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Purpose: School recess provides a valuable opportunity for children's daily moderate- to vigorous-intensity physical activity (MVPA). This study aimed to quantify MVPA during school recess in a representative sample of Scottish children and examine whether recess MVPA varied by gender, socioeconomic status, season, urban/rural residency, and recess length. Method: Five-day accelerometry MVPA data were analyzed from 773 children (53.9% girls, 46.1% boys, 10- to 11-y-olds) from 471 schools. Binary logistic regression explored associations between meeting/not meeting the recommendation to spend 40% of recess time in MVPA and the aforementioned risk factors. Descriptive recess data were also analyzed. Results: Participants spent an average of 3.2 minutes (SD 2.1) in MVPA during recess. Girls engaged in 2.5 minutes (SD 1.7) of MVPA compared with 4.0 minutes (SD 2.2) for boys. Only 6% of children met the recess MVPA recommendation. The odds of girls (odds ratio 0.09; 95% confidence interval, 0.04–0.25) meeting the recommendation was lower (P <.001) compared with boys. No statistically significant differences were observed in meeting the recommendation for the other risk factors. Conclusion: Levels of MVPA during school recess are very low in Scottish children, and interventions aimed at increasing MVPA during recess are needed. [ABSTRACT FROM AUTHOR]

In public libraries, especially those in rural settings, it is important that every dime of library funding is leveraged effectively into serving the community. As part of a year-long project beginning in January 2023, we are evaluating item-level cost-effectiveness for each circulating item housed at the public library in Lakeville, Indiana. Through the use of big(ish) data, some custom Python scripting, and machine learning algorithms we hope to answer: How much money is saved by library patrons through their use of the public library's physical collection? How much money is saved by the community through the operation of a public library based on the use of the circulating collection? And are there any non-obvious traits which make an item or title a more or less cost-effective circulating asset? In this column, I will describe the scripts, share initial findings, discuss challenges, and investigate next steps. [ABSTRACT FROM AUTHOR]

Chronic diseases are usually managed by patients over a lifetime with the help of medication and regular health checkups. Recurring expenses incurred by chronic patients on medicine to manage their chronic illness adversely affect their household income as well as increase household expenditure. Schemes such as the Prime Minister Generic Medicine Scheme (PMBJP) launched by the Government of India aims to decrease out-of-pocket (OOP) expenditure on medicine, especially for chronic patients who have recurring expenditures on medicine. With a focus on PMBJP scheme which provides cheap generic alternatives to chronic patients, this cohort study has been undertaken to investigate if using the Internet to access to these generic medicines online can reduce OOP expenditure on medicine for chronic patients. The study observed that the out-of-pocket expenditure on medicine for branded consumers is significantly higher than the expenditure on medicine for JAM (Jan Aushadhi Medicine) generic medicine consumers. The study urges that a communication intervention providing awareness about alternative access to JAM (Jan Aushadhi Medicine) generic medicines online lead to a significant shift in consumption behavior of chronic patients towards accessing these medicines online. The study found that although the PMBJP scheme has the potential of decreasing OOP expenditure on medicine for chronic patients, the scheme needs to be expanded towards online platforms run by government to ensure ease of access, increased availability which could play an instrumental role in decreasing the OOP expenditure on medicine for chronic patients. [ABSTRACT FROM AUTHOR]

Purpose: County-level hospitals in China constitute a vital component of the healthcare system, delivering essential medical services, emergency care, and specialized treatments, particularly in oncology. This study aimed to comprehensively evaluate the current status of cancer diagnosis and treatment in county hospitals and assess their overall capacity. Methods: A nationwide cross-sectional survey by the China Anti-cancer Association (CACA) from February to May 2023 assessed cancer diagnosis and treatment in mainland China's county hospitals. Using a multi-center approach, a fifty-five-question questionnaire was administered to oncology professionals and management staffs, focusing on hospital facilities, oncology specialists, cancer cases, treatment capabilities, and healthcare collaboration. Questionnaire reliability and validity were established in a 2022 national survey. Participants, aged 18 or older, were recruited through purposive sampling, receiving self-administered questionnaires for confidentiality. SAS 9.4 software facilitated statistical analysis. Results: The study encompassed 76 county-level medical institutions, with 82.9% of them featuring established oncology departments providing comprehensive cancer care, including early screening, diagnosis, treatment, and long-term follow-up. Notably, a total of 56.6% of the institutions surveyed implemented programs for cancer screening and early diagnosis. A significant proportion of advanced cancer patients received treatment and follow-up at the county level. Persistent disparities in medical insurance policies at the county level were identified as a continuing challenge. Furthermore, 82.9% of hospitals had cultivated collaborative relationships with higher-level institutions to enhance patient care quality and treatment capacity. The study revealed a 56.6% shortage of remote collaboration platforms in these hospitals. The need for a patient-centered approach in county hospitals was underscored. Conclusion: While county-level hospitals face challenges, such as a shortage of specialized oncologists and advanced resources, they exhibit progress in standardizing cancer care to enhance diagnosis and treatment in rural areas. [ABSTRACT FROM AUTHOR]

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

Background: Research on breast cancer risk factors and mortality is gaining recognition and attention globally; there is need to add more information on its determinants among patients admitted in hospital. Some studies on risk factors and mortality of breast cancer in Nigeria hospitals conducted in the urban and suburban areas have been documented. Therefore, an addition of a study conducted in the setting of a rural health institution is necessary. This study assessed the risk factors and determinants of mortality among patients admitted for breast cancer in rural Southwestern Nigeria. Methods: A retrospective observational study was conducted on 260 patients who were admitted for breast cancer between January 2010 and December 2023 using a data form and a standardized information form. The data were analyzed using SPSS version 22.0. The risk factors and the determinants of mortality of patients with breast cancer were identified using multivariate regression model. Results: The breast cancer risk factors were old age, family history, tobacco smoking, combined oral contraceptives, and hormonal therapy use. The case fatality rate was 38.1%, and its determinants of mortality were patients who were older (adjusted odds ratio [AOR], 1.956; 95% confidence interval [CI]:1.341-4.333), obese (AOR, 2.635; 95% CI: 1.485-6.778), stage IV (AOR, 1.895; 95% CI: 1.146-8.9742), mastectomy (AOR, 2.512; 95% CI: 1.003-6.569), discontinued adjuvant chemotherapy (AOR, 1.785; 95% CI: 1.092-4.6311), and yet to commence adjuvant chemotherapy (AOR, 2.568; 95% CI: 1.367-5.002). Conclusion: The study revealed that patients with breast cancer were associated with high mortality. Sustained health education to promote early diagnosis, managed co-morbidities, and access to treatment may contribute to reduction in breast cancer mortality in rural Nigeria. [ABSTRACT FROM AUTHOR]

Limited healthcare availability impacts population health. Regional disparities in GP density across Germany raise questions about their association with regional socioeconomic characteristics. This longitudinal nationwide ecological German study used regional data at the county level (n = 401) from 2015 to 2019 provided by the Federal Institute for Research on Building, Urban Affairs and Spatial Development (BBSR). The outcome was general practitioners (GPs) density, defined as the number of GPs per 10,000 inhabitants. Univariate Moran's I, cluster analysis (LISA), and spatial lag of X (SLX) models were employed to analyse the spatial distribution of GP density and its correlation with various regional socioeconomic characteristics from a cross-sectional and longitudinal perspective. In contrast to the univariate analysis, rural counties showed the highest GP density the multivariate model. Several counties were identified as embedded in low- or high-GP-density clusters. In 2015 and 2019, larger household size (2015: std. β = −2.31, p = 0.021; 2019: std. β = −4.14, p < 0.001) and higher unemployment rate (2015: std. β = −2.84, p = 0.005; 2019: std. β = −5.47, p < 0.001) were associated with lower GP density. In the longitudinal model, a greater increase in the unemployment rate was related to a greater decrease in GP density (std. β = −2.17, p = 0.030). A higher regional unemployment rate is linked to lower GP availability in Germany, and a greater increase in the unemployment rate was related to a greater decrease in GP availability over time. This necessitates policy intervention to avoid socioeconomic disparities in GP care. [ABSTRACT FROM AUTHOR]

