An investigation of stigma and self-management in individuals diagnosed with epilepsy

AIM

The complex nature of epilepsy disease confronts individuals with difficulties such as stigma. Stigma has a negative impact, particularly on individuals' coping with the disease. It is important for individuals diagnosed with epilepsy to adopt many self-management behaviors so that they can control these situations. This study aims to measure the stigma and self-management levels of individuals diagnosed with epilepsy and determine the relationship between stigma and self-management.

METHODS

This descriptive and associational study was conducted in the Neurology Outpatient Clinic of a Training and Research Hospital and 295 patients were included in the sample based on various inclusion criteria such as having a diagnosis of epilepsy for at least six months and not having any psychiatric disorder that would prevent reading and comprehension. Data were collected through the Descriptive Information Form, the Stigma Scale of Epilepsy, and the Epilepsy Self-Management Scale. Data analysis was performed using IBM SPSS Statistics Standard Concurrent User V 26 statistical package program.

FINDINGS

The Stigma Scale of Epilepsy total mean score was found 60.62 ± 15.40 in individuals diagnosed with epilepsy. The mean scores for the sub-scales were found 7.08 ± 2.20 for the false beliefs sub-scale, 18.86 ± 4.97 for the discrimination sub-scale, 21.64 ± 7.07 for the social isolation sub-scale, 8.46 ± 3.18 for the inadequacy sub-scale, and 5.45 ± 1.41 for the stigma resistance sub-scale. The ESMS total mean score of individuals diagnosed with epilepsy was found to be 140.54 ± 15.33. The mean scores for the ESMS sub-scales were 44.76 ± 4.29 for the medicine management sub-scale, 20.29 ± 5.98 for the information management sub-scale, 30.49 ± 4.80 for the safety management sub-scale, 23.95 ± 4.34 for the seizure management sub-scale, and 21.02 ± 4.65 for lifestyle management sub-scale. A significant and negative relationship was found between the Epilepsy Self-Management Scale (ESMS) and the Stigma Scale of Epilepsy.

CONCLUSION

This study found that individuals experienced a moderate level of stigma and had high levels of self-management. Stigma was found to decrease with the increase in the self-management level. In this regard, it is recommended to conduct intervention studies to increase self-management levels and reduce stigma for individuals diagnosed with epilepsy.

Research on Health Disparities: Strategies and Findings From the Black Women's Health Study

The American Journal of Epidemiology has been a platform for findings from the Black Women's Health Study (BWHS) that are relevant to health disparities. Topics addressed have included methods of follow-up of a large cohort of Black women, disparities in health-care delivery, modifiable risk factors for health conditions that disproportionately affect Black women, associations with exposures that are highly prevalent in Black women, and methods for genetic research. BWHS papers have also highlighted the importance of considering social context, including perceived experiences of racism, in understanding health disparities. In the future, BWHS investigators will contribute to documentation of the role that structural racism plays in health disparities.

Cardiac healthcare disparities and electrocardiography (ECG) differences in schizophrenia at end of life

Schizophrenia is associated with early mortality of 15 to 20 years, and 80 % of deaths are due to cardiovascular disease with a three-times greater risk of sudden-cardiac-death. While lifestyle, medications, genetics, and healthcare disparities are contributing factors, the etiology of this complex process is not fully understood. The aim of this study is to examine cardiac-related healthcare utilization and electrocardiogram (ECG) outcomes in schizophrenia at the end of life (EOL). A cohort of individuals with schizophrenia (SG) (n = 610, ≥50 years) were identified retrospectively from a unified clinical data platform and measures of cardiovascular healthcare utilization were evaluated within a 12-month period prior to death. Similarly, a control group (n = 610) was randomly identified and matched by gender (53 % females) and age of death (72.8 ± 12.4 years). Statistical methods included Cochran-Mantel-Haenszel and mixed-effects logistic & linear regression tests with adjustments for match strata and marital status, race, age, and gender as covariates. Results indicate that SG was more likely to be unmarried, unemployed, or from minority groups (all p < 0.001), and more likely to have diabetes and/or cardiovascular disease (p < 0.001). SG was less likely to receive an ECG (p = 0.001) or cardiac catheterization procedure (p < 0.001). SG had a greater mean QTc (447.2 ms vs. 434.6 ms; p = 0.001) and were twice as likely to have "prolonged QT" on ECG report (p = 0.006). In conclusion, SG had reduced likelihood of cardiac-related healthcare interventions, and despite greater likelihood of prolonged QTc, a recognized biomarker of cardiac risk, ECG was less likely at EOL. Given greater cardiac comorbidity and risk of sudden cardiac death in schizophrenia, improved practice guidelines are needed.

