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This conceptual review identifies the contributions of the Sociology of Sport Journal to the subfield of feminist sport media studies. Since the first issue of Sociology of Sport Journal, over 60 articles addressed primarily the media representations research area of feminist sport media studies, using a range of theoretical frameworks that mirrored theoretical shifts in the field. An empirical analysis of geographies of knowledge production indicates that the scholarship in Sociology of Sport Journal in this subfield is primarily based in the United States and focuses on Western contexts. The article concludes with a reflection on the importance of special issues and interdisciplinary collaborations in feminist sport media studies. [ABSTRACT FROM AUTHOR]

Although guilt is often considered the most prevalent emotional outcome of work–family conflict (WFC), most work–family research focuses on family‐related guilt stemming from work interference with family, rather than job‐related guilt stemming from family interference with work (FIW). In addition, there is little understanding of how different employee social groups experience the implications of FIW in their daily lives. To address these research gaps, this study explores the relationship between daily FIW and job‐related guilt, and its subsequent impact on job satisfaction. It also investigates variation in these relationships by (1) gender and (2) the intersection of gender and ethnicity. Bayesian multilevel structural equation modeling using data from 5‐day diary surveys from 210 solicitors in Britain shows daily FIW is associated with higher job‐related guilt and subsequently lower job satisfaction. The relationship is stronger for women than men in general, but is also stronger for South Asian women than white British women (and men), and for South Asian men than white British men. This suggests that studies focusing on single social group characteristics (e.g., gender) are likely to obscure intersectional effects that might produce significant within‐group variation. The findings also highlight the importance of integrating workplace inequality arguments into theorization of WFC. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion C‐reactive protein (CRP) is a prognostic biomarker for clear cell renal cell carcinoma (ccRCC). However, there may be potential racial heterogeneity in distribution and prognostic impact of CRP level. We investigated potential racial differences in distribution and prognostic impact of preoperative CRP among Asian (AS), African American (AA), and Caucasian (CAUC) patients with non‐metastatic ccRCC (nmccRCC).We retrospectively analyzed 1991 nmccRCC cases (AS/AA/CAUC: n = 968/223/800) undergoing nephrectomy from the international multi‐institutional database. We investigated CRP distributions and optimal cut‐off values for predicting recurrence‐free survival (RFS) and overall survival (OS) using Cox regressions for each racial group. Subgroup analyses considered comorbidities, pathological T stage, and Fuhrman grade.Preoperative CRP distributions differed significantly among the races, with median values of 0.90 mg/L (interquartile range, 0.40–2.33) for AS, 5.00 mg/L (1.98–12.20) for AA, and 3.55 mg/L (1.41–8.48) for CAUC (p < 0.01). Optimal cut‐off values for RFS were 1.2 mg/L in AS, 2.8 mg/L in AA, and 1.7 mg/L in CAUC, showing C‐indices of 0.77, 0.71, and 0.77, respectively. For OS, they were 1.6 mg/L in AS, 8.3 mg/L in AA, and 9.3 mg/L in CAUC, yielding C‐indices of 0.77, 0.70, and 0.74, respectively. Subgroup analyses revealed varying reference ranges of CRP levels among races (1.1–2.2/2.7–5.0/1.5–3.4 mg/L for RFS, and AS/AA/CAUC: 0.9–3.0/8.0–12.7/8.0–10.4 mg/L for OS, respectively).The preoperative CRP distributions and their optimal cut‐off values for predicting patient prognosis differed significantly among the races. Using race‐specific cut‐off values, CRP demonstrated consistently high‐prognostic accuracies, which may improve tailored patient management in nmccRCC. [ABSTRACT FROM AUTHOR]

How child protection and welfare policies address the disability community is a matter of utmost importance and urgency in the context of well-established inequalities. We present a policy content analysis of national policy documents across the United States, Northern Ireland, Australia, and the Republic of Ireland through the theoretical frame of a welfare regimes typology. Key findings include the conflation of disability with vulnerability in all but one context. Also evident is a lack of overt definition of disability, and opportunities for developing specific jurisdictional guidance and regulations focussed on embedding best practices in supporting disabled clients at all system levels. [ABSTRACT FROM AUTHOR]

Sun protection is essential for outdoor workers to reduce their risk for developing skin cancers. Clinicians can be encouraged to determine if patients are outdoor workers and recommend routine of sun safety practices and regular skin exams. Clinicians can advise organizations with outdoor workers to implement occupational sun protection programs. Objective: Two methods for scaling up an evidence-based occupational sun protection program were compared. Methods: Regional districts (n = 138) in 21 state Departments of Transportation throughout the United States were randomized to receive the Go Sun Smart at Work program via in-person or digital scalability methods in 2019–2022 in 1:2 ratio. Managers completed pretest and posttest surveys and employees completed posttest surveys. Because of the COVID pandemic, only posttest measures were analyzed (n = 255 managers; n = 1387 employees). Results: After scale-up, more employees reported training (b = 0.381, P = 0.021) and communication (b = 0.112, P = 0.049) at workplaces in in-person rather than digital strategy. There were no differences in managers' reports of sun protection training, communication, or actions by scalability method (P > 0.05). Conclusions: Occupational sun protection was implemented during program scale up and employees recalled training/communication more in the in-person than digital strategy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the characteristics of patients who visited the Polyclinic during the Tokyo 2020 Olympics and analyze geographical and economic correlations with the number of clinic visits. Design: Cross-sectional study. Setting: Polyclinic during the Tokyo 2020 Olympics. Participants: Patients who visited the Polyclinic. Intervention: Data from the electronic medical record system of the Polyclinic were extracted. Main Outcome Measures: The number of visits for each athlete or team official was calculated by country. Relationship between number of visits per patient and total number of team members, total health expenditure per capita, density of medical doctors, life expectancy at birth, and education expenditure per gross domestic product (GDP) were investigated. Independent variables related to medal tables were also investigated. Results: The average number of visits per athlete was 0.67, and it was higher in athletes from non–high-income countries compared with high-income countries for both male and female athletes. Number of visits per athlete was higher in countries with low life expectancy at birth (95% CI, −0.16 to −0.02, P = 0.012) and education expenditure per GDP (95% CI, −0.17 to −0.04, P = 0.003). Conclusions: During the Tokyo 2020 Olympics, the number of visits to the Polyclinic per athlete was higher in countries with low life expectancy at birth and education expenditure per GDP. [ABSTRACT FROM AUTHOR]

This study aimed to determine the attitudes of university students toward domestic violence. This is a cross-sectional descriptive study. The sample of this study consisted of 900 students enrolled in a public university's nursing and forestry faculties. The data of the study were collected by the authors in Istanbul between December 2018 and March 2019. A Participant Introduction Form and the Attitudes toward Domestic Violence Scale were used to collect data. The participants' mean Attitudes toward Domestic Violence Scale score was found to be 19.90 ± 5.58. A small percentage of the participants was found to have a supportive attitude toward domestic violence. Furthermore, this study revealed a statistically significant relationship between attitudes toward domestic violence and sociodemographic factors such as gender, department of study, region of birth, longest-lived area, place of residence, and family income. The attitudes of society toward domestic violence, as well as the factors that influence these attitudes, should be determined to prevent and eliminate domestic violence. Nurses who interact with the public on a routine basis should take an active position in research and training programs aimed at eradicating approving attitudes regarding domestic violence. [ABSTRACT FROM AUTHOR]

Context.--Interpretation of alkaline phosphatase (ALP) activity is essential for the diagnosis of certain diseases. ALP changes during life and may vary between different populations. Objective.--To establish reference intervals (RIs) and percentile charts for ALP activity in the Spanish population through a multicentric observational study and to compare the RIs to those defined in other countries. Design.--A total of 662 350 ALP measurements from individuals ages 0 to 99 years from 9 Spanish tertiary care centers collected between 2020 and 2022 were analyzed. This study is the largest published on this topic in the literature to date. Results.--Continuous percentile charts for ALP according to sex and age were established which can be used as RIs. Higher levels are reached during the first weeks of life. In puberty, a differential evolution is observed in both sexes, reaching a peak at 10 to 13 years of age in boys and remaining stable in girls at this age. Significant differences were also observed in adults, higher in men between ages 20 and 49 years and between ages 50 and 79 years in women, as reported in some countries. Conclusions.--ALP activity follows an age- and sex-dependent fluctuation with geographic differences. It is important to have appropriate reference values for each population in order to allow for a correct diagnostic interpretation and early diagnosis of diseases related to ALP abnormalities. [ABSTRACT FROM AUTHOR]

