Int. J. Environ. Res. Public Health, Volume 20, Issue 22 (November-2 2023) – 60 articles

Background: Mental-health-related stigma prevents active help seeking and therefore early therapeutic approaches and the recovery of functionality. National and international agencies recommend the implementation of prevention and mental health promotion programs that support the elimination of stigma in the classroom, since most mental health problems usually start in the adolescent stage. In view of the evidence that teachers present stigmatizing attitudes towards mental health, it has been considered as convenient to carry out an anti-stigma program with the main objective of evaluating the impact of an intervention based on the education and promotion of mental health, aimed at teachers and counsellors of a secondary school. The specific objectives were to get to know which were the most stigmatising attitudes that prevailed in the sample before and after the intervention; to evaluate the knowledge of the teaching staff and counsellors on psychosis before the intervention; to analyse correlations between clinically relevant variables; and assess whether this programme was beneficial and feasible for alphabetising counsellors/teachers of educational centres on stigma and FEP. Methods: This was a non-randomised clinical trial in which a nursing intervention was performed. Tools: a psychosis test (pre), Stigma Attribution Questionnaire (AQ-27) (pre-post), and satisfaction survey (post) were used. The inferential analysis included the Wilcoxon and the Pearson Correlation Test. Results: In the sample (n = 22), the predominant stigmatising attitude was “Help”. The p-values obtained in the Wilcoxon Test were statistically significant, except for “Responsibility” and “Pity”. The following constructs of interest were faced: “Fear”–“Age” and “Professional experience”; and “Help”–“Psychosis test”. Conclusions: Despite the scores obtained in “Responsibility” and “Pity”, the intervention was useful for reducing stigma in the sample. Implications for the profession: There are adolescents who have suffered stigma from their teachers, and consequently have minimized their symptoms and not asked for help. For this reason, we implemented a nursing intervention based on the education and promotion of mental health, with the aim of expanding knowledge and reducing stigma. In fact, this intervention, which we carried out on high school teachers, managed to reduce the majority of stigmatizing attitudes measured on the stigma attribution scale. Full article

The global COVID-19 pandemic presented not only challenges for services but also opportunities for reflection and change. This study aimed to understand young people, parents/carers, and professionals’ experiences of remote provision across a voluntary sector organization to inform the nature of future delivery. Reflections from professionals (n = 7), young people (n = 7), and parents/carers (n = 2) were collected through semi-structured interviews and focus groups. Data were thematically analysed. Five overarching themes were identified: ‘Accessibility’, ‘Remote therapeutic experiences’, ‘Translating to online’, ‘Spaces of comfort/discomfort’, and ‘Moving towards hybrid provision’. The COVID-19 pandemic changed service provision, notably with accelerated digitalisation. Although the service became more accessible, the digitalisation of services impacted the relational experiences for young people. Nevertheless, online provision was described as a ‘steppingstone’, allowing young people to engage in online therapy or group programmes before transferring to in-person provision. Although remote provision can lead to improvements in young people’s mental health, this format was not suitable for all. When considering future models of provision, assessing needs, preferences, and access to private space and hardware are all important considerations when deciding which format to use to achieve the best possible outcomes. Full article

Background: Exercise training at work has the potential to improve employees’ productivity, health, and well-being. However, exercise interventions for healthcare workers in hospitals may be challenged by time pressure and the ongoing workflow with patient care. Objective: The aim was to identify barriers and facilitators for participation in exercise training during work in a hospital department. Methods: Eight semi-structured interviews of 13 individuals were conducted with hospital employees from different staff groups who participated in 12 weeks of exercise twice weekly. The data analysis was a thematic approach based on the Theoretical Domains Framework and the COM-B factors in the Behavior Change Wheel. Results: Barriers and facilitators varied between different groups. Barriers included limited structure, busyness, and a discouraging culture. Facilitators included gaining a feeling of community and psychological and physical well-being. Seven contextual subthemes were vital for successful implementation of exercise in a hospital setting: sharing of knowledge and information; involvement; administration and structure; culture; individualization; purpose and objective; and incentives. Conclusions: The informants appreciated exercise training during work. Inpatient departments’ informants found it difficult to participate in the intervention, whilst those with more administrative tasks found it easier. This study identified barriers and facilitators vital for a successful implementation of an exercise training intervention in a hospital department. The study explains how future interventions can improve reach, adoption, and implementation of exercise training interventions to hospital staffs. Full article

