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Background: Childhood malnutrition is a major public health issue in Sub-Saharan Africa (SSA) and 61.4 million children under the age of five years in the region are stunted. Although insight from existing studies suggests plausible pathways between ambient air pollution exposure and stunting, there are limited studies on the effect of different ambient air pollutants on stunting among children., Objective: Explore the effect of early-life environmental exposures on stunting among children under the age of five years., Methods: In this study, we used pooled health and population data from 33 countries in SSA between 2006 and 2019 and environmental data from the Atmospheric Composition Analysis Group and NASA's GIOVANNI platform. We estimated the association between early-life environmental exposures and stunting in three exposure periods - in-utero (during pregnancy), post-utero (after pregnancy to current age) and cumulative (from pregnancy to current age), using Bayesian hierarchical modelling. We also visualise the likelihood of stunting among children based on their region of residence using Bayesian hierarchical modelling., Results: The findings show that 33.6% of sampled children were stunted. In-utero PM2.5 was associated with a higher likelihood of stunting (OR = 1.038, CrI = 1.002-1.075). Early-life exposures to nitrogen dioxide and sulphate were robustly associated with stunting among children. The findings also show spatial variation in a high and low likelihood of stunting based on a region of residence., Impact Statement: This study explores the effect of early-life environmental exposures on child growth or stunting among sub-Saharan African children. The study focuses on three exposure windows - pregnancy, after birth and cumulative exposure during pregnancy and after birth. The study also employs spatial analysis to assess the spatial burden of stunted growth in relation to environmental exposures and socioeconomic factors. The findings suggest major air pollutants are associated with stunted growth among children in sub-Saharan Africa., (© 2023. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Background: The caregiving scholarship widely acknowledges informal caregivers' contributions to maintaining older adults' health and well-being. However, informal caregivers encounter economic, physical, social, financial and psychological challenges when caring for older adults. The caregiving literature has shown variations in caregiving intensity and motivation between rural and urban informal caregivers of older adults. This situation is likely to result in rural-urban disparities in caregiver burden. However, the literature on predictors of caregiver burden is more focused on demographic, socio-economic, caregiving and health-related factors with very little attention to geographical dynamics. For this reason, the effects of demographic, socio-economic, caregiving, and health-related factors on the variations in caregiver burden between rural and urban informal caregivers of older adults are yet to be known in the sub-Saharan African context, including Ghana. Notably, the impact of geographical location on caregiver burden is mainly missing in the informal caregiving literature in Ghana. Situated within the stress process model, we determine the association between geographical location and caregiver burden among informal caregivers of older adults in Ghana., Methods: This study employed data from a large cross-sectional survey on informal caregiving, health, and healthcare among caregivers of older adults aged 50 years or above (N = 1,853) in Ghana. We selected the World Health Organization Impact of Caregiving Scale to measure caregiver burden. Generalized multivariable linear regression models were employed to determine the association between geographical location and caregiver burden among informal caregivers of older adults. We reported beta values and standard errors with significance levels of 0.05 or less., Results: The results showed that rural informal caregivers of older adults significantly have a decreased caregiver burden compared to urban informal caregivers (β = -1.64; SE = 0.41). Also, participants across all the self-rated health categories (poor/very poor: β = 12.63; SE = 1.65; fair: β = 9.56; SE = 1.07; good: β = 11.00; SE = 0.61, very good: β = 7.03; SE = 0.49) have a significantly increased caregiver burden for the full sample and for both rural (poor/very poor: β = 13.88; SE = 2.4; fair: β = 6.11; SE = 1.62; good: β = 9.97; SE = 0.96, very good: β = 6.06; SE = 0.71) and urban (poor/very poor: β = 11.86; SE = 2.25; fair: β = 12.33; SE = 1.42; good: β = 11.80; SE = 0.79, very good: β = 7.90; SE = 0.67) participants. This study further revealed that participants with no financial support needs reported a decreased caregiver burden compared to those with financial support needs for the full sample (β = -2.92, p-value < 0.01) and for both rural (β = -3.20; p-value < 0.01) and urban (β =-2.70; p-value < 0.01) participants., Conclusion: The findings from this study underscore geographical location differences in caregiver burden among informal caregivers of older adults in Ghana. Given these findings, the need to consider geographical location variations in providing welfare and health support programs to lessen caregiver burden among informal caregivers of older adults is welcomed. In line with the stress process model, such welfare and health programs should consider background, context, and stressor factors that contribute to variations in caregiver burden between rural and urban informal caregivers of older adults in Ghana and other sub-Saharan African countries., (© 2024. The Author(s).)

The impact of building morphology on building energy consumption has been extensively studied. However, research on how 3D building morphology affects energy consumption at a macroscopic scale is lacking. In this study, we measured the mean building height (BH), mean building volume (BV), and mean European nearest neighbor distance (MENN) of the city to quantify the 3D building morphology. We then used a spatial regression model to analyze the quantitative impact of urban 3D building morphology on per capita electricity consumption (PCEC). Results indicate that at the macroscopic scale of the city, the BH and the MENN have a significant positive impact on the PCEC, while the BV has a significant negative impact on the PCEC. Moreover, the inclusion of the 3D building morphology greatly improves the model's ability to explain building energy efficiency, surpassing the impact of traditional economic factors. Considering the 3D building morphology indicators together, buildings with a lower height, a larger volume, and a more compact 3D morphology have greater potential for energy savings and are more conducive to electricity conservation. This study offers valuable insights for the energy-efficient arrangement of buildings., (© 2024. The Author(s).)

