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Objective School-based vision programs (SBVPs) are one approach to increase access to vision care by providing vision screenings, eye examinations, and eyeglasses directly in schools. Few studies report on the perspectives of teachers and staff, who are important stakeholders, on SBVPs. We examined teacher and staff perspectives on their involvement in SBVPs. Design Qualitative study using focus groups. Participants Teachers and staff at Baltimore and Chicago public schools served by SBVPs between 2016 and 2018. Methods We conducted 21 semistructured focus groups with 117 teachers and staff in 10 Baltimore and 11 Chicago public preK–12 schools that participated in SBVPs. Sessions were recorded, transcribed, and coded using inductive thematic analysis. Results Participants identified 2 main themes regarding teacher and staff involvement in SBVPs: (i) program outreach, including using multiple communication modalities to engage parents, explaining program details to families, and helping with program consent form return and (ii) promoting vision health, including identifying vision problems in the classroom, encouraging eyeglasses wear, and supporting eyeglasses maintenance. Participants also discussed limitations in capacity to partake in these activities. Conclusion Teachers interact with parents and students throughout the SBVP process, undertaking important roles in outreach and health promotion to ensure uptake of SBVP services. SBVPs and other school-based health programs should explore strategies to support teachers in the roles they fill to optimize program impact.

Background Food access is an important aspect of health promotion for the elderly. The aim of this study was to investigate the relationship between distance to the nearest food store and diet variety in rural community-dwelling elderly Japanese. Methods This cross-sectional study analyzed data from 1,103 elderly participants surveyed by mail in rural areas of Japan. Diversity of food intake was assessed by diet variety score (DVS). Street network distance from home to food store was calculated and categorized by quartile using a geographic information system and analyzed in relation to diet by multivariable regression with the primary outcome as low DVS. Sub-analysis of the association with DVS was conducted for each food store category (convenience store, supermarket and small food store). The association between intake frequency of each food group and distance was also analyzed. Results Participants in the fourth quartile of distance to food store had significantly higher prevalence ratio (1.15, 95% CI, 1.01-1.32) for low DVS than those in the first quartile. There was a significant tendency between greater distance to food store and lower DVS (p for trend = 0.033). Supermarkets and convenience stores, in particular, showed significant associations. Greater distance was significantly associated with lower frequency of meat and fruit intake. Conclusions There was significant association between distance to nearest food store and diet variety in rural Japanese elderly. These findings suggest the importance of interventions for areas at high risk of low diet variety, such as places far away from food stores.

Study Objective The purpose of this study was to examine feasibility, acceptability, and preliminary efficacy of a mindfulness-based healthy lifestyle self-management intervention with adolescents and young adults diagnosed with polycystic ovary syndrome (PCOS). Design A pilot randomized controlled trial using a pre-post design was used. Setting Central Texas. Participants: Individuals aged 14-23 with a diagnosis of PCOS. Interventions The PCOS Kind Mind Program integrates a manualized mindfulness training program (Taming the Adolescent Mind) with health education in four key areas of self-management and health promotion; (1) medication adherence, (2) nutrition, (3) physical activity, and (4) sleep. Main Outcome Measures Psychological distress, mindfulness, physical activity strategies, nutrition and exercise self-efficacy. Results Linear regression models revealed that those in the PCOS Kind Mind condition reported significantly higher nutrition self-efficacy (β = 6.50, 95% CI = 1.71 – 11.28, p = 0.013, d = 0.48), physical activity strategies (β = 0.41, 95% CI = 0.04 – 0.79, p = 0.040, d = 0.67), and physical activity self-efficacy (β = 0.48, 95% CI = 0.07 – 0.88, p = 0.028, d = 0.46). Conclusion The PCOS Kind Mind Program improved self-efficacy in the key areas of nutrition and physical activity and increased physical activity strategies in adolescents and young people with PCOS. These findings are encouraging and suggest the need for larger scale, randomized controlled trials with longer-term follow-up in order to more robustly evaluate the PCOS Kind Mind Program on the psychological and physiological health of adolescents and young people with PCOS.

OBJECTIVES: America’s overdose crisis spurred rapid expansion in the number and scope of prescription drug monitoring programs (PDMPs). As their public health impact remains contested, little is known about PDMP user experiences and perspectives. We explore perspectives of PDMP end-users in Massachusetts. METHODS: Between 2016–2017, we conducted semi-structured qualitative interviews on overdose crisis dynamics and PDMP experiences with a purposive sample of 18 stakeholders (prescribers, pharmacists, law enforcement, and public health regulators). Recordings were transcribed and double-coded using a grounded hermeneutic approach. RESULTS: Perspectives on prescription monitoring as an element of overdose crisis response differed across sectors, but narratives often critiqued PDMPs as poorly conceived to serve end-user needs. Respondents indicated that PDMP: 1) lacked clear orientation towards health promotion; 2) was not optimally configured or designed as a decision support tool, resulting in confusion over interpreting data to guide health care or law enforcement actions; and, 3) problematized communication and relationships between prescribers, pharmacists, and patients. CONCLUSION: User insights must inform design, programmatic, and policy reform to maximize PDMP benefits while minimizing harm. Their collateral impact may be compounded by COVID-19.

Physical activity and its sustained and purposeful performance – exercise – promote a broad and diverse set of metabolic and cardiovascular health benefits. Regular exercise is the most effective way to improve cardiorespiratory fitness, a measure of one’s global cardiovascular, pulmonary and metabolic health and one of the strongest predictors of future health risk. Here, we describe how exercise affects individual organ systems related to cardiometabolic health, including the promotion of insulin and glucose homeostasis through improved efficiency in skeletal muscle glucose utilization and enhanced insulin sensitivity; beneficial changes in body composition and adiposity; and improved cardiac mechanics and vascular health. We subsequently identify knowledge gaps that remain in exercise science, including heterogeneity in exercise responsiveness. While the application of molecular profiling technologies in exercise science has begun to illuminate the biochemical pathways that govern exercise-induced health promotion, much of this work has focused on individual organ systems and applied single platforms. New insights into exercise-induced secreted small molecules and proteins that impart their effects in distant organs (“exerkines”) highlight the need for an integrated approach towards the study of exercise and its global effects; efforts that are ongoing.

