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Intermittently, the concept of herd immunity has been a potent, if sometimes ambiguous and controversial, means of framing the global response to the COVID-19 pandemic and envisaging its end. Realizing the full meaning of human herd immunity requires further attention to its connections after World War I with British social theory. Distracted by “obvious” yet unsubstantiated correspondences with veterinary research, historians of the concept have not engaged with the more proximate influence of discussions of social psychology and group dynamics on postwar epidemiology. Understanding the openness of early 20th century epidemiology to social thought deepens our appreciation of the significance of herd or population immunity, as well as suggests new avenues for exchange between public health and contemporary social sciences. (Am J Public Health. 2022;112(10):1465–1470. https://doi.org/10.2105/AJPH.2022.306931 )

In response to rapidly changing societal conditions stemming from the COVID-19 pandemic, we summarize data sources with potential to produce timely and spatially granular measures of physical, economic, and social conditions relevant to public health surveillance, and we briefly describe emerging analytic methods to improve small-area estimation. To inform this article, we reviewed published systematic review articles set in the United States from 2015 to 2020 and conducted unstructured interviews with senior content experts in public heath practice, academia, and industry. We identified a modest number of data sources with high potential for generating timely and spatially granular measures of physical, economic, and social determinants of health. We also summarized modeling and machine-learning techniques useful to support development of time-sensitive surveillance measures that may be critical for responding to future major events such as the COVID-19 pandemic. (Am J Public Health. 2022;112(10):1436–1445. https://doi.org/10.2105/AJPH.2022.306917 )

Money has been portrayed by major theorists as an agent of individualism, an instrument of freedom, a currency that removes personal values attached to things, and a generator of avarice. Regardless, the impact of money varies greatly with the cultural turf of the recipient societies. For traditional subsistence economies based on gifting and sharing, surplus perishable resources foraged from the environment carry low costs to the giver compared with the benefits to the receiver. With cash, costs to the giver are usually the same as benefits to the receiver, making sharing expensive and introducing new choices. Using quantitative data on possessions and expenditures collected over a 44-y period from 1974 to 2018 among the Ju/’hoansi (!Kung) in southern Africa, former hunter-gatherers, we look at how individuals spend monetary income, how a partial monetary economy alters traditional norms and institutions (egalitarianism, gifting, and sharing), and how institutions from the past steer change. Results show that gifting declines as cash is spent to increase the well-being of individual families and that gifting and sharing decrease and networks narrow. The sharing of meals and casual gifting hold fast. Substantial material inequalities develop, even between neighbors, but social, gender, and political equalities persist. A strong tradition for individual autonomy combined with monetary income allows individuals to spend their money as they choose, adapt to modern conditions, and pursue new options. However, new challenges are emerging to develop greater community cooperation and build substantial and sustainable economies in the face of such centrifugal forces.

Protracted droughts lasting years to decades constitute severe threats to human welfare across the Indian subcontinent. Such events are, however, rare during the instrumental period (ca. since 1871 CE). In contrast, the historic documentary evidence indicates the repeated occurrences of protracted droughts in the region during the preinstrumental period implying that either the instrumental observations underestimate the full spectrum of monsoon variability or the historic accounts overestimate the severity and duration of the past droughts. Here we present a temporally precise speleothem-based oxygen isotope reconstruction of the Indian summer monsoon precipitation variability from Mawmluh cave located in northeast India. Our data reveal that protracted droughts, embedded within multidecadal intervals of reduced monsoon rainfall, frequently occurred over the past millennium. These extreme events are in striking temporal synchrony with the historically documented droughts, famines, mass mortality events, and geopolitical changes in the Indian subcontinent. Our findings necessitate reconsideration of the region’s current water resources, sustainability, and mitigation policies that discount the possibility of protracted droughts in the future.

