Int. J. Environ. Res. Public Health, Volume 21, Issue 1 (January 2024) – 119 articles

Family caregivers provide care to people with disabilities, as well as ill and older adults, often with little to no outside assistance from the formal long-term care system. They are the backbone of long-term care, and it is a misconception that the majority of people institutionalize disabled people and older adults in the United States. Youth caregiving is under-examined in the field of public health and is in need of theoretical and practical attention. Building upon the work of Talley and Crews and Bronfenbrenner, we aim to broaden the scope of the discussion around caregiving through the application of the social–ecological model (SEM) to inform research and practice. This paper picks up where they left off, digging deeper into the ecological model to reimagine research, policy, and practices related to youth and young adult caregivers that are rooted in this framework. This application highlights care as embedded in social relations while allowing for an exploration of the ways structural barriers impact the caring unit. Looking holistically at the unit, rather than individuals as service users, provides an opportunity for understanding the interconnectedness of those giving and receiving care. It does so by rendering visible the interdependence of the caring unit, and the myriad structures, which bear down on care at the individual and household levels. This approach runs counter to dominant thinking, which focuses exclusively on the individuals involved in caregiving relationships, rather than considering them as interdependent units of care. This paper provides an analytic contribution, utilizing a narrative composite vignette based on literature and previous research. Full article

Mercury (Hg) is a toxic metal that is easily released into the atmosphere as a gas or a particulate. Since Hg has serious health impacts based on human exposure, it is a major concern where it accumulates. Southern Florida is a region of high Hg deposition in the United States. It has entered the southern Florida environment for over 56 MY. For the past 3000 to 8000 years, Hg has accumulated in the Everglades peatlands, where approximately 42.3 metric tons of Hg was deposited. The pre-industrial source of mercury that was deposited into the Everglades was from the atmosphere, consisting of combined Saharan dust and marine evasion. Drainage and the development of the Everglades for agriculture, and other mixed land uses have caused a 65.7% reduction in the quantity of peat, therefore releasing approximately 28 metric tons of Hg into the southern Florida environment over a period of approximately 133 years. Both natural and man-made fires have facilitated the Hg release. The current range in mercury release into the southern Florida environment lies between 994.9 and 1249 kg/yr. The largest source of Hg currently entering the Florida environment is from combined atmospheric sources, including Saharan dust, aerosols, sea spray, and ocean flux/evasion at 257.1–514.2 kg/yr. The remobilization of Hg from the Everglades peatlands and fires is approximately 215 kg/yr. Other large contributors include waste to energy incinerators (204.1 kg/yr), medical waste and crematory incinerators (159.7+ kg/yr), and cement plant stack discharge (150.6 kg/yr). Minor emissions include fuel emissions from motorized vehicles, gas emissions from landfills, asphalt plants, and possible others. No data are available on controlled fires in the Everglades in sugar farming, which is lumped with the overall peatland loss of Hg to the environment. Hg has impacted wildlife in southern Florida with recorded excess concentrations in fish, birds, and apex predators. This bioaccumulation of Hg in animals led to the adoption of regulations (total maximum loads) to reduce the impacts on wildlife and warnings were given to consumers to avoid the consumption of fish that are considered to be contaminated. The deposition of atmospheric Hg in southern Florida has not been studied sufficiently to ascertain where it has had the greatest impacts. Hg has been found to accumulate on willow tree leaves in a natural environment in one recent study. No significant studies of the potential impacts on human health have been conducted in southern Florida, which should be started based on the high rates of Hg fallout in rainfall and known recycling for organic sediments containing high concentrations of Hg. Full article

Rabies, caused by the Lyssavirus genus, is a highly lethal zoonotic disease transmitted by animals such as bats and domestic and wild carnivores to humans, claiming nearly 100% of lives. In Brazil, recent evidence suggests an increasing role of bats in human deaths from rabies, particularly in the Amazon region. This neglected tropical disease disproportionately affects impoverished and vulnerable populations in rural areas, where approximately 80% of human cases are concentrated. This article presents research conducted in riverine communities of the Tapajós/Arapiuns Extractive Reserve in Brazil to combat rabies in September 2022. The study adopted a participatory and collaborative approach, involving community members, healthcare professionals, and educators. Prioritizing proactive interventions, the health team administered prophylactic vaccinations to 30 individuals residing in communities exposed to the Lyssavirus. Educational activities focused on dispelling myths and raising awareness about preventive measures, with 100% of individuals reporting prior doubts about the disease, emphasizing the essential nature of the clarification, especially regarding preventive aspects. This study underscores the importance of community involvement, personalized interventions, and ongoing education to effectively combat rabies. By reinforcing public health policies and promoting health education, we can empower communities to take proactive measures in rabies prevention, leading to a reduction in incidence and an improvement in quality of life. Full article