The increasing number of older adult migrants is rapidly changing regional demographic and social structures in China. There is an urgent need to understand the spatial patterns and factors that influence older adults to migrate, especially the role of environmental health. However, this issue has been under-studied. This study focused on intra-provincial and inter-provincial older adult migrants as research subjects, estimated their spatial concentration index based on the iterative proportional fitting approach, and explored the factors influencing their migration using the GeoDetector Model. The results showed the following: (1) In 2015, more than 76% of inter-provincial older adult migrants were distributed in Eastern China, and most intra-provincial older adult migrants were scattered in sub-provincial cities. (2) Compared to factors relating to economy and amenities, environmental health by itself played a relatively weak role in the migration of older adults, but the interaction among environmental health, economy, and amenities was a key driving force of older adult migration. (3) There were significant differences in the dominant environmental health factors between inter-provincial migration and intra-provincial migration, which were temperature and altitude, respectively. Our findings can help policymakers focus on the composition of older adult migrants based on urban environmental health characteristics and rationally optimize older adult care facilities to promote supply-demand matching., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Wang, Gao, Liu, Wang and Rosenberg.)

Background: Similar to many developing countries, caregiver burden remains high in Ghana which may affect informal caregivers of older adults' health-related quality of life (HRQoL). However, no study has examined the association between caregiver burden and HRQoL among informal caregivers of older adults in Ghana to date. Understanding this association may well help to inform health and social policy measures to improve HRQoL among  informal caregivers of older adults in Ghana. Situated within a conceptual model of HRQoL, the purpose of this study was to examine the relationship  between caregiver burden and HRQoL among informal caregivers of older adults in Ghana., Methods: We obtained cross-sectional data from informal caregiving, health, and healthcare (N = 1853) survey conducted between July and September 2022 among caregivers (≥ 18 years) of older adults (≥ 50 years) in the Ashanti Region of Ghana. The World Health Organization Impact of Caregiving Scale was used to measure caregiver burden. An 8-item short form Health Survey scale developed by the RAND Corporation and the Medical Outcomes Study was used to measure HRQoL. Generalized Linear Models were employed to estimate the association between caregiver burden and HRQoL. Beta values and standard errors were reported with a significance level of  0.05 or less., Results: The mean age of the informal caregivers was 39.15 years and that of the care recipients was 75.08 years. In our final model, the results showed that caregiver burden was negatively associated with HRQoL (β = - .286, SE = .0123, p value = 0.001). In line with the conceptual model of HRQoL, we also found that socio-economic, cultural, demographic and healthcare factors were significantly associated with HRQoL. For instance, participants with no formal education (β = -1.204, SE= .4085, p value = 0.01), those with primary level of education (β = -2.390, SE= .5099, p value = 0.001) or junior high school education (β = -1.113, SE= .3903, p value= 0.01) had a significantly decreased HRQoL compared to those with tertiary level of education. Participants who were between the ages of 18-24 (β = 2.960, SE= .6306, p value=0.001), 25-34 (β = 1.728, SE= .5794, p value = 0.01) or 35-44 (β = 1.604, SE= .5764, p value= 0.01) years significantly had increased HRQoL compared to those who were 65 years or above. Also, participants who did not utilize healthcare services in the past year before the survey significantly had increased HRQoL compared to those who utilized healthcare services five or more times in the past year (β = 4.786, SE=. 4610, p value= 0.001)., Conclusion: Consistent with our hypothesis, this study reported a significant negative association between caregiver burden and HRQoL. Our findings partially  support the conceptual model of HRQoL used in this study. We recommend that health and social policy measures to improve HRQoL among  informal caregivers of older adults should consider caregiver burden as well as other significant socio-economic, cultural, demographic, and healthcare factors., (© 2024. The Author(s).)

