Community Factors Research Articles

Individual and community-level factors associated with repeat induced abortion among women in Ghana: a multivariable complex sample logistic regression analysis of 2017 Ghana maternal health survey

BackgroundRepeat induced abortion is a serious public health issue that has been linked to adverse maternal health outcomes. However, knowledge about repeat induced abortion and its associated factors among reproductive age women in Ghana is very scarce. The objective of this study is to examine individual and community factors associated with repeat induced abortion in Ghana which would be helpful to design appropriate programmes and policies targeted at improving the sexual and reproductive health of women.MethodsWe used secondary cross-sectional data from the 2017 Ghana Maternal Health Survey. The study included a weighted sample of 4917 women aged 15–49 years with a history of induced abortion. A multivariable complex sample logistic regression analysis was used to investigate individual and community factors associated with repeat induced abortion among women in Ghana. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) was used to measure the association of variables.ResultsOf the 4917 reproductive women with a history of abortion, 34.7% have repeat induced abortion. We find that, compared to women who experience single induced abortion, women who experience repeat abortion are age 25–34 years (AOR:2.16;95%CI = 1.66–2.79) or 35–49 years (AOR:2.95;95%CI:2.18–3.99), have Middle/JHS education (AOR:1.69;95%CI = 1.25–12.27), use contraceptive at the time of conception (AOR:1.48: 95%CI = 1.03–2.14), had sexual debut before 18 years (AOR:1.57; 95%CI: 1.33–1.85) and reside in urban areas (AOR:1.29;95%CI = 1.07–1.57). On the other hand, women who reside in Central (AOR:0.68;95%CI: 0.49–0.93), Northern (AOR:0.46;95%CI:0.24–0.88), Upper West (AOR:0.24; 95%CI: 0.12–0.50) and Upper East (AOR:0.49; 95%CI = 0.24–0.99) regions were less likely to have repeat induced abortion.ConclusionThe study showed that both individual and community level determinants were significantly associated with repeat induced abortion. Based on the findings, it is recommended to promote sexual and reproductive health education and more emphasis should be given to adult, those with early sexual debut, those with Middle/JHS education and those who live in urban centers.

HEALTH (DIS)EQUALITIES AND SOCIAL ISOLATION AND LONELINESS IN THE OLDER PEOPLE: A QUALITATIVE STUDY

Demographic ageing is currently a major concern worldwide and has beengrowing at an accelerated pace, which is why it is important to reflect on the aspects that can be preponderant in the process of growing old. Therefore, this study aims to understand the perspective of elderly people in Póvoa de Varzim regarding the factors that influence (in)equality in health, as well as social isolation and loneliness. A qualitative study was carried out and a total of 37 participants wererecruitedtotakepartin4focusgroups, using the intentional non-probabilistic samplingmethod. The focus groups were analyzed on the basis of thematic analysis. Findings show that the factors that seem to influence health inequalities are related to accessibility to health services (general functioning and appointments), as well as socioeconomic and demographic aspects, which are also at the heart of social isolation and loneliness, alongside community factors. These results have contributed to a better understanding of existing healthinequalities and how older people perceive social isolation and loneliness, thus making it possible to understand the helical process inherent in the subject under study. In thisway, it has allowed the development of possible actions and/or strategies at the level ofpolicies and the organization of services and communities, in which the Occupational Therapist also plays a fundamental role that will contribute to a transformation of the ageing paradigm and the promotion of a healthy life for older people.

Factors Impacting ART Adherence among HIV-Positive Older Adolescents and Younger Adults in Namibia: A Qualitative Analysis

