International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070870

Authors: Neal M. Horen Julia Sayles Kelli McDermott Kirsten Sippel-Klug Jennifer Drake-Croft Toby Long

Infant and Early Childhood Mental Health (IECMH) is a multidisciplinary field of inquiry, practice, and policy concerned with enhancing the social-emotional competence of infants and young children. Early Childhood Intervention (ECI) is a system of services that supports infants and toddlers with disabilities and their families. ECI providers promote a child’s development in all domains, including social-emotional. The purpose of this paper is to describe how two systems, Early Childhood Intervention and Infant Early Childhood Mental Health, collaborate when serving children who have developmental delays or disabilities and their families and other caregivers. We will discuss two models used to promote social-emotional development, the Pyramid Model and IECMH Consultation, and provide three examples that demonstrate how ECI and IECMH intersect at both the family, classroom, and system levels.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070869

Authors: Kate Murton Antonietta Maldari Joanne Thomas Jan Williams Marcel Nejatian Hessom Razavi Lillian Mwanri

This study describes the eye health of newly arrived refugees attending a state-funded health service in Adelaide, South Australia, helping to address the paucity of data on the eye health of refugees. Patients attending the Refugee Health Service undergo comprehensive assessment by an on-site optometrist with accredited interpreters if they have eye symptoms, personal or family history of eye disease, or visual impairment (using World Health Organization definitions). A retrospective audit of this service was performed to obtain patient demographics, presenting best-corrected distance visual acuity (better-seeing eye), diagnoses, and management. In 2017–2018, 494 of the 1400 refugees attending the service underwent an optometry assessment (age range 1–86 years, mean age 33.1 ± 18.6 years, 53% female). Regions of origin included the Middle East (25%), Bhutan (24%), Afghanistan (22%), Myanmar (15%), and Africa (14%). Of the 124 cases of visual impairment, 78% resolved with corrective lenses and 11% were due to cataracts. Ophthalmology follow-up was required for 56 (11%) patients, mostly for cataracts (22 patients). Newly arrived refugees have high rates of visual impairment from refractive error and cataracts. Integration of optometry and state-based refugee health services may improve the timely detection and treatment of these conditions.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070868

Authors: Elaine Shelford Mead Seán Paul Teeling Martin McNamara

Healthcare makes a significant contribution to the social, economic and environmental benefits of communities. It is correspondingly a significant employer and consumer of both energy and consumables, often at high costs. Lean, a quality improvement methodology focuses on the elimination of non-value add (NVA) activities (steps that do not add value from the perspective of the customer) to improve the flow of people, information or goods. Increasingly, Lean thinking is evolving from its initial focus on eliminating NVA to a more holistic approach that encompasses sustainability. However, little work has been undertaken intentionally, including environmental sustainability outcomes in Lean healthcare interventions. Realist review methodology facilitates an understanding of the extent to which an intervention works, for whom, in what context, why and how, and has proven useful in research relating to Lean interventions in healthcare settings. This protocol provides details for a realist review that will enable an understanding of the specific contexts in which certain mechanisms are activated that enable the inclusion of environmental sustainability outcomes in the design of Lean healthcare improvement interventions.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070867

Authors: Francesco Cappelli Gianfranco Castronuovo Salvatore Grimaldi Vito Telesca

Background: Several studies suggest that environmental and climatic factors are linked to the risk of mortality due to cardiovascular and respiratory diseases; however, it is still unclear which are the most influential ones. This study sheds light on the potentiality of a data-driven statistical approach by providing a case study analysis. Methods: Daily admissions to the emergency room for cardiovascular and respiratory diseases are jointly analyzed with daily environmental and climatic parameter values (temperature, atmospheric pressure, relative humidity, carbon monoxide, ozone, particulate matter, and nitrogen dioxide). The Random Forest (RF) model and feature importance measure (FMI) techniques (permutation feature importance (PFI), Shapley Additive exPlanations (SHAP) feature importance, and the derivative-based importance measure ()) are applied for discriminating the role of each environmental and climatic parameter. Data are pre-processed to remove trend and seasonal behavior using the Seasonal Trend Decomposition (STL) method and preliminary analyzed to avoid redundancy of information. Results: The RF performance is encouraging, being able to predict cardiovascular and respiratory disease admissions with a mean absolute relative error of 0.04 and 0.05 cases per day, respectively. Feature importance measures discriminate parameter behaviors providing importance rankings. Indeed, only three parameters (temperature, atmospheric pressure, and carbon monoxide) were responsible for most of the total prediction accuracy. Conclusions: Data-driven and statistical tools, like the feature importance measure, are promising for discriminating the role of environmental and climatic factors in predicting the risk related to cardiovascular and respiratory diseases. Our results reveal the potential of employing these tools in public health policy applications for the development of early warning systems that address health risks associated with climate change, and improving disease prevention strategies.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070866

Authors: Harri Sievänen Maarit Piirtola Kari Tokola Tanja Kulmala Eerika Tiirikainen Pekka Kannus Juha Kiiski Kirsti Uusi-Rasi Saija Karinkanta

Whole-body vibration training (WBV) training has shown positive effects on bone strength, muscle strength, and balance, but the evidence on fall prevention is not yet persuasive. This study aimed to evaluate the effectiveness of WBV training in preventing falls and improving physical performance among older adults at fall risk. The study was an assessor- and participant-blinded, randomized, and controlled 10-week training trial with a 10-month follow-up. One hundred and thirty older adults (mean age 78.5 years, 75% women) were randomly allocated into the WBV group (n = 68) and the low-intensity wellness group (n = 62). Falls were prospectively collected using monthly returned and verified diaries. Physical performance was evaluated at baseline before randomization, after the intervention, and follow-up with established methods. The data were analyzed on an intention-to-treat basis. Negative binomial regression was used to estimate the incidence rate ratios for falls, and Cox regression models were used to calculate the hazard ratios for fallers. Between-group differences in physical performance were estimated by generalized linear mixed models. The retention rate was 93%, and the mean adherence to the WBV training was 88% and 86% to the wellness training. Sixty-eight participants fell at least once, and there were 156 falls in total. In the WBV group, the incidence rate of falls was 1.5 (95% confidence interval 0.9 to 2.5) compared to the wellness group (p = 0.11). The hazard ratio for fallers in the WBV group was 1.29 (0.78 to 2.15) (p = 0.32). There was no between-group difference in physical performance after the training period, but by the end of the follow-up, WBV-related benefits appeared. The chair-rising capacity was maintained in the WBV group, while the benefit disappeared in the wellness group (p = 0.004). Also, the 0.5-point difference in short physical performance battery (SPPB) score favored WBV training (p = 0.009). In conclusion, progressive side-alternating WBV training was feasible and well-tolerated among fall-prone older adults. During the one-year follow-up, WBV training was associated with improved physical performance but did not prevent falls compared to chair-based group exercises.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070865

Authors: Kumi Morishita-Suzuki Shuichiro Watanabe

Dietary variety is associated with some health outcomes among older adults. Rural areas, however, often have difficulty accessing health information that influences dietary variety. This study aimed to identify patterns of health information sources by using latent class analysis and assess their association with dietary variety among older adults aged ≥75 in rural Japan (n = 411). Three patterns of health information sources were identified: multi-sources (29.7%), television-only (53.5%), and non-sources (16.8%). In the multi-sources pattern, more people used television, radio, and newspapers. The television-only pattern had mostly television users, with fewer other sources. The non-sources pattern had many reporting “none.” Logistic regression analysis revealed that the multi-sources pattern has a significant positive effect on dietary variety compared with the non-sources pattern (odds ratio: 5.434, 95% confidence interval: 1.792–16.472), even after adjusting for socioeconomic factors and physical health status. These findings underscore the positive impact of broad access to health information on the dietary habits of older individuals. The study highlights the importance of promoting access to diverse health information sources to enhance dietary variety and overall well-being among rural older adults.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070864

Authors: Fleury Cao Grenier

Patients with mental health (MH) problems are known to use emergency departments (EDs) frequently. This study identified profiles of ED users and associated these profiles with patient characteristics and outpatient service use, and with subsequent adverse outcomes. A 5-year cohort of 11,682 ED users was investigated (2012–2017), using Quebec (Canada) administrative databases. ED user profiles were identified through latent class analysis, and multinomial logistic regression used to associate patients’ characteristics and their outpatient service use. Cox regressions were conducted to assess adverse outcomes 12 months after the last ED use. Four ED user profiles were identified: “Patients mostly using EDs for accessing MH services” (Profile 1, incident MDs); “Repeat ED users” (Profile 2); “High ED users” (Profile 3); “Very high and recurrent high ED users” (Profile 4). Profile 4 and 3 patients exhibited the highest ED use along with severe conditions yet received the most outpatient care. The risk of hospitalization and death was higher in these profiles. Their frequent ED use and adverse outcomes might stem from unmet needs and suboptimal care. Assertive community treatments and intensive case management could be recommended for Profiles 4 and 3, and more extensive team-based GP care for Profiles 2 and 1.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070863

Authors: Patrick Chanda Masauso Chirwa Ackson Tyson Mwale Kalunga Cindy Nakazwe Ireen Manase Kabembo Bruce Nkole

Existing research has documented the association between bullying perpetration and bullying victimisation. However, it is still unclear how different sources of social support moderate the association between bullying perpetration and bullying victimisation at a cross-national level. Using multilevel binary logistic regression models, this study examined the moderating role of public health care spending and perceived social support (i.e., family and teacher support) in the association between traditional bullying perpetration and victimisation by traditional bullying and cyberbullying among adolescents across 27 European countries. Country-level data were combined with 2017/18 Health Behaviour in School-aged Children (HBSC) survey data from 162,792 adolescents (11-, 13-, and 15-year-olds) in 27 European countries. Results showed that adolescents who perpetrated traditional bullying had a higher likelihood of being victimised by traditional bullying and cyberbullying than adolescents who did not bully others. Results also indicated that the magnitude of the positive association between traditional bullying perpetration and victimisation by traditional bullying and cyberbullying was mitigated among adolescents with more family, teacher, and public health care support. These findings support the notion that multilayered systems of social support could play a vital role in bullying prevention and intervention strategies to address bullying among adolescents.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070862

Authors: Monique West Simon Rice Dianne Vella-Brodrick

Background: Social media is an integral part of adolescents’ lives and has a strong influence on development and wellbeing. Research examining adolescent social media use and wellbeing is confusing as findings are inconsistent, inconclusive and contradictory. To address this issue, digital wellbeing scholars recommend that researchers adopt a theoretical approach with the aim of increasing meaningfulness and applicability of findings. Hence, this review applies self-determination theory to investigate how adolescent social media use supports and thwarts the basic psychological needs of relatedness, autonomy and competence. Satisfaction of all three psychological needs is essential for optimal development and wellbeing. Methods: A scoping review was conducted using a systematic search of five databases relating to adolescent social media use. The preferred items for systematic review and meta-analysis protocols (extension for scoping reviews) was applied resulting in 86 included studies. Results: Adolescent social media use both supports and thwarts relatedness, autonomy and competence. The findings highlighted how different aspects of adolescent social media use (including intra-personal, inter-personal, situational and environmental factors) contribute to the satisfaction and frustration of basic psychological needs. Conclusions: This review illustrates how social media can be both beneficial and detrimental to satisfying the basic psychological needs of relatedness, autonomy and competence. This is important when considering that if psychological needs are satisfied or frustrated in adolescence, the repercussions can have a cascading effect throughout adulthood. This review identifies gaps in the literature and provides suggestions for future research.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070861

Authors: Christo Heunis Deirdre van Jaarsveldt Perpetual Chikobvu Gladys Kigozi-Male Moroesi Litheko

In August 2022, the Free State Provincial Health Research Committee used the online nominal group technique (NGT) for Health Research Priority Setting (HRPS) for the Free State Department of Health (FSDoH) and the research community, considering various stakeholders’ perspectives. This paper explores and describes the identified health research priorities. It also assesses their alignment with the National Health Research Strategy. Additionally, it provides an opinion on the feasibility of using the online NGT for collaborative co-creation of provincial-level health research priorities. Most of the identified health research priorities resonate with the national health research priorities identified by the National Health Research Committee. However, research to “strengthen surveillance” was uniquely perceived to be a priority by the participants in the Free State HRPS exercise. A plausible reason for this might be their heightened awareness of the vital role optimal surveillance systems play in coordinating intersectoral responses to pandemics, particularly considering the serious challenges emerging during the initial stages of the COVID-19 outbreak.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070860

Authors: Francesco Inchingolo Angelo Michele Inchingolo Alessio Danilo Inchingolo Maria Celeste Fatone Laura Ferrante Pasquale Avantario Arianna Fiore Andrea Palermo Tommaso Amenduni Francesco Galante Gianna Dipalma

Periodontitis is a chronic inflammatory disease of the tissues surrounding and supporting the teeth. Due to the development of chronic inflammation, periodontitis can contribute to the development of several systemic diseases, including thyroid disease. Thyroid pathology includes benign, malignant, and autoimmune conditions leading to hypothyroidism, hyperthyroidism, or euthyroidism. Alterations in thyroid hormones, especially hypothyroidism, can reveal significant oral manifestations, including periodontitis. This scoping review aims to explore the probable causal relationship between periodontitis and thyroid disease, in terms of epidemiology, pathogenesis, and treatment. The search strategy follows the PRISMA-ScR guidelines. PubMed, Scopus, Web of Science, and Cochrane were searched from January 2014 to January 2024, entering the MESH terms “periodontitis” and “thyroid”. Of 153 initial records, 20 articles were selected and discussed. There is a high prevalence of periodontitis among patients with thyroid disease, including thyroid cancer. The causes at the basis of this association are genetic factors, the oral microbiome, and proinflammatory cytokines. Periodontal treatment, specifically scaling and root planning, can ameliorate thyroid parameters. Although there are a few randomized controlled studies in the literature, this review lays the foundation for a bidirectional relationship between periodontitis and thyroid disease, the link to which is, once again, systemic inflammation.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070859

Authors: Muluken Dessalegn Muluneh Woldu Kidane Virginia Stulz Mhiret Ayele Sintayehu Abebe Andrea Rossetti Gedefa Amenu Azmeraw Ayehu Tesfahun Makida Berhan

This study aimed to explore the sociocultural determinants of family planning (FP) utilization among women in pastoralist areas of Ethiopia. A community-based cross-sectional survey was conducted involving 682 reproductive-aged women selected from three regions in pastoralist districts. Hierarchical logistic regression was used to identify factors associated with women who did not use FP. This study revealed that 47% of women did not use FP. Women who did not use FP were more likely to have shorter spacing between births, lack their partner’s support, not be involved in decisions regarding large household purchases, and have low household expenditures. Overall, the prevalence of not using FP is significantly high in pastoralist communities in Ethiopia. The authors recommend that investment in women’s health and FP be targeted at educational campaigns to raise awareness about FP and its importance. Engaging men and community leaders, promoting their support for FP and contraceptive use, and providing financial assistance to address financial barriers, such as transportation costs and healthcare fees, are important aspects that can increase the utilization of FP methods.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070858

Authors: Etsuko Kibayashi Makiko Nakade

Few young Japanese adults regularly consume a well-balanced diet composed of staples, main courses, and sides. We hypothesised that adopting the recommended planetary health diet with regular breakfast consumption would promote well-balanced diets among young Japanese male undergraduates. This study aimed to examine the structural association between the planetary health diet with regular breakfast consumption and a well-balanced diet intake. This cross-sectional study included 142 male engineering undergraduates who completed a 2022 online questionnaire via Google Forms at a public university in Hyogo Prefecture. The planetary health diet comprises the consumption of the recommended eight items. A covariance structure analysis was performed in a hypothetical model with factors (regular breakfast consumption and eight items) potentially associated with the intake of a well-balanced diet at least twice daily. After excluding chicken dishes and nuts from the eight recommended items of the planetary health diet, goodness-of-fit became acceptable. Frequent consumption of the remaining six recommended items (fish, eggs, soybeans/soybean products, dairy foods, vegetables, and fruits) was significantly positively correlated with regular breakfast consumption and a significant positive path to a well-balanced diet. Among male university students, regular breakfast consumption and the planetary health diet may lead to a well-balanced diet.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070857

Authors: Hester Groenewegen Arjan Vissink Fred K. L. Spijkervet Wouter F. W. Bierman Konstantina Delli

