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Although catastrophic health spending is the main measure for assessing financial healthcare protection, it varies considerably in methodological and empirical terms, which hinders comparison between studies. The aim of this study was to measure the prevalence of catastrophic health spending in Brazil in 2003, 2009, and 2018, its associated factors, and disparities in prevalence distribution according to socioeconomic status. This was a time series study. Data from the Household Budget Surveys were used. Prevalence of catastrophic health spending was measured as a percentage of the budget and ability to pay, considering thresholds of 10, 25, and 40%. It was determined whether household, family, and household head characteristics influence the likelihood of incurring catastrophic health spending. Households were stratified by income deciles, consumption, and wealth score. There was an increase in prevalence of catastrophic health spending between 2003 and 2009 in Brazil and a slight reduction in 2018. The wealth score showed more pronounced distributional effects between the poor and the rich, with the former being the most affected by catastrophic health spending. Consumption showed greater percentage variations in the prevalence of catastrophic health spending. The prevalence of catastrophic health spending was positively associated with the presence of older adults, age and female household head, rural area, receipt of government benefits, and some degree of food insecurity. The poorest families are most affected by catastrophic health spending in Brazil, requiring more effective and equitable policies to mitigate financial risk. [ABSTRACT FROM AUTHOR]

This qualitative study aimed to capture community perspectives of the risks and protective factors for social emotional development and mental health of young children in low-income South Africa settings, and was conducted as one component of a larger study with the ultimate aim of co-designing the Mazi Umntanakho ('know your child') digital tool. Twenty focus group discussions (n = 154, 97% female) were held with staff of community-based organisations (CBOs) and community health worker (CHW) programmes in urban and rural sites from four geographical regions. Data were analysed thematically, and grouped according to components of nurturing care (responsive caregiving, safety and security, good health, adequate nutrition, opportunities for early learning) and risk and protective factors. Risks reported by participants far outweighed protective factors, and the most dominant theme identified was risks associated with responsive caregiving from CBO and CHW perspectives. These related to participants' perceptions of caregivers' attitudes, knowledge, beliefs, behaviours, and challenges not conducive to the provision of responsive caregiving. The most commonly perceived risks to safety and security were substance abuse, along with economic challenges, neglect, abuse and violence. Basic needs not being met was reported as the main risk to adequate nutrition and good health, followed by insufficient services. Limited resources and caregivers' limited education and literacy were perceived to be risks to early learning. These findings highlight the urgent need to mitigate risks and amplify protective factors for the social emotional development and mental health of young children in South Africa. It is critical that these are considered within the contextual realities of low-income communities. Highlights: Children in vulnerable South African settings are exposed to multiple risks to their social emotional development and mental health. The nurturing care framework provides a useful lens to understanding risks and protective factors in early childhood. Community perspectives are integral to the co-design of interventions to promote well-being of vulnerable children. [ABSTRACT FROM AUTHOR]

This study presents the findings of Let's Be Friends (Shaanxi), Trial 2 (LBF2), which is a second test of the school‐based intervention. Let's Be Friends (LBF) is designed to promote social competence and prevent maladaptive behaviour by strengthening the social information processing (SIP) skills of third‐grade children in rural China. A cluster‐matched design with random sampling was used in LBF2. Two rural counties in China were selected by purposive sampling (one is the treatment site, and another is the control site). Nine treatment schools (n = 343) were selected by random sampling. Fifteen control schools (n = 369) were selected by using vector‐norm matching. All children of the third grade, ages 8–10, in the treatment schools received 12 sessions of LBF2 intervention. Skill‐level Activity Scale and the Carolina Child Checklist–Teacher Form were employed to measure children's SIP skills and aggressive behaviour. LBF2 promoted the improvement of study children's SIP skills and effectively improved children's authority acceptance. LBF has the potential to be applied in China. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to examine the association between neighborly relations and self-neglect. Methods: We used the Scale of the Elderly Self-neglect to measure elder self-neglect. Logistic regression was used to examine the association between neighborly relations and self-neglect and its' phenotypes. Results: After adjusting for potential confounders, the risk of overall self-neglect among individuals with harmonious neighbor relationships significantly decreased by 79.2%. In comparison to elderly individuals living alone with poor neighbor relationships, those with harmonious connections experienced a 77.6% reduction in the risk of medical self-neglect, an 89.9% decrease in the risk of hygiene self-neglect, a 65.1% decline in the risk of emotional self-neglect, a 77.9% drop in the risk of safety self-neglect, and a 56.8% lower risk of social self-neglect. Conclusion: This study highlights harmonious neighborly relations are an independent protector factor for self-neglect. Fostering neighborly relations might be a practical approach to mitigating self-neglect. [ABSTRACT FROM AUTHOR]

Migrant families face challenges to health and well-being from COVID-19. We deployed Mobile Health for Migrant Health (mHealth-4-Mhealth) to migrant families, a household-based program with mHealth-assisted at-home testing and linkages to community resources. We assessed the reach, adoption, and implementation of the program among rural migrant families enrolled in the Title IC Nebraska Migrant Education Program from February 2022 to July 2023. We describe successful adoption and longitudinal use of mHealth screening tools for severe acute respiratory syndrome coronavirus 2 infection risk and social determinants of health. (Am J Public Health. 2024;114(11):1212–1216. https://doi.org/10.2105/AJPH.2024.307746) [ABSTRACT FROM AUTHOR]

Perceived Partner Responsiveness (PPR) is vital in establishing a sense of well-being within marital relationships. However, the existing corpus of research primarily relies on Western samples, thus limiting its generalizability. Therefore, the current study, focusing on 152 couples from Northeast India, explores the role of PPR in explaining the relationship between marital and life satisfaction through the lens of interpersonal flourishing and psychological needs fulfilment. Simultaneously, employing the Actor-Partner Interdependence Model extended to Mediation (APIMeM), we analyse the mediating role of PPR, uncovering significant actor effects. Our analysis considers covariates such as marital duration, income, number of children, family structure, and positive affect. The mediation results are explained under the framework that PPR is essential for fulfilling psychological needs and allowing for individual thriving. Consequently, the study's findings underscore the importance of prioritising PPR in relationship interventions. Tailored strategies should guide couples in aligning their life and marital satisfaction goals to bolster individual well-being. [ABSTRACT FROM AUTHOR]

Introduction: Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) remains a major global public health concern, especially in low-income countries like Ethiopia. Insufficient awareness about HIV/AIDS makes women vulnerable to infection. Notably, there is a disparity in the comprehensive HIV knowledge among reproductive-aged women in poorer and wealthier households. However, the contributing factors for wealth-related disparities in comprehensive knowledge of HIV among reproductive-aged women in Ethiopia have not been explored. Methods: We used the women's record (IR) of the 2016 Ethiopian demographic health survey. Erreygers normalized concentration index and curve were used to analyze the percentage contribution of factors in the comprehensive knowledge of HIV difference across wealth index. The concentration index was decomposed into contributing factors for poor comprehensive knowledge among poorer households. Results: A total of 14,599 reproductive-aged women were included in the analysis. The comprehensive knowledge of HIV was 14.75% and 29.33% in the poorest and wealthiest households, respectively. The weighted Erreygers normalized concentration index (ECI) was 0.11 with Standard error = 0.015 (P value < 0.05). Age (− 0.17%), residence (1.4%), education (26.2%), occupation (1.38%), region (0.61%), wealth index (30.8%), media exposure (13.4%), and internet access (0.67%) significantly contributed to the wealth-related inequalities. Conclusion: There was a pro-rich distribution of comprehensive knowledge of HIV among reproductive-age women in Ethiopia. Wealth, education, and media exposure were the major contributing factors to the wealth-related inequalities. Policymakers should prioritize media exposure and education, and work to improve the comprehensive knowledge of women in poorer households. [ABSTRACT FROM AUTHOR]