Background: Existing global evidence suggests that informal caregivers prioritize the health (care) of their care recipients (older adults) over their own health (care) resulting in sub-optimal health outcomes among this population group. However, data on what factors are associated with healthcare utilization among informal caregivers of older adults are not known in a sub-Saharan African context. Guided by the Health Belief Model (HBM), the principal objective of this study was to examine the association between the dimensions of the HBM and healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana., Methods: Data were extracted from a large cross-sectional study of informal caregiving, health, and healthcare survey among caregivers of older adults aged 50 years or above (N = 1,853; mean age of caregivers = 39.15 years; and mean age of care recipients = 75.08 years) in the Ashanti Region of Ghana. Poisson regression models were used to estimate the association between the dimensions of the HBM and healthcare utilization among informal caregivers of older adults. Statistical significance of the test was set at a probability level of 0.05 or less., Results: The results showed that 72.9% (n = 1351) of the participants were females, 56.7% (n = 1051) were urban informal caregivers and 28.6% (n = 530)  had no formal education. The results further showed that 49.4% (n = 916) of the participants utilized healthcare for their health problems at least once in the past year before the survey. The final analysis showed a positive and statistically significant association between perceived susceptibility to a health problem (β = 0.054, IRR = 1.056, 95% CI = [1.041-1.071]), cues to action (β = 0.076, IRR = 1.079, 95% CI = [1.044-1.114]), self-efficacy (β = 0.042, IRR = 1.043, 95% CI = [1.013-1.074]) and healthcare utilization among informal caregivers of older adults. The study further revealed a negative and statistically significant association between perceived severity of a health problem and healthcare utilization (β= - 0.040, IRR = 0.961, 95% CI= [0.947-0.975]) among informal caregivers of older adults. The results again showed that non-enrollment in a health insurance scheme (β= - 0.174, IRR = 0.841, 95% CI= [0.774-0.913]) and being unemployed (β= - 0.088, IRR = 0.916, 95% CI= [0.850-0.986]) were statistically significantly associated with a lower log count of healthcare utilization among informal caregivers of older adults., Conclusion: The findings of this study to a large extent support the dimensions of the HBM in explaining healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana. Although all the dimensions of the HBM were significantly associated with healthcare utilization in Model 1, perceived barriers to care-seeking and perceived benefits of care-seeking were no longer statistically significant after controlling for demographic, socio-economic and health-related variables in the final model. The findings further suggest that the dimensions of the HBM as well as demographic, socio-economic and health-related factors contribute to unequal healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Hand, foot, and mouth disease (HFMD) is a public health issue in Hubei and studies of- spatiotemporal clustering at a fine scale are limited. The purpose of this research was to analyze the epidemiological characteristics, temporal variation characteristics, and spatiotemporal clustering of HFMD cases at the town level from 2009 to 2019 to improve public health outcomes., Methods: Mathematical statistics, a seasonal index, wavelet analysis, and spatiotemporal scans were used to analyze epidemiological characteristics, time series trends, and spatiotemporal clusters of HFMD in Hubei., Results: EV-A71 (Enterovirus A71) and CVA16 (Coxsackievirus A16) constitute the two primary pathogens of the HFMD epidemic in Hubei, among which EV-A71 is the dominant pathogen, especially in 2016. In terms of age distribution, a major peak occurred at 0-5 years and a very small increase appeared at 25-35 years, with the former having a higher incidence among males than females and the latter having the opposite difference between males and females. The number/rate of HFMD cases exhibited a considerable increase followed by a moderate decline from 2009 to 2019, with the first large peak in April-July and a smaller peak in November-December. HFMD in Hubei exhibited the characteristics of a 270-day cycle with multiscale nesting, which was similar to the periodicity of HFMD cases caused by EV-A71 (9 months). Cities with a higher incidence of HFMD formed a part of an "A-shaped urban skeleton". Subdistricts had the highest incidence of HFMD, followed by towns and villages. The spatiotemporal scan results showed one most likely cluster and 22 secondary clusters, which was consistent with the geographic location of railways and rivers in Hubei., Conclusions: These findings may be helpful in the prevention and control of HFMD transmission and in implementing effective measures in Hubei Province., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective(s): To understand how community as 'enabling places' is experienced by older people and brings about enabling resources for supporting ageing in community (AIC)., Methods: From a health geographical perspective, we conceptualize community as enabling places that are produced by the interaction of material, social, and symbolic resources. Focusing on a community-based care centre (CBCC) in Beijing, China, we conducted semi-structured interviews with 17 older persons to examine how a CBCC enabled AIC., Results: The CBCC site created three interdependent spaces and material/social/affective resources for enabling AIC: (1)living space (residential care beds) to create a sense of connection and safety; (2) a CBCC-supported care space at home to create an atmosphere of trust and safety; and (3) a social space to create feelings of belonging and contribution. Variations in how the three resources interacted produced not only different spaces at the same site for various users but also different AIC experiences for the same user., Conclusions: Community is not simply a static research context or spatial container. Rather, community as an enabling place involves a dynamic process in which spatial/social/affective resources are encountered and interact. Older people's AIC experiences change as their encounters change in the three types of resources we described and thus their capacities for ageing well change correspondingly. Furthermore, the binary idea of community versus institution needs to be expanded to explore how home, community, and institution are related, in order to create enabling spaces for AIC., (© 2022 AJA Inc’.)

This systematic review examined the associations between movement behaviours (i.e., physical activity, sedentary behaviour, and sleep duration) and quality of life (QOL) in adults ≥65 years of age. Four databases were searched in June 2021. Studies were eligible for inclusion if published within the last 20 years, peer-reviewed, examined apparently healthy older adults, and analysed ≥2 movement behaviours together. QOL was represented by the World Health Organization Quality of Life measure which conceptualizes QOL by distinct domains. Study results were categorized and presented by domain. Risk of bias was completed for all included studies using methods described in the Cochrane Handbook. Thirty-one studies with 307 292 participants were included that examined QOL outcomes across seven domains: superdomain (composite measures), perceived physical health, mental and psychological states, level of independence, social relationships, environment, and general health. Findings indicated that moderate-to-vigorous intensity physical activity was favourably associated with QOL. Time re-allocation studies that showed moving time into physical activity from sedentary behaviour were associated with favourable QOL changes. The evidence regarding sedentary behaviour and sleep duration was inconsistent. The quality of evidence was very low for all domains. In conclusion, there is consistent evidence that physical activity improves QOL in adults ≥65 years of age. International Prospective Register of Ongoing Systematic Reviews (PROSPERO) registration No.: CRD42021260566.

The Philadelphia chromosome (Ph) resulting from the t(9;22) translocation generates the oncogenic BCR::ABL1 fusion protein that is most commonly associated with chronic myeloid leukemia (CML) and Ph-positive (Ph+) acute lymphoblastic leukemia (ALL). There are also rare instances of patients (≤1%) with newly diagnosed acute myeloid leukemia (AML) that harbor this translocation (Paietta et al., Leukemia 12: 1881 [1998]; Keung et al., Leuk Res 28: 579 [2004]; Soupir et al., Am J Clin Pathol 127: 642 [2007]). AML with BCR::ABL has only recently been provisionally classified by the World Health Organization as a diagnostically distinct subtype of AML. Discernment from the extremely close differential diagnosis of myeloid blast crisis CML is challenging, largely relying on medical history rather than clinical characteristics (Arber et al., Blood 127: 2391 [2016]). To gain insight into the genomic features underlying the evolution of AML with BCR::ABL, we identified a patient presenting with a high-risk myelodysplastic syndrome that acquired a BCR::ABL alteration after a peripheral blood stem cell transplant. Serial samples were collected and analyzed using whole-exome sequencing, RNA-seq, and ex vivo functional drug screens. Persistent subclones were identified, both at diagnosis and at relapse, including an SF3B1 p.Lys700Glu mutation that later cooccurred with an NRAS p.Gly12Cys mutation. Functional ex vivo drug screening performed on primary patient cells suggested that combination therapies of ABL1 with RAS or PI3K pathway inhibitors could have augmented the patient's response throughout the course of disease. Together, our findings argue for the importance of genomic profiling and the potential value of ABL1 inhibitor-inclusive combination treatment strategies in patients with this rare disease., (© 2022 Rosenberg et al.; Published by Cold Spring Harbor Laboratory Press.)

