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Microorganisms are ubiquitous in nature and are central to human, animal, environmental, and planetary health. They play a particularly important role in the food chain and the production of high-quality, safe, and health-promoting foods, especially fermented foods. This important role is not always apparent to members of the public. Here, we describe Kefir4All, a citizen science project designed to provide the general public with an opportunity to expand their awareness, knowledge, and practical skills relating to microbiology, introduced through the medium of producing fermented food, i.e., milk kefir or water kefir. During the course of Kefir4All, 123 citizen scientists, from second-level school and non-school settings, participated in a study to track changes in the microbial composition of kefirs, by performing and recording details of milk kefir or water kefir fermentations they performed in their homes or schools over the21-week project. At the start of the study, the citizen scientists were provided with milk or water kefir grains to initiate the fermentations. Both types of kefir grain are semi-solid, gelatinous-like substances, composed of exopolysaccharides and proteins, containing a symbiotic community of bacteria and yeast. The experimental component of the project was complemented by a number of education and outreach events, including career talks and a site visit to our research center (Kefir Day). At the end of the study, a report was provided to each citizen scientist, in which individualized results of their fermenting activities were detailed. A number of approaches were taken to obtain feedback and other insights from the citizen scientists. Evaluations took place before and after theKefir4All project to gauge the citizen scientist's self-reported awareness, knowledge, and interest in microbiology and fermented foods. Further insights into the level of citizen science participation were gained through assessing the number of samples returned for analysis and the level of participation of the citizen scientists throughout the project. Notably, the survey results revealed a self-reported, increased interest in, and general knowledge of, science among the Kefir4All citizen scientists after undertaking the project and a willingness to take part in further citizen science projects. Ultimately, Kefir4Allrepresents an example of the successful integration of citizen science into existing education and research systems.

The importance of enhancing social and emotional skills in educational settings has gained prominence, with many countries and organizations embracing the Social and Emotional Learning (SEL) framework to equip individuals with the tools needed for shaping a self-identity, emotional regulation, goal achievement, empathy, nurturing relationships, and responsible decision-making and overall well-being. In this paper, we aim to connect the globally acknowledged Collaborative for Academic, Social, and Emotional Learning SEL framework with international policies that underscore the importance of social and emotional skills in the school context. To accomplish this goal, we first provide a brief overview of the key components of the SEL framework. Subsequently, we explore two significant educational policies within the European context. The first policy is the World Health Organization Health Promoting Schools initiative. We present its objectives, a WHO-affiliated program example, the promoted and assessed competencies of students, and its results, connecting its framework with the CASEL SEL approach. The second focus is the Organisation for Economic Co-operation and Development Study on Social and Emotional Skills, describing its developmental process and the assessment framework. Finally, we describe the alignment of SEL with these European educational policies and illustrate their role in advancing and improving the evaluation of SEL initiatives in educational environments.

Teachers are at high risk of voice disorders due to the heavy vocal demand of their profession as well as diverse classroom conditions that can stress the voice. Healthy vocal hygiene practices reduce this risk, but many teachers lack knowledge in these areas or have misconceptions about ways to improve their vocal health. This study aimed to identify knowledge deficits among teachers, and directly address topics with poorest performance to better generate vocal health resources for teachers and improve their overall vocal health.

Each August, Sugpiaq Elders, community members, and educators gather in Cape Alitak to host Akhiok Kids Camp, a week-long culture camp that provides a space for local Sugpiaq youth to learn and carry forward traditional lifeways and promotes youth's self-esteem, identity, and healthy choices. This article traces the legacy of the camp and outlines its ongoing vision and curriculum, including the Indigenous values and principles of education that guide camp activities. Of particular focus is the role of camp in fostering Sugpiaq youth's sense of connectedness to their homelands, waters, community, and culture, a focus that promotes healing, cultural resurgence, and wellbeing for Sugpiaq youth. This description of Akhiok Kids Camp highlights the valuable role that culture camps play in turning Indigenous youth toward the brilliance of their lands and lifeways, and the importance of respecting the knowledge and leadership of Indigenous families in this work.

There is a clear need for highly competent health sciences experts. No instrument currently exists for assessing the generic competences of health sciences students. The aim of this study is to develop and psychometrically test the Health sciences Generic Competence (HealthGenericCom) instrument. The instrument development four step process has been conducted with a cross-sectional study design and according to the COSMIN guidelines. Face and content validity was tested by 13 experts, structural validity was tested with exploratory factor analysis, and internal consistency was evaluated by calculating Cronbach's alpha. The structural validity was tested using data from Finnish health sciences students (n=276). The content validity index of the whole HealthGenericCom instrument was 1 for relevance and for clarity. Using exploratory factor analysis a model of eight factors (with 88 items) was created: 1) competence in leadership, administration, and finance; 2) competence in people-centred guidance; 3) competence in health promotion; 4) competence in evidence-based practice; 5) digital competence; 6) competence in work well-being and self-management; 7) competence in collaboration and problem-solving; and 8) competence in societal interaction. The HealthGenericCom was shown to be valid and reliable and provides an evidence-based conceptual framework that can be used in developing curriculums and competence management.

4-H academics responded to the COVID pandemic by rapidly adapting CDC and other resources for virtual delivery. A statewide epidemiology project was taught to 48 youth with the goal of minimizing fears and confusion, increasing prevention measures, leveraging current topics for education, and bolstering the social-emotional health of youth participants. Results indicated that youth enjoyed the project and adopted behaviors to reduce the spread of infectious diseases, such as increased mask-wearing.

This study investigates the patterns of promoting physical activity among residents in Mueang District, Mahasarakham Province, Thailand. It explores the impact of contemporary societal shifts, such as increased reliance on technology and decreased physical labor, on public health. The research identifies the rise of chronic diseases due to lifestyle changes and the need for preventive strategies emphasizing physical activity. Utilizing a questionnaire, the study analyzes residents' knowledge, awareness, motivation, and practices regarding health promotion through physical exercise. The findings reveal high general knowledge and awareness of health benefits but low levels of physical activity practice, influenced by lifestyle and societal changes. The study emphasizes the importance of tailored health promotion strategies and the role of digital platforms in enhancing physical activity awareness and participation. This research contributes to understanding effective methods to promote physical activity and addresses the health challenges faced by the local population, promoting sustainable physical and mental health.

