Int. J. Environ. Res. Public Health, Volume 21, Issue 3 (March 2024) – 136 articles

Addressing health challenges that impact human well-being requires a comprehensive, interdisciplinary approach that would be at the crossroad of population-based prevention and individual-level clinical care, which is in line with a Global Health perspective. In the absence of a unifying theoretical framework to guide such interventions, a Dynamic Ecosystem Adaptation through the Allostasis (DEA-A) framework has been proposed, emphasizing the functional adaptation of individuals and organizations in symbiosis with their living ecosystem. While a conceptual model has been presented, this methodological contribution aims at illustrating the practical application of the DEA-A framework for planning Global Health interventions. The methodology combines Intervention Mapping and Cognitive and Behavioral Theory, extended to the ecosystem. Practical guidelines and supporting tools are provided to help public health providers and clinicians in establishing a functional ecosystem diagnosis of the issue; defining not only behavioral, but also emotional and cognitive change objectives (allostasis targets) expected for each stakeholder; and designing intervention plans targeting determinants of these allostasis. The discussion addresses implementation and evaluation perspectives of interventions based on the DEA-A framework, emphasizing the importance of considering change in its processual and ecosystem complexity. Lastly, encouragements for a deeper understanding of individual and ecosystem homeostasis/allostasis processes are made in order to promote more functional interventions. Full article

Home health care companies provide health care services to patients in their homes. Due to increasing demand, the provision of home health care services requires effective management of operational costs while satisfying both patients and caregivers. In practice, uncertain service times might lead to considerable delays that adversely affect service quality. To this end, this paper proposes a new bi-objective optimization problem to model the routing and scheduling problems under uncertainty in home health care, considering the qualification and workload of caregivers. A mixed-integer linear programming formulation is developed. Motivated by the challenge of computational time, we propose the Adaptive Large Neighborhood Search embedded in an Enhanced Multi-Directional Local Search framework (ALNS-EMDLS). A stochastic ALNS-EMDLS is introduced to handle uncertain service times for patients. Three kinds of metrics for evaluating the Pareto fronts highlight the efficiency of our proposed method. The sensitivity analysis validates the robustness of the proposed model and method. Finally, we apply the method to a real-life case and provide managerial recommendations. Full article

Background: PrEP, a biomedical HIV prevention option, continues to be underutilized among transgender women who could benefit from sustained use, especially women of color and those who identify as Latina and/or reside in the southeastern US. Objective: We explored the barriers and facilitators experienced by transgender women who live in Florida regarding accessing, using, and/or staying on PrEP. Methods: In-depth interviews and focus groups were conducted in either Spanish or English with adult transgender women living in Florida (N = 22). The interviews were audio-recorded, transcribed, and coded in ATLAS.ti using thematic analyses. Results: The mean age of the participants was 42.2 years. Among the participants, 73% were Hispanic/Latina, 59% were foreign-born, and approximately one-third were living with HIV (but had past experience with PrEP). Transgender women cited the following barriers to accessing or considering PrEP: (1) costs and benefits of PrEP use; (2) under-representation in clinical trials resulting in unknown or misinformation regarding PrEP side effects; (3) chronic poverty; and (4) trauma and discrimination. Other stressors, such as behavioral healthcare needs, were identified. Conclusions: Our analysis revealed interlocking systems of oppression like transphobia, discrimination, and misgendering, which were common barriers experienced by our participants. These synergistically epidemic (i.e., syndemic) barriers contributed to their feelings of being systematically excluded in social spaces, research, public health planning and policies, laws, and social programs related to PrEP. These structural barriers are impediments to HIV preventive care but also act as a source of stress that contributes to mental health problems, financial vulnerability, substance abuse, and other deleterious health outcomes. Full article

Research into digital interventions for mental well-being promotion has grown in recent years, fuelled by the need to improve mental health prevention strategies and respond to challenges arising from the coronavirus (COVID-19) pandemic. This bibliometric analysis provides a structured overview of publication trends and themes in primary research studies reporting an array of digital interventions indexed at WoS from 2004 to 2023. Bibliometric data were collected on a sample of 1117 documents and analysed using the Biblioshiny package. Supplemental network visualisation analysis was conducted using VosViewer. The study, based on Web of Science and Scopus databases, indicates a marked increase in publications post-2020. There were seven groups of research themes clustered around “Mindfulness”, “Anxiety”, “COVID-19”, “Acceptance and Commitment Therapy”, “Depression”, “Web-based”, and “Positive Psychology”. Further, results demonstrated the growth of specific themes (e.g., mindfulness, mhealth), the defining impact of COVID-19 studies, and the importance of both randomised controlled trials and formative research. Overall, research in the field is still early in its development and is expected to continue to grow. Findings highlight the field’s dynamic response to societal and technological changes, suggesting a future trajectory that leans increasingly on digital platforms for mental health promotion and intervention. Finally, study limitations and implications for future studies are discussed. Full article