Training Among Noncustodial Health Care Workers Caring for Patients Experiencing Incarceration: A Preliminary Investigation

People experiencing incarceration in the United States receive much of their health care outside of custodial settings. Optimizing care in this setting requires further understanding of the training and experiences of noncustodial health care workers. We conducted a cross-sectional, exploratory survey of health care workers at a single academic institution to assess their training and experiences related to caring for this patient population. Of 333 respondents, 94.1% had cared for patients experiencing incarceration but only 22.5% had received any formal training, with 94.6% somewhat or very interested in further training. Common challenges included lack of privacy, difficulty obtaining patient history or completing an examination, and patient distress. Health care workers frequently experience challenges and report strong interest in further training to address knowledge gaps, and further detailed investigation is needed.

The Mass Incarceration Trauma Framework: A Conceptual Model for Understanding Trauma among Individuals Who Experience Incarceration

The Mass Incarceration Trauma (MIT) framework is a conceptual model for understanding the role of trauma in the lives of individuals who experience incarceration in the United States. This population faces poverty, violence, and discrimination across the life span. The MIT framework is guided by an ecological systems perspective, a foundational theoretical approach in social work that recognizes that effective assessment and intervention require an understanding of the complex contexts in which individuals live. The MIT framework presents the cumulative trauma exposures commonly faced by this population before, during, and after incarceration at the individual, social, environmental, and historical levels. Because traumatic stress undermines health and daily functioning, it is essential that interventions for this population address both the ongoing risk for trauma exposure and the consequences of multiple, repeated past exposures across ecological systems. It is to be hoped that a new and fundamental focus on the poverty, contexts of violence, and lifetime disadvantages experienced by those who cycle through prisons in the United States might reframe the question of how our society should prevent and respond to crime as well as respond to those swept into the criminal justice system.

Is evening chronotype associated with higher alcohol consumption? A systematic review and meta-analysis

A broader understanding of whether and to what extent chronotype should be considered a risk factor for alcohol consumption is needed. The aim of this systematic review was to summarize the evidence on the association between evening chronotype and alcohol consumption. A systematic search of observational studies on this association was conducted in the PubMed, Scopus, Web of Science, Cochrane Library and PsycINFO databases up to April 30th, 2023. Random-effect models estimated the pooled odds ratio (OR) of alcohol consumption according to chronotype. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Quality Assessment tool for Observational Cohorts and Cross-sectional Studies from the National Heart, Lung and Blood Institute were followed. A total of 33 studies involving 28 207 individuals (age range: 18-93 years) were included in this review. Overall, most studies indicated a higher volume and frequency of alcohol consumption in evening-type individuals than in individuals with different chronotypes. Additionally, a meta-analysis including 13 studies showed that evening-type individuals were 41% more likely to consume alcohol than those with other chronotypes (OR = 1.41, 95% confidence interval: 1.16-1.66; I2 = 38.0%). Limitations of the present findings are the predominance of cross-sectional studies and varied definitions of alcohol consumption. The available evidence supports an association between the evening chronotype and alcohol consumption. The evening-type population, especially young adults, is a specific target for educational interventions for preventing or reducing alcohol consumption.PROSPERO number: CRD42022343778.

