International Journal of Environmental Research and Public Health

The risk of suicidal behaviour in Australia varies by age, sex, sexual preference and Indigenous status. Suicide stigma is known to affect suicide rates and help-seeking for suicidal crises. The aim of this study was to investigate the sociodemographic correlates of suicide stigma to assist in prevention efforts. We surveyed community members and individuals who had attended specific emergency departments for suicidal crisis. The respondents were part of a large-scale suicide prevention trial in New South Wales, Australia. The data collected included demographic characteristics, measures of help-seeking and suicide stigma. The linear regression analyses conducted sought to identify the factors associated with suicide stigma. The 5426 participants were predominantly female (71.4%) with a mean (SD) age of 41.7 (14.8) years, and 3.9% were Indigenous. Around one-third of participants reported a previous suicide attempt (n = 1690, 31.5%) with two-thirds (n = 3545, 65.3%) seeking help for suicidal crisis in the past year. Higher stigma scores were associated with Indigenous status (β 0.123, 95%CI 0.074–0.172), male sex (β 0.527, 95%CI 0.375–0.626) and regional residence (β 0.079, 95%CI 0.015–0.143). Lower stigma scores were associated with younger age (β −0.002, 95%CI −0.004–−0.001), mental illness (β −0.095, 95%CI −0.139 to −0.050), male bisexuality (β −0.202, 95%CI −0.351 to −0.052) and males who glorified suicide (β −0.075, 95%CI −0.119 to −0.031). These results suggested that suicide stigma differed across the community, varying significantly by sex, sexual orientation and Indigenous status. Targeted educational programs to address suicide stigma could assist in suicide prevention efforts. Full article

Ecological flow is an important indicator for reflecting the stability of a watershed ecosystem. The calculation of ecological discharge under hydrological variation has become a research hot-spot. The Ganjiang River south of Poyang Lake in China was taken as an example in this study. Hydrological Alteration Diagnosis System methods were used to detect the change-points. The Distributed Time Variation Gain Model (DTVGM) was used to carry out runoff restoration. The Probability-weighted Flow Duration Curve was applied to calculate the ecological flow. The results showed that: (1) The hydrological alteration of the Waizhou Station occurred in 1991, the annual runoff increased by 10%, and the Gini coefficient (GI) increased by 0.07 after the change-point. The change in precipitation was the main driving factors. (2) The R value and NSE of the DTVGM were greater than 0.84, which represents the feasibility of the model used to restore runoff. (3) Compared to the traditional hydrological method, the proposed method can better reflect the inter-annual difference of ecological flow, flow ranges for high, normal, and low flow years are 398–3771 m³/s, 352–2160 m³/s, and 277–1657 m³/s, respectively. The calculation method of ecological flow in rivers considering hydrological variation can more scientifically reflect the impact of hydrological variation on ecological flow process, ecological flow under different human activities that can be calculated, such as dam control, water intake and water transfer, furthermore, it also provides a scientific basis for water resources planning and allocation under changing environment. Full article

The purpose of this study is to understand the impact of ideological and political education with regards to ecological civilization on college students’ pro-environment attitudes. Based on the survey data of 1622 college students, a series of econometric models are built to understand and test the impact of ideological and political education on students’ pro-environment willingness. The results show that the ideological and political education of ecological civilization can effectively promote the environmental will of college students; the accumulation of environmental knowledge, ecological concern, and ecological reflection are the important mediums for the ideological and political education of ecological civilization; and the medium effect of ecological reflection is the strongest. In addition, this study also indicates that the pro-environment willingness of college students and their professional categories, whether to join the eco-environmental association, and other factors have a significant correlation. Therefore, this study reveals the current impact of ecological civilization education and the role of the mechanism for college educators and policymakers to promote the protection of the ecological environment, which provides an important reference. Full article

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription. Full article

The benefits of community music activities for promoting well-being have been well recognized in previous literature. However, due to their wide variability and flexible approaches, a comprehensive understanding of the research and practice of community music activities for well-being promotion is sparse. The purpose of this scoping review was to synthesize published literature pertaining to community music activities for well-being promotion and identify key implementation characteristics and strategies to inform future practice and research. Studies of community music activities that investigated well-being outcomes in participants of all ages and conditions were eligible for inclusion. Through electronic database and manual searches, a total of 45 studies were identified and included in the analysis. The main findings showed that community music activities for well-being were characterized by a wide range of populations and applications, collaborative work, an emphasis on social components, and musical accomplishments. However, this variability also revealed a lack of consistent and thorough information as well as diversity in well-being conception across studies. The review offers practical recommendations for future research and practice based on the current findings. Full article

