International Journal of Environmental Research and Public Health

In Wales, the prevalence of Type 2 Diabetes Mellitus (T2DM) has increased from 7.3% in 2016 to 8% in 2020, creating a major concern for the National Health Service (NHS). Social prescribing (SP) has been found to decrease T2DM prevalence and improve wellbeing. The MY LIFE programme, a scheme evaluated between June 2021 and February 2022 in the Conwy West Primary Care Cluster, aimed to prevent T2DM by referring prediabetic patients with a BMI of ≥30 to a diabetes technician (DT), who then signposted patients to community-based SP programmes, such as the National Exercise Referral Scheme (NERS), KindEating, and Slimming World. Although some patients engaged with SP, others chose to connect only with the DT. A Social Return on Investment (SROI) analysis was conducted to evaluate those patients who engaged with the DT plus SP, and those who connected solely with the DT. Relevant participant outcomes included ‘mental wellbeing’ and ‘good overall health’, which were measured at baseline (n = 54) and at the eight-week follow-up (n = 24). The estimated social value for every GBP 1 invested for participants who engaged with the ‘DT only’ ranged from GBP 4.67 to 4.70. The social value for participants who engaged with the ‘DT plus SP programme’ ranged from GBP 4.23 to 5.07. The results indicated that most of the social value generated was associated with connecting with the DT. Full article

Numerous studies have investigated factors associated with osteoarthritis (OA), but few have investigated their effects on psychological problems and health-related quality of life in older adults with OA. We aimed to investigate factors associated with OA and their influence on health-related quality of life in older adults with OA. Among 1394 participants aged ≥65 years, 952 and 442 were categorized into the OA and non-OA groups, respectively. Comprehensive data on demographic characteristics, medical conditions, health-related quality of life, blood test results, and nutritional intake were obtained. Univariate and multivariate logistic regression analyses were used to evaluate the odds ratio for factors associated with OA, including age (odds ratio (OR), 1.038; p = 0.020), female sex (OR, 5.692; p < 0.001), body mass index (OR, 1.108; p < 0.001), hypertension (OR, 1.451; p < 0.050), hyperlipidemia (OR, 1.725; p = 0.001), osteoporosis (OR, 2.451; p < 0.001), and depression (OR, 2.358; p = 0.041). The OA group showed a significantly lower subjective health status (p < 0.001) and higher difficulty in mobility (p < 0.001) and pain/discomfort (p = 0.010) than the non-OA group. The sleeping hours were significantly shorter in the OA group than those in the non-OA group (p = 0.013). OA was a significant contributing factor for unfavorable health-related quality of life in older adults. Controlling the factors associated with OA should be prioritized, and health-related quality of life should be monitored in older adults with OA. Full article

The treatment and reuse of wastewater for irrigation can lead to occupational health risks for sewage treatment plant (STP) workers and farmers. Sanitation Safety Planning (SSP) is an approach which can be used to measure and mitigate these risks. This paper explores what impact a novel secondary treatment process, consisting of an integrated permeate channel (IPC) membrane combined with a constructed wetland plus, has on the occupational health risks compared with the existing activated sludge wastewater treatment process and reuse system in Kanpur, Uttar Pradesh. A mixed methodology was used, which included key informant interviews, structured observations, and E. coli analysis. This data was used to undertake semi-quantitative risk assessments following the SSP approach. The novel secondary treatment increased the number of health risks which the STP workers were exposed to, but the severity of the risks was lower. This was due to the differences in treatment processes and infrastructures. The number of health risks for the farmers decreased both in number and severity. For their children, the severity of the health impacts decreased. These changes were due to the increase in the microbiological quality of the irrigation water. This study highlights the potential of using a semi-quantitative risk assessment to assess the occupational health impacts of using novel treatment technologies. Full article

