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Background: The prevalence of type 2 diabetes (T2D) in the French overseas department of French Guiana, South America, nearly doubles that in its European counterpart, Metropolitan France. This region is demographically diverse and includes several populations of Indigenous Peoples. Although such populations are at particular risk of developing T2D across the Americas, very little is known about their health status in French Guiana, and accurate numbers of diabetic patients do not exist. Methods: In light of a potential public health crisis, an ethnomedicinal study of diabetes experienced by Indigenous Parikweneh was conducted to provide better insight into the knowledge, attitudes and practices (KAP) related to this quickly emerging disease in French Guiana. Altogether, 75 interviews were conducted with community members and Elders, as well as healthcare professionals and administrators providing services to the Parikweneh population of Macouria and Saint-Georges de l'Oyapock. Results: Interviews suggest a high incidence of T2D in this population, with cases that have risen quickly since the mid-twentieth century. Parikweneh participants linked the development of the illness to dietary changes, notably through the introduction of new and sweet foods. Recognizing the complexity of diabetes and its symptoms, diabetic patients highlighted the importance of biomedical treatments and follow-ups, though they frequently alternated or used them concomitantly with Parikweneh medicines. With the help of biomedical tools (i.e. glucometer), local medicinal practices mirrored biomedical approaches through dietary adaptation and the use of medicinal animals and plants for glycaemic control and the treatment of complications from the disease. Conclusion: Parikweneh are appropriating T2D into their knowledge system and adapting their health system in response to this relatively new health concern. A greater understanding of local practices and perceptions relating to T2D among medical staff may therefore be beneficial for meeting patients' needs, providing greater autonomy in their health path, and improving treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: The work of the WHO Commission on the Social Determinants of Health has been fundamental to provide a conceptual framework of the social determinants of health. Based on this framework, this study assesses the relationship of income inequality as a determinant of neonatal mortality in the Americas and relates it to the achievement of the Sustainable Development Goal target 3.2 (reduce neonatal mortality to at least as low as 12 deaths per 1,000 live births). The rationale is to evaluate if income inequality may be considered a social factor that influences neonatal mortality in the Americas. Methods: Yearly data from 35 countries in the Americas during 2000–2019 was collected. Data sources include the United Nations Inter-agency Group for Child Mortality Estimation for the neonatal mortality rate (measured as neonatal deaths per 1,000 live births) and the United Nations University World Institute for Development Economics Research for the Gini index (measured in a scale from 0 to 100). This is an ecological study that employs a linear regression model that relates the neonatal mortality rate (dependent variable) to the Gini index (independent variable), while controlling for other factors that influence neonatal mortality. Coefficient estimates and their robust standard errors were obtained using panel data techniques. Results: A positive relationship between income inequality and neonatal mortality is found in countries in the Americas during the period studied. In particular, the analysis suggests that a unit increase in a country's Gini index during 2000–2019 is associated with a 0.27 (95% CI [− 0.04, 0.57], P =.09) increase in the neonatal mortality rate. Conclusion: The analysis suggests that income inequality may be positively associated with the neonatal mortality rate in the Americas. Nonetheless, given the modest magnitude of the estimates and Gini values and trends during 2000–2019, the findings suggest a potential limited scope for redistributive policies to support reductions in neonatal mortality in the region. Thus, policies and interventions that address higher coverage and quality of services provided by national health systems and reductions in socio-economic inequalities in health are of utmost importance. [ABSTRACT FROM AUTHOR]

Aim: To provide a summary of the available evidence concerning prevalence and risk factors of frailty in elderly patients with CHF. Methods: PubMed, Embase, Web of Science, CINAHL, The Cochrane Library, China National Knowledge Infrastructure Database (CNKI), Chinese Biomedical Database (Sinomed), Weipu Database (VIP), and Wanfang database were searched from inception to July 2023. This study strictly followed the PRISMA guidelines. The quality of the included studies was rated by the Agency for Healthcare and Research and Quality and the Newcastle–Ottawa Scale. Results: A total of 21 original studies were included, involving 4,797 patients. Meta-analysis results showed that the prevalence of frailty in older patients with heart failure was 38% (95%CI: 0.32–0.44). Age, cardiac function grading, left atrial diameter, left ventricular ejection fraction, hemoglobin, polypharmacy, BNP, nutritional risk, and hospitalization day are the influential factors of frailty in older patients with CHF. Conclusion: The prevalence of frailty in older patients with CHF is high, and clinical medical personnel should identify and intervene early to reduce or delay the frailty in older patients with CHF as much as possible. [ABSTRACT FROM AUTHOR]

