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Background: In many Westernised countries, children do not consume a sufficient amount of vegetables for optimal health and development. Child-feeding guidelines have been produced to address this, but often only promote offering vegetables at midday/evening meals and snack times. With guidance having limited success in increasing children's vegetable intake at a population level, novel approaches to address this must be developed. Offering vegetables to children at breakfast time in nursery/kindergarten settings has the potential to increase children's overall daily vegetable consumption as children typically attend nursery/kindergarten and many routinely eat breakfast there. However, the feasibility and acceptability of this intervention (Veggie Brek) to children and nursery staff has not been investigated. Methods: A feasibility and acceptability cluster randomised controlled trial (RCT) was undertaken in eight UK nurseries. All nurseries engaged in one-week baseline and follow-up phases before and after an intervention/control period. Staff in intervention nurseries offered three raw carrot batons and three cucumber sticks alongside children's main breakfast food each day for three weeks. Control nurseries offered children their usual breakfast. Feasibility was assessed by recruitment data and nursery staff's ability to follow the trial protocol. Acceptability was assessed by children's willingness to eat the vegetables at breakfast time. All primary outcomes were assessed against traffic-light progression criteria. Staff preference for collecting data via photographs versus using paper was also assessed. Further views about the intervention were obtained through semi-structured interviews with nursery staff. Results: The recruitment of parents/caregivers willing to provide consent for eligible children was acceptable at 67.8% (within the amber stop–go criterion) with 351 children taking part across eight nurseries. Both the feasibility and acceptability of the intervention to nursery staff and the willingness of children to consume the vegetables met the green stop–go criteria, with children eating some part of the vegetables in 62.4% (745/1194) of instances where vegetables were offered. Additionally, staff preferred reporting data using paper compared to taking photographs. Conclusions: Offering vegetables to children at breakfast time in nursery/kindergarten settings is feasible and acceptable to children and nursery staff. A full intervention evaluation should be explored via a definitive RCT. Trial registration: NCT05217550. [ABSTRACT FROM AUTHOR]

Background: Family caregivers (FCs) encounter a variety of health problems in older people with chronic illness, necessitating a certain level of health literacy to access, understand, appraise and apply health information and services. This study aimed to develop and validate a scale for measuring health literacy among FCs of older people with chronic illness. Methods: Concept mapping was first employed to develop a conceptual model of health literacy of FCs. Scale domains were derived from the conceptual model, and item generation was performed using deductive and inductive methods. Quantitative methods, including merging scale dimensions and items, expert reviews, cognitive interviews, and item reduction analysis, were used to refine the scale. Confirmatory factor analysis was employed to validate the scale's structure. Concurrent validity, internal consistency, and test-retest reliability were also examined. Results: A 20-dimension conceptual model was developed, and 60 items were generated for the scale. Expert review (content validity index > 0.85) and cognitive interview with FCs confirmed the relevance and clarity of the majority of the generated scale items. Confirmatory factor analysis with 451 FCs of older people with chronic illness supported a 5-factor structure (symptom management, daily personal care and household tasks, care coordination, communication and relationship with the care recipient, and self-care of caregivers) with 42 finalized scale items, including four levels of health literacy skills (accessing, understanding, appraising and applying health information). Concurrent validity with the European Health Literacy Questionnaire (HLS-EU-Q47) was satisfactory (r = 0.67, p < 0.01). The Cronbach's α coefficient of the scale was 0.96, with subscales ranging from 0.84 to 0.91. The two-week test-retest reliability was 0.77 (p < 0.01). Conclusion: This study developed a conceptual model explaining the concept and factors of health literacy among FCs of older people with chronic illness that could provide the groundwork for future studies in developing relevant evidence-based interventions. A new Health Literacy Scale-Family Caregiver (HLS-FC) with satisfactory psychometric properties was developed in this study, which can be utilized to identify caregivers with insufficient health literacy and facilitate timely interventions by healthcare professionals. [ABSTRACT FROM AUTHOR]

