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Int. J. Environ. Res. Public Health, Volume 18, Issue 6 (March-2 2021) – 541 articles

Cover Story (view full-size image): Racism toward Black, Indigenous and People of Color continues to exist in the healthcare system. This racism is built upon a global history of white supremacy, colonialism, and slavery and has left lasting and ongoing impacts on the delivery and utilization of healthcare today. This racism leads to profound harm for people who exist and work within these settings. This scoping review identified antiracism interventions in outpatient healthcare settings and inductively identified themes. A conceptual model for implementing antiracism interventions in healthcare settings is presented based on a synthesis of the peer-reviewed and grey literature. We present key processes, principles, and strategies for consideration when antiracism interventions are planned and executed at various levels in healthcare. View this paper.
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Article
A Mixed-Methods Evaluation of CARE (Cancer and Rehabilitation Exercise): A Physical Activity and Health Intervention, Delivered in a Community Football Trust
Int. J. Environ. Res. Public Health 2021, 18(6), 3327; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063327 - 23 Mar 2021
Viewed by 1120
Abstract
With increasing cancer survivorship has come an increased necessity to support people living with cancer (PLWC) to have a good quality of life including being physically active. Using mixed methods, the current study aimed to use the RE-AIM evaluation framework (Reach, Effectiveness, Adoption, [...] Read more.
With increasing cancer survivorship has come an increased necessity to support people living with cancer (PLWC) to have a good quality of life including being physically active. Using mixed methods, the current study aimed to use the RE-AIM evaluation framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) to determine how the football community trust delivered CARE (Cancer and Rehabilitation Exercise) intervention was able to increase participants’ physical activity in order to improve their quality of life and regain physiological and psychological function. Quantitative outcome data were collected at baseline, 3 and 6 months using the Cancer Physical Activity Standard Evaluation Framework questionnaire. Semi-structured focus groups (n = 5) captured participants’ (n = 40) lived experience of the reach, effectiveness, adoption, implementation, and maintenance of CARE. Questionnaire data were analysed using repeated measures ANOVAs and qualitative data were thematically analysed. Following diagnosis, CARE was successful in providing participants with a unique and accessible opportunity to become or restart physically activity, by providing a local, socially supportive, and inclusive environment. This resulted in significant increases in physical activity (F(1.58, 23) = 5.98, p = 0.009), quality of life (QoL) (F(2,36) = 13.12, p = 0.000) and significant reductions in fatigue (F(1.57,31) = 11.19, p = 0.000) over 6 months. Participants also reported becoming more active, recovering physical function, regaining independence, and enhanced psychological well-being as a result of attending CARE. Key design features of CARE were also identified across RE-AIM. CARE, a football community trust delivered physical activity intervention was successful in significantly improving participants’ QoL and in regaining the physical and psychological functioning of people living with cancer. Results suggest that maintaining engagement in CARE for 6 months and beyond can support people to maintain these changes. Engaging in robust evaluations such as this can help organizations to successfully secure future funding for their programs. Full article
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Reply to Comment on Choi, Y.-J., et al. Cellular Phone Use and Risk of Tumors: Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2020, 17, 8079
Int. J. Environ. Res. Public Health 2021, 18(6), 3326; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063326 - 23 Mar 2021
Cited by 2 | Viewed by 1205
Abstract
We appreciate Frank de Vocht and Martin Röösli’s interest [...] Full article
Article
The Experience of Apathy in Dementia: A Qualitative Study
Int. J. Environ. Res. Public Health 2021, 18(6), 3325; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063325 - 23 Mar 2021
Cited by 2 | Viewed by 1122
Abstract
We aimed to explore and gain an understanding into how people with dementia experience apathy, and consequently suggest effective interventions to help them and their carers. Twelve participants (6 dyads of 6 people with dementia and their family carers) were recruited from “memory [...] Read more.
We aimed to explore and gain an understanding into how people with dementia experience apathy, and consequently suggest effective interventions to help them and their carers. Twelve participants (6 dyads of 6 people with dementia and their family carers) were recruited from “memory cafes” (meeting groups for people with dementia and their families), social groups, seminars, and patient and public involvement (PPI) meetings. People with dementia and their carers were interviewed separately and simultaneously. Quantitative data were collected using validated scales for apathy, cognition, anxiety, and depression. The interviews were semi-structured, focusing on the subjective interpretation of apathy and impacts on behaviour, habits, hobbies, relationships, mood, and activities of daily living. Interviews were recorded and transcribed. Transcripts were analysed using interpretative phenomenological analysis (IPA), which generated codes and patterns that were collated into themes. Four major themes were identified, three of which highlighted the challenging aspects of apathy. One described the positive aspects of the individuals’ efforts to overcome apathy and remain connected with the world and people around them. This study is the first to illustrate the subjective experience of apathy in dementia, portraying it as a more complex and active phenomenon than previously assumed. Apathy and its effects warrant more attention from clinicians, researchers, and others involved in dementia care. Full article
(This article belongs to the Special Issue Diagnosis and Healthcare for Dementias)
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Article
Daily Life Changes and Life Satisfaction among Korean School-Aged Children in the COVID-19 Pandemic
Int. J. Environ. Res. Public Health 2021, 18(6), 3324; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063324 - 23 Mar 2021
Cited by 2 | Viewed by 1860
Abstract
The recent COVID-19 pandemic has been disrupting the daily lives of people across the world, causing a major concern for psychological well-being in children. This study aimed to examine (1) how life satisfaction and its potential predictors have been affected by the pandemic [...] Read more.