Introduction and objectives Childhood obesity trends are plateauing in Spain, but limited information is available about how they differ by region. This study assessed childhood and adolescent the prevalence and incidence of overweight and obesity from 2005 to 2017 across 8 Spanish regions. Methods This longitudinal study used height and weight measurements from 2.5 million children aged 2 to 17 years to calculate overweight and obesity, according to the World Health Organization (WHO) guidelines. Data were obtained from The Base de datos para la Investigacion Farmacoepidemiologica en Atencion Primaria, and the Information System for Research in Primary Care. Prevalence and incidence rates and trends from 2005 to 2017 were calculated and stratified by age, sex, and region. Results The overall obesity prevalence increased in boys and girls from age 2 (0.8%; 95%CI, 0.8-0.9 in both sexes) until peaking at age 7 in girls (17.3%; 95%CI, 17.1-17.5) and age 9 in boys (24.1%; 95%CI 23.9-24.3). The highest and lowest obesity prevalences were observed in Murcia and Navarre. Overall obesity prevalence trends decreased from 2005 to 2017 in all age-sex groups and in most regions. Highest obesity incidence rates were found in children aged 6 to 7 years, (4.5 [4.5-4.5] and 3.5 [3.5-3.5] new obesity cases per 100 person-years in boys and girls, respectively). Boys had higher prevalence and incidence rates than girls across all regions. Overweight/obesity prevalence and incidence rates and their trends were consistently higher than the obesity results, although a similar pattern was observed across sex and age. Conclusions Overweight and obesity prevalence slightly decreased in Spain from 2005 to 2017, but regional, sex, and age differences persisted. Because incidence peaked around the age of 6 years, it may be important to begin health promotion programs at an early age.

Faith-based health programs reach broad populations and can reduce health disparities. Nurses working in communities and churches can promote health behaviors that may reduce the incidence and impact of chronic conditions. This 5-week faith-based health outreach resulted in improvement of health-promoting behaviors, including better stress management, among women.

Background: Social network analysis provides a perspective and method for inquiring into the structures that comprise online groups and communities. Traces from interaction via social media provide the opportunity for understanding how a community is formed and maintained online. Objective: The paper aims to demonstrate how social network analysis provides a vocabulary and set of techniques for examining interaction patterns via social media. Using the case of the #hcsmca online discussion forum, this paper highlights what has been and can be gained by approaching online community from a social network perspective, as well as providing an inside look at the structure of the #hcsmca community. Methods: Social network analysis was used to examine structures in a 1-month sample of Twitter messages with the hashtag #hcsmca (3871 tweets, 486 unique posters), which is the tag associated with the social media–supported group Health Care Social Media Canada. Network connections were considered present if the individual was mentioned, replied to, or had a post retweeted. Results: Network analyses revealed patterns of interaction that characterized the community as comprising one component, with a set of core participants prominent in the network due to their connections with others. Analysis showed the social media health content providers were the most influential group based on in-degree centrality. However, there was no preferential attachment among people in the same professional group, indicating that the formation of connections among community members was not constrained by professional status. Conclusions: Network analysis and visualizations provide techniques and a vocabulary for understanding online interaction, as well as insights that can help in understanding what, and who, comprises and sustains a network, and whether community emerges from a network of online interactions.

The main aim of this paper is to argue for the centrality of ‘trust’ for the development and maintenance of health and wellbeing of individuals, communities and societies. I argue that public health practitioners and policy makers need to take ‘public trust’ seriously if they intend to both improve the public’s health and improve engagement between members of the public and public health systems. Public health practitioners implement a range of services and interventions aimed at improving health, but implicit within this is a requirement for individuals to trust the practitioners and the services/interventions, before they will engage with them. I then go on to provide an overview of the theory of trust within sociology and show why it is important to understand this theory in order to promote trust in public health services. I then draw on literature in three classic areas of public health - hospitals, cancer screening and childhood immunisation - to show why trust is vital in terms of understanding and potentially improving uptake of services. The case studies within this paper reveal that public health practitioners need to understand the centrality of building and maintaining trusting relationships with patients/clients because people who distrust public health services are less likely to use them, less likely to follow advice or recommendations and more likely to have poorer health outcomes.

Background: In this paper, we present the protocol for a cluster-randomised trial to evaluate the implementation and effectiveness of a workplace mental health intervention in the state-wide police department of the south-eastern Australian state of Victoria. n. The primary aims of the intervention are to improve psychosocial working conditions and mental health literacy, and secondarily to improve mental health and organisational outcomes. Methods/design: The intervention was designed collaboratively with Victoria Police based on a mixed methods pilot study, and combines multi-session leadership coaching for the senior officers within stations (e.g., Sergeants, Senior Sergeants) with tailored mental health literacy training for lower and upper ranks. Intervention effectiveness will be evaluated using a two-arm cluster-randomised trial design, with 12 police stations randomly assigned to the intervention and 12 to the non-intervention/usual care control condition. Data will be collected from all police members in each station (estimated at >20 per station). Psychosocial working conditions (e.g., supervisory support, job control, job demands), mental health literacy (e.g., knowledge, confidence in assisting someone who may have a mental health problem), and mental health will be assessed using validated measures. Organisational outcomes will include organisational depression disclosure norms, organisational cynicism, and station-level sickness absence rates. The trial will be conducted following CONSORT guidelines. Identifying data will not be collected in order to protect participant privacy and to optimise participation, hence changes in primary and secondary outcomes will be assessed using a two-sample t-test comparing summary measures by arm, with weighting by cluster size. Discussion: This intervention is novel in its integration of stressor-reduction and mental health literacy-enhancing strategies. Effectiveness will be rigorously evaluated, and if positive results are observed, the intervention will be adapted across Victoria Police (total employees ~16,500) as well as possibly in other policing contexts, both nationally and internationally. Trial registration: Current Controlled Trials: ISRCTN82041334. Registered 24th July, 2014.

Understanding COVID-19 vaccine acceptability among clients and staff of homeless shelters can inform public health efforts focused on communicating with and educating this population about COVID-19 vaccines and thus improve vaccine uptake. The objective of this study was to assess COVID-19 vaccine acceptability and uptake among people in homeless shelters in Detroit, Michigan. A cross-sectional study was conducted from February 9 to 23, 2021. Seventeen homeless shelters were surveyed: seven male-only, three male/female, and seven women and family shelters. All clients and staff aged ≥18 years and able to complete a verbal survey in English or with a translator were eligible to participate; of the 168 individuals approached, 26 declined, leaving a total sample of 106 clients and 36 staff participating in the study. The median client and staff ages were 44 and 54 years, respectively. Most participants (>80%) identified as non-Hispanic Black or African American. Sixty-one (57.5%) clients and 27 (75.5%) staff had already received or planned to receive a COVID-19 vaccination. Twelve (11.3%) clients and four (11.1%) staff were unsure, and 33 (31.1%) clients and five (13.9%) staff did not plan to get vaccinated. Reasons for hesitancy were concerns over side effects (29 clients [64.4%] and seven staff [77.8%]) and unknown long-term health impacts (26 clients [57.8%] and six staff [66.7%]). More than half of the clients had already received or planned to receive the vaccine. Continuing efforts such as vaccine education for hesitant clients and staff and having accessible vaccine events for this population may improve acceptability and uptake.