Blue-collar workers in the freight transport industry report a high risk of developing chronic diseases, partly due to an unhealthy lifestyle. Worksite health promotion programs (WHPPs) may be able to promote a healthier lifestyle, but participation among blue-collar workers in these programs is generally lower than among other workers. The current study aimed to further examine factors that can explain participation of blue-collar workers in these programs. A pragmatic, qualitative study was conducted, and semi-structured interviews were held with 32 blue-collar workers in freight transport in the Netherlands (94% men, 81% driver, mean age 48 (SD = 11)). The interview guide was based on the Theoretical Domains Framework (TDF) and Capability-Opportunity-Motivation-Behavior (COM-B) model, and was used to assess perceived determinants that influence participation. A combination of framework analysis and thematic analysis was conducted, which yielded the following nine main themes: (i) not being aware of WHPPs on offer, (ii) no clear picture of what to expect, (iii) (not) giving priority to health, (iv) expecting feedback and practical support, (v) being open and ready to change, (vi) preferring to be self-dependent, (vii) being offered a practical, fun and joint WHPP, (viii) having an employer who cares, thinks along and facilitates participation, and (ix) working and living in an environment in which a healthy lifestyle is not the norm. With these insights we were able to formulate recommendations to enhance the participation of blue-collar workers in WHPPs. Full article

Eating outside-of-home (EOH) is one of the main changes in lifestyle that occurred worldwide in the past few decades. Given that EOH behavior is influenced by individual and contextual factors, the utilization of a theory seems to be suitable in analyzing this health behavior. The fourth-generation theory multi-theory model (MTM) is designed exclusively for health behavior change at the individual and community levels. Therefore, the purpose of this analytical cross-sectional study was to investigate EOH behavior by using the MTM among a nationally representative sample in the United States (US). Data for this study were collected from April–May 2023 via a 61-item psychometric valid, web-based, structured survey disseminated via Qualtrics. Chi-square/Fisher’s exact tests were used to compare categorical data, whereas the independent-samples t-test was used to compare the mean scores of MTM constructs across groups. Pearson correlation analysis was performed for the intercorrelation matrix between the MTM constructs and hierarchical regression models were built to predict the variance in the initiation and sustenance by certain predictor variables beyond demographic characteristics. The p values in the multiple comparisons were calculated by using adjusted residuals. Among a total of 532 survey respondents, 397 (74.6%) indicated being engaged in EOH at least twice a week, whereas 135 (25.4%) reported not being engaged in EOH. People who were engaged in EOH were younger (mean age = 42.25 ± 17.78 years vs. 55.89 ± 19.43 years) African American, (15.9% vs. 6.7%, p = 0.01), single or never married, (34.0% vs. 23.0%, p = 0.02), had a graduate degree (9.6% vs. 3.7%, p = 0.03), and were employed (72.0% vs. 34.8%, p < 0.001) as opposed to those who reported not being engaged in eating outside the home. Among the MTM constructs of initiation, “behavioral confidence” and “changes in the physical environment” were the significant predictors of initiating a reduction in EOH behavior and explained 48% of the variance in initiation. Among the MTM constructs of sustenance, “emotional transformation” and “changes in the social environment” were the significant predictors of sustaining a reduction in EOH behavior and explained 50% of the variance in sustenance. This study highlights a need to design MTM-based educational interventions that promote in-home eating instead of frequent EOH for health, family bonding, economic, and other reasons. Full article

It is known that environmental heat is associated with increased morbidity manifesting as increasing demand on acute care health services including pre-hospital transport and emergency departments. These services play a vital role in emergency care, and in rural and remote locations, where resource capacity is limited, aeromedical and other retrieval services are a vital part of healthcare delivery. There is no research examining how heat impacts remote retrieval service delivery. The Northern Territory (NT) of Australia is characterised by very remote communities with limited acute healthcare capacities and is a region subject to regular extreme tropical heat. In this study, we examine the relationship between aeromedical retrievals and hot weather for all NT retrievals between February 2018 and December 2019. A regression analysis was performed on the number of retrievals by clinical reason for retrieval matched to the temperature on the day of retrieval. There was a statistically significant exposure response relationship with increasing retrievals of obstetric emergencies in hotter weather in the humid climate zone and surgical retrievals in the arid zone. Retrieval services appeared to be at capacity at all times of the year. Given that there are no obstetric services in remote communities and that obstetric emergencies are a higher triage category than other emergencies (i.e., more urgent), such an increase will impede overall retrieval service delivery in hot weather. Increasing surgical retrievals in the arid zone may reflect an increase in soft tissue infections occurring in overcrowded houses in the hotter months of the year. Given that retrieval services are at capacity throughout the year, any increase in demand caused by increasing environmental heat will have broad implications for service delivery as the climate warms. Planning for a hotter future must include building resilient communities by optimising local healthcare capacity and addressing housing and other socioeconomic inequities that amplify heat-related illness. Full article