The COVID-19 pandemic has exacerbated health and social inequities among migrant groups more than others. Higher rates of poverty, unemployment, living in crowded households, and language barriers have placed resettled refugees at a higher risk of facing disparities during the COVID-19 pandemic. To understand how this most vulnerable population has been impacted by the ongoing pandemic, this study reports on the responses of 128 Iraqi refugees in the city of London, Ontario, to a survey on the economic, social, and health-related impacts that they have faced for almost two years since the beginning the pandemic. The analysis of the survey indicated that 90.4% of the study population reported having health concerns during the pandemic while 80.3% expressed facing financial distress. The results also show that 58.4% of respondents experienced some form of social isolation. These all suggest that refugees are faced with several barriers which can have a compounding effect on their resettlement experience. These findings provide resettlement and healthcare providers with some information that may assist in reducing the impact of COVID-19 and other possible health security emergencies on resettled refugees and their communities. Full article

Prior work has suggested that discrimination and immigration-related stress may impede mental health care seeking and utilization among Latinx populations. These effects may be more nuanced as both discrimination and immigration-related stress may increase symptomology, particularly post-traumatic stress disorder (PTSD) and depression. Both symptoms may, in turn, prompt attempts to seek care. The current study examined the direct effects of discrimination and immigration-related stress on care access, as well as potentially indirect effects with PTSD and depression symptoms as mediators. Interviews and online surveys were completed with 234 Latinx residents of the Midwest, assessing everyday discrimination, discrimination in healthcare, PTSD symptoms, depression symptoms, current mental health utilization, and previous unsuccessful attempts to seek care. Direct effects of discrimination and immigration-related stress were largely unrelated to care access variables. Discrimination in healthcare settings predicted both unsuccessful attempts to seek care and current use, but this effect was positive. The indirect effect was largely supported, but only for PTSD symptoms and not depression. Results indicate that further investigation is necessary to understand the direct effects of discrimination on care access. Further, discrimination and immigration-related stress may indirectly prompt attempts to seek mental health care. Full article

As the world grappled with the COVID-19 pandemic, healthcare workers (HCWs) continued to provide uninterrupted health care service delivery; therefore, this disproportionately affected their wellbeing. Our study explored the wellbeing of HCWs during the COVID-19 era in public health facilities in the City of Johannesburg, Gauteng province, South Africa. A qualitative study was conducted among twenty (20) HCWs through face-to-face in-depth interviews (IDIs) in the form of semi-structured interviews, audiotapes, and transcribed verbatim, and thematically analyzed with NVivo version 10. The findings showed that over half of HCWs (aged between 27 and 60 years) tested positive for COVID-19. Also, one third of HCWs’ family members tested positive while some died due to COVID-19 infection. Informed by the workers’ wellbeing framework, four themes emerged with fourteen sub-themes. Firstly, unsafe work environment was characterized by human resource related challenges such as increased workload; staff shortage; insufficient resources, e.g., personal protective equipment (PPE); poor policies in terms of compensation/allowance for being infected with COVID-19; poor health services; and death of colleagues. Secondly, poor health outcomes were described as strained emotional (psychosocial distress) and physical (respiratory related conditions) wellbeing. Thirdly, home and community environments were negatively impacted by interrupted relationships with family and friends, and experiences of deaths of loved ones. Finally, HCWs engaged personal wellbeing strategies through self-motivation; staying positive; family support; and participating in resilience-promoting extra mural activities to cope during the pandemic. In conclusion, the wellbeing of HCWs was aggravated during the COVID-19 era and led to low morale and compromised healthcare quality. This study advocates for promotion of greater resilience, and psychological and physical safety of HCWs through evidence-based, multilevel-multicomponent interventions at the workplace, home, and community environments in addition to strengthening public health policies and response to future pandemics. Full article