Background: Culinary nutrition education can support improved diet-related health and wellbeing. This pre-post pilot study aimed to assess feasibility and acceptability of an eight-session culinary nutrition programme, the Food and Lifestyle Information Programme (FLIP), for adults with mild-to-moderate intellectual disability. A secondary aim was to evaluate preliminary programme effectiveness. Method: Participants were recruited through a disability service provider. Feasibility measures were: recruitment and retention; implementation; engagement and participation; adverse outcomes; and feasibility of outcome measures. Acceptability was assessed using an interactive process evaluation. Effectiveness measures included cooking frequency, cooking and food skill confidence and diet quality. Results: Six of eight participants completed the intervention with high attendance and programme engagement. FLIP was well received by participants and support workers. No adverse outcomes occurred. Diet quality was feasible to assess. Conclusions: Findings can inform content, delivery and evaluation of future culinary nutrition programmes for adults with mild-to-moderate intellectual disability.

Background: It is vital to improve the mental health (MH) of young people in Hong Kong, where the suicide rate has nearly doubled among those aged 15-29 years since 2014. This multi-method evaluation aimed to assess Coolminds, which promoted MH literacy by engaging students, parents, and educators in secondary schools in Hong Kong. Methods: Students, parents, and teachers completed self-report measures before and after attending workshops aimed at raising MH literacy. Pre- and post-survey data were collected between November 2021 and August 2022. Qualitative data from participant feedback and a focus group interview with Coolminds staff were analyzed using descriptive content analysis. Results: The final dataset included 2903 students, 395 parents, and 325 educators from 52 schools. Only 3 schools had engagement with all 3 key groups. Significant improvements in MH knowledge were observed after the Coolminds workshops for all 3 groups. Qualitative analysis identified a reactive approach to MH issues, and bureaucratic and logistical challenges as barriers to implementation. Conclusion: Findings support the effectiveness of the Coolminds curriculum in improving MH literacy for each group and the demand for MH promotions in school settings. The implementation challenges indicate the need for future initiatives to better align with local needs and practices.

Background: Despite emerging evidence for the effectiveness of school-based suicide prevention programmes worldwide, there are few being implemented in the United Kingdom, and their social validity (i.e., the feasibility, acceptability, and utility) is not yet known. Aims: We aimed to conduct a scoping study to determine: (1) the social validity and potential benefits of school-based suicide prevention interventions, (2) the perceived need for such interventions, and (3) barriers and facilitators to implementation. Sample and Methods: A total of 46 participants took part. Semi-structured interviews were conducted with mental health professionals (N = 8), school staff (N = 8), and parents whose children had experienced suicidal ideation/behaviours (N = 3) in England. Focus groups were also completed with children and young people (N = 27) aged 15-18 across three state secondary schools. Data were analysed using thematic framework analysis. Results: Three themes were identified: (1) the need for and importance of suicide prevention in children and young people, (2) schools as a setting for delivery, and (3) key components of suicide prevention programmes. Conclusions: Participants overwhelmingly agreed that there is a need for a greater and more consistent emphasis on school-based suicide prevention. School appears to be an acceptable location for suicide prevention, and participants felt discussions about suicide should begin at the start of secondary school. However, there are potential barriers that need to be considered, including tailoring for neurodiversity, challenging cultural/family beliefs and stigma, managing personal experiences of suicidal thoughts or previous bereavement from suicide, and a lack of existing training for school staff.

Background: The COVID-19 pandemic has brought about disruptions in healthcare for adults with intellectual and developmental disabilities. There is a need to explore ways to promote proactive healthcare and better prepare individuals for healthcare encounters. Methods: A co-designed tool, the COVID Check-in Tool, was introduced as part of a virtual health education programme to encourage proactive healthcare. Implementation of this Health Check-in was evaluated with 36 adults with intellectual and developmental disabilities and 96 family caregivers who completed the programme using surveys, structured interviews and focus groups. Findings: Forty-four percent of participants engaged in the Health Check-in process, resulting in many reported benefits for those who participated. However, there were also barriers to initiating the Check-in, along with challenges using the COVID Check-in Tool, according to both the adults with disabilities who were interviewed and the family caregivers. Conclusions: The study underscores the importance of considering ways to integrate tools into routine healthcare practices, to facilitate improved healthcare delivery for people with intellectual and developmental disabilities during pandemic recovery efforts. As well, involving people with lived experience in the development and implementation of healthcare resources is critical.

Objectives: Overweight and obesity among school-aged children pose a threat to both their academic performance and public health. The Healthy Primary School of the Future (HPSF) initiative was established to address this issue. Our objective was to explore the conditions that make HPSF sustainable based on the perspectives of relevant stakeholders. Design: The study utilised Group Concept Mapping, a structured methodology for conducting mixed-methods participative research, combining qualitative data collection with quantitative data analysis measures. Method: Participants included parents, teachers, school directors, politicians, labour unions, educational, nutrition and health scientists and policymakers. They were asked to respond to the prompt, 'A necessary condition to make the HPSF sustainable is . . .'. The statements generated were then assessed for their importance and feasibility. Using multidimensional scaling and hierarchical cluster analyses, we identified the shared vision among the stakeholders. Results: A total of 106 unique statements were generated and grouped statistically into 10 clusters. The most significant clusters were identified as Financing; Accessibility for everyone; and Content/Lifestyle/School Programme. The clusters that were deemed most feasible included Content/Lifestyle/School Programme; Accessibility for everyone; and Evaluation. Conclusion: Achieving sustainability for the HPSF requires a comprehensive approach that addresses the conditions outlined in all 10 clusters. Based on the ratings of feasibility and importance, our recommendation is to prioritise implementation of Content/Lifestyle/School Programme and Accessibility for everyone. Subsequently, efforts should be directed towards realising the less feasible but crucial conditions, such as Financing and Evaluation, followed by the remaining six clusters of conditions as identified.

