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Background: While it is a generally accepted fact that many gambling screening tools are not fit for purpose when employed as part of a public health framework, the evidence supporting this claim is sporadic. The aim of this review is to identify and evaluate the gambling screening tools currently in use and examine their utility as part of a public health approach to harm reduction, providing a holistic snapshot of the field. Methods: A range of index tests measuring aspects of problem gambling were examined, including the South Oaks Gambling Screen (SOGS) and the Problem Gambling Severity Index (PGSI), among others. This review also examined a range of reference standards including the Diagnostic Interview for Gambling Severity (DIGS) and screening tools such as the SOGS. Results: The present review supports the belief held by many within the gambling research community that there is a need for a paradigm shift in the way gambling harm is conceptualised and measured, to facilitate early identification and harm prevention. Discussion: This review has identified a number of meaningful deficits regarding the overall quality of the psychometric testing employed when validating gambling screening tools. Primary among these was the lack of a consistent and reliable reference standard within many of the studies. Currently there are very few screening tools discussed in the literature that show good utility in the domain of public health, due to the focus on symptoms rather than risk factors. As such, these tools are generally ill-suited for identifying preclinical or low-risk gamblers. [ABSTRACT FROM AUTHOR]

Aim: Designing financial incentives for health behaviour change requires choices across several domains, including value (the size of the incentive), frequency of incentives, and direction (gain or loss). However, the rationale underlying complex incentive design is infrequently reported. Transparent reporting is important if we want to understand and improve the incentive development process. This paper describes a mixed methods approach for designing financial incentives for health behaviour change which involves stakeholders throughout the design process. Subject and methods: The mixed methods approach focuses on incentives for weight loss for men with obesity living in areas with high levels of disadvantage. The approach involves: (a) using an existing framework to identify all domains of a financial incentive scheme for which choices need to be made, deciding what criteria are relevant (such as effectiveness, acceptability and uptake) and making choices on each domain on the basis of the criteria; (b) conducting a survey of target population preferences to inform choices for domains and to design the incentive scheme; and (c) making final decisions at a stakeholder consensus workshop. Results: The approach was implemented and an incentive scheme for weight loss for men living with obesity was developed. Qualitative interview data from men receiving the incentives in a feasibility trial endorses our approach. Conclusion: This paper demonstrates that a mixed methods approach with stakeholder involvement can be used to design financial incentives for health behaviour change such as weight loss. Trial registration number: NCT03040518. Date: 2 February 2017. [ABSTRACT FROM AUTHOR]

Aim: To analyze the level of knowledge, attitudes, practices, and risk perception regarding COVID-19 among Chinese residents 1.5 years after the pandemic. Subject and methods: A cross-sectional study was carried out with both online and paper questionnaires. We included a variety of covariates that were characteristic-related factors such as age, gender, education level, and retirement status, as well as those closely associated with risk perception regarding COVID-19. Results: Participants (n = 3588), 53.49 ± 18.88 years old, from two provinces of China, of which 44.7% were male and 52.03% had a high school or greater level of education, answered the questions. More than 90% of participants had adequate background knowledge about COVID-19 and agreed or even strongly agreed with many attitude items related to the government's role in diagnosis, treatment, and dealing with COVID-19 infections. About three fifths of the participants reported fear of contracting COVID-19, but only a minority (18.63%) felt they were more susceptible than others. Respondents aged 45 years or younger were more likely to fear contracting the virus than those older than 45 years (adjusted OR = 1.464, 95% CI 1.196 to 1.794, P = 0.0002). High education level (adjusted OR = 1.503, 95% CI 1.187 to 1.904, P = 0.0007) and non-retired status (adjusted OR = 1.679, 95% CI 1.354 to 2.083, P < 0.0001) were associated with a higher perception of susceptibility to infection than others. Moreover, respondents who were not retired had a significantly reduced practice score (adjusted OR = 1.554, 95% CI 1.261 to 1.916, P < 0.0001). Age, retirement status, and education level were also associated with knowledge, attitude, and practice level. Conclusion: Our findings suggest that the public generally has trust in the COVID-19 vaccine and the government with regard to COVID-19 in China. We recommend that high-risk groups of communities, such as elders and patients with chronic diseases, be given greater consideration in the outbreaks. Health education campaigns combined with workplace preventive intervention should be aimed at improving COVID-19 knowledge and beliefs in order to encourage more optimistic attitudes and to maintain safe practices. [ABSTRACT FROM AUTHOR]

Female genital mutilation (FGM) involves the cutting of the external female genital organs for non-medical purposes. It is a widespread public health problem in Nigeria as it affects the health of women and girls. The views of women about FGM are widely researched and known; however, very little empirical research has been conducted to understand the views of men. Aim: This study therefore sought to examine men's views with regard to the continuation of FGM and its associated factors in a rural Igbo community in Nigeria. Subject and Method: This paper reports the results of a survey of 215 men aged 18 and above living in Isuikwuato Local Government Area, Uturu in Nigeria. Bivariate and binary logistic regression were performed on 215 completed and returned questionnaires (86% response rate) using the Statistical Package for Social Science. This is the first study to investigate Nigerian Igbo men's views of FGM. Results: Descriptive statistics revealed that almost two-thirds of the sample (63.7%) thought FGM should be discontinued. Logistic regression found that owning a television and/or a radio and holding a Christian faith significantly predicted favouring the discontinuation of FGM. Conclusion: This study provides evidence to suggest that some Nigerian Igbo men's attitudes about FGM appear to be generally less than favourable. The major implication of these findings is that policy makers must place greater emphasis on addressing the economic and social development of rural areas in Nigeria if the harmful practice of FGM is to be reduced. [ABSTRACT FROM AUTHOR]

Aim: As individuals adjust to new 'norms' and ways of living during the COVID-19 lockdown, there is a continuing need for up-to-date information and guidance. Evidence suggests that frequent media exposure is related to a higher prevalence of mental health problems, especially anxiety and depression. The aim of this study was to determine whether COVID-19 related media consumption is associated with changes in mental health outcomes. Methods: This paper presents baseline data from the COVID-19 Psychological Wellbeing Study. The cross-sectional study data was collected using an online survey following the Generalised Anxiety Disorder scale (GAD-7) and the Patient Health Questionnaire (PHQ-9), with some other basic information collected. Logistic regression analysis was used to examine the influence of socio-demographic and media specific factors on anxiety and depression. Results: The study suggested that media usage is statistically significantly associated with anxiety and depression on the GAD-7 and PHQ-9 scales with excessive media exposure related to higher anxiety and depression scores. Conclusion: This study indicated that higher media consumption was associated with higher levels of anxiety and depression. Worldwide it should be acknowledged that excessive media consumption, particularly social media relating to COVID-19, can have an effect on mental health. However, as this was a cross-sectional study we cannot infer any directionality as we cannot infer cause and effect; therefore, future research involving longitudinal data collection and analyses of variables over time is warranted. [ABSTRACT FROM AUTHOR]

Background: Undernutrition among children is a primary concern in sub-Saharan African countries such as Ethiopia. The objective of this paper is to measure the magnitude of undernutrition and associated factors among children under 2 years of age in the Jimma Zone of Southwest Ethiopia. Methods: A community-based cross-sectional study with stratified multistage sampling was conducted. Data were collected using a semi-structured questionnaire and anthropometric measurements. Bivariate and multivariable logistic regression models were fitted using SPSS 20.0 for Windows. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were used to measure the strength of the association between dependent and associated variables at a p value <0.05. Results: Among the study participants, 142 (25.4%) were stunted, 73 (13.1%) were underweight, and 54 (9.7%) were wasted. Older child age [AOR = 1.1, 95% CI (1.1, 1.2)], male sex [AOR = 2.601, 95% CI (1.681, 4.025)], and residing in an urban area [AOR = 0.526, 95% CI (0.323, 0.857)] were significantly associated with stunting. Independent predictors of wasting were younger child age [AOR = 0.894, 95% CI (0.833, 0.96)], living in a lowland area [AOR = 3.3, 95% CI (1.4, 8.1)], and living a in poor household [AOR = 6.2, 95% CI (2.2, 17.7)]. Underweight was significantly associated with male sex [AOR = 2.09, 95% CI (1.179, 3.703)], delayed initiation of breastfeeding [AOR = 2.1, 95% CI (1.0, 4.2)], and living in a poor household [AOR = 2.2, 95% CI (1.0, 4.6)]. Conclusions: Child malnutrition was found to be a moderate public health problem in the study area. Urban dwellers had higher levels of undernutrition than rural dwellers. Children living in lowlands had higher undernutrition than those living in highland areas. [ABSTRACT FROM AUTHOR]

