International Journal of Environmental Research and Public Health

The COVID-19 pandemic disrupted social support networks as well as resource access for participants. The purpose of this study was to: analyze the experiences of older adults enrolled in a geriatric-focused community health worker (CHW) support program, to gain a better understanding of how CHWs might enhance care delivery, and to further understand how COVID-19 affected the social and emotional needs and well-being of older adults during the first 18 months of the pandemic. Qualitative analysis was performed on notes entered by CHWs based on 793 telephone encounters with 358 participants between March 2020 and August 2021. Analysis was performed by two reviewers independently coding the data. Weighing the benefits of seeing family against the risks of COVID exposure was a source of emotional distress for participants. Our qualitative analysis suggests that CHWs were effective in providing emotional support and connecting participants to resources. CHWs are capable of bolstering the support networks of older adults and carrying out some of the responsibilities conventionally fulfilled by family supports. CHWs addressed participant needs that are frequently unmet by healthcare team members and provided emotional support to participants contributing to health and well-being. CHW assistance can fill gaps in support left by the healthcare system and family support structures. Full article

Background: Research suggests that changes in social support and loneliness have affected mental disorder symptoms during the COVID-19 pandemic. However, there are a lack of studies comparing the robustness of these associations. Aims: The aims were to estimate the strength of the associations of loneliness and social support with symptoms of depression, anxiety, and posttraumatic stress during the COVID-19 pandemic (2020–2022) in the general population. Method: The method entailed a systematic review and random-effects meta-analysis of quantitative studies. Results: Seventy-three studies were included in the meta-analysis. The pooled correlations of the effect size of the association of loneliness with symptoms of depression, anxiety, and posttraumatic stress were 0.49, 0.40, and 0.38, respectively. The corresponding figures for social support were 0.29, 0.19, and 0.18, respectively. Subgroup analyses revealed that the strength of some associations could be influenced by the sociodemographic characteristics of the study samples, such as age, gender, region, and COVID-19 stringency index, and by methodological moderators, such as sample size, collection date, methodological quality, and the measurement scales. Conclusions: Social support had a weak association with mental disorder symptoms during the COVID-19 pandemic while the association with loneliness was moderate. Strategies to address loneliness could be highly effective in reducing the impact of the pandemic on social relationships and mental health. Full article

The verification phase (VP) has been proposed as an alternative to the traditional criteria used for the determination of the maximum oxygen uptake (VO₂ max) in several populations. Nonetheless, its validity in patients with heart failure with reduced ejection fraction (HFrEF) remains unclear. Therefore, the aim of this study was to analyse whether the VP is a safe and suitable method to determine the VO₂ max in patients with HFrEF. Adult male and female patients with HFrEF performed a ramp-incremental phase (IP), followed by a submaximal constant VP (i.e., 95% of the maximal workload during the IP) on a cycle ergometer. A 5-min active recovery period (i.e., 10 W) was performed between the two exercise phases. Group (i.e., median values) and individual comparisons were performed. VO₂ max was confirmed when there was a difference of ≤ 3% in peak oxygen uptake (VO₂ peak) values between the two exercise phases. Twenty-one patients (13 males) were finally included. There were no adverse events during the VP. Group comparisons showed no differences in the absolute and relative VO₂ peak values between both exercise phases (p = 0.557 and p = 0.400, respectively). The results did not change when only male or female patients were included. In contrast, individual comparisons showed that the VO₂ max was confirmed in 11 patients (52.4%) and not confirmed in 10 (47.6%). The submaximal VP is a safe and suitable method for the determination of the VO₂ max in patients with HFrEF. In addition, an individual approach should be used because group comparisons could mask individual differences. Full article