Objective: Examine how student demographics and perception of on-campus counseling service availability, accessibility, acceptability, and quality is related to utilization. Participants: A total of 262 students from 49 Georgia (U.S.) higher education institutions. Methods: A logistic regression examined student perception of on-campus counseling services and associations with service utilization, controlling for covariates. Results: (1) Non-heterosexual students were more likely to use on-campus counseling services than heterosexual students, (2) students in rural areas were more likely to utilize services than students in urban areas, (3) insured students had higher odds of utilizing services than uninsured students, and (4) higher ratings of perceived accessibility were associated with likelier service use. Conclusions: The perception of accessibility was significantly associated with higher odds of on-campus service use. Thus, a better understanding of student perception of on-campus counseling center accessibility is warranted. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To compare rates and analyze health facility determinants of emergency department visits and hospitalizations for ambulatory care--sensitive conditions (ACSCs) among Medicaid patients by geographical location. STUDY DESIGN: Retrospective cross-sectional analysis of 48.3 million patients receiving Medicaid and their acute care visits across 34 states and the District of Columbia in 2019. METHODS: Descriptive analyses of county-level variations in emergency department visits and hospitalizations (acute care) for ACSCs, and multivariate regressions of proximity to and density of health facility infrastructure as correlates to utilization and spending. Regression models were adjusted for county-level poverty rates, chronic disease rates, and state fixed effects. RESULTS: Among the studied patient population receiving Medicaid, nearly 40% of acute care visits were for ACSCs, with variations across and within states. Rates ranged from 17.8 per 1000 member-months in Vermont to 39.0 in Mississippi, and from 5.9 to 77.9 between counties within states. Longer distances to the nearest urgent care center and primary care shortage area designation correlated to higher acute care visits for ACSCs (+ 4.3 per 1000 membermonths for every 100 miles; 95% CI, 2.9-5.7; P < .001; +1.5 per 1000 member-months if shortage area; 95% CI, 0.4-2.6; P = .006). Counties with more rural health clinics had fewer acute care visits for ACSCs (-3.4 fewer visits per rural clinic per 1000 population; 95% CI, -4.6 to -2.2; P < .001). Among 6 states with additional spending data, 4.2% of total Medicaid spending was attributable to acute care visits for ACSCs. CONCLUSIONS: Our evaluation revealed more than 13-fold variation in acute care utilization for ACSCs between Medicaid counties within the same state. Proximity to urgent care facilities and density of rural health clinics were major explanatory variables for these variations, underscoring the importance of local health infrastructure in reducing acute care utilization for ACSCs. [ABSTRACT FROM AUTHOR]

Pakistan has extremely poor breastfeeding indicators: fewer than half of infants under 6 months are exclusively breastfed, only 20% of infants are breastfed within the first hour of life, and nearly half are never fed colostrum. The country's high infant morbidity and mortality is in part due to this suboptimal infant feeding. A network of lady health workers (LHWs) employed by the government facilitate maternal and child health programs, including breastfeeding support in their communities. This study describes LHWs' perspectives and experiences regarding breastfeeding. We conducted semi-structured interviews with 14 LHWs and used thematic qualitative analysis to code and analyze the data. Our research revealed that LHWs use their role as members of the community and involve influential members of the family to build trust. Frequent home visits beginning prenatally help them address misconceptions about infant feeding. While they have strong knowledge about the benefits of breastfeeding and the importance of colostrum, they demonstrate gaps in their knowledge regarding breast conditions, the safe preparation of human milk substitutes, the physiology of milk production, and supporting mothers who are separated from their baby. Future training should address these areas where LHWs lack knowledge to help mothers facilitate early and exclusive breastfeeding. With adequate training, LHWs are uniquely positioned to use their role as trusted members of the community to effectively counsel families on the importance of breastfeeding and support the clinical needs of women during the perinatal time. [ABSTRACT FROM AUTHOR]

Supporting ageing in place, quality of life, and activity engagement are public health priorities for people with dementia. The importance of maintaining opportunities for meaningful activities has been widely acknowledged for those with dementia in long-term care, but little is known about what makes activities meaningful for, and how they are experienced by, people with different types of dementia in their own homes. This study used focussed ethnographic methods to explore the motivations and meanings of everyday activity engagement within the homes of 10 people with memory-led Alzheimer's disease and 10 people with posterior cortical atrophy. While participants' interactions with their everyday environments were challenged by their diagnoses, they were all finding ways to continue meaning-making via various activities. The main findings are encapsulated in three themes: (1) The fun and the function of activities; (2) Reciprocities of care, and (3) The constitution and continuity of (a changing) self. Ongoing engagement with both fun and functional activities offered participants living with different dementias opportunities to connect with others, to offer care and support (as well as receive it), and to maintain a sense of self and identity. Implications are discussed regarding the development and delivery of tailored interventions and support to enable continued engagement in meaningful activities for people with different types of dementia living in the community. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to describe depression treatment patterns, identify unique trajectory groups using a group‐based trajectory approach, and explore associated social determinants in older adults undergoing first‐time depression treatment during a 3‐year follow‐up. Methods: This Danish register‐based cohort study included all adults aged ≥ 65 who initiated depression treatment by redeeming first‐time antidepressant prescriptions (no prescriptions in the last 10 years) between 2006 and 2015. The outcome of interest during the 2‐year follow‐up was depression treatment, assessed as antidepressant prescriptions redemptions and psychiatric hospital contacts for depression. Latent class growth analyses were applied to model treatment trajectories during 3 years. Multinomial logistic regression analyses were used to analyze adjusted associations between social determinates and trajectory group membership. Results: Among the 66,540 older adults (55.2% females, mean age: 77.3 years), we identified three distinct groups with unique patterns of depression treatment trajectories: 'brief‐treatment' where individuals stopped depression treatment within 6 months (33.7%); 'gradual‐withdrawal' (26.5%) where treatment was gradually stopped over 2 years; and 'persistent‐treatment' where individuals continued depression treatment for the entire 3 years (39.8%). Females, single‐person households, and residents of less‐urbanized regions were associated with higher odds of membership in the 'persistent‐treatment' group, while older age, widowhood or separation, and non‐Danish ethnicities were associated with lower odds. Conclusions: Three distinct patterns of depression treatment trajectories were identified in older adults, indicating differential clinical courses of depression—potentially influenced by social determinants, including sex, marital status, urban residence, and ethnicity. Early patient stratification and targeted interventions are crucial in depression care for older adults. [ABSTRACT FROM AUTHOR]

Background: Research on breast cancer risk factors and mortality is gaining recognition and attention globally; there is need to add more information on its determinants among patients admitted in hospital. Some studies on risk factors and mortality of breast cancer in Nigeria hospitals conducted in the urban and suburban areas have been documented. Therefore, an addition of a study conducted in the setting of a rural health institution is necessary. This study assessed the risk factors and determinants of mortality among patients admitted for breast cancer in rural Southwestern Nigeria. Methods: A retrospective observational study was conducted on 260 patients who were admitted for breast cancer between January 2010 and December 2023 using a data form and a standardized information form. The data were analyzed using SPSS version 22.0. The risk factors and the determinants of mortality of patients with breast cancer were identified using multivariate regression model. Results: The breast cancer risk factors were old age, family history, tobacco smoking, combined oral contraceptives, and hormonal therapy use. The case fatality rate was 38.1%, and its determinants of mortality were patients who were older (adjusted odds ratio [AOR], 1.956; 95% confidence interval [CI]:1.341-4.333), obese (AOR, 2.635; 95% CI: 1.485-6.778), stage IV (AOR, 1.895; 95% CI: 1.146-8.9742), mastectomy (AOR, 2.512; 95% CI: 1.003-6.569), discontinued adjuvant chemotherapy (AOR, 1.785; 95% CI: 1.092-4.6311), and yet to commence adjuvant chemotherapy (AOR, 2.568; 95% CI: 1.367-5.002). Conclusion: The study revealed that patients with breast cancer were associated with high mortality. Sustained health education to promote early diagnosis, managed co-morbidities, and access to treatment may contribute to reduction in breast cancer mortality in rural Nigeria. [ABSTRACT FROM AUTHOR]