Vaccination is a crucial public health intervention protecting individuals and communities from vaccine-preventable diseases. However, unvaccinated children in low- and middle-income countries pose a significant challenge. Ethiopia, a Global Alliance for Vaccines and Immunisation (GAVI)-supported country, ranks fifth in zero-dose immunisation burden, indicating concerning vaccine coverage gaps. Despite the severity of this issue, there is a dearth of research investigating the disparities, prevalence and contributing factors associated with zero-dose children in Ethiopia. This study aimed to assess the prevalence, spatial distribution and determinants of zero-dose children in Ethiopia. A community-based cross-sectional study was conducted using data from the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS). Data were collected from 21 March 2019 to 28 June 2019. The study included a total of 1334 children aged 12–35 months (weighted sample). For spatial and multilevel analyses, ArcGIS 10.8 and Stata 17 software were used, respectively. The measure of association was determined by computing the adjusted odds ratio (AOR) at a 95 % confidence interval (95 % CI), and a p-value <0.05 was considered statistically significant. The prevalence of zero-dose children in Ethiopia was 46.5 % (95 % CI: 43.8, 49.2). Southeast Amhara, Afar, Somali, Oromia and SNNPR (Southern Nations, Nationalities and Peoples' Region) regions had high zero-dose proportions. Maternal age 15–19 years (AOR = 1.63; 95 % CI: 1.05, 2.64), lack of antenatal care (AOR = 1.77; 95 % CI: 1.34, 2.35), rural residence (AOR = 1.94; 95 % CI: 1.17, 3.19) and region were significantly associated to zero-dose status in Ethiopia. The prevalence of zero-dose children in Ethiopia was high and the distribution exhibited significant variation across the country's clusters. Individual and community factors were key contributors. It is essential that areas with a high prevalence of zero-dose children have access to recommended childhood vaccines. This proactive approach can help protect children from morbidity and mortality caused by vaccine-preventable diseases. [ABSTRACT FROM AUTHOR]

Child health is a social and economic development indicator. Pakistan is one of the countries with a high rate of under-five mortality. This research aims to examine several demographic, geographical, socioeconomic, health-related, and environmental factors related to under-five mortality in both rural and urban areas of Punjab, Pakistan. This is a cross-sectional study. We used data from the Multiple Indicator Cluster Survey 2017-18 of children aged between 0 and 59 months (n = 39,024), steered by the Punjab Bureau of Statistics. Children who died before reaching the age of five were considered as outcome variables. The bivariate relationship of the outcome variable with each socio-economic, demographic, health-seeking, and environmental variable is estimated with a P -value of <0.01. We used logistic regression analysis separately. Inclusive descriptive statistics were used for the detailed analysis, i.e., compare means, cross-tabulations, independent sample t-tests, and comparison across rural–urban areas. Results showed that in the mother-level variables, mother education plays a substantial role in reducing mortality; the higher the level of education, the lower the mortality rate. The study revealed that improving drinking water sources, such as tap and bottled water, can reduce the incidence of mortality, particularly in low-income households. Therefore, interventions targeting children are likely to be most effective for reducing the under-five mortality rate in Pakistan. [ABSTRACT FROM AUTHOR]

Although catastrophic health spending is the main measure for assessing financial healthcare protection, it varies considerably in methodological and empirical terms, which hinders comparison between studies. The aim of this study was to measure the prevalence of catastrophic health spending in Brazil in 2003, 2009, and 2018, its associated factors, and disparities in prevalence distribution according to socioeconomic status. This was a time series study. Data from the Household Budget Surveys were used. Prevalence of catastrophic health spending was measured as a percentage of the budget and ability to pay, considering thresholds of 10, 25, and 40%. It was determined whether household, family, and household head characteristics influence the likelihood of incurring catastrophic health spending. Households were stratified by income deciles, consumption, and wealth score. There was an increase in prevalence of catastrophic health spending between 2003 and 2009 in Brazil and a slight reduction in 2018. The wealth score showed more pronounced distributional effects between the poor and the rich, with the former being the most affected by catastrophic health spending. Consumption showed greater percentage variations in the prevalence of catastrophic health spending. The prevalence of catastrophic health spending was positively associated with the presence of older adults, age and female household head, rural area, receipt of government benefits, and some degree of food insecurity. The poorest families are most affected by catastrophic health spending in Brazil, requiring more effective and equitable policies to mitigate financial risk. [ABSTRACT FROM AUTHOR]

Background: Indigenous knowledge healers (IKHs) provide alternative healthcare to formal health services in rural South Africa, but there is a gap in knowledge regarding their treatment of surgical conditions. This study evaluated IKH surgical care and described their perspective of the dual health system. Methods: A cross sectional survey of IKHs in the Madwaleni Hospital catchment of the Eastern Cape, South Africa was conducted. Topics included the training and experience of IKHs, treatment of nine common surgical conditions, referral patterns, disease origin beliefs, benefits and limitations of care, and collaborative opportunities between the two health systems. Results: Thirty‐five IKHs completed the survey. IKHs were consulted by persons with all nine surgical conditions. The most common forms of treatment were application of an ointment on the affected site (88%) and oral medication (82%). Operative treatment was only done for abscess. Referrals to the formal healthcare sector were made for all surgical conditions. IKHs reported that they were limited by their lack of training and resources to perform operations. On the other hand, they perceived the treatment of the spiritual aspect of surgical disease as a benefit of their care. Thirty‐five (100%) IKHs were interested in closer collaboration with the formal health sector. Conclusion: IKHs treat surgical conditions but refer to the formal health sector when diagnostic and operative services are needed. More research is needed to determine the potential advantages and disadvantages between the formal health sector and IKH collaboration. [ABSTRACT FROM AUTHOR]

Objective: Examine how student demographics and perception of on-campus counseling service availability, accessibility, acceptability, and quality is related to utilization. Participants: A total of 262 students from 49 Georgia (U.S.) higher education institutions. Methods: A logistic regression examined student perception of on-campus counseling services and associations with service utilization, controlling for covariates. Results: (1) Non-heterosexual students were more likely to use on-campus counseling services than heterosexual students, (2) students in rural areas were more likely to utilize services than students in urban areas, (3) insured students had higher odds of utilizing services than uninsured students, and (4) higher ratings of perceived accessibility were associated with likelier service use. Conclusions: The perception of accessibility was significantly associated with higher odds of on-campus service use. Thus, a better understanding of student perception of on-campus counseling center accessibility is warranted. [ABSTRACT FROM AUTHOR]

Although assistive technology (AT) is recognized as a basic human right, access to AT, and particularly electronic aids to daily living (EADL), is limited. We aimed to understand how persons with high level spinal cord injury (SCI) prioritize EADL needs and assess satisfaction and efficacy of self-identified EADL. Thus, in this case series, we recruited three participants with C4, C5 or C6 SCI receiving in-patient SCI rehabilitation. Each received dedicated occupational therapy-based assistance in identifying EADL items within an unrestricted envelope of support ($5000 CDN) for use in maximizing physical independence and supporting their return to community-based living. Items identified were categorized by need (emergency/security; home environment control; or virtual access to the outside world). Each participant selected distinct EADL. Evaluation of selected EADL items indicated very high satisfaction. The selected EADL contributed to participants' returns to employment, community life, or reduced requirements for attendant services. These findings suggest that identification of essential technology should reflect the unique needs of each person and the context in which it will be used. These findings also support use of mainstream technology to meet EADL needs of individuals with limited physical abilities. IMPLICATIONS FOR REHABILITATION: Initial spinal cord injury (SCI) rehabilitation should provide individualized identification and selection of electronic aids for daily living (EADL) for those with very minimal arm and hand function, including mainstream voice-activated technologies, to increase independence and function. Individualized self-selection of EADL, rather than general prescription-based provision of EADL, is most appropriate for identifying key EADL that will enhance function and independence in the community. Support from occupational therapists with expertise in SCI rehabilitation can provide expertise in identifying and setting up EADL, including in the community, to ensure selected EADL function as intended. [ABSTRACT FROM AUTHOR]

