Childhood migration experience and adult health: evidence from China's rural migrants.

BACKGROUND: Place of residence plays an influential role in shaping individual development, and studies have established links between Childhood migration experience (CME) and health outcomes through maturity. Over the past three decades, China has undergone one of the largest rural-to-urban migrations, however, little is known about the effect of CME on rural migrants' adult health in China. METHODS: Data from 7035 members of the 2016 and 2018 China Labor-force Dynamics Survey were analyzed. CME was measured by whether the place of residence and place of birth changed at the age of 14 years. Three measures of health (self-assessed health, BMI, and mental health scale) were obtained. Causal inferential analysis was performed, using the Probit model, the OLS model and the Propensity Score Matching (PSM) method, to explore the impact of CME on the adult health of rural migrants. RESULTS: Overall, compared to individuals who did not migrate in childhood, the probability of reporting "very unhealthy", "rather unhealthy", and "fair" in the self-assessed health of the rural migrants with CME decreased by 0.23%, 1.55%, and 5.53%, the probability of reporting "healthy" and "very healthy" increased by 1.94% and 5.38%, the probability of BMI within the normal range was higher by 7.32%, and the mental health test scores were 0.2591 points higher significantly. Furthermore, in comparison with childhood non-migration, both cross-county and cross-city migration promoted the health status of rural migrants, but the positive effect of cross-province migration was not significant; from the gender perspective, CME could more dramatically improve rural women's adult health than men, especially in mental health. CONCLUSION: CME can significantly improve adult health, including physical and mental health, and the positive effect is more obvious among women, helping to reduce gender differences in health. For the migration distance, attention can be focused on the long-distance migrating individuals, who should get more support.

Confirmatory Factor Analysis of the Analgesic Adverse Drug Event Measure.

Background and Purpose: The Analgesic Adverse Drug Event Measure (AADEM) measures how people respond when they experience analgesic adverse drug events (ADEs). The purpose of this study was to confirm the underlying constructs of the AADEM: attributed ADE, consulted provider, sought care, and continued/discontinued analgesic. Methods: A cross-sectional instrumentation design was used. Three hundred and thirty-two adults who self-reported an analgesic ADE responded to the online AADEM. Confirmatory factor analysis and reliability testing were conducted. Results: Model fit was adequate across all indexes. Internal consistency for the full AADEM was low, while subscale internal consistency was generally acceptable probably due to three significant negative correlations and two positive correlations between the latent factors. Conclusions: The results supported the construct validity of the AADEM. Advanced practice nurses and other primary care providers can use the AADEM to investigate analgesic ADEs. Greater insight into how people respond to an analgesic ADE via the use of the AADEM may help prevent future analgesic ADEs.

Continuation of Pediatric Care after Transfer to Adult Care Among Autistic Youth Overlap of Pediatric and Adult Care.

The transition from pediatric to adult health care is a vulnerable time period for autistic adolescents and young adults (AYA) and for some autistic AYA may include a period of receiving care in both the pediatric and adult health systems. We sought to assess the proportion of autistic AYA who continued to use pediatric health services after their first adult primary care appointment and to identify factors associated with continued pediatric contact. We analyzed electronic medical record (EMR) data from a cohort of autistic AYA seen in a primary-care-based program for autistic people. Using logistic and linear regression, we assessed the relationship between eight patient characteristics and (1) the odds of a patient having ANY pediatric visits after their first adult appointment and (2) the number of pediatric visits among those with at least one pediatric visit. The cohort included 230 autistic AYA, who were mostly white (68%), mostly male (82%), with a mean age of 19.4 years at the time of their last pediatric visit before entering adult care. The majority (n = 149; 65%) had pediatric contact after the first adult visit. Younger age at the time of the first adult visit and more pediatric visits prior to the first adult visit were associated with continued pediatric contact. In this cohort of autistic AYA, most patients had contact with the pediatric system after their first adult primary care appointment.

Adverse childhood experiences and trajectories of multimorbidity in individuals aged over 50: Evidence from the English Longitudinal Study of Ageing.

