obtaining that information. Language barriers in accessing health promotion information were further reported as a concern. Discussion: Researchers, midwives, health providers, local authority and policy makers interested in improving the health of pregnant Pakistani women may use these findings to develop further research and interventions to improve the poor health of this population. Significance: What is already known on this subject? South Asian women have previously identified issues relating to safety in physical activity and cultural barriers to engaging in physical activity but there has been little investigation into the health concern of pregnant Pakistani women. What this study adds? We now have a clearer understanding of the barriers faced by pregnant Pakistani women living in deprived areas when trying to live a healthy lifestyle. This understanding will contribute to the development of strategies for promoting health and improving the outcomes for this population. [ABSTRACT FROM AUTHOR]

Background: Adolescents are vulnerable to stressors because of the rapid physical and mental changes that they go through during this life period. Young people residing in slum communities experience additional stressors due to living conditions, financial stress, and limited access to healthcare and social support services. The Adolescents' Resilience and Treatment nEeds for Mental Health in Indian Slums (ARTEMIS) study, is testing an intervention intended to improve mental health outcomes for adolescents living in urban slums in India combining an anti-stigma campaign with a digital health intervention to identify and manage depression, self-harm/suicide risk or other significant emotional complaints. Methods: In the formative phase, we developed tools and processes for the ARTEMIS intervention. The two intervention components (anti-stigma and digital health) were implemented in purposively selected slums from the two study sites of New Delhi and Vijayawada. A mixed methods formative evaluation was undertaken to improve the understanding of site-specific context, assess feasibility and acceptability of the two components and identify required improvements to be made in the intervention. In-depth interviews and focus groups with key stakeholders (adolescents, parents, community health workers, doctors, and peer leaders), along with quantitative data from the digital health platform, were analysed. Results: The anti-stigma campaign methods and materials were found to be acceptable and received overall positive feedback from adolescents. A total of 2752 adolescents were screened using the PHQ9 embedded into a digital application, 133 (4.8%) of whom were identified as at high-risk of depression and/or suicide. 57% (n = 75) of those at high risk were diagnosed and treated by primary health care (PHC) doctors, who were guided by an electronic decision support tool based on WHO's mhGAP algorithm, built into the digital health application. Conclusion: The formative evaluation of the intervention strategy led to enhanced understanding of the context, acceptability, and feasibility of the intervention. Feedback from stakeholders helped to identify key areas for improvement in the intervention; strategies to improve implementation included engaging with parents, organising health camps in the sites and formation of peer groups. Trial Registration: The trial has been registered in the Clinical Trial Registry India, which is included in the WHO list of Registries, Reference number: CTRI/2022/02/040307. Registered 18 February 2022. [ABSTRACT FROM AUTHOR]

We examine how Danish politicians articulate views on the 'parallel society agreement' (aka, the 'ghetto‐laws'), a controversial legislative intervention aiming to manage urban migration‐related diversity. Through nationwide urban redevelopment aimed at facilitating residential 'mixing', the goal of the legislation is to eliminate so‐called 'parallel societies'—socio‐economically deprived neighbourhoods characterized by high concentrations of ethnic minorities. In‐depth interviews with Danish politicians (n = 11) explored how this proposal was supported, contested or rejected in situated discourse. Following social representations theory, we focus on how 'parallel societies' were constructed in relation to differing ideas about 'mainstream society' and value‐laden oppositional meaning‐categories (i.e. themata). In particular, we highlight processes of socio‐ethical reasoning that occurred through thematization of a shared oppositional meaning‐category: 'freedom‐constraint'. Views on the intervention were articulated around this oppositional meaning‐category. Moreover, a connection was observed between the views articulated by individual politicians and sets of congruent ideas and images mobilized to represent 'parallel societies'. We discuss the theoretical value of taking a social representations approach to urban policy debates, and the practical limitations of dominant representations for successfully promoting intercultural dialogue and engagement—the stated goal of this intervention. [ABSTRACT FROM AUTHOR]

