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Introduction: Community Acquired Pneumonia (CAP) is the leading cause of mortality in children younger than five years of age in developing countries, including India. Hence, this prospective study was performed to estimate the incidence of CAP in children (2–59 months)in four districts of Northern India. Methods: A cross-sectional survey in rural Lucknow was conducted using cluster sampling technique to assess the proportion of CAP cases that were hospitalized in last 12 months (hospitalization fraction). Another prospective study was done to assess number of hospitalized CAP cases in same districts in 2016. For this, a surveillance network of hospitals that admitted children was established. Cases with WHO-defined CAP with less than 14 days of illness were eligible for inclusion. Informed written parental consent was obtained. A mathematical model was developed to estimate the incidence of CAP in each district, taking into account number of cases hospitalized in one year, assuming it to be equal to hospitalization fraction and using Lucknow district as reference, correcting for child-population per hospital for each district. Population census data of 2011 was taken as denominator. Results: In cross-sectional survey (February to May 2016), 3351 children (2–59 months) from 240 villages were included. Of these 24.58% (824/3351) children suffered from CAP in last 12 months and out of these 4% (33/824) children were hospitalized. Computed incidence of CAP per 1000 child-year for Lucknow was 86.50 (95%CI: 85.72–87.29); Etawah 177.01(95%CI: 175.44–178.58); Patna 207.78 (95%CI: 207.20–208.37) and Darbhanga 221.18 (95%CI: 220.40–221.97). Infants (2–11 months)had almost five to ten times higher incidence of CAP than those in 12–59 months age category. Conclusions: Incidence of CAP in Uttar Pradesh and Bihar is high, being much higher in infants. Hence there is an urgent need for introduction of preventive strategies, improving health seeking behavior and quality of care for CAP. [ABSTRACT FROM AUTHOR]

Price inflation has outbalanced the income of residents and buyers in major post-industrial city-regions, and real estate has become an important driver of these inequalities. In a context of a resilient inflation of home values during the last two decades in the greater Paris Region, it is critical to examine housing price dynamics to get a better understanding of socioeconomic segregation. This paper aims at presenting spatial analysis of the dynamics of segregation pertaining to inflation, analyzing price and sellers and buyers data. Using interpolation techniques and multivariate analysis, the paper presents a spatial analysis of property-level data from the Paris Chamber of Notaries (1996-2012) in a GIS (159,000 transactions in suburban areas, single family homes only). Multivariate analysis capture price change and local trajectories of occupational status, i.e. changes in balance between inward and outward flows of sellers and buyers. We adopt a method that fits the fragmented spatial patterns of suburbanization. To do so, we remove the spatial bias by means of a regular 1-km spatial grid, interpolating the variables within it, using a time-distance matrix. The main results are threefold. We document the spatial patterns of professionalization (a rise of executives, intermediate occupation and employees) to describe the main trends of inward mobility in property ownership in suburbs, offsetting the outward mobility of retired persons. Second, neighborhood trajectories are related the diverging patterns of appreciation, between local contexts of accumulation with a growth of residential prices, and suburbs with declining trends. The maturity of suburbanization yields a diversified structure of segregation between the social groups, that do not simply oppose executives vs. blue collar suburbs. A follow-up research agenda is finally outlined. [ABSTRACT FROM AUTHOR]

Background: The benefits of clinical supervision are more pronounced for health professionals in rural and remote areas. Most clinical supervision studies to date have occurred in metropolitan centres and have used the survey methodology to capture participant experiences. There is a lack of qualitative research that captures participants’ lived experiences with clinical supervision at the frontline. Methods: Participants were recruited from rural and remote sites of two Australian states using a purposive maximum variation sampling strategy. Data were collected through individual, semi-structured interviews with participants. Data were analysed using content analysis and themes were developed. Sixteen participants from six professions completed the interviews. Results: Eight themes were developed including the content of supervision, context of supervision, value of supervision, increased need for professional support and unique characteristics of rural and remote clinical supervision. Conclusions: This study has highlighted the value of clinical supervision for the rural and remote health professional workforce. Furthermore, it has shed light on the unique characteristics of clinical supervision in this population. This information can be used by organisations and health professionals to ensure clinical supervision partnerships are effective thereby enhancing rural and remote workforce recruitment and retention. [ABSTRACT FROM AUTHOR]

The vehicle-pedestrian encounter at midblock crosswalks in urban centers is inevitable but the challenge to urban transportation planners is in achieving a balance between traffic flow efficiency and pedestrian safety. Vehicles are expected to yield to pedestrians who have a right of way at the midblock unsignalized crosswalks but, failure to yield causes conflicts that at times are fatal. This study investigated the effect of macroscopic factors on the vehicle yielding. Six environmental factors are considered: temporal gap size, number of traffic lanes, number of waiting pedestrians, position of pedestrian (whether on street kerb or median), traffic flow direction and presence (or absence) of monitoring ePolice. Video Data on six observed variables that influenced vehicle yielding was collected from 13 uncontrolled crosswalk locations in Shanghai city in the Peoples Republic of China. A Logit model with a 95.9% accuracy was developed to describe the vehicle yielding behavior. The results showed that gap size and number of traffic lanes had the highest influence on driver yielding decision and that drivers were more likely to yield if ePolice was present. The sensitivity analysis was conducted and appropriate recommendations on improving the pedestrians crossing safety were proposed accordingly. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study is to analyze the standard expected years of life lost (SEYLL) due to chronic obstructive pulmonary disease (COPD) in Poland from 1999 to 2014 by sex and place of residence. Methods: The number of deaths due to chronic obstructive pulmonary disease (J40 –J44 and J47 according to ICD-10) over the period 1999 to 2014 was analyzed based on data obtained from the Central Statistical Office in Poland. Standard expected years of life lost due to chronic obstructive pulmonary disease were calculated by sex and place of residence according to the living population (SEYLLp) and the number of deaths caused by the disease (SEYLLd). Changes in the calculated measures were evaluated using joinpoint models. The annual percentage change (APC) and the average annual percentage change (AAPC) were also calculated. Results: The study revealed that COPD contributed to 1.8% of the total number of deaths which occurred between 1999 and 2014. The greatest decrease in the analyzed measures was observed among males from rural areas (p<0.05) (SEYLL: AAPC = -1.6; 95%CI: -3.0;-0.2; SEYLLp: AAPC = -2.0; 95%CI: -3.4;-0.6; SEYLLd: AAPC = -1.1; 95%CI: -1.2;-0.9). A statistically significant increase in the SEYLL and SEYLLp indices was observed among female city dwellers (SEYLL: AAPC = 2.4; 95%CI:0.7;4.0 and SEYLLp: AAPC = 2.4; 95%CI: 0.8;4.1). Conclusions: All studied measures were higher in the male group than in the female group, regardless of the place of residence. A male who died of COPD in Poland in 2014 potentially lost 14.9 years of life, whereas a female lost 14.2 years. [ABSTRACT FROM AUTHOR]

The world is continuously urbanising, resulting in clusters of densely populated urban areas and more sparsely populated rural areas. We propose a method for generating spatial fields with controllable levels of clustering of the population. We build a synthetic country, and use this method to generate versions of the country with different clustering levels. Combined with a metapopulation model for infectious disease spread, this allows us to in silico explore how urbanisation affects infectious disease spread. In a baseline scenario with no interventions, the underlying population clustering seems to have little effect on the final size and timing of the epidemic. Under within-country restrictions on non-commuting travel, the final size decreases with increased population clustering. The effect of travel restrictions on reducing the final size is larger with higher clustering. The reduction is larger in the more rural areas. Within-country travel restrictions delay the epidemic, and the delay is largest for lower clustering levels. We implemented three different vaccination strategies—uniform vaccination (in space), preferentially vaccinating urban locations and preferentially vaccinating rural locations. The urban and uniform vaccination strategies were most effective in reducing the final size, while the rural vaccination strategy was clearly inferior. Visual inspection of some European countries shows that many countries already have high population clustering. In the future, they will likely become even more clustered. Hence, according to our model, within-country travel restrictions are likely to be less and less effective in delaying epidemics, while they will be more effective in decreasing final sizes. In addition, to minimise final sizes, it is important not to neglect urban locations when distributing vaccines. To our knowledge, this is the first study to systematically investigate the effect of urbanisation on infectious disease spread and in particular, to examine effectiveness of prevention measures as a function of urbanisation. [ABSTRACT FROM AUTHOR]