Background Namibia, like many sub-Saharan African countries, faces the challenges of Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) affecting diverse age groups. However, the demographic group of older adolescents and younger adults, specifically those aged 15-24, faces distinct challenges in terms of psychological, sociocultural, and healthcare-related factors that impact their adherence to Antiretroviral Treatment (ART). It is important to conduct further research to investigate these specific challenges and address them effectively. Aim This paper aimed to investigate factors impacting adherence to ART medication among Older Adolescents (OA) and Younger Adults Living with HIV (YALHIV) in the seven high-burden regions in Namibia. Objective The objective of this study was to explore and describe the factors that influence adherence to ART medication among older adolescents and younger adults living with HIV to provide valuable insights to inform the development of evidence-based HIV programs that can effectively address the adherence challenges in this particular population. Methods A qualitative descriptive phenomenology research design was followed, utilising an in-depth interview to capture the experiences of older adolescents and younger adults living with HIV. Participants were recruited from healthcare facilities across Namibia, ensuring a diverse sample in terms of gender, socio-economic status, and urban-rural representation. A purposive sampling technique was employed to select 29 participants who were willing to take part in the study and data saturation was achieved with this sample size. The interviews were telephonically recorded with the permission of the participants. The researcher used Colaizzi's six steps for phenomenological study to analyze the data. Results The study reveals four main themes that contribute to adherence issues in OALHIV and YALHIV and include patients-related factors, family-related factors, facility and healthcare providers-related factors, and community and socio-cultural characteristics-related factors. Conclusion The study sheds light on factors affecting adherence to ART among OALHIV and YALHIV. It emphasizes the necessity of comprehensive interventions addressing personal, sociocultural, economic, and healthcare challenges for their well-being. Future research and policies should focus on tailored interventions based on these diverse findings.

Mapping the needs of healthcare workers caring for COVID-19 patients using the socio-ecological framework: a rapid scoping review.

Undoubtedly, the mental health of healthcare workers (HCWs) was negatively affected because of caring for patients during the COVID-19 pandemic. However, literature is limited on mapping the challenges and needs of HCWs during COVID-19 pandemic. A widely used framework in public health for mapping evidence includes the socio-ecological models, suggesting behavior can be influenced by individual, interpersonal, organizational, and community factors. The aim of this rapid scoping review was to use the socio-ecological model to map and compile lessons learnt from the literature regarding primarily the challenges and needs and secondly available psychological interventions for HCWs caring for COVID-19 patients. PubMed, CINAHL and Scopus databases were searched, with 21 studies finally included examining challenges and needs of HCWs and 18 studies presenting psychological interventions. Organizational-level challenges and needs such as inadequate staff preparation and supplies of protective equipment, flexible work policies and paid rest periods were the most reported. Individual-level challenges and needs included COVID-19-related fears and reduced mental health, whereas interpersonal-related needs included support provision. Community-level challenges included societal stigma. Certain psychological interventions were found to be promising for HCWs, but these were utilized to address only individual-level challenges and needs. Given that well-being entails an interaction of factors, multi-level interventions addressing multiple socio-ecological levels (interpersonal, organizational, community) and that place HCWs in their social context should be administrated to increase and maintain intervention' effects long-term and possibly aid in better coping with future pandemics.

Does reversal of the educational gender gap affect Men's happiness: Evidence from China

AbstractIn the context of the reversal of the educational gender gap, this article employs a nationally representative survey to examine the relationship between a wife's educational advantages (i.e., wife attains more education than her husband) and her husband's happiness. By controlling for individual, family, and community factors, we demonstrate that a husband's happiness is positively associated with his wife's educational advantages. Instrumental variable regressions and series of robustness checks corroborate the conclusion. However, certain heterogeneities are observed, with a particularly notable positive association among men with higher education levels, younger age, and those residing in the eastern region, likely influenced by their egalitarian gender ideologies. The study suggests that men are increasingly accepting of marriages in which the wife is more educated than her husband.

Addressing food insecurity in rural primary care: a mixed-methods evaluation of barriers and facilitators

BackgroundFood insecurity (FI) is associated with negative health outcomes and increased healthcare utilization. Rural populations face increased rates of FI and encounter additional barriers to achieving food security. We sought to identify barriers and facilitators to screening and interventions for FI in rural primary care practices.MethodsWe conducted a mixed-methods study using surveys and semi-structured interviews of providers and staff members from rural primary care practices in northern New England. Survey data were analyzed descriptively, and thematic analysis was used to identify salient interview themes.ResultsParticipants from 24 rural practices completed the survey, and 13 subsequently completed an interview. Most survey respondents (54%) reported their practices systematically screen for FI and 71% reported food needs were “very important” for their patients and communities. Time and resource constraints were the most frequently cited barriers to screening for and addressing FI in practices based on survey results. Interview themes were categorized by screening and intervention procedures, community factors, patient factors, external factors, practice factors, process and implementation factors, and impact of FI screening and interventions. Time and resource constraints were a major theme in interviews, and factors attributed to rural practice settings included geographically large service areas, stigma from loss of privacy in small communities, and availability of food resources through farming.ConclusionsRural primary care practices placed a high value on addressing food needs but faced a variety of barriers to implementing and sustaining FI screening and interventions. Strategies that utilize practice strengths and address time and resource constraints, stigma, and large service areas could promote the adoption of novel interventions to address FI.