Domestic violence creates multiple harms for women's health and is a ‘wicked problem’ for health professionals and public health systems. Brazil recently approved public policies to manage and care for women victims of domestic violence. Facing these policies, this study aimed to explore how domestic violence against women is usually managed in Brazilian primary health care, by investigating a basic health unit and its family health strategy. We adopted qualitative ethnographic research methods with thematic analysis of emergent categories, interrogating data with gender theory and emergent Brazilian collective health theory. Field research was conducted in a local basic health unit and the territory for which it is responsible, in Southern Brazil. The study revealed: 1) a yawning gap between public health policies for domestic violence against women at the federal level and its practical application at local/decentralized levels, which can leave both professionals and women unsafe; 2) the key role of local community health workers, paraprofessional health promotion agents, who aim to promote dialogue between women experiencing violence, health care professionals and the health care system. Resumo A violência doméstica (VD) cria múltiplos agravos à saúde das mulheres e é um desafio para profissionais e para os sistemas de saúde. O Brasil aprovou recentemente políticas públicas (PP) para manejo e cuidado de mulheres em situação de VD. Considerando essas PP, este estudo objetivou explorar como a VD contra mulheres é usualmente manejada na atenção primária à saúde brasileira, por meio da investigação de uma unidade básica de saúde e de sua estratégia de saúde da família. Foi adotada metodologia de pesquisa qualitativa de cunho etnográfico, com análise temática de categorias emergentes, interrogando os dados com teoria de gênero e com a produção teórica do campo da saúde coletiva brasileira. A pesquisa de campo foi conduzida em uma unidade básica de saúde e em seu território adscrito, localizado na região sul do Brasil. O estudo revelou: 1) um hiato entre PP direcionadas à VD contra mulheres implantadas a nível federal e sua aplicação prática a nível local/descentralizado, que pode deixar tanto profissionais quanto mulheres em risco; 2) o papel chave de agentes comunitários de saúde, profissionais de promoção da saúde, que objetivam promover o diálogo entre as mulheres experienciando violência, profissionais de saúde e o sistema de saúde.

The 17 sustainable development goals (SDGs) were established by the United Nations Agenda 2030 plan of action to achieve peace, prosperity, and well-being for all by 2030. SDG 3 aims to ensure healthy lives and promote well-being for all at all ages. However, oral health is not specifically mentioned and targeted in SDG 3. Numerous studies have demonstrated a connection between oral health and general health. Oral disease and the common non-communicable diseases have the co-existing modifying risk factors. In addition, oral health is associated with social, economic, cultural, and environmental problems. By the implementation of oral health care, oral health promotion, and universal health coverage, these could not only be good for oral health but also benefit for general health and well-being. Taken together, oral health is the first step to SDG 3.

Introduction: Dentists play a fundamental role in the detection of lesions in maxillofacial complex through the appropriate examination. Identification, diagnosis and proper conduct of these professionals are configured as a differential in health promotion. The lack of familiarization of dentists with Oral Medicine is something already reported in the literature. This lack of affinity can lead to the adoption of erroneous behaviors regarding oral lesions, which generate unnecessary burdens on public health. Objective: To evaluate the level of knowledge on Oral Medicine of dentists who work in Primary Health Care in the city of Arcoverde, Pernambuco, Brazil. Methodology: This is an observational, inductive, statistical study with a quantitative approach. The research was carried out in Arcoverde-PE. The study population involves dentists working in the Basic Health Units of the city. The data were collected through a questionnaire prepared by the researchers, containing 27 questions about the most common oral lesions, clinical diagnosis and conduct towards specific clinical diagnoses. The level of knowledge was measured from the mean of correct answers by the professionals. Collected data were processed using the IBM SPSS 20.0® statistical program. Results: The sample obtained was thirteen dentists. The mean of correct answers on specific knowledge on Oral Medicine was 17 (± 3.109). As for the classification of general performance, most professionals (69.2%) performed regularly. As for specific knowledge about clinical diagnosis, the knowledge was classified as high for the majority (53.8%). In relation to specific knowledge about the appropriate behaviors in relation to injuries, the performance classification was low for most participants (84.6%). Conclusions: In general, dentists obtained a regular performance of knowledge on Oral Medicine. Further, research is recommended due to the scarcity of discussions on the topic in the literature. Uniterms: Dentists; Oral Medicine; Primary Health Care

OBJECTIVES To evaluate the effectiveness of a multi-component school-based intervention on physical activity (PA) and screen time (ST) among urban adolescents in Bangladesh. DESIGN Cluster-randomised controlled trial. METHODS Eight high schools were randomly assigned to either intervention group (IG) or control group (CG). Participants (n = 160 per group, 40 school) were in grades 8-9. A 12-week multi-component intervention was developed based on the WHO's Health-Promoting Schools framework. The IG received weekly supervised circuit exercise (30 min/week), health education session (10 min/week) with health educational materials, and lunchtime sports activities (20 min/week). The main outcome measures included self-reported PA, ST, knowledge on PA and SB, which were assessed at baseline, 8 and 12 weeks. Repeated measures ANCOVA was used to evaluate the intervention effects. RESULTS Total PA (MET-min/week) was increased from baseline to 8 and 12 weeks in the IG (3%-5%) but decreased in the CG (5%-3%) and significantly improved in the IG compared to the CG (p

Objectives Launched in 2011 by the Public Health Agency of Canada, the Canadian Diabetes Risk Questionnaire (CANRISK) is a self-assessment tool validated in a Canadian sample, but its uptake has never been assessed. We sought to determine the level of current use of the CANRISK tool, identify common facilitators and barriers to its use and recommend future improvements. Methods Ten professional allied health organizations across Canada were contacted for in-depth interviews. Contextual content and thematic analysis were used to analyze the qualitative data set. Results According to allied health professionals, the tool is widely used, appealing and needed, and is being used for risk screening and health promotion. Respondents also identified the need to provide support and next steps for users identified as high risk. Still, several barriers to implementation were found, including readability, offensive or confusing language and difficulty ascertaining body measurements. Conclusions The CANRISK is a valuable diabetes risk assessment tool in Canada, particularly for allied health organizations.