This study compared physiological responses to two work/rest cycles of a 2:1 work-to-rest ratio in a hot environment. In a randomized crossover design, fourteen participants completed 120 min of walking and rest in the heat (36.3 ± 0.6 °C, 30.2 ± 4.0% relative humidity). Work/rest cycles were (1) 40 min work/20 min rest [40/20], or (2) 20 min work/10 min rest [20/10], both completing identical work. Core temperature (T_c), skin temperature (T_sk), heart rate (HR), nude body mass, and perception of work were collected. Comparisons were made between trials at equal durations of work using three-way mixed model ANOVA. T_c plateaued in [20/10] during the second hour of work (p = 0.93), while T_c increased in [40/20] (p < 0.01). There was no difference in maximum T_c ([40/20]: 38.08 ± 0.35 °C, [20/10]: 37.99 ± 0.27 °C, p = 0.22) or end-of-work T_sk ([40/20]: 36.1 ± 0.8 °C, [20/10]: 36.0 ± 0.7 °C, p = 0.45). End-of-work HR was greater in [40/20] (145 ± 25 b·min⁻¹) compared to [20/10] (141 ± 27 b·min⁻¹, p = 0.04). Shorter work/rest cycles caused a plateau in T_c while longer work/rest cycles resulted in a continued increase in T_c throughout the work, indicating that either work structure could be used during shorter work tasks, while work greater than 2 h in duration may benefit from shorter work/rest cycles to mitigate hyperthermia. Full article

Interest in catering for public sector schools is increasing due to its potential role in addressing the prevailing problems of malnutrition, food insecurity and non-sustainable food habits. Based on the case of secondary schools in Berlin, this study aims to explore this potential by focusing on the process of transformation towards healthy, inclusive and sustainable school catering. It employs a multi-perspective analysis based on the two concepts of food environment and social cohesion. Results are based on quantitative and qualitative data collected via an online survey of pupils from 25 secondary schools in Berlin as well as field notes from six stakeholder events. The survey findings were analyzed by descriptive means and provide explanations for the fact that most of the pupils (66.7%) never eat lunch at school. Based on the qualitative analysis of the stakeholder events, key tensions between actors from the federal state, municipal, school and private levels could be identified. Major areas of conflict arise due to (1) a lack of public funding and catering standards, (2) incompatible demands and preferences, (3) a lack of resources and opportunities for complementary education and participation, and (4) peer and parental influence. Transforming school food environments requires integrative strategies with interventions introduced by multiple actors operating on different levels. Full article

Considerable empirical evidence suggests early recognition of autism and access to support result in long-term positive outcomes for children and youth on the spectrum and their families. However, children of racialized families are often diagnosed at later ages, are more likely to be misdiagnosed, and experience many barriers to service access. There is also a paucity of research exploring the experiences of parents from specific immigrant groups caring for their children on the spectrum in Canada, many of whom identify as members of racialized communities. As such, the main aim of the study was to examine how South Asian immigrant parents in Canada are experiencing available care programs and support. Another aim was to examine their perceptions of social stigma associated with autism. We conducted an inductive thematic analysis of qualitative data from nine interviews with South Asian parents living in Ontario, Canada. Findings confirmed barriers to an autism diagnosis and to service access. Additionally, parents reported pronounced autism stigma, which enacted impediments to timely diagnosis, service access, and health-promoting behaviors. Findings also revealed that parents experience considerable caregiver stress and psychological distress. The generated evidence is anticipated to inform equitable policy, programming, and practices that better support the needs of children on the spectrum and their immigrant families. Full article

The Black populations, often treated as ethnically homogenous, face a constant challenge in accessing and utilizing healthcare services. This study examines the intra-group differences in health-seeking behavior among diverse ethnic subgroups within Black communities. A cross-sectional analysis included 239 adults ≥18 years of age who self-identified as Black in the United States and Canada. Multiple logistic regression assessed the relationship between health-seeking behaviors and ethnic origin, controlling for selected social and health-related factors. The mean age of the participants was 38.6 years, 31% were male, and 20% were unemployed. Sixty-one percent reported a very good or excellent health status, and 59.7% were not receiving treatment for chronic conditions. Advancing age (OR = 1.05, CI: 1.01–1.09), female gender (OR = 3.09, CI: 1.47–6.47), and unemployment (OR = 3.46, CI: 1.35–8.90) were associated with favorable health-seeking behaviors. Compared with the participants with graduate degrees, individuals with high school diplomas or less (OR = 3.80, CI: 1.07–13.4) and bachelor’s degrees (OR = 3.57, CI: 1.3–9.23) were more inclined to have engaged in favorable health-seeking behavior compared to those with graduate degrees. Across the Black communities in our sample, irrespective of ethnic origins or country of birth, determinants of health-seeking behavior were age, gender, employment status, and educational attainment. Full article