Cities around the world are responding to aging populations and equity concerns for older people by developing age-friendly communities plans, following the World Health Organization's guidelines. Such plans, however, often fail to account for the wide diversity of older people in cities, with the result that some older people, including Indigenous older people, do not see their needs reflected in age-friendly planning and policies. This article reports on a study involving 10 older First Nations and Métis women in the city of Prince George, Canada, comparing the expressed needs of these women with two age-friendly action plans: that of the city of Prince George, and that of the Northern Health Authority. Four main categories were raised in a group discussion and interview with these women at the Prince George Native Friendship Centre: availability of health care services, accessibility and affordability of programs and services, special roles of Indigenous Elders, and experiences of racism and discrimination. There are many areas of synergy between the needs expressed by the women and the two action plans; however, certain key areas are missing from the action plans; in particular, specific strategies for attending to the needs of Indigenous and other older populations who often feel marginalized in health care and in age-friendly planning.

Permanent migration across provinces in China has become an important strategy for Chinese older people to respond to a temperature-unfriendly place of residence in late life. However, the relation between temperature effects and permanent settlements of older migrants remains unclear. Based on the data obtained from China Migrants Dynamic Survey, this paper examined how four temperature effects (i.e., cold effect, heat effect, temperature gap effect, and temperature zone effect) play a role in shaping older migrants' intentions to settle permanently in a destination place by conducting logistic regression analysis. Our findings show that: (1) extreme cold (rather than extreme heat or mild temperature) was found to have significant effects on settlement intentions of older people; (2) relative winter temperature between origin and destination places rather than absolute winter temperature in the destination place has a significant positive effect on the settlement intentions; (3) spatially, older migrants tend to migrate to geographically adjacent temperature zones. Our findings will inform a more effective planning and allocation of services for supporting older people by better understanding trends and intentions of older migrants.

Self-adjuvanting vaccines consisting of peptide epitopes conjugated to immune adjuvants are a powerful way of generating antigen-specific immune responses. We previously showed that a Plasmodium -derived peptide conjugated to a rearranged form of α-galactosylceramide (α-GalCer) could stimulate liver-resident memory T (T RM ) cells that were effective killers of liver-stage Plasmodium berghei ANKA (Pba)-infected cells. To investigate if similar or even superior T RM responses can be induced by modifying the α-GalCer adjuvant, we created new conjugate vaccine cadidates by attaching an immunogenic Plasmodium -derived peptide antigen to 6″-substituted α-GalCer analogues. Vaccine synthesis involved developing an efficient route to α-galactosylphytosphingosine (α-GalPhs), from which the prototypical iNKT cell agonist, α-GalCer, and its 6″-deoxy-6″-thio and -amino analogues were derived. Attaching a cathepsin B-cleavable linker to the 6″-modified α-GalCer created pro-adjuvants bearing a pendant ketone group available for peptide conjugation. Optimized reaction conditions were developed that allow for the efficient conjugation of peptide antigens to the pro-adjuvants via oxime ligation to create new glycolipid-peptide (GLP) conjugate vaccines. A single dose of the vaccine candidates induced acute NKT and Plasmodium -specific CD8 + T cell responses that generated potent hepatic T RM responses in mice. Our findings demonstrate that attaching antigenic peptides to 6″-modifed α-GalCer generates powerful self-adjuvanting conjugate vaccine candidates that could potentially control hepatotropic infections such as liver-stage malaria., Competing Interests: The authors declare the following competing financial interest(s): G. F. P. and I. F. H. are the chief technical officer and chief scientific officer (respectively) of Avalia Immunotherapies Limited, and W. R. H. is a member of its Scientific Advisory Board. Avalia holds exclusive, worldwide license to patents related to aspects of the chemical design reported here. R. J. A., I. F. H., G. F. P., and B. J. C. are inventors on a granted patent (U.S. patent no. 10046046, granted 14 August 2018). B.J.C., R.J.A., I.F.H., G. F. P., L. E. H., and W. R. H. are named inventors on a PCT application (PCTNZ2020050048) submitted by Victoria University of Wellington, Malcorp Biodiscoveries Limited, and Victoria Link Limited that covers the production of tissue-resident memory T cells with glycolipid-peptide vaccines., (This journal is © The Royal Society of Chemistry.)

A growing body of research has shown that barriers in the urban environment can be disabling by reducing the ability of older people to manage independently in the community, but also because they can negatively affect health by limiting the possibilities to move outside the home. In this study, we ask how obstacles in the urban environment are associated with the need for help to go to places in the community. To respond to this question, we used the Annual Household Survey of the City of Buenos Aires, Argentina 2018, which had a specific questionnaire for people with disabilities. From this sample, we selected adults aged 65 years or older with difficulties in at least one of six domains: vision; hearing; upper and lower body mobility; cognition; self-care; and communication. The final sample consisted of 513 persons (weighted = 109,316). First, we conducted a principal component analysis identifying three factors from variables of obstacles to access and use the urban environment: transportation; outdoor spaces; and information. Second, through a logistic regression model, we observed a direct relationship between these factors and the need for help to move in the community, controlling for sociodemographic characteristics, health status, and number of disabilities. This paper provides evidence on the significance of improving urban spaces to reduce dependent mobility. In Latin America, cities still face many challenges in becoming more age-friendly.