Aim: Owing to the COVID-19 pandemic, many companies shifted to telework, with few insights into its implementation, organisational conditions or the role of workplace health promotion and management. This study focused on a multifactorial investigation of conditions in companies which implemented and evaluated telework during the first lockdown in 2020 as well as on their future intentions to facilitate teleworking under health-promoting working conditions. Subject and methods: The research hypotheses relate to an extended technology acceptance model. In a mixed-methods design, expert interviews were fed into the development of an online questionnaire. Out of 1858 contacted companies representing a broad range of Austrian businesses, 192 responses (general management, workplace health managers, etc.) were analysed using descriptive and multivariate statistics. Results: The degree of implementation and claim to teleworking increased significantly during the first lockdown and did not return to pre-pandemic levels afterwards. Changes depended on preparation and experience: evaluation of teleworking and willingness to continue offering teleworking were conditional on preparation and the degree of implementation. Prerequisites for future intentions to implement health-promoting teleworking included readiness, general willingness and existing workplace health promotion/management structures. Conclusion: This paper demonstrates the potential of health-promoting organisational cultures for development processes – particularly in times of crisis. Anchoring health-focused structures in companies helps to create health-promoting frameworks. Health-promoting teleworking can be developed from workplace health promotion/management using established approaches. It is essential to build on in-house capacities and competencies to develop awareness for a holistic culture for health-promoting (tele)work and to encourage deliberations about potential measures. [ABSTRACT FROM AUTHOR]

Aim: Prostate cancer (PCa) globally impacts men of African descent disproportionately more than any other ethnicity. Studies focusing on PCa among the U.S.-based Nigerian immigrant men (NIM) are limited. The purpose of this study was to investigate the predictive effects of health beliefs on NIM's prostate cancer screening intention using select constructs of two health behavior models. Subjects and methods: This study consisted of (N = 130) U.S. NIM, aged 40 years and older, who were recruited from local nonprofit associations in New Jersey. Pen-and-paper questionnaire data were gathered using the Behavioral Intention Scale and the modified version of the Champion's Health Belief Model Scale for Prostate Cancer, along with demographic questions. Data were analyzed in SPSS 25.0. Multiple regression analysis was conducted to evaluate how well perceived susceptibility, benefits, and barriers predicted the intention to undergo screening for prostate cancer. Results: The model was significantly related to intention (R2 = 0.22, F (4,125) = 9.02, p < 0.001). Beta weights indicated that only perceived susceptibility and perceived benefit shared in the 22% of intention variability. Perceived susceptibility (β = 0.61, p < 0.001) and perceived benefits (β = 0.41, p < 0.001) were thus the variables that significantly contributed to the model. Conclusion: Continuous education and awareness of prostate cancer and the importance of screening, as well as a better understanding of health belief perceptions, remain strategies healthcare providers can utilize to reach at-risk minority populations. [ABSTRACT FROM AUTHOR]

Background: In a global comparison, in 2006 Germany was the first in the world to switch naratriptan to an OTC medication but since then only almotriptan has been switched. Therefore, Germany has fallen behind recently because of the failure to carry out further switches. Objectives: The aim of this extensive evaluation of various surveys among pharmacies, physicians, patients and stakeholders was to investigate whether there is an obvious need for an Rx-to-OTC switch of further triptans. In addition, reasons for or against such a switch should be evaluated. Setting: The surveys were distributed in several ways. Most were based on online tools and were performed in 2017, 2018 and 2019. Methods: Several surveys have been initiated using different methodologies. The pharmacist surveys were only conducted digitally. The physician surveys were first digitally based on an online platform. A paper form could also be edited manually and returned by fax. The respective questionnaires consisted of 5 to 17 questions on the topic of switching and could all be answered in about 5 to 10 min. BAH Health Monitor hosted the patient surveys and included telephone interviews. The stakeholder survey was performed by personal interviews. The surveys on economic calculations among patients were conducted digitally. Main outcome measure: Sumatriptan and other Rx triptans are suitable and should be switched to OTC status. Results: Nine hundred forty pharmacists and pharmaceutical technical assistants took part in the initial pharmacist survey. In the subsequent pharmacist surveys, the volume of participants was even higher and reached almost 4000. For the physician survey, 540 answers were received, and the BAH Health Monitor addressed about 1000 telephone interviews. Within the stakeholder survey, 24 interviews were carried out with 32 participants from a range of professional backgrounds; most are part of the German switch process. Finally, the patient survey related to economic calculations was based on 175 answers. Seventy percent of the participating physicians < 50 years old supported a switch of further triptans. For the question about how safe OTC triptans are, 41% of the 3568 participants from the Marpinion pharmacy survey voted that they are safe. Conclusion: With a Rx-to-OTC switch of further triptans, patients would have an easier, faster and safe way to treat their migraine attacks. Impact of findings on practice statements: The outcome of these surveys and interviews provides information for all participants in the German switch process about their decision-making behaviour. Furthermore, it allows deeper insights into patients' needs and may help to fulfil them. The results can provide information about the German process and German needs worldwide and stimulate discussion about Rx-to-OTC switches. [ABSTRACT FROM AUTHOR]

Aims: Although ambient assisted living (AAL) environments and serious games for healthcare have been proposed as solutions to meet the changing demographics, the two approaches are rarely combined. We present the development and empirical evaluation of two serious games for healthcare in AAL. The first uses a cooking scenario for training of cognitive functioning. The latter uses a gardening scenario and motion capture for training agility and endurance. As the frequent lack of social acceptance is a major challenge in consumer health technology, we integrated methods of technology acceptance research by means of the UTAUT2-model and intention to use into the evaluation. Subject and methods: We developed both games utilizing user-centered and participatory design methods ranging from low-fidelity paper prototypes to usability and acceptance evaluations of functional prototypes. In the final evaluation, each game prototype was evaluated by 64 participants form different age groups. Results: The results show that although performance decreases with age, the performance attained in the games is not decisive for social acceptance measured as intention to use. However, user diversity factors shape the evaluation of the games, and older people and people with low technical competence are in danger of being excluded from using serious games for healthcare. Conclusion: Exercise games, if designed right, can mitigate the negative effects of demographic change. Nevertheless, user diversity needs must be considered to ensure that the games are usable and used by a broad audience. The article concludes with guidelines and open research questions for the design of serious games in AAL environments. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper was to investigate online health information seeking and health literacy among non-medical college students in Egypt and the differences between the two genders. Subjects and methods: A cross-sectional descriptive design was used to collect data from 600 students through a self-administered questionnaire. Results: Most of the students searched for health information on the internet (82.3%). 90.3% of them used their mobile phones and 97.8% sought data via Google. Skin and hair problems was the most searched for topic (83.3%), followed by reproductive health (79.7%). Students perceived that rapid and easy access to information were the main advantages of health information seeking online (98.5% and 95.5%, respectively), while the lack of reliability and scarcity of information in the Arabic language were the main disadvantages (78.2% and 60.5%, respectively). Only 31.2% of the sample achieved an adequate literacy level. Females in our sample had a higher frequency of online health information seeking and a higher level of health literacy. They also had a higher percentage of searching for health data on YouTube and seeking nutrition information. On the other hand, males used online health applications more frequently and were more interested in physical fitness and smoking. Females perceived the high cost as the main disadvantage of online health information seeking, while males were more concerned about the reliability of information. Health literacy was positively related to female gender and frequency of online health information seeking. Conclusion: Using the internet to deliver health information according to each gender's preferences and concerns can encourage students to search for health information online and, therefore, raise their health literacy level. [ABSTRACT FROM AUTHOR]

Aim: This paper aims to understand the dietary diversity in the selected tribal population, identify and document the available non-timber forest products (NTFPs) and locally available food resources (LAFRs) in the selected tribal area, review the functional and nutritional properties of the food resources, and promote them as functional foods in achieving food and nutrition security. Subjects and methods: The selected Irula tribes were located at the base of the Western Ghats region of Southern India. Background information was collected using a pre-tested questionnaire and a direct interview schedule. A dietary survey was carried out using the 24-h recall method and a food frequency questionnaire for individuals in the 18–65 year age group (n = 400) in consultation with senior women in the families. A scientific review process was adopted to identify the functional properties and nutritional values of the NTFPs and LAFRs. Results: The review process of the NTFPs and LAFRs revealed the presence of active compounds, including enzymes, pigments, and polyphenols, and anti-oxidant, anti-inflammatory, cardioprotective, immune-boosting, anti-cancer, anti-diabetic, gastroprotective, anti-anaemia, and anti-diarrheal functional properties. For the past few decades, a simultaneous reduction in tribal dietary diversity has been observed, with acute shortcomings in macro and micronutrients in the most vulnerable age groups. Conclusion: Efforts to document and promote the best utilization of NTFPs and LAFRs with functional food and nutritional value will help to achieve food and nutrition security in the selected population. Promotion of NTFPs and LAFRs through education and dietary interventions would be a possible solution. [ABSTRACT FROM AUTHOR]