Objective: SARS-CoV-2 outbreak has a negative psychological impact among general population. Data comparing mental health status before and during the outbreak is needed. The BIOVAL-D-COVID-19 study assess the socio-economic and psychological impact of the COVID-19 pandemic and lockdown in a representative sample of non-institutionalized Spanish adult population, and estimate the incidence of mental health disorders, including suicidal behaviours, and possible related factors. Method: Observational longitudinal study including two online surveys: baseline survey (T0) performed during 2019 and follow-up survey (T1) conducted 12-month later. The latter included nine sections: socio-demographic, health status, mental health, employment conditions and status, material deprivation, use of healthcare services, intimate partner violence and resilience. Four of the nine sections are administered in T0 and T1 assessments. Longitudinal data analyses will estimate adjusted incidence rates of mental health disorders using Poisson regression models. Risk and protective factors will be analysed through multiple logistic regression models. RESUMEN Objetivo: El estudio BIOVAL-D-COVID-19 evaluara el impacto socioeconomico y psicologico de la pandemia de COVID-19 y del confinamiento en una muestra representativa de poblacion espanola adulta no institucionalizada, y estimara la incidencia de trastornos de salud mental, incluida la conducta suicida, y los posibles factores relacionados. Metodo: Estudio longitudinal que incluye dos encuestas online: la encuesta basal (T0) realizada durante 2019 y la encuesta de seguimiento (T1) realizada 12 meses despues. Esta ultima tiene nueve secciones: variables sociodemograficas, estado de salud general, salud mental, condiciones laborales y estatus laboral, privacion material, uso de servicios de salud, violencia de pareja y resiliencia. Cuatro de las nueve secciones se administran en ambas encuestas (T0 y T1). Se utilizaran modelos de regresion de Poisson para el analisis longitudinal de las tasas de incidencia ajustadas de trastornos de salud mental. Los factores de riesgo y de proteccion se analizaran mediante modelos de regresion logistica multiple.

Background The objective of our study was to investigate the associations of characteristics inherent in large Russian Federation (RF) regions with prevalence, awareness, treatment and control of hypertension at the individual level. Methods Regional characteristics were obtained from the official website of the Federal State Statistics Service of the RF. We employed principal component analysis to reduce the dimensionality of data, which allowed defining five integral regional indices. Prevalence, awareness, treatment and control of hypertension were assessed from the data of the cross-sectional stage of ESSE-RF study conducted in 2013–2014. The final sample included 19,791 patients from 12 RF regions. Generalized estimating equations were used to identify the associations of regional indices with prevalence, awareness, treatment and control of hypertension at the individual level, taking into consideration nested data structures (study subjects in the regions). Results The index characterizing deterioration of social living conditions and societal marginalization exhibited positive associations with the prevalence of hypertension among men (OR = 1.18; 95% CI: 1.05–1.32) and elderly people (OR = 1.16; 95% CI: 1.02–1.32). Moreover, deterioration in the social environment was associated with a reduction in treatment (OR = 0.76; 95% CI: 0.64–0.90) and control of hypertension (OR = 0.79; 95% CI: 0.69–0.90). Hypertension awareness was directly connected with demographic crisis (OR = 1.13; 95% CI: 1.02–1.25) and augmented industrial development (OR = 1.15; 95% CI: 1.01–1.33) in the regions. The association of regional living conditions with the prevalence of hypertension is relatively weak, compared to predictors at the individual level, but this influence is important for awareness, treatment and control of hypertension. Conclusion The study contributed to evaluating the associations of the vital characteristics inherent in population of large RF regions with arterial hypertension prevalence, as well as with awareness, treatment and control of this disease. Our results provided original insights from the standpoint of cardiovascular disease epidemiology in the RF, as well as in the context of investigating the impact of living conditions on population health.

Objective The stress brought on by changes in social conditions due to COVID-19 is diverse. However, there have been no studies examining the relationship between the type of stress felt by an individual due to such changes in social conditions and the degree of change in HbA1c, prompting us to conduct this study. Methods We conducted a collaborative study at two diabetes clinics. A total of 1,000 subjects responded to the questionnaire. Data on HbA1c and body weight before and after the declaration of the state of emergency were collected. Results We conducted a questionnaire on some stressors, but when comparing the two groups with respect to whether or not they felt stress from each item, only “school closures for children,” seemed to be associated with a significant difference in the amount of change in HbA1c. In the stressed group, i.e. the group of parents who experienced stress due to their children's schools being closed, the HbA1c value changed from 7.30±0.78 to 7.30±1.13 (p=0.985). By contrast, in the unstressed group, the HbA1c value significantly decreased from 7.28±0.98 to 7.06±0.85 (p