A Composite Indicator of Polyvictimisation Through the Lens of the Ecological Model in Sub-Saharan Africa

Intimate partner violence (IPV) is a worldwide issue. One of the latest developments in its theoretical framework deals with the concept of polyvictimisation – the simultaneous occurrence of physical, emotional, and sexual abuse. However, the literature lacks an overall measure of violence for surveys. The aim of this research is to study IPV within the framework of the ecological model. A model-based composite indicator that takes into account the relationship between domestic abuse and individual characteristics of respondents, family dynamics, and community and societal traits is built using survey data. The data are from the Demographic and Health Survey collected in eleven African countries on women aged 15–49. The employed structural equation model shows the importance of individual characteristics while community and societal factors are less relevant. The composite indicator is also used for classification and ranking purposes, allowing areas where socio-educational interventions are more urgent to be identified.

Societal and community factors facilitating cultural adaptation and mental health of North Korean refugee women in South Korea.

North Korean (NK) refugee women face unique challenges in their acculturation process in South Korea (SK), often leading to higher rates of depression among them. This study uses the Multidimensional Individual Difference Acculturation (MIDA) model to examine the role of societal and local community factors in facilitating cultural adaptation and influencing mental health issues, such as depression, among NK refugee women. The study focuses on three predictors from the MIDA model: out-group social support, attachment to NK culture, and daily life experience of discrimination. Data from a sample of 212 NK refugee women in SK were analyzed using structural equation modeling. The findings highlight the crucial role of the social and community environment in attaining a balance between embracing a new culture and preserving one's connection to one's heritage culture. This balance is essential for promoting stable cultural adaptation, sound mental health, and overall well-being, so as to reduce the incidence of depression among NK refugee women. Based on the results, specific intervention strategies are proposed to support the acculturation journey of NK refugee women in SK.

Centering Community, Indigenous Relationships, and Ceremony through an Alaska Native Collaborative Hub to Prevent Suicide and Promote Youth Wellbeing

The Alaska Native Collaborative Hubfor Research on Resilience (ANCHRR) engages Indigenous leadership at all levelsin a strength-based study to deepen our understanding of community levelprotective factors in Indigenous communities, which are the collectiveinfluences shaping individual wellbeing across time. Overall, ANCHRR aims toposition Alaska Native Tribes, Tribal organizations, and community members asthe guides for culturally responsive research that is aligned with communitypriorities of increasing resilience and wellbeing among Alaska Native youth andreducing their suicide risk. Our approach brings together Indigenous knowledgeand research methods that humbly draw attention to the solutions that alreadyexist within communities. An Indigenous paradigm shifts the approach from asingular focus on individuals and their risks and deficits, to appreciation forthe cultural, community and systemic ways in which community members support,care for, and guide their young people into adulthood. We describe the lessonslearned about this unique approach to Indigenous leadership and community engagementand discuss the research processes that keep the relational heart-work at thecenter of every project activity. This capacity-building, mutually beneficialand relational approach offers new insights to knowledge development endeavors.

Temporal and spatial variations and driving factors of phytoplankton in Yongjiang River estuary

To explore the temporal and spatial variations in phytoplankton community in small estuaries, we collected surface water samples from Yongjiang River estuary during wet, normal, and dry seasons and determined the main driving factors of phytoplankton community. A total of 358 species belonging to nine phyla and 123 genera were identified in all seasons. During wet, normal, and dry seasons, species number was 276, 154 and 151, and the abundance was (170.45±225.43)×103, (51.92±30.28)×103 and (31.65±12.79)×103 cells·L-1, respectively. Diatoms dominated the phytoplankton community, and the main dominant species were Cyclotella meneghiniana, Skeletonema costatum, and Paralia sulcata. Shannon diversity and Pielou evenness indices decreased from inside mouth to outside mouth in wet season, but there was no obvious spatial difference in normal season or dry season. Results of non-metric multidimensional scaling analysis and analysis of similarities showed that phytoplankton community composition differed significantly among different regions (inside, at and outside mouth) and different seasons. In wet season, phytoplankton abundance was significantly positively correlated with temperature, dissolved inorganic nitrogen, and dissolved reactive phosphorus, but significantly negatively correlated with salinity. In normal season, phytoplankton abundance was significantly negatively correlated with temperature. In dry season, it was not significantly correlated with environmental factors. Results of redundancy analysis showed that temperature, salinity, ammonium and dissolved reactive phosphorus explained the variations in phytoplankton community by 19.5%, 11.9%, 9.4% and 8.2%, respectively. These results revealed high dominance of diatoms and the main driving factors (temperature, salinity and nutrients) of phytoplankton community in Yongjiang River estuary.

