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Extensive studies have explored the factors affecting caregiving stress, but how oral health of care recipients (CRs) associates with caregiving stress and the mechanism behind it are not well‐known. Guided by Stress Process Theory, this study addressed such research gaps. Caregiver services dataset came from the 13th National Survey of Older Americans Act Participants in the United States (N = 1289). Caregiving stress included physical, emotional, and financial stress. The oral health of CRs was self‐rated by a single item. The functional ability of CRs was assessed by activities of daily living (ADLs) and instrumental activities of daily living (IADLs). PROCESS 3.4 for SPSS 26.0 was used to conduct the mediation analyses. Results from the study showed that caregivers reported slightly high levels of physical (M = 3.06, SD = 1.33, Range = 1–5), emotional (M = 3.43, SD = 1.28, Range = 1–5), and financial (M = 2.83, SD = 1.43, Range = 1–5) stress. The results from hierarchical linear regression revealed that poor oral health of CRs was significantly associated with higher levels of physical (B = 0.11, p < 0.001), emotional (B = 0.09, p < 0.01), and financial (B = 0.12, p < 0.001) stress, respectively. The functional ability of CRs mediated such relationships between the oral health of CRs and the caregiving stress of their family caregivers. Findings from this study enrich our theoretical and practical understanding of caregiving stress in aged care and offer programs and policy implications of oral and physical healthcare for community‐dwelling older adults. [ABSTRACT FROM AUTHOR]

Many studies have disentangled the perceived benefits of vegetation on subjective well‐being (SWB). Yet, scant attention has been paid to the joint effect of vegetation and building density on SWB. This study explores the relationship between streetscape vegetation (SV), building density and SWB in Beijing, China. Our analysis relies on rich measures of street view data to assess SV exposure at the neighbourhood level. Notably, we distinguish between trees (SV‐tree) and grasses (SV‐grass) when evaluating SV metrics. The results suggest that streetscape trees and grasses are positively associated with SWB, though estimated effects are dependent upon tree and grass density exposures. We also find that the effects of streetscape trees and grass are moderated by building density in the neighbourhood. Additional decomposition analysis provides the insight that the well‐being implications of street vegetation and building density are varied significantly by individual sociodemographic characteristics such as sex, age and income. The findings of this study suggest the importance of considering density in SV planning and land use policies to enhance people's quality of life. [ABSTRACT FROM AUTHOR]

This study investigated the factors associated with clinical symptoms and level of functioning at baseline and after 4 months of navigation, in youth with mental health and/or addiction concerns involved with a family navigation service. Participants in this pre‐post study were caregivers who accessed a mental health and addictions navigation service between March 2018 and July 2019 on behalf of their youth aged 13–26 who had mental health and/or addiction concerns. Evaluations were conducted at baseline and at 4 months after entering navigation. The dependent variable, youth mental health symptoms and functioning, was assessed by caregivers using the Symptoms and Functioning Severity Scale. The sample included 345 caregivers of youth (youth: mean age 18 years, 57% male). At intake, using multiple linear regression, caregiver strain (β = 0.481, p < 0.001), youth completion of ADLs (β = −0.156, p = 0.002) and youth motivation (β = −0.110, p = 0.021) contributed significantly to variance in symptoms and functioning (R2 = 0.373, p < 0.001). Using ANOVA to compare complete pre/post data (n = 115), there was a significant main effect of time on the youth symptoms and functioning score (F[1, 107] = 9.278, p = 0.003). Furthermore, the interaction of time, youth completion of ADLs (low vs. high at baseline) and youth motivation (low vs. high at baseline) was significant (F[1, 107] = 4.699, p = 0.032). Youth with low motivation and low completion of ADLs at baseline experienced the largest improvements in symptoms and functioning after 4 months of navigation. These findings suggest that this group of youth should be a primary target in mental health and addiction navigation. [ABSTRACT FROM AUTHOR]

The present study investigates the effects of group appraisal and acculturation orientations on burnout of social workers working with immigrants. The study is based on the Threat‐Benefit and the Acculturation Theories. The proposed theoretical model was tested in a sample of social workers working with immigrants from the Former Soviet Union (FSU) in Israel (n = 313). Amongst the study participants, 254 were Israeli born, and 59 were immigrants from the FSU. The results demonstrated that social workers' acculturation orientations mediate the connection between the appraisal of the immigrant group and the social workers' burnout when working with immigrants from this group. Specifically, appraisal of immigrants as beneficial for the receiving society was associated with a stronger orientation towards preserving the immigrant culture (β = 0.22). On the other hand, appraisal of immigrants as threatening the receiving society was associated with a weaker orientation towards preserving the immigrant culture (β = −0.21) and with a stronger orientation towards acquiring the majority culture by immigrants (β = 0.12). A stronger acculturation orientation related to preserving the immigrant culture was associated with a lower level of burnout (β = −0.13) and a higher sense of personal accomplishments of social workers working with immigrants (β = 0.20). Immigrant social workers, compared to their native colleagues, reported a higher level of personal accomplishment (M[SD]IM = 5.08[1.24] vs. M[SD]IS = 4.21[1.39]) but also a higher level of burnout working with immigrant clients (M[SD]IM = 1.88[0.83] vs. M[SD]IS = 1.60[0.63]). The main conclusion following the present study relates to the importance of developing a positive appraisal of immigrants and accepting the immigrant culture for successful work with immigrants. [ABSTRACT FROM AUTHOR]

The transition to parenthood represents a moment of change and adaptation in which the dyadic marital relationship becomes a triadic relationship. Facilitating a positive transition requires a thorough understanding of the explanatory model of the relationship between parental–infant bonding, dyadic adjustment and quality of life (QoL) from an integrative perspective of the family unit. The aim of this work was to analyse the relationships between parent–infant bonding, dyadic adjustment and QoL from an intra‐partner perspective, 6–12 months after the birth of a child. A cross‐sectional observational study was performed in a convenience sample of 222 couples 6–12 months postpartum, enrolled from October 2013 to March 2016. The mean age of the mothers was 34.07 years (SD = 3.67), and for the fathers, it was 35.75 years (SD = 4.02). Mothers perceived better QoL and greater mother–infant bonding compared to fathers. The perception of an adequate dyadic adjustment, together with positive parent–infant bonding, had positively influenced the individual QoL of both members of the couple 6–12 months after birth. From an intra‐partner perspective, the positive transition was influenced by the relationship between parent–infant bonding, dyadic adjustment and QoL. Positive parent–infant bonding in mothers and fathers, as well as promotion of the quality of the relationships between couples, can help promote a better QoL. Positive health results can be achieved in terms of individual and family well‐being by designing healthcare interventions that encourage the presence and participation of the family unit. [ABSTRACT FROM AUTHOR]

Accessibility of health services outside metropolitan centres in Australia is sub‐optimal. Recognising the barriers and enablers of healthcare access in rural, remote and regional settings is necessary to improving health service access in these disadvantaged populations. Accordingly, this study aimed to examine the determinants of healthcare use in rural, remote and regional South Australia. Cross‐sectional survey data were collected from adults living outside metropolitan Adelaide in South Australia between April 2017 and March 2018. Using a multi‐modal recruitment campaign, eligible adults were invited to complete the 44‐item consumer utilisation, expectations and experiences of healthcare instrument. Independent predictors of health service utilisation (dependent variable) were determined using negative binomial regression. The questionnaire was completed by 3926 predominantly female (52.5%) adults aged ≥50 years (56.7%), residing in regional South Australia (84.5%). Fifteen independent variables were significantly associated with health service utilisation using univariate analyses. Using negative binomial regression analysis, two predisposing factors (sex, remoteness), three enabling factors (income, health literacy, employment), two need factors (health rating, multimorbidity) and two personal health practices (alcohol, diet) were independently and significantly associated with healthcare use. Female sex (OR = 1.436, p < 0.001), good/excellent health rating (OR = 0.589, p < 0.001) and high multimorbidity (OR = 1.408, p < 0.001) were the strongest predictors of health service use. These findings will help inform the development of targeted health promotion and service engagement strategies for regional populations, which in addition to addressing workforce shortages, may help address inequity in health outcomes, particularly for groups engaging with regional healthcare services infrequently. [ABSTRACT FROM AUTHOR]