To study the relationship between socioeconomic position (SEP) and adolescent substance use and explore the role of poor mental health in that relationship. Adolescents aged 11–15 years participated in the Health Behavior in School-aged Children survey in Armenia. Robust Poisson regression and counterfactual mediation analysis were used. In a pooled analysis with 6512 adolescents, the adjusted prevalences of current smoking (prevalence ratio [PR] = 1.93, 95%CI = 1.29–2.88), weekly beer (PR = 1.46, 95%CI = 1.07–2.01), spirits (PR = 1.54, 95%CI = 1.01–2.37) or lifetime cannabis use (PR = 3.10, 95%CI = 0.91–10.59) were greater in low-SEP adolescents compared to the middle-SEP group. Poor mental health explained 25.6%-54.7% of that relationship. Similarly, high-SEP adolescents had increased risks of current smoking (PR = 1.54, 95%CI = 0.98–2.42), weekly beer (PR = 1.55, 95%CI = 1.11–2.18), spirit (PR = 1.58, 95%CI = 1.02–2.45), wine (PR = 1.33 95%CI = 1.01–1.75) intake, than middle-SEP adolescents. Both low- and high-SEP adolescents in Armenia are at greater risk of substance use than the middle-income group. Poor mental health substantially contributes to substance use among low-SEP adolescents. Additional studies are needed to clarify the motives for substance use among high-SEP adolescents. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is a communicable disease that is a major cause of death and one of the leading causes of death worldwide. Currently, there is no analyzed data to examine the financial profile of TB by country, continent, and year; this article analyzed TB prevention, diagnosis, and treatment financial profile during the last two decades. Methods: Original research, reviews, and governmental databases are analyzed to present the financial profile of TB. Results: Analyzed data showed Europe (23137.133), Asia (20137.073), and Africa (15237.973) had the most allocated funds (US $ million), and Oceania (236.702), and America (4745.043) had the lowest allocated fund (US $ million) during 2006–2021. Additionally, the allocation of funds (domestic funds, global funds, and grants [excluding global funds]) in different countries and proper planning for TB eradication has caused that in the last two decades, the slope of the confirmed cases and deaths graph line is negative. Conclusion: The number of confirmed cases and deaths reported globally is decreasing. The trend lines showed that the assigned funds are increasing, indicating that the TB eradication plan can be apprehended soon. [ABSTRACT FROM AUTHOR]

Background: Although expanded access is an increasingly used pathway for patients to access investigational medicine, little is known on the magnitude and content of published scientific research collected via expanded access. Methods: We performed a review of all peer-reviewed expanded access publications between January 1, 2000 and January 1, 2022. We analyzed the publications for drugs, diseases, disease area, patient numbers, time, geographical location, subject, and research methodology (single center/multicenter, international/national, prospective/retrospective). We additionally analyzed endpoints reported in all COVID-19-related expanded access publications. Results: We screened 3810 articles and included 1231, describing 523 drugs for 354 diseases for 507,481 patients. The number of publications significantly increased over time ( p < 0.001 ). Large geographical disparities existed as Europe and the Americas accounted for 87.4% of all publications, whereas Africa only accounted for 0.6%. Oncology and hematology accounted for 53% of all publications. Twenty-nine percent of all expanded access patients (N = 197,187) reported on in 2020 and 2021 were treated in the context of COVID-19. Conclusions: By summarizing characteristics of patients, diseases, and research methods described in all scientific literature published on expanded access, we provide a unique dataset for future research. We show that published scientific research on expanded access has surged over the past decades, partly due to COVID-19. However, international collaboration and equity in geographic access remain an issue of concern. Lastly, we stress the need for harmonization of research legislation and guidance on the value of expanded access data within real-world data frameworks to improve equity in patient access and streamline future expanded access research. [ABSTRACT FROM AUTHOR]

Introduction: The World Health Organization identified health to be the most important social goal and the 1978 Declaration of Alma Ata placed primary health care central to its attainment and the UN Sustainable Development Goals (SDGs) as the template. The Astana Declaration called on a change of focus in primary care, from treatment of specific diseases to the prevention and inclusion of both scientific and traditional knowledge. Such objectives require public–private partnerships in providing health care, including traditional and complementary medicine systems such as naturopathy that align. However, there is limited understanding of global regulatory frameworks and officially recognized training for naturopathy. Materials and Methods: This descriptive study employs an adapted mixed-methods explanatory framework to examine naturopathy regulation and education. Analysis merges data arising from a descriptive policy analysis of regulation from 36 countries and survey analysis from 65 naturopathic organizations from 29 countries. Results: Four types of workforce regulation were identified within 107 countries where naturopathy was practiced—statutory registration or occupational licensing, coregulation, negative licensing, and voluntary certification. No form of naturopathic regulation was most common. Higher graduate/postgraduate education and access to a broader range of practices were more frequently reported in countries where naturopathy is statutory regulated. Government audits were more frequently reported where naturopathy was statutory regulated or coregulated. Discussion: Naturopathic philosophy and practice align with primary health care goals outlined in the Declaration of Astana. The naturopathic workforce represents an untapped health care resource with a demonstrated track record of translating these aspirational goals into practice. However, naturopathy remains inconsistently regulated globally, serving as a significant barrier to partnering with other health system actors to attain the health-related SDGs. Workforce regulation for the naturopathic profession offers increased standards, reduced risks, integrative health workforce planning, and assistance to countries toward achieving the promise of the Declaration of Astana. [ABSTRACT FROM AUTHOR]

Objective: Psychiatric disorders, such as depression and anxiety, can hinder academic performance among college-age individuals. Participants: Mental health among college students is a growing public health concern, with some scholars describing collegiate mental health as a crisis (Chen et al., Psychiatr Serv. 2019;70(6):442–449). Methods: This study analyzes data from four annual administrations of the American College Health Association (ACHA)'S NCHA (n = 117,430). Results: Overall, anxiety and depression were the most common conditions, at 9.2% and 8.7%, respectively. Of students reporting the focal symptom, 17.87% were treated for depression and 12.91% were treated for anxiety. Compared to not-treated students, diagnosed only students, had significantly lower grade averages, with effect sizes of −0.30 and −0.20 for depression and anxiety, respectively. Conclusions: Given the prevalence of depression and anxiety among college-aged students, continued research into help seeking behaviors and their effects on outcomes like grade average is an essential part of understanding the toll these disorders take. [ABSTRACT FROM AUTHOR]

