Subjects -> HEALTH AND SAFETY (Total: 1464 journals)
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    - HEALTH AND SAFETY (686 journals)
    - WOMEN'S HEALTH (82 journals)

HEALTH AND SAFETY (686 journals)                  1 2 3 4 | Last

Showing 1 - 200 of 203 Journals sorted by number of followers
American Journal of Public Health     Full-text available via subscription   (Followers: 220)
Journal of Public Health     Hybrid Journal   (Followers: 153)
Journal of Epidemiology & Community Health     Hybrid Journal   (Followers: 64)
Health and Social Work     Hybrid Journal   (Followers: 64)
Health Psychology     Full-text available via subscription   (Followers: 63)
Journal of Health Psychology     Hybrid Journal   (Followers: 59)
British Journal of Health Psychology     Hybrid Journal   (Followers: 55)
Journal of Child Sexual Abuse     Hybrid Journal   (Followers: 54)
Health Policy     Hybrid Journal   (Followers: 52)
Safer Communities     Hybrid Journal   (Followers: 50)
Health Psychology Review     Hybrid Journal   (Followers: 47)
Ageing & Society     Hybrid Journal   (Followers: 40)
Journal of Occupational Health Psychology     Full-text available via subscription   (Followers: 40)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 39)
American Journal of Health Education     Hybrid Journal   (Followers: 36)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 34)
Qualitative Health Research     Hybrid Journal   (Followers: 33)
Psychology & Health     Hybrid Journal   (Followers: 33)
Journal of Traumatic Stress     Hybrid Journal   (Followers: 29)
Journal of Health and Social Behavior     Hybrid Journal   (Followers: 27)
Social Work in Health Care     Hybrid Journal   (Followers: 27)
International Journal of Environmental Research and Public Health     Open Access   (Followers: 27)
Journal of Occupational Science     Hybrid Journal   (Followers: 27)
Health Promotion International     Hybrid Journal   (Followers: 26)
Journal of Public Health     Hybrid Journal   (Followers: 26)
Journal of Exercise Science & Fitness     Open Access   (Followers: 26)
Early Childhood Research Quarterly     Hybrid Journal   (Followers: 25)
Implementation Science     Open Access   (Followers: 25)
International Journal of Mental Health     Full-text available via subscription   (Followers: 25)
Health & Place     Hybrid Journal   (Followers: 23)
Quality in Primary Care     Open Access   (Followers: 23)
Journal of Public Health Policy     Partially Free   (Followers: 23)
BMC Pregnancy and Childbirth     Open Access   (Followers: 20)
International Journal of Food Safety, Nutrition and Public Health     Hybrid Journal   (Followers: 20)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 19)
Applied Ergonomics     Hybrid Journal   (Followers: 18)
International Journal of Social Welfare     Hybrid Journal   (Followers: 18)
Journal of Integrated Care     Hybrid Journal   (Followers: 18)
Mental Health Review Journal     Hybrid Journal   (Followers: 18)
Psychology, Health & Medicine     Hybrid Journal   (Followers: 17)
Ethnicity & Health     Hybrid Journal   (Followers: 16)
Health Promotion Practice     Hybrid Journal   (Followers: 16)
Social Work in Mental Health     Hybrid Journal   (Followers: 16)
Tobacco Control     Hybrid Journal   (Followers: 16)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 16)
Global Health Promotion     Hybrid Journal   (Followers: 16)
Open Journal of Safety Science and Technology     Open Access   (Followers: 16)
Health Research Policy and Systems     Open Access   (Followers: 15)
Journal of Family Social Work     Hybrid Journal   (Followers: 15)
Journal of Behavioral Health Services & Research     Hybrid Journal   (Followers: 15)
Journal of Religion and Health     Hybrid Journal   (Followers: 14)
Policy and Practice in Health and Safety     Hybrid Journal   (Followers: 14)
International Journal of Healthcare Management     Hybrid Journal   (Followers: 14)
Canadian Family Physician     Partially Free   (Followers: 14)
Systematic Reviews     Open Access   (Followers: 14)
Cambridge Quarterly of Healthcare Ethics     Hybrid Journal   (Followers: 13)
International Journal of Health Care Quality Assurance     Hybrid Journal   (Followers: 13)
Journal of Creativity in Mental Health     Hybrid Journal   (Followers: 13)
Perspectives in Public Health     Hybrid Journal   (Followers: 13)
Archives of Suicide Research     Hybrid Journal   (Followers: 13)
Social Work in Public Health     Hybrid Journal   (Followers: 13)
Family & Community Health     Hybrid Journal   (Followers: 13)
Scandinavian Journal of Work, Environment & Health     Partially Free   (Followers: 13)
International Journal of Health Promotion and Education     Hybrid Journal   (Followers: 13)
Health Care Analysis     Hybrid Journal   (Followers: 12)
Asia-Pacific Journal of Public Health     Hybrid Journal   (Followers: 12)
Public Health Ethics     Hybrid Journal   (Followers: 12)
Childhood Obesity and Nutrition     Open Access   (Followers: 12)
Disaster Medicine and Public Health Preparedness     Hybrid Journal   (Followers: 12)
Evaluation & the Health Professions     Hybrid Journal   (Followers: 11)
Family Relations     Partially Free   (Followers: 11)
International Journal for Equity in Health     Open Access   (Followers: 11)
Health, Risk & Society     Hybrid Journal   (Followers: 11)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 11)
International Journal of Health Economics and Management     Hybrid Journal   (Followers: 10)
Journal of Spirituality in Mental Health     Hybrid Journal   (Followers: 10)
Women & Health     Hybrid Journal   (Followers: 10)
Diversity and Equality in Health and Care     Open Access   (Followers: 10)
School Mental Health     Hybrid Journal   (Followers: 10)
Journal of Healthcare Risk Management     Hybrid Journal   (Followers: 10)
Journal of Family Medicine and Primary Care     Open Access   (Followers: 10)
International Journal of Evidence-Based Healthcare     Hybrid Journal   (Followers: 9)
Journal of Community Health     Hybrid Journal   (Followers: 9)
Journal of Mental Health Counseling     Full-text available via subscription   (Followers: 9)
Healthcare Quarterly     Full-text available via subscription   (Followers: 9)
Journal of Public Health Research     Open Access   (Followers: 9)
Conflict and Health     Open Access   (Followers: 8)
Families, Systems, & Health     Full-text available via subscription   (Followers: 8)
International Journal of Health Geographics     Open Access   (Followers: 8)
Journal of Immigrant and Minority Health     Hybrid Journal   (Followers: 8)
Journal of Public Child Welfare     Hybrid Journal   (Followers: 8)
Theoretical Issues in Ergonomics Science     Hybrid Journal   (Followers: 8)
International Journal of Behavioural and Healthcare Research     Hybrid Journal   (Followers: 8)
Revista Brasileira de Medicina de Família e Comunidade     Open Access   (Followers: 8)
Globalization and Health     Open Access   (Followers: 7)
International Journal of Health Services     Full-text available via subscription   (Followers: 7)
International Journal of Hygiene and Environmental Health     Hybrid Journal   (Followers: 7)
Journal of Workplace Behavioral Health     Hybrid Journal   (Followers: 7)
Medicine, Health Care and Philosophy     Hybrid Journal   (Followers: 7)
Hastings Center Report     Hybrid Journal   (Followers: 7)
The Journal of Rural Health     Hybrid Journal   (Followers: 7)
American Journal of Family Therapy     Hybrid Journal   (Followers: 7)
Journal Of Allied Health     Full-text available via subscription   (Followers: 7)
Revue d'Épidémiologie et de Santé Publique     Full-text available via subscription   (Followers: 7)
Journal of Multidisciplinary Healthcare     Open Access   (Followers: 7)
Epidemics     Open Access   (Followers: 7)
Rehabilitation Process and Outcome     Open Access   (Followers: 7)
Journal of School Nursing     Hybrid Journal   (Followers: 7)
Journal of Primary Prevention     Hybrid Journal   (Followers: 7)
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 7)
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 7)
EcoHealth     Hybrid Journal   (Followers: 6)
International Journal of Sexual Health     Hybrid Journal   (Followers: 6)
Journal of Muslim Mental Health     Open Access   (Followers: 6)
Risk Management and Healthcare Policy     Open Access   (Followers: 6)
Journal of Developing Areas     Full-text available via subscription   (Followers: 6)
International Journal of Healthcare Information Systems and Informatics     Hybrid Journal   (Followers: 6)
BMC Oral Health     Open Access   (Followers: 5)
Home Health Care Services Quarterly     Hybrid Journal   (Followers: 5)
Population Health Metrics     Open Access   (Followers: 5)
Journal of Infection and Public Health     Open Access   (Followers: 5)
Journal of Development Effectiveness     Hybrid Journal   (Followers: 5)
International Health     Hybrid Journal   (Followers: 5)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 5)
Journal of Public Health Management and Practice     Hybrid Journal   (Followers: 5)
Journal of Consumer Health on the Internet     Hybrid Journal   (Followers: 4)
Sexual Health     Hybrid Journal   (Followers: 4)
Southern African Journal of Critical Care     Open Access   (Followers: 4)
Journal of Communication in Healthcare     Hybrid Journal   (Followers: 4)
International Research in Children's Literature     Hybrid Journal   (Followers: 4)
Progress in Community Health Partnerships: Research, Education, and Action     Full-text available via subscription   (Followers: 4)
Health Promotion & Physical Activity     Open Access   (Followers: 4)
Journal of Health Care Chaplaincy     Hybrid Journal   (Followers: 3)
Reproductive Health     Open Access   (Followers: 3)
South African Family Practice     Open Access   (Followers: 3)
Social Theory & Health     Hybrid Journal   (Followers: 3)
World Health & Population     Full-text available via subscription   (Followers: 3)
Journal of Public Health in Africa     Open Access   (Followers: 3)
Hong Kong Journal of Social Work, The     Hybrid Journal   (Followers: 3)
Public Health Genomics     Full-text available via subscription   (Followers: 3)
International Journal of Health & Allied Sciences     Open Access   (Followers: 3)
AJOB Empirical Bioethics     Hybrid Journal   (Followers: 3)
NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy     Full-text available via subscription   (Followers: 2)
Vascular Health and Risk Management     Open Access   (Followers: 2)
Health SA Gesondheid     Open Access   (Followers: 2)
Institute for Security Studies Papers     Full-text available via subscription   (Followers: 2)
Noise and Health     Open Access   (Followers: 2)
ElectronicHealthcare     Full-text available via subscription   (Followers: 2)
Atención Primaria     Open Access   (Followers: 2)
Gaceta Sanitaria     Open Access   (Followers: 2)
Water Quality, Exposure and Health     Hybrid Journal   (Followers: 2)
World Medical & Health Policy     Hybrid Journal   (Followers: 2)
Environmental Sciences Europe     Open Access   (Followers: 2)
Drogues, santé et société     Open Access   (Followers: 2)
Journal of Biology, Agriculture and Healthcare     Open Access   (Followers: 2)
SMAD, Revista Electronica en Salud Mental, Alcohol y Drogas     Open Access   (Followers: 2)
International Journal of E-Health and Medical Communications     Full-text available via subscription   (Followers: 2)
Dramatherapy     Hybrid Journal   (Followers: 2)
FASEB BioAdvances     Open Access   (Followers: 1)
South African Journal of Child Health     Open Access   (Followers: 1)
Health Services Insights     Open Access   (Followers: 1)
Internationale Revue Fur Soziale Sicherheit     Hybrid Journal   (Followers: 1)
Research Methods in Medicine & Health Sciences     Open Access   (Followers: 1)
médecine/sciences     Hybrid Journal   (Followers: 1)
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 1)
Journal of The Egyptian Public Health Association     Open Access   (Followers: 1)
Revista Facultad Nacional de Salud Pública     Open Access   (Followers: 1)
Poblacion y Salud en Mesoamerica     Open Access   (Followers: 1)
International Journal of Healthcare Delivery Reform Initiatives     Full-text available via subscription   (Followers: 1)
Adultspan Journal     Hybrid Journal   (Followers: 1)
Tidsskrift for Forskning i Sygdom og Samfund     Open Access  
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Journal of Dr. NTR University of Health Sciences     Open Access  
Israel Journal of Health Policy Research     Open Access  
Revista de Ciencias Médicas de Pinar del Río     Open Access  
Revista Médica Electrónica     Open Access  
Saúde Coletiva     Open Access  
Revista Ciencias de la Salud     Open Access  
Psicologia, Saúde e Doenças     Open Access  
Portularia     Open Access  
Motricidade     Open Access  
Investigaciones Andina     Open Access  
Ensaios e Ciência : Ciências Biológicas, Agrárias e da Saúde     Open Access  
Salud Colectiva     Open Access  
Revista de la Universidad Industrial de Santander. Salud     Open Access  
Revista U.D.C.A Actualidad & Divulgación Científica     Open Access  
Revista Peruana de Medicina Experimental y Salud Pública     Open Access  
Revista Gerencia y Políticas de Salud     Open Access  
Hacia la Promoción de la Salud     Open Access  
CES Medicina     Open Access  
Annali dell'Istituto Superiore di Sanità     Open Access  
Face à face     Open Access  
Iranian Journal of Health and Environment     Open Access  
Iranian Journal of Public Health     Open Access  
Revista Chilena de Terapia Ocupacional     Open Access  
Revista Chilena de Salud Pública     Open Access  
Revista de Comunicación y Salud     Open Access  
Prävention und Gesundheitsförderung     Hybrid Journal  
Child's Nervous System     Hybrid Journal  

        1 2 3 4 | Last

Similar Journals
Journal Cover
International Journal of Environmental Research and Public Health
Journal Prestige (SJR): 0.735
Citation Impact (citeScore): 2
Number of Followers: 27  

  This is an Open Access Journal Open Access journal
ISSN (Print) 1660-4601 - ISSN (Online) 1661-7827
Published by MDPI Homepage  [258 journals]
  • IJERPH, Vol. 20, Pages 5916: Interventions to Strengthen Environmental
           Sustainability of School Food Systems: Narrative Scoping Review

    • Authors: Grace Gardner, Wendy Burton, Maddie Sinclair, Maria Bryant
      First page: 5916
      Abstract: School food systems play a role in the wider food system, but there is a scarcity of literature exploring interventions that aim to improve the environmental sustainability of school food systems. The present review aimed to understand and describe the types of interventions that have previously been explored to strengthen the sustainability of school food systems along with their impact. We applied a scoping review methodology guided by Arksey and O’Malley, which included a review of the online database Scopus and the grey literature. Information relating to intervention design, study population, evaluation method and impact were extracted. In total, 6016 records were screened for eligibility, 24 of which were eligible for inclusion. The most common types of interventions were school lunch menus designed to be more sustainable; school food waste reduction; sustainable food system education using school gardens; and dietary interventions with added environmental components. This review highlights a range of interventions which could positively influence the environmental sustainability of school food systems. Further research is needed to explore the effectiveness of such interventions.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-23
      DOI: 10.3390/ijerph20115916
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5917: ResQ Family: Respiratory Syncytial Virus
           (RSV) Infection in Infants and Quality of Life of Families—Study
           Protocol of a Multi-Country Family Cohort Study

    • Authors: Ilona Trautmannsberger, Sabina Bösl, Christina Tischer, Johanna Kostenzer, Silke Mader, Luc J. I. Zimmermann, the ResQ Family Study Group the ResQ Family Study Group
      First page: 5917
      Abstract: (1) Respiratory syncytial virus (RSV) infection in infants not only affects the child itself, but also their families. Nevertheless, information on the overall impact is scarce. A comprehensive caregiver-specific approach covering essential (health) dimensions and relevant stakeholders was initiated under the ResQ Family study conducted in Germany, France, Italy and Sweden. The primary objective is to investigate the health-related quality of life of parents and/or caregivers of children (<24 months) hospitalised for RSV. (2) Each participant completes an online questionnaire disseminated via social media and printed material in hospitals. Using the PedsQLTM FIM as well as further self-designed questions, parent and patient characteristics as well as potential stressors and preventive factors are recorded at baseline and after six weeks. Multivariate regression models with health-related quality of life as main outcome parameter will be conducted. (3) The study is currently in the recruitment process. A full analysis will be performed once the data collection phase is complete. First results are to be expected in late 2023. (4) Publishing the results in the form of scientific papers but also non-scientific (information) material will help us raise awareness for RSV and the importance of prevention among healthcare professionals, patient representatives and decision-makers.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-23
      DOI: 10.3390/ijerph20115917
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5918: Self-Reported Cognitive Aging and Well-Being
           among Older Middle Eastern/Arab American Immigrants during the COVID-19

    • Authors: Linda Sayed, Mohammed Alanazi, Kristine J. Ajrouch
      First page: 5918
      Abstract: Background: The COVID-19 pandemic posed new challenges for cognitive aging since it brought interruptions in family relations for older adults in immigrant communities. This study examines the consequences of COVID-19 for the familial and social support systems of aging Middle Eastern/Arab immigrants in Michigan, the largest concentration in the United States. We conducted six focus groups with 45 participants aged 60 and older to explore participant descriptions of changes and difficulties faced during the pandemic relating to their cognitive health, familial and social support systems, and medical care. The findings indicate challenges around social distancing for older Middle Eastern/Arab American immigrants, which generated three overarching themes: fear, mental health, and social relationships. These themes provide unique insights into the lived experiences of older Middle Eastern/Arab American adults during the pandemic and bring to light culturally embedded risks to cognitive health and well-being. A focus on the well-being of older Middle Eastern/Arab American immigrants during COVID-19 advances understanding of how environmental contexts inform immigrant health disparities and the sociocultural factors that shape minority aging.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-23
      DOI: 10.3390/ijerph20115918
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5919: Perceptions and Intentions around Uptake of
           the COVID-19 Vaccination among Older People: A Mixed-Methods Study in
           Phuket Province, Thailand

    • Authors: Chayanit Luevanich, Ros Kane, Aimon Naklong, Prapaipim Surachetkomson
      First page: 5919
      Abstract: Background: A 70% vaccination rate against COVID-19 in the general population was required for re-opening Phuket tourist industry. However, prior to this research, 39.61% of older people remained unvaccinated. This study aimed to examine perceptions and intentions around COVID-19 vaccination amongst older people and to explore the reasons and factors influencing their decisions to receive or refuse vaccination. Methods: This was a mixed-methods approach with a sequential explanatory design. We conducted an online survey and semi-structured qualitative interview with a subsample. Multinomial logistic regression was applied and thematic content analysis was conducted. Results: 92.4% of participants reported intention to receive the vaccine. Multinomial regression analysis revealed that perceived barriers (AdjOR = 0.032; 95% CI: 0.17–0.59), perceived benefit (AdjOR = 2.65; 95% CI: 1.49–4.71), good health (AdjOR = 3.51; 95% CI: 1.01–12.12) and health not good (AdjOR = 0.10; 95% CI: 0.02–0.49) were predictors of vaccine uptake. In the qualitative interviews, four key influences on up-take for the 28 vaccinated participants were: prevention and protection, convenience, fear of death from COVID-19, and trust in the vaccine. Four key influences on refusal of vaccination in the eight unvaccinated participants were: rarely leaving the house, fear of vaccine side-effects, fear of death after getting the vaccine, and not enough information for decision-making. Conclusion: Intervention and campaigns addressing COVID-19 vaccination should employ strategies, including the widespread use of social and other popular media to increase older people’s perceived benefit of vaccination on their current and future health status, while decreasing perceived barriers to receiving the vaccine.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-23
      DOI: 10.3390/ijerph20115919
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5920: Pediatric Behavioral Health during the

    • Authors: Kimberly Burkhart, Carolyn E. Ievers-Landis
      First page: 5920
      Abstract: The COVID-19 pandemic exacerbated the child mental health crisis and existing disparities. Child anxiety, depression, suicide attempts and completions, and mental-health-related emergency department visits significantly increased. In response to this crisis, the Administration for Strategic Preparedness and Response (ASPR) developed behavioral health task forces associated with funded pediatric centers of disaster excellence. The Health Resources and Services Administration (HRSA) funded the Pediatric Pandemic Network (PPN) to prepare for future endemics and pandemics, with behavioral health identified as a priority in mitigation, preparedness, response, and recovery. This commentary provides insights from pediatric disaster preparedness and response behavioral health subject matter experts. Our roles have been to identify how to build behavioral health professional competencies across disciplines and various medical settings and to strengthen emergency interdisciplinary behavioral health care capability regionally and at the national level. Specific examples of interdisciplinary training and demonstration projects are included as models for enhancing behavioral health situational awareness and developing curricula to support preparedness and response for the current ongoing pandemic and future natural and biological disasters. This commentary also includes a call to action for workforce development to move beyond a boots-on-the-ground mentality for pediatric behavioral health disaster preparedness and response toward a more inclusive role for behavioral health providers of varied specialties. This means that behavioral health providers should become more informed of federal programs in this area, seek further training, and find innovative ways to collaborate with their medical colleagues and community partners.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-23
      DOI: 10.3390/ijerph20115920
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5921: Leveraging the Expertise of the Community: A
           Case for Expansion of a Peer Workforce in Child, Adolescent, and Family
           Mental Health

