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This study explores the preferred viewing distance and character size for an electronic paper display for three age groups. Proofreading speed and accuracy ratio were measured during Chinese proofreading tests using the preferred character size and minimum acceptable character size. Data analysis showed that the mean preferred viewing distance for young, middle-aged and older groups was 503, 455 and 444 mm, respectively. The mean preferred character size determined by young, middle-aged and older groups was 42.0, 50.0 and 55.2 min arc, respectively. The proofreading test results indicated that the older group proofread significantly more slowly (1.25word/sec) than the young (1.76 word/sec) and middle-aged groups (1.74 word/sec). Further, the participants proofread more correctly with their preferred character size (73.3%) than with their minimum acceptable character size (65.4%). This study provides valuable information for the design of Chinese text presentations for various agegroups. Statement of Relevance: This study confirmed the preferred viewing distance and character size for E-paper display were influenced by age. The preferred Chinese character size for young, middle-aged and older people was 42, 50 and 55 min arc, respectively. Therefore, the age factor should be considered for E-paper displays design and video display terminal (VDT) guidelines. [ABSTRACT FROM AUTHOR]

This paper considers the distribution of mortality across social groups classified by caste, gender and sector of origin in India in the mid-2010s: as such, the essay is intended to be both a methodological/measurement-oriented study and a substantive empirical assessment of an important dimension of human functioning in India. The analysis is carried out employing micro-data on the age-distributions of population and death-rates available in the National Family Health Survey of 2015–16 (NFHS-4). Mortality in the paper is measured in terms of the crude death rate, an indicator of "inefficiency" in the age-distribution of deaths, and an "age-adjusted" death rate which takes account of both the mean and the dispersion of a distribution. The last-mentioned indicator is taken to be the preferred measure of mortality. The analysis in the paper suggests that mortality outcomes across castes replicate the caste hierarchy and that there is a sharp rural-urban divide in the distribution of death. Mortality sex-ratios are found to be relatively more favourable for the lower than the higher castes. The results presented in the paper are not unexpected, but they provide quantitative confirmation of one's worst suspicions regarding the skewed distribution of mortality across social groups in India. [ABSTRACT FROM AUTHOR]

The adult-centric concept of 'age-appropriateness' is an arbitrary signifier and yet it commands a powerful common-sense appeal in governing the shape of sexuality education. The visibility of LGBTQ+ lives in primary schools is deeply impacted by the cis-heteronormative ways in which age-appropriateness is commonly understood and mobilised; very often resulting in silence and delay. The concept of age-appropriateness also becomes entangled with moral panics about 'promoting' LGBTQ+ lives, or children being somehow 'recruited' to identify as LGBTQ+. This paper draws on findings from a study with the parents of eleven trans and gender diverse children (then aged between 5 and 13) conducted in 2017, as well as a follow-up study conducted with seven participants from the same group of parents and children in 2022. The paper explores how the politics of age and agency intersect and become intensified as trans and gender diverse children and their parents navigate and make decisions about their bodies, lives and everyday worlds in primary schools. These stories of trans and gender diverse children provide an arresting invitation to adults to attend closely to the rich stories of children themselves in (re)considering the potential of sexuality education across contexts. [ABSTRACT FROM AUTHOR]

Current speech-language pathology (SLP) services in Cambodia are limited in scope, service accessibility and integration into government systems. However, momentum is growing to develop an internationally recognised profession. This paper examines the depth and breadth of SLP support available to people with communication and/or swallowing difficulties in relation the Sustainable Development Goals (SDGs). Qualitative interview data collected from service facilities (n = 13) and speech therapy practitioners (n = 27) were mapped and analysed for accessibility and scope of SLP services. Data revealed a workforce density of 0.16:100 000. Disparity in service accessibility was identified between provincial and urban locations, adult and paediatric populations and range of practice areas. The findings demonstrate the importance of partnerships (SDG 17) among government departments, non-government organisations and private sector entities to establish a sustainable and culturally responsive SLP profession in Cambodia. Although there is no Cambodian university training program, there is a growing momentum and local commitment to establishing a workforce to support Cambodians with communication and/or swallowing difficulties. This commentary paper focuses on good health and well-being (SDG 3), decent work and economic growth (SDG 8), reduced inequalities (SDG 10), and also addresses no poverty (SDG 1), quality education (SDG 4) and partnerships for the goals (SDG 17). [ABSTRACT FROM AUTHOR]

Depersonalization-Derealization disorder (DDD) is a psychiatric condition characterized by persistent feelings of detachment from one's self and of unreality about the outside world. This review aims to examine the prevalence of DDD amongst different populations. A systematic review protocol was developed before literature searching. Original articles were drawn from three electronic databases and included only studies where prevalence rates of DDD were assessed by standardized diagnostic tools. A narrative synthesis was conducted. Twenty-three papers were identified and categorized into three groups of participants: general population, mixed in/outpatient samples, and patients with specific disorders. The prevalence rates ranged from 0% to 1.9% amongst the general population, 5–20% in outpatients and 17.5–41.9% in inpatients. In studies of patients with specific disorders, prevalence rates varied: 1.8–5.9% (substance abuse), 3.3–20.2% (anxiety), 3.7–20.4% (other dissociative disorders), 16.3% (schizophrenia), 17% (borderline personality disorder), ~50% (depression). The highest rates were found in people who experienced interpersonal abuse (25–53.8%). The prevalence rate of DDD is around 1% in the general population, consistent with previous findings. DDD is more prevalent amongst adolescents and young adults as well as in patients with mental disorders. There is also a possible relationship between interpersonal abuse and DDD, which merits further research. [ABSTRACT FROM AUTHOR]

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Since the 1980s, research on relative age effects (RAEs) consistently shows that relatively older individuals are advantaged in sport and other contexts. With the recent proliferation of studies on RAEs, periodic knowledge synthesis becomes imperative. Our purpose was to conduct a cross-disciplinary citation network analysis of RAEs literature to enhance our knowledge of RAEs citation structures and the interconnectivity of RAEs studies. We analysed 484 RAEs articles found in Web of Science that were published before 2022. Descriptive results revealed a 12.6% annual growth rate for total RAEs articles published since 1980. The articles appeared in 151 journals, had 1,180 unique authors, and averaged 23.9 citations received. Three theoretical/review papers had the most substantial influence on the field. For the conceptual structure of the field, it was apparent that RAEs research focused mainly on sport performance, maturity, and competition. Regarding intellectual structure, three distinct clusters of articles were cited together, and 13 authorship clusters were detected with few between-cluster connections. The results describe a field with productivity but little interconnectivity among authors and papers. We offer insights into this trend and the role that influential authors/articles have in the field. [ABSTRACT FROM AUTHOR]