The Internet is the most used source of HIV information second to information received from healthcare professionals. The aim of this study was to assess the quality of Internet information about periodontitis in people living with HIV (PLWH). An Internet search was performed on 18 April 2024 using the search terms “Periodontitis”, “Periodontal disease”, and “Gum disease” in combination with “HIV” in the most popular search engines (Google™, Bing™, and YAHOO!®). The first 20 results from each search term engine were pooled for analysis. Quality was assessed by JAMA benchmarks. Readability was assessed using the Flesch reading ease score (FRES). Origin of the site, type of author, and information details were also recorded. The quality of Internet information about periodontitis in PLWH varied. The mean JAMA score was 2.81 (SD = 1.0). The websites were generally fairly difficult to read (mean FRES = 57.1, SD = 15.0). Most websites provided some advice about self-treatment of oral problems, accompanied by a strong recommendation to seek professional dental care. In conclusion, advanced reading skills on periodontitis in PLWH were required and quality features were mostly not provided. Therefore, healthcare professionals should be actively involved in developing high-quality information resources and direct patients to evidence-based materials on the Internet.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070856

Authors: Yibeltal Bekele Claire Gallagher Don Vicendese Melissa Buultjens Mehak Batra Bircan Erbas

Background: Iron and folate deficiency are prevalent in pregnant women in Africa. However, limited research exists on the differential effect of oral iron-only, folate-only, or Iron Folic Acid (IFA) supplementation on adverse pregnancy and infant outcomes. This systematic review addresses this gap, focusing on studies conducted in Africa with limited healthcare access. Understanding these differential effects could lead to more targeted and potentially cost-effective interventions to improve maternal and child health in these settings. Methods: A systematic review was conducted following PRISMA guidelines. The primary exposures were oral iron-only, folate-only, or IFA oral supplementation during pregnancy, while the outcomes were adverse pregnancy and infant outcomes. A qualitative synthesis guided by methods without meta-analysis was performed. Results: Our qualitative synthesis analysed 10 articles reporting adverse pregnancy (adverse birth outcomes, stillbirths, and perinatal mortality) and infant outcomes (neonatal mortality). Consistently, iron-only supplementation demonstrated a reduction in perinatal death. However, evidence is insufficient to assess the relationship between iron-only and IFA supplementation with adverse birth outcomes, stillbirths, and neonatal mortality. Conclusion: Findings suggested that iron-only supplementation during pregnancy may reduce perinatal mortality in African women. However, evidence remains limited regarding the effectiveness of both iron-only and IFA supplementation in reducing stillbirths, and neonatal mortality. Moreover, additional primary studies are necessary to comprehend the effects of iron-only, folate-only, and IFA supplementation on pregnancy outcomes and infant health in the African region, considering rurality and income level as effect modifiers.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070853

Authors: Lam Grasse

It is estimated that three million people annually experience homelessness, with about a third of the homeless population being served by Federally Qualified Health Centers (FQHCs). Thus, FQHCs, dependent on government funding for financial viability, are vital to the infrastructure addressing the complex issues facing people experiencing homelessness. This study examines the relationship between various government funding streams and the number of homeless patients served by FQHCs. Data for this study come from three publicly available databases: the Uniform Data System (UDS), the IRS Core files, and the Area Resource File. Fixed-effects models employed examine changes across six years from 2014 to 2019. The results suggest that, on average, an additional homeless patient served increases the expenses of FQHCs more than other patients and that federal funding, specifically Health Care for the Homeless (HCH) funding, is a vital revenue source for FQHCs. We found that the number of homeless patients served is negatively associated with contemporaneous state and local funding but positively associated with substance use and anxiety disorders. Our findings have important implications for the effective management of FQHCs in the long term and for broader public policy supporting these vital elements of the social safety net.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070855

Authors: Thespina J. Yamanis Samhita Rao Alexandra J. Reichert Rachel Haws Taryn Morrissey Angela Suarez

Latino immigrants living in the United States were highly vulnerable to the health and economic consequences brought on by the COVID-19 pandemic. We use the conceptual framing of workplace dignity, worth that is acknowledged based on performance of job responsibilities, to explore Latino immigrants’ experiences during the early months of the pandemic. A qualitative study was conducted with La Clínica del Pueblo (La Clínica), a community health center serving low-income Latino immigrants. From June to December 2020, we conducted in-depth video interviews with 29 Latino immigrant clients to explore pandemic-related challenges, including workplace changes, discriminatory experiences, and effects on health. We conducted thematic analysis using Dedoose software. Nearly half of participants were undocumented immigrants. Most participants were unemployed or underemployed due to the pandemic and 26–49 years of age; one-third were still working, and one-quarter were 50 years or older. About half were cisgender women and two were transgender women. Employed participants experienced a lack of dignity through being socially isolated and stigmatized at work; receiving no compensation for their extra labor or for sick leave; and experiencing discriminatory labor practices. Unemployed participants experienced a lack of dignity in being the first to lose their jobs without government support; losing self-esteem; and not being rehired. Participants associated denial of dignity with worsening health conditions and increased anxiety and depression. Our study suggests that denial of workplace dignity—through job loss, underemployment, and poor working conditions—is linked to adverse health outcomes for Latino immigrants. More research should recognize workplace dignity as an important social determinant of health.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070854

Authors: Dragan Glavaš Irena Pavela Banai

Numerous studies have shown physical activity (PA) improves psychological functioning and well-being. However, the underpinning processes and mediating variables are less known. There is evidence that beliefs about the benefits of PA contribute to physical health, regardless of actual PA. By applying these findings in the context of mental health, we sought to investigate the role of belief in the benefits of PA in the relationship between self-reported PA and mental health. A total of 381 employed adults completed the Godin Leisure-Time Exercise Questionnaire, Center for Epidemiologic Studies Depression Scale, and Anxiety subscale of the Emotional state scale. Furthermore, participants reported the degree to which they believe that PA has benefits for their psychological health. The mediation analysis shows that greater PA intensity was associated with lower levels of depression and anxiety. Additionally, belief in the benefits of PA on psychological health had a mediating role. Specifically, more intensive PA was related to a stronger belief in PA benefits, subsequently leading to reduced levels of depression and anxiety. We discuss the neurobiological mechanisms underlying the relationship between PA and mental health, alongside the significant role of mindset.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070852

Authors: Mokhwelepa Leshata Winter Sumbane Gsakani Olivia

Complex interactions exist between sex work and parenthood, impacting the lives of those in sex work who also provide care for others. This scoping review aims to review the experiences and challenges of female sex workers who are parents or caregivers, highlighting the socioeconomic, psychological, and legal dimensions of their dual roles. The rationale for this review stems from the recognition that sex workers who are also parents face unique and multifaceted challenges that significantly impact their wellbeing and that of their children. The five stages of a scoping review suggested by Arksey and O’Malley were followed in this study. A comprehensive literature search was conducted across electronic databases such as PubMed, PsycINFO, and Google Scholar. This study covered publications written in English from 2010 to 2023. Studies were selected based on their focus on sex workers who are parents or caregivers. Both qualitative and quantitative research articles were included. Thematic analysis was employed to synthesize findings across the selected studies. Studies published prior to 2013, studies that were not published in English, and studies that did not address the experiences of female sex workers who are parents or caregivers were excluded from this study. The review identified 14 studies meeting the inclusion criteria. Five key themes emerged from this study: (1) social stigma and healthcare discrimination; (2) legal challenges; (3) mental nexus; (4) risk behaviors and exposing children to a hazardous environment; and (5) social support. Sex workers who are also parents or caregivers navigate a multifaceted landscape of challenges and resilience. Policy reforms are needed to reduce stigma, provide financial support, and ensure legal protections for this key population.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070851

Authors: Nicole Chaudhary Megan Jones Sean P. M. Rice Laura Zeigen Saurabh Suhas Thosar

Abstract: At the start of the COVID-19 pandemic, many workplaces transitioned to remote work, which altered lifestyle behaviors. We conducted a meta-analysis to understand if the transition to working from home due to the pandemic affected workers’ physical activity and sedentary behavior worldwide. We reviewed articles published between November 2019 and May 2022. Of an initial 3485 articles, a total of 17 were included, 15 of 17 were included for their physical activity (PA) comparisons (n = 36,650), and 12 of 17 (n = 57,254) were included for their sedentary behavior (SB) comparisons (10 studies have data for both PA and SB ). This work is registered through PROSPERO (CRD42022356000). Working from home resulted in a significant decrease in PA (Hedge’s g = −0.29, 95% CI [−0.41, −0.18]) and an increase in SB (Hedge’s g = +0.36, 95% CI [0.20, 0.52]). Working from home impaired preventative activity behaviors, and these results are relevant to worker health as the future of work evolves beyond the pandemic.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070850

Authors: Sipiwe Chihana Jameson Mbale Nchimunya Chaamwe

The emission of sulphur dioxide (SO2) from mining activities presents significant health hazards, particularly to communities near industrial zones. This mixed-methods study investigates the nexus between (SO2) exposure and respiratory health in Kankoyo Township, Zambia. Employing community engagement, expert interviews, spatial analysis, and a retrospective examination of 15 years of health and (SO2) data, the research identified a troubling correlation between (SO2) exposure and adverse respiratory health effects among the local population. Expert interviews highlighted that respiratory issues constituted approximately 75% of health complications, with a notable reduction in asthma cases following the installation of a monitoring station and upgrades to smelter operations. Spatial analysis demonstrated that (SO2) levels in Kankoyo exceeded the Zambian Environmental Management Agency (ZEMA) limits by 1713% identifying it as a significant pollution hotspot. Additionally, wind profile analysis indicated frequent low-speed winds from the east-northeast (ENE), contributing to pollutant accumulation. Based on these insights, the study recommends implementing real-time pollution data sharing, affordable air quality sensors, addressing medication shortages, establishing specialized respiratory clinics, launching IT-driven awareness campaigns, and further research into additional pollutants and confounding factors.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070849

Authors: Thaís Gomes Moreira Giovana Mamede Castro Jucier Gonçalves Júnior

Raynaud’s phenomenon of the nipple is a possible cause of pain and breastfeeding cessation in lactating women. However, there are still few studies on the characterization of this manifestation. Thus, we aim to develop a systematic review of the literature carried out between January 1992 and January 2024 in PubMed, Scopus, Web of Science, Virtual Health Library (VHL), and Portal de Periódicos da CAPES. Of the 438 articles, 19 met the eligibility criteria. The findings were divided by heuristic questions into two groups: “Epidemiological, pathophysiological, and clinical characterization of Raynaud’s Phenomenon of the nipple” and “Treatment of Raynaud’s Phenomenon of the nipple”. Raynaud’s phenomenon of the nipple is commonly primary, being more prevalent in the postpartum period, in women with a mean age of 32 years. The main triggers appear to be stress and temperature change. Generally, it is associated with a change in color and pain during breastfeeding. A calcium channel blocker was the most used medication with or without non-pharmacological measures.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070848

Authors: Andrea Fontana Sonia Mangialavori Grazia Terrone Lucrezia Trani Eleonora Topino Valeria Trincia Giulia Lisi Giuseppe Ducci Marco Cacioppo

Background: The COVID-19 pandemic has exacerbated fears and anxieties, potentially influencing maternal perinatal mental health. This study addresses a gap in the literature on fear of COVID-19 in pregnant women, aiming to identify contributing factors. Method: Participants were 401 primiparous women with an average age of 34 years (SD = 4.56) who were recruited through the National Health System during birth support courses. They completed a series of self-reported instruments via an online survey, providing information on their levels of reflective functioning, dyadic consensus, perinatal maternal affectivity, and fear of COVID-19. Pearson’s correlation and mediation analysis via a generalized linear model were implemented to analyze the collected data. Results: The relationship between dyadic consensus and fear of COVID-19 was significant and negative. Furthermore, a significant parallel mediation involving perinatal maternal affectivity and reflective functioning was found to the extent that, when these factors were inserted into the model, the direct association between dyadic consensus and fear of COVID-19 became non-significant (total mediation). Conclusions: The results highlight the importance of dyadic adjustment in alleviating maternal COVID-19 fear, emphasizing interventions promoting couple functioning, mentalization, and addressing affective difficulties. Such approaches are vital for supporting expecting mothers during challenging times like the COVID-19 pandemic.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070847

Authors: Marta Regina Cezar-Vaz Clarice Alves Bonow Joana Cezar Vaz Carlos Henrique Cardona Nery Mara Regina Santos da Silva Daniela Menezes Galvão Aline Soares Alves Flávia Santana Freitas Sousa Joice Simionato Vettorello Jociel Lima de Souza Joaquim Vaz

The objectives of this study were to assess the adequacy of physical parameters/factors (temperature, relative humidity, noise, and illuminance levels) of the work environment in PHC facilities, to evaluate the association between the adequacy of these measured physical parameters and the physical characteristics of the PHC facilities and their surroundings and to assess the association between health professionals’ perceptions about exposure to physical risks in the PHC work environment and the adequacy of physical parameters measured in the same facilities. The study monitored 23 PHC facilities in southern Brazil and interviewed 210 health professionals. Data analysis involved Pearson’s chi-square, Fisher’s exact test, Spearman’s correlation, and multivariate linear regression analysis was used to control for confounding factors. The significance level was set at 5% (p ≤ 0.05). The combination of temperature and relative humidity presented thermal comfort levels outside the adopted criteria for adequacy in consultation (outdoor relative humidity, p = 0.013) and procedure rooms (front door open, p = 0.034). Inadequate sound comfort (noise) levels in the morning shift were found in the vaccination (front door open, p = 0.021) and consultation rooms (movement of people, p = 0.016). In PHC facilities where reception rooms had insufficient lighting, internal curtains were opened less frequently (p = 0.047). The analysis of health professionals’ perceptions of physical factors demonstrated that physicians more frequently perceive the physical risk of temperature and humidity (p = 0.044). The higher the number of nurses (p = 0.004) and oral health technicians in the PHC facilities (p = 0.031), the greater the general percentage of adequacy of monitored physical parameters. It was also confirmed that the higher the perception of moderate or severe physical risk among health professionals, the lower the general percentage of the adequacy of the physical parameters of the work environment of the PHC facilities evaluated (rs = −0.450, p = 0.031). This study’s evidence contributes to a better understanding of physical conditions and future occupational interventions to ensure the comfort, safety, and well-being of PHC workers.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070846

Authors: Adana A. M. Llanos Adiba Ashrafi Teresa Olisa Amber Rockson Alexis Schaefer Jasmine A. McDonald Mary Beth Terry Dede K. Teteh-Brooks Dustin T. Duncan Beatrice Irungu Cecilia Kimani Esther Matu

Despite widespread use of hair products globally, little is known about the prevalence and patterns of use in populations outside the United States. As some hair products contain endocrine-disrupting chemicals (EDCs) and EDCs have been linked to breast cancer, which is increasing globally, in this study, we addressed key knowledge gaps about hair product use and practices, and perceptions of use among women in two counties in Kenya. Using community-engaged approaches in Embu and Nakuru, Kenya, we recruited women aged 15–50 years to complete a questionnaire that ascertained hair product use in the last 7–14 days, ever using hair dyes and chemical relaxers, and participants’ perceptions or harm around hair product use. In multivariable-adjusted regression models, we evaluated associations between participants’ sociodemographic characteristics and perceptions of hair product use in relation to if they have ever used hair dyes and relaxers. In our sample of 746 women (mean age, 30.4 ± 8.1 years), approximately one-third of participants reported ever using permanent and/or semi-permanent hair dyes, with approximately one-fifth reporting current use. Almost 60% reported ever using chemical relaxers, with a little over one-third reporting current use. Increasing age and having an occupation in the sales and service industry were statistically significant predictors of hair dye use (OR 1.04, 95% CI: 1.02–1.06 and OR 2.05, 95% CI: 1.38–3.03, respectively) and relaxer use (OR 1.03, 95% CI: 1.01–1.06 and OR 1.93, 95% CI: 1.30–2.87). On average, participants reported moderate-to-high levels of concern about exposures and general health effects from using hair products, and relatively high levels of perceived risk of breast cancer related to hair product use. However, in contrast to our hypotheses, we observed mixed evidence regarding whether higher levels of perceived risk were associated with lower odds of ever using hair dyes and relaxers. These findings add new knowledge to the extant literature on hair product use among women in Kenya, where breast cancer incidence rates are increasing. Improving the understanding of patterns of use of specific products and their chemical ingredients—which may be hormone disruptors or carcinogens—and exploring the role of environmental health literacy are critical for developing interventions to reduce potentially harmful exposures found in these products.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070845