The recent COVID-19 pandemic has been disrupting the daily lives of people across the world, causing a major concern for psychological well-being in children. This study aimed to examine (1) how life satisfaction and its potential predictors have been affected by the pandemic among school-aged children in Korea, and (2) which factors would predict their life satisfaction during the pandemic. We surveyed 166 fourth-graders in the Seoul metropolitan area to assess their psychological well-being and potentially related variables during the pandemic. The data were compared with those available from two pre-COVID-19 surveys, the 2018 Korean Children and Youth Panel Survey (n = 1236) and the 2019 Korean Children and Youth Well-being Index Survey (n = 334). Higher levels of stress were observed in children during the COVID-19 pandemic; however, the level of their life satisfaction remained unchanged when compared with data from the pre-COVID-19 surveys. The pandemic also affected peer relationship quality and susceptibility to smartphone addiction, but not perceived parenting style nor academic engagement. Interestingly, peer relationship quality no longer predicted life satisfaction during the pandemic; perceived parenting styles and parent-child conversation time predicted life satisfaction. The results suggest a central role of parent-child relationship in supporting the psychological well-being of school-aged children during the pandemic. Full article
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Article
Psychometric Properties of the POAGTS: A Tool for Understanding Parents’ Perceptions Regarding Autism Spectrum Disorder Genetic Testing
Int. J. Environ. Res. Public Health 2021, 18(6), 3323; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063323 - 23 Mar 2021
Viewed by 962
Abstract
Due to the increased prevalence of Autism Spectrum Disorder (ASD), more children with ASD may be referred for genetic testing. It is important to develop a tool to help parents consider the benefits and drawbacks of genetic testing for ASD before pursuing genetic [...] Read more.
Due to the increased prevalence of Autism Spectrum Disorder (ASD), more children with ASD may be referred for genetic testing. It is important to develop a tool to help parents consider the benefits and drawbacks of genetic testing for ASD before pursuing genetic testing for children with ASD. We developed the first theory-based survey—Perceptions of ASD Genetic Testing Survey (POAGTS), as a tool to assist healthcare providers to better understand parents’ perceptions and concerns regarding ASD genetic testing. The psychometric properties of POAGTS were first pre-tested and then formally tested with 308 parents of children with ASD who had not decided whether to pursue genetic testing for their children diagnosed with ASD. Findings suggest that the eight scales of the POAGTS were psychometrically sound, and had acceptable data reliability and validity. Additional research with various samples, such as parents of children with ASD who belong to diverse racial/ethnic and socioeconomic groups, is warranted in the future to determine whether the POAGTS is applicable to these particular groups. Condensing and refining this tool to a shorter, more user-friendly version is also recommended for future research. Full article
(This article belongs to the Special Issue Research on Autism Spectrum Disorders)
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Article
Associations between Well-Being State and Match External and Internal Load in Amateur Referees
Int. J. Environ. Res. Public Health 2021, 18(6), 3322; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063322 - 23 Mar 2021
Viewed by 896
Abstract
The main aim of this paper was to examine the association between prematch well-being status with match internal and external load in field (FR) and assistant (AR) soccer referees. Twenty-three FR and 46 AR participated in this study. The well-being state was assessed [...] Read more.
The main aim of this paper was to examine the association between prematch well-being status with match internal and external load in field (FR) and assistant (AR) soccer referees. Twenty-three FR and 46 AR participated in this study. The well-being state was assessed using the Hooper Scale and the match external and internal loads were monitored with Stryd Power Meter and heart monitors. While no significant differences were found in Hooper indices between match officials, FR registered higher external loads (p < 0.01; ES: 0.75 to 5.78), spent more time in zone 4 and zone 5, and recorded a greater training impulse (TRIMP) value (p < 0.01; ES: 1.35 to 1.62) than AR. Generally, no associations were found between the well-being variables and external loads for FR and AR. Additionally, no associations were found between the Hooper indices and internal loads for FR and AR. However, several relationships with different magnitudes were found between internal and external match loads, for FR, between power and speed with time spent in zone 2 (p < 0.05; r = −0.43), ground contact time with zone 2 and zone 3 (p < 0.05; r = 0.50 to 0.60) and power, speed, cadence and ground contact time correlated with time spent in zone 5 and TRIMP (p < 0.05 to 0.01; r = 0.42 to 0.64). Additionally, for AR, a relationship between speed and time in zone 1 was found (p < 0.05; r = −0.30; CL = 0.22). These results suggest that initial well-being state is not related to match officials’ performances during match play. In addition, the Stryd Power Meter can be a useful device to calculate the external load on soccer match officials. Full article
(This article belongs to the Special Issue Athlete Performance and Health)
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Article
The Association between Bone Mineral Density and Periodontal Disease in Middle-Aged Adults
Int. J. Environ. Res. Public Health 2021, 18(6), 3321; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063321 - 23 Mar 2021
Viewed by 1038
Abstract
The association between osteoporosis and periodontal disease (PD) has been revealed by previous studies, but there have been few studies on the association in younger adults. We enrolled a total of 7298 adults aged 40 to 44 who underwent PD screening between 2003 [...] Read more.
The association between osteoporosis and periodontal disease (PD) has been revealed by previous studies, but there have been few studies on the association in younger adults. We enrolled a total of 7298 adults aged 40 to 44 who underwent PD screening between 2003 and 2008. Data on quantitative ultrasound for the measurement of bone mineral density (BMD) were collected for the diagnostic criteria of osteopenia and osteoporosis. The Community Periodontal Index (CPI) was measured for defining PD. A multiple logistic regression model was used to assess the effect of low bone mass on the risk of PD. Of 7298 enrollees, 31% had periodontal pockets >3 mm, 36.2% had osteopenia, and 2.1% had osteoporosis. The 39.8% of PD prevalence was high in adults with osteoporosis, followed by 33.3% in osteopenia. A negative association was found between BMD and CPI value (p < 0.0001). Low bone mass was associated with the risk of PD (adjusted OR: 1.13; 95% CI:1.02–1.26) after adjusting the confounding factors, including age, gender, education level, overweight, smoking status, past history of osteoporosis, and diabetes mellitus. An association between BMD and PD among young adults was found. An intervention program for the prevention of PD and osteoporosis could be considered starting in young adults. Full article
(This article belongs to the Special Issue Relationships between Oral Health Management and Systemic Health)
Review
Gastrointestinal Involvement in Anderson-Fabry Disease: A Narrative Review
Int. J. Environ. Res. Public Health 2021, 18(6), 3320; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063320 - 23 Mar 2021
Viewed by 916
Abstract
Anderson-Fabry disease (FD) is an X-linked lysosomal storage disorder leading to a wide array of clinical manifestations. Among these, gastrointestinal (GI) symptoms such as abdominal pain, bloating, and diarrhea affect about half of the FD adults and more than half of FD children. [...] Read more.