Background: Ecological momentary assessments (EMA) are one way to collect timely and accurate alcohol use data, as they involve signaling participants via cell phones to report on daily behaviors in real-time and in a participant’s natural environment. EMA has never been used with American Indian populations to evaluate alcohol consumption. The purpose of this project was to determine the feasibility and acceptability of EMA for American Indian women. Methods: Eligible participants were American Indian women between the ages of 18 and 44 who were not pregnant and had consumed more than one drink within the past month. All participants received a TracFone and weekly automated messages. Self-reported measures of daily quantity and frequency of alcohol consumption, alcohol type, and context were assessed once per week for four weeks. Baseline measurements also included the Drinking Motives Questionnaire-Revised (DMQ-R) and the Interpersonal Support Evaluation List (ISEL). Results: Fifteen participants were enrolled in the study. All but one participant completed all data collection time points, and drinking patterns were consistent across the study period. A total of 420 records were completed across 86 drinking days and 334 non-drinking days. Participants reported drinking an average of 5.7 days over the 30-day period and typically consumed 3.99 drinks per drinking occasion. Sixty-six percent of participants met gender-specific cut-points for heavy episodic drinking, with an average of 2.46 binge drinking occasions across the four week study period. Conclusions: This proof-of-concept project showed that EMA was both feasible and acceptable for collecting alcohol data from American Indian women. Additional studies are necessary to fully implement EMA with American Indian women to better understand the drinking motives, contexts, patterns, and risk factors in this population. Full article

Teachers belong to a high-demand occupational group and experience work-related challenges and discretely diverse emotional turmoils of varying intensity while teaching and interacting with students. These experiences often result in high stress levels that contribute to burnout and, consequently, a breach of teachers’ occupational wellbeing. Promoting positive teacher wellbeing substantially influences teaching quality, with a flow-on effect on student wellbeing and academic development. This literature review utilised a framework to systematically explore the factors that impact the occupational wellbeing of kindergarten, primary, and secondary schoolteachers. Thirty-eight (38) studies from an initial 3766 peer-reviewed articles sourced from various databases (CINAHL, Emcare, PychINFO, Scopus, ERIC, and PsycARTICLES) were utilized for this systematic review. Four major factors were identified, including personal capabilities, socioemotional competence, personal responses to work conditions, and professional relationships. Findings highlight the importance of teachers’ occupational wellbeing in dealing with numerous challenges and competing demands, with the need for a high level of self-efficacy for instruction and behavioural management being critically significant. Teachers require adequate organisational support to successfully carry out their roles with stronger resilience and efficient job execution. Teachers also need to have social–emotional competence to be able to create a high-quality classroom environment and a conducive atmosphere that supports healthy teacher–student relationships, reduces stress and increases the occupational wellbeing of teachers. Collaborating with other relevant stakeholders such as parents, colleagues, and a school’s leadership team is critical for creating a positive work environment. A good workplace has the potential to contribute to teachers’ occupational wellbeing and provide a supportive platform for student learning and engagement. This review clearly points to the beneficial effects of prioritising teachers’ occupational wellbeing and its intentional inclusion in the professional development plan of practising teachers. Finally, while primary school teachers and secondary school teachers share many similarities in terms of the challenges they face, there are also some differences in how these challenges impact their wellbeing, and these warrant further investigation. Full article

The aim was to compare the effects of different exercise modalities (aerobic, resistance, aerobic and resistance combined, or mind–body exercise) on gestational diabetes mellitus (GDM), preeclampsia, spontaneous abortion, withdrawal from the study, and adverse events in healthy pregnant women. A systematic search was conducted in February 2022 using MEDLINE, EMBASE, Cochrane library, and SPORT Discus to identify eligible randomized trials. The meta-analysis of 18 studies that examined exercise compared to no exercise showed a reduced risk of GDM (RR: 0.66 (95% CI: 0.50 to 0.86). No subgroup differences were found regarding modality, intensity, or supervision. Exercise did not reduce the risk of preeclampsia (nine studies, RR: 0.65 (95% CI: 0.42 to 1.03)); however, in subgroup analyses, mind–body exercise and low-intensity exercise seemed to be effective in reduction of preeclampsia. There was no effect of exercise on withdrawal or adverse events found. No studies reported on spontaneous abortion, therefore, exercise during pregnancy is beneficial and safe. In the prevention of GDM, any modality and intensity seem equally effective. Subgroup analyses support an association between mind–body exercise and physical activity with low intensity and reduced risk of preeclampsia, but more high-quality randomized studies are needed. PROSPERO: CRD42022307053. Full article

