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Int. J. Environ. Res. Public Health, Volume 21, Issue 4 (April 2024) – 116 articles

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13 pages, 917 KiB  
Systematic Review
Association between the Quantity of Nurse–Doctor Interprofessional Collaboration and in-Patient Mortality: A Systematic Review
by Sandesh Pantha, Martin Jones, Nompilo Moyo, Bijaya Pokhrel, Diana Kushemererwa and Richard Gray
Int. J. Environ. Res. Public Health 2024, 21(4), 494; https://doi.org/10.3390/ijerph21040494 (registering DOI) - 17 Apr 2024
Abstract
The level of nurse–doctor interprofessional collaboration may influence patient outcomes, including mortality. To date, no systematic reviews have investigated the association between the quantity of nurse–doctor interprofessional collaboration and inpatient mortality. A systematic review was conducted. We included studies that measured the quantity [...] Read more.
The level of nurse–doctor interprofessional collaboration may influence patient outcomes, including mortality. To date, no systematic reviews have investigated the association between the quantity of nurse–doctor interprofessional collaboration and inpatient mortality. A systematic review was conducted. We included studies that measured the quantity of nurse–doctor interprofessional collaboration and in-patient mortality. Five databases (MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Register) were searched. Two researchers undertook the title, abstract, and full-text screening. The risk of bias was determined using the Effective Public Health Practice Project (EPHPP) critical appraisal tool. Six reports from three observational studies met the inclusion criteria. Participants included 1.32 million patients, 29,591 nurses, and 191 doctors. The included studies had a high risk of bias. Of the three studies, one reported a significant association and one found no association between the quantity of nurse–doctor collaboration and mortality. The third study reported on the quantity of nurse–doctor collaboration but did not report the test of this association. We found no high-quality evidence to suggest the amount of nurse–doctor interprofessional collaboration was associated with mortality in medical and surgical inpatients. There is a need for further high-quality research to evaluate the association between the amount of nurse–doctor collaboration and patient outcomes. Full article
(This article belongs to the Special Issue Advances in Nursing and Medical Education)
21 pages, 5807 KiB  
Review
World Trends in Dental Ergonomics Research: A Bibliometric Analysis
by Wita Anggraini, Dewi Ranggaini, Annisaa Putri Ariyani and Indrani Sulistyowati
Int. J. Environ. Res. Public Health 2024, 21(4), 493; https://doi.org/10.3390/ijerph21040493 (registering DOI) - 17 Apr 2024
Abstract
Dental ergonomics provides an overview of dentists’ work efficiency. The objective of this study was to obtain quantitative information and produce a visualization of the network of scientific publications on the topic of ergonomics and dentistry using bibliometric analysis. Data mining was conducted [...] Read more.
Dental ergonomics provides an overview of dentists’ work efficiency. The objective of this study was to obtain quantitative information and produce a visualization of the network of scientific publications on the topic of ergonomics and dentistry using bibliometric analysis. Data mining was conducted using the Scopus database and Boolean expressions (ergonom* AND dentist*) on 14 April 2023. Data extraction and analysis were performed using Open Refine version 3.5.2., VOSviewer version 1.6.17., VOSviewer thesaurus, Microsoft Excel, and Tableau Professional version 2020.1.2. A total of 682 documents were identified, with the United States having the largest number of documents and citations (89 documents, 1321 citations). Work, Dentistry Today, and the International Journal of Environmental Research and Public Health were the top three sources. Ergonomics and musculoskeletal disorders (MSDs) are two of the very prominent keywords, with research topics covering prevalence, causes, factors related to causes, prevention, assessment, rehabilitation, evaluation, and intervention. There was no research on ergonomic interventions that collaborated with human factors and ergonomics (HFE). We conclude that the trending topic of dental ergonomics research topics around the world is centered on MSDs. The future research challenge is to apply HFE science to improve the health, safety, efficiency, and quality of dentists’ work. Full article
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28 pages, 4119 KiB  
Article
The Development of an Oral Health Nursing Tool for Patients with a Psychotic Disorder: A Human-Centred Design with a Feasibility Test
by Sonja Kuipers, Stynke Castelein, Linda Kronenberg, Job van ’t Veer and Nynke Boonstra
Int. J. Environ. Res. Public Health 2024, 21(4), 492; https://doi.org/10.3390/ijerph21040492 - 17 Apr 2024
Abstract
Patients with psychotic disorders frequently report oral health problems, while mental health nurses (MHNs) seem not to be fully aware of these problems and the risk factors. Therefore, this study aimed to develop supportive tools for MHNs regarding oral health to increase sensitisation [...] Read more.
Patients with psychotic disorders frequently report oral health problems, while mental health nurses (MHNs) seem not to be fully aware of these problems and the risk factors. Therefore, this study aimed to develop supportive tools for MHNs regarding oral health to increase sensitisation among MHNs and provide MHNs with the knowledge to recognise (potential) oral health problems in patients with a psychotic disorder. We used a human-centred design in which the user, MHNs and experts by experience were placed at the centre of the research process. Problems and needs in MHNs working with patients with a psychotic disorder were addressed. To identify key issues of problems as well as needs in terms of resources, we started with focus groups (n = 9). We analysed the data thematically based on the context of patients and MHNs in practice regarding oral health, preferred oral health tools focused on MHNs, and the intended outcomes of tools. A multi-criteria decision matrix was developed and analysed (n = 9) to identify the most optimal and viable solution based on established criteria and issues that are prevalent in the work of MHNs. The most promising result was the development of a brochure with an awareness screener. The brochure with the awareness screener was developed as a low-fidelity prototype for MHNs regarding oral health in patients with a psychotic disorder based on the latest scientific evidence. After testing it, the feasibility was tested through semi-structured interviews (n = 19). MHNs and experts by experience were satisfied with the tool and provided recommendations for adjustments to the content. Significant augmentations to the brochure included a clinical lesson and a toothbrush with toothpaste for patients. We can conclude that a brochure with an awareness screener is feasible for MHNs. Future steps aiming to further refine and optimise care processes for oral health tools in MHNs should take refining eligibility criteria for psychiatric populations and the language level of the target group of a tool into account. Full article
(This article belongs to the Special Issue Advances and Innovations in Mental Health and Public Health)
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19 pages, 4457 KiB  
Article
Optimizing the Selection of Mass Vaccination Sites: Access and Equity Consideration
by Basim Aljohani and Randolph Hall
Int. J. Environ. Res. Public Health 2024, 21(4), 491; https://doi.org/10.3390/ijerph21040491 - 17 Apr 2024
Viewed by 50
Abstract
In the early phases of the COVID-19 pandemic, vaccine accessibility was limited, impacting large metropolitan areas such as Los Angeles County, which has over 10 million residents but only nine initial vaccination sites, which resulted in people experiencing long travel times to get [...] Read more.