Impact of regional differences and neighborhood socioeconomic deprivation on the outcomes of patients with lower extremity wounds evaluated by a limb-preservation service

ObjectiveManagement of lower extremity (LE) wounds has evolved with the establishment of specialized limb preservation services. Although clinical factors contribute to limb outcomes, socioeconomic status and community factors also influence the risk for limb loss. The Distressed Community Index (DCI) score is a validated index of social deprivation created to provide an objective measure of economic well-being in United States communities. Few studies have examined the influence of geographic deprivation on outcomes in patients with LE wounds. We examined relationships between socioeconomic deprivation and outcomes of inpatients evaluated by a dedicated limb preservation service (Functional Limb Extremity Service [FLEX]). MethodsInpatients referred to FLEX over a 5-year period were included. Wound, Ischemia, foot Infection (WIfI) staging was collected. DCI scores were determined using seven indices based on ZIP Code. Outcomes included any minor or major amputations, any endovascular or open LE revascularization, or wound care procedures. Disease etiology, demographic, and anthropometric data were collected. Associations between neighborhood deprivation and limb-specific outcomes were evaluated in models for the DCI and each of its components separately. ResultsA total of 677 patients were included. Thirty-eight percent were female, with a mean age of 64 years. Sixty percent had WIfI stage 3 or 4 risk of amputation, and 43% had WIfI stage 3 or 4 risk of revascularization. Mean ankle-brachial index and toe pressure were 0.96 (standard deviation [SD], 0.43) and 80 (SD, 57) mmHg. Thirty-five percent were non-White. Amputation was performed in 31% of patients, whereas 17% underwent revascularization. The mean distress score was 64 (SD, 24). Mean DCI scores did not differ across WIfI scores. Likewise, overall DCI distress score was not related to any of the outcomes in univariable or multivariable linear regression models. In univariable linear regression models for amputation, higher poverty rate (odds ratio for SD increase 1.20; 95% confidence interval, 1.02-1.42; P = .025) was significantly associated with the outcome. In multivariable models, neither DCI distress score nor any of its components remained significantly associated with the outcome. ConclusionsDespite known racial disparities in limb-specific outcomes, an aggregate measure of community level distress was not found to be related to outcomes. Although the poverty rate demonstrated a significant relationship with amputation in univariable analysis, this association was not found in multivariable models. Notably, non-White race emerged as a predictor of amputation, underscoring the importance of addressing racial disparities in LE outcomes. Further investigation of potential determinants of LE outcomes is needed, particularly the interaction of such factors with race.

Elevated Altitude and Limestone Soil Promoted Fungal Diversity in Rhizosphere Soil of Sophora japonica

Soil microorganisms play a crucial role in mediating material transformation and nutrient cycling. However, little attention has been paid to the relationships between microbial communities and altitude and lithology in karst regions. Sophora japonica cv. Jinhuai is an officinal plant cultivated in karst areas, and there is a correlation between the dynamics of microbial community and ecological factors. This study examined the diversity of microbial communities in the rhizosphere of S. japonica under different lithologies and altitudes in karst regions of northern Guangxi, China using high-throughput sequencing technology. It was found that the bacterial community consisted of 37 phyla, including Proteobacteria. The fungal community mainly comprised 15 phyla, including Ascomycota. The fungal Shannon and Chao1 indices increased with altitude, while the bacterial Shannon index decreased. The fungal Shannon indices in limestone soil were higher than those in dolomite. The soil’s microbial Shannon and Chao1 indices were positively affected by pH, while the available phosphorus and potassium had the opposite effect. Research shows that altitude, lithology, pH, and available phosphorus were the crucial factors influencing the rhizosphere soil microbial community. This study provides references for understanding the relationship between plants and microorganisms and the microbial distribution strategy of rocky desertification habitats in the future.