(1) Background: Health literacy (HL) debates have increased significantly in the last two decades. HL concepts/themes and models have achieved substantial development in the US and Europe. Although there have been some efforts to develop HL in Latin America and the Caribbean (LAC), these seem to be few and scattered. This paper reviews and discusses developments of HL concepts and themes globally and in LAC over the last two decades. (2) Purpose: This study aimed to identify the prevalent health literacy concepts/themes deployed globally and in LAC as reported in academic journals from 2005 to 2022. We looked into which fields of knowledge have been informing HL research over the last decades. (3) Methods: We conducted a structured search on the Web of Science (WoS), Scopus, PubMed, and SciELO databases to extract the textual data for bibliometric analysis. We analyzed the textual data with VOSviewer and Biblioshiny to better understand health literacy themes and strands currently being researched in the LAC region. We conducted the searches in two periods: the first in May 2023 and the second in October 2023. (4) Results: The bibliometric study highlighted five WoS categories informing most HL global studies: (i) public environmental occupational health; (ii) environmental sciences; (iii) health policy services; (iv) health care science services; and (v) communication. The two predominant categories in LAC are public environmental occupation health and health policy services. Journals hosting HL publications come from these WoS categories. Themes in HL publications can be organized into four thematic clusters: (i) analytical (research designs, analytic techniques, and criteria for examining HL data); (ii) psychometric (measurement properties of data collection tools); (iii) pragmatic (practical issues related to implementing HL programs); and (iv) well-being (effectiveness of HL programs on mental health and illness treatment). (5) Conclusions: There is expanding interest in health literacy among scholars. The number of publications has increased substantially, particularly over the last five years. These are dominated by the Global North. The metrics show that LAC and Africa are trailing in publications. There is an emerging focus on adult literacy, functional/low health literacy, and their effect on improving capabilities, comprehension, and communication regarding health-related topics. Full article

Polycystic ovary syndrome (PCOS) is a medical condition with important consequences for women’s well-being and reproductive outcomes. Although the etiology of PCOS is not fully understood, there is increasing evidence of both genetic and environmental determinants, including development in early life. We studied a population of 977,637 singleton women born in in Sweden between 1973 and 1995, followed sometime between the age 15 and 40. The incidence of PCOS was measured using hospital register data during 2001–2012, complemented with information about the women’s, parents’ and sisters’ health and social characteristics from population and health care registers. Cox regression was used to study how PCOS is associated with intergenerational factors, and a range of early life characteristics. 11,594 women in the study sample were diagnosed with PCOS during the follow-up period. The hazard rate for PCOS was increased 3-fold (HR 2.98, 95% CI 2.43–3.64) if the index woman’s mother had been diagnosed with PCOS, and with 1.5-fold (HR 1.51, 95% CI 1.39–1.63) if their mother had diabetes mellitus. We found associations of PCOS with lower (<7) one-minute Apgar score (HR 1.19, 95% CI 1.09–1.29) and with post-term birth (HR 1.19, 95% CI 1.13–1.26). Furthermore, heavy (10+ cigarettes/day) maternal smoking (HR 1.30, 95% CI 1.18–1.44) and maternal obesity (HR 1.90, 95% CI 1.62–2.36) were strongly associated with PCOS. This study finds support for the heritability and fetal origins of PCOS. Risk of PCOS could be reduced by further emphasizing the importance of maternal and early life health. Full article

High-intensity interval training (HIIT) is considered an effective method to improve fitness and health indicators, but its high-intensity exercises and the mechanical and metabolic stress generated during the session can lead to the occurrence of exercise-induced muscle damage. Therefore, this study aimed to describe, by means of a systematic review, the effects of a single HIIT session on exercise-induced muscle damage. A total of 43 studies were found in the Medline/PubMed Science Direct/Embase/Scielo/CINAHL/LILACS databases; however, after applying the exclusion criteria, only 15 articles were considered eligible for this review. The total sample was 315 participants. Among them, 77.2% were men, 13.3% were women and 9.5 uninformed. Their age ranged from 20.1 ± 2 to 47.8 ± 7.5 years. HIIT protocols included running with ergometers (n = 6), CrossFit-specific exercises (n = 2), running without ergometers (n = 3), swimming (n = 1), the Wingate test on stationary bicycles (n = 2), and cycling (n = 1). The most applied intensity controls were %vVO₂max, “all out”, MV, MAV, Vmax, and HRreserve%. The most used markers to evaluate muscle damage were creatine kinase, myoglobin, and lactate dehydrogenase. The time for muscle damage assessment ranged from immediately post exercise to seven days. HIIT protocols were able to promote changes in markers of exercise-induced muscle damage, evidenced by increases in CK, Mb, LDH, AST, ALT, pain, and muscle circumference observed mainly immediately and 24 h after the HIIT session. Full article

Physical education (PE) is an important part of school education worldwide, and at the same time, almost the only subject that explicitly deals with body and movement. PE is therefore of elementary importance in the upbringing of young people. This also applies to children with visual impairments. However, existing findings on participation and belonging in PE as well as on physical and motor development reveal that this group of children and adolescents is noticeably disadvantaged in this respect. Against this background, this paper aims to explore fundamental barriers and challenges across different types of schools, types of schooling, and countries from the perspective of visually impaired children. The qualitative interview study with 22 children with visual impairments at different types of schools in three countries (Austria, Germany, USA) reveals that none of the respondents could escape the power of social distinctions and related problematic and existing hierarchies. Hence, ideas of normality and associated values remain the main challenge for all of them. However, the type-forming analysis provides important insight across settings on how visually impaired children differ on this, allowing for greater sensitivity to the concerns of children with visual impairments. Full article