This study is a quasi-experimental field evaluation of Raise the Bar (RTB), a prevention programme that trains bar staff to intervene when witnessing risk factors for sexual assault. Previous studies have demonstrated effects of similar programmes on attitudes/knowledge among bar staff. Yet, no studies have examined the effects of such programmes on intervention behaviour. Using a waitlist control design, we conducted thirty observations at four trained and four waitlist control bars in a rural U.S. college town, enacting scripts that matched the prompts for intervention that were included in the RTB curriculum implemented at the trained bars. Findings indicated staff at trained bars were significantly more likely to intervene than staff at the waitlisted bars, but this effect attenuated when control variables were included in the model. RTB appears promising, but further research is needed to fully establish its effects on intervention behaviour before recommending wide-spread rollout. Practice Impact Statement: Findings from this study suggest that training bar staff to act as prosocial bystanders has the potential to prevent alcohol-involved sexual assault among college students. Yet, it is important to note that, although staff at trained bars were more likely to intervene than staff at waitlist control bars, intervention was relatively rare and the effect of training attenuated when controlling for contextual factors. Stronger evidence of the effects of such training needs to accumulate before community agencies widely implement these programmes. [ABSTRACT FROM AUTHOR]

Aims: Rural–urban disparities have been reported in the outcomes of cardiovascular diseases. We assessed whether rural–urban or other geographical disparities exist in the risk of ischemic stroke (IS) and death in patients with atrial fibrillation (AF) in Finland. Methods: The registry-based FinACAF cohort study covers all patients with AF from all levels of care in Finland from 2007 to 2018. Patients were divided into rural–urban categories and into hospital districts (HDs) based on their municipality of residence. Results: We identified 222,051 patients (50.1% female; mean age 72.8 years; mean follow-up 3.9 years) with new-onset AF, of whom 15,567 (7.0%) patients suffered IS and 72,565 (32.7%) died during follow-up. The crude IS rate was similar between rural and urban areas, whereas the mortality rate was lower in urban areas (incidence rate ratios (IRRs) with 95% confidence intervals (CIs) 0.97 (0.93–1.00) and 0.92 (0.91–0.93), respectively). However, after adjustments, urban residence was associated with slightly higher IS and mortality rates (IRRs with 95% CIs 1.05 (1.01–1.08) and 1.06 (1.04–1.07), respectively). The highest crude IS rate was in the East Savo HD and the lowest in Åland, whereas the highest crude mortality rate was in the Länsi-Pohja HD and the lowest in the North Ostrobothnia HD (IRRs with 95% CIs compared to Helsinki and Uusimaa HD for IS 1.46 (1.28–1.67) and 0.79 (0.62–1.01), and mortality 1.24 (1.16–1.32) and 0.97 (0.93–1.00), respectively. Conclusions: Rural–urban differences in prognosis of AF in Finland appear minimal, whereas considerable disparities exist between HDs. [ABSTRACT FROM AUTHOR]

Background: This study was conducted to examine in depth the disease management experiences of school‐age children with celiac disease and the effects of family, friends, and teachers on disease management at school. Methods: The study employed a qualitative research method using the phenomenology design. Face‐to‐face, semi‐structured, in‐depth interviews were conducted with children (n = 14) with celiac disease. The transcripts were analysed using a phenomenological approach and an inductive process. Results: Three main themes were identified: Individual, Institutional, and Environmental. It was observed that children adapted better to the celiac diet as they got older, but they had difficulty adjusting to the diet in the school environment. In addition, it was found that school‐age children had challenges in diagnosing the disease and finding products suitable for the diet in a rural city with limited facilities. It was determined that the approaches of peers and teachers throughout the child's school life affected the disease management levels of children. Conclusion: The study reveals the emotional, cognitive, and behavioural difficulties that children face while adapting to celiac disease and diet, especially in the school environment. The results emphasize that school‐age children with celiac disease should not be ignored and that the school nurse plays an essential role in this process. [ABSTRACT FROM AUTHOR]

Background: Insufficient physical activity, excessive screen time and short sleep duration among young children are global public health concerns; however, data on prevalence of meeting World Health Organisation 24‐h movement behaviour guidelines for 3–4‐year‐old children in low‐ and middle‐income countries (LMICs) are limited, and it is unknown whether urbanisation is related to young children's movement behaviours. The present study examined differences in prevalence of meeting 24‐h movement behaviour guidelines among 3–4‐year‐old children living in urban versus rural settings in LMICs. Methods: The SUNRISE Study recruited 429, 3–4‐year‐old child/parent dyads from 10 LMICs. Children wore activPAL accelerometers continuously for at least 48 h to assess their physical activity and sleep duration. Screen time and time spent restrained were assessed via parent questionnaire. Differences in prevalence of meeting guidelines between urban‐ and rural‐dwelling children were examined using chi‐square tests. Results: Physical activity guidelines were met by 17% of children (14% urban vs. 18% rural), sleep guidelines by 57% (61% urban vs. 54% rural), screen time guidelines by 50% (50% urban vs. 50% rural), restrained guidelines by 84% (81% urban vs. 86% rural) and all guidelines combined by 4% (4% urban vs.4% rural). We found no significant differences in meeting the guidelines between urban and rural areas. Conclusions: Only a small proportion of children in both rural and urban settings met the WHO 24‐h movement guidelines. Strategies to improve movement behaviours in LMICs should consider including both rural and urban settings. [ABSTRACT FROM AUTHOR]

Returning to work after a diagnosis of breast cancer-related lymphoedema (BCRL) can present significant challenges for cancer survivors. Understanding these challenges across cultures is important to developing support interventions. This qualitative study sought to discover the shared and unique challenges across four diverse cultural groups. Three survivor groups in the US (urban, rural/small-town, and southern Texas region) and urban Ghana were interviewed about their experiences in returning-to-work, with 46 participants interviewed. A cross-case, thematic analysis of the interviews was conducted to identify shared and unique themes of the breast cancer survivor's experience in self-managing BCRL while navigating return-to-work. Reflective and analytic memoing was completed by the researchers and used to triangulate results. Analytic memo-ing is a parallel process with coding that allows the researchers to reflect on all aspects of the analytic process in order to recognize how thoughts, words, biases, and actions shape process decisions. These memos provide a rich source of decision-making data towards answering the research question and creating the results narrative. Shared themes of limited awareness and individual creative adaptation were identified. Survivors identified unique themes of self-resilience, support relationships, co-worker perceptions, and stigma and distress. The results provide additional insight into the BCRL self-management experience across diverse cultural groups to support the development of individualised care support and provide direction for future research efforts. [ABSTRACT FROM AUTHOR]

Background: About one in five adults in the United States experience any mental illness (AMI), whereas 14.2 million experience serious mental illness (SMI). The perception of stigma among individuals experiencing mental illness is associated with care seeking behavior and treatment adherence. Purpose: Two factors that mitigate stigma are familiarity with someone experiencing AMI/SMI and general level of education. Heretofore, these factors have not been tested together to determine if familiarity moderates the relation between level of education and stigma of professional efficacy for treating mental illness. Methods: In fall 2020, an online survey in the state of Utah measured 1,300 adults' perceptions of stigma for AMI/SMI using a validated instrument. Data were analyzed using logistic regression. Results: Results indicate that familiarity (i.e. self or immediate family member versus other person) moderated level of education for stigma of professional efficacy for treatment of AMI but not SMI. Discussion: Participants viewed the professional efficacy of treating AMI and SMI differently. These findings have implications for educational interventions designed to mitigate public stigma for professional efficacy of treating mental illness. Translation to Health Education Practice: Emphasizes the National Commission for Health Education Credentialing Inc. assessment of needs and capacity, and evaluation and research competencies. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) . [ABSTRACT FROM AUTHOR]