Agricultural injuries remain a major concern in North America, with a fatal injury rate of 19.5 deaths per 100,000 workers in the United States. Numerous research efforts have sought to compile and analyze records of agricultural-related injuries and fatalities at a national level, utilizing resources, ranging from newspaper clippings and hospital records to Emergency Medical System (EMS) data, death certifications, surveys, and other multiple sources. Despite these extensive efforts, a comprehensive understanding of injury trends over extended time periods and across diverse types of data sources remains elusive, primarily due to the duration of data collection and the focus on specific subsets. This systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, consolidates and analyzes agricultural injury surveillance data from 48 eligible papers published between 1985 and 2022 to offer a holistic understanding of trends and challenges. These papers, reporting an average of 25,000 injuries each, were analyzed by database source type, injury severity, nature of injury, body part, source of injury, event/exposure, and age. One key finding is that the top source of injury or event/exposure depends on the chosen surveillance system and injury severity, underscoring the need of diverse data sources for a nuanced understanding of agricultural injuries. This study provides policymakers, researchers, and practitioners with crucial insights to bolster the development and analysis of surveillance systems in agricultural safety. The overarching aim is to address the pressing issue of agricultural injuries, contributing to a safer work environment and ultimately enhancing the overall well-being of individuals engaged in agriculture. [ABSTRACT FROM AUTHOR]

Unequal homeownership access is a major component of ethno-racial stratification. Previous studies have demonstrated substantial ethno-racial disparities in access and outcomes throughout the homeownership process. In addition, prior research has assumed that mortgage applicants have a similar age distribution across ethno-racial groups. This paper draws on annual data from the 2018 and 2019 Home Mortgage Disclosure Act (HMDA) to assess variation in ethno-racial disparities in loan outcomes associated with different ages. I show that ethno-racial disparities in loan outcomes vary tremendously when considering the age of the applicant. I demonstrate that loan rejections and high-cost loan originations are highest among Latino and Black borrowers across age groups compared to Whites. Black borrowers have worse adverse loan outcomes than Whites, regardless of age. Depending on the adverse loan outcome, Asians perform similarly or underperform compared to Whites. In addition, older applicants are more likely to be denied a mortgage loan than younger applicants, while the trends for high-cost loans vary considerably across ethno-racial groups. When examining high-cost loan originations, Latinos above 65 years old (who are the best performing Latino sub-group) underperform Whites regardless of age. [ABSTRACT FROM AUTHOR]

This paper investigated a research area worthy of greater attention: foreign language classroom anxiety (hereafter FLCA) and enjoyment (hereafter FLE) of older adults learning English as a foreign language in Chinese Universities of the Third Age. Understanding the largely overlooked emotional involvement of older language learners contributes to sustaining their motivation in lifelong learning for more remarkable personal growth and successes. Based on the survey of 587 Chinese older learners of English between the age of 50 and 80, paired sample t-test showed that more FLE was reported than FLCA. The results of Welch's ANOVA suggested that those who were better educated had less FLCA and those who believed themselves healthier had more FLE. The language performance evaluation (i.e. relative standing in class and English mastery) affects both FLE and FLCA. Further interviews with 34 older participants revealed three major sources of FLE, including the language use in life situations, the favorable attitude toward FL learning in the cognitive, aesthetic cultural and pragmatic aspects and the social interactions in the U3As. FLCA occurs when the language performance is perceived as dissatisfying and when aspects of mental health (e.g. worsening memory) impede effective learning. Although FLCA and FLE had only a very weak correlation, Chinese older adult learners commented on a shared belief that anxiety usually precedes and subsequently enhances enjoyment in learning, indicating a sign of emotional resilience later in life. This paper demonstrates a need for understanding the emotions in language learning across life stages and socio-cultural contexts. [ABSTRACT FROM AUTHOR]

Statistical body shape models (SBSM) provide compact, flexible representations of body shape that can be implemented in design software. However, few SBSMs have been created to represent adults in supported seated postures that are relevant for the design of seated environments, and none has incorporated the effects of age. This paper presents an SBSM based on surface laser-scan data from 155 U.S. adults. The data were processed to obtain homologous mesh structure and symmetric geometry, and the processed data were statistically analysed using principal component analysis to obtain a compact representation of the data variance. Regression analysis was conducted to predict body size and shape from stature, body mass index, ratio of sitting height to stature, sex, and age. The resulting model allows rapid generation of realistic body models for applications, including product design, accommodation assessment, and safety system optimisation. The model is publicly accessible at HumanShape.org. Practitioner summary: This paper presents a statistical model that represents adult body shapes in a supported seated posture based on 3 D anthropometric measurements. This model is the first whole-body parametric model known to incorporate age effects based on data extending beyond 65 years of age. [ABSTRACT FROM AUTHOR]

Recent debates surrounding intimate partner violence (IPV) have focused on its gender symmetry and gender-oriented nature. These debates center on findings from various data sources, like victimization or self-reported surveys and police-based reports. Data by Statistics Canada, from 1999 to 2014, has shown that the prevalence of IPV is similar for male and female victims, except for sexual assaults. However, there has been a paucity of studies on the severity and risk factors of IPV against men by female partners. Thus, this paper examines the severity of and risk factors for physical IPV against heterosexual men in Canada using the General Social Survey (Victimization) data of 2014. This study revealed that there is a symmetry in the experiences of physical violence between male and female victims. This study also revealed that male victims experience more severe violence than female victims. Using binary logistic regression analysis, years of dwelling together, the victim's age, childhood victimization, and marijuana use were found to predict physical IPV against heterosexual men. This paper concludes with suggestions about how these predicting factors can be used to identify male victims and the need for a more inclusive approach toward addressing IPV, which should include male victims. [ABSTRACT FROM AUTHOR]

This paper explores racial differences in maternal risk factors associated with adverse pregnancy outcomes across urban and rural geographies using 2019 data from the Behavioral Risk Factor Surveillance System. Bivariate chi-square tests and logistic regression were performed which showed statistically significant geographical differences among Non-Hispanic (NH) Black pregnant women across income levels (p =.016) and perceived health status (p =.003). Regression analyses indicated an increased racial gap between NH White pregnant women and other racial/ethnic groups. The findings support that there are statistically significant racial differences in maternal risk factors across urban and rural geographies for NH Black and Hispanic pregnant women. [ABSTRACT FROM AUTHOR]