Purpose: Phonological awareness and alphabet knowledge are fundamental building blocks for literacy development. We identified preschoolers with persistent delays in these skills and evaluated the efficacy of a supplemental curriculum to remediate deficits in early literacy skills. Method: Using a cluster design, 21 classrooms were randomly assigned to early literacy versus language intervention conditions. Sixty children identified through fall semester assessments of phonological awareness and alphabet knowledge were enrolled in small-group instruction. Teachers completed eLearning modules, used a digital platform to enter data and facilitate data-based decision making, received practice-based coaching, and delivered 12 weekly units of an early literacy curriculum. Comparison teachers delivered similarly administered small-group language instruction. Results: Large effects were evident for letter sounds, phoneme segmentation, first sound, and first sound fluency measures (d = 0.92, 4.77, 1.15, and 1.50, respectively), and nonsignificant, small effects for letter naming and blending measures (d = 0.26 and 0.27). Discussion: This early literacy intervention package had practical benefits, with 90% of experimental group preschoolers exceeding the phonemic awareness benchmark for beginning kindergarten compared to 45% in the comparison group, for example. Providing preschool teachers with tools and support for implementing a tiered approach to early literacy intervention holds promise for producing impressive gains in skills required for children to succeed in later schooling. [ABSTRACT FROM AUTHOR]

This study examines factors underlying single mothers' stress in an African slum. Using survey data from 1,221 mothers in a Kenyan informal settlement, this study examines 1) whether single mothers experience more stress due to their demographic and socioeconomic characteristics; 2) whether financial and child care support from kin offsets limited support from fathers; and 3) whether variation in the type and source of support explains stress differentials across marital status. The results suggest that lower socioeconomic status does not explain single mothers' elevated stress. Rather, despite receiving greater assistance with child care and financial support from kin, single mothers receive substantially less support of either kind from the child's father. These differences in support, particularly financial assistance, account for single mothers' elevated stress. These findings highlight the comparatively weak social support available for single mothers residing in precarious urban environments and its importance for their psychological well-being. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to examine the motivations and supports of stakeholders in the slum communities, Ghana. Design/methodology/approach: Two-stage methodologies were used for data collection. Published Google News articles about the phenomenon as well as exploratory qualitative in-depth interviews with 15 participants. Findings: The evidence shows that structured and unstructured are the two main categories of stakeholders operating in the space of slums in Ghana. It shows that stakeholders are motivated by their objectives and ethical or moral obligations to provide support in the form of consumables, housing and finance to the slums. Research limitations/implications: Because of the data collection regime used in this project, findings are specific to the Ghanaian context and not generalisable. However, the results could be beneficial in other contexts with similar slum phenomena. Practical implications: The conclusions drawn serve as a springboard for urban managers responsible for slum administration and management to develop policy packages to incentivise and enlist more non-slum stakeholders in the existing stakeholders. Originality/value: To the best of the authors' knowledge, this study is one of the few that expands the frontiers of the stakeholder model within context to discover specific slum stakeholders, their motivations and support for the slums in a consolidated manner. [ABSTRACT FROM AUTHOR]

Introduction: Hypertension, the "Silent, Invisible killer" - is a modern day's universal epidemic. The adult populations in slum area are more vulnerable for hypertension as they are so busy in the fulfilment of even day to day basic needs and care, family commitments and economic stress. Aim and objectives: To estimate the prevalence of hypertension among the adults (25-44 years) and to study the effect of sleep on blood pressure levels. Methodology: The present cross-sectional study was carried among adults aged between 25 to 44 years residing in the slums of Meerut District. 30 Cluster Sampling technique was used. The slum was selected as a cluster unit. During the visit by house-to-house survey, members of the family were listed and eligible person were interviewed and examined. Data collected on a structured and pretested questionnaire. Results: Prevalence of hypertension among those who had sleep duration of >8 hours per day was 44.8% followed by 20.1% and 17.5% among those who had 7-8 hours and less than 7 hours of sleep time respectively. It was found that 24.2% monophasic sleep pattern follower were hypertensives while the prevalence was 19.4% in biphasic pattern. Conclusion: Majority (55.4%) had a sleep duration between 7-8 hours, followed by 33.9% and 10.7% with <7 hours and >8 hours of sleep time respectively. Majority (61.3%) of the study population were having monophasic sleep pattern, while 36.3% were biphasic and 2.4% were multiphasic. [ABSTRACT FROM AUTHOR]