Depression, anxiety and eating disorders (“social-emotional disorders”) are common during adolescence/emerging adulthood, periods of intense identity development. Despite this, there are few reviews of existing research on the relationship between symptoms of these disorders and ongoing identity development. This study systematically reviewed, narratively synthesized and meta-analyzed longitudinal investigations of the relationship between identity synthesis/confusion and depression, anxiety and eating disorders symptoms during adolescence/emerging adulthood. Three databases (PsycInfo, Medline, Embase) were searched. Study quality was systematically appraised, findings were qualitatively synthesized and (where possible) meta-analyzed. 20 studies (55% “fair” quality, 45% “poor” quality) were identified, including 13,787 participants (54.2% female, mean age = 14.48 years, range 10–29 years). The narrative synthesis found evidence of bidirectional relationships between identity synthesis/confusion and depression, anxiety and eating disorder symptoms. Meta-analyses and meta-regressions of a sub-sample of studies (N = 9) indicated no significant associations between identity synthesis or confusion and anxiety or depression symptoms. More high-quality research is needed before firm conclusions can be drawn.

Despite good faith attempts by countless citizens, civil society, governments, and the international community, living in a sustainably peaceful community continues to be an elusive dream in much of our world. Among the challenges to sustaining peace is the fact that few scholars have studied enduringly peaceful societies, or have examined only narrow aspects of them, leaving our understanding of the necessary conditions, processes and policies fragmented, and deficient. This article provides a work-in-progress overview of a multidisciplinary, multimethod initiative, which aims to provide a holistic, evidence-based understanding of how peace can be sustained in societies. The Sustaining Peace Project, launched in 2014, uses complexity science as an integrative platform for synthesizing knowledge across disciplines, sectors and communities. This article introduces the multiple components of the project and shares preliminary findings. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

SUMMARY OBJECTIVE: The aim of this study was to evaluate the frequency of teenage pregnancy in all Brazilian regions and states in the period of 2000-2019 among two age groups, namely, 10-14 and 15-19 years old, and correlate it with the human development index. METHODS: A cross-sectional study was performed by using the data from the Live Birth Info System from the National Health System’s database. RESULTS: The percentage of live births from teenage mothers (age 10-19 years) in Brazil decreased by 37.2% (i.e., 23.4 in 2000 to 14.7% in 2019) in all regions. Amazonas and Maranhão were the only states to show increased fertility rates for teens in the age group of 10-14 years. The fertility index decreased from 80.9-48% in all states among mothers aged 15-19 years. Only the Southeast and South regions showed levels below the Brazilian average (i.e., 38.2 and 39%, respectively). The proportion of live birth showed an inversely proportional trend to the human development index score. CONCLUSIONS: Brazil shows a decline in the percentage of live birth among adolescent mothers and the fertility rate. Live birth is inversely proportional to the human development index score. However, the teenage pregnancy numbers are still high, with great regional inequality in the country.