Authors: Helen Cristina Nogueira Carrer Melina Nevoeiro Haik Gabriela Espósito Fernando Augusto Vasilceac Cristiane de Sousa Melo Maria Gabriela Pedroso Karina Gramani Say

Chronic musculoskeletal pain (CMP) is a global health condition that affects thousands of people. CMP can substantially affect the functional capacity and quality of life of the people impacted, resulting in high costs for health care and social security systems. Sociodemographic factors may play a significant role in pain chronification prevention and control programs. Thus, current risk factors for CMP must be seriously considered as part of an interdisciplinary management strategy. The purpose of the study was to identify the primary sociodemographic characteristics of CMP patients at a multidisciplinary and specialized center for chronic pain. This is a retrospective investigation based on a review of medical records. Age, gender, income, and the time of onset of pain symptoms were among the variables included in the analyzed data. To analyze variables related to the duration of discomfort, a multiple regression model was utilized. Sociodemographic factors explained 37.94% of experiencing prolonged pain, according to the study’s findings. Being female and having a family income above the minimum wage were variables that were directly proportional to discomfort duration. Age was not associated with a prolonged duration of pain perception.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070844

Authors: Magaly Nóblega Olenka Retiz Juan Nuñez del Prado Ramón Bartra

Increased maternal mental health during the perinatal period has been widely associated with a variety of positive outcomes for both mothers and infants. However, no studies in Peru have yet focused on studying maternal mental health and related psychological variables during this stage. Thus, the aim of this study was to test a model to associate a mother’s parental stress with infant socioemotional difficulties and maternal mental health. The sample included 988 mothers of infants aged 6 to 18 months from Peru, all from socioeconomically vulnerable settings. The findings showed that infant socioemotional difficulties were associated with poorer maternal mental health through the mother’s parental stress (χ2(7) = 28.89, p < 0.001, CFI = 0.98, RMSEA = 0.06, SRMR = 0.03). These results provide a better understanding of the key elements associated with maternal mental health during the perinatal period in Peru and offer valuable insights for developing interventions and support strategies for socioeconomically vulnerable mothers and their young children.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070843

Authors: Katherine N. Irvine Daniel Fisher Margaret Currie Kathryn Colley Sara L. Warber

Physical inactivity contributes to over 800,000 deaths annually. Numerous non-pharmacological interventions provide a route to address this behavioural risk factor linked to the growth of non-communicable diseases. Here, we consider a nature-based intervention, specifically group outdoor health walks (GOHW), as a non-pharmacological intervention to increase physical activity and contribute to health and quality of life amongst older adults. We used the theoretically grounded Capability, Opportunity, Motivation, and Behaviour (COM-B) model as a lens to examine interviews with participants in a GOHW with an activity tracker and signposted by health clinics in Scotland, UK. Analysis identified capabilities, opportunities, and motivations, their impact on behaviour, and perceived physical and mental health. The application of the COM-B model to intervention evaluation allowed us to examine two separate behaviours, that of (i) engaging with the intervention itself, and (ii) incorporating the behaviour into one’s life that the intervention targets. Analysis identified emerging capabilities, opportunities, and motivations that supported additional health-promoting behaviours, including increased time outdoors in nature and leadership to self-organise continued group walks. We offer insight into the design of nature-based interventions to effectively engage older adults with chronic health conditions and foster personal behaviour change for health and well-being.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070842

Authors: Ma Kawakami Inui

Using the 2010–2019 Comprehensive Survey of Living Conditions (CSLC) conducted in Japan, we examined the impact of long working hours on mental health in Japan while addressing the endogeneity issue arising from non-random selection bias. We assessed the variations in the effects of long working hours on mental health across different groups. The results show that first, individuals working longer hours (55 h or more per week) exhibited a higher likelihood of developing mental illness than those working regular hours or fewer hours. Second, the negative effect of long working hours on mental health is more pronounced among non-regular workers than among regular workers. Third, the effect of long working hours on mental health varies among different demographic groups, with a greater impact observed among women, managers, non-regular workers, employees in small- or large-sized firms, and those in smaller cities compared to their counterparts. Thus, to enhance worker productivity, the Japanese government should address the issue of long working hours to improve employees’ mental well-being. Initiatives aimed at promoting work–life balance, family-friendly policies, and measures to ameliorate working conditions are expected to help mitigate the challenges associated with long working hours and mental health issues, especially among non-regular workers.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070841

Authors: Maria Tzitiridou-Chatzopoulou Georgia Zournatzidou Michael Kourakos

The total fertility rate is influenced over an extended period of time by shifts in population socioeconomic characteristics and attitudes and values. However, it may be impacted by macroeconomic trends in the short term, although these effects are likely to be minimal when fertility is low. With the objective of forecasting monthly deliveries, this study concentrates on the analysis of registered births in Scotland. Through this approach, we examine the significance of precisely forecasting fertility trends, which can subsequently aid in the anticipation of demand in diverse sectors by allowing policymakers to anticipate changes in population dynamics and customize policies to tackle emerging demographic challenges. Consequently, this has implications for fiscal stability, national economic accounts and the environment. In conducting our analysis, we incorporated non-linear machine learning methods alongside traditional statistical approaches to forecast monthly births in an out-of-sample exercise that occurs one step in advance. The outcomes underscore the efficacy of machine learning in generating precise predictions within this particular domain. In sum, this research will comprehensively demonstrate a cutting-edge model of machine learning that utilizes several attributes to assist in clinical decision-making, predict potential complications during pregnancy and choose the appropriate delivery method, as well as help in medical diagnosis and treatment.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070840

Authors: Marwa Mustafa Owess Amani Yousef Owda Majdi Owda Salwa Massad

Raised blood sugar (hyperglycemia) is considered a strong indicator of prediabetes or diabetes mellitus. Diabetes mellitus is one of the most common non-communicable diseases (NCDs) affecting the adult population. Recently, the prevalence of diabetes has been increasing at a faster rate, especially in developing countries. The primary concern associated with diabetes is the potential for serious health complications to occur if it is not diagnosed early. Therefore, timely detection and screening of diabetes is considered a crucial factor in treating and controlling the disease. Population screening for raised blood sugar aims to identify individuals at risk before symptoms appear, enabling timely intervention and potentially improved health outcomes. However, implementing large-scale screening programs can be expensive, requiring testing, follow-up, and management resources, potentially straining healthcare systems. Given the above facts, this paper presents supervised machine-learning models to detect and predict raised blood sugar. The proposed raised blood sugar models utilize diabetes-related risk factors including age, body mass index (BMI), eating habits, physical activity, prevalence of other diseases, and fasting blood sugar obtained from the dataset of the STEPwise approach to NCD risk factor study collected from adults in the Palestinian community. The diabetes risk factor obtained from the STEPS dataset was used as input for building the prediction model that was trained using various types of supervised learning classification algorithms including random forest, decision tree, Adaboost, XGBoost, bagging decision trees, and multi-layer perceptron (MLP). Based on the experimental results, the raised blood sugar models demonstrated optimal performance when implemented with a random forest classifier, yielding an accuracy of 98.4%. Followed by the bagging decision trees, XGBoost, MLP, AdaBoost, and decision tree with an accuracy of 97.4%, 96.4%, 96.3%, 95.2%, and 94.8%, respectively.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070839

Authors: Wanderlei Abadio de Oliveira Antonio Marcos Neves Esteca Solange Muglia Wechsler Ersilia Menesini

This study aims to assist decision-making in anti-bullying interventions by highlighting the importance of positive factors such as gratitude, forgiveness, and self-regulation in mitigating the negative impacts of bullying/cyberbullying. The objective was to examine and synthesize available evidence on the impact of gratitude, forgiveness, and self-regulation practices in the school context regarding bullying/cyberbullying phenomena. Three databases were consulted (Web of Science, Scopus, and Scielo), and the results include 14 articles. The three character strengths were associated with psychological well-being, life and school satisfaction, improved mental health, increased likelihood of engaging in pro-social behavior, and reduced involvement in bullying/cyberbullying situations. These strengths have the potential to enhance overall well-being and decrease risk behaviors, leading to more positive outcomes in experiences of violence. These results underscore the importance of considering students’ individual strengths and the possible interventions to promote healthy school environments.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070838

Authors: Yunqi Yang Grace T. R. Lin

In Taiwan, remote healthcare initially focused on telemedicine, with systematic development starting in 2007 through the “Remote Care Pilot Program” and subsequent initiatives. Significant advancements came with the “Remote Health Care Services Development Plan” in 2010, which integratedArtificial intelligence and Information and communications technologies, enhancing smart healthcare in home care. This study investigated strategic gaps in smart healthcare applications for remote home care using a mixed-methods approach, particularly the Analytic Hierarchy Process (AHP). This study identified and ranked strategic gaps, including “legal regulations”, “economic factors”, “user behavior habits”, “policy and culture”, and “environment and technology”. Findings, based on in-depth interviews with 6 experts and 16 AHP questionnaire samples, highlight “legal regulations” and “user behavior habits” as critical areas needing attention. Addressing these gaps can improve user acceptance and the effectiveness of smart healthcare applications, providing valuable insights for future research and practice in making remote home care more comprehensive and efficient.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070837

Authors: Rafael Corrêa Matheus Britto Froner Benjamin Miranda Tabak

Studies have highlighted the importance of applying Behavioral Sciences interventions to develop equity in the prevention of chronic diseases in the public health domain. Our study aims to assess the evidence of this influence. We undertook a systematic review study using the electronic databases PubMed, Web of Science, Scopus and Cochrane, searching for work published between 2013 and 2023. The research analyzed the influence of Behavioral Sciences intervention studies on public health. This review was registered and published in PROSPERO, registration number CRD42023412377. The systematic search identified 2951 articles. The review analyzed 26 studies. The quality assessment of the articles showed an overall average of 74%, with the majority of studies being of high quality. The interventions with the best evidence for chronic diseases used framing messages, nudges and vouchers. Messages with incentives also showed satisfactory evidence. The most prevalent outcomes were related to screening tests and patient adherence to treatment. The current state of decision-making remains mainly at the patient level, with potential for further exploration of the roles of healthcare professionals and decision-makers in future research efforts. Limitations relate to the heterogeneity of the study sample, which hinders a more precise analysis of specific interventions and outcomes in chronic diseases.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070836

Authors: Thomas Hormenu Iddrisu Salifu Juliet Elikem Paku Eric Awlime-Ableh Ebenezer Oduro Antiri Augustine Mac-Hubert Gabla Rudolf Aaron Arthur Benjamin Nyane Samuel Amoah Cecil Banson James Kojo Prah

Introduction: Undiagnosed diabetes poses significant public health challenges in Ghana. Numerous factors may influence the prevalence of undiagnosed diabetes among adults, and therefore, using a model that takes into account the intricate network of these relationships should be considered. Our goal was to evaluate fasting plasma levels, a critical indicator of diabetes, and the associated direct and indirect associated or protective factors. Methods: This research employed a cross-sectional survey to sample 1200 adults aged 25–70 years who perceived themselves as healthy and had not been previously diagnosed with diabetes from 13 indigenous communities within the Cape Coast Metropolis, Ghana. Diabetes was diagnosed based on the American Diabetes Association (ADA) criteria for fasting plasma glucose, and lipid profiles were determined using Mindray equipment (August 2022, China). A stepwise WHO questionnaire was used to collect data on sociodemographic and lifestyle variables. We analyzed the associations among the exogenous, mediating, and endogenous variables using a generalized structural equation model (GSEM). Results: Overall, the prevalence of prediabetes and diabetes in the Cape Coast Metropolis was found to be 14.2% and 3.84%, respectively. In the sex domain, females had a higher prevalence of prediabetes (15.33%) and diabetes (5.15%) than males (12.62% and 1.24%, respectively). Rural areas had the highest prevalence, followed by peri-urban areas, whereas urban areas had the lowest prevalence. In the GSEM results, we found that body mass index (BMI), triglycerides (TG), systolic blood pressure (SBP), gamma-glutamyl transferase (GGT), and female sex were direct predictive factors for prediabetes and diabetes, based on fasting plasma glucose (FPG) levels. Indirect factors influencing diabetes and prediabetes through waist circumference (WC) included childhood overweight status, family history, age 35–55 and 56–70, and moderate and high socioeconomic status. High density lipoprotein (HDL) cholesterol, childhood overweight, low physical activity, female sex, moderate and high socioeconomic status, and market trading were also associated with high BMI, indirectly influencing prediabetes and diabetes. Total cholesterol, increased TG levels, WC, age, low physical activity, and rural dwellers were identified as indirectly associated factors with prediabetes and diabetes through SBP. Religion, male sex, and alcohol consumption were identified as predictive factors for GGT, indirectly influencing prediabetes and diabetes. Conclusion: Diabetes in indigenous communities is directly influenced by blood lipid, BMI, SBP, and alcohol levels. Childhood obesity, physical inactivity, sex, socioeconomic status, and family history could indirectly influence diabetes development. These findings offer valuable insights for policymakers and health-sector stakeholders, enabling them to understand the factors associated with diabetes development and implement necessary public health interventions and personalized care strategies for prevention and management in Ghana.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070835

Authors: Zhaohe Chang Susan Bodnar

Dust storms, which are common aversive occurrences in northern China, result from high winds, dry soil or dust, and soil surface disturbance. Exposure to dust storms, regardless of duration, can induce varying mental and physical distress levels. Recognizing the urgency of comprehending the impact of dust storms on residents and the scarcity of information on their effects on the indigenous civilians there, this study aims to address this gap by qualitatively sampling 29 participants from Beijing, a typical city in northern China. The current study seeks to gain insights into residents’ dust storm experiences and explore their perspectives on effective coping mechanisms. The findings align with existing knowledge regarding the mental and physical repercussions of dust storms while identifying some emerging patterns of coping mechanisms already employed by residents in Beijing. Concerns regarding mental well-being, either directly influenced by the environmental conditions or indirectly stemming from disruptions to life routines on a broader scale, persistently dominate people’s perceptions of dust storms. New themes emerged following the step-by-step exploration of feelings and coping mechanisms. This study aims to enlighten the public about the ramifications of the dust storms in Beijing and advocate for essential policy support.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070834

Authors: Jina Kang Hyeri Han Hyeongsu Kim AhHyun Park Dasom Kim Rahil Hwang Miyoung Kim Young Ko Sungwon Jung

The purpose of this study was to define the alcohol consumption norms and attitudes toward alcohol regulation policies among citizens of Seoul and the relationships between such norms and the favored regulatory policies. The study population consisted of 1001 adults aged 19–80 years living in Seoul. We collected demographic data and data on health behaviors, attitudes towards drinking, and preferred alcohol regulation policies. The correlations between drinking and the favored regulatory policies were analyzed. Male, as well as being employed, aged 19–39 years, single, a smoker, and a current or heavy episodic drinker were associated with more positive attitudes toward drinking (all p < 0.001) and less desire for alcohol regulation policies (all p < 0.001). We found a significant negative correlation between attitudes toward drinking and preferred alcohol regulation policies (p < 0.001). Participants who favored reduced or no alcohol consumption and a reduction in alcohol-related harm were more accepting of restrictive alcohol consumption policies. To establish alcohol control polices, differences in drinking norms within populations should be considered. Furthermore, for a successful alcohol control policy, efforts should be made to change drinking norms, as well as consider differences in regulatory policy preferences between population groups.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070833