Job loss during pregnancy and the risk of miscarriage and stillbirth

STUDY QUESTION

Does the exposure to job loss during pregnancy increase the risk of miscarriage or stillbirth?

SUMMARY ANSWER

The experience of own or partner's job loss during the pregnancy is associated with an increased risk of miscarriageand stillbirth.

WHAT IS KNOWN ALREADY

Prior research on the psycho-social aspect of pregnancy loss has investigated the contextual and the individual-level stressors. At the contextual level, natural disasters, air pollution, and economic downturns are associated with higher risk of pregnancy loss. At the individual level, intense working schedules and financial strain are linked with increased risk of pregnancy loss both at early and later stages of the gestation.

STUDY DESIGN, SIZE, DURATION

This work draws on high-quality individual data of 'Understanding Society', a longitudinal survey that has interviewed a representative sample of households living in the UK annually since 2009. Approximately 40 000 households were recruited. The analyses use all the available survey waves (1-12, 2009-2022).

PARTICIPANTS/MATERIALS, SETTING, METHODS

The final sample consisted of 8142 pregnancy episodes that contain complete informationon pregnancy outcome and date of conception. Ongoing pregnancies at the time of the interview were excluded from the final sample. The outcome variable indicated whether a pregnancy resulted in a live birth or a pregnancy loss whereas the exposure variable identified the women's or their partner's job loss because of redundancy or a dismissal. Logistic regression models were employed to estimate the relation between job loss during pregnancy and pregnancy loss. The models were adjusted for an array of socio-demographic and economic characteristics following a stepwise approach. Several sensitivity analyses complemented the main findings.

MAIN RESULTS AND THE ROLE OF CHANCE

Baseline models controlling for women's demographic background and prior experience of miscarriage estimated an increased risk of pregnancy loss when women were exposed to their own or their partner's job loss during their pregnancy (odds ratio (OR) = 1.99, 95% CI: 1.32, 2.99). When the models were adjusted for all socio-economic and partnership-related covariates the association remained robust (OR = 1.81, 95% CI: 1.20, 2.73).

LIMITATIONS, REASONS FOR CAUTION

First, the pregnancy outcome and the date of conception were self-reported and may besubjected to recall and social desirability bias. Second, although we adjusted for an array socio-demographic characteristics and self-reported health, other contextual factors might be correlated with both job loss and pregnancy loss. Third, owing to the limited sample size, we could not assess if the main finding holds across different socio-economic strata.

WIDER IMPLICATIONS OF THE FINDINGS

By showing that exposure to a job loss during pregnancy increases the risk of miscarriage and stillbirth, we underline the relevance of pregnancy loss as a preventable public health matter. This result also calls for policy designthat enhances labour market protection and social security buffers for pregnant women and their partners.

STUDY FUNDING/COMPETING INTERESTS

The authors received the following financial support for the research, authorship, and/or publication of this article: H2020 Excellent Science, H2020 European Research Council, Grant/Award Number: 694262 (project DisCont-Discontinuities in Household and Family Formation) and the Economic and Social Research Centre on Micro-Social Change (MiSoC). There are no conflicts of interest to declare.

Associations between teacher-student relationship and externalizing problem behaviors among Chinese rural adolescent

