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Aims The objective of this study is to explore and compare the strength of associations between work-related potential traumatic events and burnout among operating room nurses based on three different approaches. Design The study followed a multisite cross-sectional design. Methods A stratified sampling method was conducted. Cities in the Shandong Province were divided into four groups, and two tertiary hospitals were randomly selected from all tertiary hospitals in cities of each group. A total of 361 eligible operating room nurses provided valid questionnaires between June and November 2019. Work-related potential traumatic events questionnaire and the Chinese version of the Maslach Burnout Inventory were conducted. Associations between individual, cumulative potential traumatic events, as well as latent class analysis-derived patterns of potential traumatic experiences with burnout were examined using logistic regression analysis. Results Specific traumatic events (e.g., patients' sudden death, bullying and ostracism from colleagues) were independently associated with an increased risk of burnout. Work-related potential traumatic events had a cumulative effect on burnout, whereby operating room nurses exposed to cumulative potential traumatic events carried a higher risk for burnout than others. The "multiple work-related potential traumatic events" pattern derived by latent class analysis was related to an increased risk of high depersonalization. Conclusion Operating room nurses who reported specific or multiple work-related potential traumatic events were at high risk for burnout. It is of great significance to provide qualified and timely counselling or support. Impact This study is the first to focus on work-related potential traumatic events among operating room nurses and examine their relationship with burnout based on three perspectives. The findings could help identify those operating room nurses who are at high risk of burnout in clinical practice. Hospital managers should develop targeted interventions to prevent or mitigate the harmful impact of potential traumatic events on occupational health.

Aim To investigate the association between the nurses’ perception of the public image (PI) of nursing and the quality of nursing work life (QNWL). Design A descriptive correlational study. Methods 250 nurses of 12 hospitals affiliated with Tabriz University of Medical Sciences were sampled using a proportionate stratified sampling technique. Porter Nursing Image Scale and Brooks QNWL Scale were used for collecting data. Results There was a significant positive correlation between nurses’ perception of their public image and QNWL (r = .158, p = .012). Nurses’ perception of their PI along with other significant predictors including gender, age, position, work shifts, residency, financial status, level of family support, spouse's education and spouse's job significantly explained 15.2% of the predictability of QNWL (F (10,175) = 3.017, p = .001). Findings imply that enhancement of nurses' psychological status (nurses' perception of the public image of their profession) may improve their functional status (quality of nursing work life).

Stratification is commonly employed in clinical trials to reduce the chance covariate imbalances and increase the precision of the treatment effect estimate. We propose a general framework for constructing the confidence interval (CI) for a difference or ratio effect parameter under stratified sampling by the method of variance estimates recovery (MOVER). We consider the additive variance and additive CI approaches for the difference, in which either the CI for the weighted difference, or the CI for the weighted effect in each group, or the variance for the weighted difference is calculated as the weighted sum of the corresponding stratum-specific statistics. The CI for the ratio is derived by the Fieller and log-ratio methods. The weights can be random quantities under the assumption of a constant effect across strata, but this assumption is not needed for fixed weights. These methods can be easily applied to different endpoints in that they require only the point estimate, CI, and variance estimate for the measure of interest in each group across strata. The methods are illustrated with two real examples. In one example, we derive the MOVER CIs for the risk difference and risk ratio for binary outcomes. In the other example, we compare the restricted mean survival time and milestone survival in stratified analysis of time-to-event outcomes. Simulations show that the proposed MOVER CIs generally outperform the standard large sample CIs, and that the additive CI approach performs slightly better than the additive variance approach., Comment: 13 pages

Early detection and prompt response are crucial measures to prevent and control outbreaks. Public health agencies, therefore, designed the Communicable Disease Surveillance System (CDSS) to obtain essential data instantaneously to be used for appropriate action. However, a periodic evaluation of CDSS is indispensable to ensure the functionality of the system. For this reason, this study aims to assess the performance of the core and support functions of the CDSS in the Kurdistan Region of Iraq. A descriptive cross-sectional study was used. From a total of 291 health facilities HFs (Primary health care centers and Hospitals) in the Kurdistan region of Iraq that have surveillance activities, 74 HFs were selected using a random stratified sampling approach. The World Health Organization (WHO) generic questionnaire has been used to interview the surveillance staff, together with direct collection of the data. Our analysis shows a lack of surveillance guiding manual in the HFs. Even at the district level, where a surveillance manual existed, case definitions, thresholds, and control measures were still missing. To note, more than 93% of HFs had organized and comprehensive patients registers for the collection of their clinical and secondary data. Also, all HFs had functioning laboratories. The majority of them (almost 93%) were equipped to collect, process, and store blood, stool, and urine specimens. About 72% of these laboratories were also able to transport timely the specimens to more specialized laboratories. At all levels, data reporting to the higher level exceeded the recommended minimum rate of 80%. The reporting system at the district level was based on emails, while in the periphery on hand-delivered in paper-based formats (50%), telephone (22%), and social media (22%). Furthermore, our analysis highlights the lack of data analysis: only 3.8% of Primary Health Care Centers conduct simple data analysis regularly, while hospitals do not do any sort of analysis. Also, only a few HFs investigated an outbreak, though using system routine sources to capture these public health events. Our findings show a lack in epidemic preparedness (3%), in feedback (53%), in standard guidelines, training, supervision, and resource allocations in HFs (0%). Taken together, our data show the importance of strengthening the CDSS in the Kurdistan region of Iraq, by reinforcing the surveillance system with continuous feedback, supervision, well-trained and motivated staff, technical support, and coordination between researchers and physicians.

Pressure ulcers (PUs) have a profound impact on individuals, with studies demonstrating that compared with similarly aged persons, those living with a PU have a significantly lower quality of life. The aim of this study was to explore the impact of the Shanley Pressure Ulcer Prevention Programme (SPUPP) on older persons' knowledge of, and attitudes and behaviours towards, PU prevention. This was a multi-centre, open-label, randomised controlled trial. The population of interest was older persons living in the community who attended either a day care centre or a retirement group and were deemed to be at risk of PUs due to reduced mobility. Stratified random sampling was used to randomise based on days of attendance at day care centre/retirement group. Pretest and post-test were applied to the intervention and control groups. The SPUPP is a multimedia programme delivered using electronic media, hard copy materials, activities, and patient diaries and addresses the key tenets of PU prevention as described by the SKIN bundle. The programme contains five separate sessions delivered over 5 weeks. The impact of the SPUPP was assessed using the patient knowledge of and attitude and behaviour towards PU prevention instrument (KPUP). A total of 64 persons, 32 in each group, took part in the study. Of these, 75% (n = 48) were female, with a mean age of 81.9 years (SD: 5.56 years). Further, 68.8% (n = 44) were either overweight or obese and 40.6% (n = 26) were usually incontinent of urine. There were no differences between the intervention and control groups in mean scores during the pretest stage. However, at post-test, the mean scores for the intervention group were higher than the control group, 16.87 (SD: 1.88) versus 12.41 (SD: 3.21), respectively. For the post-test stage, mean differences between the two groups in favour of the intervention group (∆ = 4.46) were statistically significant, as t = 6.76, P = .0001, and equal variances were not assumed. The SPUPP impacted positively on knowledge scores of the participants and positively influenced attitudes and behaviours towards PU prevention. Thus, this research provides information regarding the potential to enhance patient involvement in PU prevention.