Objective: This study investigated active recess as an innovative approach to improving physical activity levels in European primary schools, addressing the need to counteract sedentary behaviour and enhance health in students. Method and Design: Using rapid reviewing, the article summarises empirical evidence from a variety of sources, including cross-sectional and intervention studies. Different approaches are investigated to determine their impact on physical activity during recess. Results: Different playground settings have distinct effects on physical activity, with grassland and designated zones in particular promoting moderate-to-vigorous physical activity. Gender inequalities in physical activity patterns suggest the need for gender-sensitive interventions. Playground marking and scheduled activities temporarily increase physical activity, whereas recess of more than 60 minutes dramatically enhances physically active participation. Conclusions: This study demonstrates the impact of active recess in facilitating children to engage in higher levels of physical activity. The findings have implications for school health policy decisions.

Background: Learner profiles detected from digital trace data are typically triangulated with survey data to explain those profiles based on learners' internal conditions (e.g., motivation). However, survey data are often analysed with limited consideration of the interconnected nature of learners' internal conditions. Objectives: Aiming to enable a thorough understanding of trace-based learner profiles, this paper presents and evaluates a comprehensive approach to analysis of learners' self-reports, which extends conventional statistical methods with psychological networks analysis. Methods: The study context is a massive open online course (MOOC) aimed at promoting physical activity (PA) for health. Learners' (N = 497) perceptions related to PA, as well as their self-efficacy and intentions to increase the level of PA were collected before and after the MOOC, while their interactions with the course were logged as digital traces. Learner profiles derived from trace data were further examined and interpreted through a combined use of conventional statistical methods and psychological networks analysis. Results and Conclusions: The inclusion of psychological networks in the analysis of learners' self-reports collected before the start of the MOOC offers better understanding of trace-based learner profiles, compared to the conventional statistical analysis only. Likewise, the combined use of conventional statistical methods and psychological networks in the analysis of learners' self-reports before and after the MOOC provided more comprehensive insights about changes in the constructs measured in each learner profile. Major Takeaways: The combined use of conventional statistical methods and psychological networks presented in this paper sets a path for a comprehensive analysis of survey data. The insights it offers complement the information about learner profiles derived from trace data, thus allowing for a more thorough understanding of learners' course engagement than any individual method or data source would allow.

In the field of artificial intelligence-based fitness apps, the effective integration of behavior change techniques (BCTs) is critical for promoting physical activity and improving health outcomes. However, the specific BCTs employed by apps and their impact on user engagement and behavior change are not explored sufficiently. This study investigates the Freeletics fitness app through a mixed-methods approach to evaluate the use of BCTs. In the quantitative analysis, fifteen unique BCTs were identified based on the Behavior Change Technique Taxonomy (V1). In the qualitative analysis, user reviews (n=400) were examined to understand perspectives on the app's effectiveness in promoting behavior change. Goal setting, action planning, self-monitoring of behavior, and social support were among the most prevalent BCTs identified in the Freeletics app, and their effectiveness in enhancing user engagement and promoting behavior change was also highlighted by user reviews. Among the areas of improvement identified in the study were the need for simplifying personalization options and addressing user concerns regarding the specificity of feedback. The study underscores the importance of integrating BCTs effectively within AI-based fitness apps to drive user engagement and facilitate behavior change. It contributes valuable insights into the design and implementation of BCTs in fitness apps and offers recommendations for developers, emphasizing the significance of goal setting, feedback mechanisms, self-monitoring, and social support. By understanding the impact of specific BCTs on user behavior and addressing user concerns, developers can create more effective fitness apps, ultimately promoting healthier lifestyles and positive behavior change.

Mental disorders constitute one of the population's principal health problems, especially among undergraduates. This quantitative study compared levels of depression, anxiety, and stress in a sample of emerging adult university undergraduates from a gender perspective (1) during the initial and intermediate years of emerging adulthood and (2) in two different cohorts. A total of 383 Spanish emerging adult university undergraduates were monitored longitudinally (2015-2018) and two cohorts were compared (2015-2020). Participants completed the validated Spanish version of the Depression Anxiety Stress Scale-21. Mean-level and rank-order stability was found across the two waves of the longitudinal study in relation to levels of depression, anxiety, and stress. Significant differences were found between the two cohorts, indicating higher levels of psychological distress in 2020 than in 2015. Women were found to have higher levels of psychological distress, particularly stress, than men in both waves and cohorts. Results are discussed in relation to the negative effects of the COVID-19 health crisis on the emotional health of emerging adults. The present study highlights the need to establish measures designed to improve the mental health of emerging adults, which was more severely affected by the COVID-19 crisis than by the aftermath of the 2008 financial crisis. It also underscores the need to develop interventions designed to alleviate the greater degree of stress suffered by women.

Background: Historical trauma and cultural loss resulting from colonialism have contributed to educational and health disparities among Pacific youth. Recognizing the protective factors is essential for mitigating disparities and enhancing the overall well-being of these youth. Objective: This review provides evidence about the current state of youth development among Pacific youth. Methods: We conducted a systematic review of the literature published between 2010 and 2020, including the fields of education, social, psychological, and medical sciences. We employed qualitative data analysis of 35 peer-reviewed studies. Results: The majority (69%) of the studies focused on program interventions among 10-19-year-old youth at-risk primarily in New Zealand among Maori (51%) and in the U.S. among Native Hawaiians and Pacific Islanders (46%). Health interventions were common in Hawai'i, while the New Zealand studies focused more on measuring youth resilience. Among the three outcomes identified, health/well-being was the most studied area, followed by social-emotional, and cognitive development. The outcomes suggest mainly positive effects on health and well-being, socio-emotional, and cognitive development related to Pacific youth. Conclusions: While the last decade has seen a growth of culturally anchored programs, more research is needed to account for wider social, economic, and political dynamics that impact youth development, which was largely unaccounted for in the extant studies. There is a need for broader developmental frameworks that would, first, align with the context and culture of the youth's community, and second, expand our horizon of the developmental patterns as they occur in diverse sociocultural contexts.