In the early phases of the COVID-19 pandemic, vaccine accessibility was limited, impacting large metropolitan areas such as Los Angeles County, which has over 10 million residents but only nine initial vaccination sites, which resulted in people experiencing long travel times to get vaccinated. We developed a mixed-integer linear model to optimize site selection, considering equitable access for vulnerable populations. Analyzing 277 zip codes between December 2020 and May 2021, our model incorporated factors such as car ownership, ethnic group disease vulnerability, and the Healthy Places Index, alongside travel times by car and public transit. Our optimized model significantly outperformed actual site allocations for all ethnic groups. We observed that White populations faced longer travel times, likely due to their residences being in more remote, less densely populated areas. Conversely, areas with higher Latino and Black populations, often closer to the city center, benefited from shorter travel times in our model. However, those without cars experienced greater disadvantages. While having many vaccination sites might improve access for those dependent on public transit, that advantage is diminished if people must search among many sites to find a location with available vaccines. Full article
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16 pages, 704 KiB  
Article
Multicomponent Behavioural Intervention during Pregnancy to Reduce Home Exposure to Second-Hand Smoke: A Pilot Randomised Controlled Trial in Bangladesh and India
by Veena A. Satyanarayana, Cath Jackson, Kamran Siddiqi, Mukesh Dherani, Steve Parrott, Jinshuo Li, Rumana Huque, Prabha S. Chandra and Atif Rahman
Int. J. Environ. Res. Public Health 2024, 21(4), 490; https://doi.org/10.3390/ijerph21040490 - 17 Apr 2024
Viewed by 92
Abstract
Background: Pregnant women exposed to second-hand smoke (SHS) are at increased risk of poor birth outcomes. We piloted multicomponent behavioural intervention and trial methods in Bangalore, India, and Comilla, Bangladesh. Methods: A pilot individual randomised controlled trial with economic and process evaluation components [...] Read more.
Background: Pregnant women exposed to second-hand smoke (SHS) are at increased risk of poor birth outcomes. We piloted multicomponent behavioural intervention and trial methods in Bangalore, India, and Comilla, Bangladesh. Methods: A pilot individual randomised controlled trial with economic and process evaluation components was conducted. Non-tobacco-using pregnant women exposed to SHS were recruited from clinics and randomly allocated to intervention or control (educational leaflet) arms. The process evaluation captured feedback on the trial methods and intervention components. The economic component piloted a service use questionnaire. The primary outcome was saliva cotinine 3 months post-intervention. Results: Most pregnant women and many husbands engaged with the intervention and rated the components highly, although the cotinine report elicited some anxiety. Forty-eight (Comilla) and fifty-four (Bangalore) women were recruited. The retention at 3 months was 100% (Comilla) and 78% (Bangalore). Primary outcome data were available for 98% (Comilla) and 77% (Bangalore). Conclusions: The multicomponent behavioural intervention was feasible to deliver and was acceptable to the interventionists, pregnant women, and husbands. With the intervention, it was possible to recruit, randomise, and retain pregnant women in Bangladesh and India. The cotinine data will inform sample size calculations for a future definitive trial. Full article
13 pages, 703 KiB  
Systematic Review
Early Detection and Monitoring of Gastrointestinal Infections Using Syndromic Surveillance: A Systematic Review
by Olubusola Adedire, Nicola K. Love, Helen E. Hughes, Iain Buchan, Roberto Vivancos and Alex J. Elliot
Int. J. Environ. Res. Public Health 2024, 21(4), 489; https://doi.org/10.3390/ijerph21040489 - 17 Apr 2024
Viewed by 288
Abstract
The underreporting of laboratory-reported cases of community-based gastrointestinal (GI) infections poses a challenge for epidemiologists understanding the burden and seasonal patterns of GI pathogens. Syndromic surveillance has the potential to overcome the limitations of laboratory reporting through real-time data and more representative population [...] Read more.
The underreporting of laboratory-reported cases of community-based gastrointestinal (GI) infections poses a challenge for epidemiologists understanding the burden and seasonal patterns of GI pathogens. Syndromic surveillance has the potential to overcome the limitations of laboratory reporting through real-time data and more representative population coverage. This systematic review summarizes the utility of syndromic surveillance for early detection and surveillance of GI infections. Relevant articles were identified using the following keyword combinations: ‘early warning’, ‘detection’, ‘gastrointestinal activity’, ‘gastrointestinal infections’, ‘syndrome monitoring’, ‘real-time monitoring’, ‘syndromic surveillance’. In total, 1820 studies were identified, 126 duplicates were removed, and 1694 studies were reviewed. Data extraction focused on studies reporting the routine use and effectiveness of syndromic surveillance for GI infections using relevant GI symptoms. Eligible studies (n = 29) were included in the narrative synthesis. Syndromic surveillance for GI infections has been implemented and validated for routine use in ten countries, with emergency department attendances being the most common source. Evidence suggests that syndromic surveillance can be effective in the early detection and routine monitoring of GI infections; however, 24% of the included studies did not provide conclusive findings. Further investigation is necessary to comprehensively understand the strengths and limitations associated with each type of syndromic surveillance system. Full article
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16 pages, 690 KiB  
Article
Alternative Food Practices as Pathways to Cope with Climate Distress
by Laurence Ammann-Lanthier, Katie Hayes and Iain J. Davidson-Hunt
Int. J. Environ. Res. Public Health 2024, 21(4), 488; https://doi.org/10.3390/ijerph21040488 - 16 Apr 2024
Viewed by 209
Abstract
Experiences of distress and challenging emotions in response to the climate crisis are increasingly common, particularly among young adults. These experiences can include challenging emotions caused by the harmful environmental impacts of conventional food systems, as their contributions to greenhouse gas emissions have [...] Read more.
Experiences of distress and challenging emotions in response to the climate crisis are increasingly common, particularly among young adults. These experiences can include challenging emotions caused by the harmful environmental impacts of conventional food systems, as their contributions to greenhouse gas emissions have become more widely known. While recent studies have examined various experiences of climate distress, the interaction between climate distress and food practice remains poorly understood. In this research, we turn to this intersection by examining the experiences of climate distress of young adults who have alternative food practices, and the interaction between their climate distress and their alternative food practices. Guided by an exploratory, single case study research approach, this research draws from 20 semi-structured interviews conducted with young adults located in urban centres in the Southeastern Prairie Region of Canada. Thematic analysis of the findings reveals that participants experience a variety of climate emotions and a personal responsibility to act in response to the climate crisis. The findings suggest that because of their ability to facilitate a meaningful and practical environmental impact, alternative food practices represent significant climate actions and may be pathways to facilitate coping or managing climate distress among young adults. Results demonstrate the psychological impacts of the climate crisis on young adults, highlighting the need for action on climate change and climate distress. Increasing the accessibility of alternative food practices may support young adults in coping with challenging climate emotions. Full article
(This article belongs to the Special Issue 2nd Edition: The Psychological Impacts of Global Climate Change)
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13 pages, 527 KiB  
Article
Development of Master Chef: A Curriculum to Promote Nutrition and Mindful Eating among College Students
by Kayla Parsons, Kelley Strout, Caitlyn Winn, Mona Therrien-Genest, Kate Yerxa and Jade McNamara
Int. J. Environ. Res. Public Health 2024, 21(4), 487; https://doi.org/10.3390/ijerph21040487 - 16 Apr 2024
Viewed by 240
Abstract
Research suggests that success in improving undergraduates’ diet quality can benefit from a multifaceted approach, incorporating nutrition education, mindful eating, and culinary skill-building. The current study aimed (1) to review the development of Master Chef, a mindful eating curriculum, and (2) assess its [...] Read more.
Research suggests that success in improving undergraduates’ diet quality can benefit from a multifaceted approach, incorporating nutrition education, mindful eating, and culinary skill-building. The current study aimed (1) to review the development of Master Chef, a mindful eating curriculum, and (2) assess its feasibility through an online expert review. Expert reviewers were recruited through an online mindful eating course. Survey questions included both Likert-style and open-ended questions. Quantitative survey data were analyzed using descriptive statistics. Two independent researchers coded qualitative data, which then underwent inductive thematic analysis. Reviewers (N = 7) were experts in the fields of nutrition, psychology, and mindful eating. Master Chef’s overall feasibility was rated highly. The overall curriculum was perceived positively. However, it was recommended that the program include more mindfulness. Master Chef was identified as a feasible program for improving the health behaviors of college students. Pilot dissemination and analysis will be necessary to assess the program’s effectiveness in supporting disease prevention among undergraduates. Full article
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12 pages, 633 KiB  
Article
Independent Correlates of Glycemic Control among Adults with Diabetes in South Africa
by Abdulaziz Hamid, Aprill Z. Dawson, Yilin Xu and Leonard E. Egede
Int. J. Environ. Res. Public Health 2024, 21(4), 486; https://doi.org/10.3390/ijerph21040486 - 16 Apr 2024
Viewed by 264
Abstract
Background: Globally, the prevalence of diabetes is increasing, especially in low- and middle-income countries (LMICs), including those in the sub-Saharan African region. However, the independent socioeconomic correlates of glycemic control as measured by hemoglobin A1C have yet to be identified. Therefore, the aim [...] Read more.
