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Our global communities are becoming increasingly more diverse and interwoven; thus, research that enhances our understanding of the multidimensional relationship between depression and migration among distinct ethnic groups is imperative. This study examined the relationship between migration‐related stress and depression and the extent to which that relationship is modified by other factors, through the lens of the stress process model. This cross‐sectional pilot study used purposive sampling methods to recruit 76 first‐generation Haitian immigrants living in South and West Florida from February 2018‐May 2018. Descriptive statistics, bivariate and multiple regressions were utilized to assess associations among migration‐related stress (Demands of Immigration Scale), depression (Center for Epidemiological Studies Depression (CESD), Zanmi Lasante Depression Symptom Inventory (ZLDSI)), and key demographic variables. Findings showed a strong positive correlation between migration‐related stress and depression (CESD (β =.606, 95% CI [.296,.556]) and ZLDSI (β =.624, 95% CI [.242,.440]). Relative to the standardized coefficient, migration‐related stress was the strongest predictor of depression after controlling for other predictors. Presence at the 2010 earthquake was the only significant moderator, showing an amplifying effect between migration‐related stress and depression (ZLDSI) for those in Haiti during the 2010 earthquake. Consideration of pre‐migration factors and the degree of migration‐related stress encountered while adapting to life post‐migration is critical because they play a significant role in shaping immigrants' depression realities. Community‐based services that incorporate or partner with established immigrants to strengthen support for the most vulnerable immigrants early on after migration could serve to mitigate migration‐related stressors and facilitate mental health promotion and prevention. [ABSTRACT FROM AUTHOR]

With the start of the great economic recession in 2007, homelessness increased fivefold in some regions of southern Europe. Larger numbers of people experiencing homelessness, compounded by a lowered capacity for social and health services to respond to their needs, precipitated an increase in so‐called 'chronic homelessness'. The aim of this study was to establish the presence of chronic homelessness in a defined geographical area of Spain, and to determine the prevalence of diagnosed mental disorders within both the chronic and non‐chronic homeless population. A prospective and descriptive study was designed to monitor a cohort of 826 individuals experiencing homelessness who constituted the entire identified homeless population in the relevant territory in 2006. This sample was followed until 2016 and sociodemographic as well as clinical information was collected, including the time spent homeless. The results obtained indicated that one in 10 participants met the criteria for chronic homelessness, a rate that is lower than in the US, where the definition of chronicity that was applied originates from. Alcohol use disorder was the most common mental health disorder that contributed to the chronicity associated with homelessness. Being born in the country (Spain) where the study was conducted and being older were the main other variables associated with chronicity. People defined as chronically homeless in Spain were on average younger than in the US, but women were present in the chronic subgroup at a similar rate. We also reflect on the limitations of the study and in particular the appropriateness of the concept of chronicity as applied to homelessness. [ABSTRACT FROM AUTHOR]

Older people with dementia more frequently experience episodes of hospital care, transferal to nursing home and adverse events when they are in these environments. This study synthesised the available evidence examining non‐pharmacological interventions to prevent hospital or nursing home admissions for community‐dwelling older people with dementia. Seven health science databases of all dates were searched up to 2 December 2019. Randomised controlled trials and comparative studies investigating non‐pharmacological interventions for older people with dementia who lived in the community were included. Meta‐analyses using a random‐effect model of randomised controlled trials were used to assess the effectiveness of interventions using measures taken as close to 12 months into follow‐up as reported. Outcomes were risk and rate of hospital and nursing home admissions. Risk ratio (RR) or rate ratios (RaR) with 95% confidence interval were used to pool results for hospital and nursing home admission outcomes. Sensitivity analyses were conducted to include pooling of results from non‐randomised trails. Twenty studies were included in the review. Community care coordination reduced rate of nursing home admissions [(2 studies, n = 303 people with dementia and 86 patient–caregiver dyads), pooled RaR = 0.66, 95% CI (0.45, 0.97), I2 = 0%, p =.45]. Single interventions of psychoeducation and multifactorial interventions comprising of treatment and assessment clinics indicated no effect on hospital or nursing home admissions. The preliminary evidence of community care coordination on reducing the rate of nursing home admissions may be considered with caution when planning for community services or care for older people living with dementia. [ABSTRACT FROM AUTHOR]

Due to the ageing population and the rising prevalence of chronic diseases, it is expected that the demand on informal caregivers will increase. Many informal caregivers experience burden, which can have negative consequences for their own health and that of the care recipient. To prevent caregiver burden, it is important to investigate factors associated with this burden. We aimed to identify factors associated with caregiver burden in adult informal caregivers. Among a sample of adult informal caregivers (n = 1,100) of the Dutch region of Zaanstreek‐Waterland, perceived caregiver burden, demographic factors, caregiving situation, health‐related factors and socio‐financial factors were measured as part of the national Health Survey in 2016. Using univariate and multivariate logistic regression analysis, for which a backward selection method was applied, associations with caregiver burden were studied. In the multivariate model, time spent providing informal care was significantly associated with perceived caregiver burden, with an odds ratio (OR) [95% confidence interval] of 7.52 [3.93–14.39] for those spending >16 hr compared to 1–2 hr on informal care. Also providing care to their child(ren) (OR: 2.55 [1.51–4.31]), poor perceived health (OR: 1.80 [1.20–2.68]) and loneliness of the caregiver (OR: 2.05 [1.41–2.99]) were significantly associated with caregiver burden. To possibly prevent and reduce informal caregiver burden, factors associated with such burden should be intervened on. As such, special attention should be paid to caregivers who provide many hours of care or provide care to their child(ren), as well as those who have a poor perceived health themselves and/or experience feelings of loneliness. [ABSTRACT FROM AUTHOR]

HPV vaccination is a milestone in primary prevention. However in Italy, vaccine coverage is still nowhere near the target of 95%. We investigated factors associated with inclination to get vaccinated in university students, as they are likely to have just assumed a central role in their healthcare decision‐making. University students aged 18–25 were asked to fill in a questionnaire. The effect of socio‐demographic and behavioural characteristics on HPV awareness was assessed with a logistic regression adjusting for age, gender, nationality, degree course, relationship, age at first intercourse, number of sexual partners, smoking, sexual orientation, past diagnosis of STDs and knowledge of people who had received HPV vaccine. A second regression adjusting also for information sources, awareness and knowledge investigated factors associated with inclination to receive vaccine. Nine thousand nine hundred and eighty‐eight questionnaires were included (response rate 91.3%); awareness of HPV and vaccine was 83.3% and 69.9% respectively. Awareness (AOR: 3.3; 95% CI: 2.3–4.6) and a good knowledge positively affected acceptability, as well as a previous diagnosis of STDs and knowledge of vaccinated people. Healthcare workers (AOR: 1.6; 95% CI: 1.4–1.9) and family members (AOR: 1.7; 95% CI: 1.4–2.1) were the most influencing information sources, even if knowledge of vaccinated people was by far more persuasive (AOR: 2.7; 95% CI: 2.2–3.3). Only 12% of participants were acquainted with skin to skin HPV transmission, while 75% believed in a full effectiveness of condom; less than 22% associated HPV with cancer (other than cervical cancer). Efforts to increase awareness are likely to be worth considering that: awareness is the main determinant of vaccine acceptance; only 50% of individuals not interested in receiving vaccine were aware of it; males are much less aware (AOR: 0.09; 95% CI: 0.07–0.11). Moreover, this study spotlights some misconceptions around HPV and acknowledges a pivotal role of healthcare workers, family and peer influence. [ABSTRACT FROM AUTHOR]

The prevalence of depressive symptoms in older Chinese adults has increased recently. Intergenerational relationships play an important role in the mental health conditions of older adults, especially in Chinese culture. Therefore, this study aims to unravel the complex connection between intergenerational relationships and depression, and to explore the potential mediating roles of loneliness and nighttime insomnia symptoms within that connection. A cross‐sectional household survey was conducted in China with 2038 participants aged 65 years or above. Variables were measured using the Center for Epidemiologic Studies Short Depression Scale, the Intergenerational Relationship Quality Scale for Aging Chinese Parents (IRQS‐AP), three nighttime insomnia symptoms extracted from the Insomnia Severity Index and the De Jong Gierveld Six‐Item Loneliness Scale. The IRQS‐AP includes four subdimensions: consensual‐normative solidarity, structural‐associational solidarity, affectual closeness and intergenerational conflicts. Path analyses were performed in Mplus to investigate regression coefficients and mediating effects. Results showed that three general intergenerational relationships (consensual‐normative solidarity, affectual closeness and intergenerational conflicts) were significantly correlated with all mental health outcomes, including their symptoms of loneliness, insomnia and depression. A serial mediation model suggested that loneliness mediated the connection between those constructs of intergenerational relationships and depression, with an independent path to insomnia symptoms via loneliness. The proposed mediators fully mediated the effects of affectual closeness on depression. Nighttime insomnia symptoms alone mediated only the relationship between intergenerational conflicts and depression independently from paths involving depression. Removal of sleep item from CES‐D did not affect the results of paths. Our findings highlight the importance of intergenerational relationships for mental health, especially for the mediating effects of loneliness and nighttime insomnia symptoms on the relationship between intergenerational relationships and depression. Effective mental health services for older adults can address their feelings of loneliness and sleep problems, especially for those who have a poor relationship with their adult children. [ABSTRACT FROM AUTHOR]