Authors: Heather Erwin Sarah Schreiber

The present study examined the impact of aerobic and anaerobic exercise on cognitive abilities in eighth grade students at one middle school in southeastern US. It is known that youth do not meet recommended physical activity levels, yet there is research demonstrating a clear connection between aerobic exercise and academic performance. There is a gap in evidence regarding anaerobic exercise and cognitive capabilities. If professionals know which type of exercise is most beneficial for enhancing cognition in youth, it will behoove them to incorporate these practices in physical education and other areas throughout the school day for students. Thus, this research aimed to answer the following question: what is the effect of both aerobic and anaerobic exercise on the cognitive functions of eighth grade students, specifically measuring working memory, attention, and impulsivity? Fifty research participants (N = 31 males, 18 females, 1 other), aged 13–14, consented/assented to the complete study protocols. Participants engaged in an experiment containing three different cognitive tasks after partaking in three separate exercise conditions. The cognitive measures were the Stroop color–word task, the Flanker test, and the Go/No Go task, which all measured reaction time and the number of correct responses. The exercise conditions were baseline (after no exercise), aerobic (after a continuous running activity in PE), and anaerobic (after completing an interval dumbbell workout in PE). Each condition took place on a separate day to decrease the effect of confounding variables. The data were analyzed using the Scheffe modification of the MANOVA to determine whether multiple levels of the independent variable influenced the dependent variables (the reaction time and number of correct responses) or if a combination of variables influenced the outcomes. Each cognitive test was analyzed separately. The results showed that the exercise condition did significantly impact the reaction time and the number of correct responses for the Stroop color–word task [F(4, 254) = 8.59, p < 0.001; Pillai’s Trace = 0.24]. Specifically, aerobic exercise improved both reaction time (p < 0.001) and the number of correct responses (p = 0.001) compared to baseline, while anaerobic exercise improved just reaction time compared to baseline. To find out more detailed information about the specific dependent variable affected by the exercise program, individual ANOVA tests were conducted, resulting in statistical significance for both the number of correct responses and reaction time regarding the program. The partial Eta2 of 0.07 for the number of correct responses and 0.24 for reaction time indicated that 7% of the variance in correct responses and 24% of the variance in reaction time could be explained by the exercise program. While both are significant, reaction time is more impacted by exercise program than correct responses are. Given these findings, it is recommended that aerobic physical activity be offered in school prior to assigning cognitively challenging tasks, while quick anaerobic activity breaks should be used to refocus students’ attention. More research should be conducted to examine other cognitive abilities, as well as in other populations.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070832

Authors: Bárbara Machado Paula Lobato de Faria Isabel Araújo Sónia Caridade

Background: The pervasive use of technology, especially among adolescents, has enabled cyber communication and brought many advantages but also led to potential violence. The issue of cyber interpersonal violence (CIV) impacting young individuals is increasingly recognized as a matter of public health; however, little is known about adolescents’ perspectives of the phenomenon. This study explores adolescents’ perspectives on CIV. It seeks to understand their interpretations of abuse, victim impact and reactions, violence escalation, gender issues, victimization and perpetration patterns, and bystander roles. Methods: This qualitative study used fifteen focus groups to gather elementary school participants’ perspectives on cyber interpersonal violence. From four Portuguese schools, 108 participants (M = 12.87 and SD = 0.31) participated in the study. A thematic analysis uncovered three themes. The results evidenced adolescents’ perspectives about CIV. Due to the amount of time spent online, adolescents regularly encounter cyber harassment and recognize the importance of help-seeking. Mental health problems and their influence on the social and educational lives of adolescents is arising as a CIV problem. Conclusions: Parents play a crucial role in mitigating CIV as well as bystanders. Future programs should promote healthy relationships, raise CIV awareness, involve stakeholders, guide parents, integrate perpetrators into programs, and foster effective networking.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070831

Authors: Antonella Pireddu Angelico Bedini Mara Lombardi Angelo L. C. Ciribini Davide Berardi

Increasingly, information technology facilitates the storage and management of data useful for risk analysis and event prediction. Studies on data extraction related to occupational health and safety are increasingly available; however, due to its variability, the construction sector warrants special attention. This review is conducted under the research programs of the National Institute for Occupational Accident Insurance (Inail). Objectives: The research question focuses on identifying which data mining (DM) methods, among supervised, unsupervised, and others, are most appropriate for certain investigation objectives, types, and sources of data, as defined by the authors. Methods: Scopus and ProQuest were the main sources from which we extracted studies in the field of construction, published between 2014 and 2023. The eligibility criteria applied in the selection of studies were based on the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). For exploratory purposes, we applied hierarchical clustering, while for in-depth analysis, we used principal component analysis (PCA) and meta-analysis. Results: The search strategy based on the PRISMA eligibility criteria provided us with 63 out of 2234 potential articles, 206 observations, 89 methodologies, 4 survey purposes, 3 data sources, 7 data types, and 3 resource types. Cluster analysis and PCA organized the information included in the paper dataset into two dimensions and labels: “supervised methods, institutional dataset, and predictive and classificatory purposes” (correlation 0.97–8.18 × 10−1; p-value 7.67 × 10−55–1.28 × 10−22) and the second, Dim2 “not-supervised methods; project, simulation, literature, text data; monitoring, decision-making processes; machinery and environment” (corr. 0.84–0.47; p-value 5.79 × 10−25–-3.59 × 10−6). We answered the research question regarding which method, among supervised, unsupervised, or other, is most suitable for application to data in the construction industry. Conclusions: The meta-analysis provided an overall estimate of the better effectiveness of supervised methods (Odds Ratio = 0.71, Confidence Interval 0.53–0.96) compared to not-supervised methods.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070830

Authors: Josie M. Rudolphi Richard L. Berg

Farm stress and mental health research has largely focused on adult producers, even though youths live and work on farms. The purpose of this study is to describe the stress and mental health experience of agricultural youths and describe participation in risk-taking behaviors. Farm families in the U.S. were invited to participate in an online survey that inquired about farm economics, stress (ASQ-S), mental health (PHQ-A and SCARED), parenting, social support, and risk-taking behaviors during the summers in 2021 and 2022. This analysis is limited to adolescent respondents (N = 298). Just over 70% of the farm adolescent sample met the criteria for at least mild symptoms of depression (PHQ-A score ≥ 5). Among anxiety disorders, 62.8% of the farm adolescent sample met the criteria for probable panic disorder, and 70.5% met the criteria for probable separation anxiety disorder. Adolescents reported the most stress around future uncertainty and school performance. The stress scores were significantly associated with more symptoms of depression. Over a quarter (27.7%) of the participants reported carrying a weapon at least 1 day in the past month, and 22.5% reported carrying a weapon on school property at least 1 day in the past month. Violence-related risk-taking behaviors were also associated with increased symptoms of depression. The results underscore the need for community- and school-based stress and mental health interventions in rural and agricultural communities.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070829

Authors: Zeynab Jouzi Lauren San Diego Neil A. Lewis Tashara M. Leak

Homelessness, affecting over half a million Americans, significantly elevates the risks of mental and physical health issues, consequently diminishing life expectancy when compared with the general population. Homelessness is a critical public health issue, and efforts are needed to address lack of housing as a social determinant of health. Transitional housing (TH) programs emerge as vital interventions, offering a place to stay with various support services to facilitate the transition to permanent residency. Nearly half of the unhoused population in the country and over 90% in New York live in TH or shelters. Despite the high utilization rates of TH, engagement with support services and opportunities for improvement remain poorly understood. This study aimed to fill this gap by examining the factors influencing support service usage and opportunities for enhancement through semi-structured interviews with TH residents in New York City to capture their lived experiences and perspectives. Analysis of the interviews (n = 20) revealed five main factors affecting service engagement that aligned with constructs of the socioecological model: intrapersonal (self-efficacy, chronic health conditions, mental health), interpersonal (parenthood and well-being of children with special needs, individual staff interactions, and communication), institutional (bureaucratic challenges, administrative burden, and living facilities), community (social isolation and educational opportunity), and policy (challenge meeting basic needs and undocumented status). Recommendations for bridging service gaps primarily arose at the institutional and community levels, offering critical insights for administrators to tailor services more effectively to TH residents’ needs, thus contributing to the broader goal of advancing health equity among the unhoused.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070828

Authors: Nikolaos Bountouvis Eirini Koumpa Niki Skoutarioti Dimitrios Kladitis Aristomenis K. Exadaktylos Charalampos Anitsakis

Diabetes mellitus is a non-communicable disease which poses a great burden on refugee populations, who are confronted with limited access to healthcare services and disruption of pre-existing pharmacological treatment. Aims: We sought to evaluate the degree of hyperglycaemia in refugees with known or recently diagnosed diabetes, to assess cardiovascular comorbidities and diabetes complications, to review and provide available therapeutic options, and to compare, if possible, the situation in Lesvos with other locations hosting refugee populations, thus raising our awareness towards barriers to accessing healthcare and managing diabetes in these vulnerable populations and to propose follow-up strategies. Methods: We retrospectively studied 69 refugee patients (68% of Afghan origin, 64% female) with diabetes mellitus (81% with type 2 diabetes), who were referred to the diabetes outpatient clinics of the General Hospital of Mytilene, Lesvos, Greece, between June 2019 and December 2020. Age, Body Mass Index, diabetes duration, glycaemic control (HbA1c and random glucose), blood pressure, estimated renal function, lipid profile, diabetes complications and current medication were documented at presentation and during subsequent visits. Results: For all patients with type 1 diabetes and type 2 diabetes, age at presentation was 17.7 and 48.1 years, BMI 19.6 kg/m2 and 28.9 kg/m2 and HbA1c 9.6% and 8.7%, respectively (all medians). One-third (29%) of patients with type 2 diabetes presented either with interrupted or with no previous pharmacological treatment. Insulin was administered to only 21% of refugees with poorly controlled type 2 diabetes. Only half of the patients (48%) with hypertension were taking antihypertensive medication and one-sixth (17%) were taking lipid-lowering medication. Forty-two per cent (42%) of patients were lost to follow-up. Conclusions: Our results showed that a significant portion of refugees with diabetes have either no treatment at all or have had their treatment discontinued, that insulin is still underutilised and that a significant portion of patients are lost to follow-up. It is essential to enhance our ability to identify refugees who may be at risk of developing diabetes or experiencing complications related to the disease. Additionally, it is important to expand access to crucial treatment and monitoring services. By improving our policies for managing non-communicable diseases, we can better support the health and well-being of these vulnerable populations. Furthermore, it is vital to recognize that Greece cannot bear the burden of the refugee crisis alone; international support and collaboration are necessary to address these challenges effectively.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070827

Authors: Tomohiro Izumiyama Atsuno Tsuji Katsunori Tanaka Yumiko Tateoka Ryusuke Asahi Hiroshi Hamano Masahito Hitosugi Shigeru Sugimoto

The aims of this study were as follows: the (a) creation of a pregnant occupant finite element model based on pregnant uterine data from sonography, (b) development of the evaluation method for placental abruption using this model and (c) analysis of the effects of three factors (collision speed, seatbelt position and placental position) on the severity of placental abruption in simulations of vehicle collisions. The 30-week pregnant occupant model was developed with the uterine model including the placenta, uterine–placental interface, fetus, amniotic fluid and surrounding ligaments. A method for evaluating the severity of placental abruption on this pregnant model was established, and the effects of these factors on the severity of the injury were analyzed. As a result, a higher risk of placental abruption was observed in high collision speeds, seatbelt position over the abdomen and anterior-fundal placenta. Lower collision speeds and seatbelt position on the iliac wings prevented severe placental abruption regardless of placental positions. These results suggested that safe driving and keeping seatbelt position on the iliac wings were essential to decrease the severity of this injury. From the analysis of the mechanism for placental abruption, the following hypothesis was proposed: a shear at adhesive sites between the uterus and placenta due to direct seatbelt loading to the uterus.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070826

Authors: Nicola Rizzo Pesci Elena Teobaldi Giuseppe Maina Gianluca Rosso

Background: Psychiatric disorders are large contributors to the global disease burden, but research on the impact of climate change on them is limited. Our aim is to investigate the correlation between temperature and exacerbations of psychiatric disorders to help inform clinical management and future public health policies. Methods: Temperature records for the summer months from 2013 to 2022 were obtained from the meteorological station of the Department of Physics of Turin University. Data on patients admitted to the acute psychiatric unit were extracted from registries of San Luigi Gonzaga University Hospital (Turin, Italy). Regression analyses were used to investigate the correlation between temperature and number of admissions and to test for confounding variables. Results: A total of 1600 admissions were recorded. The monthly temperature and number of admissions were directly correlated (p = 0.0020). The correlation was significant for the subgroup of admissions due to Bipolar Disorders (p = 0.0011), but not for schizophrenia or major depressive disorder. After multiple regression analyses, the effect of temperature remained significant (p = 0.0406). Conclusions: These results confirm the impact of meteorological factors on mental disorders, particularly on BD. This can contribute to personalised follow-up and efficient resource allocation and poses grounds for studies into etiopathological mechanisms and therapeutic implications.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070825

Authors: Natasja Kudzai Magorokosho Alexandros Heraclides Eleonora Papaleontiou-Louca Maria Prodromou

Background: The mental well-being of university students has been a growing concern in Public Health and has been exacerbated by the COVID-19 pandemic. The pandemic (including the post-pandemic era) introduced and exacerbated a variety of potential stressors for vulnerable individuals and communities, resulting in an increase in mental health issues among university students. Resilience, as a process, is the ability of a system to adapt and grow in the face of adversity. This is a crucial aspect to consider when examining the coping of university students in critical situations such as COVID-19. Objective: This study aims to assess the association between resilience and mental health outcomes among university students in Cyprus during the post-COVID-19 pandemic era. Methods: A parallel embedded mixed methods research design will be utilized to assess resilience, measured by the Conner–Davidson Resilience Scale (CD-RISC), the COVID-19 Impact Scale (CIS) and mental health outcomes measured by the Symptom Checklist 90-Revised (SCL 90-R), during the COVID-19 post-pandemic era (January 2022–July 2024) among university students in the Republic of Cyprus. The study will be conducted in two stages: a pilot study followed by the main study. Quantitative data will be collected through a web-based survey, while qualitative data will be obtained through in-person focus groups designed to capture participants’ experiences. Participants will be recruited using a proportional quota sampling approach to achieve representativeness based on predefined demographics. The study protocol has been approved by the Cyprus Bioethics Committee (approval no: EEC/EP/2023/31). Discussion: This study is expected to broaden our understanding of the intricate interactions between the COVID-19 pandemic’s impact, resilience, and mental health outcomes. The focus on university students’ psychological wellbeing is consistent with the call by the WHO to focus on mental health (World Health Organization, 2019).

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070824

Authors: Bert Celie Ria Laubscher Martin Bac Marianne Schwellnus Kim Nolte Paola Wood Tanya Camacho Debashis Basu Jill Borresen

Background: Personal health behaviours and lifestyle habits of health professionals influence their counselling practices related to non-communicable diseases (NCDs). There are limited data on the prevalence of unhealthy lifestyle habits among medical students and the impact of acquired health knowledge throughout the curriculum. The aim of this study was to determine and compare the prevalence of modifiable behavioural NCD risk factors of medical students in different academic years at a South African tertiary institution. Methods: A cross-sectional observational study of 532 consenting medical students was conducted. Participants completed five online questionnaires regarding lifestyle behaviours (physical activity, dietary habits, smoking, alcohol consumption and sleep). Results: Lifestyle-related risk factors with the highest prevalence were poor sleep quality (66.0%), low levels of habitual physical activity (55.8%) and low-to-moderate diet quality (54.5%). There were no differences between academic years for all risk factors measured. Over 60% of the cohort had two or more NCD risk factors and this prevalence did not differ across the degree program with the acquisition of more health knowledge. Conclusion: Medical students have a high prevalence of poor sleep quality, low levels of physical activity and low-to-moderate diet quality, which does not appear to change over the course of their academic career. Sleep hygiene, regular physical activity and healthy nutrition should be targeted in intervention programmes and be more prevalent in the medical curriculum.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070823

Authors: Gorfu Geremew Oliver Cumming Alemayehu Haddis Matthew C. Freeman Argaw Ambelu

The latest report from the Intergovernmental Panel on Climate Change (IPCC) highlighted the worsening impacts of climate change. Two climate factors—temperature and rainfall uncertainties—influence the risk of childhood diarrhea, which remains a significant cause of morbidity and mortality in low- and middle-income countries. They create a conducive environment for diarrhea-causing pathogens and overwhelm environmental prevention measures. This study aimed to produce comprehensive evidence on the association of temperature and rainfall variability with the risk of childhood diarrhea and the influence of water and sanitation conditions on those associations. We conducted a systematic review and meta-analysis using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) approach. Records published in English from 2006 to 2023 were searched on 8 January 2024 via PubMed, EMBASE, ScienceDirect, Scopus, the Cochrane Library, and Google/Google Scholar using comprehensive search terms. We assessed studies for any risk of bias using the Navigation Guide and rated the quality of the evidence using the GRADE approach. The heterogeneity among estimates was assessed using I-squared statistics (I2). The findings of the analysis were presented with forest plots using an incidence rate ratio (IRR). A meta-analysis was conducted on effect modifiers (water supply and sanitation conditions) using a random effects model with a 95% confidence interval (CI). The statistical analyses were conducted using R 4.3.2 software and Review Manager 5.3. A total of 2017 records were identified through searches, and only the 36 articles that met the inclusion criteria were included. The analysis suggests a small positive association between increased temperature and the occurrence of under-five diarrhea, with the pooled IRR = 1.04; 95% CI [1.03, 1.05], at I2 = 56% and p-value < 0.01, and increased rainfall and U5 diarrhea, with IRR = 1.14; 95% CI [1.03, 1.27], at I2 = 86% and p-value < 0.01. The meta-analysis indicated a positive association between unimproved latrine facilities and drinking water sources with a rainfall-modified effect on U5 diarrhea, with IRR = 1.21; 95% CI [0.95, 1.53], at I2 = 62% and p-value = 0.03. We found that an increase in mean temperature and rainfall was associated with an increased risk of childhood diarrhea. Where there were unimproved latrine facilities and drinking water sources, the increase in mean rainfall or temperature would increase the incidence of childhood diarrhea. The results of this review help in assessing the effectiveness of current intervention programs, making changes as needed, or creating new initiatives to lower the prevalence of childhood diarrhea.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070822