BACKGROUND The Centers for Medicare & Medicaid Services (CMS) Home Health Quality Reporting Program (HHQRP) uses performance measurement to spur improvements in home health agencies' (HHAs') quality of care. We examined quality improvement (QI) activities HHAs reported making to improve on HHQRP quality measures, and whether reported QI activities were associated with better measure performance. METHODS We used responses (N = 1052) from a Web- and mail-based survey of a stratified random sample of HHAs included in CMS Home Health Compare in October 2019. We estimated national adoption rates for 27 possible QI activities related to organizational culture, health information technology, care process redesign, provider incentives, provider training, changes to staffing responsibilities, performance monitoring, and measure-specific QI initiatives and technical assistance. We used multivariate linear regression to examine the associations between HHA characteristics and QI adoption, and between QI adoption and CMS Home Health Quality of Patient Care Star Rating. RESULTS HHAs reported implementing an average of 16 QI activities (interquartile range 11-19 activities). Larger HHA size was associated with adopting 1.6 additional QI activities (p

Recent advance in medical education is in correlation with the advances in information technology and thus computer-based learning is being increasingly employed. The objective of the present study was to design and evaluate an e-learning module in anatomy and assess the perceptions of students and faculty about this e-learning module. The participating students were randomized into three groups by block stratified randomization and Google groups were created for each of the three groups. The e-learning module was implemented in three sessions by rotating the three groups. Validated questionnaires were sent to faculty and participating students via Google forms to obtain feedback. The results of ANOVA showed that there was a significant difference among the groups in terms of marks obtained with conventional (F = 2.403, P = 0.103), online (F = 6.050, P = 0.005), and blended (F = 5.801, P = 0.006). Post hoc comparisons using the Tukey HSD test, about the gain of knowledge, indicated that the results were insignificant when comparing the conventional group with the online group, but were significant when comparing the blended group with the conventional and online group. The qualitative data regarding the perception of students toward e-learning were analyzed using thematic analysis. The introduction of an interactive e-learning module in anatomy was effective and well received by the students and faculty. The study showed that blended learning has a positive impact on the students' learning by improving cognitive gain and receptive perception for e-learning.

PURPOSE to analyze accuracy measures of the clinical indicators of Readiness for enhanced health management in patients with arterial hypertension and/or diabetes mellitus METHODS: prospective diagnostic accuracy study conducted with 359 patients with hypertension and/or diabetes mellitus, followed up in primary healthcare. Stratified random sampling was used to recruit participants. An assessment form was applied with sociodemographic data, health conditions, and information related to the clinical indicators under investigation. Sensitivity, specificity, predictive values, and likelihood ratios were analyzed FINDINGS: the sample was composed of 359 participants. The prevalence of Readiness for enhanced health management was 93.8%. There was a statistically significant association between the diagnosis and age under 60 years (p < 0.001), having only one chronic condition (p < 0.001), having normal blood pressure (p = 0.017) and blood glucose (p = 0.013) values, and having a nonsedentary (p = 0.026) and nonalcoholic (p = 0.044) lifestyle. All clinical indicators had high predictive values in predicting the nursing diagnosis under investigation. The indicator expresses desire to enhance management of symptoms was the most sensitive (99.7%) and specific (100%). The indicator expresses desire to enhance management of prescribed regimens was also highly specific (100%) CONCLUSION: all clinical indicators were accurate in predicting Readiness for enhanced health management IMPLICATIONS FOR NURSING PRACTICE: knowing which clinical indicators and sociodemographic/clinical characteristics best predict Readiness for enhanced health management, nurses in primary care can better plan nursing interventions and direct their goals.

Background Air pollution and poor ambient air quality are significantly related to multiple health risks. One associated disease is chronic obstructive pulmonary disease (COPD), a preventable disease with several contributing factors and one of the leading causes of morbidity/mortality locally and globally. A potentially high-risk population are traffic enforcers who are constantly exposed to air pollution. In the Philippines, the MMDA has the widest coverage in traffic management. The study determined the risk of COPD among Metro Manila Development Authority (MMDA) traffic enforcers in relation to ambient air quality level, as well as identified other factors that increase the risk of developing COPD. Methods Fifty-two MMDA traffic enforcers deployed in PM2.5 air quality sensor areas in Metro Manila from 2016 to 2018 were recruited through stratified sampling. The International Primary Airways Guidelines (IPAG) questionnaire was utilized to measure risk of COPD. Respiratory health and working history were obtained through questionnaires. Department of environment and natural resources provided PM2.5 ambient air quality data which aided in the construction of the Exposure-Month Index. Ordinal logistic regression was used to examine the association of PM2.5 together with the relevant factors and the risk of COPD. Results We found statistically significant associations between PM2.5 and COPD among high risk category [odds risk (OR): 1.24, 95% confidence interval (CI): 1.07–1.44]. Age (Moderate, OR: 1.16, 95% CI: 0.98–1.38 and High, OR: 10.06, 95% CI: 4.02–25.17) and chest pain (Moderate, OR: 68.65, 95% CI: 1.71–2.75 × 103) were potential risk factors, whereas body mass index (BMI) (OR: 0.05, 95% CI: 0.01–0.53) exhibited protective effect. Conclusions Exposure to PM2.5 was associated with an increased risk of COPD among high-risk category MMDA traffic enforcers. Age and chest pain were potential risk factors to risk of COPD, whereas BMI exhibited a potential protective effect. Results of this study can be used for clinical management of high-risk populations, such that of MMDA traffic enforcers., Graphical abstract Image 1