Previous research in Victoria, Australia, found differences in prostate cancer outcomes in regional and metropolitan areas. This investigation of undiagnosed men in regional areas and a metropolitan area of South Australia sought their perspectives on prostate cancer. Our aim was to learn whether men who had not been diagnosed could shed light on why men outside metropolitan areas tended to have poorer outcomes than metropolitan men. Our goal was to build on evidence contributing to improving outcomes in prostate cancer care. Semi-structured interviews were designed to elicit explanation and meaning. 15 men (10 metropolitan, 5 regional) not diagnosed with prostate cancer were recruited through widely-distributed flyers in medical and community settings. Interviews were recorded and transcribed; transcripts were analysed thematically. Five main themes were identified, four of which were prompted by the questions: Addressing prostate health, Experiences with and expectations of GPs, Differences in care between regional and metropolitan areas, and Achieving early diagnosis. The fifth theme arose spontaneously: Australian masculinity. Men identified as problematic the limited availability of GPs in regional areas, the lack of consistency in approaches to prostate cancer detection, and men’s reluctance to seek medical care. Community-level strategies appear to be valued to encourage men to address prostate health. Maintaining and extending a systemic approach to prostate care may improve outcomes for men in Australia. [ABSTRACT FROM AUTHOR]

We categorize Stockholm’s urban green spaces according to the use values and social meanings they support, based on a sociotope mapping, and estimate their impact on property prices with a hedonic pricing model. The approach allows us to identify the most and least desired green space characteristics (attributes) and to assess the willingness to pay for the multifunctionality of green spaces. To do this, we test the following hypotheses, each with a separate hedonic pricing model: We find partial support for the first hypothesis: the green space attributes of “aesthetics”, “social activity” and “nature” seem to be desired by real estate buyers, whereas “physical activity” and “play” seem not to be desired. We also find support for the second hypothesis: the higher the number of characteristics an urban green space has, the stronger its impact on property prices. This study furthers the discussion on the economic value of urban green spaces by assigning monetary value to their perceived character and use values. In doing so, it highlights the need to understand green spaces both as ecological features and social constructs. [ABSTRACT FROM AUTHOR]

Urban change (urbanization) has dominated land change science for several decades. However, few studies have focused on what many scholars call the urban densification process (i.e., urban intensity expansion) despite its importance to both planning and subsequent impacts to the environment and local economies. This paper documents past urban densification patterns and uses this information to predict future densification trends in southeastern Wisconsin (SEWI) by using a rich dataset from the United States and by adapting the well-known Land Transformation Model (LTM) for this purpose. Urban densification is a significant and progressive process that often accompanies urbanization more generally. The increasing proportion of lower density areas, rather than higher density areas, was the main characteristic of the urban densification in SEWI from 2001 to 2011. We believe that improving urban land use efficiency to maintain rational densification are effective means toward a sustainable urban landscape. Multiple goodness-of-fit metrics demonstrated that the reconfigured LTM performed relatively well to simulate urban densification patterns in 2006 and 2011, enabling us to forecast densification to 2016 and 2021. The predicted future urban densification patterns are likely to be characterized by higher densities continue to increase at the expense of lower densities. We argue that detailed categories of urban density and specific relevant predictor variables are indispensable for densification prediction. Our study provides researchers working in land change science with important insights into urban densification process modeling. The outcome of this model can help planners to identify the current trajectory of urban development, enabling them to take informed action to promote planning objectives, which could benefit sustainable urbanization definitely. [ABSTRACT FROM AUTHOR]

Land-use change can have profound effects on forest communities, compromising seedling recruitment and growth, and long-term persistence of forests on the landscape. Continued forest conversion to agriculture causes forest fragmentation which decreases forest size, increases edge effects and forest isolation, all of which negatively impact forest health. These fragmentation effects are magnified by human use of forests, which can compromise the continued persistence of species in these forests and the ability of the forests to support the communities that depend on them. We examined the extent and influence of human disturbance (e.g. weedy taxa, native and exotic tree plantations, clearings, buildings) on the ecological status of sacred church forests in the northern highlands of South Gondar, Ethiopia and hypothesized that disturbance would have a negative effect. We found that disturbance was high across all forests (56%) and was negatively associated with tree species richness, density, and biomass and seedling richness and density. Contrary to expectation, we found that forests < 15.5 ha show no difference in disturbance level with distance from population center. Based on our findings, we recommend that local conservation strategies not only protect large forests, but also the small and highly used forests in South Gondar which are critical to the needs of local people, including preserving large trees for seed sources, removing exotic and weedy species from forests, and reducing clearings and trails within forests. [ABSTRACT FROM AUTHOR]

The understanding of human mobility patterns in different transportation modes is an interdisciplinary research field with a direct impact in aspects as varied as urban planning, traffic optimization, sustainability, the reduction of operating costs as well as the mitigation of pollution in urban areas. In this paper, we study the global activity of users in bike-sharing systems operating in the cities of Chicago and New York. For this transportation mode, we explore the temporal and spatial characteristics of the mobility of cyclists. In particular, through the analysis of origin-destination matrices, we characterize the spatial structure of the displacements of users. We apply a mobility model for the global activity of the system that classifies the displacements between stations in local and non-local transitions. In local transitions, cyclists move in a region around each station whereas, in the non-local case, bike users travel with long-range displacements in a similar way to Lévy flights. We reproduce the spatial dynamics by using Monte Carlo simulations. The obtained results are similar to the observed in real data and reveal that the model implemented captures important characteristics of the global spatial dynamics in the systems analyzed. [ABSTRACT FROM AUTHOR]

Commuting by walking or cycling is a way to increase physical activity levels. The objective of this article was to determine the modes of commuting to school and the distance and time of the way to school among children from Easter Island and from the mainland (Valparaíso), in Chile. A total of 666 children and adolescents aged 10 to 18 years old (208 from Easter Island and 458 from Valparaíso) participated and completed a valid questionnaire including data about age, gender, usual commuting mode to and from school, distance, and travel time. There are important differences in the mode of commuting between students of Valparaíso and Easter Island. Private transport is more commonly used in Valparaíso than in Easter Island (p<0.001). Furthermore, it was observed that cycling and public transportation are not used as mode of commuting in Valparaíso and Easter Island respectively. Students from Easter Island, who travel more distance and during more time, are more active than students from Valparaíso (going 24.8% and 17.6%; from: 61% and 28.8% respectively). This situation is influenced by the geographic context of the island, the distances from home to school, and the type of commuting, which fosters the level of active commuting. On the other hand, the passive modes of commuting to school are higher in the mainland urban setting of Valparaíso. It is necessary to study the diverse contexts of the Easter Island population, but, for now, the rural setting of Easter Island seems to be associated with a greater level of active commuting to school. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between migration and physical activity among medical students from a university located in Lima, Peru. Methods: A cross-sectional study was conducted among second-year medical students from a Peruvian university. Data on moderate- to vigorous-intensity physical activity (MVPA) and migration features were obtained through a self-report questionnaire. To assess the associations of interest, prevalence ratios (PR) along with their 95% confidence intervals (95% CI) were calculated using Poisson regression with robust variances. Results: We analyzed data from 312 students (54.5% were women, mean age: 19.0 years, standard deviation: 1.4 years), 90 (28.9%) students performed MVPA for ≥150 minutes/week, 118 (37.8%) performed MVPA for ≤30 minutes/week, and 114 (36.7%) were migrants. Being a migrant was not associated with performing MVPA for ≤30 nor ≥150 minutes/week. However, adjusted analysis showed that the frequency of performing MVPA for ≤30 minutes/week was greater among those who migrated less than five years ago (PR: 1.43; 95% CI: 1.05–1.93) and among those who migrated to continue their studies (PR: 1.44; 95% CI: 1.06–1.94), compared to non-migrants. Conclusion: In our population, being a migrant was not associated with physical activity. However, low physical activity was more prevalent among recent migrants and among those who had migrated to study, compared to non-migrants. [ABSTRACT FROM AUTHOR]

Objective: To test the impact of a nationwide Long-Lasting Insecticidal Nets [LLINs] distribution program in the Democratic Republic of Congo [DRC] on all-cause under-five child mortality exploiting subnational variation in malaria endemicity and the timing in the scale-up of the program across provinces. Design: Geospatial Impact Evaluation using a difference-in-differences approach. Setting: Democratic Republic of the Congo. Participants: 52,656 children sampled in the 2007 and 2013/2014 DRC Demographic and Health Surveys. Interventions: The analysis provides plausibly causal estimates of both average treatment effects of the LLIN distribution campaign and geospatial heterogeneity in these effects based on malaria endemicity. It compares the under-five, all-cause mortality for children pre- and post-LLIN campaign relative to children in those areas that had not yet been exposed to the campaign using a difference-in-differences model and controlling for year- and province-fixed effects, and province-level trends in mortality. Results: We find that the campaign led to a 41% decline [3.7 percentage points, 95% CI 1.3 to 6.0] in under-5 mortality risk among children living in rural areas with malaria ecology above the sample median. Results were robust to controlling for household assets and the presence of other health aid programs. No effect was detected in children living in areas with malaria ecology below the median. Conclusion: The findings of this paper make important contributions to the evidence base for the effectiveness of large scale-national LLIN campaigns against malaria. We found that the program was effective in areas of the DRC with the highest underlying risk of malaria. Targeting bednets to areas with greatest underlying risk for malaria may help to increase the efficiency of increasingly limited malaria resources but should be balanced against other malaria control concerns. [ABSTRACT FROM AUTHOR]