It is well known that parental depression is correlated to adverse child mental health outcomes; but what is the effect of treating parental depression on the child? This narrative review aims to explore this question, and how certain specific interventions designed to help depressed parents affect mental health outcomes in their children. The academic database APA PsychInfo was searched for articles that broadly included interventions for parents with depression as well as child wellbeing or outcomes as of October 2023. Additional searches were conducted in the academic database PubMed in December 2023 and January 2024. Forty-nine articles met the inclusion criteria and were examined closely for this review. The studies included were divided into the following categories: psychotherapy, psychopharmacology, parenting support, and paternal interventions. We discuss the implications of our review on clinical practice and recommend further research in this area. Full article

(1) Background: Environmental risks such as air pollutants pose a threat to human health and must be communicated to the affected population to create awareness, such as via health literacy (HL); (2) Methods: We analyzed HL in the context of environmental health risks, including sources of information and prior knowledge, in a sample from the German general population using Kendall’s rank correlations, regression analyses, and explorative parallel mediation analysis; (3) Results: The survey included 412 German participants aged between 18 and 77. HL was found to be problematic to inadequate. The internet, family and friends, and newspapers were the most frequently cited sources of information. Mobile apps were mostly unknown but were requested by sample subjects. Although subjects expressed environmental concerns and exhibited rather good levels of knowledge, the majority perceived no risk to human health and rated air quality quite positively. Knowledge on particulate matter, the term “ultrafine particles”, and protective measures was found to be rather low. HL was associated with the use of newspapers and commercials as sources of information. The relationship between age and HL is fully mediated by the use of newspapers and information from TV commercials; (4) Conclusions: HL should be promoted by raising awareness of the health effects of environmental pollutants. In particular, the information channels preferred by the affected population should be used and further information opportunities such as apps should be publicized, e.g., through campaigns. An improved HL can assist policy makers in creating a healthier environment by empowering individuals to become more environmentally aware and protect their own health. This, in turn, has the potential to reduce health-related costs. Full article

The longevity and healthy ageing observed in Blue Zones offer valuable insights for contemporary urban neighbourhood planning and design. This paper reviews the age-friendly features of the built environment in Blue Zones, aiming to translate these insights into actionable strategies for urban neighbourhood development. Employing a systematic literature review and Convolutional Neural Networks (CNNs) analysis of Google Street View imagery, this study assesses the built environments in Blue Zones, including housing, public spaces, and transportation systems. Key findings highlight the presence of adaptable housing, building designs that foster a connection with nature, and semi-public spaces that encourage social interaction and physical activity. A notable emphasis on walkability and limited public transport access was observed. The CNN analysis corroborated these findings, providing a quantitative view of age-friendly features. This research contributes to the academic discourse in urban planning and design by providing practical insights for developing age-friendly neighbourhoods, inspired by Blue Zones. It concludes by offering policy advice and future research directions for creating sustainable and inclusive urban environments conducive to ageing populations. Full article

The present research aimed to examine bullying among diverse Arab nationalities residing in Qatar across two separate studies. Study 1 examined how Arabic-speaking adolescents and adults describe and perceive bullying, participants (N = 36) from different Arab nationalities (i.e., Egyptians, Qataris, Syrians, and other Arabs) were presented with three tasks in a focus group where they were asked questions about how they describe and perceive three scenarios without reference to the term “bullying”. Findings indicated that (1) the majority of participants referred to the intention to cause harm and the imbalance of power in their descriptions, and (2) differences in describing the behaviours in the scenarios were notable when comparing Egyptians with the three other nationalities. Overall, participants frequently chose different Arabic terms (e.g., Ta’adi (تعدي)) in their descriptions of the scenarios. Interestingly, the term Tanammor (تنمُّر), which has been used in previous studies as the Arabic term for bullying, was chosen the least by the current sample. Study 2 examined how Arab-speaking students (N = 117) describe bullying behaviour in seven scenarios using Arabic and English terms. The procedure was administered in English in the international schools, and Arabic in the independent schools. English-speaking students often used the term “bullying”, whereas Arabic-speaking students often used behavioural descriptions (e.g., the term “solok sayea” (سلوك سيء) which translates to “bad behaviour”). These findings are discussed in relation to the definition and perspective of bullying among Arabic speakers. There is a need for further investigations to introduce a novel term for bullying within the Arabic language while considering cultural values, norms, and beliefs. This has the potential to promote heightened awareness and comprehension, enabling the formulation of customised intervention approaches, policies, and educational initiatives intended to prevent and alleviate bullying behaviours. Full article

