Int. J. Environ. Res. Public Health, Volume 20, Issue 16 (August-2 2023) – 80 articles

Background: Areca nut and betel quid (ANBQ) chewing is a widespread carcinogenic habit. The BENIT (ClinicalTrials—NCT02942745) is the first known randomized trial designed for ANBQ chewers. Methods: We compared the intensive behavioral treatment intervention condition (IC) with the control condition (CC) in the BENIT and included a 5-stage early stopping rule. We report the primary analysis at stage 3. English-literate adults in Guam and Saipan who self-identified as ANBQ chewers with tobacco were enrolled between August 2016 and August 2020. IC participants (n = 88) received five in-person sessions over 22 days and a brochure containing quitting advice. CC participants (n = 88) received only the brochure. Participants were assessed at baseline and on day 22 of follow-up. Self-reported chewing status at day 22 was determined by a composite of two survey items with disparate wording and response options for cross-verification. Results: Cessation rates were 38.6% (IC) and 9.1% (CC). Proportional hazards regression revealed a p = 0.0058, which met the Stage 3 criteria for significance, and an estimated reduction in ANBQ chewing for IC compared to the CC of 71% (95% CI: 41%–88%). Conclusions: Robust self-reported intervention effects at day 22 suggest that intensive cessation programs such as BENIT should be further developed and implemented on a larger scale. Full article

Chris Cornell was a guitarist, singer, songwriter, and pioneer of grunge music. Cornell struggled with mental illness and addiction and incorporated these themes into his song lyrics. At age 52, Cornell died by suicide in his hotel bathroom following a live performance. This mixed-methods study examines Cornell’s song lyrics for references to negative words and themes related to depression and suicide. Two coders independently reviewed lyrical transcripts to identify the primary theme, secondary theme(s), and valence (positive or negative). Sentiment analysis, a natural language processing technique, was used to examine word frequency and valence. Songs (N = 215) were predominantly (79%) negative and contained more negative (N = 3244, 56.1%) than positive (N = 2537, 43.9%) words. Thematic analysis by stage of career shows a narrowing focus on depression, failed relationships, and morbid thoughts. Themes of depressed mood, death, and suicide were common and increased by stage of career. By applying qualitative and quantitative techniques to song lyrics, this study revealed that Cornell’s songs reflect a narrative of negativity consistent with someone experiencing depression and thoughts of death and suicide. Like personal notes and poems, song lyrics may reflect symptoms of depression and suicidal thoughts warranting clinical attention. Full article

This study investigates how people’s perceived COVID-19 risk, worries about financial hardship, job loss, and family conflicts, and exposures to greenspace, PM_2.5, and noise (in people’s residential neighborhoods and daily activity locations) are related to their depression, anxiety, and stress during the COVID-19 pandemic. Using a two-day activity-travel diary, a questionnaire, and real-time air pollutant and noise sensors, a survey was conducted to collect data from 221 participants living in two residential neighborhoods of Hong Kong during the COVID-19 pandemic. Linear regression was conducted to explore the relationships. Significant associations between people’s COVID-19-related worries and exposures to grassland and PM_2.5 with depression, anxiety, and stress were found in the results. These associations with depression, anxiety, and stress vary depending on people’s demographic attributes. These results can help direct the public authorities’ efforts in dealing with the public mental health crisis during the COVID-19 pandemic. Full article

Dysmenorrhea, the pain experienced by women during menstruation, affects a significant proportion of women worldwide and often leads to decreased productivity. Various pharmacological and non-pharmacological treatments are available for pain relief, but information on their effectiveness, particularly regarding green coconut water, dark chocolate, and Ibuprofen, remains limited. This study aimed to compare the effectiveness of green coconut water, dark chocolate bars, and Ibuprofen in reducing the intensity of primary dysmenorrhea. In this research, a randomized controlled trial with a quantitative design was conducted, involving 45 participants randomly assigned to receive 330 mL of green coconut water, 35 g of 70% dark chocolate, or 400 mg Ibuprofen. The interventions were administered on the first day of menstruation when dysmenorrhea symptoms typically occur in subjects. This study used a single-dose approach to evaluate the immediate impact of each treatment. The subjects were instructed to consume the given interventional product within 15 min. The pain intensity was measured using a Numeric Rating Scale before the intervention and 2 h after the subjects finished consuming the interventional product. The multivariate Kruskal–Wallis test revealed a significant difference in effectiveness among the three interventions (p < 0.05). The study found that Ibuprofen was the most effective intervention compared to the other interventions. These findings contribute to understanding the treatment options for primary dysmenorrhea and emphasize the efficacy of Ibuprofen (trial registration: ClinicalTrials.gov: NCT05971186). Full article