Recent political processes have rendered people with dementia an increasingly surveilled population. Surveillance is a contentious issue within dementia research, spanning technological monitoring, biomarker research and epidemiological data gathering. This paper explores surveillance in the relationships of people affected by dementia, how older relatives both with and without diagnoses are surveilled in everyday interactions, and the importance of expectations in guiding surveillance. This paper presents data from 41 in-depth interviews with people affected by dementia living in the community in the United Kingdom. Agedness was a key contributor to expectations that a person may have dementia, based on previous experiences, media accounts and wider awareness. Expectations provoked surveillance in interactions, with participants looking for signs of dementia when interacting with older relatives. Older people also enacted self-surveillance, monitoring their own behaviour. Various actions could be attributed to dementia because interpretation is malleable, partly vindicating expectations while leaving some uncertainties. Expectant surveillance transformed people's experiences because they organised their own actions, and interpreted those of others, in line with pre-existing meanings. The ability to interpret behaviours to fit expectations can bring coherence to uncertainties of ageing, cognition and dementia, but risks ascribing dementia to many older people who straddle those uncertainties. [ABSTRACT FROM AUTHOR]

The aim of the present study was to determine the prevalence of non-fatal overdose among people who use illicit opioids (PWUIOs) and determine the demographic and behavioral characteristics associated with non-fatal overdose among this population. Studies in English published before February 1, 2021, were searched for on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on the factors associated with non-fatal overdose among PWUIOs. After reviewing for study duplicates, the full-texts of selected papers were assessed for eligibility using PICOs criteria. After a detailed assessment of over 13,845 papers, a total of 67 studies met the eligibility criteria. The findings showed a past-year pooled prevalence rate of non-fatal overdose among PWUIOs of 26% (95% CI, 23% −29%). Greater odds of non-fatal overdose among PWUIOs was associated with (i) being younger, (ii) being female, (iii) being homeless, (iv) individuals who received money, goods, or drugs in exchange for sex, (v) individuals who had witnessed somebody else have an overdose, (vi) individuals who had used public spaces as primary injection locations, (vii) individuals who reported polydrug use, (vii) use of non-injection methamphetamine, and (viii) high injecting frequency (more than two daily drug injections). Harm-reduction programs should consider the provision of education concerning overdose-related risk factors to the vulnerable and hard-to-reach PWUIOs. [ABSTRACT FROM AUTHOR]

The amyloid hypothesis has so far been at the forefront of explaining the pathogenesis of Alzheimer's Disease (AD), a progressive neurodegenerative disorder that leads to cognitive decline and eventual death. Recent evidence, however, points to additional factors that contribute to the pathogenesis of this disease. These include the neurovascular hypothesis, the mitochondrial cascade hypothesis, the inflammatory hypothesis, the prion hypothesis, the mutational accumulation hypothesis, and the autoimmunity hypothesis. The purpose of this review was to briefly discuss the factors that are associated with autoimmunity in humans, including sex, the gut and lung microbiomes, age, genetics, and environmental factors. Subsequently, it was to examine the rise of autoimmune phenomena in AD, which can be instigated by a blood-brain barrier breakdown, pathogen infections, and dysfunction of the glymphatic system. Lastly, it was to discuss the various ways by which immune system dysregulation leads to AD, immunomodulating therapies, and future directions in the field of autoimmunity and neurodegeneration. A comprehensive account of the recent research done in the field was extracted from PubMed on 31 January 2022, with the keywords "Alzheimer's disease" and "autoantibodies" for the first search input, and "Alzheimer's disease" with "IgG" for the second. From the first search, 19 papers were selected, because they contained recent research on the autoantibodies found in the biofluids of patients with AD. From the second search, four papers were selected. The analysis of the literature has led to support the autoimmune hypothesis in AD. Autoantibodies were found in biofluids (serum/plasma, cerebrospinal fluid) of patients with AD with multiple methods, including ELISA, Mass Spectrometry, and microarray analysis. Through continuous research, the understanding of the synergistic effects of the various components that lead to AD will pave the way for better therapeutic methods and a deeper understanding of the disease. [ABSTRACT FROM AUTHOR]

Aim: Documentation is a critical element in the function of the nursing team, and cannot be separated from high-quality, patient-centered care. The aim of this study was to compare the quality of nursing documentation in electronic and paper-based systems.Method: A retrospective descriptive study was designed to compare the quality of nursing documentation in electronic health records (EHR) versus paper-based documentation systems before and after the application of the electronic system.Results: Analysis of data found a significant difference in the quality of nursing documentation in the two hospitals both before and after the implementation of an EHR system (p < 0.001).Quality of nursing documentation in the electronic system was significantly better than that of paper-based documentation systems.Conclusion: Vocal-electronic systems help to improve quality of nursing documentation, suggesting this aspect may be essential to implementing a successful system in local settings. [ABSTRACT FROM AUTHOR]

Exoskeleton can assist individuals with spinal cord injuries (SCI) with simple movements and transform their lives by enhancing strength and mobility. Nonetheless, the current utilization outside of rehabilitation contexts is limited. To promote the widespread adoption of exoskeletons, it is crucial to consider the acceptance of these devices for both rehabilitation and functional purposes. This systematic review aims to identify the barriers or facilitators of the use of lower limbs exoskeletons, thereby providing strategies to improve interventions and increase the adoption of these devices. A comprehensive search was conducted in EMBASE, Web of Science, Scopus, Cochrane, and PubMed. Studies reporting barriers and facilitators of exoskeleton use were included. The studies' quality was assessed using the Mixed Methods Appraisal Tool and undertook a thematic content analysis for papers examining the barriers and facilitators. Fifteen articles met the inclusion criteria. These revealed various factors that impact the utilization of exoskeletons. Factors like age, engagement in an active lifestyle, and motivation were identified as facilitators, while fear of falling and unfulfilled expectations were recognized as barriers. Physical aspects such as fatigue, neuropathic discomfort, and specific health conditions were found to be barriers. This systematic review provides a comprehensive overview of the barriers and facilitators to the use of exoskeleton technology. There are therefore still challenges to be faced, efforts must be made to improve its design, functionality, and accessibility. By addressing these barriers, exoskeletons can significantly improve the quality of life of people with SCI. Optimize the use of this technology to adapt as much as possible to individual needs. Offer an in-depth understanding of the challenges that can arise when adopting exoskeletons. Highlight the critical issues with the device, that prevent me from using it outside of clinical contexts. Offer useful information to therapists to select the most suitable patients for the use of the exoskeleton and to customize rehabilitation programs more effectively. [ABSTRACT FROM AUTHOR]