The primary objective of this study is to present a fresh perspective on the correlation between teacher-student relationships and externalizing problem behaviors among adolescents. While previous research has examined this connection, there is still an insufficient understanding of the underlying mechanisms. Moreover, the crucial role of peer relationships, mental health, and parental knowledge has been overlooked. In this study, a total of 6,919 Chinese rural adolescents aged 13-19 years participated by completing an anonymous self-report questionnaire. The results show that: (1) teacher-student relationship has a protective effect against the development of externalizing problem behaviors; (2) peer relationship and mental health both have a mediating role in the relationship between teacher-student relationship and externalizing problem behaviors; (3) teacher-student relationship can indirectly affect externalizing problem behaviors through the chain mediation of peer relationship and mental health; (4) parental knowledge plays a moderating role between the teacher-student relationship and externalizing problem behaviors. As the level of parental knowledge increases among rural adolescents, the impact of the teacher-student relationship on externalizing problem behaviors becomes more pronounced; and (5) the impact of teacher-student relationship on externalizing problem behaviors has no significant gender differences. Given the study's empirical outcomes, we discuss potential explanations and advocate for a comprehensive pedagogical approach to mitigate rural adolescent externalizing behaviors. This entails nurturing teacher-student relations, fostering inclusive peer environments, emphasizing mental health literacy, and synergizing with caregivers for a holistic home-school intervention.

A Pressure Release Valve: South Korean Long-Term Care Policy as Supplemental to Family Elder Care

South Korea's National Long-term Care Insurance (NLTCI) has received international acclaim for its universal continuum-of-care model. Based on 25 qualitative interviews with family caregivers, this research explores the relationship between NLTCI policies and experiences of family caregiving for older people. Caregivers who share care responsibilities or are supported by other family are coping well with minor to moderate policy recommendations. Lone caregivers without support from other family are struggling and express desire for expanded services. These findings highlight a need for more consideration of the influence of family dynamics on informal caregiver burdens. Despite many strengths, NLTCI policy functions as a pressure release valve, supplementing family care for seniors - not replacing it - with minimal gender equity contributions.

A bibliometric analysis of media coverage of mental disorders between 2002 and 2022

PURPOSE

Mental disorders are a public health concern with media as a primary source of information. This study aims to present current research on how the media reports mental disorders.

METHODS

This study conducted a bibliometric analysis of 130 published studies on media coverage of mental disorders, focusing on the research themes and research trends of the published studies.

RESULTS

The results show that media coverage of mental disorders was generally negative and influenced by socio-demographic factors (e.g., age, gender, and cultural values). Results also show that social media was becoming crucial for mental health communication.

CONCLUSION

Media worsen the stigma against those with mental disorders, continuing prejudice and discrimination. The field has shifted from traditional media to social media, and from general to specific mental disorder descriptions.

U.S. Breastfeeding Outcomes at the Intersection: Differences in Duration Among Racial and Ethnic Groups With Varying Educational Attainment in a Nationally Representative Sample

BACKGROUND

As breastfeeding rates in the United States increase, barriers persist for Black, Latine, and low-socioeconomic status household dyads when compared to White and high-socioeconomic status household dyads. Previous breastfeeding disparities research has almost exclusively considered the influence of race, ethnicity, and socioeconomic status separately, although these attributes are not randomly distributed across the population.

RESEARCH AIM

To identify breastfeeding duration patterns by race/ethnicity and educational attainment in a nationally representative U.S. National Immunization Survey sample.

METHOD

We conducted a cross-sectional, secondary analysis of the U.S. Centers for Disease Control and Prevention's 2020 National Immunization Survey-Child public-use data. To examine breastfeeding and exclusive breastfeeding durations at the intersection of race/ethnicity and educational attainment, we created a 12-item, cross-classified variable using three educational attainment groups and four race/ethnicity groups. We used linear regressions to test these associations.

RESULTS

In all, 83% of the sample breastfed. Mean durations of breastfeeding were 7.5 (SE = 1.95) months and exclusive breastfeeding duration was 4.9 (SE = 0.87) months. In adjusted models, multi-race/other high-educational attainment participants had the longest breastfeeding duration by almost 3 weeks (β: 19.53, 95% CI [5.27, 33.79]), and Black low-educational attainment participants exclusively breastfed for 1 month less than White high-educational attainment participants (β:-30.23, 95% CI [-40.87, -19.58]).