Background: Online testing for sexually transmitted infections has a lower unit cost than testing in clinical services and economic analysis has focused on the cost per test and cost per diagnosis in clinics and online. However, online services generate new demand for testing and shift activity between services, requiring system-level analysis to effectively predict cost-effectiveness. Methods and findings: Routinely collected, anonymised, retrospective data on sexual health service activity from all specialist services (clinic and online) within an inner London sexual health economy were collated and harmonised to generate a complete dataset of individual level clinic attendances. Clinic activity and diagnoses were coded using nationally standardised codes assigned by clinicians. Costs were taken from locally or regionally agreed sexual health tariffs. The introduction of online services changed patterns of testing. In an inner London sexual health economy, online STI testing increased total number of tests, the total cost of testing and total diagnoses while slightly reducing the average cost per diagnosis. Two years after the introduction of online services 37% of tests in the were provided online and total diagnoses increased. The positivity of online services is generally lower than that in clinics but varies between contexts. Where the positivity ratio between clinic and online is less than the cost ratio, online services will reduce cost per diagnosis. In this analysis, areas with different classifications as urban and rural had different clinic/online positivity ratios changing the cost effectiveness between areas. Even after the introduction of online services, simple STI testing activity continues in clinics and providers should consider online-first options where clinically appropriate. Conclusions: Online services for STI testing are not ‘stand alone’. They change STI testing behaviour with impacts on all elements of the sexual health economy. Planning, development and monitoring of such services should reference the dynamic nature of these systems and the role of online services within them. [ABSTRACT FROM AUTHOR]

Background: Adherence to option B+ antiretroviral treatment (ART) is vital to a successful implementation of Prevention of Mother to Child Transmission (PMTCT) program. Further studies show that optimal viral suppression is also crucial for a successful PMTCT program, however barriers to adherence exist and differ among populations and particularly within few years of its adoption in Tanzania. This study therefore aimed at investigating the level and predictors of adherence to ART option B+ among pregnant and lactating women in rural and urban settings of eastern Tanzania. Methodology: A cross-sectional study was conducted among 305 pregnant women and lactating mothers on Option B+ regime from six health facilities located in rural and urban settings in Morogoro region in eastern Tanzania. Data were collected using a structured questionnaire. Data analysis was performed using descriptive statistics, as well as bivariate and multivariate logistic regression. Results: Good adherence to option B+ PMTCT drugs was 26.3% and 61.1% among respondents residing in urban and rural areas respectively. The rural residents were 4.86 times more likely to adhere compared to their counterparts in an urban area (aOR = 4.86; 95% CI = 2.91–8.13). Similarly, women with male partners’ support in PMTCT were 3.51 times more likely to have good adherence than those without (aOR = 3.51, 95% CI = 1.21–10.15). Moreover, there was a significantly lower odds of adherence to option B+ among those who had been on treatment between one to two years as compared to those had less than one year of treatment (aOR = 0.45; 95%CI = 0.22–0.93). Conclusion: Adherence to PMTCT option B+ antiretroviral drugs treatment among pregnant women and breastfeeding mothers was low and much lower among urban residents. Adherence was significantly predicted by rural residence, male partner support and short duration on ART. Efforts to improve adherence should focus on increasing male participation on PMTCT, tailored interventions to urban residents and those who have been on ART for a long duration. [ABSTRACT FROM AUTHOR]

Setting: Community based tuberculosis (TB) prevalence surveys in ten sites across India during 2006–2012 Objective: To re-analyze data of recent sub-national surveys using uniform statistical methods and obtain a pooled national level estimate of prevalence of TB. Methods: Individuals ≥15 years old were screened by interview for symptoms suggestive of Pulmonary TB (PTB) and history of anti-TB treatment; additional screening by chest radiography was undertaken in five sites. Two sputum specimens were examined by smear and culture among Screen-positives. Prevalence in each site was estimated after imputing missing values to correct for bias introduced by incompleteness of data. In five sites, prevalence was corrected for non-screening by radiography. Pooled prevalence of bacteriologically positive PTB was estimated using Random Effects Model after excluding data from one site. Overall prevalence of TB (all ages, all types) was estimated by adjusting for extra-pulmonary TB and Pediatric TB. Results: Of 769290 individuals registered, 715989 were screened by interview and 294532 also by radiography. Sputum specimen were examined from 50 852 individuals. Estimated prevalence of smear positive, culture positive and bacteriologically positive PTB varied between 108.4–428.1, 147.9–429.8 and 170.8–528.4 per 100000 populations in different sites. Pooled estimate of prevalence of bacteriologically positive PTB was 350.0 (260.7, 439.0). Overall prevalence of TB was estimated at 300.7 (223.7–377.5) in 2009, the mid-year of surveys. Prevalence was significantly higher in rural compared to urban areas. Conclusion: TB burden continues to be high in India suggesting further strengthening of TB control activities. [ABSTRACT FROM AUTHOR]

Witnesses are likely to describe a crime many times before testifying or encountering misinformation about that crime. Research examining the effect of retrieval on later suggestibility has yielded mixed results. LaPaglia and Chan manipulated whether misinformation was presented in a narrative or misleading questions, and they found that retrieval increased suggestibility when misinformation was presented in a narrative, but reduced suggestibility when the same misinformation was presented in questions. In the current study, we aimed to address why these differences occurred. Specifically, we examined whether contextual detail and narrative coherence during misinformation exposure influenced the relation between retrieval and suggestibility. Participants watched a robbery video and some were questioned about the event afterwards. They were then exposed to misinformation presented in a narrative () or questions () before taking a final memory test. Testing enhanced suggestibility when the misinformation phase reinstated contextual information of the event, but not when the misinformation phase included few contextual details–regardless of whether the misinformation was in a narrative or questions. In Experiment 3, disrupting narrative coherence by randomizing the order of contextual information eliminated retrieval-enhanced suggestibility. Therefore, context processing during the post-event information phase influences whether retrieval enhances or reduces eyewitness suggestibility. [ABSTRACT FROM AUTHOR]

Background: International marriages between Vietnamese women and Korean men have increased rapidly in Korea. Successful adaptation of these women is challenging, and concerns on the issue have been raised. Most existing studies have surveyed Vietnamese immigrant women in urban Korea; less is known about women residing in rural areas of Korea. Uncovering the experiences and perspectives of these women can inform the design of community support resources. The purpose of this study was to identify a typology to effectively describe the subjective perspectives of Vietnamese women residing in rural Korea on adaptation to Korean culture and society. Methods and results: A Q-methodological study was conducted with five steps: construction of the concourse, Q sample, selection of participants, Q-sorting, and data analysis. Twenty-six Vietnamese women married to Korean men who attended local public health centers were surveyed and asked to rank-order 39 Q-statements using a 9-point scale. Principal component factor analysis using a pc-QUANL program was performed to identify adaptation sub-types. Four types of adaptation were identified and labeled: positive adaptation (35.54%), passive adaptation with reservations (8.33%), adaptation with frustration (6.20%), and adaptation and involvement (5.33%). These four types explained 55.40% of the total variance in the women’s experience of adaptation to Korean culture and society. Conclusions: This study provides data that may be helpful in understanding the challenges immigrant women in rural areas of Korea face, and in planning family-sensitive adaptation support programs for these women and their families. [ABSTRACT FROM AUTHOR]

This study endeavors to answer two questions: which category of excise taxes is more appropriate for Senegal and Nigeria and which consequences an increase of the tobacco taxes would have on the price, the demand and the tax revenues in each one of the two countries? To answer these questions, we adopt a double approach: first, a theoretical model of taxation with variety; and second, a simulation model to answer the second question. The results of the theoretical model indicate that, in the context of excise taxation, the number of products variety—or that of cigarette brands—directly affects both the degree of market concentration and the marginal effects of specific and ad valorem excise taxes on the price of tobacco. In addition, the comparison of the marginal effects of ad valorem and specific excise taxes depends on the marginal costs of production of different varieties weighted by the tax rates and the number of varieties. Our empirical results first show that the specific excise taxes are more adapted to Senegal while ad valorem excise taxes fit best Nigeria. This result crucially matters for the excise taxes are exclusively of an ad valorem nature in both Senegal and Nigeria. It is perfectly possible to envisage a situation where the two main forms of excise taxes could co-exist. It also appears from our results that tax development does not have the same implications for the two countries. Increasing tobacco taxes in Senegal strongly reduces the demand, but also induces a decrease in the tax revenues, while this will imply a lesser decline in demand in Nigeria accompanied however by a sharp increase of the country’s tax revenues. This difference stems from the fact that the price-elasticity of tobacco demand is very high in Senegal, contrary to Nigeria. Finally, it is important to mention that there is a specific threshold beyond which the tax increases cease to have a positive effect on tax revenues in Nigeria. [ABSTRACT FROM AUTHOR]