    • Authors: Hillary A. Robertson, Matthew G. Biel, Katherine R. Hayes, Sara Snowden, Latisha Curtis, Dominique Charlot-Swilley, Elyssa S. Clauson, Arrealia Gavins, Caslin M. Sisk, Noel Bravo, Erica E. Coates, Celene E. Domitrovich
      First page: 5921
      Abstract: The rise in child and adolescent mental health concerns has led to the need for an expanded workforce to meet the needs of our nation’s families. Peer paraprofessionals (PPs) have proven to be impactful in the areas of adult mental health (MH) and substance use disorders, and for persons with chronic medical conditions. PPs can contribute to addressing child, adolescent, and family MH needs by being deployed in community settings and providing both emotional and tangible support to families and children. Additional use of PPs can address equity gaps in MH services by improving access to support and enhancing the cultural acceptability of MH interventions. A concentrated effort to expand and develop this workforce may help to alleviate the strain on the current MH system. The Georgetown University Infant and Early Childhood Certificate program is a paraprofessional training program that prepares community members to meet the MH needs of families with young children. The authors will describe the results of a qualitative study examining the landscape of peer paraprofessional services in DC that was conducted to support the expansion of the peer workforce to include individuals with expertise in infant and early childhood mental health.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-23
      DOI: 10.3390/ijerph20115921
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5922: Age-Related Differences in Anxiety and
           Depression Diagnosis among Adults in Puerto Rico during the COVID-19

    • Authors: Stephanie Cameron-Maldonado, Cynthia M. Pérez, Emma Fernández-Repollet, Andrea López-Cepero
      First page: 5922
      Abstract: Residents of Puerto Rico bear a significant burden of mental health disorders, which the COVID-19 pandemic may have exacerbated. However, age-specific data on these disorders during the pandemic in Puerto Rico are scarce. This study evaluated age-related differences in the self-reported diagnosis of depression and anxiety among adults ≥18 years residing in Puerto Rico during the pandemic. An anonymous online survey was administered from December 2020 to February 2021 via Google Forms to measure self-reported sociodemographic and behavioral characteristics and physician-diagnosed mental health disorders. Multivariable logistic regression models were conducted for each self-reported mental health diagnosis after adjusting for sex, education, income, marital status, chronic diseases, and smoking. Out of 1945 adults, 50% were aged 40 years and over. Nearly 24% of responders self-reported an anxiety diagnosis, whereas 15.9% reported depression. Compared to individuals 50 years and over, those 18–29 y, 30–39 y, and 40–49 y had significantly higher odds of an anxiety diagnosis (OR = 1.84, 95% CI = 1.34–2.55; OR = 1.50, 95% CI = 1.09–2.07; and OR = 1.37, 95% CI = 1.01–1.87, respectively). However, no association between age and depression diagnosis was found. Despite anxiety and depression being frequent disorders during the pandemic in this sample, younger adults bear a higher burden of anxiety. Further research is needed to allocate appropriate mental health resources during emergencies according to population subgroups.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-23
      DOI: 10.3390/ijerph20115922
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5923: Disaster Mental Health Risk Reduction:
           Appraising Disaster Mental Health Research as If Risk Mattered

    • Authors: Lennart Reifels, Michel L. A. Dückers
      First page: 5923
      Abstract: The globally increasing frequency, intensity, and complexity of extreme climatic events and disasters poses significant challenges for the future health and wellbeing of affected populations around the world [...]
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-23
      DOI: 10.3390/ijerph20115923
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5924: Analysis of University Student Motivation in
           Cross-Border Contexts

    • Authors: Lionel Sánchez-Bolívar, Silvia Navarro-Prado, María Angustias Sánchez-Ojeda, Victoria García-Morales, Jonathan Cortés-Martín, María Isabel Tovar-Gálvez
      First page: 5924
      Abstract: The development of the personality of university students can determine their affinities for certain disciplines; therefore, it is important to know their specific socio-demographic and motivational profile, what motivates them to start a certain university degree and what encourages them to continue with it, which can help to adapt the teaching methodology. A total of 292 university students from the University of Granada (Ceuta and Melilla campuses) participated in this quantitative study with a descriptive, cross-sectional design, in which motivation and social skills were analysed. Among the results, it can be highlighted that the student population is mainly female, with a higher level of motivation. Sociability, communication, thinking (optimistic or pessimistic), empathy and self-confidence are skills that affect university students’ motivation levels. This study highlights the importance and impact of students’ motivation on their learning and the development of their social competence, so it is essential to carry out educational interventions that promote these types of skills, especially in cross-border contexts, which can be demotivating environments.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-23
      DOI: 10.3390/ijerph20115924
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5925: Conducting Violence and Mental Health
           Research with Female Sex Workers during the COVID-19 Pandemic: Ethical
           Considerations, Challenges, and Lessons Learned from the Maisha Fiti Study
           in Nairobi, Kenya

    • Authors: Mary Kung’u, Rhoda Kabuti, Hellen Babu, on behalf of The Maisha Fiti Study Champions on behalf of The Maisha Fiti Study Champions, Chrispo Nyamweya, Monica Okumu, Anne Mahero, Zaina Jama, Polly Ngurukiri, Emily Nyariki, Mamtuti Panneh, Pooja Shah, Alicja Beksinska, Erastus Irungu, Wendy Adhiambo, Peter Muthoga, Rupert Kaul, Helen A. Weiss, Janet Seeley, Joshua Kimani, Tara S. Beattie
      First page: 5925
      Abstract: Conducting violence and mental health research during the COVID-19 pandemic with vulnerable groups such as female sex workers (FSWs) required care to ensure that participants and the research team were not harmed. Potential risks and harm avoidance needed to be considered as well as ensuring data reliability. In March 2020, COVID-19 restrictions were imposed in Kenya during follow-up data collection for the Maisha Fiti study (n = 1003); hence data collection was paused. In June 2020, the study clinic was re-opened after consultations with violence and mental health experts and the FSW community. Between June 2020 and January 2021, data were collected in person and remotely following ethical procedures. A total of 885/1003 (88.2%) FSWs participated in the follow-up behavioural–biological survey and 47/47 (100%) participated in the qualitative in-depth interviews. A total of 26/885 (2.9%) quantitative surveys and 3/47 (6.4%) qualitative interviews were conducted remotely. Researching sensitive topics like sex work, violence, and mental health must guarantee study participants’ safety and privacy. Collecting data at the height of COVID-19 was crucial in understanding the relationships between the COVID-19 pandemic, violence against women, and mental health. Relationships established with study participants during the baseline survey—before the pandemic—enabled us to complete data collection. In this paper, we discuss key issues involved in undertaking violence and mental health research with a vulnerable population such as FSWs during a pandemic. Lessons learned could be useful to others researching sensitive topics such as violence and mental health with vulnerable populations.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-23
      DOI: 10.3390/ijerph20115925
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5926: Health Promotion in Debate: The Role of Women
           Leaders in the Favelas of Rio de Janeiro, Brazil

    • Authors: Nilza Rogéria de Andrade Nunes, Dais Rocha, Andréa Rodriguez
      First page: 5926
      Abstract: This study aimed to discuss the actions of women leaders in favelas in Rio de Janeiro, Brazil, regarding the health promotion of people residing in territories affected by urban violence and inequalities. The understanding of social determinants of health (SDH) is not unequivocal and challenges us to expand our practices in health promotion and equity. A mixed-methods study was conducted with 200 women living in 169 favelas of Rio de Janeiro between 2018 and 2022. Questionnaires and semi-structured face-to-face interviews followed by thematic analysis were conducted. The analysis focused on the socio-demographic profile, community activism, and health promotion strategies undertaken by these groups, expanding knowledge on the experiences of these leaders in confronting social injustices. Results showed that participants performed health promotion actions in their communities by 1. strengthening popular participation and human rights, 2. creating environments favorable to health, and 3. developing personal skills towards social participation in policy design through mobilizing health services and third-sector organizations. With the limited presence of government public agents in these spaces, participants assumed roles as managers of local demands, and, by means of resistance, intersectionality, and solidarity, they transformed this micro-power into the potential for social transformation.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-23
      DOI: 10.3390/ijerph20115926
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5927: Coping Strategies as a Moderator for the
           Association between Intimate Partner Violence and Depression and Anxiety
           Symptoms among Transgender Women

    • Authors: Shannon S. Gray, Kayla Marie Sizemore, H. Jonathon Rendina
      First page: 5927
      Abstract: Evidence suggests that intimate partner violence (IPV) is associated with negative mental health outcomes. There is currently limited research on the impact of IPV on the outcomes of mental health for transgender women. The current study aimed to examine the relationship between intimate partner violence, coping skills, depression, and anxiety in a sample of transgender women. Hierarchical regression analyses were conducted examining the relationship of IPV and depression and anxiety symptoms, where coping skills moderate this relationship. The results suggest that those with experiences of IPV are more likely to have symptoms of depression and anxiety. For individuals with no experiences of IPV and low depression, high levels of emotional processing coping and acceptance coping buffered this relationship. For individuals with more experiences of IPV and more depressive symptoms, coping skills did not show to buffer this relationship. These same coping skills did not show evidence for buffering anxiety symptoms for transgender women with low or high levels of IPV. The results, implications, and limitations of this study and suggestions for further research are discussed.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-23
      DOI: 10.3390/ijerph20115927
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5928: Psychological Impact and Coping Strategies of
           Hispanic Parents of Children with Cancer: A Qualitative Study

    • Authors: Carol Y. Ochoa-Dominguez, Kimberly A. Miller, Matthew P. Banegas, Daniel Sabater-Minarim, Randall Y. Chan
      First page: 5928
      Abstract: Throughout the cancer trajectory, parents of childhood cancer survivors (CCSs) may experience mental and social challenges requiring continual adaptation to cancer-induced stress. Using Lazarus and Folkman’s Transactional Model of Stress and Coping framework, this qualitative study aimed to describe Hispanic parents’ psychological health and explore their coping strategies. Purposive sampling was used to recruit 15 Hispanic caregivers from a safety-net hospital in Los Angeles County. To be eligible, participants had to be: the primary caregiver of a CCS who had completed active treatment, the primary caregiver or child self-identified as Hispanic, and proficient in English or Spanish. The interviews lasted approximately 60 min, were audio-recorded (in English and Spanish), and professionally transcribed. Data were analyzed following a thematic content analysis with deductive and inductive approaches on Dedoose. Participants described high levels of stress and fear when their child was diagnosed with cancer. They also shared experiencing symptoms of social anxiety, post-traumatic stress disorder, and depression. Participants’ coping strategies were encompassed by three major themes: problem-focused, emotion-focused, and avoidant coping strategies. Problem-focused coping strategies included self-efficacy, behavioral change, and social support. Emotion-focused coping strategies included religious practices and positive reframing. Avoidant coping strategies included denial and self-distraction. Despite the evident disparities in psychological health for Hispanic parents of CCSs, gaps remain in designing a culturally tailored program to help alleviate the caregiver burden. This study provides insights regarding coping strategies that Hispanic caregivers use to deal with the psychological impact of their child’s cancer diagnosis. Our findings also delve into the contextual and cultural factors that impact psychological adjustment.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-23
      DOI: 10.3390/ijerph20115928
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5929: Diabetic Foot Assessment and Care: Barriers
           and Facilitators in a Cross-Sectional Study in Bangalore, India

    • Authors: Sudha B. G., Umadevi V., Joshi Manisha Shivaram, Pavan Belehalli, Shekar M. A., Chaluvanarayana H. C., Mohamed Yacin Sikkandar, Marcos Leal Brioschi
      First page: 5929
      Abstract: (1) Background: This cross-sectional study aims to highlight the assessment and foot care practices in an advanced clinical setting, the clinical characteristics of the patients, and to understand the barriers and facilitators for effective foot care from the perspectives of healthcare practices, resources, and patients’ socioeconomic and cultural practices, and other aspects in terms of new technologies for effective foot care such as infrared thermography. (2) Methods: Clinical test data from 158 diabetic patients and a questionnaire to assess the foot care education retention rate were collected at the Karnataka Institute of Endocrinology and Research (KIER) facility. (3) Results: Diabetic foot ulcers (DFUs) were found in 6% of the examined individuals. Male patients were more likely to have diabetes complications, with an odds ratio (OR) of 1.18 (CI = 0.49–2.84). Other diabetes problems raised the likelihood of DFUs by OR 5 (CI = 1.40–17.77). The constraints include socioeconomic position, employment conditions, religious customs, time and cost, and medication non-adherence. The attitude of podiatrists and nurses, diabetic foot education, and awareness protocols and amenities at the facility were all facilitators. (4) Conclusions: Most diabetic foot complications might be avoided with foot care education, regular foot assessments as the standard of treatment, and self-care as a preventive/therapeutic strategy.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-23
      DOI: 10.3390/ijerph20115929
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5930: Association between Physical Fitness and
           Cardiovascular Health in Firefighters

    • Authors: Jaron Ras, Denise L. Smith, Elpidoforos S. Soteriades, Andre P. Kengne, Lloyd Leach
      First page: 5930
      Abstract: Firefighters perform strenuous work in dangerous and unpredictable environments requiring optimal physical conditioning. The aim of this study was to investigate the association between physical fitness and cardiovascular health (CVH) in firefighters. This cross-sectional study systematically recruited 309 full-time male and female firefighters between the ages of 20 to 65 years in Cape Town, South Africa. Physical fitness was assessed using absolute (abV̇O2max) and relative oxygen consumption (relVO2max), grip and leg strength, push-ups and sit-ups, sit-and-reach for flexibility and lean body mass (LBM). CVH encompassed age, smoking, blood pressure (BP), blood glucose, lipid profile, body mass index, body fat percentage (BF%), and waist circumference. Linear regressions and logistic regressions were applied. Multivariable analysis indicated that relVO2max was associated with systolic BP (p < 0.001), diastolic BP (p < 0.001), non-fasting blood glucose (p < 0.001), and total cholesterol (p = 0.037). Poor CVH index was negatively associated with relV̇O2max (p < 0.001), leg strength (p = 0.019), and push-ups (p = 0.012). Furthermore, age was inversely associated with V̇O2max (p < 0.001), push-up and sit-up capacity (p < 0.001), and sit-and-reach (p < 0.001). BF% was negatively associated with abV̇O2max (p < 0.001), grip and leg strength (p < 0.001), push-ups (p = 0.008), sit-ups (p < 0.001), and LBM (p < 0.001). Cardiorespiratory fitness, muscular strength, and muscular endurance were significantly associated with a better overall CVH profile.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-23
      DOI: 10.3390/ijerph20115930
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5931: A Systematic Review of the Influence of
           Overweight and Obesity across the Lifespan on Obstacle Crossing during

    • Authors: Matthias Chardon, Fabio A. Barbieri, Tiago Penedo, Paulo C. R. Santos, Nicolas Vuillerme
      First page: 5931
      Abstract: This study aimed to systematically review and summarize the available data regarding the influence of overweight and obesity across the lifespan on obstacle crossing during walking. Four databases were systematically searched with no limitation on publication date following the Cochrane Handbook for Systematic Reviews and PRISMA guidelines. Only full-text English-language articles published in a peer-reviewed journal were eligible. They had to compare obstacle crossing during walking by overweight or obese individuals with individuals of normal body weight. Five studies were considered eligible. All the studies assessed kinematics; only one assessed kinetics, but none investigated muscle activity or obstacle contact. Compared to normal individuals crossing obstacles, overweight or obese individuals exhibited lower velocity, shorter step length, lower cadence, and less time spent in single-limb support. They also exhibited increased step width, more time spent in double support, and greater trailing leg ground force reaction and centre of mass acceleration. Overall, the small number of included studies did not allow us to draw any conclusions. However, being overweight or obese seems to have a potentially negative influence on the kinematics of gait parameters due to a tendency to trip, fall, and suffer severe fall-related injuries when negotiating obstacles on foot in real-life environments.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-23
      DOI: 10.3390/ijerph20115931
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5932: Neighborhood Walkability as a Risk Factor for
           Preterm Birth Phenotypes in Two Philadelphia Hospitals from

    • Authors: Theresa A. Kash, Rachel F. Ledyard, Anne M. Mullin, Heather H. Burris
      First page: 5932
      Abstract: A total of one in ten infants is born preterm in the U.S. with large racial disparities. Recent data suggest that neighborhood exposures may play a role. Walkability—how easily individuals can walk to amenities–may encourage physical activity. We hypothesized that walkability would be associated with a decreased risk of preterm birth (PTB) and that associations would vary by PTB phenotype. PTB can be spontaneous (sPTB) from conditions such as preterm labor and preterm premature rupture of membranes, or medically indicated (mPTB) from conditions such as poor fetal growth and preeclampsia. We analyzed associations of neighborhood walkability (quantified by their Walk Score® ranking) with sPTB and mPTB in a Philadelphia birth cohort (n = 19,203). Given racial residential segregation, we also examined associations in race-stratified models. Walkability (per 10 points of Walk Score ranking) was associated with decreased odds of mPTB (aOR 0.90, 95% CI: 0.83, 0.98), but not sPTB (aOR 1.04, 95% CI: 0.97, 1.12). Walkability was not protective for mPTB for all patients; there was a non-significant protective effect for White (aOR 0.87, 95% CI: 0.75, 1.01), but not Black patients (aOR 1.05, 95% CI: 0.92, 1.21) (interaction p = 0.03). Measuring health effects of neighborhood characteristics across populations is key for urban planning efforts focused on health equity.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-24
      DOI: 10.3390/ijerph20115932
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5933: Telemedicine Support for Primary Care
           Providers versus Usual Care in Patients with Heart Failure: Protocol of a
           Pragmatic Cluster Randomised Trial within the Brazilian Heart
           Insufficiency with Telemedicine (BRAHIT) Study

    • Authors: Leonardo Graever, Aurora Felice Castro Issa, Viviane Belidio Pinheiro da Fonseca, Marcelo Machado Melo, Gabriel Pesce de Castro da Silva, Isabel Cristina Pacheco da Nóbrega, Leonardo Cançado Monteiro Savassi, Mariana Borges Dias, Maria Kátia Gomes, Jose Roberto Lapa e Silva, Raphael Mendonça Guimarães, Renato Cony Seródio, Anne Frølich, Henrik Gudbergsen, Janus Christian Jakobsen, Helena Dominguez
      First page: 5933
      Abstract: Heart failure is a prevalent condition and a frequent cause of hospital readmissions and poor quality of life. Teleconsultation support from cardiologists to primary care physicians managing patients with heart failure may improve care, but the effect on patient-relevant outcomes is unclear. We aim to evaluate whether collaboration through a novel teleconsultation platform in the Brazilian Heart Insufficiency with Telemedicine (BRAHIT) project, tested on a previous feasibility study, can improve patient-relevant outcomes. We will conduct a parallel-group, two-arm, cluster-randomised superiority trial with a 1:1 allocation ratio, with primary care practices from Rio de Janeiro as clusters. Physicians from the intervention group practices will receive teleconsultation support from a cardiologist to assist patients discharged from hospitals after admission for heart failure. In contrast, physicians from the control group practices will perform usual care. We will include 10 patients per each of the 80 enrolled practices (n = 800). The primary outcome will be a composite of mortality and hospital admissions after six months. Secondary outcomes will be adverse events, symptoms frequency, quality of life, and primary care physicians’ compliance with treatment guidelines. We hypothesise that teleconsulting support will improve patient outcomes.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-24
      DOI: 10.3390/ijerph20115933
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5934: Feasibility of a Virtual Educational
           Programme for Behaviour Change in Cardiac Patients from a Low-Resource