Low back pain (LBP) remains one of the major public health problems worldwide. However, in low‐income countries, such as those in Africa, the epidemiological data on healthcare utilisation for LBP are lacking due to more pressing problems such as infectious diseases, to which the majority of health resources are channelled. Therefore, this study aimed at investigating the determinants of healthcare utilisation for LBP in the general population of Ethiopia. A population‐based cross‐sectional study was conducted in South‐West Shewa zone of Ethiopia from June to November 2018. The data were collected by interviewing adults with LBP (n = 1812, randomly selected) using a psychometrically tested and validated instrument, analysed using R version 3.5.1. A log‐binomial regression model was used to determine the prevalence ratio with a 95% confidence interval (CI) in identifying factors associated with healthcare utilisation for LBP. Estimates of population parameters were also presented with 95% CIs and p values. For all applications of inferential statistics, a p value of ≤.05 was taken as the significance level. The lifetime prevalence of healthcare utilisation for LBP was 36.1%, 95% CI: 33.9–38.1, while the annual prevalence rate was 30%, 95% CI: 27.9–32.2. Of those with a 1‐year history of healthcare utilisation, while 7.4%, 95% CI: 4.9–10.3 rural and 36.6%, 95% CI: 29.5–44 urban populations utilised healthcare from general hospitals, 1.4%, 95% CI: 0.3–2.7 rural and 6.8%, 95% CI: 3.1–10.8 urban populations utilised healthcare from specialised hospitals. Several sociodemographic factors, modifiable health behaviours/lifestyle habits, pain interrelated factors, and specific factors such as beliefs about the pain, depressive symptoms and insomnia were associated with healthcare utilisation for LBP. The implications of this research are that it may be prudent for the Ethiopian healthcare policy makers to develop the necessary strategies to meet the health needs of both urban and rural populations with LBP. [ABSTRACT FROM AUTHOR]

New mothers may face substantial physical and mental health challenges during the postpartum period and are at a greater risk of intimate partner violence. Healthcare services provide support, however, acknowledging a problem and seeking help for it can be difficult. Research on where postpartum women seek help and how helpful they perceive it is limited. Additionally, little is known of how these help‐seeking behaviours differ between abused and non‐abused postpartum women. The aim of this study was to examine the help‐seeking behaviour and perceived helpfulness of services in abused and non‐abused postpartum women. Secondary analysis was undertaken of data collected during the MOVE (Improving Maternal and Child Health Care for Vulnerable Mothers) cluster randomised controlled trial of a nurse, intimate partner violence screening and supportive care intervention. MOVE was set in eight community‐based nurse teams in Melbourne, Australia. The trial (2010–2013) included a survey of n = 2,621 postpartum Australian women who had given birth within the previous 8 months. Data were analysed using descriptive and interferential statistics. Findings indicate that abused women who had experienced partner violence sought informal family support less frequently (81.3% compared with 92.4%, p <.001) and were more frequent users of hospital emergency departments (p =.03), nurse home visiting programs (p =.02) and some breastfeeding services (p =.001), compared with non‐abused women. They were also more frequent users of psychiatrists (p ≤ 0.001), early parenting centres (both day stay (p =.006) and residential (p =.008), child welfare services (p <.001), and were generally less satisfied with the help received. Postpartum women experiencing partner violence seek help from certain formal services more frequently and are less satisfied with the care received, compared with non‐abused women. Access to potential protective supports from family and friends is limited. Further qualitative research is needed to gain a greater understanding of abused postpartum women's experiences and help‐seeking behaviours. [ABSTRACT FROM AUTHOR]

Although permanent supportive housing (PSH) has been credited with a decline in the number of chronically homeless adults in the United States since 2007, the extent to which PSH can accommodate the needs of a prematurely aging population, including reducing the likelihood of falls, is unclear. The objective of this study is to examine the prevalence and correlates of falls with a sample of 237 tenants (45‐ to 80‐year olds) from two PSH programmes in Los Angeles from 1 January 2017 to 10 August 2017. We also explore the location and severity of fall‐related injury using a subsample of 66 tenants. Standard surveys queried demographics, health status, history of homelessness and falls. Multivariable logistic regression assessed the correlates of falling in the past year. More than half of the sample had fallen and more than 40% had multiple falls in the past year. Functional impairment, frailty and persistent pain were all associated with increased fall risk. For the 66 tenants who provided more detailed fall information, more than 40% fell at home and of those nearly half fell in their bathroom. Fall‐related injuries were common, with more than one‐third of the subsample experiencing serious injury. These findings suggest that fall prevention is needed in PSH but that more research is needed to understand the degree to which individual and environmental risk factors are contributing to falls. [ABSTRACT FROM AUTHOR]

In recent years, many western welfare states have undergone reforms in their social services. These reforms are intended to influence the work of social workers in the public sector, and depend largely upon workers' ability and willingness to implement them. The research presented in this article addresses the reform in Israeli Departments of Social Services through the perspective of the social workers tasked with its implementation. Drawing on recent developments of the Knowledge‐Power‐Politics Triad model, the relationship between aspects of social workers' support for the reform and their perceived and actual involvement in reform policy making, general attitude towards change, and professional inclinations was examined. Our sample consisted of 180 social workers employed in departments currently implementing the reform. The study's results emphasise the vital role employee participation plays in forming support for reforms' goals, and at the same time expose the complex interplay between developing a 'sense' of participation and participation's actual realisation. They offer several insights into the way social workers' support for reform is constructed, and not less so, regarding aspects of examining such support. [ABSTRACT FROM AUTHOR]

A community outreach clinic was established in 2013 in a rural part of Germany to counsel and better integrate patients with mental health disorders or clients with psychosocial problems into the healthcare and complementary social assistance system. In a pilot study, we aimed to evaluate the costs of the integration assistance system after the outreach clinic was opened, the number of visits and the trend in the costs of the social assistance system of the federal state. Anonymised secondary cost data were used to evaluate the costs associated with the integration assistance receivers before (2010–2012) and after the establishment of the outreach clinic (2013–2015). Total costs were descriptively compared between the intervention group (consultation in the outreach clinic), the non‐referral group, and a propensity score‐matched control group for the years 2013–2015. To monitor the counselling activity, we used anonymised data on visits to the outreach clinic between 2013 and 2015. Data from 50 clients in the outreach clinic and 678 non‐referral clients were analysed. The total costs of the integration assistance for the years 2013–2015 amounted to EUR 21,516 (95% CI 14,513–28,518) and EUR 28,464 (25,789–31,140) respectively. Propensity score matching of the controls resulted in equalised total costs for the years 2013 through 2015 for clients (n = 50, EUR 21,516 (14,513–28,518)) and controls (n = 250, EUR 21,725 (18,214–25,234)). The total number of integration assistance receivers in the district was lower than the average for the federal state. The number of consultations at the outpatient clinic steadily increased from 146 in 2013 to 1,090 in 2015. Counselling in the outreach clinic might help reduce the placement of clients into integration assistance, including supported housing, and slow the expected cost trend. However, counselling failed to lower total costs in the integration assistance service, possibly due to the selection of more severe cases. [ABSTRACT FROM AUTHOR]

Scene‐Based Psychodramatic Family Therapy (SB‐PFT) is a multiple‐family intervention for adolescents with behavioural problems implemented by Child Welfare Services in Spain. This intervention is aimed at promoting adolescent well‐being. The aim of this study was to evaluate the effectiveness of SB‐PFT in 17 trials, measuring its impact on the emotional intelligence, parental attachment, peer attachment and antisocial behaviour of 216 adolescents (109 participating in the intervention and 107 in the control group). Repeated measures ANOVAs for pretest/posttest differences and long‐term growth models were estimated. In the short term, the intervention had a positive impact on emotional intelligence and had a stabilising effect on parental attachment, whereas the long‐term results showed significant logarithmic growth in emotional intelligence and exponential growth in parental attachment and a decrease in antisocial behaviour. However, no changes in peer attachment were shown. This study demonstrates SB‐PFT to be a potentially effective intervention for adolescents with behavioural problems and emphasises the importance of fostering emotional intelligence. [ABSTRACT FROM AUTHOR]