With Europe’s ageing population and rising demand for palliative care, it is crucial to examine the use of palliative care among older adults during their last years of life and understand the factors influencing their access and end-of-life circumstances. This study employed a cohort of SHARE participants aged 65 years or older who had passed away between Wave 6 (2015) and Wave 7 (2017). Information on death circumstances, palliative care utilization, and associated variables were analysed. The study revealed that nearly 13.0% of individuals across these countries died under palliative care, with Slovenia having the lowest rate (0.3%) and France the highest (30.4%). Palliative care utilization in the last 30 days before death was observed in over 24.0% of participants, with the Czech Republic having the lowest rate (5.0%) and Greece the highest (48.8%). A higher risk of using or dying in palliative care was significantly associated with cognitive impairment (low verbal fluency), physical inactivity, and good to excellent self-perceived health. This work highlights the urgent need for enhanced global access to palliative care and advocates for the cross-country comparison of effective practices within Europe, tailored to the unique healthcare needs of older adults. Full article

Background: Healthy aging encompasses more than the absence of disease, emphasizing the preservation of functional abilities for enhanced well-being and quality of life. Nature-based interventions are scientifically proven contributors to healthy aging. Objective: To develop an evidence map showcasing nature-based interventions targeting older individuals’ health and well-being. Methods: The evidence map was developed through critical analysis of systematic reviews and clinical trials utilizing the tools AMSTAR2 and CONSORT. A systematic search spanning the past decade was conducted across databases: Cochrane, SCOPUS, PubMed, Web of Science, Embase, and LILACS. Results: Twelve articles met the eligibility criteria. Nature-based interventions such as forest bathing, hiking, therapeutic gardens, virtual reality, and forest sounds were identified. Outcomes were categorized into physical aspects (cardiovascular and pulmonary; neuro-immuno-endocrinological) and mental/behavioral aspects. The final map integrated interventions, outcomes, and quality assessments. Conclusions: The survey highlights the positive impact of nature-based interventions on the health of the elderly. This study provides insights across various domains, fostering the development of programs and policies in management to promote healthy aging. Regarding healthcare, it encourages discourse among professionals regarding the integration of nature-based practices for equitable care in both individual and group settings. Furthermore, it underscores the need for research in the Southern Hemisphere, particularly in Brazil, where the study was conducted. Full article

School dropout is a risky behaviour that is a threat to well-being in adolescence. This study aimed to analyse school satisfaction and self-efficacy in school activities in a sample of adolescents attending secondary school in an Italian region at high risk of school dropout. The objective was to investigate whether differences exist among students on the basis of school dropout intention, gender, and career choices. Another aim was to identify, among the students’ satisfaction variables, the main psychosocial predictors of dropout intention. Students (N = 1340) attending secondary schools in Sardinia completed Soresi’s questionnaires on life satisfaction and self-efficacy. The data were analysed with a multivariate analysis of variance and logistic regression analysis. The results indicated that students intending to drop out of school scored lower on satisfaction with perceived support and satisfaction with peer and teacher relationships than their peers not at risk of dropping out. The logistic regression analysis showed that the most significant predictors of dropout intention were academic performance, satisfaction with the school experience, satisfaction in the relationships with teachers and with family members, and satisfaction with perceived support (26.9% of model variance). The results of this research thus indicate which areas could be addressed through prevention to improve well-being conditions in education. Full article

The climate crisis is developing into a life-changing event on a global level. Health promotion with the aim to increase the health status of individuals, independent of the present health status, has been developed on a scientific basis at least for the last eight decades. There are some basic principles which are prerequisites for both health promotion and climate protection. Those principles include (1) sustainability, (2) orientation on determinants, and (3) requirement of individual as well as community approaches. People are generally aiming to protect their lifestyle habits (e.g., traveling and consumer habits) and personal property (e.g., car and house) with easy solutions and as little effort as possible, and this can affect both health and climate. To reduce the emission of greenhouse gases and to protect our environment, changes towards a sustainable lifestyle have to be embedded into everybody’s mind. Examples for domains that need to be addressed in health promotion as well as in climate protection include (health and climate) literacy, physical activity and active mobility, and nutrition and dietary habits. If health promotion fails to tackle those domains, this will continue to drive the climate crisis. And climate change, in turn, will affect health. On the other hand, developing and promoting health resources in the domains mentioned could help to mitigate the health-damaging effects of climate change. Success in the joint efforts to promote health and protect the climate would improve the One Health approach, the health of people and the environment. Full article