Globally, it is estimated that about 30% of ever-partnered women have experienced some form of intimate partner violence (IPV)-physical assault, sexual assault, or emotional abuse. The prevalence of IPV in sub-Saharan Africa is considerably higher than the global estimate. In Ghana, it is estimated that 24% of women have experienced physical and/or sexual IPV in their lifetime. Studies point to the association between alcohol misuse by intimate male partners and violence against women. However, there has been no consideration for potential spatial variation or heterogeneity in this association. Using estimates from the 2008 Ghana Demographic and Health Survey Data, we employed geographically weighted regression (GWR) analysis to examine spatial variations in the relationship between male partner's alcohol misuse and IPV among women in Ghana. We fitted three models to assess the relationship using a step-wise approach. The first model has alcohol misuse as the only predictor, whereas the second model included other male partner characteristics, such as post-secondary education and employment status. The final introduced female characteristics as additional covariates. The result of the GWR analysis shows that the effect of alcohol misuse on IPV is elevated in the south-western part of Ghana. The findings suggest the potential influence of place-based or contextual factors on the association between alcohol misuse and women's exposure to IPV.

A positive doctor-patient relationship is believed to play a key role in the healing process in clinics. While challenges to the doctor-patient relationship are a global concern, complex social contexts which introduce familial collectivism and totalitarian bureaucracy to maintain a doctor's authority have complicated doctor-patient relationships in China. This study delineates a multi-dimensional therapeutic landscape of hospitals in China, focusing on the doctor-patient relationship performances used to improve patients' healing experiences. Based on fieldwork in two primary hospitals in Eastern China, we find that primary hospitals in China are not only professional spaces, but hybrids of professional and non-professional spaces. In these spaces, both professional and other discourses in various forms of social-environmental engagement affect therapeutic experiences. Varying time and space in hospitals allow doctors to construct multi-dimensional therapeutic landscapes vis-a-vis patients to secure patients' compliance with their recommendations, and thus improve health outcomes. We argue that these dimensions may also cause negative therapeutic experience such as unnecessary health care. This study contributes to the literature on therapeutic landscapes of health care by providing a critical view on the construction of multi-dimensional therapeutic hospital landscapes. Furthermore, it links the critical health geographies literature with China's broader social context to explicate the cultural and social transformation of health care spaces in contemporary China. Findings from this study inform both theoretical and empirical debates regarding therapeutic landscapes of health care by embedding the professional spaces of health care into broader geographical discourses. This calls for health professionals to reflect on ethical concerns in multi-dimensional health care landscapes., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

While existing research acknowledges copious challenges faced by older adults (people aged 60 and over) in Ghana and most countries in sub-Saharan Africa, they fail to situate the lived experiences of this vulnerable group within the broader context of health geography and public health. This paper draws insights from ecological systems theory and the "geographies of older people" literature to examine the lived experiences of older people in Ghana. Data for the study were gathered using interviews (42) and sharing circles (10). Our findings reveal a complex mix of experiences consistent with the different levels of the environment. Dominant themes include access to social support, functional impairment and poor health status, social status, poor access to water and sanitation services, food insecurity, economic insecurity, and caregiving burden. These findings support the wide-held notion that the experiences of older people are complex and produced by the interplay of both individual and structural factors. Our findings demonstrate that sociocultural, economic, political, and climatic factors are important consideration in promoting elderly wellbeing and quality of life in Ghana.

In this study, we examine the association between social frailty and depression among older adults in Ghana over time. We employed longitudinal data analysis to examine the association between social frailty, socioeconomic status and depression using data from the WHO-SAGE survey. Our descriptive and cross-tabulation analyses show that the prevalence of depression and social frailty among older adults decreased considerably in 2014/2015 compared to 2007/2008. The finding also reveals a huge reduction in social frailty among older adults in northern Ghana-the most deprived regions in Ghana-compared to those in southern Ghana. The multivariate panel data analysis reveals that depression was significantly associated with social isolation, financial needs, and physical needs. The findings suggest an over time decline in social frailty and depression among older adults, as well as, reduction in regional differences in social frailty and depression among older adults in Ghana.

This study examines the influence of chronic health conditions and socio-economic status on overnight admission and length of stay among Canadian seniors. Incremental multivariate logistic and zero-inflated negative binomial regression models assessed the relationship between selected predictors, overnight admission, and duration of stay. The findings show that all chronic health conditions and socio-economic factors examined were significantly associated with overnight hospital admission. However, seniors with cardiovascular health conditions, the very old, and seniors living in lower-income households had a greater risk of longer stays. Canadian seniors diagnosed with hypertension, cancer, diabetes, and stroke had greater risk of longer overnight hospital stays. Seniors aged 75 to 79 years, 80 years or older, and those living in lower-income households (≤ $39,999) were more likely to have a longer overnight hospital stay. Findings suggest that improving seniors' health and socio-economic status may reduce the risk of overnight admission and longer stays of hospitalisation.

Our study seeks to examine how chronic health status, insurance coverage and socioeconomic factors predict unmet traditional, complementary and alternative medicine (TCAM) needs among immigrants from sub-Saharan African origin living in the Greater Toronto Area (GTA). The data for the study comes from a cross-sectional questionnaire survey of 273 sub-Saharan African immigrants living in the GTA. ~ 21% of respondents surveyed had unmet TCAM needs in the 12-month period prior to the survey. Persons with chronic health conditions, lower socioeconomic status, and those with previous history of TCAM use before immigrating were more likely to have unmet TCAM need. The study suggests that the current TCAM healthcare environment in the GTA limits that ability of sub-Saharan immigrants to meet their healthcare needs, especially persons in most need of such treatments-persons with chronic health conditions and those of lower socioeconomic background.