(1) Background: Infant mortality is viewed as a core health indicator of overall community health. Although globally child survival has improved significantly over the years, Sub-Saharan Africa is still the region with the highest infant mortality in the world. In Ethiopia, infant mortality is still high, albeit substantial progress has been made in the last few decades. However, there is significant inequalities in infant mortalities in Ethiopia. Understanding the main sources of inequalities in infant mortalities would help identify disadvantaged groups, and develop equity-directed policies. Thus, the purpose of the study was to provide a diagnosis of inequalities of infant mortalities in Ethiopia from four dimensions of inequalities (sex, residence type, mother’s education, and household wealth). (2) Methods: Data disaggregated by infant mortalities and infant mortality inequality dimensions (sex, residence type, mother’s education, and household wealth) from the WHO Health Equity Monitor Database were used. Data were based on Ethiopia’s Demographic and Health Surveys (EDHS) of 2000 (n = 14,072), 2005 (n = 14,500), 2011 (n = 17,817), and 2016 (n = 16,650) households. We used the WHO Health Equity Assessment Toolkit (HEAT) software to find estimates of infant mortalities along with inequality measures. (3) Results: Inequalities related to sex, residence type, mother’s education, and household wealth still exist; however, differences in infant mortalities arising from residence type, mother’s education, and household wealth were narrowing with the exception of sex-related inequality where male infants were markedly at a disadvantage. (4) Conclusions: Although inequalities of infant mortalities related to social groups still exist, there is a substantial sex related infant mortality inequality with disproportional deaths of male infants. Efforts directed at reducing infant mortality in Ethiopia should focus on improving survival of male infants. Full article

Chronic exposure to ethnic–political and war violence has deleterious effects throughout childhood. Some youths exposed to war violence are more likely to act aggressively afterwards, and some are more likely to experience post-traumatic stress symptoms (PTS symptoms). However, the concordance of these two outcomes is not strong, and it is unclear what discriminates between those who are at more risk for one or the other. Drawing on prior research on desensitization and arousal and on recent social–cognitive theorizing about how high anxious arousal to violence can inhibit aggression, we hypothesized that those who characteristically experience higher anxious arousal when exposed to violence should display a lower increase in aggression after exposure to war violence but the same or a higher increase in PTS symptoms compared to those low in anxious arousal. To test this hypothesis, we analyzed data from our 4-wave longitudinal interview study of 1051 Israeli and Palestinian youths (ages at Wave 1 ranged from 8 to 14, and at Wave 4 from 15–22). We used the 4 waves of data on aggression, PTS symptoms, and exposure to war violence, along with additional data collected during Wave 4 on the anxious arousal participants experienced while watching a very violent film unrelated to war violence (N = 337). Longitudinal analyses revealed that exposure to war violence significantly increased both the risk of subsequent aggression and PTS symptoms. However, anxious arousal in response to seeing the unrelated violent film (measured from skin conductance and self-reports of anxiety) moderated the relation between exposure to war violence and subsequent psychological and behavioral outcomes. Those who experienced greater anxious arousal while watching the violent film showed a weaker positive relation between amount of exposure to war violence and aggression toward their peers but a stronger positive relation between amount of exposure to war violence and PTS symptoms. Full article