Anderson-Fabry disease (FD) is an X-linked lysosomal storage disorder leading to a wide array of clinical manifestations. Among these, gastrointestinal (GI) symptoms such as abdominal pain, bloating, and diarrhea affect about half of the FD adults and more than half of FD children. GI symptoms could be the first manifestation of FD; however, being non-specific, they overlap with the clinical picture of other conditions, such as irritable bowel syndrome and inflammatory bowel disease. This common overlap is the main reason why FD patients are often unrecognized and diagnosis is delayed for many years. The present narrative review is aimed to promote awareness of the GI manifestations of FD amongst general practitioners and specialists and highlight the latest findings of this rare condition including diagnostic tools and therapies. Finally, we will discuss some preliminary data on a patient presenting with GI symptoms who turned to be affected by a variant of uncertain significance of alpha-galactosidase (GLA) gene. Full article
(This article belongs to the Section Health Communication and Informatics)
Article
Through the Looking Glass of Social Media. Focus on Self-Presentation and Association with Mental Health and Quality of Life. A Cross-Sectional Survey-Based Study
Int. J. Environ. Res. Public Health 2021, 18(6), 3319; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063319 - 23 Mar 2021
Cited by 4 | Viewed by 2497
Abstract
Social media (SOME) use among adolescents has been linked to mental health and well-being. SOME self-presentation has been highlighted as an important factor to better understand the potential links. The aims of this study were to investigate the association between focus on SOME [...] Read more.
Social media (SOME) use among adolescents has been linked to mental health and well-being. SOME self-presentation has been highlighted as an important factor to better understand the potential links. The aims of this study were to investigate the association between focus on SOME self-presentation and mental health and quality of life among adolescents. We used a cross-sectional survey, with n = 513 (56%; mean age 17.1 years; 58% boys) students from a senior high school in Norway. Associations between focus on SOME self-presentation and symptoms of anxiety and depression and quality of life were investigated using blobbograms, standardized mean difference (SMD), and gender-specific linear regression models. A high focus on SOME self-presentation was associated with more mental health problems and reduced quality of life. The strength of the associations with symptoms of depression (0.75SMD) and anxiety (0.71SMD) was large, while it was medium-large for quality of life (−0.58SMD). The association was similar across gender in relation to symptoms of anxiety. For symptoms of depression and quality of life, the association was stronger for girls compared to boys. Our findings yield preliminary evidence of a potential relationship between focus on SOME self-presentation and mental health. Full article
(This article belongs to the Section Mental Health)
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Article
The Impact of Multiple Sclerosis Disease Status and Subtype on Hematological Profile
Int. J. Environ. Res. Public Health 2021, 18(6), 3318; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063318 - 23 Mar 2021
Viewed by 764
Abstract
Multiple sclerosis (MS) is an immune-mediated, demyelinating disease of the central nervous system. In this study, an MS cohort and healthy controls were stratified into Caucasian and African American groups. Patient hematological profiles—composed of complete blood count (CBC) and complete metabolic panel (CMP) [...] Read more.
Multiple sclerosis (MS) is an immune-mediated, demyelinating disease of the central nervous system. In this study, an MS cohort and healthy controls were stratified into Caucasian and African American groups. Patient hematological profiles—composed of complete blood count (CBC) and complete metabolic panel (CMP) test values—were analyzed to identify differences between MS cases and controls and between patients with different MS subtypes. Additionally, random forest models were used to determine the aggregate utility of common hematological tests in determining MS disease status and subtype. The most significant and relevant results were increased bilirubin and creatinine in MS cases. The random forest models achieved some success in differentiating between MS cases and controls (AUC values: 0.725 and 0.710, respectively) but were not successful in differentiating between subtypes. However, larger samples that adjust for possible confounding variables, such as treatment status, may reveal the value of these tests in differentiating between MS subtypes. Full article
(This article belongs to the Special Issue Genetic Epidemiology: The State-of-the-Art and Future Perspectives)
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Article
Prediction of Type 2 Diabetes Based on Machine Learning Algorithm
Int. J. Environ. Res. Public Health 2021, 18(6), 3317; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063317 - 23 Mar 2021
Cited by 1 | Viewed by 1029
Abstract
Prediction of type 2 diabetes (T2D) occurrence allows a person at risk to take actions that can prevent onset or delay the progression of the disease. In this study, we developed a machine learning (ML) model to predict T2D occurrence in the following [...] Read more.
Prediction of type 2 diabetes (T2D) occurrence allows a person at risk to take actions that can prevent onset or delay the progression of the disease. In this study, we developed a machine learning (ML) model to predict T2D occurrence in the following year (Y + 1) using variables in the current year (Y). The dataset for this study was collected at a private medical institute as electronic health records from 2013 to 2018. To construct the prediction model, key features were first selected using ANOVA tests, chi-squared tests, and recursive feature elimination methods. The resultant features were fasting plasma glucose (FPG), HbA1c, triglycerides, BMI, gamma-GTP, age, uric acid, sex, smoking, drinking, physical activity, and family history. We then employed logistic regression, random forest, support vector machine, XGBoost, and ensemble machine learning algorithms based on these variables to predict the outcome as normal (non-diabetic), prediabetes, or diabetes. Based on the experimental results, the performance of the prediction model proved to be reasonably good at forecasting the occurrence of T2D in the Korean population. The model can provide clinicians and patients with valuable predictive information on the likelihood of developing T2D. The cross-validation (CV) results showed that the ensemble models had a superior performance to that of the single models. The CV performance of the prediction models was improved by incorporating more medical history from the dataset. Full article
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Article
Association between Bullying Victimization and Symptoms of Depression among Adolescents: A Moderated Mediation Analysis
Int. J. Environ. Res. Public Health 2021, 18(6), 3316; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063316 - 23 Mar 2021
Viewed by 967
Abstract
Background: Bullying victimization and its effect on symptoms of depression have received attention from researchers, but few studies have considered the potential mechanism. The aim of this study was to examine a moderated mediation model for the association between bullying victimization and depressive [...] Read more.