BACKGROUND: Adverse childhood experiences (ACE) are important for chronic diseases yet their association with multimorbidity remains understudied. Few studies consider the complexity of multimorbidity or observe multimorbidity development over time. OBJECTIVE: We investigated whether ACE were associated with multimorbidity at baseline and over a 12-year follow-up period. PARTICIPANTS AND SETTING: 5326 participants aged over 50 were obtained from the English Longitudinal Study of Ageing (ELSA). METHODS: An ACE summary score was derived using eight ACE items measuring abuse, social care, and household dysfunction. From repeated measurements of 29 chronic conditions over a 12-year period (2008-2019) we derived two multimorbidity measures: number of chronic diseases and number of chronic disease categories. We used multinomial logistic regression to assess associations between ACE and both measures. Mixed effects models were estimated to examine trajectories of multimorbidity by ACE over time. RESULTS: Graded associations between ACE and multimorbidity were observed. Compared to those without ACE, participants with ≥3 ACE had three times the risk of having ≥3 chronic diseases (RRR 3.06, 95 % CI 1.85-5.05) and falling into ≥3 chronic disease categories (RRR 2·93 95 % CI 1·74-4·95). Graded associations persisted during 12-year follow-up, though differences in multimorbidity between those with ≥3 ACE and those without ACE remained constant (B 0.02, 95 % CI 0·01-0·03, and B -0·01, 95 % CI -0·02-0·00, number of chronic conditions and chronic condition categories respectively). CONCLUSION: ACE are associated with multimorbidity risk and complexity, associations arising before the age of 50. Early intervention amongst those with ACE could attenuate this association.

Negative Emotional Reactivity and Somatic Symptoms during Adolescence Predict Adult Health and Wellbeing in Early and Middle Adulthood.

Longitudinal research is lacking with respect to how negative emotional reactivity and somatic symptoms during adolescence set the stage for later health. The aim of this longitudinal study was to examine within-person associations between negative emotional reactivity and somatic symptoms during adolescence and their effects on health and wellbeing in adulthood. Participants (N = 1527; 48.3% female) were assessed annually at the age of 12 to 16 years and at the age of 35 and 45 years. Adolescents with frequent somatic symptoms reported higher reactivity. Individual differences in levels and changes of somatic symptoms and reactivity were independently associated with adult health and wellbeing decades later. The findings underscore the importance of considering how individual differences change during adolescent development.

Young Adults' Hopes Regarding Noncommunicable Disease (NCD) Prevention and Management After the SARS-CoV-2 Virus Pandemic: Reflections From the NCD Child #YouthCOVIDCHAT Campaign.

PURPOSE: The SARS-CoV-2 virus pandemic has left a massive global death toll in its wake. Associated restrictions, precautions and lockdowns have disrupted daily routines, which has been associated with social isolation and major health implications for the world's youth. This paper shares young adults' visions for life beyond the pandemic as it relates to the prevention and management of noncommunicable diseases (NCDs). METHODS: NCD Child hosted a global Twitter campaign for young adults, some of whom are living with NCDs, to express their reflections on life beyond the pandemic. Contributions were subjected to qualitative thematic analysis. RESULTS: 52 responses from the campaign described six main themes: Health system strengthening; Access to care; Issues of sustainability, including the environment and the economy; Human rights, equity, and social issues; Mental health, and NCD prevention. DISCUSSION: Young adults expressed optimism about postpandemic life and emphasized the importance of comprehensive intersectoral approaches to create resilient health systems.

A systematic review of the facilitators and barriers to rapid response team activation.

BACKGROUND: Outcomes associated with rapid response teams (RRTs) are inconsistent. This may be due to underlying facilitators and barriers to RRT activation that are affected by team leaders and health systems. AIMS: The aim of this study was to synthesize the published research about facilitators and barriers to nurse-led RRT activation in the United States (U.S.). METHODS: A systematic review was conducted. Four databases were searched from January 2000 to June 2023 for peer-reviewed quantitative, qualitative, and mixed methods studies reporting facilitators and barriers to RRT activation. Studies conducted outside the U.S. or with physician-led teams were excluded. RESULTS: Twenty-five studies met criteria representing 240,140 participants that included clinicians and hospitalized adults. Three domains of facilitators and barriers to RRT activation were identified: (1) hospital infrastructure, (2) clinician culture, and (3) nurses' beliefs, attributes, and knowledge. Categories were identified within each domain. The categories of perceived benefits and positive beliefs about RRTs, knowing when to activate the RRT, and hospital-wide policies and practices most facilitated activation, whereas the categories of negative perceptions and concerns about RRTs and uncertainties surrounding RRT activation were the dominant barriers. LINKING EVIDENCE TO ACTION: Facilitators and barriers to RRT activation were interrelated. Some facilitators like hospital leader and physician support of RRTs became barriers when absent. Intradisciplinary communication and collaboration between nurses can positively and negatively impact RRT activation. The expertise of RRT nurses should be further studied.