This article examines the implementation, participation rates, and potential determinants of participation in the digital addiction prevention program "ready4life." A two-arm cluster-randomized trial recruited German vocational students via class-based strategies. Intervention group received 16 weeks of in-app coaching; the control group received health behavior information, with coaching offered after 12 months. Potential determinants of participation were analyzed based on class and individual characteristics. Out of 525 contacted schools, 35 participated, enrolling 376 classes. Implementation during the pandemic required flexible adjustments, with 49.7% of introductions conducted in person, 43.1% digitally via online streaming, and 7.2% received a video link via email. Despite challenges, 72.3% of the vocational students downloaded the app, and 46.7% gave informed consent. Participation rates were highest among (associate) professionals, vocational grammar school classes, classes introduced by females, younger individuals, members of the project team, and classes introduced face-to-face. Female gender, lower social competencies, lifetime cannabis use, higher problematic internet use, and higher perceived stress were associated with higher individual participation. The study highlights the importance of proactive outreach and personalized interventions for addiction prevention programs in vocational schools. While reached students aligned with the aims of the app, tailored recruitment strategies could enhance engagement among under-represented groups.

Reservation-dwelling American Indian adolescents are at exceedingly high risk for cannabis use. Prevention initiatives to delay the onset and escalation of use are needed. The risk and promotive factors approach to substance use prevention is a well-established framework for identifying the timing and targets for prevention initiatives. This study aimed to develop predictive models for the usage of cannabis using 22 salient risk and promotive factors. Models were developed using data from a cross-sectional study and further validated using data from a separate longitudinal study with three measurement occasions (baseline, 6-month follow-up, 1-year follow-up). Application of the model to longitudinal data showed an acceptable performance contemporaneously but waning prospective predictive utility over time. Despite the model's high specificity, the sensitivity was low, indicating an effective prediction of non-users but poor performance in correctly identifying users, particularly at the 1-year follow-up. This divergence can have significant implications. For example, a model that misclassifies future adolescent cannabis use could fail to provide necessary intervention for those at risk, leading to negative health and social consequences. Moreover, supplementary analysis points to the importance of considering change in risk and promotive factors over time.

To emphasize to learners how factors outside individual control impact health, scholars introduced the concept of structural competency. Structural competency refers to the development of analytical skills that reveal the larger societal context beyond the patient-clinician interaction that shapes health outcomes. The growing adoption of structural competency curricula, however, has revealed that prelicensure and early career health professionals can feel overwhelmed by the mismatch between the wide scale of entrenched problems and the limited scope of their therapeutic skills. In this Reflections paper, I draw on theories from Giddens, Bourdieu, and Foucault to restore a role for individual agency in promoting health. Conceiving of structure and agency as mutually constituting suggests that structures are human-made and can be vulnerable to challenge. Structures, however, disperse power to such an extent that people internalize their rules and discipline themselves to follow them without explicit enforcement. It is precisely in those local sites of power that health professions learners and educators can intervene to interrupt the reproduction of structures harmful to health. As I demonstrate with an example from a reproductive health emergency, being structurally competent may also include contesting agreed upon norms at the level of the learning and clinical environments rather than only macro-level societal forces. Rewriting norms within health professions education and clinical practice is not necessarily a simpler task, but it provides learners and educators with more accessible targets for action.

Background: Nutrition plays a vital role in children's physical and emotional health. More than half of school age children's calories are provided in the school food environment, making school interventions an opportunity to address child nutrition. Methods: The Creating Health Environments for Schools (CHEFS) program is designed to leverage local resources to create customized solutions that improve the nutritional content of school food and encourage children to choose healthier food. There are 8 components: (1) customizing nutrition plans, (2) modifying/replacing menu items, (3) helping procure healthier food, (4) providing equipment grants, (5) training cafeteria staff, (6) implementing environmental changes and nudges, (7) engaging students and parents, and (8) supporting sustainability. Supporting child nutrition directors is key to facilitating cooperation with schools. Implications for School Health Policy, Practice, and Equity: Menu modifications and procurement are interrelated and depend on successfully collaborating with corporate, independent, and local food services organizations. Limited school budgets require low or no-cost solutions and staff training. Student and parent engagement are critical to facilitate culturally-appropriate solutions that increase awareness of healthy food. Conclusions: Every school district has particular resources and constraints. CHEFs engaged stakeholders to design customized solutions and encourage healthier nutrition for school children.

Background: More than 20 million children in the United States lack access to primary health care. Practice Learning: Research shows that students with regular access to physical and mental health services have fewer absences, are more social, less likely to participate in risky behaviors, have improved focus and higher test scores. Implication For School Health Policy, Practice, And Equity: School-based health centers (SBHCs) can be an important, valuable and viable health care delivery option to meet the full-range of primary health care needs of students where they spend the majority of their wake hours, ie, in school. Children in rural and other underserved communities, as well as those underinsured, non-insured, economically challenged, underserved, and the most vulnerable among us are especially at risk. Conclusions: This paper discusses the history, value, and importance of SBHCs from myriad perspectives, including physical and emotional wellbeing, academic and social success, and the promotion of a positive transition to adulthood. In addition, the authors' experiences that resulted in building the first SBHC in the Mid-Hudson Valley Region of New York State are shared. These experiences form the foundation for creating an important roadmap for individuals and school leaders that are interested in bringing a SBHC to their school and district.

