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Analysis of consumer purchase intentions using functional near-infrared spectroscopy(fNIRS): A neuromarketing study on the aesthetic packaging of Korean red ginseng products

Purpose This study investigates the consumer behavior patterns for Korean red ginseng products using functional near-infrared spectroscopy (fNIRS), a neuroimaging device. By measuring brain activities, we aim to develop neuromarketing techniques and provide insights into consumer purchasing decisions influenced by the aesthetic features of product packaging. Methods Using an fNIRS device, we measured the hemodynamic responses of 50 healthy participants within the prefrontal cortex (PFC) during virtual purchase-response paradigm experiments. These experiments consisted of two scenarios depending on the purpose of purchasing red ginseng products; purchasing for self-consumption and purchasing as gifts for others. These two purchase scenarios were designed to elucidate the relationship between two purchasing scenarios and aesthetic product packaging. Results We observed distinct differences in purchasing behavior between the two scenarios influenced by the packaging of red ginseng products. We found significantly higher prefrontal ∆HbO activation during the gift-giving condition (Task 1) compared to self-consumption (Task 2). Survey results also indicated greater purchase intention (M = 4.35) and great packaging satisfaction (M = 4.18) in Task 1 (p < 0.01) compared to Task 2. No significant differences were observed across gender or age groups. These findings suggest that packaging has a differentiated effect depending on the purchasing context. Conclusions Our findings highlight the need for customized marketing strategies while proposing separate packaging designs for self-consumption and gifts. This study demonstrates the potential of neuromarketing technology based on fNIRS in predicting consumer behavior and improving marketing strategies. Significance Understanding the neural mechanisms of purchasing decisions enables Korean health functional food companies to align their marketing strategies with consumer preferences, thereby enhancing both sales performance and customer satisfaction.

Pandemic-related experiences of older adults and people with disabilities

The COVID-19 pandemic has had wide reaching effects especially for people with disabilities. Drawing on Sen’s Capability approach, we explored experiences of people with disabilities and older adults using semi-structured interviews that were conducted three to four months after the pandemic was declared. We recruited 71 adults from British Columbia, Canada: adults with spinal cord injuries (n = 22), adults who have experienced a stroke (n = 26), adults with general disabilities (n = 13), and older adults (over the age of 65) without reported disabilities (n = 10). Our analysis identified one overarching theme: “navigating the new normal: the societal reconfiguration of functionings and capabilities” described the challenges and successes participants experienced during pandemic-related restrictions and regulations. This theme encapsulated three sub-themes: 1) “Trying to stay connected: resuming functionings via alternative means,” 2) “Worrying about future capability opportunities,” and 3) “Wanting to exert control in the face of constrained capabilities.” The pandemic created unique challenges for people with disabilities. The capability approach appears to be a helpful lens to interpret pandemic restrictions among people with disabilities, which could inform future policy.

Adjuvants to improve efficacy of miticides in managed honey bee (Apis mellifera) colonies to control Varroa destructor

Beekeepers must manage Varroa destructor mites to maintain colony health. Large-scale beekeepers often use chemical treatments (miticides) to manage this pest. Miticide resistance drives a need for compounds with alternative modes of toxic action that can be used in rotation as part of a Varroa management plan. This research aimed to determine the efficacy of oxalic acid, clove oil, and fenpyroximate when delivered in glycerin soaked in strips and combined with a range of bee-safe adjuvants. Adjuvants are a group of compounds used in plant pesticide applications to increase the spreading and penetration of a pesticide. Laboratory cage trials tested a miticidal active ingredient (oxalic acid, clove oil, or fenpyroximate) and an adjuvant (Ecostep BC-12 ® , Ecostep SE-11 ® , Ecostep AE-13 ® , Ecostep CE-13 ® , or Silwet L-7500 ® ) in glycerin-soaked strips. Field trials evaluated the best performing active ingredient-adjuvant combination from cage trials, oxalic acid combined with Ecostep BC-12 ® adjuvant in glycerin-soaked strips. Neither glycerin control, oxalic acid alone, or oxalic acid with adjuvant caused a significant change in Varroa per 100 bees in field trial year 1, when starting Varroa levels were high (average 11.8 Varroa per 100 bees across all treatment groups). In year 2, when starting Varroa levels were low (average 0.58 Varroa per 100 bees across all treatment groups), Varroa per 100 bees increased 2.6-fold for the glycerin control and 2.8-fold for oxalic acid alone, while a 29% reduction was observed in the oxalic acid with adjuvant treatment. Additionally, mite drop data indicated increased speed for the miticidal effect when an adjuvant is included with oxalic acid. This research informs formulation chemistries for oxalic acid and other miticides to help beekeepers maintain healthy hives.