This paper examines whether U.S./Mexico border residence in California is related to the prevalence of DSM-5 alcohol use disorder (AUD) among Whites and Hispanics. Household survey data were obtained from 1,209 adults (59.7% female) 18 to 39 years of age resident in four counties in California: Imperial on the U.S./Mexico border; and Kern, Tulare, and Madera in California's Central Valley. Households were selected using a list assisted sample, with data collected on the phone or online. Results show that AUD rates were not different between border and non-border location and between Whites and Hispanics. AUD was negatively associated with higher income ($20,000 to $60,000: AOR=.38; 95%CI=.17–.86; p<.01—more than $60,000: AOR=.27; 95%CI:.09–.81; p<.01) and poor risk perception (AOR=.86; 95%CI=.78–.94; p<.01). AUD was positively associated with continued volume of drinking (AOR = 1.05; 95%CI = 1.01–1.09; p<.01), drinking in Mexico (AOR = 4.28; 95%CI = 1.61–11.36; p<.01), marijuana use (AOR = 4.11; 95%CI = 1.73–9.77; p<.01), and impulsivity (AOR = 1.55; 95%CI = 1.23–1.94). Efforts to prevent AUD in the population in California, and especially among those who live close to the border with Mexico, should take into consideration factors such as impulsivity, marijuana use, border crossing to drink in Mexico, all of which increased risk of AUD. [ABSTRACT FROM AUTHOR]

Heart rate variability (HRV), defined as the variability between successive heart beats, is a noninvasive measure of autonomic nervous system (ANS) function, which may be altered following traumatic brain injury (TBI). This scoping review summarizes the existing literature regarding changes in HRV after TBI as well as the association between measures of HRV and outcomes following TBI. A literature search for articles assessing 'heart rate variability' and 'brain injury' or 'concussion' was completed. Articles were included if HRV was measured in human subjects with TBI or concussion. Review articles, protocol papers, and studies including non-traumatic injuries were excluded. Sixty-three articles were included in this review. Varied methods were used to measure HRV in the different studies. Forty articles included information about differences in HRV measures after TBI and/or longitudinal changes after TBI. Fifteen studies assessed HRV and symptoms following TBI, and 15 studies assessed HRV and either functional or cognitive outcomes after TBI. HRV has been studied in the context of mortality, clinical symptoms, and medical, functional, or cognitive outcomes following TBI. Methods used to measure HRV have varied amongst the different studies, which may impact findings, standardized protocols are needed for future research. [ABSTRACT FROM AUTHOR]

When organisations make employees redundant, they increasingly offer outplacement counselling to them, either in-house or as a service of specialised companies. Despite outplacement counsellors' importance, their work-related stress has not been studied yet. In this paper we argue that internal (in-house) outplacement counsellors have a particularly demanding job (especially because being employed by firing organisations should increase role conflicts among internal outplacement counsellors) and they should thus be more emotionally exhausted than external outplacement counsellors. Data from 98 German outplacement counsellors supported this argumentation. Mediation analyses showed that these differences were mediated by increased role conflicts, consistent with role theory arguments. The same effect was found for counsellors' job satisfaction. These results help understanding the stress that outplacement counsellors experience. [ABSTRACT FROM AUTHOR]

Background: The use of a nationwide medication plan has been promoted as an effective strategy to improve patient safety in Germany. However, the medication plan only exists as a paper-based version, which is related to several problems, that could be circumvented by an electronic alternative.Objective: The main objective of this study was to report on the development of a mobile interface concept to support the management of medication information.Methods: The human-centered design (UCD) process was chosen. First the context of use was analyzed, and personas and an interaction concept were designed. Next, a paper prototype was developed and evaluated by experts. Based on those results, a medium-fidelity prototype was created and assessed by seven end-users who performed a thinking-aloud test in combination with a questionnaire based on the System Usability Scale (SUS).Results: Initially for one persona/user type, an interface design concept was developed, which received an average SUS-Score of 92.1 in the user test. Usability problems have been solved so that the design concept could be fixed for a future implementation. Contribution: The approach of the UCD process and the methods involved can be applied by other researchers as a framework for the development of similar applications. [ABSTRACT FROM AUTHOR]

Research on who does/does not disclose suicidal intent (SI) and related factors has important implications for suicide risk management. In this paper based on the 2017-2019 National Violent Death Reporting System, we compared four age groups (18-24, 25-44, 45-64, and 65þ years) of suicide decedents with respect to associations between SI disclosure and (1) suicide contributing/precipitating factors, and (2) suicide means. The results shows that those age 18-44 were more likely to disclose SI than those age> 45, especially among those with relationship problems. Physical health problems and death/suicide of family/friend increased the likelihood of SI disclosure in the 65þ age group. [ABSTRACT FROM AUTHOR]

Access to valid and reliable neuropsychological measures for use with culturally diverse groups in Australia is limited. The aim of this study was to adapt and translate a selection of English language neuropsychological tests, employ several existing standardised Greek language tests, and provide specific reference group normative data for Greek Australian older adults. A convenience sample of 90 healthy older Greek Australians (M = 77.14 ± 4.46; range = 70–85), with a primary school level of education (M = 5.60 ± 0.68; Range = 4–6), was recruited throughout the Melbourne metropolitan area. Several neuropsychological measures were administered which assessed domains such as verbal and visual memory, confrontational naming, and executive functions. Regression modelling revealed that age, education and sex predicted between 5% and 35% of the variance of test scores, with age being the most significant predictor of performance across a majority of measures. Therefore, the normative data for all tests were stratified according to three age bands (70–74, 75–79, 80–85). The use of culture-specific tests and norms for assessment of older Greek-Australians with limited education may facilitate accuracy of assessment findings, improve diagnostic outcomes, and reduce misclassification. What is already known about this topic: The use of English language tests with migrant populations and tests developed in nations of origin can lead to misclassification when applied to long-term immigrant peers. The use of test content derived from English language tests has been found to be inappropriate for use with culturally diverse groups. Access to norms and tests for assessment of culturally diverse groups in Australia are limited. What this topic adds: This paper provides a template for translating and adapting existing English language tests for use with culturally diverse groups. This is the first study to provide a set of comprehensive norms for Greek Australian older adults. Utilising culturally appropriate and specific reference group norms for Greek-Australians may improve the accuracy of assessment findings and reduce misclassification. [ABSTRACT FROM AUTHOR]