Background: Bullying victimization and its effect on symptoms of depression have received attention from researchers, but few studies have considered the potential mechanism. The aim of this study was to examine a moderated mediation model for the association between bullying victimization and depressive symptoms in terms of it being mediated by social anxiety, and investigated whether sleep duration would show moderating effects in this relationship. Methods: In this study, there were 2956 students, who completed three questionnaires, including a bullying victimization scale, as well as a social anxiety and epidemiologic studies depression scale. Results: Bullying victimization’s effects on depressive symptoms were mediated by social anxiety. Furthermore, sleep duration moderated the relationship between bullying victimization and depressive symptoms. Conclusions: The research contributes by clarifying the mechanisms underlying the relationship between bullying victimization and depressive symptoms. Full article
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Article
Associations between Greenspace and Gentrification-Related Sociodemographic and Housing Cost Changes in Major Metropolitan Areas across the United States
Int. J. Environ. Res. Public Health 2021, 18(6), 3315; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063315 - 23 Mar 2021
Viewed by 1032
Abstract
Neighborhood greenspace may attract new residents and lead to sociodemographic or housing cost changes. We estimated relationships between greenspace and gentrification-related changes in the 43 largest metropolitan statistical areas (MSAs) of the United States (US). We used the US National Land Cover and [...] Read more.
Neighborhood greenspace may attract new residents and lead to sociodemographic or housing cost changes. We estimated relationships between greenspace and gentrification-related changes in the 43 largest metropolitan statistical areas (MSAs) of the United States (US). We used the US National Land Cover and Brown University Longitudinal Tracts databases, as well as spatial lag models, to estimate census tract-level associations between percentage greenspace (years 1990, 2000) and subsequent changes (1990–2000, 2000–2010) in percentage college-educated, percentage working professional jobs, race/ethnic composition, household income, percentage living in poverty, household rent, and home value. We also investigated effect modification by racial/ethnic composition. We ran models for each MSA and time period and used random-effects meta-analyses to derive summary estimates for each period. Estimates were modest in magnitude and heterogeneous across MSAs. After adjusting for census-tract level population density in 1990, compared to tracts with low percentage greenspace in 1992 (defined as ≤50th percentile of the MSA-specific distribution in 1992), those with high percentage greenspace (defined as >75th percentile of the MSA-specific distribution) experienced higher 1990–2000 increases in percentage of the employed civilian aged 16+ population working professional jobs (β: 0.18, 95% confidence interval (CI): 0.11, 0.26) and in median household income (β: 0.23, 95% CI: 0.15, 0.31). Adjusted estimates for the 2000–2010 period were near the null. We did not observe evidence of effect modification by race/ethnic composition. We observed evidence of modest associations between greenspace and gentrification trends. Further research is needed to explore reasons for heterogeneity and to quantify health implications. Full article
(This article belongs to the Section Environmental Health)
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Article
A School-Level Examination of the Association between Programs and Policies and Physical Activity Outcomes among Females from the COMPASS Study
Int. J. Environ. Res. Public Health 2021, 18(6), 3314; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063314 - 23 Mar 2021
Cited by 1 | Viewed by 799
Abstract
(1) The majority of Canadian youth are not meeting physical activity guidelines, and more female than male youth are falling short of these recommendations. School programs and policies are a viable strategy to improve youth physical activity. However, they may differentially affect female [...] Read more.
(1) The majority of Canadian youth are not meeting physical activity guidelines, and more female than male youth are falling short of these recommendations. School programs and policies are a viable strategy to improve youth physical activity. However, they may differentially affect female and male activity. This study aimed to examine school-level differences in physical activity outcomes among male and female students and to explore how school programs and policies associate with school-level physical activity outcomes among females. (2) This study used data from 136 schools participating in year 7 (Y7 2018–2019) of the COMPASS study. Data on school programs and policies and on student physical activity were collected. School-level means and percentages for outcomes were calculated and compared between males and females and the impact of physical activity programs and policies on female physical activity outcomes were examined. (3) More males met the guidelines, achieved more strength training days and physical activity minutes compared to females. The number of female varsity sports, community partnerships and fitness ambassadors were all positively and significantly associated with female physical activity. (4) Supportive physical activity environments fostered by offering varsity sports, establishing community partnerships and positive role models may promote physical activity among female youth. Full article
(This article belongs to the Special Issue The Health and Well-Being of Youth: Evidence from the COMPASS System)
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Article
Lifestyle Habits and Mental Health in Light of the Two COVID-19 Pandemic Waves in Sweden, 2020
Int. J. Environ. Res. Public Health 2021, 18(6), 3313; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063313 - 23 Mar 2021
Cited by 10 | Viewed by 2769
Abstract
The COVID-19 pandemic has become a public health emergency of international concern, which may have affected lifestyle habits and mental health. Based on national health profile assessments, this study investigated perceived changes of lifestyle habits in response to the COVID-19 pandemic and associations [...] Read more.
The COVID-19 pandemic has become a public health emergency of international concern, which may have affected lifestyle habits and mental health. Based on national health profile assessments, this study investigated perceived changes of lifestyle habits in response to the COVID-19 pandemic and associations between perceived lifestyle changes and mental health in Swedish working adults. Among 5599 individuals (50% women, 46.3 years), the majority reported no change (sitting 77%, daily physical activity 71%, exercise 69%, diet 87%, alcohol 90%, and smoking 97%) due to the pandemic. Changes were more pronounced during the first wave (April–June) compared to the second (October–December). Women, individuals <60 years, those with a university degree, white-collar workers, and those with unhealthy lifestyle habits at baseline had higher odds of changing lifestyle habits compared to their counterparts. Negative changes in lifestyle habits and more time in a mentally passive state sitting at home were associated with higher odds of mental ill-health (including health anxiety regarding one’s own and relatives’ health, generalized anxiety and depression symptoms, and concerns regarding employment and economy). The results emphasize the need to support healthy lifestyle habits to strengthen the resilience in vulnerable groups of individuals to future viral pandemics and prevent health inequalities in society. Full article
(This article belongs to the Section Exercise and Health)
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Article
Determinants of Population-Based Cancer Screening Performance at Primary Healthcare Institutions in China
Int. J. Environ. Res. Public Health 2021, 18(6), 3312; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063312 - 23 Mar 2021
Cited by 1 | Viewed by 884
Abstract
Background: For a decade, most population-based cancer screenings in China are performed by primary healthcare institutions. To assess the determinants of performance of primary healthcare institutions in population-based breast, cervical, and colorectal cancer screening in China. Methods: A total of 262 primary healthcare [...] Read more.