COVID-19 created a global crisis, exacerbating disparities in social determinants of health (SDOH) and mental health (MH). Research on pandemic-related MH and help-seeking is scarce, especially among high-risk populations such as college/university students. We examined self-rated MH and psychological distress, the perceived need for MH services/support, and the use of MH services across the SDOH among college/university students during the start of the pandemic. Data from the COVID-19 Texas College Student Experiences Survey (n = 746) include full- and part-time undergraduate/graduate students. Regressions examined self-rated MH, psychological distress, perceived need, and service use across SDOH, controlling for pre-pandemic MH, age, gender, and race/ethnicity. Economic stability was associated with higher risk of poor MH and need for MH services/support. Aspects of the social/community context protected student MH, especially among foreign-born students. Racial discrimination was associated with both greater psychological distress and use of services. Finally, beliefs related to the sufficiency of available institutional MH resources shaped perceived need for and use of services. Although the worst of the pandemic is behind us, the inequitable distribution of the SDOH among students is unwavering. Demand for MH support is high, requiring higher education institutions to better mobilize MH services to meet the needs of students from diverse social contexts. Full article

Education is not a factor included in most cardiovascular risk models, including SCORE2. However, higher education has been associated with lower cardiovascular morbidity and mortality. Using CACS as a proxy for ASCVD, we studied the association between CACS and educational status. Subjects, aged 40–69, from the Paracelsus 10,000 cohort, who underwent calcium scoring as part of screening for subclinical ASCVD, were classified into low, medium, and high educational status using the Generalized International Standard Classification of Education. CACS was dichotomised as either 0 or >0 for logistic regression modelling. Our analysis showed that higher educational status was associated with higher odds for 0 CACS (aOR 0.42; 95%CI 0.26–0.70; p = 0.001). However, there was no statistically significant association between the levels of total, HDL or LDL cholesterol and educational status, nor any statistical differences in HbA1c. SCORE2 did not differ between the three educational categories (4 ± 2% vs. 4 ± 3% vs. 4 ± 2%; p = 0.29). While our observations confirmed the relationship between increased educational status and lower ASCVD risk, the effect of educational status was not mediated via its impact on classical risk factors in our cohort. Thus, perhaps educational status should be taken into account to more accurately reflect individual risk in cardiovascular risk models. Full article

Background: The coronavirus disease of 2019 (COVID-19) pandemic has led to a global health crisis that has affected the psychological well-being of individuals across the world. The persistence of the pandemic and measures to curtail it have tested people’s ability to cope successfully and bounce back from the pandemic, otherwise referred to as resilience. The present study examined resilience levels among residents of Fort McMurray and identified the demographic, clinical and social factors associated with resilience. Methods: The study used a cross-sectional survey design and collected data from 186 participants using online questionnaires. The survey included questions assessing sociodemographic information, mental health history and COVID-19-related variables. The main study outcome was resilience measured using the six-item Brief Resilience Scale (BRS). The data from the survey were analyzed using chi-squared tests and binary logistic regression analyses in the Statistical Package for Social Sciences (SPSS), version 25. Results: The results showed that seven independent variables (age, history of depression, history of anxiety, willingness to receive mental health counselling, support from the government of Alberta and support from employer) were statistically significant within the context of the logistic regression model. A history of an anxiety disorder was demonstrated to best predict low resilience. Participants who had a history of anxiety disorder were five times more likely to show low resilience compared to those without such a history. Participants with a history of depression showed a three-fold likelihood of having low resilience in comparison to those who did not have a history of depression. Individuals who expressed a desire to receive mental health counselling had a four-times likelihood of having low resilience than those who did not express a desire to receive mental health counselling. The results also showed that younger participants were more prone to low resilience compared to older participants. Receiving support from the government and one’s employer is a protective factor. Conclusions: This study highlights the importance of examining resilience and its associated factors during a pandemic such as COVID-19. The results demonstrated that a history of anxiety disorder, depression and being younger were important predictors of low resilience. Responders who reported the desire to receive mental health counselling also reported expressing low resilience. These findings could be used to design and implement interventions aimed at improving the resilience of individuals affected by the COVID-19 pandemic. Full article

