Unveiling the anxiety about teaching math in Spain: A psychometric study of MAST15 and MTAS19 instruments.

Uptake and performance of self-collection offered through primary care to all eligible participants in a national cervical screening programme in Australia: a retrospective cohort study.

Green space, blue space and psychological distress in regional Australia: Cross-sectional and longitudinal analyses.

Maternal mortality in the United States disproportionately affects racial minorities and rural populations, yet limited research examines how these factors intersect to compound risks. We conducted a systematic review of four databases (PubMed, CINAHL, Google Scholar, Scopus) from 2015 to 2023, identifying studies that analyzed maternal mortality disparities by both race and geography in the United States. Using predetermined inclusion criteria, we extracted data on study design, population characteristics, and outcomes. A descriptive synthesis was performed due to methodological heterogeneity across studies. Seven studies met inclusion criteria, drawing from national surveillance systems, state health departments, and hospital databases across diverse geographic regions. All studies documented significantly higher maternal mortality among Black women compared to White women, with adjusted odds ratios ranging from 1.65 to 1.81. Rural areas showed pregnancy-related mortality ratios up to 60% higher than large metropolitan areas. Intersectional analyses revealed a "double disparity" pattern where racial minorities in rural or socioeconomically disadvantaged areas faced compounded risks. Black women experienced 3.4 times higher pregnancy-related mortality across all geographic settings, while the most deprived neighborhoods showed 78% higher odds of severe maternal outcomes. Insurance gaps, particularly postpartum Medicaid coverage loss, emerged as a critical contributing factor. The intersection of racial minority status and rural residence creates compounded maternal mortality risks. Interventions must simultaneously address systemic racism in healthcare and expand rural obstetric services while ensuring continuous postpartum insurance coverage.

This paper evaluates how English as a medium has played out in digital storytelling practices and how it engages with the local languages in South Punjab which is a diverse linguistic and socioeconomically disadvantaged area of Pakistan. Based on poststructuralist views on language, identity, and investment, the study takes a qualitative design using the narrative inquiry, critical discourse analysis, and multimodal analysis. The sampling method used was purposive, and three locally produced digital vlogs posted on social media sites were chosen in which spoken storytelling is combined with visual representation and audio. The review indicates that English has been employed strategically and selectively as opposed to being a dominant language of narration. It is mainly a symbolic and a practical resource of digital literacy, modernity, aspiration, and a broader audience reach whereas Saraiki, Punjabi, and Urdu are the key to emotional expression, identity anchoring, and cultural representation. The results also show that code-switching between languages is strategic and structurally diffused and is a product of a complementary multilingual ecology and not a linguistic displacement. Digital storytelling by the English in South Punjab can therefore be seen as a place of negotiation of identity wherein the local and the global are developed simultaneously. The paper has added to the sociolinguistic and applied linguistic research by anticipating the fringe voices and emphasizing how marginalized groups make use of English in the digital community to facilitate power, identity, and cultural maintenance.

The effectiveness of collaborative care for treating depression in primary care has been well-established in high-income countries and, more recently, in a few trials in low- and middle-income countries(LMICs). However, evidence for its effectiveness, costs and how it can be implemented in 'real-world' settings within resource-constrained health systems in LMICs is currently limited. We aim to investigate the implementation, clinical and cost-effectiveness of a contextually adapted collaborative care model for depression in primary care clinics in Pakistan. A hybrid type-II effectiveness-implementation cluster randomised controlled trial with embedded process and economic evaluations will be conducted. Twenty-four primary care clinics located in socioeconomically disadvantaged areas of Karachi will be randomly allocated (1:1) using minimisation to either (i) a contextually adapted collaborative care model for depression supported by co-designed implementation strategies or (ii) optimised usual care (routine practice with additional depression screening and provision of information leaflets about depression for those screening positive). Participants aged 18years or above, scoring ≥ 10 on the 9-item Patient Health Questionnaire(PHQ-9) and not under any active treatment for depression, will be recruited. The Reach, Effectiveness, Adoption, Implementation and Maintenance framework will guide our outcome evaluation. The primary clinical outcome will be depression severity, assessed using the PHQ-9 at 6months after participant recruitment. The primary implementation outcome will be 'reach' (proportion calculated as the number of people who participated in depression treatment divided by those eligible for such treatment) using routine, clinic-level aggregated data at 6months. The process evaluation will explore factors such as fidelity, acceptability and sustainability of collaborative care using a mixed-methods approach guided by the Consolidated Framework for Implementation Research. A within-trial economic evaluation will explore the cost-effectiveness of both collaborative care and implementation activities. Individual-level effectiveness outcomes will be analysed using mixed-effect linear regression; and clinic-level implementation outcomes using generalised linear regression. Trial data analysis will be based on an intention to treat principle. If collaborative care is shown to be successfully implemented, clinically, and cost-effective, it will provide health and economic benefits for people with depression presenting in primary care. It will also be a means to strengthen primary care services through a trained workforce that can recognise and manage depression, improve information management systems, and promote evidence-based care. ISRCTN13462277 prospectively registered on 07 October 2024 https://doi.org/10.1186/ISRCTN13462277.