The increase in the number of commercial flights highlights the need for air traffic to follow air procedures. Unfortunately, general aviation aircraft used for recreational purposes keep entering controlled and restricted airspace without obtaining permission from air traffic services. Given the safety and operational problems this could potentially cause, this paper examines the underlying reasons for these incidents occurring. In particular, it analyses airspace infringements between 2008 and 2017 involving general aviation flights that were recorded in airspace in which a large number of commercial flights also fly in Europe and America. The reports were analysed based on an initial assessment of their quality. Information was latent in the narrative and subsequently both qualitative (content analysis) and quantitative methods (descriptive statistics) of analysis were used. The analysis revealed that airspace infringements were related to the pilot's flight planning, that is, flight-route choice, navigation skills and communication, in addition to requirement to adhere to airspace procedure. The findings could be used by national authorities and flying clubs to promote safe flying in these regions. [ABSTRACT FROM AUTHOR]

Background: The Scottish Government introduced a free Baby Box scheme for all new parents in 2017, modelled on the Finnish scheme, to give every baby 'an equal start in life'. There is little evidence that it results in better health outcomes, but there has been limited research into different perspectives and discourses on such schemes. Methods: Four focus groups were conducted with 21 parents in North‐East Scotland. Recordings were transcribed verbatim, anonymized and analysed thematically with NVivo 12 software. Our thematic analysis was both inductive and deductive—remaining open to themes identified by participants themselves but also informed by the social policy literature on universalism and social cohesion. Results: Across all the focus groups, we found a high degree of positivity about the principle of the Baby Box scheme, and for the most part the practical value of the contents. This was remarkably consistent across different communities and backgrounds. There was little evidence of the strongly polarized views present in media reporting. Parents seemed considerably less focused than the media on safety and health outcomes, and more focused on practical, material and social impacts. They reported little in the way of feeling patronized or monitored by the government. Conclusion: Our findings have important implications for future economic evaluations of the baby box. Such evaluations should broaden the valuation space beyond health outcomes to allow for the value of feelings of inclusion, solidarity and being part of a community. Patient or Public Contribution: This small project was designed in response to parent views already collected in the early roll‐out of the Baby Box scheme in Scotland, about their priorities and responses to the scheme. Additional views were sought on the topic guide for the focus groups, and local community groups advised us on recruitment and the best timing and location for the focus groups to be held. The focus groups themselves were conducted as research, but with the intent of ensuring parent views featured more prominently in a debate that has been largely dominated by clinical and public health perspectives. [ABSTRACT FROM AUTHOR]

Objectives: Protein is a key macronutrient for preserving physical function, but the role of protein intake on functional status may differ in men and women. We sought to examine the associations of daily protein intake and distribution on functional limitations in older American men and women. Design: Cross-sectional. Setting: Population-based survey. Participants: The analytic sample included 3,976 men and 4,081 women aged ≥60-years from the 2007–2016 waves of the National Health and Nutrition Examination Survey. Measurements: Participants reported their ability to perform basic activities of daily living, instrumental activities of daily living, leisure and social activities, lower extremity mobility activities, and general physical tasks. Those reporting difficulty or an inability in completing such functional tasks were considered as having a functional limitation. Protein intake was determined with dietary recalls and participants revealed functional limitations. Protein recommendations of ≥0.80, ≥1.00, and ≥1.50 g/kg/day were used. Based on these cut-points, we also investigated distribution of protein across 4 eating occasions at ≥0.20, ≥0.25, and ≥0.38 g/kg/meal, respectively. Results: Older women meeting each recommendation had decreased odds for functional limitations: 0.55 (95% confidence interval (CI): 0.40–0.75) for ≥0.80 g/kg/day, 0.75 (CI: 0.58–0.97) for ≥1.00 g/kg/day, and 0.72 (CI: 0.55–0.94) for ≥1.5 g/kg/day. No significant associations were observed in older men. Further, older women with protein consumption ≥0.20 g/kg/meal had decreased odds for functional limitations: 0.24 (CI: 0.10–0.61) for 1 occasion, 0.20 (CI: 0.08–0.49) for 2 occasions, 0.16 (CI: 0.07–0.40) for 3 occasions, and 0.12 (CI: 0.04–0.32) for 4 occasions. A similar trend was observed for intake ≥0.25 g/kg/meal: 0.31 (CI: 0.16–0.62) for 2 occasions, 0.30 (CI: 0.14–0.61) for 3 occasions, and 0.31 (CI: 0.12–0.78) for 4 occasions. Women with 1 and 2 eating occasions at ≥0.38 g/kg/meal of protein had 0.66 (CI: 0.48–0.91) and 0.54 (CI: 0.37–0.79) decreased odds for functional limitations, respectively. Conclusion: Trials that are powered to detect the effects of protein on functional status in women will help to establish causality. [ABSTRACT FROM AUTHOR]

