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Background: People with intellectual disabilities are at much higher risk of preventable deaths compared to the general community. However, studies identifying the cause of death in people with intellectual disability are generally based on one primary cause which is frequently attributed to the person's disability. Therefore, the aim of this study was to identify the most common associated causes that may have contributed to the deaths of Australians with intellectual or learning disabilities, particularly those that may be avoidable. Methods: Linked data that had previously been used to identify underlying causes of deaths were re-analysed to determine other contributing causes of death in Australians with intellectual disabilities aged under 65 years who accessed disability services between July 2013 and June 2018. Findings: Two thousand three hundred and thirty-three deaths occurred among 180,790 people with intellectual disability. Contributing causes of death with the greatest disparities compared to the general community were lung diseases due to external agents (adjusted rate ratio (RR) 70.6 (95% confidence interval [95% CI] 63.7-78.2), influenza and pneumonia (RR 18.3; 95% CI 16.4-20.4), and coronary heart disease (RR 3.3; 95% CI 2.8--3.8). Conclusions: Analysing all contributing causes of death in people with intellectual disabilities can ensure that the higher rates of preventable deaths in people with intellectual disability are identified and addressed earlier in the disability and health sectors.

Rheumatic diseases are known to be associated with the development of metabolic syndrome, which increases mortality rates due to cardiovascular complications. Although a variety of self-management programs for rheumatic diseases have been developed, few have concentrated on metabolic syndrome. This study aimed to develop and verify a blended (a mixture of telephone and online interventions) metabolic syndrome self-management program. The program was developed in four stages: analysis to identify program contents, website design, website development, and validity testing. A quasi-experimental nonequivalent control group, pretest-posttest design was adopted to verify the program effectiveness in 54 patients with rheumatic disease. The program was initially implemented via telephone for 4 weeks and then self-administered via a web-based platform for 20 weeks. Indices of metabolic syndrome and self-management and quality of life scores were measured as outcome variables. Data were collected three times: before intervention, after 4 weeks of telephone interventions, and after 20 weeks of online self-interventions. The devised program had a significant overall effect on metabolic syndrome indices, metabolic syndrome-related self-management behaviors, and quality of life. Detailed analysis showed the program effectively reduced body mass index, waist circumference, systolic blood pressure, and blood glucose levels and improved metabolic syndrome self-management behaviors. Based on our findings, it can be expected that the use of this program may retard or prevent the progression of metabolic syndrome by improving some metabolic syndrome indices and metabolic syndrome-related self-management behaviors, which are key components of care in rheumatic disease patients with metabolic syndrome. This web-based program appears to be beneficial in public health care settings because it is cost-effective, readily available, and may provide long-term support.

Autism spectrum disorder (ASD) is a neuropsychiatric condition that may be associated with negative health outcomes. This retrospective cohort study reveals the odds of hospitalization and mortality based on ASD for a population of insured patients with COVID-19. The odds of hospitalization and mortality for people with ASD were found to be greater than individuals without ASD when adjusted for sociodemographic characteristics. Hospitalization and mortality was associated with a dose-response increase to comorbidity counts (1 to 5+). Odds of mortality remained greater for those with ASD when adjusting for comorbid health conditions. ASD is a risk factor for COVID-19 mortality. Comorbid health conditions play a particular role in increasing the odds of COVID-19 related hospitalization and death for ASD patients.

Mortality disparities among persons with intellectual disability are important to guide health-care practices. The objective was to evaluate mortality patterns of persons with intellectual disability in a nationwide study from 1976 to 2020. This study establishes a Danish nationwide cohort of persons with intellectual disability and age- and sex-matched reference cohort through linkage between several registers. We established a cohort of 79,114 persons with intellectual disability. Standardized mortality ratios were increased for persons with intellectual disability, most pronounced among younger persons and among females. Life expectancies were markedly lower; among persons with intellectual disability 63.6 years among females and 59.8 years among males in 2016-2020 compared to 82.4 and 78.7 years among females and males in the reference cohort. Life expectancies decreased with severity of intellectual disability. This study reports the establishment of a nationwide Danish cohort of persons with intellectual disability.