Introduction: The objective of this cross-sectional, descriptive study was to identify unpaid caregiver differences in demographics, competing work responsibilities, support, health, caregiver burden, and interaction with healthcare professionals in US metropolitan and non-metropolitan settings., Methods: This study leveraged the nationally representative survey of older adults and their unpaid caregivers residing in the USA: the 2017 National Health and Aging Trends Study and National Study of Caregiving. Participants were unpaid caregivers for community-dwelling older adults., Results: A total of 2278 unique unpaid caregivers corresponding to 1431 care recipients were investigated for this study. Non-metropolitan caregivers had significantly lower income than their metropolitan counterparts, were more likely to be married or have a partner, missed less work, and, when traveling to provide care, traveled on average fewer minutes than metropolitan caregivers. However, there were no significant differences in relationship to caregiver, impact on primary work responsibilities, financial assistance, resource utilization or access, caregiver burden, relationship with primary care providers, or self-rated caregiver health., Conclusion: Non-metropolitan caregivers experience lower income with possible greater familial support, but despite the financial disparities do not have higher caregiver burden, poorer self-rated health, or differences in other important measures. Additional studies that further divide the non-metropolitan cohort into more refined categories by population and with larger sample sizes are essential for designing policy and programs to learn from rural caregivers and build resilience among all care providers.

Acute myeloid leukemia (AML) is a heterogeneous malignancy with the most common genomic alterations in NPM1, DNMT3A, and FLT3. Midostaurin was the first FLT3 inhibitor FDA approved for AML and is standard of care for FLT3 mutant patients undergoing induction chemotherapy [1, 2]. As there is a spectrum of response, we hypothesized that biological factors beyond FLT3 could play a role in drug sensitivity and that select FLT3-ITD negative samples may also demonstrate sensitivity. Thus, we aimed to identify features that would predict response to midostaurin in FLT3 mutant and wild-type samples. We performed an ex vivo drug sensitivity screen on primary and relapsed AML samples with corresponding targeted sequencing and RNA sequencing. We observed a correlation between FLT3-ITD mutations and midostaurin sensitivity as expected and observed KRAS and TP53 mutations correlating with midostaurin resistance in FLT3-ITD negative samples. Further, we identified genes differentially expressed in sensitive vs. resistant samples independent of FLT3-ITD status. Within FLT3-ITD mutant samples, over-expression of RGL4, oncogene and regulator of the Ras-Raf-MEK-ERK cascade, distinguished resistant from sensitive samples. Overall, this study highlights the complexity underlying midostaurin response. And, our results suggest that therapies that target both FLT3 and MAPK/ERK signaling may help circumvent some cases of resistance., Competing Interests: CONFLICTS OF INTEREST B.J.D. potential competing interests; SAB: Aileron Therapeutics, Therapy Architects (ALLCRON), Cepheid, Vivid Biosciences, Celgene, RUNX1 Research Program, EnLiven Therapeutics, Gilead Sciences (inactive), Monojul (inactive); SAB & Stock: Aptose Biosciences, Blueprint Medicines, Iterion Therapeutics, Third Coast Therapeutics, GRAIL (SAB inactive); Scientific Founder: MolecularMD (inactive, acquired by ICON); Board of Directors & Stock: Amgen; Board of Directors: Burroughs Wellcome Fund, CureOne; Joint Steering Committee: Beat AML LLS; Founder: VB Therapeutics; Clinical Trial Funding: Novartis, Bristol-Myers Squibb, Pfizer; Royalties from Patent 6958335 (Novartis exclusive license) and OHSU and Dana-Farber Cancer Institute (one Merck exclusive license). C.E.T. potential competing interests; SRA Ignyta Pharmaceuticals (inactive)., (Copyright: © 2020 Rosenberg et al.)

Evidence from existing studies suggests social capital has mixed effects on depression and other common mental disorders. There is little knowledge of the possible association between social capital and depression among the growing older population in sub-Saharan Africa. This study investigates the effect of cognitive social capital (trust and sense of safety) and structural social capital (social participation or engagement in social activities) on depression among older adults in Ghana. Utilizing multilevel mixed-effect analysis, we investigate the effect of individual-level and neighborhood-level social capital (cognitive and structural) on depression using data from the World Health Organization Study on Global Ageing and Adult Health (WHO-SAGE) survey (Wave 1). The findings show that at an individual level, older adults who felt safe at home were less likely to have depression. We observed mixed results for elements of structural social capital at the individual level. Older adults who frequently engaged in club or group meetings, worked with neighbors and engaged in social outings were more likely to have depression; while attending public meetings and socializing with co-workers were associated with reduced likelihood of having depression. At the neighborhood level, increased trust in neighbors was associated with an increased likelihood of having depression (OR = 1.01, p < 0.05) while higher levels of neighborhood safety and structural social capital were associated with a reduced likelihood of having depression. The findings suggest that the differential associations between elements of social capital and depression may be the result of contextual factors., (Copyright © 2020 Elsevier B.V. All rights reserved.)

China is facing serious population aging issues because of many unintended consequences of the economic reforms that began in the 1980s and with social policies such as the "one child" policy. Understanding the spatial distribution of the health status of older people has attracted more and more attention in many countries, including China. By employing descriptive analysis, this study uses data from the Chinese Population Censusand Statistical Year Bookto explore the health inequalities of older people at the national level. Based on the Getis-Ord Gi*, this study finds that the uneven spatial distribution of socio-economic status results in health inequalities for older people at the national level. The geographic distribution of life expectancy was correlated with a number of important demographic, socio-economic, and environmental variables. For further research, investigations should be conducted among individuals at micro-geographic scales.