Combined deficiencies of nutrients such as iron and folic acid intake during pregnancy are related to nutritional deficiencies risk, such as anemia. The objective of this study was to analyze the association between risk factors (sociodemographic, dietary and lifestyle) and the intake of iron and folate by pregnant women followed up in Primary Health Care (PHC) in the Federal District, Brazil. A cross-sectional observational study was carried out with adult pregnant women of different gestational ages. A semi-structured questionnaire was applied by researchers trained to collect sociodemographic, economic, environmental, and health data. Two nonconsecutive 24-hour recalls (24hr) were carried out to collect data about food consumption. Multivariate linear regression models were used to analyze the association between sociodemographic and dietary risk factors and the consumption of iron and folate. The mean daily energy intake was 1726 kcal (95% CI 1641–1811), with 22.4% (95% CI 20.09–24.66) derived from ultra-processed foods (UPFs). The mean iron and folate intake were 5.28 mg (95% CI 5.09–5.48) and 193.42 µg (95% CI 182.22–204.61), respectively. According to the multivariate model, the highest quintile of ultra-processed foods intake was associated with lower iron (β = −1.15; IC 95%: −1.74; 0.55; p < 0.001) and folate intake (β = −63.23; IC 95%: −98.32; −28.15; p < 0.001). Pregnant women with high school degree presented higher iron intake (β = 0.74; IC 95%: 0.20; 1.28; p = 0.007) and folate intake (β = 38.95; IC 95%: 6.96; 70.95; p = 0.017) compared to pregnant women with elementary school degree. Folate consumption was also associated with the second gestational period (β = 39.44; IC 95%: 5.58; 73.30; p = 0.023) and pregnancy planning (β = 26.88; IC 95%: 3.58; 50.18; p = 0.024). Further research is warranted to enhance evidence on the relationship between the role of processed foods and micronutrients intake to strengthen the nutritional quality of diet of pregnant women attended in Primary Health Care. Full article

This exploratory paper examines individual levels of risk assessment as impacting institutional trust in the CDC while also contributing to disparities in expressed willingness to mask early in the COVID-19 pandemic. Using both content and thematic analysis of the CDC’s Facebook (FB) page from April 2020 and Gidden’s modern risk society theory, I consider how social media (SM) users retrospectively perceived a dramatic change in public health (PH) advisory—from the CDC advising against masking in February 2020 (Time 1) to advising the use of “do-it-yourself” (DIY) cloth masking in April 2020 (Time 2)—through a lens of prior, self-guided research. Expressed “knowledge” of masking as preventative (or not) yielded unwavering and sometimes increasing distrust in the CDC based on user perception of the “correct” advisory, regardless of the CDC’s position at Time 1 or Time 2. Simultaneously, disparities in masking behaviors appeared to be driven not by CDC guidance but by this same self-guided research. I show this via three themes: (1) claims of ineffectiveness for DIY masking (do not trust CDC now—no masking from the start); (2) conflict between the first and second CDC advisories on masking (do not trust CDC—either already masking anyway or will now); (3) disappointed in the CDC for length of time taken to make a DIY mask recommendation (do not trust CDC—either already masking anyway or will mask now). I discuss the imperative nature of two-way engagement with SM users by PH rather than using SM as a one-way mode of advisory dissemination. This and other recommendations may decrease disparities in preventative behaviors based on individual-level risk assessment as well as increase institutional trust and transparency. Full article

