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The impact of navigating one's mental health in a rural community is a unique lived experience because of the many barriers associated with seeking and receiving mental health services. Using arts-based visual ethnography and an analysis of 47 semi-structured interviews, we examine the lived experiences of navigating mental health struggles and healthcare infrastructure in a rural community in the western United States. To do so, we leverage the tenets 'social exclusion' in tandem with an 'availability, accessibility, acceptability, and appropriateness' framework to situate our analysis centered around three key, intertwined themes: the internalized shame and stigmatization experienced by rural people with mental health struggles, exclusionary communal attitudes and practices that exacerbate rural individuals' experiences, and an unreliable, fragmented rural mental healthcare infrastructure that further aggravates the individual and community-level experiences of stigmatization and mental health struggles. Our paper concludes with participant-driven solutions for future policy- and community-level improvements to better address rural mental health. • Rural voices are elevated to understand challenges while navigating mental health. • Findings are organized according to individual-, community-, and societal-level experiences. • Shame, stigma, and exclusionary communal attitudes exacerbate rural mental health. • Tenuous, de facto healthcare infrastructure aggravates rural struggles. • Social exclusion fused with availability, accessibility, acceptability, and appropriateness of services situate our findings. [ABSTRACT FROM AUTHOR] more...

Background: There was a distinct rise in mean birthweights in Norway starting in 1991 that plateaued in 1996-2002 and then declined to previous levels. We investigated whether these changes corresponded to trends in neonatal mortality or other birthweight-associated pregnancy outcomes. We also explored known predictors of birthweight and examined whether these could explain the birthweight trends.Methods: We calculated mean birthweight for all live births in Norway in each year from 1982 to 2016, together with annual neonatal mortality and proportion of infants born preterm, or with low Apgar score. We stratified mean birthweight over time by factors including parity, gestational age, and Scandinavian versus non-Scandinavian origin of mother, to test robustness of the pattern. In addition, we used multivariable linear regression to obtain adjusted estimates for mean birthweight per year.Results: A 50-g rise and fall of mean birthweights during a 25-year period was not accompanied by corresponding changes in neonatal mortality, preterm births, or Apgar scores. The distinct hump pattern was restricted to term births and was not apparent among infants of mothers born outside Scandinavia. We saw a similar pattern for Sweden but not Finland. Known predictors of birthweight (such as parity, mode of onset of delivery, and marital status) did not explain the hump.Conclusions: A distinct temporal hump in mean birthweight among Norwegian term births had no obvious explanations. Furthermore, these fluctuations in birthweight were not associated indirectly with adverse outcomes in measures of infant health. [ABSTRACT FROM AUTHOR] more...