Uso dos serviços de saúde por pessoas idosas em áreas rurais e urbanas do Brasil / Health services utilization by older adults in rural and urban areas of Brazil

Resumo Objetivo Avaliar o uso dos serviços de saúde por pessoas idosas residentes em áreas urbanas e rurais do Brasil. Método Estudo transversal que analisou dados da Pesquisa Nacional de Saúde 2019, referentes aos moradores idosos (≥60 anos) selecionados nos domicílios, totalizando 22.728 entrevistas (3.300 em área rural e 19.426 em área urbana). Foram estimadas para as áreas rurais e urbanas as prevalências de cadastro na Estratégia Saúde da Família, intervalo de tempo da última consulta médica e odontológica, procura do serviço nas últimas duas semanas, última aferição da pressão arterial e da glicemia e avaliados os fatores associados à utilização dos serviços de saúde médicos e odontológicos nos últimos 12 meses. Resultados A autopercepção da saúde como 'muito boa' ou 'boa' foi maior na área urbana (47,32%), assim como a proporção de pessoas idosas que relataram consulta médica e odontológica nos últimos 12 meses (90,54%). Evidenciou-se menor frequência do acompanhamento da aferição de pressão arterial (81,30%) e da glicemia (45,83%) em áreas rurais. As pessoas idosas que possuem baixa escolaridade, residem em áreas rurais, na região Norte são as que possuem menor chance de utilização dos serviços. Conclusão A população idosa residente em área rural apresenta piores condições de saúde em relação à população residente em área urbana.

Abstract Objective To assess health services utilization by older adults in urban and rural areas of Brazil. Method A cross-sectional study was conducted analyzing data from the 2019 National Health Survey on older adults (≥60 years) selected from households based on 22,728 interviews (3,300 in rural and 19,426 in urban areas). For rural and urban areas, the prevalence of Family Health Strategy enrolment, time since last medical and dental visit, service use in past 2 weeks, and last blood pressure and blood glucose measurements were estimated. Also, the factors associated with medical and dental health services utilization in the past 12 months were explored. Results Self-rated health of "Very good" or "Good" was greater in urban areas (47.32%), as was the proportion of older adults reporting a medical or dental visit within the last 12 months (90.54%). Rates of blood pressure (81.30%) and glucose (45.83%) monitoring were lower in rural areas. Older individuals that had low education, resided in rural areas, and the North region, had a lower likelihood of using health services Conclusion The older population living in rural areas had poorer health status compared with the urban population.

Lifetimes of Vulnerability: Childhood Adversity, Poor Adult Health, and the Criminal Legal System.

On average, incarcerated people have higher rates of poor health, mental illness, and histories of adverse childhood experiences (ACEs) than the general population. This mixed-methods analysis examines the relationship between ACEs and poor adult health among a sample of formerly incarcerated people. The quantitative analysis (N = 122) shows childhood adversity is associated with various health conditions in adulthood, although the strength of this relationship varies by the kinds of ACEs respondents encountered. The qualitative analysis of life history timelines (N = 42) reveals two pathways relating ACEs to poor health and legal system involvement: (1) violence and victimization and (2) drug use as a coping mechanism. Unaddressed mental health challenges in the aftermath of adversity emerged as an important precursor to both pathways. Prisons lack a meaningful consideration of these early life events and the social structures that result in the high rates of vulnerable people in its care.

A cognitive-behavioral skills building program improves mental health and enhances healthy lifestyle behaviors in nurses and other hospital employees.

