Search Results (105)

Phosphogypsum, the primary solid waste from the wet-process phosphoric acid industry, poses significant environmental and health risks due to large-scale stockpiling. To promote its resource utilisation, this study systematically evaluated the solidification and stabilisation performance of phosphogypsum–coal fly ash cementitious material (PAC) for Cr(VI)-contaminated soil under high-chloride conditions. Phosphogypsum reactivity was enhanced via mechanical activation and high-temperature calcination. An orthogonal experimental design was employed to analyse the effects of multiple factors—including calcination temperature and duration—on compressive strength and heavy metal leaching behaviour. Results show that PAC prepared from coal ash calcined at 600 °C for 3 h exhibits excellent mechanical properties and Cr(VI) stabilisation efficacy under high-chloride conditions, achieving a maximum compressive strength of 28.75 MPa and a Cr(VI) leaching concentration as low as 15.69 μg/L. Microstructural characterisation revealed the synergistic formation of a dense framework between C–S–H gel and calcium aluminate, conferring superior mechanical strength. Substitution and chelation mechanisms of Cl⁻ ions played a key role in enhancing corrosion resistance. This study provides theoretical support and technical guidance for the high-value utilisation of phosphogypsum-based materials in remediating saline–alkali-contaminated soils. Full article

Background/Objectives: In England, gay, bisexual, and other men who have sex with men (GBMSM) are eligible for vaccination at NHS sexual health services, including human papillomavirus (HPV), hepatitis A virus (HAV), and hepatitis B virus (HBV) vaccines. However, current research shows limited understanding of the factors influencing vaccination uptake among GBMSM. This study aimed to examine the barriers and facilitators affecting the offer and uptake of these vaccination programmes. Methods: A qualitative interview study following the Person-Based Approach (a systematic method for developing and optimising health interventions) involving GBMSM and sexual health service staff from two regions of England. Purposive sampling aimed to include GBMSM with diverse backgrounds and engagement with sexual health services. Patient and public involvement shaped the study design and interview topic guides. The interviews were recorded, transcribed, and thematically analysed to identify barriers and facilitators which were interpreted using the COM-B model of behaviour change. Results: Twenty GBMSM and eleven staff took part. The findings showed that opportunistic delivery of HPV, HAV, and HBV vaccination within sexual health services is mostly acceptable and feasible for GBMSM and staff, while also highlighting areas for optimization. Despite low knowledge of these viruses and their associated risks, willingness to be vaccinated was high, with healthcare provider recommendations and the convenience of vaccine delivery during routine clinic visits acting as important facilitators. However, the reach of opportunistic models was limited, particularly for individuals underserved by sexual health services or disengaged from GBMSM social networks. System-level barriers such as complex vaccine schedules (particularly when multiple schedules are combined), inconsistent access to vaccination histories, and limited system-level follow-up processes (e.g., automated invites and reminders) were also found to act as obstacles to vaccination uptake and delivery. Conclusions: To improve equitable uptake, sexual health services should explore the feasibility of addressing both individual and structural barriers through additional strategies, including targeted and persuasive communication to increase knowledge, leveraging regular contact with GBMSM to promote uptake, and implementing enhanced approaches to support vaccination completion (e.g., automated prompts or reminders). Full article

