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ObjectiveThe Mexican government has pursued multiple initiatives to improve healthcare coverage and financial protection. Yet, out-of-pocket health spending and use of private sector providers in Mexico remains high. In this paper, we sought to describe the characteristics of public and private healthcare users, describe recent visit quality across provider types, and to assess whether perceiving the public healthcare sector as poor quality is associated with private health sector use.Methods and findingsWe analyzed the cross-sectional People's Voice Survey conducted from December 2022 to January 2023. We used Chi-square tests to compare contextual, individual, and need-for-care factors and ratings of most recent visits between users of public (social security and other public providers) and private sector providers (stand-alone private providers and providers adjacent to pharmacies). We used a multivariable Poisson regression model to assess associations between low ratings of public healthcare sources and the use of private care. Among the 811 respondents with a healthcare visit in the past year, 31.2% used private sources. Private healthcare users were more educated and had higher incomes than public healthcare users. Quality of most recent visit was rated more highly in private providers (70.2% rating the visit as excellent or very good for stand-alone private providers and 54.3% for pharmacy-adjacent doctors) compared to social security (41.6%) and other public providers (46.6%). Those who perceived public health institutions as low quality had a higher probability of seeking private healthcare.ConclusionUsers rated public care visits poorly relative to private care; at the population level, perceptions of poor quality care may drive private care use and hence out-of-pocket costs. Improving public healthcare quality is necessary to ensure universal health coverage.

Nurse, Midwives and Allied Health Professionals (AHPs), along with other health and social care colleagues are the backbone of healthcare services. They have played a key role in responding to the increased demands on healthcare during the COVID-19 pandemic. This paper compares cross-sectional data on quality of working life, wellbeing, coping and burnout of nurses, midwives and AHPs in the United Kingdom (UK) at two time points during the COVID-19 pandemic. An anonymous online repeated cross-sectional survey was conducted at two timepoints, Phase 1 (7th May 2020-3rd July 2020); Phase 2 (17th November 2020-1st February 2021). The survey consisted of the Short Warwick-Edinburgh Mental Wellbeing Scale, the Work-Related Quality of Life Scale, and the Copenhagen Burnout Inventory (Phase 2 only) to measure wellbeing, quality of working life and burnout. The Brief COPE scale and Strategies for Coping with Work and Family Stressors scale assessed coping strategies. Descriptive statistics and multiple linear regressions examined the effects of coping strategies and demographic and work-related variables on wellbeing and quality of working life. A total of 1839 nurses, midwives and AHPs responded to the first or second survey, with a final sample of 1410 respondents -586 from Phase 1; 824 from Phase 2, (422 nurses, 192 midwives and 796 AHPs). Wellbeing and quality of working life scores were significantly lower in the Phase 2 sample compared to respondents in Phase 1 (p

To date, the effect of both fixed and time-varying individual, social, psychological, environmental, and behavioral characteristics on temporal growth trends in physical activity (PA) among younger individuals remains an under-studied topic. In this paper, we address this gap in previous work by examining how temporal growth trends in PA respond to changing social, environmental, and behavioral characteristics using a large sample of college students (N = 692) who participated in the NetHealth project at the University of Notre Dame and from which fine-grained longitudinal data on physical activity and social interaction were collected unobtrusively via the use of wearables for 637 days (August 16, 2015 to May 13, 2017). These data are augmented by periodic survey data on fixed sociodemographic and psychological variables. We estimate latent growth-curve models for daily activity status, steps, active minutes, and activity calories. We find evidence of both a generalized friendship paradox and a peer effect for PA, with the average PA level of study participants' contacts being on average larger than their own, and with this average level exerting a statistically significant effect on individual PA levels. Notably, there was limited evidence of temporal growth in PA across the 637 days of observation with null temporal effects for three out of the four PA indicators, except for daily steps taken. Finally, we find that social, psychological, and behavioral factors (e.g., large network size, high extroversion levels, and more courses taken) are systematically associated with higher PA levels in this sample. Overall, our findings highlight the importance of social, environmental, and behavioral factors (such as peer networks and daily sociability) in modulating the dynamics of PA levels among college students.

Undocumented status is widely recognized as an important social determinant of health. While undocumented immigrants have lower levels of health care access, they do not have consistently poorer physical health than the US-born or other immigrant groups. Furthermore, heterogeneity by race/ethnicity has been largely ignored in this growing literature. This paper used the 2001, 2004, 2008 panels of the restricted Survey of Income and Program Participation (SIPP), one of the only representative surveys equipped to adequately identify Asian undocumented immigrants, to compare health patterns between Asians and Latinos by immigration status. We examined three general measures of health/health access: self-rated health, disability, and current health insurance. Latino undocumented immigrants displayed some advantages in self-rated health and disability but had lower insurance coverage compared to US-born Latinos. In contrast, Asian undocumented immigrants did not differ from US-born Asians in any of the three outcomes. While undocumented status has been proposed as a fundamental cause of disease, we found no evidence that Latino and Asian undocumented immigrants consistently fare worse in health access or physical health outcomes than immigrants in other status categories. Different racial groups also appeared to have unique patterns between immigration status and health outcomes from one another.