Rates of depression in youth are continuing to increase at a steady rate, yet these youth often do not receive mental health services (Bertha & Balázs, 2013; Thomas et al., 2011). Schools are an ideal setting to connect youth to mental health services; however, many barriers exist with respect to schools having adequate resources and access to the appropriate levels of services (Duong et al., 2021; Owens & Peltier, 2002). Schools may collaborate with local community providers with available resources to address these gaps. The current article describes the pilot of a school-based mental health promotion program intended to reduce depression in youth by promoting access to care through referrals to community providers. Data were collected, via self-report measures, every 3 months for 12 months from students from three middle and high schools in North Texas. The students (N = 88) enrolled in this program experienced significant reductions in their depression symptoms at the end of 12 months. This program highlights the importance of school-community partnerships to promote access to care to address mental health concerns. The results from our pilot study demonstrate the feasibility and the potential of school-based programs in improving the mental health of youth in schools through community partnership.

School counselors support the academic, career, and social/emotional development of all students in their care, and one important method of delivery of a comprehensive school counseling program is the use of classroom instruction. In this exploratory, sequential mixed-methods study, we examined participant responses from nine focus groups regarding the school counselors' experiences with delivery of classroom lessons, in combination with a national survey of 247 practicing school counselors. Results underscored participants' desire to spend more time in classrooms and ongoing barriers to classroom access. We discuss implications for school counseling practice and school counselor education.

Recently, there has been an emphasis on keeping the study of anatomy using donor material confined to the domain of medical and allied healthcare professionals. Given the abundance of both accurate and inaccurate information online, coupled with a heightened focus on health following the COVID-19 pandemic, one may question whether it is time to review who can access learning anatomy using donors. In 2019, Brighton and Sussex Medical School (BSMS) obtained a Human Tissue Authority Public Display license with the aim of broadening the reach of who could be taught using donor material. In 2020, BSMS received its first full-body donor with consent for public display. Twelve workshops were delivered to student groups who do not normally have the opportunity to learn in the anatomy laboratory. Survey responses (10.9% response rate) highlighted that despite being anxious about seeing inside a deceased body, 95% felt more informed about the body. A documentary "My Dead Body" was filmed, focusing on the rare cancer of the donor Toni Crews. Viewing figures of 1.5 million, and a considerable number of social media comments highlighted the public's interest in the documentary. Thematic analysis of digital and social media content highlighted admiration and gratitude for Toni, the value of education, and that while the documentary was uncomfortable to watch, it had value in reminding viewers of life, their bodies, and their purpose. Fully consented public display can create opportunities to promote health-conscious life choices and improve understanding of the human body.

This systematic review evaluated interventions and relevant outcomes for health promotion and obesity prevention among children and adolescents with developmental disabilities (DD). Twenty-one studies including randomized control trials (n= 9) and quasi-experimental studies (n=12) published between 2010 and 2021 met inclusion criteria related to participant characteristics, intervention type, and child obesity-related outcomes. Five types of intervention programs were identified: aerobic and strength training, sport-based physical activity, aquatic exercise, active video gaming, and diet and lifestyle. Whereas analysis of intervention outcomes, efficacy, and study rigor showed mixed results and weak evidence of effective interventions, this review identified gaps in the literature, promising strategies for addressing obesity in children with DD, and implications for practice and future research.

The War on Diabetes campaign was launched in 2016, encouraging Singapore residents to engage in regular exercise, adopt healthy dietary habits and screen for early detection of diabetes. This study aims to examine campaign awareness and its associations with sedentary behaviour, dietary habits and identifying diabetes. Data were obtained from the nationwide Knowledge, Attitudes and Practices study on diabetes in Singapore. A total of 2895 participants responded to a single question assessing campaign awareness. The Dietary Approaches to Stop Hypertension (DASH) diet screener assessed dietary habits, and the Global Physical Activity Questionnaire (GPAQ) measured sedentary behaviour. Recognition of diabetes was established using a vignette depicting a person with diabetes mellitus. Logistic and linear regression models were used to measure the associations. Most participants were 18- to 34-years old (29.9%) and females (51.6%). About 57.4% identified the campaign. Campaign awareness exhibited positive associations with identifying diabetes based on the vignette [odds ratio (OR): 1.5; 95% confidence interval (CI): 1.1-2.2; P = 0.022], lower odds of sedentary behaviour [greater than or equal to] 7 h/day (OR: 0.7; CI: 0.5-0.9; P = 0.018) and higher DASH scores ([beta] = 1.3; P < 0.001). The study recognized early significant associations between the behavioural outcomes and the campaign, emphasizing the need for ongoing campaign sustainability and evaluation of its long-term impact on population health.

A revised way of thinking is essential for promoting harm reduction strategies and reducing the negative implications of injection drug use (IDU). Despite the growth of harm reduction approaches in the United States, there is limited guidance for designing and implementing multi-sector efforts that address the external determinants that promote and facilitate IDU. Current frameworks fail to acknowledge the individual's role and influence in multi-sector change. To address the multifaceted nature of IDU, we must address the complex relationship between people who inject drugs (PWID) and their external environment. As part of a community-academic partnership, a framework was developed to address the gaps in current theoretical models and community practice. Our Harm Reduction Collaboration Framework (HRCF) accepts PWID as key stakeholders and presents a practical framework in which PWID and community organizations partner in decision making to influence policy, systems, and environmental change. We provide examples of two organizations that have made substantive changes in implementing harm reduction strategies in their communities by utilizing the HRCF.

This article reports on a 3-year longitudinal study focused on the impact of cross-sector, collective impact approaches to creating cultures of campus health. The study sought to understand the integration of health and well-being concepts into university operations, including business practices and policies, as well as the contribution of public health initiatives focused on health-promoting universities to creating cultures of campus health for students, staff, and faculty. Research was carried out from spring 2018 to spring 2020 via focus group data collection and rapid qualitative analysis involving template and matrix analysis. A total of 18 focus groups were conducted across the 3-year study, six with students, eight with staff, and four with faculty. The initial cohort included 70 participants: 26 students, 31 staff, and 13 faculty. Qualitative analysis findings indicate a general pattern of change over time from a primary focus on well-being characterized by programs and services (e.g., fitness classes) to policy and structural-level interventions (e.g., stairwell beautification and hydration stations) promoting well-being for all. Grass-top and grassroots leadership and action were instrumental to changes in working and learning environments, policies, and campus environment/infrastructure. This work contributes to the growing literature on health-promoting universities and colleges and demonstrates the critical role of both top-down and ground-up approaches and leadership efforts to create more equitable and sustainable cultures of campus health and well-being.