This paper assesses the psychometric properties of four child care quality instruments administered in 404 child care centers in Ecuador: the Classroom Assessment Scoring System for Toddlers, the Infant/Toddler Environment Rating Scale–Revised Edition, the Child Care Infant/Toddler Home Observation for Measurement of the Environment, and the Missouri Infant/Toddler Responsive Caregiving Checklist. We examined their internal consistency, tested the underlying subscale structure by means of confirmatory factor analysis (CFA), verified construct validity by testing associations with quality-related factors (e.g., child-caregiver ratio), and checked concurrent validity of the instruments’ total scores. We found high internal consistency of the instruments at the full scale level and moderate to high at the subscale/domain level. CFA showed high factor loadings, but goodness of fit statistics were low. Construct validity results varied from low to very low depending on the quality-related factor, and concurrent validity from low to very high depending on the instruments compared. This validity exercise provides useful information for policy-makers and researchers interested in using these instruments in the Ecuadorian context or elsewhere in the region. The findings will also inform future research and development of affordable and culturally-appropriate tools for monitoring process quality in child care centers in Latin American countries. [ABSTRACT FROM AUTHOR]

Introduction: Improving maternal health remains one of the targets of sustainable development goals. A maternal death can occur at any time during pregnancy, but delivery is by far the most dangerous time for both the woman and her baby. Delivery at a health facility can avoid most maternal deaths occurring from preventable obstetric complications. The influence of both individual and community factors is critical to the use of health facility delivery services. In this study, we aim to examine the role of individual and community factors associated with health facility-based delivery in Bangladesh. Methods: This cross-sectional study used data from the Bangladesh Maternal Mortality Survey. The sample size constitutes of 28,032 women who had delivered within five years preceding the survey. We fitted logistic random effects regression models with the community as a random effect to assess the influence of individual and community level factors on use of health facility delivery services. Results: Our study observed substantial amount of variation at the community level. About 28.6% of the total variance in health facility delivery could be attributed to the differences across the community. At community level, place of residence (AOR 1.48; 95% CI 1.35–1.64), concentration of poverty (AOR 1.15; 95% CI 1.03–1.28), concentration of use of antenatal care services (AOR 1.11, 95% CI 1.00–1.23), concentration of media exposure (AOR 1.20, 95% CI 1.07–1.34) and concentration of educated women (AOR 1.12, 95% CI 1.02–1.23) were found to be significantly associated with health facility delivery. At individual level, maternal age, educational status of the mother, religion, parity, delivery complications, individual exposure to media, individual access to antenatal care and household socioeconomic status showed strong association with health facility-based delivery. Conclusion: Our results strongly suggest factors at both Individual, and community level influenced the use of health facility delivery services in Bangladesh. Thus, any future strategy to improve maternal health in Bangladesh must consider community contexts and undertake multi-sectorial approach to address barriers at different levels. At the individual level the programs should also focus on the need of the young mother, the multiparous the less educated and women in the poorest households. [ABSTRACT FROM AUTHOR]

Objective: To explore influential factors contributing to the choice of primary care facilities (PCFs) for the initial treatment among rural and urban residents in Southwestern China. Methods: A face-to-face survey was conducted on a multistage stratified random sample of 456 rural and 459 urban residents in Sichuan Province from January to August in 2014. A structured questionnaire was used to collect data on residents’ characteristics, provider of initial treatment and principal reason for the choice. Multivariate logistic regression was performed to identify factors associated with choosing PCFs for the initial treatment. Results: The result showed that 65.4% of the rural residents and 50.5% of the urban residents chose PCFs as their initial contact for medical care. Among both rural and urban residents, the principal reason for choosing medical institutions for the initial treatment was convenience (42.3% versus 40.5%, respectively), followed by high quality of medical care (26.5% versus 29.4%, respectively). Compared to rural residents, urban residents were more likely to value trust in doctors and high quality of medical care but were less likely to value the insurance designation status of the facilities. Logistic regression analysis showed that both rural and urban residents were less likely to choose PCFs for the initial treatment if they lived more than 15 minutes (by walk) from the nearest facilities (rural: OR = 0.15, 95%CI = 0.09–0.26; urban: OR = 0.19, 95%CI = 0.10–0.36), had fair (rural: OR = 0.49, 95%CI = 0.26–0.92; urban: OR = 0.31, 95%CI = 0.15–0.64) or poor (rural: OR = 0.14, 95%CI = 0.07–0.30; urban: OR = 0.22, 95%CI = 0.11–0.44) self-reported health status. Among rural residents, attending college or higher education (OR = 0.21, 95%CI = 0.08–0.59), being retired (OR = 0.90, 95%CI = 0.44–1.84) and earning a per capita annual income of household of 10,000–29,999 (OR = 0.24, 95%CI = 0.11–0.52) and 30,000–49,999 (OR = 0.26, 95%CI = 0.07–0.92) were associated with lower rates of seeking care at PCFs. Conclusion: Efforts should be made to improve the accessibility of PCFs and to upgrade the services capability of PCFs both in rural and urban areas in China. At the same time, resources should be prioritized to residents with poorer self-reported health status, and rural residents who retire or have better education and higher income levels should be taken into account. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine the trend in socioeconomic inequalities in child undernutrition in Nigeria. Methods: The study analysed cross-sectional data from the Nigeria Demographic and Health Survey (NDHS) 2003 to 2013. The outcome variables were stunting, wasting and underweight among children under-five years. The magnitude of child undernutrition in Nigeria was estimated via a concentration index, and the socioeconomic factors contributing to child undernutrition over time were determined using the decomposition method. Results: The concentration index showed an increase in childhood wasting and underweight in Nigeria over time. The socioeconomic factors contributing to the increase in child undernutrition were: child’s age (0–23 months), maternal education (no education), household wealth index (poorest household), type of residence (rural) and geopolitical zone (North East, North West). Conclusions: To address child undernutrition, there is a need to improve maternal education and adopt effective social protection policies especially in rural communities in Nigeria. [ABSTRACT FROM AUTHOR]

Government funding accounts for a large proportion of conservation and environmental improvements, and is often the result of citizen votes on state ballot measures. A key concern surrounding public investments in the environment is whether that funding serves lower-income communities, which are often the communities of greatest need. We applied three statistical methods to analyze the spatial distribution of conservation funding derived from California’s Proposition 84, which distributed nearly $4 billion across California between 2006 and 2015. First, we used hurdle models to ask if income, population density, urban coverage, or pollution could explain receipt of grants or magnitude of funding. Second, we compared the income levels of funded and unfunded communities for each chapter of the proposition. Finally, we examine two sections of the proposition that were intended to fund parks around the state and compare the attributes of funded and unfunded communities. Proposition 84 offers lessons for environmental legislation and future research. While there were general tendencies for more funding to flow to poor areas and areas with pollution problems, the language in Proposition 84 as a whole was vague with respect to the funding of disadvantaged areas, and as a result the targeting of these areas overall was at best modest. However, when enabling legislation (AB 31) defined specific “metrics of disadvantage” that had to be met by communities to receive funds from some sections of Proposition 84, the funds did flow much more selectively to poorer communities. This suggests that future ballot measures should be very explicit in their language if they want to promote equity in conservation investments, and that future research should investigate the extent to which technical workshops and outreach could further increase the number of funded grant proposals from low-income communities. [ABSTRACT FROM AUTHOR]