The purpose of this cross-sectional study was to determine individual, sociocultural, policy, and economic predictors of overweight/obesity in early care and education (ECE) teachers to identify modifiable opportunities to enhance the health of this critical workforce. ECE teachers (n = 1434) in the U.S. completed an online survey in late spring to mid-summer 2020. Teachers self-reported height and weight; body mass index (BMI) and weight status were calculated. Teachers reported micro-environment variables including age, race, gender, obesogenic lifestyle behaviors, well-being, food security, personal health, stress, job stress, type of ECE, COVID-19 teaching modality, and age of children in the classroom. Logistic regression predicting overweight/obesity and linear regression predicting BMI were conducted. Teachers with more years of teaching experience (OR: 1.022: 95% CI 1.005, 1.039) and higher consumption of fast food (2.038: 1.310, 3.169) had higher odds of overweight/obesity. Teachers with higher levels of education (0.58: 0.407, 0.828) and higher physical health (0.836: 0.775, 0.902) had lower odds of overweight/obesity. Other variables were not associated with overweight/obesity. Variables significant in logistic regression were also associated with higher BMI. Additionally, Native American race (β = 2.467 SE = 1.206) and sedentary hours/day (β = 0.152 SE = 0.075) were associated with higher BMI. Implications for enhancing workplace health for these ECE teachers are emerging. Full article

Introduction: Musculoskeletal injury (MSI) contributes to global health burdens. Effective MSI prevention is necessary. MSI risk factor screening tools can be used by employers to identify and mitigate occupational hazards. Rigorous synthesis of the effectiveness of these tools has not taken place. We synthesized literature on effectiveness of MSI risk factor screening tools for reducing injury through informing prevention interventions. Materials and Methods: A literature search of Medline, Embase, Cochrane Library (Trials), CINAHL, Scopus and PsycINFO databases was performed. Included studies required an analytic design, used an MSI risk factor screening tool to inform an intervention in a working-age population and reported an outcome of MSI development, injury or compensation/work absence. Data extraction and study quality rating (Downs and Black criteria) were completed. Studies were sub-categorized as having used a single MSI screening tool (single-tool) to inform an injury prevention intervention or involving multiple simultaneous screening tools (multiple-tool). Study outcomes were synthesized when possible. Results: Eighteen articles representing fourteen studies met our inclusion criteria. No high-quality studies were identified (maximum Downs and Black score of 19). Studies did not employ previously validated tools but instead, typically, those purpose-built for a single use. The results were inconsistent both when using tools alone and in combination with other tools. Outcome measure heterogeneity precluded meaningful meta-analysis. Conclusions: There is limited evidence regarding use of MSI risk factor screening tools for preventing injury. Rigorous studies that utilize previously validated tools are needed. Full article

The existence of interprovincial embodied carbon transfer not only makes it difficult to achieve carbon emission reductions but also exacerbates the inequity, inefficiency, and high costs of interprovincial carbon emission reduction rights and responsibilities. This paper uses multi-regional input–output analysis (MRIOA) to measure the interprovincial embodied carbon transfer in 2017, obtains the net carbon transfer between 30 provinces (municipalities and autonomous regions) and eight regions in 2017, and accounts for the interprovincial carbon compensation amount based on the carbon price in the national carbon market. This study finds that carbon transfer from economically developed provinces to less developed provinces still exists in China, and the overall distribution shows a spatial transfer pattern from south to north and from east to west, with the northwestern region bearing most of the carbon emission pressure for which it should receive corresponding financial compensation. As part of the process to achieve the “dual carbon” target, appropriate emission reduction policies should be formulated according to the characteristics of provincial carbon transfer and the principle of “who benefits, who compensates”, and economically developed regions should give corresponding financial or technical compensation to less developed regions based on net carbon transfer. Compensation and support should be given to less developed regions based on net carbon transfer to prevent further regional development imbalances. Full article