    • Authors: Rafaella Zulianello dos Santos, Sidnei Almeida, Andrea Korbes Scheafer, Marlus Karsten, Paul Oh, Magnus Benetti, Gabriela Lima de Melo Ghisi
      First page: 5934
      Abstract: Patient education is an integral part of recovery from a critical cardiac life event and a core component of cardiac rehabilitation (CR) programmes. This study addressed the feasibility of a virtual educational programme for behaviour change in CR patients from a low-resource setting in Brazil. Cardiac patients from a CR programme closed due to the pandemic received a 12-week virtual educational intervention (WhatsApp messages and bi-weekly calls from healthcare providers). Acceptability, demand, implementation, practicality, and limited efficacy were tested. Overall, 34 patients and 8 healthcare providers agreed to participate. The intervention was considered practical and acceptable by the participants, who reported a satisfaction median of 9.0 (7.4–10.0)/10 (patients) and 9.8 (9.6–10.0)/10 (providers). The main difficulties in carrying out the intervention activities were related to technology, motivation to self-learning, and a lack of in-person orientation. All the patients reported that the information included in the intervention was aligned with their information needs. The intervention was associated with changes in exercise self-efficacy, sleep quality, depressive symptoms, and performance of high-intensity physical activity. In conclusion, the intervention was considered feasible to educate cardiac patients from a low-resource setting. It should be replicated and expanded to support patients that face barriers to onsite CR participation. Challenges related to technology and self-learning should be addressed.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-24
      DOI: 10.3390/ijerph20115934
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5935: Reliability of ADR Jumping Photocell:
           Comparison of Beam Cut at Forefoot and Midfoot

    • Authors: Jose M. Jimenez-Olmedo, Alfonso Penichet-Tomas, Basilio Pueo, Lamberto Villalon-Gasch
      First page: 5935
      Abstract: The ability to detect small changes in a vertical jump is crucial when data are used by sports science specialists to monitor their athletes. This study aimed to analyze the intrasession reliability of the ADR jumping photocell and the reliability relative to the position of the transmitter when it is located facing the phalanges of the foot (forefoot) or the metatarsal area (midfoot). A total of 12 female volleyball players performed 240 countermovement jumps (CMJ), alternating both methods. The intersession reliability was higher for the forefoot method (ICC = 0.96; CCC = 0.95; SEM = 1.15 cm; CV = 4.11%) than for the midfoot method (ICC = 0.85; CCC = 0.81; SEM = 3.68 cm; CV = 8.75%). Similarly, the sensitivity values were better for the forefoot method (SWC = 0.32) than for the midfoot method (SWC = 1.04). Significant differences were found between the methods (13.5 cm, p < 0.05, ES = 2.1) with low agreement (rs = 0.57; ICC = 0.49; CCC = 0.15; SEM = 4.7 cm) and heteroscedasticity was observed (r2 > 0.1). In conclusion, the ADR jumping photocell is shown to be a reliable tool for measuring CMJs. However, the reliability of the instrument can be influenced depending on the placement of the device. Comparing the two methods, the midfoot placement was less reliable as indicated by higher values of SEM and systematic error, and thus its use is not recommended.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-24
      DOI: 10.3390/ijerph20115935
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5936: Medication Decision-Making and the
           Medicines’ Pathway in Nursing Homes: Experiences and Expectations of
           Involvement of Residents and Informal Caregivers

    • Authors: Amber Damiaens, Ann Van Hecke, Veerle Foulon
      First page: 5936
      Abstract: Background: Information on how residents and their informal caregivers are involved in the medicines’ pathway in nursing homes is scarce. Likewise, it is not known how they would prefer to be involved therein. Methods: A generic qualitative study using semi-structured interviews with 17 residents and 10 informal caregivers from four nursing homes was performed. Interview transcripts were analyzed using an inductive thematic framework. Results: Four themes were derived to describe resident and informal caregiver involvement in the medicines’ pathway. First, residents and informal caregivers show behaviors of involvement across the medicines’ pathway. Second, their attitude towards involvement was mainly one of resignation, but variation was noted in their involvement preferences, ranging from minimal information to active participation needs. Third, institutional and personal factors were found to contribute to the resigned attitude. Last, situations were identified that drive residents and informal caregivers to act, regardless of their resigned attitude. Conclusions: Resident and informal caregiver involvement in the medicines’ pathway is limited. Nevertheless, interviews show that information and participation needs are present and show potential for residents’ and informal caregivers’ contribution to the medicines’ pathway. Future research should explore initiatives to increase the understanding and acknowledgement of opportunities for involvement and to empower residents and informal caregivers to take on their roles.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-24
      DOI: 10.3390/ijerph20115936
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5937: HIV and Hepatitis C Risk among Tajik Migrant
           Workers Who Inject Drugs in Moscow

    • Authors: Mary Ellen Mackesy-Amiti, Judith A. Levy, Mahbatsho Bahromov, Jonbek Jonbekov, Casey M. Luc
      First page: 5937
      Abstract: The human immunodeficiency virus (HIV) epidemic in Eastern Europe and Central Asia continues to grow with most infections occurring in high-risk groups including people who inject drugs and their sexual partners. Labor migrants from this region who inject drugs while in Russia are at especially high HIV risk. Male Tajik migrant workers who inject drugs in Moscow (N = 420) were interviewed prior to a randomized trial of the Migrants’ Approached Self-Learning Intervention in HIV/AIDS (MASLIHAT) peer-education HIV-prevention intervention. Participants were interviewed about their sex and drug use behavior and tested for HIV and hepatitis C (HCV) prior to the intervention. Only 17% had ever been tested for HIV. Over half of the men reported injecting with a previously used syringe in the past month, and substantial proportions reported risky sexual behavior. Prevalence rates of HIV (6.8%) and HCV (2.9%) were elevated, although lower than expected when compared to estimates of prevalence among people who inject drugs at the national level in Tajikistan. Risk behavior in diaspora varied across the men’s regional area of origin in Tajikistan and occupation in Moscow, with HIV prevalence rates highest among those working at the bazaars. Evidence-based prevention approaches and messaging that specifically address the drug- and sex-related risk behavior of migrants with varying backgrounds are needed.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-24
      DOI: 10.3390/ijerph20115937
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5938: Factors Associated with the Level of
           Knowledge about Biosafety against COVID-19 in Peruvian Dental Students: A
           Cross-Sectional Study under a Multivariable Regression Model

    • Authors: John Santome-Pariona, Gissela Briceño-Vergel, Nancy Córdova-Limaylla, Marysela Ladera-Castañeda, José Huamani-Echaccaya, Rita Tolmos-Valdivia, Juan Huamani-Cantoral, Fredy Solís-Dante, Luis Cervantes-Ganoza, César Cayo-Rojas
      First page: 5938
      Abstract: Aim: Biosafety is a set of preventive measures aimed at controlling risk factors arising from biological, physical, and/or chemical agents. This topic is particularly important in the dental field since saliva is the main biological agent of the transmission of coronavirus. The present study aimed to determine the factors associated with the level of knowledge about biosafety against COVID-19 in Peruvian dentistry students. Materials and Methods: The present observational, cross-sectional, and analytical study evaluated 312 Peruvian dentistry students. A validated 20-question questionnaire was used to measure the level of knowledge. The nonparametric Mann–Whitney U and Kruskal–Wallis tests were used to compare levels of knowledge between categories of each variable. A logit model was used to evaluate associated factors such as sex, age, marital status, place of origin, academic year of study, being in the academic upper third, history of COVID-19, and living with vulnerable family members. A significance level of p < 0.05 was considered. Results: 36.2%, 31.4%, and 32.4% presented poor, fair, and good knowledge levels, respectively. Students under 25 years of age were 64% less likely to pass the biosafety against COVID-19 questionnaire than students 25 years of age and older (OR = 0.36; CI: 0.20–0.66). Students in the academic upper third were nine times more likely to pass the test than other students (OR = 9.38; CI: 4.61–19.07). Finally, third-year students were 52% less likely to pass the exam than fifth-year students (OR = 0.48; CI: 0.28–0.83). Conclusion: Only a minority of dentistry students had a good level of knowledge about biosafety against COVID-19. Younger and less educated students were more likely to fail the questionnaire. On the other hand, those students with outstanding academic performance were more likely to pass the questionnaire.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-24
      DOI: 10.3390/ijerph20115938
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5939: Gardening in Childcare Centers: A Randomized
           Controlled Trial Examining the Effects of a Garden Intervention on
           Physical Activity among Children Aged 3–5 Years in North Carolina

    • Authors: Nancy M. Wells, Nilda Graciela Cosco, Derek Hales, Muntazar Monsur, Robin C. Moore
      First page: 5939
      Abstract: This study examined the effects of a childcare gardening intervention on children’s physical activity (PA). Eligible childcare centers were randomly assigned to: (1) garden intervention (n = 5; year 1); (2) waitlist control (n = 5; control year 1, intervention year 2); or (3) control (n = 5; year 2 only) groups. Across the two-year study, PA was measured for 3 days at four data collection periods using Actigraph GT3X+ accelerometers. The intervention comprised 6 raised fruit and vegetable garden beds and a gardening guide with age-appropriate learning activities. The sample included a total of 321 3–5-year-olds enrolled in childcare centers in Wake County, North Carolina, with n = 293 possessing PA data for at least one time point. The analyses employed repeated measures linear mixed models (SAS v 9.4 PROC MIXED), accounting for clustering of the children within the center and relevant covariates (e.g., cohort, weather, outside days, accelerometer wear). A significant intervention effect was found for MVPA (p < 0.0001) and SED minutes (p = 0.0004), with children at intervention centers acquiring approximately 6 min more MVPA and 14 min less sedentary time each day. The effects were moderated by sex and age, with a stronger impact for boys and the youngest children. The results suggest that childcare gardening has potential as a PA intervention.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-24
      DOI: 10.3390/ijerph20115939
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5940: Measuring Experience of Inpatient Child and
           Adolescent Mental Health Services (CAMHS)

    • Authors: Jacob Clark, Euan MacLennan
      First page: 5940
      Abstract: There has been an important drive towards embedding feedback and experience data to improve health services in the UK. The current paper examines the gap in evidence and the lack of adequate measures of inpatient CAMHS experience. It presents the context of inpatient CAMHS and what factors influence care experience, before exploring the current practices for measuring experience and the implications for young people and families. The paper explores the dialectic that—given the nature of the work balancing risk and restrictions in inpatient CAMHS—it is essential that patient voice is at the centre of quality measures, and achieving this comes with a great complexity. The health needs of adolescents are unique, as are the interventions of psychiatric inpatient care, but current measures in routine use are often not developmentally adapted and lack validity. This paper looks to interdisciplinary theory and practice to consider what the application of a valid and meaningful measure of inpatient CAMHS experience might incorporate. It makes the case that the development of a measure of relational and moral experience of inpatient CAMHS would have significant implications for the quality of care and safety of adolescents during a period of acute crisis.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-24
      DOI: 10.3390/ijerph20115940
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5941: Estimating Overall and Cause-Specific Excess
           Mortality during the COVID-19 Pandemic: Methodological Approaches Compared

    • Authors: Claudio Barbiellini Amidei, Ugo Fedeli, Nicola Gennaro, Laura Cestari, Elena Schievano, Manuel Zorzi, Paolo Girardi, Veronica Casotto
      First page: 5941
      Abstract: During the COVID-19 pandemic, excess mortality has been reported worldwide, but its magnitude has varied depending on methodological differences that hinder between-study comparability. Our aim was to estimate variability attributable to different methods, focusing on specific causes of death with different pre-pandemic trends. Monthly mortality figures observed in 2020 in the Veneto Region (Italy) were compared with those forecasted using: (1) 2018–2019 monthly average number of deaths; (2) 2015–2019 monthly average age-standardized mortality rates; (3) Seasonal Autoregressive Integrated Moving Average (SARIMA) models; (4) Generalized Estimating Equations (GEE) models. We analyzed deaths due to all-causes, circulatory diseases, cancer, and neurologic/mental disorders. Excess all-cause mortality estimates in 2020 across the four approaches were: +17.2% (2018–2019 average number of deaths), +9.5% (five-year average age-standardized rates), +15.2% (SARIMA), and +15.7% (GEE). For circulatory diseases (strong pre-pandemic decreasing trend), estimates were +7.1%, −4.4%, +8.4%, and +7.2%, respectively. Cancer mortality showed no relevant variations (ranging from −1.6% to −0.1%), except for the simple comparison of age-standardized mortality rates (−5.5%). The neurologic/mental disorders (with a pre-pandemic growing trend) estimated excess corresponded to +4.0%/+5.1% based on the first two approaches, while no major change could be detected based on the SARIMA and GEE models (−1.3%/+0.3%). The magnitude of excess mortality varied largely based on the methods applied to forecast mortality figures. The comparison with average age-standardized mortality rates in the previous five years diverged from the other approaches due to the lack of control over pre-existing trends. Differences across other methods were more limited, with GEE models probably representing the most versatile option.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-24
      DOI: 10.3390/ijerph20115941
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5942: The Association between Adult Sport, Fitness,
           and Recreational Physical Activity and Number and Age of Children Present
           in the Household: A Secondary Analysis Using NHANES

    • Authors: Jerraco L. Johnson, Ailton Coleman, Jamila L. Kwarteng, Ahondju U. Holmes, Dulcie Kermah, Marino A. Bruce, Bettina M. Beech
      First page: 5942
      Abstract: Only one in three adults in the United States meets the weekly recommendation for physical activity (PA). The presence of children in the home may restrict adult PA. The purpose of this study was to examine the association between adult moderate and vigorous sport, fitness, and recreational physical activities and the number and age (0–5 and 6–17) of children in their household. Secondary data were drawn from the National Health and Nutrition Examination Survey (NHANES) from 2007–2016. Adults with complete survey data for self-reported moderate (MPA) and vigorous physical activities (VPA), number of children in the home, and other sociodemographic variables were included. The final sample included 2034 adults from 22–65 years of age. Analyses included ANOVAs and separate multivariable regression analyses to determine if the number of children in the household aged 0–5 and 6–17 were significant predictors of weekly moderate-to-vigorous physical activity (MVPA) after controlling for covariates. For MPA, no differences were found between adult PA regardless of the number and age of children in the home. For VPA, adults with two or more children aged 0–5 reported 80 fewer minutes of weekly VPA (p < 0.05) compared to those with no children or just one child in this age group after controlling for all covariates. Finally, adults with three or more children in the household aged 6–17 reported fifty fewer minutes of weekly VPA (p < 0.05) compared to those with no children, one, or just two in the household. These findings highlight a need to support the vigorous PA behaviors of this population, as the majority of the family-based PA intervention studies to date have primarily focused on family dyads.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-24
      DOI: 10.3390/ijerph20115942
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5943: Analysis and Prediction of COVID-19
           Multivariate Data Using Deep Ensemble Learning Methods

    • Authors: Shruti Sharma, Yogesh Kumar Gupta, Abhinava K. Mishra
      First page: 5943
      Abstract: The global economy has suffered losses as a result of the COVID-19 epidemic. Accurate and effective predictive models are necessary for the governance and readiness of the healthcare system and its resources and, ultimately, for the prevention of the spread of illness. The primary objective of the project is to build a robust, universal method for predicting COVID-19-positive cases. Collaborators will benefit from this while developing and revising their pandemic response plans. For accurate prediction of the spread of COVID-19, the research recommends an adaptive gradient LSTM model (AGLSTM) using multivariate time series data. RNN, LSTM, LASSO regression, Ada-Boost, Light Gradient Boosting and KNN models are also used in the research, which accurately and reliably predict the course of this unpleasant disease. The proposed technique is evaluated under two different experimental conditions. The former uses case studies from India to validate the methodology, while the latter uses data fusion and transfer-learning techniques to reuse data and models to predict the onset of COVID-19. The model extracts important advanced features that influence the COVID-19 cases using a convolutional neural network and predicts the cases using adaptive LSTM after CNN processes the data. The experiment results show that the output of AGLSTM outperforms with an accuracy of 99.81% and requires only a short time for training and prediction.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-24
      DOI: 10.3390/ijerph20115943
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5944: Gas Phase Emissions of Volatile Organic
           Compounds Arising from the Application of Sunscreens

    • Authors: Amber M. Yeoman, Marvin Shaw, Martyn Ward, Lyndsay Ives, Stephen J. Andrews, Alastair C. Lewis
      First page: 5944
      Abstract: The speciation of volatile organic compounds (VOCs) emitted from personal care products (PCPs) is complex and contributes to poor air quality and health risks to users via the inhalation exposure pathway. Detailed VOC emission profiles were generated for 26 sunscreen products; consequently, variability was observed between products, even though they were all designed for the same purpose. Some were found to contain fragrance compounds not labelled on their ingredients list. Five contaminant VOCs were identified (benzene, toluene, ethylbenzene, o-xylene, and p-xylene); headspace sampling of an additional 18 randomly selected products indicated that ethanol originating from fossil petroleum was a potential source. The gas phase emission rates of the VOCs were quantified for 15 of the most commonly emitted species using SIFT-MS. A wide range of emission rates were observed between the products. Usage estimates were made based on the recommended dose per body surface area, for which the total mass of VOCs emitted from one full-body application dose was in the range of 1.49 × 103–4.52 × 103 mg and 1.35 × 102–4.11 × 102 mg for facial application (men aged 16+; children aged 2–4). Depending on age and sex, an estimated 9.8–30 mg of ethanol is inhaled from one facial application of sunscreen.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-24
      DOI: 10.3390/ijerph20115944
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5945: The Relationship between Meaning in Life and
           the Childhood Family Environment among Emerging Adults

    • Authors: Emily Dameron, Marcie C. Goeke-Morey
      First page: 5945
      Abstract: This study investigates the impact of the childhood family environment on reported meaning in life among emerging adults (n = 507) at a private, urban, religious university. This study found that participants who reported growing up in an emotionally warm family environment ultimately reported more meaning in life as adults and that this effect was mediated by loneliness. This suggests that people from emotionally cold and rejecting early family environments may struggle with meaning in life as adults because they are lonelier. This research contributes a developmental perspective to understanding meaning in life. The public health implications of these findings are discussed. Future research should consider accounting for the effects of early life experiences on meaning in life.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-24
      DOI: 10.3390/ijerph20115945
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5946: Exploration of Existing Integrated Mental
           Health and Addictions Care Services for Indigenous Peoples in Canada

    • Authors: Jasmine Wu, Victoria Smye, Bill Hill, Joseph Antone, Arlene MacDougall
      First page: 5946
      Abstract: Due to the persistent impacts of colonialism, Indigenous peoples of Canada face disproportionate rates of mental health and substance use disorders, which are often insufficiently addressed by Eurocentric ‘mainstream’ mental health and addiction services. The need to better address Indigenous mental health has led to Indigenous mental health integrated care (hereafter integrated care): programs using both Indigenous and Western practices in their care delivery. This research describes the common lessons, disjunctures, and solutions experienced by existing integrated care programs for Indigenous adults across Canada. It reveals the best practices of integrated care for programs, and contributes to the Truth and Reconciliation Commission of Canada’s Calls to Action #20 and #22. This study, co-designed by an Indigenous Knowledge Keeper and Practitioner, explores the programs’ relational processes through interviews with key informants. The data was analyzed in consultation with Indigenous collaborators to highlight Indigenous values and interpretations, and knowledge co-production. In highlighting the complexity of integrated care, study results show the lessons of ‘Real Commitment to Communities and Community Involvement,’ and tensions and disjunctures of ‘Culture as Healing,’ ‘People-focused vs. Practitioner-focused Programs,’ ‘Community-oriented vs. Individual-oriented Programs,’ and ‘Colonial Power Dynamics in Integrated Care.’ The discussion explores why tensions and disjunctures exist, and suggests how to move forward using integrated care’s lessons and the concept of IND-equity. Ultimately, Indigenous-led partnerships are paramount to integrated care because they leverage Indigenous knowledge and approaches to achieve health equity within integrated care.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-25
      DOI: 10.3390/ijerph20115946
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5947: The Professional Identity of Social Workers
           in Mental Health Services: A Scoping Review

    • Authors: Harry Bark, Jeremy Dixon, Judy Laing
      First page: 5947
      Abstract: Recent research into the role of mental health social work has identified a need for increased critical engagement with accounts of professional role and identity. Notably, a number of studies have found that social workers struggle to articulate their role within mental health teams and services. This study aimed to identify the ways in which social workers in mental health settings defined their professional identity and role. An international scoping review utilizing Arksey and O’Malley’s method was conducted, identifying 35 papers published between 1997 and 2022. A thematic analysis grouped the findings into three predominant themes: (i) distinct social work approaches to mental health, (ii) organizational negotiations for mental health social workers, and (iii) professional negotiations for mental health social workers. These thematic findings are discussed in relation to existing research and critical perspectives, with particular emphasis on accounts of the bureaucratic and ideological functioning of professionalism in mental health services, as well as the global direction of mental health policy. This review finds that mental health social work embodies a coherent identity that aligns with international mental health policy agendas but faces significant challenges in developing and expressing this identity within mental health services.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-25
      DOI: 10.3390/ijerph20115947
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5948: Experiences of Sex Workers in Chicago during
           COVID-19: A Qualitative Study