Objective: Access to assistive products (APs) is essential to maximising function, participation, and inclusion of persons with disabilities. Challenges to AP access in low- and middle-income countries include stigma, costs, supply, and rehabilitation capacity gaps. This study aimed to examine AT access in the context of a low-resource setting in rural South India. Objectives were to examine rehabilitation professionals' perceptions of AP needs, barriers and facilitators of AP provision, and AT knowledge. Methods: A descriptive study design with a 2-part online survey methodology was utilized. This study was conducted in April-September 2020 at a non-governmental organization (NGO) serving children and adults with disabilities in 3 districts of rural South India. Purposive sampling of NGO's multidisciplinary rehabilitation professionals (N=62) was used. The survey was developed based on WHO's Assistive Products List (APL). Barriers and facilitators were classified according to the principles of AT access. Analyses revealed acceptability, affordability, and availability as the top three barrier themes across disciplines, including poor acceptance by clients/families due to stigma, high AP costs, and a long waitlist for government-provided devices. Acceptability, affordability, and accessibility were the top three facilitator themes, including community awareness, availability of AP funding, client/family education, and AT service provision training. Impact: Our study identified key enabling strategies for AT access, aimed at reducing reported barriers. Enabling AP provision was determined to be multi-factorial, aimed at users/ families, service providers, organizations, communities, and policymakers. Local stakeholder groups are crucial to understanding challenges and opportunities to AP provision within a low-resource context. IMPLICATIONS FOR REHABILITATION: Identified barriers to assistive product (AP) provision in rural South India include poor acceptance by clients/families due to stigma, high AP costs, limited AP availability, and rehabilitation capacity gaps. Suggested facilitators to AP provision in rural South India include improving AP acceptability, affordability, and accessibility through community awareness, client/family education, AP funding and supply, and assistive technology (AT) service provision capacity building. An organisational-level survey based on the WHO's Priority Assistive Products List and the Principles of AT Access can identify local needs, barriers and facilitators. An AT access strategies in resource-limited areas may be developed based on barriers and facilitators identified by local/regional rehabilitation professionals. [ABSTRACT FROM AUTHOR]

Staff implementation fidelity of behavioral interventions is an ongoing challenge in many educational settings. The Performance Diagnostic Checklist‐Human Services (PDC‐HS) is one tool that may be effective in identifying effective solutions to identified staff performance issues. This study examined the use of the PDC‐HS to assess and identify interventions for increasing staff delivery of token reinforcers within a Positive Behavior Interventions and Supports (PBIS) school‐wide system. Participants included five classroom teachers, ranging from 2 to 22 years of teaching experience. A concurrent multiple baseline design across participants was used including a baseline condition, implementation of a non‐indicated intervention based on the PDC‐HS, and implementation of a PDC‐HS indicated intervention. The number of teacher‐delivered tokens per school day was measured across the study. Results indicated participants' daily number of delivered tokens increased following implementation of the PDC‐HS indicated intervention. [ABSTRACT FROM AUTHOR]

Rural Australian youth exhibit high rates of mental ill-health, exacerbated by reduced access to mental health services. While the need for innovative solutions is well-established rural youth themselves are frequently excluded from the dialogue, creating a significant gap in evidence and the development of relevant service provision that reflects young people's lived experiences. Drawing on the concepts of individualism and healthism and research highlighting the continuing importance of relationships and trust in the lives of young people in a digital society, we aim to better understand how rural youth understand mental health and navigate mental health services and information. Using a qualitative methodology, we held 2 small focus groups with a total of 8 young people in rural Tasmania to identify aspects of rural mental healthcare that require improvement and to contribute to developing new and innovative solutions. Findings indicate that rural Tasmanian youth face numerous structural, social, and cultural barriers to positive mental health. Rural self-reliance and generational differences in attitudes towards mental health can negatively affect youths' help-seeking behaviours. Findings from this study suggest a need to combine technology-and community-based approaches creating a multi-generational approach to combat mental ill-health among rural youth. [ABSTRACT FROM AUTHOR]

Background: Palliative care improves the quality of life for people with life‐limiting conditions, which are common among older adults. Despite the Veterans Health Administration (VA) outpatient palliative care expansion, most research has focused on inpatient palliative care. This study aimed to compare veteran characteristics and hospice use for palliative care users across care settings (inpatient vs. outpatient) and dose (number of palliative care encounters). Methods: This national cohort included veterans with any VA palliative care encounters from 2014 through 2017. We used VA and Medicare administrative data (2010–2017) to describe veteran demographics, socioeconomic status, life‐limiting conditions, frailty, and palliative care utilization. Specialty palliative care encounters were identified using clinic stop codes (353, 351) and current procedural terminology codes (99241–99245). Results: Of 120,249 unique veterans with specialty palliative care over 4 years, 67.8% had palliative care only in the inpatient setting (n = 81,523) and 32.2% had at least one palliative care encounter in the outpatient setting (n = 38,726), with or without an inpatient palliative care encounter. Outpatient versus inpatient palliative care users were more likely to have cancer and less likely to have high frailty, but sociodemographic factors including rurality and housing instability were similar. Duration of hospice use was similar between inpatient (median = 37 days; IQR = 11, 112) and outpatient (median = 44 days; IQR = 14, 118) palliative care users, and shorter among those with only one palliative care encounter (median = 18 days; IQR = 5, 64). Conclusions: This national evaluation provides novel insights into the care setting and dose of VA specialty palliative care for veterans. Among veterans with palliative care use, one‐third received at least some palliative care in the outpatient care setting. Differences between veterans with inpatient and outpatient use motivate the need for further research to understand how care settings and number of palliative care encounters impact outcomes for veterans and older adults. [ABSTRACT FROM AUTHOR]

Background Despite the increased availability of evidence-based treatments for chronic pain, many patients in rural areas experience poor access to services. Patients receiving care through the VA may also need to navigate multiple systems of care. Objective To examine the effectiveness of a remotely delivered collaborative care intervention for improving pain interference among veterans with high-impact chronic pain living in rural areas. Design We will conduct a four-site pragmatic effectiveness trial of remotely delivered collaborative care for high-impact chronic pain. Participants (n  = 608) will be randomized to the Tele-Collaborative Outreach to Rural Patients (CORPs) intervention or to minimally enhanced usual care (MEUC). Participants randomized to CORPs will complete a biopsychosocial assessment and five follow-up sessions with a nurse care manager (NCM), who will collaborate with a consulting clinician to provide personalized recommendations and care management. CORP participants will also be invited to a virtual 6-session pain education group class. Participants randomized to MEUC will receive a one-time education session with the NCM to review available pain services. All participants will complete quarterly research assessments for one year. The primary study outcome is pain interference. This trial will oversample veterans of female birth sex and minoritized race or ethnicity to test heterogeneity of treatment effects across these patient characteristics. We will conduct an implementation process evaluation and incremental cost-effectiveness analysis. Discussion This pragmatic trial will test the real-world effectiveness of a remotely delivered collaborative care intervention for chronic pain. Study findings will inform future implementation efforts to support potential uptake of the intervention. [ABSTRACT FROM AUTHOR]