In this paper, we present the results of a scoping review in which we examined the scientific literature (2010–2021) on faith-based organizations (FBOs) working within the field of poverty alleviation, focusing on the way studies define and use the term FBO. Fifty-two relevant studies were identified and included. Our research shows that the term FBOs is primarily used in American studies. Moreover, there is no broad consensus on the exact definition or meaning of the term nor on its scope. Because of this lack of consensus and the inherent shortcomings of the term, we suggest to replace the term FBO by the term "religion-based solidarity initiatives" (RSIs), We define RSIs as: "Initiatives that, from a religious inspiration, aim at organizing collective action for and/or providing support or services to people in vulnerable positions." These initiatives can range from small scale ad hoc initiatives till large scale formal organizations. [ABSTRACT FROM AUTHOR]

Introduction: Inspired by examples in low- and middle-income countries, 50 community health workers (CHWs) were introduced in Belgium to improve access to primary care for people living in socio-economically vulnerable circumstances. This article aims to explore the ways in which CHWs support people living in socio-economically vulnerable circumstances in their access to primary care. Methods: The qualitative research focuses on the first year of implementation of this pioneer nationwide CHW programme in Belgium. To respond to the research aim, thirteen semi-structured in-depth interviews were held with people living in socio-economically vulnerable circumstances. In addition, a photovoice study was conducted with fifteen CHWs comprising four phases: (1) photovoice training; (2) participatory observation with each CHW individually; (3) an individual semi-structured in-depth interview; and (4) three focus group discussions. The transcripts and the observation notes were analysed in accordance with the abductive analysis procedures described by Timmermans and Tavory. Results: The qualitative results show that the CHWs' outreaching way of working allows them to reach people living at the crossroads of different vulnerabilities that are intertwined and reinforce each other. They experience complex care needs, while at the same time they face several barriers that interrupt the continuum of access to primary care – as conceptualised in the theoretical access-to-care framework of (Levesque et al. Int J Equity Health. 12:18, 2013). Building on the theoretical access-to-care framework described by (Levesque et al. Int J Equity Health. 12:18, 2013), the conceptual model outlines first the underlying mechanisms of CHW-facilitated access to primary care: (I) outreaching and pro-active way of working; (II) building trust; (III) providing unbiased support and guidance in a culturally sensitive manner; and (IV) tailoring the CHWs' approach to the unique interplay of barriers at the individual and health system level along the access-to-care continuum as experienced by the individual. Further disentangling how CHWs provide support to the barriers in access to care across the continuum and at each step is outlined further in the process characteristics of this conceptual model. Furthermore, the qualitative results show that the way in which CHWs support people is also impacted by the broader health system, such as long waiting times and unwelcoming healthcare professionals after referral from a CHW. Discussion: The conceptual model of CHW-facilitated access to primary care developed in this article explores the way in which CHWs support people living in socio-economically vulnerable circumstances in their access to primary care in Belgium. Through their outreaching method, they play a valuable bridging role between the Belgian healthcare system and people living in socio-economically vulnerable circumstances. Highlights: - Community health workers (CHWs) reach people who live at the crossroads of different vulnerabilities. - CHWs adjust their support to the unique interplay of barriers at the individual and health system level across the access-to-care continuum. - Through their outreaching method, they play a valuable bridging role between the Belgian healthcare system and people living in socio-economically vulnerable circumstances. - The conceptual model of CHW-facilitated access to primary care explores the ways in which CHWs support people living in socio-economically vulnerable circumstances in their access to primary care in Belgium. [ABSTRACT FROM AUTHOR]