Legal and relational permanence have long been viewed as a central outcome of child welfare services. Timely termination of parental rights (TPR) has been a cornerstone of these permanency efforts because TPRs facilitate permanency through adoption. Yet the number of adoption plans that are not finalized or sustained are not trivial. Over 2,000 youth emancipate from foster care each year and many more leave earlier but not before a TPR has occurred. Some states have passed legislation to allow reinstatements of parental rights. This paper reviews the range of factors state legislation includes, reviews scant existing literature on how TPRs may effect youth, and proposes several options for ways that unproductive TPRs can be reduced, and timely reinstatements increased. [ABSTRACT FROM AUTHOR]

Self-rated health (SRH) is a salient outcome for cancer survivors. Although depression is a well-studied correlate with SRH, few studies have focused on the role of cancer survivors' age on the association between depression and SRH. This study evaluates demographic and psychosocial factors associated with cancer survivors' SRH. We also assess the moderating role of age to the association between depression and SRH. This paper analyzed 2,470 U.S. cancer survivors from the 2019 National Health Interview Survey. Two ordered logistic regression models with complex survey weights were used for analyses. Missing data was addressed using multiple imputations by chained equations. Being female, higher education and higher income were positively associated with better SRH. While the relationship between higher education and higher income was consistent with previous findings, the positive association between being female and SRH was different from previous studies. Age significantly moderated the association between depression and SRH, evidenced by results of the joint tests of all interaction term coefficients being statistically significant, F(2, 544.6) = 5.13, p < 0.01. The findings of the study highlighted the significance of screening for social determinants of health and health disparity when supporting cancer survivors. Additionally, findings of this study emphasized the significance of adopting an age-specific approach when evaluating and addressing depression across different age groups of cancer survivors. [ABSTRACT FROM AUTHOR]

Spanish legislation obliges the public administration to ensure equal opportunities and support for access to higher education for people with disabilities. This work has one central goal: to analyse and understand the causes for the potential inequality for people with disabilities in accessing higher education in Spain and the barriers they encounter during their academic life. This paper focuses on the differences in inclusive education between people with disabilities and people without disabilities by sex, age, and type of university. A mixed research design is used: qualitative research of two focus groups and fourteen interviews to sixteen students with disabilities; and statistical analysis of the Social Integration and Health Survey 2012, using two-way and multi-way cross-tables. There are significant differences between presence of disability and learning variables. Controlling by sex and age, almost every age-group is significant. Using sex as independent variable, and controlling by disability, there is no relationship with the variables relating to barriers to accessing education; therefore, the larger differences by sex are in the group of people without disabilities. [ABSTRACT FROM AUTHOR]

Excessive use of personal social media has become prevalent in the work environment and has caused significant psychological and behavioural problems among employees. These problems call for in-depth study. In this paper, we develop a usage experience–stressor–strain model to examine the consequences of excessive social media usage behaviour of employees at work, revealing the effects of different excessive usage patterns (i.e. social, hedonic, and cognitive) on employees' psychological state (i.e. emotional exhaustion) and behavioural outcome (i.e. job performance) through dimensions of social media overload (i.e. information, communication, and social). We empirically test the research model with a survey of 422 employees who use social media at work. Our analysis presents that excessive social use at work is the major predictor of dimensions of overload. Furthermore, in contrast to the single effect of communication overload on emotional exhaustion and social overload on job performance, information overload has a significant impact on both emotional exhaustion and job performance of employees. This study advances our understanding of the complex relationships between excessive usage patterns, overload, emotional exhaustion, and job performance. [ABSTRACT FROM AUTHOR]

This paper illuminates how teachers are influenced by age, gender and sexuality in teaching about sex and relationships. In this analysis grounded in feminist theory, age, gender and sexuality are considered to be enacted as doings. Six interviews with teachers working with sexuality education in K-12 schools in Sweden were chosen from of a larger body of material consisting of 21 interviews with professionals engaged in school-based sexuality education. The six interviewees were selected because they explicitly addressed how teachers' age, gender and/or sexuality come to matter in the classroom. Findings show how male and female teachers organise their teaching in relation to normative expectations of age, gender and sexuality. In sexuality education, the diverse life-courses of (hetero)sexual women offer a wide range of pedagogic possibilities for female teachers to address issues of sexuality, consent and relationships whereas male teachers are constrained to doing safe(r) forms of masculinity by directing attention away from their bodies and experiences. In understanding these results, I argue that the figure of the tant has been key in forming the pedagogic backdrop to Swedish sexuality education, hence embedding a normative 'who' in the 'how' to teach sexuality education. [ABSTRACT FROM AUTHOR]

The purpose of this paper is twofold: to explore the factors influencing the emergence and growth of informal e-waste activities and to examine workers' motivation for involvement in informal e-waste activities. Semi-structured interviews and observations among actors in the recently established Dagomba-Line e-waste site in Kumasi, Ghana were employed to gather relevant data. Emergence and growth of e-waste activities are largely influenced by spatial, political, socio-cultural and economic factors. The reuse and open disposal of e-waste are the common practices due to the cost of transportation to a final disposal site. Similar to findings at the well-established Agbogbloshie e-waste site, also in Ghana, scavengers are found at the bottom of the e-waste financial ladder. The major motivating factor for engaging in e-waste handling is poverty. Additionally, some respondents mentioned the lucrative nature of the activity, landlessness, and peer influence as a motivation. The results showed that younger workers (below 35 years) were more likely to be engaged in the activity for reasons of peer influence and poverty and major source of livelihood. The paper recommends that policy and planning should reflect ways of delivering and creating stable socio-economic conditions that promote an inclusive and sustainable development. [ABSTRACT FROM AUTHOR]

As health care improves and more people work into later age, it is important to understand what impacts open-mindedness has on decision-making. This paper examined the role of aging on open-mindedness. Open-mindedness was measured across 12 studies before data amalgamation. The Actively Open-minded Thinking (AOT) scale and Actively Open-minded Thinking about Evidence (AOT-e) scale measured open-mindedness in this sample (n = 9010) of participants between 18 and 87-years of age. Summary AOT positively correlated with AOT-e (r = 0.27). For two subfactors derived from factor analysis based on the AOT, scores for both subfactors positively correlated with AOT-e (subfactor-1: r = 0.17/subfactor-2: r = 0.31) but negatively correlated with age (subfactor-1: r = −0.01/subfactor-2: r = −0.16). Age negatively correlated with both AOT (r = −0.11) and AOT-e (r = −0.13). Regressions revealed that open-mindedness decreased with aging. Age marginally predicted the change in open-mindedness, and sex differences were not a predictor. It is proposed that the observed differences are the result of a reluctance to change long-established values and ideas at the cognitive level and cortical changes that occur with aging. In an aging population where more adults work into later age, the decrease in open-mindedness could influence many areas of judgments of decision-making. Importantly, this demonstrates that open-mindedness varies across lifespan. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to (1) translate and validate the PEACH + Rating Scale in Malay and (2) establish normative curves as a function of age and examine test-retest reliability for the Malay and English versions of PEACH+. This is a cross-sectional study that used a convenient sampling technique. One hundred and fifty-seven parents of typically developing children aged between 4 months and 7 years participated in the study. Forty-nine completed the Malay PEACH + in a pen-to-paper format (Aim 1). One hundred and eight parents completed PEACH + online (69 completed the Malay version and 39 the English version), and 20 of them completed the questionnaire twice (Aim 2). The PEACH + in Malay showed high internal consistency and item-total correlation. The normative data revealed that scores for frequency of auditory behaviour increased rapidly with age until about 20 months and reached an asymptote of around 90% by about 40 months of age. A similar trend was observed for ease of listening scores, which asymptoted around 85%. The validated Malay PEACH + Rating Scale can be used as a guide to monitor auditory functional performance and listening efforts of Malaysian children in real-world environments. [ABSTRACT FROM AUTHOR]