Lifestyle-related non-communicable diseases (NCDs) and their risk factors are unequivocally associated with SARS-CoV-2 susceptibility and COVID-19 severity. NCD manifestations and their lifestyle risks are associated with chronic low-grade systemic inflammation (CLGSI). This review supports that immuno-modulation with positive lifestyle change aimed at reducing SARS-CoV-2 susceptibility and COVID-19 severity, is a goal consistent with contemporary physiotherapy practice. Physiotherapists have a long tradition of managing a , thus, managing CLGSI is a logical extension. Improving patients' lifestyle practices also reduces their NCD risks and increases activity/exercise capacity, health and wellbeing - all principal goals of contemporary physiotherapy. The COVID-19 pandemic lends further support for prioritising health and lifestyle competencies including smoking cessation; whole food plant-based nutrition; healthy weight; healthy sleep practices; and stress management; in conjunction with reducing sedentariness and increasing physical activity/exercise, to augment immunity as well as function and overall health and wellbeing. To support patients' lifestyle change efforts, physiotherapists may refer patients to other health professionals. The authors conclude that immuno-modulation with lifestyle behaviour change to reduce susceptibility to viruses including SARS-CoV-2, is consistent with contemporary physiotherapy practice. Immuno-modulation needs to be reflected in health competencies taught in physiotherapy professional education curricula and taught at standards comparable to other established interventions. ispartof: Physiotherapy vol:114 pages:63-67 ispartof: location:England status: Published online

Background: Physical activity (PA) has substantial health benefits and is important in combatting chronic diseases, which have been associated with elevated levels of advanced glycation endproducts (AGEs). AGEs play a role in the aging process, and an association between PA and AGEs has been reported. We aimed to investigate the relationship between PA and AGE accumulation in a general population and in a population with chronic diseases.Methods: This large cross-sectional population study used data from adult participants in the LifeLines project, with participant information drawn from the LifeLines database as well data from patients with diabetes mellitus or renal and/or cardiovascular diseases. Tissue AGE accumulation was assessed non-invasively by skin-autofluorescence (SAF) using an AGE reader (DiagnOptics Technologies BV, Groningen, the Netherlands). PA was assessed using the short questionnaire to assess health-enhancing physical activity (SQUASH). Multivariate linear regression analyses were adjusted for age, body mass index, sex, and smoking status.Results: Data from 63,452 participants (general population n = 59,177, chronic disease n = 4275) were analyzed. The general population was significantly younger (43.58 +/- 11.77 years, mean +/- SD) and had significantly lower SAF (1.90 +/- 0.42 arbitrary units (AU)) compared to the population with chronic disease (age: 55.51 +/- 12.07 years; SAF: 2.27 +/- 0.51 AU). In the group with chronic disease, more hours of moderate to vigorous physical activities per week were associated with lower SAF (beta= -0.002, 95% confidence interval (95%CI): -0.002 to -0.001). For the general population, there was no association between hours of moderate to vigorous activity and SAF (beta= 3.2 x 10(-5), 95%CI: 0.000-0.001, p = 0.742). However, there was an association in the general population between total hours of PA per week and SAF (beta= 4.2 x 10(-4), 95%CI: 0.000-0.001, p < 0.001), but this association was not found in the chronic disease population (beta = -3.2 x 10(-4), 95%CI: -0.001 to 0.000, p = 0.347).Conclusion: Our study demonstrates that an inverse relationship exists between PA and AGE accumulation in the population with chronic disease. More hours of moderate to vigorous activity is associated with a significantly decreased SAF. More PA is associated with a lower SAF, even after adjusting for the established predictors (age, body mass index, smoking status, and sex). Our findings could help to promote health and prolong longevity.

Zika virus (ZIKV) can be sexually transmitted and can lead to severe neonatal and child health issues. The current study examines whether ZIKV-related ideational factors, including awareness of ZIKV and associated birth defects, are related to modern contraceptive use among women and men with sexual partners in four Latin American and Caribbean (LAC) countries. Data used are from cross-sectional household surveys conducted in 2018 in the Dominican Republic, El Salvador, Guatemala, and Honduras with representative samples of men and women aged 18–49 (N = 1,100). The association between self-reported use of modern contraception and measures of Zika knowledge, risk perceptions and social norms, and contraceptive self-efficacy was examined via sex disaggregated multivariate logistic regression models. Both men (OR 3.70, 95% CI 1.36–10.06, P P P

Objective: People with intellectual disabilities (ID) are largely dependent on their environment to live healthily and, in this, ID-support organizations play a vital role. An environmental asset mapping tool for ID-support settings has been developed. This study aims to provide insight into whether or not the tool can provide a comprehensive view on assets in the system and actionable knowledge to improve healthpromoting capacities in ID-support settings. Methods: Fifty-seven users from four setting completed the tool on availability, user satisfaction, and dreams regarding social, physical, organizational, and financial assets. Results: The findings provide a comprehensive view of available assets. Together with user satisfaction and dreams for improvements, they provide actionable knowledge for improving the health-promoting capacities of the settings, including: (1) how use of available assets can be improved, (2) the type of assets that should be enriched, and (3) the assets that can be added to the system. Conclusion: The asset mapping tool provides a comprehensive view on assets in the system and actionable knowledge to improve health-promoting capacities in ID-support settings. Practice implications: ID-support organizations can use the tool to generate actionable bottom-up knowledge for priority setting and implementing interventions to improve their health-promoting capacities. (c) 2021 The Author(s). Published by Elsevier B.V. CC_BY_NC_ND_4.0

The digital era is introducing technological innovations that create valuable data resources and provide opportunities to health care providers to more effectively communicate, treat, and manage patient populations. However, in order to achieve effective and financially viable population management solutions, a number of elements are required. These include domain expertise in the health care spectrum, application of appropriate technologies, and analytics that address effectiveness and valuation issues (eg, cost, revenue streams) in generating proposed solutions in population management. This work provides a conceptual framework that illustrates the various elements essential to achieve success in population health management with an emphasis on behavioral health. These elements include domain-specific knowledge of medical ailments, application and management of appropriate technologies including digital platforms, and data and analytic approaches such as actuarial and financial informatics that are essential to achieving a sustainable valuation in managing the health of a population.

Objectives Lifestyle interventions during pregnancy improve maternal and infant outcomes. We aimed to compare the cost-effectiveness of 4 antenatal lifestyle intervention types with standard care. Methods A decision tree model was constructed to compare lifestyle intervention effects from a novel meta-analysis. The target population was women with singleton pregnancies and births at more than 20 weeks’ gestation. Interventions were categorized as diet, diet with physical activity, physical activity, and mixed (lacking structured diet and, or, physical activity components). The outcome of interest was cost per case prevented (gestational diabetes, hypertensive disorders in pregnancy, cesarean birth) expressed as an incremental cost-effectiveness ratio (ICER) from the Australian public healthcare perspective. Scenario analyses were included for all structured interventions combined and by adding neonatal intensive care unit costs. Costs were estimated from published data and consultations with experts and updated to 2019 values. Discounting was not applied owing to the short time horizon. Results Physical activity interventions reduced adverse maternal events by 4.2% in the intervention group compared with standard care and could be cost saving. Diet and diet with physical activity interventions reduced events by 3.5% (ICER = A$4882) and 2.9% (ICER = A$2020), respectively. Mixed interventions did not reduce events and were dominated by standard care. In scenario analysis, all structured interventions combined and all interventions when including neonatal intensive care unit costs (except mixed) may be cost saving. Probabilistic sensitivity analysis showed that for physical activity and all structured interventions combined, the probability of being cost saving was 58% and 41%, respectively. Conclusions Governments can expect a good return on investment and cost savings when implementing effective lifestyle interventions population-wide.