Background: People with intellectual disability frequently have eating, drinking and swallowing difficulties (dysphagia) and are at greater risk of premature mortality, particularly from aspiration and respiratory infections. The insertion of a percutaneous endoscopic gastrostomy (PEG), as part of a multidisciplinary management plan, may help to maintain and improve nutrition. This study included people with intellectual disability who had ever had a PEG inserted and who presented to the specialist Speech and Language Therapy team in one Greater Manchester borough between 2000 and 2022 and assessed the risk of death and sociodemographic and clinical factors associated with this. Methods: This was a cohort study using secondary data. Kaplan--Meier estimates were used to construct the probability of mortality curves. Cox proportional hazards were used to compare death rates in the different sociodemographic and clinical characteristic groups and were presented as hazard ratios and 95% confidence intervals. Findings: Of 42 people included in the study, 18 (43%) died from the point of PEG insertion to the end of the study (December 2022). The median (interquartile range) time to death from PEG insertion was 5 (2-10) years, with four people (10%) dying in the first year. Aspiration pneumonia and unspecified pneumonia were responsible for seven (39%) deaths. No significant associations were found between sociodemographic and clinical factors and risk of death. Conclusion: In persons with intellectual disability and a PEG who were followed up between 2000 and 2022, the mortality was around 40% with deaths occurring in the first year and respiratory conditions being an important cause. The lack of association with sociodemographic and clinical characteristics may have been due to a limited sample size. Further research is needed with larger samples and more variables, including quality of life data, to help understand and improve clinical practice in this area.

Could the standardisation of language narrow disparities in achievement in education amongst people of different social class, and within and across ethnicities and genders, and could this have implications for injustices and inequities in wider society? In analysing socio-economic diversity through the lens of its correlation with language, this paper examines how the standardisation of language could be used as a means to reduce such diversity. It examines links between the standardisation of language, and the reduction of inequalities between socio-economic groups, in regard to achievement in education. It also examines the correlation between language and social class, and propensity towards being a perpetrator and/or victim of hostility and violence, as well as their relationship with health and life expectancy etc. The paper further examines the effect of the use of technology and teaching methods on the acquisition of knowledge, and how this impacts upon children of different social class within the learning environment. In order to help address some of these questions, an auto-ethnographic methodology is adopted with the aim of being able to explore, and reflect upon, personal experience, and to be able to weave greater understanding and connections between apparently disparate factors related to diversity, all through the lens of language and its relationship to aspects of culture relating to social class. Amongst its conclusions, the paper argues that the standardisation and enhancement of spoken language would narrow the disparities in academic achievement between socio-economic groups. The paper also argues that in order to challenge inequitable power structures which have arisen from historical injustices, then rather than concentrating on underrepresentation of groups of people within high status positions in society, the focus of diversity should be directed towards challenging the over representation, in a range of settings, of groups of people within low status positions in society.

In this essay, we argue for racializing approaches to teaching climate change to better understand and address climate injustices. We draw upon the example of the Buffalo Blizzard of 2022 which caused a disproportionate number of deaths in the Black community. Extreme weather events such as the blizzard highlight the ways in which climate catastrophes and racial injustices are inextricably linked. We urge educators across all content areas to incorporate a climate justice education approach and outline an approach to transformative climate justice learning.

Background: Individuals with Down syndrome are an at-risk population for severe COVID-19 outcomes, due to genetic predispositions and comorbidities. The current study focused on differences between persons with and without Down syndrome regarding age and severity of disease. Method: We used medical statistics to compare patients with and without Down syndrome who were admitted to Swiss hospitals (2020 and 2022) with a COVID-19 diagnosis. Differences in age, hospitalisation characteristics, mortality, and additional diagnoses were investigated. Results: Results revealed a lower median age and greater risk of intensive care unit admission and mortality among patients with Down syndrome. No differences were found in length of hospital stay. Conclusions: There is some evidence of increased vulnerability in people with Down syndrome compared to other patients, particularly in terms of mortality rates. However, compared to studies from other countries, the situation of people with Down syndrome does not appear to be particularly critical.

Background: States are often ranked on a range of different indicators. In this study, states were ranked for each of the leading actual causes of death. Purpose: This study ranks states on how hazardous they are to the health of the citizenry in terms of the actual causes of death as identified in the seminal article by McGinnis and Foege. and later updated by Pilar et al. Methods: We ranked states for actual cause of death using multiple data sources. We also calculated an overall state ranking across all actual causes of death using the percent weightings attributable to each actual cause from the Pilar et al. study. States were ranked based on their overall score. Results: Significant differences were noted in actual cause ranking both within and across states. A different profile was found for the top and lowest ten ranking states. Discussion: Results suggest a comprehensive approach grounded in the socio-ecological model combining health promotion/education and health policy to affect change. Translation to Health Education Practice: Health professionals may use these rankings to determine methods for improving health services, programs, and behaviors in their communities.