Abstract Farmland and migratory bird populations are in decline. The Common quail (Coturnix coturnix) provides an exception to this trend and its populations have remained stable over the last two decades. However, some basic facts regarding quail biology and ecology, such as the geographic distribution of age and sex classes during the summer, remain poorly understood. We analyzed 43,194 Spanish quail ringing records from 1961 to 2014 to assess the effects of geography and weather conditions on the probability that individuals will be ringed during the various stages of their annual cycle (arrival –spring migration-, stationary breeding period, departure –autumn migration- and winter) for the different quail age-sex classes over time. We found that spatial distribution of the age and sex classes can be explained by date, latitude, longitude, altitude, rainfall, and temperature. Our results suggest that date accounts for most of the variation in the distribution of quail age classes, followed by the weather variables, and then latitude, and altitude. Similarly, date also accounts for most of the variation in the distribution of the two sexes. These results could partially explain why this species has avoided population decline, since its ecological strategy is based on its temporal and spatial distribution combined with the segregation of age and sex groups. We hypothesize that the distribution of quail age and sex classes follows variations in weather and habitat suitability to exploit seasonal and geographic variations in resource availability. The migratory and nomadic movements of quail, combined with the occurrence of multiple breeding attempts within a single season, may also allow these birds to overcome the impacts of predators and anthropogenic environmental change. Conservation and management efforts should therefore take account of these age and sex related temporal and spatial patterns. Graphical abstract Unlabelled Image Highlights • Afro-paleartic migratory birds can subsist to global change effects. • Migration and nomadism timely distribute groups of age and sex in suitable habitats. • The distribution of quail age and sex class follows variations in weather and habitat suitability. • The migration added to nomadism is consistent with success in finding optimal habitats. • Temporal, spatial, age and sex distributions facilitate offset mortality. [ABSTRACT FROM AUTHOR]

Background: A large body of research shows that social isolation and loneliness have detrimental health consequences. Identifying individuals at risk of social isolation or loneliness is, therefore, important. The objective of this study was to examine personal (e.g., sex, income) and geographic (rural/urban and sociodemographic) factors and their association with social isolation and loneliness in a national sample of Canadians aged 45 to 85 years. Methods: The study involved cross-sectional analyses of baseline data from the Canadian Longitudinal Study on Aging that were linked to 2016 census data at the Forward Sortation Area (FSA) level. Multilevel logistic regression analyses were conducted to examine the association between personal factors and geographic factors and social isolation and loneliness for the total sample, and women and men, respectively. Results: The prevalence of social isolation and loneliness was 5.1% and 10.2%, respectively, but varied substantially across personal characteristics. Personal characteristics (age, sex, education, income, functional impairment, chronic diseases) were significantly related to both social isolation and loneliness, although some differences emerged in the direction of the relationships for the two measures. Associations also differed somewhat for women versus men. Associations between some geographic factors emerged for social isolation, but not loneliness. Living in an urban core was related to increased odds of social isolation, an effect that was no longer significant when FSA-level factors were controlled for. FSAs with a higher percentage of 65+ year old residents with low income were consistently associated with higher odds of social isolation. Conclusion: The findings indicate that socially isolated individuals are, to some extent, clustered into areas with a high proportion of low-income older adults, suggesting that support and resources could be targeted at these areas. For loneliness, the focus may be less on where people live, but rather on personal characteristics that place individuals at risk. [ABSTRACT FROM AUTHOR]

Introduction: In many Sub-Saharan African countries, women with infertility search relentlessly for treatment. Guided by the Partners for Applied Social Sciences model for health seeking behaviour and access to care research, this study aims to understand the health seeking behaviour of women with infertility in the West Coast region of The Gambia and the influence of aetiological beliefs on health seeking paths. Methodology: A qualitative approach was used to generate both primary and secondary data for thematic analysis. The data collection methods included in-depth interviews (36), observations (18), informal conversations (42), group discussion (7) and made use of pile-sorting exercises. Sources of secondary data included government and non-governmental reports and media outputs. Results: The health seeking approaches of women living in both rural and urban areas were extremely complex and dynamic, with women reporting that they looked for biomedical treatment as well as seeking indigenous treatment provided by local healers, sacred places and kanyaleng groups. While treatment choice was related to the perceived aetiology of infertility, it was also strongly influenced by the perceived effectiveness of the treatment available and the duration of the fertility problems. Other relevant factors were the affordability, accessibility and availability of treatment and respondents’ family and social networks, whereby access to the biomedical health sector was strongly influenced by people’s socio-economic background. Conclusion: On the basis of this analysis and our wider research in the area, we see a need for health authorities to further invest in providing information and counselling on issues related to infertility prevention and treatment. The availability of locally applicable guidelines for the management of infertility for both men and women at all levels of the health system would facilitate such work. In addition, the public sphere should provide more space for alternative forms of social identity for both men and women. [ABSTRACT FROM AUTHOR]

Background: China is experiencing rapid age, which will lead to increasing burden of age-related diseases, such as Alzheimer disease and other forms of dementia. Objectives: The aim of this study was to 1) Explore the temporal trend of mortality of Alzheimer disease (AD) and other forms of dementia in China and 2) Analyze its geographic variations and urban-rural differences and calculate the years of life lost (YLLs) from AD and other forms of dementia. Data and methods: Data were extracted from the National Mortality Surveillance System (NMS). Age-standardized mortalities were calculated with the Western Grade 26 Standard Life List, and the YLLs were calculated using the DALY template provided by the WHO / World Bank global burden of disease (GBD) Working Group. The trends in crude and age-standardized mortality of AD and other forms of dementia were examined using Cochran-Armitage trend test. Results: In China, the crude mortality from AD and other forms of dementia increased from 2009 to 2015, but the age-standardized mortality decreased. The YLLs of AD and other forms of dementia increased during the study period. The age-standardized mortality in the east was higher than those in the west and middle regions, and the age-standardized mortality in rural areas was higher than that in urban areas. Conclusion: In China, the age-standardized mortality of AD and other forms of dementia decreased from 2009 to 2015. However, the disease burden from AD and other forms of dementia is becoming heavier due to increasing elderly population. Moreover, there were geographic variations and urban-rural differences in mortality of AD and other forms of dementia in China. [ABSTRACT FROM AUTHOR]

When we think of our family and friends, we probably know someone who is good at finding their way and someone else that easily gets lost. We still know little about the biological and environmental factors that influence our navigational ability. Here, we investigated the frequency and sociodemographic determinants of wayfinding and their association with vestibular function in a representative cross-sectional sample (N = 783) of the adult German-speaking population. Wayfinding was assessed using the Wayfinding Strategy Scale, a self-report scale that produces two scores for each participant representing to what degree they rely on route-based or orientation (map-based) strategies. We were interested in the following research questions: (1) the frequency and determinants of wayfinding strategies in a population-based representative sample, (2) the relationship between vestibular function and strategy choice and (3) how sociodemographic factors influence general wayfinding ability as measured using a combined score from both strategy scores. Our linear regression models showed that being male, having a higher education, higher age and lower regional urbanization increased orientation strategy scores. Vertigo/dizziness reduced the scores of both the orientation and the route strategies. Using a novel approach, we grouped participants by their combined strategy scores in a multinomial regression model, to see whether individuals prefer one strategy over the other. The majority of individuals reported using either both or no strategy, instead of preferring one strategy over the other. Young age and reduced vestibular function were indicative of using no strategy. In summary, wayfinding ability depends on both biological and environmental factors; all sociodemographic factors except income. Over a third of the population, predominantly under the age of 35, does not successfully use either strategy. This represents a change in our wayfinding skills, which may result from the technological advances in navigational aids over the last few decades. [ABSTRACT FROM AUTHOR]

Background: In many developing countries there is paucity of evidence regarding the epidemiology of road traffic accidents (RTAs). The study determines the rates of injuries and fatalities associated with RTAs in Ethiopia based on the data of a recent national survey. Methods: The study is based on the secondary data of the Ethiopian Demographic and Health Survey conducted in 2016. The survey collected information about occurrence injuries and accidents including RTAs in the past 12 months among 75,271 members of 16,650 households. Households were selected from nine regions and two city administrations of Ethiopia using stratified cluster sampling procedure. Results: Of the 75,271 household members enumerated, 123 encountered RTAs in the reference period and rate of RTA-related injury was 163 (95% confidence interval (CI): 136–195) per 100,000 population. Of the 123 causalities, 28 were fatal, making the fatality rate 37 (95% CI: 25–54) per 100,000 population. The RTA-related injuries and fatalities per 100,000 motor vehicles were estimated as 21,681 (95% CI: 18,090–25,938) and 4,922 (95% CI: 3325–7183), respectively. Next to accidental falls, RTAs were the second most common form of accidents and injuries accounting for 22.8% of all such incidents. RTAs contributed to 43.8% of all fatalities secondary to accidents and injuries. Among RTA causalities, 21.9% were drivers, 35.0% were passenger vehicle occupants and 36.0% were vulnerable road users including: motorcyclists (21.0%), pedestrians (12.1%) and cyclists (2.9%). Approximately half (47.1%) of the causalities were between 15–29 years of age and 15.3% were either minors younger than 15 years or seniors older than 64 years of age. Nearly two-thirds (65.0%) of the victims were males. Conclusion: RTA-related causalities are extremely high in Ethiopia. Male young adults and vulnerable road users are at increased risk of RTAs. There is a urgent need for bringing road safety to the country's public health agenda. [ABSTRACT FROM AUTHOR]