The Aral Sea region is among the territories with the most pronounced and prolonged environmental distress, formed under the influence of natural-climatic and anthropogenic factors. Long-term exposure to adverse environmental conditions is accompanied by the development of chronic environmental stress and the formation of metabolic disorders in the population. This problem is of particular medical and social significance for women of reproductive age, whose health status determines the reproductive potential and demographic sustainability of the region. The article presents the results of an extended analysis of the biochemical status of women of reproductive age living under the conditions of the environmental crisis in the Aral Sea region. It is shown that chronic exposure to environmental risk factors leads to disturbances in protein and lipid metabolism, overstrain of detoxification systems, and the formation of prenosological conditions. The feasibility of using a complex of biochemical indicators in the system of preventive health monitoring of populations in environmentally disadvantaged areas is substantiated.

Despite availability of effective diabetes medications, 27% of Israeli patients did not reach glycemic control goals in 2019. Financial hardship markedly impacts diabetes management. The American Diabetes Association recommends financial incentive initiatives as part of quality improvement programs. We investigated the impact of a conditional reduction in medication out-of-pocket costs vs standard payment on glycemic control. A total of 186 patients with uncontrolled type 2 diabetes were recruited from neighborhoods having low socioeconomic status and randomly assigned to an intervention group or a control group. Patients in the intervention group were offered a discount on drug expenses (up to 600 new Israeli shekels or US $156, distributed through vouchers redeemable at pharmacies) that was conditional on improved glycemic control. Patients in the control group paid for their medications as usual. At baseline, study participants had a mean glycated hemoglobin (HbA1c) level of 9.1%. The mean reduction in HbA1c level at 6 months in per protocol analysis was 1.4% (95% CI, 1.1%-1.7%) in the intervention group and 0.7% (95% CI, 0.3%-1.0%) in the control group (P <.001). Multivariate linear regression analysis also demonstrated a significant difference in HbA1c reduction between groups (difference = 0.7%; 95% CI, 0.3%-1.2%;P = .001) after controlling for age, sex, baseline HbA1c level, body mass index, societal sector, income, education, and diabetes duration. Financial incentives have the potential to enhance diabetes control in populations having low socioeconomic status and could be integrated into health plans as an optional program for patients with chronic disease in disadvantaged areas.

ABSTRACT This cross-sectional study examined 156 children from a disadvantaged area in Hungary. Food security was assessed using the USDA 6-item module. Data were analyzed using the Mann – Whitney U-test and Spearman’s correlation. Higher maternal education was associated with higher home availability of vegetables served with dinner (r = 0.259). Fruit (r = 0.293) and cooked vegetable intake (r = 0.273), parental demand (r = 0.318), and allowance for fruit (r = 0.233) and vegetable consumption (r = 0.225) were significantly lower in food-insecure households. These findings highlight that social determinants and the home food environment may influence children’s diets.

The extent to which inpatient hospital costs for children and young patients (CYP) from the priority population in Australia differ from their peers is unknown. Using a multivariate analysis approach, this study (1) investigated variations in inpatient hospital costs between priority and non-priority CYP; and (2) identified the associations between CYP patient characteristics and inpatient hospital costs. Priority populations were defined as Indigenous Australian, National Disability Insurance Scheme (NDIS) participants and refugee/asylum seeking CYP. They were identified using electronic medical records (EMRs) within the Sydney Children’s Hospitals Network (SCHN). Data from inpatient hospital admissions (public hospitals) by CYP aged 0–17 years between January 2015 and December 2019 within the SCHN were collected from the EMRs. This study employed mixed-effects generalised linear models (GLMMs) with a log-link function and gamma distribution to investigate patient factors associated with inpatient hospital costs. The model incorporated demographic characteristics, socioeconomic and location variables, and hospital admission severity as covariates. Gender (females 1.03 times higher than males), area of residence (1.12 times higher) (non-major city vs. major city) and socioeconomic status (1.04 times higher) (living in socially disadvantaged areas vs. living in less disadvantaged areas) were significantly associated with inpatient hospital costs. Priority CYP who were Indigenous Australian (1.07 times) and NDIS participants (1.02 times) were associated with substantially higher costs compared to those who were non-Indigenous Australian or non-NDIS participants, respectively. Australian CYP with multiple disadvantaged social statuses (priority CYP living in non-major cities) were associated with higher inpatient hospital costs. Reducing health disparities for priority CYP presents a potential opportunity to lower overall hospital inpatient costs in Australia.