Introduction Although limited, existing epidemiological data on dementia in sub-Saharan Africa indicate that prevalence may be increasing; contrasting recent decreases observed in high-income countries. We have previously reported the age-adjusted prevalence of dementia in rural Tanzania in 2009-2010 as 6.4% (95% CI 4.9-7.9) in individuals aged ≥70 years. We aimed to repeat a community-based dementia prevalence study in the same setting to assess whether prevalence has changed. Methods This was a two-phase door-to-door community-based cross-sectional survey in Kilimanjaro, Tanzania. In Phase I, trained primary health workers screened all consenting individuals aged ≥60 years from 12 villages using previously validated , locally developed, tools (IDEA cognitive screen and IDEA-Instrumental Activities of Daily Living questionnaire). Screening was conducted using a mobile digital application (app) on a hand-held tablet. In Phase II, a stratified sample of those identified in Phase I were clinically assessed using the DSM-5 criteria and diagnoses subsequently confirmed by consensus panel. Results Of 3011 people who consented, 424 screened positive for probable dementia and 227 for possible dementia. During clinical assessment in Phase II, 105 individuals met DSM-5 dementia criteria. The age-adjusted prevalence of dementia was 4.6% (95% CI 2.9-6.4) in those aged ≥60 years and 8.9% (95% CI 6.1-11.8) in those aged ≥70 years. Prevalence rates increased significantly with age. Conclusions The prevalence of dementia in this rural Tanzanian population appears to have increased since 2010, although not significantly. Dementia is likely to become a significant health burden in this population as demographic transition continues. This article is protected by copyright. All rights reserved.

AIMS To examine the level of decision difficulties of long-term-care facility (LTCF) nurses when transferring residents to the emergency department (ED) and associated influencing factors. DESIGN A cross-sectional nationwide study. METHODS The LTCFs were selected through random stratified sampling across the whole Taiwan during February 2018 to January 2019. LTCF nurses who met the selection criteria were invited to participate with two or three nurses selected from each LTCF. The Patient Transfer Decision Difficulty Scale (PTDDS) was used to measure the level of difficulty in making decisions related to the transfer of residents to the ED. Data were collected by mailing the questionnaires and asking the nurses to return the completed form in 2 weeks. Data were analysed using simple linear regression and multiple regression with stepwise methods. RESULTS In total, 618 valid questionnaires with an 85.32% response rate from 319 LTCFs were used for the data analysis. Decision difficulties that LTCF nurses experienced were moderate, the nursing personnel-bed ratio, LTCF professional training and basic life support training were predictive factors of the level of difficulty experience (scores of PTDDS) for the LTCF nurse (F = 6.81, p

A clinical audit of hospitals in Thailand was conducted to assess compliance with the national hypertension treatment guidelines and determine hypertension control rates across facilities of different sizes. Stratified random sampling was used to select sixteen hospitals of different sizes from four provinces. These included community (120 beds) hospitals. Among new cases, the audit determined whether (i) the recommended baseline laboratory assessment was completed, (ii) the initial choice of medication was appropriate based on the patient's cardiovascular risk, and (iii) patients received medication adjustments when indicated. The hypertension control rates at six months and at the last visit were recorded. Among the 1406 patients, about 75% had their baseline glucose and kidney function assessed. Nearly 30% (n = 425/1406) of patients were indicated for dual therapy but only 43% of them (n = 182/425) received this. During treatment, 28% (198/1406) required adjustments in medication but this was not done. The control of hypertension at six months after treatment initiation was 53% varying between 51% in community and 56% in large hospitals (p

AIM This article describes the methodology of the 2018 Malaysian National Health and Morbidity Survey, and provides an overview of the sociodemographic details of the respondents and key findings on the health of older adults. METHODS The survey included 3977 community-dwelling respondents, aged ≥60 years across Malaysia. Two-stage stratified random sampling with selection of enumeration blocks from both urban and rural areas ensured the findings were representative of the Malaysian older population. RESULTS Complex sampling analyses ensured that findings on various geriatric syndromes, non-communicable diseases, nutritional status, functional status, social well-being and quality of life are representative of the Malaysian older population. Among the limitations are that the composition of older persons varied slightly from the general older population. CONCLUSIONS This article presents the methodology of the survey, and a baseline of the major health issues for older persons in Malaysia to provide clear guidance to researchers, program managers and policymakers to fully utilize the data from the Malaysian National Health and Morbidity Survey toward achieving healthy aging. The findings might stimulate more research on the health problems faced by older people to provide inputs for policymaking and program implementation. Geriatr Gerontol Int 2020; 20: 7-15.

Aim Older persons are vulnerable to food insecurity. Therefore, this study aimed to determine the prevalence of food insecurity and associated factors among older persons in Malaysia. Methods This is a cross-sectional study with two-stage stratified random sampling. In total, 3977 older persons participated in this study. Face-to-face interviews were conducted using a mobile device to obtain information about socio-demographic background, food insecurity, non-communicable diseases, social support and living arrangements. Descriptive and multiple complex sample logistic regression analyses were performed for data analysis. Results The overall prevalence of food insecurity among older persons was 10.4%. Older persons from rural areas with no or only primary and secondary education, income less than RM 2000 (USD 477.57), at risk of malnutrition and not receiving very high social support were more likely to be food-insecure. Conclusion Approximately, one-tenth of Malaysian older adults were classified as food-insecure; particularly those living in rural areas from lower socio-economic status, not receiving very high social support and malnourished were more likely to be at risk. A specific nutrition program, such as meals on wheels and food vouchers, should be targeted toward older persons who are at risk to improve their malnutrition status. Geriatr Gerontol Int 2020; 20: 73-78.

OBJECTIVE To study the prevalence of gum bleeding in children aged 12-15 years in Jiangxi Province and related influencing factors for the development of effective prevention and treatment strategies. METHODS A multistage cluster stratified sampling method was used to select 8,160 children aged 12-15 years for this study. Enrolled children completed a set of survey questionnaires covering children's gender, age, parents' educational level, oral health knowledge scores, attitude scores, and brushing habits in addition of dental examination. All the data were analyzed using the chi-square test and logistic regression. RESULTS Among 8,160 children, the gum bleeding rate was 66.5 percent (95% CI: 65.8%-68.1%). The gum bleeding rate in urban children (68.0 percent) was higher than that in rural areas (65.0 percent) (P

Aim: The need to cope with life concerns may drive an individual to resort to high-risk behaviours. This study aimed to determine the relationship between health concerns and high-risk behaviours. Design: A cross-sectional study. Methods: We sampled 926 Medical Sciences' students from the North of Iran from September�December 2017 using the stratified sampling method. Results: The most and less common high-risk behaviour was physical inactivity (97.5) and high-risk sexual behaviour (15.7), respectively. In multivariate logistic regression analysis, participants' concerns about human sexuality (AOR: 1.39; CI: 1.22, 1.57), injury prevention and control (AOR: 1.12; CI: 1.01, 1.20), nutrition (AOR: 1.13; CI: 1.02, 1.26) and emotional health (AOR: 1.08; CI: 1.02, 1.15) increased the odds of risky behaviours. Among Medical Sciences' students, health concerns are linked with risky behaviours. The result of this study can be used to develop relevant interventions targeting mental health to reduce risky behaviour among youth. © 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd.