Background: The COVID-19 pandemic has promoted a shortage of filtering facepiece respirators (FFRs) and the emergence of new FFRs brands. We aimed to determine the fit provided by in-use FFRs in Peruvian healthcare workers (HCWs) during the COVID-19 pandemic. Methods: We enrolled 279 HCWs from 37 primary healthcare centers with highest burden of care for TB in Peru, of which 263 were assessed using quantitative fit tests (QNFT). Results were expressed as real-time fit factor (rt-FF) and overall fit factor (overall-FF), which was categorized as ≥100 (optimal result), 50–99, and <50. Results: We identified 3M 1860 FFRs (33.1%), Xiantao Zhong Yi ZYB-11 FFRs (24.6%) and Makrite 9500 FFRs (20.5%), mainly. Eighty-seven FFRs (33.1%) had an optimal overall-FF, 27 (10.3%) between 50–99, and 149 (56.6%) less than 50. Of the 87 FFRs with optimal overall-FF, 73 (83.9%) were 3M 1860 FFRs. Of the 27 FFRs with overall-FF between 50–99, 7 (25.9%) were Makrite 9500, while of the 149 with overall-FF less than 50, 58 (38.9%), and 47 (31.5%) were Xiantao Zhong Yi ZYB-11 and Makrite 9500, respectively. Conclusion: Xiantao Zhong Yi and Makrite FFRs do not adapt adequately to the face of Peruvian HCWs, most having fit factors less than 50. Full article

In the United States, there is an opportunity to improve the nutritional health of university students through the campus food environment. This project used a content analysis approach to investigate whether healthy food standards and policies were incorporated into the contract agreements between North Carolina (NC) public universities and their food service management companies. Food service contracts were collected from 14 NC public universities using food service management companies on campus. Each contract was evaluated using the 35-item North Carolina Food Service Policy Guidelines Assessment to examine four elements of the campus food environment: Beverages, Packaged Snacks, Prepared Foods, and Other (e.g., strategic placement of healthier food). Five university food service contracts incorporated no North Carolina Food Service Policy Guidelines, three university contracts included one to five guidelines, and six university contracts included six to nine guidelines. Altogether, 13 of the 35 guidelines were incorporated into at least one university food service contract. This project presents a cost and time-effective assessment method for determining if evidence-based nutrition guidelines have been included in university food service contracts. This approach and findings may lead to contract revisions to improve the campus food environment and, subsequently, the nutritional health of college populations. Full article

HIV diagnosis and management have often caused disruption to the everyday life and imagined futures of people living with HIV, both at individual and social levels. This disruption has been conceptualised, in a rather dystopian way, as ‘biographical disruption’. This paper explores whether or not biographical disruption of living with HIV encourages men living with HIV (MLHIV; n = 40) in Yogyakarta and Belu, Indonesia, to reinvent their sense of self and future over time using internal and external assets. Our analysis uses the concepts of additive and subtractive resilience strategies, and we show how, rather than having a purely disrupted biography, participants talked about their experiences of ‘biographical reinvention’. Study participants were recruited using the snowball sampling technique, beginning with two HIV clinics as the settings. Data were collected using one-on-one in-depth interviews, and a qualitative framework analysis was used to guide step-by-step data analysis. The findings showed that, despite the disruptions in their everyday lives (i.e., mental health condition, work, activities, social relationships, etc.) following the HIV diagnosis and management, MLHIV in our study managed to utilise their internal assets or traits (i.e., hope, optimism, resilience) and mobilised external resources (i.e., support from families, friends and healthcare professionals) to cope with the disruptions. An interweaving of these internal assets and external resources enabled them to take on new activities and roles (additive resilience strategies) and give up health compromising behaviours (subtractive resilience strategies). These were effective for most MLHIV in our study, not only to cope with the HIV repercussions and improve their physical and mental health conditions, but to think or work on a ‘reinvented’ biography which encompassed resilience, hope and optimism for better health, life and future. The findings indicate the need for HIV interventions and healthcare systems that provide appropriate support for the development and maintenance of internal assets of PLHIV to enable them to cope with the repercussions of HIV and work on a ‘reinvented’ biography. Full article