The study "Quality of life and well-being of the very old in North Rhine-Westphalia NRW80+" aims at giving a representative picture of the quality of life (QoL) in this population. Conceptually, QoL research has rarely considered the values of older individuals themselves and societal values, and their relevance for successful life conduct. Empirically, comparisons of different age groups over the age of 80 years are rare and hampered by quickly decreasing numbers of individuals in oldest age groups in the population of very old individuals.This paper describes the population of the NRW80+ study and different age groups of very old individuals with respect to biographical background. Furthermore, using the challenges and potentials model of QoL in very old age (CHAPO), key aspects of QoL in late life are discussed and the importance of normative stipulations of what constitutes a successful life conduct are highlighted. In the NRW80+ study older age groups (i.e., 85-89 years, 90+ years) were deliberately overrepresented in the survey sample to enable robust cross-group comparison. Individuals willing to participate in the study but unable to participate in the interview themselves for health reasons were included by means of proxy interviews. The total sample included 1863 individuals and 176 individuals were represented by proxy interviews. Pronounced differences were observed between age groups 80-84 years (born 1933-1937, N = 1012), 85-89 years (born 1928-1932, N = 573), and 90 years or older (*born before 1927, N = 278) with respect to education, employment and the timing of major life events (e.g., childbirth).Different life courses and resulting living conditions should be considered when discussing QoL disparities in very old age.HINTERGRUND: Die Studie „Lebensqualität und Wohlbefinden hochaltriger Menschen in Nordrhein-Westfalen (NRW80+)“ zeichnet ein repräsentatives, differenziertes Bild der Lebensqualität (LQ) in der Hochaltrigkeit. Bisher vorgeschlagene LQ-Modelle berücksichtigen nur unzureichend sowohl individuelle Werthaltungen älterer Menschen als auch gesellschaftliche Werte bei der Diskussion von Konstellationen gelingender Lebensführung. Nur wenige empirische Studien erlauben gegenwärtig einen differenzierten Blick auf Altersunterschiede jenseits von 80 Jahren, nicht zuletzt wegen des geringen Anteils der Ältesten in der Population.Der Artikel beschreibt die NRW80+-Studienpopulation und Altersgruppen hinsichtlich ihres biografischen Hintergrunds. Die Nutzung des Challenges and Potentials Model of QoL in Very-Old Age (CHAPO) erlaubt es, Kernpunkte von LQ zu erörtern und die Relevanz von normativen Wertevorstellen über eine erfolgreiche Lebensführung herauszustellen. Ältere Hochaltrige wurden in der Stichprobe gezielt überrepräsentiert, um aussagekräftige Altersvergleiche zu erlauben. Informationen über Personen, die aufgrund ihres Gesundheitszustands das Interview nicht selbst führen konnten, wurden durch Stellvertreterinterviews mit einem nahen Angehörigen/Bekannten erhoben. Die Gesamtstichprobe umfasste 1863 Interviews; für 176 Personen wurden Stellvertreterinterviews geführt. Die betrachteten Kohorten 80–84 Jahre (geb. 1933–1937, N = 1012), 85–89 Jahre (geb. 1928–1932, N = 573) und 90 Jahre oder älter (geb. vor 1927, N = 278) unterschieden sich wesentlich mit Blick auf Lebensverlauf und grundlegende Lebensumstände.Unterschiedliche Lebensverläufe und resultierende Lebensbedingungen sollten bei der Diskussion von ungleicher LQ im sehr hohen Lebensalter berücksichtigt werden.

Ambulatory impairments; Machine learning; Multiple sclerosis Deficiencias ambulatorias; Aprendizaje automático; Esclerosis múltiple Deficiències ambulatòries; Aprenentatge automàtic; Esclerosi múltiple Abstract Background and objectives Multiple sclerosis (MS) is a progressive inflammatory and neurodegenerative disease of the central nervous system affecting over 2.5 million people globally. In-clinic six-minute walk test (6MWT) is a widely used objective measure to evaluate the progression of MS. Yet, it has limitations such as the need for a clinical visit and a proper walkway. The widespread use of wearable devices capable of depicting patients’ activity profiles has the potential to assess the level of MS-induced disability in free-living conditions. Methods In this work, we extracted 96 features in different temporal granularities (from minute-level to day-level) from wearable data and explored their utility in estimating 6MWT scores in a European (Italy, Spain, and Denmark) MS cohort of 337 participants over an average of 10 months’ duration. We combined these features with participants’ demographics using three regression models including elastic net, gradient boosted trees and random forest. In addition, we quantified the individual feature's contribution using feature importance in these regression models, linear mixed-effects models, generalized estimating equations, and correlation-based feature selection (CFS). Results The results showed promising estimation performance with R2 of 0.30, which was derived using random forest after CFS. This model was able to distinguish the participants with low disability from those with high disability. Furthermore, we observed that the minute-level (≤ 8 minutes) step count, particularly those capturing the upper end of the step count distribution, had a stronger association with 6MWT. The use of a walking aid was indicative of ambulatory function measured through 6MWT. Conclusions This study demonstrates the utility of wearables devices in assessing ambulatory impairments in people with MS in free-living conditions and provides a basis for future investigation into the clinical relevance. The RADAR-CNS project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 115902. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA, www.imi.europa.eu. This paper reflects the views of the RADAR-CNS consortium and neither IMI nor the European Union and EFPIA are liable for any use that may be made of the information contained herein. The funding body have not been involved in the design of the study, the collection or analysis of data, or the interpretation of data. RJBD is supported by the following: (1) NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK; (2) Health Data Research UK, which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation and Wellcome Trust; (3) The BigData@Heart Consortium, funded by the Innovative Medicines Initiative-2 Joint Undertaking under grant agreement No. 116074. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA; it is chaired by DE Grobbee and SD Anker, partnering with 20 academic and industry partners and ESC; (4) the National Institute for Health Research University College London Hospitals Biomedical Research Centre; (5) the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London; (6) the UK Research and Innovation London Medical Imaging & Artificial Intelligence Centre for Value Based Healthcare; (7) the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust.