Evaluating the protection effectiveness of natural protected areas is an important step in successful management. Adopting 330 natural protected areas on the Qinghai–Tibet Plateau as research subjects, the regional dominant ecosystem service function was selected, and various temporal and spatial analysis methods were employed to analyze the evolution characteristics and influencing factors of ecosystem service patterns from 2000 to 2020. Our results indicated that (1) the water conservation function stabilized after fluctuation and decline, the soil conservation function fluctuated upward, and the windbreak and sand fixation function exhibited an increase after a decreasing fluctuation. (2) The protection effectiveness of25 protected areas significantly improved, that of 151 protected areas improved, that of 84 protected areas stabilized, that of 56 protected areas worsened, and that of 14 protected areas significantly worsened. (3) The top three influencing factors in descending order were precipitation change > altitude > mining area density. (4) Remarkable protection results were achieved in national protected areas, established management institutions, earlier established areas (before 2000), and areas exhibiting alow built-up area density (<0.75%) and low mining density (<1%). Our study provides technical support for the construction and management of protected areas and improvement in ecosystem service functions on the Qinghai–Tibet Plateau. Full article

Peer Mentors (PMs) are valuable health educators within food-insecure communities; however, little is known about PMs’ perspectives and experiences after serving in their peer mentor role. Therefore, this qualitative study explored PMs’ (n = 10) perceptions and analyzed data using thematic analysis based on descriptive phenomenology. Four themes emerged: (1) Successes and Struggles in Sharing Nutrition Knowledge; (2) Establishing a Conducive Learning Environment; (3) The Peer Mentor and Mentee Connection: Impact of Shared Experiences; (4) Empowerment of the Peer Mentor Experience. PMs have many advantages; however, more research is needed to evaluate the sustainability and efficacy of PMs within food-insecure communities. Full article

Similar to the problems surrounding carbon transfers that exist in international trade, there are severe carbon emission headaches in regional industrial systems within countries. It is essential for emission reduction control and regional industrial restructuring to clarify the relationship of carbon emissions flows between industrial sectors and identify key carbon-emitting industrial sectors. Supported by the input–output model (I-O model) and social network analysis (SNA), this research adopts input–output tables (2017), energy balance sheets (2021) and the energy statistics yearbooks (2021) of the three Chinese provinces of Hei-Ji-Liao to construct an Embodied carbon emission transfer network (ECETN) and determine key carbon-emitting industrial sectors with a series of complex network measurement indicators and analysis methods. The key abatement control pathways are obtained based on the flow relationships between the chains in the industrial system. The results demonstrate that the ECETNs in all three provinces of Hei-Ji-Liao are small-world in nature with scale-free characteristics (varying according to the power function). The key carbon emission industry sectors in the three provinces are identified through centrality, influence, aggregation and diffusion, comprising coal mining, the chemical industry, metal products industry, machinery manufacturing and transportation in Liaoning Province; coal mining, non-metal mining, non-metal products, metal processing and the electricity industry in Jilin Province; and agriculture, metal processing and machinery manufacturing in Heilongjiang. Additionally, key emission reduction control pathways in the three provinces are also identified based on embodied carbon emission flow relationships between industry sectors. Following the above findings, corresponding policy recommendations are proposed to tackle the responsibility of carbon reduction among industrial sectors in the province. Moreover, these findings provide some theoretical support and policy considerations for policymakers. Full article

Attention-deficit/hyperactivity disorder (ADHD) is a childhood neurodevelopmental disorder that can persist into adulthood. The co-occurrence of ADHD and substance use disorders is very frequent and has received considerable attention in recent clinical/scientific investigations. However, few studies have investigated the prevalence of ADHD in heroin addicts. This study aimed to investigate the prevalence of attention-deficit/hyperactivity disorder (ADHD) in a sample of heroin addicts treated with opioid agonists and to report this clinical experience in a public service for addiction. Outpatients over 18 years old and being treated with opioid agonists for heroin addiction were enrolled. Each patient took part in a psychiatric examination and completed an ASRS (Adult ADHD Self-Report Scale) self-assessment. Subjects with positive results were called in for another psychiatric visit, and the Brown ADD scale was used as a second-level test for ADHD; furthermore, the Mini International Neuropsychiatric Interview (MINI) and Hypomania/Mania Checklist (HCL-32) were used for differential diagnoses and to assess comorbidities. In total, 111 patients were enrolled. All were followed up by the psychiatrist, who is also the author of this report and the person who formulated the diagnoses. The prevalence of ADHD in this sample was 18%. Among the 20 patients diagnosed with ADHD, 5 (25%) were female and 15 (75%) were male. The most frequent psychiatric comorbidity was major depression, found in 11 patients (55%), of which 4 presented with hypomania (bipolar disorder). In this sample, making diagnoses was very difficult. Frequently, multiple comorbidities further complicated these cases. In conclusion, the results of this study are consistent with the literature: There seems to be a significant prevalence of ADHD even among heroin addicts, and often, the diagnosis is difficult to make. We also do not know the exact effect of opioid agonist therapy on ADHD symptoms. Hypotheses have been put forward, but studies are needed. Full article