Background: New care models are needed for the increasing elderly, chronically ill, and multimorbid population, especially in primary healthcare. Rural regions are particularly affected where bottlenecks in provision of care and a shortage of health professionals are emerging. To address these challenges, nurse practitioners have been implemented in Swiss general practices to improve primary healthcare of chronically ill people. Aim: We aimed to explore Swiss primary healthcare delivery for chronically ill people in general practices with and without nurse practitioners and identify similarities and differences in these general practices. Methods: We conducted multiple case studies. Data were collected using interviews, observations, patient records, and questionnaires. We described the similarities and differences by drawing on Wagner's Chronic Care Model and applied deductive thematic cross-case analysis. We included five general practices located in rural areas in Switzerland, with nurse practitioners in two general practices. A total of 34 patients and 26 health professionals were included. The Enhancing the QUAlity and Transparency Of health Research (EQUATOR) reporting standards for organizational case studies were used. Results: Similarities were that chronically ill patients valued to be perceived as a whole person; guidelines for multimorbidity and reimbursement of relevant services such as coordination were limited. Differences in general practices with nurse practitioners were unclear role allocation, criteria for patient referral were missing and interprofessional teams were in an extended process of change. Nurse practitioners provided a bridge between the general practices and local home healthcare organizations, thereby, strengthening interface management and obtaining a more comprehensive nursing perspective. Conclusion: This study highlights that new models of care can better respond to patients' needs as additional nursing skills are available. Interprofessional teams undergo substantial changes in the new care model requiring a revision of existing structures. [ABSTRACT FROM AUTHOR]

Purpose: This paper describes the planning and implementation program of Remaja Berdaya Sehat Tanpa Rokok (JayaStar) or Empower Youth Healthy without Smoking (EYHWS). This is a pilot tobacco control program for smoking behavior with a community-based participatory research (CBPR) approach in a rural area of Indonesia. Design/methodology/approach: This research used the participatory rural appraisal (PRA) method. The paper would describe three stages of the JayaStar program that started from diagnosis, planning action and taking action. Participants in this research were all youths aged 17–25 years including as many as 33 people. The key informants were the village head, the hamlet head, the hamlet head's wife, the youth leader, health promotion officers at the Pleret Health Center and the Health Promotion Section of the Bantul Health Office. Findings: The determinants of the youth empowerment process are divided into (1) predisposing factors, (2) group structure and (3) group climate. It has an important role in the success of the youth empowerment process in smoking behavior control. The implementation of the JayaStar program consisted of (1) outbound, and training with the theme of increasing self-potential; (2) training on the impact of cigarettes/vapors on the health of youths; (3) discussion and practice of making health campaign videos; (4) parenting program with the theme of the important role of parents in creating a healthy and superior young generation; (5) declaration and inauguration of JayaStar volunteers. Originality/value: This research is an example of a successful community-based youth project that resulted in a demonstrable positive outcome. It demonstrates the importance of good relations between stakeholders. The JayaStar movement could be a potential model for youth empowerment projects to control smoking behavior among future generations in Indonesia. [ABSTRACT FROM AUTHOR]

Background Over 1.5 million community healthcare workers (CHWs) work in pos pelayanan terpadu (posyandu) in Indonesia. They are in charge of growth monitoring and counseling, as part of a community-based stunting prevention program. Recent literature suggests that the program requires quality improvements to maximize its potential. Objective To understand the impacts of a quality improvement model comprising capacity building for CHWs and home-based growth monitoring using smart charts on posyandu performance, particularly related on its stunting prevention components. Methods This cross-sectional study was conducted in two rural villages in Lombok, Indonesia, in May 2023. We interviewed 130 CHWs and 317 mothers with children under-five with a pre-validated questionnaire on posyandu performance that was developed using an input-process-output framework. We evaluated the CHWs dan mothers performances in the height measurement and counseling process. Results Both CHWs and mothers perceived performance improvements in the height measurement and counseling processes, with statistically significant differences between pre- and postintervention performance scores for height measurement [mean differences of 0.38 points; 95%CI 0.188 to 0.566; P<0.000 for CHWs, and 0.276 points; 95%CI 0.469 to 0.846; P<0.000 for mothers]; for counseling [mean differences of 0.285 points; 95%CI 0.149 to 0.42; P<0.001 for CHWs, and 0.142 points; 95%CI 0.098 to 0.186; P<0.000 for mothers]. Performance improvements were also found across all posyandu components, including those related to stunting. Conclusion Capacity building for CHWs and home-based growth monitoring using smart charts are beneficial in improving community-based stunting prevention programs. [ABSTRACT FROM AUTHOR]

Background/Objectives: With population aging, disability and chronic conditions are increasingly prevalent among middle-aged and older adults in China. Using panel data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018, this paper explores the effects of Activities of Daily Living limitations, Instrumental Activities of Daily Living limitations, and chronic conditions on Out-of-Pocket Expenditures (OOPEs) among middle-aged and older adults in China. Methods: A first-difference model and a system-generalized method of moment model (GMM) are used. Results: The system-GMM model for the first time addresses unobserved heterogeneity and produces unbiased estimates of the effects of health and OOPEs. Additionally, this paper assesses the heterogeneity of the results across the demographic and socioeconomic groups. Conclusions: These findings can be used to inform policymakers on improving medical resource allocation and ensure better financial protection for those living with a disability and chronic diseases. [ABSTRACT FROM AUTHOR]

Background: Pregnancy termination (PT) is a major public health concern in low-and middle-income countries like Bangladesh. This cross-sectional study aimed to determine the prevalence and factors of PT using the nationally representative Bangladesh Demographic and Health Survey data 2017–2018. Materials and Methods: A weighted population-based sample of 8759 ever-married reproductive-aged women (15–49 years) was included in the study. The outcome variable was PT in any of the following forms: miscarriage, induced abortion, and stillbirth. A univariate analysis for mean, frequency, and percentage and multiple logistical regression were used to determine the factors associated with PT. Results: Around 18% of the women were found to have PT. The mean age of the women in the study was 25.79 years; 65.1% lived in the rural areas, and the majority of them were Muslims. Advanced age of the women (AOR:3.49, p = 0.004), residence in the countryside (AOR:0.81, p = 0.002), higher education (AOR:0.72, p = 0.027), not being a Muslim (AOR:0.74, p = 0.010), higher socio-economic status (AOR:1.28, p = 0.027), having a job (AOR:1.15, p = 0.041), being married at the age of >22 years (AOR:0.71, p = 0.036), and using a mobile phone (AOR:1.22, p = 0.002) were significant factors of PT. This study did not find any association between PT and contraceptive use. Conclusions: Age, living region, education, religion, wealth index, working status, marital age, and mobile phone use are the determinants of PT. Interventions including these factors need to be made to reduce PT in Bangladeshi women. These findings could be helpful in undertaking further epidemiological studies to understand the actual causes of PT in various rural and urban settings among different socio-demographic groups in Bangladesh. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to examine how an educational intervention, using the lens of the LEADS framework, can influence the development of primary care doctors' leadership skills in Aceh, Indonesia. In order to persevere in the face of inadequate resources and infrastructure, particularly in rural and remote settings of low- and middle‐income countries, physicians require strong leadership skills. However, there is a lack of information on leadership development in these settings. Design/methodology/approach: This study applied an educational intervention consisting of a two-day workshop. The authors evaluated the impact of the workshop on participants' knowledge and skill by combining quantitative pre- and post-intervention questionnaires (based on Levels 1 and 2 of Kirkpatrick's model) with qualitative post-intervention in-depth interviews, using a phenomenological approach and thematic analysis. Findings: The workshop yielded positive results, as evidenced by participants' increased confidence to apply and use the information and skills acquired during the workshop. Critical success factors were as follows: participants were curiosity-driven; the use of multiple learning methodologies that attracted participants; and the use of authentic scenarios as a critical feature of the program. Originality/value: The intervention may offer a preliminary model for improving physician leadership skills in rural and remote settings by incorporating multiple teaching approaches and considering local cultural norms. [ABSTRACT FROM AUTHOR]