Objectives: The Pasifika Prediabetes Youth Empowerment Programme (PPYEP) was a community‐based research project that aimed to investigate empowerment and co‐design modules to build the capacity of Pasifika youth to develop community interventions for preventing prediabetes. Methods: This paper reports findings from a formative evaluation process of the programme using thematic analysis. It emphasises the adoption, perceptions and application of empowerment and co‐design based on the youth and community providers’ experiences. Results: We found that the programme fostered a safe space, increased youth's knowledge about health and healthy lifestyles, developed their leadership and social change capacities, and provided a tool to develop and refine culturally centred prediabetes‐prevention programmes. These themes emerged non‐linearly and synergistically throughout the programme. Conclusions: Our research emphasises that empowerment and co‐design are complementary in building youth capacity in community‐based partnerships in health promotion. Implications for public health: Empowerment and co‐design are effective tools to develop and implement culturally tailored health promotion programmes for Pasifika peoples. Future research is needed to explore the programme within different Pasifika contexts, health issues and Indigenous groups.

Background Handwashing has long been promoted to maintain health and in preventing disease transmission. One of the most valuable ways to convey messages related to handwashing is through visual display, such as video for educational purposes and to enhance learning. Social media is an important and popular way to disseminate messages to a wide audience. Methods In this cross-sectional, descriptive study, two hashtags, #WashYourHands and #SafeguardSplash were used to select the sample of 100 from available TikTok videos. In order to code each video, the same coding categories were used for both hashtags, including (1) wetting and rinsing hands (2) lathering soap (3) time used for scrubbing (4) drying hands (5) mentions COVID-19 (6) mentions using hand sanitizer instead of soap (7) mentions how germs spread (8) mentions key times to wash hands (9) and actual depiction of washing hands. Additional descriptive categories were coded as well. The observations recorded were tabulated and descriptive statistics were performed. Independent one-tailed t-tests (α = .05) were calculated to determine if a video's hashtag had a significant association with its garnered views, likes, and/or comments. Results In total, the 100-video sample received 1,990,834,567 views, 40,355,468 likes, and 173,422 comments. Despite the fact that each hashtag made up an equal proportion (50%) of the total sample, videos with #WashYourHands accounted for 93.3% of the total views. Coverage of the important steps involved in handwashing, such as drying hands, was minimal as was relevant background information. Conclusion The results indicate that while this opportunity is being realized to some degree, the majority of videos did not cover topics related important concepts of hand hygiene. Given the high engagement of younger audiences with TikTok, this could be a powerful mechanism for demonstrating and encouraging proper handwashing, especially in a population with low rates of handwashing.

Post-stroke patients have risk factors for recurrent stroke. The main risk factor is hypertension. The purpose of this community service activity is to improve the ability of the community, especially post-stroke patients, to control hypertension as a risk factor for recurrent stroke through identification of risk factors, health education and the application of light activity and deep breathing exercises. Before education is given, post-stroke patients and their families are given prestest first and after education, posttest returns to evaluate the patient's understanding. The results of the activity, there was a significant difference between the knowledge before and after being given education to post-stroke patients and their families with p value

Introduction Knowing the information regarding the panorama of lymphoma diagnosis in patients treated in the Brazilian Public Unified Health System from the last 10 years is a challenge for Strategic Health Planning. Objective To characterize the Brazilian population with lymphoma treated in the Brazilian Public Unified Health System between 2008 and 2017 regarding staging, sex, residence site and mortality. Material and methods A descriptive, retrospective, and longitudinal trial with secondary data from DataSUS (SIA/SUS and SIM/SUS) obtained from patients with ICD-10 C81−85. Results There were 70,850 lymphoma cases between 2008 and 2017, of which 55% were male, the median age was 51 years, and 27% had Hodgkin Lymphoma. Most patients (56%) were treated outside the residence city. Sao Paulo State accounted for 25% of patients. Treatment initiation took more than 60 days in 27% of cases. A total of 45,601 deaths were due to lymphoma (12% Hodgkin Lymphoma and 88% Non-Hodgkin Lymphoma), with a median age 63 years, and were mainly males (55%). Staging data were inadequate in 23% of patients, and analysis was performed only on the valid records. Advanced disease was diagnosed in 58% of patients (60% male; 57% female) and was more common in Non-Hodgkin Lymphoma (62%) versus Hodgkin Lymphoma (49%). Discussion Late diagnosis interferes with mortality rates. Health promotion and cancer prevention campaigns, especially targeting the male public, and training for early diagnosis and early treatment are needed. Conclusion Effective measures for early diagnosis and treatment are urgently needed for lymphoma control.

BACKGROUND: It is unknown whether behavioral interventions to improve diet are effective in people with a genetic predisposition to obesity. OBJECTIVES: To examine associations between BMI genetic risk and changes in weight and workplace purchases by employees participating in a randomized controlled trial of an automated behavioral workplace intervention to promote healthy food choices. METHODS: Participants were hospital employees enrolled in a 12-mo intervention followed by a 12-mo follow-up. Hospital cafeterias utilized a traffic-light labeling system (e.g., green = healthy, red = unhealthy) that was used to calculate a validated Healthy Purchasing Score (HPS; higher = healthier). A weighted genome-wide BMI genetic score was generated by summing BMI-increasing alleles. RESULTS: The study included 397 adults of European ancestry (mean age, 44.9 y; 80.9% female). Participants in the highest genetic quartile (Q4) had a lower HPS and higher purchases of red-labeled items relative to participants in the lowest quartile (Q1) at baseline [Q4–Q1 Beta HPS, –4.66 (95% CI, –8.01 to –1.32); red-labeled items, 4.26% (95% CI, 1.45%–7.07%)] and at the 12-mo [HPS, –3.96 (95% CI, –7.5 to –0.41); red-labeled items, 3.20% (95% CI, 0.31%–6.09%)] and 24-mo [HPS, –3.70 (95% CI, –7.40 to 0.00); red-labeled items, 3.48% (95% CI, 0.54%–6.41%)] follow-up periods. In the intervention group, increases in HPS were similar in Q4 and Q1 at 12 mo (Q4–Q1 Beta, 1.04; 95% CI, –2.42 to 4.50). At the 24-mo follow-up, the change in BMI from baseline was similar between Q4 and Q1 (0.17 kg/m(2); 95% CI, –0.55 to 0.89 kg/m(2)) in the intervention group, but higher in Q4 than Q1 (1.20 kg/m(2); 95% CI, 0.26–2.13 kg/m(2)) in the control group. No interaction was evident between the treatment arm and genetic score for BMI or HPS. CONCLUSIONS: Having a high BMI genetic risk was associated with greater increases in BMI and lower quality purchases over 2 y. The 12-mo behavioral intervention improved employees’ food choices, regardless of the genetic burden, and may have attenuated weight gain conferred by having the genetic risk.