Purpose: To examine the lifespace of participants referred for occupational therapy driving assessment following acquired brain injury, to understand how, why, where and with whom access and participation in community-based occupations is occurring during the period of driving disruption. Materials and methods: The mixed methods, convergent research design utilised a travel diary and Lifespace Mobility Assessment-Composite quantitative elements and semi-structured interviews analysed qualitatively with an interpretive description lens. Results: Forty-eight participants (56.25% male) aged between 26 and 65 years, left home on average once/day, primarily to conduct instrumental activities of daily living, health management, and social participation community-based occupations. Most reported restricted lifespace (54.2%) requiring assistance to conduct community occupations (68.1%). Support was primarily provided by family members (80.3%). Analysis of semi-structured interviews (n = 15) created three themes that shaped participant occupational experience during driving disruption: (i) changes to occupational participation; (ii) reliance on others for community access and participation; and (iii) trying to move forward. Conclusion: The period of driving disruption following the onset of acquired brain injury is a time of occupational disruption which restricts lifespace, changing how, why, where and with whom participation in community-based occupations occurs. Rehabilitation facilitating occupational adaptation process to enhance community access capacity is indicated. IMPLICATIONS FOR REHABILITATION: The period of driving disruption following the onset of acquired brain injury is a time of occupational disruption which restricts lifespace and influences participation in community-based occupations. Occupational therapists should provide an individualised potential pathway to return to driving with frequent and varied means of reinforcing interim advice to abstain from driving. Implementing occupational adaptation can progress community participation goals by establishing community access skills, habits, routines and confidence to foster participation and satisfaction and rebuild occupational identity following acquired brain injury. [ABSTRACT FROM AUTHOR]

Introduction: Self-poisoning is the most common form of hospitalised self-harm in young people and has been increasing over the last decade. The COVID-19 pandemic was associated with further increases in self-harm in adolescents. There are limited data on changes after pandemic restrictions ended. This study aimed to describe recent trends in self-poisoning in young people. Setting: Australia 2018–2023. Methods: A retrospective analysis of self-poisoning calls to Australia's poisons information centres. Intentional poisoning exposures in people aged 5–19 years were included in the main analysis. We also examined intentional poisonings in people aged 20 and over for comparison. We used interrupted time-series analysis to estimate the impact of COVID-19 (March 2020) and 're-opening' (December 2021), when many restrictions were lifted in Australia. We compared effects in the jurisdictions with most disruptions and lockdowns with other jurisdictions. Results: There were 201,755 self-poisonings documented, 64% female, with 19,946 children (aged 5–14, 9.9%) and 44,388 adolescents (aged 15–19, 22.0%). There was a steep increase in the rate of poisoning in female children and adolescents – with the annual increase being 1.361 (95% confidence interval = [1.074, 1.735]) and 1.154 (95% confidence interval = [1.049, 1.283]) times faster than pre-pandemic trends in these two groups between March 2020 and December 2021. Following relaxation of restrictions, there was a sudden drop and then slow decline in self-poisonings (despite rising COVID-19 infection rates). There was an overall 29.6% increase in intentional poisonings in young people over the study period. This is markedly more pronounced among young females (37.0%) vs males (11.2%). There were substantial jurisdictional variations, with larger increases in Victoria, Tasmania and the Australian Capital Territory. Conclusion: There has been a marked increase in child and adolescent female self-poisonings over the last 6 years, with increases strongly associated with COVID-19 pandemic restrictions but persisting after their removal. [ABSTRACT FROM AUTHOR]

Objectives: Prior research shows that perceived racism was associated with higher risks of suicidal ideation among US Asians. Nevertheless, the relationship between internalized racism and the suicidal risks of US Asians has not been adequately researched. In addition, as an important social institution, religion has been left out of the studies of racism and suicide for US Asians. This study is aimed at filling in these gaps and contributing to a better understanding of internalized racism, religion, and the mental health of US Asians. Design: This study surveyed 970 Asian or Asian American adults living in the United States. Survey participants were recruited using Qualtrics online panel samples between April and June 2024. Quotas were set for key demographic variables, such as sex and ethnicity, following the national census. Results: The main results suggest that even after controlling important mental health measures such as anxiety and loneliness, higher internalized racism was still tied to higher risks of suicidal ideation. The effect of internalized racism was not only robust but also stronger than other mental health measures as well as perceived external racism. Finally, the deleterious internalized racism effect on suicidal ideation was stronger among US Asians, who attend religious services more often. Conclusion: Internalized racism exerts a fairly strong and robust effect on suicidal ideation among US Asians. This deleterious effect is also interactive with the religious characteristics of US Asians. Healthcare providers, community workers, and religious leaders may want to take internalized racism into consideration in their future service to the US Asian community. [ABSTRACT FROM AUTHOR]

Aim: To examine parents' perceptions of care quality at child health centres. Specific objectives were to examine parents' perceptions of the care received and the subjective importance of such care. Furthermore, to examine the relationship between parents' sociodemographic characteristics and the perceptions of care quality. Design: A cross‐sectional study. Methods: A random sample of parents of children born in Sweden in 2021 participated. Data were collected by the QPP‐CHC questionnaire and analysed using descriptive and analytical statistics. Results: The response rate was 19.4%. The targeted sample size of 210 participants was reached as 584 parents responded to the questionnaire. Parents' overall ratings of care quality at child health centres indicated optimal quality with mean values >3. However, various potential improvements areas were identified as needing additional information. These included dental care (m = 2.82), allergy prevention (m = 2.25), breastfeeding (m = 2.97), sleep (m = 2.83), the child's behaviour (m = 2.47) and the child's crying (m = 2.47). Also, parents rated suboptimal quality regarding that the care was based on healthcare routines rather than parental preferences and needs (m = 2.86). Parents born outside of the Nordic countries rated higher care quality than those born in the Nordic countries, as well as parents with a non‐academic education. Conclusion: Parents want information based on their preferences and needs. Parent's perceptions of areas for improvement are new and important knowledge for registered nurses at child health centres. Implications for the Profession and/or Patient Care: The findings indicate that parents feel that insufficient attention is given to areas of care that they perceive as important. Parents' perspectives on the care quality at child health centres is an important component of quality work and might lead to improvements in the care quality at child health centres. Reporting Method: The Strengthening the Reporting of Observational Studies (STROBE) checklist for cross‐sectional studies was used to guide reporting. Implications for policy and practice: The findings of this study suggests that parents feel that insufficient attention is given to areas of care that they perceive as important. Parents' perspectives on the care quality at child health centres provides important knowledge which can guide further development of care quality at child health centres. The findings indicate that a family‐centred approach that integrates relational and routine‐oriented nursing can be a way to ensure that the care is based on parents' preferences and needs. No patient or public contribution. [ABSTRACT FROM AUTHOR]

Women of reproductive age are particularly vulnerable to low‐quality diets due to their higher micronutrients needs. The minimum dietary diversity for women (MDDW) is a proxy for micronutrient adequacy in this group of women. Its relationship with other aspects that lead to malnutrition is not fully elucidated and depends on the context. In this study, we assessed the prevalence of MDDW among women of a rural area in Chad and its association with socioeconomical, agricultural, dietary and food security data. A cross‐sectional study was conducted. Following a multistage cluster sampling, 984 women of reproductive age were randomly selected and interviewed in March 2019. We obtained food consumption data through unquantified 24 h recalls and computed MDDW as consuming at least five out of 10 predefined food groups. We constructed a Food Production Diversity Score (FPDS) with crop and livestock information. We obtained multivariable logistic regression models including different covariates. MDDW was achieved by only 33% of women in the sample. In our final model, we identified a significant association of MDDW with the FPDS and gathering of wild plants. Women in households with the highest FPDS had 70% more chances of achieving MDDW than those with the lowest FPDS. Gathering wild plants doubled these chances. Areas of cultivated land, Water, Sanitation and Hygiene resources, and a high level of food security, measured with the Household Food Insecurity Access Scale, were also significantly related to the achievement of MDDW. This illustrates the importance of nutrition‐sensitive policies, also considering biodiversity and food production diversification. Key messages: Only one in three women in a rural area of the Guerá region in Chad reach the minimum dietary diversity measured by the minimum dietary diversity for women (MDDW) indicator.Food insecurity is highly prevalent among households (HHs) of these rural areas of Chad, with more than 90% of the HHs being moderately or severely food insecure.Diverse food production and gathering of wild foods in HHs has a positive impact on MDDW.Water, Sanitation and Hygiene resources, areas of cultivated land and greater HH food security also showed this positive association. Altogether, this indicates the importance of nutrition‐sensitive policies that address malnutrition through a holistic approach. [ABSTRACT FROM AUTHOR]