Background: American Student Placements and Internships in Rehabilitation Engineering is founded on the principal of sparking the interest in a new generation of rehabilitation engineering scientists to transform the lives of older adults and people with disabilities. Each year a minimum of 10 students were enrolled. Methods: The internship runs for 10 weeks and activities center on developing excitement about technology and engineering and understanding the principles and processes of conducting rehabilitation engineering research. This was accomplished by student participation in 1) rehabilitation engineering research projects; 2) educational research training, and 3) professional activities with clinical and engineering faculty, staff, and graduate students. Of the 162 participants, 53% were women and 47% men. 23% of participants were from minority or underrepresented groups, and 18% identified as having a disability. Results: From post-internship follow-up efforts, 65% of program participants went on to pursue or have graduated with advanced degrees, 27% of whom are engineers from underrepresented groups. Of those students that are working post-baccalaureate, 70% are engineers working in a biomedical/technology field. In the past 3 years, 92% of students stated that the program met or exceeded their expectations, while 100% of the 2018 group felt that their expectations were met. Conclusion: The American Student Placements and Internships in Rehabilitation Engineering program has demonstrated efficacy in preparing undergraduate students for future academic work and employment. Creative researchers and designers will lead the way in advancing accessibility standards and engineering for people with disabilities. The ASPIRE program increases excitement for and interest in the fields of rehabilitation engineering among undergraduate students to positively influence academic and professional careers. Students enrolled in the ASPIRE program actively participated in a real multidisciplinary project supervised by professor mentors. This led students to take a problem-based approach in their professional development. The ASPIRE program stimulates rehabilitation engineering in students' mindset and promotes inclusive academic environments and communities. Rehabilitation engineering is not a mainstream discipline, but the ASPIRE program indicates that there are benefits to student education, including participatory action engineering, that need to continue gain momentum until rehabilitation engineering is a mainstream discipline or a core component of engineering education. We must move beyond a "survival of the fittest" mentality. A "survival of the fittest" model places a disproportionate burden on groups that are underrepresented in science and engineering, and thereby postpones the day on which the demographics of science and engineering are comparable to that of society as a whole. The ASPIRE program needs to be replicated at various institutions around the world. [ABSTRACT FROM AUTHOR]

Introduction. Subclinical hypothyroidism during pregnancy can be associated with numerous adverse outcomes. The purpose of this study was to compare short-term adverse pregnancy outcomes in treated versus nontreated patients who fall within the numerical range of thyroid-stimulating hormone (TSH) between the Iranian and American reference ranges. Materials and Methods. Eighty pregnant women with a known level of antithyroid peroxidase (anti-TPO) and TSH levels of 2.5–3.9 mIu/L in the first trimester and 3–4.1 mIu/L in the second and third trimesters were enrolled in the study and randomly assigned into two groups including 41 patients in the intervention group and 39 in the control group. The intervention group was treated with levothyroxine at least 50 μg/day and the control group received no treatment. The data were analyzed by SPSS software version 23. Results. The only significant findings were a correlation between pregnancy loss frequency (p − 0.011) and/or increased TSH level in the follow-up period (p = 0.008) with anti-TPO antibody positivity. Forty-four percent of mothers with positive anti-TPO Ab needed treatment initiation with levothyroxine, based on Iranian guidelines, due to increased TSH level during the follow-up period. Conclusion. Untreated pregnant women with subclinical hypothyroidism, who were placed in the intermediate range of TSH, recommended by Iranian and American guidelines, did not show any significant difference in short-term adverse pregnancy outcomes compared to the treated patients. Positive anti-TPO Ab may play a role in the development of short-term complications in mothers with subclinical hypothyroidism or it may increase the likelihood of an increase in TSH level during pregnancy. [ABSTRACT FROM AUTHOR]

There are currently no studies examining healthcare access and utilization by Syrian Americans. A better understanding of the determinants of healthcare utilization among this group could help aid in the design of culturally competent programs. A self-administered survey was distributed at events across Southern California and Jacksonville, Florida from January 2018 to May 2019. Statistical analysis utilized multivariate regressions. Insurance coverage was associated with a preference for speaking Arabic (OR 0.433, p = 0.02) and increased length of residency (OR 1.04, p = 0.02). Routine checkup was associated with female sex (OR 1.97, p = 0.001), age (OR 1.05, p < 0.001), and insurance coverage (OR 6.96, p < 0.001). Colonoscopy compliance rate was 43.3% and positively associated with higher education (OR 2.70, p = 0.002), routine checkup (OR 7.61, p = 0.009) and increased length of residency (OR 1.06, p < 0.001). Syrian Americans may benefit from further health promotion campaigns with regard to insurance coverage, preventative care and cancer screenings. [ABSTRACT FROM AUTHOR]

Introduction: Low stress is one of many plausible mechanisms that may explain the health effects of educational attainment. However, Marginalization-related Diminished Returns (MDRs) refer to the weaker health effects of educational attainment for marginalized, compared to privileged, groups. We are unaware of any previous studies that have compared Asian and non-Hispanic White Americans for the effects of educational attainment on perceived economic stress. The aim was to compare Chinese and non-Hispanic White Americans for the association between educational attainment and perceived economic stress in a national sample of American adults. This is important given stress is a risk factor for poor health. Methods: This study analyzed cross-sectional data of 20,793 adults who participated in the National Health Interview Survey (NHIS 2015). From all participants, 403 individuals were Chinese Americans, and 20,390 were non-Hispanic Whites. Perceived economic stress was the outcome of interest. Years of education (educational attainment) was the predictor variable of interest. Gender, age, region, marital status, sexual orientation (i.e., lesbian, gay, bisexual, and transgender (LGBT)), and immigration status were covariates. Race/ethnicity was the effect modifier. Results: Overall, higher educational attainment was associated with lower levels of perceived economic stress. A statistically significant interaction showed that the effect of educational attainment on reducing perceived economic stress is smaller for Chinese Americans than Non-Hispanic Whites. Conclusion: Educational attainment is not similarly protective against perceived economic stress across all social groups. Thus, perceived economic stress may explain why ethnic minorities and immigrants gain decreased benefits from their educational attainment than the mainstream and privileged social group. [ABSTRACT FROM AUTHOR]