Violence against paramedics is increasingly recognized as an important occupational health problem, but pervasive and institutionalized underreporting hinders efforts at risk mitigation. Earlier research has shown that the organizational culture within paramedicine may contribute to underreporting, and researchers have recommended involving paramedics in the development of violence prevention policies, including reporting systems. Eighteen months after the launch of a new violence reporting system in Peel Region, Ontario, Canada, we surveyed paramedics about their experiences reporting violent encounters. Our objectives were to assess their willingness to report violence and explore factors that influence their decisions to file a report. Between September and December 2022, a total of 204 (33% of eligible) paramedics chose to participate, of whom 67% (N = 137) had experienced violence since the launch of the new reporting process, with 83% (N = 114) reporting the incidents at least some of the time. After thematically analyzing free-text survey responses, we found that the participants cited the accessibility of the new reporting process and the desire to promote accountability among perpetrators while contributing to a safer workplace as motivating factors. Their decisions to file a report, however, could be influenced by the perceived ‘volitionality’ and severity of the violent encounters, particularly in the context of (un)supportive co-workers and supervisors. Ultimately, the participants’ belief that the report would lead to meaningful change within the service was a key driver of reporting behavior. Full article

The prevalence of dementia increases with nearly 10 million new cases each year, with Alzheimer’s disease contributing to 60–70% of cases. Environmental factors such as drinking water have been evaluated to determine if a relationship exists between trace elements in drinking water and the risk of developing cognitive disorders in the elderly. The purpose of the current systematic review was to evaluate an association between the composition of drinking water and cognitive function in the elderly. In accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, a literature search was conducted using PubMed and CINAHL databases. A total of 10 studies were included in the current systematic review. Aluminum is the most commonly evaluated trace element in studies (n = 8), followed by silica (n = 5), calcium (n = 4), and fluoride (n = 4). Aluminum exposure showed an increased risk of cognitive decline in four studies, with no association reported in the other studies. Higher silica and pH levels were shown to be protective against a decline in cognitive function. A similar protective effect of calcium was found in two studies. Future research should measure multiple trace mineral levels in all water sources to evaluate the impact on cognitive function. Full article

Electronic Heath Records (EHRs) play vital roles in facilitating streamlined service provision and governance across the Australian health system. Given the recent challenges due to the COVID-19 pandemic, an ageing population, health workforce silos, and growing inefficiencies in traditional systems, a detailed historical analysis of the use of EHR research in Australia is necessary. The aim of this study is to examine the trends and patterns in EHR research in Australia over the past three decades by employing bibliometric methods. A total of 951 articles published in 443 sources were included in the bibliometric analysis. The annual growth rate of EHR research in Australia was about 17.1%. Since 2022, the main trending topics in EHR research were COVID-19, opioid usage, and natural language processing. A thematic analysis indicated aged care, clinical decision support systems, cardiovascular disease, drug allergy, and adverse drug reaction as the “hot” themes in EHR research in Australia. This study reveals a significant uptrend in EHR research in Australia, highlighting the evolving intellectual and collaborative landscape of this interdisciplinary field. The data also provide guidance for policymakers and funding institutions in terms of the most significant contributions and key fields of research while also holding public interest. Full article

Assuring home care (HC) workers’ safety is challenging because the work environment is a private home. This paper presents the process evaluation for a proof-of-concept safety intervention study to assess whether nurse-led safety coaching, using motivational interviewing and a safety handbook, could enable HC clients to improve safety in their homes. The process evaluation objectives were to (i) document the intervention’s implementation progress and (ii) assess the intervention’s dose delivery, dose reception, and fidelity. Five agencies employing liaisons (n = 5) and nurse managers (NMs, n = 8) implemented this study’s intervention and control arms. NMs assigned to the intervention arm (n = 6) coached 34 clients. Process evaluation metrics were assessed with mixed-methods data from (i) surveys completed by NMs during the intervention, (ii) postintervention audio-recorded and transcribed interviews (n = 6) with NMs and liaisons, and (iii) study progress tracking tools. The delivered dose efficiency was 85%, measured by the distribution of safety handbook copies to clients. About 94% of clients (n = 32) were considered “engaged” or “maybe engaged” during the safety coaching. Most coached clients (n = 30) were reachable for follow-up by NMs to assess intervention progress. Despite challenges, the intervention was implemented with good fidelity. Safety coaching can be applied in many HC contexts in larger populations. Full article