Background Asian Americans are understudied in the literature on alcohol, due to data limitations and the perception that they are at low risk for alcohol misuse. Yet, certain subpopulations-such as college students-may be at higher risk. The current study examined longitudinal change in alcohol use and motivations for drinking among Asian American students. We tested for differences by nativity status, ethnic origin, and gender and examined whether motivations covaried with alcohol use. Methods Asian American first-year college students (N = 199, 45.7% female, 37.7% foreign-born) attending a US university were identified through stratified random sampling using registrar information. For 7 consecutive semesters, students completed online surveys about their behaviors and beliefs. Results Multilevel models demonstrated that alcohol use and alcohol-related motivations increased over time. US-born students consistently consumed more alcoholic drinks, reached higher peak drinking levels, and drank more frequently than foreign-born students; however, motivations did not differ by nativity status. Chinese American students consumed less alcohol, drank less, and were more motivated to avoid alcohol-related consequences than students of other/multiple heritage ethnic origins. Each motivation subscale was associated with alcohol use at the between-person level. Likewise, within-person variability in motivations was linked to variability in drinking across semesters. Controlling for other motivations, drinking for fun emerged as the strongest correlate of alcohol use variability. Conclusions Alcohol misuse was highest among US-born students and those with higher motivations for drinking. Furthermore, alcohol use varied in tandem with motivations, suggesting that motivations may be a useful intervention target among this population.

Aim To assess the impact of smartphone addiction on depression and self‐esteem among nursing students. Setting Faculty of Nursing. Design Cross‐sectional, survey‐based research design used in this study. Sample: Stratified random sample consists of 320 nursing students. Tools: Four tools used for data collection: personal data sheet, Hamilton rating scale of depression, smartphone addiction scale and Self‐esteem Inventory. Results About 95.8% of nursing students reported smartphone addiction, while 32.5% were pseudonormal of depression. Twenty‐eight percent of them had low self‐esteem. The study also revealed a statistically significant positive correlation between smartphone addiction and levels of depression. There was a statistically significant negative correlation between levels of depression and self‐esteem.

Islamic financing products are modes of finance based on principles of profit and loss sharing, no interest and no remunerative betting or speculation. Islamic home financing is one such mode of financing which is based on ownership sharing or deferred payment arrangement with the bank, hence avoiding chances of interest and speculation. This study examines the factors that affect customers' decision in selecting Islamic home financing services. A quantitative research methodology was adopted to study the dynamics of Islamic home financing by determining the level of key factors in Pakistani consumer market. Using stratified random sampling technique, data was collected from 250 bank customers through five‐point Likert scale questionnaires. Various tests were applied to check the reliability, sampling adequacy and correlation. Multiple regression analysis was applied for hypothesis testing. The findings of the study reveal that the level of knowledge, media advertisement, bank reputation, product choices and Shariah compliance are the key factors for the Pakistani bank customers who selected Islamic home financing. More importantly, we find no significant impact of price and bank services on selection of Islamic home financing. The results of the study enable the Islamic banking professionals and managers to identify the factors that are most valuable to customers for the selection of Islamic home financing over conventional home financing modes. They are suggested to develop strategies and plans to educate people more about Islamic home finance and develop their product portfolio to provide people with more Shariah compliant choices. This study contributes to the Islamic banking literature by extending and identifying the factors of Islamic home financing.

Introduction There is considerable international research indicating health disparities between people with and without intellectual disabilities. It is important that comparative studies use representative population samples. This study compares a total administrative population of adults with intellectual disability to a random stratified general population sample. Methods An administrative population of 217 adults with intellectual disability and a random stratified sample of 2,350 adults without intellectual disability participated. A questionnaire using the International Classification of Diseases (ICD‐10) Chapter Headings was administered to all participants to enable a like‐for‐like comparison. Findings Unadjusted comparisons identified that adults with intellectual disability have a greater prevalence of health problems. These problems start early in adulthood and continue throughout life. However, they were less likely to experience cancers and musculoskeletal diseases. Conclusions These findings are consistent with the hypothesis that adults with intellectual disabilities have greater prevalence rates of health problems than the general population.

The muskrat (Ondatra zibethicus) is an invasive species in Europe. The extensive waterways of the Netherlands provide ideal habitat for muskrats, and a large population established itself after arrival in 1941. A control program was put into effect immediately because muskrat burrowing can compromise the integrity of dikes and, hence, poses a significant public safety risk. The current (2015) annual catch of approximately 89,000 individuals is equivalent to approximately 0.30 muskrats/km of waterway, well above the national objective in spite of decades of effort. The control program is expensive (€35 M annually) and contested by animal rights groups. These factors created the need for a careful evaluation of the full range of control possibilities, from ‘no control’ to ‘extermination.’ As part of this, we experimentally evaluated the validity of a previously published correlation (based on historical data) between catch and effort. We raised or lowered removal effort (2013–2016) in a stratified random sample of 117 5-km × 5-km ‘atlas squares’ from the national grid. We found that catch-per-unit effort (CPUE) decreased after effort was increased, and rose after effort was decreased, by amounts slightly greater than expected based on the correlational data, though confidence intervals enclose zero. As anticipated, CPUE varied consistently and strongly between seasons. The biggest (and unanticipated) effects were those of the catch in the preceding 3 years (‘history’), and surrounding area (‘neighborhood’). Our experiment confirms estimates of intensity of control required to lower muskrat populations. These results will help with more effective allocation of control effort, and better-informed evaluation of the economic costs of various control options.