Social intervention with children with disabilities and their families should be understood through the principles of family‐centred practice. In Spain, early intervention is understood as interventions aimed at children from 0 to 6 years old and their families. Professionals carry out the reception, assessment and intervention. This study aims to analyse the relationship between mental and physical health, caregivers' levels of anxiety and depression and the child's development during the fostering and assessment phase. The sample is made up of 135 families using child development centres in the Balearic Islands. Four questionnaires were completed: Health‐Related Quality of Life SF‐12, Anxiety and Depression Scale, Child Behaviour Checklist (CBCL 1½–5) and socio‐demographic questionnaire. The results show that parents of children with disabilities have higher levels of mental health impairment than physical health impairment. They also score higher on anxiety than on depression. It is worth noting that professional discipline is a variable to be taken into account in relation to parents' perception of their child's developmental improvement. In addition, the association between the developmental subscales, where the more the child is affected, the more the parents' mental health is affected. The same pattern occurs with caregivers' levels of anxiety and depression. In short, we propose a reflection on the application of family‐centred practices during interventions, understanding the lack of professional training as a predictor of the quality of early intervention. [ABSTRACT FROM AUTHOR]

Females and males frequently report substantial differences in social capital indicators and may use healthcare distinctly. Nevertheless, the potential effect of sex on the relation between social capital and healthcare use remains unclear. This study aims to quantify the association between different indicators of individuals' social capital and healthcare use, according to sex. Data were retrieved from the Sixth Wave of the Survey of Health, Ageing and Retirement in Europe (SHARE), which was conducted in 2015, and included 68,188 participants from 18 countries. Adjusted odds ratios (AOR) and 95% confidence intervals (95%CI) were computed using logistic regression. Overall, males and females with smaller social networks, those who live alone or with any other relatives besides their partners, and those whose first close confidant was a family member or a neighbour reported fewer contacts with medical doctors or nurses, as well as with dentists or dental hygienists. Amongst females, participation in educational or training courses (AOR = 1.67, 95%CI:1.40–2.00; p for interaction = 0.035) and sport, social or any other club (AOR = 1.79, 95%CI:1.58–2.02; p for interaction = 0.043) was associated with a more frequent contact with dentists or dental hygienists. Females who participated in volunteer or charity work (AOR = 0.76, 95%CI:0.64–0.91; p for interaction = 0.042) and political or community‐related organisations (AOR = 0.72, 95%CI:0.52–1.00; p for interaction = 0.030) were less likely to report the use of polypharmacy. This outcome was more frequently observed amongst females who referred feelings of severe loneliness (AOR = 1.44, 95%CI:1.22–1.68; p for interaction < 0.001). Social capital is associated with healthcare use distinctively amongst males and females. Increasing opportunities for social participation may improve healthcare use, particularly amongst females. [ABSTRACT FROM AUTHOR]

This study investigated how physicians, nurses, and social workers in community health care services make judgements about possible child maltreatment in ambiguous situations. We examined the influences of social biases (i.e., perceptions linking ethnicity, gender, and family socioeconomic status to child maltreatment) and belonging to distinctive occupational groups (i.e., physicians, nurses, and social workers) on professionals' assessment of suspected child maltreatment, intention to consult with others, and reporting. We used an experimental survey design including vignettes presenting a child's history inspired by real‐life clinical cases. Data were collected from 397 health care professionals—170 physicians, 179 nurses, and 48 social workers—employed at community health care clinics in northern Israel. Findings show that the child's gender and family socioeconomic status had significant effects on assessment of possible child maltreatment. Also, professionals' occupational group had significant effects on assessment of child maltreatment and intention to pursue consultation. Another key finding was the significant effects of judgements about child maltreatment assessment, consultation, and reporting on one another. The study reinforces efforts to improve health care professionals' management of suspected child maltreatment that include the development of clinical decision support systems that use routinely collected electronic medical record data. [ABSTRACT FROM AUTHOR]

Policy guidance promotes supporting people to live in their own homes for as long as possible with support from homecare services. People living with dementia who need such support can experience a range of physical and cognitive difficulties, which can increase the risks associated with homecare for this group. We aimed to examine risk and safety issues for people with dementia and their homecare workers and risk mitigation practices adopted by homecare workers to address identified risks. We searched MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, ASSIA and Cochrane Central Register of Controlled Trials databases 5 March 2021. Included studies focussed on homecare for people with dementia and had a risk or safety feature reported. Risk of bias was assessed with the Joanna Briggs Institute Critical Appraisal tools. Two authors assessed articles for potential eligibility and quality. A narrative synthesis combines the findings. The search identified 2259 records; 27 articles, relating to 21 studies, met the eligibility criteria. The review identified first‐order risks that homecare workers in the studies sought to address. Two types of risk mitigation actions were reported: harmful interventions and beneficial interventions. Actions adopted to reduce risks produced intended benefits but also unintended consequences, creating second‐order risks to both clients with dementia and homecare workers, placing them at greater risk. Risk mitigation interventions should be person‐centred, the responsibility of all relevant professions, and planned to minimise the creation of unintended risks. [ABSTRACT FROM AUTHOR]

Hepatitis B testing is the gateway for prevention and care. However, previous studies document low hepatitis B testing uptake in sub‐Saharan Africa. This study investigated knowledge, stigma endorsement and knowing someone with hepatitis B as correlates of hepatitis B testing behaviours among people in the Greater Accra and Northern regions of Ghana. A cross‐sectional survey was completed by 971 participants (Greater Accra = 503, and Northern region = 468) between October 2018 and January 2019. Approximately 54% of the participants reported having been tested for hepatitis B. The logistic regression analyses showed that having greater hepatitis B knowledge was positively associated with hepatitis B testing (OR = 1.22, 95% CI: 1.14–1.30). Higher hepatitis B stigma endorsement was negatively related to hepatitis B testing (OR = 0.97, 95% CI: 0.96–0.99). Also, participants who knew someone (i.e. parent, sibling and/or friend) with hepatitis B were more likely to have tested compared to those who did not know someone with hepatitis B (OR = 7.15, 95% CI: 5.04–10.14). This study demonstrates that knowing someone with hepatitis B increases the likelihood of testing, highlighting the need to create safe and non‐judgmental contexts for people with hepatitis B (PWHB) to disclose if they want to. Also, given that greater hepatitis B knowledge increases testing and hepatitis B stigma endorsement impedes testing, interventions that increase knowledge and reduce stigma should be incorporated in efforts to promote testing in Ghana. [ABSTRACT FROM AUTHOR]

Youth in special education have complex needs that are supported across multiple systems. Our research investigates the use of adult income assistance, as one structure that supports youth as they transition to adulthood. We created a cohort of youth (5–22 years old) using linked administrative data from British Columbia government ministries from 1996 to 2018. Youth were grouped by their special education funding (most to least; Level 1, Level 2, Level 3, Unfunded, and no special education). We investigated (1) youth characteristics and service use patterns, (2) which youth used income supports after the child‐to‐adult transition (19–22 years old), and what youth characteristics and service use patterns were associated with use, and (3) how much income support they used (CAD$). Of 174,527 youth, 254 (0.1%) were Level 1, 6020 (3.4%) were Level 2, 4409 (2.5%) were Level 3, 21,232 (12.2%) were Unfunded, and 142,612 (81.7%) were not in special education. Youth assigned higher funding levels, compared to lower levels, generally had increased service use, and in the transition to adult services were more likely to use income supports, and received more income support. An important exception was youth with serious behavioural/mental health special education funding (Level 3), who had increased service use for their level of funding, but received less income support due to a reliance on Temporary versus Disability Assistance. Youth that received an accredited diploma were less likely to use income supports. Factors related to the use of income supports are further described. This study highlights differences in access to income support when youth transition to adult services and considerations around equitable access to support. [ABSTRACT FROM AUTHOR]

We aimed to assess the association between change in social participation and long‐term improved cognitive function among older adults. Data were obtained from 9648 participants aged ≥60 years in the 2011, 2014 and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey, a national prospective cohort study. Cox regression models were used to calculate adjusted risk ratios (aRRs). Social participation was increased in 20.5% of the participants, decreased in 37.8% of the participants and stable in 41.7% of the participants from the 2011 wave to the 2014–2018 waves. The improved cognitive function rate was 17.9% at follow‐up. Compared to individuals with decreased social participation from the 2011 wave to the 2014–2018 waves, individuals with unchanged total social participation were 59% (aRR = 1.59, 95% CI: 1.35–1.87) more likely to have improved cognitive function in the 2014–2018 waves, and individuals with increased social participation were 61% (aRR = 1.61, 95% CI: 1.43–1.82) more likely to have improved cognitive function, regardless of the baseline social participation status. As for the three forms of social participation, compared with the participants with decreased social participation, those with increased participation in organised social activities, increased participation in group leisure‐time activities, unchanged informal social interactions and increased informal social interactions were 24% (aRR = 1.24, 95% CI: 1.02–1.51), 49% (aRR = 1.49, 95% CI: 1.21–1.84), 55% (aRR = 1.55, 95% CI: 1.37–1.76) and 57% (aRR = 1.57, 95% CI: 1.34–1.84) more likely to have improved cognitive function (all p < 0.05) respectively. The results were stable in the sensitivity analysis. Our findings highlight the importance of promoting social participation from a multidimensional perspective (duration, frequency and forms) to improve cognitive function among older adults, for policy makers and healthcare workers in the community. [ABSTRACT FROM AUTHOR]