Informal caregivers play a crucial role in supporting persons with multiple sclerosis (MS), a neurodegenerative disease resulting in progressive worsening of physical and cognitive functioning. While research extensively showed that caregiving workload can be perceived as burdensome, little attention was devoted to the relation connecting workload and caregivers' well‐being. Building on previous literature on stress and coping, the aim of this study was to test the mediational role of coping between caregivers' tasks and well‐being. A group of 680 caregivers of persons with MS (M age = 46.45; 51.2% women) was recruited in eight Italian MS centres between June 2015 and December 2016. Caregiving tasks related to basic activities of daily living (ADL), instrumental ADL, psycho‐emotional and social‐practical care were assessed through the Caregiving Tasks in MS Scale; coping strategies (avoidance, criticism and coercion, practical assistance, supportive engagement, positive reframing) were investigated through the Coping with MS Caregiving Inventory; well‐being was evaluated through the Psychological Well‐Being Scales. Analyses substantiated a multi‐mediation model including tasks in basic ADL, psycho‐emotional and social‐practical care, and the coping strategies avoidance, criticism/coercion, supportive engagement, positive reframing. Basic ADL care was negatively related to psychological well‐being through lower use of supportive engagement and positive reframing. By contrast, psycho‐emotional and social‐practical tasks were both negatively and positively related to psychological well‐being, through higher use of avoidance and criticism/coercion as well as supportive engagement and positive reframing. Findings suggest that caregiving tasks are not solely detrimental to well‐being, but they may also provide a positive contribution through the adaptive coping strategies supportive engagement and positive reframing. Findings also highlighted task‐specific areas that could be targeted in intervention in order to effectively lighten burden and promote well‐being among caregivers. [ABSTRACT FROM AUTHOR]

Maternal HIV disclosure to children has numerous benefits for both mothers and children. However, the prevalence of maternal HIV disclosure to children remains low in many countries. The present study examined factors associated with intention to disclose maternal HIV status to children among Chinese HIV+ women who have not disclosed their HIV status to their child. Factors from the Theory of Planned Behavior and various norms (injunctive, descriptive and moral norm) were examined. Findings from 179 HIV+ women revealed that only 16.8% intended to disclose their HIV status to their child in the future. Adjusted for significant background variables, all factors from the TPB and various norms (i.e. attitude, injunctive norm, descriptive norm, moral norm, perceived behavioural control) were associated with intention to disclose HIV status (adjusted odds ratios ranged from 3.22, 15.85). Stepwise logistic regression showed that attitude (ORm = 6.96) and injunctive norm (ORm = 6.81) were associated with intention to disclose HIV status. Interventions to promote maternal HIV disclosure were warranted to promote attitude, perceived behavioural control, and various norms associated with HIV disclosure. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate delays in the presentation of symptomatic breast cancer in women (time interval between the perception of their first sign or symptom until the first medical appointment) and its risk factors. A cohort study composed of patients with breast cancer (symptomatic) admitted to an oncological centre in the city of Rio de Janeiro, Brazil was performed. The patients were interviewed during their first hospital visit. To assess time interval as a continuous variable, the median and interquartile ranges (IQR) were calculated. The outcome comprised delay in breast cancer presentation when time from the first sign or symptom perception to the first medical appointment was ≥90 days. A descriptive analysis was performed. The association between independent variables (epidemiological, social and demographic data, related to individual healthcare, clinical and current disease) and the outcome (delay in symptomatic presentation) was assessed by a univariate analysis applying odds ratios (OR). Associations with p < .20 in the univariate analysis were included in the multiple logistic regression model. Variables with a p < .05 were retained in the final model. A total of 388 women were included. The median time was of 41 days (interquartile range — IQR: 13.2–130.0); 34.3% delayed presentation at ≥ 90 days. After adjustment, the variables associated with a delay in presentation were frequency of gynaecological examination of over than 1 year (OR: 2.59, 95% CI: 1.67–4.05), no family history of breast cancer (OR: 1.96, 95% CI: 1.15–3.35), and income lower than the minimum wage (OR: 1.62, 95% CI: 1.03–2.55). A higher score in tangible support (OR: 0.98; 95% CI: 0.96–0.99) was associated with a lesser chance of delay in presentation. Thus, delay in presentation was associated with social barriers, access to health service, health information and individual factors. [ABSTRACT FROM AUTHOR]

The current study is a health facility‐based cross‐sectional study that aims to measure the prevalence of psychological distress and to determine its associated factors among primary healthcare (PHC) service users in Mansoura district, Egypt. The study included service users aged ≥18 years. A predesigned structured interviewer‐administered questionnaire was used to collect data from participants during the period from January 2018 to November 2018. The questionnaire included four sections; sociodemographic characteristics, recent history of stressful life events, history of relevant health conditions and a validated Arabic version of General Health Questionnaire, that was used to screen for psychological distress. The total calculated sample size was 573. Data was analysed using SPSS V. 16. Results indicated that the prevalence of psychological distress among PHC service users was 72.2% (95% CI: 68.6%–75.9%). Being a female, non‐working, or married increased the risk of high psychological distress [OR (95%CI): 1.6 (1.2–2.4), 1.8(1.2–2.8) and 1.7 (1.1–2.8) respectively], but these factors were insignificant in multiple regression. Exposure to domestic violence (DV) and being current smokers were the only independent significant predictors of psychological distress [adjusted OR (95%CI): 3.8 (1.7–8.1) and 0.7 (0.4–0.9) respectively]. Findings indicate that psychological distress is common among PHC service users. Exposure to DV significantly predicts psychological distress, while smoking is associated with lower stress. Screening of PHC service users for mental health problems should be integrated within the PHC system. [ABSTRACT FROM AUTHOR]

Intensive unpaid caring is associated with greater likelihood of not being employed, but impacts for mental health carers specifically remain unknown. This study aimed to: (a) examine the association between caring intensity and not being employed for primary mental health carers, (b) ascertain whether this relationship differs from that for other disability carers, (c) enumerate Australian primary mental health carers with a possible need for employment support and (d) describe these carers' unmet support needs and barriers to employment. Co‐resident, working age primary mental health (n = 137) and other disability carers (n = 821) were identified in the Survey of Disability, Ageing and Carers (collected July‐December 2015). Multiple logistic regression analyses examined associations between levels of caring intensity (1–9, 10–19, 20–39, 40+ hr/week) and not being employed. A 'possible need for employment support' indicator was derived from information about current employment status, caring hours, past impact of caring on employment and desire for more work or workplace accommodations. After controlling for demographic and caring role factors, mental health carers providing 40+ hr of care weekly had greater odds of not being employed compared to carers providing <10 hr (AOR 13.38, 95% CI: 2.17–82.39). For other disability carers, the odds of not being employed were also higher among those providing 20–39 hr of care (AOR 3.21, 95% CI: 2.18–4.73). An estimated 54.1% (95% CI: 43.1–64.8) of carers had a possible need for employment support, with the proportion increasing as level of caring intensity increased. Of carers who were not employed, 42.2% (95% CI: 30.3–55.0) reported a desire to work, and the main reported barrier was no alternative care arrangements or disruption to the person supported. Findings suggest that improving employment participation for mental health carers requires a greater balance between unpaid care and access to formal services for people with mental illness. [ABSTRACT FROM AUTHOR]

High‐quality bystander cardiopulmonary resuscitation (CPR) and early defibrillation in the community are important for survival in out‐of hospital‐cardiac‐arrest, but maintaining the quality of CPR in bystanders is difficult. We aimed to determine the effect of an automated external defibrillator (AED) with real‐time feedback on the quality of bystander CPR in a community setting. A before‐and‐after simulation study was designed. Trainees of basic life support education were recruited for the simulation experiment. Each team consisted of two bystanders with different roles (initial witness and CPR supporter). 82 teams performed simulation scenarios with the real‐time feedback function of AED disabled initially, and then repeated it with feedback function enabled. Quality measures of chest compression depth and no‐flow fraction were compared between each of the two simulation scenarios. CPR quality data from 82 teams were analysed. The mean percentage of chest compressions with adequate depth was significantly higher in simulations with real‐time feedback (78.1% vs. 89.3%, p < 0.01). Similarly, no‐flow fractions were lower in simulation scenarios with real‐time feedback (32.0% vs. 30.3% p = 0.05). In a subgroup with the lowest percentage of adequate depth performance in the initial simulation without real‐time feedback, a mean increase of 47.7% (95% CI 31.3–64.0) in the fraction of chest compressions with adequate depth was seen with real‐time feedback. Use of an AED with real‐time feedback improves the quality of bystander CPR in a simulated community setting. The positive effect of real‐time feedback is greatest among people with a low level of CPR skill. [ABSTRACT FROM AUTHOR]