Background: Bangladesh has achieved remarkable progress in reducing maternal mortality, yet postpartum deaths remain a significant issue. Emphasis on quality postnatal care (qPNC) is crucial, as increased coverage alone has not sufficiently reduced maternal morbidity and mortality. Methods: This study included data from the Bangladesh Maternal Mortality Survey of 32,106 mothers who delivered within three years prior to the survey. Descriptive statistics were used to report coverage and components of postnatal care stratified by covariates. Log-linear regression models were used to assess the determinants of quality postnatal care among facility and home births. Results: From 2010 to 2016, postnatal care coverage within 48 h of delivery by a qualified provider rose from 23% to 47%. Of the births, 94% were facility births that received timely PNC, contrasted with only 6% for home births. Despite the increased coverage, quality of care remained as low as 1% for home births and 13% for facility births. Key factors affecting qPNC utilization included socio-demographic factors, pregnancy complications, type of birth attendant, delivery method, and financial readiness. Conclusion: Importantly, deliveries assisted by skilled birth attendants correlated with higher quality postnatal care. This study reveals a significant gap between the coverage and quality of postnatal care in rural Bangladesh, especially for home births. It underscores the need for targeted interventions to enhance qPNC. Full article

Residents in nursing homes are fragile and at high risk of serious illness or death from healthcare-associated infections. The COVID-19 pandemic posed a significant risk of suffering and mortality for residents of nursing homes. Surveillance of infections is essential for infection prevention and is missing in many countries. The aim of this study is to explore infection rates and antibiotic use in nursing homes during the COVID-19 pandemic. Data collection was conducted from February to September 2021. Each week, healthcare workers at 21 nursing home wards answered a questionnaire on infections, antibiotic use, deaths, and hospital admissions related to infections. A total of 495 infections were reported, and 97.6% were treated with antibiotics. The total infection rate was 5.37 per 1000 bed days, and there were reported 53 hospital admissions and 11 deaths related to or caused by infections. The infection rate and high use of antibiotics found in this study indicated that it is difficult to treat infections in residents in nursing homes and make it difficult to achieve the global goal of reducing infections and antibiotic resistance rates. This emphasizes the need for stricter infection control programs to reduce antibiotic use and patient suffering. Full article

Grief after suicide or patient-perpetrated homicide can be complex for those involved in the patient’s care. Mental health practitioners with patients who die unexpectedly may be called to assist in the formal investigation processes that follow. The aim of this study was to examine the experience of mental health practitioners called to attend a coroner’s inquest or other forms of formal inquiry. A protocol for a systematic review was prospectively registered on PROSPERO (CRD42023400310). A thematic synthesis of existing literature was conducted. We identified six articles for inclusion and constructed three themes from our analysis: Blame and enduring hostility, In the dark, and Limited learning. We found mental health practitioners may construct narratives of self-blame. These can be reinforced by the investigatory processes that follow. Feedback from inquiries is often delivered haphazardly and may not reflect the realities of clinical work. The support given to assist practitioners through inquiry processes varied—both in amount and how helpful it was. The research conducted on this topic is limited. More qualitative research should be conducted to understand the factors that make this experience more or less difficult as well as well as what support is needed for whom. Full article

Food and/or housing instability (FHI) has been minimally examined in post-9/11 US veterans. A randomly selected nationally representative sample of men and women veterans (n = 38,633) from the post-9/11 US veteran population were mailed invitation letters to complete a survey on health and well-being. Principal component analysis and multivariable logistic regression were used to identify FHI’s key constructs and correlates for 15,166 men and women respondents (9524 men, 5642 women). One-third of veterans reported FHI; it was significantly more likely among women than men (crude odds ratio = 1.31, 95% CI:1.21–1.41) and most prevalent post-service (64.2%). “Mental Health/Stress/Trauma”, “Physical Health”, and “Substance Use” were FHI’s major constructs. In both sexes, significant adjusted associations (p < 0.01) were found between FHI and homelessness, depression, adverse childhood experiences, low social support, being enlisted, being non-deployed, living with seriously ill/disabled person(s), and living in dangerous neighborhoods. In men only, posttraumatic stress disorder (adjusted odds ratio (AOR) = 1.37, 95% CI:1.14–1.64), cholesterol level (elevated versus normal, AOR = 0.79, 95% CI:0.67–0.92), hypertension (AOR = 1.25, 95% CI:1.07–1.47), and illegal/street drug use (AOR = 1.28, 95% CI:1.10–1.49) were significant (p < 0.01). In women only, morbid obesity (AOR = 1.90, 95%CI:1.05–3.42) and diabetes (AOR = 1.53, 95% CI:1.06–2.20) were significant (p < 0.05). Interventions are needed that jointly target adverse food and housing, especially for post-9/11 veteran women and enlisted personnel. Full article