Background Emergency volunteering becomes a necessity in the face of unprecedented disasters like the coronavirus disease 2019 (COVID‐19) pandemic. There is a paucity of empirical data on volunteerism not imported from the developed countries. It became necessary to evaluate the local‐bred volunteerism with its peculiarity, as it emerged within the public health sector of Nigeria's COVID‐19 epicenter. Objectives To compare the family characteristics, professional profiles, and personality traits of volunteer and nonvolunteer COVID‐19 frontline healthcare workers (HCWs). To determine the significant predictors of volunteering as well as the deterrents to and motivation for volunteering. Method A comparative cross‐sectional study was conducted between May and August 2020 among COVID‐19 volunteer and nonvolunteer HCWs serving at the six dedicated COVID‐19 isolation/treatment centers and the 27 general hospitals, respectively. Using a stratified sampling technique, three professional categories of HCWs (doctors, nurses, and medical laboratory scientists) were randomly selected from the nonvolunteers while total enumeration of volunteers was done. The survey employed pilot‐tested self‐administered questionnaires. The univariate, bivariate, and multivariate analyses were carried out with IBM Statistical Package for Social Sciences (SPSS) version 23.0. The level of statistical significance was determined by a P‐value of

Objective To estimate prevalence of lifetime and current eating disorders (ED) in a sample of pregnant women in South‐East London and to describe their sociodemographic and clinical characteristics. Method Secondary analysis of data from a cross‐sectional survey. Using a stratified sampling design, 545 pregnant women were recruited. Diagnostic interviews were administered to assess lifetime and current ED, depression, anxiety, and borderline personality disorder. Data were extracted from maternity records to assess identification of ED in antenatal care. Estimates of population prevalence of ED were obtained using sampling weights to account for the stratified sampling design. Results Weighted prevalence of lifetime ED was 15.35% (95% confidence interval [CI] [11.80, 19.71]), and current ED was 1.47% (95% CI [0.64, 3.35]). Depression, anxiety, and history of deliberate self‐harm or attempted suicide were common in pregnant women with ED. Identification of ED in antenatal care was low. Conclusions Findings indicate that by early pregnancy, a significant proportion of pregnant women will have had ED, although less typically during pregnancy, and psychiatric comorbidity is common. Yet ED were poorly recognised in antenatal care. The findings highlight the importance of increasing awareness about maternal ED to improve identification and response to the healthcare needs of pregnant women with ED.

This exploratory study was conducted to examine the reasons behind credit defaults in Self‐help Group‐based microfinance programs in India. The study adopted the mixed‐method approach. Focus group discussions (FGDs) were conducted to collect information, and thematic analysis was followed to analyze data to identify the possible causes of loan defaults in self‐help groups (SHGs). Further, 120 defaulting and 120 performing SHGs were selected through stratified random sampling method. Finally, 960 respondents were randomly selected from 240 SHGs to collect information for quantitative inquiry. The ordinary least square (OLS) and probit models were engaged to process the data. This study identified three important attribution sets causing credit defaults, (i) bank‐related attributes, (ii) agency related attributes, and (iii) group dynamics. The probability of defaults in SHGs was predicted by the amount of loan disbursed by bank, agency's help in enterprise development, age of the microenterprise, microentrepreneurship of the SHG member, SHG visits to the bank, members dropped out from SHG, tenure of the president and secretary, and monthly membership saving in the SHG.

Background The patient satisfaction rate is considered a challenge for nurse leaders, especially among patients with cancer, due to the complexity of the disease, diagnostic procedures, and treatment. Aim The purpose of this study was to evaluate the impact of structured nurse leader rounds (NLRs) on satisfaction with nursing care among patients with cancer. Moreover, we assessed the relationship among NLRs, patient satisfaction, and demographical variables. Methods A two-group posttest design was used in four adult inpatient oncology units in a specialized oncology center. A stratified random sampling technique was utilized to select 169 patients for the experimental group (80 patients) and control group (89 patients). Structured leader rounds were conducted by nurse leaders using a scripted nurse leader tool to standardize the rounds in the experimental group, while the unstructured leader round was conducted in the control group. Patient satisfaction was measured using the Patient Satisfaction with Nursing Care Quality Questionnaire. Results The findings revealed that there was a significant difference in total score of patients' satisfaction between study groups (t = -9.213, p > .001). Conversely, the structured leader round has a significant impact on the patient's experience with nurse concern and caring (t = -2.054, p = .042). Conclusions Adoption of a structured NLR has a significant impact on improving patient satisfaction in an oncology setting where patients receive care from many disciplines, such as surgical, medical, radiotherapy, and radiology. Clinical relevance Efficient structured NLRs of nursing professionals are important for enhancing the quality of nursing care and patient satisfaction.

Objective: Vaccinations in Australia are reportable to the Australian Immunisation Register (AIR). Following major immunisation policy initiatives, the New South Wales (NSW) Public Health Network undertook an audit to estimate true immunisation coverage of NSW children at one year of age, and explore reasons associated with under‐reporting. Methods: Cross‐sectional survey examining AIR immunisation records of a stratified random sample of 491 NSW children aged 12≤15 months at 30 September 2017 who were >30 days overdue for immunisation. Survey data were analysed using population weights. Results: Estimated true coverage of fully vaccinated one‐year‐old children in NSW is 96.2% (CI:95.9‐96.4), 2.1% higher than AIR reported coverage of 94.1%. Of the children reported as overdue on AIR, 34.9% (CI:30.9‐38.9) were actually fully vaccinated. No significant association was found between under‐reporting and socioeconomic status, rurality or reported local coverage level. Data errors in AIR uploading (at provider level) and duplicate records contributed to incorrect AIR coverage recording. Conclusions: Despite incentives to record childhood vaccinations on AIR, under‐reporting continues to be an important contributor to underestimation of true coverage in NSW. Implications for public health: More reliable transmission of encounters to AIR at provider level and removal of duplicates would improve accuracy of reported coverage.

OBJECTIVE Effective use of family planning (FP) services significantly improves sexual and reproductive health of both women and men. Recently, the Chinese government has launched the two-child policy allowing families to have an additional child. This study aimed to explore the population's interest for FP services, unmet needs, and expectations. METHODS A cross-sectional study using stratified random sampling was conducted in 102 counties of Hubei province and 17 555 randomized individuals from rural, transitional, and urban areas were interviewed through a guided semi-structured questionnaire. RESULTS The Han ethnicity dominated our population and number of living children per family ranged from zero to six. Although 81% reported FP services and sexual and reproductive health (SRH) as a shared responsibility, the contraceptives used excluding condoms, were mainly intrauterine devices (76%), tubal ligation (16%), and vasectomy (8%). Although 24% of participants had a history of contraceptive failure, effective contraceptive use after failure among men remained lower (6% for tubal ligation and vasectomy) and 74% of naive contraceptive users strongly rejected vasectomy. Demographic factors, awareness of FP services/SRH, discussing and making joint decisions, and gender discrepancies were strongly associated with unmet FP services/SRH needs (P