Objectives: Characterise the circumstances associated with death during admission of adults with Down syndrome (DS) and to identify predictors of mortality. Patients and Methods: Observational study based on data on all emergent admissions of adults with DS to hospitals of the Spanish National Health System between 1997 and 2014. We analysed epidemiological and clinical variables. Results: We analysed admissions of 11,594 adults with DS, mean age 47 years. 1715 patients died (15%), being the highest mortality (35%) in individuals aged 50-59. A past medical history of cerebrovascular disease (aOR 2.95 [2.30-3.77]) or cancer (aOR 2.79 [2.07-3.75]), gross aspiration's admission (aOR 2.59 [2.20-3.04]), immobility (aOR 2.31 [1.46-3-62]), and readmission within 30 days (aOR 2.43 [2.06-2.86]) were identified as predictors of mortality. Conclusions: Adults with DS have a high in-hospital mortality rate. The main predictors of death were cerebrovascular disease, cancer, early readmission, and conditions commonly associated with advanced dementia.

Background: People with learning disabilities are at increased risk of physical health conditions and mortality compared to the general population. Initiatives to address these health inequalities include the introduction of learning disability registers, through which people with learning disabilities can be identified and offered annual health checks and reasonable adjustments in their healthcare provision. A barrier to offering such initiatives to people with learning disabilities is that practitioners/providers may be unaware of the presence of a learning disability, and people who meet criteria may not be entered onto general practice learning disability registers. Screening tools can be used to help identify people with learning disabilities in order that they can be offered appropriate health services and reasonable adjustments. This study aimed to explore the awareness and views of UK primary care staff about the existence and role of screening tools for learning disability in their services. Methods: A qualitative approach was used; semistructured online interviews were conducted with a purposive sample of primary care staff recruited via a regional professional network of primary care practitioners. Five general practitioners and one nurse practitioner, representing five primary care practices in the North-East of England, participated. Interview transcripts were analysed using thematic analysis. Findings: Two themes and associated subthemes were identified. Within Theme 1 ('I haven't had anything much to do with them') two subthemes related to reasons why screening tools were not routinely used. Theme 2 ('I think they're great that they exist') comprised two subthemes that explored the benefits of screening tools, for example, for those practitioners less experienced with people with learning disabilities, and also explored potential reluctance to use them. The study found that most practitioners had some knowledge of screening tools and the general consensus was that they are beneficial. However, the tendency of participants was not to use screening tools in a consistent and/or systematic way, instead relying on informal approaches or other services for identifying the presence of learning disabilities. Conclusions: The study findings highlight the need for changes in practice to support primary care staff to access and systematically use evidence-based effective and efficient screening tools for learning disability.

The rise of Black maternal mortality rates throughout the country demonstrates a great need to utilize innovative frameworks to craft solutions that improve health outcomes for Black birthing people. Previous research and interventions have examined individual- and policy-level factors to reduce maternal mortality; however, these methods may lack a true community-centered approach to understanding the experiences of Black birthing people in local communities that have been disproportionately impacted. In addition, certain research methods may not recognize other marginalized intersectional identities (e.g., Black transgender men) who experience inequities in Black maternal health. This commentary aims to provide recommendations for utilizing community-centered strategies on Black maternal mortality informed by community-based participatory research principles.

The purpose of our study was to systematically compile fatality data in Canada involving minors in school and youth groups engaged in outdoor learning, and then compare these incidents to other available data related to risk of fatalities, fatality rates, patterns, and contributory causes. This mixed methods study involved collecting fatality data using a passive environmental scan of publicly available data from multiple sources such as Google, library databases, online databases, and relevant organizations. Data analysis involved using descriptive statistics and principles of case-based analysis to uncover patterns across and within cases. There were 37 fatal incidents involving 78 youth and 6 adult fatalities related to school and youth groups engaged in outdoor learning activities in Canada. All incidents occurred between 1926 and 2019. The fatalities were categorized as water-based, land-based, and snow-based incidents involving alpine skiing (9), flat water canoeing (7), swimming/swim testing (7), walking/hiking (4), mountain climbing (2), white water rafting (2), group camping (1), solo camping (1), sailing (1), skating (1), ski touring (1), and zip-lining (1). It was not possible to determine a fatality rate from our data, however there was adequate comparative data suggesting that the probability of fatal incidents related to outdoor learning by minors in school and youth groups is relatively low in Canada, however there was inadequate data available to make direct comparisons to other contexts. Several patterns emerged from within cases, across cases, and many were similar patterns to those from a series of case-based studies in Australia.