The construction industry is one of the riskiest sectors worldwide, with crane operations being one of the most dangerous activities. The aim of this study was to gain insight into the key factors involved in crane-related occupational accidents in the construction industry in Spain. To this end, 1314 accidents involving cranes were analyzed from a total of 241,937 accidents that occurred in the construction of buildings. The data were collected from the Spanish government’s occupational accident statistics corresponding to the years 2012–2021. The results evidenced a statistically significant relationship between cranes as the material agent and the size of the company, with 95% of cases corresponding to small- or medium-sized companies (less than 250 employees). Additionally, it shows how the crane operator is identified as a material contributor to crane accidents in the construction industry, and may be considered a key component to these accidents. In conclusion, improving the knowledge gained about the key factors in crane-related accidents at work in the construction industry provides essential information that helps to design and implement appropriate preventive measures to avoid the recurrence of unwanted events with these machines. Full article

Background: Electronic cigarettes (e-cigarettes) comprise a variety of products designed to deliver nicotine, flavorings, and other substances. To date, multiple epidemiological and experimental studies have reported a variety of health issues associated with their use, including respiratory toxicity, exacerbation of respiratory conditions, and behavioral and physiological effects. While some of these effects appear to be sex- and/or gender-related, only a portion of the research has been conducted considering these variables. In this review, we sought to summarize the available literature on sex-specific effects and sex and gender differences, including predictors and risk factors, effects on organ systems, and behavioral effects. Methods: We searched and selected articles from 2018–2023 that included sex as a variable or reported sex differences on e-cigarette-associated effects. Results: We found 115 relevant studies published since 2018 that reported sex differences in a variety of outcomes. The main differences reported were related to reasons for initiation, including smoking history, types of devices and flavoring, polysubstance use, physiological responses to nicotine and toxicants in e-liquids, exacerbation of lung disease, and behavioral factors such as anxiety, depression, sexuality, and bullying. Conclusions: The available literature supports the notion that both sex and gender influence the susceptibility to the negative effects of e-cigarette use. Future research needs to consider sex and gender variables when addressing e-cigarette toxicity and other health-related consequences. Full article

Intimate partner violence (IPV) is a complex and pervasive global phenomenon. Despite extensive research on physical and sexual violence, there has been a relative lack of investigation into the detrimental and distinctive consequences of psychological violence against women. This is surprising given the profound impact it has on the psychological well-being of victims, notably in the form of depression, which is commonly observed as an outcome in cases of psychological IPV victimization. The present study analyzes the impact of psychological IPV on depressive symptoms, considering the moderating influence of personal positivity, defined as positive self-perceptions, optimistic life perspectives, and a hopeful view of the future in a sample of 171 Italian women seeking assistance from anti-violence centers in different localities of Italy. The findings show that in line with the hypothesis, the association between psychological violence and depressive symptoms is moderated by the levels of perceived positivity, even when controlling for instances of physical violence. These results and implications for interventions are discussed within the framework of existing literature on positive psychology and psychological well-being in the context of IPV. Full article

Firefighters face many hazards on the job and have a high rate of work-related injuries and illnesses (WRII). We analyzed Washington workers’ compensation claims from 2006–2020 to characterize WRII in firefighters compared to law enforcement officers and “all other” workers. There were 9187 compensable claims for firefighters, 7801 for law enforcement officers, and 586,939 for “all other” workers. Nearly 40% of claims for firefighters were work-related musculoskeletal disorders (WMSDs). The claim rate per 10,000 full-time equivalent (FTE) firefighters was 716.4, which is significantly higher than that of law enforcement officers (510.0) and “all other” workers (163.2). The rate per 10,000 FTE of WMSD claims was also higher in firefighters (277.0) than in law enforcement officers (76.2) and “all other” workers (57.6). Additional WRII among firefighters commonly included being struck or caught in objects, slipping or tripping, and exposure to caustic or noxious substances; and amongst law enforcement, transportation accidents and violence. Medical costs and time-loss days per claim were lower for firefighters and law enforcement than for “all other” workers. Common tasks associated with WMSDs in firefighters included lifting and transporting patients, using specific tools and equipment, and physical training. WMSDs stand out as an area for prevention and intervention activities. Full article