Aim: Knowledge about nurses' error perception is crucial for establishing a sustainable risk management. This paper presents categories and frequencies of errors as identified by nurses. The cross-sectional study results provide further knowledge for professional and organizational development. Subject and methods: Data from 1,100 German nurses working in 30 hospitals and 46 nursing homes were collected using a self-administered questionnaire. This paper firstly presents results from a content analysis of nurses' descriptions of errors and, secondly, results on frequencies of predefined nursing errors (closed-ended, ordinal frequency estimation). Thirdly, it compares the answers of hospital nurses with those of nurses employed in nursing homes and finally it compares answers of participant groups defined by sex or migration background. Results: In the open-ended section, errors described by 60.5 % of the participants concerned medical diagnosis/therapy. 20.7 % had experienced errors in hands-on care, while errors in communication with patients were noted by 3.7 %. In contrast, when offering predefined activities in the questionnaire's closed-ended part, indicated frequencies of errors stressed issues of hands-on care and documentation. Significant differences exist between participants from both settings regarding direct care and relationship building. Sex and migration background were related to frequency estimations. Conclusions: Findings point to shortened professional perspectives in the debates on risk and safety. This might lower nurses' compliance in risk management systems. The influence of health professionals' sex and migration background on their error perception needs further exploration. Field specific approaches for error prevention are needed. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to investigate the level of physical activity of children and reveal a physical activity map in Northern Cyprus. Relevant factors, facilitators, and inhibitors for physical activity were also investigated. Methods: Sample size and pilot schools were determined for the cross-sectional population-based study. Region, school, class, age, and gender were recorded. The Physical Activity Questionnaire for Children (PAQ-C) was used as a self-report questionnaire. Time spent on screen-based activities and presence of a park were examined. Results: The data for 2283 (1131 = girls) children were used in the study. The mean PAQ-C score of all children was determined as 3.48 ± 0.71. Gender, age ,and region significantly changed the PAQ-C scores of the children (p < 0.05). The children who stated that their homes had neighbourhood park areas had higher PAQ-C levels than those who stated otherwise (p < 0.05). There was no significant difference between the levels of PA of the children who spent normal time and excess time for technological devices with screen (p > 0.05). Conclusion: Physical activity and related sociodemographic comparisons were indicated for the children living in Northern Cyprus. While park availability was found essential to support the physical activity levels as an opportunity, screen-based activities were not found to be have an effect on physical activity as a barrier. [ABSTRACT FROM AUTHOR]

Aim: Although several variables appear to be associated with reluctance of African Americans to participate in research, most research on this topic has utilized hypothetical study scenarios, and there is a need for empirical studies of factors that predict actual study participation. The purpose of the present paper was to assess five potential predictors of participation in an actual study of psychological stress and health. Subjects and methods: African American adults ( n = 236) completed the Barriers to Research Participation Questionnaire (BRPQ), which assesses attitudes toward research participation, and indicated whether they were willing to be contacted for involvement in a study of psychological stress and health. Results: Respondents who declined to be contacted for further involvement ( n = 191) scored significantly lower (less willingness/greater barriers) on the overall BRPQ, and on the health beliefs/fears, role overload/time demands, and perceived benefits subscales than respondents who were enrolled in the study ( n = 45). Conclusion: Investigators might enhance enrollment of African American adults by ameliorating health-related fears, increasing accessibility, or communicating benefits of the research. [ABSTRACT FROM AUTHOR]

Aim: Many employers offer worksite health promotion (WHP), but a high percentage of the workforce does not participate. As the employees' perspective regarding potential barriers to participation has received little attention in research so far, improvements in program design are delayed. The aims of the present paper therefore are to investigate perceived barriers to WHP participation from the employees' point of view, and to construct a barrier typology. Subject and methods: A quantitative questionnaire was developed on the basis of existing studies and distributed in four Austrian organisations offering comprehensive WHP programs. 237 respondents rated the appreciability of 22 potential barriers to WHP participation. Barrier categories and typologies were defined using principal component analysis (PCA), multiple correspondence analysis (MCA), and regression analysis. Results: The PCA identified six barrier types: (1) integration into the daily routine; lack of (2) information; an (3) imbalance of benefits and costs; the requirement of too much (4) involvement; (5) interpersonal barriers; and (6) incredibility of the company's honest commitment. According to the MCA, one group perceives barriers intensively, another hardly, and a third mainly program design related barriers. The regression analysis shows that especially being too busy at work and feeling physically not up to participating in WHP activities are major barriers. Conclusion: The results provide a comprehensive overview and categorization of barriers to WHP participation perceived by employees in companies offering holistic programs. Moreover, they can be used as guidelines for analysing existing and/or preventing barriers of occurring when designing and implementing WHP programs. [ABSTRACT FROM AUTHOR]

Aim: Nurses constitute an important group in identifying and preventing errors and risks in health care, but research on their perception of errors is scarce. This paper presents results of a representative study on health care errors, focusing on factors causing and influencing the occurrence of errors as perceived by nurses. Subject and methods: The cross-sectional research design comprised descriptive and correlational parts. The sample consisted of 1,100 nurses employed at 30 hospitals and 46 nursing homes in Germany. Data were collected in 2008/2009 using a questionnaire listing 21 factors that can potentially cause or influence errors. Participants could choose up to three factors they deem the most important. Differences between the two settings and variables which might have an influence on the perception of error-causing factors were analyzed using cluster-adjusted methods. Results: High workload, staff shortage and excessive labour topped the list. Hospital nurses more often chose 'workload' and 'interruptions' while nursing home nurses more often ranked 'lack of knowledge' and 'lack of motivation' as the most important. There are some significant variables such as years of professional experience and migration background that could affect nurses' perception. Conclusion: The findings support other studies, pointing to workload issues and below-optimum work processes producing errors. Inter-sectoral differences suggest the necessity of sector-specific support in education and on-going training as well as risk and quality management. [ABSTRACT FROM AUTHOR]

Aim: The paper aims to study whether (1) abusive husbands demonstrate higher sexually transmitted infection (STI) infection prevalence compared with non-abusive husbands and (2) women's risk is due to their exposure to IPV as the predictor of adverse reproductive health outcomes including use of contraceptives and treatment seeking pattern. Subject and methods: A multi-centric study with analytical cross-sectional design was applied, covering 18 states in India including 14,507 women respondents. Multi-stage sampling and probability proportion to size was done. Results: STI has a significant association with women who have survived physical and sexual assaults. Interpersonal violence increases the risk of STI, less use of contraceptives and low treatment-seeking behavior. The reason for not seeking treatment in women with STIs was found to be stigma, embarrassment and lack of knowledge. Conclusion: Inspite of the Domestic Violence Act in India, the public health system in India is not accessible to the women subjected to violence for the treatment required. Similar research results would enable the creation of an environment where violence would be acknowledged and referral networks between healthcare providers and legal/government organizations would provide further redressal where needed. [ABSTRACT FROM AUTHOR]

Aims: The aims of this paper are (1) to assess if perceptions of the food environment are associated with select dietary intake by neighborhood, and (2) to map neighborhood-specific findings, demonstrating a method for policy-relevant research. Methods: Using pre-collected data from a Philadelphia, PA community health survey, we aggregated individual-level data ( n = 4,434 respondents) to neighborhoods ( n = 381 census tracts), adjusting for conceptually-relevant socio-demographic factors. We estimated Spearman correlations between multivariable adjusted food-environment perceptions (perceived produce availability, supermarket accessibility, grocery quality) and select dietary intake (reported fruit-and-vegetable and fast-food consumption), and mapped variables by neighborhood using geographic information systems (GIS). Results: Difficulty finding fruits and vegetables, having to travel outside of one's neighborhood to get to a supermarket, and poor grocery quality were each directly correlated with fast-food intake (rho = 0.21, 0.34, 0.64 respectively; p values <0.001); and inversely correlated with fruit-and-vegetable intake (rho = -0.35, -0.54, -0.56 respectively; p values <0.001). Maps identified neighborhoods within the city with the worst food-environment perceptions and poorest dietary intakes. Conclusion: Negative perceptions of the food environment were strongly correlated with less-healthy eating in neighborhoods. Maps showed the geographic areas of greatest concern. Our findings demonstrate a method that might be used prospectively in public health for policy planning (e.g. to identify neighborhoods most in need), or retrospectively for policy assessment (e.g. to identify changes in neighborhoods after policy implementation). [ABSTRACT FROM AUTHOR]