This study aims to describe and compare cardiopulmonary and subjective responses during high-intensity interval training with elastic resistance (EL-HIIT) and traditional high-intensity interval training (HIIT) sessions. Twenty-two healthy adults (27.6 ± 4.4 years) performed an EL-HIIT and a HIIT protocol consisting of 10 × 1 min at ~85% $\stackrel{·}{\mathrm{V}}{\mathrm{O}}_{\mathrm{2max}}$ prescribed by cardiopulmonary-specific tests. Pulmonary parameters, heart rate (HR), blood lactate, and rate of perceived exertion (RPE) were measured during exercise. Paired t-test and Cohen’s d effect size were used to compare peak and average values. Two-way repeated measures ANOVA and mixed model with Bonferroni’s post hoc test were used to compare each bout during the session. The EL-HIIT session showed higher peak and average values of HR, ventilation ($\stackrel{·}{\mathrm{V}}\mathrm{E}$), relative and absolute oxygen uptake ($\stackrel{·}{\mathrm{V}}{\mathrm{O}}_2$), carbon dioxide production ($\stackrel{·}{\mathrm{V}}\mathrm{C}{\mathrm{O}}_2$), and RPE than HIIT (p < 0.05). The effect size (ES) comparing HIIT and EL-HIIT was large for HR, $\stackrel{·}{\mathrm{V}}\mathrm{E}$, and lactate (≥0.8) in peak values. Comparing each bout between HIIT and EL-HIIT, no difference was found in peak values (p > 0.05) during the session (excluding baseline, warm-up, and recovery). EL-HIIT presented a more pronounced cardiopulmonary and subjective response than HIIT. Full article

This study explores the impact of the COVID-19 pandemic on the work and social and emotional well-being (SEWB) of staff at Aboriginal Community Controlled Health Services (ACCHS) in Australia. Between September and November 2021, staff from three ACCHSs in New South Wales completed an online survey to report changes to their roles, concerns about becoming infected with the COVID-19 virus, and job satisfaction in the last month. The survey measured emotional exhaustion and psychological distress by using the Maslach Burnout Inventory-Human Services Survey and Kessler-5 scale, respectively. The survey determined staff’s access to SEWB support. Descriptive statistics were calculated for each variable. Among 92 staff from three ACCHSs, 36% reported a COVID-19-related change in their role and 64% were concerned about becoming infected. In spite of the pandemic, most staff (69%) were satisfied with their job. While most staff were not burnt out or psychologically distressed, 25% had high emotional exhaustion and 30% had high to very high psychological distress. Relatedly, 37% had accessed SEWB support at least once in their lifetime and 24% had accessed support in the last month. As the pandemic continues, it is important to identify factors influencing burnout or psychological distress among ACCHS staff and implement evidence-based solutions. Full article

The knee is an essential part of our body, and identifying its injuries is crucial since it can significantly affect quality of life. To date, the preferred way of evaluating knee injuries is through magnetic resonance imaging (MRI), which is an effective imaging technique that accurately identifies injuries. The issue with this method is that the high amount of detail that comes with MRIs is challenging to interpret and time consuming for radiologists to analyze. The issue becomes even more concerning when radiologists are required to analyze a significant number of MRIs in a short period. For this purpose, automated tools may become helpful to radiologists assisting them in the evaluation of these images. Machine learning methods, in being able to extract meaningful information from data, such as images or any other type of data, are promising for modeling the complex patterns of knee MRI and relating it to its interpretation. In this study, using a real-life imaging protocol, a machine-learning model based on convolutional neural networks used for detecting medial meniscus tears, bone marrow edema, and general abnormalities on knee MRI exams is presented. Furthermore, the model’s effectiveness in terms of accuracy, sensitivity, and specificity is evaluated. Based on this evaluation protocol, the explored models reach a maximum accuracy of 83.7%, a maximum sensitivity of 82.2%, and a maximum specificity of 87.99% for meniscus tears. For bone marrow edema, a maximum accuracy of 81.3%, a maximum sensitivity of 93.3%, and a maximum specificity of 78.6% is reached. Finally, for general abnormalities, the explored models reach 83.7%, 90.0% and 84.2% of maximum accuracy, sensitivity and specificity, respectively. Full article