Syndromic aortic diseases (SADs) encompass various pathological manifestations affecting the aorta caused by known genetic factors, such as aneurysms, dissections, and ruptures. However, the genetic mutation underlying aortic pathology also gives rise to clinical manifestations affecting other vessels and systems. As a consequence, the main syndromes currently identified as Marfan, Loeys–Dietz, and vascular Ehlers–Danlos are characterized by a complex clinical picture. In this contribution, we provide an overview of the genetic mutations currently identified in order to have a better understanding of the pathogenic mechanisms. Moreover, an update is presented on the basis of the most recent diagnostic criteria, which enable an early diagnosis. Finally, therapeutic strategies are proposed with the goal of improving the rates of patient survival and the quality of life of those affected by these SADs. Full article

Prevention and treatment of childhood obesity is a global concern, and in Malaysia, it is considered a national public health priority. Determinants of childhood obesity are multifactorial and include factors that directly and indirectly influence energy balance-related behaviours, including energy intake and energy expenditure. Interventions to address childhood obesity that have multiple components at different levels have been shown to be the most influential. The ToyBox-study is a childhood obesity intervention aimed at preschool-aged children and their families that had been shown to be effective in several European countries and so was chosen for adaption for the Malaysian setting. Materials were translated and adjusted for the Malaysian context and audience and implemented in kindergartens in Peninsular Malaysia and Sarawak. However, during the COVID-19 pandemic and lockdown, teaching transitioned to being online. This brought an opportunity to reach a wider audience and consider the long-term sustainability of the intervention, and thus eToybox was born. eToybox aims to bring support for healthy energy balance behaviours directly to the teachers, into kindergartens and homes, to encourage families to be active and eat healthily, and prevent or reduce obesity. Through online innovation, the Toybox Study Malaysia programme has been expanded to enhance its potential to impact the promotion of healthy lifestyles among preschoolers and their families, highlighting the importance of a holistic approach to preventing and treating childhood obesity in Malaysia. Full article

In Uganda, the uptake of cervical cancer (CC) screening services is low, at 46.7%, among HIV-infected women, and only 9% of these women adhere to annual CC screening. Some studies have evaluated the possibility of community or home-based human papillomavirus (HPV) self-collected vaginal swabs, but not clinic-based HPV self-collected vaginal swabs. Therefore, we propose a study to determine the efficacy of clinic-based versus home-based HPV DNA self-sampling among HIV-infected women attending a rural HIV clinic in Uganda. We believe that a randomized, single-blinded trial would achieve this objective, and so we have chosen it to guide the study. Including a total of 382 participants from a rural HIV clinic, randomized into a ratio of 1:1 for clinic- and home-based HPV self-sampling, would allow us to appropriately ascertain the difference in the uptake of HPV self-sampling between the two arms. The Integrated Biorepository of H3 Africa Uganda Laboratory would be used as a reference laboratory for the HPV DNA extraction, typing, and sequencing. At baseline, modified Poisson regression models would be used to measure factors associated with the prevalence of HPV and uptake in both arms at baseline. Visual inspection under acetic acid (VIA), as a gold-standard test for CC to grade for CIN, would be performed at 0 and 6 months among a random sample of 75 women with a self-collected HPV sample. The difference in uptake could be determined using the intention-to-treat analysis. The difference in the groups by each variable would be summarized as the standardized mean difference (i.e., the mean difference divided by the pooled standard deviation). The predictors of the time for which participants would continue with HPV self-sampling in both arms, recovery, and Cox proportional hazards regression would be used. At the bivariate level, the associations between each independent variable and time, with the time of continuing HPV self-sampling, would be computed. Crude hazard ratios and their 95% confidence interval would be used in the presentation of the results, with p-values < 0.05 considered significant at the bivariate level. Incremental cost-effectiveness analysis (CEA) using a Markov model would be used to determine the cost of clinic-based HPV self-sampling. We believe that screening approaches to disease stratification could provide an insight into the merits and limitations of current approaches to the diagnosis of cervical cancer, and how these could eventually be implemented into HIV clinics in Uganda and other developing African countries. It is anticipated that the findings would guide the development of step-by-step guidelines for the HPV self-sampling approach. Full article