Refugees from diverse socio-cultural backgrounds and geopolitical locations face temporal challenges during their transition, yet more research needs to be conducted to understand their time conception in the host society. This study explores how North Korean refugees from remote rural areas in North Korea and China adjusted their time conception in a metropolitan city in South Korea. Data were collected through a pilot study (January-March 2017) and ethnographic fieldwork (February-July 2018), entailing semi-structured interviews, informal conversations, and field notes. Vygotsky's psychological tool and Ricoeur's interpretive approach were employed to solicit the mediation of time conception through organizational activities and narrative meanings. The analysis reveals themes that challenge refugees' time conception reflecting North Korean values and daily activities—Kimilsungism, collectivism, and task-oriented attitude—and the changes in time conception on the sense of the self. Refugees' learning in time conception is a holistic spiritual, social, and personal process. [ABSTRACT FROM AUTHOR]

Purpose: To describe program characteristics and outcomes of a residential substance use recovery program serving pregnant and parenting women in a rural and urban location. Description: This assessment of administrative records from April 1, 2020 through March 31, 2022, included women in a rural (n = 140) and urban (n = 321) county in Kentucky. Assessment: This retrospective case study used descriptive and non-parametric analyses to assess the population and examine differences between locations, race, and ethnicity for women served. Logistic regression tested predictors of goal achievement by community. Of 461 women served, 65 (14.1%) delivered a baby while in treatment; 62 of which were considered healthy. 13% of the women were Black, 83.1% non-Hispanic (NH) white, and 3.7% were other races/biracial; 1.3% were Hispanic. The mean age was 30.92 years (SD 6.23) and treatment duration was 90.11 days (SD 67.70). Program goals were achieved by 312 (67.7%). There were no differences in rates of goal achievement or treatment duration by race, ethnicity, or age and no difference in the rate of achievement by location in univariate analyses. However, treatment duration was positively associated with program success in both communities. In the urban community, Black women were 8% more likely to successfully complete the program compared to NH white women (OR = 9.77 [95% CI 1.21,79.18; p = 0.033]) after controlling for confounders. Insufficient sample size for non-white women in the rural community prohibited evaluation. Conclusions: Duration of time in the program best predicted successful completion for women in recovery. These findings have policy implications. Significance: Women having difficulties with substance use are typically of childbearing age. Integrated programs are needed to address the multi-factorial needs of these women. Models suggest that optimal care involves services that are co-located or closely aligned. The current evaluation contributes to the literature by examining outcomes for women in recovery. This case study examines client outcomes at a community-based residential treatment program and found evidence that the length of stay was associated with achievement of program goals. Lastly, contrary to previous reports, Black women in an urban community had an 8% greater probability of successful completion compared to white women. [ABSTRACT FROM AUTHOR]

Electronic nicotine delivery systems (ENDS, commonly referred to as e‐cigarettes), have become popular among young adults (YAs, 18–24 years) in the United States. YAs in rural areas increasingly consume more ENDS than those in urban areas. However, there is a knowledge gap regarding the perspectives of public health advocates (PHAs) on ENDS use and cessation among YAs in rural areas. The objectives of the study are to describe the perspectives of PHAs and identify strategies to strengthen the capacity for promoting the cessation of ENDS among YAs in rural communities. A qualitative study and interpretive description were used with semi‐structured interviews. The content analysis was used to analyze the data. Twenty‐two PHAs, including public health officers, nurses, and tobacco‐free educators, from Wisconsin, Minnesota, and North Dakota, were invited to the semi‐structured interviews. Four themes emerged: (a) Perceived ENDS use and cessation; (b) rural contexts and infrastructure influencing ENDS use; (c) essential public health responsibilities controlling ENDS use in rural areas; and (d) regulating ENDS use: Policies and law. PHAs stressed the importance of increased awareness of ENDS use in YAs, improved regulation, and tailored policies to tackle rural communities' distinct challenges. The study emphasizes the urgency for specialized programs to aid YAs in quitting ENDS in rural areas. A comprehensive strategy is needed to effectively address ENDS use among YAs in rural areas, involving education, policy adjustments, and community‐based initiatives. [ABSTRACT FROM AUTHOR]

Objective: To understand rural older farmers' perspectives and attitudes toward skin cancer risk and prevention. Design and sample: This study used a grounded theory approach and semi‐structured interviews with 12 rural older farmers (farm owners, farmworkers ages 50 years or older) in Washington. Participants' perspectives were explored relative to Health Belief Model constructs. Inductive and deductive analyses were used to generate relevant themes. COREQ guidelines were followed. Results: The findings fit well and extended the Health Belief Model, which was used to arrange key themes identified in relation to skin cancer risk and prevention, specifically participants' perceived barriers to accessing primary care and protection when outdoors, perceived benefits of sun‐protective behaviors, perceived hereditary susceptibility to skin cancer, perceived severity of the increased skin cancer risk, and cues to action for skin checks. A new construct of hope was identified to emphasize the importance of establishing emotional, instrumental, and informational support systems for promoting skin cancer prevention. Participants also indicated their hope of raising awareness of skin cancer prevention among all ages. Conclusions: Findings highlighted the importance of integrating skin cancer prevention services for rural older farmers and across the lifespan. Public health approaches are needed to enhance the awareness of and access to preventive care in these underserved populations. [ABSTRACT FROM AUTHOR]

Introduction: Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) remains a major global public health concern, especially in low-income countries like Ethiopia. Insufficient awareness about HIV/AIDS makes women vulnerable to infection. Notably, there is a disparity in the comprehensive HIV knowledge among reproductive-aged women in poorer and wealthier households. However, the contributing factors for wealth-related disparities in comprehensive knowledge of HIV among reproductive-aged women in Ethiopia have not been explored. Methods: We used the women's record (IR) of the 2016 Ethiopian demographic health survey. Erreygers normalized concentration index and curve were used to analyze the percentage contribution of factors in the comprehensive knowledge of HIV difference across wealth index. The concentration index was decomposed into contributing factors for poor comprehensive knowledge among poorer households. Results: A total of 14,599 reproductive-aged women were included in the analysis. The comprehensive knowledge of HIV was 14.75% and 29.33% in the poorest and wealthiest households, respectively. The weighted Erreygers normalized concentration index (ECI) was 0.11 with Standard error = 0.015 (P value < 0.05). Age (− 0.17%), residence (1.4%), education (26.2%), occupation (1.38%), region (0.61%), wealth index (30.8%), media exposure (13.4%), and internet access (0.67%) significantly contributed to the wealth-related inequalities. Conclusion: There was a pro-rich distribution of comprehensive knowledge of HIV among reproductive-age women in Ethiopia. Wealth, education, and media exposure were the major contributing factors to the wealth-related inequalities. Policymakers should prioritize media exposure and education, and work to improve the comprehensive knowledge of women in poorer households. [ABSTRACT FROM AUTHOR]