Physical medicine and rehabilitation has rapidly been garnering interest as health care increases the emphasis on rehabilitation and management for acute and chronic diseases. This study analyzes recent geographical trends of physical medicine and rehabilitation residents via physical medicine and rehabilitation residents from 2019 to 2023, which were identified from publicly available data. The relative distribution from medical school to residency, medical school to preliminary program, and preliminary program to residency were analyzed. These locations were categorized as within 100 miles, same state, same region, or different region. Odds ratio were calculated for the aforementioned relative locations with respect to the presence of a home residency program. A total of 1836 residents were included. The majority of residents (51%) stayed within the same region as their medical school. Residents from medical schools with a home program were more likely to stay within 100 miles (odds ratio: 3.64), the same state (odds ratio: 3.19), and same region (odds ratio: 2.56). Overall, physical medicine and rehabilitation residents are likely to stay within the same region as their medical school and preliminary year. In addition, the presence of a home program significantly increases the odds of matching within 100 miles, same state, and same region. [ABSTRACT FROM AUTHOR]

Aims: The aims of this study were to identify alcohol‐related population surveys administered in the Americas, determine which alcohol‐related measures are examined and identify coverage gaps regarding alcohol‐related measures. Methods: As part of the Global Information System on Alcohol and Health study, a systematic search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses criteria to identify regionally or nationally representative survey reports of the general population from 1 January 2010 to 6 August 2019. Alcohol‐related measures extracted from surveys were categorized into 10 domains: alcohol consumption status; alcohol consumption; unrecorded alcohol consumption; drinking patterns; symptoms of dependence and/or harmful use; drinking during pregnancy; treatment coverage; second‐hand harms; economic; and other. Results: The systematic search identified 7417 survey reports, 94 of which were new and included in this study, with an additional 11 studies included from a previous systematic study of alcohol surveys. In total, 94 unique surveys and 161 unique survey waves were located, representing 105 unique survey questionnaires covering 30 countries. No population surveys were found for five member states; namely, Antigua and Barbuda, Dominica, Haiti, Saint Vincent and the Grenadines and Saint Kitts and Nevis. All countries with population‐based alcohol surveys had had a population survey probing alcohol use in the past year/month. Questions regarding heavy episodic drinking, alcohol use disorders, treatment‐seeking for alcohol use, drinking during pregnancy, harms to others and the amounts spent on alcohol were asked in 26, 25, 10, 6, 22 and 11 countries, respectively. Conclusions: The heterogeneity in alcohol‐related population surveys in the Americas from 2010 to 2019 limits their comparability throughout countries and over time. Future surveys should implement a standardized set of core questions to provide consistency in the monitoring of alcohol consumption and alcohol‐related harms. [ABSTRACT FROM AUTHOR]

Objectives: In the United States, hepatitis C is the most commonly reported bloodborne infection. It is a leading cause of liver cancer and death from liver disease and imposes a substantial burden of hospitalization. We sought to describe regional differences in hepatitis C virus (HCV)–related hospitalizations during 2012 through 2019 to guide planning for hepatitis C elimination. Methods: We analyzed discharge data from the National Inpatient Sample for 2012 through 2019. We considered hospitalizations to be HCV-related if (1) hepatitis C was the primary diagnosis or (2) hepatitis C was any secondary diagnosis and the primary diagnosis was a liver disease–related condition. We analyzed demographic and clinical characteristics of HCV-related hospitalizations and modeled the annual percentage change in HCV-related hospitalization rates, nationally and according to the 9 US Census Bureau geographic divisions. Results: During 2012-2019, an estimated 553 900 HCV-related hospitalizations occurred in the United States. The highest hospitalization rate (34.7 per 100 000 population) was in the West South Central region, while the lowest (17.6 per 100 000 population) was in the West North Central region. During 2012-2019, annual hospitalization rates decreased in each region, with decreases ranging from 15.3% in the East South Central region to 48.8% in the Pacific region. By type of health insurance, Medicaid had the highest hospitalization rate nationally and in all but 1 geographic region. Conclusions: HCV-related hospitalization rates decreased nationally and in each geographic region during 2012-2019; however, decreases were not uniform. Expanded access to direct-acting antiviral treatment in early-stage hepatitis C would reduce future hospitalizations related to advanced liver disease and interrupt HCV transmission. [ABSTRACT FROM AUTHOR]

Objectives: Evidence-informed population health initiatives often leverage data from various sources, such as epidemiologic surveillance data and administrative datasets. Recent interest has arisen in using area-level composite measures describing a community's social risks to inform the development and implementation of health policies, including payment reform initiatives. Our objective was to capture the breadth of available area-level composite measures that describe social determinants of health (SDH) and have potential for application in population health and policy work. Methods: We conducted a scoping review of the scientific literature from 2010 to 2022 to identify multifactorial indices and rankings reflected in peer-reviewed literature that estimate SDH and that have publicly accessible data sources. We discovered several additional composite measures incidental to the scoping review process. Literature searches for each composite measure aimed to contextualize common applications in public health investigations. Results: From 491 studies, we identified 31 composite measures and categorized them into 8 domains: environmental conditions and pollution, opportunity and infrastructure, deprivation and well-being, COVID-19, rurality, food insecurity, emergency response and community resilience, and health. Composite measures are applied most often as an independent variable associated with disparities, risk factors, and/or outcomes affecting individuals, populations, communities, and health systems. Conclusions: Area-level composite measures describing SDH have been applied to wide-ranging population health work. Social risk indicators may enable policy makers, evaluators, and researchers to better assess community risks and needs, thereby facilitating the evidence-informed development, implementation, and study of initiatives that aim to improve population health. [ABSTRACT FROM AUTHOR]

Long-acting injectable pre-exposure prophylaxis for HIV prevention (LAI-PrEP) was approved for use in the United States in 2021, yet little is known about perceptions of LAI-PrEP among transgender and nonbinary young adults, a group that faces substantial barriers to HIV prevention. We investigated US transgender and nonbinary young adults' perceptions of and attitudes toward LAI-PrEP and how perceived advantages and disadvantages of LAI-PrEP related to the PrEP continuum of care. We conducted semi-structured interviews with 31 transgender and nonbinary young adults who reported oral PrEP use or were PrEP-eligible. We analyzed responses using both a deductive RADaR approach, to identify LAI-PrEP perceptions relevant to the PrEP continuum of care, and an inductive thematic analysis to explore key themes. In this study, all PrEP-experienced and most PrEP-naïve participants indicated an interest in LAI-PrEP, citing advantages over daily oral medication (e.g., fewer adherence challenges). Three key themes emerged: (1) Some participants linked perceived advantages of LAI-PrEP to experiences with gender-affirming care (e.g., familiarity with needles via hormone use). (2) Participants weighed trade-offs and contextual factors that influenced their LAI-PrEP preferences (e.g., interest contingent on whether location for receiving injection was geographically accessible). (3) Participants envisaged alternative delivery methods that could enhance LAI-PrEP acceptability and uptake (e.g., home injection). HIV prevention programs should incorporate the insights of transgender and nonbinary young adults to ensure that emerging HIV prevention technologies are accessible and responsive to the needs and concerns of people of all gender modalities. [ABSTRACT FROM AUTHOR]