Background: Limited published data exist on the association between parity (number of deliveries) and diabetes mellitus (DM). This study was conducted to evaluate the association between parity and type 2 DM (T2DM) among Sudanese women. Method: A multistage sampling survey was conducted in four villages in the River Nile State, Sudan, between July and September 2022. The World Health Organization's three-level stepwise questionnaire was adopted to collect women's sociodemographic characteristics (age, sex, height, weight, marital status, parity, education level, occupation, detailed obstetric history, and family history of T2DM). Multivariate analyses were performed. Results: A total of 397 women were recruited. Their median (interquartile range) age was 45.0 (33.0‒55.7) years. A total of 154 women (38.8%) were nulliparous, whereas 93 (23.4%), 70 (17.6%), and 80 (20.2%) had para 1‒3, 4 or 5, and more than 5, respectively. A total of 112 (28.2%) women had T2DM. In multivariate analysis, older age (adjusted odds ratio, AOR, 1.04, 95%, confidence interval, CI, 1.02‒1.06), high parity (AOR, 1.1, 95% C, 1.01‒1.20), and a family history of DM (AOR, 3.26, 95% CI, 1.98‒5.38) were associated with T2DM. Compared with the nulliparity, para 1‒3 (AOR, 2.33; 95% CI, 1.17‒4.61), para 4 or 5 (AOR, 2.12; 95% CI, 1.04‒4.30), and para > 5 (AOR, 2.16; 95% CI, 1.09‒4.27) were at higher risk of T2DM. In women aged < 50 years, high parity (AOR, 1.22; 95% CI, 1.06‒1.44) was associated with T2DM. Compared with the nulliparous women, para 4 or 5 (AOR, 3.47; 95% CI, 1.16‒10.34) and para > 5 (AOR, 4.63; 95% CI, 1.54‒13.87) were associated with T2DM, whereas para 1‒3 was not associated with T2DM. In the women aged ≥ 50 years, parity and parity groups were not associated with T2DM. Conclusion: There is a high prevalence of T2DM among Sudanese women. Parity and high parity are significant predictors of T2DM among these women in this part of Sudan. [ABSTRACT FROM AUTHOR]

Background: Several vaccines were introduced in Tanzania to combat the COVID-19 pandemic. While studies have explored the acceptability and hesitancy of COVID-19 vaccines within the general population, there is limited research focusing on the confidence and associated factors among People Living with HIV (PLHIV). This study aims to fill that gap by investigating vaccine confidence and its determinants in this demographic group. Methods: A cross-sectional study was conducted in centres for care and treatment in four regions of mainland Tanzania using structured questionnaires. A generalized linear mixed model was fitted to determine the factors associated with confidence in the COVID-19 vaccine. Results: A total of 1,100 participants were interviewed; 761 (69.2%) were female. The mean age and standard deviation were 41.6 ±12.1 years. The overall level of confidence in COVID-19 vaccines was 55.3%. Females were less likely to express confidence compared to males (aOR = 0.77; 95% CI: 0.72–0.84). Participants with primary (aOR = 1.79; 95% CI: 1.65–1.94), secondary (aOR = 1.81; 95% CI: 1.57–2.09), and university-level education (aOR = 2.14; 95% CI: 0.17–26.54) were more likely to report confidence in COVID-19 vaccines. Attending a dispensary-level health facility (aOR = 1.32; 95% CI: 1.27–1.38) and living in rural areas (aOR = 1.43; 95% CI: 1.23–1.66) were significantly associated with confidence in COVID-19 vaccines. Conclusion: Although COVID-19 is no longer a global public threat, these findings highlight the significance of being prepared in public health and the necessity of continuous efforts to comprehend and enhance vaccine acceptance and confidence among people living with HIV. By tackling the factors that impact vaccine attitudes in this group, we can improve our preparedness for future public health challenges where vaccine uptake may once again become crucial. [ABSTRACT FROM AUTHOR]

Background: Evidence suggests that family-centered care for sick newborns, where parents are co-caregivers in newborn care units, can result in increased breastfeeding frequency, higher weight gain, earlier discharge, and reduced parental anxiety. This study explored healthcare providers' perceptions and experiences of parental participation in care for sick newborns in the newborn care units in two high-volume maternity units in Uganda, with the aim of informing interventions that promote family-centered care for newborns. Methods: An exploratory qualitative study was conducted between August and December 2023. Sixteen in-depth interviews were held at a regional and general hospital in the rural eastern region of Uganda. The interviews were audio-recorded and then transcribed, followed by a reflexive thematic analysis approach to generate themes. Findings: We identified four key themes: (1) creating order to ensure the safety of newborns in the newborn care unit; (2) parental participation as a tool for overcoming workload in the Newborn care unit; (3) redirecting parental involvement to focus on medically endorsed newborn care practices; and (4) stress management targeting mothers to ensure newborn survival. Conclusion: Healthcare providers encourage parents to participate in caring for their newborns in the newborn care units, mainly to reduce their workload. However, our study highlights the imbalanced nature of parental involvement, where HCPs control the tasks parents can or cannot perform, essentially deploying them as "assistants" rather than equal partners, contrary to the ideals of family-centered care. Transforming the current "healthcare provider-centered" model of caring for sick newborns to one that is family-centered will require training providers on the benefits of family-centered care and developing guidelines for its structured implementation within a resource-limited setting. [ABSTRACT FROM AUTHOR]

Introduction: Identifying the associations between rural-living or neighborhood disadvantage and neurobiology may clarify rural–urban disparities in older adults with cognitive impairment related to Alzheimer’s disease. Methods: We examined rural–urban differences and neighborhood disadvantages in brain cortical thickness (CT) measures among 71 rural and 87 urban-dwelling older adults. Analysis of covariance was used to test each FreeSurfer-derived CT measures’ associations with rural–urban living, clinical impairment status, and their interactions. Post-hoc linear regressions were used to test the association between CT measures and neighborhood disadvantage index. Results: Rural-dwelling older adults had thinner cortices in temporal and inferior frontal regions compared to urban participants, especially among clinically normal participants, where the thinner temporal cortex further correlated with higher neighborhood disadvantage. Conversely, rural participants had thicker cortices in superior frontal, parietal and occipital regions. Discussion: Our results suggest a complex interplay between community contexts and neurobiology. For memory-related regions, rural-living and neighborhood disadvantage might be negatively associated with subjects’ brain structures. [ABSTRACT FROM AUTHOR]

Birth vaccination is a cornerstone of health protection for infants globally and its timely administration is generally recommended. In Nigeria, however, the coverage and timeliness of birth vaccination have been suboptimal, primarily attributed to the high proportion of children born outside the health facility where the vaccines are available. The situation re-enacts the existing challenges with health service access and utilization in the country, especially the geographic inaccessibility of healthcare facilities. Difficulty in accessing care facilities, in terms of the insufficient number, uneven distribution, long distance and travel times, and transportation challenges, is a well-documented barrier to skilled obstetric service use, institutional delivery, and immunization coverage. This has been linked to poor maternal and child health outcomes, especially among the rural subpopulations. Geospatial mapping of health facilities has emerged as a tool to surmount the accessibility barriers and influence other determinants of vaccination uptake. Spatial technologies have been used to promote the accessibility and reach of health interventions, including immunization programs. This paper advocates maximizing the utility of this tool for enhanced birth vaccination coverage in Nigeria, by integrating private actors like private clinics and traditional birth attendants who contribute significantly within the country's obstetric space. [ABSTRACT FROM AUTHOR]

Psychological help-seeking for suicidal ideation is a critical aspect of effective suicide prevention. Past research has documented low help-seeking amongst rural residents in China. This study investigates the patterns and predictors of help-seeking intentions for suicidal ideation versus mental (depression) and physical (heart disease) health conditions among Chinese rural residents using General Help-Seeking Questionnaire Vignette version. A total of 143 rural participants from sixteen villages in Hubei province of China completed the survey via home-visiting interviews. Results revealed a general trend that the help-seeking intentions decreased as the helping sources shifted from close others (spouses, family, etc.) to professional helpers and online sources. Additionally, rural residents with higher educational levels, high self-efficacy, and more severe suicide ideations were more willing to seek help; and suicide literacy was found to be negatively associated with help-seeking intentions. The implications of the research findings are discussed. [ABSTRACT FROM AUTHOR]