The Role of Gut Microbiota in the Etiopathogenesis of Multiple Chronic Diseases.

Chronic diseases (CD) may result from a combination of genetic factors, lifestyle and social behaviours, healthcare system influences, community factors, and environmental determinants of health. These risk factors frequently coexist and interact with one another. Ongoing research and a focus on personalized interventions are pivotal strategies for preventing and managing chronic disease outcomes. A wealth of literature suggests the potential involvement of gut microbiota in influencing host metabolism, thereby impacting various risk factors associated with chronic diseases. Dysbiosis, the perturbation of the composition and activity of the gut microbiota, is crucial in the etiopathogenesis of multiple CD. Recent studies indicate that specific microorganism-derived metabolites, including trimethylamine N-oxide, lipopolysaccharide and uremic toxins, contribute to subclinical inflammatory processes implicated in CD. Various factors, including diet, lifestyle, and medications, can alter the taxonomic species or abundance of gut microbiota. Researchers are currently dedicating efforts to understanding how the natural progression of microbiome development in humans affects health outcomes. Simultaneously, there is a focus on enhancing the understanding of microbiome-host molecular interactions. These endeavours ultimately aim to devise practical approaches for rehabilitating dysregulated human microbial ecosystems, intending to restore health and prevent diseases. This review investigates how the gut microbiome contributes to CD and explains ways to modulate it for managing or preventing chronic conditions.

Prevalence of childhood stunting and determinants in low and lower-middle income African countries: Evidence from standard demographic and health survey.

Undernutrition poses a significant global public health challenge, adversely affecting childhood cognitive and physical development while increasing the risk of disease and mortality. Stunting, characterized by impaired growth and development in children due to insufficient psychological stimulation, frequent infections, and inadequate nutrition, remains a critical issue. Although economic growth alone cannot fully address the prevalence of stunting, there exists a robust correlation between a country's income level and childhood stunting rates. Countries with higher incomes tend to have lower rates of childhood stunting. Notably, while childhood stunting is declining worldwide, it remains persistent in Africa. Consequently, this study aims to assess the prevalence of childhood stunting and its determinants in low- and lower-middle-income African countries. This study conducted a secondary analysis of standard demographic and health surveys in low- and lower-middle-income African countries spanning the period from 2010 to 2022. The analysis included a total sample of 204,214 weighted children under the age of five years. To identify the determinants of stunting, we employed a multilevel mixed-effect model, considering the three levels of variables. The measures of association (fixed effect) were determined using the adjusted odds ratio at a 95% confidence interval. Significance was declared when the association between the outcome variable and the explanatory variable had a p-value less than 0.05. In low and lower-middle-income African countries, 31.28% of children under five years old experience stunting, with a 95% confidence interval ranging from 31.08% to 31.48%. The results from a multilevel mixed-effect analysis revealed that 24 months or more of age of child, male gender, low and high birth weight, low and high maternal BMI, no and low maternal education, low household wealth index, multiple (twin or triplet) births, rural residence, and low income of countries were significantly associated with childhood stunting. Stunting among children under five years of age in low- and lower-middle-income African countries was relatively high. Individual, community, and country-level factors were statistically associated with childhood stunting. Equally importantly, with child, maternal, and community factors of stunting, the income of countries needs to be considered in providing nutritional interventions to mitigate childhood stunting in Africa.

Influence of tree mycorrhizal type, tree species identity, and diversity on forest root-associated mycobiomes.

Understanding the complex interactions between trees and fungi is crucial for forest ecosystem management, yet the influence of tree mycorrhizal types, species identity, and diversity on tree-tree interactions and their root-associated fungal communities remains poorly understood. Our study addresses this gap by investigating root-associated fungal communities of different arbuscular mycorrhizal (AM) and ectomycorrhizal (EcM) tree species pairs (TSPs) in a subtropical tree diversity experiment, spanning monospecific, two-species, and multi-species mixtures, utilizing Illumina sequencing of the ITS2 region. The study reveals that tree mycorrhizal type significantly impacts the alpha diversity of root-associated fungi in monospecific stands. Meanwhile, tree species identity's influence is modulated by overall tree diversity. Tree-related variables and spatial distance emerged as major drivers of variations in fungal community composition. Notably, in multi-species mixtures, compositional differences between root fungal communities of AM and EcM trees diminish, indicating a convergence of fungal communities irrespective of mycorrhizal type. Interestingly, dual mycorrhizal fungal communities were observed in these multi-species mixtures. This research underscores the pivotal role of mycorrhizal partnerships and the interplay of biotic and abiotic factors in shaping root fungal communities, particularly in varied tree diversity settings, and its implications for effective forest management and biodiversity conservation.