Background: Public assistance recipients have diverse and complex needs for health and social support in addition to financial support. Segmentation, which means dividing the population into subgroups (segments) with similar sociodemographic characteristics, is a useful approach for allocating support resources to the targeted segments. Clustering is a commonly used statistical method of segmentation in a data-driven marketing approach. This explanatory sequential mixed methods study applied a clustering technique, aiming to identify segments among older public assistance recipients quantitatively, and assess the meaningfulness of the identified segments in consultation and support activities for older recipients qualitatively. Methods: We identified the segments of older recipients in two municipalities using probabilistic latent semantic analysis, a machine learning-based soft clustering method. Semi-structured interviews were subsequently conducted with caseworkers to ask whether the identified segments could be meaningful for them in practice and to provide a reason if they could not think of any older recipients from the segment. Results: A total of 3,165 older people on public assistance were included in the analysis. Five distinct segments of older recipients were identified for each sex from 1,483 men and 1,682 women. The qualitative findings suggested most of identified segments reflected older recipients in practice, especially two of them: female Cluster 1 (facility residents aged over 85 years with disability/psychiatric disorder), and female Cluster 2 (workers). Some caseworkers, however, did not recall older recipients in practice when working with certain segments. Conclusions: A clustering technique can be useful to identify the meaningful segments among older recipients and can potentially discover previously unrecognized segments that may not emerge through regular consultation practices followed by caseworkers. Future research should investigate whether tailored support interventions for these identified segments are effective. [ABSTRACT FROM AUTHOR]

Background : Chronic renal disease is considered a main public health problem due to its high prevalence in the population. The solution of choice currently available is kidney transplantation but when this option is not available, blood purification treatments, notably haemodialysis (HD), are necessary. The presence of chronic renal disease combined with this demanding medical procedure leads to a hard symptomatology. To face this situation, HD patients often resort to complementary and alternative medicines (CAM) as they perceive that the healthcare professionals aren't paying enough attention to their quality of life. Given this background, we aim to describe the prevalence and the type of the CAM used among HD patients and their possible relations with patients' symptomatology and quality of life. Methods: We interviewed 88 patients, undergoing hemodialysis in three hemodialysis centers in French-speaking Switzerland, about the presence of symptoms, their quality of life, and the possible use of CAM. Cluster analysis was used to create patients' profiles about CAM use and regression analysis to explore the links between symptoms' presence, patients' quality of life, and CAM use. Results: Our results show a large use of CAM: almost two HD patients out of three uses at least one CAM. Using cluster analysis, we were able to identify five patients' profiles: non-users (37.5% of our sample), users of herbal medicine (20.5%), users of prayer-based practices (18.2%), people mainly using massages (9.1%), and a residual group including the users of other CAMs, with a predominance of meditation (14.8%). As expected, we observe a negative relation between the number of declared symptoms and patients' quality of life. Contrarily, we observe no relation between the use of CAM and the presence of symptoms. Our results show a positive relationship between the use of CAM and patients' overall perception of health as well as the psychological dimension of their quality of life. No relationship is observed with other dimensions of quality of life, notably the physical dimension. Conclusions: Our results suggests that CAMs aren't used as a substitute of official medicine but as a parallel support to HD patients' quality of life. [ABSTRACT FROM AUTHOR]