Background: A sedentary lifestyle contributes to chronic disease risk in adults and may predict unfavourable body composition in adolescents. Declining physical activity and rising sedentary behaviour are linked to increasing global obesity rates. Given the scarcity of longitudinal studies examining how participation in organized sports and screen device use relate to body composition in early adolescence, this study aims to address this gap by analyzing temporal trends in both sexes. Methods: A sample of 158 Italian students, 38% of whom were female, was followed longitudinally from ages 11 to 13. Annual anthropometric assessments were conducted, and self-reported data on screen time and organised sports participation were collected. Fat mass (FM), fat-free mass (FFM), fat mass index (FMI), fat-free mass index (FFMI), body mass index (BMI), and waist-to-height ratio (WHtR) were subsequently calculated, along with annual increments. Repeated-measures ANOVA assessed age and sex effects, while multiple regression models evaluated associations between behavioural variables or sex and body composition indices. Results: Significant differences in %F, FM, FFM and its increment, WHtR and its increment, FMI, and FFMI (all p < 0.01) were observed by age and sex interaction. At age 13, weekly sports participation was negatively associated with annual increments in %F (β = −0.204, p = 0.04) and FMI (β = −0.227, p = 0.03). Female sex was associated with greater increments in %F (β = 0.188, p < 0.05) and WHtR (β = 0.323, p < 0.01), and with smaller increments in FFM (β = −0.421, p < 0.01). No significant associations were found for screen time (p > 0.05). Conclusions: Sporting during early adolescence seems to have positive effects on body composition changes, while sex-specific patterns warrant further attention. A deeper understanding of how early adolescent lifestyle factors, such as physical activity and sedentary behaviour, shape body composition is essential for promoting long-term health. Full article

Background/Objectives: The global epidemic of type 2 diabetes (T2D) is a critical public health issue, particularly in New Zealand, where prevalence rates are high, especially among Māori and Pacific people. Recent research indicates that dietary interventions, particularly carbohydrate reduction, can lead to the remission or reversal of T2D. However, little is known about how such approaches perform when implemented in routine New Zealand primary care, particularly within high-risk and underserved populations. This study aimed to evaluate changes in HbA1c, diabetes status, and cardiometabolic outcomes among adults with prediabetes and T2D engaged in such a model of care. Methods: This study reports findings from a retrospective, observational, real-world, multi-site clinical audit (service evaluation) of a holistic model of care implemented in three primary care practices in New Zealand. The model of care is characterised by a three-pronged approach: whole food, carbohydrate reduction; a health-coach, behaviour-change-based delivery approach; and community- or peer-based initiatives. Audit data from 106 patients with prediabetes (PD) and T2D were analysed (median follow-up 19 months; IQR 6–32) to assess changes in glycosylated haemoglobin (HbA1c) levels, diabetes status, and cardiometabolic outcomes. Results: We observed an overall reduction in HbA1c (median change −3 mmol/mol (IQR: −7 to 3), p = 0.004), with 32% of patients with T2D at baseline achieving reversal and 44% of those with PD attaining normoglycaemia at final follow-up. Weight loss was associated with greater HbA1c reduction (0.56 mmol/mol decrease per kg lost) and additional improvements seen in lowered alanine aminotransferase (ALT). HDL cholesterol showed a small decline (r = 0.31), and triglycerides and blood pressure showed no significant change, indicating that these measures remained broadly stable over the evaluation period. Conclusions: Given the retrospective and uncontrolled audit design, findings should be interpreted with appropriate caution. However, the consistent improvements observed across multiple practices suggest that carbohydrate-reduction strategies within holistic models of care can meaningfully improve diabetes outcomes in real-world primary care settings. Future research should evaluate longer-term sustainability, implementation fidelity, and the applicability of this model at scale, particularly for Māori and Pacific communities. Full article