Health equity research has identified fundamental social causes of health, many of which disproportionately affect Black Americans, such as early life socioeconomic conditions, neighborhood disadvantage, and racial discrimination. However, the role of life course factors in premature mortality among Black Americans has not been tested extensively in prospective samples into later adulthood. To better understand how social factors at various life stages impact mortality, this study examines the effect of life course poverty, neighborhood disadvantage, and discrimination on mortality and factors that may buffer their effect (i.e., education, social integration) among the Woodlawn cohort (N = 1242), a community cohort of urban Black Americans followed since 1966. Taking a life course perspective, we analyze mortality data for deaths through age 58 years old, as well as data collected at ages 6, 16, 32, and 42. At age 58, 204 (16.4%) of the original cohort have died, with ages of death ranging from 9 to 58.98 (mean = 42.9). Cox proportional hazard models adjusting for confounders show statistically significant differences in mortality risk based on timing and persistence of poverty; those who were never poor or poor only in early life had lower mortality risk at ages 43-58 than those who were persistently poor from childhood to adulthood. Education beyond high school and high social integration were shown to reduce the risk of mortality more for those who did not experience poverty early in their life course. Findings have implications for the timing and content of mortality prevention efforts that span the full life course.

The COVID-19 pandemic is a major threat to global education. Incidental emotions of fear and anxiety during pandemic have unconsciously influenced preference and outcome about their future career. This study aimed to assess the effect of the COVID-19 pandemic towards career preference change in medical students. A total of 1,027 responses from all over the medical students in Indonesia were collected from an online questionnaire which was broadcasted through social media from 14th July 2020-21st July 2020. This study was using Fear of COVID-19 Scale (FCV-19S) and Depression Anxiety Stress-Scale-21 (DASS-21) to assess fear of COVID-19, stress, anxiety, and depression. Out of 1,027 respondents, 44.6% had stressed, 47.8% had anxiety, and 18.5% had depression with an average FCV-19S score was 17.1. The result showed that the fear and anxiety of COVID-19 during the pandemic had associated significantly with the career decisions in medical students (p=<0.05). Indonesian policymakers had to keep in mind that the fear of the COVID-19 pandemic in medical students is due to the high mortality COVID-19 cases of health workers in Indonesia. Health workers need adequate working conditions and specific protection, this requires prompt attention from stakeholders.

Objectives: To describe the clinical and epidemiological characteristics of adult patients with Down syndrome admitted to Spanish hospitals between 1997 and 2014. Secondary goals were to study trend changes over time, and to analyse differences between patients admitted to medical and surgical departments. Patients and Methods: Retrospective observational study on data collected from the Minimum Basic Dataset (MBDS, Conjunto Mínimo Básico de Datos [CMBD]) of admissions of adults with Down syndrome to hospitals belonging to the Spanish National Health System from 1 January 1997 through 31 December 2014. We analysed epidemiological and clinical variables. Results: We analysed 28,716 admissions of 16,874 adult patients with Down syndrome. Men accounted for 58.2% of the sample, and the mean age on admission was 41 ± 13 years, with an 11-year increase in mean age during the study period. Admissions among persons with Down syndrome increased by 5% during the study period, with a noticeable rise in admissions of older adults and to medical departments. Almost one-third of patients (31.8%) were admitted more than once. Age-adjusted mortality was 15.7%. The most common comorbid conditions were chronic obstructive pulmonary disease (25%), hypothyroidism (18.6%), and epilepsy (14.3%). The departments with the highest numbers of admissions were internal medicine (26.3%), pulmonary medicine (6.9%), and general surgery (5.25%). Conclusion: Hospital admissions among Spanish adults with Down syndrome have increased in recent decades, especially in older patients. We identified substantial differences between patients admitted to medical and surgical departments.