Background: Stanford Type A Aortic Dissection (TAAD) is associated with high in-hospital mortality and the need for immediate surgical intervention. Larger hospital size may be associated with better patient care and surgical outcomes. This study aimed to examine the effect of hospital size on TAAD outcomes. Method: Patients who underwent TAAD repair were identified in National Inpatient Sample (NIS) from Q4 2015-2020. NIS stratifies hospital size into small, medium, and large based on the number of hospital beds, geographical location, and the teaching status of the hospitals. Patients admitted to small/medium and large hospitals were stratified into two cohorts. Multivariable logistic regressions were performed to compare in-hospital outcomes, adjusted for demographics, comorbidity, primary payer status, and hospital characteristics including procedural volume. Results: There were 1106 and 3752 TAAD admitted to small/medium and large hospitals, respectively. Among patients admitted to small/medium hospitals, there was higher mortality (17.27% vs 14.37%, aOR = 1.32, P < 0.01), but shorter length of stay (P < 0.01) and lower cost (P = 0.03) compared to larger hospitals. There was no difference in morbidities. Conclusions: Marked higher mortality is associated with admission to smaller hospitals among patients with TAAD, which may in turn decrease the average hospital stay and cost. Given that a significant percentage of patients are already being transferred out of the initial hospital and small/medium hospital is associated with higher mortality, centralization of care in centers of excellence may decrease the high mortality associated with TAAD. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore how medical resources and vaccine coverage relate to infant mortality rate (IMR) and under-five mortality rate (U-5MR), which are both key national health indicators. This longitudinal study was based on panel data from the national level of 200 countries. Data from 1990 to 2021 were grouped into seven regions based on geographic and epidemiological similarities. Regarding correlation, the high-income region showed a different trend from that shown by other regions. Health expenditure was positively associated with IMR and U-5MR globally. Number of medical doctors per 1,000 people was negatively associated with IMR and U-5MR globally. Hepatitis type B (HBV) and measles, first dose (MCV) were negatively associated with IMR and HBV, MCV, and Bacillus Calmette–Guérin were negatively associated with U-5MR globally. In quadratic regression, the correlation between the number of doctors and mortality stabilizes or plateaus at approximately four individuals. Overall vaccine coverage was positively correlated with mortality up to a certain threshold, beyond which it became negatively correlated. A higher number of doctors was consistently associated with decreased mortality, regardless of location, while other factors varied by region. Our study findings highlight the importance of implementing global strategies that are specific to each region's characteristics to reduce IMR and U-5MR. [ABSTRACT FROM AUTHOR]

For the last four decades, policymakers have attempted to control the United States's high health care costs by reducing patients' demand for care (e.g., by imposing managed-care restrictions or high costs on patients at the time of use). Yet studies based mostly on data from the public Medicare program, which covers mostly elderly Americans, suggest that supply (e.g., number of physicians or hospital beds) rather than demand drives aggregate service use and, hence, costs. Using variation between U.S. states in per enrollee Medicare spending versus per capita spending of all other (non-Medicare) individuals, we find that greater supply boosts costs for the entire population. Furthermore, we find that factors that suppress demand in the non-Medicare population do reduce non-Medicare health care spending, but simultaneously increase Medicare spending. This suggests that for a given supply of medical resources, suppressing demand for one group of patients may produce a compensatory increase in provision of care to those whose demand has not been suppressed. Health planning to assure adequate medical resources where they are needed while preventing excess supply where it is duplicative and wasteful is likely a more effective cost control strategy than the imposition of managed-care restrictions or imposing higher costs onto patients seeking care. [ABSTRACT FROM AUTHOR]

Background: Understanding of socioeconomic context might enable more efficient evidence‐based preventive strategies in oral health. Aim: The study assessed the caries‐related socioeconomic macro‐factors in 12‐year‐olds across European countries. Design: This systematic review involved epidemiological surveys on the caries status of 12‐year‐olds from 2011 to 2022. DMFT was analyzed in relation to gross national income (GNI), United Nations Statistical Division geographical categorization of European countries (M49), unemployment rate, Human Development Index (HDI), and per capita expenditure on dental health care. A meta‐analysis was performed for countries reporting data on DMFT, stratified by GNI, and geographical location of European countries, using a random‐effects model. Results: The study involved 493 360 children from 36 countries in the geographic region of Europe. The analysis confirmed a strong negative correlation between income and caries experience (p <.01). Children living in higher‐income countries showed 90% lower odds of poor oral health than in middle‐income countries. Children living in West Europe showed 90% lower odds of poor oral health than children living in East Europe. Conclusion: The strong effect of macro‐level socioeconomic contexts on children's oral health suggests favoring upstream preventive oral health strategies in countries with economic growth difficulties, Eastern and Southern parts of Europe. [ABSTRACT FROM AUTHOR]

Objective: Duration of untreated psychosis (DUP) is considered an important factor in outcome. Individual, familial and illness factors may prolong DUP. Little data on this issue is available from the country of Nepal. The purpose of the present study was to assess DUP in patients with first-episode psychosis and identify associations with patients' sociodemographic and clinical factors. Methods: A cross-sectional, descriptive study was conducted in the department of psychiatry at Tertiary Hospital in the Eastern part of Nepal. Eighty-six patients were enrolled. ICD-10 was used to make the diagnosis. The Nottingham Onset Schedule-DUP version (NOS-DUP) was used to assess DUP. Positive and Negative Syndrome Scale (PANSS) was used to assess patients' clinical symptoms. Results: The mean (SD) DUP was 21.4 (42.1) months and median DUP was 3.0 months (IQR = 23.5). Participants from mountainous regions, those who were unemployed, having an insidious onset of illness, and patients with a diagnosis of schizophrenia had significantly longer DUP (P <.005). Duration of untreated psychosis was also positively correlated with negative symptoms (r =.42, P <.001) and total PANSS score (r =.42, P <.001). Conclusion: Duration of untreated psychosis in first-episode psychotic patients was relatively long (compared to studies in other countries) and was found to be positively associated with living in mountainous regions of Nepal, being unemployed, having an insidious onset of illness, and having a diagnosis of schizophrenia. Programs and educational efforts are needed to ensure early treatment of patients with first-episode psychosis, especially in the mountainous rural areas of Nepal. [ABSTRACT FROM AUTHOR]

Background: Understanding optimal prosthesis alignment in TKA remains crucial despite ongoing debate. While current research focuses on osteoarthritic knees, a gap exists in characterizing healthy young adult knees in Asians. This study aims to fill this gap by identifying the distribution of CPAK phenotypes in this population, including potential gender variations and individual differences. Methods: A total of 390 knees from 195 young adults aged 20 to 35 years without knee pain who underwent hip-knee-ankle radiography were prospectively collected between February 2024 and March 2024. The average MPTA, LDFA, aHKA, and JLO were measured. The overall CPAK distribution was analyzed to assess gender variations and individual differences. On average, participants were 25.7 years old, 165.7 cm tall, and had a BMI of 23.6 kg/m². LDFA, MPTA, aHKA, and JLO averaged at 86.8°, 87.2°, 0.3°, and 174.0°, respectively. Results: This study demonstrates significant differences in knee alignment between men and women, as measured by the CPAK system. While zone II was the most common overall (43.3%), the distribution of CPAK zones varied by gender, with men exhibiting a higher prevalence of distal apex point alignments (89.9%) and women having a higher prevalence of CPAK zone V (18.3%). Finally, analysis of paired knees revealed a comparable zonal distribution for both genders (approximately 56%). Conclusion: This study examined CPAK distribution in young Asian adults without knee osteoarthritis and identified potential sex-based variations. The findings suggest a predominance of distally pointed CPAK (76.9%) and a possible benefit for slightly varus tibial cuts during TKA in this population for optimal joint alignment. Additionally, gender-specific considerations should be incorporated into knee alignment assessments and treatment planning. Level of evidence: II, A prospective descriptive study. [ABSTRACT FROM AUTHOR]

Background: Stroke ranks as the second leading cause of death worldwide. Meanwhile, headaches are considered the second leading cause of disability, and they often occur as a stroke complication. However, insufficient attention has been given to the treatment and rehabilitation of headaches among stroke patients, and the research on the epidemiology and risk factors of headaches in stroke patients in China is limited. Therefore, in this study, China Health and Retirement Longitudinal Study (CHARLS) data were utilized for a cross-sectional analysis to estimate the prevalence of headaches in stroke patients and identify the associated risk factors. Method: This study utilized data, which included those of participants aged 45 and above from 28 provinces across China, from the nationally representative CHARLS 2018 database. A total of 876 stroke patients and 17,469 nonstroke patients were considered in this work. Stroke diagnosis and headache status were determined based on self-reported questionnaire responses. Cross-sectional analysis determined the prevalence of headaches in patients with strokes and those without through quantification of individuals diagnosed with headaches. Categorical variables were presented as percentages and counts, and univariate and multivariate logistic regression models were used to calculate the odds ratios (OR) for the risk factors associated with headaches in stroke patients. Results: In the 2018 data, 328 individuals with stroke-related headaches were screened and compared with 4,249 individuals without the condition. Overall, a cross-sectional survey revealed that the headache prevalence among stroke patients reached 37.44% (95% confidence interval (CI): 34.23%-40.74%), which was higher than the overall headache prevalence among nonstroke patients 24.32% (95% CI: 23.69%-24.97%). Headaches were considerably more common in women (45.95%; 95% CI: 41.31%-50.58%) than in men (26.70%; 95% CI: 24.44%-32.97%; gender difference, p < 0.001). According to multifactorial logistic regression analysis, the risk factors for stroke-related headaches included being female (OR: 1.45, 95% CI: 1.02–2.07), residency in Central (2.50, 1.37–4.54), Eastern (1.87, 1.07–3.27), and Northwest China (2.49, 1.06–5.84), Very poor self-health (4.06, 1.90–8.68), diabetes (1.85, 1.11–3.07), shoulder pain (4.01, 2.77–5.81), back pain (2.01, 1.32–3.05), and chest pain (2.51, 1.55–4.06). Conclusion: Enhancement of self-awareness of health, effective management of diabetes, and minimization of the physical discomfort in the shoulders, back, and chest may contribute to the decreased occurrence of headaches. Therefore, targeted prevention and treatment of headaches are necessary. [ABSTRACT FROM AUTHOR]