Analisis Yuridis tentang Aktivitas Pembelian Bahan Bakar Minyak (BBM) di SPBU Menggunakan Jeriken untuk Dijual Kembali Ditinjau dari Undang-Undang Nomor 22 Tahun 2001 tentang Minyak dan Gas Bumi

Law Number 22 of 2001 concerning Oil and Gas that oil and gas business activities are divided into two, namely upstream business activities and downstream business activities. The activity of buying and selling fuel oil is usually in retail form which is put in a glass bottle with a liter size that will be sold to buyers who have previously been bought by sellers from gas stations where fuel oil (BBM) is one of the important elements in fulfilling the community's economy. Based on the initial observations of researchers, especially in Kupang City, retail fuel oil sellers cannot be calculated so much and usually, these retail fuel oil sellers sell in front along the road or in ordinary places, vehicles pass by by setting up mini kiosks or workshops. Therefore, researchers formulate the main problems, namely: (1) How is the implementation of legal regulations related to the act of purchasing fuel oil (BBM) at gas stations using jerry cans for resale in terms of Law Number 22 of 2001 concerning Oil and Gas? (2) What are the factors that hinder the police in handling the activity of purchasing fuel oil (BBM) using jerry cans at gas stations in terms of Law Number 22 of 2001 concerning Oil and Gas? This research is a research that uses the Empirical Juridical method. This research is a legal research conducted by researching regulations, primary data, documentation studies. The research aspects studied are Law Number 22 of 2001 concerning Oil and Gas, legal factors, law enforcement factors, facilities and facilities factors, community factors, buying and selling fuel oil, cultural factors. The results of the study found that: (1) Law Number 22 of 2001 concerning Oil and Gas in its implementation has not run well and is less firm against people who abuse fuel oil (BBM); (2) Factors that become obstacles for the police in handling fuel purchase activities are legal factors, law enforcement factors, facilities and facilities factors, community factors and cultural factors.

Barriers to dental utilization among Medicaid-enrolled young children from primary care practices in Northeast Ohio.

To evaluate the individual and community factors that contribute to dental utilization among young children on Medicaid utilizing the Anderson Model and the Socio-Ecological Framework. This observational cross-sectional study was conducted using baseline data (socio-demographics, clinical dental need) from a cluster-randomized hybrid effectiveness-implementation trial among 1021 child-parent dyads recruited from primary care practices across northeast Ohio. The baseline data were then linked to dental Medicaid claims data (categorized as any dental visit, volume, and type in the past 12 months) and ICD-10 codes from the child's EHR data (individual-level) together with Dental Health Provider Shortage Area (HPSA) status and Area Deprivation Index (ADI) which were obtained at the neighbourhood-level using home address of each dyad (community-level). Multivariable analyses using generalized estimating equations (GEE) accounted for clustering by practice, and models included individual-level alone, and individual + community-level factors to evaluate their effects on dental utilization. Medicaid claims data indicated that among the 1021 children (mean age: 4.3 ± 1.1 years; 54.4% males; 43.8% Black, Non-Hispanic), a majority of children were seeing the dentist at least once a year by the age of 4 (56.1%). The mean ADI of their neighbourhoods was 109.22 (20.2) and 27.5% lived in a HPSA area. The GEE analyses revealed that individual factors such as older children, parents being married, and continuous Medicaid enrollment were associated with significantly higher dental utilization. Among community factors, being in a HPSA had an OR = 1.53 (CI: 1.03, 2.27) associated with higher dental utilization. Being in a HPSA was associated with higher dental utilization possibly due to dentists or safety net dental clinics in these areas accepting Medicaid-eligible children.