The purpose of this study is to identify the factors associated with the burden on primary family caregivers of stroke patients at home without care services. For this study, the Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) data were used. Of the total 8010 caregivers, 1133 family caregiver burden was assessed with the shortened Caregiver Burden Inventory (CBI) 3 months after stroke. Patient and caregiver-related factors affecting the heavier burden of caregivers were identified by comparing the heavier caregiver burden group and the lighter caregiver burden group, which divided according to the CBI scores. The 719 (63.5%) family caregiver cared for patients at home without care services. Logistic regression analysis showed that four or more comorbidities (p = 0.002), neurological impairment at early onset (p < 0.001), dependence on daily life (p < 0.001), aphasia(p = 0.024), and depression(p < 0.001) were associated with a heavier burden of care. According to the shortened CBI, caregivers tended to be concerned more about psychological stress than physical strain. The findings suggest the importance of proactively guiding the emotional support services to caregivers who are at high risk of the heavier burden of patient care. Full article

AIM. The aim of the study was to retrospectively evaluate the efficacy and safety of GATT during a 6-month observation period. MATERIAL AND METHODS. The studied group consisted of 69 open-angle glaucoma patients treated with GATT as the only procedure or in combination with cataract surgery. Patients were assessed 1 day, 10 days, 1 month, 3 months, and 6 months after the surgery via standard ophthalmic examination including VF, IOP, and BCVA. The number of medications taken daily and possible complications were checked. Two criteria of success were established (S1: IOP decrease by 30% and S2: IOP lower than 18 mm Hg). RESULTS. Before the surgery, the mean IOP was 26.94 mmHg and significantly decreased after GATT to 15.59 mmHg at 6M. BCVA did not significantly differ between the visits. The mean MD did not change significantly within the 6-month observation period (−8.20 dB vs. −8.16 dB, p = 0.9824), similar to the mean VFI (64.31% vs. 63.05%, p = 0.8571). A 30% IOP decrease at 6M visit was obtained in 95.6% of patients, and 37.7% needed medications to stabilize IOP. An IOP lower than 18 mmHg at 6M was obtained in 91.3% of studied patients after the GATT procedure, and in 58.0% without additional medications. The mean number of medications received daily decreased significantly at 6M compared to preoperative results (2.59 at inclusion vs. 0.76 at 6M, p = 0.0004). The most frequent complication after surgery was hyphema, which resolved spontaneously within 10 days. CONCLUSION. The 6-month observation showed that GATT is a minimally invasive glaucoma-surgery technique that enables an effective and safe IOP decrease. Full article

The emergence of coronavirus disease has impacted human lives, one of which is economic disruption. Many Malaysian organisations have devised various crisis-response techniques, such as downsizing, laying off, retrenching, and combining. As a result, the number of Malaysians working in precarious jobs, which are defined by unpredictable and uncertain situations, has indirectly increased, hence increasing job insecurity. Therefore, maintaining psychological health is essential to safeguarding the mental health of employees. In the current working landscape, job security and work–life balance have commonly been deemed necessary in contributing to well-being among employees. As a result, the purpose of this study was to examine how work–life balance influences the relationship between job insecurity and psychological well-being among Malaysian precarious workers. It also fills a gap in the research by explaining the causal association between job insecurity and psychological well-being among precarious workers, as previous well-being studies have largely focused on employees with secure jobs. There were 442 responders collected using purposive and snowball sampling methods, and they were requested to complete the Job Insecurity Scale (JIS), Work–Life Balance, and Well-Being Index Scale (WHO-5). Job instability was negatively connected with work–life balance and psychological well-being. On the other hand, work–life balance was found to be positively related to psychological well-being. This supports the notion that work–life balance is a significant mediator in the relationship between job insecurity and psychological well-being. These findings emphasise that Malaysian precarious workers with job security could enhance their psychological well-being by achieving work–life balance. Full article

Workplace health promotion programmes (WHPPs) are among the most important measures to improve the health and motivation of the ageing workforce. However, they are accompanied with certain challenges, such as low participation rates and higher participation levels of the more health-conscious workers, often failing to engage those who need such interventions the most. Following the PRISMA guidelines, this scoping review examined participation rates reported in articles on WHPPs to identify potential knowledge gaps. The results are worrying: participation rates are not only infrequently reported, but also low. Of the 58 articles, 37 report participation rates, with the majority (20) reporting an average participation rate of less than 50%. Reported participation rates refer either to different target groups, the type of intervention, or to single points in time, which makes it difficult to establish consistent criteria for comparison. We argue that despite the importance of WHPP efficacy, research focus should shift to the determinants of participation, as well as the issue of standardising the reporting of participation rates, alongside the potential problem of reporting bias. Full article