Background: Immunization plays a significant role in global health, yet many children in Nigeria do not receive full immunization due to several influencing factors. Therefore, this study examined the trends in Nigeria's full immunization coverage and identified key predictors that influence full coverage. Methods: The data for children aged one to five years, across the six geopolitical zones of Nigeria was retrieved from the 2007, 2011, 2016/17, and 2021 national Multiple Indicator Cluster surveys We analyzed the data using univariate logistic regression. Results were presented as adjusted odds ratios (aORs), and statistical significance was set at 0.05. Results: The results showed that 12,229 children (74.2%) had been fully immunized. The trend of immunization coverage was 63.6%, 82%, 63.7%, and 76.4% in 2007, 2011, 2016/17, and 2021 respectively. Children of educated mothers (aOR: 2.6; 95% CI 1.45, 4.76) and from the richest families (aOR: 2.1; 95% CI 1.41, 3.11), were more likely to be fully immunized. Conversely, children in rural areas (aOR: 0.6; 95% CI 0.42, 0.81) and from families of more than five (aOR: 0.6; 95% CI 0.46, 0.81) were less likely to be fully immunized. Conclusion: As of 2021, the rate of full immunization coverage in Nigeria was 76.4%, an improvement from the low 2003 rate (12.3%). Maternal education and wealth index are significant sociodemographic determinants for full immunization coverage. Adopting policies that improve access to education for females nationally and access to healthcare, especially in rural areas may significantly increase full immunization coverage. [ABSTRACT FROM AUTHOR]

This study aimed to understand the potassium voltage-gated channel KQT-like subfamily, member 1 gene polymorphism in a rural elderly population in a county in Guangxi and to explore the possible relationship between its gene polymorphism and blood sugar. The 6 SNP loci of blood DNA samples from 4355 individuals were typed using the imLDRTM Multiple SNP Typing Kit from Shanghai Tianhao Biotechnology Co. The data combining epidemiological information (baseline questionnaire and physical examination results) and genotyping results were statistically analyzed using GMDR0.9 software and SPSS22.0 software. A total of 4355 elderly people aged 60 years and above were surveyed in this survey, and the total abnormal rate of glucose metabolism was 16·11 % (699/4355). Among them, male:female ratio was 1:1·48; the age group of 60–69 years old accounted for the highest proportion, with 2337 people, accounting for 53·66 % (2337/4355). The results of multivariate analysis showed that usually not doing farm work (OR 1·26; 95 % CI 1·06, 1·50), TAG ≥ 1·70 mmol/l (OR 1·19; 95 % CI 1·11, 1·27), hyperuricaemia (OR 1·034; 95 % CI 1·01, 1·66) and BMI ≥ 24 kg/m2 (OR 1·06; 95 % CI 1·03, 1·09) may be risk factors for abnormal glucose metabolism. Among all participants, rs151290 locus AA genotype, A allele carriers (AA+AC) were 0.70 times more likely (0.54 to 0.91) and 0.82 times more likely (0.70 to 0.97) to develop abnormal glucose metabolism than CC genotype carriers, respectively. Carriers of the T allele at the rs2237892 locus (CT+TT) were 0.85 times more likely to have abnormal glucose metabolism than carriers of the CC genotype (0.72 to 0.99); rs2237897 locus CT gene. The possibility of abnormal glucose metabolism in the carriers of CC genotype, TT genotype and T allele (CT + TT) is 0·79 times (0·67–0·94), 0·74 times (0·55–0·99) and 0·78 times (0·66, 0·92). The results of multifactor dimensionality reduction showed that the optimal interaction model was a three-factor model consisting of farm work, TAG and rs2237897. The best model dendrogram found that the interaction between TAG and rs2237897 had the strongest effect on fasting blood glucose in the elderly in rural areas, and they were mutually antagonistic. Environment–gene interaction is an important factor affecting abnormal glucose metabolism in the elderly of a county in Hechi City, Guangxi. [ABSTRACT FROM AUTHOR]

Background: It is unclear how rising obesity among people with HIV (PWH) impacts their risk of type 2 diabetes mellitus (diabetes). We examined associations between HIV, prevalent diabetes and adiposity among South African PWH and their peers without HIV (PWOH). Methods: HIV status was ascertained by antibody testing. Diabetes was defined as current use of oral hypoglycemics, insulin, and/or HbA1c ≥6.5%. Adiposity was measured by body mass index (BMI), waist circumference and waist-to-height ratio. Their associations were examined using sex-stratified multivariable fractional polynomial generalized linear models, reporting adjusted prevalence and prevalence ratios (adjPR). Results: The mean age among 1,254 PWH and 4,381 PWOH was 41 years (95%CI 28, 56). The prevalence of diabetes among males was similar between PWH [11.3% (7.1, 15.5)] and PWOH [9.8% (8.5, 11.1); p=0.740]. By contrast, diabetes prevalence was higher among female PWOH [15.7% (14.4, 17.0)] than female PWH [10.5 (8.3, 12.8)%; adjPR: 0.67 (0.51, 0.82); p<0.001]. This difference was accentuated with obesity but reversed with leanness. At BMI ≥25 kg/m2, female PWH had lower diabetes prevalence [adjPR: 0.58 (0.41, 0.76); p<0.001] than female PHIV. In contrast, at BMI <18 kg/m2, female PWH had higher prevalence [adjPR: 1.72 (−1.53, 4.96); p=0.756] than female PWOH. Conclusion: We found sex-specific differences in the relationship between adiposity and diabetes prevalence by HIV serostatus in South Africa. Notably, females living with obesity and HIV had lower prevalence of diabetes than females living with obesity and without HIV, which may have particular implications for diabetes prevention programs in the region. [ABSTRACT FROM AUTHOR]

Background: Studies have shown the positive impact of perceived social support on cognitive function among older adults in rural areas. However, existing studies often overlook the impact of different support sources. This study aimed to explore the relationship between the diverse sources of perceived social support and cognitive function. Methods: Participants were drawn from the Guizhou Rural Older Adults' Health Study (HSRO) in China. We included 791 participants who participated in a baseline survey in 2019 and a 3-year follow-up survey. Perceived social support was investigated from the six main sources (friend, relative, children, spouse, sibling, and neighbor). Hierarchical linear regression models were used to observe the effects of diverse sources of perceived social support and their combinations on cognitive function. Results: Cognitive function was positively associated with perceived support from children, friends, and neighbors. A positive association was found between cognitive function and increases in each additional source [ß = 0.75 (95%CI: 0.51, 0.98), p < 0.001]. Older adults who perceived support from both children and friends showed better cognitive function [ß = 2.53 (95%CI: 1.35, 3.72), p < 0.001]. The perception of support from spouse, siblings, and relatives did not show a statistically significant association with cognitive function among older adults in rural areas. Conclusion: This study found that the association between different sources of perceived social support and cognitive function was varied. This study provides scientific evidence that personalized support strategies may benefit in promoting cognitive health in rural older adults. [ABSTRACT FROM AUTHOR]