Background: Globally, the prevalence of diabetes is increasing, especially in low- and middle-income countries (LMICs), including those in the sub-Saharan African region. However, the independent socioeconomic correlates of glycemic control as measured by hemoglobin A1C have yet to be identified. Therefore, the aim of this analysis was to understand the independent correlates of glycemic control in South Africa. Methods: Data from the 2016 South Africa Demographic and Health Survey on adults with diabetes were used for this analysis. The dependent variable, glycemic control, was defined using hemoglobin A1c (HbA1c). Independent variables included: age, gender, ethnicity, marital status, region, urban/rural residence, ability to read, education, insurance, wealth, occupation, and employment in the last year. Analysis of variance was used to test for differences in mean HbA1c for each category of all independent variables, and a fully adjusted linear regression model was used to identify independent correlates of glycemic control (HbA1c). Results: Among the 772 people included in this analysis, there were significant differences in mean HbA1c by age (p < 0.001), ethnicity (p < 0.001), place of residence (p = 0.024), wealth index (p = 0.001), and employment in the last year (p = 0.008). Independent correlates of HbA1c included age, ethnicity, and wealth index. Conclusions: This study used data from a large diverse population with a high prevalence of diabetes in sub-Saharan Africa and provides new evidence on the correlates of glycemic control and potential targets for interventions designed to lower HbA1c and improve diabetes-related health outcomes of adults in South Africa. Full article
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16 pages, 532 KiB  
Review
Interventions to Foster Resilience in Family Caregivers of People with Alzheimer’s Disease: A Scoping Review
by Lucía Santonja-Ayuso, Silvia Corchón-Arreche and Mari Carmen Portillo
Int. J. Environ. Res. Public Health 2024, 21(4), 485; https://doi.org/10.3390/ijerph21040485 - 16 Apr 2024
Viewed by 280
Abstract
The family caregiver of a person with Alzheimer’s disease still experiences, in most cases, negative consequences in their biopsychosocial environment, which are related to the acquisition of this role. However, it has been observed that this fact is not universal in this type [...] Read more.
The family caregiver of a person with Alzheimer’s disease still experiences, in most cases, negative consequences in their biopsychosocial environment, which are related to the acquisition of this role. However, it has been observed that this fact is not universal in this type of population since benefits can be obtained in the act of caring through the development of resilience. Given this possibility and given that nurses are the health professionals who support people in this illness process, there is an urgent need to identify which non-pharmacological interventions could improve or promote resilience in family caregivers of people with Alzheimer’s disease. Therefore, our overall objective was to determine which interventions are useful in promoting resilience in family caregivers of people with Alzheimer’s disease through a scoping review. The data were analysed using an adapted version of Arksey and O’Malley’s methodological framework, after critically reading the articles with the CasP and MMAT tools. Nine articles were included (five analytical experimental, two quantitative and two mixed). Three types of interventions related to promoting resilience in family caregivers of people with Alzheimer’s disease were identified: meditation, multicomponent psychoeducation and creative art; nurses participated as co-therapists in the last two. Full article
(This article belongs to the Special Issue Family Caregiving of Older Adults)
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18 pages, 1101 KiB  
Article
Insights into the Impact of Organizational Factors and Burnout on the Employees of a For-Profit Psychiatric Hospital during the Third Wave of the COVID-19 Pandemic
by Michael Seyffert, Chunyi Wu and Gülru F. Özkan-Seely
Int. J. Environ. Res. Public Health 2024, 21(4), 484; https://doi.org/10.3390/ijerph21040484 - 15 Apr 2024
Viewed by 384
Abstract
In this paper, we provide insights into the interplay among the organizational, job, and attitudinal factors and employees’ intentions to resign during the third wave of the COVID-19 pandemic at a mental health hospital. We point out shortcomings in the relationship dynamics between [...] Read more.
In this paper, we provide insights into the interplay among the organizational, job, and attitudinal factors and employees’ intentions to resign during the third wave of the COVID-19 pandemic at a mental health hospital. We point out shortcomings in the relationship dynamics between executive administration and operational staff and propose a pathway to develop more effective leadership frameworks to increase job satisfaction. We integrate qualitative data from case information and open-ended questions posed to employees at a mental health hospital and quantitative data from a small-scale survey (n = 19). We highlight that the ability to achieve objectives, work autonomy, burnout, affective commitment, distributive and procedural justice, and job satisfaction are critical in determining individuals’ intentions to resign. Individuals identified disconnectedness and moral distress as critical aspects, while highlighting empathy, compassion, satisfaction, and confidence as pivotal elements. Mental healthcare settings could benefit from enhancing the staff’s ability to achieve objectives, work autonomy, affective commitment, and both distributive and procedural justice. Addressing burnout and implementing measures to increase job satisfaction are equally vital. Efficiently restructuring dynamics between various leadership levels and staff can significantly improve employee retention. Full article
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11 pages, 313 KiB  
Article
Study Circles as a Possible Arena to Support Self-Care—A Swedish Pilot Study
by Birgitta Kerstis, Jorgen Herlofson and Lena Wiklund Gustin
Int. J. Environ. Res. Public Health 2024, 21(4), 483; https://doi.org/10.3390/ijerph21040483 - 15 Apr 2024
Viewed by 327
Abstract
Today, issues related to people’s mental health and well-being have been described as a challenge for society, globally as well as in Sweden. This calls for new approaches to mental health promotion. The aim was to evaluate the adequacy of its content and [...] Read more.
Today, issues related to people’s mental health and well-being have been described as a challenge for society, globally as well as in Sweden. This calls for new approaches to mental health promotion. The aim was to evaluate the adequacy of its content and structure, describing experiences of study circles as a means of supporting participants’ self-care and self-compassion. The overall design is a descriptive QUAL + quan design, where the quantitative and qualitative results are integrated. Five participants participated in a focus group interview, of whom four completed questionnaires. One individual interview was conducted with the study circle leader. Study circles can be an arena for mental health promotion, as learning and sharing of experience contributes to a sense of coherence, as well as self-compassion and a genuine concern for one’s own and others’ well-being, but are not considered an alternative to psychiatric care for those in need of professional services. Study circles can be a possible means to support self-care and thereby promote mental health in the general population and are a valuable contribution to public health. However, in addition to modifications of the content, further research is needed on the qualifications for study circle leaders, as well as the dissemination of study circles. Full article
(This article belongs to the Section Behavioral and Mental Health)
18 pages, 322 KiB  
Article
Attitudes to Short-Term Staffing and Workforce Priorities of Community Users of Remote Aboriginal Community-Controlled Health Services: A Qualitative Study
by Zania Liddle, Michelle S. Fitts, Lisa Bourke, Lorna Murakami-Gold, Narelle Campbell, Deborah J. Russell, Supriya Mathew, Jason Bonson, Edward Mulholland, John S. Humphreys, Yuejen Zhao, John Boffa, Mark Ramjan, Annie Tangey, Rosalie Schultz and John Wakerman
Int. J. Environ. Res. Public Health 2024, 21(4), 482; https://doi.org/10.3390/ijerph21040482 - 15 Apr 2024
Viewed by 336
Abstract
In recent years, there has been an increasing trend of short-term staffing in remote health services, including Aboriginal Community-Controlled Health Services (ACCHSs). This paper explores the perceptions of clinic users’ experiences at their local clinic and how short-term staffing impacts the quality of [...] Read more.