The worldwide rise of shared bicycle use has changed the way people travel. Here we analyze shared bicycle use from the perspective of the theory of planned behavior, and propose a model to investigate factors influencing shared bicycle usage in China. A total of 211 shared bicycle users selected from 28 provinces throughout China completed a self-reported survey. Structural equation modelling (SEM) was used to delineate the pathway from shared bicycle usage. The SEM model demonstrated that: (1) shared bicycle use intention was significantly associated with four variables, namely travel attitude(β = 0.491, t = 24.569), social norms(β = 0.149, t = 6.771), travel habits(β = 0.146, t = 7.226) and perceived behavioral control (β = 0.190, t = 11.110); (2) shared bicycle use behavior was significantly affected by shared bicycle use intention(β = 0.406, t = 15.936), and also by travel habits(β = 0.320, t = 11.921); (3) shared bicycle use behavior was also affected by demographic variables (gender, age) and situational factors (distance). The conclusions of this study provide useful data for operators of bicycle services and government policy makers. [ABSTRACT FROM AUTHOR]

Background: There is a deficiency of healthcare administrators in China as compared with other countries; furthermore, the distribution is unequal. To inform an effective policy intervention, it is crucial to understand healthcare administration students’ career decision-making. This study aims to investigate the undergraduate students’ stated preferences when choosing a job. Methods: A discrete choice experiment (DCE) was conducted among a population-based multistage sample of 668 final year undergraduate healthcare administration students during April to June 2017 in eight universities of China to elicit their job preferences. Attributes include location, monthly income, bianzhi (which refers to the established posts and can be loosely regarded as state administrative staffing), training and career development opportunity, working environment and workload. Conditional and mixed logit models were used to analyze the relative importance of job attributes. Results: All six attributes were statistically significant with the expected sign and demonstrated the existence of preference heterogeneity. Monthly income, workload and working environment were of most concern to healthcare administration students when deciding their future. Among the presented attributes bianzhi was of the least concern. Sub-group analysis showed that students who have an urban background and/or with higher annual family incomes were willing to pay more for working in the city. In addition, students from western and middle universities valued bianzhi higher than students from eastern universities. Conclusions: This is the first study focusing on the career decision-making of Chinese healthcare administration students at a critical career decision-making point. Both monetary and non-monetary interventions could be considered by policy-makers to attract students to work in health institutions, especially in rural and remote health institutions in China. There exists preference heterogeneity on healthcare administration students’ job preferences, which should also be taken into account in developing more effective policy incentive packages. [ABSTRACT FROM AUTHOR]

This paper presents a new public-use dataset for community-level life satisfaction in Canada, based on more than 500,000 observations from the Canadian Community Health Surveys and the General Social Surveys. The country is divided into 1216 similarly sampled geographic regions, using natural, built, and administrative boundaries. A cross-validation exercise suggests that our choice of minimum sampling thresholds approximately maximizes the predictive power of our estimates. The resulting dataset reveals robust differences in life satisfaction between and across urban and rural communities. We compare aggregated life satisfaction data with a range of key census variables to illustrate some of the ways in which lives differ in the most and least happy communities. [ABSTRACT FROM AUTHOR]

Significance: Foraged leafy greens are consumed around the globe, including in urban areas, and may play a larger role when food is scarce or expensive. It is thus important to assess the safety and nutritional value of wild greens foraged in urban environments. Methods: Field observations, soil tests, and nutritional and toxicology tests on plant tissue were conducted for three sites, each roughly 9 square blocks, in disadvantaged neighborhoods in the East San Francisco Bay Area in 2014–2015. The sites included mixed-use areas and areas with high vehicle traffic. Results: Edible wild greens were abundant, even during record droughts. Soil at some survey sites had elevated concentrations of lead and cadmium, but tissue tests suggest that rinsed greens of the tested species are safe to eat. Daily consumption of standard servings comprise less than the EPA reference doses of lead, cadmium, and other heavy metals. Pesticides, glyphosate, and PCBs were below detection limits. The nutrient density of 6 abundant species compared favorably to that of the most nutritious domesticated leafy greens. Conclusions: Wild edible greens harvested in industrial, mixed-use, and high-traffic urban areas in the San Francisco East Bay area are abundant and highly nutritious. Even grown in soils with elevated levels of heavy metals, tested species were safe to eat after rinsing in tap water. This does not mean that all edible greens growing in contaminated soil are safe to eat—tests on more species, in more locations, and over a broader range of soil chemistry are needed to determine what is generally safe and what is not. But it does suggest that wild greens could contribute to nutrition, food security, and sustainability in urban ecosystems. Current laws, regulations, and public-health guidance that forbid or discourage foraging on public lands, including urban areas, should be revisited. [ABSTRACT FROM AUTHOR]

Objective: Until now, little was known about the epidemiological characteristics of twins in China due to a lack of reliable national data. In this study, we aimed to analyze temporal trends and perinatal mortality of twins from China. Methods: Data on twins between 2007 and 2014 were obtained from the China National Population-Based Birth Defects Surveillance System. Twin and singleton deliveries after at least 28 weeks of gestation were recruited and followed until postnatal day 42. Twinning rates were defined as the number of twin individuals per 1000 births(stillbirths and live births). The Weinberg’s differential method was utilized to estimate the number of monozygotic and dizygotic twins. Results: During 2007–2014, the twinning rate increased by 32.3% from 16.4 to 21.7 per 1000 total births with an average of 18.8‰. Among twins, both the perinatal mortality rate (26.1 per 1000 total births) and neonatal death rate (15.7 per 1000 live births) presented a downward tendency but remained at a high level. Large urban-rural and geographic disparities were identified in twinning rates, in perinatal and neonatal mortality, and in their temporal trends. Conclusions: The upward trend of twinning rates in China paired with the relatively high rates of perinatal and neonatal mortality among twins highlights the need for improved perinatal care in the light of socio-demographic differences. [ABSTRACT FROM AUTHOR]

Over the past several decades there have been dramatic shifts in demographic patterns pertaining to family formation, with declining and delayed marriage and childbearing, and increased cohabitation in the United States and other Western industrialized nations. These trends in family demography have been predominantly studied using large-scale datasets, which have identified total population and subgroup trends over time, including differences by age, gender, racial/ethnic, economic, educational, religious, and other characteristics. However, there is limited knowledge and understanding of how individuals across different levels of social position, as well as other important characteristics, make decisions around forming families. This lack of qualitative data on contemporary attitudes regarding family formation has hampered our ability to more completely understand the factors driving behaviors pertaining to the large-scale (ie, international) shifts in demographic trends. The Social Position and Family Formation (SPAFF) project is an in-depth interview study that used quantitative data to guide recruitment of a large sample for qualitative interview data collection on factors influencing different aspects of family formation among heterosexual females and males (18–35 years) in the context of individuals’ social position. This methodological paper describes the use of a ‘quantitatively-informed’ purposive sampling approach in a large metropolitan area to collect qualitative data (through in-depth interviews) from a large sample (n = 200), utilizing web-based tools for successful community-based recruitment and project management. [ABSTRACT FROM AUTHOR]

Background: A previous analysis of the impact of drought in Africa on HIV demonstrated an 11% greater prevalence in HIV-endemic rural areas attributable to local rainfall shocks. The Lesotho Population-Based HIV Impact Assessment (LePHIA) was conducted after the severe drought of 2014-2016, allowing for reevaluation of this relationship in a setting of expanded antiretroviral coverage.Methods and Findings: LePHIA selected a nationally representative sample between November 2016 and May 2017. All adults aged 15-59 years in randomly selected households were invited to complete an interview and HIV testing, with one woman per household eligible to answer questions on their experience of sexual violence. Deviations in rainfall for May 2014-June 2016 were estimated using precipitation data from Climate Hazards Group InfraRed Precipitation with Station Data (CHIRPS), with drought defined as <15% of the average rainfall from 1981 to 2016. The association between drought and risk behaviors as well as HIV-related outcomes was assessed using logistic regression, incorporating complex survey weights. Analyses were stratified by age, sex, and geography (urban versus rural). All of Lesotho suffered from reduced rainfall, with regions receiving 1%-36% of their historical rainfall. Of the 12,887 interviewed participants, 93.5% (12,052) lived in areas that experienced drought, with the majority in rural areas (7,281 versus 4,771 in urban areas). Of the 835 adults living in areas without drought, 520 were in rural areas and 315 in urban. Among females 15-19 years old, living in a rural drought area was associated with early sexual debut (odds ratio [OR] 3.11, 95% confidence interval [CI] 1.43-6.74, p = 0.004), and higher HIV prevalence (OR 2.77, 95% CI 1.19-6.47, p = 0.02). It was also associated with lower educational attainment in rural females ages 15-24 years (OR 0.44, 95% CI 0.25-0.78, p = 0.005). Multivariable analysis adjusting for household wealth and sexual behavior showed that experiencing drought increased the odds of HIV infection among females 15-24 years old (adjusted OR [aOR] 1.80, 95% CI 0.96-3.39, p = 0.07), although this was not statistically significant. Migration was associated with 2-fold higher odds of HIV infection in young people (aOR 2.06, 95% CI 1.25-3.40, p = 0.006). The study was limited by the extensiveness of the drought and the small number of participants in the comparison group.Conclusions: Drought in Lesotho was associated with higher HIV prevalence in girls 15-19 years old in rural areas and with lower educational attainment and riskier sexual behavior in rural females 15-24 years old. Policy-makers may consider adopting potential mechanisms to mitigate the impact of income shock from natural disasters on populations vulnerable to HIV transmission. [ABSTRACT FROM AUTHOR]