This study aims to analyze the repercussions of the ongoing COVID-19 pandemic on the health of male immigrants, refugees, and asylum seekers in Brazil. A qualitative study involving 307 adult men living in Brazil during the COVID-19 pandemic was conducted. Data were collected between August 2021 and March 2022 and interpreted based on the Transcultural Nursing Theory. Cultural care repercussions were identified in various dimensions: technological: changes in daily life and disruptions in routine; religious, philosophical, social, and cultural values: changes stemming from disrupted social bonds, religious practices, and sociocultural isolation; political: experiences of political partisanship, conflicts, government mismanagement, a lack of immigration policies, human rights violations, and xenophobia; educational/economic: challenges arising from economic impoverishment, economic insecurity, unemployment, language difficulties, and challenges in academic and literacy development during the pandemic. The persistence of the COVID-19 pandemic in Brazil had significant repercussions for the health of migrant men, resulting in a transcultural phenomenon that requires sensitive nursing care. Implications for nursing: the uniqueness of cultural care in nursing and health, as most of the repercussions found were mostly negative, contributed to the increase in social and health vulnerabilities. Full article

Food insecurity is a known health equity threat for formerly chronically homeless populations even after they transition into permanent housing. This project utilized a human-centered design methodology to plan and implement a nutrition-focused community-health-worker (CHW) intervention in permanent supportive housing (PSH). The project aimed to increase access to healthy foods, improve nutritional literacy, healthy cooking/eating practices, and build community/social connectedness among 140 PSH residents. Validated food-security screening conducted by CHWs identified low or very low food security among 64% of 83 residents who completed the baseline survey, which is similar to rates found in a previous study among formerly homeless populations placed in PSH. Major themes identified through an analysis of resident feedback include (1) lack of needed kitchenware/appliances for food preparation, (2) knowledge gaps on how to purchase and prepare healthier food, (3) positive perceptions of healthy food options, (4) expanded preferences for healthy, easy-to-prepare foods, (5) regaining cooking skills lost during homelessness, (6) positive experiences participating in group activities, (7) community re-entry, and (8) resident ownership. Preliminary findings suggest the use of a human-centered design methodology for planning and implementing this multi-level CHW intervention helped reduce food insecurity, engaged participants in learning and adopting healthy and safe cooking and eating practices, and fostered social connectedness and feelings of community among formerly chronically homeless PSH residents. Full article

Background: This study, conducted in October 2017 at two Canadian universities, aimed to explore the relationships between gender expression, protective coping strategies, alcohol saliency, and high-risk alcohol use. Methods: Validated scales were employed to assess these variables using survey data. Multivariate analyses were conducted to investigate the associations between these factors and high-risk drinking. Results: This study revealed significant associations between high-risk drinking and androgynous gender roles (OR = 1.58, 95% CI: 1.19–2.10) as well as among self-reported males (OR = 2.21; 95% CI: 1.77–2.75). Additionally, protective behavioural strategies were inversely related to high-risk drinking (OR = 0.95; 95% CI: 0.94–0.96), while higher alcohol saliency exhibited a positive correlation with high-risk drinking (OR = 1.12; 95% CI: 1.11–1.14). Conclusions: These findings underscore the importance of considering gender, alcohol saliency beliefs, and protective behavioural strategies in the development and refinement of interventions aimed at reducing high-risk alcohol use on Canadian campuses. Full article

The interplay between disordered eating, depressive symptoms and self-objectification differs between genders and sexual orientations, and merits further study in homosexual and heterosexual men. We examined disordered eating, depressive symptoms and self-objectification in a sample of Israeli heterosexual and homosexual men. Participants were 215 men aged 19–65, 108 of whom were classified by the Kinsey scale as being heterosexual and 107 as homosexual. They completed online measures of self-objectification, disordered eating and depressive symptoms. Heterosexual men reported lower levels of disordered eating and self-objectification than homosexual men, however the difference in depressive symptoms was not statistically significant. Correlations between disordered eating, self-objectification and depressive symptoms when controlling for age, BMI and number of children were all significant, with similar patterns of association for heterosexual and homosexual men. Self-objectification partially mediated the association between sexual orientation and disordered eating. However, contrary to our hypothesis, sexual orientation (homosexual/heterosexual) did not moderate the association between disordered eating and self-objectification. The tendency of homosexual men towards self-objectification is linked to unhealthy eating habits. Self-objectification helps explain the propensity of homosexual versus heterosexual men to develop disordered eating and possibly eating disorders. It should therefore be targeted in prevention and in therapy. Full article