Background and objective: The triglyceride-glucose (TyG) index, a surrogate marker for insulin resistance, has been proposed as a predictor of cardiovascular events. However, the combined impact of the TyG index and obesity indicators, such as body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), on stroke risk was not fully understood. This study aimed to investigate the association between the TyG index combined with these obesity indicators and stroke risk in the Chinese population. Materials and methods: Data on 17,708 participants aged 45 years or older for this study were collected from the China Health and Retirement Longitudinal Study (CHARLS) from baseline (2011) to the Wave 5 follow-up (2020). Cox proportional hazards model, restricted cubic spline (RCS) and receiver operating characteristic (ROC) analysis were employed to examine the association between the TyG index and its combined obesity-related indicators with stroke. Mediation analysis was conducted to explore the mutual potential mediating role of TyG and obesity indicators in the above relationships. Results: A total of 8,207 participants with an average age of 58.2 years were investigated, of which 11.0% were stroke individuals, 44.80% were men and 84.6% were from rural areas. TyG, TyG-BMI, TyG-WHtR, TyG-WC were significantly higher in stroke subjects than in the non-stroke subjects (P < 0.001), and were significantly and positively associated with stroke in all 3 models (P < 0.05). Restricted cubic spline models revealed nonlinear associations between TyG and TyG-BMI with stroke (P-overall < 0.001, P-nonlinear = 0.003 for TyG, and P-overall < 0.001, P-nonlinear = 0.028 for TyG-BMI), while TyG-WC and TyG-WHtR (P-overall < 0.001 and P-nonlinear > 0.05) demonstrated linear associations with stroke after adjusting for covariates. TyG-WHtR, TyG-BMI and TyG-WC had more robust predictive power than TyG for risk of stroke. TyG-WHtR or TyG-WC had the highest predictive power for stroke (AUC:0.696, 95% CI 0.677–0.715), slightly higher than the other indicators. Associations between TyG, TyG-WC, TyG-WHtR, and TyG-BMI with stroke were found to be stronger among individuals who were ≥ 55 years of age, male. The relationship between TyG and stroke was significantly mediated by BMI, WHtR and WC (15.79%, 21.72%, and 24.06% respectively), while the relationship between these obesity measures and stroke was significantly mediated by TyG (18.48%, 14.45%, and 14.70% respectively). Conclusion: The combination of TyG and obesity-related indicators was significantly associated with stroke risk, and could improve predictive power for stroke compared to the single TyG. Obesity indicators and TyG mediated each other in their respective associations with stroke risk. [ABSTRACT FROM AUTHOR]

Background: Mapping health outcomes related to environmental health hazards at the county level can lead to a simplification of risks experienced by populations in that county. The Centers for Disease Control and Prevention's National Environmental Public Health Tracking Program has developed sub-county geographies that aggregate census tracts to allow for stable, minimally suppressed data to be displayed. This helps to highlight more local variation in environmental health outcomes and risk data. However, we wanted to understand whether the aggregation method used was aggregating sociodemographically similar or dissimilar areas with one another. This analysis attempts to explore whether the distributions of select people who may be at increased risk for exposure to environmental health hazards as identified by the Tracking Program are preserved in these sub-county geographies with the census tracts used as the foundation to create them. Methods: Mean values of three sociodemographic characteristics (persons aged 65 years and older, people from racial and ethnic minority groups, and population below the poverty level) for each sub-county geography in five states were calculated and placed into five break groups. Differences in break groups were determined and compared for each sub-county geography and census tract. Results: The sociodemographic characteristics among the census tracts and two aggregated sub-county geographies were similar. In some instances, census tracts with a low population or a highly skewed population (e.g., very high percentage of population aged 65 years and older) were aggregated with dissimilar census tracts out of necessity to meet the requirements set by the Tracking Program's aggregation methodology. This pattern was detected in 2.41-6.59% of census tracts within the study area, depending on the sociodemographic variable and aggregation level. Conclusions: The Tracking Program's sub-county aggregation methodology aggregates census tracts with similar characteristics. The two new sub-county geographies can serve as a potential option for health officials and policymakers to develop targeted interventions using finer resolution health outcome and environmental hazard data compared to coarser resolution county-level data. [ABSTRACT FROM AUTHOR]

Access to medical and supportive care services is important for the health and quality of life of cancer survivors; however, services are not always available or accessible to all survivors equally. This study aims to explore the experiences of cancer services among cancer survivors in urban and rural settings to inform social work practice. Authors conducted interviews with 25 cancer survivors (colorectal, n = 13; hematological, n = 12) in the West of Ireland, using a narrative inquiry approach. Thematic analysis was used to analyze the data. Authors found variations in the availability of supportive care services for urban and rural cancer survivors. Often, services designed to maximize survivors' individualized choices and needs in community care were limited in rural communities, preventing some survivors from having their physical and psychological needs met. Additionally, access to services proved to be a barrier for rural cancer survivors. Rural survivors stated that traveling to appointments required time and planning, and the implications of travel costs were an increased burden. When rural survivors had good social support, access to services became less of an issue. The study confirms geographical disparities and recommends a review of supports that better meet survivors' needs and informs social work practice. [ABSTRACT FROM AUTHOR]

Beyond navigating normative developmental tasks, Black American adolescents cope with race-related experiences that are distinct to their racial-ethnic group. However, little is known about how Black American adolescents, particularly those in racially homogenous communities, experience and cope with race-related stress. Using qualitative measures, this study investigates how Black American adolescents in urban, racially homogenous environments experience race-related stress and the coping methods used to combat it. Qualitative data via individual interviews with 20 high school seniors revealed that these adolescents experience race-related stress in individual, institutional, and cultural contexts, which evoked intense negative emotions. Seeking support from family and friends and social referencing positive cultural artifacts were the most widely utilized coping strategies. Implications of the protective nature of racially homogenous environments and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Objectives: The COVID-19 pandemic demonstrated how vaccination decisions are influenced by misinformation, disinformation, and social pressures, leading to varied and inequitable uptake rates. In this study, we examined how COVID-19 vaccine messages received via social networks were associated with vaccine uptake in rural Alabama. Methods: From November 2021 through March 2022, we collected 700 responses to a telephone survey administered in 4 rural Alabama counties. We asked respondents to indicate whether certain social relationships (eg, family, businesses) tried to influence them to (1) obtain or (2) avoid a COVID-19 vaccine. We used χ2 tests, Kruskal–Wallis tests, Mantel–Haenszel χ2 tests, and Fisher exact tests to examine the associations between vaccination status and survey responses. Results: Respondents in majority–African American counties were significantly more likely than those in majority–White counties to have received ≥1 dose of COVID-19 vaccine (89.8% vs 72.3%; P <.001). Respondents who received ≥1 dose had a significantly higher mean age than those who had not (58.0 vs 39.0 years; P <.001). Respondents who were encouraged to get vaccinated by religious leaders were more likely to have received ≥1 dose (P =.001), and those who were encouraged to avoid vaccination by family (P =.007), friends (P =.02), coworkers (P =.003), and health care providers (P <.001) were less likely to have received ≥1 dose. Respondents with more interpersonal relationships that encouraged them to avoid vaccination were more likely to be unvaccinated (P <.001). Conclusions: Interpersonal relationships and demographic characteristics appeared to be important in COVID-19 vaccine decision-making in rural Alabama. Further research needs to identify how to facilitate vaccine-positive interpersonal relationships, such as peer mentoring and trusted messenger interventions. [ABSTRACT FROM AUTHOR]

Objectives: Evidence has emerged on the health dangers of electronic cigarette (e-cigarette) use among pregnant women and neonates. We examined whether rural residence is a risk factor for smoking and e-cigarette use among women during the peripartum period in the United States. Methods: This study was based on pooled cross-sectional 2015-2020 data from the Pregnancy Risk Assessment Monitoring System. The outcome was exclusive smoking, exclusive e-cigarette use, and use of both products (ie, dual use) versus use of neither tobacco product by women with live infants aged 2 to 6 months. We examined rural–urban differences in outcome by using univariate and multivariable multinomial logistic regressions with post hoc contrasts and marginal analyses, adjusting for complex survey design and nonresponse. Results: During the peripartum period, 5.0% of women were smoking combustible cigarettes, 5.0% were using e-cigarettes, and 1.9% were using both tobacco products. The crude prevalence of e-cigarette use was 1.1 percentage point higher, and the adjusted prevalence was 0.8 percentage points lower for rural versus urban women (P <.001 for both). Among rural women, 6.7% (95% CI, 6.3%-7.1%) smoked combustible cigarettes exclusively and 2.6% (95% CI, 2.3%-2.8%) used both products, as compared with 4.5% (95% CI, 4.4%-4.8%) and 1.7% (95% CI, 1.6%-1.8%) of urban women, respectively, adjusting for sociodemographic and health-related characteristics. Conclusions: Maternal sociodemographic and health-related characteristics differed by combustible smoking versus e-cigarette use during the peripartum period. The effect of residence on e-cigarette use was significantly confounded by sociodemographic and health-related characteristics, resulting in clinically comparable prevalence of e-cigarette use in rural and urban mothers with live infants aged 2 to 6 months. [ABSTRACT FROM AUTHOR]