To investigate the international development status and hot trends in the field of environmental security management in recent years, the published the environmental security management literature from 1997 to 2021, which was retrieved from Web of Science, with VOSviewer as the main and CiteSpace as the auxiliary, through the cooperation network of authors, scientific research institutions, and countries. The keywords were visualized by clustering, time zone analysis, and burst analysis. A total of 7596 articles were retrieved, forming six main clustering labels, including 28,144 authors. The research hotspots are from the fields of personal health, society, agriculture, ecological environment, energy, and sustainable development, as well as the development of internet environmental safety management, such as big data, Bayesian networks, and conceptual frameworks. Through cluster analysis, the cooperation of major research teams and scientific research institutions and the cooperation and development between countries were analyzed. The cooperation between scientific research institutions in various countries is relatively close. The United States currently occupies a dominant and authoritative position in this field. China has cooperated more closely with the United States, Britain, Australia, and India. Full article

The purpose of this study was to investigate the effects of long-term endurance exercise on cardiac morphology and function, as well as injury indicators, among amateur marathon runners. We recruited 33 amateur runners who participated in a marathon. Participants were divided into experimental and control groups according to their National Athletic Grade. The experimental group included participants with a National Athletic Grade of 2 or better, and the control group included participants who did not have a National Athletic Grade. Cardiac morphology, function, and injury indicators were assessed before and after the participants’ involvement in the Changsha International Marathon. All cardiac morphology and function indicators returned to pre-race levels at 24 h post-race, and left ventricular end-diastolic volume and left ventricular end-systolic volume indicators showed similar trends. Both stroke volume (SV) and percent fractional shortening (%FS) indicators showed similar trends in changes in the measurements before and after the race. SV showed no change between the pre-race and post-race periods. On the other hand, %FS showed a significant increase in the immediate post-race period, followed by restoration of its level at 24 h post-race. Among myocardial injury indicators, serum levels of cardiac troponin I, creatine kinase (CK), creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and N-terminal pro-b-type natriuretic peptide (NT-proBNP) measured before the race, immediately after the race, and 24 h after the race displayed similar trends in changes among CK, CK-MB, LDH, and AST, while NT-proBNP levels did not change. We concluded that high-level amateur marathon runners had greater heart volumes, as well as wall and septal thicknesses, than low-level marathon runners, with differences in heart volume being the most pronounced. Long-term high-intensity endurance exercise caused some damage to the hearts of amateur runners. High-level runners showed better myocardial repair ability, and their levels of myocardial injury markers showed greater decreases at 24 h post-race, while low-level runners had poorer myocardial repair ability. Full article

The effective control of air pollution to advance human health and improve well-being has risen to the forefront of discussion in recent years. Based on China’s 2019 environmental protection tax data and China Social Survey (CSS) data, this paper studies the effects of subjective air pollution and the environmental protection tax on residents’ well-being using an econometric intermediary effect model. The research conclusions are as follows: (1) Subjective air pollution can significantly reduce residents’ well-being, (2) an environmental protection tax can significantly improve residents’ well-being and it can eliminate some of the negative influence of subjective air pollution on residents’ well-being, and (3) the grouping test of residents’ income, regional distribution, urban and rural structure, age structure, gender structure, and other variables shows that the effects of subjective air pollution on residents’ well-being are heterogeneous among different populations. After further endogeneity testing with the instrumental variables method, adjusting the primary variables, and altering the research procedures, the results are still robust. Based on these findings, we should vigorously promote the development of ecological civilization and good air quality and support reforming the environmental protection tax system to enhance well-being. It is also necessary to shift from a crude development model to a green industry and business model. While emphasizing social equity and production efficiency, we should ensure the synchronous development of cities and villages. Additionally, tangible steps should be implemented to raise people’s incomes, expand young people’s work options, and enhance their satisfaction. The article focuses on the impact of subjective air pollution on residents’ well-being, adding air pollution to the factors affecting well-being. Furthermore, the article finds that the environmental protection tax has two advantages: it can govern air pollution and promote green development, and, at the same time, it can enhance social harmony and improve residents’ well-being. Full article