The Child Dental Benefits Schedule (CDBS) is an ongoing scheme administered through the Australian Government providing eligible children funding for clinical dental treatment. This study aimed to investigate the access of dental services across children's early childhood and examine whether the CDBS has improved access to dental care. The longitudinal study of Australian children is an ongoing cross‐sequential cohort study with a representative sample of Australian children recruited in 2004. Birth (0–1 year) and kindergarten (4–5 years) cohorts were recruited through Medicare enrolment information at baseline and were representative of the Australian child population. Population‐weighted longitudinal mixed effects Poisson models with individual identifiers as a random effect were used to assess the effect of Medicare dental schedules on reported dental attendance. Prior to the implementation of the CDBS for both cohorts, the birth cohort reported the lowest attendance rate at age 4–5. The introduction of the CDBS increased the rate of dental attendance for the low household income group by 8% (95% CI: 1%, 15%) after adjusting for confounders. The model provides evidence that dental attendance increased with age and the Indigenous population have 31% (95% CI: 4%, 55%) lower attendance rate after adjustment. The increase in reported access to dental services and favourable visiting patterns in low‐income households during the operation of the CDBS provides some evidence that the schedule's primary aims to improve access to care in the child population are being met. Access to healthcare is multifaceted and the underutilisation of the schedule in the population warrants review of the schedule performance using other patient‐centred indicators. [ABSTRACT FROM AUTHOR]

This study examines if parental neglect is significantly associated with adolescent cyberbullying perpetration, and whether this relationship is mediated by smartphone addiction. In addition, the moderation of self‐regulation in the direct and indirect effects of parental neglect on cyberbullying perpetration among adolescents is determined. A random sample of 728 Chinese adolescents from Grade 10 to 12 in senior high schools respond to anonymous questionnaires regarding parental neglect, smartphone addiction, self‐regulation and cyberbullying perpetration. The data are then analysed using macro PROCESS. Results reveal that adolescents who are neglected by parents are more likely to engage in cyberbullying perpetration. Smartphone addiction significantly partially mediates the above relationship. Moreover, self‐regulation not only moderates the relationship of cyberbullying perpetration with parental neglect but also its association with smartphone addiction among adolescents. This study contributes to a better understanding of how parental neglect increases the risk of adolescent cyberbullying perpetration, which may be reduced through tailored interventions. [ABSTRACT FROM AUTHOR]

In Ontario, new home care clients are screened with the interRAI Contact Assessment and only those expected to require longer‐term services receive the comprehensive RAI‐Home Care assessment. Although Ontario adopted this two‐step approach in 2010, it is unknown whether the assessment guidelines were implemented as intended. To evaluate implementation fidelity, the purpose of this study is to compare expected to actual client profiles and care co‐ordinator practice patterns. We linked interRAI CA and RAI‐HC assessments and home care referrals and services data for a retrospective cohort of adult home care clients admitted in FY 2016/17. All assessments were done by trained health professionals as part of routine practice. Descriptive analyses were used to evaluate congruency between recommended and actual practice. Adjusted cause‐specific hazards and logistic approaches were used to examine time to RAI‐HC assessment and being a high‐priority client. Of 225,989 unique home care clients admitted to the publicly funded home care program, about three‐quarters of clients were assessed with the interRAI CA only (27.9% completed the Preliminary Screener only and 46.6% completed both the Preliminary Screener and Clinical Evaluation). There was substantial agreement between the skip logic and completion of the Clinical Evaluation section (Cohen's kappa = 0.67 [95% CI: 0.66–0.67]). One‐quarter of clients were assessed with both the interRAI CA and RAI‐HC. As expected, RAI‐HC assessed clients were older, reported more health needs, and often received home care services for >6 months. Clients in higher Assessment Urgency Algorithm (AUA) levels were significantly more likely to receive a RAI‐HC assessment and be assigned to a higher home care priority level; however, 28.3% of clients in the highest AUA level did not receive a RAI‐HC assessment. We conclude that the use of the interRAI CA and RAI‐HC balances the investment of time and resources with the information and tools to deliver high‐quality, holistic, and client‐centred care. The interRAI CA guides the care co‐ordinator to screen every client for a broad range of possible needs and tailor further assessment to each client's unique needs. We recommend integrating the AUA into provincial assessment guidelines as well as developing a new quality indicator focused on measuring access to the home care system. [ABSTRACT FROM AUTHOR]

Care‐giving burden and internalised stigma are prevalent among family caregivers of people diagnosed with schizophrenia. Internalised stigma has been regarded as a source of care‐giving burden. But it remains unclear if high levels of internalised stigma directly contribute to an increased risk of care‐giving burden or if the effects could be buffered by psychological factors. This cross‐sectional study was to investigate the relationship between internalised stigma and care‐giving burden, and to determine the mediating effects of coping styles and social support. Data were collected from 344 Chinese family caregivers of adults diagnosed with schizophrenia in a psychiatric outpatient department of a tertiary hospital in Changsha, Hunan between April and August 2018. A self‐reported questionnaire was used to collect data anonymously. Instruments included the Simplified Coping Style Questionnaire, the Multidimensional Scale of Perceived Social Support, the Internalized Stigma of Mental Illness Scale and the Caregiver Burden Inventory. Data analysis was conducted using descriptive statistics, the Spearman correlation and regression analysis to estimate direct and indirect effects using bootstrap analysis. Results showed that internalised stigma, social support and passive coping were significant correlates of care‐giving burden; social support partially mediated the relationship between internalised stigma and care‐giving burden; active coping did not show impacts on internalised stigma and care‐giving burden. This study provided social workers and healthcare providers with a better understanding of the development of care‐giving burden. Comprehensive interventions should be designed to provide supportive resources and reduce the possibilities of internalisation of stigma and passive coping, to alleviate care‐giving burden. [ABSTRACT FROM AUTHOR]

There is increasing appreciation that group memberships can have both beneficial and damaging impacts on health. In collaboration with Nepal Leprosy Trust (NLT), this longitudinal study explores a group‐based approach to stigma reduction among people affected by leprosy in rural Nepal (N = 71)—a hard to reach and underrepresented non‐WEIRD population. Informed by the 'social cure' literature, and the progressive model of self‐stigma, we use a longitudinal design. We found that a sense of belonging to a self‐help group can facilitate education in terms of health literacy, and over time these two factors also have impacts on participants stigma. Specifically, self‐help group belonging predicted improvements in health literacy, leading to reduced endorsement of negative stereotypes and thus less stigma‐related harm among people affected by leprosy. The study offers promising evidence that group‐based interventions, which support health education, can reduce the harmful impact of stigma in very challenging contexts. [ABSTRACT FROM AUTHOR]