Global burden of metabolic-associated fatty liver disease among women of childbearing age: Trends from 1990 to 2021 and projections to 2040

Background Metabolic-associated fatty liver disease (MAFLD) is a growing global health concern, particularly among women of childbearing age (WCBA). We aimed to analyze the global burden of MAFLD among WCBA from 1990 to 2021 and project trends to 2040. Methods Data on incidence, prevalence, deaths, and disability-adjusted life years (DALYs) were extracted from the Global Burden of Disease Study 2021. Joinpoint regression and decomposition analysis were used to assess historical trends, and Bayesian Age-Period-Cohort (BAPC) modeling projected future burdens. Results From 1990 to 2021, the age-standardized rate (ASR) of MAFLD incidence and prevalence among WCBA increased globally (EAPC = 0.76 and 0.71, respectively). China showed declining trends in deaths (EAPC = −2.63) and DALYs (EAPC = −2.62). By 2040, BAPC modeling predicts a continued rise in global incidence and prevalence, with regional disparities in mortality. Population growth was the primary driver of the global increase in MAFLD incidence, accounting for 63.38% of the rise. Conclusion MAFLD imposes a significant burden on WCBA globally, with socioeconomic disparities driving regional variations. Targeted interventions addressing obesogenic environments and healthcare inequities are urgently needed.

Enhanced cardiovascular risk prediction in the Western Pacific: A machine learning approach tailored to the Malaysian population

Background Cardiovascular disease (CVD) is a significant public health challenge in the Western Pacific region, including Malaysia. Objective This study aimed to develop and validate machine learning (ML) models to predict 10-year CVD risk in a Malaysian cohort, which could serve as a model for other Asian populations with similar genetic and environmental backgrounds. Methods Utilizing data from the REDISCOVER Registry (5,688 participants from 2007 to 2017), 30 clinically relevant features were selected, and several ML algorithms were trained: Support Vector Machine (SVM), Logistic Regression (LR), Random Forest (RF), Extreme Gradient Boosting (XGBoost), Neural Network (NN) and Naive Bayes (NB). Ensemble model were also created using three commonly used meta learners, including RF, Generalized Linear Model (GLM), and Gradient Boosting Model (GBM). The dataset was split into a 70:30 train-test ratio, with 5-fold cross-validation to ensure robust performance. Model evaluation was primarily based on the Area Under the Curve (AUC), with additional metrics such as sensitivity, specificity, and the Net Reclassification Index (NRI) to compare the ML models against traditional risk scores like the Framingham Risk Score (FRS) and Revised Pooled Cohort Equations (RPCE). Results The LR model achieved the highest AUC of 0.77, outperforming the FRS (AUC = 0.72) and RPCE (AUC = 0.74). The ensemble model provided robust performance, though it did not significantly exceed the best individual model. SHAP (SHapley Additive exPlanations) analysis identified key predictors such as systolic blood pressure, weight and waist circumference. The study showed a significant NRI improvement of 13.15% compared to the FRS and 7.00% compared to the RPCE, highlighting the potential of ML approaches to enhance CVD risk prediction in Malaysia. The best-performing model was deployed on a web platform for real-time use, ensuring ongoing validation and clinical applicability. Conclusions These findings underscore the effectiveness of ML models in improving CVD risk stratification and decision-making in Malaysia and beyond.