This study investigates the impact of experienced contact on prejudiced attitudes towards individuals with intellectual disabilities (IDs), examining beliefs in a just world (BJW) and social dominance orientation (SDO) as potential serial mediators. Data were collected from 224 university students (M = 23.02, SD = 2.48). Path analysis modelling assessed the structural relationships between the study variables. The findings revealed that experienced contact was negatively and significantly associated with BJW and SDO. Additionally, BJW and SDO fully mediated the relationship between experienced contact and overt prejudice. These findings underscore the influence of individual differences on attitudes towards individuals with ID, establishing a crucial foundation for future research and the development of interventions aimed at reducing prejudice and discrimination. Full article

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age. It increases the risk of type 2 diabetes, cardiovascular disease, endometrial cancer, infertility, gestational diabetes, preeclampsia, and preterm birth. Accurately identifying predictors of these health risks is crucial. Electronic health records (EHRs) offer an affordable approach, however, the validity and reliability of EHRs for PCOS diagnosis are unclear. A scoping review of the literature on the prevalence and reliability of the diagnosis of PCOS using EHRs was performed. An analysis of the feasibility of obtaining diagnostic variables from a PCOS patient database was also carried out. Eight studies met the criteria. The prevalence of PCOS ranged from 0.27% to 5.8%. Reliability varied, with one study reporting a sensitivity of 50% and a specificity of 29%. Another study found a 74.4% agreement between international classification of disease (ICD) codes and clinical criteria. The database analysis found only 13.7%, 8%, and 7.5% of women had all the necessary variables for an objective diagnosis of PCOS using the Rotterdam, National Institutes of Health (NIH), and Androgen Excess and PCOS Society (AEPCOS) criteria, respectively. Using EHRs results in an underestimation of PCOS prevalence compared to other diagnostic criteria, and many women identified may not meet the complete diagnostic criteria. These findings have implications for future research studies on PCOS prevalence and related health risks. Full article

Background: Community health workers (CHWs) cover extensive areas observing the environmental conditions in which community members live. However, current CHW training modules do not have modules focusing specifically on environmental health. CHWs appear to lack knowledge of environmental health hazards, and little is known of their attitudes and practices regarding environmental health hazards. The purpose of this study was to determine the knowledge, attitudes, and practices of CHWs in relation to environmental health hazards in the Nelson Mandela Bay (NMB). Methods: This study used a quantitative, cross-sectional research design. A sample of 110 respondents completed the questionnaire. The questionnaire was based on the literature, consisting of 36 items in four sections. Data analysis consisted of descriptive and inferential statistics. Reliability and validity were enhanced by utilizing a pre-test study. Results: There were significant differences in attitudes (t = −2.308, df = 91.107, p = 0.023) and practices (t = −2.936, df = 62.491, p = 0.005). Those trained in environmental health had a significantly lower mean attitudes score (m = 3.2365, sd = 1.113) compared to those not trained in environmental health (m = 3.694, sd = 0.894). In addition, those trained in environmental health had a significantly lower mean practice score (practiced more frequently) (m = 1.231, sd = 0.327) compared to those not trained in environmental health (m = 1.4605, sd = 0.4162). Regarding training, 62% (n = 67) of CHWs felt they needed additional training in environmental health. Conclusion: Most of the CHWs had a moderate knowledge of environmental health hazards. Furthermore, most of the CHWs had a very positive or positive attitude towards environmental health hazards. However, there is a need for CHWs to receive very specific training in environmental health. In addition, the scope of work of CHWs, as well as their role in relation to environmental health, needs to be further explored. Full article