Nordic walking (NW) may be a beneficial treatment for people with Parkinson's disease (PD). Since high‐quality research has been published on the effects of NW on people with PD by now, an actualised and comprehensive, in‐depth review is recommended to guide practitioners in prescribing this exercise modality. The purpose of this study was to conduct a systematic review and meta‐analysis on the effectiveness of NW as a rehabilitation strategy for PD. According to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, a literature search was performed using Pubmed, SportDiscus and Scopus up to May 2021. Randomised controlled trials (RCTs) addressing the impact of a NW intervention on any outcomes in people with PD were included. The critical appraisal of the RCTs was retrieved from the Physiotherapy Evidence Database (PEDro) or evaluated using the PEDro scale. The Cochrane Collaboration's risk of bias tool was also employed. The review was not registered a priori on any database and a review protocol was not published. Twelve studies were included in the review. The investigations were mostly good‐to‐fair methodological quality, and risk of bias was acceptable. None of the reported statistically significant benefits of NW were clinically meaningful, except for walking ability. Although adherence to NW programs was good, some adverse effects derived from its practice were informed. The practice of Nordic Walking does not lead to clinically significant changes in global motor impairment, functional mobility, balance and physical fitness in patients with PD. This therapy seems to improve walking ability and quality of life, although further research in this latter outcome is needed. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) has recently been recognised as a global public health issue that can cause various kinds of long‐lasting physical, sexual and psychological health problems. Limited studies are available concerning the relationship between objective and subjective socioeconomic status (SES) and IPV, and the impact of experiencing IPV on health consequences. This is a cross‐sectional study aiming to examine the association between objective and subjective SES as risk factors of IPV, and further investigate how they affect health status in adults who experienced IPV. A total of 400 participants were recruited from June to September 2016 among 18 districts in Hong Kong. Results from multiple linear regression showed that having a higher education (adjusted B [aB] = 0.22, 95% CI = 0.01, 0.45), having lower levels of subjective SES (aB = −0.08, 95% CI = −0.15, −0.01), experiencing childhood stress (aB = 0.58, 95% CI = 0.27, 0.89) and being married (aB = 0.60, 95% CI = 0.01, 1.19) were significantly associated with IPV. While employment and household income were not associated with IPV. Participants with higher levels of subjective SES were more likely to report somatic symptom (aB = −0.44, 95% CI = −0.87, −0.02), anxiety (aB = −0.38, 95% CI = −0.72, −0.04) and depressive symptom (aB = −0.52, 95% CI = −0.94, −0.10). Low subjective SES, instead of low objective SES, was found associated with IPV in Chinese adults. A priority for future studies is the confirmation and expansion of subjective SES and its function in clinical measures. Programmes instilling hope and optimism will be helpful to enhance subjective SES and boost physical and mental well‐being in IPV survivors. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study is to investigate the influence of perceived discrimination on children's depression and behavioral problems via the mediator of integration among Chinese migrant children. Rural‐urban differences in the proposed relationships are also examined. Methods: The sample included 484 migrant children (Mean age = 11.65 years; 52.9% girls), which was collected through multi‐stage cluster random sampling in Kunming, Southwest China. Structural equation modelling (SEM) was adopted for data analysis. Results: Results indicate that perceived discrimination reduces the integration of Chinese migrant children, which in turn, leads to their higher levels of depression and more behavioral problems. The multi‐group analysis on rural‐urban differences reveals that the effects of discrimination on depression and behavioral problems are significant among rural‐urban migrants but not among urban–urban ones. Conclusions: This study contributes to current knowledge by revealing the mechanisms among perceived discrimination, integration, depression and behavioral problems of Chinese migrant children. The migration pattern differences in terms of their depression and behavioral problems are also highlighted. [ABSTRACT FROM AUTHOR]

Family caregivers provide long‐term, home‐based, informal medical care to patients with special healthcare needs. We examined whether informal care involving medical device use is associated with caregiver burden, considering potential risk variables as moderators. Data were collected from March to May 2019 through a Japanese public visiting care system. This system is offered to patients with severe chronic or intractable disease or impairment. After contacting government‐certified offices that provide visiting care systems, the offices that agreed to participate invited dyads of patients and caregivers to complete our questionnaire. To focus on new parameters other than the caregiver factor that had been clarified previously, we aimed to analyse the data from patient–caregiver dyads. Using a questionnaire‐based cross‐sectional design, we asked participants about caregiver and patient characteristics, care types, and caregiver burden using the Zarit Caregiver Burden Interview. Logistic regression analyses were conducted to test the association between caregiver burden and informal medical care. Data from 371 complete patient–caregiver dyads were analysed; 49.3% showed high caregiver burden, and 40.4% were administering at least one informal medical care procedure. Univariate analyses indicated a relationship between high caregiver burden among caregivers who slept less, provided care for longer periods daily, performed medical care procedures and cohabited with patients. Importantly, logistic regression analyses indicated a significant relationship between high caregiver burden and care involving multiple medical procedures (i.e. 4–6 procedures with medical devices; adjusted odds ratio (AOR) = 2.03, 95% confidence intervals (95% CI) = [1.01, 4.09]). In propensity‐matched participants (n = 314), results continued to show that multiple medical care procedures were significantly related to high caregiver burden (AOR = 2.19, 95% CI [1.14–4.22]). The effects of non‐medical informal care on caregiver burden were moderate. This result suggests that more intensive interventions are required for patients with multiple medical care needs to reduce caregiver burden. [ABSTRACT FROM AUTHOR]

As the COVID‐19 pandemic persists in the U.S. and elsewhere, there is a growing need to understand the impacts of the pandemic on essential and frontline workers. Given the dearth of research on the experiences of homelessness services workers during the COVID‐19 pandemic, this study aimed to understand the impact of COVID‐related stressors in the workplace on the wellbeing of the homelessness services workers in the state of Texas (U.S.). Using a cross‐sectional survey design, the analysis focusses on examining the relationship between COVID stressors with mental health symptoms and job stress indictors. Data were collected from a sample of 132 frontline homelessness services workers across the state during April, May and June of 2021. Primary outcomes of interest were measured with the Depression, Anxiety and Stress Scale (DASS‐42) and the Professional Quality of Life Scale (ProQOL). Multiple linear regression models were specified to explore associations between the outcomes of interest and predictor variables (i.e. demographics, work experiences and COVID‐19 stressors). Results showed that perceiving a decline in job satisfaction because of the COVID‐19 pandemic was associated with higher stress (β = ++0.18), 95% CI [.13, 6.68], higher burnout (β = 0.32), 95% CI [2.54, 7.30] and lower compassion satisfaction (β = 0.42), 95% CI [−8.14, −3.69]. Additionally, being worried about contracting COVID‐19 at work was associated with an increase in burnout (β = 0.19), 95% CI [.40, 4.79]. Also notable is that older age and Black/African American race were associated with lower stress, lower burnout and higher compassion satisfaction. Implications for supporting the homelessness sector through high‐quality supervision, useful training, adequate benefits and routine check‐ins are discussed. [ABSTRACT FROM AUTHOR]

Cardiac patients show alarming levels of nonadherence to medications. It is important to consider also patient activation levels. Furthermore, the partner could have a supporting role in these processes. The aim of this study was to investigate the mediating role of patient health self‐efficacy (HSE) in the link between dyadic coping (DC) and two self‐management outcomes (i.e. medication adherence and patient activation) across the first 6 months of cardiac disease. One hundred couples completed two self‐report questionnaires during the hospitalisation for cardiac disease and 6 months after discharge. A longitudinal and dyadic research design was adopted. Cross‐sectional analyses at T0 revealed that patient‐provided and perceived positive DC and common DC are positively associated with HSE, which in turn is positively associated with medication adherence. HSE mediated the association between patient positive and common DC styles, with the only exception of Patient‐provided positive DC, and patient activation. Conversely, patient‐provided and perceived negative DC are negatively associated with HSE, which in turns is positively associated with medication adherence and patient activation. Prospective analyses showed that only patient‐perceived negative DC at discharge is negatively associated with HSE at T1, which in turns is positively associated with patient activation over time. These results suggest to consider patient perceived and provided DC as antecedents of self‐management outcomes via patient HSE. Furthermore, our results recommend to pay particular attention to negative DC, whose negative consequences are manifested also over time, planning interventions targeting partners' awareness of their own DC style. [ABSTRACT FROM AUTHOR]

We examined the effect of person‐related factors on capacity to obtain needed healthcare for non‐COVID‐19 health conditions/disabilities under COVID‐19 restrictions. This was an anonymous online survey of Australian residents ≥18 years (3rd April to 2nd May 2020). We determined the ability to obtain care needed for non‐COVID‐19 health conditions/disabilities, experience of COVID‐19, COVID‐19 restrictions and sociodemographic characteristics using study‐specific questions; and clinically significant depressive and anxiety symptoms using Patient Health Questionnaire 9 and Generalised Anxiety Disorder Scale 7 respectively. We calculated the population attributable fraction (PAF) to determine the proportion of worse access to non‐COVID‐19 health/disability care attributable to independent risk factors. 13,829 (91.5%) participants had complete data. 6,712 (46.4%) identified a need for healthcare/disability services (<45 years 42.1%, ≥45 years 50.3%). 31.6% aged <45 years and 24.3% aged ≥45 years reported worse access to health/disability care than experienced prior to the pandemic. In those aged <45 years the PAF was highest for depressive symptoms (21.4%; 95% CI 12.6%–29.3%) and anxiety (PAF 19.9%, 12.3%–26.9%). with a PAF of 49.6% (40.1%–57.6%) if any one of the following was being experienced: doing unpaid work; being a student; depressive symptoms; symptoms of anxiety; experiencing high adverse impact of COVID‐19 restrictions. In those ≥45 years, PAF was highest for having depressive symptoms (PAF 20.9%, 16.6–24.8) with a PAF of 44.1% (36.0%–51.2%) if any one of the following was being experienced: depressive symptoms; symptoms of anxiety; doing unpaid work; living alone; being in lowest socioeconomic quintile; main source of income from government benefits; any personal experience of COVID‐19. The identified risk factors, which include many that characterise those with worse health outcomes generally, explained 44%–50% of worse access to necessary health/disability care. These data have the potential to inform targeted strategies aimed at reducing a post‐pandemic escalation of poor health outcomes, especially in vulnerable populations. [ABSTRACT FROM AUTHOR]