Most of the studies that examine the effect of the COVID-19 pandemic on mental health have been restricted to pandemic mental health data alone. The aim of the current study was to estimate the pandemic’s effect on young Swiss adults’ mental health by comparing pandemic to pre-pandemic mental health. Longitudinal data of 1175 young Swiss adults who participated in the S-YESMH study in 2018 and were followed-up in 2020 and 2021 were analyzed. The study outcomes were self-reported symptoms of depression, generalized anxiety disorder (GAD), attention-deficit/hyperactivity disorder (ADHD), thoughts about death or self-harm, and risky single-occasion drinking (RSOD). Generalized estimation equations, logistic regression and statistical mediation analysis were used to analyze the data. Evidence was found of increased depression, GAD, and ADHD among young women and increased depression among young men, resulting from the COVID-19 pandemic. Uncertainty about the future predicted young women’s depression and anxiety in 2021. COVID-19 stress in 2021 fully mediated the effect of COVID-19 stress in 2020 on depression and GAD in 2021. Young Swiss women’s and men’s mental health appears to have been adversely affected by the COVID-19 pandemic, especially during the second pandemic year. Uncertainty about the future and stress becoming chronic in 2021 likely explain some of the adverse effects. Full article

Objective: A pulse waveform is regarded as an information carrier of the cardiovascular system, which contains multiple interactive cardiovascular parameters reflecting physio-pathological states of bodies. Hence, multiple parameter analysis is increasingly meaningful to date but still cannot be easily achieved one by one due to the complex mapping between waveforms. This paper describes a new analysis method based on waveform recognition aimed for extracting multiple cardiovascular parameters to monitor public health. The objective of this new method is to deduce multiple cardiovascular parameters for a target pulse waveform based on waveform recognition to a most similar reference waveform in a given database or pattern library. Methods: The first part of the methodology includes building the sub-pattern libraries and training classifier. This provides a trained classifier and the sub-pattern library with reference pulse waveforms and known parameters. The second part is waveform analysis. The target waveform will be classified and output a state category being used to select the corresponding sub-pattern library with the same state. This will reduce subsequent recognition scope and computation costs. The mainstay of this new analysis method is improved dynamic time warping (DTW). This improved DTW and K-Nearest Neighbors (KNN) were applied to recognize the most similar waveform in the pattern library. Hence, cardiovascular parameters can be assigned accordingly from the most similar waveform in the pattern library. Results: Four hundred and thirty eight (438) randomly selected pulse waveforms were tested to verify the effectiveness of this method. The results show that the classification accuracy is 96.35%. Using statistical analysis to compare the target sample waveforms and the recognized reference ones from within the pattern library, most correlation coefficients are beyond 0.99. Each set of cardiovascular parameters was assessed using the Bland-Altman plot. The extracted cardiovascular parameters are in strong agreement with the original verifying the effectiveness of this new approach. Conclusion: This new method using waveform recognition shows promising results that can directly extract multiple cardiovascular parameters from waveforms with high accuracy. This new approach is efficient and effective and is very promising for future continuous monitoring of cardiovascular health. Full article

Family health history (FHH) is an essential foundation for personalized disease prevention. As the incidence of early-onset chronic diseases is increasing among college students, it is important to provide them with the education required to learn about their FHH. This study aimed to assess college students’ interest in receiving FHH education, preferred topics, and desired learning methods. We invited college students to complete an online survey from a large research-intensive university. A total of 2276 college students completed the survey. Nearly half of the participants self-identified as non-Hispanic white (45.5%). Slightly more than half of the sample (53.9%) were not interested in receiving FHH education mainly due to low prioritization. Among those who expressed interest in obtaining FHH education, the three most desired learning topics were the ability to interpret FHH information (76.1%), the application of FHH in disease prevention (72.0%), and FHH information collection strategies (63.6%). Computer-based learning (51.1%) was the most preferred educational method. Moreover, females, older individuals, those who have FHH in first-degree relatives, and participants who were members of racial and ethnic groups showed greater interests in receiving FHH education (ps < 0.05). Strategies to promote college students’ awareness, collection, and use of FHH are needed. Full article