BACKGROUND: Mental health outcomes in nurses have historically indicated a greater prevalence of anxiety, depression, and suicide than the general population. It is vital to provide programming for healthcare workers to gain the necessary skills to reduce burnout and improve their mental and physical health. AIMS: The aims of this study were to evaluate mental health outcomes and healthy lifestyle beliefs and behaviors among nurses and other hospital employees who completed MINDBODYSTRONG, a cognitive-behavioral skill building program. METHODS: A pre-experimental, pre- and poststudy design was used to examine mental health and well-being outcomes among 100 hospital personnel who participated in MINDBODYSTRONG, a program designed to improve coping and resiliency and decrease stress, anxiety, and depressive symptoms. Outcomes measured included healthy lifestyle behaviors, healthy lifestyle beliefs, anxiety, depression, stress, and burnout. RESULTS: One hundred hospital personnel, including 93 nurses, completed the pre- and post-survey. Among all participants, post- MINDBODYSTRONG scores for healthy lifestyle beliefs (p = .00; Cohen's d = 0.52) and healthy lifestyle behaviors (p = .00; Cohen's d = -0.74) increased significantly with medium effects, while depression (p = .00; Cohen's d = -0.51), anxiety (p = .00; Cohen's d = -0.54), stress (p = .00; Cohen's d = -0.33), and burnout (p = .00; Cohen's d = -0.37) decreased significantly with small and medium effects. The program produced even stronger positive effects on mental health outcomes for participants who started the study with higher levels of depression and anxiety. LINKING EVIDENCE TO PRACTICE: Anxiety, depression, stress, and burnout decreased significantly postintervention. Participants also significantly improved their healthy lifestyle beliefs and behaviors with the MINDBODYSTRONG program. MINDBODYSTRONG is an effective program that reduces anxiety, depression, burnout, and stress and improves healthy lifestyle beliefs and behaviors in hospital-based clinicians. It is of utmost importance to provide evidence-based programs to improve mental resiliency and decrease stress, anxiety, burnout, and depressive symptoms, which will ultimately improve the safety and quality of health care.

Exploring configurations of social determinants for enhancing older adult health in China: an fuzzy-set qualitative comparative analysis based on 31 provinces in China.

With China's aging population on the rise, addressing population aging has become a national priority, particularly focusing on improving older adult health. This study employs the social determinants of health framework, considering China's unique macro-social, economic, policy, healthcare, and family cultural factors, to develop a framework for understanding the social determinants of health for older adult in China. Using the fsQCA method and a configurational perspective, the complex relationship between social determinants of health and older adult health status is examined. The findings indicate that individual social determinants alone are insufficient for achieving high levels of older adult health. Instead, three configurations of social determinants have been identified as conducive to high older adult health: Economic Development-Environment - Cultural Dominant Type, Socio-Economic Development - Older Adult Security - Environment - Cultural Dominant Type, and Economic Development Dominant Type. These configurations offer diverse pathways for enhancing older adult health. Conversely, the study identifies two configurations associated with low older adult health levels, exhibiting an asymmetric relationship with the configurations resulting in high older adult health levels. Moreover, economic development consistently emerges as a core condition across all three configurations associated with high older adult health levels, while two configurations associated with low older adult health lack this core condition. These findings underscore the universal contribution of enhancing economic development to improving older adult health.

Role of School Quality and Neighborhood Disadvantage in Educational Attainment: Do They Vary by Race?

Schools and neighborhoods are adolescents' primary environments, and each has a significant influence on their academic success. The majority of studies on educational attainment have examined the impact of a single context-either the school or the neighborhood-suggesting mixed findings on school and neighborhood effects as well as potential disparities across racial groups. To address this gap, the present study examined the roles of school quality and neighborhood disadvantage on educational attainment for White and Black adolescents. This study used the National Longitudinal Study of Adolescent to Adult Health data collected from a nationally representative sample of U.S. adolescents, merging multiple data sources including in-home surveys, school administrator surveys, student-level educational records, and contextual data. Educational attainment was measured using college enrollment and graduation status. School quality was a significant predictor of college enrollment and graduation for both White and Black adolescents. Neighborhood disadvantage is significantly associated with college enrollment for both racial groups; however, college graduation is significant only for White adolescents. These findings suggest that improving school quality is particularly important for educational attainment regardless of racial background. The article concludes with a discussion on the differential roles of school quality and neighborhood disadvantage in relation to White and Black adolescents.