Smart technologies are essential in improving higher education teaching and learning. The present study explores the factors that influence students’ behavioural intentions to adopt and use smart technologies in blended learning. Based on the Unified Theory of Acceptance and Use of Technology (UTAUT2) model, a survey of 305 students was conducted to collect data. A structural equation model was applied to analyse the data. The findings show that adopting smart technologies requires appropriate social context and organizational support. Moreover, the data indicated that performance expectancy, effort expectancy, social influence, hedonic motivation, and habit are vital in determining students’ behavioural intention to use smart technologies. However, facilitating conditions and price value were found to have no significant impact on the students’ behavioural intention to use smart technologies. The study contributes to a better understanding of the nexus of blended learning and smart technologies, thus improving students’ experiences in blended learning settings. Full article

Objective: To evaluate the effect of a multicomponent progressive training program (MPTP) on functionality, quality of life (QoL) and motivation to exercise (EM) in a group of older adults (OA) of a community. Methods: A total of 55 participants of 69.42 ± 6.01 years of age were randomized into two groups; experimental (EG:35) and control (CG:20), and subjected to 27 weeks of MPTP. Functionality (pre/post-intervention) was assessed using the Short Physical Performance Battery (SPPB), Time Up and Go (TUG), Walking While Talking Test (WWT), Manual Dynamometry (MD), Forced Expiratory Volume in the first second (FEV₁), Sit and Reach (SR), Back Scratch (BS), and walk for 2 min (2 mST). QoL was assessed using the SF-36 questionnaire and EM using the BREQ-3. The Kolmogorov–Smirnov and Levene tests were applied. A two-way repeated measures ANOVA was applied. A significance level of p < 0.05 was accepted for all comparisons. Results: The EG compared to the CG improved in SPPB (ΔEG/CG: 29.67%/p < 0.001), TUG (ΔEG/CG: 35.70%/p < 0.05), WWT (ΔEG/CG: 42.93%/p < 0.001), MD (ΔEG/CG: 20.40%/p < 0.05), FEV₁ (ΔEG/CG: 21.37%/p < 0.05), BS (ΔEG/CG: 80.34%/p < 0.05), 2 mST (ΔEG/CG: 33.02%/p < 0.05), SF-36 (ΔEG/CG: 13.85%/p < 0.001), and Intrinsic Regulation (ΔEG/CG: 27.97%/p < 0.001); Identified by regulation (ΔEG/CG: 9.29%/p < 0.05). Conclusion: An MPTP improves functionality, QoL and EM, and is a safe and effective method for community OAs. Full article

Globally, the prevalence of attention deficit hyperactivity disorder (ADHD) is increasing. The treatment for ADHD is multifaceted and requires long-term care and support. Pharmacists are capable of assisting patients and their caretakers in achieving desired outcomes. This work discusses and summarizes pharmacists’ roles in ADHD care and their associated outcomes. Overall, pharmacists are positioned to educate on ADHD, optimize medications in a collaborative practice model, manage and monitor side effects, and provide remote and virtual pharmaceutical care. Pharmacists could directly contribute to ensuring medication safety and increasing awareness regarding the optimal use of ADHD medications. Patients with ADHD can benefit from pharmacist involvement in a variety of ways, including, but not limited to, initial screening and referral, the provision of clinical consultation and feedback, and the improvement of self-management and self-awareness of the illness. Pharmacists also play a significant role in therapeutic decision making regarding the initiation, intensification, and monitoring of ADHD treatment to ensure its effectiveness and quality of life improvement. Lastly, pharmacists could help identify more cost-effective treatment approaches for ADHD patients based on the clinical scenario that is encountered. Full article