A crucial question in the governance of infectious disease outbreaks is how to ensure that people continue to adhere to mitigation measures for the longer duration. The present paper examines this question by means of a set of cross-sectional studies conducted in the United States during the COVID-19 pandemic, in May, June, and July of 2020. Using stratified samples that mimic the demographic characteristics of the U.S. population, it seeks to understand to what extent Americans continued to adhere to social distancing measures in the period after the first lockdown ended. Moreover, it seeks to uncover which variables sustained (or undermined) adherence across this period. For this purpose, we examined a broad range of factors, relating to people's (1) knowledge and understanding of the mitigation measures, (2) perceptions of their costs and benefits, (3) perceptions of legitimacy and procedural justice, (4) personal factors, (5) social environment, and (6) practical circumstances. Our findings reveal that adherence was chiefly shaped by three major factors: respondents adhered more when they (a) had greater practical capacity to adhere, (b) morally agreed more with the measures, and (c) perceived the virus as a more severe health threat. Adherence was shaped to a lesser extent by impulsivity, knowledge of social distancing measures, opportunities for violating, personal costs, and descriptive social norms. The results also reveal, however, that adherence declined across this period, which was partly explained by changes in people's moral alignment, threat perceptions, knowledge, and perceived social norms. These findings show that adherence originates from a broad range of factors that develop dynamically across time. Practically these insights help to improve pandemic governance, as well as contributing theoretically to the study of compliance and the way that rules come to shape behavior.

Primary symptoms of adults with autism spectrum disorder (ASD), such as pervasive social deficits in social interaction and communication, cause adults with ASD to adopt a sedentary lifestyle. Meanwhile, gamified and behavioral theory-based interventions have been shown to improve physical activity in a fun and unobtrusive way. In this paper, we describe the iterative design inquiry process of PuzzleWalk, a gamified, physical activity-promoting mobile app designed for adults with ASD. We report the design rationales and lessons learned across four user-centered design phases with ASD experts and adults with ASD, including user requirement gathering, iterative participatory design, usability evaluation, and field deployment. The design insights generated from this work could inform future research focusing on designing sociotechnical systems, games, and interventions for people with ASD.

BackgroundApproximately one in every five adolescent girls in Kenya has either had a live birth or is pregnant with her first child. There is an urgent need to understand the language and symbols used to represent adolescent pregnancy, if the current trend in adolescent pregnancy is to be reversed. Agreement on the definition of a societal problem is an important precursor to a social issue's political prioritization and priority setting.MethodsWe apply the Public Arenas Model to appraise the environments, definitions, competition dynamics, principles of selection and current actors involved in problem-solving and prioritizing adolescent pregnancy as a policy issue. Using a focused ethnographic approach, we undertook semi-structured interviews with 14 members of adolescent sexual reproductive health networks at the national level and conducted thematic analysis of the interviews.FindingsWe found that existing definitions center around adolescent pregnancy as a "disease" that needs prevention and treatment, socially deviant behaviour that requires individual agency, and a national social concern that drains public resources and therefore needs to be regulated. These competing definitions contribute to the rarity of the topic achieving traction within the political agenda and contribute to conflicting solutions, such as lowering the legal age of consenting to sex, while limiting access to contraceptive information and services to minors.ConclusionThis paper provides a timely theoretical approach to draw attention to the different competing definitions and subsequent divergent interpretations of the problem of adolescent pregnancy in Kenya. Adolescent reproductive health stakeholders need to be familiar with the existing definitions and deliberately reframe this important social problem for better political prioritization and resource allocation. We recommend a definition of adolescent pregnancy that cuts across different arenas, and leverages already existing dominant and concurrent social and economic issues that are already on the agenda table.