Staff turnover in long-term care (LTC) is considered one of the main causes of staff shortages and a key problem for LTC systems in the developed world. Factors affecting staff turnover in LTC facilities are poorly understood due to a fragmented approach. The aim of this study was to use multivariate analysis to identify the factors at the macro-, meso-, and micro-level that influence LTC workers’ turnover in Slovenia, a typical Central and Eastern European country. A correlational cross-sectional survey design with a self-reported online questionnaire was used among Slovenian LTC workers (N = 452). The results show that more than half of LTC workers intend to quit their jobs and leave the LTC sector. LTC workers who intend to leave are generally younger, have worked in the LTC sector for a shorter period, are mainly employed in the public sector, especially in nursing homes, and earn less. The connection between the intention to leave and the factors at the macro-, meso-, and micro-level is very high. Over 75% of the variance of intention to leave was explained by the linear influence of sociodemographic characteristics, social recognition, and work environment. Urgent measures for improving the work environment are needed. Full article

Mental health of trauma-affected refugees is an understudied area, resulting in inadequate and poorer treatment outcomes. To address this, more high-quality treatment studies that include predictive analyses, long-term evaluations, cultural adaptations, and take account for comorbidities, are needed. Moreover, given the complex intertwining of refugees’ health with post-migration stressors and other social factors, it is crucial to examine the social determinants of refugee mental health. The Danish Trauma Database for Refugees (DTD) is a multicenter research database uniting six national centers that provide outpatient treatment for trauma-affected refugees. Through the database, we collect clinical and sociodemographic data from approximately 1200 refugees annually and will merge the database with Danish population register data. The purpose of the DTD is two-fold; clinical and research. The DTD offers data-driven guidance for routine clinical treatment planning of the individual patient, as well as exceptional research opportunities for testing treatment interventions in clinical settings, with larger sample sizes, and more representative heterogeneity of the population. Complex analyses of risk and protective factors, barriers, access to treatment, and societal and transgenerational aspects of trauma are possible with the DTD. This conceptual paper introduces the DTD, the historical background, the development process and implementation strategy, and the associated challenges with developing and running a multicenter database. Most importantly, it highlights the clinical and research potential of the DTD for advancing the understanding and treatment of trauma-affected refugees. Full article

People on buprenorphine maintenance treatment (BMT) commonly present cognitive deficits that have been associated with illicit drug use and dropout from buprenorphine treatment. This study has compared cognitive responses to the Stroop Task and the Continuous Performance Task (CPT) among individuals on BMT, with recent drug use, and healthy controls and explored the associations between cognitive responses and drug use, craving, and buprenorphine use among participants on BMT. The participants were 16 individuals on BMT and 23 healthy controls. All participants completed a 60 min laboratory session in which they completed the Stroop Task and the CPT, a saliva drug test, a brief clinical history that collected substance-use- and treatment-related information, and the Opioid Craving Scale. The results showed that the BMT participants presented more commission errors (MBMT participants = 2.49; Mhealthy controls = 1.38; p = 0.048) and longer reaction times (MBMT participants = 798.09; Mhealthy controls = 699.09; p = 0.047) in the Stroop Task than did the healthy controls. More days on buprenorphine were negatively associated with reaction time in the CPT (−0.52) and the number of commission errors (−0.53), simple reaction time (−0.54), and reaction time correct (−0.57) in the Stroop Task. Neither drug use nor craving was significantly associated with the results for the cognitive tasks. Relative to the control participants, the BMT individuals performed worse in terms of longer reaction times and more commission errors in the Stroop Task. Within the BMT participants, longer times on buprenorphine were associated with better cognitive results in terms of faster reaction times for both tasks and lower commission errors for the Stroop Task. Full article