COVID-19 disrupted families' food supply. Based on in-depth interviews with 45 Black low-income mothers of young children in an underserved Houston, Texas, neighborhood from April 2020 to June 2021, we compared two aid programs—Pandemic Electronic Benefits Transfer cash assistance and in-kind food distributions. We found that mothers preferred cash assistance for boosting existing food strategies, while food distributions presented new challenges for already burdened families. We argue that food assistance interventions can be more successful and equitable by integrating service user context, needs, and preferences. (Am J Public Health. 2023;113(S3):S227–S230. https://doi.org/10.2105/AJPH.2023.307458) [ABSTRACT FROM AUTHOR]

Obtaining reliable estimates in small areas is a challenge because of the coverage and periodicity of data collection. Several techniques of small area estimation have been proposed to produce quality measures in small areas, but few of them are focused on updating these estimates. By combining the attributes of the most recent versions of the structure-preserving estimation methods, this article proposes a new alternative to estimate and update cross-classified counts for small domains, when the variable of interest is not available in the census. The proposed methodology is used to obtain and up-date estimates of the incidence of poverty in 81 Costa Rican cantons for six postcensal years (2012–2017). As uncertainty measures, mean squared errors are estimated via parametric bootstrap, and the adequacy of the proposed method is assessed with a design-based simulation. [ABSTRACT FROM AUTHOR]

Introduction: Rapid urbanisation affects lifestyle and eating habits, predominantly causing a dietary shift that adds challenges to meet dietary recommendations within a complex food system. This research investigated dietary diversity and food choice drivers among low‐income consumers in three urban settlements (Nairobi, Kenya; Bulawayo, Zimbabwe and Lilongwe, Malawi, representing rapid, moderate and slow urban growth patterns, respectively) as a first step towards improving diets across cultures and geographies. Methods: Mixed methods data collection was employed for this study. Qualitative methods such as rapid foodscape appraisal workshops and food stories in selected low‐income settlements in Nairobi, Bulawayo and Lilongwe were utilised to collect information on the food environments (food balances, infrastructure, safety, policies and institutions). Quantitative data such as socio‐demographic characteristics and dietary diversity were collected via structured questionnaires using Cognitive Edge's SenseMaker® (n = 890, 450 and 440 for Nairobi, Bulawayo and Lilongwe, respectively). The dietary intake of respondents was assessed using a 24‐h recall, which was then converted to the food group diversity score (FGDS). Results: Different levels of compounded stress affected dietary diversity and quality, including high food prices, concerns about sanitation and hygiene and the role of food standards regulation bodies. The mean FGDS across all locations was lower than the recommended cut‐off of 5 (4.5, 2.8 and 2.6 across Nairobi, Zimbabwe and Lilongwe, respectively). Additionally, in Nairobi, there were gender differences in diet diversity, with men having a higher dietary diversity score than women (4.6% vs. 4.3%; p = 0.004). The majority of respondents in Lilongwe (65%) reported price as the most important driver of food choice, compared to 38% in Nairobi and 42% in Bulawayo. Discussion/Conclusions: Our observation of poor‐quality diets provides further evidence of the need for food policies that are cognisant of the nutrition and health of the growing population of the urban poor. Such policies would focus on lowering the costs of nutritious foods as well as ensuring food safety within the complex food system observed in the urban low‐income environment. Key points: An investigation conducted in contrasting food environments in three urban low‐income settlements in Lilongwe, Bulawayo and Nairobi suggests low consumption of nutrient‐dense foods, such as fruits and animal‐source foods.Several drivers of dietary diversity and food choice, as well as perceptions, were identified. Price and convenience were identified as key drivers of food choice, with gender differences reported in dietary diversity.Policies and programmes need to consider steering diets towards higher consumption of nutrient‐dense foods while taking into account price, convenience and environmental sustainability. [ABSTRACT FROM AUTHOR]