Objective: To explore migrant physicians’ conceptions about working in rural and remote areas in Sweden to understand what influences their motivation to work in these areas. Method and material: The study employed a qualitative approach with semi-structured interviews with 24 migrant physicians. Transcripts were thematically analysed. Results: Conceptions were identified about foremost work content and tasks, and about living in rural and remote areas. Work content and tasks related to the health care systems, type of health care facility, duties, specialty, resources, patient population, colleagues, and professional development. Conceptions about living concerned geographical characteristics, people living in rural and remote areas, opportunities for travelling, family, leisure activities, social life, and language skills. Conceptions seemed to be influenced by individual, professional and societal aspects from both previous countries and Sweden. Conceptions and biographical aspects both appeared to affect motivation. Discussion: Motivation regarding working in rural and remote areas appeared to be influenced by conceptions of these areas. A specific type of place could be understood as being able to provide (or not) the external conditions needed for fulfilling needs and reaching goals, whether professional or personal, and as a tool for reaching or facilitating the achievement of these. Conceptions of an area can hence affect motivation and choices for where to work and live. However, biographical aspects also impact motivation. Our results indicate that positive rural experience in the recipient country might be a predictor for motivation. Conclusion: Professional and personal life and are intertwined. Conceptions about an area influence willingness to work there. Willingness is also affected by, and intertwined with, other aspects such as previous experiences, age, marital status and family circumstances. [ABSTRACT FROM AUTHOR]

Background and Objective: The shortage of doctors, especially in rural areas, is a major concern in India, which in turn affects the effective delivery of health care services. To support new policies able to address this issue, a study was conducted to determine the discouraging and encouraging factors affecting medical students’ interests towards working in rural areas. Methods: This cross-sectional, descriptive qualitative study has been conducted in three states of North India. It comprised six focus group discussions, each consisting of 10–20 medical students of six government medical colleges. The verbatim and thematic codes have been transcribed by using a ‘categorical aggregation approach’. The discussions were thematically analyzed. Results: Ninety medical students participated in the study. The discouraging factors were grouped under two broad themes namely unchallenging professional environment (poor accommodation facilities and lack of necessary infrastructure; lack of drug and equipment supplies; inadequate human resource support; lesser travel and research opportunities) and gap between financial rewards and social disadvantages (lower salary and incentives, social isolation, political interference, lack of security). Similarly, the encouraging factors were congregated under three main themes namely willingness to give back to disadvantaged communities (desire to serve poor, underprivileged and home community), broader clinical exposure (preferential admission in post-graduation after working more than 2–3 years in rural areas) and higher status and respect (achieving higher social status). Conclusions: This qualitative study highlights key factors affecting medical students’ interest to work in rural areas. A substantial similarity was noted between the factors which emerge from the current study and those documented in other countries. These findings will help policymakers and medical educators to design and implement a comprehensive human resource strategy that shall target specific factors to encourage medical students to choose job positions in rural areas. [ABSTRACT FROM AUTHOR]

Background: Little is known about the utilization of cardiac diagnostic testing in Brazil and how such testing is related with local rates of acute coronary syndrome (ACS)-related mortality. Methods and results: Using data from DATASUS, the public national healthcare database, absolute counts of diagnostic tests performed were calculated for each of the 5570 municipalities and mapped. Spatial error regression and geographic weighted regression models were used to describe the geographic variation in the association between ACS mortality, income, and access to diagnostic testing. From 2008 to 2014, a total of 4,653,884 cardiac diagnostic procedures were performed in Brazil, at a total cost of $271 million USD. The overall ACS mortality rate during this time period was 133.8 deaths per 100,000 inhabitants aged 20 to 79. The most commonly utilized test was the stress ECG (3,015,993), followed by catheterization (862,627), scintigraphy (669,969) and stress echocardiography (105,295). The majority of these procedures were conducted in large urban centers in more economically developed regions of the country. Increased access to testing and increased income were not uniformly associated with decreased ACS mortality, and tremendous geographic heterogeneity was observed in the relationship between these variables. Conclusions: The majority of testing for ACS in Brazil is conducted at referral centers in developed urban settings. Stress ECG is the dominant testing modality in use. Increased access to diagnostic testing was not consistently associated with decreased ACS mortality across the country. [ABSTRACT FROM AUTHOR]

Background: In most western countries a shortage of general practitioners (GP) exists. Newly qualified GPs often prefer to work in teams rather than in single-handed practices. Therefore, new practices offering these kinds of working conditions will be attractive in the future. From a health care point of view, the location planning of new practices will be a crucial aspect. In this work we studied solutions for locating GP practices in a defined administrative district under different objectives. Methods: Using operations research (OR), a research discipline that originated from logistics, different possible locations of GP practices were identified for the considered district. Models were developed under two main basic requirements: that one practice can be reached by as many inhabitants as possible and to cut down the driving time for every district’s inhabitant to the next practice location to less than 15 minutes. Input data included the demand (population), driving times and the current GP locations. Results: Three different models were analysed ranging from one single practice solution to five different practices. The whole administrative district can reach the central community “A” in at most 23 minutes by car. Considering a maximum driving time of 15 minutes, locations in four different cities in the district would be sufficient. Conclusion: Operations research methods can be used to determine locations for (new) GP practices. Depending on the concrete problem different models and approaches lead to varying solutions. These results must be discussed with GPs, mayors and patients to find robust locations regarding future developments. [ABSTRACT FROM AUTHOR]

Background: Depression and obesity are two major conditions with both psychological and somatic burdens. Some data suggest strong connections between depression and obesity and more particularly associated prevalence of both disorders. However, little is known about the geographical distribution of these two diseases. This study aimed to determine if there is spatial overlap between obesity and depression using data from the entire French territory. Methods: Data for 5,627 geographic codes for metropolitan France were collected from the two national hospital databases (PMSI-MCO and RIM-P) for the year 2016. We identified people who were depressed, obese or both registered in the two public medico-administrative databases, and we assessed their location. In addition, a multivariable analysis was performed in order to determine geographic interactions between obesity and depression after controlling for age, sex, environmental and socio-economic factors (social/material deprivation, urbanicity/rurality). Results: 1,045,682 people aged 18 years and older were identified. The mapping analysis showed several cold and hot regional clusters of coinciding obesity and depression. The multivariable analysis demonstrated significant geographic interactions, with an increasing probability of finding a high prevalence of obesity in regions with major depression (OR 1.29 95% CI 1.13–1.49, p = 0.0002) and an increased probability of finding a high prevalence of depression in regions with a high ration of obesity (OR 1.32, 95% CI 1.15–1.52, p<0.0001). Conclusion: Our study confirms the significant bidirectional relationships between obesity and depression at a group level. French geographic patterns reveal a partial overlap between obesity and depression, suggesting these two diseases can be included in a common approach. Further studies should be done to increase the understanding of this complex comorbidity. [ABSTRACT FROM AUTHOR]

Many Canadians experience unequal access to primary care services, despite living in a country with a universal health care system. Health inequalities affect all Canadians but have a much stronger impact on the health of vulnerable populations. Health inequalities are preventable differences in the health status or distribution of health resources as experienced by vulnerable populations. A geospatial approach was applied to examine how closely the distribution of primary care providers (PCPs) in London, Ontario meet the needs of vulnerable populations, including people with low income status, seniors, lone parents, and linguistic minorities. Using enhanced two step floating catchment area (E2SFCA) method, an index of geographic access scores for all PCPs and PCPs speaking French, Arabic, and Spanish were separately developed at the dissemination area (DA) level. To analyze how PCPs are distributed, comparative analyses were performed in association with specific vulnerable groups. Geographical accessibility to all PCPs, and PCPs who speak specific minority languages vary considerably across the city of London. Access scores for French- and Arabic-speaking PCPs are found comparatively high (mean = 2.85 and 1.01 respectively) as compared to Spanish-speaking PCPs (mean = 0.47). Additionally, many areas with high proportions of vulnerable populations experience low accessibility. Despite its exploratory nature, this study offers insight into intra-urban distributions of geographical accessibility to primary care resources for vulnerable groups. These findings can facilitate health researchers and policymakers in the development of recommendations to increase levels of accessibility of specific population groups in underserved areas. [ABSTRACT FROM AUTHOR]