Carers contribute essential support to enable people with dementia to continue living within the community. Admiral Nurses provide specialist dementia support for carers of people with dementia, including offering expert emotional support and guidance, and work to join up different parts of the health and social care system to address needs in a co‐ordinated way. The cost‐effectiveness of this service is not clear. We undertook a feasibility study to explore related outcomes and costs for these carers. A cross‐sectional, clustered survey was undertaken in England in 2017, in areas with and without Admiral Nursing (AN). The survey questionnaire included questions on the characteristics of the carers and the person with dementia, outcomes (care‐related quality of life [CRQoL], self‐efficacy and subjective well‐being), use of health and social care services, out‐of‐pocket costs and time spent on informal care. We used different econometric techniques to compare the outcomes and the costs of the carers with and without AN services: linear regression, propensity score matching and instrumental variables analysis. These techniques allowed us to control for differences in observed and unobserved characteristics between the two groups of carers which determined outcomes and costs. We concluded that AN services might have a positive effect on carers' CRQoL, self‐efficacy and subjective well‐being. Furthermore, we found little difference in costs between carers using AN and those using usual care, or in the costs of the people with dementia they care for. Our findings provided an initial indication as to whether AN services could be good value for money. The key limitation of the study was the difficulty in controlling for unobserved characteristics because of the cross‐sectional nature of our observational data. To diminish this limitation, our survey could be used in future studies following carers with and without AN services over time. [ABSTRACT FROM AUTHOR]

The two components of hope (i.e., hope‐agency defined as the ability to envision and believe in one's ability to achieve goals; hope‐pathway defined as belief in one's ability to devise strategies to achieve one's goals) propel adolescents toward well‐being, academic achievement and personal fulfillment. This study compares levels of hope and its components, for different groups of immigrant and ethnic non‐immigrant youths, while adjusting for and measuring the impact of racism, school and family characteristics, and the youth's unique individual attributes. Using a community‐based participatory research approach and a cross‐sectional study design, data were collected from immigrant and non‐immigrant youth (n = 567) between May 2015 and December 2015 at three Israeli public high schools. The study included five groups of youth based on their self‐descriptions: Ethiopian immigrant (n = 48), Russian immigrant (n = 145), Israeli‐born Mizrachi/Sephardi (n = 59), Israeli‐born Ashkenazi (n = 49), or Israeli‐born Unspecified (n = 266). Linear regression models showed that Ethiopian immigrant youth, compared to Russian immigrant youth and all Israeli‐born groups of youth, had significantly lower hope‐agency, hope‐pathway and overall hope. However, an interaction effect between racism and ethnicity indicated that adolescents who perceived racism and self‐identified as Ethiopian had higher hope‐agency, hope‐pathway and overall hope. This effect was not found with Russian immigrant or Israeli‐born youth. Immigrants of color compared to other immigrants and ethnicities have less overall hope; but those who acknowledge racism feel more control over their future (hope‐agency), able to devise strategies to surmount barriers blocking goals (hope‐pathway), and have greater overall hope. [ABSTRACT FROM AUTHOR]

Community pharmacy services (CPS) have been shown to be positive in many disease management and patient care programs, but clinical outcomes were followed by process indicators and methodological flaws in previous researches made it difficult to prove the effectiveness of clinical outcomes of CPS. Therefore, this study attempted to review the clinical outcomes of CPS. Interventions included are provision of medication review, patient education, adherence assessment, health/lifestyle advice, physical assessment, monitoring, prescribing, or adjusting and administering therapy from community pharmacists. By searching for key words like community pharmacists, pharmaceutical services, clinical outcomes in MEDLINE and EMBASE and manually searching (up to June 2017), 1910 studies investigating the clinical outcomes of CPS were obtained. After screening the titles, abstracts and full texts for relevancy, 52 researches with controlled groups were included and assessed for methodological quality. Finally, 25 studies were selected for the meta‐analysis based on their common endpoints: systolic blood pressure, diastolic blood pressure and glycosylated haemoglobin. The Cochrane tool was used to assess the risk of bias. Chi‐square and I‐square tests were performed to assess heterogeneity, and the weighted mean differences were estimated using random effect models. Of the 52 articles, 47 studies demonstrated that CPS had positive clinical outcomes, 3 studies showed mixed outcomes and 2 studies revealed no effects. In the meta‐analysis, intervention groups displayed greater reductions in systolic BP (95% CI: −8.198–2.356), diastolic BP (95% CI: −3.648–0.645) and HbA1c (95% CI: −0.905–0.224) than usual care groups. CPS have positive clinical outcomes, particularly significant reductions in systolic BP, diastolic BP and HbA1c. It was difficult to find out which intervention(s) of CPS directly led to certain changes and influence of CPS might be underestimated for only three common surrogate endpoints. More researches should be conducted with sufficient data. [ABSTRACT FROM AUTHOR]

Non‐deferrable medical conditions (NDMC) are clinical entities other than exacerbations of chronic diseases which are too frequently managed by emergency departments. The primary care setting would be indeed the ideal environment to proficiently treat them. Few studies have investigated the epidemiology of NDMC in primary care, especially in Italy. With the aim to better identify NDMC sufferers, we assessed the accuracy of the NDMC definition by means of four algorithms, featured by different specificities and sensitivities. Four algorithms, based on the hierarchical definition of NDMC, were developed to calculate the incidence rate of NDMC in 2014. Each was tested using a Cox univariate model adjusted for gender, comparing patients aged <45 years old with older patients. Algorithms 1 and 3 gave similar results (408.1 vs. 405.5 per 1,000 person‐years); Algorithms 2 and 4 reported sensibly lower rates (84.7 and 84.0 per 1,000 person‐years). Incidence rate of NDMC for female patients was higher than in males and for older age group (i.e. 75–84 age group) than younger patients, for both gender groups. Regarding the regression model, a higher risk of NDMC was estimated in patients aged 45 years or more and in females. This study allowed us to assess the incidence rate of NDMC in Italy which was unexpectedly higher among older patients. Given the crucial role of general practitioners (GPs) in the diagnosis and management of these conditions, as well as the healthcare system reforms imposed by the ongoing financial crisis, our findings may contribute to informing the capacity and strategic workload planning in group of GPs to improve service quality and profitably to reduce the excessive use of emergency departments. [ABSTRACT FROM AUTHOR]

In a number of countries, unemployment rates for people with psychiatric disabilities are much higher than in the general population. On the one hand, the expenses for mental health reach 3.5% of the total public health and social services budget in Québec. On the other hand, social firms (SFs) receive government subsidies. The objective was to compare public healthcare expenses for people with psychiatric disabilities who work in SFs with those associated with people with a similar condition who are looking for a job in the competitive labour market. This study followed a retrospective comparative design and considered two groups, namely: 122 employees working in SFs and 64 individuals participating in a supported employment program as job‐seekers. Two complementary datasets were used: a self‐report questionnaire and public healthcare databases. The cost analysis was performed from the perspective of the public healthcare system and included outpatient visit fees to physicians, outpatient visits to health professionals other than physicians in public healthcare centres, inpatient expenses due to hospitalisations, emergency room visits and amounts reimbursed to patients for medication. Regression analyses using generalised linear models with a gamma distribution and log link were used. Our results revealed that when controlling for sociodemographic variables (gender, age, marital status, education, physical disability), global health (EuroQol EQ‐5D‐5L), the severity of psychiatric symptoms (18‐item Brief Symptom Inventory) and self‐declared primary mental health diagnosis, annual healthcare costs paid by the public insurance system were between $1,924 and $3,912 lower for people working in SFs than for the comparison group. An explanatory hypothesis is that working in SFs could act as a substitute for medical treatments such as outpatient visits and medication use. There might be a form of compensation between supporting SFs and financing the public healthcare system, which provides valuable insights for public decision‐making. [ABSTRACT FROM AUTHOR]

The prevalence of health scams in Canada is increasing, facilitated by the rise of the Internet as a mass communication medium. However, little is known about the nature of this phenomena. Building on previous work exploring the nature of Internet health scams (IHS), this project sought to better understand the reasons why people engaged with IHS, and if contemporary psychosocial theory can help explain IHS engagement. A mixed‐methods study, involving a web‐based survey incorporating qualitative questions and the Susceptibility to Persuasion‐II Brief psychometric scale (STP‐II Brief), were administered (N = 194) in British Columbia, Canada, in 2017. Results (n = 156) demonstrated that 40% of participants had ever engaged with IHS, but only 1% reported to have actually lost money to a deceptive product/service. Associations between scam engagement, participant demographics and STP‐II Brief scores were explored, with Sex and Employment Status both found to have a significant effect on odds of IHS engagement. STP‐II Brief scores were positively correlated with a likelihood of engagement with IHS, even when adjusting for demographic characteristics. The types of IHS most frequently engaged with were those related to body image products, and social influence appeared to be a dominant psychosocial factor promoting engagement. Participants reported that claims of products being 'natural', the result of scientific breakthroughs, use of pseudoscientific language, use of testimonials, and celebrity or professional endorsement could lead them to engage with a product. These findings can help inform health professionals' understanding of public health‐seeking behaviours with respect to deceptive marketing. [ABSTRACT FROM AUTHOR]