Background: The food truck industry has rapidly expanded in the United States and kitchen environments can contain harmful contaminants from cooking emissions. The objective of this study was to examine the levels of aldehydes, polycyclic aromatic hydrocarbons (PAHs), and Particulate Matter (PM)2.5 generated from cooking process in food trucks. Methods : Area sampling was performed twice at two participating food trucks during work shifts. Nine aldehydes and eighteeen PAHs were analyzed according to the relevant standard methods while PM2.5 was measured with a real time monitor. Ventilation performance of the food truck exhaust hoods was also investigated using a thermal anemometer. Findings : Formaldehyde was the only aldehyde detected in all samples with a concentration range of 7.16 to 53.68 µg/m3. No PAHs were detected above the limit of quantification. Average PM2.5 concentrations ranged from 0.65 to 7.03 mg/m3. Food Trucks 1 and 2 have an average exhaust flow rate of 211 and 215 L/s per linear meter of hood, respectively. Conclusions/Application to practice : Overall, Food Truck 2 had consistently higher levels of aldehydes and PM2.5 with comparable ventilation performance as Food Truck 1. The higher exposure levels of Food Truck 2 could possibly be attributed to a larger volume of food orders and the heavy duty cooking equipment with an exhaust flow rate below the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) recommendations. Although more investigations need to be performed, the findings could be used to raise awareness of food truck workers and health practitioners to reduce potential exposure risks. [ABSTRACT FROM AUTHOR]

In many contexts, individuals with lower socioeconomic status, especially immigrants, have a higher burden of negative alcohol-related consequences and a higher probability of receiving a psychiatric diagnosis. This study aimed at exploring sociodemographic and clinical characteristics associated with harmful use of alcohol (HUA) among immigrant patients. A cross-sectional study was conducted in Rome (Italy) on a sample of 330 immigrant patients admitted to the gastroenterology outpatient clinic of the INMP (March 2013–October 2014). HUA was evaluated through the Alcohol Use Disorders Identification Test (AUDIT) questionnaire. The presence of psychiatric disorders was diagnosed through SCID I–II interviews. The association between sociodemographic characteristics and psychiatric disorders and HUA was evaluated through a multivariate log-binomial regression model. HUA was associated with unemployment, longer stay in Italy, mood disorder and not being married, especially among African immigrants. We provide original findings about a selected, hard-to-investigate population, suggesting priorities in interventions on HUA among specific vulnerable subgroups. [ABSTRACT FROM AUTHOR]

Purpose: This article compares acoustic data of normally developing children from two dominant and one nondominant variety of English in order to determine phonetic proximity. Method: The study focuses on one variety of American English (AE), one British English (BE) variety, and one Jamaican English (JE) variety owing to the historical and sociopolitical influences of both dominant varieties on JE. The work examines the four corner vowels (/a/, /ɑ/, /u:/, and /i:/) of the specified varieties. Speech from children aged 8-11 years was processed to extract duration, intensity, and fundamental frequency as well as the first three formants (F1, F2, and F3) of each vowel. Results: Analysis of the acoustic variables showed, for the first time, that child-produced JE is phonetically closer to the variety of BE studied, than it is to the American variety. The acoustic properties of the child-produced JE vowels were found to be similar to those of adultproduced vowels, suggesting that, as has been shown for adult speech, there appears to be a limited impact of AE on JE. Conclusions: This is the first acoustic study of children's speech to show that, despite the proximity to BE, the Jamaican variety is clearly a distinct variety of English. As the first study comparing AE, BE, and JE, the article provides experimental evidence of the acoustic differences in the varieties and points to the implications for automatic speech recognition and educational applications for children who speak JE. [ABSTRACT FROM AUTHOR]

Recent decades have brought growing interest in understanding and measuring psychological well-being. Although multiple measures of well-being exist, most were developed with Western populations. The current study tested the factor structure of a Chinese translation of the engagement, perseverance, optimism, connectedness and happiness (EPOCH) Measure of Adolescent Well-Being with 3,629 Chinese students (1,980 males, 1,649 females), and tested measurement invariance. The five-factor structure of the model was supported, and the model was invariant across age and gender. Combined with data from 2,041 American and 1,057 Australian adolescents, measurement invariance across cultures was supported for factor loadings but not intercepts or residuals. Results suggest that the factor structure is adequate across cultures, but the mean scores should not be directly compared. The findings support the EPOCH measure as an adequate scale, raise questions about different modeling decisions, and inform culturally sensitive approaches to comparing positive psychological variables across cultures. [ABSTRACT FROM AUTHOR]

What is known and objective: The use of generic oral contraceptives (OCPs) can improve adherence and reduce healthcare costs, yet scepticism of generic drugs remains a barrier to generic OCP discussion and prescription. An educational web module was developed to reduce generic scepticism related to OCPs, improve knowledge of generic drugs and increase physician willingness to discuss and prescribe generic OCPs. Methods: A needs assessment was completed using in‐person focus groups at American College of Physicians (ACP) Annual Meeting and a survey targeting baseline generic scepticism. Insights gained were used to build an educational web module detailing barriers and benefits of generic OCP prescription. The module was disseminated via email to an ACP research panel who completed our baseline survey. Post‐module evaluation measured learner reaction, knowledge and intention to change behaviour along with generic scepticism. Results and discussion: The module had a response rate of 56% (n = 208/369). Individuals defined as generic sceptics at baseline were significantly less likely to complete our module compared to non‐sceptics (responders 9.6% vs non‐responders 16.8%, P = 0.04). The majority (85%, n = 17/20) of baseline sceptics were converted to non‐sceptics (P < 0.01) following completion of the module. Compared to non‐sceptics, post‐module generic sceptics reported less willingness to discuss (sceptic 33.3% vs non‐sceptic 71.5%, P < 0.01), but not less willingness to prescribe generic OCPs (sceptic 53.3% vs non‐sceptic 67.9%, P = 0.25). Non‐white physicians and international medical graduates (IMG) were more likely to be generic sceptics at baseline (non‐white 86.9% vs white 69.9%, P = 0.01, IMG 13.0% vs USMG 5.0% vs unknown 18.2%, P = 0.03) but were also more likely to report intention to prescribe generic OCPs as a result of the module (non‐white 78.7% vs white 57.3%, P < 0.01, IMG 76.1% vs USMG 50.3% vs unknown 77.3%, P = 0.03). What is new and conclusion: A brief educational web module can be used to promote prescribing of generic OCPs and reduce generic scepticism. [ABSTRACT FROM AUTHOR]