Psychosocial support programs have been increasingly implemented to protect asylum seekers’ wellbeing, though how and why these interventions work is not yet fully understood. This study first uses questionnaires to examine how self-efficacy, satisfaction of basic psychological needs, and adaptive stress may influence wellbeing for a group of asylum-seeking mothers attending a community-based psychosocial program called Welcome Haven. Second, we explore mothers’ experiences attending the Welcome Haven program through qualitative interviews. Analysis reveals the importance of relatedness as a predictor of wellbeing as well as the mediating role of adaptive stress between need satisfaction and wellbeing. Further, attending Welcome Haven is associated with reduced adaptive stress and increased wellbeing, which correspond with the thematic analysis showing that attendance at the workshops fostered a sense of belonging through connection with other asylum seekers and service providers as well as empowerment through access to information and self-expression. The results point to the importance of community-based support that addresses adaptive stress and the promotion of social connection as key determinants of wellbeing. Nonetheless, the centrality of pervasive structural stressors asylum seekers experience during resettlement also cautions that relief offered by interventions may be insufficient in the face of ongoing systemic inequality and marginalization. Full article

Despite great strides in the development of contraceptive technologies, the United States has one of the highest teen pregnancy rates in the world. Religion and associated values may shape the sexual health behaviors of college students, as prior studies have aimed to determine how social factors may influence the use of contraception amongst college students. Thus, we sought to examine the differences in current contraceptive methods and the age of first contraceptive usage among sexually active female college students with different religious affiliations and strengths of religiosity. It was hypothesized that there would be no difference in current contraceptive methods among different religious affiliations and strengths of religions and that there would be a difference in the age of first contraceptive usage among different religious affiliations and strengths of religiosity. Two hundred and twenty-four college-aged females completed a 20-question survey about sexual health and religious practices. Chi-squared tests were implemented to determine the frequencies of responses across religious affiliations and strengths of religiosity. Significant differences in the frequency of responses for the age of first contraceptive usage were observed across different strengths of religiosity (p = 0.016) and for the self-perceived impact of religion on sexual health across different religious affiliations (p = 0.033) and strengths of religiosity (p = 0.005). All other differences were found not to be statistically significant. It was determined that increased strengths of religiosity resulted in delayed onset of contraceptive usage and that both different religious affiliations and greater strengths of religiosity lead to different self-perceived impacts of religion on sexual health despite low levels of current practice. Full article

After more than two decades of the expansion of antiretroviral treatment (ART) in adolescents living with perinatal HIV (APHIV) in sub-Saharan Africa, there is still poorly sustained long-term adherence to ART due to multifactorial factors with the consequence of increased mortality and morbidity. There are little data available on the familial and structural factors which affect sustenance to long-term adherence to ART. A qualitative exploratory design was used to conduct in-depth interviews with 21 APHIV attending HIV care and management in the rural health facilities of Vhembe district in Limpopo Province, South Africa. Transcripts were translated verbatim into English, and data were analyzed using Tesch’s eight steps of qualitative data analysis. The sample consisted of APHIV 10–19 years old who were aware of their HIV status, and all had received ART for more than 5 years. They lived in extended, disrupted, grandparent- and child-headed households. They experienced food insecurities due to poverty or orphanhood, as well as living in disrupted households, which deterred them from long-term adherence. In addition, dependency on social support grants to sustain their livelihoods affected long-term adherence. APHIV had challenges with structural factors such as inconsistent clinic attendance, clashes between school activities and clinic appointments, and the lack of transport fare to the clinic, which affected adherence. Although APHIV were on one-pill fixed-dose ART, they were not able to sustain long-term adherence due to various familial, structural, and psychosocial challenges. In addition to institution-based interventions, there is a need for family, community-based, and multi-sectorial interventions to support long-term ART adherence among APHIV. Full article

Cardiovascular diseases (CVD) are prevalent and lead to high morbidity and mortality globally. Physiotherapists regularly interact with patients with or at risk of CVDs (pwCVDs). This study aimed to assess the nature of existing evidence, interventional approaches used, and the population groups included in physiotherapy-led health promotion (PLHP) for pwCVDs. The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Medline, PubMed, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, and PEDro databases were searched from inception until June 2023. Two reviewers independently screened the titles, abstracts, and full text and conducted data extraction. All conflicts were resolved with a third reviewer. A total of 4992 records were identified, of which 20 full-text articles were included in the review. The studies had varied populations, including those with stroke, coronary artery diseases, peripheral artery diseases, hypertension, diabetes, and multiple CVD risk factors. The interventions ranged from exercise and physical activity programmes, dietary interventions, education, and counselling sessions with various supplementary approaches. Most interventions were short-term, with less than 12 months of follow-up. Interventions were personalised and patient-centred to promote adherence and health behaviour change. Among the included studies, 60% employed experimental designs, with the remainder using quasi-experimental designs. Although a wide range of PLHP strategies have been used for pwCVDs, exercise and physical activity were employed in 85% of the included studies. Other components of health promotion, such as sleep, smoking, and alcohol abuse, should be investigated within PLHP. Full article