The impact of using community home-based elderly care services on older adults' self-reported health: fresh evidence from China.

Background: The rapid population aging in China, characterized by a higher prevalence of illnesses, earlier onset of diseases, and longer durations of living with ailments, substantially engenders challenges within the domain of older adults' healthcare. Community home-based elderly care services (CHECS) are a feasible solution to solve the problem of older adults' care and protect older adults' health. The aim of this study is to investigate the relationship, heterogeneity effects and influential mechanisms between older adults' use of CHECS and their self- reported health. Methods: The study employs the Instrumental Variable technique and empirically investigates the relationship, heterogeneity effects and influential mechanisms between older adults using CHECS and their self-reported health using data from the China Longitudinal Aging Social Survey from 2018. Results: The findings indicate, firstly, that using CHECS considerably improves older adults' self-reported health. Secondly, the heterogeneity test reveals that the effect is more pronounced for older adults who are under the age of 80, have functional disabilities, are free of chronic diseases, have never attended school, reside in lower-income households, are single, rarely interact with their children, and live in central urban or city/county regions. Thirdly, the mechanism test reveals that the "social network effect" and "family care effect" are the key influence channels of using CHECS. Conclusion: An empirical foundation for the policy reform of community home-based care for seniors is provided by this study with the limitations to discuss the other socioeconomic aspects such as government health expenditure and discuss the specific services aspects such as health care. The findings carry substantial implications for improving the health of older individuals and provide suggestions for establishing a socialized aged care system in China.

Hearing the voices of adolescents: Evaluating the quality of care for young adults with chronic illnesses in the UAE.

BACKGROUND: Quality care for adolescents and young adults with chronic illnesses has been under-explored in the United Arab Emirates (UAE) and internationally, especially from patients' perspectives. Most available international studies focused on quality of life and the transition to adulthood rather than service quality. AIM: This research assesses care quality for adolescents with chronic illnesses in the UAE, aiming to understand their perspectives, appraise current practices, and identify service gaps. METHODS: A cross-sectional survey employed a validated questionnaire examining 33 essential care components. Participants comprised 576 adolescents and young adults with chronic conditions from five UAE Emirates. RESULTS: Participant's reports indicated that none of the 33 care elements were received consistently. Most participants (80.6%) reported crucial care aspects were absent, and across most investigated items, 19.4%-46.5% of participants reported receiving the services they were supposed to receive only some or many of the times, indicating significant areas for improvement. CONCLUSIONS: Findings demonstrate significant care quality gaps for UAE's adolescents and young adults with chronic illnesses. These may critically affect their ability to manage their conditions and ensure holistic growth. These insights can guide healthcare enhancements tailored to this demographic. PRACTICE IMPLICATIONS: There is an urgency for enhanced patient-centered care in UAE healthcare, emphasizing clinicians' roles in supporting adolescents with chronic illnesses, especially during transitions. Healthcare managers should prioritize standardized care policies, improved communication, and training that emphasizes consistent patient feedback and transition readiness. Further research into care gaps and tailored interventions within the region's distinct sociocultural setting is essential.

Características sociodemográficas, hábitos de vida y condiciones de salud de las personas privadas de libertad / Características sociodemográficas, hábitos de vida e condições de saúde de pessoas privadas de liberdade / Sociodemographic characteristics, life habits and health conditions of people deprived of liberty