Background: Historically, Indigenous Australians experienced poorer oral health than non-Indigenous Australians. We aimed to ascertain if Indigenous Australian oral health improved relative to non-Indigenous oral health between the 2004-06 and 2017-18 National Surveys of Adult Oral Health (NSAOH). Methods: Both NSAOHs were population-based cross-sectional surveys of Australian adults aged 15 years or more. In both surveys, representative samples of adults were drawn through a three-stage, stratified sample design within metropolitan and regional areas in each state/territory. Frequencies of Indigenous and non-Indigenous self-reported and clinical oral health variables were ascertained, and differences were calculated between the 2004-06 and 2017-18 NSAOHs. Ninety-five per cent confidence intervals were calculated and weights were used to account for the complex sampling methodology of both surveys. Results: In 2004-06, 229 Indigenous and 13 882 non-Indigenous Australians provided self-report data, and 87 and 5418 of these had dental examinations, respectively. In 2017-18, 334 Indigenous and 15 392 non-Indigenous Australians provided self-report data, and 84 and 4937 of them had dental examinations respectively. Between the surveys, relative to their non-Indigenous counterparts, Indigenous Australians experienced greater levels of: inadequate dentition (4.2%), experience of toothache (4.8%), problem-based dental attendance (4.5%) and 1+ teeth decayed, missing or filled (4.4%). Conclusions: The gap between poor self-reported and clinical oral health between Indigenous and non-Indigenous Australians was greater in the more recent survey.

The involvement of children in healthy meal preparation activities has emerged as a potential strategy to promote healthy eating behaviour among children. However, there is a lack of understanding of children's internal (psychosocial factors) and external factors (home food availability) that may support the practice of preparing healthy meals. This study aimed to determine children's psychosocial factors of healthy meal preparation within themselves and their external environment of home food availability as predictors for the practice of healthy meal preparation. Public schools (n = 8) from all three zones (Bangsar‐Pudu, Keramat and Sentul) in Kuala Lumpur, Malaysia, were selected through stratified random sampling. Two hundred children aged 9–11 and their parents participated. Children's psychosocial factors towards healthy meal preparation and their home food availability were assessed through children and parents, respectively, using validated questionnaires. Majority of the schoolchildren (86.5%) had poor practice of healthy meal preparation. Increased attitude (r = 0.344, P < 0.001) and self‐efficacy (r = 0.501, P < 0.001) of healthy meal preparation and the availability of fruits (r = 0.304, P < 0.001), vegetables (r = 0.243, P < 0.001) and healthful ready‐to‐eat foods (r = 0.227, P = 0.001) at home were positively correlated with the practice of preparing healthy meals. After adjusting for age, sex and monthly household income, increased self‐efficacy (P < 0.001), availability of fruits (P = 0.01) and lower availability of less healthful ready‐to‐eat food (P = 0.01) were associated with better healthy meal preparation practices. Outcomes revealed that positive self‐efficacy of healthy meal preparation, home food availability of fruits and less healthful alternatives were associated with the practice of healthy meal preparation and thus should be targeted in future health‐promotion strategy.

Background In the face of the global pandemic of coronavirus disease-2019 (COVID-19), people's adherence to precautionary behavioral measures (e.g. social distancing) largely influences the effectiveness of those measures in containing the spread of the coronavirus. The present study aims at testing the applicability of the health belief model (HBM) and generalised social beliefs (i.e. social axioms) to explore strategies for promoting adherence to COVID-19 precautionary measures. Methods We conducted a telephone survey with a two-step stratified random sampling method and obtained a probability sample of 616 adults in Macao, China (18-87 years old; 60.9% women) in April 2020. Results Our participants showed stronger adherence to some COVID-19 precautionary measures (e.g. face mask wearing; 96.4%) but not others (e.g. social distancing; 42.3%). Their adherence to those measures was found to be significantly associated with four HBM factors and two social axioms, after controlling for gender, age, and years of education. Conclusions The HBM and the generalised social beliefs of social cynicism and reward for application can be applied to understanding adherence to precautionary measures against COVID-19. Strategies based on beliefs were proposed to facilitate the promotion of precautionary measures.

In international debates on climate change mitigation and forests, there is increased recognition of the importance of a landscape approach to effectively address tropical deforestation. Such an approach, although increasingly promoted, remains only loosely defined and requires further development in order to effectively integrate different interventions at landscape level. In particular, it is important to understand the possible interactions between different landscape interventions at local level—where they are intended to have effect—and the challenges associated with them. Inspired by the complexity of policy mix analysis, this article seeks to shed light on these interactions by analysing how different policies and measures for reducing deforestation and degradation have played out in a jurisdiction with wide-ranging actors and interventions aimed at shaping their behaviour. Focusing on smallholders, we examine the Sustainable Landscapes Pilot Programme in São Félix do Xingu, looking at how different policies interact—categorising interactions as “complementary,” “mutually reinforcing” (synergistic), “in conflict,” “interdependent,” and/or “redundant”—and explain how proponents of this pilot programme seek to integrate them. Most analysis is based on primary data collected through quantitative (i.e., random stratified sampling and surveys) and qualitative (i.e., observation and focus groups) methods. The São Félix do Xingu case shows that understanding effects of different policies and measures on people's behaviour requires a deeper look at local perceptions and reactions to such policies and measures, something most studies on the topic have overlooked. Ultimately, the heterogeneity and complexity of social practices that permeate landscapes must be recognised in order to integrate diverse measures to reduce deforestation.

While age is the variable most often used to explain household recycling behavior, research findings reveal only limited or contradictory effects. This study demonstrates the utility of several additional variables related to age in regard to explaining the effect of aging on household recycling behavior. These variables are generativity, available time, and perceived skills. By drawing on the theory of planned behavior, this paper offers a model that clarifies how age indirectly influences household recycling behavior. The model is tested on a stratified sample, and the results are analyzed through mediation tests and structural equation modeling. While aging is associated with lower levels of enthusiasm for recycling, more skills and available time allow recycling to be accomplished with increased ease. Finally, the results enable an explanation of the previous contradictory results about age effects and lead to managerial and societal recommendations on how household recycling can be effectively promoted

Hepatocellular carcinoma (HCC) is closely associated with abnormal DNA methylation. In this study, we analyzed 450K methylation chip data from 377 HCC samples and 50 adjacent normal samples in the TCGA database. We screened 47,099 differentially methylated sites using Cox regression as well as SVM‐RFE and FW‐SVM algorithms, and constructed a model using three risk categories to predict the overall survival based on 134 methylation sites. The model showed a 10‐fold cross‐validation score of 0.95 and satisfactory predictive power, and correctly classified 26 of 33 samples in testing set obtained by stratified sampling from high, intermediate and low risk groups.