Background The overall aim of this study was to examine essential aspects of reliability and validity of a constructed Occupational Mechanical Job Exposure Index for use in analyses of Norwegian register data. Methods We utilized data from the Norwegian nationwide Survey of Living Conditions on work environment in 2006, 2009, 2013, 2016 and 2019. Occupations were classified on a 4-digit level based on the Norwegian version of the International Standard Classification of Occupations (ISCO-88). We constructed a 4-digit correspondence table between the occupational codes used in the 2006 and 2009 surveys (STYRK-98) and the codes used in 2013, 2016 and 2019 (STYRK-08). The mechanical exposures were collected by Statistics Norway using telephone interviews. As for reliability, we examined the agreement between the individual- and the occupational-based mechanical exposures using Cohen’s kappa, sensitivity and specificity measures. Construct, concurrent and predictive validity pertaining to the Occupational Mechanical Job Exposure Index were analysed using both survey data and nationwide register data. Results The analysis shows a fair-to-moderate overlap between occupational-based mechanical exposures and the individually reported exposures. Construct validity of the Occupational Mechanical Job Exposure Index, as estimated by a confirmatory factor analysis using the occupational-based mechanical exposures, showed that the 8 exposures formed one underlying factor. When assessing the concurrent value of the Occupational Mechanical Job Exposure Index to the index based on the individual reported exposures, the occupational mechanical index showed lower and reproducible associations with lower back pain for both men and women. For long-term sick leave, the occupational mechanical index showed higher and reproducible associations for both genders. As for predictive validity, the register data analysis shows that the occupational mechanical index was associated with disability and a higher number of long-term sickness benefits periods for both men and women. For men the index also predicted higher mortality. Conclusion Our tests of reliability and validity of the Occupational Mechanical Job Exposure Index indicate that the index overall has acceptable statistical properties and will be useful in analyses of Norwegian register data where individual information on these types of exposures is missing.

BACKGROUND: Introduction: Patients with cancer as a life-threatening illness have needs in various dimensions. One of the most crucial dimension is spiritually. The present study was conducted to elucidate the spiritual needs of patients with cancer. METHODS: A qualitative approach involving face to face semi-structured interviews conducted in Arak city, Iran. In total, 24 participants were recruited through purposive sampling. All interviews were recorded and transcribed verbatim. The data were analyzed using content analysis. RESULTS: Patients' experiences of spirituality were classified into four themes, including spiritual needs (need to be in nature, need to communicate with others, need to perform religious practices, need for solitude and reflections, need to trust and security), strategies to address spiritual needs (physical activity, achieving inner peace, communication with the nurse or physician, doing dhikr (Zikr) and pray, reading the religious book and texts, making vows, paying attention to and loving others), reasons for not using spiritual resources (lack of belief in the healing powers of praying, believing in a better life after death), and impacts of spiritual beliefs (hope of Life, belief in divine destiny, trusting in God’s support, accepting the divine test). CONCLUSION: Exploring the experiences, perceptions, and spiritual needs of cancer patients is of great importance in providing spiritual care as one of the critical aspects of holistic care. Nurses should be educated for assessing spiritual needs of patients to provide spiritual care.