Background: The Canadian HIV Cure Enterprise (CanCURE) is a pan-Canadian research collaboratory, investigating approaches for achieving sustainable HIV remission. In preparation for the next research cycle, CanCURE researchers and the Community Advisory Board (CAB) co-designed a web-based survey to identify HIV research priorities from the perspective of people with HIV (PWH) in Canada. The current study examined gender-based differences in these priorities. Methods: From August to December 2024, we recruited PWH across Canada through community organizations and community members. We collected data using REDCap electronic data capture tools hosted at The Research Institute of the McGill University Health Centre. The survey included 36 demographic questions, 16 questions related to general knowledge about HIV and HIV cure-related concepts, and 21 questions ranking research priorities. Knowledge questions were multiple choice, while priorities could be ranked on a scale. We summarized participant characteristics via descriptive statistics, and the research priorities were further stratified according to gender. Results: Of 109 participants, 48.6% self-identified as men, 46.8% as women, and 4.6% as two-spirit, non-binary, agender, or other. The median age was 53 years old. Approximately one-third of participants had lived with HIV for ≤14 years, one-third for 15–24 years, and one-third for ≥25 years. Overall, the median knowledge score of respondents was 79%. Among the 78 participants with prior HIV research experience, three times as many men (61.1%) as women (19.0%) participated in interventional studies involving medication or medical procedures. Men ranked preventing HIV transmission to partners as a priority, studying where the virus hides as the second, and avoiding high comorbidity risks as the third. In contrast, women ranked not having to take pills daily as a priority and avoiding higher risks for comorbidities as the second priority. Both genders equally valued expanding community involvement in HIV cure research. However, men focused more on integrating social and behavioural research, while women emphasized the need for diverse ethnic representation in research. Conclusions: Although both men and women share some common priorities regarding HIV cure research, there are notable gender differences in their specific concerns. Furthermore, a significant gender gap in participation in interventional studies, essential for advancing HIV cure research, highlights the importance of aligning research priorities with concerns of both genders. Full article

Fear, anxiety, and stress (FAS) in canine patients is a growing concern for the veterinary industry. FAS affects the health of the patient while also increasing the risk to veterinary staff. Studies show that many veterinarians do not feel confident in managing behavioural issues like FAS, making engaging effectively with clients more difficult. Pre-visit pharmaceuticals (PVPs) can be an important tool in mitigating the effects of FAS; however, conclusive research is lacking on the efficacy of many of the medications and combinations currently used for this purpose. A comprehensive literature search was conducted in multiple databases. The most current research available on medications identified as widely used for treating FAS, and available for use in New Zealand, has been reviewed and discussed. Combinations selected for inclusion were the ‘chill protocol’ of acepromazine, gabapentin, and melatonin. Single agents included are clonidine, dexmedetomidine, gabapentin, and trazodone. Research into the use of the ‘chill protocol’ suggests this may be a combination particularly useful in highly stressed and aggressive dogs; however, additional studies need to be conducted to strengthen the evidence for its use. A multimodal approach has been identified as being desirable when addressing FAS in a clinical setting, with less evidence to support the use of single-agent medications in mitigating problematic behaviours. Full article

Research in western countries concludes that children and adolescents are exposed to multiple forms of online risks and harms. However, in the context of Saudi Arabia, research in online safety education is lagging. Currently, online safety education is generic and not research informed. Hence, this exploratory study seeks to generate a qualitative understanding of online risks and harms experienced by Saudi children, adolescents, and parents as well as online safety strategies. Using a semi-structured interview, this study explores the views of 15 children (12–15 years) and 10 parents. Interpretative Phenomenological Analysis (IPA) yielded four key themes: Negotiating the Promise and Peril of the internet, Living with the Shadows of the Online World, Psychological, and Physical Health Consequences, and Navigating Safety in a Digital Landscape of Uncertainty. While the benefits are clear (e.g., education and socialisation), children and parents have shared worries about cyberbullying, aggression, and exploitation. Internet addiction and isolation are notable consequences along with vision impairment and obesity. Children’s online safety practices are reactive, e.g., blocking and deleting risky content/behaviour, while parents share their struggles in monitoring children online. Online safety education, or the lack of it, is to blame. Children’s and parents’ limited awareness of online risks and poor online safety practices need to improve in Saudi Schools and households; there is an urgent need for further research and adequate implementation of systematic online safety education. Full article