Navigating the combined adult and pediatric infectious disease (ID) fellowship application, interview, and matching process requires careful consideration from applicants and programs alike. Currently, it is functional but not streamlined, and as the ID community is facing recruitment and workforce challenges, it is important to be transparent about this process for applicants while emphasizing areas of potential improvement for fellowship programs. As it stands, this process requires foresight from the applicant and coordination between the adult and pediatric fellowship programs. This perspective article provides an anecdote and discusses issues and suggestions for troubleshooting, including, but not limited to: strategic approach to applications, interviews, and ranking; mentorship; geographic preference; and program saturation. [ABSTRACT FROM AUTHOR]

Background The increased prevalence of antimicrobial-resistant (AMR) infections is a significant global health threat, resulting in increased disease, deaths, and costs. The drivers of AMR are complex and potentially impacted by socioeconomic factors. We investigated the relationships between geographic and socioeconomic factors and AMR. Methods We collected select patient bacterial culture results from 2015 to 2020 from electronic health records of 2 expansive healthcare systems within the Dallas–Fort Worth, Texas, metropolitan area. Among individuals with electronic health records who resided in the 4 most populous counties in Dallas–Fort Worth, culture data were aggregated. Case counts for each organism studied were standardized per 1000 persons per area population. Using residential addresses, the cultures were geocoded and linked to socioeconomic index values. Spatial autocorrelation tests identified geographic clusters of high and low AMR organism prevalence and correlations with established socioeconomic indices. Results We found significant clusters of AMR organisms in areas with high levels of deprivation, as measured by the area deprivation index (ADI). We found a significant spatial autocorrelation between ADI and the prevalence of AMR organisms, particularly for AmpC β-lactamase and methicillin-resistant Staphylococcus aureus , with 14% and 13%, respectively, of the variability in prevalence rates being attributable to their relationship with the ADI values of the neighboring locations. Conclusions We found that areas with a high ADI are more likely to have higher rates of AMR organisms. Interventions that improve socioeconomic factors such as poverty, unemployment, decreased access to healthcare, crowding, and sanitation in these areas of high prevalence may reduce the spread of AMR. [ABSTRACT FROM AUTHOR]

Background We conducted a global comprehensive literature review of observational studies reporting respiratory syncytial virus (RSV) incidence in adults and determined current evidence gaps. Methods PubMed and Embase were searched for English-language publications (2000–2022) and congress abstracts (2019–2021) reporting RSV incidence rates/cumulative incidence. Cross-sectional studies, case series, and other designs estimating only RSV frequency were excluded. The search included all geographic areas; data were extracted by age group and underlying condition where available. Results In total, 528 potentially relevant records were identified, of which 37 primary studies were relevant to this review. Most evidence was from high-income regions. Approximately two-thirds of the studies reported RSV incidence in the hospital setting. Fifteen studies included or focused exclusively on RSV incidence in adult populations with underlying conditions. Studies varied in their measurement and presentation of incidence. RSV incidence estimates were highly variable within and between geographic regions. Overall, RSV incidence tended to increase with age and was highest in adults with underlying conditions. Conclusions Estimates of RSV incidence are highly variable across populations and geographies. Further population-based studies with well-defined, consistent case definitions and surveillance strategies are needed for accurate and comparable estimates of RSV incidence, particularly in the geographic regions identified by the gap analysis. [ABSTRACT FROM AUTHOR]

Background: High unmet need for family planning combined with other factors, such as high early marriage and teenage pregnancy, increases the risk of developing obstetric fistula and other complications. This study aimed to assess spatial distribution and urban–rural disparities of unmet need for family planning among married/in-union women in Ethiopia. Methods: The study was conducted on secondary data from a cross-sectional survey that was conducted nationally between September and December 2019 using a two-stage cluster design on a total of 265 enumeration areas. A total weighted sample of 5,349 married/in-union women was included in the analysis. ArcGIS Pro and SaTScan software were used to handle spatial analysis. Finally, multivariable decomposition analysis via a logit model was used to decompose the observed difference in unmet need by the compositional difference and the difference in effects of explanatory variables between places of residence. Results: Spatial distribution of unmet need for family planning was clustered in Ethiopia with a global Moran's I index value of 0.25 (p -value = 0.004). Accordingly, enumeration areas in West Hararge, Arsi, Bale, Gujji, Borena, Jimma, and East Wellega zones of Oromia region, and Gurage, Hadiya, Silte, Gedio, Sidama, Wolaita, Alaba, and Dawro zones of South Nation and Nationality People region, and the southern part of Zone 3 in Afar region were detected as hotspot areas. The decomposition results revealed that there is a significant disparity in unmet need between urban and rural resident women (0.074, p -value < 0.001). Endowment and coefficient factors accounted for the urban–rural disparity, contributing 68.32% and 31.68%, respectively. Household size, husband's opinion of family planning, community acceptance of family planning, woman's age at first sexual intercourse, and the woman's age were key determinants of the urban–rural disparity. Conclusion: The results revealed a significant disparity in the unmet need for family planning based on place of residence, with a clustered spatial distribution across the study area and notable hotspot areas. Thus, targeted interventions should focus on mobilizing resources to high-risk areas and addressing the needs of high-risk groups to reduce the observed variation. [ABSTRACT FROM AUTHOR]

Introduction: Pharmacists play an important role in HIV post-exposure prophylaxis. This study compared the knowledge, attitude, and practice (KAP) of HIV post-exposure prophylaxis (PEP) among pharmacists practicing in two Nigerian teaching hospitals. Methods: This survey, which adopted a cross-sectional design, was conducted among pharmacists at Ahmadu Bello University Teaching Hospital (ABUTH) and the University of Nigeria Teaching Hospital (UNTH). Seventy-seven eligible pharmacists completed the standard questionnaire, which was analysed using SPSS Version 25 with appropriate descriptive (frequencies, percentages, mean) and inferential (t test) statistics. The structured questionnaire which was self-administered had four sections: Sect. 1 evaluated the sociodemographic characteristics of the participants, Sect. 2 evaluated their knowledge of HIV PEP, Sect. 3 evaluated their attitude towards HIV PEP, and Sect. 4 evaluated their practice of HIV PEP. A student's t test was used to compare the knowledge scores of the respondents of the two hospitals. The same comparison was done for the attitude scores. Study participants were divided into two groups for each domain based on the group mean scores for each population: good versus poor knowledge and good versus poor attitude. Pharmacists scoring at or above the group mean in each domain were categorised as "good," while those scoring below were categorised as "poor". For all analyses, the confidence interval was set at 95%, with p values, less than 0.05 considered statistically significant. Results: There was a 100% response rate for the questionnaire. Pharmacists aged 26–35 years in ABUTH were 32 (60.4%), while those aged 36–45 years in UNTH were 11 (47.8%). B.Pharm/PharmD was the only qualification of 47 (87%) pharmacists in ABUTH, while 10 (43.5%) had the same qualification in UNTH. The mean knowledge of PEP scores for ABUTH and UNTH were 53.70 ± 1.90 and 56.52 ± 2.85 respectively. The mean knowledge of PEP score in both hospitals was 54.54 ± 1.59%. The mean attitude towards PEP scores for ABUTH and UNTH were 84.22 ± 1.54 and 85.12 ± 2.06 respectively. Their overall mean attitude of PEP score was 84.51 ± 1.23%. For the practice of PEP, 32 (41.56%) of the 75 pharmacists in both hospitals had never dispensed PEP drugs. In ABUTH, 3 (5.8%) pharmacists changed patients' PEP drugs without consulting the prescriber. Conclusion: While about half of the pharmacists in ABUTH had a good knowledge of PEP, only a few of their colleagues at UNTH had poor knowledge of PEP. However, the majority of the pharmacists at both hospitals had a good attitude and practice towards PEP, although pharmacists from UNTH performed better. [ABSTRACT FROM AUTHOR]