Home clutter can adversely affect work performance, health and well‐being. Clinical‐level hoarding disorders usually manifest during early adolescence, so early detection and prevention of subclinical hoarding tendencies are essential. This study aimed to evaluate a community‐based programme for individuals with poor organising and decluttering skills who volunteered to receive education on how to organise their homes. We conducted an open‐label randomised controlled trial beginning in January 2016 in Tokyo. We enrolled 61 volunteers aged 12–55 years with problems with organising and decluttering. A workshop and home visit group (n = 30) attended four workshop sessions on organising skills and received a visit from a home organiser. The home visit only group (n = 31) only received the home organiser visit. The primary outcome was Saving Inventory‐Revised (SI‐R; Japanese version) scores. The secondary outcomes were Clutter Image Rating Scale and Rosenberg Self‐Esteem Scale (Japanese version) scores. Between‐group changes from baseline to 7 months were analysed using a general linear model. At follow‐up, the SI‐R scores of both groups had improved. The mean change from baseline in SI‐R scores was −20.8 (standard deviation = 9.8) and −13.1 (standard deviation = 14.3) in the workshop and home visit and home visit only groups, respectively. The estimated between‐group difference in SI‐R score changes from baseline (adjusted for baseline SI‐R score) was non‐significant at −5.7 (95% confidence interval, −12.4 to 0.9; p =.089). However, the difference was significant in the univariate model: −7.2 (95% confidence interval, −13.7 to −0.8; p =.029). Although both groups improved, after adjusting for baseline values and participant characteristics, there was no significant difference between the groups. Our results suggest that a workshop‐style educational intervention and assistance and advice from professional organisers may help to improve the living conditions of people with hoarding tendencies. [ABSTRACT FROM AUTHOR]

International students in the US occupy a precarious position at the intersection of immigration policy and global education mobility, one made more challenging by the disparate impact of COVID‐19 on college students' mental health. Few studies, however, have explored the pandemic's effects on mental well‐being among the international student population in the US. Our study aims to provide initial empirical evidence on the mental health status of these students, with a specific focus on discrimination, loneliness, anxiety, and depression. We propose a mediation framework and estimate the mediating effects of loneliness and anxiety in the relationships between discrimination and depression in a sample of US‐based international students (N = 103). We collected cross‐sectional data from July to August 2020, using a 50‐item online survey instrument with three open‐ended questions. Mediation analyses using PROCESS Macro were used to analyse quantitative data and thematic analysis was used to analyse qualitative data. Findings showed that higher levels of discrimination were significantly associated with higher levels of loneliness. Higher levels of loneliness were significantly associated with higher levels of anxiety, which in turn led to high levels of depressive symptoms. Our study contributes to understanding the needs and capacities of international students in the wake of COVID‐19 and simultaneously provides pragmatic program and policy implications for inclusive higher education environments and the overall health and well‐being of this crucial US student population. [ABSTRACT FROM AUTHOR]

Postpartum depression (PPD), a perinatal mood and anxiety disorder (PMAD), is a leading cause of complications of pregnancy and childbirth. In the United States, approximately 20 percent of women suffer from PMADs. In Houston, Texas, an estimation of 12,000 – 15,000 women experience PPD each year. Within the Texas Children's Paediatrics network, a large paediatric network located in Houston, Texas, mothers are screened during paediatric well‐child visits and those screening positive receive a referral to a psychiatrist with the network. However, there are not enough psychiatrists to meet the demand of services and Black, Latina, and women on Medicaid during pregnancy are less likely to attend a psychiatric visit compared to White, non‐Hispanic women. This study used a randomised control trial design to measure the effectiveness of an alternative treatment option for a racially diverse population of postpartum women with mild to moderate symptoms of PPD, a five‐session home visitation program using the Problem‐Solving Tools for PPD (PST4PPD) model delivered by master's level social workers. The control group was allocated to standard treatment with a psychiatrist. A total of 118 women gave consent and were randomised, 72 to home visiting and 46 to psychiatry. Results demonstrated that all participating mothers had significant decreases in PPD symptoms. The change in PPD symptoms among those in the home visitation program was not significantly different from the change in the control condition, indicating that the home visitation program was as effective as psychiatric treatment in significantly reducing PPD symptoms. Additionally, a high proportion of women in the home visitation program completed visits and demonstrated increased maternal self‐efficacy. Based on these results, a short‐term home visitation program by a social worker (PST4PPD) appears to be a promising treatment option for postpartum women with mild to moderate PPD symptoms. [ABSTRACT FROM AUTHOR]

Service‐users' inclusion (SUI) in decision‐making regarding services provided by public social services has numerous benefits for both users and providers. However, studies show a gap between the evolution of inclusive discourse and policy, and the implementation of SUI in social services' daily practice. Focusing on the organisational context, the present study is the first to empirically test the relationship between social workers' perception of the services' participative organisational culture (POC), their actual participation in organisational decision‐making (SWAP) and their inclusive praxes with service‐users (SUI). Data were collected between January and March of 2019 via an online survey of 317 Israeli social workers from 173 public departments of social services. Findings show that social workers who find the organisational culture at their workplace to be more participative, do in fact take a significantly greater part in decision‐making at the organisational level, and include service‐users more in decision‐making throughout the intervention. Furthermore, SWAP mediates the connection between services' POC and SUI. Findings suggest that establishing a POC is not enough to increase users' inclusion, as social workers' active participation in decision‐making is vital for their ability to include their marginalised users. [ABSTRACT FROM AUTHOR]

Non‐transport to a hospital after emergency medical services (EMS) encounters for falls is common. However, incident factors associated with non‐transport have not been well studied, especially beyond older adults. The objectives of this study are to (1) describe trends in fall‐related EMS utilisation among adult patients from 2010 to 2018; (2) describe incident characteristics by age; and (3) identify incident factors associated with non‐transport following a fall. This retrospective observational study includes prehospital clinical records data on falls from a large ambulance service in Minnesota, USA. Multivariable logistic regression was used to assess the independent association between non‐transport and the following factors: sex, age, race, previous fall‐related EMS encounter, incident location and primary impression. Of 62,835 fall‐related encounters studied, 14.7% (9,245) did not result in transport by EMS. Fall calls were less common among younger people and the location and medical conditions primarily treated by an EMS provider during a 9‐1‐1 call differed greatly from those occurring among patients 65 and older. Factors most strongly associated with an increased risk of non‐transport in the multivariable model were a primary impression of 'No apparent illness/injury' (OR = 34.5, 95% CI = 30.7–38.7), falling in a public location (OR = 2.09, CI = 1.96–2.22) and having had a fall‐related EMS encounter during the prior year (OR = 1.15, CI = 1.1–1.2). Falls that occur in public locations, in patients with a previous fall, or result in no clinical detection of apparent illness or injury have a significantly increased odds of non‐transport. Non‐transport fall incidents in the United States require significant agency resources. Knowledge about the incident factors associated with non‐transport calls is informative for development of alternative models for prehospital care delivery and initiatives to better serve patients. [ABSTRACT FROM AUTHOR]

The social connection of mothers is important for the sound development of children and the prevention of child maltreatment. Understanding the attributes of mothers at risk of isolation enables community workers to support vulnerable mothers. This cross‐sectional study aimed to identify the socioeconomic predictors of isolation risk for mothers and was conducted in Japan between December 2018 and February 2019. The self‐administered questionnaire included the Social Connectivity of Mother Scale along with maternal age, marital status, employment status, education, number of children, years of child‐rearing experience, whether childcare or kindergarten was used, family structure, years of residence, housing type, family finances, and level of neighbourhood interactions. There were 510 valid responses (51.6%). In the multiple regression analysis, five socioeconomic characteristics were associated with mothers' low social connectivity: the standardised coefficient of the maternal age of 20–24 was −0.12 (p = 0.004), lack of childcare or kindergarten usage, −0.09 (p = 0.032), and poor family finances, −0.09 (p = 0.031); mothers' perception of neighbourhood interactions was found to be poor at −0.29 (p < 0.001). The model did not take into account the effects of family finances, and the scores were low when the highest level of education of the mother was junior high or high school. Mothers' perception of neighbourhood interactions was a significant predictor of isolation risk, along with maternal age, education level, and financial comfort. Our findings give policymakers, community workers, and community leaders an insight into the importance of cultivating interactions among neighbourhood communities. [ABSTRACT FROM AUTHOR]