Background: Rates of death and avoidable deaths are reportedly higher among people with intellectual and developmental disabilities. This study contributes to our understanding of how mortality and intellectual and development disabilities are associated. Method: General population and intellectual and developmental disabilities adult cohorts were defined using linked administrative data. All-cause and amenable deaths between 2010 and 2015 were reported for these cohorts and subcohorts with and without Down syndrome. Cox proportional hazards models evaluated the impact of potential contributors to amenable deaths. Results: Adults with intellectual and developmental disabilities had higher all-cause (6.1 vs. 1.6%) and amenable death percentages (21.4 vs. 14.1%) than general population comparators. Within intellectual and developmental disabilities, those with Down syndrome had higher all-cause (12.0 vs. 6.0%) but lower amenable death percentages (19.2 vs. 21.8%) than those without. Conclusions: Results suggest that interventions to reduce amenable deaths target provider-care-recipient interactions and coordination across care and support sectors.

Multistate models are often used in social research to analyze how individuals move between states. A typical application is the estimation of the lifetime spent in a certain state, like the lifetime spent in employment, or the lifetime spent in good health. Unfortunately, the estimation of such quantities is prone to several biases. In this paper, we study the bias due to the often implicitly used assumption that there are no unobserved transitions between states. This assumption does often not hold for the panel data typically used to estimate multistate models, as the states occupied by individuals are only known at specific points in time, and further transitions between panel waves are not recorded. We present partially identified estimates of the lifetime spent in a state, or worse-case bounds, which show the maximum possible level of bias due to unobserved transitions. We provide two examples studying the lifetime spent in disability (disabled life expectancy; DLE). The first example applies our methods to results on cohort trends in DLE in the U.S. taken from Crimmins et al. (2009). In the second example, we replicate findings from Mehta and Myrskylä (2017), and apply our methods to data from the U.S. Health and Retirement Study (HRS) in order to estimate the effects of health behaviors on DLE.

Evidence suggests increased mortality rates among autistic individuals. However, risks of mortality, including natural-cause, suicide, and accident mortalities, among autistic individuals remain unclear. Among the entire Taiwanese population (N = 29,253,529), between 2003 and 2017, 45,398 autistic individuals were identified and 1:4 matched to 181,592 non-autistic individuals based on birth year and sex. All-cause mortality, including natural-cause, accident, and suicide mortalities, was assessed from 2003 to 2017 between the two cohorts. Cox regression models were used to investigate the mortality risk between autistic and non-autistic individuals. Autistic individuals had increased likelihoods (hazard ratio, 95% confidence interval) of all-cause mortality (3.43, 3.00-3.92), natural-cause mortality (4.73, 3.99-5.60), and suicide mortality (3.67, 2.37-5.68) compared with non-autistic individuals. In particular, autistic males were more likely to die by suicide (hazard ratio: 3.81, 95% confidence interval: 2.37-6.13), and autistic females were more likely to die of accident (hazard ratio: 5.07, 95% confidence interval: 2.54-10.13) compared with non-autistic individuals. Appropriate and effective medical and mental health care is recommended for autistic individuals.

We discuss a case study on how misinformation regarding COVID-19 health outcomes can arise due to confounding. Data from the UK on mortality rates suggest that people who have some level of vaccination and contract the Delta variant of COVID are twice as likely to die than those who are unvaccinated. Age, however, a confounding variable, when accounted for, produces a more complicated picture. The mortality rates for the vaccinated are statistically lower than the unvaccinated for the older but not younger age group. We present several approaches for teaching confounding to help students better understand this underemphasized concept's cause, effects, and origins.

As we have seen from the current COVID-19 pandemic, misconceptions concerning viruses can lead to disease spread and panic. Therefore, it is imperative to determine misconceptions held concerning epidemics and pandemics. One virus that warrants study of misconceptions, albeit given limited attention in the West, is the Ebola virus. An assessment of college students' knowledge and misconceptions about the Ebola virus was created and validated using data from 203 non-science majors at a Midwestern United States university. The data were analyzed using both classical and Rasch measurement methods to make a case for the validity of the assessment and to explore students' misconceptions. The assessment was shown to be a valid and useful measure for students' knowledge and misconceptions concerning Ebola. Integrating a confidence scale into students' responses made the scale more reliable and assisted in identifying students' tenacious misconceptions. Students displayed multiple misconceptions about viruses, including confusion between the characteristics of viruses and prokaryotes. Students also displayed misconceptions about Ebola itself, including the overestimation of the number of Ebola strains and the number of patients who experience massive blood loss, misunderstandings about the incubation period, and overestimation of the mortality in comparison to other diseases like Influenza and Anthrax. This assessment can be used as a starting point in future studies to determine what misconceptions people have about Ebola and which types of educational and behavioral interventions need to be undertaken.