Background: There is a global demand for rehabilitation services but to date little attention has been paid to rehabilitation as part of the health agenda, especially in low- and middle-income countries. The objective of the scoping review was to get an overview of the needs and unmet needs for rehabilitation services described in the literature. Materials and methods: Electronic search was performed in PubMed and REHABDATA for studies published between 2000 and 2017. Results: Eighty-six articles met the inclusion criteria. Results revealed a profound need for rehabilitation among different user groups with non-communicable diseases and injuries across countries. However, this need considerably outstripped the provision of services, which left many people with substantial unmet needs for rehabilitation. The main reasons for the unmet needs for rehabilitation were the absence of or unequal geographical distribution of services within a country, lack of transportation, and unaffordability of the services. Conclusions: There are substantial unmet needs for rehabilitation and numerous barriers to accessing services. Efforts need to focus on building the capacity for rehabilitation research predominantly in low- and middle-income countries. The comprehensive data that this review provides is useful for raising awareness for the need of rehabilitation at policy level. There is a profound need for rehabilitation services due to the ageing population and growing prevalence of non-communicable diseases. This scoping review shows that the need for rehabilitation considerably outstrips the provision of services. There are substantial unmet needs for rehabilitation and numerous barriers to accessing services. Concerted global action to scale up quality rehabilitation services is needed, especially in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

BACKGROUND: The risk of heat-related illness and death may continue to increase in many locations as a consequence of climate change, but information on the effectiveness of policies to protect populations from the adverse effects of excessive heat is limited. In 2009, the National Athletic Trainers' Association Inter-Association Task Force (NATA-IATF) released guidelines to reduce exertional heat illness (EHI) among U.S. high school athletes participating in preseason sports activities, including preseason practice sessions for American football. A subset of state high school athletic associations have implemented state-mandated guidelines consistent with the 2009 NATA-IATF recommendations, but their effectiveness for reducing preseason EHI is unknown. OBJECTIVES: This study examines the association between the enactment of state high school athletic association-mandated NATA-IATF guidelines and the rate of EHI among high school students during preseason American football practice sessions. METHODS: We performed a quasi-experimental interrupted time-series study of EHI during high school American football practices in the 2005/2006-2016/2017 school years. We estimated state-level EHI rates using High School Reporting Information Online injury and athlete-exposure data, and used generalized estimating equations Poisson regression models to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) comparing state-years with and without mandated NATA-IATF guidelines. State-level covariates included state-year-specific average August temperatures, yearly deviations from each state's August average temperature across the study period, and school year. RESULTS: Data were available for 455 state-years from 48 states, including 32 state-years (7.0%) from 8 states when mandated guidelines consistent with the NATA-IATF recommendations were implemented. During an estimated 2,697,089 athlete-exposures, 190 EHIs were reported. Estimated preseason EHI rates were lower during state-years with versus without mandated guidelines (adjusted IRR=0:45, 95% CI: 0.23, 0.87). CONCLUSIONS: Our findings suggest that high school athletes would benefit from enactment of the 2009 NATA-IATF guidelines. Similar analyses of the effectiveness of other public health policies to reduce adverse health effects from ambient heat are warranted. [ABSTRACT FROM AUTHOR]

Introduction: This article describes an evaluation of MagNav, a speech-based, infrastructurefree indoor navigation system. The research was conducted in the Mall of America, the largest shoppingmall in theUnited States, toempirically investigate the impact ofmemory load on routeguidance performance. Method: Twelve participants who are blind and 12 age-matched sighted controls participated in the study. Comparisons are made for route-guidance performance between use of updated, real-time route instructions (system-aided condition) and a system-unaided (memory-based condition) where the same instructions were only provided in advance of route travel. The sighted controls (who navigated under typical visual perception but used the system for route guidance) represent a best case comparison benchmark with the blind participants who used the system. Results: Results across all three test measures provide compelling behavioral evidence that blind navigators receiving realtime verbal information from the MagNav system performed route travel faster (navigation time), more accurately (fewer errors in reaching the destination), and more confidently (fewer requests for bystander assistance) compared to conditions where the same route information was only available to them in advance of travel. In addition, no statistically reliable differences were observed for any measure in the system-aided conditions between the blind and sighted participants. Posttest survey results corroborate the empirical findings, further supporting the efficacy of the MagNav system. Discussion: This research provides compelling quantitative and qualitative evidence showing the utility of an infrastructure-free, lowmemory demand navigation system for supporting route guidance through complex indoor environments and supports the theory that functionally equivalent navigation performance is possible when access to real-time environmental information is available, irrespective of visual status. Implications for designers and practitioners: Findings provide insight for the importance of developers of accessible navigation systems to employ interfaces that minimize memory demands. [ABSTRACT FROM AUTHOR]