Background: Ethiopia, sub-Saharan Africa's second most populous country has seen improvements in women's reproductive health. The study objectives are (1) using mixed methods research, to identify determinants of contraceptive use in four regions of Ethiopia, and (2) to explore the relationship between social norms, gender equitable norms, couple communication and contraceptive use. Methods: The study includes both quantitative and qualitative methods. Researchers interviewed a total of 2770 women of reproductive age (15–49 years) in 2016 using a structured survey covering six health areas. Eligible households were identified using a multi-stage cluster-sampling technique. Using probability proportionate to size sampling, the researchers selected 10% of the proposed target woredas (24 of 240 woredas). The qualitative study included 8 rapid assessments, 16 in-depth interviews, 24 key informant interviews, and 16 focus group discussions. Qualitative data were analyzed using NVivo version 8. Results: Adjusted odds ratios were estimated for current modern family planning use among married women with logistic regression. The primary influencing factors for contraceptive use are gender equitable norms, high self-efficacy, and weekly exposure to the radio. Qualitative data indicate that the timing of contraceptive use is linked to the social norm of the desired family size of 4–5 children. Gender inequity is evident in couple communication with men controlling decision making even if women initiated conversations on family planning. A key finding based on an inductive analysis of qualitative data indicates that the micro-processes of couple communication and decision making are often dictated by male advantage. The study identified six micro-processes that lead to gender inequity which need to be further examined and researched. Conclusions: Barriers to contraceptive use include unequal couple communication and compromised decision making. Inequitable gender norms are also barriers to modern contraceptive use. The study recommends using a gender lens to study couple communication and decision making, with the goal of making both processes more equitable to accelerate the adoption of modern family planning methods in Ethiopia. Plain Language summary: A reproductive health study involving mixed quantitative and qualitative methods was conducted in Ethiopia in 2016–2017. The overall objectives of the study are (1) to use mixed methods research to identify determinants of contraceptive use in four regions of Ethiopia, and (2) to explore the relationship between social norms, gender equitable norms, couple communication, and contraceptive use. The survey identified gender inequitable norms as a major barrier to contraceptive use. The qualitative study further examined the gender dimension and the interlinkages between gender norms, couple communication, and decision making for contraceptive use. Data showed that gender norms related to the daily living dimension of the gender equitable men (GEM) scale are significantly associated with current contraceptive use. The qualitative component provides us with in-depth data on the daily experiences of rural Ethiopian women in the context of modern contraceptive use. We learned that social norms related to the desired number of children and the timing of first contraceptive use are interlinked. Specifically, both women and men told us that most couples do not use contraceptives until their family size is complete, after 4–5 children. Similarly, couples who opt for 2 or fewer children are termed "selfish" and "not interested in children." Couple communication occurs within the context of decision making where men's decisions are usually accepted, and women's decisions are often deferred or rejected. Programs should promote respect for women's decision-making abilities and equitable couple communication. Notably, this study finds that microprocesses of couple communication and decision making are gendered, featuring female disadvantage. Further research is required on these microprocesses of gendered couple communication. [ABSTRACT FROM AUTHOR]

Background: Mushrooms are important forest resources, mostly as food, despite the serious health threat posed by toxic species. In the Highlands of Chiapas, numerous wild mushroom intoxications have been registered. While Chiapas has been vastly studied from an ethnomycological perspective, no certainty exists as to how nomenclature systems differentiate edible and toxic species, which species are most culturally significant, and whether sociodemographic factors relate to how well-known they are in the Highlands of Chiapas. This paper evaluates which are the most culturally significant edible and toxic wild mushroom species in seven Tsotsil communities from this region and whether differences exist in their knowledge relating to different sociodemographic subsets (gender, schooling, and occupation). The hypothesis that there is a difference in the number of species that people mention, as well as the number of times each ethno-taxon is mentioned, between people from different social groups was tested. Methods: With consent, 133 Tsotsil people from seven communities were interviewed. Interviews focused on local systematics and free listings of edible and toxic mushrooms. Qualitative and quantitative analyses were performed, including multivariate methods and non-parametric statistics. Results: Twenty-five edible and 15 toxic taxa were mentioned. Some directly correspond to Linneanean species, while others are subdifferentiated or supradifferentiated. Only 62% of the interviewees named toxic mushrooms. The most frequently mentioned edible taxa were Amanita hayalyuy and A. jacksoniii, Agaricus spp., and Armillaria mellea. The most frequently mentioned toxic species were Amanita muscaria, Suillellus luridus, and Russula emetica. Significant differences in the number of mentioned edible ethnotaxa were found only among different occupations and schooling. The models including schooling interacting with either gender or occupation are better supported. Significant differences in the number of times toxic ethnotaxa are mentioned were found only between men and women. Conclusions: The Tsotsil region of the Highlands of Chiapas is where the most average mushroom species are recognized state-wide. Schooling and occupation seem most determinant for people to know more or less species of mushrooms, while gender appears irrelevant. People with no studies and field-related occupations name more species. Identification criteria to distinguish edible from toxic species seem to rest not on detailed recognition of the second set but precise knowledge of the first. [ABSTRACT FROM AUTHOR]