Carbon and oxygen isotope evidence for a protoplanetary disk origin of organic solids in meteorites

Macromolecular organic solids found in primitive meteorites were the main source of carbon delivered to forming planets in the early Solar System. However, the conditions under which this material formed and its subsequent incorporation into growing planetesimals remains a subject of vigorous debate. Here, we show that C isotope variations among these organics in most carbonaceous chondrites are strongly correlated with mass-independent O isotope anomalies exhibited by their host meteorites. As the latter signature has been argued to track abundances of nebular water generated from photochemical processing of CO gas, the C isotope variability of refractory organic solids may relate to this same process. We propose a framework in which CO photolysis simultaneously produces H 2 O and generates a pool of C + ions that serve as precursors for C-rich organic solids, with their C isotope compositions suggesting formation over a relatively narrow and warm range of temperatures in the protoplanetary disk (~200 to 400 K). Two populations of organic precursors with different C isotope compositions became associated with distinct dust reservoirs prior to their delivery to the carbonaceous-chondrite-forming region, which likely resided at lower temperatures (<170 K). This finding places detailed constraints on the location and distribution of chemical reactions that generated both water and organic-rich reservoirs in the early Solar System.

Will the inclusion of AI anchors enhance the operational performance of live streaming e-commerce supply chains?

With the rapid growth of the live streaming e-commerce market, traditional live streaming models are encountering mounting challenges, whereas the advent of artificial intelligence (AI) technology has breathed new life into live streaming. This paper delves into the role of the AI anchor and model selection in scenarios both with and without the involvement of the Key Opinion Leader (KOL). Specifically, the AI anchor, whether invested in by the brand or the live streaming platform, is integrated into the regular anchor model (Model NN) and the hybrid model combining the KOL and the regular anchor (Model NK). A series of Stackelberg game models are formulated to compare the sales effort level, AI intelligence level, anchor influence, and the proportion of live streaming time on live streaming e-commerce. The findings suggest that the AI anchor can effectively substitute for the human anchor under certain conditions, particularly when the brand controls the AI intelligence level. To further explore the impact of the AI anchor on decision-making and profits among supply chain participants, the paper offers a thorough analysis of decisions and profits in scenarios both with and without KOL involvement. The results disclose that, under suitable conditions, the incorporation of the AI anchor can substantially enhance the operational efficiency of live streaming e-commerce supply chains, leading to increased profitability for the brand. Notably, the allocation of live streaming time between different anchors in hybrid models significantly influences the profitability of supply chain members. This discovery provides crucial insights for brands in devising live streaming strategies.

Clinical characteristics and resource utilization of emergency department patients with obstructive sleep apnea

Background This study investigates the differences between patients with and without obstructive sleep apnea (OSA) in U.S. emergency departments (EDs), focusing on demographics, resource utilization, clinical characteristics, and outcomes. Methods Using data from the 2016−2017 National Hospital Ambulatory Medical Care Survey Emergency Department Subfile (NHAMCS-ED), we analyzed adult ED visits. Patients were classified as having OSA based on documented diagnoses or ICD-10-CM codes. Outcomes included hospital and ICU admission rates, medical resource utilization (e.g., imaging, blood tests), and mortality. Logistic regression was used to adjust for confounders. Results OSA accounted for approximately 5,985,955 (2.8%) annual ED visits. Compared to non-OSA patients, those with OSA were more likely to be male (adjusted OR: 1.34, 95% CI: 1.14–1.57) and older, with the highest prevalence in the 60–74 age group. OSA patients were more likely to visit for respiratory (16.4% vs. 10.1%) and cardiovascular symptoms (3.5% vs. 2.1%). They required higher levels of care, with elevated hospital (30.3% vs. 13.7%, adjusted OR: 1.27, 95% CI: 1.03–1.58). Resource use was significantly higher, including blood tests (75.0% vs. 54.9%, adjusted OR: 1.58, 95% CI: 1.26–1.98) and imaging (73.1% vs. 53.9%, adjusted OR: 1.30, 95% CI: 1.07–1.59). Conclusions Patients with OSA represent a distinct subgroup in EDs, characterized by greater resource needs, higher acuity, and worse outcomes. These findings underscore the importance of optimizing care strategies for this population to reduce the clinical and economic burden.