Culturally-adapted evidence-based programs (EBPs) are needed to promote healthy behaviors among Native teens and young adults. Little is known about the facilitators and barriers of implementing and sustaining EBPs in Native communities. This paper aims to identify those factors described by educators who implemented the Native Students Together Against Negative Decisions (STAND) curriculum. Methods: We conducted qualitative, semi-structured interviews with 44 Native STAND educators from 48 sites throughout the United States. We used a modified grounded theory approach to explore barriers, facilitators, and sustainability factors related to implementing Native STAND. Results: We learned that disruptions to staffing, coordination, and organizational factors were the most common barriers. Factors that improved implementation success included: tailoring the program to local needs/constraints, having a supportive Project Manager, improved fidelity due to check-in calls, and participation in summer training. Factors that improved sustainability included: access to needed infrastructure, administrative support, community support, and student interest. Discussion: The delivery of Native STAND was further improved by person-to-person communication and resource sharing across sites. Sustaining EBPs in AI/AN settings requires culturally-tailored technical assistance, sufficient implementation funds for materials and staffing, and a community of peer educators to inspire forward progress. Conclusion: EBPs that reflect the needs and experiences of American Indian and Alaska Native (AI/AN) youth are necessary to address systemic inequities in adolescent health outcomes. The Native STAND Dissemination and Implementation study is among the first to assess facilitators and barriers to program delivery in diverse AI/AN settings.

Background. Health-promoting behaviors and positive lifestyle changes are crucial for effective stroke prevention. However, individuals at high risk of stroke exhibit poor health behavior due to a deficiency of individual motivation. Moreover, there are only a few studies on health-promoting behaviors that have applied behavior change theories in individuals at high risk of stroke. Objective. This study aimed to use the theory of the planned behavior (TPB) model to investigate determinants of health-promoting behaviors for stroke prevention and control. Method. In this cross-sectional study, 263 participants were recruited from five community health centers in Qingdao. Confirmatory factor analysis was performed to assess the reliability and validity of the constructs, and structural equation modeling was used to analyze the proposed relationships between the TPB-related variables. Results. The attitudes, subjective norms, and perceptions of behavioral control positively influenced behavioral intention. The behavioral intention had a positive effect on health-promoting behaviors. Attitudes, subjective norms, and perceived behavioral control were influenced primarily by the mediating variable behavioral intention to affect health-promoting behaviors. Stroke knowledge was an influential facilitator of behavioral attitudes, subjective norms, and perceived behavior control. Conclusion. The TPB-based model is suitable for explaining health-promoting behaviors in individuals at risk of stroke and for guiding the development of effective health management programs. A comprehensive person-centered motivation behavior strategy that is based on health education and complemented by social support and health resource optimization is critical in promoting health behavior motivation and health promotion behaviors in stroke high-risk groups.

Community-engaged patient navigation safety net programs are established as an evidence-based approach to address cancer prevention and early detection efforts, but barriers to expand and sustain such programs persist. In addition, few studies describe how these programs impact buy-in among communities and policy change within health care systems and government. We describe how we used the Capacity for Sustainability Framework to guide efforts for program sustainability and community, institutional, and policy level change in a breast cancer screening and patient navigation safety net program. The nine domains of the Capacity for Sustainability Framework were used to develop program logic models, to inform program implementation and quality improvement agendas, and to guide multi-level partner and stakeholder engagement, outreach, and dissemination of outcomes. The program is currently in its seventh year and continues to be annually funded by a city public health department. In 2021, additional 5-year renewable funding from a state public health department was secured. In addition, institutional program support was expanded for patients diagnosed with breast cancer. Program leaders worked with policymakers to draft legislation to support training certification and third-payor reimbursement for patient navigators and community health workers. The program is well-known and trusted among community members, community-based organizations, and providers. Community, organizational, and policy-level outcomes demonstrate that community-engaged patient navigation safety net programs can influence more than individual and interpersonal outcomes and can be sustained over time.

Sleeping difficulties among adolescents constitute a pressing public health issue, and it is of the utmost importance that these are approached from a health-promotion perspective. This study explores adolescents' suggestions on how their sleep could be supported. Data were collected via eight focus group interviews with 43 adolescents aged 15-16, in Sweden, and analyzed using qualitative content analysis. The results describe the adolescents' suggestions on how their sleep could be supported in three themes: being supported by involved parents--routines, engagement, and warmth are vital; being supported to achieve knowledge on the "whys" and "hows" of sleep--increased knowledge gives the ability to make well-grounded sleep choices; and being guided into finding balance--balance in life is difficult to achieve and adolescents desire support. Parents, school nurses, health professionals, and anyone who has the opportunity to improve and promote sleep should consider adolescents' suggestions.

Background: Medicaid is a key policy lever for expanding access to mental health services and supports for children in schools, especially low-income and minority children. This study examines how Medicaid finances mental health promotion and prevention (tier 1), screening and selected interventions (tier 2), and treatment (tier 3) in schools, informing policy recommendations to expand school mental health. Methods: Seventeen key informant interviews were conducted virtually from March to October 2022 with research, practice, and policy leaders in school mental health and Medicaid. Interview transcripts were thematically coded to inform recommendations. Results: Interview themes included that Medicaid is a key funder of mental health services, primarily in tier 3, and that braiding and blending funds is necessary to support services across all tiers in schools. Interviewees underscored the need to expand tier 2 in schools, to expand and diversify the behavioral health workforce (including via non-licensed providers, aligning school-employed provider licensure and billing requirements and building school-community referral relationships), strengthen teaming structures (including state children's cabinets, student case management, and education/Medicaid agency coordination), and leverage technical assistance and training to speed up adoption of new policies (including via guidance and templates that facilitate billing for school health services). Conclusions: Policymakers, practitioners, and advocates can use these findings to identify policies and strategies to expand school mental health and reduce inequities.