Behaviours such as hitting, spitting, swearing and kicking can be a common response to personal, social and environmental challenges experienced by people with dementia. Little attention, however, has been given to how partners in care experience and respond to these behaviours in the home. This paper examines the emerging theme of 'aggression,' in seven interviews with nine former partners in care of people with dementia in Ontario, Canada. We explore how partners in care talk about, interpret and respond to these behaviours drawing on recent conceptualizations of structural and interpersonal violence in health and social geography and contributing to the growing body of research on relational care. We discuss the responses to, and implications of, these behaviours at a range of spatial scales and identify important considerations for future research.

Background and Aims: The combination of the rapid process of social-economic development, urbanization, and population ageing brings many challenges for care providers and quality of life of the community-living elderly in Beijing, China. This research aims to understand the intergenerational differences of social support for the elderly in the socio-cultural context of Beijing., Methods and Results: To answer this research question, we collected 30 semi-structured in-depth interviews from elders aged 60 and over in three communities in Beijing. The constant comparative method was used for analysis. The results show that the young-old (people aged 60 to 74) received more formal social support and less informal social support compared to their parents' generation. The formal social support they received was not much different but they received less informal social support compared to the older-old (people aged 75 and over) living in the same communities. The young-old expect to receive more formal social support when they become the older-old, as the informal social support from their children would be reduced due to the one-child policy and socio-cultural changes., Conclusions: Intergenerational differences of social support for the elderly do exist in the form of instrumental, financial, and emotional support. The findings help us understand how socio-economic development and urbanization processes affect the daily life and social support of the community-living elderly from different age groups, and also provides knowledge for improving the quality of life for the elderly in Beijing.

Studies on the victimization and abuse of seniors in Canada have largely ignored the influence of place-based variations in social bonds and socioeconomic characteristics. Using the 2014 General Social Survey (GSS) data on Canadians' safety, we examine neighborhood, social capital, and socioeconomic characteristics as predictors of the incidence of victimization among seniors and their satisfaction with personal safety from crime. Generally, seniors with poor neighborhood ties and social capital were more likely to have experienced victimization and have a lower satisfaction with personal safety. Seniors who viewed people in their neighborhood as unhelpful were more likely to have experienced some form of victimization and more likely to have a lower satisfaction with personal safety. Highly educated and high-income seniors were also more likely to have experienced some form of victimization. Paradoxically, such seniors were less likely to have lower satisfaction with personal safety. The results also show that place, defined as population centers (urban and rural) may have a significant influence on variations in victimization and satisfaction with personal safety. A significant proportion of the variance in victimization (38%) and satisfaction with personal safety (23%) are largely the result of differences in place of residence (urban and rural). Our findings suggest that there is the need to improve neighborhood social capital, reduce neighborhood disorder and improve the socioeconomic status of community-dwelling seniors in order to minimize their susceptibility to victimization as well as to improve their sense of safety from crime., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Physical activity is a highly gendered health behaviour, with women less likely than men to meet internationally accepted physical activity guidelines. In this article, we take up recent arguments on the potential of indoor spaces to illuminate processes shaping health, together with social theories of gender, to conceptualize the place of the gym as a window into understanding and intervening in wider gender disparities in physical activity. Using a triangulated strategy of qualitative methods, including semi-structured interviews, drawing, and journaling with men and women in a mid-sized Canadian city, we examine how gender influences exercise practices and mobilities in gym environments. Results of our thematic analysis reveal three socio-spatial processes implicated in the gendering of physical activity: 1) embodying gender ideals, 2) policing gender performance, and 3) spatializing gender relations. A fourth theme illustrates the situated agency some individuals enact to disrupt gendered divisions. Although women were unduly disadvantaged, both women and men experienced significant limitations on their gym participation due to the presiding gendered social context of the gym. Gender-transformative interventions that go beyond engaging women to comprehensively contend with the place-based gender relations that sustain gender hegemony are needed. While gyms are potentially sites for health promotion, they are also places where gendered inequities in health opportunities emerge., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

China's rapid socioeconomic growth in recent years and the simultaneous increase in many forms of pollution are generating contradictory pictures of residents' well-being. This paper applies multilevel analysis to the 2013 China General Social Survey data on social development and health to understand this twofold phenomenon. Multilevel models are developed to investigate the impact of socioeconomic development and environmental degradation on self-reported health (SRH) and self-reported happiness (SRHP), differentiating among lower, middle, and higher income groups. The results of the logit multilevel analysis demonstrate that income, jobs, and education increased the likelihood of rating SRH and SRHP positively for the lower and middle groups but had little or no effect on the higher income group. Having basic health insurance had an insignificant effect on health but increased the likelihood of happiness among the lower income group. Provincial-level pollutants were associated with a higher likelihood of good health for all income groups, and community-level industrial pollutants increased the likelihood of good health for the lower and middle income groups. Measures of community-level pollution were robust predictors of the likelihood of unhappiness among the lower and middle income groups. Environmental hazards had a mediating effect on the relationship between socioeconomic development and health, and socioeconomic development strengthened the association between environmental hazards and happiness. These outcomes indicate that the complex interconnections among socioeconomic development and environmental degradation have differential effects on well-being among different income groups in China.