Many governments have introduced or encouraged home‐care reablement schemes for older people at home with the aim of improving outcomes and reducing costs. We examined if such schemes have the potential to reduce costs from the perspective of the National Health Service (NHS) and Personal Social Services (PSS) in England. Our study was carried out to inform recommendations of a national guideline. Cost‐minimisation analysis was carried out using decision‐analytic Markov modelling. Home‐care reablement was compared with standard home care. Costs included those of the intervention, home care and hospital admission. Uncertainty was explored using univariate and probabilistic sensitivity analysis. Mean costs per person were £56,499 (95% confidence interval 55,690 to 57,307) in the reablement group, and £58,560 (95% confidence interval 57,800 to 59,319) in the standard care group. The mean difference was ‐£2,061 (95% confidence interval 1,933 to 2,129). The probability that home‐care reablement costs less than standard home care was 94.5% (95% confidence interval 93.1 to 95.9). In sensitivity analyses, this probability remained above 85% in all scenarios. Home‐care reablement can be a successful cost‐minimisation strategy for supporting some older people. More research is needed about the impact of home‐care reablement on health outcomes for different groups of older people; and the effects of different durations of reablement on outcomes and costs for different subpopulations. [ABSTRACT FROM AUTHOR]

Social quality is the extent to which people are able to participate in social relationships under conditions which enhance their well‐being, capacities and potential and enables them to shape their own circumstances and contribute to societal development. We assessed whether women in homeless shelters differed from men on social quality factors that constitute the quality of their daily life and whether factor scores changed at a different rate for women and men after shelter exit. Data were collected as part of a randomised controlled trial. In 18 shelters across the Netherlands, 183 participants were recruited between December 2010 and December 2012 and followed for 9 months. Adults were eligible if they were about to move from shelter to (supported) independent housing and their shelter stay had been shorter than 14 months. At baseline, women were significantly younger than men. They were more likely to have children, to have minor children staying with them, to be lower educated, to be unemployed and to have been victimised than men. Women had used more services and reported lower self‐esteem, less satisfaction with health and empowerment and higher psychological distress. They were less likely than men to have used alcohol excessively or cannabis. We found no significant differences between women and men in changes over time on the social quality factors. As women were disadvantaged at baseline compared to men regarding many factors, we concluded that women in homeless shelters are a particularly vulnerable group. Moreover, an opportunity remains for shelter services to improve women's social quality during and after their shelter stay. [ABSTRACT FROM AUTHOR]

While emotional and behaviorial problems increase risks to youth development, resilience helps youth adapt and overcome adversity. Research has discussed factors related to youth resilience, emotional problems, and behaviorial problems; however, existing literature excludes non‐western sociocultural contexts and has not explored the potential relations among mindfulness and life skills. This study examines the effects of mindfulness and life skills on resilience, emotional problems, and behaviorial problems of adolescents in China. Our data come from a group‐administered survey among 60 adolescents from a school for behaviourally delinquent students in Beijing, China, in 2017. The regression results indicate that mindfulness is associated with reduced adolescent emotional and behaviorial problems, whereas life skills are associated with increased resilience. The findings suggest the importance of adolescent interventions that incorporate concepts from both mindfulness and life skills training. [ABSTRACT FROM AUTHOR]

Significant differences in health across racial/ethnic and socioeconomic groups in the US signal increasing numbers of low‐income homebound older adults in a rapidly ageing society. The purpose of this study was to examine physical and psychiatric conditions and their association with incidence of self‐reported falls and hospitalisations among largely low‐income and racial/ethnic minority adults age 50+ (N = 2,224), clients from a home‐delivered meals programme in Central Texas. Data came from comprehensive, in‐home assessments done in 2017 by these older adults' case managers. We used bivariate analyses to compare those with and without incidence of self‐reported past‐year falls and those with and without a hospitalisation episode with respect to their sociodemographic and clinical characteristics. We used multivariable logistic regression analysis to examine sociodemographic and clinical correlates of any incidence of falls and negative binomial regression analysis to examine these correlates of the number of hospitalisations in the preceding 12 months. The rates of chronic physical illnesses, including cardiovascular disease, diabetes, gastrointestinal disease, lung disease and renal failure, were extremely high. The 41% of reported falls among the study sample was also higher than the rate among US older adults in general. More diagnosed physical illnesses, depression, chewing/swallowing problems, chronic/severe pain, activities and instrumental activities of daily living (ADL/IADL) impairments and ambulation assistive device use were associated with greater odds of falling. The rate of past‐year hospitalisation was 26%, and more diagnosed physical illnesses, ADL/IADL impairments, ambulation assistive device use and any fall incidence were positively associated with the number of hospitalisations. These findings indicate the need for fall prevention programmes for frail homebound older adults as well as health and social care services that help older adults better manage physical/mental health problems and reduce preventable health crises and hospitalisations. [ABSTRACT FROM AUTHOR]

The number of older homeless people with a limited life expectancy is increasing. European studies on their health‐related characteristics are lacking. This study compared self‐reported health, healthcare service use and health‐related needs of older and younger homeless people in the Netherlands. It is part of a cohort study that followed 513 homeless people in the four major Dutch cities for a period of 2.5 years, starting from the moment they registered at the social relief system in 2011. Using cross‐sectional data from 378 participants who completed 2.5‐year follow‐up, we analysed differences in self‐reported health, healthcare service use, and health‐related needs between homeless adults aged ≥50 years (N = 97) and <50 years (N = 281) by means of logistic regression. Results show that statistically significantly more older than younger homeless people reported cardiovascular diseases (23.7% versus 10.3%), visual problems (26.8% versus 14.6%), limited social support from family (33.0% versus 19.6%) and friends or acquaintances (27.8% versus 14.6%), and medical hospital care use in the past year (50.5% versus 34.5%). Older homeless people statistically significantly less often reported cannabis (12.4% versus 45.2%) and excessive alcohol (16.5% versus 27.0%) use in the past month and dental (20.6% versus 46.6%) and mental (16.5% versus 25.6%) healthcare use in the past year. In both age groups, few people reported unmet health‐related needs. In conclusion, compared to younger homeless adults, older homeless adults report fewer substance use problems, but a similar number of dental and mental problems, and more physical and social problems. The multiple health problems experienced by both age groups are not always expressed as needs or addressed by healthcare services. Older homeless people seem to use more medical hospital care and less non‐acute, preventive healthcare than younger homeless people. This vulnerable group might benefit from shelter‐based or community outreach programmes that proactively provide multidisciplinary healthcare services. [ABSTRACT FROM AUTHOR]

Perceived stress has been associated with adverse health outcomes. Although people experiencing homelessness often report multiple acute and chronic stressors, research on resilience and perceived stress on the general homeless population is limited. This longitudinal study examined homeless adults with mental illness who were part of a 24‐month trial of Housing First to explore: (a) changes in levels of resilience and perceived stress during the trial, and (b) the association between levels of resilience and perceived stress with measures of social support, social functioning and percentage of days stably housed over the study period. This longitudinal study (2009–2013) that used trial data included 575 participants in Toronto, Ontario. Of these individuals, 507 were included in this study. Connor‐Davidson Resilience Scale and Perceived Stress Scales (PSS) measured the two outcomes, resilience and perceived stress. Time (baseline, 12 and 24 months), housing stability and three measures of social support and social functioning were the main predictors. A longitudinal analysis was done with repeated measures analysis of resilience and perceived stress using linear mixed models with random intercepts. Mean resilience scores increased (baseline: 5.1 [95% CI: 4.9, 5.2], 12 months: 5.5 [95% CI: 5.3, 5.7], 24 months: 5.6 [95% CI: 5.4, 5.8]), and PSS scores decreased (baseline: 22.3 [95% CI: 21.5, 23.0], 24 months: 18.6 [95% CI: 17.9, 19.4]). In the multivariable analyses, increased resilience was associated with higher scores on the three social support and social functioning measures, (estimates = 0.12, 0.04, 0.02) but not percentage days stably housed. Lower PSS scores were associated with higher scores on all three social support and social functioning measures (−0.20, −0.33, −0.21) and higher percentages of days stably housed (−0.015). Strong social support and social functioning may minimise the harmful effects of stressful life events on homeless individuals by increasing resilience and reducing stress. Interventions to help homeless people build appropriate support networks should be delivered in parallel to efforts that increase housing stability. [ABSTRACT FROM AUTHOR]

"Buddhist Lent Dry Campaign" is an alcohol‐control programme that uses religious opportunities to promote behavioural changes among the Thai population. It is undertaken at the national and community levels. This study aimed to systematically evaluate the effectiveness of the community‐level intervention under the campaign on alcohol consumption behaviour. A prospective cohort study was conducted. The sample comprised 447 drinkers from four intervention communities and 388 from four non‐intervention communities. All were subjected to a series of sequential interviews. Our findings showed that the availability of the community intervention had a significant effect on alcohol abstinence not only during Buddhist Lent (OR = 2.74, 95% CI = 1.96, 3.85), but also 3 months after the end of Buddhist Lent (OR = 2.19, 95% CI = 1.42, 3.38). Furthermore, the intervention was very effective among drinkers who took an abstinence pledge (OR = 7.04, 95% CI = 4.49, 11.04). However, the effectiveness of the community intervention weakened after the intervention it ended. Additional interventions might be required to maintain the effects of the community intervention. [ABSTRACT FROM AUTHOR]