Every moment counts (EMC) is a multi-tiered mental health promotion initiative designed to build the capacity of practitioners to address the mental health needs of children and youth in school settings. This study evaluated the impact and cultural relevance of EMC workshops in supporting practitioners to apply a public health approach to children's mental health in Aotearoa New Zealand. A longitudinal mixed methods design employed a survey and semi-structured interviews to evaluate the applicability, impact and cultural relevance of the EMC workshops. Themes identified from participants' reflections on their experiences of implementing EMC represented everyday practices at individual, team, and organizational levels. Specifically, intersectorial collaboration was perceived as beneficial. There is a call to action for practitioners to work more cohesively and interprofessionally, at policy and practice levels, to effectively promote children's mental health and achieve equitable health and well-being outcomes. Communities of practice offer a potential mechanism to support translation of knowledge into practice in schools. Application of a public health approach to children's mental health in schools, facilitated by the EMC initiative, is applicable and positively impacts outcomes in Aotearoa New Zealand, with some modifications needed to better fit the cultural context.

Special Olympics promotes the health of their athletes year-round and offers their athletes options to obtain free health screenings. Following screening events, athletes often have difficulties finding needed referral care. Obstacles to finding a healthcare provider (HCP) for a referral is what necessitates the need for a state-wide HCP referral list in South Dakota. Creation of a HCP referral list was done via an online two-part survey and sent to HCPs throughout the state of South Dakota. Currently, this is the only database of healthcare providers that is accessible to individuals with intellectual and developmental disabilities (IDD) that are members of Special Olympics South Dakota (SOSD). While the created referral list offers increased opportunities to access HCPs in South Dakota, there are still limits to ensuring easy access to HCPs throughout the entire state.

The need to foster resilience amongst young people with intellectual disabilities is increasingly recognised within policy. Critically, understanding of the actual means by which this aspiration might be most sensitively and effectively met is considered weak. This paper reports on an exploratory case-study of a social enterprise community café -- "The Usual Place" -- that through the promotion of employability, seeks to promote resilience amongst its young 'trainees' with intellectual disabilities. Two research questions were set: "how is 'resilience' conceptualized within the organisation" and "what features within the organisation are significant in fostering resilience"? We identify a range of significant features associated with being able to successfully foster resilience -- the need for a foundational 'whole organisation'(settings) approach based on high levels of participation and choice; the negotiation of a constructive dynamic tension between 'support' and 'exposure'; and the embedding of these actions in embodied actions and day-to-day organisational activities.

Background: We explored the experiences of staff working in Norwegian community-based living facilities, caring for people with intellectual disabilities during the Covid-19 pandemic, and what self-regulatory strategies staff used to maintain health and care service delivery and contribute to organisational resilience. Methods: A qualitative design was utilized. Data were collected from September 2021 to April 2022 with individual and focus group interviews. In this study, 25 staff members participated. Thematic analysis was conducted. Findings: Five main themes were identified regarding the experiences of staff during the pandemic: Lockdown of facilities, social isolation of residents, lack of health follow-up, high sick leave rates and communication challenges. Only some of the strategies to mitigate pandemic-related challenges were based on current Norwegian infection control guidelines. Some strategies were successful while others were not and some were negligent and challenged the delivery of health and care services for the residents. Conclusions: Our study shows that people with intellectual disabilities living in the community-based living facilities were subjected to human rights violations and violations of the Norwegian infection control law. This was caused by a lack of several important organisational qualities in the facilities.

Background: We now have sufficient evidence demonstrating inequalities in specific avoidable causes of death for adults with intellectual disability compared to their peers without intellectual disability. Apart from COVID-19, the largest differentials that disadvantage people with intellectual disability are in relation to pneumonia, aspiration pneumonia, epilepsy, cerebrovascular disease, ischaemic heart disease, deep vein thrombosis, diabetes and sepsis. The aim of this systematic review is to report on strategies at the individual, population or policy levels aimed at preventing these conditions that are applicable to adults with intellectual disability and that have been based on or recommended by research. Methods: Systematic review of PUBMED, EMBASE, CINAHL, PsychInfo, Social Care Online, International Bibliography of the Social Sciences (IBSS), Web of Science, Scopus, Overton, the Cochrane Library and Google Scholar databases was carried out. Searches were completed on 30 June 2023. Quantitative, qualitative and mixed-methods research; systematic, scoping or evidence-based reviews; and audit and reports of mortality reviews were included. Publications included in the review were about preventing the eight potentially avoidable causes of death. Findings: Ninety-four papers were included in the review (9 in relation to pneumonia; 11 for aspiration pneumonia; 18 for sudden unexpected death in epilepsy; 7 for cerebrovascular disease; 8 for ischaemic heart disease; 4 for deep vein thrombosis; 31 for diabetes; 6 for sepsis). The eight most frequently occurring potentially avoidable causes of death in people with intellectual disability are very different medical conditions, but they shared striking similarities in how they could be prevented. The literature overwhelmingly implicated the need to make lifestyle changes to address obesity, lack of exercise and poor nutrition, and to have regular medical reviews. In addition, 'whole-population' approaches are required that look beyond the individual to the social determinants of health. Conclusions: We found little peer-reviewed evidence specifically about preventing these conditions in people with intellectual disability. However, most of the literature about preventative strategies pertaining to the general population was applicable to people with intellectual disability, albeit that some 'reasonable adjustments' would be required.

The sharp rise over the past decade in young children's access to various forms of screen media (e.g., smartphones, tablets, TVs) has posed new and significant challenges to caregivers in managing children's use of this type of media. For caregivers of young children with externalizing behavior problems, managing children's time with screen media is especially important and challenging. In this article, we summarize evidence of bidirectional links between early externalizing behavior problems and unhealthy screen media use in young children and discuss the extent to which prior interventions have responded to the needs of caregivers of children with these problems. We propose a conceptual model for an intervention to promote healthy screen media use for children with externalizing behavior problems that leverages current behavioral parenting interventions.