Informing a governance model for integration of community pharmacists and family physicians and nurse practitioner-led practices and teams within Ontario Health Teams: A protocol

Background The expansion of the scope of practice for community pharmacists has the potential to improve timely access to primary care. However, overlapping scopes of practice with family physicians (FPs) and nurse practitioners (NPs) have the potential for duplication of services or fragmented care. To optimize the benefits of this change, clear integrated governance mechanisms are needed to define roles, responsibilities, and accountabilities between providers. To date, there is no research on integrated governance models for independent primary care provider organizations. Objective To develop a governance model that will enable better integration of community pharmacists with FPs and NPs within Ontario Health Teams. Methods A multi-method study design will be used. A literature review will be conducted to identify innovative programs and policies between community pharmacies, FPs, and NPs. Then, relevant stakeholders will be identified and engaged in key informant interviews to exchange knowledge, identify priorities, and co-create policy and governance strategies. Results The scoping review will identify existing models, gaps, and governance approaches that support or hinder integration. Interviews will explore stakeholder experiences related to integrated governance. A conceptual integrated governance model will be developed based on these findings. Discussion This initiative aligns with the broader mission of improving healthcare services and outcomes in Ontario by establishing a governance model that enables better integration between community pharmacists, FPs, and NPs. This research will support policy and practice innovations to strengthen integrated delivery in Ontario and beyond.

Growth of a newly isolated oleaginous microalgal strain (Asterarcys sp. RA100) in oil produced water and its potential for biodiesel production

The prospects of using produced water (PW), a by-product of oil extraction, as a cultivation medium to not only grow microalgae but also generate value-added by-products has not been much investigated. This study demonstrates the ability of a newly isolated microalga, Asterarcys sp. RA100, for growth in PW and biodiesel production. Although the used PW was slightly alkaline (pH < 10), nutrient deficient and high in boron content, Asterarcys sp. RA100 exhibited good growth with phosphate, and nitrate, reaching optimal growth at 1% salinity, 25°C, 150 rpm, and 4000–8000 Lux LED light intensity. To test for its scalability in a greenhouse, Asterarcys sp. RA100 exhibited areal productivity of 10.3 ± 0.5 g m–2 day–1. Lipid accumulation in Asterarcys sp. RA100 reached 27.0 ± 5.1% of dry weight when grown in PW. The resulting fatty acids methyl esters (FAME) displayed properties aligning with international biodiesel standards. The FAME profiles showed elevated contents of palmitic acid (C16:0), elaidic acid (C18:1n9t), stearic acid (C18:0) and palmitoleic acid (C16:1n7C). This study demonstrates the immense potential of Asterarcys sp. RA100 to grow in PW and to serve as valuable feedstock for biodiesel production thereby, providing an eco-friendly method to re-use PW and sustain future energy demands.

Bank-firm relationships and corporate ESG greenwashing

This study explores how bank-firm relationships and executives with banking backgrounds influence greenwashing among Chinese A-share listed firms, based on Institutional and Agency Theories. Firms with bank shareholding or banking-experienced executives show a higher propensity for greenwashing, driven by executive compensation structures tied to inflated ESG scores. Financialization amplifies symbolic ESG disclosures, while transparency reduces greenwashing. Heterogeneity analysis reveals that non-state-owned enterprises and firms in less financially developed regions are more affected. These findings highlight the need for robust governance and transparency to promote authentic ESG practices, offering insights into mitigating greenwashing in emerging markets.

Impact of joint commission international accreditation on occupational health and patient safety: A systematic review

Objectives To illuminate the benefits of Joint Commission International (JCI) accreditation and other experiences related to the accreditation process in relation to occupational health and patient safety. Design Systematic review Methods We systematically searched CINAHL (n = 77), ProQuest (n = 69), PsycINFO (n = 13), PubMed (n = 166), and Scopus (n = 211) for articles on JCI accreditation published until December 2023. Overall, 290 articles were found. JCI-accredited hospitals with before–after accreditation follow-up processes, hospitals during the accreditation process, and job satisfaction and/or patient safety as the primary outcome measures were included. Non-original articles, articles including non-accredited hospitals, hospitals missing before–after accreditation changes, studies with no follow-up time, hospitals implementing accreditation guidelines but not accredited, non-English publications, reviews, meta-analyses, master theses, and poor-quality studies were excluded. Results Two authors independently applied the above criteria, following which 16 articles were analyzed. Two of these, however, were further excluded due to poor quality; 14 articles were finally included. All the articles were extremely heterogeneous, leaving no possibility for a meta-analysis. Conclusions The impacts of accreditation are significant in underdeveloped than in developed nations where the legal requirements are high. Concerns regarding costs and workload associated with accreditation processes are increasing. Moreover, studies regarding JCI accreditation and its impact on occupational health or patient safety are limited, thus warranting further investigations. PROSPERO registration number: CRD42021275665.