Short stature in children is a marker of low nutritional status and has been suggested to be associated with dental caries. However, longitudinal studies on this topic are scarce. Data from a longitudinal study of elementary school children in Adachi City, Tokyo, Japan, were analyzed. In 2015, caregivers of children at grade 1 answered questionnaires, and information on dental caries and height measured at school health checkups was merged and followed to grade 6 (N = 3576; follow up rate = 83.3%). The association between short stature at grade 1 (−2.01 standard deviation (SD)–−3.00 SD, or <−3.00 SD in height-for-age according to the World Health Organization criteria) and the number of decayed, missing, or filled permanent teeth (DMFT) at grade 6 was examined using multivariable Poisson regression with robust standard error. After adjusting for confounders, children with a short stature at grade 1 had a higher DMFT number at grade 6: the mean ratios (95% confidence interval) were 1.17 (0.89–1.54) and 2.18 (1.03–4.64) for children with a height-for-age −2.01 SD–−3.00 SD, and those with a height-for-age < −3.00, respectively. Short stature at grade 1 could be a marker of future dental caries in the permanent teeth at grade 6. Full article

Penitentiaries have a higher burden of communicable diseases compared to the general population. Prisoners should be tested for hepatitis C virus (HCV) and have direct access to treatment. We analysed the HCV cascade of care in two penitentiaries in Brescia, Northern Italy. At admission, prisoners are offered a voluntary screening for HCV, while patients with known infections are tested with an HCVRNA measurement. We performed an observational retrospective study including all the subjects admitted to the penitentiaries from 1 January 2015 to 31 October 2021. We conducted a descriptive analysis. During the study period, 5378 admissions were registered, and 2932 (54.5%) screenings were performed. Hepatitis C virus antibody positivity was found in 269 tests (9.2%). Hepatitis C virus RNA was detectable in 169 people. During the study period, 77 treatments with direct-acting antivirals (DAAs) were administered. Follow-up was available in 45 patients, and sustained virological response (SVR) was documented in 44 of them. Retention in care occurred in less than half of the prisoners after release. Our data demonstrate poor screening adherence that could benefit from educational programs. Treatment rates could be improved with test-and-treat programs. More efforts are needed to eliminate HCV as a public threat by 2030. Dedicated local networks, including infectious diseases (ID) departments, substance abuse services and prisons, could mitigate these issues. Full article

Self-harm is becoming increasingly common in student populations. Brief psychological therapies might be helpful for those who have recently self-harmed. The current paper reports on an evaluation of a brief psychotherapy service delivered via remote means, namely University–Community Outpatient Psychotherapy Engagement (U-COPE). The service combines elements of psychodynamic interpersonal and cognitive analytic therapy to help students who present with self-harm related difficulties. The primary aim was to understand students’ and practitioners’ experiences of a remote psychotherapy service. Semi-structured interviews were conducted with a total of nine participants (seven students and two practitioners). Interview data were analysed using thematic analysis. Analyses of the interviews across the stakeholders revealed three overarching themes: ‘Accessibility’; ‘Therapeutic experiences’; and ‘Spaces and places of therapy’. Students appreciated the rapid access to intervention, especially as student services are typically characterised by long waiting lists. Despite the brief nature of the intervention, many students reported feeling a sense of control over the direction and pace of the therapeutic sessions, which is an important consideration for those who self-harm. The findings suggest that U-COPE may be helpful to students with difficulties related to self-harm. Further investigation of this brief intervention is warranted in order to ascertain whether U-COPE has a long-term impact on difficulties and distress-related behaviours. Full article

This study examines support for the Department of Housing and Urban Development’s (HUD) mandatory smoke-free rule up to four years post-rule among smokers and non-smokers. A repeated cross-sectional design was used where District of Columbia public housing residents aged 18+ (n = 529) completed surveys during three time points: July 2018 (pre-rule), November 2018–March 2020 (post-rule), and September 2020–December 2022 (post-rule + COVID-19). Full support for the rule was indicated by agreeing that smoking should not be allowed in all indoor locations and within 25 feet of buildings. Descriptive statistics showed significant differences in support across time for smokers (5.3%, 30.7%, and 22.5%, respectively) and similar support across time for nonsmokers (48.2%, 52.2%, and 40.0%, respectively). In unstratified regression analysis, pre-rule support was lower than when the rule was in effect (aOR = 0.47, 95% CI = 0.25, 0.90), and tobacco users were less likely to support the rule (aOR = 0.34, 95% CI = 0.23, 0.50). Stratified logistic regression results showed that pre-rule support was lower among smokers compared to post-rule support (aOR = 0.14, 95% CI = 0.03, 0.59); support among nonsmokers did not vary by time. Findings overall indicate low support for the smoke-free rule up to 4 years post-implementation. Engaging residents with the rule and promoting health and well-being may further enhance policy effectiveness and acceptance. Full article