Urbanization has significantly impacted the environment and urban life, with urban green spaces playing a crucial role in enhancing sustainability and public health. Urban Green Spaces (UGS) offer benefits such as temperature regulation, ecological services, and improved thermal comfort, while providing entertainment, culture, disaster avoidance, and ecological services. This study evaluates the cooling effects of UGS in mitigating the Urban Heat Islands (UHIs) phenomenon in Delhi, India, using satellite imagery to assess the Land Surface Temperature (LST) of 24 parks. We calculated the Park Cooling Intensity (PCI) by applying the mono-window algorithm. We found that parks larger than 1.55 hectares with dense vegetation and water bodies significantly reduced surrounding temperatures by up to 8.28 °C. The PCI effect was significantly influenced by park size, vegetation density, and the presence of water bodies, with larger parks and denser vegetation and water bodies demonstrating enhanced cooling capacity. These findings highlight the importance of integrating green spaces into urban planning as vital infrastructure for enhancing urban resilience, reducing heat-related health risks, and ensuring equitable access to public health benefits. The study also highlights the importance of addressing socio-economic disparities in park accessibility, which have significant implications for equitable urban development. This study emphasized the importance of formulating a strategic urban planning approach that focuses on green spaces' growth, conservation, and equitable allocation, thereby fostering eco-friendly, habitable, and robust urban environments. [ABSTRACT FROM AUTHOR]

Background: Chronic diseases contribute significantly to global morbidity and mortality, with their prevalence projected to rise due to lifestyle changes and socioeconomic factors. This study examines the prevalence and determinants of chronic diseases in Somaliland, utilizing data from the 2020 Somaliland Demographic and Health Survey (SLDHS) data. Methodology: The SLDHS employed a stratified multi-stage probability cluster sampling technique to select 5,994 households. Data was collected using computer-assisted personal interviewing (CAPI) through smartphones. The study analyzed data from 5,709 individuals to assess the prevalence and determinants of chronic diseases. Results: The study revealed a significant prevalence rate of 8.25% for chronic diseases in Somaliland. Several risk factors were identified, including smoking, age, obesity, regional disparities, marital status, and Khat chewing. Individuals residing in the Sool region had a significantly higher risk of developing chronic diseases (Adjusted Odds Ratio (AOR) = 2.31; 95% CI 1.594–3.348) compared to those in the Awdal region. Individuals who were abandoned had a significantly higher likelihood of experiencing chronic diseases (AOR = 2.631; 95% CI 1.042–6.646) compared to those who were married. Widowed individuals also had a significantly higher likelihood of experiencing chronic diseases (AOR = 1.759; 95% CI 1.006–3.076) compared to those who were married. Individuals classified as obese had a significantly higher odds ratio of having a chronic disease (AOR = 2.013; 95% CI 1.354–2.994) compared to those who were underweight. Conclusion: The significant prevalence of chronic diseases in Somaliland necessitates immediate preventive interventions and targeted strategies. Addressing risk factors such as smoking, age-related vulnerabilities, obesity, regional disparities, marital status, and Khat chewing is crucial to reduce the burden of chronic diseases. Future research should focus on longitudinal designs and broader risk factor analysis to inform effective prevention and control strategies. [ABSTRACT FROM AUTHOR]

Deviations from normal postnatal growth patterns in infancy and early childhood are indicators to predict future negative health outcomes and to direct early interventions, such as changes in feeding regimens. The objective of our study was to examine potential differences in BMI trajectory during the first year of life between infants of different birth weight categories. A pooled, fully anonymized dataset was constructed based on individual subject data of 4,777 participants from 12 clinical studies in which infant growth outcome measurements were collected at several timepoints during their first year of life. A BMI model was constructed using a joint bivariate growth model for weight and height (and their deterministic relationship). A Bayesian approach was used to explore birthweight category-specific differences in BMI development. Our main finding is that the BMI trajectories of the birthweight categories (particularly the small vs large groups) continue to show differences over time, although these differences become less apparent after the first months of age. Both weight and length continue to show consistent differences between categories across the first year of life. A more detailed analysis including the effect of region and gender, showed differential BMI patterns among the three birthweight categories over time across the different subgroups (combinations of region and gender). [ABSTRACT FROM AUTHOR]

Purpose of review: Women in Africa bear the burden of the HIV epidemic, which has been associated with the high prevalence of bacterial vaginosis (BV) in the region. However, little progress has been made in finding an effective cure for BV. Drawing on advances in microbiome-directed therapies for gastrointestinal disorders, similar live-biotherapeutic based approaches for BV treatment are being evaluated. Here, we summarize current knowledge regarding vaginal microbiota in BV, explore geographical differences in vaginal microbiota, and argue that novel BV therapeutics should be tailored specifically to meet the needs of African women. Recent findings: Cervicovaginal microbiota dominated by Lactobacillus crispatus are optimal, although these are uncommon in African women. Besides socio-behavioural and environmental influences on the vaginal microbiota, host and microbial genetic traits should be considered, particularly those relating to glycogen metabolism. Novel microbiome-directed approaches being developed to treat BV should employ transfers of multiple microbial strains to ensure sustained colonization and BV cure. Summary: Improving the efficacy and durability of BV treatment with microbiome-directed therapies by appropriately accounting for host and microbial genetic factors, could potentially reduce the risk of HIV infection in African women. [ABSTRACT FROM AUTHOR]

This commentary examines the influence of fathers in early childhood development in Africa and its implications for child and adolescent mental health. Historically overshadowed by maternal influence, research increasingly highlights the multifaceted impact of paternal involvement on children's cognitive, emotional, social, and behavioural development. Fathers contribute uniquely to children's mental growth through stimulating play and rich language interaction. Their emotional engagement fosters children's self-esteem and resilience. Moreover, fathers influence social skills by modelling interactions and encouraging exploration. Paternal involvement is linked to improved behaviour regulation. Beyond direct interaction, factors such as paternal mental health, economic stability, and co-parenting dynamics also shape child outcomes. Despite the impact of engaged fatherhood on children's cognitive, emotional, and social development, many fathers encounter barriers such as economic pressures, cultural norms, and migration. These challenges often hinder their ability to participate actively in their children's lives, resulting in a disconnect that can affect family dynamics and child well-being. Addressing cultural and societal barriers to father involvement is crucial to optimise child development. To address these issues, the paper outlines several key policy implications aimed at promoting paternal involvement. This commentary serves as a foundation for further exploration of fathers' complex and vital role in shaping children's lives. [ABSTRACT FROM AUTHOR]

Background: The Child Opportunity Index (COI) is a new and innovative tool designed to assess the environment in which children grow up, offering a broad evaluation of the opportunities available to them in different neighborhoods. This initiative aims to ensure improvements in children's living conditions and future health outcomes. Methods: The study was performed in the cities of Palermo and Rome. Our Italian COI consists of three main domains: education, health and environment, and economy, each subdivided into specific indicators. We collected information, when available, useful for our indicators from institutional sites and municipal archives. Furthermore, in the city of Rome, we distributed a questionnaire through local pediatricians, collecting data in 2 randomly chosen neighborhoods with questions on children's health and quality of life, proposing an initial approach that, when implemented using data provided by the government and public and private health institutions, aims to evaluate the correlation between socio-economic opportunities and the psycho-physical health of children, as demonstrated in the literature. Results: As a result, many aspects, such as the rate of air pollution or the illegal occupation of houses, were not taken into consideration. We therefore consider our COI proposal only a starting model that will have to be implemented once all the necessary information has been obtained. However, what can be deduced from this first descriptive study is how the opportunities in different neighborhoods are not the same for all children. The number of educational opportunities as well as the number of environmental opportunities differs between the various districts and is not homogeneous between different cities or within the same city. Conclusions: In conclusion, it is not simple to analyze in a scientific manner the child's health impact of living in different areas. The COI could be a useful and simple tool that can give us this information. Pediatricians could collaborate with institutions to implement intervention plans and to reduce existing differences, social and health inequalities. Future studies will have to implement this pilot study to create and validate an Italian model of COI to be used as a useful tool in children's assistance. [ABSTRACT FROM AUTHOR]