CONCLUSIONS

Examining race/ethnicity and educational attainment together provides an intersectional understanding of breastfeeding outcomes and can inform targeted, culturally appropriate interventions.

"I thought it was for guys that did needles": Medication perceptions and lay expertise among medical research participants

INTRODUCTION

Although randomized controlled trials (RCTs) examine "objective" indicators of safety and efficacy of investigational drugs, participants may not perceive study medications as neutral entities. Some medications are imbued with social and cultural meaning, such as stigmatized medications for opioid use disorders. Such perceptions surrounding substance use treatments can extend to the research context and shape RCT participants' experiences with and adherence to study medications.

METHODS

Considering these complexities in substance use research, we conducted a nested qualitative study within a multi-site, pragmatic RCT in Canada testing two treatments (methadone versus buprenorphine/naloxone) for opioid use disorder. Between 2017 and 2020, we conducted 115 interviews with 75 RCT participants across five trial sites in British Columbia, Alberta, Ontario, and Quebec.

RESULTS

Using an abductive coding approach, we characterized participants by their previous experience with medication for opioid use disorder and by their exposure to drug culture and drug scenes. Across these experience types, we identified systematic differences around participants' perceptions of the study medications, sources of information and expertise, and medication stigma.

CONCLUSION

Our findings illustrate the critical importance of social context in shaping medication beliefs and study experiences among people who use drugs, with implications for the conduct of future RCTs in substance use.

Diversity, equity, and inclusion correlates of racial/ethnic harassment and discrimination in the U.S. military

As one of the most racially/ethnically diverse workplaces in the United States, the Department of Defense (DoD) has been on the forefront in driving diversity initiatives. Yet, racial/ethnic harassment and discrimination (REHD) in the military persist and threaten mission readiness. Despite this, limited research exists identifying factors that influence REHD in the U.S. military that could be leveraged for prevention and intervention. In this study, we sought to identify how diversity, equity, and inclusion (DEI) factors in the workplace are associated with REHD in order to identify potential targets for prevention and policy efforts to improve racial/ethnic relations in the U.S. military. Using the 2017 Workplace and Equal Opportunity Survey of Active Duty Members, we found military, leadership, and unit DEI climate factors were the top predictors of REHD, though the relative importance of each predictor varied by racial/ethnic minority status. In particular, we found military and leadership attention to REHD to be the top predictors for Racial/Ethnic Minority active duty members whereas workplace hostility was the top predictor for non-Hispanic White active duty members. Implications for programs and policies surrounding REHD in the U.S. military are discussed.

The positive effects of online group singing on psycho-physiological variables during the COVID-19 pandemic-A pilot randomized controlled trial

The psychological variables that were particularly influenced by social distancing during the COVID-19 pandemic-stress, loneliness, social participation, and well-being-correspond closely to variables that can also be influenced by music. The present study is a pilot randomized controlled trial examining the effects of online group singing on psycho-physiological variables during the pandemic. Over 4 weeks, an online singing group sang together once a week, for 1 h, under the guidance of a professional voice coach. In a first control group, participants also met for 60 min per week but only discussed and exchanged personal experiences about music. A second control condition consisted of a waiting list group. Across all variables studied (positive and negative affect, life satisfaction, stress, loneliness, social participation, self-efficacy, and body perception), positive effects were revealed in the singing group and in the discussion group, but not in the waiting list group. The effects of the variables self-efficacy, social participation, loneliness, and life satisfaction were markedly stronger in the singing group than in the discussion group. The results demonstrate the effectiveness of group singing on a number of psycho-physiological variables, which can be used profitably in and outside of times of crisis, in both clinical and non-clinical settings.