    • Authors: Randi Singer, Sarah Abboud, Amy K. Johnson, Jessica L. Zemlak, Natasha Crooks, Sangeun Lee, Johannes Wilson, Della Gorvine, Jahari Stamps, Douglas Bruce, Susan G. Sherman, Alicia K. Matthews, Crystal L. Patil
      First page: 5948
      Abstract: COVID-19 exacerbated health disparities, financial insecurity, and occupational safety for many within marginalized populations. This study, which took place between 2019 and 2022, aimed to explore the way in which sex workers (n = 36) in Chicago were impacted by COVID-19. We analyzed the transcripts of 36 individual interviews with a diverse group of sex workers using thematic analysis. Five general themes emerged regarding the detrimental impact of COVID-19 on sex workers: (1) the impact of COVID-19 on physical health; (2) the economic impact of COVID-19; (3) the impact of COVID-19 on safety; (4) the impact of COVID-19 on mental health; and (5) adaptive strategies for working during COVID-19. Participants reported that their physical and mental health, economic stability, and safety worsened due to COVID-19 and that adaptive strategies did not serve to improve working conditions. Findings highlight the ways in which sex workers are particularly vulnerable during a public health crisis, such as COVID-19. In response to these findings, targeted resources, an increased access to funding, community-empowered interventions and policy changes are needed to protect the health and safety of sex workers in Chicago.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-25
      DOI: 10.3390/ijerph20115948
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5949: One-Year Follow-Up of Seroprevalence of
           SARS-CoV-2 Infection and Anxiety among Health Workers of a French Cancer
           Center: The PRO-SERO-COV Study

    • Authors: Brice Richez, Coralie Cantarel, Françoise Durrieu, Isabelle Soubeyran, Julie Blanchi, Simon Pernot, Camille Chakiba Brugère, Guilhem Roubaud, Sophie Cousin, Gabriel Etienne, Anne Floquet, Florence Babre, Julie Rivalan, Caroline Lalet, Marine Narbonne, Yaniss Belaroussi, Carine Bellera, Simone Mathoulin-Pélissier
      First page: 5949
      Abstract: Infection of SARS-CoV-2 among health workers (HWs) in contact with cancer patients has been a major issue since the beginning of the pandemic. We aimed to assess the serological immune status of SARS-CoV-2 infection among these HWs. A prospective cohort study was initiated in the comprehensive cancer center of the Nouvelle-Aquitaine region (NA, France). Volunteer HWs working on March 2020 without active infection or symptoms of COVID-19 completed a self-questionnaire and had a blood test at inclusion, at 3 and 12 months. Positive serological status of SARS-CoV-2 infection was defined by anti-nucleocapsid antibodies and/or IgG anti-spike antibodies, except at 12 months due to vaccine. Half of the HWs were included (N = 517) and 89% were followed for three months (N = 500) and one year (N = 462). Seroprevalence of SARS-CoV-2 infection was 3.5% (95% CI: 1.9–5.1), 6.2% (95% CI: 4.1–8.3), and 10% (95% CI: 7.2–12.7) on June–September 2020, September 2020–January 2021, and June–October 2021, respectively. At 12 months, 93.3% had detectable antibodies with 80% vaccinated in the first three months of vaccine availability. The COVID-19-free policy of the institution, respect for barrier gestures, high and early vaccination of HWs, and low prevalence of SARS-CoV-2 in NA may explain the low rate of seropositivity among the HWs of the Institut Bergonié.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-25
      DOI: 10.3390/ijerph20115949
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5950: Minimal Clinically Important Difference
           (MCID), Substantial Clinical Benefit (SCB), and Patient Acceptable Symptom
           State (PASS) of the Shoulder Disability Questionnaire (SDQ) in Patients
           Undergoing Rotator Cuff Repair

    • Authors: Umile Giuseppe Longo, Rocco Papalia, Sergio De Salvatore, Carlo Casciaro, Ilaria Piergentili, Benedetta Bandini, Alberto Lalli, Edoardo Franceschetti, Vincenzo Denaro
      First page: 5950
      Abstract: The Shoulder Disability Questionnaire (SDQ) is a Patient-Reported Outcome Measure (PROM) applied to evaluate shoulder surgery outcomes. The purpose of this study is to identify the accurate Minimal Clinically Important Difference (MCID), Substantial Clinical Benefit (SCB) and Patient Acceptable Symptom State (PASS) values for the SDQ score. A total of 35 patients (21 women and 16 men, mean age 76.6 ± 3.2 years) were followed up at 6 months postoperatively. To assess the patient’s health satisfaction and symptoms, anchor questions were used. The MCID and SCB values of the SDQ score for patients who underwent arthroscopic rotator cuff repair from inception to final follow-up were 40.8 and 55.6, respectively. A change of 40.8 in the SDQ score at 6 months after surgery shows that patients achieved a minimum clinically important improvement in their state of health, and a 55.6 change in the SDQ score reflects a substantial clinically important improvement. The PASS cut-off of the SDQ score at 6 months postoperatively ranged from 22.5 to 25.8. If an SDQ score of 22.5 or more is attained after surgery, the health condition can be recognized as acceptable by the majority of patients. These cut-offs will help with understanding specific patient results and allow clinicians to personally assess patient improvement after rotator cuff repair.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-25
      DOI: 10.3390/ijerph20115950
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5951: Reply to Ott, M.; Werneke, U. Comment on
           “Liu et al. Hemodialysis Treatment for Patients with Lithium
           Poisoning. Int. J. Environ. Res. Public Health 2022, 19, 10044”

    • Authors: Yu-Hsin Liu, Tzung-Hai Yen
      First page: 5951
      Abstract: We would like to thank Professor Ott and Professor Werneke for their helpful comments [...]
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-25
      DOI: 10.3390/ijerph20115951
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5952: Risk Factors and Protective Factors of
           Internet Addiction in University Students during the Pandemic:
           Implications for Prevention and Treatment

    • Authors: Daniel T. L. Shek, Wenyu Chai, Kaiji Zhou
      First page: 5952
      Abstract: While the prevalence rates of Internet addiction (IA) amongst young people during the pandemic are disturbing, few studies have investigated the risk and protective factors of IA in Hong Kong university students under COVID-19. In this study, we examined the relationship between COVID-19-related stress and IA and the role of psychological morbidity and positive psychological attributes in the relationship. In summer 2022, 978 university students completed a survey assessing pandemic-related stress, psychological morbidity, and positive psychological attributes. While psychological morbidity was indexed by depression, post-traumatic stress disorder, and suicidal behavior, positive psychological attributes included life satisfaction, flourishing, adversity beliefs, emotional competence, resilience, and family functioning measures. Results showed that stress and psychological morbidity positively predicted IA, and psychological morbidity mediated the association between stress and IA. Positive psychological attributes negatively predicted stress and IA, and mediated the connection between stress and IA. Positive psychological attributes moderated the mediating effect of psychological morbidity on the relationship between stress and IA. In addition to theoretical contributions, this study contributes to IA prevention and treatment: reducing psychological morbidity and promoting positive psychological attributes are promising strategies to address IA issues in young people.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-25
      DOI: 10.3390/ijerph20115952
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5953: “I Don’t Want to Go to
           Work”: A Mixed-Methods Analysis of Healthcare Worker Experiences
           from the Front- and Side-Lines of COVID-19

    • Authors: Smith F. Heavner, Mackenzie Stuenkel, Rebecca Russ Sellers, Rhiannon McCallus, Kendall D. Dean, Chloe Wilson, Marissa Shuffler, Thomas W. Britt, Shannon Stark Taylor, Molly Benedum, Niki Munk, Rachel Mayo, Kathleen Buford Cartmell, Sarah Griffin, Ann Blair Kennedy
      First page: 5953
      Abstract: During the COVID-19 pandemic, healthcare workers (HCW) were categorized as “essential” and “non-essential”, creating a division where some were “locked-in” a system with little ability to prepare for or control the oncoming crisis. Others were “locked-out” regardless of whether their skills might be useful. The purpose of this study was to systematically gather data over the course of the COVID-19 pandemic from HCW through an interprofessional lens to examine experiences of locked-out HCW. This convergent parallel mixed-methods study captured perspectives representing nearly two dozen professions through a survey, administered via social media, and video blogs. Analysis included logistic regression models of differences in outcome measures by professional category and Rapid Identification of Themes from Audio recordings (RITA) of video blogs. We collected 1299 baseline responses from 15 April 2020 to 16 March 2021. Of those responses, 12.1% reported no signs of burnout, while 21.9% reported four or more signs. Qualitative analysis identified four themes: (1) professional identity, (2) intrinsic stressors, (3) extrinsic factors, and (4) coping strategies. There are some differences in the experiences of locked-in and locked-out HCW. This did not always lead to differing reports of moral distress and burnout, and both groups struggled to cope with the realities of the pandemic.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-25
      DOI: 10.3390/ijerph20115953
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5954: The “Dedicated” C.B.C.T.
           in Dentistry

    • Authors: Salvatore Distefano, Maria Grazia Cannarozzo, Gianrico Spagnuolo, Marco Brady Bucci, Roberto Lo Giudice
      First page: 5954
      Abstract: This position statement represents a consensus of an expert committee composed by the Italian Academy of General Dentistry (Accademia Italiana Odontoiatria Generale COI-AIOG) and Italian Academy of Legal and Forensic Dentistry (Accademia Italiana di Odontoiatria Legale e Forense OL-F) on the appropriate use of cone beam computed tomography (C.B.C.T.) in dentistry. This paper analyzes the use of C.B.C.T. in light of the rapid evolution of volumetric technologies, with the new low- and ultra-low-dose exposure programs. These upgrades are determining an improvement in the precision and safety of this methodology; therefore, the need of a guideline revision of the use of C.B.C.T. for treatment planning is mandatory. It appears necessary to develop a new model of use, which, in compliance with the principle of justification and as low as reasonably achievable (ALARA) and as low as diagnostically acceptable (ALADA), can allow a functional “Dedicated C.B.C.T.” exam optimized for the individuality of the patient.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-25
      DOI: 10.3390/ijerph20115954
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5955: Association of Insomnia with 30-Day
           Postpartum Readmission: A Retrospective Analysis

    • Authors: Anthony M. Kendle, Justin Swanson, Jason L. Salemi, Judette M. Louis
      First page: 5955
      Abstract: Insomnia is prevalent in pregnancy and is associated with increased use of health services. We aimed to evaluate the association between insomnia diagnosed at the delivery hospitalization and risk of 30-day postpartum readmission. We conducted a retrospective analysis of inpatient hospitalizations from the 2010–2019 Nationwide Readmissions Database. The primary exposure was a coded diagnosis of insomnia at delivery as determined by ICD-9-CM and ICD-10-CM codes. Obstetric comorbidities and indicators of severe maternal morbidity were also determined through coding. The primary outcome was all-cause 30-day postpartum readmission. Survey-weighted logistic regression was used to generate crude and adjusted odds ratios representing the association between maternal insomnia and postpartum readmission. Of over 34 million delivery hospitalizations, 26,099 (7.6 cases per 10,000) had a coded diagnosis of insomnia. People with insomnia experienced a 3.0% all-cause 30-day postpartum readmission rate, compared to 1.4% among those without insomnia. After controlling for sociodemographic, clinical, and hospital-level factors, insomnia was associated with 1.64 times higher odds of readmission (95% CI 1.47–1.83). After adjustment for obstetric comorbidity burden and severe maternal morbidity, insomnia was independently associated with 1.33 times higher odds of readmission (95% CI 1.18–1.48). Pregnant patients with insomnia have higher rates of postpartum readmission, and diagnosis of insomnia is independently associated with increased odds of readmission. Additional postpartum support may be warranted for pregnancies affected by insomnia.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-25
      DOI: 10.3390/ijerph20115955
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5956: First Nations, Inuit and Métis Peoples
           Living in Urban Areas of Canada and Their Access to Healthcare: A
           Systematic Review

    • Authors: Simon Graham, Nicole M. Muir, Jocelyn W. Formsma, Janet Smylie
      First page: 5956
      Abstract: In Canada, approximately 52% of First Nations, Inuit and Métis (Indigenous) peoples live in urban areas. Although urban areas have some of the best health services in the world, little is known about the barriers or facilitators Indigenous peoples face when accessing these services. This review aims to fill these gaps in knowledge. Embase, Medline and Web of Science were searched from 1 January 1981 to 30 April 2020. A total of 41 studies identified barriers or facilitators of health service access for Indigenous peoples in urban areas. Barriers included difficult communication with health professionals, medication issues, dismissal by healthcare staff, wait times, mistrust and avoidance of healthcare, racial discrimination, poverty and transportation issues. Facilitators included access to culture, traditional healing, Indigenous-led health services and cultural safety. Policies and programs that remove barriers and implement the facilitators could improve health service access for Indigenous peoples living in urban and related homelands in Canada.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-25
      DOI: 10.3390/ijerph20115956
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5957: The Epidemiological Surveillance of
           Mesothelioma Mortality in Italy as a Tool for the Prevention of Asbestos

    • Authors: Lucia Fazzo, Giada Minelli, Marco De Santis, Emiliano Ceccarelli, Ivano Iavarone, Amerigo Zona
      First page: 5957
      Abstract: As part of a surveillance plan active since the early 1990s, this study evaluates malignant mesothelioma (MM) mortality for the time-window 2010–2019 in Italy, a country that banned asbestos in 1992. National and regional mortality rates for MM, and municipal standardized mortality ratios (all mesotheliomas, pleural (MPM) and peritoneal (MPeM)), by gender and age group were calculated. A municipal clustering analysis was also performed. There were 15,446 deaths from MM (11,161 males, 3.8 × 100,000; 4285 females, 1.1 × 100,000), of which 12,496 were MPM and 661 were MPeM. In the study period, 266 people ≤50 years died from MM. A slightly decreasing rate among males since 2014 was observed. The areas at major risk hosted asbestos-cement plants, asbestos mines (chrysotile in Balangero), shipyards, petrochemical and chemical plants, and refineries. Female mortality excesses particularly were found in municipalities with a fluoro-edenite-contaminated mine (Biancavilla) and textile facilities. Excesses were also found in a region with the presence of natural asbestos fibres and in males living in two small islands. The Italian National Prevention Plan stated recommendations to eliminate asbestos exposures and to implement health surveillance and healthcare for people exposed to asbestos.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-25
      DOI: 10.3390/ijerph20115957
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5958: Education Level and Self-Reported
           Cardiovascular Disease in Norway—The Tromsø Study,

    • Authors: Celina Janene Cathro, Tormod Brenn, Sairah Lai Fa Chen
      First page: 5958
      Abstract: Background: Cardiovascular disease (CVD) is a leading source of morbidity and mortality, and research has shown education level to be a risk factor for the disease. The aim of this study was to investigate the association between education level and self-reported CVD in Tromsø, Norway. Methods: This prospective cohort study included 12,400 participants enrolled in the fourth and seventh surveys of the Tromsø Study (Tromsø4 and Tromsø7) in 1994–1995 and 2015–2016, respectively. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Results: For every 1-level increase in education, the age-adjusted risk of self-reported CVD decreased by 9% (OR = 0.91, 95% CI: 0.87–0.96), but after adjustment for covariates, the association was weaker (OR = 0.96, 95% CI: 0.92–1.01). The association was stronger for women (OR = 0.86, 95% CI: 0.79–0.94) than men (OR = 0.91, 95% CI: 0.86–0.97) in age-adjusted models. After adjustment for covariates, the associations for women and men were similarly weak (women: OR = 0.95, 95% CI: 0.87–1.04; men: OR = 0.97, 95% CI: 0.91–1.03). In age-adjusted-models, higher education level was associated with a lower risk of self-reported heart attack (OR = 0.90, 95% CI: 0.84–0.96), but not stroke (OR = 0.97, 95% CI: 0.90–1.05) or angina (OR = 0.98, 95% CI: 0.90–1.07). There were no clear associations observed in the multivariable models for CVD components (heart attack: OR = 0.97, 95% CI: 0.91–1.05; stroke: OR = 1.01, 95% CI: 0.93–1.09; angina: OR = 1.04, 95% CI: 0.95–1.14). Conclusions: Norwegian adults with a higher education level were at lower risk of self-reported CVD. The association was present in both genders, with a lower risk observed in women than men. After accounting for lifestyle factors, there was no clear association between education level and self-reported CVD, likely due to covariates acting as mediators.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-25
      DOI: 10.3390/ijerph20115958
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5959: Reviewing Publicly Available Reports on Child
           Health Disparities in Indigenous and Remote Communities of Australia

    • Authors: Kedir Y. Ahmed, Julaine Allan, Hazel Dalton, Adrian Sleigh, Sam-ang Seubsman, Allen G. Ross
      First page: 5959
      Abstract: Developing programs that ensure a safe start to life for Indigenous children can lead to better health outcomes. To create effective strategies, governments must have accurate and up-to-date information. Accordingly, we reviewed the health disparities of Australian children in Indigenous and remote communities using publicly available reports. A thorough search was performed on Australian government and other organisational websites (including the Australian Bureau of Statistics [ABS] and the Australian Institute of Health and Welfare [AIHW]), electronic databases [MEDLINE] and grey literature sites for articles, documents and project reports related to Indigenous child health outcomes. The study showed Indigenous dwellings had higher rates of crowding when compared to non-Indigenous dwellings. Smoking during pregnancy, teenage motherhood, low birth weight and infant and child mortality were higher among Indigenous and remote communities. Childhood obesity (including central obesity) and inadequate fruit consumption rates were also higher in Indigenous children, but Indigenous children from remote and very remote areas had a lower rate of obesity. Indigenous children performed better in physical activity compared to non-Indigenous children. No difference was observed in vegetable consumption rates, substance-use disorders or mental health conditions between Indigenous and non-Indigenous children. Future interventions for Indigenous children should focus on modifiable risk factors, including unhealthy housing, perinatal adverse health outcomes, childhood obesity, poor dietary intake, physical inactivity and sedentary behaviours.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-25
      DOI: 10.3390/ijerph20115959
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5960: Eudaimonic Well-Being of Italian Young Adults
           during the COVID-19 Pandemic: Predictive and Mediating Roles of Fear of
           Death and Psychological Inflexibility

    • Authors: Vincenzo Calvo, Chiara Masaro, Chiara Fusco, Camilla Pellicelli, Simona Ghedin, Cristina Marogna
      First page: 5960
      Abstract: The literature has widely acknowledged the impact of the COVID-19 pandemic on the mental health of young adults. Despite extensive research, eudaimonic well-being, which focuses on self-knowledge and self-realization, has been scarcely investigated. This cross-sectional study aimed to add knowledge on the eudaimonic well-being of young adults one year after the outbreak of the COVID-19 pandemic, verifying its potential linkages with fear of death and psychological inflexibility. A total of 317 young Italian adults (18–34 years), recruited through a chain sampling method, completed measures of psychological inflexibility, fear of death, and eudaimonic well-being included in an online survey. The study’s hypotheses were tested with multivariate multiple regression and mediational analyses. Results showed that psychological inflexibility was negatively associated with all the dimensions of well-being, while fear of the death of others was associated with autonomy, environmental mastery, and self-acceptance. Furthermore, in the association between fear of death and well-being, the mediation role of psychological inflexibility was verified. These results contribute to the extant literature on the factors associated with eudaimonic well-being, providing clinical insights into the work with young adults within challenging times.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-26
      DOI: 10.3390/ijerph20115960
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5961: One-Hour Post-Load Plasma Glucose and Altered
           Glucometabolic Profile in Youths with Overweight or Obesity