Background: Madagascar has made significant progress in the fight against malaria. However, the number of malaria cases yearly increased since 2012. ITNs and IRS are key interventions for reducing malaria in Madagascar. Given the increasing number of cases and limited resources, understanding the cost-effectiveness of these strategies is essential for policy development and resource allocation. Methods: Using a societal perspective, this study aims to estimate the cost of the National Malaria Control Program (NMCP) through the first national malaria strategic plan (implemented over the period 2009–2013) and to assess the cost-effectiveness of two individually implemented malaria control interventions (ITNs and IRS) in two districts, Ankazobe and Brickaville. The cost-effectiveness ratio (CER) of ITN intervention was then compared to the CER of IRS intervention to identify the most cost-effective intervention. The cost of the NMCP and the costs incurred in the implementation of each intervention at the district level were initially estimated. On the basis of two results, the CERs of ITN or IRS correspond to the total cost of ITN or IRS divided by the number of people protected or the number of disability-adjusted life years (DALYs) averted. A deterministic univariate sensitivity analysis was conducted to assess the robustness of the results with a discount rate of 2.5% (0–5%) (costs and DALYs) and a 95% CI (person protected). Results: From 2009 to 2013, the NMCP cost USD 45.4 million (USD 43.5–47.5, r = 0–5%) per year, equivalent to USD 2.0 per capita per year. IRS implementation costs were four times higher than those of ITNs. The CER of IRS per case protected (USD 295.1 [285.1-306.1], r = 0–5%) was higher than the CER of ITNs (USD 48.6 [USD 46.0-51.5, r = 0–5%] in Ankazobe and USD 26.5 [USD 24.8–28.4, r = 0–5%] in Brickaville). The CERs per DALY averted of IRS was USD 427.6 [USD 413.0-546.3, r = 0–5%] in Ankazobe and, for ITNs, it was USD 85.4 [USD 80.8–90.5, r = 0–5%] in Ankazobe and USD 45.3 [USD 42.2–48.4, r = 0–5%] in Brickaville. Compared to the country GDP per capita (USD PPP 1494.6 in 2013), ITN intervention was "highly cost-effective" while the CER for IRS interventions was sensitive to parameter variation (CI, 95% of persons protected), which ranges from highly cost-effective to only cost-effective (USD 291.5–2004, r = 2.5%). Conclusion: In the Malagasy context, IRS intervention cost more and was less effective than ITN intervention. Willingness to pay for IRS is questioned. A relevant budget impact analysis should be conducted before a potential extension of this intervention. [ABSTRACT FROM AUTHOR]

Background: Health financing system in Tanzania changed in the early 1990s as a result of the introduction of cost-sharing policies by the 1990s health sector reforms. The reforms brought about user fees which has led to inequity in access to health care services and catastrophic health expenditure among the elderly. In efforts to reduce the inequity gap among vulnerable groups, in 1994, the government introduced an exemption and waiver policy. More than three decades later, inequity in health care services access has persisted with the elderly population being more affected. The latter poses questions on the implementation efficiency of the exemption policy. We aimed to assess the implementation of the exemption policy on access to health services among the elderly in Tanzania by learning from the experiences of the priority setting process in two districts of western Tanzania. Methods: An exploratory qualitative case study adopting Key informant interviews (KIIs) was used to collect data in Nzega and Igunga districts. The key informants involved the representatives of the planning team and decision makers from the community, health facility and district level. Information saturation was attained after the 24th interview and thus data collection ended. The content analysis approach was used to analyse the data. Findings: Although there is a designated office that deals with exemptions for the elderly in health facilities, there are challenges in accessing health services. The challenges include insufficient drugs, some laboratory tests not covered by the exemption, a lengthy process to access service, poor financial mechanisms for exempted services, inadequate information and clarity of the exemption categories, and limited to no involvement of different stakeholders in the exemption process. Conclusion: The exemption policy was introduced to help disadvantaged groups, including the elderly. However, its implementation encountered challenges which burden both the elderly and the health facilities. Its implementation has thus become a controversy to its initial aim that was to relieve the elderly from high healthcare costs. Revisiting the policy through a thorough stakeholders' engagement and establishing alternative financing of the exemption policy are recommended. [ABSTRACT FROM AUTHOR]

Objectives. To compare pregnancy-related mortality ratios (PRMRs) associated with COVID-19 by race/ethnicity, by region of residence, and in states with and without Medicaid expansion. Methods. We used 2020–2021 data from the US Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research in our analysis. We stratified PRMRs by race/ethnicity, census regions, and Medicaid expansion and nonexpansion states. Results. The 2020–2021 PRMR was 40.3 per 100 000 live births. American Indian/ Alaska Native pregnant people had the greatest PRMR, followed by non-Hispanic Blacks and non-Hispanic Native Hawaiians/other Pacific Islanders. PRMRs associated with COVID-19 in the southern region were at least 2 times higher than in other regions and were highest for all pregnant people in the various racial/ethnic groups. PRMRs associated with COVID-19 were lower in Medicaid expansion states than in nonexpansion states. Conclusions. The US COVID-19 epidemic exacerbated racial and ethnic disparities in pregnancy-related mortality. Public Health Implications. The alarming increase in disparities among racial and ethnic pregnant people during the COVID-19 pandemic underscores the need to address social determinants of health at the structural level. (Am J Public Health. 2024;114(S9): S723–S730. https://doi.org/10.2105/AJPH.2024.307814) [ABSTRACT FROM AUTHOR]

Poor-quality medicines (substandard or counterfeit) can lead to treatment failure. There is a vast global imbalance in cancer treatment outcomes due to the difficulty of accessing quality chemotherapeutic products. Early diagnosis of cancer brings more hope for curative treatment of cancer and increases the demand for chemotherapeutic products. Consequently, it creates opportunities for unethical manufacturers and suppliers to develop substandard and/or counterfeit products. An ongoing review of cost-effective analytical methods is therefore paramount to tracking and tracing poor chemotherapeutic pharmaceutical products. Low- and middle-income country (LMIC) regulators lack safety equipment and standard operating procedures to handle chemotherapeutic products safely in the drug analysis laboratory and have limited capacity to perform post-marketing surveillance on these products. This review aimed to provide a compressive review of the Chemotherapeutic Paper Analytical Device (ChemoPAD). ChemoPAD is an important tool for quality screening of commonly used chemotherapeutic products in LMIC settings. It is an efficient, fast, simple, accessible, cost-effective, and transferable analytical method for verifying substandard and/or counterfeit chemotherapeutic products. Designed as a complete paper-based laboratory the size of a playing card, the ChemoPAD provides a promising solution for healthcare providers, patients, and other parties involved in post-marketing surveillance of chemotherapeutic products. Thus, in the near future, scientists could probably witness the use of the ChemoPAD technology platform to trace and track substandard and/or counterfeit chemotherapeutic products. [ABSTRACT FROM AUTHOR]

Non-adherence to antipsychotic medications is a commonly recognized problem that can lead to lack of follow-up for patients with schizophrenia spectrum disorders, increasing risk for psychotic symptoms, hospitalizations, and decreased quality of life. We conducted a secondary data analysis of electronic health record data of patients with schizophrenia spectrum disorders (n = 1,341) in Central Florida to explore relationships between geographic access to mental healthcare facilities, socioeconomic factors, and follow-up visits, and whether these conditions contributed to adherence over 1 years' time. Using Geographic Information Systems among six mental health facilities, spatial analysis and logistic regression indicated that patients had 27.9% increased odds (p = 0.02) of adherence to treatment when travel time to facilities was 30 min or less. Spatial autocorrelation revealed significant positive clusters in areas with low travel time (15 min or less). Patients who had Medicaid, a case manager and/or a life skills coach, medication side effects, a substance use disorders history, and/or closer proximity to mental healthcare services, had an increased likelihood of attending four or more follow-up visits in 1 year. Identifying effects of spatial and non-spatial variables on non-adherence to treatment can provide useful insights for developing targeted interventions to improve treatment outcomes. [ABSTRACT FROM AUTHOR]

Digital media which involve narrative storytelling are increasingly used in nursing and health research, including clinical applications such as cinematherapy. A pilot study was conducted on how digital media self-accessed by marginalized individuals may be beneficial toward mindfulness and healing from trauma. Qualitative interviews were conducted with individuals (n = 8) who self-reported marginalizations via: race; gender; rural geography; socioeconomic status; indigenous or colonial experience; survivor of abuse; experiences of homelessness; or disability. Results indicated that trauma-narratives often organically emerge through discussions on digital media, with notable intersections with mindfulness-based practices and interventions. First, digital media can create a mindfulness of trauma as valid to discuss and disseminate. Mindfulness of authentic resolution also emerged as critical, as trauma may be employed in media narratives for attention or sympathy with no intent to support healing. Participant responses illustrate value in being mindful of individuals with severe trauma, who may be less likely to benefit from digital media. Digital media can foster sense-of-belonging and community-building amidst isolation; additionally, parasocial relationships may help foster supportive identities and ideologies on vulnerability. Findings are outlined in a preliminary conceptual framework, toward supporting future digital media with intent to create mindfulness or heal trauma. [ABSTRACT FROM AUTHOR]