Adverse Childhood Experiences (ACEs) are associated with poor health outcomes, underlining the significance of early identification and intervention. Currently, there is no validated tool to screen for ACEs exposure in childhood. To fill this gap, we designed and implemented a pediatric ACEs questionnaire in an urban pediatric Primary Care Clinic. Questionnaire items were selected and modified based on literature review of existing childhood adversity tools. Children twelve years and under were screened via caregiver report, using the developed instrument. Cognitive interviews were conducted with caregivers, health providers, and clinic staff to assess item interpretation, clarity, and English/Spanish language equivalency. Using a rapid cycle assessment, information gained from the interviews were used to iteratively change the instrument. Additional questions assessed acceptability of screening within primary care and preferences around administration. Twenty-eight (28) caregivers were administered the questionnaire. Cognitive interviews conducted among caregivers and among 16 health providers and clinic staff resulted in the changes in wording and addition of examples in the items to increase face validity. In the final instrument, no new items were added; however, two items were merged and one item was split into three separate items. While there was a high level of acceptability of the overall questionnaire, some caregivers reported discomfort with the sexual abuse, separation from caregiver, and community violence items. Preference for methods of administration were split between tablet and paper formats. The final Pediatric ACE and other Determinants of Health Questionnaire is a 17-item instrument with high face validity and acceptability for use within primary care settings. Further evaluation on the reliability and construct validity of the instrument is being conducted prior to wide implementation in pediatric practice.

BackgroundDengue virus (and Chikungunya and Zika viruses) is transmitted by Aedes aegypti and Aedes albopictus mosquitoes and causes considerable human morbidity and mortality. As there is currently no vaccine or chemoprophylaxis to protect people from dengue virus infection, vector control is the only viable option for disease prevention. The purpose of this paper is to illustrate the design and placement process for an attractive lethal ovitrap to reduce vector populations and to describe lessons learned in the development of the trap.MethodsThis study was conducted in 2010 in Iquitos, Peru and Lopburi Province, Thailand and used an iterative community-based participatory approach to adjust design specifications of the trap, based on community members' perceptions and feedback, entomological findings in the lab, and design and research team observations. Multiple focus group discussions (FGD) were held over a 6 month period, stratified by age, sex and motherhood status, to inform the design process. Trap testing transitioned from the lab to within households.ResultsThrough an iterative process of working with specifications from the research team, findings from the laboratory testing, and feedback from FGD, the design team narrowed trap design options from 22 to 6. Comments from the FGD centered on safety for children and pets interacting with traps, durability, maintenance issues, and aesthetics. Testing in the laboratory involved releasing groups of 50 gravid Ae. aegypti in walk-in rooms and assessing what percentage were caught in traps of different colors, with different trap cover sizes, and placed under lighter or darker locations. Two final trap models were mocked up and tested in homes for a week; one model was the top choice in both Iquitos and Lopburi.DiscussionThe community-based participatory process was essential for the development of novel traps that provided effective vector control, but also met the needs and concerns of community members.

The tendency to mimic the behaviour of others is affected by a variety of social factors, and it has been argued that such "mirroring" is often unconsciously deployed as a means of increasing affiliation during interpersonal interactions. However, the relationship between automatic motor imitation and status/power is currently unclear. This paper reports five experiments that investigated whether social status (Experiments 1, 2, and 3) or power (Experiments 4 and 5) had a moderating effect on automatic imitation (AI) in finger-movement tasks, using a series of different manipulations. Experiments 1 and 2 manipulated the social status of the observed person using an associative learning task. Experiment 3 manipulated social status via perceived competence at a simple computer game. Experiment 4 manipulated participants' power (relative to the actors) in a card-choosing task. Finally, Experiment 5 primed participants using a writing task, to induce the sense of being powerful or powerless. No significant interactions were found between congruency and social status/power in any of the studies. Additionally, Bayesian hypothesis testing indicated that the null hypothesis should be favoured over the experimental hypothesis in all five studies. These findings are discussed in terms of their implications for AI tasks, social effects on mimicry, and the hypothesis of mimicry as a strategic mechanism to promote affiliation.

Recent research of task-irrelevant perceptual learning (TIPL) demonstrates that stimuli that are consistently presented at relevant point in times (e.g. with task-targets or rewards) are learned, even in the absence of attention to these stimuli. However, different research paradigms have observed different results for how salient stimuli are learned; with some studies showing no learning, some studies showing positive learning and others showing negative learning effects. In this paper we focused on how the level of processing of stimuli impacts fast-TIPL. We conducted three different experiments in which the level of processing of the information paired with a target was manipulated. Our results indicated that fast-TIPL occurs when participants have to memorize the information presented with the target, but also when they just have to process this information for a secondary task without an explicit memorization of those stimuli. However, fast-TIPL does not occur when participants have to ignore the target-paired information. This observation is consistent with recent models of TIPL that suggest that attentional signals can either enhance or suppress learning depending on whether those stimuli are distracting or not to the subjects' objectives. Our results also revealed a robust gender effect in fast-TIPL, where male subjects consistently show fast-TIPL, whereas the observation of fast-TIPL is inconsistent in female subjects.