    • Authors: Procolo Di Bonito, Giuliana Valerio, Maria Rosaria Licenziati, Domenico Corica, Malgorzata Wasniewska, Anna Di Sessa, Emanuele Miraglia del Giudice, Anita Morandi, Claudio Maffeis, Enza Mozzillo, Valeria Calcaterra, Francesca Franco, Giulio Maltoni, Maria Felicia Faienza
      First page: 5961
      Abstract: In youths, two cut-offs (133 and 155 mg/dL) have been proposed to identify high glucose levels at the 1 h (G60) mark during an oral glucose tolerance test (OGTT). We evaluated which cut-off was more closely associated with isolated impaired glucose tolerance (IGT) and cardiometabolic risk (CMR) in 1199 youth with overweight/obesity (OW/OB) and normal fasting glucose and/or HbA1c. The disposition index (DI) was available in 724 youths. The sample was divided by two cut-offs of G60: <133 mg/dL (n = 853) and ≥133 mg/dL (n = 346), or G60 < 155 mg/dL (n = 1050) and ≥155 mg/dL (n = 149). Independent of the cut-off, youths with high levels of G60 showed higher levels of G120, insulin resistance (IR), triglycerides to HDL ratio (TG/HDL), alanine aminotransferase (ALT), and lower insulin sensitivity (IS) and DI than youths with lower levels of G60. The percentage of youths showing IGT, IR, low IS, high TG/HDL ratio, high ALT, and low DI was 50% higher in the G60 ≥ 133 mg/dL group than in the G60 ≥ 155 mg/dL one. In youths with OW/OB and IGT, a cut-off of G60 ≥ 133 mg/dL is more useful than G60 ≥ 155 mg/dL to identify those at high risk of IGT and altered CMR profile.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-26
      DOI: 10.3390/ijerph20115961
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5962: Prevention of Type 1 Diabetes in Children: A
           Worthy Challenge'

    • Authors: Diletta Maria Francesca Ingrosso, Maria Teresa Quarta, Alessia Quarta, Francesco Chiarelli
      First page: 5962
      Abstract: Nowadays, the development of new immuno-therapeutic drugs has made it possible to alter the course of many autoimmune diseases. Type 1 diabetes is a chronic disease with a progressive dependence on exogenous insulin administration. The ability to intercept individuals at high risk of developing type 1 diabetes is the first step toward the development of therapies that can delay the process of β-cell destruction, thus permitting a better glycemic control and reducing the incidence of ketoacidosis. The knowledge of the main pathogenetic mechanisms underlying the three stages of the disease may be helpful to identify the best immune therapeutic approach. In this review, we aim to give an overview of the most important clinical trials conducted during the primary, secondary and tertiary phases of prevention.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-26
      DOI: 10.3390/ijerph20115962
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5963: Renewed Urgency: Reimagining Roles in Nursing
           and Academia Amidst Rapid AI Advancements

    • Authors: Jennie C. De Gagne
      First page: 5963
      Abstract: As a professor of nursing in higher education, I am constantly situated at the nexus of tradition and innovation [...]
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-26
      DOI: 10.3390/ijerph20115963
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5964: Mixed Method Evaluation of My Vital
           Cycles®: A Holistic School-Based Ovulatory Menstrual Health Literacy

    • Authors: Felicity Roux, HuiJun Chih, Jacqueline Hendriks, Sharyn Burns
      First page: 5964
      Abstract: There is a high prevalence of ovulatory menstrual (OM) dysfunctions among adolescents, and their menstrual health literacy is poor. The OM cycle can be used as a personal health monitor provided that the skills to understand it are correctly taught. My Vital Cycles®, a holistic school-based OM health literacy program, was trialed with a Grade 9 cohort in one single-sex school in Western Australia using the Health Promoting School framework. A validated OM health literacy questionnaire was administered pre- and post-program with 94 participants. Functional OM health literacy improved overall, with 15 out of 20 items showing improvement post-program (p < 0.05). In addition, 19 out of 53 items for interactive OM health literacy, and 18 out of 25 items for critical OM health literacy improved (p < 0.05). The improvement in mood concerns (p = 0.002) was unexpected. Thematic analysis of three focus groups of 18 girls revealed four themes of increasing comfort levels; finding the program informative; inclusion of non-teaching support such as healthcare professionals; and suggestions for future refinements. Overall, this Western Australian PhD project which developed and trialed My Vital Cycles® improved OM health literacy and was positively received. Future research possibilities include understanding the program’s impact on mental health and further trials in co-educational settings; amongst different populations; and with extended post-program testing.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-26
      DOI: 10.3390/ijerph20115964
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5965: Reliability and Validity of the Japanese
           Version of the Short Form of the Expanded Version of the Posttraumatic
           Growth Inventory (PTGI-X-SF-J): A Cross-Sectional Study

    • Authors: Rei Oshiro, Takafumi Soejima, Sachiko Kita, Kayla Benson, Satoshi Kibi, Koichi Hiraki, Kiyoko Kamibeppu, Kanako Taku
      First page: 5965
      Abstract: A Japanese version of the short form of the expanded Posttraumatic Growth Inventory (PTGI-X-SF-J) was developed in this study, as the extended version captures broader, more diverse personal growth perspectives, such as existential spiritual growth. We collected cross-sectional data from 408 (first sample) and 284 (second sample) Japanese university students using the expanded version of the Posttraumatic Growth Inventory (PTGI-X-J). Exploratory factor analysis (EFA) was performed with the first sample and confirmatory factor analysis (CFA) with the second; reliability and validity were examined. The short-form version resulting from the EFA and CFA comprised 10 items and five factors. Cronbach’s alpha for the PTGI-X-SF-J total and subscale scores ranged from 0.671 to 0.875. The intraclass correlation coefficient for the total and subscale scores between the PTGI-X-J and PTGI-X-SF-J ranged from 0.699 to 0.821. Regarding external validity, no significant correlation was found between posttraumatic growth and posttraumatic stress disorder checklists. Due to its brevity, the PTGI-X-SF-J can help assess diverse spiritual and existential personal growth experiences among clients, patients, and trauma survivors while reducing physical and psychological burdens.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-26
      DOI: 10.3390/ijerph20115965
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5966: Impacts of Urban Green on Cardiovascular and
           Cerebrovascular Diseases—A Systematic Review and Meta-Analysis

    • Authors: Alessandro Bianconi, Giulia Longo, Angela Andrea Coa, Matteo Fiore, Davide Gori
      First page: 5966
      Abstract: Cardiovascular diseases (CVDs) are a leading cause of mortality globally. In particular, ischemic heart diseases (IHDs) and cerebrovascular diseases (CBVDs) represent the main drivers of CVD-related deaths. Many literature examples have assessed the association between CVD risk factors and urban greenness. Urban green (UG) may positively affect physical activity, reduce air and noise pollution, and mitigate the heat island effect, which are known risk factors for CVD morbidity. This systematic review aims to assess the effects of urban green spaces on CVD morbidity and mortality. Peer-reviewed research articles with a quantitative association between urban green exposure variables and cardiovascular and cerebrovascular outcomes were included. Meta-analyses were conducted for each outcome evaluated in at least three comparable studies. Most of the included studies’ results highlighted an inverse correlation between exposure to UG and CVD outcomes. Gender differences were found in four studies, with a protective effect of UG only statistically significant in men. Three meta-analyses were performed, showing an overall protective effect of UG on CVD mortality (HR (95% CI) = 0.94 (0.91, 0.97)), IHD mortality (HR (95% CI) = 0.96 (0.93, 0.99)), and CBVD mortality (HR (95% CI) = 0.96 (0.94, 0.97)). The results of this systematic review suggest that exposure to UG may represent a protective factor for CVDs.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-26
      DOI: 10.3390/ijerph20115966
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5967: ‘The Addiction was Making Things Harder
           for my Mental Health’: A Qualitative Exploration of the Views of
           Adults and Adolescents Accessing a Substance Misuse Treatment Service

    • Authors: Liam Spencer, Hayley Alderson, Steph Scott, Eileen Kaner, Jonathan Ling
      First page: 5967
      Abstract: The relationship between substance use and mental health is complex, and both constitute a global public health burden. In the UK, the estimated annual financial costs of alcohol-related harm and illicit drug use are GBP 21.5 billion and GBP 10.7 billion, respectively. This issue is magnified in the North East of England, where treatment access is low and a large proportion of individuals experience socioeconomic deprivation. The present study aimed to explore the experiences of adults and adolescents accessing a substance misuse treatment service in the North East, in order to inform policy makers, commissioners, and providers of substance misuse treatment and prevention. Semi-structured qualitative interviews were conducted with an opportunistic sample of n = 15 adult participants (aged 18 years and over) and n = 10 adolescent participants (aged between 13 and 17 years). Interviews were audio-recorded, transcribed, anonymised, and analysed thematically. Five key themes were identified: (1) initiation of substance use, (2) early life experiences, (3) the bi-directional relationship of mental health and substance use, (4) cessation of substance use, and (5) accessing treatment. Future preventative interventions should focus on providing support to individuals who have been exposed to adverse childhood experiences, with treatment provision for individuals experiencing co-occurring mental health and substance use issues taking a more holistic approach.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-26
      DOI: 10.3390/ijerph20115967
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5968: Job Seekers’ Burnout and Engagement: A
           Qualitative Study of Long-Term Unemployment in Italy

    • Authors: Nonnis, Agus, Frau, Urban, Cortese
      First page: 5968
      Abstract: Long-term unemployment has major consequences from an economic, physical and psychosocial perspective. Several authors have pointed out that the search for employment is in itself work, which can generate feelings of exhaustion of psychophysical energies, cynicism and disinvestment, as well as a sense of ineffectiveness to the point of complete disillusion. The construct of burnout can be used to describe this psychological process. This study evaluated the burnout and engagement dimensions in individuals searching for work for a long time, from a qualitative perspective. Fifty-six semi-structured interviews were conducted with a sample of long-term unemployed job seekers (Sardinia, Italy), based on Maslach’s model of burnout (exhaustion, cynicism, effectiveness in job search). The answers to the semi-structured interviews were processed through T-Lab, a semi-automatic textual analysis software. Four thematic cores emerged: exhaustion vs. engagement, cynicism vs. trust, inefficacy vs. efficacy in job search and disillusion vs. hope. This result is consistent with the four-dimensional theoretical model of burnout, originally proposed by Edelwich and Brodsky, recently taken up by Santinello, and framed as the opposite of engagement, as shown in the JD-R model. This study highlights that burnout can describe the psychosocial experiences of long-term unemployed job seekers.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-26
      DOI: 10.3390/ijerph20115968
      Issue No: Vol. 20, No. 11 (2023)
  • IJERPH, Vol. 20, Pages 5869: Long-Term Changes in the Pollution of Warta
           River Bottom Sediments with Heavy Metals, Poland—Case Study

    • Authors: Michał Fiedler
      First page: 5869
      Abstract: Variability in the heavy metal concentrations in aquatic environments may be influenced by a number of factors that may occur naturally or due to anthropopressure. This article presents the risk of contaminating Warta River bottom sediments with heavy metals such as As, Cd, Co, Cr, Cu, Hg, Mn, Ni, Pb, and Zn. Samples collected from 35 sites located along the river course were analysed over the period of 2010–2021. The calculated pollution indices are characterised by significant spatial variability that was additionally subject to changes in subsequent years. The analysis may have also been influenced by individual measurement results that, in extreme cases, may strongly deviate from the concentration values determined in the same site during the remaining years. The highest median concentrations of Cd, Cr, Cu, Hg, and Pb were in samples collected from sites that are surrounded by areas of anthropogenic land use. Samples from adjacent sites to agricultural areas showed the highest median concentrations of Co, Mn, and Ni, and Zn for those adjacent to forest areas. The research results indicate that, when analysing the degree of the risk of contaminating river bottom sediments with heavy metals, it is necessary to take into account long-term variability in metal concentrations. Taking into consideration data from only one year may lead to inappropriate conclusions and hinder planning protective measures.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-18
      DOI: 10.3390/ijerph20105869
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5870: Clinicians’ and Users’ Views and
           Experiences of a Tele-Mental Health Service Implemented Alongside the
           Public Mental Health System during the COVID-19 Pandemic

    • Authors: Anton Isaacs, Eleanor K. L. Mitchell, Keith Sutton, Michael Naughton, Rochelle Hine, Shane Bullock, Denise Azar, Darryl Maybery
      First page: 5870
      Abstract: A tele-mental health model called Head to Health was implemented in the state of Victoria, Australia to address the crisis caused by the COVID-19 pandemic. It was a free centralized intake service that adopted a targeted approach with several novel elements, such as stepped care and telehealth. This study examines the views and experiences of clinicians and service users of the tele-mental health service in the Gippsland region of Victoria during the COVID-19 pandemic. Data from clinicians were obtained via an online 10-item open-ended survey instrument and from service users through semi-structured interviews. Data were obtained from 66 participants, including 47 clinician surveys and 19 service user interviews. Six categories emerged from the data. They were: ‘Conditions where use of tele-mental health is appropriate’, ‘Conditions where tele-mental health may not be useful’, ‘Advantages of tele-mental health’, ‘Challenges in using tele-mental health’, ‘Client outcomes with tele-mental health’, and ‘Recommendations for future use’. This is one of a few studies where clinicians’ and service users’ views and experiences have been explored together to provide a nuanced understanding of perspectives on the efficacy of tele-mental health when it was implemented alongside public mental health services.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-19
      DOI: 10.3390/ijerph20105870
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5871: Changes in and Predictors of HIV among People
           Who Inject Drugs in Mizoram, Northeast India, from 2007 to 2021

    • Authors: Lucy Ngaihbanglovi Pachuau, Caterina Tannous, Richard Lalramhluna Chawngthu, Kingsley Emwinyore Agho
      First page: 5871
      Abstract: This study aimed to examine the changes in and predictors of the human immunodeficiency virus (HIV) among people who inject drugs (PWID) in Mizoram, Northeast India, over a period of 15 years (2007–2021). A sample of 14783 PWID was extracted from the Targeted Intervention (TI) services under the Mizoram State AIDS Control Society (MSACS). A chi-square test was used to compare the differences in HIV prevalence across the three 5-year periods, and a multiple logistic regression analysis was used to determine predictors after adjusting for sociodemographic, injecting and sexual behaviours. The results showed that compared to 2007–2011, HIV prevalence was almost three times higher in 2012–2016 (AOR 2.35; 95% CI 2.07–2.66) and almost two times higher in 2017–2021 (AOR 1.41; 95% CI 1.24–1.59). The results suggest that participants who were females (AOR 2.35; 95% CI 2.07–2.66), married (AOR 1.13; 95% CI 1.00–1.27), separated/divorced/widowed (AOR 1.74; 95% CI 1.54–1.96), of middle school level education (AOR 1.24; 95% CI 1.06–1.44), sharing needles/syringes (AOR 1.78; 95% CI 1.61–1.98) and receiving a regular monthly income were positively associated with HIV infection. Condom use with a regular partner (AOR 0.77; 95% CI 0.70–0.85) was high among PWID. Despite targeted interventions under MSACS to reduce HIV in Mizoram, the prevalence of HIV/AIDS among PWID remained high between 2007 and 2021. Policymakers and stakeholders should tailor future interventions based on the factors identified in this study that are associated with HIV infection. Our findings highlight the importance of socio-cultural factors in HIV epidemiology among PWID in Mizoram.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-19
      DOI: 10.3390/ijerph20105871
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5872: Effects of Aquatic Exercises for Women with
           Rheumatoid Arthritis: A 12-Week Intervention in a Quasi-Experimental Study
           with Pain as a Mediator of Depression

    • Authors: Miguel A. Perez-Sousa, Jéssica Pedro, Rocio Carrasco-Zahinos, Armando Raimundo, Jose A. Parraca, Pablo Tomas-Carus
      First page: 5872
      Abstract: Background: Rheumatoid arthritis (RA) is characterized by low physical fitness, pain, and depression. The present study aimed to examine the effects of a supervised aquatic exercise program on physical fitness, depression, and pain in women with RA and determine whether decreases in pain mediate depression. Methods: Forty-three women with RA, divided into an experimental group (EG; n = 21) and a control group (CG; n = 23), participated in a 12-week exercise program. Treatment effects were calculated via standardized difference or effect size (ES) using ANCOVA adjusted for baseline values (ES, 95% confidence interval (CI)). A simple panel of mediation was executed to determine whether changes in pain mediated improvements in depression after controlling for confounding variables, such as age, physical activity, and body mass index (BMI). Results: The aquatic exercise program had trivial and small effects on physical fitness, large effects on pain, and moderate effects on depression. The mediation model confirmed the indirect effect of pain on the decrease of depression in the participants of the aquatic exercise program. Conclusions: Participants with RA in the aquatic exercise program experienced improvements in physical fitness, depression, and joint pain. Moreover, the improvements in joint pain mediated improvements in depression.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-19
      DOI: 10.3390/ijerph20105872
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5873: Relationship between COVID-19
           Pandemic-Related Life Behavior, Dispositional Mindfulness, and
           Psychological Health: Evidence from a Sample of Japanese Working Adults

    • Authors: Hiromitsu Miyata, Kaho Yamasaki, Noh ChaeEun, Haruyuki Ishikawa
      First page: 5873
      Abstract: The present study investigated how altered daily life behavior and its self-evaluation associated with the coronavirus disease 2019 (COVID-19) pandemic relate to psychological health in Japanese working adults, and how such relationships may be moderated by dispositional mindfulness. A total of 1000 participants completed an online survey comprising questions on how they used time and self-evaluated life behavior before and during the pandemic, as well as scales on mindfulness and psychological health. The results revealed that after the pandemic, participants spent significantly more time at home and using a PC/smartphone. They were also more likely to perceive frequent exposure to COVID-19-related media reports and less likely to find their work going well. Many of these variables were significantly correlated with lower psychological health. Moreover, hierarchical multiple regression analyses revealed the moderating effects of mindfulness, such that the perceived frequency of exposure to pandemic-related media reports and poorer views that work was going well were less likely to predict lower psychological health when mindfulness was high. These findings suggest that altered daily life behavior and its self-evaluation after the pandemic are associated with deteriorated psychological health, but that mindfulness can serve as a protective factor against psychological distress among Japanese workers.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-19
      DOI: 10.3390/ijerph20105873
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5874: Validating the Perceived Active School Travel
           Enablers and Barriers–Parent (PASTEB–P) Questionnaire to
           Support Intervention Programming and Research

    • Authors: Andrew F. Clark, Melissa Thomas, Adrian Buttazzoni, Matthew Adams, Stephanie E. Coen, Jamie Seabrook, Danielle Tobin, Trish Tucker, Jason Gilliland
      First page: 5874
      Abstract: A child’s ability to participate in active school travel (AST) is complicated by several factors. Of particular note are parental controls, which are informed by their perceptions of the local built and social environments, assessments of their child’s skills, and convenience preferences, among other considerations. However, there is currently a lack of AST-specific scales that include validated parental perception measures related to such notable barriers and enablers, or those that tend to frame their AST decision-making processes. Framed within the social-ecological model of health behaviour, the aims of the present paper were thus threefold, specifically to (1) outline and test the construct validity of measures delineating parental perceptions of barriers and enablers to AST, (2) evaluate the reliability and consistency of the developed measures, and (3) connect these measures to develop broader constructs for use in the Perceived Active School Travel Enablers and Barriers–Parent (PASTEB–P) questionnaire. To achieve these aims, a mixed-methods approach featuring cognitive interviews and surveys, along with qualitative (thematic analysis) and quantitative (Cohen’s Kappa, McDonald’s Omega, and confirmatory factor analysis) analyses, was applied across two studies. The validation processes of the two studies resulted in the development of fifteen items comprising seven distinct constructs (barriers: AST Skills, Convenience, Road Safety, Social Safety, and Equipment Storage; enablers: Supportive Environment and Safe Environment) related to parental perceptions of AST. The developed PASTEB–P questionnaire can be used to inform and evaluate AST intervention programming and can be applied for AST research purposes.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-19
      DOI: 10.3390/ijerph20105874
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5875: Multiscale Geographically Weighted Regression
           in the Investigation of Local COVID-19 Anomalies Based on Population Age
           Structure in Poland

    • Authors: Mateusz Ciski, Krzysztof Rząsa
      First page: 5875
      Abstract: A growing number of various studies focusing on different aspects of the COVID-19 pandemic are emerging as the pandemic continues. Three variables that are most commonly used to describe the course of the COVID-19 pandemic worldwide are the number of confirmed SARS-CoV-2 cases, the number of confirmed COVID-19 deaths, and the number of COVID-19 vaccine doses administered. In this paper, using the multiscale geographically weighted regression, an analysis of the interrelationships between the number of confirmed SARS-CoV-2 cases, the number of confirmed COVID-19 deaths, and the number of COVID-19 vaccine doses administered were conducted. Furthermore, using maps of the local R2 estimates, it was possible to visualize how the relations between the explanatory variables and the dependent variables vary across the study area. Thus, analysis of the influence of demographic factors described by the age structure and gender breakdown of the population over the course of the COVID-19 pandemic was performed. This allowed the identification of local anomalies in the course of the COVID-19 pandemic. Analyses were carried out for the area of Poland. The results obtained may be useful for local authorities in developing strategies to further counter the pandemic.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-19
      DOI: 10.3390/ijerph20105875
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5876: Mothers with Intellectual/Developmental
           Disabilities and Behavioral Health Conditions and Community Experts
           Provide Recommendations for Treatment/Services, Systems, and Research