Current programming and resources aimed at supporting the well-being of family caregivers often fail to address considerations unique to those caring for people with intellectual and/or developmental disabilities (IDDs). As a result, many caregivers of people with IDD feel isolated, stressed, and burnt out. A targeted research agenda informed by key stakeholders is needed and would allow research teams to coordinate resources, talents, and efforts to progress family caregiver well-being research in this area quickly and effectively. To address this aim, this pilot study used a Delphi design based on 2 rounds of questionnaires. In round 1, 19 stakeholders (18 females, 1 male), including 12 family caregivers, 3 rehabilitation providers, 2 researchers, and 2 organizational representatives, identified broad areas for caregiver well-being research. After collating the responses from round 1, stakeholders were asked to rank whether each area was considered a research priority in round 2. Data were analyzed using descriptive statistics and conventional content analysis. Eighteen stakeholders completed the round 2 survey (1 caregiver did not complete the round 2 survey), after which a consensus was reached. Stakeholders identified nine broad priorities, including system-level programs and services, models of care, health promotion, social inclusion, equity and diversity, capacity building, care planning along the lifespan, and balancing formal and natural community-based supports. Although preliminary in nature, the research priorities generated using an inclusive and systematic process may inform future efforts to promote the well-being of caregivers of Canadians with IDD. Full article

The Health Literacy for School-Aged Children (HLSAC) is a brief, generic instrument measuring health literacy among school-aged children. Given its brevity and broad conceptualization of health literacy, the HLSAC is a potentially valuable measuring instrument among adults as well. This validation study aimed to adapt the HLSAC questionnaire to an adult population through assessment of content validity and subsequently determine the structural validity of the adapted instrument, the Brief Health Literacy scale for Adults (B-HLA). The content validity of the HLSAC was assessed through interviews with respondents and experts, and the structural validity of the adapted instrument (B-HLA) was evaluated using Rasch analysis. The content validity assessment (n = 25) gave rise to adjustments in the wording of five items. The B-HLA demonstrated an overall misfit to the Rasch model (n = 290). Items 6 and 8 had the poorest individual fits. We found no signs of local dependency or differential item functioning concerning sex, age, education, and native language. The B-HLA demonstrated unidimensionality and ability to discriminate across health literacy levels (PSI = 0.80). Discarding items 6 or 8 resulted in an overall model fit and individual fit of all items. In conclusion, the B-HLA appears to be a valid and reliable instrument for assessing health literacy among adults. Full article

Background: It is well-established that cross-sectional measurements of poor body composition are associated with impaired physical function and that power training effectively enhances total lean mass and physical function in older adults. However, it is unclear if power training-induced changes in body composition are associated with improved physical function in older adults. Aim: The present study investigated associations between body composition and physical function cross-sectionally and with power training-induced changes in older men. Methods: Forty-nine older men (68 ± 5 yrs) completed a 10-week biweekly power training intervention. Body composition was measured using dual-energy X-ray absorptiometry. Physical function was assessed as a composite Z-score combining measures from Sit-to-stand power, Timed up-and-go time, and loaded and unloaded Stair-climbing time (15 steps). Linear and quadratic regression analyses were performed to assess associations between body composition and physical function. Results: At baseline, total (R² = 0.11, p < 0.05) and percentage body fat (R² = 0.15, p < 0.05) showed a non-linear relationship with physical function. The apex of the quadratic regression for body composition was 21.5% body fat. Furthermore, there was a non-linear relationship between changes in body fat percentage and physical function from pre- to post-intervention (R² = 0.15, p < 0.05). Conclusion: The present study’s findings indicate that participants with a body composition of ~20% body fat displayed the highest level of physical function at baseline. Furthermore, despite small pre–post changes in body fat, the results indicate that those who either preserved their body fat percentage or experienced minor alterations observed the greatest improvements in physical function. Full article