The purpose of this study was to evaluate oral health status, behavioral risk indicators, and the impact of smoking on oral health among Lithuanian adolescents. This representative cross-sectional study was conducted among 15-year-old Lithuanian adolescents. The method of multistage cluster sampling was used. A total of 1127 adolescents met the inclusion criteria. Two originally created self-reported questionnaires were used in this study. Dental caries, periodontal status, and oral hygiene status were evaluated by four trained researchers. A p-value ≤ 0.05 was set to indicate statistically significant differences. Statistical analysis included Mann–Whitney, Kruskal–Wallis, and Spearman correlation tests. Out of all the participants, 9.6% self-reported being a current tobacco smoker. The mean PI value was 1.14 ± 0.69 among all the participants. Currently smoking adolescents had more active caries lesions (D-S) than those who did not smoke (13.2 ± 16.4 vs. 9.8 ± 10.7, p = 0.023). Considering periodontal status, non-smoking adolescents had significantly lower mean PSR index scores than current smokers (0.52 ± 0.51 vs. 0.61 ± 0.50, p = 0.0298). Tobacco smoking and the consumption of energy drinks were significantly associated (OR = 3.74, 95% CI 2.66–5.26, p < 0.001) among participants. Currently smoking adolescents tended to have improper dietary habits, especially a higher consumption of energy drinks; thus, they were more likely to have active dental caries lesions, as well as poorer periodontal status, than their non-smoking peers. Full article

Meeting the health needs of migrant and refugee communities is crucial to successful settlement and integration. These communities are often under-served by mental health services. Previous research has demonstrated the effectiveness of a group mindfulness-based intervention tailored for Arabic and Bangla speakers living in Sydney, Australia. This study aimed to explore community partner perspectives on the program’s impact, contributing factors and sustainability, and to elicit suggestions for future development. Data were collected via semi-structured telephone interviews with a purposively selected sample of 16 informants. Thematic analysis was conducted using the Rigorous and Accelerated Data Reduction (RADaR) technique. Community partners welcomed the emphasis on promoting wellbeing and reported that the community-based in-language intervention, in both face-to-face and online formats, overcame many of the barriers to timely mental health care for culturally and linguistically diverse (CALD) communities, with a beneficial impact on group participants, program providers, partner organisations and the broader community. Positive outcomes led to stronger community engagement and demand for more programs. For group mental health programs, both trust and safety are necessary. Relationships must be nurtured, diversity within CALD communities recognised, and projects adequately resourced to ensure partner organisations are not overburdened. Full article

A model of recovery and recovery-oriented practice has been developed based on three previously published meta-syntheses of experiences and processes of mental health and substance use recovery. The model integrates the findings of these three meta-syntheses into three components: experiences of recovery, processes of recovery-oriented practice, and social and material capital. The experiences of recovery involve being, doing, and accessing and are viewed as embedded in the processes of recovery. The processes of recovery-oriented practice aim to mobilize and apply various forms of capital to support the recovery journey. Social and material capital, in turn, constitute the context in which recovery occurs and requires mobilization for the individual and the service system. The model is grounded in the principles of well-being, person-centeredness, embedding, self-determination, and the interdependency of human living. The model is both descriptive and explanatory, as it depicts the experiential and processual aspects of recovery and recovery-oriented practice and their interrelationships. The model as a framework needs to be elaborated further through application in practice and research, especially for understanding how experiences, processes and practices interact over time, and how they are affected by access to material and social capital. Full article

Background: To identify people at risk of type 2 diabetes. Primary health care needs efficient and noninvasive screening tools to detect individuals in need of follow-up to promote health and well-being. Previous research has shown people with lower levels of health literacy and/or well-being scores are vulnerable but may benefit from intervention and follow-up care. Aims: This cross-sectional study, aimed to identify people at risk for type 2 diabetes by comparing the Finnish Diabetes Risk instrument with the waist-to-height ratio. Further, the difference was examined in health literacy and well-being scale scores in the countryside versus town areas, respectively. Results: In total, 220, aged 18–75 years, participated. Thereof, 13.2% displayed biomarkers at prediabetes level of HbA1c (39–47 mmol/mol); none had undiagnosed diabetes. Of the participants, 73% were overweight or obese. Waist-to-height ratio demonstrated 93.1% of the prediabetes group at moderate to high health risk and 64.4% of the normal group, with an area under the curve of 0.759, sensitivity of 93.3%, and specificity of 63.1%. Residency did not influence prediabetes prevalence, health literacy, or well-being. Conclusion: Waist-to-height ratio and the Finnish Diabetes Risk instrument may be suitable for identifying who need further tests and follow-up care for health promotion in primary care. Full article