Since the 2000s, hundreds of government-funded health insurance (GFHI) schemes were introduced in India. These schemes are meant to prevent poorer households from incurring catastrophic health expenditures. Through GFHIs, policy-makers want to mobilize the decision-making powers of private consumers in a liberalized healthcare market. Patients are called upon to act as 'co-creators' of healthcare value by optimizing supply through demand. Based on long-term ethnographic fieldwork with insurance users in South India, we argue that GFHIs fail because people experience the value of insurance in drastically different ways that only partly overlap with how the policy assumes they value insurance. In addition, the hollow promises of health coverage can be experienced as so frustrating that signing up for health insurance actually makes people feel devalued. [ABSTRACT FROM AUTHOR]

Children's socio‐emotional adjustment during the COVID‐19 pandemic could depend on their pre‐pandemic risk of heightened socio‐emotional distress and available resources. In a sample of elementary school‐aged children from low‐income neighbourhoods in Germany, we examined children's socio‐emotional adjustment throughout two pandemic‐related school closing periods of 5 months each and explored possible determinants of their adjustment. On three occasions before and after school closing, home‐room teachers reported on the distress of 365 children (Mage = 8.45, 53% female) and provided information on their family backgrounds and internal resources. We studied child pre‐pandemic risk of low socio‐emotional adjustment based on low basic care by families and group membership (i.e., recently arrived refugee, deprived Roma family). We studied child resources regarding families' home learning support during school closings and selected internal resources of the children (German reading skills, academic ability). Results showed that children's distress did not increase throughout the school closings. Instead, their distress remained at constant levels or even decreased. On pre‐pandemic risk, only low basic care was linked to higher levels of distress and worse trajectories. On child resources, home learning support, academic ability, and German reading skills were inconsistently linked to less distress and better trajectories depending on the school closing period. Our findings suggest better‐than‐expected socio‐emotional adjustment of children from low‐income neighbourhoods during the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Attention bias confers risk for anxiety development, however, the influence of sociodemographic variables on the relationship between attention bias and anxiety remains unclear. We examined the association between attention bias and anxiety among rural Latinx youth and investigated potential moderators of this relationship. Clinical symptoms, demographic characteristics, and a performance-based measure of attention bias were collected from 66 rural Latinx youth with clinical levels of anxiety (33.3% female; Mage = 11.74; 92.4% Latinx, 7.6% Mixed Latinx). No moderating effects for age or gender were found. Youth below the poverty line displayed an attention bias away from threat in comparison to youth above the poverty line, who displayed an attention bias towards threat. Among youth below the poverty line, this bias away from threat was associated with increased anxiety. Findings highlight the importance of economic adversity in understanding the relationship between attention bias and anxiety. [ABSTRACT FROM AUTHOR]

Background: Informal settlements are high density areas in and around cities, characterized by a lack of formal planning and basic amenities, being known in South Africa for high levels of mental disorder driven by violence, and complex social and economic challenges. In particular, young men's poor mental health goes untreated, with relatively few evidenced-based interventions available in this setting. Aim: This cluster randomized controlled trial investigated the effectiveness of Stepping Stones and Creating Futures (SS/CF), a participatory gender transformative and economic empowerment intervention, on the mental health of young men living in South African informal settlement. Methods: A total of 674 young men ages 18 to 30 years were recruited in 34 clusters in Durban's urban informal settlements. Clusters were randomly allocated (1:1) to either the experimental SS/CF or control arm and participants were followed-up over 24-months. Intention-to-treat analysis based on generalized estimating equations (GEE) were fitted to quantify the impact of SS/CF on the men's anxiety and post-traumatic stress (PTS) symptomatology. Results: At end of the 24 months follow-period, anxiety (adjusted odds ratio [aOR]: 0.62, p =.04, 95% CI [0.39, 0.99]) and PTS (aOR = 0.52, p =.03, 95% CI [0.29, 0.93]) were significantly lower for group assigned to the SS/CF compared to the control group. Conclusion: SS/CF, a gender transformative and livelihoods strengthening intervention designed to address poverty and other socio-economic challenges in informal settlements reduced anxiety and PTS among men with mental health challenges living in informal settlements. [ABSTRACT FROM AUTHOR]