Background: Personal, social, and environmental factors may influence self-efficacy and social reintegration among people living with spinal cord injury or disease (SCI/D) in urban and rural areas. Novel data collection methods have the potential to characterize community participation (CP) in diverse settings. Objectives: The objectives were (1) to describe and compare self-reported community participation (Reintegration to Normal Living Index (RNLI) and Moorong Self-Efficacy Scale (MSES)) levels of individuals with SCI/D living in urban or rural Ontario, Canada; and (2) to determine the accuracy of an artificial intelligence (AI) optical mark recognition tool for extracting data from CP surveys conducted among participants after transitioning from inpatient rehabilitation to home and residing in the community. Methods: We partnered with SCI Ontario staff to collect MSES and RNLI survey data from adults with motor complete (e.g., AIS A–B) and incomplete (AIS C–D) SCI/D living in urban or rural Ontario, Canada, between January and October 2022. The Rurality Index of Ontario (RIO) from the postal code determined urban or rural residency. Optical mark recognition (OMR) software was used for survey data extraction. A Research Associate validated the extracted survey responses. Descriptive statistics, correlation analysis, and non-parametric statistics were used to describe the participants, their impairments, and their reported CP levels across urban and rural settings. Results: Eighty-five individuals with SCI/D (mean age 53.7 years, 36.5% female) completed the survey. Most of the participants resided in major urban areas (69.4%) and had traumatic injuries (64.7%). The mean total MSES score for Ontarians with SCI/D was 87.96 (95% confidence interval [CI]: 84.45, 91.47), while the mean total RNLI score for the same individuals was 75.61 (95% CI: 71.85, 79.37). Among the MSES domains, the lowest score was observed in response to sexual satisfaction (mean: 4.012, 95% CI: 3.527, 4.497), while the lowest RNLI domain item score was associated with the ability to travel out of town (mean: 5.965, 95% CI: 5.252, 6.678). Individuals with incomplete injuries in rural areas reported lower MSES and RNLI scores than those with complete motor injuries, whereas no significant differences were found in MSES and RNLI scores among urban residents based on impairment. These findings suggest that, depending on the environmental context (e.g., rural vs. urban areas), AIS categories may influence the perception of CP among people living with SCI/D. The OMR tool had 97.4% accuracy in extracting data from the surveys. Conclusions: The CP (MSES and RNLI) scores reported by individuals with SCI/D differ based on their living setting. In rural Ontario, individuals with greater functional ability reported lower CP than their counterparts living in urban settings. Although CP remains a challenge, the needs of individuals with motor incomplete SCI/D and heterogeneous levels of mobility residing in rural areas require exploration and targeted interventions. The OMR tool facilitates accurate data extraction from surveys across settings. [ABSTRACT FROM AUTHOR]

Background: Adolescent mental health (AMH) is a critical issue worldwide, particularly in West Africa, where it is intensified by socio-economic, cultural, and security challenges. Insecurity and the presence of mining sites expose adolescents to hazardous environments, substance abuse, and adulterated alcohol, further aggravating their mental health. Despite these severe issues, research on AMH in this region remains limited. This study aims to analyze the provision of AMH services in Burkina Faso, Ghana, and Niger, highlighting the unique challenges these countries face within the broader West African healthcare context. Methods: The study adopted a multi-stage, stratified sampling design to collect data from primary healthcare centers (PHCs) in the three countries. Using STATA.17, Descriptive analysis was conducted on the data related to availability of AMH services, types of mental health disorders treated, resources available, and OPD attendance rates. The analysis also incorporated factors such as the rural-urban divide and the presence of national guidelines for AMH services. Results: The findings reveal a significant shortfall in the provision of AMH services across the region, with less than 30% of PHCs across all the countries offering these services. The study also highlights a pronounced rural-urban disparity in AMH service availability, a general absence of national guidelines for AMH care, and low OPD attendance rates. Conclusion: The study highlights the urgent need for comprehensive policy reform and targeted interventions to enhance AMH services in West Africa. Key policy reforms should include the development and implementation of national guidelines for AMH care and integration of AMH services into primary healthcare. Additionally, efforts should focus on capacity building through the training of mental health professionals, increasing public awareness to reduce stigma, and ensuring equitable resource allocation across rural and urban areas. Improving AMH care is essential not only for the well-being of adolescents but also for driving broader socio-economic development in the region. [ABSTRACT FROM AUTHOR]

Lassa fever is an acute viral zoonotic illness endemic in parts of West Africa. In Nigeria, the disease causes periodic large outbreaks, putting strain on healthcare resources and infrastructure. This article reviews the burden and socioeconomic impact of Lassa fever in Nigeria. The vast majority of cases are mild or asymptomatic, however severe illness still occurs in 20% of patients. Late-stage pregnancy infection has high fatality rates. Diagnosis is challenging and early supportive care is critical for survival. The disease affects all age groups in endemic regions, especially impoverished rural communities. Outbreaks disrupt local economies and agriculture and require increased healthcare spending. Specific economic impacts include industry shutdowns, expenditure on protective equipment for healthcare workers, costs for specialized training programs and treatment facilities, high treatment costs for patients, deterrence of investors and businesses, job losses, and declines in tourism revenue. Social impacts include stigmatization of patients. Recommendations for control emphasize improvements to rural healthcare infrastructure, disease surveillance, affordable diagnostics and treatment access, community outreach and education programs, and fostering local economic growth and sustainability. A multidimensional approach engaging all levels of government and civil society is required to mitigate the burden of Lassa fever on Nigeria. This article covers the disease background, populations affected, economic and social impacts, and recommendations to address the substantial public health burden of Lassa fever outbreaks on Nigeria. [ABSTRACT FROM AUTHOR]

Undignified care of women during labor has been associated with increased preventable maternal morbidity and mortality. The purpose of this study was to explore midwives' perspectives on undignified care of women in a midwife's obstetric unit within a rural community healthcare center in South Africa. Using ethnographic methods, seven midwives were recruited to participate in individual interviews and participant observations were conducted in the unit. Three main themes describing undignified care were identified based on an inductive analysis of observations and interview data. These included a lack of respect for women's bodily autonomy during labor, structural challenges in the provision of quality maternity care, and the lack of confidential care for women in labor and delivery. The study findings show that obstetric violence remains a serious crisis in the well-being of women during childbirth. Policy development by stakeholders in maternity care, including operational healthcare practitioners, should prioritize training, monitoring, and peer support on dignified care and curbing disrespect and abuse of women during childbirth, which seemed to be deeply rooted in the routine unorthodox treatment of childbirth. [ABSTRACT FROM AUTHOR]

Aim: To explore the distributed impact of severe mental health conditions (SMHCs) among people with lived experience of SMHCs, their family members, and community members. Methods: We conducted in-depth interviews with family key informants of people with SMHCs (n = 32), people with SMHCs (schizophrenia, bipolar disorder, and major depression) (n = 10), and community members (n = 6) in rural Ethiopia. The study was nested within a long-standing population-based cohort of people with SMHCs. Interviews were conducted in Amharic and were audiotaped. We conducted a thematic analysis. Results: We identified four themes: stress and physical tolls, lost expectations, social disruption, and economic threat. Family members reported stress and hopelessness; some also tried to harm themselves. Family members reported that their relationships with each other and with the wider community were disrupted significantly. Spouses and children did not get the support they needed, leading to unmet expectations: being left alone to care for children, unable to go to school or dropping out early. The study participants with SMHCs also spoke about the impacts of their illness on other family members and the community which appeared to be a source of shame and self-isolation. Both the family and the community respondents reported the economic effect of the illness which sometimes led to selling assets, debt, unemployment, forced migration, and food insecurity. Community members emphasised the economic burden and danger related to the aggressive behavior of the person with SMHCs, while the person with the illness and their family members blamed the community for the stigma and discrimination they experienced. Conclusion: SMHCs have profound consequences for the person with the illness, their family members, and the community. Future interventions for SMHCs should consider household-level interventions to address economic and care needs and mitigate the intergenerational impact. The community should be considered as a resource as well as a target for intervention. [ABSTRACT FROM AUTHOR]