Exploring a Moderation Analysis in the Interactive Relationship between the Determinants of ITN use in Ghana. A Multi-Level Analysis Based on the DHS 2019 Malaria Indicator Survey

Background: Insecticide-treated mosquito net (ITN) use is considered a highly efficient vector-control strategy for reducing malaria transmission and while this tool is widely available in vast malaria-endemic areas, there is still a gap in determining its effective use given household access and ownership. Malaria analysis posits that although the availability of ITNs in a household is a prerequisite for use, it does not determine its effective use. Rather, the determinants of ITN use are a result of the complex interplay of factors at the various socioecological levels (i.e., the individual, household, community, and net levels). These complexities are context-specific and shape the behavioral choices of ITN users. This study explores the context-specific factors associated with ITN use and focuses on the interactive relationships among the individual determinants of ITN use. A conceptual approach is developed to test the interactive effect of ITNs in the household on the relationship between the number of children under five years and ITN use by household members in Ghana. Method: Survey data with a sample size of 10,997 were drawn from the Ghana 2019 Demographic and Health Survey and the 2020 Malaria Indicator Survey to analyse the interactive relationship among individual, household, community, and net level variables. The relationship between these variables was assessed in a multivariate setting via a linear regression model. A further analysis involved a moderation effect of the number of ITNs on the relationship between the number of children under five years and household members´ ITN use using a single moderation model. Results: From the data analyses, the number of children under five years was positively associated with household members' ITN use (OR = 0.29, p < .001), and the number of ITNs was negatively associated with ITN use (OR = -06, p < .05) and was positively associated with the number of children under five years (OR = .23, p < .05). Gender was positively associated with ITN use and the number of children under five years and negatively associated with the number of ITNs. Increasing age was associated with decreased ITN use, number of children, and number of ITNs respectively. An increasing wealth index was associated with decreased ITN use, the number of children under five years, and the number of ITNs. The region was not significant with ITN use but associated with the number of children under five years. Place of residence was associated with ITN use, number of children under five years, and number of ITNs. A moderation effect of the number of ITNs (OR = -.05, p < .001) on the relationship between the number of children under five years and household members' ITN use was reported. Conclusion: The number of children under five years influenced household members´ ITN use but this relationship was moderated by the number of ITNs in the household. The proportion of the number of children under five years was moderately different for a high and low household ITN availability whereby ITN use decreased with higher ITN ownership and increased with lower ownership. Future research should focus on more moderation analysis to better understand the complexity of interactions between individual, household, community, and net-level factors that determine ITN use. This might help to better understand and engage better-targeted action in increasing effective ITN use in households relevant to their needs.

Resilience among Caregivers of the Pediatric Cancer Patients

Abstract Backgound: Studies portray that one in every nine Indians develops cancer during their lifetime. Admissions to the Pediatric Oncology departments are increasing like any other department. Cancer affects not only the patients but also their caregivers both physically and psychologically. Aims and Objectives: In this scenario, the study aims to understand the caregivers’ level of resilience and the associated risk and protective factors. Materials and Methods: This descriptive study was conducted in Kerala. Sixty caregivers of the children in the age group between 1-17 years, diagnosed with cancer were selected for the study. Mexican Resilience Scale and self-prepared interview schedule were used to collect the quantitative data. Qualitative data were collected using an in-depth interview guide. Results: The study found that the majority of the respondents are moderately resilient, with men exhibiting higher resilience than women. The prime factors contributing to resilience were identified as strength and self-confidence, social competence, family support, social support, and structure. The study further identified individual factors (flexibility, emotional stability, etc.), familial factors (positive family environment), and community factors (support from NGOs and support groups, etc.) as protective factors contributing to resilience. Additionally, the study revealed how individual (lack of emotional stability, introverted nature, etc.), familial (relationship issues), and community (social perceptions about the disease) levels of risk factors impact resilience. Conclusion: The importance of strengthening the support systems around the caregivers and importance of oncology social worker to deal with the psychosocial issues of patients and caregivers are also discussed in this paper.

Transforming Public Libraries into Community Centers: Case of Iran

ABSTRACT The purpose of this research was to identify and rank social factors effective in transforming Iran’s public libraries into social centers and develop a conceptual model. This is a mixed research conducted with a systematic grounded theory approach. Four effective community factors in transforming public libraries into community centers were identified: 1. promotion of social activities, 2. participation of public groups, 3. awareness of the community situation, and 4. promotion of community skills. By applying the theory of the public sphere, public libraries can inform people about government decisions and facilitate public debate between the government and citizens.