Objective To examine the role of protective factors and risk factors in suicidal ideation among adolescents in Taiwan based on a resilience protective model. Design and sample A cross-sectional design was employed. A total of 390 adolescents aged 15-19 years were recruited from four high schools in Taiwan by stratified random sampling. Methods An anonymous self-report questionnaire was used to collect demographic characteristics, suicidal ideation, depressive symptoms, life stress, emotion-focused coping, self-esteem, and problem-focused coping. Hierarchical multiple regression was used to test the hypotheses. Results Depressive symptoms were significantly and positively correlated with suicidal ideation. The interaction between depressive symptoms and self-esteem as well as between emotion-focused coping and problem-focused coping were significantly and negatively correlated with suicidal ideation. Conclusions Depressive symptoms were a risk factor of suicidal ideation. Self-esteem can moderate the negative effect of depressive symptoms on suicidal ideation. Problem-focused coping can moderate the negative effects of emotion-focused coping on suicidal ideation. Public health nurses could cooperate with school nurses to periodically screen depressive symptoms and provide early interventions. Teaching parents and teachers methods for improving self-esteem of adolescents and enhancing adolescents to apply problem-focused coping strategies could be useful to reduce suicidal ideation of adolescents.

Purpose To define and validate a case-finding algorithm to identify incident colorectal cancer (CRC) in the Spanish primary care database BIFAP. Methods All potential incident CRC cases recorded during the study period 2001 to 2014 among patients 20 to 89 years old were identified using a defined case-finding algorithm tailored to BIFAP database characteristics and based on codes plus text mining strategies. Potential CRC cases identified by the algorithm were classified into eight homogeneous groups according to recording characteristics. Random samples of 100 cases per group were obtained, and electronic medical records were manually reviewed by two independent researchers. Positive predictive values (PPVs) were estimated per each group and for the whole sample taking into account the stratified sampling. Standardized incidence rate (SIR) of CRC was estimated and compared with that reported by the National Cancer Registry. Negative predictive value (NPV) was also estimated in a random sample of 100 non-CRC patients by the algorithm. Results A total of 17 008 potential CRC cases were identified. Most of them (14793; 87%) were recorded as incident diagnosis with linked clinical notes as free text, having this group a PPV of 92.1% (95%CI: 87.1%-95.3%). The overall PPV including all groups was 87.3% (95%CI: 83.3%-90.4%). SIR of CRC was 55.5 per 100.000 person-years. SIR increased with age and was higher in men as compared with women (77.7 vs 38.1 per 100.000 py, respectively) which were in line with those reported by the Network of Cancer Registries in Spain. NPV was of 100% (96.3%-100%). Conclusions This study shows a high validity of the CRC cases identified by the algorithm and a high level of CRC recording in BIFAP database and supports its appropriateness to validly identify incident CRC cases in BIFAP.

PURPOSE Low oral health literacy (OHL) is an emerging risk factor for several oral health outcomes, but there are very few studies of OHL overall and no studies of OHL in the rural United States. The purpose of this study was to examine the association between OHL and sociodemographic factors, as well as several oral health outcomes, in rural adults served by an integrated medical and dental care system in Wisconsin. METHODS A cross-sectional survey was administered to a stratified random sample of patients from 2 rural communities. Survey data were linked to local electronic health records. Multivariable regression was used to identify sociodemographic determinants of low OHL, as well as associations between OHL and: oral hygiene, oral health quality of life, dentist visits, and emergency/urgent care visits for nontraumatic dental conditions. FINDINGS Among the 164 respondents, OHL scores were generally high but were significantly lower among nonwhite participants (P < .001), as well as those without a college degree (P < .001) and those with an annual household income under $40,000 (P = .029). Lower OHL scores were significantly associated with lower quality of life scores (P = .005), fewer visits to the dentist (P = .007), and more emergency room visits for nontraumatic dental conditions (P = .021). CONCLUSION In rural Wisconsin, low OHL tracked closely with markers of socioeconomic status and appeared most influential in the context of appropriate dental care utilization. Future research should consider longitudinal explorations of how OHL influences preventive and emergency dental visits over time.

Purpose Nurses are exposed to a poor psychological work environment; this may cause poor mental health, which is a risk factor for suicidal ideation. We investigated the association between psychological work environment and suicidal ideation among hospital nurses in Taiwan. Design We conducted a cross-sectional survey in Taiwan female nurses using stratified sampling by region (north, central, south, and east) to select representative centers for this study. Methods A self-report questionnaire including items on demographic data, the psychological work environment, and suicidal ideation was sent to nurses working in hospitals. Multiple logistic regression and population attributable risk analyses were performed to assess the effect of the psychological work environment on suicidal ideation. Findings A total of 2,734 eligible questionnaires (76.8%) were returned. The prevalence of suicidal ideation was 18.3%, and higher risk was found to be associated with the educational level of junior college or below, higher personal burnout, higher client-related burnout, and always feeling stressed at work. Estimation of population attributable risk showed that higher personal burnout, client-related burnout, and always feeling stressed at work were the most crucial factors among nurses, accounting for 19.4%, 8.6%, and 10.5% of suicidal ideation, respectively. Conclusions A considerable proportion of nurses developed suicidal ideation. A poor psychological work environment was a relevant factor for suicidal ideation. Clinical evidence This study provides relevant knowledge for nursing management levels in preventing the development of suicidal ideation among nurses. Not only for nurses' mental health, but for patient safety and care quality, further studies in improving nurses' psychological work environment are warranted.

The prevalence of childhood overweight and obesity is increasing in Malaysia and currently nearly 10% of children aged between 6 months and 12 years are overweight and almost 12% are obese. Early interventions to prevent excess weight gain are needed. ToyBox Study Malaysia is a feasibility project, funded by the Medical Research Council Newton-Ungku Omar Fund, to assess the practicalities of adapting the existing European ToyBox Study intervention programme to the Malaysian kindergarten setting. The main aims of all ToyBox programmes are related to improving four key energy balance-related behaviours, namely drinking water, eating healthy snacks and meals, reducing sedentary behaviour and increasing physical activity. Using stratified sampling, the ToyBox Study Malaysia intervention will be delivered and compared to usual practice by assessing behaviour, physical activity and health-related outcomes as measured by questionnaires, accelerometry and anthropometry. It is hoped that the evidence-based ToyBox Study Malaysia will help to achieve healthier energy balance-related behaviours in the children and their families and provide lifelong benefits to health. This article provides information on the dietary patterns, physical activity levels and prevalence of overweight and obesity in Malaysian children, and the approach of the ToyBox Study Malaysia.