The construct of violence has scarcely been researched in relation to suicidality in Mexico. The aim of the present study was to explore the role of different types of violence (e.g., violence at home, non-suicidal self-injury) in suicidal behaviour (e.g., suicidal ideation, suicidal acts) of the citizens of the Yucatan State using a massive online screening approach through a smartphone application. A prospective cohort study design was undertaken during 2022 including 32,531 Mexican participants aged between 15 and 80 years old, which constituted the second wave of the SmartScreen project, through the TEDUCA survey. We selected as the main variables violence at home, non-suicidal self-injuries, and suicidal behaviour (Columbia—Suicide Severity Rating Scale; C-SSRS). A set of univariate regression analyses was performed for the entire sample connecting the variables with the C-SSRS. Subsequently, a multiple linear regression model was used. The model explained a significant portion of the variance in C-SSRS scores (R²adj = 0.3227) indicating the following as predictors affecting suicidality: perceived violence at home, followed by a history of NSSI, and previous mental health service attendance, among other associations between the sociodemographic predictors and suicidal behaviour. Significant interactions between perceived violence and NSSI history were also found. In conclusion, our study highlights the significant role of perceived violence at home and NSSI history in shaping suicide risk understood as the ideation and intention of suicidality among Yucatan citizens. The interaction between these factors and sociodemographic variables such as gender and age underscore the complex nature of suicide risk. Full article

Background: Eating disorder (ED) symptoms and body image (BI) concerns involve serious risks to the physical and mental health of women and men. Social networking sites have amplified the promotion of idealised body images, contributing to this issue. Objectives: This study examines the link between personal and emotional factors, social media body image-related behaviours, BI concerns, and ED symptoms, as well as the differential role of these factors according to gender. Methods: A cross-sectional design was applied. The participants were 201 Spanish adults (mean age = 28.26; 76.6% women) who completed self-reported measures on BI (MBSRQ), ED symptoms (EAT-26), perfectionism (EDI-2), anxiety, depression, stress (DASS-21), emotional dysregulation (DERS), life satisfaction (SWLS), and social media BI-related behaviours. Results: Significant relationships between ED symptoms and BI concerns with personal and emotional factors and social media body image-related behaviours have been found. Women have scored higher in ED symptoms and social media BI-related behaviours than men. Multiple regression analyses showed that the difficulty in accepting emotions and not posting images due to BI dissatisfaction were risk factors for ED symptoms in both men and women. Furthermore, the adverse effect of perfectionism and low life satisfaction on women’s ED symptoms were demonstrated, whereas in men, goal-directed behaviours were associated with ED risk. Conclusions: These results suggest that prevention programmes focusing on emotional regulation and healthier social media use can be effective for ED symptoms and BI concerns. Full article

Background: The growing challenge of multimorbidity for healthcare systems worldwide demands a dual prevention framework, targeting both primary and secondary prevention. Multimorbidity–multibehaviours can provide such a theoretical and clinical framework to explore new aetiological evidence for multimorbidity risk. While the role of single health risk behaviours, such as smoking, nutrition, alcohol, and physical activity (SNAP), in chronic disease prevention is well-documented, their synergistic effect on multimorbidity has received relatively little attention. Methods: Using retrospective observational data from electronic health records of 21,079 patients from a convenience sample of three general practices in Staffordshire, UK (2015–2018), we examined the association between SNAP-multibehaviours and multimorbidity risk, defined as follows: MM2+ (≥2 morbidities), MM3+ (≥3 morbidities), and complex multimorbidity (accumulated morbidities affecting ≥3 body systems). Multiple logistic regression models, stratified by sex and adjusted for age and area, were applied to analyse the associations between both combined and accumulative SNAP-health risk behaviours (HRBs) and all multimorbidity operational definitions. Results: A dose–response association was observed, indicating increased multimorbidity risk with greater accumulation of SNAP-HRBs. Additionally, sex-specific patterns were identified, which varied according to the operational definitions of multimorbidity. These findings underscored both the clinical significance of the identified outcomes for promoting tailored multimorbidity guidelines and the need for further sex-sensitive research. Conclusion: These findings support the importance of transcending traditional silos in healthcare and public health research by integrating preventive and curative medicines under a multimorbidity–multibehaviour framework. Embracing the complexity of coexisting morbidities and health risk behaviours, healthcare systems can move beyond disease-specific and behaviour-specific paradigms. This approach has the potential to enhance clinical outcomes and to address the complex needs of individuals with multimorbidity in real-world healthcare settings. Full article