During the COVID-19 pandemic, first responders faced significant biosafety challenges, especially while handling patient transport, potentially exposing them to infection. The PANDEM-2 (European project on pandemic preparedness and response) project, funded by the Horizon 2020 program, sought to investigate the challenges confronting Emergency Medical Systems throughout the EU. First responders from Portugal’s National Institute of Medical Emergency (INEM) were considered as a representative operational model of the national first responder agencies of European member states because they played a critical role during the COVID-19 pandemic. As a result, they were asked to complete an online survey about their COVID-19 pandemic-related professional activities. The survey focused on their perspectives on current biosafety guidelines and their operational practices. It covered opinions on existing protocols, technical concerns during patient transport, and issues after the patients arrived at the hospital. The key findings revealed concerns about risk assessment, the inadequacy of guidelines, and disparities in equipment access. This survey emphasizes the importance of developing streamlined, adaptable biosafety protocols, better coordination between prehospital and in-hospital services, and the development of scalable, cost-effective biosafety solutions. Based on our findings, we propose improvements to national and European biosafety directives and advocate for streamlined adaptation during pandemics. Full article

COVID-19 vaccination during pregnancy has been recommended, but the perceptions related to uptake remain unexplored. This pilot study aimed to explore how perceptions influence COVID-19 vaccine uptake among a sample of 115 pregnant women in Kenya, recruited via WhatsApp. Data were collected using an adapted online questionnaire between May and October 2022. Logistic analyses assessed the relationship between COVID-19 vaccination uptake and the Theory of Reasoned Action (TRA) constructs: attitudes and subjective norms. COVID-19 vaccination coverage was 73%, with vaccine hesitancy estimated at 41.4% among the unvaccinated group. Most participants had completed college education and had good knowledge of COVID-19 vaccines. There was no significant effect of enrollment in WhatsApp pregnancy groups on attitudes toward COVID-19 vaccination. Pregnant women were concerned about vaccine effectiveness (31.1%), and almost one-half (47.3%) were discouraged from receiving COVID-19 vaccines. Positive attitudes towards vaccination were associated with COVID-19 vaccination (aOR 2.81; 95% CI 1.12–7.04; p = 0.027), but no significant relationship was found between COVID-19 vaccination and strong subjective norms (influences to get COVID-19 vaccines). Our findings suggest that strategies to improve vaccination should consider targeting attitudes and proximal social networks (friends/family) to facilitate vaccination decision-making. WhatsApp can be used for research distribution and enhance the dissemination of accurate information. Full article

Trail running is a fast-growing sport, linked to improvements in both physical and psychological well-being. Despite its popularity, the preferences of trail runners are not well known. The objective of this study was to examine the environmental preferences and concerns of trail runners with respect to age and gender. We conducted a cross-sectional survey of recreational trail runners. A total of 548 people responded, of which 50.1% of respondents were women and 44.2% were men. The sample was distributed relatively evenly across age groups, up to 54 years; respondents over 55 represented only 9.4% of the sample. Comparisons of runner characteristics by gender indicated significant differences (p < 0.05) according to age, distance run per week, and number of days run per week. Certain runner preferences also differed significantly by gender, including importance of running around others, the type of trail races they seek, and whether or not they like to seek “vert” or elevation in their runs. Major concerns for both genders while running included lack of cell reception (Men: 33.8%; Women: 50.8%) and getting lost (Men: 26.8%; Women: 35.5%). Comparisons of the results of this study help to strengthen our understanding of trail runners’ environmental preferences and concerns and can be used to guide future design and maintenance of trail environments to encourage greater participation in the sport. Full article

Background: Loneliness in older adults is a critical issue that negatively affects their well-being. The potential of personal voice assistant (PVA) devices like Amazon’s Alexa Echo in reducing loneliness is an emerging area of interest, but it remains under-researched. Objective: this study aims to investigate the effect of interaction time and verbal engagement with PVA devices on reducing loneliness among older adults living alone. Method: In this experiment, individuals aged 75 and older (n = 15), living alone, were provided with Amazon Alexa Echo devices. They were instructed to interact with the device at least five times a day for a duration of four weeks. The study measured participants’ loneliness levels using the UCLA loneliness scale both before and after the study. Additionally, the interaction time and verbal engagement with the device were measured by the total time of use and the total number of intentional commands spoken to Alexa during the four-week period. Results: The findings revealed that the total time spent interacting with Alexa was a significant predictor of loneliness reduction. A mediation analysis indicated an indirect effect, showing that the number of intentional commands spoken to Alexa contributed to loneliness reduction indirectly by increasing the total time spent with the device (verbal engagement → interaction time → loneliness reduction). Conclusions: This study suggests that the key to reducing loneliness among older adults through PVA devices is not just initiating verbal interaction, but the overall time devoted to these interactions. While speaking to Alexa is a starting point, it is the duration of engagement that primarily drives loneliness alleviation. Full article