Aim: Sometimes treatment is not necessarily according to guidelines, which is partly due to attitudes rather than lack of knowledge. In Germany, regional differences concerning prevalence rates of ADHD exist without valid explanation. We contribute with our data to the question of attitudes toward ADHD among pediatricians in Germany. Method: A specially designed questionnaire based on the Knowledge of Attention Deficit Disorders Scale and previous surveys was sent to pediatricians. In addition to descriptive statistics, we performed factor analysis and multiple linear regression analysis. Results: The vast majority (85.5%) of 581 respondents have a positive attitude toward ADHD, i.e., ADHD exists and should be treated appropriately. Physicians with positive attitudes were older and more often had a neuropediatric specialization. Conclusion: Most of the pediatricians surveyed in Germany assess ADHD and treatment in line with medical guidelines and treat as part of multimodal therapy. [ABSTRACT FROM AUTHOR]

Background: Active transport to school (ATS) is an effective health-promoting intervention to integrate physical activity into children's everyday lives. While previous studies have examined environmental and behavioural determinants on ATS in urban areas, evidence on rural areas is rare. Method: This study examined whether environmental and psychosocial characteristics are associated with ATS in two rural communities in Austria. Participants from four schools (two primary / two secondary schools) returned a self-reported questionnaire on individual and environmental determinants of ATS consisting of one section for parents and one for children, with 382 of the 467 total responses being included in the analysis. Results: Bivariate analyses showed a significant association of psychosocial characteristics of parents and children (intention, attitude, social norm, perceived behavioural control: p < 0.001), one environmental item (walking and cycling network: p ≤ 0.001) as well as distance and duration for walking to/from school between ATS. In a multiple regression model, the chances of participating in ATS were higher among children who have higher perceived behavioural control, walk between 5 to 10 minutes to school, and whose parents have a higher commitment to ATS. Conclusions: Future initiatives to enhance ATS in rural areas should focus on the control beliefs of parents and children, and should involve parents in order to increase parents' commitment to ATS. Additionally, measures should explore the effects of active transport promotion in the context of public transport and school buses. Above all, further opportunities for ATS should be considered in spatial and community planning. [ABSTRACT FROM AUTHOR]

Aim: Sedentary behavior is a severe and independent risk factor for health. According to current research, sitting time is at a dangerously high level. Especially young adults show a high prevalence compared to others. The study aimed to assess the effectiveness of a 6-week messenger-based intervention to reduce sedentary behavior in university students. Subject and methods: The 345 university students that enrolled were randomly assigned to the intervention group (n = 173) and control group (n = 172). Randomization and allocation to the trial group were computer assisted. The trial was conducted remotely, without any personal contact. A drop out of 276 participants led to a primary analysis of 71 (IG n = 41; CG n = 31) participants. Sedentary behavior was assessed online using the Heidelberg Questionnaire for the Assessment of Sitting Behavior, at 5 time points: baseline (T0), 2 weeks (Z1), 4 weeks (Z2) 6 weeks (end of the intervention, T1), and follow-up 4 weeks after intervention (T2). Results: Mixed ANOVA was carried out for T0 and T1 to reveal interaction effects between time and group. Mean differences show a highly practically and statistically relevant reduction in sitting time in the intervention group of 60 min between baseline and T1. No sustained effect of the intervention could be detected by analyzing sitting times at follow-up, 4 weeks after the end of the intervention. Conclusions: Reduction in sedentary behavior in the intervention group after 6 weeks shows that the intervention is practically and statistically relevant. Limitations concerning the assessment method (questionnaire) as well as the sample size should be considered. The trial serves as a pilot study. However, the positive outcome of sitting time reduction paves the way for further research in this field. [ABSTRACT FROM AUTHOR]

Aim: Even though students attending vocational school are very vulnerable to the development of mental health problems, few studies identify the correlation between suicidal ideations and vocational education. Therefore, this study aimed to identify the prevalence and associated risk factors for suicidal ideations among vocational students in Germany. Methods: We conducted a cross sectional survey with a total of 555 pupils. The pupils received a standardized questionnaire, assessing sociodemographic data, the use of protective factors, possible risk factors, traits for neuroticism and depressive symptoms. For our study, we excluded item 9 from the Beck depression index (BDI-II) to identify the prevalence of suicidal ideation. Results: Our results show that the prevalence of suicidal ideation among students attending vocational school is 23.2%. A combination of feeling lonely, male sex, low importance of religion, little time for hobbies and BMI scores outside the norm show the highest risk for suicidal ideation and can be identified as significant predictors. Conclusion: This cross-sectional study highlights the mental burden vocational students in Germany are confronted with and underlines the necessity of paying special attention to this group of young adults. Furthermore, it emphasizes the necessity of further studies on this topic, especially including larger student populations. The results should be used to decrease the significant loss of life caused by suicidal behavior in young adults. [ABSTRACT FROM AUTHOR]

Aim: The maintenance of physical activity (PA) over the life course is considered a hallmark for ageing well, but individuals who practice PA also often pursue lifestyles (e.g., smoking) that may inhibit the medicinal impact of PA on them. PA is said to protect against cardiovascular diseases (CVDs), but the literature has little to say about the impact of PA on the risk of CVDs when it is associated with lifestyle factors, comorbidities, and personal characteristics. This study aimed to assess the association between PA time and CVDs, with relevant lifestyle factors, comorbidities, and personal characteristics treated as covariates. Subject and methods: The study's population was retired and working older people aged 60 years or more in Accra, Ghana. A total of 686 individuals responded to self-reported questionnaires. Pearson's chi-square test and binary logistic regression were used to present findings. Results: The study found that the risk of having one or more CVDs increases as time spent in moderate and vigorous PA increases, whereas individuals who drank alcohol a few days a week or most days a week are respectively 2 (OR = 2.415; p = 0.037) and 22 (OR = 21.933; p = 0.000) times more likely to have one or more CVDs compared to those who never drank alcohol. Conclusion: Health education should not only encourage PA maintenance but should also make individuals aware of the need to avoid unhealthy behaviours to maximize the positive effect of PA on health. [ABSTRACT FROM AUTHOR]

Background and aim: Early action is important for promoting newly arrived migrants' health. Politicians are major actors in decision-making that affects health outcomes in the population. Therefore, the aim of this study was to explore local and regional politicians' considerations of newly arrived migrants' health in political decision-making: whether politicians reflect on or discuss the effects of decision-making specifically on newly arrived migrants' health, whether considerations differ between municipality and regional politicians, and how knowledge and attitudes are associated with such considerations. Subject and methods: A cross-sectional quantitative study was conducted. A total of 667 municipality and regional politicians from northern Sweden responded to a questionnaire developed based on interviews with politicians. Bivariate analyses were performed using χ2 tests, the independent samples t-test, and the Wilcoxon signed-rank test. Multivariate analysis was performed using binary logistic regression. Results: Politicians considered the effects on newly arrived migrants' health significantly less frequently than those on the total population's health. Regional politicians discussed such effects more often than municipality politicians. Knowledge (odds ratio [OR] = 1.343), attitude (OR = 5.962), previous experience working on public health issues (OR = 1.784), and female gender (OR = 1.787) were positively associated with considering effects on newly arrived migrants' health in decision-making. Conclusion: Politicians play important roles in health promotion, and most consider health-related effects in their decision-making. However, about a third do not consider such effects. General health-related knowledge and attitude are important factors that could be affected or changed during political assignments. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic brought quick, severe and unexpected changes to our everyday life and also changed the traditional education pattern of Semmelweis University in the middle of academic year 2019–2020. We explored adaptive changes in Hungarian students' behaviour and their time-budget in order to determine whether quarantine and/or fear of infection were responsible for these changes. Methods: A self-administered online questionnaire was distributed to all students in the Hungarian language program (N = 7436) of Semmelweis University. Information was collected on basic demographic data, knowledge and attitude about COVID-19, methods of prevention as well as the students' behaviour before, during and after the first wave of the pandemic. Statistical analyses were processed using the IBM-SPSS 25.0 software package. Results: The overall response rate was 11% (N = 816). Only complete responses were processed (55%, N = 447). Among these responders, 83% did not fear the pandemic. Those who greatly feared COVID-19 infection strictly kept all regulations. The number of non-smokers increased by the end of the first wave. The nutrition of 100 students (21%) became healthier and the lockdown reduced the level of physical activity. Conclusion: Social and health-related behaviour of medical students changed basically during the first wave of the pandemic and some changes remained after it in tobacco smoking, nutrition and sleeping habits. Time-budget of students changed significantly during the pandemic and did not return to the baseline values. Results of this study justify future multiple systematic research to analyse and better understand the short- and long-term effects of the current crisis. [ABSTRACT FROM AUTHOR]