Authors: Sylwia Jarzynka Kamila Strom Olga Barbarska Emilia Pawlikowska Anna Minkiewicz-Zochniak Elzbieta Rosiak Gabriela Oledzka Aleksandra Wesolowska

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International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070821

Authors: Roberta Foster Mariana Matera Veras Andre Luis Lacerda Bachi Jonatas Bussador do Amaral Victor Yuji Yariwake Dunia Waked Ana Clara Bastos Rodrigues Marilia Farrajota Robério Pereira Pires Karina Pantaleão Juliana de Melo Batista dos Santos Francys Helen Damian Paulo Hilário Saldiva Mauro Walter Vaisberg

Atmospheric pollution can be defined as a set of changes that occur in the composition of the air, making it unsuitable and/or harmful and thereby generating adverse effects on human health. The regular practice of physical exercise (PE) is associated with the preservation and/or improvement of health; however, it can be influenced by neuroimmunoendocrine mechanisms and external factors such as air pollution, highlighting the need for studies involving the practice of PE in polluted environments. Herein, 24 male C57BL/6 mice were evaluated, distributed into four groups (exposed to a high concentration of pollutants/sedentary, exposed to a high concentration of pollutants/exercised, exposed to ambient air/sedentary, and exposed to ambient air/exercised). The exposure to pollutants occurred in the environmental particle concentrator (CPA) and the physical training was performed on a treadmill specially designed for use within the CPA. Pro- and anti-inflammatory markers in blood and bronchoalveolar lavage (BALF), BALF cellularity, and lung tissue were evaluated. Although the active group exposed to a high concentration of pollution showed a greater inflammatory response, both the correlation analysis and the ratio between pro- and anti-inflammatory cytokines demonstrated that the exercised group presented greater anti-inflammatory activity, suggesting a protective/adaptative effect of exercise when carried out in a polluted environment.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070820

Authors: Alex Kihehere Mukiga Evans Sakyi Boadu Tayebwa Edson

Abstract: Citizen participation is a crucial aspect of the national health system, empowering individuals to contribute to improving local health services through Health Committees (HCs). HCs promote the participation of citizens in the delivery of primary healthcare services. The study explores the perceptions of citizen participation in the context of the Ruhama County Ntungamo local government area, Uganda. This study aims to understand the impact of HCs on healthcare service delivery. Using a qualitative approach of inquiry grounded in thematic analysis and rooted in principal–agent theory in a single case study, this study examined citizens’ participation in the delivery of a local healthcare service. The study is based on interviews with 66 participants comprising health workers, patients, residents, health administrators, local councillors, and HC members. The findings reveal a notable absence of a health committee in healthcare delivery in Ruhama County. The absence is attributed to a need for a formalised citizen participation structure in managing health facilities and service delivery. It raises concerns about the limited influence of citizens in shaping healthcare policies and decision-making processes. The study recommends the incorporation of health committees into the local health systems to enhance participation and grant communities greater influence over the management of health facilities and service delivery. Incorporating health committees into local health systems strengthens citizen participation and leads to more effective and sustainable healthcare services aligned with people’s needs and preferences. Integrating health committees within Itojo Hospital and similar facilities can grant citizens a meaningful role in shaping the future of their healthcare.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070818

Authors: Gillian Parker Sarah Hunter Karen Born Fiona A. Miller

Reducing low-value care (LVC) and improving healthcare’s climate readiness are critical factors for improving the sustainability of health systems. Care practices that have been deemed low or no-value generate carbon emissions, waste and pollution without improving patient or population health. There is nascent, but growing, research and evaluation to inform practice change focused on the environmental co-benefits of reducing LVC. The objective of this study was to develop foundational knowledge of this field through a scoping review and bibliometric analysis. We searched four databases, Medline, Embase, Scopus and CINAHL, and followed established scoping review and bibliometric analysis methodology to collect and analyze the data. A total of 145 publications met the inclusion criteria and were published between 2013 and July 2023, with over 80% published since 2020. Empirical studies comprised 21%, while commentary or opinions comprised 51% of publications. The majority focused on healthcare generally (27%), laboratory testing (14%), and medications (14%). Empirical publications covered a broad range of environmental issues with general and practice-specific ‘Greenhouse gas (GHG) emissions’, ‘waste management’ and ‘resource use’ as most common topics. Reducing practice-specific ‘GHG emissions’ was the most commonly reported environmental outcome. The bibliometric analysis revealed nine international collaboration networks producing work on eight key healthcare areas. The nineteen ‘top’ authors were primarily from the US, Australia and Canada.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070819

Authors: Yunxi Zhang Lincy S. Lal Yueh-Yun Lin J. Michael Swint Ying Zhang Richard L. Summers Barbara F. Jones Saurabh Chandra Mark E. Ladner

During the COVID-19 pandemic, tele-mental health (TMH) was a viable approach for providing accessible mental and behavioral health (MBH) services. This study examines the sociodemographic disparities in TMH utilization and its effects on healthcare resource utilization (HCRU) and medical expenditures in Mississippi. Utilizing a cohort of 6787 insured adult patients at the University of Mississippi Medical Center and its affiliated sites between January 2020 and June 2023, including 3065 who accessed TMH services, we observed sociodemographic disparities between TMH and non-TMH cohorts. The TMH cohort was more likely to be younger, female, White/Caucasian, using payment methods other than Medicare, Medicaid, or commercial insurers, residing in rural areas, and with higher household income compared to the non-TMH cohort. Adjusting for sociodemographic factors, TMH utilization was associated with a 190% increase in MBH-related outpatient visits, a 17% increase in MBH-related medical expenditures, and a 12% decrease in all-cause medical expenditures (all p < 0.001). Among rural residents, TMH utilization was associated with a 205% increase in MBH-related outpatient visits and a 19% decrease in all-cause medical expenditures (both p < 0.001). This study underscores the importance of addressing sociodemographic disparities in TMH services to promote equitable healthcare access while reducing overall medical expenditures.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070817

Authors: Eric Adzivor Fidelis Emuze Moses Ahiabu Moses Kusedzi

The Ghanaian construction industry faces challenges in managing safety, especially for small and medium-sized enterprises (SMEs) that need more resources. This research addressed the critical need for a positive safety culture framework specifically designed for SMEs in Ghana. The study adopts the Delphi research approach, which involves a series of questionnaire ‘rounds’ to gather and refine information and develop a collaborative safety culture framework with SME stakeholders. The study employed a mixed-methods strategy, harnessing quantitative and qualitative data to meet the research goals. The critical components of the developed framework included safety commitment, adaptability, information, awareness, culture, and performance. The research offered evidence-based recommendations for effective positive safety practices across Ghana’s SMEs by analysing the relationship between these interventions and safety outcomes. Applying the framework should reduce workplace accidents and foster a positive safety culture that aligns with international best practices.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070816

Authors: Yamisha Bermudez Amy DeGroff Jacqueline Miller Kristy Kenney Jala Lockhart Djenaba Joseph Lisa Richardson

Introduction: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) observed significant declines in screening volume early in the COVID-19 pandemic, January–June 2020, with variation by race/ethnicity and geography. We aimed to determine how screening in the NBCCEDP recovered from these early declines as it is important for monitoring the long-term impact on women served by the program. Methods: Extending the previous analyses, we compared monthly breast (BC) and cervical cancer (CVC) screening volume in the NBCCEDP during 2020–2022, to five-year, pre-COVID-19 pandemic averages (2015–2019), and calculated percent change. Results were stratified by race/ethnicity and rurality groups. We employed multiple one-way ANOVA tests, which included multiple comparisons, to test for significant differences between groups. Results: By December 2022, NBCCEDP breast and cervical cancer screening volumes had not fully recovered to pre-COVID-19 5-year averages, and recovery in breast cancer screening volume was slower than that of cervical cancer. Both BC and CVC screening among women in metro areas showed the smallest average monthly deficits (−8.8% BC and −4.9% CVC) compared to monthly pre-COVID-19 pandemic 5-year averages, and screening among women in rural areas showed the greatest deficits (−37.3% BC and −26.7% CVC). BC and CVC screening among Hispanic women showed the greatest improvements compared to the pre-COVID-19 averages (8.2% BC and 9.5% CVC), and cervical cancer screening among non-Hispanic Asian and Pacific Islander women showed the greatest deficits (−41.4% CVC). Conclusion: For increased intervention efforts, NBCCEDP recipients can focus on populations demonstrating greatest deficits in screening volume.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070815

Authors: Sockho Jeong Yeonyeop Lim Yeji Kang Chaeyeon Yi

Heat vulnerability maps are vital for identifying at-risk areas and guiding interventions, yet their relationship with health outcomes is underexplored. This study investigates the uncertainty in heat vulnerability maps generated using health outcomes and various statistical models. We constructed vulnerability maps for 167 municipalities in Korea, focusing on the mild and severe health impacts of heat waves on morbidity and mortality. The outcomes included incidence rates of heat-related outpatient visits (morbidity) and attributable mortality rates (mortality) among individuals aged 65 years and older. To construct these maps, we utilized 11 socioeconomic variables related to population, climate, and economic factors. Both linear and nonlinear statistical models were employed to assign these socioeconomic variables to heat vulnerability. We observed variations in the crucial socioeconomic variables affecting morbidity and mortality in the vulnerability maps. Notably, nonlinear models depicted the spatial patterns of health outcomes more accurately than linear models, considering the relationship between health outcomes and socioeconomic variables. Our findings emphasize the differences in the spatial distribution of heat vulnerability based on health outcomes and the choice of statistical models. These insights underscore the importance of selecting appropriate models to enhance the reliability of heat vulnerability maps and their relevance for policy-making.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070814

Authors: Sinnathamby N. Surendran S. H. P. Parakrama Karunaratne

The objective of this review was to update the current knowledge on major malaria vectors in Sri Lanka and their bio-ecology and insecticide resistance status. Relevant data were collected through a comprehensive literature search performed using databases such as PubMed, NIH, Google Scholar and Web of Science. Sri Lanka had been endemic to malaria for centuries. However, due to a coordinated public health effort last indigenous malaria case was reported in 2012 and the island nation was declared free of malaria in 2016. Although 25 anopheline mosquitoes have been reported so far on the island, only Anopheles culicifacies and An. subpictus have been established as primary and secondary vectors of malaria respectively. Both vector species exist as a species complex, and the sibling species of each complex differ in their bio-ecology and susceptibility to malaria parasites and insecticides. The article provides a comprehensive and updated account of the bio-ecology and insecticide resistance of malaria vectors and highlights the challenges ahead of retaining a malaria-free status.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21070813

Authors: Michael J. Popovich Brandon S. Wright Abigail C. Bretzin Mark T. Roberts Bara Alsalaheen Andrea A. Almeida Matthew T. Lorincz James T. Eckner

Background: Headache is among the most common symptoms following concussion, yet headache after concussion (HAC) remains poorly characterized. This study describes headache characteristics over the first four weeks following pediatric sport-related concussion. Methods: This is a retrospective case series of 87 athletes (mean: 14.9 years; range: 8.4–18.8 years; 38% female) treated in a specialty sports concussion clinic within 28 days of injury. Primary outcomes of headache consistency, frequency, duration, and associated migrainous symptoms were assessed at immediate (0 to 48 h) and weekly time points over the first 28 days post-injury. Generalized mixed linear models compared headache characteristics across time points. Secondary analyses compared each outcome by as-needed analgesic use. Results: During the immediate post-injury period, headache was more often constant (p = 0.002) and associated with migrainous symptoms (p < 0.001). By the third week post-injury, episodic headache was more prevalent (p < 0.001). Most patients (54%) transitioned from constant, migrainous headache to episodic, non-migrainous headache. This finding was uninfluenced by as-needed analgesic medication use. Conclusions: These findings document the trajectory of HAC. Future studies should assess relationships between initial headache characteristics and recovery.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060812

Authors: Tan Van Nguyen Thu Thi Xuan Pham Tu Ngoc Nguyen

Background. There is limited evidence on the complexity of cardiovascular disease (CVD) and geriatric syndromes in older patients with end-stage renal disease. Our aims were to (1) examine the prevalence of CVD in older patients on chronic hemodialysis, (2) compare the burden of geriatric syndromes in patients with and without CVD, and (3) examine the impact of CVD on hospitalization. Methods. This prospective, observational, multi-center study was conducted at two dialysis units of two major hospitals in Vietnam. Consecutive older adults receiving chronic hemodialysis were recruited from November 2020 to June 2021. CVD was defined as having one of these conditions: heart failure, ischemic heart disease, or stroke. Participants were assessed for geriatric conditions including frailty, malnutrition, impairment in instrumental activities/activities of daily living, depression, falls, and polypharmacy. Multivariable logistic regression analysis was applied to examine the impact of CVD on 6-month hospitalization, adjusting for age, sex, duration of dialysis, Charlson Comorbidity Index, and geriatric conditions. Results were presented as odds ratios (ORs) and 95% confidence intervals (CIs). Results. There were 175 participants (mean age 72.4 ± 8.5 and 58.9% female). CVD was present in 80% of the participants (ischemic heart disease: 49.7%, heart failure: 60.0%, and stroke: 25.7%). Participants with CVD had a higher burden of geriatric syndromes compared to those without CVD. During the 6-month follow-up, 48.6% of the participants were hospitalized (56.4% of those with CVD vs. 17.1% of those without CVD), p < 0.001). CVD independently increased the risk of hospitalization (adjusted OR 3.32, 95% CI 1.12–9.80). Conclusions. In this study, there was a very high prevalence of CVD in older patients undergoing chronic dialysis. Participants with CVD had a higher burden of geriatric syndromes and their risk of 6-month hospitalization increased by three times. There is a need for a multidisciplinary and patient-centered approach to treatment planning for these patients.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060811

Authors: Celia Landmann Szwarcwald Paulo Roberto Borges de Souza Junior Thaiza Dutra Gomes de Carvalho Rita Suely Bacuri de Queiroz Euclides Ayres de Castilho Maria do Carmo Leal

In 2021, an RDS survey was conducted among Venezuelan migrant women of reproductive age who migrated to two Brazilian cities (Manaus and Boa Vista) from 2018 to 2021. To start the RDS recruitment, we chose seeds non-randomly in both cities. The study variables were age, educational level, self-rated health, pregnancy, migratory status and use of health services. We estimated the prevalence, confidence intervals and homophily effects by variable category. We used a multivariate logistic regression model to identify the main factors associated with healthcare use. A total of 761 women were recruited in Manaus and 1268 in Boa Vista. Manaus showed more irregular migrants than Boa Vista. The main reasons for using health services were as follows: illness, disease prevention and prenatal care. The logistic regression model showed the use of health services was associated with educational level and healthcare needs but not with migratory status. The social inclusion of Venezuelan migrants is extremely relevant, although many challenges must be overcome. The strategy of the Brazilian Federal Government for providing humanitarian assistance to Venezuelan migrants should be expanded to include and facilitate their integration into labor markets, access to healthcare and education, benefiting both migrants and the Brazilian people by reducing social inequality.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060810

Authors: Shikha Sharma Dustin Rousselle Erik Parker Carolyn Damilola Ekpruke Rachel Alford Maksat Babayev Sarah Commodore Patricia Silveyra