    • Authors: Joanne Nicholson, Shayna Mazel, Kristen Faughnan, Allie Silverman
      First page: 5876
      Abstract: Mothers with intellectual and developmental disabilities (IDD) are vulnerable to perinatal complications and adverse outcomes. Their vulnerabilities may also be exacerbated by co-occurring behavioral health (BH) conditions. Their wellbeing may be compromised by a lack of tailored treatments or by treatments and services that are inaccessible, irrelevant, and/or ineffective. A five-session virtual Ideas Lab workshop series was implemented to bring together diverse community experts (n = 30), including mothers with IDD/BH, to discuss the experiences of mothers and set priorities for treatment/services, systems, and research. Participants completed background and evaluation surveys and brainstormed, grouped, and ranked items of importance, which fell into two broad categories: (1) cross-cutting themes drawn from lived experience with recommendations applicable to all substantive domains (i.e., accessibility, diversity, adverse experiences and trauma, and trust) and (2) substantive themes with specific recommendations for treatment/services and systems (i.e., services and supports, peer support, provider practices and training, and systems navigation/transformation). Research recommendations were generated in all discussions and emerged in relation to all themes, underscoring the importance of including mother-driven questions and priorities in research agendas and strengthening researcher training and skills to engage mothers with IDD/BH and other community members actively, and in meaningful ways.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-19
      DOI: 10.3390/ijerph20105876
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5877: COVID-19-Related Testing, Knowledge and
           Behaviors among Severe and Chronic Non-Communicable Disease Patients in
           Neno District, Malawi: A Prospective Cohort Study

    • Authors: Haules Robbins Zaniku, Moses Banda Aron, Kaylin Vrkljan, Kartik Tyagi, Myness Kasanda Ndambo, Gladys Mtalimanja Banda, Revelation Nyirongo, Isaac Mphande, Bright Mailosi, George Talama, Fabien Munyaneza, Emilia Connolly, Luckson Dullie, Dale A. Barnhart, Todd Ruderman
      First page: 5877
      Abstract: COVID-19-related knowledge and behaviors remain essential for controlling the spread of disease, especially among vulnerable patients with advanced, chronic diseases. We prospectively assessed changes over 11 months in COVID-19-related testing, knowledge, and behaviors among patients with non-communicable diseases in rural Malawi using four rounds of telephone interviews between November 2020 to October 2021. The most commonly reported COVID-19-related risks among patients included visiting health facilities (35–49%), attending mass gatherings (33–36%), and travelling outside the district (14–19%). Patients reporting having experienced COVID-like symptoms increased from 30% in December 2020 to 41% in October 2021. However, only 13% of patients had ever received a COVID-19 test by the end of the study period. Respondents answered 67–70% of the COVID-19 knowledge questions correctly, with no significant changes over time. Hand washing, wearing face masks and maintaining a safe distance were the most frequently reported strategies to prevent the spreading of COVID-19. Wearing face masks significantly improved over time (p < 0.001). Although the majority reported accurate knowledge about COVID-19 and enhanced adherence to infection prevention measures over time, patients commonly visited locations where they could be exposed to COVID-19. Government and other stakeholders should increase COVID-19 testing accessibility to primary and secondary facilities.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-19
      DOI: 10.3390/ijerph20105877
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5878: Challenges in Improving Adherence to Diet and
           Drug Treatment in Hypercholesterolemia Patients

    • Authors: Francesco Baratta, Francesco Angelico, Maria Del Ben
      First page: 5878
      Abstract: Poor adherence to chronic disease treatment may seriously compromise the effectiveness of therapy, characterizing itself as a critical element for the population’s health, both from the point of view of quality of life and health economics. The causes of low adherence are many and can depend on the patient, the physician and the healthcare system. Low adherence to dietary recommendations and lipid-lowering drug therapy for hypercholesterolemia is a widespread phenomenon that may strongly limit the great advantages of serum lipid reduction strategies in primary and secondary cardiovascular prevention. Many patients discontinue treatment, and adherence decreases with time. Increasing therapeutic adherence can have a much greater impact on the health of the population than any other therapeutic advance. There are numerous strategies to increase therapy adherence according to behavior change theories. They concern the doctor and the patient. Some must be implemented at the time of prescription, others later during the follow-up. The active role of the patient in the therapeutic decision and the shared definition of LDL cholesterol targets are of paramount importance. The aim of this narrative review is to summarize evidence on current levels of adherence to lipid-lowering strategies, the causes of the lack of adequate adherence and possible physician-applicable strategies to improve it.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-19
      DOI: 10.3390/ijerph20105878
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5879: Decision-Making and Abuse, What Relationship
           in Victims of Violence'

    • Authors: Giulia Lausi, Jessica Burrai, Michela Baldi, Fabio Ferlazzo, Stefano Ferracuti, Anna Maria Giannini, Benedetta Barchielli
      First page: 5879
      Abstract: Gender-Based violence is a worldwide persisting phenomenon: during their lifetime, 30% of women have experienced sexual and/or physical violence. The literature has investigated for several years the association between abuse and possible psychiatric and psychological consequences which may occur even after many years. The most common consequences involve mood and stress disorders (e.g., depression and PTSD). These disorders seem to have secondary long-term effects, such as decision-making and cognitive function impairments. Therefore, the present literature synthesis aimed to investigate whether and how the decision-making capacities of individuals experiencing violence can change because of abuse. We conducted a thematic synthesis using PRISMA guidelines: through a double-blind procedure, 4599 studies were screened; a total of 46 studies were selected for full-text reading, which was reduced to 13 by excluding papers with a wrong focus. To better understand the results of the thematic synthesis, two main focuses have been identified: “leave or stay decision making” and “multifactorial dimensions of decision making”. Results showed that decision-making is an important process in avoiding secondary victimization.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-19
      DOI: 10.3390/ijerph20105879
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5880: “Instead of Being on a Screen You Can
           Be More Out There and Enjoy Your Life”: Young People’s
           Understandings of Physical Activity for Health

    • Authors: Natasha Wilson, Lorraine Cale, Ashley Casey
      First page: 5880
      Abstract: Background: Despite documented evidence of the benefits of leading a physically active life, it is reported that less than half of young people in Europe meet the physical activity recommendations. Schools, and in particular physical education (PE), are viewed to be at the forefront of addressing inactive lifestyles and educating young people about physical activity. Nonetheless, given advancements in technology, young people are increasingly exposed to physical activity information “beyond the school gates”. Consequently, if PE teachers are to support young people to understand the information they receive surrounding physical activity online, then they need to be able to address any misconceptions about health they may have. Methods: In this study, fourteen young people (7 boys and 7 girls) in year 9 (13–14 years old) from two secondary schools in England participated in a digitally-based activity and semi-structured interviews which aimed to explore their conceptions of physical activity for health. Results: It was found that the young people had limited and narrow conceptions of what it means to be physically active. Conclusions: It was suggested the findings could be partly attributed to limitations in students’ learning and experiences with respect to physical activity and health in the PE curriculum.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-19
      DOI: 10.3390/ijerph20105880
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5881: Using Machine Learning Algorithms to Pool
           Data from Meta-Analysis for the Prediction of Countermovement Jump

    • Authors: Indy Man Kit Ho, Anthony Weldon, Jason Tze Ho Yong, Candy Tze Tim Lam, Jaime Sampaio
      First page: 5881
      Abstract: To solve the research–practice gap and take one step forward toward using big data with real-world evidence, the present study aims to adopt a novel method using machine learning to pool findings from meta-analyses and predict the change of countermovement jump. The data were collected through a total of 124 individual studies included in 16 recent meta-analyses. The performance of four selected machine learning algorithms including support vector machine, random forest (RF) ensemble, light gradient boosted machine, and the neural network using multi-layer perceptron was compared. The RF yielded the highest accuracy (mean absolute error: 0.071 cm; R2: 0.985). Based on the feature importance calculated by the RF regressor, the baseline CMJ (“Pre-CMJ”) was the most impactful predictor, followed by age (“Age”), the total number of training sessions received (“Total number of training_session”), controlled or non-controlled conditions (“Control (no training)”), whether the training program included squat, lunge, deadlift, or hip thrust exercises (“Squat_Lunge_Deadlift_Hipthrust_True”, “Squat_Lunge_Deadlift_Hipthrust_False”), or “Plyometric (mixed fast/slow SSC)”, and whether the athlete was from an Asian pacific region including Australia (“Race_Asian or Australian”). By using multiple simulated virtual cases, the successful predictions of the CMJ improvement are shown, whereas the perceived benefits and limitations of using machine learning in a meta-analysis are discussed.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-19
      DOI: 10.3390/ijerph20105881
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5882: Three Reasons Why Expecting
           ‘Recovery’ in the Context of the Mental Health Impacts of
           Climate Change Is Problematic

    • Authors: Jo Longman, Rebecca Patrick, Sarah Bernays, Fiona Charlson
      First page: 5882
      Abstract: Global warming is bringing with it continued long-term changes in the climate system. Extreme weather-related events, which are already becoming a daily reality around the world, are predicted to be more intense and frequent in the future. The widespread occurrence of these events and climate change more broadly are being experienced collectively and at scale and do not affect populations evenly. These climate changes have profound impacts on mental health and wellbeing. Existing reactive responses include frequent implied and direct references to the concept of ‘recovery’. This is problematic in three ways: it conceives of extreme weather events as single, one-off occurrences; implies their unexpected nature; and contains an integral assumption of an end point where individuals/communities are ‘recovered’. Models of mental health and wellbeing support (including funding) need to change, shifting away from ‘recovery’ towards a focus on adaptation. We argue that this presents a more constructive approach that may be used to collectively support communities.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-19
      DOI: 10.3390/ijerph20105882
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5883: Trajectories of Drug Use and Depressive
           Symptoms among Latinx Youth and Sexual Minority Youth

    • Authors: Alyssa Lozano, Tae Kyoung Lee, Elliott R. Weinstein, Yannine Estrada, Beck Graefe, Maria I. Tapia, Guillermo Prado
      First page: 5883
      Abstract: Drug use and depression co-occur and disproportionately affect Latinx sexual minority youth relative to their heterosexual Latinx peers. However, heterogeneity in co-occurring patterns of drug use and depressive symptoms is unknown. The objective of the current study was to identify patterns of drug use and depressive symptom trajectories and examine how these patterns varied between Latinx sexual minority youth and Latinx non-sexual minority youth. Latent class trajectory analysis identified distinct patterns of drug use and depressive symptom trajectories among 231 Latinx adolescents (Latinx sexual minority youth: n = 46, 21.4%; Latinx non-sexual minority youth: n = 169, 78.6%). After identifying class mean trajectories, we examined differences in mean trajectories across groups. A 3-class model was selected as the optimal class trajectory model for both groups, yet classes and trajectories differed. There were differences in initial levels of depression and drug use trajectories between both groups, as well as differences in patterns of drug use trajectories between both groups in two of the three classes. Given the variation in trajectory patterns, there is a need for practitioners to consider the unique needs of both groups to inform the development of preventive interventions for these two populations.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-19
      DOI: 10.3390/ijerph20105883
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5884: Food Insecurity in Higher Education: A
           Contemporary Review of Impacts and Explorations of Solutions

    • Authors: Brittany M. Loofbourrow, Rachel E. Scherr
      First page: 5884
      Abstract: Food insecurity is a global phenomenon which impacts a variety of social, economic, and life-stage groups. One such group affected by food insecurity is college students, who tend to experience food insecurity at a prevalence which exceeds the average of their local communities. The impacts of food insecurity in this population are multifaceted and have implications for their college experience and beyond. Food insecurity has been observed to have negative effects on college student academic performance, physical health, and mental health. This review explores the impacts of and solutions for food insecurity in this population globally, with particular emphasis on the United States, and specifically California.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-19
      DOI: 10.3390/ijerph20105884
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5885: Facilitating an Interprofessional Course on
           Climate Change and Public Health Preparedness

    • Authors: Heidi Honegger Rogers, Megan Tucker, Mary Pat Couig, Vanessa Svihla
      First page: 5885
      Abstract: In this paper, we share the theories that guided the design of an interprofessional education course on Climate Change and Public Health Preparedness and how the course supported students’ professional interest and action competence as they move through their education and into their professional work in the context of our unfolding climate crisis. The course was guided by the public health emergency preparedness domains and was built to allow for students to explore applications of the content for themselves and their own profession. We designed the learning activities to support personal and professional interest development and help students move into perceived and demonstrated action competence. For the evaluation of our course, we asked the following research questions: What kinds of personal and professional commitments to action did students propose by the end of the course' Did these vary in depth and specificity and by the number of credits they enrolled in' In what ways did students develop personal and professional action competence over the course' Finally, how did they show personal, professional, and collective agency related to the course content on adaptation, preparedness, and mitigation of the health impacts from climate change' Using qualitative analysis guided by action competence and interest development theories, we coded student writing from course assignments. We also conducted comparative statistical analysis to assess differential impacts for students who enrolled for one versus three credits. The results show that this course design supported students’ progression of knowledge and perceived ability in specific individual and professional collective actions to reduce the health impacts of climate change.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-19
      DOI: 10.3390/ijerph20105885
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5886: Active and Assisted Living, a Practice for
           the Ageing Population and People with Cognitive Disabilities: An
           Architectural Perspective

    • Authors: Santiago Quesada-García, Pablo Valero-Flores, María Lozano-Gómez
      First page: 5886
      Abstract: The current digital revolution is causing a paradigm shift encompassing all environments in which human beings conduct their daily activities. Technology is starting to govern the world, gradually modifying not only individual and social behaviour, but also ways of living. The necessary adaptation to new information and communication technologies forces societies to rethink both public and private spaces, in which evolution is slower than rapid social transformation. As part of this change, the concept of Active Assisted Living (AAL) has developed. Assisted spaces can be designed to provide older adults, carers, or people who have cognitive disabilities, such as Alzheimer’s disease or other dementias, with a healthier, safer, and more comfortable life, while also affording them greater personal autonomy. AAL aims to improve people’s quality of life and allow them to remain in their own homes for as long as possible, not in residences. This study conducted a critical review about AAL from an architectural point of view. The research adopted a qualitative approach in which we collected the studies during the last twenty years, then used descriptive, narrative and critical analysis methods. Based on these, this paper aims to explain this new technological paradigm, its characteristics, its main development trends, and its implementation limitations. The results obtained show how the development of AAL will be in the next ten years, and how this concept, and its application, can influence architecture and provide the bases for further research into the design of buildings and cities.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-19
      DOI: 10.3390/ijerph20105886
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5887: Self-Management of Diabetes and Associated
           Factors among Patients Seeking Chronic Care in Tshwane, South Africa: A
           Facility-Based Study

    • Authors: Janke Zwane, Perpetua Modjadji, Sphiwe Madiba, Lucky Moropeng, Kabelo Mokgalaboni, Peter Modupi Mphekgwana, Andre Pascal Kengne, Zandile June-Rose Mchiza
      First page: 5887
      Abstract: The burden of diabetes continues to increase in South Africa and a significant number of diabetes patients present at public primary healthcare facilities with uncontrolled glucose. We conducted a facility-based cross-sectional study to determine the diabetes self-management practices and associated factors among out-patients in Tshwane, South Africa. An adapted validated questionnaire was used to collect data on sociodemography, diabetes knowledge, and summaries of diabetes self-management activities measured in the previous seven days, and over the last eight weeks. Data were analysed using STATA 17. A final sample of 402 diabetes out-patients was obtained (mean age: 43 ± 12 years) and over half of them were living in poor households. The mean total diabetes self-management of score was 41.5 ± 8.2, with a range of 21 to 71. Almost two thirds of patients had average self-management of diabetes, and 55% had average diabetes knowledge. Twenty-two percent of patients had uncontrolled glucose, hypertension (24%) was the common comorbidity, and diabetic neuropathy (22%) was the most common complication. Sex [male: AOR = 0.55, 95% CI: 0.34–0.90], race [Coloured: AOR = 2.84, 95% CI: 1.69–4.77 and White: AOR = 3.84, 95% CI: 1.46–10.1], marital status [divorced: AOR = 3.41, 95% CI: 1.13–10.29], social support [average: AOR = 2.51, 95% CI: 1.05–6.00 and good: AOR = 4.49, 95% CI: 1.61–7.57], body mass index [obesity: AOR = 0.31, 95% CI: 0.10–0.95], diabetes knowledge [average: AOR = 0.58, 95% CI: 0.33–0.10 and good: AOR = 1.86, 95% CI: 0.71–4.91], and uncontrolled glucose [AOR = 2.97, 95% CI: 1.47–5.98] were factors independently predictive of diabetes self-management. This study emphasizes that the self-management of diabetes was mostly on average among patients and was associated with the aforementioned factors. Innovative approaches are perhaps needed to make diabetes education more effective. Face-to-face sessions delivered generally during clinic visits should be better tailored to the individual circumstances of diabetes patients. Considerations should be given to the options of leveraging information technology to ensure the continuity of diabetes education beyond clinic visits. Additional effort is also needed to meet the self-care needs of all patients.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-19
      DOI: 10.3390/ijerph20105887
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5888: Cancer Prevention Literacy among Different
           Population Subgroups: Challenges and Enabling Factors for Adopting and
           Complying with Cancer Prevention Recommendations

    • Authors: Lena Sharp, Nikolina Dodlek, Diane Willis, Arja Leppänen, Helena Ullgren
      First page: 5888
      Abstract: It is estimated that 40% of the cancer cases in Europe could be prevented if people had better information and tools to make healthier choices and thereby reduce some of the most important cancer risk factors. The aim of this study is to gain knowledge and understanding about cancer prevention literacy among people with intellectual disabilities, immigrants, young people and young cancer survivors. In this qualitative study, we conducted six online focus-group interviews, including forty participants, to explore the cancer prevention literacy of four population subgroups and determine how cancer prevention recommendations according to the European Code Against Cancer (ECAC) were perceived. The analysis resulted in the following main categories: current health beliefs and their impacts on how the ECAC recommendations were perceived, communication strategies and sources benefiting or hindering cancer prevention information from reaching out, and how vulnerabilities in these subgroups impact cancer prevention literacy. To improve cancer prevention literacy in Europe, more attention is needed this topic to overcome barriers among different population subgroups. Recommendations include improved and adapted cancer prevention information, support to individuals, as well as societal support, such as easy-access screening and vaccination programmes and regulations related to tobacco, alcohol, and diet.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-19
      DOI: 10.3390/ijerph20105888
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5889: Factors Affecting Delirium in ICU Patients

    • Authors: I Seul Jeong, Mi-Kyoung Cho
      First page: 5889
      Abstract: This study examined delirium severity using a delirium screening tool and analyzed the predictors, including pain, acuity, level of consciousness, fall risk, and pain score, to increase understanding of delirium and present foundational data for developing nursing interventions for delirium prevention. This was a retrospective study of 165 patients admitted to three intensive care units (ICUs). the Nursing Delirium Screening Scale (Nu-DESC) was used as a research tool to screen for delirium and measure the degree of delirium. The incidence of delirium in patients was 53.3%, and the average delirium score in the delirium group was 2.40 ± 0.56. Nu-DESC scores were significantly correlated with ICU days, ventilator days, restraint applications, the number of catheters inserted, sedative medication use, the Simplified Acute Physiology Score (SAPS III), the Morse Fall Scale (MFS), the Glasgow Coma Scale (GCS) scores, pain scores, and blood urea nitrogen (BUN). Stepwise multiple linear regression showed that the number of restraint applications, GCS score, ICU days, and BUN levels were factors influencing delirium. Based on the findings, ICU nurses should use delirium screening tools to ensure accurate delirium screening and work to reduce the incidence and degree of delirium by observing factors affecting delirium in patients.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-19
      DOI: 10.3390/ijerph20105889
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5890: Assessment of the Environmental Impacts of a
           Localized Food System and Food Waste Reduction in a Water-Scarce Region
           Using Diet Optimization Models