In recent years, there has been an increasing trend of short-term staffing in remote health services, including Aboriginal Community-Controlled Health Services (ACCHSs). This paper explores the perceptions of clinic users’ experiences at their local clinic and how short-term staffing impacts the quality of service, acceptability, cultural safety, and continuity of care in ACCHSs in remote communities. Using purposeful and convenience sampling, community users (aged 18+) of the eleven partnering ACCHSs were invited to provide feedback about their experiences through an interview or focus group. Between February 2020 and October 2021, 331 participants from the Northern Territory and Western Australia were recruited to participate in the study. Audio recordings were transcribed verbatim, and written notes and transcriptions were analysed deductively. Overall, community users felt that their ACCHS provided comprehensive healthcare that was responsive to their health needs and was delivered by well-trained staff. In general, community users expressed concern over the high turnover of staff. Recognising the challenges of attracting and retaining staff in remote Australia, community users were accepting of rotation and job-sharing arrangements, whereby staff return periodically to the same community, as this facilitated trusting relationships. Increased support for local employment pathways, the use of interpreters to enhance communication with healthcare services, and services for men delivered by men were priorities for clinic users. Full article
25 pages, 402 KiB  
Article
Perceptions and Experiences of Inequity for Women of Refugee Background Having a Baby during the COVID-19 Pandemic in Melbourne, Australia
by Fran Hearn, Stephanie J. Brown, Josef Szwarc, Shadow Toke, May Alqas Alias, Maryaan Essa, Shogoufa Hydari, Ashay Baget and Elisha Riggs
Int. J. Environ. Res. Public Health 2024, 21(4), 481; https://doi.org/10.3390/ijerph21040481 - 15 Apr 2024
Viewed by 320
Abstract
Listening to What Matters is an exploratory descriptive qualitative study that aimed to (1) understand how women of refugee background in Melbourne, Australia experienced access to health information and maternity and/or early parenting care during the COVID-19 pandemic and (2) whether pandemic health [...] Read more.
Listening to What Matters is an exploratory descriptive qualitative study that aimed to (1) understand how women of refugee background in Melbourne, Australia experienced access to health information and maternity and/or early parenting care during the COVID-19 pandemic and (2) whether pandemic health directives had an impact on structural inequities for women of refugee background who received maternity and/or early parenting care during the COVID-19 pandemic. Semi-structured interviews were conducted with 41 participants including 17 women of refugee background, who identified as belonging to the Karen, Assyrian Chaldean, Iraqi, Syrian, Afghan, Sudanese, or South Sudanese communities and 24 health and social care professionals who identified as providing pregnancy or early parenting care during the pandemic in the north western suburbs of Melbourne. Interviews with women were conducted in preferred languages by community researchers. Interviews with professionals were conducted in English by researchers. Reflexive thematic data analysis included constructivist positionality and a trauma and violence informed approach. The results reported in this paper include three themes, with four accompanying subthemes, as follows: theme (1), ‘Structural inequities and the toll of the pandemic’; theme (2), ‘Supportive infrastructure’; and theme (3), ‘Cultural safety during the pandemic’. The results demonstrate that cumulative negative impacts such as unequal access to health information, family separation and isolation, inadequate household income, and mental and social health concerns had the potential to amplify pre-existing structural inequities for women of refugee background. Community engagement facilitated by bicultural workers, interpreters, and trusted care providers facilitated fast-paced, two-way communication that built capacity and health literacy for women who were unable to speak English and unfamiliar with the health care system and, improved experiences of care. More research is needed to understand how the intersectional cumulative impacts of structural inequities have affected maternal and neonatal health outcomes for women of refugee background during the pandemic, as well as any differences in maternal and neonatal health outcomes between Australian-born and refugee background women and babies. Full article
27 pages, 973 KiB  
Systematic Review
The Social Context of Pregnancy, Respectful Maternity Care, Biomarkers of Weathering, and Postpartum Mental Health Inequities: A Scoping Review
by Bridget Basile-Ibrahim, Joan Combellick, Thomas L. Mead, Alee Sorensen, Janene Batten and Robyn Schafer
Int. J. Environ. Res. Public Health 2024, 21(4), 480; https://doi.org/10.3390/ijerph21040480 - 15 Apr 2024
Viewed by 297
Abstract
Background: Mental health disorders are the number one cause of maternal mortality and a significant maternal morbidity. This scoping review sought to understand the associations between social context and experiences during pregnancy and birth, biological indicators of stress and weathering, and perinatal mood [...] Read more.
Background: Mental health disorders are the number one cause of maternal mortality and a significant maternal morbidity. This scoping review sought to understand the associations between social context and experiences during pregnancy and birth, biological indicators of stress and weathering, and perinatal mood and anxiety disorders (PMADs). Methods: A scoping review was performed using PRISMA-ScR guidance and JBI scoping review methodology. The search was conducted in OVID Medline and Embase. Results: This review identified 74 eligible English-language peer-reviewed original research articles. A majority of studies reported significant associations between social context, negative and stressful experiences in the prenatal period, and a higher incidence of diagnosis and symptoms of PMADs. Included studies reported significant associations between postpartum depression and prenatal stressors (n = 17), socioeconomic disadvantage (n = 14), negative birth experiences (n = 9), obstetric violence (n = 3), and mistreatment by maternity care providers (n = 3). Birth-related post-traumatic stress disorder (PTSD) was positively associated with negative birth experiences (n = 11), obstetric violence (n = 1), mistreatment by the maternity care team (n = 1), socioeconomic disadvantage (n = 2), and prenatal stress (n = 1); and inverse association with supportiveness of the maternity care team (n = 5) and presence of a birth companion or doula (n = 4). Postpartum anxiety was significantly associated with negative birth experiences (n = 2) and prenatal stress (n = 3). Findings related to associations between biomarkers of stress and weathering, perinatal exposures, and PMADs (n = 14) had mixed significance. Conclusions: Postpartum mental health outcomes are linked with the prenatal social context and interactions with the maternity care team during pregnancy and birth. Respectful maternity care has the potential to reduce adverse postpartum mental health outcomes, especially for persons affected by systemic oppression. Full article
25 pages, 384 KiB  
Article
No Women’s Land: Australian Women Veterans’ Experiences of the Culture of Military Service and Transition
by Sharon Lawn, Elaine Waddell, Louise Roberts, Pilar Rioseco, Tiffany Beks, Tiffany Sharp, Liz McNeill, David Everitt, Lee Bowes, Dylan Mordaunt, Amanda Tarrant, Miranda Van Hooff, Jonathan Lane and Ben Wadham
Int. J. Environ. Res. Public Health 2024, 21(4), 479; https://doi.org/10.3390/ijerph21040479 - 15 Apr 2024
Viewed by 556
Abstract
Women’s experiences of military service and transition occur within a highly dominant masculinized culture. The vast majority of research on military veterans reflects men’s experiences and needs. Women veterans’ experiences, and therefore their transition support needs, are largely invisible. This study sought to [...] Read more.