The article focuses on a study that measured lead levels in maternal and cord blood in a convenience sample of mothers delivering at a hospital that serves women from the informal settlements of Dandora and Kariobangi in Nairobi. It describes the methods used to investigate maternal lead exposures in the settlements as well as associations between potential lead sources and blood lead levels. It discusses the implications of the discovery of high BLL found in the study participants.

Retrieval practice typically benefits learning in children, although little is known about the benefits of retrieval practice for learning spelling. We investigated this issue in three experiments with fifth-grade children from a low-income area of Brazil. In the experiments, children first read a list of words (study), and after a short interval wrote down the studied words after hearing and rereading them (copy) or after only hearing them (retrieval practice). After an interval of 4 days, spelling performance was greater for words from the retrieval practice condition than for words from the copy condition, but only when immediate corrective feedback was provided (Experiment 3). The current findings, therefore, suggest that retrieval practice followed by corrective feedback is an effective strategy to improve spelling performance of fifth-grade children. [ABSTRACT FROM AUTHOR]

Poverty is at the forefront of the basic components that reveal the need for urban transformation. In our country, the transformation of urban areas takes place especially in poor neighborhoods. The basic discourse in the implementations is the "low quality of life" and "the right to live humanely" of the poor neighborhoods. However, the results of the implementation in our country, as in many other times in the world, show us that urban transformation does not increase the quality of life of poor neighborhoods, but the "relative" quality of the space. This situation shows that while the quality of the space increases "relatively", two forms of behavior emerge for the urban poor: In the first case, the poor are displaced by public power and forced to settle elsewhere and borrow money. In the second case, the poor either create new areas of poverty or are included in existing areas of poverty, as they cannot afford the cost of the changed space. However, the result is the same in both cases: After the urban transformation, the poor can no longer live in their old neighborhoods and poverty spreads through the city by leaps and bounds. Often the process results in dispossession for the poor. This result refutes the basic claim and aim of urban transformation practices that increase the quality of life. The quality of life of the poor living in the urban transformation area does not increase; on the contrary, they are affected more negatively by reasons such as their displacement and even their dispossession. What has changed is not only their living spaces, but also their socio-cultural and economic lives. Due to their alienation from their social environment, the problems of integration with the city increase and this situation brings along many other socio-economic problems. This study focuses on the problem of how the poor can stay in place while improving the quality of life in the field of urban transformation. It will seek a solution to this problem by bringing a different perspective to urban transformation approaches. The relative quality of the place, the quality of life will be discussed from the perspective of the local community and the results of the survey conducted by Fatih Municipality in 2006 in the area will be read and interpreted from this perspective. Interviews were also held with real estate consultants to observe the change in economic conditions in the region. The study aims to explain the subject through the Sulukule experience, which was experienced only a few years ago and in which irreparable results emerged, and to create a comprehensive framework for the principles to be adopted for similar projects in the future. Today, Sulukule is no longer in place. In New Sulukule, mostly foreign nationals live as owners or tenants. The real inhabitants of Sulukule, on the other hand, were first sent to the Tasoluk region, but they could not live here and settled again near Sulukule, where they could not return. This situation clearly shows that the transformation made in the region does not benefit the people of the region and does not improve their quality of life. [ABSTRACT FROM AUTHOR]