    • Authors: Felix Haifeng Liao, Robert Heinse, Darin Saul, Soren Newman, Li Huang, Colette DePhelps, Steven Peterson
      First page: 5890
      Abstract: Despite growing interest in fresh local produce across the United States, scaling up local agricultural development might impose new environmental pressures on increasingly scarce water and land resources in specific localities. Drawing upon the case of the Palouse of the US Inland Northwest, this study evaluates land and water footprints of local foods along with food waste reduction in a water-scarce region. We used both non-robust and robust diet-optimization techniques to estimate the minimum amounts of irrigation water necessary to grow foods locally and to satisfy the local population’s caloric or nutrition needs. Our modeling results indicate that, on an annual basis, an increase of less than 5% of the current freshwater withdrawal on the Palouse could satisfy 10% of the local population’s aspirational demand for locally grown food products, while more than 35% of local foods (by mass) may be wasted. Furthermore, reducing food waste by 50% could simultaneously reduce water use by up to 24%, cropland use by 13%, and pastureland use by 20%. Our findings not only provide intriguing information for access to local food but could also be used to stimulate new efforts to increase consumers’ and retailers’ awareness of environmental benefits associated with food waste reduction.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-20
      DOI: 10.3390/ijerph20105890
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5891: The Influence of Whey Protein on Muscle
           Strength, Glycemic Control and Functional Tasks in Older Adults with Type
           2 Diabetes Mellitus in a Resistance Exercise Program: Randomized and
           Triple Blind Clinical Trial

    • Authors: André Luiz de Seixas Soares, Adriana Machado-Lima, Guilherme Carlos Brech, Júlia Maria D’Andréa Greve, Joselma Rodrigues dos dos Santos, Thiago Resende Inojossa, Marcelo Macedo Rogero, João Eduardo Nunes Salles, José Maria Santarem-Sobrinho, Catherine L. Davis, Angelica Castilho Alonso
      First page: 5891
      Abstract: Objectives: To evaluate the effect of whey protein (WP) supplementation associated with resistance training (RT) on glycemic control, functional tasks, muscle strength, and body composition in older adults living with type 2 diabetes mellitus (T2DM). Secondly, to evaluate the safety of the protocol for renal function. Methods: The population comprised twenty-six older men living with T2DM (68.5 ± 11.5 years old). The participants were randomly assigned to the Protein Group (PG) and the Control Group (CG). The handgrip test and evolution of exercise loads, according to the Omni Resistance Exercise Scale, evaluated muscle strength. Functional tasks were assessed by force platform in three different protocols: Sit-to-Stand, Step/Quick Turn, and Step Up/Over. Body composition was evaluated by bioimpedance and glycemic control and renal function were assessed by biochemical analyses. Both groups performed RT for 12 weeks, twice a week, prioritizing large muscle groups. Protein supplementation was 20 g of whey protein isolate and the CG was supplemented with an isocaloric drink, containing 20 g of maltodextrin. Results: There was a significant difference in muscle strength, according to the evolution of the exercise loads, but it was not confirmed in the handgrip test. However, there was no significant difference between the groups, regarding performance in functional tasks, glycemic control, or body composition. Renal function showed no alteration. Conclusion: The intake of 20 g of WP in older male adults living with T2DM did not increase the effect of RT on muscle strength, functional tasks, and glycemic control. The intervention was proven safe regarding renal function.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-20
      DOI: 10.3390/ijerph20105891
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5892: Theory of Mind and Young Children’s
           Behaviour: Aggressive, Victimised, Prosocial, and Solitary

    • Authors: Katie Rix, Claire P. Monks, Sarah O’Toole
      First page: 5892
      Abstract: Theory of mind (ToM) undergoes significant developments during childhood, particularly between the ages of four and seven years. A growing body of research has indicated that children’s social understanding may be related to their social behaviour with peers, in line with Theory Theory which proposes that children’s social cognition is influenced by and influences their peer interactions. The current study examined the relationship between ToM and behaviour among 193 children aged 4–7 years. Children carried out a battery of ToM tasks, and teaching staff reported on children’s aggressive, prosocial, and solitary behaviour and victimisation experiences. Aggression was not directly related to ToM; prosocial behaviour was positively associated with ToM for girls but not boys. Solitary behaviour and victimisation were negatively related to ToM. When this was broken down by gender, there was only a significant association between solitary behaviour and ToM for boys. When controlling for the relationship between behaviours, the only significant predictor of ToM was solitary behaviour for boys. ToM was also a significant predictor of solitary behaviour for boys, demonstrating that there is a bidirectional relationship at play. The findings highlight the importance of looking across these four behaviour types and understanding the relationship between behaviour profiles and ToM for boys and girls separately.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-20
      DOI: 10.3390/ijerph20105892
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5893: Impact of National Tobacco Control Policy on
           Rates of Hospital Admission for Pneumonia: When Compliance Matters

    • Authors: Marine Gambaryan, Anna Kontsevaya, Oxana Drapkina
      First page: 5893
      Abstract: A number of studies claim that tobacco control (TC) regulations are associated with reductions in smoking-related hospitalisation rates, but very few have estimated the impact of TC laws (TCL) at both countrywide and regional levels, and none of them have studied the impact of TCL in relation to compliance with TC regulations. This study evaluates the effects of Russian TCL on hospital admission (HA) rates for pneumonia countrywide and in 10 Russian regions and the extent of these effects in connection with the compliance with TCL. Methods: HA rates for pneumonia from 2005–2019 were analysed to compare the periods before and after the adoption of TCL in 2013. An interrupted time series design and a Poisson regression model were used to estimate the immediate and long-term effects of TCL on pneumonia annual hospitalisation rates after the TCL adoption, compared with the pre-law period. The 10 Russian regions were compared using the TCL implementation scale (TCIS) developed on the basis of the results of the Russian TC policy evaluation survey; Spearman’s rank correlation and linear regression models were employed. Results showed a 14.3% reduction in HA rates for pneumonia (RR 0.88; p = 0.01) after the adoption of TCL in Russia with significant long-term effect after 2013 (RR 0.86; p = 0.006). Regions with better enforcement of TCL exhibited greater reductions in pneumonia HA rates (rsp = −0.55; p = 0.04); (β = −4.21; p = 0.02). Conclusions: TCL resulted in a sustained reduction in pneumonia hospitalisation rates, but these effects, varying by region, may depend on the scale of the TCL enforcement.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-20
      DOI: 10.3390/ijerph20105893
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5894: Consumer Views and Experiences of
           Secondary-Care Services Following REFOCUS-PULSAR Staff Recovery-Oriented
           Practices Training

    • Authors: Michelle Kehoe, Ellie Fossey, Vrinda Edan, Lisa Chaffey, Lisa Brophy, Penelope June Weller, Frances Shawyer, Graham Meadows
      First page: 5894
      Abstract: Background: The use of recovery-oriented practice (ROP) can be challenging to implement in mental health services. This qualitative sub-study of the Principles Unite Local Services Assisting Recovery (PULSAR) project explored how consumers perceive their recovery following community mental health staff undertaking specific ROP training. Methods: Using a qualitative participatory methodology, 21 consumers (aged 18–63 years) participated in one-on-one interviews. A thematic analysis was applied. Results: Four main themes were extracted: 1) connection, 2) supportive relationships, 3) a better life, and 4) barriers. Connections to community and professional staff were important to support consumers in their recovery journey. Many consumers were seeking and striving towards a better life that was personal and individual to each of them, and how they made meaning around the idea of a better life. Barriers to recovery primarily focused on a lack of choice. A minor theme of ‘uncertainty’ suggested that consumers struggled to identify what their recovered future might entail. Conclusion: Despite staff undertaking the ROP training, all participants struggled to identify language and aspects of recovery in their interaction with the service, suggesting a need for staff to promote open, collaborative conversations around recovery. A specifically targeted recovery resource might facilitate such conversation.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-20
      DOI: 10.3390/ijerph20105894
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5895: Resilience and Extrinsic Motivation as
           Mediators in the Relationship between Fear of Failure and Burnout

    • Authors: Murat Yıldırım, Ömer Kaynar, Francesco Chirico, Nicola Magnavita
      First page: 5895
      Abstract: Athletes with fear of failure are at risk of developing the symptoms of a wide range of psychological problems, including burnout. Understanding the risks and protective factors of athletes’ psychological health is an essential step in tailoring strategies and interventions to promote athletes’ psychological and mental health. This study examined the mediating roles of resilience and extrinsic motivation in the relationship between fear of failure and burnout among Turkish athletes. The study included 335 young athletes (93.4% males) whose ages ranged from 18 to 55 years (M = 24.95, SD = 8.22). Participants completed the self-reported measures of fear of failure, resilience, extrinsic motivation, and burnout. The analysis revealed that fear of failure had significant predictive effects on resilience, extrinsic motivation, and burnout. Resilience and extrinsic motivation also had significant predictive effects on burnout. The mediation analysis results showed that both resilience and extrinsic motivation partially mediated the effect of fear of failure on athlete burnout. The findings of the study provide a better insight into the underlying mechanisms between fear of failure and athlete burnout by considering resilience and extrinsic motivation as mediators. These results suggest that the adverse impact of fear of failure on athlete burnout can be mitigated by cultivating resilience and hindering extrinsic motivation.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-20
      DOI: 10.3390/ijerph20105895
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5896: Hematological Changes in Gas Station Workers

    • Authors: Isabela Giardini, Katia Soares da da Poça, Paula Vieira Baptista da da Silva, Valnice Jane Caetano Andrade Andrade Silva, Deborah Santos Cintra, Karen Friedrich, Barbara Rodrigues Geraldino, Ubirani Barros Otero, Marcia Sarpa
      First page: 5896
      Abstract: (1) Background: Benzene, toluene, and xylene isomers (BTX) are present in gasoline. Exposure to benzene may lead to the appearance of a series of signs, symptoms, and complications, which are characterized by benzene poisoning, which is an occupational disease. This study evaluated the presence of signs and symptoms related to occupational exposure and whether occupational exposure to BTX is associated with the development of hematological changes. (2) Material and Methods: This cross-sectional epidemiological study included 542 participants, in which 324 were gas station workers (GSWs) and 218 were office workers (OWs) with no occupational exposure to benzene. To characterize the type of exposure (exposed and not exposed), trans,trans-Muconic acid (tt-MA), Hippuric acid (HA), and Methylhippuric acid (MHA) were used as exposure biomarkers. The tt-MA analysis revealed that the GSWs had 0.29 mg/g of urinary creatinine and the OWs had 0.13 mg/g of urinary creatinine. For HA, the GSWs presented 0.49 g/g of creatinine while the OWs presented 0.07. MHA analysis revealed that the GSWs had 1.57 g/g creatinine and the OWs had 0.01 g/g creatinine. Occupation habits and clinical symptoms were collected by questionnaire and blood samples were analyzed for hematological parameters. The persistence of hematological changes was evaluated with three serial blood collections every 15 days followed by laboratory hematological analysis. A descriptive analysis by the Chi-square test method was performed to evaluate the association between occupational exposure to fuels and the occurrence of changes in hematological parameters. (3) Results: In the GSWs, the most described signs and symptoms were somnolence (45.1%), headache (38.3%), dizziness (27.5%), tingling (25.4%), and involuntary movement (25%). Twenty GSWs that presented hematological alterations performed serial collections fifteen days apart. In addition, these workers presented total leukocyte counts above the upper limit and lymphocyte counts close to the lower limit. Leukocytosis and lymphopenia are hematological alterations present in chronic benzene poisoning. (4) Conclusion: The results found an initial change in different hematological parameters routinely used in clinics to evaluate health conditions. These findings reveal the importance of valuing clinical changes, even in the absence of disease, during the health monitoring of gas station workers and other groups that share the same space.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-20
      DOI: 10.3390/ijerph20105896
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5897: The Feasibility and Acceptability of the
           Adverse Childhood Experiences Questionnaire in Danish Antenatal
           Care—A Qualitative Study of Midwives’ Implementation

    • Authors: Helle Johnsen, Vibeke de Lichtenberg, Eva Rydahl, Sara Mbaye Karentius, Signe Camilla Hjuler Dueholm, Majbritt Friis-Alstrup, Mette Grønbæk Backhausen, Katrine Røhder, Michaela Louise Schiøtz, Lotte Broberg, Mette Juhl
      First page: 5897
      Abstract: Adverse childhood experiences have a potential lifelong impact on health. A traumatic upbringing may increase antenatal health risks in mothers-to-be and impact child development in their offspring. Yet, little is known about the identification of adverse childhood experiences in antenatal care. The objective of this study was to explore the feasibility and acceptability of the adverse childhood experiences questionnaire among midwives and factors affecting its implementation. Three Danish maternity wards participated in the study. The data consisted of observations of midwifery visits and informal conversations with midwives, as well as mini group interviews and dialogue meetings with midwives. The data were analysed using systematic text condensation. Analysis of the data revealed three main categories; “Relevance of the adverse childhood experiences questionnaire”, “Challenges related to use of the adverse childhood experiences questionnaire” and “Apprehensions, emotional strain, and professional support”. The findings showed that the adverse childhood experiences questionnaire was feasible to implement in Danish antenatal care. Midwives’ acceptability of the questionnaire was high. Training courses and dialogue meetings motivated the midwives to work with the questionnaire in practice. The main factors affecting the implementation process were time restrictions, worries of overstepping women’s boundaries, and a lack of a specific intervention for women affected by their traumatic upbringing circumstances.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-20
      DOI: 10.3390/ijerph20105897
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5898: Built Environment Accessibility and
           Disability as Predictors of Well-Being among Older Adults: A Norwegian
           Cross-Sectional Study

    • Authors: Grace Katharine Forster, Leif Edvard Aarø, Maria Nordheim Alme, Thomas Hansen, Thomas Sevenius Nilsen, Øystein Vedaa
      First page: 5898
      Abstract: Knowledge about the influence environmental factors have on well-being is important to deliver policies supporting healthy ageing and sustainable health equity. An under-researched question is whether and how the built environment plays a role on well-being among older adults with disabilities. This study explores the relationship between built environment accessibility and disability on psychosocial well-being among older adults. Data were used from the Norwegian Counties Public Health Survey collected during February 2021 in Møre and Romsdal county (N = 8274; age = 60–97, mean = 68.6). General linear modelling was performed to examine the relationship and interaction between built environment accessibility (services, transportation, and nature) and disability on psychosocial well-being (quality of life, thriving, loneliness, and psychological distress). Higher levels of disability and poorer accessibility were each significantly related to lower psychosocial well-being across all variables (p < 0.001). Significant interaction effects were observed between disability and built environment accessibility on thriving (F[8, 5936] = 4.97, p < 0.001, η2 = 0.006) and psychological distress (F[8, 5957] = 3.09, p = 0.002, η2 = 0.004). No significant interaction effects were found for quality of life and loneliness. These findings indicate good built environment accessibility is associated with thriving and reduces psychological distress among older adults with disabilities. This study supports and extends previous findings on the importance of accessible and equipped environments for well-being and may aid policy makers when planning built environments to foster healthy ageing among this population group.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-20
      DOI: 10.3390/ijerph20105898
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5899: Postpartum Blues in Fathers: Prevalence,
           Associated Factors, and Impact on Father-To-Infant Bond

    • Authors: Claire Baldy, Eloi Piffault, Margaux Chabbert Chopin, Jaqueline Wendland
      First page: 5899
      Abstract: In this study we explored, in men, one of the most common postpartum syndromes in women: the postpartum blues. The aims of the study were (a) to evaluate the prevalence of postpartum blues in fathers, (b) to explore the sociodemographic and perinatal factors that may be associated with its intensity, and (c) to investigate the relationship between the intensity of blues symptoms and the quality of father-to-infant bonding. Three hundred and three French-speaking fathers living in France completed a sociodemographic and obstetrical questionnaire, the Maternity Blues Questionnaire, and the Postpartum Bonding Questionnaire. The fathers were recruited from two maternity hospitals and a Child and Maternal Health Centre within 10 days of their infant’s birth, or from online forums devoted to parenting. At least 17.5% of fathers experienced postpartum blues. A high level of education was associated with a higher level of postpartum blues symptoms. Dissatisfaction with the maternity care and significant father involvement during pregnancy and delivery predicted more severe postpartum blues symptoms. Symptoms of postpartum blues were positively correlated with impairment in the father-to-infant bond. This study lends support to the existence of postpartum blues among fathers and highlights its possible consequences on early father–infant relationships.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-20
      DOI: 10.3390/ijerph20105899
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5900: Individual and Contextual Determinants of Flu
           Vaccination Adherence: A University Nudge Intervention

    • Authors: Nadia Pecoraro, Francesca Malatesta, Luna Carpinelli, Domenico Fornino, Claudio Giordano, Giuseppina Moccia, Matilde Perillo, Mario Capunzo, Giulia Savarese, Francesco De Caro
      First page: 5900
      Abstract: Introduction: The University of Salerno has implemented a nudge intervention with the aim of promoting vaccine adherence among employees of academia and identifying individual and contextual determinants that influence adherence. Method: A purpose-built questionnaire was used during the reference period of October–December 2022 in order to assess levels of state anxiety (STAI-Y1), perceived stress (PSS-10), and public sentiments, which influence vaccination behavior, with consequences for the whole population (VCI). Results: Analysis of the results revealed a difference in mean scores on the PSS: those who have always adhered to the vaccination campaign compared to those who have never been vaccinated perceived higher levels of stress (12.01 vs. 11.33; F = 4.744, p = 0.031); furthermore, there was a relationship between the presence/absence of pathologies and VCI (F = 3,93; df = 1; p = 0.04). Conclusions: The University of Salerno’s nudge intervention made its employees more responsible for protecting the health of the academic community and encouraged good adherence to the flu vaccination campaign. University employees, equipped with high cultural tools, sought information primarily from institutional sources indicated by the university during the free vaccination campaign at the university’s vaccine center.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-21
      DOI: 10.3390/ijerph20105900
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5901: To Get Vaccinated or Not' The Vaccination
           Decision-Making by Healthcare Professionals Working in Haematology: A
           Qualitative Study

    • Authors: Gian Luca Tunisi, Elisa Ambrosi, Giorgia Zulianello, Elisabetta Allegrini, Domenico Provenzano, Tiziana Rizzello, Federica Canzan
      First page: 5901
      Abstract: Haematological patients are more susceptible to infections. Vaccination has always been the most effective primary prevention strategy, even during the COVID-19 pandemic. However, the efficacy of vaccines for some haematological patients is low. Although vaccination of Healthcare Workers (HCWs) could protect patients from vaccine-preventable diseases, there is evidence of a high level of hesitation among healthcare workers in Italy. The aim of this study was to explore the attitudes towards vaccination of HCWs caring for haematology patients. Qualitative descriptive design was conducted. Twenty-one HCWs were interviewed. Content analysis was applied to the qualitative data. The following themes were generated from the analysis: “Trust”, “Decision-making process focusing on individual health”, “Decision-making process focusing on community health”, “Changing opinion”, and “Two sides of vaccination commitment”. The most hesitant HCWs were oriented towards individual health. They perceived a lack of benefit from vaccines, feared side effects, or were influenced by negative experiences of others. In contrast, community-health-oriented HCWs showed more positive attitudes towards vaccination. Some hesitant HCWs changed their opinion on vaccination because they began to reflect on the importance of vaccination for the community. The change in opinion of some HCWs interviewed provided insight into the importance of focusing organisational efforts on collective responsibility.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-21
      DOI: 10.3390/ijerph20105901
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5902: Who Stays, Who Moves on and the Host
           Population: A Picture of Adolescents’ Perceived Well-Being and Risk

    • Authors: Lorena Charrier, Rosanna Irene Comoretto, Michela Bersia, Paola Dalmasso, Emanuele Koumantakis, Alberto Borraccino, Adriana Baban, Paola Berchialla, Patrizia Lemma
      First page: 5902
      Abstract: The study aims to evaluate the health profile of first- and second-generation Romanian immigrants living in Italy compared to their adolescent peers in the country of origin (Romania) and the host population (Italian-borns). Analyses were performed on the 2013/2014 Health Behaviour in School-aged Children (HBSC) survey data. Romanian natives showed lower levels of health complaints and higher life satisfaction than Romanian migrants, who were similar to the host population, especially the second-generation ones. A comparable prevalence of being bullied was registered among Romanians, both native and immigrant, with significantly lower levels among Italian natives. Bullying others showed the second-generation migrants share a similar prevalence with the host population. The prevalence of liking school a lot was three times higher among the Romanian natives than among their peers living in Italy. Thanks to the HBSC data, this study is the first to examine the health of adolescent migrants from both the perspective of the host country and the population of origin. The results highlight the need for a more nuanced approach to studying immigrant populations, taking into account both the host country’s perspective and the health patterns of the population of origin.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-21
      DOI: 10.3390/ijerph20105902
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5903: Exposure to Disinfectants and Cleaning
           Products and Respiratory Health of Workers and Children in Daycares: The
           CRESPI Cohort Protocol