In March 2020, the French government implemented nation-wide measures to reduce social contact and slow the progression of the emerging coronavirus responsible for COVID-19, the most significant being a complete home lockdown that lasted 8 weeks. Reunion Island is a French overseas department marked by large social inequalities. We draw the hypothesis that distancing and lockdown measures may have contributed to an increase in the social inequalities in health (SIH) on Reunion Island. The aim of our study was to describe the SIH during lockdown in the Reunionese population. We implemented a cross-sectional telephone survey conducted between 13 May and 22 July 2020, using a retrospective data collection on the lockdown period. A total of 892 adult participants (≥18 years) were recruited in the 114 large Reunionese neighborhoods using the quota method within the national “White Pages” telephone directory. Degraded psychological states, an increase in addictive behaviors, difficulties in accessing food, a decrease in physical activity, delayed medical appointments, violence against women, and health problems in children were driven by the socio-economic characteristics of the population, most often to the disadvantage of social groups exposed to poor living conditions. These results suggest that the COVID-19 lockdown contributed to an increase in SIH.

Significant changes are taking place in the structure of tourism participants. Due to the ageing of societies, the tourism sector has to respond to the increasing tourist activity of seniors. The main aim of our research was the recognition of the needs of senior tourists from selected regions of Poland, considering their health and financial situation as well as their physical activity. The study shows how to combine the knowledge of assumptions of active ageing with the actual views of senior tourists on tourism and active leisure. An additional objective was to determine the reasons why seniors gave up tourism and to compare the reasons why seniors from selected regions of Poland and seniors from other European countries did not participate in tourism. Based on Eurostat data, we identify the most common reasons for people not participating in tourism who are over 65 years of age. In 2020, we surveyed seniors. The respondents for the sample were selected as 65 years and older. In order to compare countries due to exclusion and non-participation of seniors in tourism, the results classification was used. To analyse the touristic behaviours of Polish seniors, we used correspondence analysis. As indicated by analysing the reasons for the non-participation of Europeans aged 65 and over in tourism, in most countries, financial and health reasons are ranked first or second in 2016 and 2019. In a survey of Polish seniors, except for the financial reasons responsible for non-participation in tourism, an additional obstacle was the language barrier in foreign tourism. The analysis of physical and tourist activity showed that non-participation in tourism is associated with low physical activity. Women reported that they were satisfied with their financial independence and most often used the opportunity of short-term tourism. The people who are fully or largely involved in organising their trips also willingly change their locations during their next travels.

Behavioral responses influence the trajectories of epidemics. During the COVID-19 pandemic, nonpharmaceutical interventions (NPIs) reduced pathogen transmission and mortality worldwide. However, despite the global pandemic threat, there was substantial cross-country variation in the adoption of protective behaviors that is not explained by disease prevalence alone. In particular, many countries show a pattern of slow initial mask adoption followed by sharp transitions to high acceptance rates. These patterns are characteristic of behaviors that depend on social norms or peer influence. We develop a game-theoretic model of mask wearing where the utility of wearing a mask depends on the perceived risk of infection, social norms, and mandates from formal institutions. In this model, increasing pathogen transmission or policy stringency can trigger social tipping points in collective mask wearing. We show that complex social dynamics can emerge from simple individual interactions and that sociocultural variables and local policies are important for recovering cross-country variation in the speed and breadth of mask adoption. These results have implications for public health policy and data collection.

The purpose of the study was to develop prediction models to estimate physical activity (PA)-related energy expenditure (AEE) based on accelerometry and additional variables in free-living adults. In 50 volunteers (20–69 years) PA was determined over 2 weeks using the hip-worn Actigraph GT3X + as vector magnitude (VM) counts/minute. AEE was calculated based on total daily EE (measured by doubly-labeled water), resting EE (indirect calorimetry), and diet-induced thermogenesis. Anthropometry, body composition, blood pressure, heart rate, fitness, sociodemographic and lifestyle factors, PA habits and food intake were assessed. Prediction models were developed by context-grouping of 75 variables, and within-group stepwise selection (stage I). All significant variables were jointly offered for second stepwise regression (stage II). Explained AEE variance was estimated based on variables remaining significant. Alternative scenarios with different availability of groups from stage I were simulated. When all 11 significant variables (selected in stage I) were jointly offered for stage II stepwise selection, the final model explained 70.7% of AEE variance and included VM-counts (33.8%), fat-free mass (26.7%), time in moderate PA + walking (6.4%) and carbohydrate intake (3.9%). Alternative scenarios explained 53.8–72.4% of AEE. In conclusion, accelerometer counts and fat-free mass explained most of variance in AEE. Prediction was further improved by PA information from questionnaires. These results may be used for AEE prediction in studies using accelerometry