Evidence-based practice (EBP) is an essential approach in healthcare, attracting growing interest among both practitioners and researchers. This scoping review aims to (1) systematically investigate the effectiveness of pedagogical methods used to facilitate learning of the EBP approach, and (2) explore the perceptions, experiences, and issues related to these learning methods. The overarching purpose is to identify the state of the art in pedagogical methods, instruments, influences, and barriers in teaching and learning EBP within entry-level physiotherapy education programs. This scoping review was conducted following PRISMA guidelines, with PubMed and Eric databases being searched for peer-reviewed original research articles using a combination of keywords. Excluding non-pertinent articles from the initial 465 identified, 12 were eligible for final inclusion (5 quantitative, 3 qualitative, and 4 mixed-methodology studies). A range of pedagogical methods and instruments for teaching EBP in physiotherapy education were detected, all of which having the capability to positively affect physiotherapy outcomes. Findings from this study support the significant influence that EBP exerts on the improving of the quality of teaching, together with the necessities that the involvement of EBP in physiotherapy education programs provide. Several barriers were identified, which should be taken into consideration when designing population-specific EBP strategies tailored to these particular needs. Full article

The interactions that take place in physical education (PE) between teachers and students have received large attention from the scientific community. However, despite the existence of different studies aiming to promote motivation among students through school interventions, there seem to be no interventions based on motivational strategies in which interventions are personalized to better fit teachers’ own characteristics on the basis of theoretical contents grounded in self-determination theory. This study aims to present a protocol intervention in the PE context based on SDT to improve teaching behaviours through an individualized and lifelong training program. This protocol is a convenience study in which PE teachers will design and implement motivational strategies to increase students’ motivation in class. The training program will take place along the intervention to allow teachers to personalize their implementation of motivational strategies according to their specific context. Data collection will be conducted before, during and after the intervention using recorded sessions (observational methodology), interviews (qualitative approach), and questionnaires (quantitative approach). The measures will assess teachers’ and students’ perceived teaching styles. This intervention program is expected to change and improve the quality of teaching behaviours, which could foster students’ psychosocial health. Full article

Parents self-medicating their children with antibiotics (SMA) without consulting healthcare professionals is a common practice in China. Previous research has focused primarily on examining the socioeconomic factors that contribute to the prevalence of SMA. This study adopts and extends the theory of planned behavior to understand the cognitive and emotional factors that are associated with parental SMA in China. The responses to an online survey were collected from 961 parents of children aged 6–12 years old, primarily from Gansu, Shandong, and Shaanxi provinces. More than half of the participants (66.5%) engaged in parental SMA. Amoxicillin, Cephradine, and Azithromycin were the most frequently selected antibiotics used for children. Structural equation modeling showed that uncertainty was positively associated with negative emotions, which were in turn positively associated with attitude toward SMA. Uncertainty was also negatively associated with perceived behavioral control (PBC), but the association between PBC and SMA behavior was not significant. Attitude and subjective norm were both positively associated with SMA behavior. The relationship between subjective norm and attitude was also positive. Understanding the psychological factors driving parental SMA may inform tailored interventions to promote responsible antibiotic use among parents. Full article

The association between neighborhood-built environment and body mass index (BMI) is well-characterized, whereas fewer studies have explored the mechanisms underlying the relationship between neighborhood social environment and obesogenic behaviors. Using data from a random sample of 16,820 residents ≥18 years from all 169 Connecticut towns and seven ZIP Codes in New York, this study examines the influence of neighborhood social environment on residents’ mental wellbeing, physical activity, and BMI. Structural equation modeling was conducted to estimate direct and indirect effects of neighborhood social environment on BMI, using mental wellbeing and physical activity as intermediate variables. There were significant total [β(SE) = 0.741 (0.170), p < 0.0001], direct [β(SE) = 0.456 (0.1890), p = 0.016], and indirect [β(SE) = 0.285 (0.061), p < 0.0001] effects of neighborhood social environment on BMI. Low physical activity was a partial mediator of the effect of non-favorable neighborhood social environment on BMI [β(SE) = −0.071 (0.011), p < 0.0001]. The association between neighborhood social environment and BMI was also mediated by mental wellbeing [β(SE) = 0.214 (0.060), p < 0.0001], and by mental wellbeing through physical activity [β(SE) = 0.071 (0.011), p < 0.0001]. Study findings provide further support for building strong social environments to improve population health and suggest that strategies prioritizing mental wellbeing may benefit behavioral interventions aimed at reducing obesity risk and should be a focus of prevention efforts in and of itself. Full article