This paper analyzes the role of political neighborhood brokers in the execution of public policies in slums. It studies their relationships to the State as well as their capabilities to boost or hinder the implementation of public policies. In particular, the paper focuses on the processes of redevelopment at two slums in the City of Buenos Aires: Rodrigo Bueno and Playón de Chacarita. The evidence gathered shows that if the State and the brokers establish relationships of cooperation the process of redevelopment smoothly moves forward. On the contrary, if they come into conflict the entire process is put at risk. Furthermore, the absence of brokers compels the State to lead the redevelopment without links to the neighborhood which obstructs the development of the project. The same situation occurs if brokers lose their legitimacy. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to explore and describe the infant feeding experiences of mothers of children aged 3 to 24 months, living in two selected informal settlements in Tshwane, South Africa. Design: This exploratory qualitative study gathered data via six focus-group discussions (FGDs). These were facilitated using a semi-structured questionnaire guide with probes. Data were then transcribed, coded and thematically analysed. Setting: The study was conducted in the two selected informal settlements in the west of Tshwane, South Africa. Subjects: Biological mothers (n = 28) of infants and young children aged 3 to 24 months, living in the selected informal settlements participated. The mothers had to be living with their child with some responsibility for their daily care and feeding. Results: Three themes with six sub-themes were identified following thematic analysis. First was the mothers' experience of infant feeding, which included their interpretations and practices of exclusive breastfeeding and complementary feeding. Second, mothers received infant feeding support from their elders based on common beliefs. The support received from healthcare workers was sometimes perceived negatively. However, healthcare workers based at healthcare facilities were important sources of exclusive breastfeeding and complementary feeding information. Third were the setting-related factors that negatively affected the mothers' ability to access nutritious food for themselves and their infants. These included household food insecurity, plus environmental and household factors affecting food storage and preparation. Conclusion: Mothers experienced several challenging circumstances affecting their infant feeding efforts. These findings highlight the need to strengthen targeted infant feeding counselling and support for mothers living in resource-constrained environments. [ABSTRACT FROM AUTHOR]

Background Long-term opioid use and associated adverse outcomes have increased dramatically in recent years. Limited research is available on long-term opioid use in older adults. Objective We aimed to determine the incidence and predictors of long-term or persistent opioid use (POU) amongst opioid-naïve older adults without a cancer diagnosis. Methods This was a retrospective cohort study using five national administrative healthcare databases in New Zealand. We included all opioid-naïve older adults (≥65 years) who were initiated on opioid therapy between January 2013 and June 2018. The outcome of interest was POU, defined as having continuously filled ≥1 opioid prescription within 91–180 days after the index opioid prescription. Multivariable logistic regression was used to examine the predictors of POU. Results The final sample included 268,857 opioid-naïve older adults; of these, 5,849(2.2%) developed POU. Several predictors of POU were identified. The use of fentanyl (adjusted odds ratio (AOR) = 3.61; 95% confidence interval (CI) 2.63–4.95), slow-release opioids (AOR = 3.02; 95%CI 2.78–3.29), strong opioids (AOR = 2.03; 95%CI 1.55–2.65), Charlson Comorbidity Score ≥ 3 (AOR = 2.09; 95% CI 1.78–2.46), history of substance abuse (AOR = 1.52; 95%CI 1.35–1.72), living in most socioeconomically deprived areas (AOR = 1.40; 95%CI 1.27–1.54), and anti-epileptics (AOR = 2.07; 95%CI 1.89–2.26), non-opioid analgesics (AOR = 2.05; 95%CI 1.89–2.21), antipsychotics (AOR = 1.96; 95%CI 1.78–2.17) or antidepressants (AOR = 1.50; 95%CI 1.41–1.59) medication use were the strongest predictors of POU. Conclusion A significant proportion of patients developed POU, and several factors were associated with POU. The findings will enable healthcare providers and policymakers to target early interventions to prevent POU and related adverse events. [ABSTRACT FROM AUTHOR]