Background Increasing participation in the Australian National Bowel Cancer Screening Program (NBCSP) is the most efficient and cost-effective way of reducing mortality associated with colorectal cancer by detecting and treating early-stage disease. Currently, only 44% of Australians aged 50–74 years complete the NBCSP. This efficacy trial aims to test whether this SMS intervention is an effective method for increasing participation in the NBCSP. Furthermore, a process evaluation will explore the barriers and facilitators to sending the SMS from general practice. Methods We will recruit 20 general practices in the western region of Victoria, Australia to participate in a cluster randomised controlled trial. General practices will be randomly allocated with a 1:1 ratio to either a control or intervention group. Established general practice software will be used to identify patients aged 50 to 60 years old who are due to receive a NBCSP kit in the next month. The SMS intervention includes GP endorsement and links to narrative messages about the benefits of and instructions on how to complete the NBCSP kit. It will be sent from intervention general practices to eligible patients prior to receiving the NBCSP kit. We require 1400 eligible patients to provide 80% power with a two-sided 5% significance level to detect a 10% increase in CRC screening participation in the intervention group compared to the control group. Our primary outcome is the difference in the proportion of eligible patients who completed a faecal occult blood test (FOBT) between the intervention and control group for up to 12 months after the SMS was sent, as recorded in their electronic medical record (EMR). A process evaluation using interview data collected from general practice staff (GP, practice managers, nurses) and patients will explore the feasibility and acceptability of sending and receiving a SMS to prompt completing a NBCSP kit. Discussion This efficacy trial will provide initial trial evidence of the utility of an SMS narrative intervention to increase participation in the NBCSP. The results will inform decisions about the need for and design of a larger, multi-state trial of this SMS intervention to determine its cost-effectiveness and future implementation. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12620001020976. Registered on 17 October 2020.

Background/purpose: Oral exercise is a training method for swallowing dysfunction in older adults. The study investigated the effect of oral exercise on tongue pressure in older adults in Taiwanese community day care centers over a 3-month period. Materials and methods: Participants over age 50 who were able to communicate and participating for the duration of the 12-week period were recruited from five community day care centers. A 15-min weekly group oral exercise activity was conducted. The tongue pressures were measured and multivariable linear regression models were used to assess the effect of oral exercise intervention on the participants’ tongue pressures. Results: A total of 66 older adult participants, among whom the mean age was 78.06 ± 10.74 years. Tongue pressure continued improving during the intervention period, and the mean tongue pressure at the end of the study was 20.63 ± 10.45 kPa, which was significantly higher than the baseline measurement (16.92 ± 10.62 kPa, p

Objectives Epidemiological data on cancer diseases are alarming. The workplace has become an increasingly important site for disseminating health information and implementing health promotion activities. Occupational medicine physicians (OMPs) have the opportunity to carry out primary and secondary preventive activities focused on civilization diseases, especially cancer. The aim of this study was to evaluate the potential of OMPs in cancer prevention, including the analysis of factors determining the implementation of preventive measures, as part of standard healthcare for employees. Material and Methods The study was conducted among 362 OMPs. The interviews were carried out by the computer assisted telephone interview (CATI) method. Results Over 60% of the surveyed OMPs are ready to implement cancer preventive activities among employees. The doctors with the longest seniority in occupational health services are more likely to declare unwillingness to implement cancer preventive activities. Patient’s consent, informing women about the program and adjusting the time of the medical visit are the most important conditions for introducing cancer prevention programs by OMPs. Neither seniority nor the number of examinations performed by a physician influenced the currently implemented cancer preventive activities as part of occupational health services (including the evaluation of cancer risk factors occurrence among employees). Conclusions In Poland, OMPs are willing to implement cancer preventive activities among employees, but their current activity in this area is limited and needs development. The most specific actions should be addressed to doctors with the longest seniority in occupational health services, who are frequently unwilling to implement cancer preventive activities. Strengthening the preventive potential of Polish occupational health services requires a systemic approach to the scope and way of action of healthcare professionals. Int J Occup Med Environ Health. 2021;34(6):723–36

Social media platforms are increasingly used by patients to research and discuss medical problems.The aim of this study was to identify by whom, how frequently, and in what manner allergic contact dermatitis (ACD) is discussed on social media sites.Search terms "allergic contact dermatitis" and "contact dermatitis" were queried across Twitter, Instagram, Reddit, Facebook, YouTube, and Google search metrics. The frequency, content, and creators of the content were assessed.ACD content was identified on all platforms, generated by by patients, physicians, professional organizations, and companies. When comparing the volume of posts, more content was on Instagram than Twitter, particularly among patients. Patient support groups were identified on Facebook but not on Reddit. A formal analysis of YouTube videos found that the medical information presented in these videos was often of poor quality.Patch testing physicians should be aware that information on ACD exists across social media sites. While some content is generated by physicians, patients and industry groups also post and share material. Patch testing physicians should know that there is an opportunity to share ACD information, but they should also be aware that patients are posting and creating online support communities independent of physicians.Online support communities exist for patients with ACD on Facebook. Online information is of lower quality, with a mean QUEST quality score of 7.4/28 on reviewed YouTube videos. Of the five social media sites reviewed, patients are most active on Instagram, Reddit, and Facebook. Approximately 9000 Google searches per month are conducted using contact dermatitis-related search terms. Differences in terminology exist between physicians and non-physicians. While the most popular hashtag term was "contact dermatitis", physicians disproportionately authored posts tagged with "allergic contact dermatitis."

Aim To clarify if Sense of Coherence could be used as an element of primary-focused health services in schools. Background The United Arab Emirates is striving to develop a high-quality, primary focused healthcare system. School healthcare services are well established in the UAE but have not yet been fully used to play a key role in this development. Methods Cross-sectional survey study to explore Adolescents SOC and their behavioral, psychosocial, and clinical outcomes. Results 408 adolescents participated in this study. Compared with others, adolescents with higher SOC had better adherence to treatment, fewer visits to the school nurse, better self-efficacy, fewer hyperactivity problems, fewer emotional problems, more prosocial behaviors, and fewer conduct problems. Conclusion Implementing interventions that improve SOC may support improved well-being among adolescents. The findings also support the use of SOC and salutogenesis as a framework to reinforce primary healthcare services for this population. Implications for nursing management Health service managers can utilize SOC as a framework to focus service on illness prevention and health promotion, they should collaborate with education authorities to include more health-related topics as part of school curricula to promote students SOC, and finally, should assess and build awareness of SOC and associated tools among school nurses and primary healthcare providers.