Objectives: Indigenous people experience poorer mental health compared to the general population. Socioeconomic gaps partly explain these disparities. However, there is variability between populations and French overseas territories are understudied. This study examines the prevalence of mental health problems among Indigenous people in New Caledonia and French Polynesia, describing and comparing it with that of their counterparts while considering associated factors. Methods: We used the data from the cross-sectional Mental Health in the General Population survey in the only 3 sites for which information on indigenous status was available: Noumea (2006) and the 'Bush' (2008) in New Caledonia, and French Polynesia (2015–2017). Current mental health issues were screened using the Mini-International Neuropsychiatric Interview. In multivariable analyses, we considered the following factors: gender, age, education level, marital status, occupational activity and monthly income. Results: Overall, 2294 participants were analysed. Among the 1379 indigenous participants, 52.3% had at least one mental health issue. The prevalence of depressive disorder (18.0% vs 11.7%), alcohol use disorder (16.7% vs 11.7%) and suicide risk (22.3% vs 16.7%) were higher among indigenous participants compared to non-indigenous participants. After adjustment, the association between indigenous status and these mental health issues did not persist, except for alcohol use disorder. Conclusion: We found higher prevalence of depressive disorder, alcohol use disorder and suicide risk among indigenous people of French Polynesia and New Caledonia compared to their counterparts. These differences seemed largely explained by socioeconomic disparities. Future studies could explore the use of and access to healthcare by indigenous populations. [ABSTRACT FROM AUTHOR]

To address teenage learners' risk of HIV, STIs and pregnancy, good quality school-based sexuality education is of great importance. In this paper we address Zimbabwean young people's construction of sex and sexuality education. We draw from semi-structured individual interviews conducted with forty-seven teenage boys and girls aged between 15 and 19 years in two rural schools in Zimbabwe. The study's findings suggest that teenagers make sense of sex and sexuality education within dominant discursive frameworks that stress the importance of sexual innocence and abstinence, with the sexuality of teenage girls receiving special surveillance. However, the learners in our study also occupied positions which suggested young people's sexual agency beyond innocence. In the light of these contradictions, teenagers in Zimbabwe are caught up in producing both sexual innocence and sexual agency, making abstinence only education irrelevant to their day to day lives. Implications for future forms of sexuality education and teenagers' sexual agency in rural Zimbabwean schooling are suggested. [ABSTRACT FROM AUTHOR]

This study aims to explore Kinh Vietnamese adults' perception of older adults, and examine their anxiety about ageing and its associated factors. Purposive sampling method was used to recruit rural community members who aged from 18 to 59 by the time of the study and self-identified with Kinh ethnicity, the major ethnicity in Vietnam. A total of 322 eligible participants completed face-to-face, semi-structured interviews conducted by research assistants. The survey consisted of both close-ended questions and open-ended questions to collect quantitative and qualitative data. The qualitative results from open-ended questions show that 'older adults' were perceived and described with overwhelmingly negative characteristics regarding their appearance (wrinkles, gray hair), physical and cognitive health conditions (weak, frail, confused), capacity (incapable of working), and personality and behavioral characteristics (being difficult and irritable). The quantitative findings show that contact with older adults, correct understanding of qualified age of older adults, and worry about getting dementia and caring for someone with dementia in the future were significantly associated with anxiety about aging. Stereotype and prejudice about older adults, as well as anxiety about aging are critical issues among Vietnamese adults. These results have their implications for educational programs and media campaigns to address ageist stereotypes and aging anxiety in community. [ABSTRACT FROM AUTHOR]

Despite efforts made in Zimbabwe to address intimate partner violence (IPV), critical gaps still exist regarding the efficacy of IPV service provision in rural areas. This study examines male service providers' perceptions of IPV in Chimanimani Rural District in Zimbabwe to provide guidance for policy and practice on IPV intervention in rural areas. A qualitative study was conducted with six male service providers using in-depth interviews and thematic analysis. Our findings revealed how the intersection of social norms and the geographical location of rural areas influence service providers' perceptions of IPV and service provision. Most of the service providers interviewed had a general understanding of IPV and regarded it as unacceptable social behavior. However, constraints to service delivery typical in rural areas negatively impacted their IPV intervention, including having limited intervention resources, limited male participation, and conflicting identities (professional versus cultural identity). We conclude that service provision in rural areas is essential to respond to and prevent the occurrence of IPV, yet how service providers perceive IPV affects the quality of services rendered to victims. [ABSTRACT FROM AUTHOR]

Objectives: This umbrella review aims to synthesise and summarise the role of teledentistry in improving oral health outcomes and access to dental care. Methods: We searched the databases PubMed (Medline), Scopus, CINHAL, OVID, ScienceDirect, JSTOR, JBI Database of Systematic Reviews & Implementation Reports and the Cochrane Database of Systematic Reviews through March 2024. Systematic reviews and meta‐analyses on teledentistry were eligible for inclusion. No publication time or language restrictions were applied. Our search retrieved 24 studies for which we conducted quality assessments using the Joanna Biggs Institute (JBI) for Systematic Reviews and Research Synthesis Critical Appraisal Tool. Results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Results: Studies addressed clinical oral health outcomes, health‐related quality of life and patient experience, access to dental care and cost‐effectiveness of teledentistry compared to conventional, face‐to‐face dental consultations. We found that there was consensus that teledentistry enhanced oral health through the early detection of oral lesions and increased access to dental care in remote areas and was time‐ and cost‐saving. Conclusion: Teledentistry can improve oral health outcomes and access to dental care. Future research on its impact on oral health equity is warranted. [ABSTRACT FROM AUTHOR]

Aims: Rural–urban disparities have been reported in the outcomes of cardiovascular diseases. We assessed whether rural–urban or other geographical disparities exist in the risk of ischemic stroke (IS) and death in patients with atrial fibrillation (AF) in Finland. Methods: The registry-based FinACAF cohort study covers all patients with AF from all levels of care in Finland from 2007 to 2018. Patients were divided into rural–urban categories and into hospital districts (HDs) based on their municipality of residence. Results: We identified 222,051 patients (50.1% female; mean age 72.8 years; mean follow-up 3.9 years) with new-onset AF, of whom 15,567 (7.0%) patients suffered IS and 72,565 (32.7%) died during follow-up. The crude IS rate was similar between rural and urban areas, whereas the mortality rate was lower in urban areas (incidence rate ratios (IRRs) with 95% confidence intervals (CIs) 0.97 (0.93–1.00) and 0.92 (0.91–0.93), respectively). However, after adjustments, urban residence was associated with slightly higher IS and mortality rates (IRRs with 95% CIs 1.05 (1.01–1.08) and 1.06 (1.04–1.07), respectively). The highest crude IS rate was in the East Savo HD and the lowest in Åland, whereas the highest crude mortality rate was in the Länsi-Pohja HD and the lowest in the North Ostrobothnia HD (IRRs with 95% CIs compared to Helsinki and Uusimaa HD for IS 1.46 (1.28–1.67) and 0.79 (0.62–1.01), and mortality 1.24 (1.16–1.32) and 0.97 (0.93–1.00), respectively. Conclusions: Rural–urban differences in prognosis of AF in Finland appear minimal, whereas considerable disparities exist between HDs. [ABSTRACT FROM AUTHOR]