Epac1 increases myosin regulatory light-chain phosphorylation, energetic cost of contraction, and susceptibility to heart failure

β-Adrenergic receptor (β-AR) stimulation of the heart, leading to increased cardiac output, is mediated by cyclic AMP (cAMP), which induces protein kinase A (PKA)-mediated phosphorylation of the myofilament proteins troponin I (TnI) and myosin binding protein-C (MyBP-C). The aim of this study was to investigate the contribution of the exchange protein activated by cAMP (Epac1), a PKA-independent cAMP effector, to the response of cardiac myofilaments to β-AR stimulation. The calcium sensitivity of force and ATPase activity, and the tension cost (ATPase activity/force) were significantly greater in skinned myocardium from transgenic mice specifically overexpressing Epac1 in the heart (Epac1TG) and wild-type (WT) mice treated with 8CPT-AM, an Epac-selective cAMP analogue, as compared with non-transgenic (NTG) or control mice, respectively. In addition, myosin regulatory light chain (RLC) phosphorylation was significantly greater in Epac1TG and WT mice treated with 8CPT-AM than in NTG or control mice via phospholipase C/phosphokinase C, without any change in the phosphorylation of TnI or MyBP-C. We also examined the effects of chronic β-AR stimulation on cardiac function in Epac1TG. The left ventricular ejection fraction was significantly decreased from baseline in both NTG and Epac1TG after isoproterenol infusion (60 mg/kg/day for 1 week), but the magnitude of the decrease was much greater in Epac1TG. Our results suggest that Epac1 activation might induce an imbalance between force-generating capacity and ATPase activity in skinned myocardium. This could increase oxygen consumption and the energetic cost of contraction in living myocardium under conditions of chronic β-AR stimulation, leading to the development of heart failure.

Association between dietary inflammatory and antioxidant potential and systemic inflammatory and oxidative status with the risk and severity of coronary artery disease

Background and aims Unhealthy diets have pro-inflammatory properties that have been shown to contribute to coronary artery disease (CAD). The dietary inflammatory index (DII®) and the dietary antioxidant quality score (DAQS) quantify the anti-/pro-inflammatory and antioxidant potential of a diet. This study aims to investigate the association between the energy-adjusted DII (E-DIITM), DAQS, oxidant/anti-oxidant biomarkers, and CAD risk and severity. Methods and results This cross-sectional study investigated 158 participants for the presence and severity of CAD based on coronary angiography. E-DII and DAQS scores, malondialdehyde (MDA), total oxidant status (TOS), glutathione peroxidase (GPX) activity, total antioxidant capacity (TAC) and conventional cardiometabolic risk factors were assessed. The triglyceride-glucose (TyG) index and mean arterial pressure (MAP) were also calculated. No association was observed between the E-DII or DAQS and the presence or severity of CAD. Based on the final regression models, age (adjusted odds ratio (AOR) =1.07, P = 0.002), male sex (AOR = 5.02, P < 0.001), MAP (AOR = 1.03, P = 0.03), HDL-C (AOR = 1.04, P = 0.06) and hs-CRP (AOR = 1.06, P = 0.045) as well as TOS (AOR = 1.16, P = 0.03) and TAC (AOR = 1.51, P = 0.07) increased and GPX activity (AOR = 0.51, P = 0.07) decreased the odds of having CAD. Male sex (adjusted β (Aβ) =22.04, P < 0.001), age (Aβ = 0.87, P = 0.003), hs-CRP (Aβ = 0.72, P = 0.045) and TOS (Aβ = 2.75, P = 0.003) were associated with higher Gensini scores. Higher GPX activity (Aβ = −10.95, P = 0.03) was associated with lower Gensini scores. Conclusion Biomarkers of oxidative stress, including TOS, TAC, and GPX activity, were associated with the presence, extent or severity of coronary atherosclerosis while no associations were observed for E-DII and DAQS scores.