The aim of this study was to determine the perceptions of bicyclists to promote the use of bicycles in the cities. The sample was selected using simple random sampling method. A total of 1087 bicyclists, including 178 women and 909 men, who used bicycles in their everyday lives in the city, voluntarily participated in the research. The study was a descriptive research in the survey model and quantitative research approach was adopted in the research. Data were collected with "Bike Use Dissemination Scale" developed by Çeyiz (2019). The scale consists of two parts; a personal information form and expressions of participants' dissemination of bicycle use. The t-test was used for the variables consisting of the bipartite groups and the One-Way ANOVA was used for the variables consisting of more than two groups. According to the data obtained from the bicyclists participating in the survey, there was a significant difference in the dimensions of security and dissemination by gender. It was found that women bicyclists' safety perceptions were more negative than men's perception; and their perceptions of the spreading dimension were more positive than the male bicyclists.

Obesity is linked with health and psychosocial outcomes among many populations. However, it is unclear the extent to which obesity is linked with these outcomes among autistic adults. We searched seven research databases for articles examining the association between obesity and autistic adults' health and psychosocial outcomes. Three studies found that obesity was associated with health outcomes, including: in-hospital mortality, risk of type II diabetes, cardiovascular disease, and number of co-occurring medical conditions. One study found no significant association between autism diagnosis, mental health conditions, and body mass index. Obesity increases the risk of in-hospital mortality and some chronic conditions among autistic adults, highlighting the need for clinicians trained to promote weight management among autistic adults.

In this review, we will investigate the pathways linking education and health to understand why education appears to improve health in some settings or among certain populations, and not in others, as well as to inform recommendations about how best to target investments in education to maximize the benefits to health. We will seek to answer the following key research questions, focusing specifically on the mechanisms that affect fertility, HIV, and infant and child mortality. If feasible, these answers will include meta-analyses of comparable education and mediator outcomes: (1) Do changes in education affect the primary theorized mediators (e.g., knowledge, attitudes, resources, and agency; health behaviors and harmful practices) of the relationship between education and fertility, HIV and child mortality? (2) How does the relationship between these mediators and education vary across different aspects of education (e.g., grade attainment vs. literacy/numeracy vs. attendance)?

In England, the national mortality review programme for people with intellectual disabilities, the LeDeR programme, was established in 2015. The programme supports local areas to review the deaths of all people with intellectual disabilities aged 4 years and over. Each death has an initial review; if indicated, a full multi-agency review takes place. The learning from the mortality reviews contributes to service improvements locally and nationally. This paper describes the programme's introduction and processes, exploring the challenges faced, and the successes achieved. It considers the background and rationale for the programme and the steps taken during its implementation, in order that others can learn from our experiences. Now the programme is established, its focus needs to shift so that we have a better understanding about how the findings of mortality reviews are leading to local and national service improvements and their impact.

The incidence of drug-related deaths in Scotland has reached crisis proportions. Comparable only to the rust belt States in the US these figures point to the impact of the rapid scale of deindustrialisation and a global neoliberal economy, based on austerity, deepening class divisions and a return to a more naked form of capitalism. The question is, does a critical pedagogy have a role to play in understanding and addressing the challenges involved? In other words, how can a practice of such a pedagogy allow participants to deconstruct and decode the structures of domination that oppress and divide them/us? Such pedagogy has undergone differing degrees of reassessment as it no longer serves as an 'adequate platform from which to mount a vigorous challenge to the current social division of labour'. However, the need for a critical pedagogy, rooted in a Freirean notion of hope, for such communities has never been more apparent. This article will attempt to resolve the extent to which such a pedagogy translate from its esoteric detachment to one rooted in history, place and practices, and one capable of engaging with the most disadvantaged, and colonialised fraction of the Scottish society.