Perceived Partner Responsiveness (PPR) is vital in establishing a sense of well-being within marital relationships. However, the existing corpus of research primarily relies on Western samples, thus limiting its generalizability. Therefore, the current study, focusing on 152 couples from Northeast India, explores the role of PPR in explaining the relationship between marital and life satisfaction through the lens of interpersonal flourishing and psychological needs fulfilment. Simultaneously, employing the Actor-Partner Interdependence Model extended to Mediation (APIMeM), we analyse the mediating role of PPR, uncovering significant actor effects. Our analysis considers covariates such as marital duration, income, number of children, family structure, and positive affect. The mediation results are explained under the framework that PPR is essential for fulfilling psychological needs and allowing for individual thriving. Consequently, the study's findings underscore the importance of prioritising PPR in relationship interventions. Tailored strategies should guide couples in aligning their life and marital satisfaction goals to bolster individual well-being. [ABSTRACT FROM AUTHOR]

Migrant families face challenges to health and well-being from COVID-19. We deployed Mobile Health for Migrant Health (mHealth-4-Mhealth) to migrant families, a household-based program with mHealth-assisted at-home testing and linkages to community resources. We assessed the reach, adoption, and implementation of the program among rural migrant families enrolled in the Title IC Nebraska Migrant Education Program from February 2022 to July 2023. We describe successful adoption and longitudinal use of mHealth screening tools for severe acute respiratory syndrome coronavirus 2 infection risk and social determinants of health. (Am J Public Health. 2024;114(11):1212–1216. https://doi.org/10.2105/AJPH.2024.307746) [ABSTRACT FROM AUTHOR]

This study presents the findings of Let's Be Friends (Shaanxi), Trial 2 (LBF2), which is a second test of the school‐based intervention. Let's Be Friends (LBF) is designed to promote social competence and prevent maladaptive behaviour by strengthening the social information processing (SIP) skills of third‐grade children in rural China. A cluster‐matched design with random sampling was used in LBF2. Two rural counties in China were selected by purposive sampling (one is the treatment site, and another is the control site). Nine treatment schools (n = 343) were selected by random sampling. Fifteen control schools (n = 369) were selected by using vector‐norm matching. All children of the third grade, ages 8–10, in the treatment schools received 12 sessions of LBF2 intervention. Skill‐level Activity Scale and the Carolina Child Checklist–Teacher Form were employed to measure children's SIP skills and aggressive behaviour. LBF2 promoted the improvement of study children's SIP skills and effectively improved children's authority acceptance. LBF has the potential to be applied in China. [ABSTRACT FROM AUTHOR]

Purpose: Job satisfaction in social work has been widely studied, and yet continuity measurement tools utilized to assess job satisfaction among social workers are rare. The purpose of this study was to validate the use of the Social Work Satisfaction Scale (SWSS) with U.S.-based social workers. Moreover, we sought to examine the validity of the scale across rural, suburban, and urban designations. Method: A sample of U.S.-based social workers (N = 1,764) were recruited via social media to participate in an online survey that collected demographic information and assessed job satisfaction using the SWSS. Descriptive statistics were generated. MPlus (8.5) was used to conduct a confirmatory factor analysis of the SWSS. Results: Results indicate the SWSS is an appropriate measure to use with U.S.-based social workers across geographic settings. Discussion: The SWSS can assist social work-employing organizations seeking to better understand the multidimensional nature of job satisfaction. [ABSTRACT FROM AUTHOR]

This study is a quasi-experimental field evaluation of Raise the Bar (RTB), a prevention programme that trains bar staff to intervene when witnessing risk factors for sexual assault. Previous studies have demonstrated effects of similar programmes on attitudes/knowledge among bar staff. Yet, no studies have examined the effects of such programmes on intervention behaviour. Using a waitlist control design, we conducted thirty observations at four trained and four waitlist control bars in a rural U.S. college town, enacting scripts that matched the prompts for intervention that were included in the RTB curriculum implemented at the trained bars. Findings indicated staff at trained bars were significantly more likely to intervene than staff at the waitlisted bars, but this effect attenuated when control variables were included in the model. RTB appears promising, but further research is needed to fully establish its effects on intervention behaviour before recommending wide-spread rollout. Practice Impact Statement: Findings from this study suggest that training bar staff to act as prosocial bystanders has the potential to prevent alcohol-involved sexual assault among college students. Yet, it is important to note that, although staff at trained bars were more likely to intervene than staff at waitlist control bars, intervention was relatively rare and the effect of training attenuated when controlling for contextual factors. Stronger evidence of the effects of such training needs to accumulate before community agencies widely implement these programmes. [ABSTRACT FROM AUTHOR]

Background/Objectives: With population aging, disability and chronic conditions are increasingly prevalent among middle-aged and older adults in China. Using panel data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018, this paper explores the effects of Activities of Daily Living limitations, Instrumental Activities of Daily Living limitations, and chronic conditions on Out-of-Pocket Expenditures (OOPEs) among middle-aged and older adults in China. Methods: A first-difference model and a system-generalized method of moment model (GMM) are used. Results: The system-GMM model for the first time addresses unobserved heterogeneity and produces unbiased estimates of the effects of health and OOPEs. Additionally, this paper assesses the heterogeneity of the results across the demographic and socioeconomic groups. Conclusions: These findings can be used to inform policymakers on improving medical resource allocation and ensure better financial protection for those living with a disability and chronic diseases. [ABSTRACT FROM AUTHOR]

Background: Pregnancy termination (PT) is a major public health concern in low-and middle-income countries like Bangladesh. This cross-sectional study aimed to determine the prevalence and factors of PT using the nationally representative Bangladesh Demographic and Health Survey data 2017–2018. Materials and Methods: A weighted population-based sample of 8759 ever-married reproductive-aged women (15–49 years) was included in the study. The outcome variable was PT in any of the following forms: miscarriage, induced abortion, and stillbirth. A univariate analysis for mean, frequency, and percentage and multiple logistical regression were used to determine the factors associated with PT. Results: Around 18% of the women were found to have PT. The mean age of the women in the study was 25.79 years; 65.1% lived in the rural areas, and the majority of them were Muslims. Advanced age of the women (AOR:3.49, p = 0.004), residence in the countryside (AOR:0.81, p = 0.002), higher education (AOR:0.72, p = 0.027), not being a Muslim (AOR:0.74, p = 0.010), higher socio-economic status (AOR:1.28, p = 0.027), having a job (AOR:1.15, p = 0.041), being married at the age of >22 years (AOR:0.71, p = 0.036), and using a mobile phone (AOR:1.22, p = 0.002) were significant factors of PT. This study did not find any association between PT and contraceptive use. Conclusions: Age, living region, education, religion, wealth index, working status, marital age, and mobile phone use are the determinants of PT. Interventions including these factors need to be made to reduce PT in Bangladeshi women. These findings could be helpful in undertaking further epidemiological studies to understand the actual causes of PT in various rural and urban settings among different socio-demographic groups in Bangladesh. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to examine how an educational intervention, using the lens of the LEADS framework, can influence the development of primary care doctors' leadership skills in Aceh, Indonesia. In order to persevere in the face of inadequate resources and infrastructure, particularly in rural and remote settings of low- and middle‐income countries, physicians require strong leadership skills. However, there is a lack of information on leadership development in these settings. Design/methodology/approach: This study applied an educational intervention consisting of a two-day workshop. The authors evaluated the impact of the workshop on participants' knowledge and skill by combining quantitative pre- and post-intervention questionnaires (based on Levels 1 and 2 of Kirkpatrick's model) with qualitative post-intervention in-depth interviews, using a phenomenological approach and thematic analysis. Findings: The workshop yielded positive results, as evidenced by participants' increased confidence to apply and use the information and skills acquired during the workshop. Critical success factors were as follows: participants were curiosity-driven; the use of multiple learning methodologies that attracted participants; and the use of authentic scenarios as a critical feature of the program. Originality/value: The intervention may offer a preliminary model for improving physician leadership skills in rural and remote settings by incorporating multiple teaching approaches and considering local cultural norms. [ABSTRACT FROM AUTHOR]