Background A growing global nursing shortage has affected the quality of care (QOC) provision. Aim To test the structure-process-outcome model for quality of nursing care in regional medical centres in Thailand. Methods A cross-sectional study with multi-stage, proportional stratified random sampling. The sample comprised 136 units, 916 nurses and 943 patients from nine regional medical centres. Data were collected from six instruments in February-June 2016 and analysed with structural equation modelling. Results The modified model fitted the empirical data. The nurse practice environment (NPE) had a negative direct effect on pressure ulcer prevalence and a positive direct effect on patient satisfaction, perceived QOC and interpersonal processes of care (IPC). Increasing the patient-to-nurse ratio had a positive direct effect on catheter-associated urinary tract infections and pressure ulcer prevalence and had negative direct effects on patient satisfaction and perceived QOC. Skill mix had negative direct effects on the two former conditions but had a positive direct effect on patient satisfaction. The patient-to-nurse ratio and skill mix also had indirect effect on four outcomes via NPE. Limitations The generalizability of findings may be limited to settings similar to this study. Conclusion We empirically demonstrated that NPE, patient-to-nurse- ratio and skill mix had direct effects on unfinished nursing care and four outcomes. Also, the IPC had significant influence on patient satisfaction. Implications for nursing and health policy The findings add to increasing international evidence that favourable nurse working conditions, low nurse-to-patient ratio and richer skill mix result in positive patient outcomes. Health systems can foster nurses to perform high-quality care by improving work conditions, and providing sufficient nurses and resources.

This study is the first to systematically investigate the extent to which apps for children aged 0-5 foster play and creativity. There is growing evidence of children’s use of tablets, but limited knowledge of the use of apps by children of children of this age. This ESRC-funded study (ES/M006409/1) undertook research that identified how UK children aged from 0-5 use apps, and how far the use of apps promotes play and creativity, given the importance of these for learning and development. A survey was conducted of 2000 parents of under 5s in the UK, using a random, stratified sample, and ethnographic case studies of children in six families were undertaken. Over 17 hours of video films of children using apps were analysed. Findings indicate that children of this age are using a variety of apps, some of which are not aimed at their age range. The design features of such apps can lead to the support or inhibition of play and creativity. The study makes an original contribution to the international field in that it offers an account of how apps contribute to the play and creativity of children aged five and under.

Background The aim of this paper was to summarize the main results of the POMONA-ESP project, the first study to explore health status in a large representative, randomized and stratified sample of people with intellectual developmental disorders in Spain. Methods The POMONA-ESP project collected information about the health of 953 individuals with intellectual developmental disorders. Results Diseases such as urinary incontinence, oral problems, epilepsy, constipation or obesity were highly prevalent among the participants; with gender-differentiated prevalences for certain conditions, and age and intellectual disability level as risk factors for disease. Overmedication was common in the sample, and drugs were often prescribed without any clinical indication or follow-up. The present authors also found a lack of important relevant information about the participant's health and a lack of adequate genetic counselling. Conclusions Our findings may contribute to a better understanding of health status and needs of people with intellectual developmental disorders and suggest several courses of action to improve their health care.

The first autism surveys were simple head counts of children already diagnosed with a severe autism phenotype and residing in small, circumscribed geographical areas. Prevalence was low, ranging from 0.4 to 2/1,000 in the 1960's and 1970's. Today, the methodology of surveys has become more complex; studies include large populations, multiple sites, stratified samples and rely on intricate sets of screening activities followed by some form of diagnostic confirmation procedures. Yet, and as surprising as it may be, there is no standardization of autism survey methodology. Each survey has unique design features that reflect the local educational and health services infrastructure and current social policies for children with disabilities, they include or not parents, teachers and subjects with Autism Spectrum Disorder (ASD), and rely on variable screening and diagnostic instruments and methods. As such, prevalence differences between studies are hazardous to evaluate and whether observed discrepancies are due to method factors or true differences in population parameters, cannot be determined.

Aims This study aimed to identify risk indicators associated with periodontitis and the contribution of each of the indicators towards the prevalence, extent and severity of periodontitis in a rural Indian population. Methods A cross-sectional study design was used to collect data according to National Survey of Adult Oral Health Australia guidelines. A multistage stratified random sampling was followed to select 1401 participants, who were in the age group of 35-54 years. The participants were selected from 50 villages belonging to the 5 sub-provinces of 2 Indian districts. Data were collected through face-to-face interviews and oral examination. Statistical analysis was performed using SAS version 9.3. The univariate, bivariate and multivariate analyses were performed to determine the risk indicators of prevalence, extent and severity of periodontitis. Population attributable fraction was estimated for each of the significant risk indicators of prevalence and extent. Results In this study, factors such as age, education, tobacco chewing and plaque accumulation were significantly associated with the prevalence of periodontitis. Age, socioeconomic status, method of tooth cleaning, alcohol consumption and plaque accumulation were significant risk indicators for generalized periodontitis. Age, tobacco chewing and plaque were associated with severity of periodontitis in the population. Conclusion The rural population had a high prevalence of periodontitis. Sociodemographic factors, poor oral hygiene, tobacco and alcohol were the main risk indicators attributable to periodontitis.

Objectives To investigate the prevalence of frailty using a Comprehensive Geriatric Assessment (CGA) in older community‐dwelling adults living in rural northern Tanzania. Design Cross‐sectional survey. Setting Five randomly selected villages in Hai District, Kilimanjaro region, Tanzania. Participants All adults aged 60 and older living in the selected villages were eligible to participate, including older adults with cognitive impairment provided a close relative was able to assent on their behalf. All participants were community dwelling because institutionalization is very rare. Measurements Participants were screened using a short frailty screening tool, the Brief Frailty Instrument for Tanzania (B‐FIT), comprising an abbreviated test of cognitive function and the Barthel Index, which assesses functional independence. Based on B‐FIT score, a frailty‐weighted, stratified sample was selected for in‐depth assessment using CGA and characterized as frail or not frail. Results Two hundred thirty‐six CGAs were performed in 1,207 people screened, 91 of whom were deemed frail. After adjusting for stratification, the prevalence of frailty was 19.1% (95% confidence interval=15.2–23.1). Conclusion This is the first study in sub‐Saharan Africa to report the prevalence of frailty in community‐dwelling older adults according to a CGA. The strengths of reporting frailty according to a CGA include the ability to consider likely medical diagnoses based on clinical assessment and to assess individuals' social circumstances and environment.