It has been demonstrated that alcohol continues to be the most prevalent reason causing traffic accidents. This study aimed to evaluate the alcohol levels in the traffic accident cases admitted to Ege University Hospital. Blood samples of the 4,266 cases were analyzed with the enzymatic immunoassay method between 2016 and 2017. The data was obtained from the hospital automation system and analyzed statistically. Of all cases (n = 20,058) admitted to the hospital department, the rate of traffic accidents was 21.3% (n = 4,266). The mean age was 32.38 ± 12.4, and 70.4% of the cases were male. Ethyl alcohol was positive in 9.6% (n = 409) of the cases, and 33.1% (n = 136) of them were in the 25–34 age range. A significant increase was observed in 2017 compared to 2016 (p < 0.05). About 87.6% (n = 360) of the positive cases were above the legal limit of 0.50 g/L for drivers except for professional drivers. About 57.7% (n = 237) of the positive traffic accident cases were passengers, and 27.2% (n = 112) were motor vehicle and motorcycle drivers. This paper presented an updated ethyl alcohol determination in the traffic accidents of the Izmir region in order to have an overall picture of Turkey. Continuous and systematic follow-up studies may help to monitor the alcohol use problem. [ABSTRACT FROM AUTHOR]

Purpose: Using a minority stress paradigm, this paper examines the relationship between anti-transgender discrimination, harassment, and violence among transgender adults. Methods: Data from the 2015 U.S. National Transgender Survey were used to examine twenty types of anti-transgender experiences/problems (e.g., harassment at work, problems with police officials, verbal and physical assaults) in a sample of 27,715 transgender Americans aged 18 or older. Binge drinking during the previous month was the dependent variable, and eight control measures were examined in the multivariate analysis. Results: Experiencing any of the twenty types of anti-transgender discrimination, harassment, or violence increased the odds of binge drinking by 48%. Experiencing many such problems increased the odds of binge drinking by 104%. Multivariate analysis showed that anti-transgender discrimination, harassment, and violence remains a predictor of binge drinking even when other key measures are taken into account. Younger people, racial minority group members, and persons who were not married or "involved" were at particularly great risk. Conclusions: Consistent with the minority stress paradigm, the more different types of anti-transgender experiences people had, the more likely they were to engage in binge drinking. Targeted intervention needs to help transgender persons to avoid anti-transgender discrimination, harassment, and violence to the greatest extent possible, and to develop resiliency skills whenever they are victimized. This is particularly true for transgender persons who are younger, minority, and not "involved" in a relationship. [ABSTRACT FROM AUTHOR]

Aging in place has become a popular social policy worldwide. This paper argues that well-being is an important outcome of aging in place, upon which older people develop autonomy and environmental proactivity. The temporal dimension of aging in place highlights development of place attachment, which includes place identity and place dependence. The study explores how older people, who live inhigh-density urban environments, make sense of well-being and place attachment by articulating their daily lives. Community dwelling older people aged 65 and above, who came from neighborhoods with high aging population and residential density but high and low median household incomes, were invited for focus group discussions. Multifaceted meanings of well-being include various dimensions that cover individual-collective and material-spiritual (psychological) construct. Meanings of place attachment include values of, bonding ties to, and memories about places. Three pathways are identified linking place attachment and multifaceted well-being. The study finds that social welfare and material richness are not the only determinants of well-being. Fulfillment of higher psychological needs, such as positive evaluation of life and self-actualization, should be emphasized by which older people can make the most of their life in old age. [ABSTRACT FROM AUTHOR]

In this paper, the first virtual reality (VR) photography application that incorporates elements on panoramic images to assess short-term spatial memory is presented. It also allows the interaction with these elements. A study was conducted (N = 50) to compare participants' performance outcomes and subjective experience when using a VR application with and without panoramic photography. The results show that both applications are effective in assessing short-term spatial memory. The results with panoramic photography include: 1) It was effective for short-term recall since, after using the application, the participants were able to verbally recall the objects and place them without significant differences with respect to the objects correctly placed; 2) The performance outcomes were independent of age and gender; 3) The perceived level of presence was directly related to experiencing less cybersickness when using the application; 4) The level of satisfaction was directly related to perceived enjoyment, concentration, usability, competence, calmness, and expertise; 5) The more the familiarity with VR applications, the less the perceived cybersickness. Finally, the application offers two main advantages: 1) The evaluators can customize the environment by adding as many elements as desired to the panoramic photograph; 2) It could be especially suitable for groups with reduced mobility. [ABSTRACT FROM AUTHOR]

Recent declines in life expectancy in the US, especially for middle-aged White persons, have called attention to mortality from deaths of despair – deaths due to alcohol, drugs, and suicide. Using data from the Centers for Disease Control and the U.S. Census Bureau, this paper examined deaths of despair by race/ethnicity, age, cause of death, birth cohort, and sex in Missouri. We focused on Area Agencies on Aging as geographic units of interest to increase usefulness of our findings to public administrators. Deaths of despair began trending up for all age groups beginning in 2007–2009, with the sharpest increases occurring for Black or African American non-Hispanics beginning in 2013–2015. The most dramatic increases occurred for the population age 50–59 in St. Louis City and Area Agency on Aging regions in southern Missouri. For older adults, considerable variation in rates, trends, and cause of deaths of despair is evident across the state. [ABSTRACT FROM AUTHOR]