Background: About one in five adults in the United States experience any mental illness (AMI), whereas 14.2 million experience serious mental illness (SMI). The perception of stigma among individuals experiencing mental illness is associated with care seeking behavior and treatment adherence. Purpose: Two factors that mitigate stigma are familiarity with someone experiencing AMI/SMI and general level of education. Heretofore, these factors have not been tested together to determine if familiarity moderates the relation between level of education and stigma of professional efficacy for treating mental illness. Methods: In fall 2020, an online survey in the state of Utah measured 1,300 adults' perceptions of stigma for AMI/SMI using a validated instrument. Data were analyzed using logistic regression. Results: Results indicate that familiarity (i.e. self or immediate family member versus other person) moderated level of education for stigma of professional efficacy for treatment of AMI but not SMI. Discussion: Participants viewed the professional efficacy of treating AMI and SMI differently. These findings have implications for educational interventions designed to mitigate public stigma for professional efficacy of treating mental illness. Translation to Health Education Practice: Emphasizes the National Commission for Health Education Credentialing Inc. assessment of needs and capacity, and evaluation and research competencies. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) . [ABSTRACT FROM AUTHOR]

Background: Limited published data exist on the association between parity (number of deliveries) and diabetes mellitus (DM). This study was conducted to evaluate the association between parity and type 2 DM (T2DM) among Sudanese women. Method: A multistage sampling survey was conducted in four villages in the River Nile State, Sudan, between July and September 2022. The World Health Organization's three-level stepwise questionnaire was adopted to collect women's sociodemographic characteristics (age, sex, height, weight, marital status, parity, education level, occupation, detailed obstetric history, and family history of T2DM). Multivariate analyses were performed. Results: A total of 397 women were recruited. Their median (interquartile range) age was 45.0 (33.0‒55.7) years. A total of 154 women (38.8%) were nulliparous, whereas 93 (23.4%), 70 (17.6%), and 80 (20.2%) had para 1‒3, 4 or 5, and more than 5, respectively. A total of 112 (28.2%) women had T2DM. In multivariate analysis, older age (adjusted odds ratio, AOR, 1.04, 95%, confidence interval, CI, 1.02‒1.06), high parity (AOR, 1.1, 95% C, 1.01‒1.20), and a family history of DM (AOR, 3.26, 95% CI, 1.98‒5.38) were associated with T2DM. Compared with the nulliparity, para 1‒3 (AOR, 2.33; 95% CI, 1.17‒4.61), para 4 or 5 (AOR, 2.12; 95% CI, 1.04‒4.30), and para > 5 (AOR, 2.16; 95% CI, 1.09‒4.27) were at higher risk of T2DM. In women aged < 50 years, high parity (AOR, 1.22; 95% CI, 1.06‒1.44) was associated with T2DM. Compared with the nulliparous women, para 4 or 5 (AOR, 3.47; 95% CI, 1.16‒10.34) and para > 5 (AOR, 4.63; 95% CI, 1.54‒13.87) were associated with T2DM, whereas para 1‒3 was not associated with T2DM. In the women aged ≥ 50 years, parity and parity groups were not associated with T2DM. Conclusion: There is a high prevalence of T2DM among Sudanese women. Parity and high parity are significant predictors of T2DM among these women in this part of Sudan. [ABSTRACT FROM AUTHOR]

Introduction: Identifying the associations between rural-living or neighborhood disadvantage and neurobiology may clarify rural–urban disparities in older adults with cognitive impairment related to Alzheimer’s disease. Methods: We examined rural–urban differences and neighborhood disadvantages in brain cortical thickness (CT) measures among 71 rural and 87 urban-dwelling older adults. Analysis of covariance was used to test each FreeSurfer-derived CT measures’ associations with rural–urban living, clinical impairment status, and their interactions. Post-hoc linear regressions were used to test the association between CT measures and neighborhood disadvantage index. Results: Rural-dwelling older adults had thinner cortices in temporal and inferior frontal regions compared to urban participants, especially among clinically normal participants, where the thinner temporal cortex further correlated with higher neighborhood disadvantage. Conversely, rural participants had thicker cortices in superior frontal, parietal and occipital regions. Discussion: Our results suggest a complex interplay between community contexts and neurobiology. For memory-related regions, rural-living and neighborhood disadvantage might be negatively associated with subjects’ brain structures. [ABSTRACT FROM AUTHOR]

Background: Several vaccines were introduced in Tanzania to combat the COVID-19 pandemic. While studies have explored the acceptability and hesitancy of COVID-19 vaccines within the general population, there is limited research focusing on the confidence and associated factors among People Living with HIV (PLHIV). This study aims to fill that gap by investigating vaccine confidence and its determinants in this demographic group. Methods: A cross-sectional study was conducted in centres for care and treatment in four regions of mainland Tanzania using structured questionnaires. A generalized linear mixed model was fitted to determine the factors associated with confidence in the COVID-19 vaccine. Results: A total of 1,100 participants were interviewed; 761 (69.2%) were female. The mean age and standard deviation were 41.6 ±12.1 years. The overall level of confidence in COVID-19 vaccines was 55.3%. Females were less likely to express confidence compared to males (aOR = 0.77; 95% CI: 0.72–0.84). Participants with primary (aOR = 1.79; 95% CI: 1.65–1.94), secondary (aOR = 1.81; 95% CI: 1.57–2.09), and university-level education (aOR = 2.14; 95% CI: 0.17–26.54) were more likely to report confidence in COVID-19 vaccines. Attending a dispensary-level health facility (aOR = 1.32; 95% CI: 1.27–1.38) and living in rural areas (aOR = 1.43; 95% CI: 1.23–1.66) were significantly associated with confidence in COVID-19 vaccines. Conclusion: Although COVID-19 is no longer a global public threat, these findings highlight the significance of being prepared in public health and the necessity of continuous efforts to comprehend and enhance vaccine acceptance and confidence among people living with HIV. By tackling the factors that impact vaccine attitudes in this group, we can improve our preparedness for future public health challenges where vaccine uptake may once again become crucial. [ABSTRACT FROM AUTHOR]

Background: Evidence suggests that family-centered care for sick newborns, where parents are co-caregivers in newborn care units, can result in increased breastfeeding frequency, higher weight gain, earlier discharge, and reduced parental anxiety. This study explored healthcare providers' perceptions and experiences of parental participation in care for sick newborns in the newborn care units in two high-volume maternity units in Uganda, with the aim of informing interventions that promote family-centered care for newborns. Methods: An exploratory qualitative study was conducted between August and December 2023. Sixteen in-depth interviews were held at a regional and general hospital in the rural eastern region of Uganda. The interviews were audio-recorded and then transcribed, followed by a reflexive thematic analysis approach to generate themes. Findings: We identified four key themes: (1) creating order to ensure the safety of newborns in the newborn care unit; (2) parental participation as a tool for overcoming workload in the Newborn care unit; (3) redirecting parental involvement to focus on medically endorsed newborn care practices; and (4) stress management targeting mothers to ensure newborn survival. Conclusion: Healthcare providers encourage parents to participate in caring for their newborns in the newborn care units, mainly to reduce their workload. However, our study highlights the imbalanced nature of parental involvement, where HCPs control the tasks parents can or cannot perform, essentially deploying them as "assistants" rather than equal partners, contrary to the ideals of family-centered care. Transforming the current "healthcare provider-centered" model of caring for sick newborns to one that is family-centered will require training providers on the benefits of family-centered care and developing guidelines for its structured implementation within a resource-limited setting. [ABSTRACT FROM AUTHOR]