The illegal dumping of solid waste is a prevalent issue in Nigeria, affecting all states. Lagos State, in particular, faces waste disposal problems that stem from urbanization, negative public perception towards waste management, insufficient waste disposal education, poor waste disposal practices, and the disposal of waste at illegal and unauthorized sites. This situation is further exacerbated by inadequate municipal solid waste (MSW) collection rates, making it challenging to combat illegal dumping effectively. To align with Sustainable Development Goal (SDG) 11 of Sustainable Cities, which seeks to minimize negative environmental effects associated with managing MSW by 2030, this study aims to assess the environmental and health impact of illegal dumping of solid waste in Lagos State. The objectives of this study include assessing people’s attitudes towards illegal dumping, evaluating the extent of environmental degradation resulting from illegal solid waste dumping in Lagos, and assessing the health risks associated with exposure to illegally dumped solid waste in Lagos State, as well as determining if illegal dumping contributes to the diseases prevalent in Lagos State. This study will use a quantitative approach to collect data from study participants on demographics, educational background, waste management, and environmental and health issues using computer-assisted self-administered questionnaires (Google Forms). This study will also use observations and photographs of illegally dumped waste in communities and major illegal dumpsites in the study area to provide valuable information to complement the questionnaire responses. By combining both approaches, the study will be able to capture both numerical data and people’s behaviors and attitudes associated with illegal dumping. This study will use a mixed sampling method consisting of cluster sampling and convenience sampling, focusing on communities impacted by illegal dumping in Lagos State. The sample size for this study will be 100. The questionnaire for this study will be administered via a Google Forms link that will be shared through various online platforms, enabling participants to access and complete the questionnaire from any location with internet access. To ensure representative participation, as part of the informed consent form on the initial page of the online questionnaire, a screening question that requires participants to indicate if they live or work in the study areas or have been exposed to the impact of illegal dumping will be included. Only those who meet these criteria will be able to proceed with the study. The primary data obtained will be carefully analyzed using the Statistical Package for the Social Sciences (SPSS) version 28. The study’s results will highlight the importance of the linkage between illegal dumping, environmental degradation, and diseases prevalent in Lagos State, which could inform policymakers and relevant departments in developing effective strategies to improve public health. Full article

Melasma is a common skin disorder of acquired hyperpigmentation that appears commonly on the face. Although asymptomatic, melasma causes psychosocial and emotional distress. This study aimed to assess melasma’s severity on people with darker skin types, evaluate the effects of melasma on the quality of life (QoL), and establish QoL predictors in affected individuals. This was a cross-sectional analytic study that enrolled 150 patients from three private dermatology clinics in Durban, South Africa who were diagnosed with melasma. The severity of melasma alongside QoL were measured using a melasma area and severity index (MASI) score and melasma quality of life scale (MELASQoL), respectively. The associations among factors and QoL were explored using multivariable methods and stepwise regression analysis. p-values less than 0.05 were considered significant. Enrolled patients were predominantly females (95%), of which 76% were of black African ethnicity, 9% were of Indian ethnicity, and 15% had mixed ancestry, with an average age of 47.30 years. Family history revealed that 61% had no prior melasma cases, while 39% had affected relatives, most commonly mothers (41%). The cheeks were the most common site for melasma. MASI score of Masi (β = 0.209, t = 2.628, p < 0.001), the involvement of cheeks (β = −0.268, t = −3.405, p < 0.001), level of education (β = −0.159, t = −2.029, p = 0.044), and being menopausal (β = −0.161, t = −2.027, p = 0.045) were found to be predictors of QoL. A regression model was created to forecast MELASQoL using these four predictors. This equation’s significance lies in its ability to enable the remote assessment of MELASQoL based on these four variables. It offers a valuable tool for researchers and medical professionals to quantitatively and objectively evaluate the impact of melasma on an individual’s quality of life. Full article

Firefighting is inherently dangerous, though recently concerns have shifted from traditional fireground injuries (burns and asphyxiation) to a focus on mental and behavioral health. Although firefighters are remarkably resilient, research suggests many suffer negative psychological consequences from repeated exposures to trauma. While the Stress First Aid (SFA) model has gained increased attention and adoption among fire departments as a model for behavioral health training, it has not been formally evaluated. This cluster randomized controlled trial used a crossover design comparing the immediate SFA group to delayed SFA control to test the impact of the SFA on firefighters’ mental and behavioral health changes after 10–12 months (n = 400; Mage = 37.6, 4.8% women). A convenience sample of 79 firefighters (Mage = 41.4; 8.7% women) provided evaluations on one or more of the training modules. Participants reported satisfaction with all training components (Peer team training 97.6%, Online SFA 94.9%, Curbside Manner 88.4%, After Action Review 89.4%) and reported success in changing personnel’s perception of their department’s ability to respond to behavioral health issues (SFA M = 3.93, Control 3.50; t = 2.52, p = 0.042). Future work should focus on additional resources and training to augment existing efforts to help departments continue their efforts. Full article

Harmful use of alcohol is a problem in the Northern Territory (NT), Australia. The aim of this study was to assess and compare alcohol-attributable deaths and the contribution of alcohol to the burden of disease and injury (BOD) among the Aboriginal and non-Aboriginal populations in the NT between 2014 and 2018. The alcohol-use data for adults aged 15+ years old in the NT population was taken from the 2016 National Drug Strategy Household Survey. BOD was measured in disability-adjusted life years (DALY) as part of the NT BOD study. Population-attributable fractions were derived to analyse deaths and BOD. Between 2014 and 2018, 673 Aboriginal and 392 non-Aboriginal people died of harmful use of alcohol, accounting for 26.3% and 12.9% of the total deaths in the Aboriginal and non-Aboriginal population, respectively. Alcohol caused 38,596 and 15,433 DALY (19.9% and 10.2% of the total), respectively, in the NT Aboriginal and non-Aboriginal population for the same period. The alcohol-attributable DALY rate in the Aboriginal population was 10,444.6 per 100,000 persons, six times the non-Aboriginal rate. This study highlights the urgent need to reduce harmful alcohol use in the NT, which disproportionately affects Aboriginal peoples in rural and remote areas. Full article