Objective To analyse the evolution and diffusion of health warnings on cigarette packs around the world, including tobacco industry attempts to block this diffusion. Methods We analysed tobacco industry documents and public sources to construct a database on the global evolution and diffusion of health warning labels from 1966 to 2012, and also analysed industry strategies. Results Health warning labels, especially labels with graphic elements, threaten the tobacco industry because they are a low-cost, effective measure to reduce smoking. Multinational tobacco companies did not object to voluntary innocuous warnings with ambiguous health messages, in part because they saw them as offering protection from lawsuits and local packaging regulations. The companies worked systematically at the international level to block or weaken warnings once stronger more specific warnings began to appear in the 1970s. Since 1985 in Iceland, the tobacco industry has been aware of the effectiveness of graphic health warning labels (GWHL). The industry launched an all-out attack in the early 1990s to prevent GHWLs, and was successful in delaying GHWLs internationally for nearly 10 years. Conclusions Beginning in 2005, as a result of the World Health Organisation Framework Convention on Tobacco Control (FCTC), GHWLs began to spread. Effective implementation of FCTC labelling provisions has stimulated diffusion of strong health warning labels despite industry opposition. [ABSTRACT FROM AUTHOR]

Narratives are a pervasive form of discourse and a rich source for exploring a range of language and cognitive skills. The limited research base to date suggests that narratives generated using aided communication may be structurally simple, and that features of cohesion and reference may be lacking. This study reports on the analysis of narratives generated in interactions involving aided communication in response to short, silent, video vignettes depicting events with unintended or unexpected consequences. Two measures were applied to the data: the Narrative Scoring Scheme and the Narrative Analysis Profile. A total of 15 participants who used aided communication interacted with three different communication partners (peers, parents, professionals) relaying narratives about three video events. Their narratives were evaluated with reference to narratives of 15 peers with typical development in response to the same short videos and to the narratives that were interpreted by their communication partners. Overall, the narratives generated using aided communication were shorter and less complete than those of the speaking peers, but they incorporated many similar elements. Topic maintenance and inclusion of scene-setting elements were consistent strengths. Communication partners offered rich interpretations of aided narratives. Relative to the aided narratives, these interpreted narratives were typically structurally more complete and cohesive and many incorporated more elaborated semantic content. The data reinforce the robust value of narratives in interaction and their potential for showcasing language and communication achievements in aided communication. [ABSTRACT FROM PUBLISHER]

Vocabulary learning reflects the language experiences of the child, both in typical and atypical development, although the vocabulary development of children who use aided communication may differ from children who use natural speech. This study compared the performance of children using aided communication with that of peers using natural speech on two measures of vocabulary knowledge: comprehension of graphic symbols and labeling of common objects. There were 92 participants not considered intellectually disabled in the aided group. The reference group consisted of 60 participants without known disorders. The comprehension task consisted of 63 items presented individually in each participant’s graphic system, together with four colored line drawings. Participants were required to indicate which drawing corresponded to the symbol. In the expressive labelling task, 20 common objects presented in drawings had to be named. Both groups indicated the correct drawing for most of the items in the comprehension tasks, with a small advantage for the reference group. The reference group named most objects quickly and accurately, demonstrating that the objects were common and easily named. The aided language group named the majority correctly and in addition used a variety of naming strategies; they required more time than the reference group. The results give insights into lexical processing in aided communication and may have implications for aided language intervention. [ABSTRACT FROM PUBLISHER]

Purpose: Little is known about the psychological well-being and social barriers among immigrant Chinese American breast cancer survivors. The aim of the present study was to explore the social needs and challenges of Chinese American immigrant breast cancer survivors. Method: This study used the expressive writing approach to explore the experiences among 27 Chinese American breast cancer survivors. The participants were recruited through community-based organizations in Southern California, most of whom were diagnosed at stages I and II (33 and 48%, respectively). Participants, on average, had been living in the USA for 19 years. Participants were asked to write three 20-min essays related to their experience with breast cancer (in 3 weeks). Participants' writings were coded with line-by-line analysis, and categories and themes were generated. Results: Emotion suppression, self-stigma, and perceived stigma about being a breast cancer survivor were reflected in the writings. Interpersonally, participants indicated their reluctance to disclose cancer diagnosis to family and friends and concerns about fulfilling multiple roles. Some of them also mentioned barriers of communicating with their husbands. Related to life in the USA, participants felt unfamiliar with the healthcare system and encountered language barriers. Conclusion: Counseling services addressing concerns about stigma and communication among family members may benefit patients' adjustments. Tailor-made information in Chinese about diagnosis and treatment for breast cancer and health insurance in the USA may also help patients go through the course of recovery. [ABSTRACT FROM AUTHOR]

Background Trends in disability among older Americans has declined since the 1980s. The study examines whether the trend continues to decline and whether educational disparities exist in the prevalence of functional limitations. Methods I used the 2000--2014 National Health Interview Survey and included adults aged ≥65 years. Functional limitations was measured by three outcomes: the need for help with activities of daily living (ADLs) or instrumental activities of daily living (IADLs) and physical function limitations. I used a set of logistic models to estimate the average annual change rate of functional limitations. I examined whether the annual rate of change differed by education, age group and sex. Results During 2000--2014, the annual increase rate of ADL limitations was 1.7% (P < 0.001) and was 2.0% (P < 0.001) for physical function limitations; IADL limitation did not change significantly. All subgroups experienced an increase in ADL and physical function limitations except for adults with a more than high school education. The lower-educated group had a higher proportion and a higher annual rate of increase in all outcomes. Increasing trends in chronic conditions may contribute to the increasing trend in functional limitations. Conclusions The study highlighted a large educational disparity in late-life disability among older Americans. [ABSTRACT FROM AUTHOR]