The emerging concern about chemicals in electronic cigarettes, even those without nicotine, demands the development of advanced criteria for their exposure and risk assessment. This study aims to highlight the sensitivity of lung nuclear receptors (NRs) to electronic cigarette e-liquids, independent of nicotine presence, and the influence of the sex variable on these effects. Adult male and female C57BL/6J mice were exposed to electronic cigarettes with 0%, 3%, and 6% nicotine daily (70 mL, 3.3 s, 1 puff per min/30 min) for 14 days, using the inExpose full body chamber (SCIREQ). Following exposure, lung tissues were harvested, and RNA extracted. The expression of 84 NRs was determined using the RT2 profiler mRNA array (Qiagen). Results exhibit a high sensitivity to e-liquid exposure irrespective of the presence of nicotine, with differential expression of NRs, including one (females) and twenty-four (males) in 0% nicotine groups compared to non-exposed control mice. However, nicotine-dependent results were also significant with seven NRs (females), fifty-three NRs (males) in 3% and twenty-three NRs (female) twenty-nine NRs (male) in 6% nicotine groups, compared to 0% nicotine mice. Sex-specific changes were significant, but sex-related differences were not observed. The study provides a strong rationale for further investigation.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060809

Authors: Elizabeth G. Klein Abigail B. Shoben Kelly M. Carpenter Kristina Mullis Julianna M. Nemeth Elizabeth Mayers Katrina A. Vickerman

Despite interest in quitting vaping among young adults (YAs), little is known about characteristics of e-cigarette (EC) users seeking treatment. In this study, YAs aged 18–24 living in the United States interested in vaping cessation treatment were recruited to complete an online survey regarding demographics and EC use. Primary eligibility criteria were EC use on at least 20 days per month (no other tobacco use), and interest in quitting in the next month. We report descriptive statistics for those who did and did not complete a mandatory coaching call (n = 981). In this sample, most EC users reported high nicotine dependence, a history of unsuccessful quit attempts (including 29.4% with previous NRT use), along with stress, anxiety, and depression. There were few meaningful differences in demographics, EC use behaviors, or behavioral health factors between those who engaged with a phone coaching call (fully enrolled in study; n = 508), and those who did not (n = 473). YAs demonstrated interest in vaping cessation support, but there were no clear characteristics for the half who did not complete a coaching call. Vaping cessation program designers should consider tailoring for the self-reported behavioral health concerns present in this population.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060808

Authors: Susan Gonya Pamela Kallmerten Pamela Dinapoli

Deoxynivalenol (DON) is a foodborne mycotoxin produced by Fusarium molds that commonly infect cereal grains. It is a potent protein synthesis inhibitor that can significantly impact humans’ gastrointestinal, immune, and nervous systems and can alter the microbiome landscape. Low-dose, chronic exposure to DON has been found to stimulate the immune system, inhibit protein synthesis, and cause appetite suppression, potentially leading to growth failure in children. At higher doses, DON has been shown to cause immune suppression, nausea, vomiting, abdominal pain, headache, diarrhea, gastroenteritis, the malabsorption of nutrients, intestinal hemorrhaging, dizziness, and fever. A provisional maximum tolerable daily intake (PMTDI) limit of 1 µg/kg/body weight has been established to protect humans, underscoring the potential health risks associated with DON intake. While the adverse effects of dietary DON exposure have been established, healthcare communities have not adequately investigated or addressed this threat to child health, possibly due to the assumption that current regulatory exposure limits protect the public appropriately. This integrative review investigated whether current dietary DON exposure rates in infants and children regularly exceed PMTDI limits, placing them at risk of negative health effects. On a global scale, the routine contamination of cereal grains, bakery products, pasta, and human milk with DON could lead to intake levels above PMTDI limits. Furthermore, evidence suggests that other food commodities, such as soy, coffee, tea, dried spices, nuts, certain seed oils, animal milk, and various water reservoirs, can be intermittently contaminated, further amplifying the scope of the issue. Better mitigation strategies and global measures are needed to safeguard vulnerable youth from this harmful toxicant.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060807

Authors: Sander M. Brink Heleen M. Wortelboer Ard F. ten Hoff Cornelis H. Emmelot Tommy L. S. Visscher Herman A. van Wietmarschen

This study presents the outcomes of a 5-year personalized integrative coaching program for adults with obesity (body mass index BMI ≥ 30 kg/m2), based upon a systems health perspective, during the first 2 years. This longitudinal study, which had an evolutionary design, included all adults who enrolled in the program. Health-related quality of life (HRQoL) was measured with the Short Form-36 (SF-36), and physical outcomes included weight, waist circumference, aerobic capacity, lipid profile, and HbA1c. Subsequently, participants completed questionnaires (e.g., the Symptom Checlist-90 (SCL-90) and the Checklist Individual Strength (CIS)). Seventy-nine adults with a mean BMI of 39.5 kg/m2 (SD 5.3) were included. Forty-four participants completed 2 years in the program. Compared to baseline, there were significant improvements in the SF-36 subscales ‘physical functioning’ (MD 9.9 points, 95% CI: 2.1–17.5, p = 0.013) and ‘general health perceptions’ (MD 9.3 points, 95% CI 2.9–15.7, p = 0.006). Furthermore, significant improvements in physical outcomes and psychosocial questionnaires (e.g., weight loss (MD 3.5 kg, 95% CI: 1.2–5.7, p = 0.003), waist circumference (MD 5.1 cm, 95% CI: 2.4–7.8, p < 0.001), and CIS fatigue (MD 6.8, 95% CI: 3.1–10.5, p = 0.001) were observed. This study highlights the importance of a systems health perspective supporting the development of a personalized integrative coaching program for adults with obesity in a ‘real-world’ setting.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060806

Authors: Nicole Redvers Jamie Hartmann-Boyce Sarah Tonkin-Crine

Nature prescription programs have become more common within healthcare settings. Despite the health benefits of being in nature, nature prescriptions within the context of Indigenous Peoples have received little attention. We therefore sought to answer the following question: What are circumpolar-based physicians’ and Indigenous Elders’ views on nature prescribing in the Northwest Territories, Canada? We carried out thirteen semi-structured interviews with physicians between May 2022 and March 2023, and one sharing circle with Indigenous Elders in February 2023. Separate reflexive thematic analysis was carried out to generate key themes through inductive coding of the data. The main themes identified from the physician interviews included the importance of cultural context; barriers with nature prescriptions in the region; and the potential for nature prescriptions in the North. Reflections shared by the Elders included the need for things to be done in the right way; the sentiment that the Land is not just an experience but a way of life; and the importance of traditional food as a connection with Nature. With expanding nature prescription programs, key considerations are needed when serving Indigenous communities. Further investigation is warranted to ensure that nature prescriptions are appropriate within a given context, are inclusive of supporting Land-based approaches to health and wellbeing, and are considered within the context of Indigenous self-determination.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060805

Authors: Godfred O. Boateng Karin Wachter Roseanne C. Schuster Tanya L. Burgess Mary Bunn

This study aimed to systematically review current research on the application of existing social support scales in research with refugees in resettlement, assess their quality, and identify gaps in measurement to enhance research and practice. A scoping review was conducted on the extant literature published until March 2023. A team of researchers conducted search, sorting, and data extraction processes following best practices for scale development and validation. Of the 1185 studies collected from the search process, 41 articles were retained in the final analysis, from which 17 distinct social support instruments used in research with resettled refugees were identified. An assessment of all 17 instruments showed the presence of one or more limitations associated with construct, criterion, convergent, and/or discriminant validity. Test of reliability was assessed in all studies, with a range of 0.80 to 0.90. Our findings show that most of the research evaluating social support among resettled refugees is conducted without measurement instruments adequately validated in the resettlement context. This analysis highlights the need for rigorously developed social support scales that reflect the lived experiences, needs, and priorities of resettled refugees.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060804

Authors: Amanda Popolino Diniz Raquel de Deus Mendonça George Luiz Lins Machado-Coelho Adriana Lúcia Meireles

This cross-sectional study, carried out between October and December 2020 in two Brazilian cities, aimed to evaluate the joint association of education and sex with habitual and episodic excessive alcohol consumption during the COVID-19 pandemic. Habitual alcohol consumption was defined as drinking any quantity of alcohol at least once per week. Excessive episodic alcohol consumption was defined as the consumption of five or more drinks by men or four or more drinks by women at least once in the last 30 days. Adjusted multivariate logistic regression models were used to analyze associations of education and sex with alcohol consumption. Education was not associated with habitual alcohol consumption and excessive episodic alcohol consumption. However, when evaluating the joint effect between education and sex, it can be seen that men with low education were more likely to habitually consume (OR: 5.85; CI95:2.74–14.84) and abuse alcohol (OR: 4.45; IC95:1.54–12.82) and women with high education were more likely to have habitual (OR: 2.16; IC95:1.18–3.95) and abusive alcohol consumption (OR: 2.00; IC95:1.16–3.43). These findings highlight the modifying effect of sex on the relationship between education and alcohol consumption, such that education influenced alcohol consumption differently between sexes during the pandemic.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060803

Authors: James E. Cone Lucie Millien Cristina Pollari Jennifer Brite Heather Badger John Kubale Grace Noppert Sonia Hegde Robert Brackbill Mark Farfel

On 11 September 2001, attacks on the World Trade Center (WTC) killed nearly three thousand people and exposed hundreds of thousands of rescue and recovery workers, passersby, area workers, and residents to varying amounts of dust and smoke. Former New York City Mayor Rudy Giuliani ordered the emergency evacuation of Lower Manhattan below Canal Street, but not all residents evacuated. Previous studies showed that those who did not evacuate had a higher incidence of newly diagnosed asthma. Among the 71,424 who enrolled in the WTC Health Registry in 2003–2004, we evaluated the bivariate association of educational attainment, household income, and race or ethnicity with reported evacuation on or after 9/11/01. We used log binomial regression to assess the relative risks of not evacuating from their home following the 9/11 attacks, adjusting for age, gender, and marital status. Out of a total of 11,871 enrollee residents of Lower Manhattan, 7345 or 61.79% reported evacuating their home on or after 9/11. In a fully adjusted model, the estimated relative risk for not evacuating was elevated for those who identified as non-Hispanic Black, Asian/Pacific Islander, and Hispanic residents compared to non-Hispanic White residents. Residents with a high school diploma/GED had an elevated estimated risk compared to those with at least a bachelor’s degree. Those with lower household incomes had an elevated estimated risk compared to those with the highest income category. These significant inequities will need to be prevented in future disasters.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060802

Authors: Andrea Fenwicke Ajesh George Stacy Blythe Neeta Prabhu

A scoping review was conducted to synthesize available evidence of knowledge, attitudes, and practices of dental practitioners in providing care to children in out-of-home care (OOHC). Scientific databases and the grey literature were searched: 855 studies were screened after removing duplicates; 800 studies were excluded based on the title and/or abstract, and the full text of 55 studies was reviewed, with 7 included in the analysis. These included three peer-reviewed articles regarding the knowledge, attitudes, and practices of dental practitioners in providing care to children in OOHC, as well as four guidelines. Dental practitioners had some knowledge of the high health care needs of OOHC children, but knowledge regarding when children entering care received dental assessment and about OOHC dental care pathways was low. Practices of dental practitioners were varied, most gave oral hygiene instructions, but there was inconsistency in practices regarding continuity of care following placement changes and failure to attend policies. There was more consensus with dental practitioner attitudes, with practitioners in private settings seeming to prefer not to treat children in OOHC. Three of the identified guidelines provided logistical information about OOHC and consent. The final guideline gave practical information on treating children with a background of adverse childhood events (ACEs), including children in OOHC. Further research and education is warranted to aid dental practitioners in providing care to children in OOHC.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060801

Authors: Raul Ruiz Camacho Shiryn D. Sukhram

The suicide rates in Guyana, Suriname and Trinidad and Tobago are among the highest in the Americas, containing significant Indo-Caribbean populations that are suggested to be most vulnerable to suicide. This systematic review analyzes the existing literature and identifies knowledge gaps in risk and protective factors against suicide in these countries. The literature search conducted followed PRISMA guidelines using the PubMed and APA PsycInfo databases. The PRISMA flow diagram illustrated that eight scholarly papers were eligible for inclusion. Included literature examined stratified data focused on the aforementioned countries, as well as their Indo-Caribbean adolescent populations. Excluded literature did not mention suicidality, adolescents, Indo-Caribbeans, or the focal countries or was focused on the Jonestown mass murder–suicide event. The studies encompassed 6581 individuals. Identified risk factors include social stigma regarding suicide, mental health resource scarcity, and difficult socioeconomic conditions. The identified protective factors for youth include religious/spiritual practices and group activities. Limitations include database quantity, risk of publication bias, and the small sample for each study. A prevailing social stigma regarding suicide was identified. Greater research is needed relating to effects of suicide legislation, bereavement experiences, sociocultural contexts, geography, migration patterns, and culturally compatible interventions to aid future suicide prevention efforts. The protocol was registered with PROSPERO (CRD42023417494).

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060800

Authors: Viniece Jennings Alessandro Rigolon Jasmine Thompson Athena Murray Ariel Henderson Richard Schulterbrandt Gragg

Social cohesion is a key factor within social determinants of health and well-being. Urban green spaces can provide environments that potentially facilitate meaningful and positive social interactions that promote social cohesion, equity, human health, and well-being. However, the lack of integration of existing research on social cohesion, urban green spaces, and public health in diverse (e.g., racially and ethnically) communities limits culturally relevant strategies to address health disparities. In this manuscript, we synthesize research on the potential of urban green spaces to promote social cohesion and public health in historically excluded communities. Particularly, we explore the development of social cohesion as it relates to the social environment, built environment, leisure opportunities, green space maintenance, safety, and green gentrification. We highlight key factors and their application to meet opportunities and challenges to social and public health. A conceptual framework is presented to provide an overview and illustrate connections found in the literature.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060799

Authors: Marcelle M. Dougan Marian Tzuang Bora Nam Oanh L. Meyer Janice Y. Tsoh Van M. Ta Park

Background: Reports of escalated discrimination experiences among Asian American and Native Hawaiian Pacific Islanders (AANHPI) continue. Methods: Using the original and follow-up surveys of the COVID-19 Effects on the Mental and Physical Health of AAPI (Asian American and Pacific Islanders) Survey Study (COMPASS I and COMPASS II) (n = 3177), we examined changes over approximately a 1-year period in discrimination experiences attributable to being AAPI and factors associated with worse mental health outcomes. Results: Experiences of discrimination remained high in COMPASS II with 60.6% (of participants (compared to 60.2% among the same people in COMPASS I) reporting one or more discrimination experiences, and 28.6% reporting worse mental health outcomes. Experiences of discrimination were associated with modest but significant increase in the odds of worse mental health: adjusted OR 1.02 (95% CI 1.01–1.04). Being younger, being of Native Hawaiian/Pacific Islander or Hmong descent (relative to Asian Indian), and having spent 50% or less of their lifetime in the US (vs. US born), were significantly associated with worse mental health. Conclusions: The fall-out from the pandemic continues to adversely impact AANHPI communities. These findings may help influence policy initiatives to mitigate its effects and support interventions designed to improve mental health outcomes.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060798

Authors: Anneliese de Groot Bena Brown Daniel Lindsay Alana Gall Nicole Hewlett Amy Hickman Gail Garvey

As the number of people living with cancer increases, it is important to understand how people can live well with and after cancer. First Nations people diagnosed with cancer in Australia experience survival disparities relating to health service accessibility and a lack of understanding of cultural needs and lived experiences. This study aimed to amplify the voices of First Nations individuals impacted by cancer and advance the development of a culturally informed care pathway. Indigenist research methodology guided the relational and transformative approach of this study. Participants included varied cancer experts, including First Nations people living well with and after cancer, health professionals, researchers, and policy makers. Data were collected through online Yarning circles and analysed according to an inductive thematic approach. The experience of First Nations people living well with and after cancer is inextricably connected with family. The overall themes encompass hope, family, and culture and the four priority areas included the following: strength-based understanding of cancer, cancer information, access to healthcare and support, and holistic cancer services. Respect for culture is interwoven throughout. Models of survivorship care need to integrate family-centred cancer care to holistically support First Nations people throughout and beyond their cancer journey.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060797

Authors: Caterina DeFazio Samantha I. Moyers-Kinsella Elizabeth A. Claydon Michelle D. Hand Christa Lilly Keith J. Zullig Danielle M. Davidov