Inequalities in survival among children with central nervous system cancers and neuroblastoma: A population-based study.

Addressing inequalities in maternal and newborn health is a UK public health priority. Evidence on effective multi-interventional strategies is urgently needed. This study evaluated the impact of community-based midwife continuity of care (CBMCOC) models for women and babies in ethnically diverse and socially disadvantaged areas of South London. We conducted a prospective cohort study using the eLIXIR, Born in South London, maternity-child data linkage. United Kingdom. Pregnant women exposed to CBMCOC and standard care between 2018 and 2020. Propensity score matching (1:4) was used to account for differences between CBMCOC and standard care cohorts and control for confounding bias. Conditional logistic regression estimated risk ratios. Subgroup analysis included women of Black, Asian and other ethnic minority groups, and those living in highly deprived areas. The primary outcome was preterm birth (< 37 weeks' gestation). Secondary outcomes included other relevant maternal, perinatal, process and clinical variables. Before matching, 12 386 women were exposed to standard care and 1338 to CBMCOC; after matching, 5352 and 1338 were included, respectively. The risk of preterm birth was lower among women exposed to CBMCOC (unmatched: 4.6% vs. 10.3%, RR = 0.50, 95% CI: 0.38-0.64; matched: 4.6% vs. 8.4%, RR = 0.54, 95% CI: 0.40-0.70). Subgroup analyses showed reduced preterm birth rates among ethnic minority women and those in deprived areas when exposed to CBMCOC. In this diverse population with a range of risk factors, locality-based interventions integrating community-based care and midwife continuity may reduce maternal and newborn health inequalities. Further trials of such models should be conducted.

The increasing prevalence of dementia is expanding the role of primary care in its management. However, inequities exist in primary care for people with dementia, particularly with socioeconomic status. Individuals from socio-economically disadvantaged areas are underrepresented in research on this topic. To explore primary care experiences of people with dementia and their carers from socio-economically disadvantaged areas. Qualitative interviews with people with dementia and their carers recruited from Index of Multiple Deprivation (IMD) quintile 1 or 2 postcodes. We undertook 20 semi-structured interviews. Participants were purposively sampled by postcode via the Join Dementia Research Database. Participants were aged >18 years, with any type of dementia or were a carer for someone with dementia. Data were analysed using reflexive thematic analysis. We identified four interrelated themes. These were: maintaining identity amidst impending loss, the paradox of healthcare support dropping away as needs increased, navigating the complex primary healthcare system, and uncertainty about where dementia healthcare sits within general practice. Views about the impact of socio-economic disadvantage varied. Some participants felt local resources, or individual social capital affected healthcare they received. Changes in primary care, including proactive contact, clearer communication of dementia-related care and consistent relationships could improve patient experience. Clarifying primary care's role in dementia management is essential, especially with proposed shifts towards primary care-led post-diagnostic support. Further work is needed to establish if these experiences are described by people with dementia across all social-strata or are specific to areas of socio-economic disadvantage.

Association between comorbid anxiety and depression symptomatology, quality of life, social support and use of mental health services in youth from Bogota, Buenos Aires, and Lima

The primary aim of this study was to provide a technology addiction education program to parents of children aged 9-15 residing in a socioeconomically disadvantaged region and to measure the program's subsequent impact. A mixed-methods approach was employed in the research design. The qualitative phase of the study involved pre-test and post-test interviews, while the quantitative phase utilized the "Parental Attitudes Towards Children's Use of Information and Communication Technologies Scale," the "Internet Addiction Scale," and the "Family-Child Internet Addiction Scale." The study was conducted with parents attending a family life academy located in a socially disadvantaged area within Ankara, the capital of Turkey. The technology addiction training program, developed by the researchers, was administered to the parents over one day in two separate sessions. The results indicated a statistically significant difference in parents' attitudes towards Information and Communication Technologies in favor of the post-test scores. Furthermore, the findings demonstrated an increase in parental knowledge levels regarding technology addiction, and parents frequently utilized the concept of "conscious technology use" in their post-intervention discourse. Based on these findings, it is recommended that the technology addiction education program be offered for longer durations and be more widely disseminated. Keywords: Parents, Disadvantaged families, Addiction.