Background: For a decade, most population-based cancer screenings in China are performed by primary healthcare institutions. To assess the determinants of performance of primary healthcare institutions in population-based breast, cervical, and colorectal cancer screening in China. Methods: A total of 262 primary healthcare institutions in Tianjin participated in a survey on cancer screening. The survey consisted of questions on screening tests, the number of staff members and training, the introduction of the screening programs to residents, the invitation of residents, and the number of performed screenings per year. Logistic regression models were used to analyze the determinants of performance of an institution to fulfil the target number of screenings. Results: In 58% and 61% of the institutions between three and nine staff members were dedicated to breast and cervical cancer screening, respectively, whereas in 71% of the institutions ≥10 staff members were dedicated to colorectal cancer screening. On average 60% of institutions fulfilled the target number of breast and cervical cancer screenings, whereas 93% fulfilled the target number for colorectal cancer screening. The determinants of performance were rural districts for breast (OR = 5.16 (95%CI: 2.51–10.63)) and cervical (OR = 4.17 (95%CI: 2.14–8.11)) cancer screenings, and ≥3 staff members dedicated to cervical cancer screening (OR = 2.34 (95%CI: 1.09–5.01)). Conclusions: Primary healthcare institutions in China perform better in colorectal than in breast and cervical cancer screening, and institutions in rural districts perform better than institutions in urban districts. Increasing the number of staff members on breast and cervical cancer screening could improve the performance of population-based cancer screening. Full article
(This article belongs to the Section Public Health Statistics and Risk Assessment)
Article
What Do Adolescents and Young Adults Think a Cigarillo Is? Implications for Health Communication
Int. J. Environ. Res. Public Health 2021, 18(6), 3311; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063311 - 23 Mar 2021
Viewed by 751
Abstract
Cigarillo use has increased among adolescents and young adults and has remained high. Public education efforts are needed to communicate with these populations about cigarillo use risks, but little is known about the implications of using the term “cigarillo” in such efforts. The [...] Read more.
Cigarillo use has increased among adolescents and young adults and has remained high. Public education efforts are needed to communicate with these populations about cigarillo use risks, but little is known about the implications of using the term “cigarillo” in such efforts. The study goal was to assess adolescent and young adult perceptions of the term “cigarillo”. We conducted a nationally representative online survey of 3517 adolescents and young adults (ages 13–25). We asked participants “what is a cigarillo?” with several response options. Participants were 49.6% female, 69.8% white, 5.2% reported past 30-day cigarillo use, and 11.6% reported lifetime cigarillo use. The most common response to the question “what is a cigarillo” was “I don’t know” (51% of participants), followed by “a thinner and smaller version of a traditional cigar” (30.1% of participants), which was chosen by 19.4% of adolescents and 36.8% of young adults. Among past 30-day cigarillo users, the most common response was “I don’t know” (54.9%) followed by “a thinner and smaller version of a traditional cigar” (45.1%). Cigarillo users were more likely to select the “a thinner and smaller version of a traditional cigar” response than nonusers. Findings suggest that many adolescents and young adults have varied understandings of the term “cigarillo”. Researchers and practitioners need to ensure that terminology used in health communication campaigns is clearly understood by the target audience to maximize effectiveness. Full article
Review
Fowler’s Syndrome—The Cause of Urinary Retention in Young Women, Often Forgotten, but Significant and Challenging to Treat
Int. J. Environ. Res. Public Health 2021, 18(6), 3310; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063310 - 23 Mar 2021
Viewed by 807
Abstract
Urinary retention in young women is a relatively rare clinical problem and is often underdiagnosed. In particular, functional causes of urinary retention pose a diagnostic challenge. One of them is Fowler’s syndrome, which is associated with impaired urethral relaxation. Fowler’s syndrome is characterized [...] Read more.
Urinary retention in young women is a relatively rare clinical problem and is often underdiagnosed. In particular, functional causes of urinary retention pose a diagnostic challenge. One of them is Fowler’s syndrome, which is associated with impaired urethral relaxation. Fowler’s syndrome is characterized by a large bladder capacity, reduced sensation, increased maximal urethral closure pressure, and detrusor underactivity. Several hypotheses have arisen to explain the cause of urethral relaxation disorders: hormonal changes characteristic of Polycystic Ovary Syndrome (PCOS), causing abnormal stabilization of the muscle membrane, primary failure of relaxation of the striated muscle of the urethra sphincter, and increased urethral afferent activity, inhibiting the bladder afferent signals from reaching the brain by potentiating a spinal mechanism of urinary continence. Currently, sacral neuromodulation is the only intervention that can restore an atypical voiding pattern in women with Fowler’s syndrome. The therapeutic effectiveness exceeds 70%, although the revision rate is relatively high, exceeding 50%. Well-designed, long-term prospective studies comparing sacral neuromodulation (SNM) with other therapies such as pelvic floor muscle physiotherapy are warranted to offer the best patient-tailored treatment. Full article
(This article belongs to the Special Issue Obstetrics and Gynecology in Public Health)
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Article
24-h Movement Guidelines and Substance Use among Adolescents: A School-Based Cross-Sectional Study
Int. J. Environ. Res. Public Health 2021, 18(6), 3309; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063309 - 23 Mar 2021
Viewed by 942
Abstract
Children and youth are recommended to achieve at least 60 min/day of moderate-to-vigorous physical activity, no more than 2 h/day of recreational screen time, and a sleep duration of 9–11 h/night for 11–13-year-olds or 8–10 h/night for 14–17-year-olds. Meeting the physical activity, screen [...] Read more.