Background: Ethnic groups throughout the world have developed their own cultures expressed in the form of customs, taboos, and traditional healthcare systems. Traditional medicine system is one of the widespread cultures known throughout the world which is very much tied to cultural practices of the community or ethnic group. Medicinal plant treasure found in Gurage and Silti zones remained poorly characterized and understood. Therefore, this study was conducted in four ethnic groups: three from Gurage zone (Gurage, Qebena, and Mareqo) and one from Silti zone (Silti) which have lived in close proximity and contact for many centuries in the respective zones. In the present study, unique and shared cultural elements in connection to traditional herbal medicine were examined through investigation of the diversity of medicinal plants. Moreover, attempts have been made to determine similarities among the society in the medicinal plants they have used in general and in medicinal plant species considered culturally most important. Methods: In a study that involved 320 randomly sampled informants, semi-structured interviews, focus group discussions, and participant observation were used and qualitative and quantitative data were collected. Descriptive statistics, rank order priority (ROP), informant consensus factor, Jaccard similarity coefficient, and clustering were used for data analysis. Results: A total of 244 medicinal plant species and a fungal species used to treat human and/or livestock ailments were documented. The number of plants (80 plants, 33 %) with ROP value greater than 50% were considerably fewer than that of plants with ROP < 50% (164, 67 %). Jaccard similarity index and clustering analysis for all cited plants, among the respective studied districts, indicated that grouping generally followed the existing ethnic origin. On the contrary, clustering based on culturally important medicinal plant species (80 plant species, score ROP ≥ 50%) showed the influence of proximity and geographical orientation rather than ethnic relation. Conclusions: Culturally, most important plants (80 spp.) are widely used and best shared with nearby communities and this could imply current (new) knowledge being practiced in the communities. This knowledge must be documented and better utilized in a modern way including modernized use of traditional medicinal plants. [ABSTRACT FROM AUTHOR]

Background There is scarce information available on oral health service utilization patterns and common oral hygiene practices among adult Nigerians. We conducted the 2010-2011 national oral health survey before the introduction of the national oral health policy to determine the prevalence of oral health service utilization, patterns of oral hygiene practices, and self reported oral health status, among adults in various social classes, educational strata, ethnic groups and geopolitical zones in Nigeria. Methods We conducted a cross-sectional survey in North-Central, North-West, South-East, South- South and South-West geopolitical zones of Nigeria. Multi-stage cluster sampling method was used for the sample selection. We administered a structured questionnaire to a total of 7,630 participants. Information on the socio-demographic characteristics, oral hygiene practices and oral health services utilization pattern of participants was obtained. Results We interviewed 7, 630 participants (55.6% female). The participants ages ranged between 18 and 81 years, mean age was 37.96 (SD = 13.2). Overall 21.2% of the participants rated their oral health status as very good, 37.1% as good and 27.4% as fair. Only 26.4% reported having visited the dentist at least once prior to the conduct of the survey. More than half of these visits (54.9%) were for treatment purpose. Utilization of oral health services was significantly (p < 0.05) associated with being older, more educated and being engaged in a skilled profession. More educated persons, females and younger persons used toothbrushes for daily tooth cleaning. Age, sex, marital status, level of education and occupation were significantly related to daily frequency of tooth cleaning (p < 0.05). Conclusion Our results show that while most Nigerian adults have a positive view of their oral health status, majority reported poor oral health utilization habits. Older persons resident in the northern zones of the country and less educated persons displayed poorer oral hygiene practices. The study findings suggest that there is low oral health service utilization among adult Nigerians and that socio-demographic variables influence oral health utilization habits and oral hygiene behavior among adult Nigerians Further studies to identify other factors influencing oral health behavior are suggested. [ABSTRACT FROM AUTHOR]