To examine the prevalence of hearing loss (HL) among employed persons, the association between HL and non-employment, assessing whether this has changed over the last two decades. To identify susceptible groups for HL-related work problems and examine the association between HL and co-worker relations. Cross-sectional analyses of working-age participants (20–66 years). HL was defined as the pure-tone average threshold of 0.5–4 kHz in the better hearing ear: 20–34 dB (mild) or ≥35 dB (disabling). Associations were assessed with logistic regression. Data from two waves of the Trøndelag Health Study (HUNT): HUNT2 1996–1998 (N = 38,603), HUNT4 2017–2019 (N = 19,614). The nationally weighted prevalence of HL among employees was 5.8%. HL was associated with non-employment, more strongly in HUNT2 (odds ratio (OR) 2.2, 95% confidence interval (CI) 2.0–2.4) than HUNT4 (OR 1.9, CI 1.7–2.1). HL was not associated with poorer co-worker relations. The association between HL and non-optimal work performance was stronger among white-collar workers than blue-collar workers. Our study shows that HL is common in the employed population. It also indicates a weakened association between HL and non-employment in recent generations. White-collar workers appear to be more vulnerable to HL-related work problems than blue-collar workers. This paper evaluates employment and work performance among hearing impaired. We show a prevalence of hearing loss (HL) among employed persons of 5.8% and that HL is associated with higher odds of non-employment. Our study indicates that the association between HL and non-employment has weakened in recent generations. [ABSTRACT FROM AUTHOR]

Trauma experiences and symptomatology may be overlooked by clinicians as a significant impediment to aging in place. This paper presents the types of traumas and the impact of culture and racism on older adults. Additionally, age-related stressors may influence the reemergence of trauma memories and reactions and therefore, impact aging in place. Assessment, case examples, and best practice issues are presented. [ABSTRACT FROM AUTHOR]

Being aware of factors that affect fertility can help people make informed decisions about their reproductive futures. To some, however, fertility information leads to worry and self-blame. In this paper, we explore how people from different generations discuss fertility and reproductive decision-making, along with their perceptions of fertility information. The study was conducted in southern Sweden with 26 focus-group discussions that included a total of 110 participants aged 17–90 years. The material was analysed thematically. Our results show that fertility knowledge and openness to talking about fertility problems have increased over generations. Participants who were assigned female at birth were more often concerned about their fertility than those who were not, and fertility concerns were transferred from mothers to daughters. While age-related fertility concerns had been uncommon in older generations, participants aged 25–40 often expressed these concerns. Young adults appreciated being knowledgeable about fertility but simultaneously expressed how fertility information could lead to distress. Our conclusion is that fertility information was best received by high-school students, and efforts to improve fertility education in schools are therefore recommended. [ABSTRACT FROM AUTHOR]

Autism spectrum disorder (ASD) is an etiologically heterogeneous neurodevelopmental condition that eludes a single explanation or cure. Epidemiological studies reveal risk factors, relevant comorbidities, and behavioral correlates to reach a better understanding of ASD. To contribute such data from an understudied ASD population, this paper presents epidemiological data from a Turkish sample of individuals with ASD (n = 911, 748 boys (82.1%) and 163 girls (17.9%) between 1 and 18 years of age). Average age at diagnosis was 31.06 ± 11.88 months, and the male-to-female ratio was 4.6:1. Three in 4 individuals with ASD had obsessive behaviors, and 1 in 4 had allergic conditions, inappropriate sexual behaviors, self-harming behaviors, and harmful behaviors towards others. One in 3 received a dietary treatment for at least 3 months; almost half received vitamin supplements; the majority (70%) did not experience constipation; and 2 in 3 were picky eaters. This paper presents data on the age of diagnosis, gender ratios, accompanying behaviors, and dietary interventions in Turkish individuals with ASD, which are topics of current research interest about ASD. Such data from non-Western populations may supplement epidemiological knowledge gained from Western populations to help reach a more comprehensive understanding of this condition with many unknowns. [ABSTRACT FROM AUTHOR]

Deaf and hard-of-hearing (DHH) children with cochlear implants (CwCIs) constitute a heterogeneous population. A multitude of factors influence their spoken language development. There is evidence that CwCIs follow similar trajectories in language development as typically developing (TD) children but there is a lack of research on specific types of skills. This study aimed to (1) map the trajectory of receptive and expressive language skill development of a representative group of CwCIs and (2) evaluate the impact of age at switch-on (ASO) on skill development. This paper presents a detailed analysis of the language outcomes of 44 CwCIs with ASO between 11 and 45 months (M = 26.02 SD = 8.31). These children were tracked for the first two years following implantation. Clustered bar charts were used to compare specific types of skills acquired by CwCIs with ASO ≤2 years versus >2 years. The results suggest that CwCIs generally acquire receptive and expressive language skills along a similar sequence to TD children, but there is individual variability relating to specific skills. However, the language outcomes of CwCIs are ultimately the result of a complex interplay of demographic variables. [ABSTRACT FROM AUTHOR]

Consistency of word production contributes to carers' ability to understand children's speech. Reports of the proportion of words produced consistently by typically developing preschool children, however, vary widely from 17% to 87%. This paper examines the quantitative (consistency count) and qualitative (e.g. phonemic analysis) characteristics of word consistency in 96 children aged 36–60 months. Children named 15 pictures twice, in separate trials, in the same assessment session. The mean consistency of the production for the whole group was 82%. Older children were more consistent than younger children. Girls were more consistent than boys. Words produced correctly in one trial and in error in another may indicate resolving error patterns. Words produced in error in two different ways provided useful evidence about the nature of inconsistent word production in typically developing children. The clinical and theoretical implications are discussed. [ABSTRACT FROM AUTHOR]

Many transgender people enjoy positive intimate relationships, however such relationships exist within a context of broader discrimination, specifically cisgenderism. The present study sought to investigate the relationships between demographic variables, significant other support, relationship satisfaction, resiliency, past relationship experiences and future relationship expectations, and gender-related discrimination amongst a convenience sample of transgender people living in the United States. 345 participants completed an online questionnaire designed by the authors assessing psychological distress, relationships with partners, and partner support. Findings suggest that participants had some difficulties in negotiating past relationships, though remained hopeful about future relationships. This was especially true for those who lived with animal companions and who reported higher levels of resiliency. Participants currently in relationships reported relatively high levels of significant other support (and this was especially true for participants in relationships with other transgender people), and such support was related to lower levels of psychological distress, though this was less true for older and/or agender participants. Participants were on average satisfied with their current relationships, though this was particularly true for participants with higher incomes. The paper concludes by discussing the implications of the findings for clinicians who work with transgender people and their partners. [ABSTRACT FROM AUTHOR]