Children and youth are recommended to achieve at least 60 min/day of moderate-to-vigorous physical activity, no more than 2 h/day of recreational screen time, and a sleep duration of 9–11 h/night for 11–13-year-olds or 8–10 h/night for 14–17-year-olds. Meeting the physical activity, screen time, and sleep duration recommendations have previously been associated with substance use among adolescents. However, previous research has mainly examined these factors individually rather than looking at how these indicators could concurrently relate to substance use in this age group. Therefore, this study examined the associations between meeting the 24-h movement guidelines for screen time, sleep duration, and physical activity (independent variables) with substance use outcomes including alcohol consumption, cannabis use, and cigarette smoking (dependent variables) among adolescents. Self-reported data from a cross-sectional and representative sample of 10,236 students (mean age = 15.1 years) in Ontario, Canada were analyzed. Logistic regression models stratified by gender were adjusted for potential confounders. Combinations of 24-h movement guidelines was differentially associated with substance use in boys and girls. Overall, findings showed that meeting 24-h movement guidelines is associated with lower odds of alcohol consumption, cannabis use, and cigarette smoking differentially with type of recommendation met and gender. Given that the associations between 24-h movement guidelines and substance use differ between boys and girls, future efforts should take this into consideration. Full article
(This article belongs to the Special Issue Physical Activity and Health Behaviors in Children and Adolescents)
Article
Life Satisfaction and Adaptation in Persons with Parkinson’s Disease—A Qualitative Study
Int. J. Environ. Res. Public Health 2021, 18(6), 3308; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063308 - 23 Mar 2021
Cited by 2 | Viewed by 842
Abstract
Persons with Parkinson’s disease (PD) need to adapt to their progressive disability to achieve and maintain a high degree of life satisfaction (LS), but little is known about the meaning of LS and adaptation. This study aimed to gain an in-depth understanding of [...] Read more.
Persons with Parkinson’s disease (PD) need to adapt to their progressive disability to achieve and maintain a high degree of life satisfaction (LS), but little is known about the meaning of LS and adaptation. This study aimed to gain an in-depth understanding of the meaning of LS and adaptation in persons with PD. Open-ended in-depth interviews were performed with 13 persons diagnosed with PD, 9 women, 3 men, and one non-binary person (mean age 54 years, mean time since diagnosis 3.4 years). The interviews were analyzed using a phenomenological–hermeneutic approach. The participants were in the process of adapting to their new health situation. There were two quite distinct groups: one that adapted through acceptance and one that struggled to resist the disease and the profound impact it had on their lives. The thematic structural analysis covers eight themes illustrating the meaning of LS and adaptation, through either acceptance or resistance. Adaptation to PD involves a transitional process characterized by either acceptance or resistance, which influences a person’s LS. Acceptance makes LS possible, whereas resistance constitutes a behavioral barrier to adaptation and LS. Rehabilitation professionals need to understand this individual process to be able to support a person with PD to reach and maintain a high level of LS. Understanding the link between LS and adaptation can support rehabilitation professionals to provide targeted interventions for people with PD. Full article
(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)
Article
Drinking Behavior, Taste Preferences and Special Beer Perception among Romanian University Students: A Qualitative Assessment Research
Int. J. Environ. Res. Public Health 2021, 18(6), 3307; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063307 - 23 Mar 2021
Cited by 3 | Viewed by 948
Abstract
The transition from adolescence to adulthood can be a challenging period for many students. This period is associated with an increase in alcohol consumption (AC) which can develop a drinking behavior or shape the preferences for certain alcoholic beverages. The purpose of this [...] Read more.
The transition from adolescence to adulthood can be a challenging period for many students. This period is associated with an increase in alcohol consumption (AC) which can develop a drinking behavior or shape the preferences for certain alcoholic beverages. The purpose of this study was to analyze the AC pattern among Romanian university students, by investigating the association between taste and consumption, including preferences for special beer. A 30-item omnibus-type questionnaire was distributed to undergraduate students and used to gather sociodemographic data, alcohol expectancies, drinking motives and consequences, and special beer consumption. Results showed a statistically significant relationship between the age of first alcohol use and the existence of an alcoholic family member. The main reasons for AC are taste, sensation, relaxation, and socialization. Both female and male students tend to drink occasionally, with a preference for public places. Female students prefer a sweet taste, choosing special beers over the regular ones. The students’ residence may also influence the choice of special beers. Understanding the students’ drinking behavior and taste preferences is essential to create useful strategies to discourage excessive AC. Special beer, a growing segment in the beverage industry, could represent a healthier and safety alternative to AC. Full article
(This article belongs to the Special Issue Consumer Behaviors, Food, Nutrition, and Human Health)
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Article
Pro-Environmental Behaviors: Determinants and Obstacles among Italian University Students
Int. J. Environ. Res. Public Health 2021, 18(6), 3306; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063306 - 23 Mar 2021
Cited by 3 | Viewed by 1056
Abstract
The awareness of citizens concerning the health risks caused by environmental pollution is growing, but studies on determinants of pro-environmental behaviors have rarely examined health-related aspects. In this study, we investigated these determinants using data from a large survey among Italian university students [...] Read more.
The awareness of citizens concerning the health risks caused by environmental pollution is growing, but studies on determinants of pro-environmental behaviors have rarely examined health-related aspects. In this study, we investigated these determinants using data from a large survey among Italian university students (15 Universities: 4778 filled questionnaires). Besides the health-related aspects, represented by environmental health risk perception and functional health literacy, we considered social and demographic characteristics (gender, area of residence, sources of information, trust in institutional and non-institutional subjects, and students’ capacity of positive actions, indicated as internal locus of control). The attitudes towards pro-environmental behaviors were positive for more than 70% of students and positively related with health risk perception, internal locus of control, and health literacy. The correspondence between the positive attitudes towards pro-environmental behaviors and the real adoption of such behaviors was approximately 20% for most behaviors, except for the separate collection of waste (60%). Such a discrepancy can be attributable to external obstacles (i.e., lack of time, costs, lack of support). The health-related aspects were linked to the pro-environmental attitudes, but to a lesser extent to pro-environmental behaviors, owing to the complexity of their determinants. However, they should be taken in account in planning education interventions. Full article
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Article
Lessons Learned from Replicating a Randomized Control Trial Evaluation of an App-Based Sexual Health Program
Int. J. Environ. Res. Public Health 2021, 18(6), 3305; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063305 - 23 Mar 2021
Viewed by 712
Abstract
This study presents findings from a randomized control trial replication evaluation of Pulse, an app-based pregnancy prevention program implemented with Black and Latinx women aged 18–20, a population with high rates of unplanned pregnancy. We used social media advertisements to enroll 1013 women [...] Read more.