Aim: Previous studies have suggested variable levels of associations between work–family conflict (W_F_C) and its antecedents in different populations. We aimed to assess the antecedents of this conflict and its two types; work-to-family (WFC) and family-to-work (FWC) among Egyptian civil workers. Subjects and methods: In a convenience sample of 3134 Egyptian civil workers, we assessed the W_F_C using the National Study of Midlife Development in the US and attributed it, by logistic and linear regression analyses, to several sociodemographic, work/family situational, behavioral, and health-related variables which were collected by a questionnaire survey between October 2019 and January 2020. Results: W_F_C was prevalent in 56% of the sample (51% for WFC and 62% for FWC). The work and family situational factors were the most significant antecedents of the W_F_C and its two types; partial R2 was 0.71. Both the health-related and behavioral clusters of antecedents were also predictors of W_F_C, while the sociodemographic antecedents contributed minimally to the FWC. The multivariable odds ratios (95% CIs) for high W_F_C in those with high vs low work demands, job control, social support at work, and family were 4.11 (2.89–7.03), 0.0 (0.66–0.90), 0.86 (0.62–0.98), and 0.74 (0.59–0.94), respectively. Conclusions: Work and family situational factors were the most significant antecedents of the levels of W_F_C in Egyptian civil workers. The Egyptian authorities could reduce the civil workers' W_F_C by improving the work environment, finding ways to relieve the workload demands, and helping the civil workers to have more job control and social support. [ABSTRACT FROM AUTHOR]

Aim: The study aimed to determine trends in the prevalence of underweight, overweight, obesity and their putative risk factors in different cohorts from a representative population of adolescents in Central Italy. Subject and methods: After random sampling, five cohorts of adolescents attending public high schools – aged 14 to 18 years – were evaluated from 2005 to 2018 (n: 25,174). Collected information included self-reported body mass index (BMI), descriptors of family environment, eating behaviour, physical activity, screen use, bullying victimisation, sexual behaviour (age at first intercourse, number of partners) and perceived psychological distress. For these data, between-cohort prevalence differences were used to esteem prevalence variations across time. In the 2018 cohort, the association between these factors and body weight was evaluated through multinomial regressions with sex-specific crude relative risk ratios for different BMI categories. Results: An increased prevalence of overweight was observed for both boys and girls. The study outlined a transition towards higher parental education and unemployment, reduced soft drinks consumption and higher psychological distress. Sex-specific changes were observed for physical and sexual activity, and a rising percentage of girls reported being bullied and distressing family relationships. Parental education and employment, together with physical activity, confirmed to be protective factors against pathological weight. The latter clustered with reduced soft drinks consumption, bullying victimisation, early sexual activity, worse family relationships and higher distress. Conclusion: An increased prevalence of both overweight and underweight was observed across time. Economic factors associated with unemployment and changes in behavioural patterns may have contributed to this trend. [ABSTRACT FROM AUTHOR]

Background: In 2019, a migrant camp on the Greek island of Samos designed for 650 people was home to a growing population of over 5500. We aimed to quantitatively describe living conditions and health needs in the camp. Methods: A questionnaire was designed with reference to international humanitarian standards, following a consultative process with the asylum-seeker population. Domains assessed included demographics, living conditions, safety/vulnerability, and health. The questionnaire was piloted and then conducted in June 2019 on a sample of asylum seekers. Results: Five hundred participants, predominantly from Afghanistan and the Democratic Republic of Congo (DRC). Of these, 79.4% lived in tents. Respondents cared for a total of 570 children; 20.6% of women were pregnant, 35.4% had experienced violence, 83% psychological distress, 71% skin disease, 66% diarrhoea and vomiting, and 64% respiratory disease. Accommodation, sanitation, and nutrition fell below internationally recognised standards, and poor access to water was significantly associated (p < 0.001) with respiratory disease, diarrhoea and vomiting, skin disease ,and psychological distress. Conclusions: Living conditions in the Samos camp fall below basic humanitarian standards and are associated with poor health status. Further research is imperative to analyse and monitor the diverse, varying needs of asylum-seekers and inform policies to improve conditions. [ABSTRACT FROM AUTHOR]

Background: According to recent polling, public trust in the healthcare sector remains low relative to other industries globally. The implications of low healthcare trust permeate throughout the industry in a number of ways, most visibly by discouraging therapy compliance. Methods: This study investigated four putative determinants of trust in healthcare-related scenarios: individuals vs. collective groups as communicators of healthcare advice; expert vs. laypeople as providers of healthcare communication; public vs. private healthcare sector; and positive vs. negative information. Two hundred seventy-four participants were recruited via Prolific Academic and were presented with four statements in random order, related to a positive reflection of the public healthcare sector, a negative reflection of the public healthcare sector, a positive reflection of the private healthcare sector and a negative reflection of the private healthcare sector. According to these reflection, participants were repeatedly asked to rate the system on its trustworthiness. Trust outcomes were constructed using a four-dimension framework, consisting of benevolence, reliability, competence and predictability. Results: Claims relating to the public sector had a significantly stronger impact on benevolence and reliability than claims relating to the private sector; claims from individuals had a significantly stronger impact on all trust variables than claims from collectives; and claims from laypeople had a significantly greater impact on reliability and competence ratings than claims from experts. Conclusions: The findings in this study offer insight into the patterns with which trust decisions are made in healthcare contexts. More importantly, this research offers a novel perspective of how different factors interact to affect the various facets of trust. These results provide a foundation for future study in this evolving area, and offer insights into designing effective communication strategies that cultivate greater levels of individual trust in the healthcare sector. [ABSTRACT FROM AUTHOR]

Aim: We aimed to investigate the association of the working environment noise with the psychosocial status and occupational stress level of the workers of an industrial company. Subject and methods: In this cross-sectional study, we enrolled all the employees at an industrial company. The Copenhagen Psychosocial Questionnaire was used to measure the workplace psychosocial factors and stress levels of the participants. Based on the sound level measurements, the company sections were divided into two areas: the areas with noise ≥85 dB (dB) A and the areas with noise <85 dB A. Then the participants were categorized into two groups based on the working area and the study variables were compared between the two groups. Results: We enrolled 401 workers from an industrial company. For 154 (38.4%) workers, the level of noise was equal to or above 85 dB A. According to the results of the Copenhagen Psychosocial Questionnaire, scores of the two groups were significantly different for scales related to cognitive, emotional, and sensory demands, possibilities for development, and predictability as well as workplace demand domain, which showed noise exposure level was significantly associated with perceived workplace demands (P = 0.002). Conclusion: This study showed a slight association between the psychosocial status and the level of noise in the workplace environment. [ABSTRACT FROM AUTHOR]

Aim: The study aim was to further clarify the relationship between psychological factors and myocardial infarction (MI) by simultaneously examining anger, depression, and anxiety as risk factors for incident MI in a healthy working sample. Subject and method: Baseline measurements of psychological variables were assessed through a self-reported questionnaire in a healthy cohort of 968 middle-aged men working at the Volvo Corporation. Single-item questions assessed depression and anxiety. Anger was assessed by the Trait Anger subscale of the Spielberger State-Trait Anger Expression Inventory. The endpoint was incident MI verified by national registers or medical records with follow up after 22 years. The main outcome was computed through logistic regression, reported as odds ratios. Additional correlation analyses were performed between psychological variables and coronary risk factors. Results: None of the psychological variables was significantly associated with the outcome; thus, the results failed to show an association between anger, depression, or anxiety and incident MI in this sample. There were some significant, but weak, correlations between psychological factors and negative health behaviors. Other components of traditional risk scoring instruments did not correlate with the psychological factors. Conclusion: A cohort restricted to middle-age healthy men limits applicability. However, our failure to replicate earlier results of population samples suggests a need for further research on associations between psychological factors and MI in healthy samples. [ABSTRACT FROM AUTHOR]