Gait aid provision is a standard approach to improve mobility and balance for older people. This research aims to understand and compare community care staff practice (health vs. non‐health professionals) for gait aid use by people with and without dementia. A cross‐sectional survey was conducted with Australian community care staff between October 2020 and February 2021. Survey items consisted of closed/open‐ended questions to explore staff practice for people with/without dementia, and assessments/procedures health professionals used for people with dementia. Likert‐scale items gauged staff agreement on factors that influenced their decisions regarding gait aid use for people with dementia. Univariate logistic regression analyses were used to examine staff practice for people with/without dementia and their interaction effects, and factors that influenced decision‐making regarding gait aid use for people with dementia. Content analyses were used to collate responses on assessments/procedures used for people with dementia. Health (n = 109) and non‐health professionals (n = 138) completed the survey. Compared with non‐health professionals, health professionals were more likely to (1) refer the person without dementia [odds ratio, 95% CI: 23.9 (12.1, 47.3), p <.01] and person with dementia [27.8 (12.5, 61.7), p <.01] to a physiotherapist for gait aid assessment, (2) agree with gait aid use if the person with dementia: (a) lives with someone who can monitor gait aid safety [coefficient, 95% CI: −0.75 (−1.29, −0.21), p =.01], (b) performs well on a cognitive functional screen [−0.68 (−1.20, −0.16), p =.01] and (c) gives feedback about gait aid use [−0.64 (−1.15, −0.12), p =.02]. No interaction effects existed between health/non‐health professionals and whether the person had dementia/no dementia on the practice options examined. Health professionals infrequently reported using single/dual task, simple/complex gait or motor sequence testing to assess people with dementia for gait aid use. Strategies such as developing decision aid tool(s) may guide mobility practice for community care staff. [ABSTRACT FROM AUTHOR]

Deciding if and when might be the 'optimal' time for a person living with dementia to move to a care home is often difficult for the individual, family and practitioners. In this study, we describe the outcome of a factorial survey conducted with 100 dementia care practitioners (a frontline health or social care worker who works with people living with dementia) in England, which investigated factors used in deciding when a person living with dementia moves to a care home. Using findings from qualitative interviews with older people living with dementia, family carers, care home managers and social workers, we identified four factors that appeared to influence the decision to move to a care home: (1) Family carers' ability to support the person with daily activities, (2) amount of support provided by home care workers, (3) level of risk of harm and (4) the person living with dementia's wishes. These factors were then randomised within skeleton vignettes that told the story of a fictitious woman (Jane) living with dementia at home with her husband. Fifty‐four variations of the vignettes were produced and randomly assigned to 100 surveys. A total of 100 volunteer dementia care practitioners (78% female, 54% over 50 years of age) received their own personalised online survey link via email and were asked to read each vignette and decide whether to suggest Jane (a) move to a care home or (b) continue living at home. Results indicated that Jane's wishes principally drove most dementia care practitioners' decision on whether to suggest a move to a care home or stay living at home (odds ratio = 6.5–19.5). Findings will inform a better understanding of the factors that contribute toward a decision to move to a care home and be of relevance to policy, practice, training and support. [ABSTRACT FROM AUTHOR]

Attrition from clinical interventions targeting underserved populations is a substantive challenge to achieving optimal health outcomes. Our nationally recognised enriched medical home intervention (EMHI) utilised community health worker home visitation to improve health outcomes of children by engaging the entire family and removing barriers to care‐seeking. Families were enrolled into the program between 2013 and 2016, and, as part of the evaluation of the program's success, we identified predictors of program completion by conducting a secondary analysis of 304 families participating in the EMHI evaluation research. Program completers finished participation in the EMHI with mutual agreement that the family can independently follow recommended care. Program non‐completers were either lost to follow‐up or dropped out before reaching this milestone. Data were collected using electronic medical records and validated self‐report surveys to assess constructs such as social support, mental health difficulties and neighbourhood characteristics. The EMHI participants were primarily families with infants <24 months old, Medicaid‐insured and Latino. In the multivariable logistic regression model, EMHI program factors as well as community factors independently predicted program continuation and retention. Specifically, families learning about newborn care or with preferred spoken language Spanish were more likely to complete the program. Participants reporting neighbourhood distrust had a greater likelihood of non‐completion than others. Results underscore the importance of cultural competency and community involvement in program design and dissemination. Our findings are applicable to other home‐based interventions with the goal of supporting underserved families in following recommended clinical care. [ABSTRACT FROM AUTHOR]

An area for concern in public health research is the extent to which USA student loans are associated with poor health. This study's objective examines whether falling behind on student loans may compound ill‐health by deterring people from seeking healthcare. The results of this study confirm that borrowers behind or in collections on student loans are forgoing healthcare after self‐reporting general physical ill‐health. This study used the 2019 Survey of Household Economics and Decision‐making (SHED) questionnaire that measures the economic well‐being of USA households. There were 337 participants behind or in collections on student loans. The size effects for forgoing mental healthcare and seeing a specialist were observed. Respondents behind on student loans were more likely to forgo mental healthcare (adjusted odds ratio (AOR) = 1.66, 95% confidence interval [CI] = 1.18, 2.33) and seeing a doctor/specialist (AOR = 1.53, 95% CI = 1.13, 2.07) even when controlling for sociodemographic variables, health insurance, childcare and eldercare payments, and medical debt. The implications for enlarging access to healthcare among people behind on student loans are discussed. [ABSTRACT FROM AUTHOR]

There are potential benefits associated with advance care planning (ACP), and general practitioners (GPs) are well placed to coordinate ACP initiatives with their patients. Few studies have reported on the uptake of different forms of advance care plan conducted by GPs and how this affects patients' place of death. The primary aims of the study were to examine uptake of verbal (conversations regarding care preferences) and written (documented care preferences) advance care plans and their associated factors from the perspective of Australian GPs. The secondary aim was to determine the impact of different types of advance care plans on place of death. Sixty‐one GPs from three Australian states used a validated clinic‐based data collection process to report on care provided for decedents in the last year of life, including provision of services, place of death, and uptake of ACP. We found that 58 (27.9%), 91 (43.7%) and 59 (28.4%) reported decedents had no advance care plans, verbal plans or written plans, respectively. There were increased uptake of both verbal plans (relative risk ratio [RRR] = 13.10, 95% confidence interval [CI]: 2.18–77.34) and written plans (RRR = 10.61, 95% CI: 1.72–65.57) if GPs foresaw the death for >90 days versus <7 days. Palliative care training history for GPs predicted uptake of verbal plans (RRR = 5.83, 95% CI: 1.46–31.93). Patients with verbal plans versus no plans were more likely to die at a private residence (odds ratio = 4.97, 95% CI: 1.32–18.63). Our findings suggest that expectation of death for at least three months prior to the event (where clinically possible) and palliative care training for GPs improve the uptake of ACP in general practice. Larger pragmatic trials are required to determine the impact of ACP on patients' place of death. [ABSTRACT FROM AUTHOR]

The purpose of this study was to estimate the prevalence of unintentional injuries and to identify factors mediating the risk of unintentional injuries among internal migrant children in southern China using self‐reported data collected between April 2016 and March 2017. Logistic regression models were used to identify significant risk factors for unintentional injuries among the internal migrant children. The prevalence of self‐reported unintentional injuries among internal migrant children in this study was 19.15%. Internal migrant children exhibiting antisocial (antisocial behaviour vs. no behaviour problems, OR = 2.162, 95% CI: 1.194–3.915, p =.011) and neurotic behaviours (neurotic behaviour vs. no behaviour problems, OR = 2.064, 95% CI: 1.098–3.880, p =.024) were more likely to report unintentional injuries. There was a positive correlation between the number of risk behaviours and the prevalence of unintentional injuries among non‐migrant and internal migrant children. Children's behavioural problems were closely related to unintentional injuries and may be useful as predictors of unintentional injuries in children. [ABSTRACT FROM AUTHOR]