La privación de la libertad, por sus características, impone a las personas hábitos y costumbres diferenciados que pueden influir en su salud. En ese sentido, el propósito de este estudio es describir las características sociodemográficas, hábitos de vida y condiciones de salud de las personas privadas de libertad. Se trata de un estudio transversal y descriptivo, realizado en cuatro centros penitenciarios de una ciudad del sur de Brasil. La recopilación de datos se realizó mediante un instrumento semiestructurado y se utilizó la estadística descriptiva para el análisis. Participaron 326 personas privadas de libertad, 90,8% eran hombres, 53,4% jóvenes, entre 18 y 29 años, 43,3% solteros, 55,8% con menos de nueve años de escolaridad, 61,3% realizaban alguna actividad en la unidad carcelaria, 63,2% eran fumadores o exfumadores, 28,2% ingerían bebidas alcohólicas y 60,4% eran usuarios o exusuarios de drogas ilícitas, 71,2% practicaban actividades físicas, 86,1% evaluaban positivamente su estado de salud y 52,5% reportaban alguna enfermedad crónica. Las enfermedades más frecuentes declaradas en sus relatos fueron las respiratorias, las gastrointestinales, las mentales, las cardiovasculares y las musculoesqueléticas. Las personas privadas de libertad tienen enfermedades crónicas y factores de riesgo prevalentes en la población general. Conocer el perfil epidemiológico de este grupo de población puede contribuir a las acciones de promoción de la salud, prevención y control de los factores de riesgo. (AU)

A privação de liberdade, por suas características, impõe as pessoas hábitos e costumes diferenciados que podem influenciar em sua saúde. Nesse sentido, o objetivo deste é descrever as características sociodemográficas, hábitos de vida e condições de saúde de pessoas privadas de liberdade. Trata-se de um estudo transversal, descritivo, realizado em quatro unidades penais de um município do sul do Brasil. A coleta de dados foi realizada por instrumento semiestruturado e utilizou-se estatística descritiva para análise. Participaram 326 pessoas privadas de liberdade, dessas 90,8% eram do sexo masculino, 53,4% jovens, com idade entre 18 e 29 anos, 43,3% solteiras, 55,8% com escolaridade inferior a nove anos, 61,3% realizavam alguma atividade na unidade penal, 63,2% eram fumantes ou ex-fumantes, 28,2% ingeriam bebida alcoólica e 60,4% usuários ou ex-usuários de drogas ilícitas, 71,2% praticavam atividades físicas, 86,1% avaliaram positivamente o estado de saúde e 52,5% relatou alguma doença crônica. As doenças que prevaleceram nos autorrelatos foram as respiratórias, gastrointestinais, psíquicas, cardiovasculares e osteomusculares. As pessoas privadas de liberdade possuem as doenças crônicas e fatores de risco prevalentes na população em geral. Conhecer o perfil epidemiológico desse grupo populacional pode contribuir com ações promotoras de saúde, prevenção e controle dos fatores de risco. (AU)

The deprivation of liberty, due to its characteristics, imposes on people differentiated habits and customs that can influence their health. In that sense, the objective of this is to verify the prevalence of chronic diseases in the prison population. This is a cross-sectional descriptive study, carried out in four prison unity in a city in southern Brazil. Data collection was performed by a semi-structured instrument and descriptive statistics were used for analysis. Participated 326 people deprived of freedom, 90.8% were male, 53.4% young, aged between 18 and 29 years, 43.3% single, 55.8% with less than nine years of schooling, 61.3% performed some activity in the penal unit, 63.2% were smokers or former smokers, 28.2% drank alcohol and 60.4% used or ex used illicit drugs, 71.2% practiced physical activities, 86.1% positively evaluated their health status and 52.5% reported some chronic disease. The most prevalent self-reported diseases were respiratory, gastrointestinal, mental, cardiovascular, and musculoskeletal. People deprived of freedom have chronic diseases and risk factors prevalent in the general population. Knowing the epidemiological profile of this population group can contribute to health-promoting actions, prevention, and control of risk factors. (AU)

Missed nursing care in relation to registered nurses' level of education and self-reported evidence-based practice.