Aims: The first aim was to determine if four lifestyle behaviors (i.e., vegetable/fruit intake, physical activity, tobacco use, and alcohol use) predicted depressive symptoms among permanent supportive housing (PSH) residents. The second aim was to determine if the effect of lifestyle factors on depressive symptoms depended on the participants' level of social support. Subject and methods: Participants were 420 adults enrolled in a technology-assisted health coaching program for PSH residents with symptoms of a mental health condition. A longitudinal analysis was conducted utilizing the screening/baseline, six-month, and twelve-month visit timepoints. The four lifestyle behaviors were included as predictors, and depressive symptoms (Patient Health Questionnaire [PHQ-9] scores) was the outcome variable. Potential confounding variables included social support and satisfaction with leisure activities. Additional covariates included age, sex, race, and visit timepoint. Social support was also evaluated as a potential effect modifier. Results: In the adjusted analysis, moderate alcohol consumption predicted lower depressive symptoms compared with heavy alcohol consumption (b = −1.54, p =.01). However, the difference in depressive symptoms between non-consumption and heavy consumption of alcohol was not statistically significant (b = −0.76, p =.07). Vegetable and fruit intake, physical activity, and tobacco use were not statistically significant predictors of depressive symptoms. Social support was not a statistically significant effect modifier. Conclusion: Moderate alcohol consumption may reduce the risk of having depressive symptoms among PSH residents. Interventions among PSH residents should consider approaches to reduce heavy alcohol consumption to moderate alcohol consumption to lower depressive symptoms in this population. [ABSTRACT FROM AUTHOR]

Objective: To determine whether sense of coherence acts as a mediator between perceived stress and depression in newly diagnosed breast cancer patients. Methods: A single face-to-face interview was administered to characterize sociodemographic, clinical, and psychological characteristics; perceived stress scale (PSS), sense of coherence scale (SOC) and Hamilton depression scale (HAMD). Part of the characterize sociodemographic information was extracted from the women's medical charts. The interview was with 1100 patients newly diagnosed with breast cancer from breast wards in Zhengzhou, Henan Province, China; 1046 respondents completed this survey from May 2018 to March 2019. A data analysis was conducted based on correlation analysis, multiple linear regression, and structural equation model. Results: The total score of the sense of coherence was negatively correlated with perceived stress (r = −0.595, p < 0.01) and depression (r = −0.821, p < 0.01), and the total scores of perceived stress and depression were positively correlated (r = 0.755, p < 0.01). As indicated from the structural equation model, sense of coherence had a partial mediation effect between perceived stress and depression, with the mediator effect of 0.566, taking up 63.1% of the total effect. Conclusions: Sense of coherence acted as a mediator between perceived stress and depression in newly diagnosed breast cancer patients, demonstrating that medical staff should actively assess patients' sense of coherence level to provide personalized interventions for patients. [ABSTRACT FROM AUTHOR]

Background: Very little is known about the association of back pain with subjective health and well-being and sleep problems among the older population in middle-income countries. In this study, we examine the association of back pain with four health outcomes — poor self-rated health, impairments in activities of daily living (1+ADL), sleep problems and World Health Organization Quality of Life score (WHOQOL) — and to study what extent the association differs by age group. Methods: Nationally representative data from World Health Organization's Study on global AGEing and adult health (WHO-SAGE) consisting of 33,878 older adults aged 50 or above were analyzed. The linkages of back pain with poor self-rated health, impairments in activities of daily living (1+ADL), and sleep problems were examined using multivariate logistic regression analysis. Multivariate linear regression was used to assess the association between back pain and quality of life. Results: In the pooled analysis, the association of back pain with four health outcomes were significant. Older adults who reported low back pain were more likely to report poor self-rated health (OR=1.91; p <.001), impairments in activities of dailiy living (ADL) (OR=2.06; p <.001), and sleep problems (OR=2.04; p <.001), and had lower quality of life score (β = −3.23, p <.001). Furthermore, the association of back pain and poor self-rated health, impairments in ADL, and sleep problems was stronger for the 50–59 age group than the 80 or above age group, suggesting significant age interaction in the association. Conclusion: This study suggested the significant role of back pain in determining subjective health, wellbeing, and sleep problems. Measures to prevent back pain, particularly among those in the 50–59 age group, are important to enhance overall wellbeing of the growing older population in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Aim: This study estimated the prevalence of undetected, untreated and uncontrolled hypertension in Brunei Darussalam and the associations with socio-demographic and non-communicable diseases (NCDs) risk factors. Subjects and methods: Participants were aged 18–69 years old from the national NCDs and risk factors survey in Brunei Darussalam, conducted from August 2015 to April 2016. Multiple logistic regression was applied to estimate the associations of undetected, untreated and uncontrolled hypertension with socio-demographic and NCDs risk factors. Results: The crude prevalence of hypertension was estimated to be 40.4% [95% confidence interval (CI) = 37.2–43.6] in men and 32.3% (95% CI = 29.6–35.0) in women. Multivariable adjustment using logistic regression found that those who were currently married [odds ratio (OR) = 0.34, p < 0.001], have family history of hypertension (OR = 0.43, p < 0.001), reported buying food with low salt content (OR = 0.67, p = 0.039) and diabetic (OR = 0.28, p < 0.001) were found to be significantly less likely to have undetected hypertension. Amongst those who were previously diagnosed with hypertension, younger age groups, tobacco use and having no other NCDs diagnosis were found to have significantly higher odds of having untreated hypertension. Amongst those who were on antihypertensive treatment, having body mass index (BMI) 30 kg/m2 and above was significantly associated with lower odds of uncontrolled hypertension. Conclusion: More than one-third (35.8%) of the adult population in Brunei Darussalam were found to have hypertension. Among them, over one-quarter (28.6%) of hypertension cases were not previously detected. Amongst those previously diagnosed with hypertension, more than one-third (35.1%) were not treated or on antihypertensive medication. Screening for hypertension should be emphasised in public health education and media campaigns so that hypertension can be detected and treated earlier. [ABSTRACT FROM AUTHOR]

Objectives: COVID-19 incidence became a pandemic immediately after its origin and spread. Apart from death because of coronavirus infection, the pandemic brought unbearable psychological pressure to all. We assessed the psychological pressure on college and university students in India through cluster sampling. Methods: The students responded (n = 209) to an online questionnaire following the Generalized Anxiety Disorder Scale (GAD-7) and Hamilton Anxiety Rating Scale (HAM-A) with some other basic information. Results: According to GAD-7 scoring, we found the respondent students had severe anxiety (1.44%), moderately severe anxiety (14.35%), moderate anxiety (36.36%) and mild anxiety (47.85%). Following HAM-A scoring, anxiety level among the students could be scaled as severe (0.96%), high (4.31%), moderate (13.40%) and mild anxiety (34.93%) level. Age of the students was a confounding factor (p = 0.049, HAM-A) of experiencing anxiety, students <20 years of age were more anxious. We found female students to be more anxious than the males following the HAM-A scoring tool. Academic delays (R2 = 0.996, p = 0.036) and impact on daily life (R2 = 0.996, p = 0.117) were positively associated with anxiety symptoms, while social support was marginally correlated (R2 = 0.726, p = 0.069) with the anxiety level. Conclusions: As the study found almost all the students are experiencing anxiety because of the current pandemic situation, continuous observation of psychological health for all is recommended as well as establishing psychological intervention during the preparedness phase. [ABSTRACT FROM AUTHOR]

Aim: Neighborhood walking environment is an environmental issue affecting human health-related behaviors in China and worldwide. High school is a special period in China, during which students need to prepare for the college entrance examination and are physically inactive. Therefore, the influence of environment on high school students' physical activities is particularly prominent. The purpose of this study was to examine the relationship between neighborhood environment walkability and physical activity in Chinese youth. Subject and methods: We conducted a retrospective questionnaire study on 3424 freshmen from Tsinghua University in Beijing, China. The mean age at the moment of completing the questionnaire was 18.74 years (SD = 0.95) and the mean body mass index (BMI) was 21.37 kg/m2 (SD = 2.86). Participants were asked to look back on their usual weekly physical activity and perceived neighborhood environment during high school. Neighborhood environment was measured using the Neighbourhood Environment Walkability Scale for Youth (NEWS-Y). Physical activity data by the Global Physical Activity Questionnaire (GPAQ) were collected. The data were analyzed using multiple linear regression. Results: The mean scale total score of NEWS-Y was 14.66 (SD = 1.30). Participants on average engaged in 754.46 (SD = 844.69), 479.79 (SD = 687.24), 920.47 (SD = 994.92), and 2172.72 (SD = 1736.21) MET-minutes/week of travel physical activity (travel PA), moderate physical activity (MPA), vigorous physical activity (VPA), and total physical activity (total PA), respectively. A one scale score increases in neighborhood walkable environmental was associated with an increase in travel PA and MPA by 42.64 (P < 0.001) and 31.11 (P < 0.01) MET-minutes/week, respectively. Conclusion: A possibly positive correlation between neighborhood environment walkability and physical activity was found. Future studies are warranted to replicate this study's findings, as well as provide evidence for potential policies to make neighborhood environment conducive to physical activity. [ABSTRACT FROM AUTHOR]