A cross-sectional study of inequalities in digital air pollution information access and exposure reducing behavior uptake in the UK

Air pollution is a pervasive global environmental challenge that presents substantial and differential risk across populations. Individual-level pollution exposure is a function of varying factors, including but not limited to geographic location, proximity to point sources, ventilation, and behavioral patterns. Mounting evidence suggests that informational interventions can play a substantial role in mediating exposures for specific population subgroups and reduce downstream adverse health outcomes. The literature has yet to address whether access to air quality information is sociodemographically stratified, and whether such access correlates with increased uptake of exposure reducing behaviors at the population level. This study represents a first step in answering these questions by analysing responses from the "Clean Air Public Insight Tracker" nationally representative survey (n = 1,993) of the UK population, administered by UK charity Global Action Plan. Results from logistic regression and zero-inflated negative binomial models estimate 28% of the population have accessed air pollution information, while the odds of younger individuals (ages 18-36), men, and non-white individuals of accessing digitally available air quality information are greater that those outside these categories. Additionally, the odds of behavior uptake is greater if an individual accesses digital information sources like the internet, mobile apps or social media, has a higher education qualification or cares for someone with a health condition. These findings contribute to the growing literature surrounding which population groups engage with environmental and health-relevant information channels, and what connects engagement with air quality channels and uptake of exposure reducing behaviors. These results reinforce the need for additional research around air pollution informational alerts and exploring causal links between specific exposure reducing behaviours and improved health outcomes. It can also help inform the flow of resources and targeting of informational campaigns towards sociodemographic groups that are less likely to engage with air quality information.

Effects of social norms and message framing on reducing the stigma of gynecological diseases: A cognitive-affective-behavioral model

This paper presents an experiment exploring message strategies to reduce the stigma of gynecological diseases and promote women's sexual and reproductive health. Drawing on the cognitive-affective-behavioral model of stigma, we propose that social norms and message framing as two message strategies, respectively, address the cognitive and affective components of the stigma of gynecological diseases, which lead to desired changes in the help-seeking intention as the behavioral component. We conducted a 3 (no norm vs. descriptive norm vs. descriptive plus injunctive norms) by 2 (gain-framed vs. loss-framed) between-subject experiment (N = 202). The results reveal that messages with the combination of descriptive and injunctive norms reduce the greatest cognitive components of stigma. Gain-framed messages induced fewer affective components than loss-framed ones. The results suggest that changes in the cognitive and affective components of stigma may sequentially lead to favorable changes in the behavioral component. This study contributes to public understanding of the stigma of gynecological diseases by disentangling the various components and identifying the specific message strategies for stigma reduction.

The Early 2020 COVID-19 Outbreak in China and Subsequent Flourishing: Medium-Term Effects and Intervening Mechanisms

In early 2020, a COVID-19 outbreak occurred in Hubei Province of China. Exploiting the geographic concentration of China's COVID-19 cases in Hubei (the initial epicenter), we compare Hubei and non-Hubei residents to examine the medium-term effect of exposure to the COVID-19 outbreak on mental well-being. We examine flourishing-a comprehensive assessment of well-being that is not merely the absence of mental illness-and investigate a broad set of psychosocial and economic mediators that may link initial outbreak exposure to subsequent flourishing. We use ordinary least squares regression models to analyze national panel data collected in early 2020 and late 2021 (N = 3,169). Results show that flourishing scores remain lower for Hubei than non-Hubei residents almost two years following the early 2020 COVID-19 outbreak. Mediation analysis reveals that Hubei residents' lower incidences of job promotion and lower sense of control are the two most important mediators accounting for their lower flourishing relative to non-Hubei residents. Combined, this study provides the first evidence of the medium-term psychological vulnerability borne by individuals who lived in the initial epicenter of the COVID-19 pandemic. Findings on the intervening mechanisms shed light on the policy initiatives needed for post-pandemic mental well-being recovery in China and other countries.