Background: The COVID-19 pandemic has had effects on sexual and reproductive health and intimate partner violence (IPV). This study aims to describe changes in sexual health and IPV in the Italian population both during and after the lockdowns. Methods: This cross-sectional online study was conducted, as part of the I-SHARE multicountry project, between June 2020 and January 2021. Recruitment was carried out through convenience sampling; a total of 329 participants were included in the analysis. A generalized linear model was used to analyze the difference in sexual health and IPV variables before, during, and after the lockdown. Results: Fifty-three percent of the participants reported having sexual problems during the first wave of the pandemic. Sexual satisfaction decreased during the first wave, and then, returned to the pre-lockdown level. While during the lockdown, some activities were reduced (such as kissing, cuddling, and sexual activities with a steady partner), for other activities, no difference was reported (such as masturbation, sexual activities with casual partners, or sexting). Few participants reported having issues accessing HIV testing and contraception. There was no difference in terms of physical and sexual violence, while there was a significant decrease in feeling vulnerable to sexual or physical assault during the first wave. Conclusions: The first wave of the pandemic has had significant effects on sexual health. This should be taken into consideration when preparing for future epidemics and health emergencies. Full article

The digitisation of healthcare has allowed a significant rethinking of the previous clinical protocols, improving their interoperability through substantial standardisation. These technological advances have ensured that data are comparable, as they are obtained from ‘reliable’ and certified processes; however, there are billions of data that are neither structured nor quality-controlled. They are collectively referred to as ‘Real World Data’ (RWD). Blockchain (BC) is a procedure with specific characteristics and algorithms that ensure that the stored data cannot be tampered with. Nowadays, there is an increasing need to rethink blockchain in a one-health vision, making it more than just a ‘repository’ of data and information, but rather an active player in the process of data sharing. In this landscape, several scholars have analysed the potential benefits of BC in healthcare, focusing on the sharing and safety of clinical data and its contact tracing applications. There is limited research on this matter; moreover, there is a strategic interest in managing RWD in a reliable and comparable way, despite the lack of knowledge on this topic. Our work aims to analyse systematically the most impacting literature, highlighting the main aspects of BC within the context of the new digital healthcare, and speculating on the unexpressed potential of RWD. Full article

Up until now, the measurement of Quality of Life (QoL) was based on validated subjective rating tools rather than objective measurement. To become more independent of the self-assessment of probands, a way to objectively measure QoL should be found. A monocenter, cross-sectional, observational, non-interventional trial was performed from 2012 to 2014 at Inselspital Bern to evaluate the bio-functional status (BFS), a complex, generic, non-invasive, sex- and age-validated assessment tool, in a wide range of areas. A standardized battery of assessments was performed on 464 females and 166 males, ages 18 to 65 (n = 630). In addition to the survey of the BFS, participants replied—among others—to the validated questionnaire SF-36 for health-related QoL (n = 447, subgroup 1). Since the accepted cut-off value for BFA calculation is age ≥ 35 years, subgroup 2 included 227 subjects (all participants aged ≥ 35 years out of subgroup 1). In order to be able to compare the eight SF-36 subscales to BFS parameters, a comparable score set of single BFS items had to be constructed. Subsequently, we aimed to statistically identify BFS item combinations that best represented each SF-36 subscale. All eight SF-36 subscales were significantly represented by various different combinations of BFS items. A total of 24 single BFS items significantly correlated with SF-36 subscales, of which 15 were objective and nine were subjective. All eight SF-36 subscales were significantly represented by various different combinations of BFS items leading to stronger correlations (range five to nine BFS items), and overall, sex and age did not affect these associations, but in the SF-36 subscales ‘bodily pain’ (sex) and ‘role limitations due to physical health problems’ (age in men). To our knowledge, we are the first to correlate a validated set of 34 objective and 9 subjective parameters with subjectively evaluated SF-36 subscales. This first study on the objectifiability of the SF-36 questionnaire demonstrated that questions on quality of life can be answered independently of a subjective assessment by subjects in future scientific studies. Full article