Objectives Although neighborhood is considered to be a crucial source of social network to promote health among older adults, current findings are mostly derived from observational study designs. This study examined whether participations in event-based community programs could increase neighborhood social network and whether such increase could lead to desirable changes in mental and physical health among older adults. Method This study employed quasi-experimental design. A baseline questionnaire survey was sent to residents of Tsurukabuto community aged 60 years or more (n = 1769); 1,068 responded. Community events were implemented approximately once a month for three years. Then, a three-year follow-up survey questionnaire was sent to the respondents of the baseline survey. The total number of respondents in the latter survey was 662; of the total, 173 participated in the intervention. Strong and weak ties with neighbors, mental well-being (Ikigai-9), health-related quality of life (HRQOL), and instrumental activity of daily living (IADL) were measured in the surveys. Results The path analysis revealed that intervention participation was significantly associated with changes in strong ties (standardized path coefficient = 0.12) and changes in strong ties were associated with those in Ikigai-9 scores (standardized path coefficient = 0.15). The total and indirect effects of intervention participation on Ikigai-9 scores were significant. Significant intervention effects were not observed for HRQOL and IADL scores. Conclusion This study found that participation in our event-based intervention could indirectly and positively influence older adults' mental well-being through their strong ties with their neighbors.

Objectives To analyze and compare the experience of climacteric symptoms and their associations with sociodemographic and health-related characteristics in two cohorts of Finnish women aged 52–56 years, born ten years apart and not now or previously on menopausal hormone therapy (MHT). Study design Nationwide population-based time-trend study with a large number of participants (n = 1986 + 1988). Main outcome measures The experience of climacteric symptoms was assessed by 12 commonly used menopause-related symptoms. Results Women aged 52–56 experienced more moderate or severe symptoms and fewer mild symptoms in 2010 than in 2000. Being unemployed or inactive was associated with more severe symptoms (P = 0.007), but employment status had no effect on the relative odds estimates. Conclusions The influence of the birth cohort and time-period effects as well as work-related factors on the experience of climacteric symptoms in women not now or previously on MHT needs further research, particularly since the change in the experience of symptoms found in this study occurred within only ten years.

Introduction Untreated dental caries is the most frequent childhood chronic disease worldwide. Silver diamine fluoride (SDF) offers a safe and effective alternative treatment, especially for children. Objective To inform the dental community about the efficacy of SDF in community dental caries programs and to advocate for its use as an affordable and equitable approach to promote health and well-being within the dental setting. Methods A summary of the literature shared during a webinar about the use and efficacy of SDF in community dental programs hosted by the Oral Health Working Group of the World Federation of Public Health Associations Results Based on the traditional “drill-and-fill” approach, the current treatment for severe caries is associated with pain, fear, and poor oral health outcomes in later life. Innovative approaches to prevent and control caries are needed. SDF offers an alternative treatment option for caries. It is a practical, affordable, and acceptable option for caries treatment, eliminating the need for general anaesthetic in young children, and improving long-term oral health outcomes. Conclusion SDF can improve oral health outcomes for community members, especially for individuals from low-socioeconomic settings.

Objective To assess the quality of national cancer screening program leaflets in Japan from the informed-decision perspective. Methods Cross-sectional content analysis of invitation leaflets issued by centralized organizations and used nationwide in Japan was conducted. Three members independently evaluated the materials using International Patient Decision Aids Standards six-item minimum criteria for qualifying patient decision aids. Patient public involvement Co-author KH is a cancer patient himself. We also sought feedbacks from three other cancer survivors and two bereaved family members. Results Inter-rater agreement was substantial (Fleiss’ kappa=0.62). The median score was 2 out of 6 (range: 2–3). All leaflets described the cancer (Q1: 7/7) and screening modality (Q2: 7/7). None stated not undergoing screening as an option. One stated another screening modality (Q3: 1/7). None stated both the positive and negative features of multiple options (Q4: 0/7. Q5: 0/7). One described the psychological and social experience of screening but only its positive side (Q6: 1/7). Conclusions There is room for improvement in the content of the public cancer screening invitation leaflets in Japan from informed-decision perspective. Practice implications Cancer screening leaflets should provide evidence-based, well-balanced, easy-to-understand information to educate people on cancer screening while maintaining people’s autonomy.

Introduction Osteoporosis is considered a healthcare problem due to the increased risk of fractures and high cost of care. In Colombia, the Ministry of Health introduced SISPRO, a tool to collect nationwide information from the health system. The information collected from SISPRO is available for scientific analysis. This article presents an analysis of the prevalence and characteristics of patients with osteoporosis using data from 2012 to 2018. Aim To estimate prevalence of osteoporosis between January 2012 to December 2018 and describe the patients’ demographic characteristics. Methods This is a descriptive epidemiological study using the International Statistical Classification of Diseases and Related Health Problems related to osteoporosis as search terms using the SISPRO database. Results National records report 249,803 patients over 50 years old diagnosed with osteoporosis. The estimated prevalence is 2440 cases per 100,000 inhabitants over 50 years old (based on a total population of 10,236,132), being more frequent in women (92% of cases), with a female/male ratio of 12.3:1. Conclusion This study shows a lower prevalence than previous estimates or projections. Given these findings we think it is necessary to act to promote health policies for patients with osteoporosis.

Purpose The absence of routine health check-ups during adolescence in low- and middle-income countries is a missed opportunity for prevention, early identification, and treatment of health issues, and health promotion. We aimed to codesign the content and delivery for routine adolescent health checkups in Zimbabwe, with adolescents and key adults in their lives. Methods We held participatory workshops with adolescents (16 workshops; 96 adolescents) and parents (8 workshops; 95 parents), and in-depth interviews with key informants including policymakers, programmers, and healthcare workers (n = 25). Analysis was iterative and the design of the checkups was refined based on participant preferences, document review of burden of disease data, and feasibility considerations. Results Participants overwhelmingly supported the introduction of routine health checkups. Reported facilitators to attendance included free cost and desire to know one’s health status. Barriers included tendencies for health service seeking only when ill, fear of diagnosis and judgment, and religious beliefs. Delivery preferences were by nonjudgmental medical professionals, in a youth friendly environment, and accompanied by youth engagement activities. Preferred location was schools for younger adolescents (10–14 years), and community settings for older adolescents (15–19 years). Prioritized content included sexual health, oral health, mental health, hearing, eyesight, growth and nutrition, anemia, immunization, and deworming, based on health burden and participant preferences. Discussion This study resulted in an outline design of two routine health checkups with stakeholders in Zimbabwe, in schools for young adolescents, and in community settings for older adolescents. Evidence of feasibility, effectiveness, and cost-effectiveness of such checkups is required.