Women’s experiences of military service and transition occur within a highly dominant masculinized culture. The vast majority of research on military veterans reflects men’s experiences and needs. Women veterans’ experiences, and therefore their transition support needs, are largely invisible. This study sought to understand the role and impact of gender in the context of the dominant masculinized culture on women veterans’ experiences of military service and transition to civilian life. In-depth qualitative interviews with 22 Australian women veterans elicited four themes: (1) Fitting in a managing identity with the military; (2) Gender-based challenges in conforming to a masculinized culture—proving worthiness, assimilation, and survival strategies within that culture; (3) Women are valued less than men—consequences for women veterans, including misogyny, sexual harassment and assault, and system failures to recognize women’s specific health needs and role as mothers; and (4) Separation and transition: being invisible as a woman veteran in the civilian world. Gendered military experiences can have long-term negative impacts on women veterans’ mental and physical health, relationships, and identity due to a pervasive masculinized culture in which they remain largely invisible. This can create significant gender-based barriers to services and support for women veterans during their service, and it can also impede their transition support needs. Full article
19 pages, 1488 KiB  
Article
Use of and Beliefs toward Novel Tobacco and Nicotine Products among Portuguese University Students: A Pandemic Survey
by Marina Vaz, Pedro Cascais and Olga Lourenço
Int. J. Environ. Res. Public Health 2024, 21(4), 478; https://doi.org/10.3390/ijerph21040478 - 14 Apr 2024
Viewed by 518
Abstract
Over the last decade, novel tobacco and nicotine product experimentation and use have dramatically increased among the youth, even in countries with strong tobacco control and anti-smoking social norms. We performed an online questionnaire-based cross-sectional study in March-June 2021, targeting students from the [...] Read more.
Over the last decade, novel tobacco and nicotine product experimentation and use have dramatically increased among the youth, even in countries with strong tobacco control and anti-smoking social norms. We performed an online questionnaire-based cross-sectional study in March-June 2021, targeting students from the University of Beira Interior, Portugal. The aim was to assess the experimentation and use of tobacco and nicotine products and students’ beliefs towards these products. Of the 452 participants, 67.0% were female; the mean age was 21.9 ± 3 years. Most students (60.4%) reported experimenting with tobacco/nicotine products; 31.2% were current users; polyconsumption was common. Of the current users, all used cigarettes, 41.1% used heated tobacco, 20.6% e-cigarettes, and 14.9% used water pipes. Our multivariate analysis showed that being male, being in the third year of study, and cohabiting or socializing with smokers were strongly associated with tobacco/nicotine use. While most students agree that heated tobacco and e-cigarettes are addictive, that they are not less harmful than cigarettes, and that second-hand exposure may cause health problems, few tobacco/nicotine users are ready to quit, and few students support a smoke-free university campus. These findings indicate high experimentation and the regular dual use of novel tobacco and nicotine products and suggest a pro-smoking social norm among university students. Full article
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16 pages, 324 KiB  
Article
Characteristics and Circumstances of Adolescents Obtaining Abortions in the United States
by Doris W. Chiu, Ava Braccia and Rachel K. Jones
Int. J. Environ. Res. Public Health 2024, 21(4), 477; https://doi.org/10.3390/ijerph21040477 - 13 Apr 2024
Viewed by 503
Abstract
The purpose of this study is to describe the sociodemographic and situational circumstances of adolescents obtaining abortion in the United States prior to the Dobbs decision. We use data from the Guttmacher Institute’s 2021–2022 Abortion Patient Survey, a cross-sectional survey of 6698 respondents; [...] Read more.
The purpose of this study is to describe the sociodemographic and situational circumstances of adolescents obtaining abortion in the United States prior to the Dobbs decision. We use data from the Guttmacher Institute’s 2021–2022 Abortion Patient Survey, a cross-sectional survey of 6698 respondents; our analytic sample includes 633 adolescents (<20 years), 2152 young adults (20–24 years), and 3913 adults (25+ years). We conducted bivariate analyses to describe the characteristics and logistical and financial circumstances of adolescents obtaining abortions in comparison to respondents in the other age groups. The majority of adolescents identified as non-white (70%), and 23% identified as something other than heterosexual. We found that 26% of adolescents reported having no health insurance, and two-thirds of adolescent respondents reported that somebody had driven them to the facility. Adolescents differed from adults in their reasons for delays in accessing care; a majority of adolescents (57%) reported not knowing they were pregnant compared to 43% of adults, and nearly one in five adolescents did not know where to obtain the abortion compared to 11% of adults. Adolescents were more likely than adults to obtain a second-trimester abortion, which has increased costs. This study found that this population was more vulnerable than adults on several measures. Findings suggest that adolescents navigate unique barriers with regard to information and logistics to access abortion care. Full article
11 pages, 1200 KiB  
Article
Evaluating Intraocular Pressure Alterations during Large Muscle Group Isometric Exercises with Varying Head and Body Positions
by Nina Krobot Cutura, Maksimilijan Mrak, Dominik-Mate Cutura, Ivanka Petric Vickovic and Lana Ruzic
Int. J. Environ. Res. Public Health 2024, 21(4), 476; https://doi.org/10.3390/ijerph21040476 - 13 Apr 2024
Viewed by 361
Abstract
Performing physical exercise affects intraocular pressure, and its elevation and fluctuations are the main risk factors for glaucoma development or progression. The aim of this study was to examine the acute alterations in intraocular pressure (IOP) during four unweighted isometric exercises and to [...] Read more.
Performing physical exercise affects intraocular pressure, and its elevation and fluctuations are the main risk factors for glaucoma development or progression. The aim of this study was to examine the acute alterations in intraocular pressure (IOP) during four unweighted isometric exercises and to determine whether the different head and body positions taken during exercise additionally affect IOP. Twelve healthy volunteers between the ages of 25 and 33 performed four isometric exercises: wall sit in neutral head and body position, elbow plank in prone head and body position, reverse plank in supine head and body position for 1 min, and right-side plank in lateral head and body position for 30 s. Intraocular pressure was measured by applanation portable tonometry, before performing the exercise, immediately after exercise completion, and after five minutes of rest. A significant acute increase in intraocular pressure was found as a response to the performance of the elbow plank (p < 0.01), the reverse plank (p < 0.001), and the right-side plank (p < 0.001). The wall sit exercise did not reveal a statistically significant IOP elevation (p = 0.232). Different head and body positions had no significant additional influence on IOP (F (3,33) = 0.611; p = 0.613), even though the alteration in IOP was found to be greater in exercises with a lower head and body position. Our data revealed that IOP elevation seems to be affected by the performance of the elbow plank, the reverse plank, and the right-side plank; and not by the wall sit exercise. More different isometric exercises should be examined to find ones that are safe to perform for glaucoma patients. Full article
(This article belongs to the Special Issue Sports Medicine and Physical Rehabilitation)
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15 pages, 459 KiB  
Article
Addressing the Rehabilitation Needs of Women Experiencing Infertility in Ethiopia: Time for Action
by Bilen Mekonnen Araya, Maria P. Velez, Kassahun Alemu Gelaye, Silke Dyer and Heather M. Aldersey
Int. J. Environ. Res. Public Health 2024, 21(4), 475; https://doi.org/10.3390/ijerph21040475 - 13 Apr 2024
Viewed by 428
Abstract
The psychological, social, and financial disabilities caused by infertility are significant for women, particularly those living in low- and middle-income countries such as Ethiopia. Although rehabilitation can be an important form of support for such women, infertility is frequently overlooked as a disability [...] Read more.