Background: Self-harm in young people is influenced by multiple factors, with media playing a significant role. While research has examined its harmful and protective effects, little attention has been paid to how healthcare professionals interpret and respond to media’s role in shaping young people’s experiences of self-harm. To our knowledge, no research has examined adolescent mental health professionals’ perspectives and, crucially, how these are constructed and understood. The study aimed to examine the following: (1) how mental health practitioners construct and use discourses to interpret the role of media in young people’s self-harm; and (2) how these discourses shape clinical understanding and practice. Methods: This qualitative study employed semi-structured interviews with ten clinicians from child and adolescent mental health services across England working with young people who self-harm. Data were analysed using critical discourse analysis to uncover how broader societal and institutional narratives shape clinicians’ perspectives. Results: Two dominant discourses were identified: “Media as Disruptor” and “The Hidden World of Youth”. These discourses framed media as both a risk factor and a potential intervention tool, positioning media as a powerful yet morally ambiguous force in young people’s lives. Clinicians largely framed media’s influence as negative but acknowledged its capacity for education and intervention. Conclusions: This research offers new insights into how media-related self-harm risks and benefits are framed and managed in mental health care settings. The study underscores the need for systemic changes in clinical practice, enhanced training, updated guidelines and a shift towards broader sociocultural perspectives in understanding self-harm and suicidal behaviour. Full article

Gestational diabetes mellitus (GDM) is a growing global health concern due to its impact on maternal and infant health. GDM risk factors vary across populations, but international comparisons using standardised assessment tools are lacking. This study aimed to examine variations in risk factors, demographics and health behaviours among pregnant women at increased risk of GDM across four international sites and to investigate factors associated with maternal body mass index (BMI), a modifiable risk factor for GDM. This cross-sectional study included data from 804 pregnant women in Dublin (n = 213), Bristol (n = 205), Granada (n = 211) and Melbourne (n = 175) identified as having an increased risk of GDM, using the Monash GDM screening tool. Between-site differences were analysed using analysis of variance, Kruskal–Wallis and chi-square tests and factors associated with BMI at each site were examined using multiple linear regression. Despite standardised risk screening, significant heterogeneity was observed between sites in key GDM risk factors, including age (mean range 33.8–36.7 years), BMI (Melbourne 28.9 vs. Granada 26.9 kg/m²), physical activity (34.86–41.77 METs/week) and dietary intake (mean energy 1881–2136 kcal/day). Multiple factors were independently associated with BMI, including education level, ethnicity, health literacy and energy intake, with patterns varying by site. This study challenges the concept of a homogeneous “high-risk” GDM population by revealing substantial variations in risk factors and characteristics across different patient cohorts, highlighting the importance of developing context-sensitive approaches to GDM prevention. Full article

Objective: This study aimed to explore the association between adolescents’ health risk behaviours (excessive use of alcohol, (e)cigarette smoking, cannabis use) and familial factors. A special objective of this study was to compare findings between Bulgarian and Lithuanian adolescents aged 15 years. Material and Methods: National samples from the WHO Health Behaviour in School-aged Children (HBSC) survey in 2021/2022 were analysed. The focus was on adolescents aged 15 (n = 64,349), including those from Bulgaria (n = 793) and Lithuania (n = 1137). The set of outcome variables included drunkenness, smoked cigarettes, e-cigarettes, and used cannabis (all variables were measured during the last 30 days); their indicators were child’s talking separately to their father and separately to their mother, as well as the four-item family support scale. All variables were dichotomised and their associations were analysed using Structural Equation Modelling with a WLSMV estimator. Results: In the total sample, the prevalence of drunkenness was 14.9%, cigarette smoking at 12.6%, e-cigarette smoking at 18.4%, and cannabis use at 5.9%; while in Bulgaria, in contrast to Lithuania, these behaviours were much more prevalent, at 27.0%, 29.9%, 29.8%, and 11.1%, respectively. The use of substances was significantly associated with selected familial factors, which were more pronounced among girls than boys in most subsamples. Low family support showed the strongest association with increased substance use (in the total sample, regression weight B varied from 0.231 to 0.382). Adolescents’ difficulty in talking to mother was more pronounced (B = 0.123 to 0.204) than difficulty in talking to their father (B = 0.058 to 0.140). Comparison of data samples from Bulgaria and Lithuania showed stronger relationships in Bulgarian adolescents compared to other countries, which are more pronounced among boys. In addition, among Bulgarian adolescents, easy communication with their father had an inverse association (increasing prevalence) with cannabis use. Conclusions: Adolescent health risk behaviours, such as use of substances, are associated with familial factors, including parent–teen communication and family support. Generally, these associations are more pronounced among girls than boys, and more evident among Bulgarian adolescents than their Lithuanian counterparts. Identifying environmental factors in families helps to plan interventions to prevent development of multiple health risk behaviours in adolescents. Full article