In this paper, we propose a lossless electrocardiogram (ECG) compression method using a prediction error-based adaptive linear prediction technique. This method combines the adaptive linear prediction, which minimizes the prediction error in the ECG signal prediction, and the modified Golomb–Rice coding, which encodes the prediction error to the binary code as the compressed data. We used the PTB Diagnostic ECG database, the European ST-T database, and the MIT-BIH Arrhythmia database for the evaluation and achieved the average compression ratios for single-lead ECG signals of 3.16, 3.75, and 3.52, respectively, despite different signal acquisition setup in each database. As the prediction order is very crucial for this particular problem, we also investigate the validity of the popular linear prediction coefficients that are generally used in ECG compression by determining the prediction coefficients from the three databases using the autocorrelation method. The findings are in agreement with the previous works in that the second-order linear prediction is suitable for the ECG compression application. Full article

This article concerns internalizing and externalizing behaviors among Polish adolescents attending primary schools in a medium-sized city in Poland. The aim of the study was to examine the levels of select problem behaviors (i.e., depression, withdrawal, somatic complaints, aggressive behaviors, delinquent behaviors, thought problems, and internalizing and externalizing disorders) in early adolescence. Another important aim was to establish the ranges of the norm and deviation which would indicate the need for intervention aimed at internalizing and externalizing disorders in the sample. The relationships between variables such as age, gender, and school achievement (grade average) and the groups of problem behaviors and externalizing and internalizing disorders were also examined. To diagnose the occurrence of internalizing and externalizing behaviors, a sample of 550 students (55.3% girls, 46.7% boys) were measured using the Youth Self-Report (YSR) questionnaire. The results showed statistically significant differences in internalizing and externalizing behaviors between boys and girls. Girls achieved higher scores on most of the YSR scales, including internalizing and externalizing disorders, as well as on the total score. The student subgroup scores were also differentiated in terms of age and their average grades. The results also have practical implications; namely, the need for obligatory screening tests of students’ emotional states; encouraging preventive measures in schools, including diagnosis and psychological support in the context of depression; monitoring aggressive behaviors and social problems, both in boys and girls; and implementing universal, selective, and indicated prevention through complex, empirically validated educational-therapeutic programs. Full article

Sexualized drug use (SDU) has been identified as a health risk factor among gay, bisexual, and other men who have sex with men (GBMSM). This study aimed to analyze the associations between SDU frequency and a broad set of substances, motives, consequences, and self-perceptions. Sampling was conducted through an online survey. The final sample consisted of 185 GBMSM aged between 18 and 78 years old (mean age = 38.38, SD = 11.52) who engaged in SDU. We analyzed the frequency of SDU in terms of practicing it “once,” “moderately” (“once a month or less” or “a few times a month”), or “frequently” (from “once a week” to “daily”) during the previous 18 months. A questionnaire was administered through which sociodemographic variables, substances, reasons, consequences, and self-perceptions of SDU practice were analyzed. Participants who did so frequently were significantly more likely to use mephedrone, methamphetamine, and GHB/GBL than those who performed SDU less often (large effect sizes). In addition, habitual SDU was associated with motivations to achieve pleasurable emotions and sensations and manage negative feelings. Health implications, such as blackout moments, were also significantly related to frequent SDUs. Finally, those who practiced frequent SDU perceived it as a severe problem and wanted to control it. These data indicate the importance of raising awareness of chemsex as a public health problem among GBMSM. Specific identification, education, and prevention programs need to be strengthened to reduce the incidence of the most undesirable implications of SDU among GBMSM. Full article