Partnership and fertility trajectories of immigrants and descendants in the United Kingdom: A multilevel multistate event history approach

We study the interrelationships between partnership and fertility trajectories of immigrant women and female descendants of immigrants using the UK Household Longitudinal Study. We propose a novel multistate event history approach to analyse the outcomes of unpartnered, cohabiting, and married women. We find that the partnership and fertility behaviours of immigrants and descendants from European and Western countries are similar to those of native women: many cohabit first and then have children and/or marry. Those from countries with conservative family behaviours (e.g. South Asian countries) marry first and then have children. Women from the Caribbean show the weakest link between partnership changes and fertility: some have births outside unions; some form a union and have children thereafter. Family patterns have remained relatively stable across migrant generations and birth cohorts, although marriage is being postponed in all groups. Our findings on immigrants support the socialization hypothesis, whereas those on descendants are in line with the minority subculture hypothesis.

Abolition and harm reduction in the struggle for "Care, Not Cages"

Care that is organized around the principles of harm reduction and the movement for police and prison abolition has the potential to uproot and transform structural causes of harm and violence, in the interconnected crises of drug-related harm, policing, and punishment. The United States' crisis of overdose and drug-related harm and its system of policing and punishment are historically and empirically linked phenomena. The abandonment of people whose use of drugs leads to their premature death, in the form of an overdose, is directly and indirectly connected to wider systems of criminalization and incarceration that also produce premature suffering and death. Organizations advocating for harm reduction for people who use drugs (PWUD) and organizations seeking the abolition of police and prisons have developed in parallel albeit with different genealogies. We examine the historical origins, principles, and practical applications of the two movements to identify points of overlap and lessons to be learned for the public health goals of addressing and preventing premature suffering and death in the United States. A case study of Los Angeles (LA) County, where elected officials have promised a new paradigm of care, not punishment, frames our analysis. We show how the principles and strategies of harm reduction and abolition are both necessary to practically realizing a paradigm of care, not punishment, and achieving system transformation.

Aligning public health and public safety: Probation as a touchpoint to identify and link patients with opioid use disorder to opioid agonist treatment

BACKGROUND

People in criminal justice settings (CJS) have high rates of opioid use disorder (OUD) and HIV. Probation is part of the CJS and congregates many individuals with high rates of mental health and substance use disorders relative to the general population; nevertheless, probation remains a major improvement to incarceration. As a steppingstone to full decarceration efforts, community supervision settings like probation can be leveraged as "touchpoints" to identify and link people with OUD (and other co-morbid conditions) to treatment and reduce criminal activity.

METHODOLOGY

To determine the feasibility of a modified screening, brief intervention and referral to treatment (SBIRT) strategy to link probationers to opioid agonist therapies (OAT) in the newly created probation system in Ukraine, we conducted a single-arm SBIRT intervention in eight probation centers in four Ukrainian administrative regions. For those screening positive for OUD, interest in OAT was assessed before and after a brief intervention. Those interested in OAT were referred to community OAT services. Participants with OUD also underwent HIV testing.

PRINCIPAL FINDINGS

Of the 1,298 consecutive individuals screened, 208 (16.0%) met criteria for opioid dependence. Of these, 122 (58.7%) enrolled in brief intervention, of which 54 (44.3%) had HIV and 14 (25.9%) of these were newly diagnosed. After the brief intervention, interest in starting OAT increased significantly from a median of 7.0 to 8.0 (P = <0.001) using a 10-point scale. Thirty (N = 30; 24.6%) of the enrolled participants initiated OAT and 21 of these (70%) were retained in treatment for 6 months.

SIGNIFICANCE

The prevalence of OUD (and HIV) is high among people in probation in Ukraine. SBIRT can identify a large number of people eligible for OAT, many of whom were willing to initiate and remain on OAT. Integrating SBIRT into probation can potentially assist with OAT scale-up and help address HIV prevention efforts.