ObjectiveStudies investigating strategies to limit the risk of nocturnal hypoglycemia associated with physical activity (PA) are scarce and have been conducted in standardized, controlled conditions in people with type 1 diabetes (T1D). This study sought to investigate the effect of daily PA level on nocturnal glucose management in free-living conditions while taking into consideration reported mitigation strategies to limit the risk of nocturnal hyoglycemia in people with T1D.MethodsData from 25 adults (10 males, 15 females, HbA1c: 7.6 ± 0.8%), 20-60 years old, living with T1D, were collected. One week of continuous glucose monitoring and PA (assessed using an accelerometer) were collected in free-living conditions. Nocturnal glucose values (midnight–6:00 am) following an active day “ACT” and a less active day “L-ACT” were analyzed to assess the time spent within the different glycemic target zones (10.0 mmol/L) between conditions. Self-reported data about mitigation strategies applied to reduce the risk of nocturnal hypoglycemia was also analyzed.ResultsOnly 44% of participants reported applying a carbohydrate- or insulin-based strategy to limit the risk of nocturnal hypoglycemia on ACT day. Nocturnal hypoglycemia occurrences were comparable on ACT night versus on L-ACT night. Additional post-meal carbohydrate intake was higher on evenings following ACT (27.7 ± 15.6 g, ACT vs. 19.5 ± 11.0 g, L-ACT; P=0.045), but was frequently associated with an insulin bolus (70% of participants). Nocturnal hypoglycemia the night following ACT occurred mostly in people who administrated an additional insulin bolus before midnight (3 out of 5 participants with nocturnal hypoglycemia).ConclusionsAlthough people with T1D seem to be aware of the increased risk of nocturnal hypoglycemia associated with PA, the risk associated with additional insulin boluses may not be as clear. Most participants did not report using compensation strategies to reduce the risk of PA related late-onset hypoglycemia which may be because they did not consider habitual PA as something requiring treatment adjustments.

Background A significant decline in malaria burden was documented in previously high burden African countries. Even though the global decline in malaria burden is significant, about 95% of it was typically found in 29 African countries and the decline was affected by COVID-19 in 2020. The considerable reduction in malaria incidence was noted due to effective prevention and treatment efforts, and rapid changes in living conditions. The relationship between the occurrence of asymptomatic malaria infection and household living conditions is well unstudied. This study aimed to determine the association between household living conditions and the occurrence of asymptomatic malaria in the lowlands of Ethiopia. Methods A community-based cross-sectional study was conducted from January to March 2021 in twelve villages of Gambella, Southern Nation Nationalities and People Region and Afar in Ethiopia. A total of 1366 households were randomly selected, interviewed, and tested for malaria by rapid diagnostic test and blood film microscopic examination. Multiple logistic regression model was used to determine the independent association between living conditions and asymptomatic malaria infection. Results The prevalence of asymptomatic malaria infection among individuals living in dwellings built with traditional floor/wall/roof ranges from 8.1% to 8.4% while it ranges from 2.0% to 4.6% among those living in modern floor/wall/roof houses. Dwellings built with traditional wall materials (P = 0.050), spending nights with cattle in the same house (P P = 0.004) were significantly associated with asymptomatic malaria infection. Conclusions Asymptomatic malaria infection was 4.3 times higher among occupants residing in dwellings built with traditional wall materials; 5.6 times higher among households spending nights with cattle in the same house, and 2.3 times higher among households with kitchen in the main house with no partition. Therefore, policies and strategies on malaria elimination need to address or target improvements of the above listed living conditions for the community. A multi sectoral action is required to use these social determinants as a vector control strategic addition; and malaria elimination programs are expected to coordinate the implementation.