This study presents findings from a randomized control trial replication evaluation of Pulse, an app-based pregnancy prevention program implemented with Black and Latinx women aged 18–20, a population with high rates of unplanned pregnancy. We used social media advertisements to enroll 1013 women online across the U.S. and automatically randomized participants to either the Pulse reproductive health app or a general health control app, stratifying by age and race/Latinx ethnicity. Participants received reminder text messages to view the app as well as text messages with app-related content throughout the intervention. Linear probability models were conducted on the analytic sample of 871 participants who completed the six-week survey and 798 who completed the six-month survey and adjusted for permuted block randomization and multiple hypothesis testing. Compared to the control group, intervention group participants had higher contraceptive knowledge (p = 0.000), which replicates findings from an earlier evaluation. However, these impacts were not sustained at six-month follow-up (p = 0.162). We found no other significant program impacts. This contrasts with an earlier evaluation that found intervention participants were less likely to have had sex without a hormonal or long-acting reversible contraceptive (LARC) method and had greater self-confidence to use contraception consistently than the control group. Different demographic characteristics, lower app usage, and more negative attitudes about and usage of hormonal/LARC contraception in the current sample may help to explain fewer impacts than the earlier evaluation. Full article
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Article
Health Literacy as a Major Contributor to Health-Promoting Behaviors among Korean Teachers
Int. J. Environ. Res. Public Health 2021, 18(6), 3304; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063304 - 23 Mar 2021
Viewed by 744
Abstract
Teachers are not only subjects of school health efforts but also role models for students’ health behaviors; teachers’ health-promoting behaviors can induce students’ healthy behaviors with their positive health outcomes. This study was an examination of personal factors, situational factors, and health literacy [...] Read more.
Teachers are not only subjects of school health efforts but also role models for students’ health behaviors; teachers’ health-promoting behaviors can induce students’ healthy behaviors with their positive health outcomes. This study was an examination of personal factors, situational factors, and health literacy as influences on teachers’ health-promoting behaviors. A hierarchical multiple regression analysis was implemented based on an integrated model of health literacy. The study results showed that health literacy was the strongest predictor of teachers’ health-promoting behaviors. In addition, school type and school culture were situational factors related to the interpersonal relations and stress management domains of the Health-Promoting Lifestyle Profile II scale. These findings could serve as foundational evidence for developing programs at the individual and organizational levels that enhance teachers’ health-promoting behaviors. Full article
(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)
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Article
Mental Health, Greenness, and Nature Related Behaviors in the Adult Population of Stockholm County during COVID-19-Related Restrictions
Int. J. Environ. Res. Public Health 2021, 18(6), 3303; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063303 - 23 Mar 2021
Cited by 1 | Viewed by 1628
Abstract
International data suggest that exposure to nature is beneficial for mental health and well-being. The restrictions related to the COVID-19 pandemic have created a setting that allows us to investigate the importance of greenness exposure on mental health during a period of increased [...] Read more.
International data suggest that exposure to nature is beneficial for mental health and well-being. The restrictions related to the COVID-19 pandemic have created a setting that allows us to investigate the importance of greenness exposure on mental health during a period of increased isolation and worry. Based on 2060 responses from an online survey in Stockholm County, Sweden, we investigated: (1) whether the COVID-19 pandemic changed peoples’ lifestyle and nature-related habits, and (2) if peoples’ mental health differed depending on their exposure to greenness. Neighborhood greenness levels were quantified by using the average normalized difference vegetation index (NDVI) within 50 m, 100 m, 300 m, and 500 m buffers surrounding the participant’s place of residence. We found that the number of individuals that reported that they visited natural areas “often” was significantly higher during the pandemic than before the pandemic. Higher levels of greenness surrounding one’s location of residence were in general associated with higher mental health/well-being and vitality scores, and less symptoms of depression, anxiety, and perceived and cognitive stress, after adjustments for demographic variables and walkability. In conclusion, the results from the present study provided support to the suggestion that contact with nature may be important for mental health in extreme circumstances. Full article
(This article belongs to the Section Environmental Health)
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Article
Secular Trends of Underweight, Overweight, and Obesity in Children and Adolescents from Ukraine
Int. J. Environ. Res. Public Health 2021, 18(6), 3302; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063302 - 23 Mar 2021
Viewed by 683
Abstract
Overweight and obesity, as well as underweight in children and adolescents, pose a significant public health issue. This study aimed to investigate the secular trend of the incidence of underweight, overweight, and obesity in children from Ukraine in 2013/2014 and 2018/2019. The studies [...] Read more.
Overweight and obesity, as well as underweight in children and adolescents, pose a significant public health issue. This study aimed to investigate the secular trend of the incidence of underweight, overweight, and obesity in children from Ukraine in 2013/2014 and 2018/2019. The studies were conducted in randomly selected primary and secondary schools in Ukraine. In total, 13,447 children (6468 boys and 6979 girls) participated in the study in 2013/2014 and 18,144 children (8717 boys and 9427 girls) participated in 2018/2019. Measurements of body weight and height were performed in triplicate. Underweight, overweight, and obesity were diagnosed according to the standards of the World Health Organization (WHO). In the group of girls, a significant difference between 2013/2014 and 2018/2019 measurements was found only among 7-year-olds. The percentage of girls at this age exceeding the body mass index (BMI) norm was lower in the 2018/2019 study. In boys, a significant difference was also found in 7-year-olds, and, as in girls, a lower share of overweight and obesity was found in 2018/2019. But for the ages of 12, 13, and 15, the significant differences had a different character—more overweight or obese boys were found in the 2018/2019 study. The proportion of underweight children was similar for the majority of age groups in both genders and did not differ in a statistically significant way. Full article
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Article
Health Literacy, Digital Health Literacy, and COVID-19 Pandemic Attitudes and Behaviors in U.S. College Students: Implications for Interventions
Int. J. Environ. Res. Public Health 2021, 18(6), 3301; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063301 - 23 Mar 2021
Cited by 7 | Viewed by 2802
Abstract
The COVID-19 pandemic has been accompanied by rapidly emerging evidence, changing guidance, and misinformation, which present new challenges for health literacy (HL) and digital health literacy (DHL) skills. This study explored whether COVID-19-related information access, attitudes, and behaviors were associated with health literacy [...] Read more.