    • Authors: Nicole Le Moual, Orianne Dumas, Pierre Bonnet, Anastasie Eworo Nchama, Barbara Le Bot, Etienne Sévin, Isabelle Pin, Valérie Siroux, Corinne Mandin, The CRESPI Study Group The CRESPI Study Group
      First page: 5903
      Abstract: Although cleaning tasks are frequently performed in daycare, no study has focused on exposures in daycares in relation to respiratory health. The CRESPI cohort is an epidemiological study among workers (n~320) and children (n~540) attending daycares. The purpose is to examine the impact of daycare exposures to disinfectants and cleaning products (DCP) on the respiratory health of workers and children. A sample of 108 randomly selected daycares in the region of Paris has been visited to collect settled dust to analyze semi-volatile organic compounds and microbiota, as well as sample indoor air to analyze aldehydes and volatile organic compounds. Innovative tools (smartphone applications) are used to scan DCP barcodes in daycare and inform their use; a database then matches the barcodes with the products’ compositions. At baseline, workers/parents completed a standardized questionnaire, collecting information on DCP used at home, respiratory health, and potential confounders. Follow-up regarding children’s respiratory health (monthly report through a smartphone application and biannual questionnaires) is ongoing until the end of 2023. Associations between DCP exposures and the respiratory health of workers/children will be evaluated. By identifying specific environments or DCP substances associated with the adverse respiratory health of workers and children, this longitudinal study will contribute to the improvement of preventive measures.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-21
      DOI: 10.3390/ijerph20105903
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5904: Trends in Robotics Research in Occupational
           Safety and Health: A Scientometric Analysis and Review

    • Authors: Ci-Jyun Liang, Marvin H. Cheng
      First page: 5904
      Abstract: Robots have been deployed in workplaces to assist, work alongside, or collaborate with human workers on various tasks, which introduces new occupational safety and health hazards and requires research efforts to address these issues. This study investigated the research trends for robotic applications in occupational safety and health. The scientometric method was applied to quantitatively analyze the relationships between robotics applications in the literature. The keywords “robot”, “occupational safety and health”, and their variants were used to find relevant articles. A total of 137 relevant articles published during 2012–2022 were collected from the Scopus database for this analysis. Keyword co-occurrence, cluster, bibliographic coupling, and co-citation analyses were conducted using VOSviewer to determine the major research topics, keywords, co-authorship, and key publications. Robot safety, exoskeletons and work-related musculoskeletal disorders, human–robot collaboration, and monitoring were four popular research topics in the field. Finally, research gaps and future research directions were identified based on the analysis results, including additional efforts regarding warehousing, agriculture, mining, and construction robots research; personal protective equipment; and multi-robot collaboration. The major contributions of the study include identifying the current trends in the application of robotics in the occupational safety and health discipline and providing pathways for future research in this discipline.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-21
      DOI: 10.3390/ijerph20105904
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5905: Redirected Attention and Impaired Recognition
           Memory during Exhaustive Cycling Has Implications for Information
           Processing Models of Effort-Regulation

    • Authors: Dominic Micklewright, Bernard X. W. Liew, Steffan Kennett
      First page: 5905
      Abstract: Perception of internal and external cues is an important determinant of pacing behaviour, but little is known about the capacity to attend to such cues as exercise intensity increases. This study investigated whether changes in attentional focus and recognition memory correspond with selected psychophysiological and physiological parameters during exhaustive cycling. Methods: Twenty male participants performed two laboratory ramped cycling tests beginning at 50 W and increasing by 0.25 W/s until volitional exhaustion. Ratings of perceived exertion, heart rate and respiratory gas exchange measures were recorded during the first test. During the second test, participants listened to a list of spoken words presented through headphones at a rate of one word every 4 s. Afterwards, their recognition memory for the word pool was measured. Results: Recognition memory performance was found to have strong negative correlations with perceived exertion (p < 0.0001), percentage of peak power output (p < 0.0001), percentage of heart rate reserve (p < 0.0001), and percentage of peak oxygen uptake (p < 0.0001). Conclusions: The results show that, as the physiological and psychophysiological stress of cycling intensified, recognition memory performance deteriorated. This might be due to impairment of memory encoding of the spoken words as they were presented, or because of a diversion of attention away from the headphones, perhaps towards internal physiological sensations as interoceptive sources of attentional load increase with exercise intensity. Information processing models of pacing and performance need to recognise that an athlete’s capacity to attend to and process external information is not constant, but changes with exercise intensity.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-22
      DOI: 10.3390/ijerph20105905
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5906: Adverse Childhood Experiences and Mental
           Health among Students Seeking Psychological Counseling Services

    • Authors: Francesco Craig, Rocco Servidio, Maria Luigia Calomino, Francesca Candreva, Lucia Nardi, Adriana Palermo, Alberto Polito, Maria Francesca Spina, Flaviana Tenuta, Angela Costabile
      First page: 5906
      Abstract: Recent years have seen a marked rise in the number of students accessing University Psychological Counseling (UPC) services, and their concerns have been increasingly severe. This study aimed to examine the impact of cumulative adverse childhood experiences (ACEs) on mental health in students who had approached counseling services (N = 121) and students who had no experience with counseling services (N = 255). Participants completed an anonymous online self-report questionnaire measuring exposure to adverse childhood experiences (ACE-Q), psychological distress (General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9), personality traits (PID-5), and coping strategies. We found that students who approached UPC services scored higher on cumulative ACEs than the non-counseling group. While ACE-Q score was a direct positive predictor of PHQ-9 (p < 0.001), it did not predict GAD-7. Moreover, the results supported the existence of a mediation effect of avoidance coping, detachment, and psychoticism on the indirect effects of ACE-Q score on PHQ-9 or GAD-7. These results underlined the importance of screening for ACEs in a UPC setting because it can help identify students at higher risk for developing mental and physical health problems and provide them with early interventions and support.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-22
      DOI: 10.3390/ijerph20105906
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5907: Pulmonary Rehabilitation Outcomes of
           Post-Acute COVID-19 Patients during Different Waves of the Pandemic

    • Authors: Marc Spielmanns, Corina E. Schaer, Anna-Maria Pekacka-Egli, Sabine Spielmanns, Olberk Ibish, Guzel Gafina, Antonela Stiube, Matthias Hermann
      First page: 5907
      Abstract: (1) Background: Between the beginning of the coronavirus pandemic and summer 2022, we distinguished four pandemic waves, with different characteristics of the affected patients. This study investigated the impact of patient characteristics on the outcome of inpatient pulmonary rehabilitation (PR). (2) Methods: Using a prospective approach, the characteristics of post-acute COVID-19 patients of the different waves who participated in inpatient PR were compared based on their assessments and results collected as part of PR (Cumulative Illness Rating Scale (CIRS), six-minute walk test (6-MWT), Pulmonary Function Testing (PFT), and Functional Independent Measurement (FIM). (3) Results: A total of 483 patients were included in the analysis (Wave 1 n = 51, Wave 2 n = 202, Wave 3 n = 84, Wave 4 n = 146). Compared to Wave 3 + 4, patients of Wave 1 + 2 were older (69 vs. 63 years; p < 0.001), had a significantly lower CIRS (13.0 vs. 14.7 points; p = 0.004), had significant better PFT (FVC: 73 vs. 68%pred; p = 0.009; DLCOSB: 58 ± 18 vs. 50 ± 17%pred; p = 0.001), and showed significantly more comorbidities (2.0 vs. 1.6 n/pers.; p = 0.009). Wave 3 + 4 showed significantly greater improvements according to the 6-MWT (147 vs. 188 m; p < 0.001) and the FIM (5.6 vs. 21.1 points; p < 0.001). (4) Conclusions: Patients of the COVID-19 infection waves differed significantly according to their anthropometric data, incidence of comorbidities, and impact of the infection. All cohorts achieved clinically relevant and significant functional improvements during PR, with significant higher improvements in Wave 3 + 4.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-22
      DOI: 10.3390/ijerph20105907
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5908: Effect of Individualized Coaching at Home on
           Quality of Life in Subacute Stroke Patients

    • Authors: Rodeline Telfils, Axelle Gelineau, Jean-Christophe Daviet, Justine Lacroix, Benoit Borel, Emna Toulgui, Maxence Compagnat, Stéphane Mandigout
      First page: 5908
      Abstract: Background: Stroke causes psychological disorders and cognitive impairments that affect activities of daily living and quality of life. Physical activity (PA) in stroke recovery is beneficial. The benefits of PA on quality of life after stroke are less documented. The aim of the study was to evaluate the effect of a home-based PA incentive program at home in post-stroke patients in the subacute phase on quality of life. Methods: This is a prospective, randomized, single-blind, and monocentric clinical trial. Eighty-three patients were randomly assigned to either an experimental group (EG; n = 42) or to a control group (CG; n = 41). The experimental group followed a home-based PA incentive program for 6 months. Three incentive methods were used: daily monitoring with an accelerometer, weekly telephone calls, and home visits every three weeks. Patients were evaluated before intervention (T0) and after intervention (T1) at 6 months. The control group was a non-intervention group receiving usual care. The outcome was the quality of life with the EuroQol EQ-5D-5L evaluated at baseline and 6 months post-intervention. Results: The mean age was 62.2 years ± 13.6 with a post-stroke time of 77.9 ± 45.1 days. The mean values of the utility index (EQ-5D-5L) in the control group and experimental group at T1 were 0.721 ± 0.207 and 0.808 ± 0.193, respectively (p = 0.02). Discussion: Our study shows a significant difference in the Global QOL index (EQ-5D-5L) between the two groups of subacute stroke patients after 6 months of the individualized coaching program, which combined home visits and weekly telephone calls.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-22
      DOI: 10.3390/ijerph20105908
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5909: Association between the Nursing Practice
           Environment and Safety Perception with Patient Safety Culture during

    • Authors: Nataly Julissa Membrillo-Pillpe, Jhon Alex Zeladita-Huaman, Kimberlym Jauregui-Soriano, Roberto Zegarra-Chapoñan, Eduardo Franco-Chalco, Gabriela Samillan-Yncio
      First page: 5909
      Abstract: Aims: In this study, we aimed to identify the relationship between nursing practice environments (NPEs) and safety perceptions with patient safety culture (PSC) during COVID-19. Design: We conducted a quantitative, non-experimental, correlational, and cross-sectional study. We interviewed 211 nurses from Peru using two scales: PES–NWI and HSOPSC. We used the Shapiro–Wilk test and Spearman’s coefficient and estimated two regression models. Results: NPE was reported as favorable by 45.5% of the participants, and PSC was reported as neutral by 61.1%. Safety perception, the workplace, and NPE predict PSC. All NPE factors were correlated with PSC. However, safety perception, support of nurses subscale, the nurse manager’s ability, and leadership were predictors of PSC. Conclusion: To promote a safe work culture, health institutions should foster leadership that prioritizes safety, strengthens managers’ abilities, encourages interprofessional collaboration, and considers nurses’ feedback for constant improvement.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-22
      DOI: 10.3390/ijerph20105909
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5910: The Scorching Truth: Investigating the Impact
           of Heatwaves on Selangor’s Elderly Hospitalisations

    • Authors: Kun Hing Yong, Yen Nee Teo, Mohsen Azadbakht, Hai Phung, Cordia Chu
      First page: 5910
      Abstract: Global climate change has contributed to the intensity, frequency, and duration of heatwave events. The association between heatwaves and elderly mortality is highly researched in developed countries. In contrast, heatwave impact on hospital admissions has been insufficiently studied worldwide due to data availability and sensitivity. In our opinion, the relationship between heatwaves and hospital admissions is worthwhile to explore as it could have a profound impact on healthcare systems. Therefore, we aimed to investigate the associations between heatwaves and hospitalisations for the elderly by age group in Selangor, Malaysia, from 2010 to 2020. We further explored the impact of heatwaves on the risks of cause-specific hospital admissions across age groups within the elderly. This study applied generalized additive models (GAMs) with the Poisson family and distributed lag models (DLMs) to estimate the effect of heatwaves on hospitalisations. According to the findings, there was no significant increase in hospitalisations for those aged 60 and older during heatwaves; however, a rise in mean apparent temperature (ATmean) by 1 °C significantly increased the risk of hospital admission by 12.9%. Heatwaves had no immediate effects on hospital admissions among elderly patients, but significant delay effects were identified for ATmean with a lag of 0–3 days. The hospital admission rates of the elderly groups started declining after a 5-day average following the heatwave event. Females were found to be relatively more vulnerable than males during heatwave periods. Consequently, these results can provide a reference to improve public health strategies to target elderly people who are at the greatest risk of hospitalisations due to heatwaves. Development of early heatwave and health warning systems for the elderly would assist with preventing and reducing health risks while also minimising the burden on the whole hospital system in Selangor, Malaysia.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-22
      DOI: 10.3390/ijerph20105910
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5911: Conditions for Social Exclusion Leading to
           Distress Change in Chinese Lesbian, Gay, and Bisexual (LGB) People

    • Authors: Chau-kiu Cheung, Eileen Yuk-ha Tsang
      First page: 5911
      Abstract: Lesbian, gay, and bisexual (LGB) people are likely to be at risk of distress because of social exclusion, including the feelings of resentment, resistance, and rejection they might experience from society. Nevertheless, the conditions for social exclusion leading to changes in distress are empirically unclear, especially in Chinese LGB people. To examine these conditions, this study surveyed 303 Chinese LGB people in Taiwan, Hong Kong, and various places in Mainland China. For comparability with other LGB studies, the study did not explicitly identify asexual, demisexual, or pansexual people in the LGB group. Results show that the retrospective reporting of social exclusion in 2016 did not significantly and unconditionally predict levels of distress in 2017. However, the reporting of exclusion significantly predicted current distress when the retrospective report of distress in 2016 was high. These results from the stress–vulnerability model indicate that prior distress is a vulnerability condition that allows social exclusion to exert its stressful effect. This study implies the need to prevent the social exclusion of highly distressed LGB people.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-22
      DOI: 10.3390/ijerph20105911
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5912: What’s Your Pension Story'
           Women’s Perspectives during the COVID-19 Pandemic on Their Old-Age
           Pension Status, Past and Present

    • Authors: Anat Herbst-Debby
      First page: 5912
      Abstract: This study examines the present and retrospective views of mothers who are nearing or are at retirement age regarding their economic status, pension planning, and perceptions of state pension policy. The paper addresses gaps in the literature on the cross-intersections of employment history, vulnerable economic retirement status, and marital and parental status, thereby adopting a life course perspective. Based on in-depth interviews of thirty-one mothers (ages 59–72) during the COVID-19 pandemic, the findings revealed five themes—economic abuse: an unequal distribution of pension funds following divorce; regrets over past choices; COVID-19 and pensions; the state’s responsibility for old-age economic security; and knowledge is important, and I can help others. The study concludes that the majority of women at these ages perceive their current economic situation as a product of insufficient familiarity with pension plans, while voicing opinions about the state’s irresponsibility regarding people of retirement age.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-22
      DOI: 10.3390/ijerph20105912
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5913: Stress Response Analysis via Dynamic Entropy
           in EEG: Caregivers in View

    • Authors: Ricardo Zavala-Yoé, Hafiz M. N. Iqbal, Roberto Parra-Saldívar, Ricardo A. Ramírez-Mendoza
      First page: 5913
      Abstract: According to the World Health Organization (WHO), stress can be defined as any type of alteration that causes physical, emotional, or psychological tension. A very important concept that is sometimes confused with stress is anxiety. The difference between stress and anxiety is that stress usually has an existing cause. Once that activator has passed, stress typically eases. In this respect, according to the American Psychiatric Association, anxiety is a normal response to stress and can even be advantageous in some circumstances. By contrast, anxiety disorders differ from temporary feelings of anxiousness or nervousness with more intense feelings of fear or anxiety. The Diagnostic and Statistical Manual (DSM-5) explicitly describes anxiety as exorbitant concern and fearful expectations, occurring on most days for at least 6 months, about a series of events. Stress can be measured by some standardized questionnaires; however, these resources are characterized by some major disadvantages, the main one being the time consumed to interpret them; i.e., qualitative information must be transformed to quantitative data. Conversely, a physiological recourse has the advantage that it provides quantitative spatiotemporal information directly from brain areas and it processes data faster than qualitative supplies. A typical option for this is an electroencephalographic record (EEG). We propose, as a novelty, the application of time series (TS) entropies developed by us to inspect collections of EEGs obtained during stress situations. We investigated this database related to 23 persons, with 1920 samples (15 s) captured in 14 channels for 12 stressful events. Our parameters reflected that out of 12 events, event 2 (Family/financial instability/maltreatment) and 10 (Fear of disease and missing an important event) created more tension than the others. In addition, the most active lobes reflected by the EEG channels were frontal and temporal. The former is in charge of performing higher functions, self-control, self monitoring, and the latter is in charge of auditory processing, but also emotional handling. Thus, events E2 and E10 triggering frontal and temporal channels revealed the actual state of participants under stressful situations. The coefficient of variation revealed that E7 (Fear of getting cheated/losing someone) and E11 (Fear of suffering a serious illness) were the events with more changes among participants. In the same sense, AF4, FC5, and F7 (mainly frontal lobe channels) were the most irregular on average for all participants. In summary, by means of dynamic entropy analysis, the goal is to process the EEG dataset in order to elucidate which event and brain regions are key for all participants. The latter will allow us to easily determine which was the most stressful and on which brain zone. This study can be applied to other caregivers datasets. All this is a novelty.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-22
      DOI: 10.3390/ijerph20105913
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5914: Non-Traditional Physical Education Classes
           Improve High School Students’ Movement Competency and Fitness: A
           Mixed-Methods Program Evaluation Study

    • Authors: Katie M. Heinrich, Cassandra M. Beattie, Derek A. Crawford, Peter Stoepker, Jason George
      First page: 5914
      Abstract: Non-traditional physical education (PE) programs may facilitate functional movement patterns and develop fitness and work capacity to facilitate long-term physical activity. This program evaluation study compared changes in body composition, movement competency, work capacity, and fitness for high school students in CrossFit or weight training PE; both classes were hypothesized to improve each area, with greater improvements in the CrossFit class. Students participated in 57 min classes 4 days per week for 9 months. Measures including body composition, movement competencies (squat, lunge, push-up, pull-up, hinge, and brace), work capacity (two CrossFit workouts), and fitness (air squats, push-ups, inverted row, plank hold, horizontal and vertical jumps, 5 rep max back squat and press, 500 m bike, and 12 min run) were taken at baseline, midpoint, and post-test. Focus groups to assess students’ experiences and outcomes were conducted at post-test. Students significantly improved in movement competencies (ps = 0.034 to <0.001), work capacity (ps < 0.001), and all fitness tests (ps = 0.036 to <0.001). The CrossFit class was only superior on the 500 m bike. Four themes were identified from the focus groups: (1) increased self-confidence, (2) health improvements, (3) newfound community, and (4) translational sports improvements. Future research should examine changes using an experimental design.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-22
      DOI: 10.3390/ijerph20105914
      Issue No: Vol. 20, No. 10 (2023)
  • IJERPH, Vol. 20, Pages 5915: Research Participant Selection Bias in the
           Workshop Using Socially Assistive Robots for Older Adults and Its Effect
           on Population Representativeness

    • Authors: Toshiharu Igarashi, Ikuko Sugawara, Takenobu Inoue, Misato Nihei
      First page: 5915
      Abstract: Every research participant has their own personality characteristics. For example, older adults assisted by socially assistive robots (SAR) may have their own unique characteristics and may not be representative of the general population of older adults. In this research, we compared the average personality characteristics of participants in a workshop on robotics recruited directly through posting with those of older Japanese adults to examine participant selection bias and group representativeness for future study of SARs. After a one-week recruitment period, the workshop was attended by 20 older participants (nine males and 11 females) aged between 62 and 86 years. Extroversion among workshop participants was 4.38, 0.40 higher than the average for older adults in Japan. The workshop participants’ openness was 4.55, 1.09 higher than the average for the Japanese elderly. Thus, the results indicate a slight selection bias in the personal characteristics of the participants depending on the recruitment method when compared to the Japan national average for older adults. In addition, only one of 20 participants was below the cutoff on the LSNS-6 score and considered to have a tendency toward social isolation. The development and introduction of socially assistive robots is often being considered to support people in social isolation in their daily lives; however, the results of this study showed that it is difficult to recruit people who tend to be socially isolated when gathering research participants by methods such as posting. Therefore, the effectiveness of the method of recruiting participants should be carefully verified in research regarding socially assistive robots.
      Citation: International Journal of Environmental Research and Public Health
      PubDate: 2023-05-22
      DOI: 10.3390/ijerph20105915
      Issue No: Vol. 20, No. 10 (2023)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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