Mental health services continue to experience rising demand that exceeds capacity. The COVID-19 pandemic exacerbated this crisis, with access to services being reduced. Although video consultations (VCs) are a solution, usage in UK community mental healthcare settings remains limited. This study aims to investigate psychiatrists’ and general practitioners’ (GPs) perceptions of the benefits and challenges of VC for the diagnosis and follow-up of general adult mental health patients in the community during the COVID-19 pandemic. Semi-structured interviews in NHS community mental healthcare settings were conducted. Psychiatrists (n = 11) and GPs (n = 12) were recruited through purposive sampling. An explorative qualitative approach was employed. Data were analysed using thematic analysis. Four key themes were identified: (1) patient access to VC, (2) suitability of VC for mental health consultations, (3) information gathering with VC and (4) clinician satisfaction with VC. This study provides valuable insights into the experiences of psychiatrists and GPs working in the UK during the COVID-19 pandemic. To facilitate a digital-first future for the NHS, greater investment in remote technologies is required, particularly in the context of growing mental healthcare demand. Though face-to-face consultations remain the gold standard, VC provides an efficient way of communicating with patients, particularly those with less severe forms of mental illness. Full article

Insufficient pandemic preparedness and underfunding of human and economic resources have conditioned the response to COVID-19 in Spain. This underfunding has continued since the austerity measures introduced during the 2009 financial crisis. This study aims to understand the perceptions of healthcare staff in Spain on the relationship between the funding of the health system and its capacity to respond to the COVID-19 pandemic. To this end, we carried out a thematic content analysis, based on 79 online semi-structured interviews with healthcare staff across the regions most affected by the COVID-19 first wave. Participants reported a lack of material resources, which had compromised the capacity of the health system before the pandemic. The lack of human resources was to be addressed by staff reorganisation, such as reinforcing hospital units to the detriment of primary health care. Staff shortages continued straining the COVID-19 response, even after material scarcities were later partially alleviated. Personnel shortages need to be adequately addressed in order to adequately respond to future health crises. Full article

Dubbed the “inequality virus”, coronavirus disease (COVID-19) has unveiled and magnified many of the global society’s long-standing inequalities and health inequities. This work brings together the phenomena of increased inequality and health inequities felt by the poor and young working class of the Philippines and how they interact negatively with existing vaccine policies. The poor and the young were more likely to have experienced employment disruptions with limited access to technologies that allowed for teleworking. Informal economy workers suffered from diminished labor protection and draconian lockdowns. Disadvantaged areas persistently dealt with limited health resources, and the working class was disproportionately vulnerable to COVID-19 infection. Utilitarian vaccine policies such as mandatory vaccination and the prioritization scheme negatively interacted with these COVID-induced inequalities and health inequities. While the young working class was more likely to be unemployed, mandatory vaccine policy required that they get vaccinated before seeking re-employment. However, the prioritization scheme adopted by the government failed to target them as a priority. This left them in a vulnerable state of prolonged unemployment while on standby for better supply and improved infrastructure for vaccine rollout. Future prospects in terms of economic recovery and health equity will be affected by issues such as potential increased taxation, the rapidly digitalizing labor market that is evolving to favor highly-skilled workers, and the staging of universal healthcare in the country. Full article

Background: Virtual reality used for the treatment of mental health disorders is showing promising potential in clinical practice. Increasing self-compassion and self-protections and decreasing self-criticism have been identified as trans-diagnostic mechanisms helping to build a resilient self. The goal of this systematic review was to provide an overview of research studies about virtual reality while exploring its effectiveness in increasing self-compassion and self-protection and decreasing self-criticism. Methods: On 6 December 2022, titles, abstracts, and, where available, keywords were searched in the following databases: PubMed, Scopus, and Web of Science. The inclusion criteria were: empirical study; quantitative methodology; outcomes measured, including self-compassion and/or self-protection, and/or self-criticism; pre/post and/or control group intervention measures of selected outcomes; participants aged 18 and above; application of virtual reality technology as part of the intervention; full study availability; and English language. Exclusion criteria were: ruminations related only to physical pain; self-protection in the context of physical survival; VR used to increase ruminations. Results: Selection criteria were met by 19 studies (two randomized controlled trials, 16 longitudinal studies, and one case study) with an overall number of 672 participants. Results suggest that VR interventions targeting self-criticism, self-compassion, and self-protection might be effective for non-clinical (self-compassion) as well as clinical (self-criticism and self-protection) samples. Discussion: The present systematic review partially supports the effectiveness of VR interventions on self-criticism, self-protection, and self-compassion. To properly answer the question of its effectiveness, more randomized control trials with larger samples from different populations are needed. The results are also limited by the variability of intervention protocols and the amount of exposure to VR. Other: This work was supported by the Vedecká grantová agentúra VEGA under Grant 1/0075/19. This systematic review has not been pre-registered. Full article