Background: A conceptual shift in healthcare emphasises multimorbidity and multibehaviours as interconnected phenomena, highlighting dose–response associations and sex-specific differences. Data-driven approaches have been suggested for overcoming methodological challenges, of multimorbidity research. By using exploratory factor analysis, this study aimed to identify sex specific lifestyle associative multimorbidity patterns, providing valuable evidence to primary care providers and informing future multimorbidity guidelines. Methods: A retrospective observational study examined the electronic health records of three general practices in the UK between 2015 and 2018. The participants were aged 18+ with lifestyle multimorbidity, having engaged with multiple health risk behaviours. Stratified exploratory factor analysis with oblique rotation was used to identify sex specific lifestyle associative multimorbidity patterns. Results: The study included N = 7560 patients, with females comprising 53.9%. Eight independent lifestyle associative multimorbidity patterns were identified and distributed as follows. For females, three patterns emerged: cardiometabolic–neurovascular spectrum disorders (42.97% variance), respiratory conditions (8.08%), and sensory impairment (5.63%), with 25.4% assigned to these patterns. For males, five patterns were revealed: cardiometabolic–vascular spectrum disorders (34.10%), genitourinary (9.19%), respiratory–vision (8.20%), ocular (5.70%), and neurovascular–gastro–renal syndrome (4.54%), with 43%. Conclusions: We revealed eight different sex-specific lifestyle-associated patterns, implying the need for tailored clinical approaches. The application of exploratory factor analysis yielded clinically valuable and scientifically rigorous multimorbidity patterns. Clinically, the findings advocate for a paradigm shift towards person-centred care, integrating multimorbidity and SNAP multibehaviours to enhance the complexity of inquiry and treatment of high-risk populations. Full article

HIV remains a major public health challenge in sub-Saharan Africa, with South Africa bearing the highest burden. This study confirms that KwaZulu-Natal (KZN) is a hotspot, with a high HIV prevalence of 47.4% (95% CI: 45.7–49.1) among females aged 15–34. We investigated the spatial distribution and key socio-demographic, behavioural, and economic factors associated with HIV prevalence in this group using a Bayesian spatial logistic regression model. Secondary data from 3324 females in the HIV Incidence Provincial Surveillance System (HIPSS) (2014–2015) in uMgungundlovu District, KZN, were analysed. Bayesian spatial models fitted using the Integrated Nested Laplace Approximation (INLA) identified key predictors and spatial clusters of HIV prevalence. The results showed that age, education, marital status, income, alcohol use, condom use, and number of sexual partners significantly influenced HIV prevalence. Older age groups (20–34 years), alcohol use, multiple partners, and STI/TB diagnosis increased HIV risk, while tertiary education and condom use were protective. Two HIV hotspots were identified, with one near Greater Edendale being statistically significant. The findings highlight the need for targeted, context-specific interventions to reduce HIV transmission among young females in KZN. Full article