BACKGROUND: Patient safety is one of the cornerstones of high-quality healthcare systems. Evidence-based practice is one way to improve patient safety from the nursing perspective. Another aspect of care that directly influences patient safety is missed nursing care. However, research on possible associations between evidence-based practice and missed nursing care is lacking. AIM: The aim of this study was to examine associations between registered nurses' educational level, the capability beliefs and use of evidence-based practice, and missed nursing care. METHODS: This study had a cross-sectional design. A total of 228 registered nurses from adult inpatient wards at a university hospital participated. Data were collected with the MISSCARE Survey-Swedish version of Evidence-Based Practice Capabilities Beliefs Scale. RESULTS: Most missed nursing care was reported within the subscales Basic Care and Planning. Nurses holding a higher educational level and being low evidence-based practice users reported significantly more missed nursing care. They also scored significantly higher on the Evidence-based Practice Capabilities Beliefs Scale. The analyses showed a limited explanation of the variance of missed nursing care and revealed that being a high user of evidence-based practice indicated less reported missed nursing care, while a higher educational level meant more reported missed nursing care. LINKING EVIDENCE TO ACTION: Most missed nursing care was reported within the subscales Planning and Basic Care. Thus, nursing activities are deprioritized in comparison to medical activities. Nurses holding a higher education reported more missed nursing care, indicating that higher education entails deeper knowledge of the consequences when rationing nursing care. They also reported varied use of evidence-based practice, showing that higher education is not the only factor that matters. To decrease missed nursing care in clinical practice, and thereby increase the quality of care, educational level, use of evidence-based practice, and organizational factors must be considered.

"Minha vida é me cuidar": itinerários terapêuticos de cuidado para a pessoa idosa em processo de fragilização / "My life is about to take care of myself": therapeutic itineraries of care for frail older adults

Resumo O trabalho buscou compreender a percepção de pessoas idosas em processo de fragilização sobre seus itinerários terapêuticos de cuidados. Esta pesquisa qualitativa, ancorou-se na antropologia médica crítica. A coleta dos dados ocorreu por meio de entrevistas no domicílio de 22 pessoas idosas, com média etária de 79 anos. A análise êmica foi guiada pelo modelo dos signos, significados e ações. Todos os(as) entrevistados(as) expressam acessar cuidados profissionais em sua trajetória que são interpretados como: insuficientes, despreparados, preconceituosos, incômodos, contraditórios, (in)acessíveis, um achado, respeitosos e excessivos. Os itinerários terapêuticos revelam-se também nos âmbitos psicossociais e culturais. Diversas ações do dia a dia vão sendo avaliadas e interpretadas no registro do cuidado consigo e justificadas por esse fim: o horário que acorda, que dorme, o que come, como se comporta. Em suas trajetórias, deparam-se com a falta de políticas de cuidados, com o enquadramento de seus corpos como indesejáveis, com barreiras físicas, simbólicas, comunicacionais, atitudinais, sistemáticas, culturais e políticas. Desse modo, revelam o pluralismo terapêutico, os desafios, os enfrentamentos, a insistência e a resistência na manutenção de cuidados ao experienciar velhices com fragilidades.

Abstract The present study sought to understand how frail older adults perceive their therapeutic care itineraries. This qualitative research was based on Critical Medical Anthropology. Data were collected through interviews in the homes of 22 older adults, whose average age was 79. The emic analysis was guided by the model of Signs, Meanings, and Actions. All interviewees expressed access to professional care in their trajectories, which are understood as insufficient, unprepared, prejudiced, uncomfortable, contradictory, (un)accessible, realization, respectful, and excessive. Therapeutic itineraries were also revealed in the psychosocial and cultural spheres. Several day-to-day actions were evaluated and interpreted in the record of self-care and justified by this end: the time they wake up, sleep, what they eat, and how they behave. They face the lack of care policies in their trajectories, labeling their bodies as undesirable due to physical, symbolic, communicational, attitudinal, systematic, cultural, and political barriers. Thus, they bring to light therapeutic pluralism, challenges, confrontations, insistence, and resistance in maintaining care when experiencing old age with frailties.

[Questionnaire for Kinki area Japanese Society of Neurology board members regarding transitional medicine for neurological disease patients].

In July 2020, The Special Committee for Measures Against Transition from Pediatric to Adult Health Care of the Japanese Society of Neurology was established to address transitional care for patients with childhood-onset neurological disorders. One of the measures used was a questionnaire regarding transitional medicine given to the 129 board members in the Kinki area. Of the 46 respondents, 42 answered that they would "generally examine such patients" or "judge on a case-by-case basis" for patients referred from a pediatric physician. Most of the responses noted "epilepsy" and "neuromuscular disease" as target conditions. Generally, doctors in an adult medical department do not form a relationship with the patient or their family members, different than pediatric department doctors. Furthermore, adult clinical departments typically do not have sufficient knowledge regarding treatment of diseases such as developmental disorders. The present support system for transitional medicine is not sufficient and there is no means for reimbursement. Several issues must be resolved to facilitate a smooth medical transition.