Income and employment are recognised as social determinants of health. Occupationally related exposures and working conditions impact health behaviours. Taxi drivers have been recognised as an occupationally COVID‐19 at‐risk group. COVID‐19 threatens their lives and livelihoods. This study describes self‐reported income changes attributed to the COVID‐19 pandemic among taxi drivers. Associations between percentage change in income and reported prevention practices were ascertained. In May 2020, a cross‐sectional study was done among 282 taxi drivers in the Kingston and St. Andrew Metropolitan Area in Jamaica. Multi‐stage sampling was used to select taxi driver from seven hubs. Data collection utilised a 28‐item questionnaire. Self‐reported income before and during the COVID‐19 pandemic was ascertained and correlations between relative changes in income and COVID‐19 prevention practices were assessed. The median pre‐COVID‐19 monthly income was USD 1,428.57 (IQR = 1,467.26), about USD 51/day. Median monthly income since the COVID‐19 outbreak was USD 500 (IQR = 472.37), about USD 18/day, representing a 65% reduction in income. There was a statistically significant association between the relative change in income and the practice of wearing mask while transporting passengers. Generally, as the relative change (decline) in income increased, reported compliance with mask wearing decreased (Spearman's rho = −0.15, p = 0.02). Taxi drivers have experienced marked decline in income due to the COVID‐19 pandemic, with implications for health practices and the maintenance of desired health behaviours. Authorities should be cognisant of the economic impact and COVID‐related consequences in the taxi industry, as they seek to develop COVID‐19 occupationally related prevention and control programmes. [ABSTRACT FROM AUTHOR]

Social exclusion is a widely accepted risk factor for child well‐being, but relatively little is known about its dynamics and effect on multiple well‐being domains. This study aims to extend prior research by examining the influencing mechanisms of structural‐economic and socio‐relational exclusion on the physical, psychological, behavioural and educational well‐being of Chinese migrant children. Multi‐stage cluster random sampling is used to recruit a sample of migrant children (N = 484; Mage = 11.65 years; 52.9% girls) in Kunming, China, and structural equation modelling is used for data analysis. Results indicate that a high level of structural‐economic exclusion predicts a high level of socio‐relational exclusion, which, in turn, leads to low levels of physical, psychological, behavioural and educational well‐being among migrant children. This study not only contributes to the understanding of the dynamic effects of social exclusion but also provides practical implications for social policy and interventions to reduce social exclusion and improve the well‐being of Chinese migrant children. [ABSTRACT FROM AUTHOR]

Medical error frequently occurs in ambulatory care, and healthcare professionals may encounter situations in which they need to speak up to ensure better practice. This study aims to investigate the factors that influenced the intention to speak up about medical errors among healthcare professionals in primary care settings. Data were generated through a national cross‐sectional survey of primary healthcare centres in the Republic of Chile. A research instrument was designed using the constructs of the theory of planned behaviour and was analysed using the structural equation model technique. In total, 203 healthcare professionals were recruited between March and May 2020. The model showed that the intention to speak up was directly and positively influenced by attitudes towards speaking up and perceived control (standard deviation [SD] = 0.284 and 0.576, respectively). Subjective norms indirectly and negatively influenced the intention to speak up through attitudes towards speaking up and perceived control (total effect SD = –0.303). The exploratory construct of willingness to change self‐behaviour positively influenced the attitude towards behaviour. The intention to speak up strongly influenced the speaking up behaviour (total effect SD = 0.631). The proposed model explained 40% of the variance in behaviour. Based on this model, it was concluded that the intention to speak up strongly influenced the speaking up behaviour and predicted it by 40%. Factors that modify the intention to speak up are expected to influence the occurrence of this behaviour. This knowledge will inform strategies to enhance communication among healthcare professionals, improve speaking up behaviour and improve patient care. [ABSTRACT FROM AUTHOR]

Motherhood increases women's use of health and social services, presenting opportunities to identify and refer women with substance use disorder (SUD) to treatment. We pooled 4 years (2015–2018) of cross‐sectional data from National Survey on Drug Use and Health on women of child‐bearing age (18–44) in the United States (n = 64,346). (1) We compared the use of services (health, social and criminal justice involvement) by SUD and 'motherhood' (pregnant or has one or more children under 18). We used multivariable logistic regression models to estimate the association between motherhood, SUD and their interaction with the use of services. (2) We estimated the association between the use of different services and SUD treatment use among women with SUD. Among women of child‐bearing age, 9.7% had SUD. Mothers who had SUD were more likely to use social services (AOR = 1.48 [95% CI: 1.22, 1.79]) and mental health services compared with non‐mothers who did not have SUD (AOR = 1.40 [95% CI: 1.19, 1.65]). The following factors were associated with increased odds of receiving SUD treatment among mothers: mental health treatment utilisation (AOR = 1.94 [95% CI: 1.29, 2.93]); Medicaid coverage (AOR = 2.48 [95% CI: 1.64, 3.76]); and criminal justice involvement (AOR = 3.38 [95% CI: 1.97, 5.80]). To increase treatment access, it is important to address women's different stages in life, including how to best engage women in SUD care across different settings. [ABSTRACT FROM AUTHOR]

Immigrants and second‐generation immigrants from Ethiopia in Israel are assumed to be more vulnerable to problematic risk behaviours than host culture population. The aim of this study was to assess risk and protective factors associated with multiproblem behaviours such as committing driving violations, alcohol use, drugs use and violence among Ethiopian young adult immigrants and second‐generation immigrants in Israel. This is a cross‐sectional study, based on a self‐reported anonymous structured questionnaire distributed to 383 Ethiopian emerging adults (mean age 25.3; SD = 3.27, 59.3% female). Multiple Problem Behavior Index (MPBI) was created from their responses to 21 risk behaviour variables including driving violations, alcohol use, Marijuana use and violence. Logistic regression to predict multiproblem behaviours was used. We found that unplanned leisure activity hours during weekends (adjusted odds ratio – AOR = 2.594, p <.01, 95% CI 1.332–5.052), excitement seeking (AOR = 2.122, p<.01, 95% CI 1.257–3.582), depression symptoms (AOR = 2.521, p <.01, 95% CI 1.491–4.261) and gender (AOR = 0.277, p <.001, 95% CI 0.164–0.469) were associated with MPBI. In contrast, racism, perceived discrimination, Israeli and Ethiopian identities were not significantly associated with MPBI after adjusting for gender and family status. These results suggest that in a minority of Ethiopian emerging adult immigrants similar to host culture populations, risk factors such as unplanned leisure activities, excitement seeking and depression symptoms are stronger and significant factors associated with multiproblem behaviours rather than racism, perceived discrimination or Israeli and Ethiopian identities. Resources should be allocated to produce appropriate intervention programs with planned content for leisure time, especially on weekends. [ABSTRACT FROM AUTHOR]

Transgender women sex workers (TGSW), as a highly stigmatised population, are at substantial risk for mental health problems but lack access to mental health care. This study investigated factors of mental health service utilisation (MHSU) behaviour and related behavioural intention among TGSW who were at risk of mental health problems in the past year [subsample 1: scored above the cut‐off for probable depression or probable anxiety or had suicidal ideation (N = 126); subsample 2: perceived needs for mental health services (N = 109)]. A cross‐sectional survey was conducted among TGSW in Shenyang, China during 2017–2018. Data on minority stress, coping, mental health and MHSU were collected. 10.3% of participants in subsample 1 and 14.7% in subsample 2 had sought help from mental health professionals in the last year. Unwillingness to disclose minority identity and gender non‐affirmation were negatively associated with MHSU. Factors for behavioural intention of MHSU included unwillingness to disclose minority identity and social support for both subsamples and adaptive coping for subsample 2. Confidentiality concern, discrimination and cost were the most frequently endorsed barriers to mental health services. Interventions should promote gender affirmation, social support and adaptive coping as well as remove stigma to increase health service access and utilisation among minority populations. [ABSTRACT FROM AUTHOR]

This study identifies the key factors underlying the unmet dental care needs of South Korean homeless adults that obstructed their dental service access. We analysed data from 551 Korea Homeless Survey respondents (17 years and older) who reported having an oral disease in the previous 12 months. We conducted multiple logistic regression analyses to examine the factors associated with homeless individuals' unmet dental care needs, using weights to make the data nationally representative. Approximately 43% of the homeless people reported having unmet dental care needs. Housing type (living in the street) was significantly associated with an increased odds ratio of unmet dental care needs. However, when social protection programs (housing benefits and Medical Aid [MA]) were included in the model, the statistical significance of the housing type disappeared. Homeless MA recipients were less likely to have unmet needs than those not covered by MA. On the other hand, homeless people who received housing benefits were more likely to receive dental care than people who do not receive these benefits. Consequently, policy makers should develop social protection programs influencing homeless individuals' access to dental care and ensure the sustainable implementation of integrated community‐based dental services for homeless adults. [ABSTRACT FROM AUTHOR]