Background: Peru is one of the 20 countries that has significantly reduced maternal mortality before the pandemic due to implementing policies to strengthen maternal health care, mainly in rural areas with greater poverty. However, the implementation of these policies has been different across the territory; such is the case of the indigenous communities of the Peruvian Amazon that are characterized by the inaccessibility of their territory and continue to face severe problems in accessing maternity care in health services. Objective: Analyze the main dimensions of accessibility for maternal care in public health services for women of the Asháninka community of Peru between 2016 and 2018. Methods: Qualitative research was carried out in the Asháninka community of the Tambo River. Key informants involved in maternal health care were selected, and 60 in-depth interviews were conducted that explored geographical, financial, cultural, and organizational accessibility. The interviews were recorded and transcribed into a word processor; then, a content analysis was performed to classify the texts according to the dimensions of specified accessibility. Results: Geographical accessibility: health units in the territory do not have the resolution capacity to attend maternal health problems. Financial accessibility: the programs implemented by the government have not been able to finance the indirect costs of care, such as transportation, which has high costs that a family cannot afford, given their subsistence economy. Cultural: there are efforts for cultural adaptation of maternal care, but its implementation needs to be improved, and the community cannot recognize it due to the lack of continuity of the model and the high personnel turnover. Organizational: health units are characterized by insufficient human resources, supplies, and medicines that fail to offer continuous and quality care. Conclusions: The poor geographical, financial, cultural, and organizational accessibility that women from the Asháninka community face for maternal care in public health services are evident. So, the Peruvian government must review the implementation processes of its models of care and maternal health programs in these communities and propose strategies to improve the coverage, quality and continuity of maternal care. [ABSTRACT FROM AUTHOR]

Diarrhoeal disease remains a leading cause of death in children in sub-Saharan Africa, attributed to environmental health factors such as inadequate water, sanitation and hygiene (WASH) and food hygiene. This formative study in low-income areas of Blantyre focussed on the practices in Early Childhood Development Centre (ECDCs) environments where children spend a significant amount of time. A mixed-methods approach was applied to identify key hygiene behaviours in ECDCs through; checklist and structured observations (n = 849 children; n = 33 caregivers), focus group discussions (n = 25) and microbiological sampling (n = 261) of drinking water, food handler's hands, and eating utensils. ECDCs had inadequate WASH infrastructure; coupled with poor hygiene practices and unhygienic environments increased the risk of faecal-oral disease transmission. Presence of E. coli in drinking water confirmed observed poor water handling habits by staff and children. Addressing undesired hygiene practices in ECDCs has the potential to improve the health outcomes of children in low-income settings. [ABSTRACT FROM AUTHOR]

Background: Noncommunicable diseases (NCDs) are the leading cause of death and disability globally, and the burden is expected to grow rapidly in developing countries. In the absence of health insurance, public provisioning, and donor funds, the management and treatment of NCDs such as hypertension and diabetes might result in very large out-of-pocket expenditures (OOPEs) for households. Objectives: The objectives were as follows: to estimate OOPE and to study the association between sociodemographic characteristics and OOPE among patients suffering from NCDs. Materials and Methods: The sample size was estimated based on a mean OOPE of 63.5 Indian rupees (INR), with a standard deviation (SD) of 110 INR, a sample size of 464 was obtained, and individuals with NCDs were interviewed. Results: Of the total 464 participants, 325 (70%) were female and 139 (30%) were male, with a mean (SD) age of 55.78 ± 13.204. Three hundred and two (65.1%) participants were having hypertension and 232 (50%) were having diabetes. The mean total OOPE was 1173.0603 (INR), with a SD of 1424.54108 (INR), and the mean direct cost incurred was 1141.03. The mean (SD) direct cost spent for medication was 895.61 ± 1100.32, for the laboratory was 148.38 ± 440.7, and for consultation was 97.04 ± 113.86. Only 34 (7.7%) participants were having health insurance. There was an association between the OOPE and sociodemographic profiles such as occupation, educational status, and economic status where the P (<0.05) was noted as P = 0.004, P = 0.024, and P < 0.001, respectively. Conclusion: Knowledge and awareness about health insurance scheme and their benefits help in reducing the OOPE. [ABSTRACT FROM AUTHOR]