Background: Differences in 30-day survival between males and females following out-of-hospital cardiac arrest (OHCA) are well documented. Biological sex does not appear to be responsible for this survival gap independently of potential mediating factors. We investigated the role of potential mediating factors in the association between sex and 30-day survival after OHCA in Scotland. Methods: A retrospective cohort study of adult non-emergency medical services (EMS)-witnessed OHCA cases was conducted. We included incidents from the whole of Scotland where resuscitation was attempted by the Scottish Ambulance Service (SAS) between April 1, 2011 and March 1, 2020. Logistic regression was used to assess the contribution of age, socioeconomic status, urban–rural location of the incident, initial cardiac rhythm, bystander cardiopulmonary resuscitation (CPR) and location of the arrest (home or away from home). Results: The cohort consisted of 20,585 OHCA cases (13,130 males and 7,455 females). Median (IQR) age was 69 years (22) for males versus 72 years (23) for females. A higher proportion of males presented with initial shockable rhythm (29.4% versus 12.4%) and received bystander CPR (56.7% versus 53.2%) compared with females. A higher proportion of females experienced OHCA at home (78.8% versus 66.8%). Thirty-day survival after OHCA was higher for males compared with females (8.2% versus 6.2%). Males had higher age-adjusted odds for 30-day survival after OHCA than females (OR, 1.26; (95% CI), 1.12–1.41). Mediation analyses suggested a role for initial cardiac rhythm and location of the arrest (home or away from home). Conclusion: Males had higher age-adjusted 30-day survival after OHCA than females. However, after adjusting for confounding/mediating variables, sex was not associated with 30-day survival after OHCA. Our findings suggest that initial cardiac rhythm and location of the arrest are potential mediators of higher 30-day OHCA survival in males than females. Improving proportions of females who present with initial shockable rhythm may reduce sex differences in survival after OHCA. [ABSTRACT FROM AUTHOR]

Background: This paper aimed to explore the palliative care (PC) needs and barriers to access among cancer patients in a rural region of North India with a high cancer burden. Methods: A Participatory action research (PAR) approach was employed. Situational assessment, community sensitization workshops (CSWs) and door-to-door surveys were planned, conducted and developed over three PAR cycles. A parallel convergent mixed-methods approach was adopted wherein the quantitative data from door-to-door surveys and qualitative data from CSWs and investigator field notes were collected and analyzed to provide a comprehensive understanding of PC needs and barriers to access. Descriptive statistics and thematic analysis were used. Results: A total of 27 CSWs involving 526 stakeholders were conducted. A total of 256 cancer patients were assessed for PC needs and symptom burden using the Supportive and Palliative Care Indicators (SPICT-4ALL) and the Edmonton Symptom Assessment System (ESAS) tool, respectively. Based on the SPICT assessment, all patients (n = 256) satisfied general and/or cancer-specific indicators for PC. The majority (56.6%) had ≥ one moderate-severe symptom, with the most common symptoms being tiredness, pain and loss of appetite. Analysis of qualitative findings generated three themes: unmet needs, burden of caregiving, and barriers and challenges. Cancer affected all domains of patients' and their families' lives, contributing to biopsychosocial suffering. Social stigma, discrimination, sympathizing attitudes and lack of emotional and material support contributed to psychosocial suffering among cancer patients and their caregivers. Lack of awareness, nearby healthcare facilities, transportation, essential medicines, trained manpower and education in PC, collusion, fear of social discrimination, faulty perceptions and misconceptions about cancer made access to PC difficult. Conclusions: The study emphasize the need for and provide a roadmap for developing context-specific and culturally appropriate CBPC services to address the identified challenges and needs. The findings point towards education of CHWs in PC; improving community awareness about cancer, PC, government support schemes; ensuring an uninterrupted supply of essential medicines; and developing active linkages within the community and with NGOs to address the financial, transportation, educational, vocational and other social needs as some of the strategies to ensure holistic CBPC services. Trial registration: Clinical Trial Registry of India (CTRI/2023/04/051357). [ABSTRACT FROM AUTHOR]

Background: Vaccines have been instrumental in preventing up to three million deaths globally, according to the WHO. Despite this, COVID-19 vaccine uptake has faced challenges due to vaccine issues, production difficulties, and various socio-demographic, economic, structural, and cultural factors. Objective/aim: This study examined the factors influencing vaccine hesitancy among adults aged 18 and older in the Volta Region of Ghana. Methods: A population-based cross-sectional study was conducted among 590 adults from three districts using multistage sampling. Respondents aged 18 years and above were recruited using a structured questionnaire and an interviewer-administered approach. Data analysis was conducted using STATA version 16. The relationship between the dependent and independent variables was assessed through logistic regression analysis, with statistical significance determined at a p-value of less than 0.05. Results: A 42.5% rate of vaccine hesitancy was found. Key predictors included being an artisan (aOR = 1.99), a trader (aOR = 3.64), lacking nearby healthcare centres (aOR = 1.52), residing in rural areas (aOR = 0.41), earning less than 500 cedis (aOR = 0.57), and having a larger household size (aOR = 0.37). Not receiving information on vaccine side effects from health personnel (aOR = 5.6) was also a significant factor (p < 0.05). Conclusion: To enhance COVID-19 vaccine uptake and advance towards ensuring healthy lives and promoting well-being for all at all ages (SDG 3), healthcare interventions designed by health professionals should address these major predictors. [ABSTRACT FROM AUTHOR]

The present work establishes the interface between quilombola school education and rural education, to highlight the advancement of educational policies in Brazil, conceived with peasant subjects who live in quilombola communities. We propose to highlight the mobilization of organizations and social movements, as protagonists in the struggle to remain in their territories and in consolidating public policies that meet the demands of quilombola communities, based on the approval of specific curricular guidelines that guarantee equal conditions and access to public education. Quilombola and countryside education have specificities in their policies instituted by the State, considering the urgent need to overcome the historical conditions attributed to rural populations and quilombola communities. It is a research with a qualitative, bibliographical, and documental approach, which intends to list the main elements in the construction of the political pedagogical project of the Quilombola schools, based on the legislation, resolutions, and guidelines that support the interface between Countryside Education and quilombola education. Regarding the results achieved, we highlight the challenges for the implementation of such guidelines, with emphasis on the current Brazilian situation and the role that social movements assume in this context. [ABSTRACT FROM AUTHOR]

Balanced energy protein supplementation (BEP) is recommended for contexts of high maternal undernutrition by the World Health Organization. Despite recent improvements in undernutrition, Bangladesh remains a context where BEP could help accelerate progress towards nutrition goals. In preparation for an effective trial testing a fortified BEP, a qualitative study was undertaken to better understand sociocultural factors influencing dietary behaviours in pregnancy. Married women of reproductive age (n = 23), their husbands (n = 6) and mothers‐in‐law (n = 6) were interviewed, and focus group discussions were conducted with women (n = 4). Women had a clear understanding of which nutritious foods are important to consume during pregnancy, including green leafy vegetables, dairy and other animal‐source foods. Many explained affordability as a barrier to consuming those foods with the desired frequency. Women acquired information about diet and nutrition in pregnancy from community health workers as well as other women in the community. Most preferred to seek information from their own networks before formal health care providers. Women and husbands generally had positive views about micronutrient supplements, although some mothers‐in‐law were more hesitant. Some food taboos relating to the consumption of certain foods like duck and pigeon meat persist, mainly stemming from concerns for the unborn child. Opportunities exist to build on existing perceptions of healthy diets, potentially framing food or nutrient supplements as a beneficial 'add‐on' to promote a healthy pregnancy. There is a scope to strengthen nutrition counselling, especially for the family members, to dispel myths and misconceptions and promote dietary and other support for pregnant women. Key messages: Women in this part of rural Bangladesh understood which foods were beneficial for health and nutrition during pregnancy and the importance of increasing food intake during pregnancy.Women and husbands were more likely to view nutrition supplements as beneficial during pregnancy; some mothers‐in‐law expressed reservations about supplements.In the context of a planned effectiveness trial of balanced‐energy and protein supplementation, nutrition education should reinforce existing concepts of the importance of healthy diets during pregnancy and build on them to promote the use of nutritious supplements to meet nutrient needs in pregnancy.Financial constraints limit access to nutritious food and micronutrient supplements in pregnancy despite widespread beliefs about their value. [ABSTRACT FROM AUTHOR]