Subjective socioeconomic status and self-rated health in the English Longitudinal Study of Aging: A fixed-effects analysis

Higher subjective socio-economic status (SES) goes along with better self-rated health: This finding is well-established in the literature, yet the majority of studies it is based on only rely on cross-sectional analyses and only account for few potential confounders of the association. Particularly wealth, which is increasingly thought of as an important dimension of accumulated advantage, is only rarely examined as a confounder. Using eight waves of panel data from the English Longitudinal Study of Aging (ELSA, 2002-19), we investigate the association between subjective SES and self-rated health. We use random effects models that account for theoretically important time-constant (such as education and social class) and time-varying confounders (such as income and wealth) as well as fixed-effects models, that in addition control for all time-constant confounders, whether observed or unobserved. The fully adjusted fixed-effects model reveals a statistically significant association between subjective SES and self-rated health. Yet, a one-point increase on the subjective SES ladder goes along with a two per cent of a standard deviation increase in self-rated health, only around a quarter of the size of the random-effects estimate. The role of wealth for the subjective SES-self-rated health association is negligible in the fixed-effects specifications. Smoking, drinking, and physical activity do not appear to mediate the association. A substantial part, though not all, of the observed association between subjective SES and self-rated health is due to unobserved confounding rather than a causal effect. Reducing health inequalities based on objective SES is likely more effective than based on subjective SES.

"I Was Like a Bird Without Wings": Autistic Women's Retrospective Experiences in General Schools

Autistic individuals' experience of the inclusion process is poorly understood, especially that of female pupils. This study retrospectively explored the views of autistic women who were included in general schools throughout childhood and adolescence, from elementary to high school, to understand their unique experiences and learn more about their needs in general schools. Semi-structured interviews were conducted, data were thematically analyzed, and key issues emerged pertaining to each educational level. The women described a complex journey within the general education system. Their responses highlight the need for greater attention to autistic females' patterns of behavior in research and practice. Implications and recommendations for educators and schools are provided, and directions for future research are outlined.

General Public Knowledge, Attitude, and Practice Regarding the Impact of Air Pollution and Cardiopulmonary Diseases in Jeddah, Saudi Arabia

Introduction Air pollution is a critical public health issue associated with various respiratory and cardiovascular diseases. The lungs and heart are the organs most affected by air pollution, and damage to these organs is strongly associated with inhaled particulate matter produced by burning fossil fuels. Household and ambient air pollution have been closely linked to lower respiratory infections, with ambient air pollution alone estimated to be responsible for millions of deaths globally each year. Therefore, this study aimed to assess the general public knowledge attitude and practice regarding air pollution and cardiopulmonary morbidity in Jeddah, Saudi Arabia. Methods The study was conducted in Saudi Arabia using a self-administered questionnaire distributed through popular social media apps. A snowball sampling technique was used, including only Saudi citizens aged 18 or older. The questionnaire consisted of 30 questions derived from a comprehensive literature review on the subject matter. Questions were validated through face validity, pilot testing, and Cronbach's alpha reliability measurement. The questionnaire included questions on demographic data, knowledge of air pollution, the relationship between air pollution and cardiopulmonary diseases, and attitudes and practices toward lowering exposure to air pollution. Results The study included 649 participants, with a mean age of 32.11 ± 13.47 years, and over half were females (54.7%). Most participants were aware of outdoor and indoor air pollution, but only a tiny percentage recognized cooking as a primary indoor source of pollution. However, the majority believed that indoor pollution could contribute to outdoor pollution. Participants associated air pollution with cardiopulmonary diseases, mainly secondhand tobacco smoke and outdoor air pollution caused by factories and industrial facilities. Knowledge and practice levels varied, with older individuals, females, and those in non-health-related occupations having higher levels of knowledge. Positive attitudes, particularly believing that moving to a less polluted area improves health, were associated with better knowledge. Females exhibited better air pollution-related practices, and there was a positive correlation between knowledge and practice scores. Conclusion The study highlighted the need for targeted public health campaigns to improve awareness and promote healthier practices, particularly among young adults, to mitigate the potential health impacts of air pollution, especially cardiopulmonary health.