Japanese diet adherence has been inversely correlated with muscle weakness. In this study, we aimed to validate that association. Longitudinal data from 1699 individuals aged ≥50 years (mean age 62.5 ± 6.9 years, 50.4% female) at two time points (2007 and 2011) were used. Participants without muscle weakness from several regions in Japan were included. The 12-component revised Japanese Diet Index (rJDI12) classified by tertiles assessed adherence to the Japanese dietary pattern. Muscle weakness was defined as a handgrip strength of ˂18 kg for females and ˂28 kg for males based on the Asian Working Group for Sarcopenia criteria 2019. A multivariate logistic approach was used to determine the relationship between rJDI12 tertile and the occurrence of muscle weakness by calculating the odds ratio (OR) and its 95% confidence interval (95% CI) throughout the observation period. Muscle weakness was negatively correlated with the highest rJDI12 tertile (OR [95% CI] 0.891 [0.814, 0.973] for T3). This association was consistent in sensitivity analyses with multiple imputations of missing values. Closely following the Japanese dietary pattern appears to reduce the occurrence of muscle weakness among the aging population in this study, suggesting it may prevent frailty and sarcopenia in the aging population. Full article

Rates of suicidality amongst Indigenous Peoples are linked to historical and ongoing settler-colonialism including land seizures, spiritual oppression, cultural disconnection, forced enculturation, and societal alienation. Consistent with decolonial practices, Indigenous voices and perspectives must be centered in the development and evaluation of suicide prevention programs for Indigenous Peoples in the United States to ensure efficacy. The current study is a meta-synthesis of qualitative research on suicide prevention among Indigenous populations in the United States. Findings reveal little evidence for the centering of participant voices within existing suicide prevention programs. Applied thematic analysis of synthesis memos developed for each article in the final sample surfaced four primary themes: (1) support preferences; (2) challenges to suicide prevention; (3) integration of culture as prevention; and (4) grounding relationships in prevention. The need for culturally centered programming and the inadequacy of ‘pan-Indian’ approaches are highlighted. Sub-themes with respect to resiliency, kinship connection, and safe spaces to share cultural knowledge also emerge. Implications of this work to further the decolonization of suicide prevention and aid in the promotion of culturally grounded prevention science strategies are discussed. Full article

Climate change is a public health threat on a global scale. Over the last two decades, research has uncovered the myriad health effects of climate change and its associated costs. The literature is also beginning to show the direct and indirect effects of climate change to be an indicator of increased adverse mental health outcomes including excessive worry, anxiety, grief, and post-traumatic stress disorder. The development of scales to measure some of these effects in adult populations has shown the critical need to understand the various ways climate change affects mental well-being in adolescent populations who are at a critical juncture in psychological development. The purposes of this study were to understand the lived experience of adolescents who are concerned about climate change and uncover the meaning of climate change concern for adolescents as informed by emerging patterns. This study utilized Hermeneutic Phenomenology as a philosophical foundation and methodological approach for data retrieval and analysis. An interview-based approach with a purposeful sample (n = 11, aged 12–17 years) revealed the multi-layered elements of climate change concern and its effects. Three patterns emerged: Climate Change as a Temporal Threat and Pressure, Awareness and Concern as a Continuum, and Experiencing Concern and Making Meaning. These findings may now inform interdisciplinary knowledge on upstream mitigation efforts and the promotion of positive outcomes relating to climate change. The need for focused educational attention to adolescent behaviors and concerns is explicated and exemplified. Full article

The Health Assessment Questionnaire Disability Index (HAQ-DI) was completed with five visual analog scales to assess systemic sclerosis (SSc) called Scleroderma HAQ (SHAQ). We performed a validation of the European Portuguese version of SHAQ for patients with SSc. Patients with different forms of SSc from five Hospital Centers were invited. The reliability of the Portuguese SHAQ was evaluated by internal consistency and by test–retest reliability. Content validity was checked by two rheumatologists and by a panel of patients. Construct validity was assessed by structural validity and by known-groups hypothesis tests. Criterion validity was addressed with selected dimensions from the UCLA GIT 2.0, the SF-36v2, and the EuroQoL EQ-5D-5L. A total of 102 SSc patients agreed to participate, 31 of which answered to the retest. HAQ-DI demonstrated high internal consistency reliability (α = 0.866) and SHAQ also showed high test–retest reliability (ICC 0.61–0.95). We evidenced the unidimensionality of all VASs. HAQ-DI scores were worse in males, patients older than 65 years, and individuals with a diffuse form of SSc. Criterion validity was mainly evidenced through the correlation between the HAQ-DI and SF-36v2 physical summary measure (r = −0.688) and EQ-5D-5L index score (r = −0.723). Likewise, the SHAQ overall disease severity VAS was also correlated with SF-36v2 physical summary measure (r = −0.628). Mental score correlations were smaller. With the exception of the Raynaud’s VAS, all the other VASs correlated well with similar clinical variables. This paper provides evidence to demonstrate how reliable and valid the European Portuguese version of SHAQ is, to be used in SSc patients to assess the clinical severity under the perspective of patients. Full article