The psychological, social, and financial disabilities caused by infertility are significant for women, particularly those living in low- and middle-income countries such as Ethiopia. Although rehabilitation can be an important form of support for such women, infertility is frequently overlooked as a disability or potential target of rehabilitation interventions. This study aimed to determine what rehabilitation-related services and supports are available for women experiencing infertility in Ethiopia. We used an Interpretive Description design. We purposefully selected fourteen rehabilitation, medical, and policy service providers from diverse institutions across three geographical locations. We used semi-structured questions during our in-person and telephone interviews. The data were analyzed using reflexive thematic analysis with the assistance of NVivo. We identified five main themes, including (a) policies related to infertility, (b) the concept that disabilities are physically visible fails to recognize infertility, (c) the need for rehabilitation services for women with infertility, (d) the importance of wellness services for women experiencing infertility, and (e) the role of religion in rehabilitation services. In conclusion, it is essential to strengthen the policies around infertility, incorporate rehabilitation services in fertility care, and view infertility as a disabling condition for women who experience it in Ethiopia. Full article
21 pages, 419 KiB  
Article
Exploring the Potential Impact of Training on Short-Term Quality of Life and Stress of Parents of Children with Autism: The Integrative Parents’ Autism Training Module
by Nikoletta Mavroeidi, Christos Sifnaios, Ariadne Ntinou, Giorgos Iatrou, Olympia Konstantakopoulou, María Merino Martínez, Martina Nucifora, Ibrahim Tanrikulu and Antonios Vadolas
Int. J. Environ. Res. Public Health 2024, 21(4), 474; https://doi.org/10.3390/ijerph21040474 - 13 Apr 2024
Viewed by 706
Abstract
Parents of autistic children experience high levels of parental stress and low quality of life related to the demanding child caring burden they experience. Parent education and training programs are acknowledged to improve parental well-being and reduce parenting stress. In the framework of [...] Read more.
Parents of autistic children experience high levels of parental stress and low quality of life related to the demanding child caring burden they experience. Parent education and training programs are acknowledged to improve parental well-being and reduce parenting stress. In the framework of the Erasmus+ Integrative Autism Parents Training Project (IPAT), we developed the IPAT Training Module based on parents’ expressed needs, in order to improve parental quality of life (QoL) and decrease their perceived stress. Sixty-two parents from four countries participated in the IPAT Module Training activity. We used WHOQOL-BREF and Perceived Stress Scale (PSS-10 version) for QoL and stress, respectively, before and after training and a study-specific questionnaire to assess participants’ satisfaction. Parents’ QoL improved significantly in the environment domain and specific items, while stress levels remained unmodified. Training appeared more advantageous for parents with lower initial QoL and those whose child had been enrolled in a special education program for an extended duration. Parents were quite satisfied, in particular those with lower initial social relationships QoL. Larger studies including a control group are necessary to support preliminary evidence provided by this study, identify additional effect moderators, and disentangle the contribution of different components of the training. Full article
23 pages, 1057 KiB  
Systematic Review
Pathophysiological Mechanisms in Long COVID: A Mixed Method Systematic Review
by Nawar Diar Bakerly, Nikki Smith, Julie L. Darbyshire, Joseph Kwon, Emily Bullock, Sareeta Baley, Manoj Sivan and Brendan Delaney
Int. J. Environ. Res. Public Health 2024, 21(4), 473; https://doi.org/10.3390/ijerph21040473 - 12 Apr 2024
Viewed by 1487
Abstract
Introduction: Long COVID (LC) is a global public health crisis affecting more than 70 million people. There is emerging evidence of different pathophysiological mechanisms driving the wide array of symptoms in LC. Understanding the relationships between mechanisms and symptoms helps in guiding clinical [...] Read more.
Introduction: Long COVID (LC) is a global public health crisis affecting more than 70 million people. There is emerging evidence of different pathophysiological mechanisms driving the wide array of symptoms in LC. Understanding the relationships between mechanisms and symptoms helps in guiding clinical management and identifying potential treatment targets. Methods: This was a mixed-methods systematic review with two stages: Stage one (Review 1) included only existing systematic reviews (meta-review) and Stage two (Review 2) was a review of all primary studies. The search strategy involved Medline, Embase, Emcare, and CINAHL databases to identify studies that described symptoms and pathophysiological mechanisms with statistical analysis and/or discussion of plausible causal relationships between mechanisms and symptoms. Only studies that included a control arm for comparison were included. Studies were assessed for quality using the National Heart, Lung, and Blood Institute quality assessment tools. Results: 19 systematic reviews were included in Review 1 and 46 primary studies in Review 2. Overall, the quality of reporting across the studies included in this second review was moderate to poor. The pathophysiological mechanisms with strong evidence were immune system dysregulation, cerebral hypoperfusion, and impaired gas transfer in the lungs. Other mechanisms with moderate to weak evidence were endothelial damage and hypercoagulation, mast cell activation, and auto-immunity to vascular receptors. Conclusions: LC is a complex condition affecting multiple organs with diverse clinical presentations (or traits) underpinned by multiple pathophysiological mechanisms. A ‘treatable trait’ approach may help identify certain groups and target specific interventions. Future research must include understanding the response to intervention based on these mechanism-based traits. Full article
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12 pages, 317 KiB  
Article
Provision of E-Cigarettes for Smoking Cessation in Pregnancy: Perceptions and Experiences of Pregnant Women from Two UK Sites
by Eleanor Lutman-White, Riya Patel, Lauren Bell, Deborah Lycett, Kelly Hayward, Ruth Sampson, Janani Arulrajah and Maxine Whelan
Int. J. Environ. Res. Public Health 2024, 21(4), 472; https://doi.org/10.3390/ijerph21040472 - 12 Apr 2024
Viewed by 442
Abstract
Introduction: Smoking in pregnancy is associated with negative health outcomes for both mothers and babies; e-cigarettes, which contain nicotine without hazardous tobacco, may offer an additional smoking cessation strategy for pregnant women. Although e-cigarettes are being increasingly offered within services, there is limited [...] Read more.
Introduction: Smoking in pregnancy is associated with negative health outcomes for both mothers and babies; e-cigarettes, which contain nicotine without hazardous tobacco, may offer an additional smoking cessation strategy for pregnant women. Although e-cigarettes are being increasingly offered within services, there is limited understanding about whether e-cigarettes can improve smoking cessation support for pregnant individuals. This study aimed to explore service users’ experiences of using e-cigarettes as a tool for smoking cessation during pregnancy. Methods: Semi-structured interviews were conducted with 14 women who had accepted one of two pilots and were analysed using inductive reflexive thematic analysis. The findings from each site were integrated to develop qualitative insight. Results: Participants largely had positive perceptions of the free and easy-to-use e-cigarette, preferring it to nicotine replacement therapies. The desire to have a healthy pregnancy and baby and the inclusion of non-judgemental behavioural support facilitated motivation to quit. Many participants reduced or quit tobacco use, with positive social and health implications reported. However, numerous barriers to quitting were present and intentions about long-term quitting of combustible cigarettes and e-cigarettes were mixed and uncertain. Conclusions: Providing e-cigarettes within smoking cessation services was indicated to be a positive and effective strategy for pregnant women trying to quit tobacco. However, numerous barriers to quitting and staying quit remained, suggesting scope for further improvements to smoking cessation support for pregnant women. Full article
(This article belongs to the Special Issue Women's Health, Pregnancy and Child Health)
14 pages, 303 KiB  
Article
Practices and Awareness Regarding an Infant’s Sleep Environment among Japanese Caregivers: A Cross-Sectional Survey
by Ayako Himemiya-Hakucho, Ayumi Taketani, Aoi Nakagawa, Hiroki Sakai, Azumi Shigemoto and Izumi Takase
Int. J. Environ. Res. Public Health 2024, 21(4), 471; https://doi.org/10.3390/ijerph21040471 - 12 Apr 2024
Viewed by 408
Abstract
Preventing sudden, unexpected infant death related to sleep, especially suffocation and sudden infant death syndrome, remains challenging globally. To evaluate factors associated with an unsafe sleep environment (SE) for infants in Japan, this cross-sectional study investigated the current status of practices and awareness [...] Read more.