The COVID 19 pandemic illuminates the role data has in public policy-making, i.e. datafication of society, and the importance of exploring the local sources of data to reveal errors in what has assuredly been from the beginning an undercount of cases and deaths. I note four interrelated error sources. The first two are common to any quantitative data collection project: (1) representation, measurement, and data processing; and (2) problems of data standardization from unequally resourced local and national data providers. COVID 19 casts a special light on (3) the possibility of government intervention in at least the public presentation of these data; and (4) human errors in the data chain caused by a stressful data collection environment. To identify errors, we should look to national pressures and the local contexts from which these data are collected and the upstream reporting process.

COVID-19, which has become a worldwide pandemic, prompted various healthcare organizations to take measures to stop or slow its spread. These measures require behavioral change. According to the health belief model, knowledge and awareness are needed to establish an assessment of threat and determine whether a behavior will be changed. Since the situation is related to a viral infection, it is expected that people with health backgrounds will have more knowledge and awareness about COVID-19. This study aims to compare the levels of COVID-19 knowledge and awareness of faculty, staff, and students in health sciences and non-health sciences disciplines at an all-female college in Dubai. This will help anticipate the risk for individuals, and predict compliance with regulations. A cross-sectional study was conducted using a self-administered online questionnaire. The results were analyzed using chi-square or Fisher's exact test. Participants' knowledge and awareness regarding contagiousness, transmission, incubation period, recovery and mortality rate, susceptibility of elderly people, and the stay-at-home policy were generally high, regardless of their background. This high level of knowledge could be attributed to the rapid dissemination of information through social media. Participants from the health sciences were significantly more knowledgeable about certain preventive measures, the causative pathogen, and its transmission through animals (p < 0.05). Overall, there was a high level of knowledge and awareness among the participants, regardless of their background, yet there are some areas that needs enhancement. Assessing knowledge and awareness is important for ensuring that people understand and change their behavior to mitigate its spread.

Purpose: Breast cancer (BC) presents a major public health challenge world-over including India. While several risk-factors, early signs and symptoms of BC are known, the knowledge and awareness of this disease remains poor among the population. The present study aimed to determine the extent of knowledge and awareness of BC, its risk factors, early signs and symptoms and breast self-examination (BSE) practice as an early detection method among Indian college-going female students. Design/methodology/approach: The authors conducted a cross-sectional survey at a University in Delhi-NCR. Data on socio-demographic, knowledge and awareness of BC including BSE was collected using a pretested questionnaire. Chi-square test and logistic regression analysis was performed. All tests were two-sided and significance was set at p < 0.05. Findings: A total of 866 female students participated in the study with mean age of 22.32 (±0.146) years having mean body mass index (BMI) of 21.22 (±3.52). As high as 82.1% of the participants had heard of BC but while 74.8% thought early detection is possible, 70.7% believed BC cannot be prevented. Gene mutations (60.2%) were identified as a significant risk factor, while breast pain (61.4%) was commonly recognized as a sign of BC. Only 29.8% of students ever performed BSE. Increased odds of performing BSE (OR = 3.4) was found among students who recognized gene mutations as an important BC risk factor. Research limitations/implications: Knowledge and awareness of BC including BSE among female college students were found to be below average. It is suggested that there is an urgent need for increasing BC awareness among young girls through workshops and mobile-health interventions. Practical implications: This study provides new information on the level of knowledge and awareness of BC risk factors, sign and symptoms and self-examination practice among young college girls. Moreover, this study advocates the need for design and implementation of a sustainable digital health model for active population BC screening, which is not being done currently. Social implications: BC is a highly aggressive disease, which is now one of the leading causes of morbidity and mortality in India and world over. Although the knowledge of BC risk factors and its signs and symptoms have increased, the awareness of these elements among the general population at large is low and/or missing, especially in India. Furthermore, as a consequence of unorganized screening programs in the country, majority of women are presenting young with locally advanced disease. Understanding the existing level of knowledge and educating school, college and University students of the pertinent factors and screening practices such as BSE could drastically help in improving the self-screening and/or clinical examination rates. This could potentially lead to early detection and improved prognosis, thus ameliorating disease burden. Originality/value: This study is one of the few studies conducted in India among young female college students belonging to non-medical backgrounds, delineating the level of knowledge and awareness of BC risk factors and signs and symptoms along with practice of early detection method such as BSE. The study has a considerable sample size and provides valuable evidence for a need to implement programs incorporating digital health models for accelerating awareness and screening of young girls in both rural and urban settings.