This study examined anxiety in preschool children within a South-African context. The parents and teachers of 101 South African children aged 2 to 6 years completed measures of children's anxiety-prone temperament (behavioral inhibition) and anxiety disorders symptoms. Parents and teachers of 59 children could be re-approached one year later, with the request to fill in both scales again, while parents at that time also completed a measure of parental overprotection. Results indicated that, compared with normative scores collected in Western countries, young South African children displayed relatively high levels of anxiety-proneness and anxiety disorders symptoms, although this cultural difference could only be demonstrated when using the parentreport data. Further, on both occasions there were substantial and positive correlations between children's behavioral inhibition and anxiety symptoms. Behavioral inhibition and anxiety symptoms, in particular when assessed by parent report, appeared to be fairly stable during the one-year period, and we found only tentative support for the idea that behavioral inhibition on time 1 increased the risk for anxiety symptoms on time 2. Finally, a cross-sectional analysis of the data collected on time 2 revealed a positive correlation between overprotection and children's anxiety symptoms as well as a marginally significant interaction of behavioral inhibition and overprotection on children's anxiety symptoms, indicating that in particular the combination of high behavioral inhibition and high overprotection tended to be associated with the highest anxiety levels. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate heavy drinking and social and health correlates in university students in low, middle income and emerging economy countries. Using anonymous questionnaires, data were collected in a cross-sectional survey of 17,590 undergraduate university students (mean age 20.8, SD 2.9) from 25 universities in 24 countries across Asia, Africa and the Americas. Overall, 71.6 % were non-drinkers, 17.1 % moderate and 11.3 % heavy alcohol drinkers (14.2 % in men and 9.2 % in women) in the past 2 weeks. In a multivariate logistic regression analysis, older age, poorer family background, living in a higher income country, weak beliefs in the importance of limiting alcohol use, higher country per capita alcohol consumption, other substance use (tobacco and illicit drug use), and poor life satisfaction was associated with heavy drinking. Addressing health beliefs and co-occurring addictive behaviors may be crucial in the prevention of heavy drinking in this population. [ABSTRACT FROM AUTHOR]

Aim: To examine the activities and concerns of critical care nurses and professional critical care nursing organizations around the world and to identify expectations held of nursing leaders and policy makers to help address their concerns. Background: This study is the fourth worldwide review of its type. Previous surveys were undertaken in 2001, 2005 and 2009. Methods: An online descriptive survey was emailed to 88 potential participants from countries with critical care nursing organizations or known critical care nursing leaders. Responses were downloaded into Survey Monkey™ (Version 22) and analysed by geographical region and income level. Results: Fifty ‐ nine respondents from 58 countries completed the questionnaire, of whom 43 had critical care nursing organizations established in their countries and 29 were members of the World Federation of Critical Care Nurses. The services provided by the organizations to be of most value were national conferences, website, professional representation, and practice standards and guidelines. Professional policies had been developed by some organizations on workforce, education and practice, while almost half provided their members with either a newsletter or journal. Collectively, the most important issues for critical care nurses were working conditions, provision of formal practice guidelines and competencies, staffing levels and access to quality education programmes. Conclusions: Important issues continue to challenge the specialty of critical care nursing as new developments, priorities, clinical issues and other global events and influences impact critical care nursing worldwide. Implications for Nursing and Health Policy: This study will help guide nursing leaders and policy makers to address the needs of critical care nurses and their patients. Collaborative approaches between the specialty, nursing leaders and health policy advisors will assist to inform appropriate change in areas recommended for further action. [ABSTRACT FROM AUTHOR]

Background: More than a decade of satellite observations offers global information about the trend and magnitude of human exposure to fine particulate matter (PM2.5). Objective: In this study, we developed improved global exposure estimates of ambient PM2.5 mass and trend using PM2.5 concentrations inferred from multiple satellite instruments. Methods: We combined three satellite-derived PM2.5 sources to produce global PM2.5 estimates at about 10 km × 10 km from 1998 through 2012. For each source, we related total column retrievals of aerosol optical depth to near-ground PM2.5 using the GEOS–Chem chemical transport model to represent local aerosol optical properties and vertical profiles. We collected 210 global groundbased PM2.5 observations from the literature to evaluate our satellite-based estimates with values measured in areas other than North America and Europe. Results: We estimated that global population-weighted ambient PM2.5 concentrations increased 0.55 μg/m3/year (95% CI: 0.43, 0.67) (2.1%/year; 95% CI: 1.6, 2.6) from 1998 through 2012. Increasing PM2.5 in some developing regions drove this global change, despite decreasing PM2.5 in some developed regions. The estimated proportion of the population of East Asia living above the World Health Organization (WHO) Interim Target-1 of 35 μg/m3 increased from 51% in 1998–2000 to 70% in 2010–2012. In contrast, the North American proportion above the WHO Air Quality Guideline of 10 μg/m3 fell from 62% in 1998–2000 to 19% in 2010–2012. We found significant agreement between satellite-derived estimates and ground-based measurements outside North America and Europe (r = 0.81; n = 210; slope = 0.68). The low bias in satellite-derived estimates suggests that true global concentrations could be even greater. Conclusions: Satellite observations provide insight into global long-term changes in ambient PM2.5 concentrations. Satellite-derived estimates and ground-based PM2.5 observations from this study are available for public use. [ABSTRACT FROM AUTHOR]

The Residential Environment Impact Survey (REIS) and the REIS-Short Form (REIS-SF), based on the Model of Human Occupation, are non-standardized, semi-structured assessments aimed at evaluating how a home influences the quality of life of the resident(s). Occupational therapy practitioners have used these instruments as consulting tools to formulate and implement recommendations to improve residents' occupational functioning. Using a faculty-practitioner collaboration framework, international REIS and REIS-SF users were surveyed to elicit feedback regarding how these tools are being used, and how they can be improved. Survey results were analyzed and will be used to further develop these instruments to better meet the needs of practitioners. [ABSTRACT FROM AUTHOR]