This study explores both epidemiological and spatial characteristics of domestic and community interpersonal violence. We evaluated three years of violent trauma data in the medium-sized city of Campina Grande in North-Eastern Brazil. 3559 medical and police records were analysed and 2563 cases were included to identify socioeconomic and geographic patterns. The associations between sociodemographic, temporal, and incident characteristics and domestic violence were evaluated using logistic regression. Using Geographical Information Systems (GIS), we mapped victims’ household addresses to identify spatial patterns. We observed a higher incidence of domestic violence among female, divorced, or co-habitant persons when the violent event was perpetrated by males. There was only a minor chance of occurrence of domestic violence involving firearms. 8 out of 10 victims of domestic violence were women and the female/male ratio was 3.3 times greater than that of community violence (violence not occurring in the home). Unmarried couples were twice as likely to have a victim in the family unit (OR = 2.03), compared to married couples. Seven geographical hotspots were identified. The greatest density of hotspots was found in the East side of the study area and was spatially coincident with the lowest average family income. Aggressor sex, marital status, and mechanism of injury were most associated with domestic violence, and low-income neighbourhoods were coincident with both domestic and non-domestic violence hotspots. These results provide further evidence that economic poverty may play a significant role in interpersonal, and particularly domestic violence. [ABSTRACT FROM AUTHOR]

Rapid and extensive urbanization has adversely impacted humans and ecological entities in the recent decades through a decrease in surface permeability and the emergence of Urban Heat Islands (UHI). While detailed and continuous assessments of surface permeability and UHI are crucial for urban planning and management of landuse zones, they mostly involve time consuming and expensive field studies and single sensor derived large scale aerial and satellite imageries. We demonstrated the advantage of fusing imageries from multiple sensors for landuse and landcover (LULC) change assessments as well as for assessing surface permeability and temperature and UHI emergence in a fast growing city, i.e. Tirunelveli, Tamilnadu, India. IRS-LISSIII and Landsat-7 ETM+ imageries were fused for 2007 and 2017, and classified using a Rotation Forest (RF) algorithm. Surface permeability and temperature were then quantified using Soil-Adjusted Vegetation Index (SAVI) and Land Surface Temperature (LST) index, respectively. Finally, we assessed the relationship between SAVI and LST for entire Tirunelveli as well as for each LULC zone, and also detected UHI emergence hot spots using a SAVI-LST combined metric. Our fused images exhibited higher classification accuracies, i.e. overall kappa coefficient values, than non-fused images. We observed an overall increase in the coverage of urban (dry, real estate plots and built-up) areas, while a decrease for vegetated (cropland and forest) areas in Tirunelveli between 2007 and 2017. The SAVI values indicated an extensive decrease in surface permeability for Tirunelveli overall and also for almost all LULC zones. The LST values showed an overall increase of surface temperature in Tirunelveli with the highest increase for urban built-up areas between 2007 and 2017. LST also exhibited a strong negative association with SAVI. Southeastern built-up areas in Tirunelveli were depicted as a potential UHI hotspot, with a caution for the Western riparian zone for UHI emergence in 2017. Our results provide important metrics for surface permeability, temperature and UHI monitoring, and inform urban and zonal planning authorities about the advantages of satellite image fusion. [ABSTRACT FROM AUTHOR]

Purpose: The study purpose was to investigate the acceptability and utility of, and preference for, wearable activity trackers (WATs) amongst cancer survivors living in regional and remote areas of Western Australia. Methods: Twenty participants were recruited (Mean age = 63 years, SD = 13) to test two to three trackers from five available models (Fitbit Alta, Garmin Vivofit 2, Garmin Vivosmart, Polar loop 2 and Polar A300). Participants wore each device for two weeks, followed by a one-week washout period between devices. Interviews were conducted with participants to explore user perceptions and experiences. Interview transcripts were analysed using thematic analysis. Results: Four main themes emerged: (i) Consciousness raising; (ii) Prompts and Feedback; (iii) Accuracy and registry of activities; and, (iv) WAT preferences and features. Conclusions: WATs were acceptable and useful to cancer survivors. WATs increased self-awareness of physical activity, provided real time feedback in relation to step goals, and reinforced progress and efforts towards goals. The aesthetics of the WATs were deemed crucial in determining preference and likelihood of use. Implications for cancer survivors: Future interventions may do well to have two different WATs available for participants to choose from, according to activity preferences, aesthetic preferences, and display size. [ABSTRACT FROM AUTHOR]

Most of future population growth will take place in the world’s cities and towns. Yet, there is no well-established, consistent way to measure either urban land or people. Even census-based urban concepts and measures undergo frequent revision, impeding rigorous comparisons over time and place. This study presents a new spatial approach to derive consistent urban proxies for the US. It compares census-designated urban blocks with proxies for land-based classifications of built-up areas derived from time-series of the Global Human Settlement Layer (GHSL) for 1990–2010. This comparison provides a new way to understand urban structure and its changes: Most land that is more than 50% built-up, and people living on such land, are officially classified as urban. However, 30% of the census-designated urban population and land is located in less built-up areas that can be characterized as mainly suburban and peri-urban in nature. Such insights are important starting points for a new urban research program: creating globally and temporally consistent proxies to guide modelling of urban change. [ABSTRACT FROM AUTHOR]

On September 7, 2017, three potentially autochthonous cases of chikungunya were notified in the Lazio region. An Outbreak investigation based on established surveillance system data and molecular analysis of viral variant(s) were conducted. Epidemiological analysis suggested the occurrence of 3 main foci of local transmission. The major focus involved 317 cases with epidemiological link with the area of Anzio. The other two foci occurred in Rome (80 cases) and Latina (8 cases). Cumulative incidence in Anzio and Latina were 331.4 and 7.13 per 100,000 residents, respectively. Cumulative incidences ranged from 1.4 to 14.3/100,000 residents in Rome. This is the first report of a chikungunya outbreak involving a densely populated urban area in a western country. The outbreak probably started in Anzio, spread by continuity to neighbouring villages, and then to the metropolitan area of Rome and to the Latina area favoured by the touristic nature of the Anzio area. [ABSTRACT FROM AUTHOR]

Background: Kenya is 1 of 14 priority countries in Africa scaling up voluntary medical male circumcision (VMMC) for HIV prevention following the recommendations of the World Health Organization and the Joint United Nations Programme on HIV/AIDS. To inform VMMC target setting, we modeled the impact of circumcising specific client age groups across several Kenyan geographic areas. Methods: The Decision Makers’ Program Planning Tool, Version 2 (DMPPT 2) was applied in Kisumu, Siaya, Homa Bay, and Migori counties. Initial modeling done in mid-2016 showed coverage estimates above 100% in age groups and geographic areas where demand for VMMC continued to be high. On the basis of information obtained from country policy makers and VMMC program implementers, we adjusted circumcision coverage for duplicate reporting, county-level population estimates, migration across county boundaries for VMMC services, and replacement of traditional circumcision with circumcisions in the VMMC program. To address residual inflated coverage following these adjustments we applied county-specific correction factors computed by triangulating model results with coverage estimates from population surveys. Results: A program record review identified duplicate reporting in Homa Bay, Kisumu, and Siaya. Using county population estimates from the Kenya National Bureau of Statistics, we found that adjusting for migration and correcting for replacement of traditional circumcision with VMMC led to lower estimates of 2016 male circumcision coverage especially for Kisumu, Migori, and Siaya. Even after addressing these issues, overestimation of 2016 male circumcision coverage persisted, especially in Homa Bay. We estimated male circumcision coverage in 2016 by applying correction factors. Modeled estimates for 2016 circumcision coverage for the 10- to 14-year age group ranged from 50% in Homa Bay to approximately 90% in Kisumu. Results for the 15- to 19-year age group suggest almost complete coverage in Kisumu, Migori, and Siaya. Coverage for the 20- to 24-year age group ranged from about 80% in Siaya to about 90% in Homa Bay, coverage for those aged 25–29 years ranged from about 60% in Siaya to 80% in Migori, and coverage in those aged 30–34 years ranged from about 50% in Siaya to about 70% in Migori. Conclusions: Our analysis points to solutions for some of the data issues encountered in Kenya. Kenya is the first country in which these data issues have been encountered because baseline circumcision rates were high. We anticipate that some of the modeling methods we developed for Kenya will be applicable in other countries. [ABSTRACT FROM AUTHOR]