Most surgical wounds heal by primary intention, that is, the wound is closed with sutures, clips, or glue. However, some surgical wounds are either left open to heal from the bottom up ("healing by secondary intention") or break open partially or fully after primary closure. There is little basic knowledge about the occurrence and natural history of surgical wounds healing by secondary intention (SWHSI); therefore, the aim of this survey was to estimate the number of people with SWHSI in Slovenia, the nature of these wounds, and to investigate how they are managed. A multiservice, cross‐sectional survey was carried out over a 2‐week period in the city of Ljubljana, Slovenia (population 288,919). Healthcare professionals across health and social care settings completed one anonymised form for each patient with a SWHSI. Forms were completed for 110 patients. The point prevalence of SWHSI was 0.38 per 1,000 of the population (95% CI: 0.33–0.44). Patients' mean age was 50.5 years. The majority of SWHSI were planned to heal by secondary intention before surgery (76/110, 69%). Of SWHSI, 83% (92/110) were treated with wound dressings, and 6% were treated with negative pressure wound therapy. Data were missing for 11 cases. This survey is the first to provide essential information about the extent, nature, and treatment of SWHSI in Slovenia. Furthermore, it is one of the latest of a very small number of studies to have contributed to knowledge about SWHSI globally. The results from the survey can be used for planning future research, health resources management, and policy development. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine whether loneliness mediates the relationship between social engagement and depressive symptoms and to determine how age moderates the mediation effect. Data for this study came from the survey with community‐dwelling adults aged 18 and older in South Korea, from March to April 2017. The total of 1,017 respondents were drawn from three age groups (18–44, 45–64, or 65 and older). The mediating effect of loneliness was tested between each of three social engagement‐related variables (family network, friend network, and perceived community support) and depressive symptoms. The results showed age differences in mediation: the effect was most pronounced in the relationship of family network with loneliness for the older group, whereas the size of friend network significantly predicted loneliness for younger adults. Both younger and older groups felt less lonely when they had a higher level of perceived community support; the middle age group remained uninfluenced by the mediation effects. Our findings confirm that loneliness is one of the mechanisms by which social engagement exerts its effect on depressive symptoms. As the Korean society embraces its growing proportions of older adults, the results of the study provide implications for adaptive strategies for changing social engagement need and mental health associated with ageing. [ABSTRACT FROM AUTHOR]

Progressive aged care reforms are shifting dementia care into the community. These efforts have been shown to prevent transition to residential aged care facilities and hospitals. There is a paucity of studies examining the utilisation of home care services for people living with dementia. This study aims to address the current knowledge gap by providing a comprehensive summary of older adults receiving home care and comparing service use for people with and without dementia. A retrospective secondary data analysis was conducted using routine data prospectively collected from a cohort (n = 2,703 with dementia matched to 9,224 without dementia; total 11,927) using a community home nursing service in metropolitan Melbourne, Australia, in 2014. Descriptive statistics compared individuals with and without dementia on client‐level demographics and their episode of home care service use. A comparative analysis on select variables was also performed using a conditional Poisson regression to estimate relative risk (RR). Compared to older adults without dementia, people with dementia were more likely to be born overseas (RR 1.10, 95% CI [1.03–1.19]), require an interpreter (RR 1.41, 95% CI [1.26–1.59]), and live with family (RR 1.09 [1.01–1.16]). When examining an individual's episode of care, people with dementia were more likely to require acute care (RR 1.07, 95% CI [1.01–1.14]) and be discharged from home care with personal care services (RR 1.46, 95% CI [1.24–1.72]). People with dementia were less likely to be referred from a hospital (RR 0.73, 95% CI [0.69–0.77]), achieve their home care goals (RR 0.91, 95% CI [0.87–0.94]), or die while in receipt of home care services (RR 0.82, 95% CI [0.72–0.94]). Our findings suggest that people with dementia have different socio‐demographic characteristics and interactions with home care services compared to people without dementia. [ABSTRACT FROM AUTHOR]

Population‐based studies on blood donation prevalence and its association with sociodemographic and behavioural factors are scarce, but remain the best approach to assess correlates of donation, including those which could be the target for donor recruitment campaigns. This study describes the population of primary healthcare users from the public system in a medium‐sized Brazilian municipality to investigate the association of blood donation practice with other sociodemographic factors. A stratified, representative sample of primary healthcare users at 12 healthcare facilities in Ribeirão Preto, São Paulo, Brazil, were invited to participate. Analysis focused on demographic and psychosocial factors including, sex, age, marital status, socioeconomic status, educational level, health insurance, self‐perception of health, religious beliefs, and blood donation history. Blood donors, self‐defined ineligible donors, and never donors were compared. Multiple correspondence analysis (MCA) was used to assess positively and negatively associated variables in the dataset. MCA was conducted on respondents' age and monthly household income to assess dimensionality of other questionnaire responses. Of a total of 1,055 study participants, 79.7% were females and the mean age was 40.6 years. Blood donation practice was reported by 246 participants (23.3%), 669 (63.4%) had never donated, and 140 (13.3%) reported being unable to donate blood. Graphical presentation of the MCA showed that male, older age groups, those who have health insurance, and with higher socioeconomic and educational level are more likely to donate blood. Poor or average self‐perception of health, lower socioeconomic status, and divorced or widowed marital status were associated with self‐defined inability to donate blood. Thus, our results are useful to understand the multifactorial nature of blood donation behaviour. Our findings provide guidance for targeted recruitment campaigns focused on relevant contextual factors. The focus on reducing barriers to blood donation according to sociodemographic groups can be a relevant strategy to expand the donor base. [ABSTRACT FROM AUTHOR]

The family is the key for survival and success of the 4.6 million older immigrants in the United States. It is also an overlooked context to understand older immigrants' health service utilisation. Most prior studies on this topic either focus on individual or institutional factors that affect how older immigrants use formal health services. Using data from 2011 Population Study of Chinese Elderly in Chicago (N = 3,159), this study examined potential linkages between family relationships and health service utilisation among US Chinese elderly. Negative binomial and logistic regressions were carried out to investigate whether health service use of these older immigrants are related to positive family relations, negative family relations, and health‐related communications among family members. The findings showed that positive spousal or family relations were not associated with either physician visits or hospital stays. However, respondents with more negative family relations had more doctor visits (β = 0.065, p < 0.05) and were marginally more likely to use inpatient services (OR = 1.15, CI: 0.88–1.04, p = 0.08). Respondents who talked to their spouse for medical concerns were less likely to use inpatient services (OR = 0.68, CI: 0.46–0.99, p < 0.05). The findings showed that family relations play a role in Chinese older immigrants' health service use. In addition, family conflict seems to be more influential than close family relations in predicting service use. Practitioners need to thoroughly assess family dynamics to fully understand the resources and barriers for health service utilisation among the older immigrant populations. [ABSTRACT FROM AUTHOR]

Healthcare support workers face challenging situations in their day‐to‐day work but may have minimal training on how to deal with such incidents. Although staff training is often recommended as an essential part of any comprehensive approach for preventing and managing workplace violence, there is paucity of evidence on the content and effectiveness of such training. This study aimed to evaluate the effect of an intervention (communication skills training) to reduce the experience of aggression for healthcare support workers. A two arm, cluster randomised, single‐blinded, controlled trial among healthcare support workers in nongovernmental organisations (NGOs) and District Health Boards (DHBs) in New Zealand was conducted. The trial was conducted across 14 NGOs and DHB in Otago, Southland, and Auckland regions of New Zealand. One hundred and twenty‐seven participants were randomised to one of two groups. Both the intervention (communication skills) and control condition (mindfulness) were group‐based, fully scripted, and structured training interventions that consisted of four once weekly workshops that were facilitated by one of two nonclinical facilitators. Measurements of perceived aggression, psychological well‐being, and distress and communication competence were taken pre‐, post‐, 3 months' post‐, and 6 months' postintervention. There was a significant drop in the rate of aggression over time with a mean score and standard deviation of 10.37 (9.169) at baseline dropping to 6.07 (6.923) for the Perception of Patient Aggression Scale‐New Zealand across both intervention and control. Equivalent results were noted with increased psychological well‐being and communication competence and decreased distress with both interventions. This was sustained at 6 months' follow‐up. However, the between groups effect did not demonstrate a statistically significant difference between the intervention and control groups. Both mindfulness and communication skills training can reduce the experience of aggression reported by healthcare support workers. [ABSTRACT FROM AUTHOR]