Background: The provision of health information via whatsapp media can increase knowledge about pregnancy health. Furthermore, good knowledge can lead to awareness, which would eventually cause a pregnant woman to behave in accordance with their knowledge. Aim: To evaluate the effect of Whats-App reminder messages on pregnant women′ knowledge and behavior regarding antenatal health. Design: Quasi experimental research design was used in this study. Setting: It was conducted at Antenatal Clinics in Women Health Hospital, Assiut University. Sample: purposive sample of 100 pregnant women. Tools: Three tools were used in this study (1) structured interviewing questionnaire, (2) knowledge assessment tool, (3) healthy behaviors assessment tool. Results: There is highly statistical significance difference between pre &posttest regarding total knowledge about antenatal health and the healthy behaviors of studied women with p-value 0.001. Conclusion: There was an improvement in the knowledge regarding antenatal health and adherence to healthy behaviors of pregnant women after health promotion by whatsapp reminder messages. Recommendations: Health facilities should start utilizing whatsApp reminder as a policy to promote adherence of pregnant women with the healthy behaviors.

Rationale, aims and objectives: Health illiteracy is an important contributor to the burden of non-communicable diseases (NCDs); in particular in settings where health illiteracy is part of a perpetuating system of risk factors. Interventions that promote health literacy may provide an important tool in the primary and secondary prevention of NCDs. The objective of this systematic review was to evaluate the effectiveness of health literacy interventions on health literacy in the management of patients with selected NCDs living in low-to-middle income countries (LMIC). Methods: Seven electronic databases were searched (October 29, 2020) for RCTs aimed at improving health literacy in adults with NCDs in LMICs. Eligible NCDs included those pertaining to cancer, cardiovascular disease (CVD), chronic respiratory disease (CRD) or Diabetes. Studies were included that explicitly focussed on improving health literacy, and reported comprehensive measures of health literacy, or components thereof (ie, knowledge, attitude or behaviour). Random-effect meta-analyses were conducted for continuous outcome measures (Hedges-g). Results: The completed search yielded 2573 unique results of which 53 unique studies met the inclusion criteria. Studies included patients with cancer (n = 1, 2%), CRD (n = 8, 15%), CVD (n = 11, 21%) or Diabetes (n = 33, 62%). A significant (P

The purpose of this study was to identify correlates of changes in physical activity (PA) and sedentary behaviour (SB) among university-based young adults in Bangladesh. Data were from a 1-year prospective study with 2 assessment points (baseline n ​= ​573, 20.7 ​± ​1.35 years, 45% female; retention rate 69%, analytical sample ​= ​395). Participants completed a self-administered written survey on PA, SB, health and lifestyle behaviours, and sociodemographics. Changes in PA were categorised as: negligible (± < 60 ​min/week), > 60 ​min/week decrease, or > 60 ​min/week increase. Changes in SB were categorised as negligible (± < 120 ​min/week), > 120 ​min/week decrease, and > 120 ​min/week increase. Multinomial logistic regression analysis was used to identify the correlates. About quarters (72%) of participants had insufficient PA at both assessment points. Of those who were sufficiently active at Wave 1, 5% became insufficiently active at Wave 2. One quarter of participants (23%) had high SB at Wave 1 and Wave 2. Of those who had low SB at Wave 1, 16% had high SB at Wave 2. Being male [OR ​= ​2.04 (95% CI: 1.06–3.93)], baseline phone time of > 2 h/day [OR ​= ​3.14 (95% CI: 1.04–7.04)] and not participating in organised sports at baseline [OR ​= ​2.56 (95% CI: 1.24–5.29) were associated with a decrease in PA by ​> ​60 ​min/week. Participants who frequently experienced stress at baseline had higher odds of increasing SB by ​> ​120 min/day [OR ​= ​1.83 (95% CI: 1.04–3.23)]. SB is more variable than PA over 1 year in university-based young adults in Bangladesh. Males, those with high phone time, those not engaging with organised sports, and those with frequent stress may change to a more inactive lifestyle.

Summary Objectives The aim of this study was to compare the effects of aerobic + interval exercise (AI) and aerobic exercise (AE) on the cardiovascular functional state in a female cohort. Equipment and methods Seventeen healthy adult females from the same health sport club participated in this study. An orthostatic manoeuvre was used to determine the state of the cardiovascular system before and 40 min after completion. During the procedure, a 12-lead electrocardiogram (ECG) was recorded for later analysis of heart rate (HR), ST-segment depression and arterial blood pressure (ABP). Results Comparing HR, ABP and ST-segment depression results before and after AE and AI, we found no significant differences for HR and ABP averaged data (P > 0.05) but ST-segment depression was significant higher in nine out of 37 ECG after the AI session (P Conclusion Serious ischaemic episodes in the myocardium during the orthostatic manoeuvre highlight the atypical physiological response of some participants to the high-intensity sprint-type workloads of the AI session. The orthostatic manoeuvre also revealed individual limitations for the high-intensity sprint-type tasks in the AI session.

African American pastors are recognized as trusted information sources for their communities. The pastors willing to address health-related concerns such as preventing the spread of the coronavirus are invaluable for leading their congregation through relevant health programs. Underlining the importance of religion, spirituality, and faith-based leaders in addressing and furthering health promotion research, the article discusses lessons learned during the study implementation and the recommendations for engaging minority pastors in research during a global health pandemic.

Weight bias and stigma exist in a variety of realms in our society (media, education, employment, and health care), and unfortunately many view it as a socially acceptable form of discrimination. Patients with obesity often avoid scheduling appointments for health promotion visits and routine care due to perceived weight bias and stigma from their health care provider. Within the health care setting, it is important that health care providers strategically focus on reducing obesity bias and provide high-quality obesity management. People-first language should be used and waiting rooms and examination rooms should be accommodating to people of all sizes.

Malaria is a preventable, mosquito-borne parasitic infection that remains one of the leading causes of imported fever, hospitalization and death in travellers returning from Sub-Saharan Africa. Early symptoms of malaria infection can mimic other common conditions presenting to healthcare settings. A high index of suspicion and early diagnosis and management, alongside patient education and prevention methods, can greatly reduce morbidity and mortality from malaria worldwide. In this article we aim to cover the different types of malaria, individuals at particular risk of malaria acquisition, malaria prevention, treatment and key advances. We will focus on falciparum malaria as this causes the greatest morbidity and mortality.