The fast‐developing Internet is changing the way people interact, this new phenomenon helps people build and accumulate online social capital. However, the influence of online social capital on individual health is controversial. Based on the social capital theory, this study examined the effect of online social capital on health in subgroups with different levels of offline social capital. Data from the China Family Panel Studies of 2016 were used (N = 13,910), and the propensity score matching approach was used to address potential endogeneity problems. The results show that offline social capital had significant positive associations with individual health; although online social capital had few effects on individual health overall, significant health effects of online social capital were observed in subgroups with different offline social capital levels. In subgroups with less general trust and neighborhood social capital, more online social capital was associated with less depression; while in subgroups with more neighborhood social capital, more online social capital was associated with an elevated probability of two‐week morbidity. Our findings further clarify the relationship between online/offline social capital and individual health. Online social capital can be considered as a supplement of offline social capital when it comes to health promotion, and more online contact should be encouraged when offline social capital of individuals or within the community is scarce. [ABSTRACT FROM AUTHOR]

While demand for care‐giving is increasing rapidly among older adults in Korea, there are large unmet care needs. In the face of an elder care crisis, older adults feel uncertain about how and by whom they will be cared for. This study examines the relationship between expectations of receiving care in the future and all‐cause mortality among Korean older adults. We explore whether mortality risk differs by sources of care (non‐family vs. family caregivers), and further disaggregate different sources of care by family member type (spouse, sons and daughters). Using data from the Korean Longitudinal Study of Ageing (N = 3,111 participants aged 65 or older), we estimate Cox proportional hazards regression models predicting all‐cause mortality. Expecting to receive care from either non‐family or family members is significantly associated with lower mortality risk. Expecting care from a spouse and/or daughter was associated with lower mortality risk, but expecting care from sons was not. After adjusting for covariates, expecting future care from a spouse and/or daughter predicted lower mortality risk (HR = 0.83; 95% CI = 0.71–0.97 [spouse], HR = 0.79; 95% CI = 0.67–0.94 [daughter]), and the coefficient for expectations of formal care from non‐family members became statistically insignificant. After controlling for family structure, only the association between expecting care from daughters and mortality remained statistically significant (HR = 0.78; 95% CI = 0.66–0.94). These effects are more pronounced among women than men. Initiatives to support and maintain high‐quality family relationships across the life course and remove barriers that obstruct family members from providing care to their elders would improve older adults' longevity. [ABSTRACT FROM AUTHOR]

Direct care workers are a major part of the long‐term services and supports (LTSS) needed to address the health of individuals and accounted for $112 billion in United States spending in 2015. Direct care workers are hired within professional agency models (PAMs) or consumer‐directed models (CDMs) where workers (including family) are contracted by the individual to obtain services. We sought to identify differences in cost and utilisation outcomes between PAM and CDM participants. Data were obtained from the University of Pittsburgh Medical Center (UPMC) Insurance Services Division from the participants enrolled in UPMC Community HealthChoices in Pennsylvania during 2018. A retrospective, observational cohort study design was performed using claims data. Utilisation outcomes were assessed using multivariate logistic regression and cost outcomes by linear regression. The 3,232 participants met the inclusion criteria. Of these, 69% (N = 2,217) were in a PAM, 23% (N = 752) were in a CDM, and 8% (N = 263) used a combination of services. PAM groups were older (mean 62.4 years vs 54.1 years), more likely to be women (69.0% vs 62.8%), and had more healthcare needs. Hospital utilisation was the same among groups. However, total cost was lower in CDM groups due to differences in LTSS costs between CDM and PAM services. Among dually eligible Medicare and Medicaid beneficiaries receiving LTSS, there are significant differences in age, gender, race and health needs. While hospital utilisation was not different between groups, CDM groups had lower total costs of care compared to PAM. These findings have implications for families, policymakers and insurers in helping to govern community LTSS while supporting member autonomy. [ABSTRACT FROM AUTHOR]

We aimed to explore how different social isolation components were associated with depression among older adults in Portugal. We analysed data collected through structured questionnaires in 2017 from 643 Portuguese adults aged 60 and over. Depression was assessed using the Geriatric Depression Scale (Short‐Form). Social isolation was operationalised using objective indicators – living alone, marital status, leisure activities – and subjective indicator – perceived social support. Because social isolation is a multidimensional construct that is likely to be more than the sum of its components, cluster analysis was conducted to group individuals into social isolation profiles. Associations were estimated using adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Five profiles were identified: Cluster 1 (partnered; high social support; high variety of leisure activities); Cluster 2 (partnered; high social support; few leisure activities); Cluster 3 (not partnered; low social support; few leisure activities); Cluster 4 (living alone; high social support; high variety of leisure activities); Cluster 5 (partnered; high social support; limited variety of leisure activities). Compared with Cluster 1, participants in Cluster 2 were three times more likely to have depression, independent of age, gender, education, comorbidities and self‐rated health (OR = 3.04; 95% CI: 1.38–6.71). Participants in Cluster 3 presented the highest probability of depression that was not explained by any of the confounders (OR = 4.74; 95% CI: 2.15–10.44). Older adults living alone are not necessarily more prone to depression, with social support and leisure activities playing an important role. To disentangle how social isolation affects health, objective and subjective isolation measures should be considered. [ABSTRACT FROM AUTHOR]

Impacts of the COVID‐19 pandemic in the United States have been exacerbated by pre‐existing inequities in resources and opportunities, leaving the most vulnerable to face a multitude of hardships. The goal of the current study was to characterise COVID‐19–related stressful life events in specific life domains and to identify the sociodemographic characteristics of individuals who are more likely to experience such events. Participants (n = 372, 57% female) in a follow‐up study of the NICHD Study of Early Child Care and Youth Development completed the Epidemic‐Pandemic Impacts Inventory (June–August 2020) to assess COVID‐19–related stressors. Sociodemographic factors (gender, race/ethnicity, socioeconomic status and wealth) were examined simultaneously as predictors of the number of stressful life events in separate categories of work/finances, home life, social activity, health and healthcare, adjusted for covariates (household size, community COVID‐19 transmission risk). In negative binomial regression analyses, being female (vs. male) predicted a 31%, 64%, 13% and 94% increase in the number of stressful life events in domains of work/finances, home life, social activity and healthcare, respectively, whereas each one standard deviation increase in wealth predicted a 17%, 16% and 21% reduction in the number of stressful life events in domains of work/finances, COVID‐19 infection and healthcare, respectively. Findings highlight the pronounced and far‐reaching impacts of the COVID‐19 pandemic on women as well as the unique role wealth may play in lessening such impacts. This new knowledge may be leveraged to develop intervention and policy‐related strategies to remediate impacts of COVID‐19–related stressors on those most vulnerable. [ABSTRACT FROM AUTHOR]

We investigate the importance of adult children and/or cohabitation with a partner for older hip fracture patients' probability of independent living, public home care use and hospital readmission. Data from 35,066 Swedish hip fracture patients between 2012 and 2017, aged 65 years, and living at home at the time of the fracture in the Swedish Registry for Hip Fracture Patients and Treatment were linked with national registers. We applied adjusted logistic regression models and Cox proportional hazard models. In total, 959 (4.0%) women and 817 (7.3%) men had no adult children, 13,384 (56.0%) women and 3,623 (32.5%) men had no cohabiting partner and 2,780 (11.6%) women and 1,389 (12.5%) men neither had a cohabiting partner nor adult children. In comparison with women and men who had both a cohabiting partner and adult children, those without a cohabiting partner (i.e. only adult children) and those who neither had a cohabiting partner nor adult children had significantly lower probabilities of returning home (at discharge and after 4 months). They also had a greater probability of both receiving home care and having an increase in the amount of home care they receive. Having a close next of kin and hospital readmission were not associated. In conclusion, absence of a close next of kin, specifically a cohabiting partner, reduces the chance of return to independent living and increases the use of home care after a hip fracture hospitalisation. The findings highlight the importance of family support for older adults living situation after a hip fracture. [ABSTRACT FROM AUTHOR]