A traumatic upbringing increases the risks of antenatal health problems, unfavourable pregnancy outcomes, and mental disorders. Such childhood experiences may affect women’s pa-renting skills and the social–emotional functioning of their children. Research on screening for adverse childhood experiences in antenatal care is limited. The objective of this study was to explore pregnant women’s attitudes towards and experiences of an adverse childhood experiences questionnaire, and to assess the relevance of the questionnaire among a population of pregnant women referred to antenatal care levels one and two, targeting women who are generally not perceived to be vulnerable. Data were collected at three maternity wards and consisted of quantitative data on 1352 women’s adverse childhood experience scores, structured observations of 18 midwifery visits, and in-depth interviews with 15 pregnant women. Quantitative data were analysed by descriptive statistics, and qualitative data were analysed using systematic text condensation. The qualitative analysis revealed two main categories: “Being screened for childhood adversities” and “Having adverse childhood experiences”. In the study population, the prevalence of adverse childhood experiences was high. The women assessed the adverse childhood experiences questionnaire to be a relevant and acceptable screening method. Furthermore, women’s perceptions of their relationship with their midwife greatly impacted their attitudes towards and experiences of the questionnaire. Full article

Contamination of soils by automotive residual oil represents a global environmental problem. Bioremediation is the technology most suitable to remove this contaminant from the medium. Therefore, this work aimed to evaluate the effectiveness of bioremediation of automotive residual oil-contaminated soils by biostimulation with enzymes, surfactant, and vermicompost. The bioremediation efficiency was examined using a factorial design of 2⁴ to determine the effect of the time, pH and temperature conditions, biostimulation with enzyme-vermicompost, and biostimulation with enzyme-surfactant. Enzymes obtained from Ricinus communis L. seeds, commercial vermicompost, and Triton X-100 were used. Results showed that the highest removal efficiency (99.9%) was achieved at 49 days, with a pH of 4.5, temperature of 37 °C, and using biostimulation with enzyme-vermicompost (3% w/v–5% w/w). The addition of surfactant was not significant in increasing the removal efficiency. Therefore, the results provide adequate conditions to bioremediate automotive residual oil-contaminated soils by biostimulation using enzymes supported with vermicompost. Full article

While the detrimental effects of protracted political conflict on the wellbeing of Palestinians living in the occupied Palestinian territory (oPt) are generally recognized, the impact of perceived threat on quality of life (QoL) faced from within their community (ingroup; Palestinians) and from the outgroup (Israelis) is unexplored. This cross-sectional study examined the following: (1) The status of perceptions of QoL on four domains measured by the World Health Organization Quality of Life (WHOQoL-Bref) instrument, physical health, psychological health, social relationships, and environment, among Palestinian adults (n = 709) living in the Gaza Strip; (2) The associations between perceived ingroup threat (PIT) and QoL on the four domains; (3) The associations between perceived outgroup threat (POT) and QoL on the four domains. Multivariable linear regression models revealed PIT was negatively associated with QoL in each of the four domains (p < 0.001). POT was positively associated with QoL in three of the four domains: physical health (p < 0.001), psychological health (p < 0.001), and social relationships (p < 0.001). This study contributes valuable insights into how QoL is viewed by a group experiencing collective existential threat. The findings expand the limited recognition of the reciprocal roles of perceived threat from the ingroup and outgroup on the QoL of vulnerable populations. Full article