In August 2016, MSI Australia (MSIA) brought to scale a direct‐to‐patient telehealth medication abortion service. We used MSIA's patient management systems from January 2015 to December 2018 to assess changes in the proportion of abortion patients obtaining care after 13 weeks' gestation, proportion of abortion patients obtaining medication abortion versus procedural abortion and proportion of abortion patients from regional and remote versus metropolitan areas. The proportions of abortion patients obtaining care before 13 weeks' gestational duration and those from regional and remote residents did not change between the pre‐ and post‐periods. We observed an increase in medication abortion use that was greater among those in regional and remote areas than those in metropolitan areas. [ABSTRACT FROM AUTHOR]

Background: Vaccination is efficacious at preventing influenza disease transmission, morbidity and mortality. Benefits of influenza vaccination for healthcare workers (HCW) are emphasized, yet vaccine uptake among HCW remains suboptimal. Mandatory vaccination programs may increase influenza vaccine uptake, however, attitudes and beliefs of HCW towards these mandates are not well known. Aims: This scoping review examined the attitudes and beliefs of HCW to ascertain the barriers and enablers to the implementation and acceptance of mandatory vaccination programs in healthcare settings. Design: Scoping review, guided by the PRISMA Extension for Scoping Reviews. Methods: Literature published between 2019 and 2023 was reviewed from five electronic databases, between June and October 2023. Data sources: Quantitative, qualitative and mixed-methods studies were obtained. Studies were limited to full-text English articles, published within peer-reviewed journals over the last five years. Data were extracted by both authors and documented using a modified version of the JBI's scoping review data extraction instrument, and analyzed thematically. Results: The original search yielded 319 articles. Forty-two articles were screened, with 10 studies included. Most HCW had negative views towards mandatory influenza vaccination, influenced by geographical location, age and discipline. The protection of patients and affordability/accessibility of vaccination were described as enablers to the acceptance of mandatory measures. The belief that mandatory vaccination was a violation of autonomy and misconceptions concerning influenza transmission, vaccine mechanism of action, side effects and effectiveness, were described as common barriers. Conclusions: Health services must carefully consider the context in which mandatory vaccination programs are implemented and employ strategies that incorporate education and promote vaccine accessibility, affordability and HCW autonomy. The quality of evidence retrieved was moderate to poor, with high heterogeneity between studies. Minimal Australian research was evident, limiting the generalisability of findings. These results should be interpreted with caution and further high-quality research is recommended. [ABSTRACT FROM AUTHOR]

This study examined the factors associated with medical expenses among LTCI (long‐term care insurance) recipients in Korea. Secondary data analysis was performed using the 2019 Korea National Health Insurance (KNHI) reimbursement data of I metropolitan city. Data from 52 434 older adults who were LTCI recipients and living in I metropolitan city areas were included. Based on the Andersen healthcare utilization model, the variables included the predisposing (age, sex, and living alone), enabling (health insurance and place of residence), and need factors (disability, LTC grade, use of LTCI services, and participation in health screening). All the predisposing, enabling, and need factors were significant. Older age, higher LTC grade, use of visiting nursing service, admission to an aged care facility, and participation in health screenings were negatively associated with medical expenses. Females, those living alone, non‐disabled individuals, medical aid beneficiaries, and rural residents were less likely to incur medical expenses. Appropriate use of LTCI services (e.g., visiting nursing) will help reduce unnecessary medical expenses. Nevertheless, access to health care services for older adults living alone in rural areas must be improved. [ABSTRACT FROM AUTHOR]

Background: Through an in‐depth exploration of mental health family carers' experiences during the COVID‐19 pandemic in Australia, this co‐produced study identified recommendations for advocacy, practice and policy implications to uphold family carer wellbeing. Government‐enforced restrictions, changed service availability and difficulties accessing hospitals, led to additional anxiety, depression and elevated distress, especially for people experiencing mental health challenges before the pandemic. The National Mental Health Consumer and Carer Forum alongside two academic researchers aimed to discern the impact of care provision, levels of distress, unmet needs, challenges and benefits of providing support, across geographic locations and diverse communities. Methods: This article reports on the survey component of a co‐designed mixed‐methods exploratory study of family carer experiences. A project steering group worked with two academic researchers, members of SWITCH Research Group, Monash University, to develop the 71‐question online survey across 9‐domains. Results: Family carers were relied upon to provide support and care when mental health services changed or closed. Carers support more than one person and typically people with daily and high‐level needs. Caring levels increased from 26‐h to an average of 40‐h a week of support provision, with changed roles and increased complexity. Heightened demands became stress‐inducing to the point of mental ill health and suicidality for some family carers. Conclusion: Government policy and pandemic responses failed to address the financial, practical or emotional resources needed to fulfil the role of care provision and support to unwell and extremely distressed people with new or ongoing mental and psychological ill‐health. Patient or Public Contribution: From its inception, this project was co‐produced and co‐designed with mental health family carers and service users based on their expertise in understanding their experiences and ways to best explore these to the benefit and wellbeing of families in distress. The academic research partners both have active experience of supporting people with mental health challenges. Through each of the identified phases, lived experience expertise (family carers and service users) co‐designed and co‐facilitated the process. At times leading the process, such as in recruitment strategies, and at other times acting as guides. Guidance was provided by lived experience expertise in reflecting upon the literature review to understand what had been researched internationally and what would be important to understand in Australia. The academic partners advised on the possible processes for data collection, and the lived experience experts decided on the methodology based on that advice. Both the focus group and survey questions were developed and scrutinised from the perspective of the service users and carers in the project team. Difficult conversations were handled with respect, service users within the project team gently addressed areas of enquiry that may suggest stigma or feed into societal stereotypes of people with mental health challenges. Carers were able to consider the wording of questions to still be able to address areas of concern including domestic violence within the family unit and suicide. Dissemination strategies were planned together with the carer and service user representatives being co‐presenters at conferences. The report for submission to the National Mental Health Commission (Australia) was written and reviewed with all partners. A committee of service users and carers, alongside the academic partners, planned the launch of the report in August 2023. The co‐authorship of peer‐reviewed articles has included family carers and service users from the National Mental Health Consumer and Carer Forum. [ABSTRACT FROM AUTHOR]

Infectious diseases were one of the most important public health problems in Ardabil during the first Pahlavi period (1925-1941 AD). These diseases caused the illness and death of many people. The purpose of this study is to investigate the factors and consequences of the spread of infectious diseases in Ardabil during the first Pahlavi period. The research method is descriptive and historical-retrospective, which tries to answer the research questions using documentary and library sources. The findings show that malaria, trachoma, smallpox, tuberculosis, rinderpest, venereal diseases, and diphtheria were among the most common infectious diseases. Poverty, illiteracy, poor public health, lack of medical facilities, and the geographical location were the main factors in the spread of these diseases. Considering the critical nature of the issue, the first Pahlavi government tried to control and prevent diseases by carrying out measures such as public education, establishing health and treatment centers and reforming their structure, sending doctors and distributing medicine, and implementing quarantine and vaccination. The results showed that the efforts of the first Pahlavi government in fighting infectious diseases in Ardabil were relatively successful and reduced the prevalence of some diseases. [ABSTRACT FROM AUTHOR]

Campus sexual misconduct policies (SMPs) outline prohibited conduct. We sought to document the range of terms used to refer to forms of nonconsensual sexual contact in SMPs and to analyze the content of definitions provided for the term "sexual assault." We coded the 2016-2017 SMPs from a sample of 381 U.S. schools. We identified 125 unique terms and documented both a terminological and conceptual morass around sexual assault. Policy language may have implications for students' and administrators' evaluation of experiences and reports of sexual assault. [ABSTRACT FROM AUTHOR]

The objective was to analyze the temporal effects of age, period, and cohort on mortality from all female homicides, and from female homicides and by firearms, in Brazil from 1980 to 2019. Data were accessed from Brazilian health records. There was an increase in the risk of death in the 2000s in the North and Northeast regions and a decrease in the Southeast, South, and Midwest. Younger women had a higher risk of death than women born between 1950 and 1954. The findings may be correlated with the inefficiency of the Brazilian state in protecting female victims of violence. [ABSTRACT FROM AUTHOR]