Bystander-based sexual violence (SV) prevention trainings are offered on college campuses across the United States to meet federal Title IX requirements, as they have proven to be an effective strategy for violence prevention. Greek-affiliated students (fraternity and sorority members) are at a higher risk of sexual assault than their peers; however, few trainings consider the specific needs of this population, and program adaptations for this high-risk group may be needed. This scoping review identifies and describes the bystander trainings delivered to Greek-affiliated students in the US and Canada. An eight-database search was conducted following PRISMA-ScR guidelines. The review identified 81 unique sources, with 18 meeting the inclusion criteria. Eleven specific training programs were identified, encompassing qualitative, quantitative, and mixed-method studies. The thematic analysis revealed best practices, including the importance of peer leaders, interactive sessions, and tailored content to Greek culture, as well as barriers such as a lack of engagement and an inadequate session length. The review underscores the need for tailored interventions to effectively address the unique cultural characteristics and high-risk nature of Greek-affiliated students. These findings provide valuable insights for improving the design and implementation of bystander interventions to enhance their efficacy in preventing sexual violence within this population.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060796

Authors: Ben Wadham Lisa Andrewartha Sharon Lawn Ilke Onur Laura Catherine Edney

Serving in the military can have significant impacts on the mental health of veterans and their families. Military personnel can be exposed to a range of physical stressors, psychological trauma, risky lifestyle factors, a regimented military culture, and inadequate support when transitioning out of service. This article reviews research on interventions designed to improve the mental health of Australian military veterans in order to synthesise current knowledge and identify gaps in the literature. Our scoping review followed PRISMA recommendations and comprised peer-reviewed literature published since 2000. The review demonstrates a dominance of psychologically driven research paradigms and interventions and a neglect of the importance of social factors in shaping veteran mental health. There is a wide range of interventions available; however, the literature is narrow and limited. We found little evidence that the lived experience of veterans had been harnessed in program design or delivery. We argue the need for a holistic approach that moves beyond psychological and biological understandings of health and wellbeing to incorporate social and cultural determinants. Future research could adopt a stronger multidisciplinary approach, increased socio-cultural understanding, and greater consideration of the lived experience of veterans and their families.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060795

Authors: Lynne Keevers Deborah Gough Jacqui Cameron Anthony McKnight Saskia Ebejer Susan Duchesne Adam Gowen Karen Fildes Maria Mackay

This systematic review investigated the practices that support and hinder the recovery and healing of communities and the environments within which they live, following climate-related environmental disasters. Although the literature focused on recovery is dominated by interventions aimed at the individual and their mental health, a thematic analysis of thirty-six studies established a range of practices that enhance collective recovery and healing. Four narratives were identified from the findings highlighting key practices: (1) collective and community-led recovery; (2) recognising the criticality of context, place, and identity; (3) adopting a holistic conception of well-being and Country-centred practices; and (4) decolonising and Indigenising the literature. This study details recommendations for research and practice. First Nations’ knowledges and healing practices need to be recognised and harnessed in climate-related environmental disaster recovery. Community-led interventions harness local knowledge, networks, and expertise, which improves the dissemination of resources and enables recovery efforts to be tailored to the specific needs of communities.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060794

Authors: Zhanette Coffee Kevin Cheng Maribeth Slebodnik Kimberly Mulligan Chong Ho Yu Todd W. Vanderah Judith S. Gordon

Despite the lack of evidence, opioids are still routinely used as a solution to long-term management for chronic noncancer pain (CNCP). Given the significant risks associated with long-term opioid use, including the increased number of unregulated opioid pills at large in the opioid ecosystem, opioid cessation or reduction may be the desired goal of the patient and clinician. Viable nonpharmacological interventions (NPIs) to complement and/or replace opioids for CNCP are needed. Comprehensive reviews that address the impact of NPIs to help adults with CNCP reduce opioid use safely are lacking. We conducted a literature search in PubMed, CINAHL, Embase, PsycINFO, and Scopus for studies published in English. The initial search was conducted in April 2021, and updated in January 2024. The literature search yielded 19,190 relevant articles. Thirty-nine studies met the eligibility criteria and underwent data extraction. Of these, nineteen (49%) were randomized controlled trials, eighteen (46%) were observational studies, and two (5%) were secondary analyses. Among adults with CNCP who use opioids for pain management, studies on mindfulness, yoga, educational programs, certain devices or digital technology, chiropractic, and combination NPIs suggest that they might be an effective approach for reducing both pain intensity and opioid use, but other NPIs did not show a significant effect (e.g., hypnosis, virtual reality). This review revealed there is a small to moderate body of literature demonstrating that some NPIs might be an effective and safe approach for reducing pain and opioid use, concurrently.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060793

Authors: Nelsensius Klau Fauk Alfonsa Liquory Seran Paul Aylward Lillian Mwanri Paul Russell Ward

Parental labour migration, of either one or both parents, has been associated with various challenges among left-behind children (LBC). However, there is a limited understanding of the LBC’s own views and experiences of social and mental well-being and how the new daily life circumstances they encounter following their parents’ migration impact them. This study aimed to understand the influence of parental migration and its aftermath on the social and mental well-being of adolescents (referred to as LBC) in two rural districts in Indonesia. Employing a qualitative design, data were collected through individual in-depth interviews with LBC (n = 24) aged 14 to 18 years, recruited using the snowball sampling technique. Data were thematically analysed, guided by a qualitative data analysis framework. The findings showed that parental migration negatively impacted the social well-being of LBC. This impact was reflected in negative labelling from friends and changes in familial roles which influenced their social interactions and activities with peers. Parental migration was also associated with challenges to the mental well-being of LBC. These manifested in the LBC experiencing fractured emotional bonds, leading to negative emotions, including stress, anxiety, sadness, depression, frustration, loss of motivation, and self-imposed isolation, which were associated with their parents’ migration and abrupt disruptions in parent–child communication. The transition to new life situations with caregivers after parental migration and the dynamics within the caregivers’ households were additional factors that detrimentally affected their mental well-being. Unmet basic needs and educational needs due to financial hardships faced by mothers and caregivers further exacerbated mental health challenges for the children. The findings indicate the importance and improvement of policies and interventions in Indonesia (e.g., counselling services, non-cash food assistance, family hope program, direct cash assistance) that cover and address the diverse needs of mothers or caregivers and the LBC.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060792

Authors: Nayara dos Santos Oliveira Yovanka Perez Ginoris Harsha Ratnaweera

This study assessed three powdered activated carbons (BETM, COCO, and SIAL) commercialized in Brazil at the bench scale in agitated reactors, analyzing their kinetic behavior and adsorptive capacity for BPS and BPA in ultrapure water. BETM exhibited the highest adsorption capacities (Q0max) for BPS and BPA at 260.62 and 264.64 mg/g, respectively, followed by SIAL, with a Q0max of 248.25 mg/g for BPS and for 231.20 mg/g BPA, and COCO, with a Q0max of 136.51 mg/g for BPS and 150.03 mg/g for BPA. The Langmuir isotherm model can describe the processes well. A pseudo-second-order model can describe the adsorption kinetics, and SIAL carbon had the highest rate constants (7.45 × 10−3 mg/g/min for BPS and 2.84 × 10−3 mg/g/min for BPA). The Weber–Morris intraparticle diffusion model suggests intraparticle diffusion as the rate-limiting step of all adsorption processes. Boyd’s model confirmed more than the mechanism actuating in the bisphenol adsorption. The results suggest that adsorbents with basic surfaces, high specific surface areas, and high mesopore volumes tend to remove BPS and BPA efficiently. Therefore, activated carbons can effectively complement the existing treatment in Brazilian water treatment plants (WTPs).

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060791

Authors: Rebecca Purc-Stephenson Nicole Roy Adachukwu Chimaobi Deanna Hood

Individuals living in rural areas often face challenges in accessing healthcare, increasing their risk of poor health outcomes. Farmers, a sub-population in rural areas, are particularly vulnerable to mental health issues and suicide, yet they exhibit low rates of help-seeking behavior. The aim of our study was to develop an in-depth understanding of the issues influencing mental help-seeking among farmers living in rural areas from the perspectives of healthcare providers, as well as to explore the strategies providers use to navigate through these issues to effectively engage with this vulnerable population. Methods: We used a descriptive phenomenological approach to understand healthcare providers’ perspectives, experiences, and approaches to providing mental healthcare to farmer clients in rural areas. Semi-structured interviews were conducted with 21 participants practicing in Canada between March and May 2023. Results: Our analysis yielded five thematic areas: (1) ensuring accessibility, (2) establishing relatability, (3) addressing stoicism and stigma, (4) navigating dual roles, and (5) understanding community trauma. Conclusions: Healthcare service delivery for farmers is multifaceted. This study fills a gap in knowledge by translating these data to inform an evidence-based model and a list of recommendations for implementing agriculturally informed practices in rural areas.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060790

Authors: Aida Suárez-González Sharon A Savage Suvarna Alladi Viviane Amaral-Carvalho Faheem Arshad Julieta Camino Paulo Caramelli Adelina Comas-Herrera Julia Cook Claudia Cooper Laura García Díaz Stephanie M. Grasso Regina Jokel Monica Lavoie Tomás León Thomas Priya Teresita Ramos Franco Cathleen Taylor-Rubin Rosemary Townsend Angelika Thöne-Otto Andrea Slachevsky Anna Volkmer Wendy Weidner Claire MC O’Connor

The WHO Dementia Global Action Plan states that rehabilitation services for dementia are required to promote health, reduce disability, and maintain quality of life for those living with dementia. Current services, however, are scarce, particularly for people with young-onset dementia (YOD). This article, written by an international group of multidisciplinary dementia specialists, offers a three-part overview to promote the development of rehabilitation services for YOD. Firstly, we provide a synthesis of knowledge on current evidence-based rehabilitative therapies for early-onset Alzheimer’s disease (EOAD), behavioural variant frontotemporal dementia (bvFTD), primary progressive aphasia (PPA), and posterior cortical atrophy (PCA). Secondly, we discuss the characteristics of rehabilitation services for YOD, providing examples across three continents for how these services can be embedded in existing settings and the different roles of the rehabilitation multidisciplinary team. Lastly, we conclude by highlighting the potential of telehealth in making rehabilitation services more accessible for people with YOD. Overall, with this paper, we aim to encourage clinical leads to begin introducing at least some rehabilitation into their services, leveraging existing resources and finding support in the collective expertise of the broader multidisciplinary dementia professional community.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060789

Authors: Santiago Rendon-Marin Luis Felipe Higuita-Gutiérrez Diana Maryory Gomez-Gallego

Background: Air pollution has emerged as a global public health concern. Specifically, in Medellín, Colombia, episodes of elevated air pollution have been documented. Medical students’ knowledge of air pollution is paramount for implementing future interventions directed toward patients. The aim of this research was to delineate the knowledge, attitudes, and practices regarding air pollution among medical students at a private university in Medellín. Methods: A cross-sectional study involving 352 medical students was conducted. A questionnaire was administered, generating scores ranging from 0 to 100, where a higher score signified better knowledge, attitudes, and practices. Data were analyzed using frequencies, summary measures, non-parametric tests, and linear regression. Results: In total, 31% rated the education received at the university on the relationship between health and air quality as fair to poor, and 81% perceived the air quality in the city as poor. The knowledge score was 77.8 (IQR 71.1–85.6), with 90% acknowledging that exposure to air pollution increases the risk of various diseases. The attitudes score was 82.1 (IQR 71.8–87.2), and 25.9% believed that air pollution is a multifactorial problem, rendering their actions ineffective. In terms of practices, the score was 50 (IQR 42.9–57.1), indicating that students either did not employ protective measures against pollution or used inappropriate practices such as masks or air purifiers. Regression analysis revealed no association between knowledge and practices. Conclusion: The findings of this study underscore that medical students possess commendable knowledge regarding the health effects of air pollution. However, their adoption of inappropriate practices for self-protection is evident. The lack of correlation between knowledge and practices highlights the necessity of educational initiatives to be complemented by regulatory and cultural interventions.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060788

Authors: Hussain Chattha Markus J. Duncan Negin A. Riazi Scott T. Leatherdale Karen A. Patte

The purpose of this study was to explore the adaptations that schools made to physical activity programs and facilities, and disparities by area urbanicity and income, during the first school year after the emergence of the COVID-19 pandemic. In a convenience sample of 132 secondary schools in Canada, school contacts responded to an annual survey in the 2020–2021 school year on changes to physical activity programs and facilities, and related staff training. Content analysis categorized open-ended text responses, and schools were compared based on area urbanicity and median income. Most schools canceled all interschool sports (88.9%) and intramurals (65.9%). New programs were added by 12.6% of schools, and about half (49%) of schools reported some continuing programs, most of which were sports programs, followed by facility and equipment access. Physical activity facilities were closed in 18.1% of schools, while 15.7% had new facilities added, and 11% temporarily converted facilities into learning spaces. Large/medium urban schools were at greater odds of having made any change to their facilities compared to schools in rural/small urban areas (odds ratio (95% confidence interval): 2.3 (1.1, 4.8)). The results demonstrate the considerable scale and nature of the restrictions in school provisions of physical activity opportunities during this period, as well as the resourcefulness of some schools in adding new programs and facilities.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060787

Authors: Andrew Klein Mehmet A. Begen

The COVID-19 pandemic highlighted the challenges that go into effective policymaking. Facing a public health crisis of epic proportion, government bodies across the world sought to manage the spread of infectious disease and healthcare-system overwhelm in the face of historic economic instability and social unrest. Recognizing that COVID-19 debates and research are still actively ongoing, this paper aims to objectively compare COVID-19 responses from countries across the world that exhibit similar economic and political models to Canada, identify notable failures, successes, and key takeaways to inform future-state pandemic preparedness.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060786

Authors: Marta Frazão Pinheiro Inês Carvalho Relva Mónica Costa Catarina Pinheiro Mota

Social support enhances the development of adaptive strategies to cope with difficulties, which may affect psychological well-being. Sleep quality has been highlighted as having a relevant role in psychological well-being. The present study aimed to analyse the role of social support and sleep quality in the psychological well-being of health professionals (nurses and doctors) compared to the general population. The sample comprised 466 adults aged between 18 and 75 (M = 43.4; SD = 10.8), of which 272 were the general population and 194 nurses and doctors. Data were collected through a Sociodemographic Questionnaire, the Multidimensional Scale of Perceived Social Support, the Pittsburgh Sleep Quality Index, and the Psychological Well-Being Manifestation Measure Scale. Nurses presented less balance (also doctors), sociability and happiness than other professionals. Less significant sociability was observed in nurses compared with doctors. The results also allowed us to observe the positive role of social support from significant others on social involvement and sociability and the positive role of the family in self-esteem. Social support from friends played a positive role in all dimensions of psychological well-being. Males had a higher prevalence of psychological well-being. Other professionals and sleep quality show high levels of psychological well-being in all dimensions. Data discussion highlights the role of social support, sleep, and sex and the implications of health professions (nurses and doctors) on psychological well-being.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060785

Authors: Shaila M. Strayhorn-Carter Ken Batai Francine C. Gachupin

Racism has been a long-standing influential factor that has negatively impacted both past and current health disparities within the United Sates population. Existing problems of racism and its impact on both health disparities and health inequalities were only amplified during the COVID-19 pandemic. The pandemic allowed both clinicians and researchers to recognize a growing list of health concerns at the macro-, meso-, and micro-level among underserved racially minoritized patients with specific chronic illnesses such as cancer. Based on these concerns, this Special Issue was designed to highlight the challenges of cancer screening, cancer treatment, and cancer-centered educational outreach among racially minoritized communities.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060784

Authors: Kristof Santa Chloe Dixon Rafaela Neiva Ganga Gemma Trainor Grahame Smith Victoria Furfie Holly Brown

(1) Background: Pre-pandemic, child and adolescent mental health service (CAMHS) referrals were paper based in Liverpool and Sefton (England, United Kingdom), causing delays in waiting times. The “CYP as One” online mental health referral platform was co-created to overcome these challenges. (2) Methods: This study aims to improve “CYP as One” accessibility and usability and, subsequently, support CAMHS to improve waiting times. The current study utilised the Living Lab approach. We conducted content analysis on completed online referrals extracted from the “CYP as One” platform. These findings were supplemented by seven online focus groups, with 16–19-year-old young people, parents of children under 16, and health service providers. Thematic analysis was conducted on all data. (3) Results: The thematic analysis returned seven themes, namely (i) ”CYP as One” vs. Traditional Referrals, (ii) Gender and Language Dynamics, (iii) Digital Empathy in Action, (iv) the Influence of the Provider Perspective, (v) Age and Social Sensitivity, (vi) Enhancing Access to Information, and (vii) Boosting Admin and Clinical Efficiency. (4) Conclusions: Digital content that seeks to replace in-person referrals can provide adequate support to children and young people who have faced difficulties accessing mental health services.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060783