Reading nutrition facts labels is a competency for which training is given in several nutrition education programs, especially in obesity outreach workshops. The Top Trumps-style card game is commonly used in obesity prevention educational programs to engage participants in reading nutrition facts labels; however, the success of TV cooking shows among children and teenagers has not been explored for educational purposes. This paper is a descriptive study of developing a gamified activity as part of the one-time outreach workshop facilitated by the Obesity and Comorbidities Research Center (OCRC) in Brazil. By playing the MestreChef Nutritional (MCN) game, participants followed similar rules as the corresponding TV cooking show. They were challenged to decide to select food items, calculate dietary food intake, and prepare a recipe to visualize the proportion of macronutrients contained in daily diets. The analysis of the nutritional dietary table completed by participants revealed to be a rich source of information, and we identified in our cohort that selecting an adequate number of food items and making healthy food choices was not concerning. However, their lack of competency in performing mathematical reasoning, particularly in calculating serving sizes and converting grams of macronutrients into calories, was evident. Moreover, facilitators of the workshops agreed that the MCN game presents definitively more didactic effectiveness and playability than the Foods Top Trumps, a former game used in the outreach workshops. The MCN game nourishes the engagement of the participants in learning nutrition-related concepts and may be an efficient didactic resource to improve nutrition knowledge in outreach activities when an alternative method is required to stimulate reading nutrition facts labels.

We offered an enrichment program for high school students with the theme, "The Environment, Health, and You" during the Summer of 2022 and the Spring of 2023. We developed several educational modules for high school students that provided them with an opportunity to learn and explore the foundations of physiological systems, nutrient needs to maintain health, and the impact that environmental factors can have on them. The modules included videos, discussion boards, games, readings, and labs. These modules were integrated into the first session: Your Body and Health. On "day 1," the first module explored the basic physiology and anatomy of the body with respect to the organization of cells into organ systems. Additionally, the educational content included information on macro- and micronutrients and their impact on body development, nutrition, and metabolism. The nutrition module explored nutrition concepts and various factors that can impact healthy eating patterns, such as food insecurity issues and the consumption of ultraprocessed foods. A lab activity on label reading was included to help empower students to make healthy choices. A total of 43 high school students participated in the program. Overall, the quality of the educational content in the modules was rated highly by the students, and they indicated that the educational experience inspired them to learn more about the physiology and nutrition concepts associated with human metabolism, and the importance of healthy food choices to maintain health.

Indonesian physicians working in rural and remote areas must be equipped not only with generic competencies but also with the attributes and skills necessary to provide health care services without compromising quality. This study sought to reach a consensus on the attributes and competencies that are viewed as essential and important for working effectively as an early career doctor in rural and remote practice in Indonesia. A two-round Delphi study was conducted by reference to 27 consenting physicians working in rural and remote Indonesia. Forty-three items covering 9 attributes and 34 competencies were sent to these physicians to be rated on a Likert scale ranging from 1 to 5 in terms of their importance for effective rural and remote practice. Nine attributes and 29 competencies progressed to Round 2. All nine attributes and 29 competencies were identified as essential or important for junior physicians' ability to be effective in their practice. The essential attributes included professional quality related to prioritising the rural community. The essential competencies included medical skills, professional behaviour, interprofessional skills, health promotion and connection to the rural community. The consensus thus reached on these essential and important attributes and competencies can inform curriculum development for the undergraduate and postgraduate training of junior rural and remote physicians.

Medical schools have a duty of care to support student wellbeing but there is little guidance on how to translate this mandate into practice. Often schools focus on implementing and reporting individual-level interventions which typically only address one aspect of wellbeing. Conversely, less attention has been paid to holistic school-wide approaches towards student wellbeing that address multiple wellbeing dimensions. Thus, this review sought to improve our understanding of how support is mediated within such school-wide wellbeing programmes. This critical narrative review was conducted in two stages. First, the authors searched several key databases for papers published up to 25th May 2021, using a systematic search strategy and TREND checklist to guide our data extraction process. We later expanded our search to include literature published from the original date to 20th May 2023. Second, the identified articles were critically analysed using activity theory as a theoretical lens to aid explanation. We found school-wide wellbeing programmes emphasize social connectivity and building a sense of community. Tutors take a key role in the activity of supporting students' wellbeing. We mapped out the activity system components to describe the complexity of this tutor role. This analysis illustrated: tensions and contradictions in the system which may open up opportunities for change; the importance of context for influencing how system components interact; and that students' trust underpins the whole activity system. Our review shines a light into the black-box of holistic school-wide wellbeing programmes. We identified that tutors play a key role in wellbeing systems but confidentiality is a recurring tension which may jeopardise a wellbeing system. The time has come to investigate these systems in more detail, embracing and exploring the role of context at the same time as looking for common threads.

Background: The Reducing Disability in Alzheimer's Disease in Kansas City (RDAD-KC) intervention has been shown to improve the health of individuals with dementia and caregiver dyads. This manuscript reports the results of implementing the RDAD among individuals with intellectual disabilities and caregiver dyads. Methods: Nine community agencies deployed the 12-week intervention. We assessed changes in individuals with intellectual disabilities' behavioural symptom related severity and physical activity, and caregivers' behavioural symptom-related distress, unmet needs, and caregiver strain. Results: Forty-four dyads enrolled, and 23 (~60 years, 48% female) completed [greater than or equal to] 75% of the intervention. We observed decreases in behavioural symptom related severity (p = 0.07) and increases in physical activity (p = 0.20) among individuals with intellectual disabilities. We also observed decreases in behavioural symptom related distress (p = 0.14), unmet needs (p = 0.50), and caregiver strain (p = 0.50) among caregivers. Conclusions: The RDAD-KC intervention showed promising, although statistically non-significant, benefits among individuals with intellectual disabilities and their caregivers.