The present study examines various activities of social participation (i.e., church or religious activities; educational or cultural activities; service club or fraternal organization activities; neighbourhood, community, or professional association activities; volunteer or charity work; and recreational activities) as contributing factors to successful aging. Successful aging in this study includes the following: adequate social support, no limitations with respect to Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), no mental illness in the preceding year, no serious cognitive decline or pain that prevents activity, as well as high levels of happiness, and self-reports of good physical health, mental health, and successful aging. Methods: The Canadian Longitudinal Study on Aging (CLSA) is a large, national, longitudinal study on aging. A secondary analysis of the baseline (i.e., 2011–2015) and Time 2 (i.e., 2015–2018) data of the CLSA was conducted on a sample of 7623 older adults who were defined as “aging successfully” at baseline and were aged 60+ at Time 2. Binary logistic regression analyses were employed to examine the association between engaging in various social participation activities at baseline and aging successfully at Time 2. Results: In a subsample (n = 7623) of the Canadian Longitudinal Study on Aging (CLSA) Comprehensive Cohort who were aging successfully at baseline, the prevalence of successful aging at Time 2 was significantly higher among the participants who participated in volunteer or charity work and recreational activities compared to those who were not involved in these activities. After adjusting for 22 potential factors, the results of the binary logistic regression analyses reported that participants who, at baseline, participated in volunteer or charity work and recreational activities had higher age–sex-adjusted odds of achieving successful aging (volunteer or charity work: aOR = 1.17, 95% CI: 1.04, 1.33; recreational activities: aOR = 1.15, 95% CI: 1.00, 1.32). Conclusions: Among six types of social participation activities, people who participated in volunteer or charity work and recreational activities were more likely to achieve successful aging than their counterparts who did not engage in these activities. If these associations are found to be causal, policies and interventions encouraging older adults to participate in volunteer or charity work and recreational activities may support older adults to achieve successful aging in later life. Full article

Firefighters are at an increased risk of cancer due to their occupational exposure to combustion byproducts, especially when those compounds penetrate the firefighter personal protective equipment (PPE) ensemble. This has led to questions about the impact of base layers (i.e., shorts vs. pants) under PPE ensembles. This study asked 23 firefighters to perform firefighting activities while wearing one of three different PPE ensembles with varying degrees of protection. Additionally, half of the firefighters unzipped their jackets after the scenario while the other half kept their jackets zipped for five additional minutes. Several volatile organic compound (VOC) and naphthalene air concentrations outside and inside of hoods, turnout jackets, and turnout pants were evaluated; biological (urinary and exhaled breath) samples were also collected. VOCs and naphthalene penetrated the three sampling areas (hoods, jackets, pants). Significant (p-value < 0.05) increases from pre- to post-fire for some metabolites of VOCs (e.g., benzene, toluene) and naphthalene were found. Firefighters wearing shorts and short sleeves absorbed higher amounts of certain compounds (p-value < 0.05), and the PPE designed with enhanced interface control features appeared to provide more protection from some compounds. These results suggest that firefighters can dermally absorb VOCs and naphthalene that penetrate the PPE ensemble. Full article

(1) Background: Despite efforts to improve access to health services, between- and within-country access inequalities remain, especially for individuals with complex disabling conditions like spinal cord injury (SCI). Persons with SCI require regular multidisciplinary follow-up care yet experience more access barriers than the general population. This study examines health system characteristics associated with access among persons with SCI across 22 countries. (2) Methods: Study data are from the International Spinal Cord Injury Survey with 12,588 participants with SCI across 22 countries. Cluster analysis was used to identify service access clusters based on reported access restrictions. The association between service access and health system characteristics (health workforce, infrastructure density, health expenditure) was determined by means of classification and regression trees. (3) Results: Unmet needs were reported by 17% of participants: lowest (10%) in Japan, Spain, and Switzerland (cluster 1) and highest (62%) in Morocco (cluster 8). The country of residence was the most important factor in facilitating access. Those reporting access restrictions were more likely to live in Morocco, to be in the lowest income decile, with multiple comorbidities (Secondary Conditions Scale (SCI-SCS) score > 29) and low functioning status (Spinal Cord Independence Measure score < 53). Those less likely to report access restriction tended to reside in all other countries except Brazil, China, Malaysia, Morocco, Poland, South Africa, and South Korea and have fewer comorbidities (SCI-SCS < 23). (4) Conclusions: The country of residence was the most important factor in facilitating health service access. Following the country of residence, higher income and better health were the most important facilitators of service access. Health service availability and affordability were reported as the most frequent health access barriers. Full article