Violence has immediate and long-term repercussions for the health of individuals and communities. Recent increases in the understanding of public health approaches to violence prevention have focused on the policies and practices of government, health, and other public sector agencies. However, the roles of commercial bodies in fostering and preventing violence remain largely unaddressed. The wealth and influence of some companies now exceeds that of many countries. Consequently, it is timely to explore the roles of commercial processes in violence. Using a conceptual framework for the commercial determinants of health, we examine seven practices: political; scientific; marketing; supply chain and waste; labor and employment; financial; and reputational management. We include areas directly linked with violence (e.g., firearms) and those that indirectly impact violence through the following: design and promotion of products; employment practices; and impacts on environment, poverty, and local resources. A range of avoidable commercial behaviors are found to increase levels of violence including the following: lobbying practices; distortion of scientific processes; polluting manufacture and supply lines; poor employee protections; financial investment in organizations and regimes associated with violence; and misleading communications and marketing. We conclude commercial actors can take action to ensure their workers, clients, suppliers, and distributors help prevent, not promote, violence. New technologies such as artificial intelligence are transforming corporate processes and products and offer opportunities to implement violence prevention through commercial developments (e.g., monitoring online content). International regulation of commercial behaviors is needed to prevent interpersonal and interstate conflict and harms to health and trade. Full article

Effective communication by governmental organizations is essential to keep the public informed during a public health emergency. Examining the content of these communications can provide insight into their alignment with best practices for risk communication. We used content analysis to determine whether news releases by the Ontario government contained key elements of effective risk communication, as outlined by the Health Canada and Public Health Agency of Canada Strategic Risk Communication Framework. News releases between 25 January 2020 and 31 December 2022 were coded following the five elements of the framework: situational transparency, stakeholder-centered content; evidence-based rationales for decisions; continuous improvements in updating information; and descriptions of risk management. All 322 news releases contained at least one element of the framework, and all five elements were identified at least once across the dataset. Risk management, transparency, and stakeholder-centered content were the most frequently identified elements. News releases near the beginning of the pandemic contained most elements of the framework; however, over time, there was an increase in the use of vague language and lack of evidence-based rationales. Increasing transparency regarding evidence-based decisions, as well as changes in decisions, is recommended to improve risk communication and increase compliance with public health measures. Full article

Since a single forest walk (Shinrin-yoku or forest bathing) session is reported to improve sleep temporarily, occasional forest walks may have a positive effect on daily sleep. Therefore, this study aimed to examine whether more frequent forest walking is associated with better daily sleep conditions. Data from the second survey of the Japan Multi-Institutional Collaborative Cohort (J-MICC) Daiko Study conducted among residents of Nagoya City, Japan, were used. The study design was a cross-sectional study. In total, 2044 participants (529 men and 1515 women; age, mean ± standard deviation: 58.8 ± 9.9 years) were included in the analysis. Frequent forest walks were associated with a low percentage of insomnia symptoms (Insomnia Severity Index ≥10) in women, but not in men. The adjusted odds ratio for the group that rarely took forest walks with reference to the group that engaged in the activity once a month or more often was 2.04 (95% confidence interval: 1.29–3.23) in women. Forest walk frequency was not significantly associated with sleep duration or sleep efficiency as measured by actigraphy in either men or women. In conclusion, the results suggested that increasing the frequency of forest walks or Shinrin-yoku may be effective in preventing insomnia in women. Full article

The Work Ability Index (WAI) is the most widely used questionnaire for the self-assessment of working ability. Because of its different applications, shorter versions, and widespread use in healthcare activities, assessing its characteristics is worthwhile. The WAI was distributed online among the employees of a healthcare company; the results were compared with data contained in the employees’ personal health records and with absence registers. A total of 340 out of 575 workers (59.1%) participated; 6.5% of them reported poor work ability. Exploratory factor analysis indicated that the one-factor version best described the characteristics of the WAI. The scores of the complete WAI, the shorter form without the list of diseases, and the minimal one-item version (WAS) had equal distribution and were significantly correlated. The WAI score was inversely related to age and significantly lower in women than in men, but it was higher in night workers than in their day shift counterparts due to the probable effect of selective factors. The WAI score was also correlated with absenteeism, but no differences were found between males and females in the average number of absences, suggesting that cultural or emotional factors influence the self-rating of the WAI. Workers tended to over-report illnesses in the online survey compared to data collected during occupational health checks. Musculoskeletal disorders were the most frequently reported illnesses (53%). Psychiatric illnesses affected 21% of workers and had the greatest impact on work ability. Multilevel ergonomic and human factor intervention seems to be needed to recover the working capacity of healthcare workers. Full article