The purpose of the authors in this paper is to investigate the effects of negative experiences during delivery and postpartum period on the relationship between the mother. The quantitative part of this study was conducted with 289 mothers and the qualitative part with 40 mothers. It was found that experiencing upsetting problems during delivery (p = 0.006) and in the postpartum period (p = 0.002) had an effect on separation anxiety. Based on the examination of the feelings experienced during annoying or distressing situations in the postpartum period, it was determined that there was a significant correlation between guilt (p = 0.000), fear of not being a good mother (p = 0.035), and feeling weak (p = 0.001) and separation anxiety. Blues of birth is fear and anxiety that the baby will be harmed if the mother is separated from it, and it is attributed to negative experiences during delivery and the postpartum period. [ABSTRACT FROM AUTHOR]

The Covid-19 pandemic created an environment wherein stress and isolation could increase alcohol consumption. The effects of alcohol consumption on Covid-19 susceptibility and the impact of the Covid-19 pandemic on alcohol use, related harms and services were explored. Search terms were inputted to Medline and Embase databases, with relevant published papers written in English chosen. Alcohol ingestion both increased and decreased throughout the population globally, however, the overall trend was an increase. Risk factors for this included female sex, young age, family conflicts, unemployment, mental health disorders, substance misuse and lack of support. Alcohol misuse was found to be an aggravator of domestic violence and worsening mental health. It exacerbated the risk of contracting SARS-CoV-2 and worsened the Covid-19 infection severity, with >10 drinks/week increasing the acute respiratory distress syndrome (ARDS) risk similarly to established risk factors. This was attributed to the immunosuppressive and disinhibition effects of alcohol. Therefore, healthcare professionals should provide support to vulnerable groups, encouraging stress reduction, healthy habits, limiting alcohol consumption (<5 drinks/week) and promoting coping techniques. Self-help tools that monitor individual alcohol intake and psychosocial interventions in a primary care setting can also be employed. Finally, governing bodies should inform the public of the risks of alcohol ingestion during the Covid-19 pandemic. Thus, the Covid-19 pandemic could create a cycle whereby alcohol misuse could become a risk factor for Covid-19 infection and the Covid-19 pandemic could become a risk factor for alcohol misuse. Healthcare professionals should counsel people on alcohol misuse risk and protective factors. [ABSTRACT FROM AUTHOR]

Research has demonstrated that performing a sequence of saccadic horizontal eye movements prior to retrieval facilitates performance on tests of episodic memory. This has been observed in both laboratory tasks of retention and autobiographical memory. To date, the work has centred on performance in younger individuals. This paper extends previous investigations by examining the effects of saccadic eye movements in older persons. Autobiographical episodic and semantic memory fluency was assessed in younger (age range 18–35, mean = 22.50), and older (age range 55–87, mean = 70.35) participants following saccadic (vs. fixation control) manipulations. The main effects of eye movements and age were found for episodic autobiographical memory (greater fluency after eye movements and in younger participants). Semantic autobiographical memory showed a main effect of age (greater fluency in younger participants), whereas general semantic memory showed no effect of age or eye movement. These findings indicate that saccadic horizontal eye movements can enhance episodic personal memory in older individuals. This has implications as a technique to improve autobiographical recollection in the elderly and as an adjunct in reminiscence therapy. [ABSTRACT FROM AUTHOR]

In Finland, Young people’s sexuality education has not been examined from a multicultural perspective, with the exception of a few policy-oriented papers. This paper examines how cultural diversity is addressed in chapters on sexuality and sexuality education in Finnish health education textbooks. The analysis is based on material contained in textbooks used in grades 7-9 and upper secondary schools. Findings suggest that cultural diversity is included in textbooks in one of two ways: either to demonstrate the uniqueness of liberal, emancipated and progressive ‘Finnish’ sexuality; or as a way of distancing Finland and Finnish values from the rest of the world. In these textbooks, culture is understood as belonging to non-Finnish ‘others’ and a culture that itself as not being Finnish. This somewhat tendentious treatment of cultural diversity leaves teachers with limited tools with which to promote anti-discriminatory education. The textbooks also overlook the diverse backgrounds of young people growing up in Finland today. [ABSTRACT FROM AUTHOR]

From 2005-06 to 2015-16, proportion of cesarean deliveries in total deliveries has almost doubled in India. In this paper, we study changes in prevalence of cesarean deliveries across different social-economic groups and study factors affecting odds of undergoing cesarean delivery. The present paper was based on National Family Health Surveys and employs logistic regression. We find that rise in cesarean deliveries has been across social groups, religions, urban/rural India, wealth groups, though increase has not been uniform. Further, many economically affluent states have high proportion of cesarean deliveries. We find that women delivering at private hospitals had significantly higher odds of opting for cesarean delivery. Further, women belonging to rich households were more likely to go through surgery for birth. In case of earlier terminated pregnancies, odds were higher too. The higher odds of cesarean sections in the relatively affluent geographic regions, richer households and private institutions indicate that these procedures may be driven by non-medical reasons in many cases, pointing toward the use of surgical procedures for the convenience. [ABSTRACT FROM AUTHOR]

Although people with a migration background (MB) have more unmet mental health needs than the general population, patients with a MB are still underrepresented in mental health care services. Provider bias towards these patients has been evidenced repeatedly but its driving factors remain elusive. We assessed the moderating effect of the individual (e.g. age and ethnicity), interpersonal (e.g. healthcare provider trust), and organisational (e.g. perceived workload) factors on general practitioners (GPs) differential decision-making regarding diagnosis, treatment, and referral for a depressed patient with or without a MB. An experimental study was carried out in which GPs were shown one of two video vignettes featuring adult male depressed patients, one with a MB and the other without. Belgian GPs (n = 797, response rate was 13%) had to decide on their diagnosis, treatment, and referral. Analysis of variance and logistic regression were used to analyse the effect of a MB, adding interaction terms for the explanatory variables. Overall, we found that there were ethnic differences in GPs' decisions regarding diagnosis and treatment recommendations. GPs perceived the symptoms of the patient with a MB as less severe (F = 7.68, p < 0.01) and demonstrated a reduced likelihood to prescribe a combination of medical and non-medical treatments (F = 11.55, p < 0.001). Those differences increased in accordance with the GP's age and perceived workload; at an interpersonal level, we found that differences increased when the GP thought the patient was exaggerating his distress. This paper showed that lower levels of trust among GPs' towards their migrant patients and high GP workloads contribute to an increased ethnic bias in medical decision-making. This may perpetuate ethnic inequalities in mental health care. Future researchers should develop an intervention to decrease the ethnic inequities in mental health care by addressing GPs' trust in their migrant and ethnic minority patients. [ABSTRACT FROM AUTHOR]