This study shows the Western theorization and interpretation of aging, place and health are not well suited to a non-western case. The current generation of older Chinese has experienced the transition from a planned economy to a socialist market economy. Urban changes have taken place in various ways. This study explains the spatio-temporal processes of older people with their changing places by conducting in-depth interviews with 47 older people living at home in Beijing. Their generational consciousness and old place identities are deeply rooted in pre-reform Collectivism and shaped by socialist ideologies of the past. The representation of the old identity among older people is circumscribed by their living situations and selectively manifested. In most cases, there are limited mechanisms formed to recreate positive place meanings and reintegrate older people and place. The processes reflect the growing social inequality and changing cultural values in a society in transition. Growing social inequality and changing cultural values have a great impact on older people's health and well-being., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: In the transitional stage of socioeconomic development, the traditional practice of home-based care in China is being tested. The evolution and factors of home-based care utilization are the prerequisites for the formulation of a support policy. However, no extant research has studied home-based elder care on a national scale., Aim: This paper aims to examine changing caregiving relationships nationwide for home-based elderly individuals and investigate the changing factors of care utilization in a ten-year period, with special attention to the effects of "location" on care patterns., Methods: The data come from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Andersen and Newman's behavioral model is employed as the theoretical framework for this research. The trends in care use from 2002 to 2011 are explored and multilevel multinomial analyses are performed to investigate the changing factors of care patterns between 2002 and 2011., Results: From 2002 to 2011, China saw a sharp decrease in children as caregivers, a significant increase in spousal caregivers, and a gradual decrease in other caregivers. Compared to 2002, the effects of the predisposing and enabling factors are more important than the need factors in 2011. Location and the interactions of the north-south divide and the urban-rural divide had a significant effect on care patterns., Conclusions: From 2002 to 2011, there was a decline in the traditional values-advocated care system and the elderly had to rely more on their own resources to find caregivers. In the design of a support program, there is an urgent need for policy makers to take social inequality among elderly individuals and the effects of location into consideration., (Copyright © 2017 Elsevier B.V. All rights reserved.)

People with dementia can live meaningful and engaged lives with the appropriate social and physical supports in place. There has been relatively little research, however, on the experiences and desires of people with dementia themselves as they negotiate informal and formal support in rural and small town settings. In this article, we draw on semi-structured interviews with 46 community-dwelling people with dementia and 43 partners in care in rural Ontario, Canada to examine how people with dementia relate to and within their communities as well as their perceptions of community support services. We identify the continued contributions of people with dementia to their own care and the care of others as well as common social, cultural, and organizational factors related to delayed service use and refusal to use particular services. We argue that care is "not there yet" for people in the earlier stages of dementia and that more attention needs to be paid to what people with dementia can offer their communities as well as the role of culture and gender in developing support. Our findings make an important contribution to understanding the experience of dementia in rural and small town Canada, which is relevant to rural healthcare and community support in other industrialized countries., (Copyright © 2016. Published by Elsevier Ltd.)

In this article, we contribute to the social sciences literature on voluntarism by examining the dynamics of voluntary service provision for people living with dementia in rural settings. Although volunteer-based organizations provide community support services across a range of Western countries, little attention has been directed towards understanding the organization and actions of volunteers and voluntarism in dementia care. To address this gap, we conducted a case study of Alzheimer support organizations in Ontario, Canada, using questionnaires with service providers (N=20) and semi-structured interviews with people with dementia (N=46) and partners in care (N=43). In our analysis, we identify challenges related to increasing demands for support, partner relations, reaching rural communities, a lack of early stage supports, a lack of volunteers for programs that families have requested, and loss of volunteers in programs families depended on. Moreover, we argue that the current model of voluntary sector service provision for people living with dementia is unevenly developed and potentially unsustainable., (Copyright © 2016. Published by Elsevier Ltd.)

Background: Vehicular traffic is a major source of outdoor air pollution in urban areas, and studies have shown that air pollution is worse during hours of commuting to and from work and school. However, it is unclear to what extent different commuting behaviors are a source of air pollution compared to non-commuters, and if air pollution exposure actually differs by the mode of commuting. This study aimed to examine the relationships between commuting behaviors and air pollution exposure levels measured by urinary 1-OHP (1-hydroxypyrene), a biomarker of exposure to polycyclic aromatic hydrocarbons (PAHs)., Methods: A cross-sectional study of 174 volunteers living in Montreal, 92 females and 82 males, aged 20 to 53 years was conducted in 2011. Each participant completed a questionnaire regarding demographic factors, commuting behaviors, home and workplace addresses, and potential sources of PAH exposure, and provided a complete first morning void urine sample for 1-OHP analysis. Multivariable general linear regression models were used to examine the relationships between different types of commuting and urinary 1-OHP levels., Results: Compared to non-commuters, commuters traveling by foot or bicycle and by car or truck had a significantly higher urinary 1-OHP concentration in urine (p=0.01 for foot or bicycle vs. non-commuters; p=0.02 for car or truck vs. non-commuters); those traveling with public transportation and combinations of two or more types of modes tended to have an increased 1-OHP level in urine (p=0.06 for public transportation vs. non-commuters; p=0.05 for commuters with combinations of two or more types of modes vs. non-commuters). No significant difference in urinary 1-OHP variation was found by mode of commuting., Conclusion: This preliminary study suggests that despite the mode of commuting, all types of commuting during rush hours increase exposure to air pollution as measured by a sensitive PAH metabolite biomarker, and mode of commuting did not explain exposure variation., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: The incorporation of meaningful activity or occupation in supporting those transitioning from homelessness to being housed has been promoted by researchers; however, there is little evidence to support the promotion of initiatives encouraging its use in support models., Purpose: This manuscript aims to advocate for further research into the role of occupation in supporting persons transitioning from homelessness to permanent housing., Key Issues: The transition from homelessness to becoming housed can be facilitated through use of occupation as a way of promoting the security of meaningful roles and a "housed identity" among persons experiencing homelessness., Implications: By promoting an emphasis on occupation, persons experiencing homelessness may undergo a positive change in identity. This change may improve housing tenure and the likelihood of a more permanent transition away from homelessness. More research is required to identify the relationship between occupation and the transition from homelessness.