Usability and Satisfaction Testing of Game-Based Learning Avatar-Navigated Mobile (GLAm), an App for Cervical Cancer Screening: Mixed Methods Study.

BACKGROUND: Barriers to cervical cancer screening in young adults include a lack of knowledge and negative perceptions of testing. Evidence shows that mobile technology reduces these barriers; thus, we developed a web app, Game-based Learning Avatar-navigated mobile (GLAm), to educate and motivate cervical cancer screening using the Fogg Behavioral Model as a theoretic guide. Users create avatars to navigate the app, answer short quizzes with education about cervical cancer and screening, watch videos of the screening process, and earn digital trophies. OBJECTIVE: We tested ease of use, usefulness, and satisfaction with the GLAm app among young adults. METHODS: This mixed methods study comprised a qualitative think-aloud play interview session and a quantitative survey study. Participants were cervical cancer screening-eligible US residents aged 21 to 29 years recruited through social media. Qualitative study participants explored the app in a think-aloud play session conducted through videoconference. Data were analyzed using directed content analysis to identify themes of ease of use, usefulness, and content satisfaction. Qualitative study participants and additional participants then used the app independently for 1 week and completed a web-based survey (the quantitative study). Ease of use, usefulness, and satisfaction were assessed using the validated Technology Acceptance Model and Computer System Usability Questionnaire adapted to use of an app. Mean (SD) scores (range 1-7) are presented. RESULTS: A total of 23 individuals participated in one or both study components. The mean age was 25.6 years. A majority were cisgender women (21/23, 91%) and White (18/23, 78%), and 83% (19/23) had at least some secondary education. Nine participants completed the think-aloud play session. Direct content analysis showed desire for content that is concise, eases anxiety around screenings, and uses game features (avatars and rewards). Twenty-three individuals completed the quantitative survey study. Mean scores showed the app was perceived to be easy to use (mean score 6.17, SD 0.27) and moderately useful to increase cervical cancer screening knowledge and uptake (mean score 4.94, SD 0.27). Participants were highly satisfied with the app (mean score 6.21, SD 1.20). CONCLUSIONS: Survey results showed participants were satisfied with the app format and found it easy to use. The app was perceived to be moderately useful to inform and motivate cervical cancer screening; notably, the screening reminder function was not tested in this study. Qualitative study results demonstrated the app's ability to ease anxiety about screening through demonstration of the screening process, and brevity of app components was favored. Interpretation of results is limited by the predominantly cisgender, White, and educated study population; additional testing in populations which historically have lower cervical cancer screening uptake is needed. A modified version of the app is undergoing efficacy testing in a randomized clinical trial.

Strong Father-Child Relationships and Other Positive Childhood Experiences, Adverse Childhood Experiences, and Sexual Risk Factors for HIV among Young Adults Aged 19-24 Years, Namibia, 2019: A Cross-Sectional Study.

Using cross-sectional data from the 2019 Namibia Violence Against Children and Youth Survey and sex-stratified multivariable models, we assessed the associations between four different positive childhood experiences (PCEs) and having ≥3 adverse childhood experiences (ACEs), including ≥3 ACE-PCE interaction terms, and seven sexual risk factors for HIV acquisition among young adults aged 19-24 years. One PCE, having a strong father-child relationship, was inversely associated with two risk factors among women (lifetime transactional sex (OR, 0.4; 95% CI, 0.2-0.7) and recent age-disparate sexual relationships (OR, 0.3; 95% CI, 0.2-0.5)), and significantly interacted with having ≥3 ACEs for three risk factors among women (not knowing a partner's HIV status, infrequently using condoms, and ever having an STI) and one among men (having multiple sexual partners in the past year). The other PCEs were significantly associated with ≤1 HIV risk factor and had no significant interaction terms. Strong father-child relationships may reduce HIV acquisition risk and mitigate the effect of childhood adversity on HIV risk among young adults in Namibia.