Patients hospitalized with medical complications from substance use disorder (SUD) encounter unique health problems that may complicate their recovery. Recovery barriers are not well understood in this population. The study objective is to characterize recovery barriers in this patient population. Participants (n = 96) in this six-month longitudinal study were randomized to a peer recovery coaching intervention or standard of care. The primary outcome measures were qualitative, open-ended questions addressing factors interfering with participants’ recovery. Data were analyzed using content analysis. Themes were identified a priori using past research on recovery capital domains; these seven barriers were (1) psychological health difficulties, (2) physical health challenges, (3) lack of social support, (4) insufficient treatment or recovery support to maintain sobriety, (5) environmental and housing concerns, (6) deficits in coping skills, and (7) lack of meaningful activities. At baseline, the most common recovery barriers were in the environment and housing (28.1%), psychological health (27.1%), and social support (22.9%) domains. At six-month follow-up, participants were asked to describe barriers they felt they had made improvement in over the last six months. The primary themes that participants reported improvements in were treatment and recovery support to maintain sobriety (52.1%), coping skills (35.4%), and social support (27.1%). Hospitalization and participation in a randomized controlled trial may be a turning point in which to address recovery barriers for patients hospitalized with complications from SUD. Full article

Background: the integration of dentistry services in the Unified Health System in Brazil (SUS) is essential in primary care assistance. Objective: we aimed to develop a tool for improving demand flowby evaluating the impact of oral health on the daily activities of users of the Family Health Unitusing the Oral Impacts of Daily Performance (OIDP)tool. Methods: In Barretos, Brazil, a cross-sectional study was conducted at a Family Health Unit (FHU)including patients over 12 years old. Oral health impact was assessed using the Oral Impacts of Daily Performance (OIDP) tool, and family risk was measured with the Coelho–Savassi scale. Results: 430 participants, including 411 adults and 19 young people, were recruited. Of the adults, 31% had an average OIDP score of 16.61. For young people, 53% reported an impact (average OIDP score: 28.61). Family risk (R1) was prevalent in 57.9% of young people and 53.3% of adults. Among adults, different activities were affected by risk: smiling without embarrassment (risk level 2), enjoying contact with people (risk level 3), and performing one’s job or social role (risk level 1). Emotional state (R3) had the lowest OIDP score (p = 0.029). Conclusion: implementation of the OIDP scale in clinical practice enhances healthcare planning and ensures better-quality and equitable services, thus emphasizing comprehensive oral healthcare within the SUS. Full article

The relationship between exposure to inhaled inorganic particulate matter and risk for deployment-related lung disease in military personnel is unclear due in part to difficulties characterizing individual exposure to airborne hazards. We evaluated the association between self-reported deployment exposures and particulate matter (PM) contained in lung tissue from previously deployed personnel with lung disease (“deployers”). The PM in deployer tissues was compared to normal lung tissue PM using the analytical results of scanning electron microscopy and inductively coupled plasma mass spectrometry. The majority of PM phases for both the deployers and the controls were sub-micrometer in size and were compositionally classified as aluminum and zirconium oxides, carbonaceous particles, iron oxides, titanium oxides, silica, other silicates, and other metals. The proportion of silica and other silicates was significantly higher in the retained dust from military veterans with biopsy-confirmed deployment-related lung disease compared to the control subjects. Within the deployer population, those who had combat jobs had a higher total PM burden, though the difference was not statistically significant. These findings have important implications for understanding the role of inhaled inorganic dusts in the risk for lung injury in previously deployed military veterans. Full article

Telehealth has improved patient access to healthcare services and has been shown to have a positive impact in various healthcare settings. In any case, little is understood regarding the utilization of telehealth in hypertension management in primary healthcare (PHC) settings. This study aimed to identify and classify information about the types of interventions and types of telehealth technology in hypertension management in primary healthcare. A scoping review based on PRISMA-ScR was used in this study. We searched for articles in four databases: Pubmed, Scopus, Science Direct, and Embase in English. The selected articles were published in 2013–2023. The data were extracted, categorized, and analyzed using thematic analysis. There were 1142 articles identified and 42 articles included in this study. Regarding the proportions of studies showing varying trends in the last ten years, most studies came from the United States (US) (23.8%), were conducted in urban locations (33.3%), and had a quantitative study approach (69%). Telehealth interventions in hypertension management are dominated by telemonitoring followed by teleconsultation. Asynchronous telehealth is becoming the most widely used technology in managing hypertension in primary care settings. Telehealth in primary care hypertension management involves the use of telecommunications technology to monitor and manage blood pressure and provide medical advice and counselling remotely. Full article