Aims: Vaccine hesitancy is widely recognised as one of the most serious threats to current global health. While the causes underlying vaccine hesitancy have been extensively described and several mitigation strategies trialled amongst current and prospective parents, there is a relative scarcity of research investigating its extent and causative factors amongst university students, a critical demographic due to its temporal proximity to the average child-rearing age. The present study sought to address this literature gap by elucidating the social and demographic factors that might underpin vaccine hesitancy in university students. Subject and methods: An anonymous online survey was carried out to investigate the opinions and perspectives on the practice of vaccination within undergraduate students' social sphere. The statistical significance of the differences observed between groups of participants was analysed using non-parametric tests of variance. Results: Amongst the 739 volunteers who participated in the survey, vaccine confidence varied significantly (p < 0.001) with age, ethnicity and religion, and to a lesser (yet still statistically significant) extent (p < 0.05) with graduate status. No statistically significant differences were observed with regard to gender or number of children. Conclusions: By shedding new light on the factors underpinning vaccine hesitancy within undergraduate students' social network, the present study provides a stepping stone towards the development of targeted mitigation strategies. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this empirical study was to understand, explore and analyse how the COVID-19 pandemic has affected the mothers of our society, with particular emphasis on Bangladesh, which has so far been a relatively unexplored area. Subject and methods: The study adopted qualitative and interpretative methods of social research, including content analysis and a perception study of 223 respondents through a semi-structured questionnaire survey, who were selected using purposive random sampling. The data obtained from the perception study was further complemented through phone interviews. Results: The study found that the pandemic has not affected all mothers uniformly; rather, the intensity of its impact varied depending on factors such as the occupation of mothers and their husbands and their family pattern. Despite such variation, all mothers experienced a subsequent increase in workload, challenges while availing routine health facilities and higher levels of stress, anxiety, depression and certain behavioural changes. Conclusion: However, the worst affected have been the mothers belonging to the lower socio-economic strata because the pandemic has made them and their husbands jobless, leading them towards an uncertain future. [ABSTRACT FROM AUTHOR]

Background: The increasing intake of dietary supplements (DS) can be observed worldwide. These preparations are classified as a special category of foods and are subject to food law, not pharmaceutical regulations. As a result, the requirements for DS are much less restrictive than for medications. Methodology: This research was conducted in a group of young Polish students of pharmacy at the Medical University of Silesia in Katowice (SUM) and of finance and accounting at the University of Economics in Katowice (UE). The survey contained questions concerning DS, such as difference to drugs, scope of use, and safety. Results: The respondents answered questions about taking DS and the effects of their use. DS were used either currently or in the past by about 70% of the respondents, while about 30% of the surveyed population declared that they did not use these preparations. Women and UE students predominated among those not taking DS. Conclusion: Multi-component products taken for a period of less than 3 months to supplement a deficit for a given component were used the most often. One product was taken at a time. The respondents read product information and followed the recommended doses. Over 50% of the studied population was aware of the negative effects of DS. Adverse symptoms of DS use were observed by 5% of the respondents. [ABSTRACT FROM AUTHOR]

Aim: Norway's health scheme provides no-cost HIV pre-exposure prophylaxis (PrEP) when prescribed by a specialist, typically preceded by a general practitioner's (GP) referral. The GP perspective with regard to PrEP implementation in Norway has yet to be captured. Subject and methods: We explored PrEP knowledge, attitudes, and clinical experience of GPs in the Norwegian capital of Oslo, where HIV incidence and PrEP demand are highest. An anonymous survey was designed and distributed between November 2019 and February 2020. Univariate and multivariate logistic regression analyses were performed to identify determinants of GPs' previous clinical PrEP experience (PrEP adoption). Results: One hundred and seventeen GPs responded to the survey. GP PrEP adopters were more likely to: identify as men (aOR 2.1; 95% CI: 1.0–4.5); identify as lesbian, gay, or bisexual (LGB) (aOR 4.4; 95% CI: 1.4–14.5); have ≥ 10 LGB identifying patients on their list (aOR 4.4; 95% CI:1.8–10.4); and self-report higher levels of PrEP knowledge (aOR 2.4; 95% CI: 1.3–4.4). Conclusion: Our findings suggest that GP PrEP knowledge is crucial to patient PrEP access. Educational interventions ought to be considered to enhance GP PrEP adoption capacities, such as easy-to-access PrEP guidelines and peer-based training opportunities in both online and in-person formats. [ABSTRACT FROM AUTHOR]

Background: Many states, local authorities, organizations, and individuals have taken action to reduce the spread of COVID-19, particularly focused on restricting social interactions. Such actions have raised controversy regarding their implications for the spread of COVID-19 versus mental health. Methods: We examined correlates of: (1) COVID symptoms and test results (i.e., no symptoms/tested negative, symptoms but not tested, tested positive), and (2) mental health symptoms (depressive/anxiety symptoms, COVID-related stress). Data were drawn from Fall 2020 surveys of young adults (n = 2576; Mage = 24.67; 55.8% female; 31.0% sexual minority; 5.4% Black; 12.7% Asian; 11.1% Hispanic) in six metropolitan statistical areas (MSAs) with distinct COVID-related state orders. Correlates of interest included MSA, social distancing behaviors, employment status/nature, household composition, and political orientation. Results: Overall, 3.0% tested positive for COVID-19; 7.0% had symptoms but no test; 29.1% reported at least moderate depressive/anxiety symptoms on the PHQ-4 Questionnaire. Correlates of testing positive (vs. having no symptoms) included residing in Oklahoma City vs. Boston, San Diego, or Seattle and less social distancing adherence; there were few differences between those without symptoms/negative test and those with symptoms but not tested. Correlates of greater depressive/anxiety symptoms included greater social distancing adherence, being unemployed/laid off (vs. working outside of the home), living with others (other than partners/children), and being Democrat but not Republican (vs. no lean); findings related to COVID-specific stress were similar. Conclusion: Despite curbing the pandemic, social distancing and individual (e.g., political) and environmental factors that restrict social interaction have negative implications for mental health. [ABSTRACT FROM AUTHOR]

Aim: The prevalence of cesarean section (CS) delivery has been increasing dramatically in both developed and developing countries. South Asian countries, including Bangladesh, have recorded substantial increases in CS over the past decade. The objective of this study was to assess the prevalence and associated factors of cesarean delivery in Bangladesh. Subject and methods: Nationally representative cross-sectional secondary data was extracted from the Multiple Indicator Cluster Survey (MICS) 2019, Bangladesh. CS was measured in two categories with cesarean and non-cesarean responses obtained by interviewing the women aged 15–49 years with a live birth in the past 2 years. Chi-square test was used to examine the significant association of mode of delivery (cesarean or non-cesarean delivery). Binary logistic regression was used to assess the factors of CS. Analysis was carried out using STATA version 16. Results: The study showed that among 9208 respondents, 36.1% of women underwent CS. The multivariate analysis indicated that mothers who were over 30 years old [OR 1.02; (95% CI 0.85, 1.21)], had higher education [OR 3.80; (95% CI 2.92, 4.94)], had rich wealth indexes [OR 2.41; (95% CI 2.12, 2.75)], gave birth in private health facility [OR = 8.77; (95% CI 7.6, 10.2)], took antenatal care (ANC) more than three times [OR 4.84, (95% CI 4.02,5.83)], and also gave birth to a larger than average sized baby [OR 1.45; (95% CI 1.22, 1.73)] were significantly associated with CS delivery. Conclusion: Bangladesh's health system urgently needs policy guidelines to monitor clinical indications of CS delivery and prevent an exessive number of CS in private health facilities, which is an essential step to reduce the high prevalence of CS. [ABSTRACT FROM AUTHOR]