Lung cancer is the second most common cancer diagnosis and is the leading cause of cancer-related death in the United States for both men and women. The etiologies of many different types of lung cancer can be linked to risk factors that can be prevented, such as chronic tobacco smoking. Lung cancer is significantly more prevalent among socioeconomically disadvantaged and minority populations. Due to the significance of lung cancer as a public health issue, the authors have developed a module on the topic of pulmonology--a medical specialty field that deals with disease processes involving the respiratory system--to (1) explain the basics of normal lung physiology; (2) explain the pathological changes associated with lung cancer and other lung diseases; (3) provide preventive education on the importance of tobacco abstinence and the damaging effects of tobacco smoking on the lungs; and (4) introduce students to some pulmonologic interventions. The Cancer Education Initiative Program is targeted toward first- through third-grade students from underrepresented minorities of the Los Angeles Unified School District (LAUSD) and aims to address students' misconceptions and lack of knowledge regarding the pathogenesis, diagnosis, and treatment of cancer; provide preventive health promotion education so that students may make more healthy lifestyle choices, and foster students' interests in STEM and health care fields. In compliance with the "Next Generation Science Standards" (NGSS), a cancer education curriculum was developed and implemented featuring lessons based in science, technology, engineering, and math (STEM) concepts in relation to cancer. The lesson plans and activities align with grades 3-5 NGSS standards; however, they were implemented with students of grades 1-3.

Background: We examined the association between intellectual disabilities (ID) and pneumonia severity at admission. Methods: We extracted patients admitted to hospital for pneumonia from July 2010 to March 2018 using the Diagnosis Procedure Combination database. We measured pneumonia severity using the A-DROP system. After 1:4 cohort matching between patients with and without ID, we conducted conditional logistic regression and mediation analyses. Results: Of 1,141,158 patients, 531 had ID, and they had more severe pneumonia at admission (24.5% vs. 9.5%; P < 0.001). ID was significantly associated with severe pneumonia at admission (OR = 3.50; 95% CI: 2.68-4.58) and activities of daily living (ADL) mediated 73.8% (95% CI: 50.9%-105.0%) of the total association. Conclusions: Social barriers caused by reduced ADL may prevent patients with ID from accessing health care before their pneumonia becomes severe. Removing these barriers may decrease mortality from pneumonia among patients with ID by improving health care access.

Congenital heart disease (CHD), the result of structural changes to the heart present at birth, is the most common congenital birth condition. As survival rates for infants with complex CHD have increased in recent years, risk for neurodevelopmental challenges has also increased. Early referral to developmentally supportive care is recommended as best practice; however, there is limited information about how to best support occupations of infants with CHD as early as possible while still in the hospital. Recommendations for developmentally supportive care structured around occupations of infancy, existing developmental care models, and current evidence are reviewed and discussed for infants hospitalized following cardiac surgery. Key occupations of infancy discussed include movement and sensory exploration, procurement (communication of needs), sleep, feeding, and social interaction and play. Future work is recommended to develop occupation-based training and education resources for interprofessional hospital staff about developmentally supportive care for the hospitalized infant with CHD.

Maturity and citizenship in a democracy require that laypersons are able to critically evaluate experts' use of mathematics. Learning to critically reflect on the use of mathematics, including the acquisition of the mathematical knowledge and skills required to that end, has been repeatedly postulated as an indispensable goal of compulsory education in mathematics. However, it remained unclear in how far such reflection is possible, even for the well-educated layperson in mathematics. We use different discussions in German mass media on the pandemic policy in the SARS-CoV-2 crisis in 2020 as examples with far-reaching individual and social consequences. The selected discussions build heavily on mathematical concepts such as mortality rates, casualty numbers, reproduction numbers, and exponential growth. We identify the concepts and discuss how far they can be understood by laypersons. On the one hand, we found that some mathematical models are inappropriate, which can also be determined by laypersons. On the other hand, we found uses of mathematics where ideal concepts are intermingled with complex statistical concepts. While only the ideal concepts can be understood by laypersons, only the statistical concepts lead to actual data. The identification of both types of concepts leads to a situation where the use of mathematics evades social control and opens spaces for misconceptions and manipulation. We conclude that the evaluation of experts' use of mathematics by laypersons is not possible in all relevant cases, and we discuss possible implications of this result.