Authors: Takashi Morihara Yasuhiro Murakami Koji Shimoyama Makoto Morinaga Shigenori Yokoshima Sohei Tsujimura Yasuhiro Hiraguri Takashi Yano

Kyushu Shinkansen and conventional railway lines run parallel in the areas 5 km north of Kumamoto Station (northern area) and 12 km south of the station (southern area). Following the operation of the Kyushu Shinkansen Line in 2011, the adjacent conventional railway line in the north was elevated, a new station was operated in the south, and large earthquakes struck the Kumamoto area from March to April 2016. Sleep disturbances were compared before and after the interventions and earthquakes based on noise source (Shinkansen and conventional railways), area (northern and southern), and house type (detached and apartment) through socio-acoustic surveys from 2011 to 2017. The Shinkansen railway caused significantly less sleep disturbances in detached houses in the north after compared to before the earthquakes, presumably due to more frequent closures of bedroom windows in northern detached houses following the earthquakes. The Shinkansen railway caused significantly more sleep disturbances in apartments in the south after compared to before the earthquakes, presumably because the Shinkansen slowed down immediately after the earthquakes and returned to normal speed during the survey, suddenly increasing the noise exposure. There was no significant difference in the other six cases investigated. Overall, the interventions may not have caused significant differences in sleep disturbances. This article expands on the congress paper by Morihara et al. presented in the “Community Response to Noise” session at the 52nd International Congress and Exhibition on Noise Control Engineering in Makuhari, Japan, organized by the International Institute of Noise Control Engineering.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060782

Authors: Emmanuel F. Koku

This paper examines how African immigrants living with HIV negotiate and reconstruct their productive (i.e., educational and career opportunities), sexual, and reproductive identities. We used data from a mixed-methods study to explore how stigma and social networks in which participants were embedded shaped how they understood and negotiated their role expectations and responsibilities. Participants revealed how HIV not only changed their identities and limited their sex life, partner choices, and fundamental decisions about fertility and reproduction, but also presented them with the opportunity to reinvent/reshape their lives. Our analysis revealed that the cultural discourses about illness and HIV in participant’s countries of origin, the acculturative and migratory stressors, and the competing influences and expectations from family and friends in their home and host countries shape their illness experience, and how they adjust to life with HIV. This paper builds on sociological understanding of illness experience as a social construct that shapes the ill person’s identity, role, and function in society. Specifically, the paper contributes to discourses on how (i) participants’ social location and identity (as transnational migrants adjusting to acculturative stressors associated with resettlement into a new country), (ii) cultural discourses about illness and HIV in their countries of origin, and (iii) embeddedness in transnational social networks influence health outcomes, including lived experiences with chronic illnesses and stigmatized conditions such as HIV.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060781

Authors: Vivian Tieu Samuel MacDowell Sedra Tibi Bradley Ventayen Mukesh Agarwal

Lung cancer (LC) is the leading cause of cancer mortality in the United States. To combat this predicament, early screening and critically assessing its risk factors remain crucial. The aim of this study was to identify the value of specific factors from the National Health and Nutrition Examination Survey (NHANES) from 2001–2018, as they relate to lung cancer mortality in the US Preventive Services Task Force (USPSTF)-eligible population. A total of 3545 adults who met USPSTF criteria were extracted from 81,595 NHANES participants. The LC Death Risk Assessment Tool was used to calculate the number of deaths per 1000 individuals. The Mann–Whitney U test and one-way ANOVA determined the statistical significance of the factors involved in LC mortality. Male sex, African and Hispanic ethnicity, lower education attainment, and secondhand exposure to cigarette smoke correlated with an increased risk of LC mortality. Additionally, the factor of emotional support from NHANES data was analyzed and did not show any benefit to reducing risk. By identifying individuals at high-risk, preventative measures can be maximized to produce the best possible outcome

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060780

Authors: Steven H. Rauchman Lora J. Kasselman Ankita Srivastava Joshua De Leon Allison B. Reiss

The effect of airborne exposure on the eye surface is an area in need of exploration, particularly in light of the increasing number of incidents occurring in both civilian and military settings. In this study, in silico methods based on a platform comprising a portfolio of software applications and a technology ecosystem are used to test potential surface ocular toxicity in data presented from Iraqi burn pits and the East Palestine, Ohio, train derailment. The purpose of this analysis is to gain a better understanding of the long-term impact of such an exposure to the ocular surface and the manifestation of surface irritation, including dry eye disease. In silico methods were used to determine ocular irritation to chemical compounds. A list of such chemicals was introduced from a number of publicly available sources for burn pits and train derailment. The results demonstrated high ocular irritation scores for some chemicals present in these exposure events. Such an analysis is designed to provide guidance related to the needed ophthalmologic care and follow-up in individuals who have been in proximity to burn pits or the train derailment and those who will experience future toxic exposure.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060779

Authors: Carolina Facci Andrea Baroncelli Paul J. Frick Enrica Ciucci

Research has clearly indicated that the development of serious behavioral problems in children and adolescents is influenced by parenting. However, recent research has refined the role of parenting by showing the importance of distinguishing between different types of parenting and in considering the role of callous–unemotional traits (CU traits) and conduct problems (CP) of the children. In the current study, we advance this research by distinguishing between emotional (e.g., parental warmth; parental hostility) and behavioral (e.g., use of positive reinforcement; inconsistent discipline/harsh discipline) aspects of parenting and by considering the way parents respond to children’s emotions (i.e., coaching and dismissing). The sample consisted of 136 mothers (M = 38.09 years, SD = 4.51 years, 45.41% high school degree) with a child (age range 3–5 years) enrolled in kindergarten in central Italy. Multiple regression analyses indicated that, after controlling for level of CP, use of positive reinforcement (β = −0.31, p < 0.001) and warm feelings (β = −0.22, p < 0.05), remained associated with CU traits and punitive parenting was no longer significant. Consistent with predictions, use of positive reinforcement was no longer associated with conduct problems when controlling for CU traits and the positive associations with punitive parenting (β = 0.24, p < 0.05) and negativity (β = 0.36, p < 0.001) remained significant. These findings support the need for continued research that considers both the emotional and behavioral aspects of parenting and disentangles their associations with conduct problems and CU traits. Such research could not only advance causal theories for children with conduct problems but also help to guide more effective treatments, especially for those with elevated CU traits who often leave treatment with significant conduct problems remaining.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060778

Authors: Rafael Tavares Andreia Inácio Helena Sousa Jaime Ribeiro

Duchenne muscular dystrophy (DMD) is a disease that primarily affects males and causes a gradual loss of muscle strength. This results in a deterioration of motor skills and functional mobility, which can impact the performance of various occupations. Individuals with DMD often rely heavily on caregivers to assist with daily activities, which can lead to caregiver burden. A case study was conducted to explore and describe potential variations in the performance of a young adult diagnosed with DMD and his caregivers resulting from the integration of smart speakers (SS)-controlled Internet of Things (IoT) devices in the home environment. The study also examined the potential of SS as an environment control unit (ECU) and analysed variations in caregiver burden. Smart devices and SS were installed in the most frequently used spaces, namely, the bedroom and living room. The study employed WebQDA software to perform content analysis and Microsoft Excel to calculate the scores of the structured instruments. The implementation of the IoT-assisted environment compensated for previously physical tasks, resulting in a slight increase in independent performance and reduced demands on caregivers.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060777

Authors: Shiva Salehian Peter Cunningham Andrew Barnes Shoou-Yih Daniel Lee

We evaluated the impact of Medicaid policies in Virginia (VA), namely the Addiction and Recovery Treatment Services (ARTS) program and Medicaid expansion, on the number of behavioral health acute inpatient admissions from 2016 to 2019. We used Poisson fixed-effect event study regression and compared average proportional differences in admissions over three time periods: (1) prior to ARTS; (2) following ARTS but before Medicaid expansion; (3) post-Medicaid expansion. The number of behavioral health acute inpatient admissions decreased by 2.6% (95% CI [−5.1, −0.2]) in the first quarter of 2018 and this decrease gradually intensified by 4.9% (95% CI [−7.5, −2.4]) in the fourth quarter of 2018 compared to the second quarter of 2017 (beginning of ARTS) in VA relative to North Carolina (NC). Following the first quarter of 2019 (beginning of Medicaid expansion), decreases in VA admissions became larger relative to NC. The average proportional difference in admissions estimated a decrease of 2.7% (95% CI, [−4.1, −0.8]) after ARTS but before Medicaid expansion and a decrease of 2.9% (95% CI, [−6.1, 0.4]) post-Medicaid expansion compared to pre-ARTS in VA compared to NC. Behavioral health acute inpatient admissions in VA decreased following ARTS implementation, and the decrease became larger after Medicaid expansion.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060776

Authors: Zhiyuan Yu Steve Cole Kharah Ross Martha Hart Lubna Anis Nicole Letourneau

Objective: To determine whether maternal Adverse Childhood Experiences (ACEs) are (a) associated with increased inflammatory gene expression in mother–child dyads and (b) whether a parenting intervention (ATTACH™) moderates the association between maternal ACEs and mother and/or child inflammatory gene expression. Methods: Twenty mother–child dyads, recruited from a domestic violence shelter in Calgary, AB, Canada, were randomized into an ATTACH™ parenting intervention group (n = 9) or a wait-list control group (n = 11). Maternal ACEs were assessed. The mothers and children each provided one non-fasting blood sample after the intervention group completed the ATTACH™ program, which was assayed to quantify the Conserved Transcriptional Response to Adversity (CTRA) score, indicating inflammatory gene expression profile. Mixed-effect linear models were used, separately in mothers and children, to examine the associations between CTRA score, maternal ACEs, and the ACEs-by-intervention group interaction term. The covariates were age, sex, ethnicity, and maternal medication use. Results: Higher maternal ACEs were associated with higher child CTRA scores (b = 0.123 ± SE 0.044, p = 0.005), indicating an increased pro-inflammatory gene expression profile. The ATTACH™ parenting intervention moderated this association between maternal ACEs and child CTRA scores (b = 0.328 ± SE 0.133, p = 0.014). In mothers, the ACEs-by-intervention interaction terms were insignificant (p = 0.305). Conclusions: Maternal ACEs could exert an intergenerational impact on child inflammatory activity, and this association could be moderated by participating in the ATTACH™ parenting intervention.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060775

Authors: Saintpee Kim Sungho Won Young Yi

This study aims to examine the association between the occurrence of diabetic foot and air quality (SO2, CO, NO2, O3). Open data were collected to conduct a big data study. Patient information was gathered from the National Health Insurance Service, and the National Institute of Environmental Science’s air quality data were used. A total study population of 347,543 cases were reviewed (case = 13,353, control = 334,190). The lag period from air quality changes to the actual amputation operation was calculated for each factor. The frequency of diabetic foot amputation in each region was identified and analyzed using a distributed lag non-linear model. Gangwon-do showed the highest relative risks (RRs) for SO2 and CO, while Chungcheongnam-do exhibited the highest RR for NO2. Jeju had the highest RR for O3. Regions like Incheon, Busan, and the capital region also showed significant risk increases. These findings emphasize the importance of tailored air quality management to address diabetic foot complications effectively.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060774

Authors: Murat Bas Meryem Kahriman Cansu Gencalp Selen Koksal Koseoglu Ladan Hajhamidiasl

Brain fog is a condition that is characterized by poor concentration, memory loss, decreased cognitive function, and mental fatigue. Although it is generally known as a long-term COVID-19 symptom, brain fog has also been reported to be caused by many other diseases. Thus, it is necessary to assess this condition in certain populations. This study aimed to evaluate the reliability and validity of the Brain Fog Scale in a Turkish population. We conducted the study in two phases. In a pilot study including 125 participants, we confirmed the suitability of the scale for validity analyses and then conducted exploratory (n = 230) and confirmatory factor analyses (n = 343). The Cronbach’s alpha value of the 23-item Brain Fog Scale was 0.966. In addition, the 23-item and three-factor structure was confirmed as a result of the analyses. These three factors are mental fatigue, impaired cognitive acuity, and confusion. We also found that participants previously diagnosed with COVID-19 had higher brain fog scores. This finding indicates that brain fog is an important condition that can accompany COVID-19. Furthermore, this validated construct has an acceptable fit and is a valid and useful tool for the Turkish population.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060773

Authors: Mediss Tavakkoli Erick Valarezo Luis F. García

Background: In contrast to conventional definitions, the contemporary conceptualization of adulthood emphasizes psychological characteristics over sociodemographic milestones. At the same time, an increasing number of theorists propose that the way individuals view adulthood may have a significant impact on the mental health of both adolescents and adults. However, empirical examination of this hypothesis has been notably limited to date. The aim of this study is to explore the association between individuals’ perceptions of adulthood and multiple dimensions of mental health. Method: This study applied some adulthood markers and multiple mental health indexes (including well-being, optimism, Alexithymia, satisfaction with life, Goldberg’s index of mental health, the dark triad, and dimensional personality disorders) to a community sample comprising 1772 individuals in Spain, spanning ages from 16 to 93 years. Results: The findings support the overarching hypothesis, as perceptions of adulthood display strong correlations with nearly every assessed index of mental health, particularly those that comprise a dimension of negative emotions. These associations persist even after accounting for age and socio-economic status, and in alignment with the psychological paradigm of adulthood, they show a notable consistency across various age groups. Conclusions: This study establishes that such perceptions of adulthood represent a modifiable factor contributing to positive mental health. The implications of these findings for the formulation of public policies aimed at promoting mental health in the context of adulthood, as well as a number of future studies, are deliberated.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060772

Authors: Timothy Hasenoehrl Margarete Steiner Felix Ebenberger Philipp Kull Julia Sternik Lukas Reissig Galateja Jordakieva Richard Crevenna

Background: Projects for workplace health promotion (WHP) for back pain traditionally focus exclusively on work-related but not on leisure-time stress on the spine. We developed a comprehensive WHP project on the back health of hospital workers regardless of the physical characteristics of their work and compared its effects on sedentary and physically active hospital workers. Methods: Study assessments were carried out before and six months after participation in the WHP intervention. The primary outcome parameter was back pain (Oswestry Disability Index, ODI). Anxiety (Generalized Anxiety Disorder-7), work ability (Work Ability Index), depression (Patient Health Questionnaire-9), stress (Perceived Stress Scale-10), and quality of life (Short Form-36) were assessed via questionnaires as secondary outcome parameters. Physical performance was measured via the 30 seconds Sit-to-Stand test (30secSTS). Results: Sixty-eight healthcare workers with non-specific back pain were included in the evaluation study of the WHP project “Back Health 24/7/365”. After six months, back pain, physical performance, and self-perceived physical functioning (SF-36 Physical Functioning subscale) improved significantly in both groups. Not a single parameter showed an interaction effect with the group allocation. Conclusions: A comprehensive WHP-intervention showed significant positive effects on hospital workers regardless of the physical characteristics of their work.

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph21060771

Authors: Saurav Guha Michael Alonzo Pierre Goovaerts LuAnn L. Brink Meghana Ray Todd Bear Saumyadipta Pyne

Background: Social and Environmental Determinants of Health (SEDH) provide us with a conceptual framework to gain insights into possible associations among different human behaviors and the corresponding health outcomes that take place often in and around complex built environments. Developing better built environments requires an understanding of those aspects of a community that are most likely to have a measurable impact on the target SEDH. Yet data on local characteristics at suitable spatial scales are often unavailable. We aim to address this issue by application of different data disaggregation methods. Methods: We applied different approaches to data disaggregation to obtain small area estimates of key behavioral risk factors, as well as geospatial measures of green space access and walkability for each zip code of Allegheny County in southwestern Pennsylvania. Results: Tables and maps of local characteristics revealed their overall spatial distribution along with disparities therein across the county. While the top ranked zip codes by behavioral estimates generally have higher than the county’s median individual income, this does not lead them to have higher than its median green space access or walkability. Conclusion: We demonstrated the utility of data disaggregation for addressing complex questions involving community-specific behavioral attributes and built environments with precision and rigor, which is especially useful for a diverse population. Thus, different types of data, when comparable at a common local scale, can provide key integrative insights for researchers and policymakers.