Community resilience is a relevant concept in public health, but its empirical relationship with health outcomes remains underexplored. This study examines whether a Community Resilience Index (CRI) is associated with population health outcomes in England, and whether it offers explanatory added value beyond the Index of Multiple Deprivation (IMD). The CRI comprises 44 indicators reflecting community-level resilience to chronic stressors. Associations between CRI scores and five health outcomes, deaths of despair, cardiovascular disease (CVD) mortality, COVID-19 mortality, excess all-cause mortality during two waves of COVID-19 and self-rated health were assessed at local authority district level. IMD was adjusted to remove health-related indicators. Linear regression models assessed the explanatory power of the CRI and IMD, using likelihood ratio tests to compare model fit. Interaction and stratified analyses explored effect modification by IMD. Higher CRI scores were associated with lower Deaths of Despair and CVD mortality, and higher self-rated health; these associations remained significant after adjusting for IMD. CRI was not significantly associated with COVID-19 outcomes. IMD remained the stronger predictor of health outcomes, but CRI significantly improved model fit. The interaction between CRI and IMD was significant for deaths of despair and self-rated health. Stratified analyses showed the CRI-deaths of despair association was strongest in more deprived areas. Community resilience is associated with health outcomes in England. While not a substitute for deprivation-based measures, resilience indices offer complementary insight into structural and social factors shaping health. Resilience-building efforts may be particularly impactful in areas of greatest disadvantage.

Economic evaluation of participation in community led organisations for individuals living in disadvantaged areas in the UK.

Preparation, Participation and Impact (PPI): the best practice principles of Place-Based Approaches (PBAs).

Indonesia's educational transformation faces complex challenges in preparing a generation capable of competing in the global era. This research examines the implementation of the Merdeka Curriculum as a strategic response to 21st-century learning needs through a systematic literature review approach. The study focuses on three fundamental aspects: policy implementation practices across various educational institutions, identification of supporting and inhibiting factors in learning transformation, and evaluation of impacts on student competency improvement. The research method employs a qualitative approach with content analysis techniques on scientific literature from 2021-2025 sourced from national and international journals and official policy documents from the Ministry of Education, Culture, Research, and Technology. Data analysis was conducted through content analysis techniques encompassing reduction, data presentation, and conclusion drawing. Findings reveal that Merdeka Curriculum implementation successfully integrates 4C skills through project-based learning and differentiation that accommodates diverse student characteristics. Principal leadership, teacher competency, and Platform Merdeka Mengajar support emerge as key success elements, while infrastructure limitations, inter-regional digital gaps, and human resource readiness remain significant obstacles. Positive impacts are evident in improved student literacy and numeracy, character strengthening through the Pancasila Student Profile, and teacher role transformation from teacher-centered to student-centered approaches. This research recommends strengthening continuous mentoring systems, equalizing access to learning technology, and affirmative policies for disadvantaged areas to accelerate inclusive and quality educational transformation throughout Indonesia.

Social drivers of health (SDOH) are nonmedical factors that influence health outcomes. We aim to evaluate if there are differences in MR enterography (MRE) utilization among the various zip codes surrounding UMass Memorial Medical Center in Worcester, MA stratified by various SDOH. In this HIPAA compliant IRB approved retrospective population-based study, MRE utilization for patient zip codes within a 10 mile radius of UMass Memorial Medical Center was determined by dividing the number of MREs performed from 01/08/2018 to 07/27/2022 by the population for each zip code. Data on median household income (MHI), population in poverty (PIP), health insurance status, race and ethnicity, and transportation access was collected from the United Census Bureau and data on social vulnerability index (SVI) was collected from the Centers of Disease Control for each zip code. Disadvantaged zip codes for each SDOH were defined as zip codes in the bottom quartile for MHI and the top quartile for the remaining SDOH. MRE utilization was compared between the two groups for each SDOH by one-way analysis. The mean MRE utilization for the included zip codes was 1.1 MRE per 1000 capita over the study period of 55 months. The MRE utilization was lower for the disadvantaged zip codes stratified by each studied SDOH. The largest difference in MRE utilization was identified between disadvantaged zip codes and non-disadvantaged zip codes stratified by SVI and percentage of population without a car, at 0.5 MRI per 1000 capita. Individuals living in disadvantaged areas have lower rates of MRE utilization, which is commonly used in the evaluation of inflammatory bowel disease (IBD). Disparate utilization of MRE could lead to disparities in outcome for those with IBD.