Preventing sudden, unexpected infant death related to sleep, especially suffocation and sudden infant death syndrome, remains challenging globally. To evaluate factors associated with an unsafe sleep environment (SE) for infants in Japan, this cross-sectional study investigated the current status of practices and awareness among caregivers about a safe SE. Two hundred and fifty-four caregivers of infants in Yamaguchi Prefecture participated. Among the caregivers, 96.0% could not thoroughly practice a safe SE, although 65.0% had knowledge about a safe SE. More unsafe SE practices were significantly associated with 8- to 11-month-old infants than with 0- to 3-month-old infants, using the same practice as for an older child than with accessing information or a familiar person than with mass media as the most useful source of information. The differences in having knowledge were not associated with their practice. Many caregivers obtained information about an infant’s SE from mass media and a familiar person. They preferred education via a face-to-face method by medical experts to raise awareness about a safe SE. Thus, efforts need to be developed in Japan in which experts who directly attend to caregivers can truly educate them to ensure that caregivers are continuously aware of the importance of an SE. Full article
(This article belongs to the Collection Sleep in Children)
10 pages, 545 KiB  
Article
Water, Sanitation, and Hygiene Infrastructure and Resources in Schools in Belize during the COVID-19 Pandemic, 2021–2023
by Anh N. Ly, Kelsey McDavid, Christina Craig, Dian Maheia, Yolanda Gongora, Alexandra Medley, Francis Morey, Russell Manzanero, Gerhaldine Morazan, Allison Lino, Vickie Romero, Rosalva Blanco, Kanako Ishida, Matthew Lozier and Kristy O. Murray
Int. J. Environ. Res. Public Health 2024, 21(4), 470; https://doi.org/10.3390/ijerph21040470 - 12 Apr 2024
Viewed by 504
Abstract
Access to water, sanitation, and hygiene (WASH) resources in schools is critical for disease prevention and control, especially during public health emergencies. In Belize, systematic, national data on WASH in schools are needed to inform public health decisions and interventions. From December 2021 [...] Read more.
Access to water, sanitation, and hygiene (WASH) resources in schools is critical for disease prevention and control, especially during public health emergencies. In Belize, systematic, national data on WASH in schools are needed to inform public health decisions and interventions. From December 2021 to January 2022, a national survey was sent electronically to government and government-aided primary and secondary schools in Belize (N = 308) to gather information on WASH services. From the survey, 12 pilot schools were selected based on the highest self-reported need for WASH resources to participate in additional evaluation and intervention, which included environmental nudges, supplemental supply provision, and hand hygiene education. To understand how the progression of the COVID-19 pandemic may have influenced hand hygiene, facility assessments to evaluate access to hand hygiene resources were conducted in person when most schools reopened for face-to-face learning during the pandemic (March 2022) and 15 months later (June 2023). Among the schools participating in the national survey (N = 221), 55% reported times when water was not available at the schools. Almost 9 in 10 schools (89%) had a functional handwashing station, and 47% reported always having soap for handwashing. Between baseline and follow-up at the 12 pilot schools, we observed decreases in the proportion of functional handwashing access points (−11%), functional handwashing access points accessible for individuals with disabilities (−17%) and small children (−29%), and functional alcohol-based hand rub dispensers (−13%). Despite the ongoing COVID-19 pandemic, we observed gaps in WASH resources in schools in Belize during the onsite assessments at the pilot schools. Schools should be encouraged and provided with WASH resources to maintain vigilance for disease control measures. Full article
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20 pages, 1300 KiB  
Article
Prevalence of Wheezing and Its Association with Environmental Tobacco Smoke Exposure among Rural and Urban Preschool Children in Mpumalanga Province, South Africa
by Rodney Mudau, Kuku Voyi and Joyce Shirinde
Int. J. Environ. Res. Public Health 2024, 21(4), 469; https://doi.org/10.3390/ijerph21040469 - 11 Apr 2024
Viewed by 516
Abstract
Background: This study aimed to investigate the prevalence of wheezing and its association with environmental tobacco smoke exposure among rural and urban preschool children in Mpumalanga province, South Africa, an area associated with poor air quality. Methods: In this study, parents/caregivers of preschool [...] Read more.
Background: This study aimed to investigate the prevalence of wheezing and its association with environmental tobacco smoke exposure among rural and urban preschool children in Mpumalanga province, South Africa, an area associated with poor air quality. Methods: In this study, parents/caregivers of preschool children (n = 3145) completed a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Data were analysed using multiple logistic regression models. Results: The overall prevalence of Wheeze Ever was 15.14%, with a higher prevalence in urban preschoolers than rural preschoolers (20.71% vs. 13.30%, p < 0.000). Moreover, the total prevalence of Asthma Ever was 2.34%. The prevalence was greater in urban preschoolers than in rural preschoolers (3.92% vs. 1.81%, p < 0.001). In the final adjusted model, both urban- and rural-area children who lived with one or more people who smoked in the same household (WE: OR 1.44, 95% CI 1.11–1.86) (CW: OR 2.09, 95% CI 1.38–3.16) and (AE: OR 2.49, 95% CI 1.12–5.54) were found to have an increased likelihood of having Wheeze Ever, Current Wheeze, and Asthma Ever as compared to those who lived with non-smokers. Conclusions: The implementation of smoking limits and prohibition is crucial in areas that are frequented or utilized by children. Hence, it is imperative for healthcare providers to actively champion the rights of those who do not smoke within the society, while also endorsing legislative measures aimed at curtailing the extent of tobacco smoke exposure. Full article
(This article belongs to the Section Environmental Health)
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22 pages, 1950 KiB  
Article
Association of Combined Per- and Polyfluoroalkyl Substances and Metals with Chronic Kidney Disease
by Issah Haruna and Emmanuel Obeng-Gyasi
Int. J. Environ. Res. Public Health 2024, 21(4), 468; https://doi.org/10.3390/ijerph21040468 - 11 Apr 2024
Viewed by 584
Abstract
Background: Exposure to environmental pollutants such as metals and Per- and Polyfluoroalkyl Substances (PFAS) has become common and increasingly associated with a decrease in the estimated Glomerular Filtration Rate (eGFR), which is a marker often used to measure chronic kidney disease (CKD). [...] Read more.