Previous research has shown a discrepancy in incidences of knee injuries, stress fractures, and concussions between cisgender men and women. Little is known regarding the incidence of musculoskeletal injuries among patients on gender-affirming hormone therapy (GAHT). This retrospective cohort study examines cumulative incidence of knee injuries, concussions, and stress fracture injuries among transgender patients on GAHT at one health system from 2011–2020. Using relevant ICD-9 and 10 codes, incidences of knee injury, concussion, and stress fracture were calculated. Cohorts included 1971 transgender and 3964 cisgender patients. Transgender patients had significantly higher incidence of all-cause knee injuries over the study period, 109 (5.5%) versus 175 (4.4%) (p < 0.001; OR: 2.14, 95% CI [1.17–3.92]). Subgroup analysis showed significantly higher incidence of knee injuries among cisgender men (5.6%) versus cisgender women (4.1%) (p = 0.042) and among transgender women (6.6%) versus cisgender women (4.1%) (p = 0.005). There were no significant differences between incidences of concussion and stress fracture between groups. This sample showed that patients on GAHT had increased cumulative incidences of all-cause knee injury compared to controls but similar cumulative incidences of concussion and bone-stress injuries. Transgender women on exogenous estrogen had significantly higher cumulative incidences of all-cause knee injuries compared to cisgender women. Full article

Climate change threatens the health of all Australians: without adaptation, many areas may become unlivable, in particular the tropical north. The Northern Territory (NT) health workforce is already under colliding operational pressures worsened by extreme weather events, regional staff shortages and infrastructure that is poorly adapted to climate change. The H3 Project (Healthy Patients, Workforce and Environment) explores nature-based interventions in the NT health sector aiming to strengthen the resilience and responsiveness of health infrastructure and workforce in our climate-altered future. The H3 Project engaged the health workforce, climate researchers and the wider community, in recognition that meaningful and timely climate action requires both organization-led and grassroots engagement. We recruited campus greening volunteers and sustainability champions to Royal Darwin Hospital (RDH) to develop strategies that enhance climate adaptation, build climate and health literacy, and incentivize active mobility. We implemented low-cost biophilic design within the constraints of legacy healthcare infrastructure, creating cool and restorative outdoor spaces to mitigate the impacts of heat on RDH campus users and adapt to projected warming. This case study demonstrated substantial cooling impacts and improved local biodiversity and hospital campus aesthetics. We collaborated with Indigenous healers and plant experts to harness the synergy between Aboriginal people’s traditional knowledge and connectedness to land and the modern concept of biophilic design, while seeking to improve hospital outcomes for Indigenous patients who are both disconnected from their homelands and disproportionately represented in NT hospitals. Full article

Vitamin D deficiency has been studied in the context of acute coronavirus disease 2019 (COVID-19), revealing associations with increased severity and mortality. Yet, the influence of vitamin D on long COVID symptoms remains unknown. The purpose of this study is to examine the effect of vitamin D on long COVID symptoms. Over the study period, 50,432 individuals within the catchment area of the outpatient COVID-19 clinic tested positive for SARS-CoV-2 via PCR, with 547 patients subsequently referred to a specialized Post-COVID Clinic, and 447 of them enrolled in the study. Patient-reported symptoms and paraclinical measures including vitamin D were evaluated in 442 patients. The majority of participants were female (72%, n = 320/442). The consumption of alcohol and number of current smokers were low. Low vitamin D was observed in 26% (n = 115/442) of the patients, most commonly in male participants (odds ratio (OR) = 1.77, 95% confidence interval (CI) (1.12, 2.79), p = 0.014). Additionally, low vitamin D was correlated with a younger mean age of 41 years (standard deviation (SD) = 12) as opposed to 48 years (SD = 13) in patients with normal vitamin D levels (OR = 0.96, 95% CI (0.94, 0.97), p < 0.001). While our study population indicated a potentially higher prevalence of vitamin D insufficiency in this population compared to the general population, no significant differences in prevalence of symptom or symptom severity scores were observed between the low and normal vitamin D groups. In patients in a Post-COVID Clinic, we found no association between vitamin D levels and long COVID symptoms. Full article