Little is known about the types of home care services granted to older clients in Sweden. The objectives of this study were to: (a) identify and describe the range of granted home care services and service hours; (b) compare services granted for clients with and without documented cognitive impairment; and (c) examine associations between the range of granted home care services and factors related to cognitive impairment and demographical characteristics. The study design was descriptive and cross‐sectional. The data, included records of granted home care services for clients age 65+ with (n = 43) and without (n = 88) cognitive impairment documented by the local municipality assessors, collected from one agency in Sweden during a 2‐month period in 2015. Data analyses resulted in an overview of the range of home care services divided into two categories: personal care and service. In the personal care category, the median was 3 for types of services (range 0–12), and shower (n = 69; 52.7%) was the most common service. In the service category, the median was 5 for types of services (range 0–10), and cleaning the household (n = 103; 78.6%) was the most common service. The median for service hours was 27 hr per month (range 2.5–127.5). Logistic regression models revealed that cognitive impairment was associated with a higher number of services in the personal care category and a higher number of hours per month. Living alone was associated with a higher number of services in the service category. In conclusion, a wide range of home care services were provided for clients who have complex needs in daily life. Home care services were granted to clients with cognitive impairment and to a greater extent with clients who were living alone. [ABSTRACT FROM AUTHOR]

This study examined ageing parents' care expectations across multiple care domains (financial and material, emotional, personal and informational) towards filial and formal sources and identified intergenerational correlates of care expectation patterns using a proposed care expectation model. Data of 780 eligible ageing parents were drawn from a representative household survey of ageing adults (≥50 years) conducted in 2016–2017. Latent class analysis was used to examine the typological structure underlying ageing parents' care expectations. Four patterns of care expectations were discovered: mixed–maximal, filial–modest, formal–modest and neither–minimal. Multinomial logistic regression analysis was conducted to validate the newly proposed care expectation model. In addition to certain predisposing factors (participants' age, sex and education), parental enabling resources (economic status), health characteristics (physical, mental and functional health status), children‐related enabling characteristics (number of sons and marital status of children), and intergenerational enabling circumstances (intergenerational relationships and caregiving to their own parents) were introduced into the model and found to be associated with ageing parents' care expectations. The findings can inform policy and programmes that effectively respond to ageing adults' diverse care expectations in Hong Kong and have implications for other Asian societies facing rapid population ageing and increasing care demands. [ABSTRACT FROM AUTHOR]

Abstract: Accumulating evidence demonstrates that experiencing intrafamilial adversities (abuse, neglect and household dysfunction) during childhood is linked to addictive behaviours. However, the impact of social adversities (peer, community and collective violence) as well as gender, on tobacco initiation and dependence has received much less attention. The aim of this study was to examine the relationships between social childhood adversities and tobacco use patterns by gender among young adults in Tunisia. We performed a cross‐sectional study from May to December, 2014 on 1,200 respondents using the validated Arabic version of the World Health Organization Adverse Childhood Experiences—International questionnaire (WHO ACE‐IQ). Data on smoking characteristics among current smokers were also collected. Data analysis was performed using logistic and linear regression models. The rate of current tobacco use was significantly higher for males (43.9%) than for females (9.3%). Female and male respondents differed significantly on almost every examined adversity. Males were more likely to have experienced all types of social violence than females. The odds of tobacco use were significantly higher regardless the mental health status and the occurrence of intrafamilial early life adversity for both genders. Smokers exposed to social violence during childhood had a strong association between nicotine dependence and the overall burden of adversity. That is, 74 and 58% of nicotine dependence was explained by the number of childhood social adversities in females and males respectively. The findings underscore the role of community and collective violence in addictive behaviours among young adults. Multisectorial and population‐based strategies are needed to minimise the occurrence of social early life adversity and related tobacco patterns. [ABSTRACT FROM AUTHOR]

Abstract: We designed and ran an empowerment‐oriented social group work intervention to assess whether the intervention could improve the quality of life of older Iranians. The intervention consisted of nine group sessions that focused on capacity building and increasing individual competences, environmental resources and opportunities. Using a randomised controlled trial (RCT), 60 elderly people (30 men and 30 women in the intervention and control groups) from Social Services Centres in Tehran Municipality participated in this study. The WHOQOL‐BREF instrument was used to measure quality of life, comparing before, after and follow‐up measures between the groups and within each group. ANOVA and GEE tests were applied to analyse the data. The results showed significant progress in overall quality of life of the participants, particularly in the domains of physical health, psychological health, social relationships and environmental health. In pretest, there were no significant differences between the groups in terms of quality of life and its domains, but there were significant differences in the post‐ and follow‐up tests. This study provides support for the empowerment‐oriented social group work intervention with Iranian elderly people. This kind of intervention can be a useful model for empowering older people, especially in countries where social support and health services for seniors are not yet freely available. [ABSTRACT FROM AUTHOR]

Abstract: This study investigated whether individuals with different socioeconomic status (SES) should be provided differently tailored health messages to promote healthy dietary behaviour (HDB). Prior research has suggested that people with different SESs tend to exhibit different types of beliefs about health, but it remains unclear how SES interacts with these beliefs to influence health outcomes. To better understand the differences in HDB between high‐ and low‐SES populations and propose effective intervention strategies, we examined (i) how SES is associated with HDB, (ii) how internal health locus of control (HLC) and powerful others HLC are associated with HDB, and (iii) how SES interacts with internal and powerful others HLC to influence HDB. Using data from the Annenberg National Health Communication Survey, collected from 2005 to 2012 (N = 6,262) in the United States, hierarchical multiple regression analyses were conducted. Education level was found to be positively associated with HDB, while income level was not. Both internal and powerful others HLC beliefs were positively associated with HDB. The positive relationship between internal HLC and HDB strengthened as the level of education and income increased, whereas the positive relationship between powerful others HLC and HDB weakened as respondents' education level increased. These results suggest that the design and delivery of communication messages should be tailored to populations' specific SES and HLC beliefs for effective public health interventions. For example, messages enhancing internal HLC (e.g. providing specific skills and knowledge about health behaviours) might be more helpful for the richer and more‐educated, while messages appealing to one's powerful others HLC beliefs (e.g. advice on health lifestyles given by well‐known health professionals) might be more effective for less‐educated people. [ABSTRACT FROM AUTHOR]

Abstract: Prisoners are known to report worse health than the general population. Research has also shown that the prison population counts disproportionally more people with a lower socioeconomic status (SES), making it difficult to determine whether the worse self‐reported health of prisoners is an effect of their detention or of their lower SES. This study assesses the influence of being in prison on self‐rated health and if (and how) this relationship is mediated by SES. Data from detainees were collected in 12 Flemish prisons. To compare with the general population, data from the Belgian national health survey 2013 were used. To estimate the direct and indirect effect of being in prison on self‐reported health, mediation analysis was carried out by means of natural effect models using nested counterfactuals. Following previous literature we find that prisoners report worse health than the general population and that SES has a significant influence on subjective health. Our results showed that the direct effect (exp(B) = 3.43; [95% CI: 2.924–4.024]) of being in prison on self‐reported health is larger than the indirect effect (through SES) (exp(B) = 1,236; [95% CI: 1.195–1.278]), thus contradicting the hypotheses in previous literature that the SES is the main explanation for variation in self‐reported health among prisoners. Lastly, the effect of SES on health is more important for the general population compared to detainees, suggesting that for prisoners the effect of being in prison seems to surpass the effect of SES on health. [ABSTRACT FROM AUTHOR]

Abstract: SMS reminders sent to personal mobiles are increasingly used by clinical services to promote patient engagement, including adherence to antiretroviral treatment (ART) for HIV. From August to September 2015, a 6‐week, randomised SMS reminder for ART adherence intervention was implemented among 98 HIV‐positive clients of Australian's largest HIV charitable organisation located in Sydney. This was followed by a mixed‐method evaluation, comprising a self‐completed online survey and a one‐to‐one interview. Of the 62 survey participants, all being men, the majority were gay (85.5%) and living long‐term with HIV (median year of HIV diagnosis = 1998). While everyone was on ART, a substantial proportion (n = 27, 43.5%) had interrupted treatment in the past. At the end of the intervention, based on the standard SMAQ measure, 82% had consistently adhered to ART in the previous week. While there was no statistically significant intervention effect, perceiving less stigma were independently associated with better ART adherence (adjusted odds ratio = 0.37; 95% CI 0.16–0.89; P = .026). Of the 11 interviewees, despite limited add‐on effects on individual ART adherence, the campaign was well‐received as a unique community support service. This study underscores the essential role of empowerment through enhancing disease self‐management, increasing social support and reducing stigma, particularly for long‐term HIV survivors. SMS messaging, part of mHealth, delivered by community services could have broader impacts on reducing health and social inequity. [ABSTRACT FROM AUTHOR]