Aim: Work-related injuries and diseases are usually severe among informal sector workers (ISW) because they work under poor working conditions. However, there are scant studies on the role of demographic and socio-economic factors in predicting occupational injuries and diseases among ISW in Ghana. Subject and methods: The purpose of the study was to determine the demographic and socio-economic factors associated with exposure to occupational injuries and diseases among ISW in the Kumasi metropolis of Ghana. A cross-sectional survey design involving 350 ISW was employed for the study. Findings: The study revealed that 38.9% and 60.6% of the respondents were exposed to occupational injuries and diseases respectively in 2016. Females (AOR: 1.144; CI: 0.410–3.193; p = 0.007), those aged 50 years or above (AOR: 1.616; CI: 1.051–7.484; p = 0.014), and those who were not using personal protective devices (PPEs) (AOR: 1.062; CI: 0.604–1.867; p = 0.036) were significantly more likely to be exposed to occupational injuries. Further, females (AOR: 1.504; CI: 0.532–4.253; p = 0.041), those aged 50 years or over (AOR: 1.062, CI: 0.089–12.735; p = 0.032) and those who were not using PPE (AOR: 1.742, CI: 0.817–2.320; p = 0.10) have higher odds of being exposed to occupational diseases. Participants with more than 10 years of work experience were less likely to suffer from occupational diseases (AOR: 0.284, CI: 0.096–0.835, p = 0.022). Conclusion: This study suggests the need to consider demographic and socio-economic factors in the formulation and implementation of occupational health and safety policies that aim to lessen exposure to occupational injuries and diseases among ISW in Ghana. [ABSTRACT FROM AUTHOR]

Aim: The links between poor complementary feeding and child malnutrition in South Asia argue for greater attention to improving young children's diets. This study examined the status of policy and programme actions to support complementary feeding across four systems in South Asia: food, health, social protection, and water, sanitation, and hygiene (WASH). Methods: We conducted a review to assess the status of national policy and programme actions to improve complementary feeding in children aged 6–23 months in eight South Asian countries across four systems, including the comprehensiveness of the enabling environment and the geographic scale of programmes. Results: All countries have policy and programme commitments to improving complementary feeding; however, no country has a comprehensive set of legislation, policies, strategies, and plans that fully incorporate relevant global recommendations and guidance. The health system has the strongest enabling environment for complementary feeding, but the lack of supportive legislation, policies, strategies, and plans in other systems may hinder multisystem action. There are few examples of nationwide programmes to improve complementary feeding beyond the health system. Conclusion: Governments should mobilize their institutions and resources to enable a coherent and multisystem response to complementary feeding that addresses the gaps in legislation, policies, and programmes and the barriers and bottlenecks to implementation at scale, with a focus on the food, health, social protection, and WASH systems. Further operational research is needed on the factors and processes that enable multisystem action to secure nutritious, safe, affordable, and sustainable diets for young children in South Asia. [ABSTRACT FROM AUTHOR]

Purpose: How old are young people when they start having sex? Although this question is important for educators and policymakers, its answer can easily mislead due to methodology that does not take into account age-censoring and generational trends. This study investigated whether 1-year birth-year cohorts can be jointly modeled by Cox proportional hazards regression to estimate sexual debut ages and to investigate age trends for different sexual behaviors. Method: We used pooled data from three Dutch periodic population-based surveys, for which 33,377 participants, born between 1980 and 2004, completed an online questionnaire. Results: Cox proportional hazards regression is appropriate if hazard changes over birth years appear proportionally similar among ages. The Dutch data shows such hazard changes for petting, oral sex, and sexual intercourse, but not for masturbation, French kissing, or manual sex. For sexual intercourse, the Cox model estimates can be interpreted as an approximate linear increase of 1 month in the median sexual debut age per birth-year cohort, resulting in an estimated debut age of 18.17 years in the current (2020) generation of Dutch adolescents. Conclusion: If the assumptions are met, we recommend using the Cox regression modeling approach to estimate how old young people are when they start having sex, since this method yields precise and current debut ages by pooling information across birth-year cohorts without arbitrarily combining them in multiple-year groups. The age of first intercourse is increasing, so continuous sexuality education throughout high school is advisable, in addition to early sexuality education. [ABSTRACT FROM AUTHOR]

Aim: To investigate the association between smoking, environmental tobacco smoke (ETS), and lung cancer risk. Methods: This case–control study included 1622 newly diagnosed cases of lung cancer and 1622 healthy frequency-, age-, and gender-matched control participants. Epidemiological data were collected by in-person interviews using a standard questionnaire. Results: Smoking was a risk factor for lung cancer in men (odds ratio (OR) = 4.486, 95% confidence interval (95%CI) 3.586–5.611). In addition, decreased starting age, increased number of cigarettes smoked per day, duration of smoking, pack–years, and depth of inhalation were all risk factors that met the dose–response relationship (P < 0.001). The risk of lung cancer was lower among men who had quit smoking for more than 10 years compared to current smokers. Additionally, male smokers with lung squamous cell carcinoma were at a higher risk of lung cancer than male smokers with lung adenocarcinoma. Workplace ETS increased the risk for lung cancer for male nonsmokers (OR = 2.452, 95%CI 1.534–3.920). In contrast, household ETS increased the risk for lung cancer for female nonsmokers (OR = 2.224, 95%CI 1.644–3.009). Approximately 65.93% cases of lung cancer in men could be attributed to smoking, whereas approximately 31.03% cases of lung cancer among nonsmokers could be attributed to ETS. Conclusions: Smoking is the main risk factor for lung cancer. Workplace ETS is associated with increased lung cancer risk in male nonsmokers, while household ETS is associated with increased lung cancer risk in nonsmoking women. Thus, smoking and ETS increase the risk of lung cancer and are major public health concerns. [ABSTRACT FROM AUTHOR]

Aim: In 1993, a study of 1000 automotive workers in Sweden and France looked into national differences of cardiovascular disease. Here, we evaluate the proportion of the Swedish cohort that suffered a stroke or died over a 25-year period and associated risk factors. Subject and methods: Data from 1993 included a life-style questionnaire, a health examination and laboratory data. Figures on stroke and survival status up until the end of 2018 were collected from national registers. Survival analysis was used for both univariable and multivariable analyses to study associations between potential risk factors and stroke and death, respectively. Results: By the end of 2018, 65 individuals had suffered a stroke and 160 had died. In the univariable analysis, we found age, systolic blood pressure, Framingham risk index and diabetes at baseline to be significantly associated with stroke during follow-up. For death, most of the traditional risk factors were significantly associated with the outcome, as was blue-collar work and living alone. In the multivariable analysis, age and diabetes at baseline remained significantly associated with stroke, whereas eight factors (age, blue-collar work, living alone, systolic blood pressure, waist–hip ratio, smoking habits, diabetes and hypertension at baseline) were significantly associated with death during follow-up. Conclusion: Few of the traditional risk factors were significantly associated with stroke possibly explained by low power and/or different pathogenetic mechanism than for myocardial infarction. Partly because death occurred more often, we did find a number of potential risk factors to be significantly associated with this outcome. [ABSTRACT FROM AUTHOR]

Aim: The COVID-19 pandemic drove the Government of Bangladesh to shut down educational institutions, which had an enormous effect on the psychological health of students. This study aimed to assess the mental health status of Bangladeshi university students during the lockdown period. Subject and methods: Through an online-based questionnaire, information was collected from 509 university students of Bangladesh from June 19, 2020, to June 28, 2020, using convenient sampling. K-means clustering was applied to organize students according to their psychological health score, and confirmatory factor analysis (CFA) was also conducted to determine the association among the student's activities and their mental health during the pandemic. In addition, these associations were examined through chi-square test and ordinal logistic regression. Results: Students were categorized into four categories where 4.32% had mild, 72.7% had moderate, 12.57% had moderately severe, and 10.41% suffered from severe mental health imbalance. The results showed that having family members affected by the coronavirus, facing insecurity, using social media, and smoking habits increased the mental health imbalances of students; in contrast, being worried about studying, future career, spending more time with family members, and participation in household chores reduced the mental health disturbances of students. On the other hand, the results of the ordinal logistic regression indicated that sleeping time and participation in household chores were preventive factors for students. Conclusion: This study reveals that a large proportion of University students of Bangladesh suffered from mental health disturbances during the lockdown period. Implementing mental health plans and providing job security, improved communication approaches toward family members, not flattening illusive news, and preoccupation in household activities may assist to enhance the mental health status of the university students. The authors believe that this study's findings will be helpful to expedite the rate of attaining the sustainable development goal associated with health status in Bangladesh. [ABSTRACT FROM AUTHOR]