Background: Exposure to environmental pollutants such as metals and Per- and Polyfluoroalkyl Substances (PFAS) has become common and increasingly associated with a decrease in the estimated Glomerular Filtration Rate (eGFR), which is a marker often used to measure chronic kidney disease (CKD). However, there are limited studies involving the use of both eGFR and the urine albumin creatinine ratio (uACR), which are more comprehensive markers to determine the presence of CKD and the complexity of pollutant exposures and response interactions, especially for combined metals and PFAS, which has not been comprehensively elucidated. Objective: This study aims to assess the individual and combined effects of perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), Cadmium (Cd), Mercury (Hg), and Lead (Pb) exposure on CKD using data from the National Health and Nutritional Examination Survey (NHANES) 2017–2018. Methods: We employed the use of bivariate logistic regression and Bayesian Kernel Machine Regression (BKMR) in our analysis of the data. Results: Logistic regression results revealed a positive association between PFOA and CKD. Our BKMR analysis revealed a non-linear and bi-phasic relationship between the metal exposures and CKD. In our univariate exposure–response function plot, Cd and Hg exhibited a U and N-shaped interaction, which indicated a non-linear and non-additive relationship with both low and high exposures associated with CKD. In addition, the bivariate exposure–response function between two exposures in a mixture revealed that Cd had a U-shaped relationship with CKD at different quantiles of Pb, Hg, PFOA, and PFOS, indicating that both low and high levels of Cd is associated with CKD, implying a non-linear and complex biological interaction. Hg’s interaction plot demonstrated a N-shaped association across all quantiles of Cd, with the 75th quantile of Pb and the 50th and 75th quantiles of PFOA and PFOS. Furthermore, the PIP results underscored Cd’s consistent association with CKD (PIP = 1.000) followed by Hg’s (PIP = 0.9984), then PFOA and PFOS with a closely related PIP of 0.7880 and 0.7604, respectively, and finally Pb (PIP = 0.6940), contributing the least among the five environmental pollutants on CKD, though significant. Conclusions: Our findings revealed that exposure to environmental pollutants, particularly Hg and Cd, are associated with CKD. These findings highlight the need for public health interventions and strategies to mitigate the cumulative effect of PFAS and metal exposure and elucidate the significance of utilizing advanced statistical methods and tools to understand the impact of environmental pollutants on human health. Further research is needed to understand the mechanistic pathways of PFAS and metal-induced kidney injury and CKD, and longitudinal studies are required to ascertain the long-term impact of these environmental exposures. Full article
(This article belongs to the Section Environmental Health)
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14 pages, 568 KiB  
Article
Influence of School Type and Class Level on Mean Caries Experience in 12-Year-Olds in Serial Cross-Sectional National Oral Health Survey in Germany—Proposal to Adjust for Selection Bias
by Julian Schmoeckel, Goetz Wahl, Ruth M. Santamaría, Roger Basner, Elisabeth Schankath and Christian H. Splieth
Int. J. Environ. Res. Public Health 2024, 21(4), 467; https://doi.org/10.3390/ijerph21040467 - 10 Apr 2024
Viewed by 506
Abstract
The objective of this study is to analyse the effects of attended school type and class level on the reported caries experience (DMFT) obtained in the serial cross-sectional National Oral Health Study in Children in Germany (NOHSC) for the WHO reference group of [...] Read more.
The objective of this study is to analyse the effects of attended school type and class level on the reported caries experience (DMFT) obtained in the serial cross-sectional National Oral Health Study in Children in Germany (NOHSC) for the WHO reference group of 12-year-olds. Methods: Caries data from the 2016 NOHSC were adjusted for each federal state on the basis of two additional large-scale datasets for school type and class level. Results: Twelve-year-olds in all grades in Saxony-Anhalt (n = 96,842) exhibited significantly higher DMFT values than 12-year-olds in 6th grade (n = 76,456; +0.10 DMFT; ~14.2%, p < 0.001). Adjustments for school type had effects on DMFT on the level of federal states but almost balanced out on the national level (−0.01 DMFT; ~2%). Due to putatively similar structures of the federal states, the national mean DMFT for 12-year-olds in the latest NOHSC (2016; n = 55,002) was adjusted from 0.44 to 0.50 DMFT, correcting for selection bias. Conclusion: Selection bias in this NOHSC leads to an underestimation of caries levels by about 15%. Due to very low caries experience in children in Germany, these precise adjustments (+0.06 DMFT) have only a minor effect on interpretations of the national epidemiologic situation. Consequently, other national caries studies worldwide using the robust marker of DMFT should also adjust for systematic selection bias related to socio-economic background rather than increasing efforts in examination strategy. Full article
(This article belongs to the Special Issue State-of-the-Art of Oral Health in Japan and Other Aging Countries)
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16 pages, 1154 KiB  
Article
Is the Invisibility of Dementia a Super-Power or a Curse? A Reflection on the SUNshiners’ Questionnaire into the Public Understanding of Dementia as an Invisible Disability: A User-Led Research Project
by Danielle Tingley, Rosalie Ashworth, Dalia Torres Sanchez, Grace Hayes Mac Mahon, Yvette Kusel, Brigitta Maria Rae, Tracey Shorthouse, Alan Bartley, Gabrielle Howell and Joanne Hurley
Int. J. Environ. Res. Public Health 2024, 21(4), 466; https://doi.org/10.3390/ijerph21040466 - 10 Apr 2024
Viewed by 557
Abstract
The SUNshiners group includes people in the early stages of dementia with an interest in dementia activism and research. The group found that despite the growing awareness of invisible disabilities, there is very limited research into the pros and cons of the invisibility [...] Read more.
The SUNshiners group includes people in the early stages of dementia with an interest in dementia activism and research. The group found that despite the growing awareness of invisible disabilities, there is very limited research into the pros and cons of the invisibility of dementia. Our paper explores the SUNshiners research which stemmed from varied individual experiences of disclosing diagnoses. The group designed and developed a short survey to explore what the public knew about dementia and what they thought about the invisibility of dementia. A mixture of open- and closed-ended questions were used to gain meaningful data. A total of 347 people completed the survey (315 online and 32 paper-based), which was then co-analysed. The findings suggest that the majority of the public felt that the invisibility of dementia was negative; that knowing someone had dementia when first meeting them would be beneficial; that people living with dementia should maintain the right to vote; and that people living with dementia do not automatically require a consistent, regular carer. Common themes from the open-ended answers included capacity, severity of dementia, and access to support. The findings support the disclosure of dementia diagnosis; however, more action is needed to tackle stigmatised views, particularly as the SUNshiners felt that people do not have enough dementia education to support a positive disclosure experience. They shared their experiences of the group and the project’s benefits, but also the losses they have faced. Our paper aims to be as accessible as possible. Full article
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16 pages, 1433 KiB  
Article
Increasing Preterm Delivery and Small for Gestational Age Trends in South Carolina during the COVID-19 Pandemic
by Kalyan J. Chundru, Jeffrey E. Korte, Chun-Che Wen, Brian Neelon, Dulaney A. Wilson, Julio Mateus, John L. Pearce, Mallory Alkis, Matthew Finneran, Sarah Simpson, Hermes Florez, Kelly J. Hunt and Angela M. Malek
Int. J. Environ. Res. Public Health 2024, 21(4), 465; https://doi.org/10.3390/ijerph21040465 - 10 Apr 2024
Viewed by 597
Abstract
Preterm delivery (PTD) complications are a major cause of childhood morbidity and mortality. We aimed to assess trends in PTD and small for gestational age (SGA) and whether trends varied between race–ethnic groups in South Carolina (SC). We utilized 2015–2021 SC vital records [...] Read more.
Preterm delivery (PTD) complications are a major cause of childhood morbidity and mortality. We aimed to assess trends in PTD and small for gestational age (SGA) and whether trends varied between race–ethnic groups in South Carolina (SC). We utilized 2015–2021 SC vital records linked to hospitalization and emergency department records. PTD was defined as clinically estimated gestation less than (<) 37 weeks (wks.) with subgroup analyses of PTD < 34 wks. and < 28 wks. SGA was defined as infants weighing below the 10th percentile for gestational age. This retrospective study included 338,532 (243,010 before the COVID-19 pandemic and 95,522 during the pandemic) live singleton births of gestational age ≥ 20 wks. born to 260,276 mothers in SC. Generalized estimating equations and a change-point during the first quarter of 2020 helped to assess trends. In unadjusted analyses, pre-pandemic PTD showed an increasing trend that continued during the pandemic (relative risk (RR) = 1.04, 95% CI: 1.02–1.06). PTD < 34 wks. rose during the pandemic (RR = 1.07, 95% CI: 1.02–1.12) with a significant change in the slope. Trends in SGA varied by race and ethnicity, increasing only in Hispanics (RR = 1.02, 95% CI: 1.00–1.04) before the pandemic. Our study reveals an increasing prevalence of PTD and a rise in PTD < 34 wks. during the pandemic, as well as an increasing prevalence of SGA in Hispanics during the study period. Full article
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