Correction: Piloting the informed health choices resources in Barcelona primary schools: A mixed methods study

Circulating exosome-circRNAs mediated downregulation of FGF9 through ceRNA mechanism aggravates renal fibrosis in diabetic nephropathy

Diabetic nephropathy (DN) is one of the most serious microvascular complications of diabetes mellitus. It is characterized by progressive tubulointerstitial fibrosis. The aim of this study was to investigate the role of exosomal circular RNA (circRNAs) in regulating fibroblast growth factor 9 (FGF9) expression in DN through a competitive endogenous RNA (ceRNA) mechanism, and to reveal its potential therapeutic targets. Exosomes were isolated from serum of 3 healthy people and 3 patients with DN by ultra-fast centrifugation method, and the circRNA-miRNA-FGF9 regulatory network was constructed by combining high-throughput circRNA sequencing, bioinformatics analysis and weighted co-expression network (WGCNA). The results showed that the expression of circRNAs in serum exosomes of DN patients was significantly down-regulated, and hsa_circ_0006382 and hsa_circ_0019539 targeted the expression of FGF9 by binding to miR-34a-5p, miR-766-3p, miR-147a and miR-27a-3p. Further verification showed that the expression of FGF9 was decreased in renal tissues of DN patients (AUC = 0.902), and its recombinant protein could inhibit the expression of α-SMA and vimentin in high glucose-induced NRK-52E cells, indicating that activation of the circRNA/miRNA-FGF9 network promotes the EMT of renal tubular epithelial cells. This study revealed for the first time the mechanism of the circRNA-miRNA-FGF9 regulatory network in DN fibrosis, providing a theoretical basis for the development of diagnostic markers and targeted therapy strategies based on exosomal circRNA.

The effect of cognitive behavioural therapy on pain and disability in chronic non-specific low back pain: An overview of systematic reviews

Background Low back pain (LBP) is experienced by most people at least once in their lifetime and is the leading cause of disability worldwide. Cognitive behavioural therapy (CBT) is a non-invasive method used to manage chronic non-specific low back pain (CNSLBP) and contains less adverse effects than analgesic medications. Aims To determine the efficacy of interventions incorporating CBT on reducing pain intensity and physical disability in CNSLBP. Methods An overview of reviews without meta-analysis was conducted. Four electronic databases (MEDLINE, Embase, Cochrane Library and PsycINFO) were searched. Adults aged 18 or above with CNSLBP were included. AMSTAR 2 was used to assess risk of bias of included systematic reviews and data synthesis was conducted via vote counting methods. Results Ten systematic reviews were included. Results showed that CBT is more effective in reducing pain and disability compared to waiting list/usual care (WL/UC). CBT in conjunction with other active treatments (AT) are also more effective than some standalone AT such as physiotherapy and exercise, but less effective than surgery. Conclusion CBT has some effect in reducing pain and disability, however, it may not be more effective than other treatments. The quality of evidence was low for most outcomes as there was high risk of bias and heterogeneity between studies. Future research could evaluate specific therapies such as acceptance and commitment therapy (ACT) and mindfulness-based cognitive therapy (MBCT), as these treatments lacked primary studies. There is no recognised standard for conducting CBT, and further research could determine the most effective duration, mode of delivery (e.g., online, group-based) and intensity of CBT.

Electrical circuit model of spatiotemporal trade dynamics: Foundations and derivation of the gravity model

A model of time-dependent trade of goods between spatial locations is formulated via an electric circuit analogy, in which goods are analogous to charge and price to voltage, while producers and consumers are represented by sources and sinks of goods flow, which is represented by current, located at the nodes of a trade network. The core ansatz is that the flow of goods along each network link is driven by the voltage difference across that link, opposed by resistance that represents trade friction. Market prices are then determined indirectly by internal balances of flows, subject to external constraints on supply and demand. The model yields multiple outcomes that support its validity and applicability, including price setting via emergent balance of supply and demand, price fluctuations, traditional and generalized elasticities, network structure-flow relations, competition between producers, and substitution between suppliers, between consumers, and/or between trade links. All these results prove to be consistent with observed features of trade dynamics, thereby supporting the validity of the model. The new model is then used to derive the widely used gravity model of international trade from a mechanistic basis, yielding exponents consistent with published data and leading naturally to core-periphery structure, as observed in real trade networks. The analysis also implies that trade flows self-organize to minimize trade friction in the system as a whole, an emergent global outcome from the purely local dynamics of the populations of producers, consumers, and traders. Possible generalizations and further applications are outlined, including incorporation of asymmetry and capacity limits of trade links, constraints on supply and demand, behavioral responses, and coupling to models of investment strategies.