In the context of climate change, heat waves are a serious hazard having significant impacts on human health, especially vulnerable populations. Many studies have researched the association between extreme heat and mortality. In the context of urban planning, many studies have explored the cooling effect of green roofs, parks, urban forests and urban gardens. Nevertheless, few studies have analyzed the effect mechanism of specific ecosystem services (ESs) as mitigation measures to heat waves. This study aimed to determine the relationship among ESs, heat waves and the heat-related mortality risk of different groups by diseases, age and sex. The research was conducted in three cities in Jiangsu Province, including Nanjing, Suzhou and Yancheng. We quantified five ecosystem services, i.e., water supply service, carbon sequestration service, cooling service, biodiversity and cultural service. Based on the previous studies, we took the frequency of heat waves into account, extending the concept of the Heat Wave Magnitude Index (HWMI). A distributed lag nonlinear model (DLNM) was applied to estimate the effect of extreme heat on mortality. Then, the study used the process analysis method to explore the relationship among ESs, heat waves and heat-related mortality risks. The results indicated that (i) water supply service, carbon sequestration service, cooling service and biodiversity can reduce heat-related mortality while cultural service increases; (ii) the effects of carbon sequestration service and cultural service are stronger than other ESs; (iii) the effects of ESs on cardiorespiratory disease, stroke and chronic obstructive pulmonary disease (COPD) mortality risks are higher than others; and (iv) women and elderly heat-related mortality risks are more affected by the ESs. This study can provide a theoretical support for policy makers to mitigate heatwave events, thus limiting heat-related mortality. Full article

Mining activities have been a part of the history of Chile since time immemorial, generating pollution and environmental liabilities. Due to the lack of regulation, many tailings are deposited close to rivers or/and on unstable ground, near which towns have been built, generally in locations with no budget for their treatment. This study tested three plant species from Northern and Central Chile to remove total chromium, nickel, and zinc from tailings: Solidago chilensis, Haplopappus foliosus, and Lycium chilense, which complements the few existing studies on heavy metals removal with native or endemic Chilean shrubs. The experiments were conducted ex situ, and the initial and final concentrations of metals were determined in tailings and plants to obtain the removal efficiency, translocation and bioconcentration factors. Among these species, the best performance was obtained using Solidago chilensis, achieving removal efficiencies of 24% for Cr, 19% for Ni, and 17% for Zn, showing the ability to phytostabilize chromium and the higher resistance concerning the toxicity threshold. Haplopappus foliosus and Lycium chilense presented a slight tendency to stabilize chromium. Only Solidago chilensis showed little ability to extract Zn. Full article

Introduction: Chronic pain in older people is a global health problem not only in terms of a negative subjective feeling, but also as a social and economic factor. Deterioration of functional capacity is one of the main symptoms of chronic pain; therefore, it should be assessed as a basic parameter in the life of older people. The aim of the study was to analyze the factors which have an impact on the functional capacity of older people with chronic pain. Material and methods: The study was conducted among 181 people over 65 suffering from chronic pain lasting more than 6 months. The study used a questionnaire that included questions about demographic and social characteristics and the following scales: Abbreviated Mental Score (AMTS), Personal Activities of Daily Living (PADL) by Katz, Instrumental Activities of Daily Living (IADL) by Lawton, Geriatric Pain Measure-24 (GPM-24). Results: In the study group, a positive correlation was found between: coexisting diseases and withdrawal due to pain, pain intensity, pain resulting from walking or from the effort from other activities, and in terms of the total GPM-24 score. A positive correlation was also found between the Geriatric Depression Scale (GDS) and withdrawal due to pain, pain intensity, pain resulting from walking or from the effort from other activities, and in terms of the total GPM-24 score. A significantly negative correlation was found between: AMTS, ADL, IADL performance and: withdrawal due to pain, pain intensity, pain resulting from walking or from the effort from other activities, and in terms of total GPM-24 score. Conclusions: Chronic pain is more common in people with disabilities in basic and complex activities of daily living, with limited efficiency in cognitive functions and an increased sense of depression. The standard in everyday practice and clinical trials should be taking a history of chronic pain in every older person, monitoring the pain’s intensity and accompanying characteristics by using a multidimensional scale for assessing pain in older people. Full article