The COVID-19 pandemic has been accompanied by rapidly emerging evidence, changing guidance, and misinformation, which present new challenges for health literacy (HL) and digital health literacy (DHL) skills. This study explored whether COVID-19-related information access, attitudes, and behaviors were associated with health literacy and digital health literacy among college students in the United States. Self-reported measures of health literacy, along with items on pandemic-related attitudes, behaviors, information sources, and social networks, were collected online using a managed research panel. In July 2020, 256 responses were collected, which mirrored the racial/ethnic and gender diversity of U.S. colleges. Only 49% reported adequate HL, and 57% found DHL tasks easy overall. DHL did not vary by HL level. In multivariable models, both HL and DHL were independently associated with overall compliance with basic preventive practices. Higher DHL, but not HL, was significantly associated with greater willingness to get a COVID-19 vaccine and the belief that acquiring the disease would negatively impact their life. On average, respondents discussed health with 4–5 people, which did not vary by HL or DHL measures. The usage of online information sources varied by HL and DHL. The study findings can inform future student-focused interventions, including identifying the distinct roles of HL and DHL in pandemic information access, attitudes, and behaviors. Full article
(This article belongs to the Special Issue eHealth Literacy 2.0)
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Article
Response Activity in Mixed-Method Survey Data Collection—The Methods Used in a Survey among the Foreign-Born Population in Finland (FinMonik)
Int. J. Environ. Res. Public Health 2021, 18(6), 3300; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063300 - 23 Mar 2021
Viewed by 911
Abstract
In terms of the number of respondents, Survey on Well-Being among Foreign Born Population (FinMonik) is so far the most extensive survey carried out among the population with foreign background in Finland. It comprises a wide range of self-reported data, including information on [...] Read more.
In terms of the number of respondents, Survey on Well-Being among Foreign Born Population (FinMonik) is so far the most extensive survey carried out among the population with foreign background in Finland. It comprises a wide range of self-reported data, including information on the respondent’s health, well-being and access to care, which can be widely utilized in planning and assessing integration, health and welfare policies. A mixed-method approach (an electronic questionnaire, a paper questionnaire and phone interviews) was used in collecting the data which consists of responses by 6836 respondents aged 18–64 years. All response types included, the response rate was 53.1% (n = 6836). This study describes in detail the methods used in the FinMonik survey. In addition, we describe the demographics of the respondents partaking in each response format. The aim of the study is to promote the development of mixed-method survey as a way of collecting reliable data that can be used to enhance foreign-born people’s health, well-being and access to health care. The survey responses will be used as a baseline in observing the respondents’ well-being through the register-based data available in several national registers on health, medicine use and access to care as well as the data collected in the study Impact of Coronavirus Epidemic on Well-Being among Foreign Born Population Study (MigCOVID). Furthermore, the FinMonik study protocol will be repeated every four years. Full article
(This article belongs to the Special Issue Data and Methods for Monitoring and Decisions in Public Health)
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Article
Disasters without Borders: The Coronavirus Pandemic, Global Climate Change and the Ascendancy of Gradual Onset Disasters
Int. J. Environ. Res. Public Health 2021, 18(6), 3299; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063299 - 23 Mar 2021
Cited by 1 | Viewed by 1124
Abstract
Throughout much of its history, the sociological study of human communities in disaster has been based on events that occur rapidly, are limited in geographic scope, and their management understood as phased stages of response, recovery, mitigation and preparedness. More recent literature has [...] Read more.
Throughout much of its history, the sociological study of human communities in disaster has been based on events that occur rapidly, are limited in geographic scope, and their management understood as phased stages of response, recovery, mitigation and preparedness. More recent literature has questioned these concepts, arguing that gradual-onset phenomena like droughts, famines and epidemics merit consideration as disasters and that their exclusion has negative consequences for the communities impacted, public policy in terms of urgency and visibility and for the discipline itself as the analytical tools of sociological research are not brought to bear on these events. We agree that gradual-onset disasters merit greater attention from social scientists and in this paper have addressed the two most significant ongoing disasters that are gradual in onset, global in scope and have caused profound impacts on lives, livelihoods, communities and the governments that must cope with their effects. These disasters are the coronavirus pandemic and global climate change both of which include dimensions that challenge the prevailing definition of disaster. We begin with an examination of the foundational work in the sociological study of a disaster that established a conceptual framework based solely on rapidly occurring disasters. Our focus is on several components of the existing framework for defining and studying disasters, which we term “borders.” These borders are temporal, spatial, phasing and positioning, which, in our view, must be reexamined, and to some degree expanded or redefined to accommodate the full range of disasters to which our globalized world is vulnerable. To do so will expand or redefine these borders to incorporate and promote an understanding of significant risks associated with disaster agents that are gradual and potentially catastrophic, global in scope and require international cooperation to manage. Full article
(This article belongs to the Special Issue Urban Disaster Resilience and Sustainability)
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Article
Measuring Satisfaction and Comfort with Gender Identity and Gender Expression among Transgender Women: Development and Validation of the Psychological Gender Affirmation Scale
Int. J. Environ. Res. Public Health 2021, 18(6), 3298; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063298 - 23 Mar 2021
Cited by 1 | Viewed by 908
Abstract
Among transgender and gender diverse people, psychological gender affirmation is an internal sense of valuing oneself as a transgender or gender diverse person, being comfortable with one’s gender identity, and feeling satisfied with one’s body and gender expression. Gender affirmation can reduce gender [...] Read more.
Among transgender and gender diverse people, psychological gender affirmation is an internal sense of valuing oneself as a transgender or gender diverse person, being comfortable with one’s gender identity, and feeling satisfied with one’s body and gender expression. Gender affirmation can reduce gender dysphoria and mitigate deleterious health effects of marginalization. We sought to create an instrument to measure psychological gender affirmation among transgender women. Following initial item development using qualitative interviews, we used self-administered survey data from two distinct samples (N1 = 278; N2 = 368) of transgender women living with HIV in the USA. We used data from Study 1 to perform exploratory factor analysis (EFA) and data from Study 2 to perform confirmatory factor analysis (CFA), yielding the five-item single-factor Psychological Gender Affirmation (PGA) scale with high reliability (α = 0.88). This scale is psychometrically sound as demonstrated by its convergent and discriminant validity via correlations with select measures and by its predictive validity through associations in hypothesized directions with measures of mental health and substance use. The PGA scale will aid research on psychological gender affirmation that can in turn inform interventions as well as gender-affirming clinical and social practices to promote the health and well-being of transgender and gender diverse people. Full article
(This article belongs to the Special Issue Measuring Health Inequities among Vulnerable Populations)
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