Factors affecting caregivers’ HPV vaccination decisions for adolescent girls: A secondary analysis of a Chinese RCT

Background Despite the HPV vaccine’s effectiveness against cervical cancer, uptake among adolescent girls in China remains low, with caregivers playing a crucial role in vaccination decisions. This study investigates factors influencing caregivers’ action to vaccinate their adolescent daughters. Methods Pay-it-forward is a novel model that motivates participants in adopting healthy behaviors and making community contributions. In this study, it offers an individual a free shot of HPV vaccine and then asks whether they would like to donate to support another person to get the same vaccination. This study was embedded in a two-arm randomized controlled trial in China. Potential associated factors were identified based on Anderson’s Health Service Utilization Behavioral Model and analyzed through univariate and multivariate binary logistic regression. Caregivers’ information, knowledge, attitudes, vaccine confidence, hesitancy, and willingness to vaccinate were collected through online questionnaires. The endpoint was the receipt of the first dose HPV vaccine following an intervention or no intervention (pay-it-forward vs. standard-of-care), which was obtained from an electronic vaccination registry system. Results Among 321 caregivers, 25.9% of their daughters received the HPV vaccine, with 34.2% in the pay-it-forward group and 17.5% in the standard-of-care group. Daughters of caregivers who were previously unaware of the HPV vaccine were three times more likely to be vaccinated (OR=3.01,95%CI:1.27–7.14). Caregivers who did not intend to delay vaccination had daughters with eight times higher vaccination uptake (OR=8.26,95%CI:4.36–15.67). Participation in the “pay-it-forward” intervention increased vaccination rates by more than twofold (OR=2.22,95%CI:1.19–4.15). Daughters of unemployed or retired caregivers had nearly four times higher vaccination rates compared to those whose caregivers were employed (OR=3.97,95%CI:1.81–8.72). Prior refusal of the vaccine by caregivers was associated with an 80% reduction in vaccination uptake among daughters (OR=0.23,95%CI:0.06–0.81). Conclusion The pay-it-forward intervention, caregivers’ knowledge, intention to delay vaccination, occupation, and prior vaccine refusal significantly influence HPV vaccine uptake among adolescent girls in China. Tailored health education, financial support, and community involvement are essential to encourage HPV vaccination among adolescent girls in China.

“Place-finding” as the key to reintegration after release from prison in older age: A transdisciplinary, holistic and strengths-based reintegration framework using grounded theory

Prisons globally face an ‘ageing epidemic,’ releasing unprecedented numbers of older adults into the community. Research highlights substantial challenges in reintegrating this underserved and marginalised group. Urgent work is needed to understand their needs and develop effective social, criminological, and public health solutions. This study aimed to create a transdisciplinary, strengths-based conceptual framework to understand and begin addressing the reintegration needs of older individuals leaving prison. Applying grounded theory to qualitative data from Australia – including interviews and workshops with stakeholders and individuals with lived experience – resulted in the development of the ‘Place-finding’ conceptual framework. Successful reintegration can be understood in terms of a journey through stages of “institutionalisation,” “crisis,” “survival & adjustment,” and “grounding”. The framework posits that incarceration produces a ‘loss of place’ in individuals, primarily through institutionalisation and disconnection from society. It argues for the consideration of the right supports at the right time for the unique needs of individuals who will vary in their levels of disconnection. It finds key concepts such as facilitating timely access to services, reconnection with society, building key literacies and healing and restoration from past experiences to be vital in this journey. This preliminary framework offers novel theoretical insights and practical implications for understanding and improving reintegration success in older adults, and is potentially applicable to individuals of various ages, incarceration length and location.