Abstract: The growth in the numbers of older adults needing long‐term care has resulted in rising costs which have forced the Dutch government to change its long‐term care system. Now, the local authorities have greater responsibility for supporting older adults and in prolonging independent living with increased support provided by the social network. However, it is unclear whether these older adults have such a network to rely upon. The objective of this study was to gain insight into the providers of formal and informal care to older adults, and to assess possible differences between older adults who are frail and those who are not. In addition, we investigated their care and support needs. We used data from a quantitative survey using a cross‐sectional design in different regions of the Netherlands from July until September 2014 (n = 181). Frailty was measured using the Tilburg Frailty indicator. To analyse the data chi‐square tests, crosstabs and odds ratios were used for dichotomous data and the Mann–Whitney U‐Test for nominal data. The number of formal care providers involved was significantly higher (median = 2) for those deemed frail than for those not deemed frail (median = 1), U = 2,130, p < .005. However, more than one‐third of the respondents deemed frail did not get the care or support they needed (33.7%). There was a significant positive association between being frail and having an informal care provider (χ2 = 18.78, df = 1, p < .005). However, more than one‐third of those deemed frail did not have an informal care provider (36.8%). One‐third of older adults deemed to be frail did not have their needs sufficiently addressed by their care network. For a substantial part of this group of older adults, the informal network seems to be unable to support them sufficiently. Additional attention for their needs and wishes is required to implement the policy reforms successfully. [ABSTRACT FROM AUTHOR]

Abstract: Supporting people to live at home in line with community care policies requires increasing attention to assessing, communicating and managing risks. There is a challenge in supporting client choices that include risk‐taking while demonstrating professional accountability. Risk communication becomes increasingly important with the need to engage clients and families in meaningful shared decision‐making. This presents particular challenges in dementia services. This survey of risk communication in dementia care was administered to all health and social care professionals in community dementia services in Northern Ireland: June–September 2016. Of 270 professionals, 70 questionnaires were fully completed, with 55 partial completions. Scores on the Berlin Numeracy Test plus Schwartz items was low‐moderate (mean 2.79 out of 7). This study did not find a significant association between numeracy and accurate perceptions of risk likelihoods in practice‐based scenarios. Although 86% reported using numeric information in practice (mostly from assessment tools), respondents rarely communicated themselves using numbers. As in other domains, participants’ responses were widely variable on numeric estimates of verbal terms for likelihood. In relation to medication side effects, few participants provided responses that were concordant with those in the guidance of the European Union. The risks most commonly encountered in practice were (in rank order): falls, depression, poor personal hygiene, medicines mismanagement, leaving home unsupervised, financial mismanagement, malnutrition, swallowing difficulties, abuse from others, risks to others, home appliance accidents and refusing equipment. Respondents generally overestimated the likelihood of serious harmful events by approximately 10‐fold (having a missing person's report filed with the police; having a fall resulting in hospitalisation) and by approximately double (being involved in a car accident; causing a home fire), and with wide variation between respondents. There is potential in icon arrays for communicating risks. Risk literacy among dementia care practitioners needs to be developed. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this study was to develop and test the construct and content validity, internal consistency of the Family‐Carer Diabetes Management Self‐Efficacy Scale (F‐DMSES). A sample of 70 Thai individuals who cared for those living with type 2 diabetes mellitus (T2DM) in a rural community in Thailand was included in the study. Data were collected by a questionnaire survey in January 2014. The F‐DMSES was initially derived from the DMSES, with subsequent forward and backward translations from and to English and Thai languages. The psychometric properties (content, construct and internal consistency) of the Thai version were explored using the Content Validity Index approach, exploratory factor analysis and Cronbach's alpha test. The F‐DMSES initially designed with 20 items was reduced to 14 items within four factors (general diet and blood glucose monitoring, medications and complications, diet in differing situations, and weight control and physical activities), and explained 72.2% of the total variance in overarching construct. Internal consistency was supported (α = 0.89). The F‐DMSES was also able to measure change over time following an intervention, with an effect size of 0.9. The F‐DMSES is a valid and reliable self‐administered instrument that measures the diabetes management self‐efficacy of family‐carers of individuals with T2DM. This instrument can be used in practice and clinical trials to assess the impact of family‐carers on the health outcomes of individuals with T2DM. [ABSTRACT FROM AUTHOR]

Social participation may improve the health and well-being of older adults, and may increase the social and human capacity of their communities. This study investigates the level and forms of social participation among older adults (aged 55 years or older) in the region of South Limburg, the Netherlands, and their association with socio-demographic and health-related characteristics. The study provides evidence that can be used by policy makers to enhance social participation in the region. We use cross-sectional data collected in a survey in 2012 among a sample of older adults (aged 55 years or older) representative for the region of South Limburg. The results indicate that 56% ( N = 16,291/weighted sample N = 213,332) of the older adults in the region participate in social activities. Specifically, 25.5% perform paid labour, 20% give informal care and 25% participate in volunteer work. Older adults with a higher education ( OR = 2.49 for the highest education group) or higher income ( OR = 1.70 for the highest income group) are significantly more likely to participate in social activities compared with the respective reference categories. Increased age ( OR = 0.23 for the oldest age group), female gender ( OR = 0.83), loneliness ( OR = 0.75 for severe loneliness) and restrictions ( OR = 0.78 for restrictions on the OECD scale, OR = 0.68 for restrictions on the HDL scale, OR = 0.52 for transportation restrictions) significantly hinder social participation. The lower social participation rate among older adults that we observe compared with the national statistics can be explained by the relatively higher proportion of people with low or average socioeconomic status in South Limburg. And as South Limburg is the unhealthiest region of the Netherlands, this also contributes to the low social participation. Prevention of poor physical and mental health, and provision of care services are important to encourage social participation among the older adults in South Limburg. [ABSTRACT FROM AUTHOR]

An increasing number of people combine paid work with the provision of informal care for a loved one. This combination of work and care may cause difficulties, necessitating adaptations at work, i.e. work arrangements. The present study explores what types of work arrangements are used by working caregivers, and which caregiver, care and work characteristics are associated with the use of these work arrangements. Within the Lifelines Informal Care Add-on Study (Lifelines ICAS), data on 965 Dutch informal caregivers in the North of the Netherlands were collected between May 2013 and July 2014 (response rate 48%), and data on 333 working adult-child caregivers (aged 26-68 years, 82% female) were used in this study. A small majority (56%) of the working caregivers used one or more work arrangement(s): taking time off (41%), individual agreements with supervisor (30%), formal care leave arrangement (13%), and reduction in paid work hours (6%). Logistic regression analyses showed that long working hours ( OR 1.06, 95% CI 1.01-1.08), and the experience of more health problems ( OR 2.54, 95% CI 1.56-4.05) or a disrupted schedule due to caregiving ( OR 2.50, 95% CI 1.66-3.78) increased the chance to have used one or more work arrangements. Lower educated working caregivers were less likely to have used a formal care leave arrangement (tertiary vs. primary education OR 2.75, 95% CI 1.13-6.67; tertiary vs. secondary education OR 1.27, 95% CI 1.27-5.09). Policy makers should inform working caregivers about the availability of the different work arrangements, with specific attention for low educated working caregivers. Employers need to consider a more caregiver-friendly policy, as almost half of the working adult-child caregivers did not use any work arrangement. [ABSTRACT FROM AUTHOR]

There is growing concern about alcohol problems in low- and middle-income countries. More research is required, particularly among the younger generation. The aim of this study was to investigate the prevalence of alcohol disorders and associated socioeconomic characteristics among young men and women living in the Eastern Cape Province, South Africa. This was a cross-sectional population-based study of 977 participants (52% male and 48% female) aged 18-40, the majority of whom lived in low-income areas. Data collection was carried out in 2012 by trained fieldworkers. The Mini International Neuropsychiatric Interview ( DSM- IV) was used to investigate the prevalence of alcohol dependence (increased tolerance to alcohol, failed attempt to cut down, risk of physical and mental effects) and alcohol abuse (harmful use, consistent intoxication, risk behaviour, physically hazardous, social problems). A high 12-month prevalence of alcohol dependence was found (26.5% in total; 39.0% among men and 19.1% among women) as well as of alcohol abuse (9% in total; 19.0% among men and 6.0% among women). Few socioeconomic differences emerged among the men, except older men ( OR 1.94, CI 1.11-3.42) and those supported by social grants ( OR 2.28, CI 1.06-4.93), who presented higher odd ratios for alcohol dependence than the reference groups. Among the women, more differences emerged: women who were widowed/single ( OR 2.35, CI 1.20-4.62), had no education ( OR 3.41, CI 1.04-11.21), had a low income ( OR 3.26, CI 1.55-6.80) and had no social support from friends when ill presented higher odd ratios ( OR 1.73, CI 1.07-2.80). In the adjusted model, marital status and low income remained statistically significant. With regard to alcohol abuse, fewer socioeconomic differences emerged. Interventions need to address the early onset of alcohol misuse in order to meet both current needs and long-standing mental and physical illness. [ABSTRACT FROM AUTHOR]