Background: The COVID-19 pandemic from 2019 to 2022 devastated many aspects of life and the economy, with the commercial aviation industry being no exception. One of the major concerns during the pandemic was the degree to which the internal aircraft environment contributed to virus transmission between humans and, in particular, the stability of SARS-CoV-2 on contact surfaces in the aircraft cabin interior. Method: In this study, the stability of various major strains of SARS-CoV-2 on interior aircraft surfaces was evaluated using the TCID₅₀ assessment. Results: In contrast to terrestrial materials, SARS-CoV-2 was naturally less stable on common contact points in the aircraft interior, and, over a 4 h time period, there was a 90% reduction in culturable virus. Antiviral and surface coatings were extremely effective at mitigating the persistence of the virus on surfaces; however, their benefit was diminished by regular cleaning and were ineffective after 56 days of regular use and cleaning. Finally, successive strains of SARS-CoV-2 have not evolved to be more resilient to survival on aircraft surfaces. Conclusions: We conclude that the mitigation strategies for SARS-CoV-2 on interior aircraft surfaces are more than sufficient, and epidemiological evidence over the past three years has not found that surface spread is a major route of transmission. Full article

Developing countries have not carried out the adequate management of wastewater and are a long way off meeting the sustainability goal of universal access to safely managed sanitation services by 2030. This article discusses sustainability in wastewater management and conducts a narrative literature review to analyze four stages on the path toward sustainability: (1) the prevention of or reduction in pollution at the source; (2) wastewater collection and treatment; (3) using wastewater as an alternative source of water; and (4) the recovery of useful by-products. It also provides an overview of wastewater management in Brazil and shows the advantages of using wastewater to produce biofuel in a country in which 48.3% of energy production comes from renewable sources. Full article

Alaska Native communities are working to prevent cancer through increased cancer screening and early detection. We examined the prevalence of self-reported colorectal (CRC), cervical, and breast cancer screening among Alaska Native participants in the southcentral Alaska Education and Research toward Health (EARTH) study at baseline (2004–2006) and ten-year follow-up (2015–2017); participant characteristics associated with screening; and changes in screening prevalence over time. A total of 385 participants completed questionnaires at follow-up; 72% were women. Of those eligible for CRC screening, 53% of follow-up participants reported a CRC screening test within the past 5 years, significantly less than at baseline (70%) (p = 0.02). There was also a significant decline in cervical cancer screening between baseline and follow-up: 73% of women at follow-up vs. 90% at baseline reported screening within the past three years (p < 0.01). There was no significant difference in reported breast cancer screening between baseline (78%) and follow-up (77%). Colorectal and cervical cancer screening prevalence in an urban, southcentral Alaska Native cohort declined over 10 years of follow-up. Increased cancer screening and prevention are needed to decrease Alaska Native cancer-related morbidity and mortality. Full article

A free maternal health policy started in Ghana in 2008, however, health facility utilization is still low, and out-of-pocket payments (OOPPs) are putting households at risk of catastrophic expenditure. To improve this situation, some rural communities have assigned a midwife to a health post called community-based health planning and services (CHPS), where only assistant nurses are allocated. This study explored the effectiveness of the new approach in Upper West Region, Ghana. We conducted a cross-sectional study and interviewed women who gave birth in the last year. We systematically selected communities matched into four criteria: communities near CHPS (functional CHPS), communities near CHPS with a midwife (advanced CHPS), communities near a health centre, and communities without a health facility in their neighbourhood. In total, 534 women were interviewed: functional CHPS 104, advanced CHPS 131, near health centre 173, and no facility 126. About 78% of the women were 20 to 34 years old. About half of the women incurred OOPP, however, catastrophic payment (household spending > 5% of annual income) was significantly lower in advanced CHPS communities for normal delivery compared with the other three communities. The new local approach of assigning a midwife to CHPS functioned well, improving access to healthcare facilities for childbirth. Full article

Resilient stormwater infrastructure is one of the fundamental components of resilient and sustainable cities. For this, the resilience assessment of stormwater infrastructure against earthquake hazards is crucial for municipal authorities. The objective of this study is to develop a resilience assessment framework for stormwater pipe infrastructure against seismic hazards. A Bayesian belief network (BBN)-based stormwater infrastructure resilience model is constructed based on the published literature and expert knowledge. The developed framework is implemented in the city of Regina, Canada, to assess the city’s stormwater pipe infrastructure resilience. The outcome of the model indicates that proposed BBN-based stormwater infrastructure resilience model can effectively quantify uncertainties and handle the nonlinear relationships between several reliability and recovery factors. The model is also capable of identifying the most sensitive and vulnerable stormwater pipes within the network. Full article