Social and cultural forces shape almost every aspect of infectious disease transmission in human populations, as well as our ability to measure, understand, and respond to epidemics. For directly transmitted infections, pathogen transmission relies on human-to-human contact, with kinship, household, and societal structures shaping contact patterns that in turn determine epidemic dynamics. Social, economic, and cultural forces also shape patterns of exposure, health-seeking behaviour, infection outcomes, the likelihood of diagnosis and reporting of cases, and the uptake of interventions. Although these social aspects of epidemiology are hard to quantify and have limited the generalizability of modelling frameworks in a policy context, new sources of data on relevant aspects of human behaviour are increasingly available. Researchers have begun to embrace data from mobile devices and other technologies as useful proxies for behavioural drivers of disease transmission, but there is much work to be done to measure and validate these approaches, particularly for policy-making. Here we discuss how integrating local knowledge in the design of model frameworks and the interpretation of new data streams offers the possibility of policy-relevant models for public health decision-making as well as the development of robust, generalizable theories about human behaviour in relation to infectious diseases.

The author proposes that the concept of framing activity provides a useful approach to neutrality by synthesizing relational approaches with an extension of José Bleger's (1967, 2012) conceptualization of the frame as containing primitive aspects of the analysand. She argues that the analytic frame also serves as a depository, or bulwark, for the analyst's ideological alignments. Identifying how ongoing framing activity is in tension with this bulwark affords a means of approaching, interrogating, and "doing" neutrality that elaborates the flexibility and self-reflection that contemporary psychoanalytic thinking seeks to bring to an earlier, more rigid idea of "the frame." Clinical vignettes focus on framing and its connection to neutrality in the context of remote treatments.

The present study investigated whether critical consciousness (CC) and feminist identity help explain emerging adult women's participation in actions to reduce gender inequality. CC is an applied tool marginalized and oppressed youth can use to combat inequality. It is conceptualized as three components: Critical reflection, critical efficacy, and critical action. Youth who have reflected on inequality are theorized to act against injustice if they have critical efficacy. However, empirical support for connections among components is mixed and questions remain concerning the contexts in which and people for whom CC serves as a resource. For instance, CC has rarely been examined as a tool to reduce sexism. Furthermore, researchers theorize that social identity is related to CC, yet little empirical evidence exists testing these associations. Finally, CC is typically examined within samples of children and adolescents, although advances in cognitive development and identity suggest emerging adulthood is an ideal time to use CC. To begin to fill these gaps, we investigated whether the components of CC in association with feminist identity could predict when emerging adult women act against sexism. A serial mediation model revealed reflection may lead to action for women who identify as feminist and who report greater internal efficacy. The pathway through external efficacy was not significant. Findings suggest CC together with feminist identity may be tools women can employ to transform unjust social conditions and improve their lives. Applied applications of findings are considered.

Congenital anomalies (CA) contribute to disabilities and health conditions throughout life. Furthermore, they can cause emotional distress to the mothers and children, who may also experience limitations in individual and social development. This study investigated the prevalence of CA and the relationship with maternal education and age according to local development in the extreme south of Brazil. This is a retrospective observational study with birth data from the Live Birth Information System from 2000 to 2017. The association between age and maternal education with the presence of CA was verified using multiple Poisson regression for robust variances in models adjusted for those variables with a preliminary significant association. A total of 5131 (1.5%) had some CA identified at birth between 2000 and 2017. Only advanced age (≥36 years) was associated with CA regardless of macro-region development (p ≤ 0.001). The highest risk was observed in regions with medium development (RR = 1.60; 95% CI 1.30–1.97). Maternal education (

Background The Zika virus (ZIKV) epidemic hit Brazil in 2015 and resulted in a generation of children at risk of congenital Zika syndrome (CZS). The social vulnerability of certain segments of the population contributed to the disproportional occurrence of CZS in the Brazilian Northeast, the poorest region in the country. Living conditions are essential factors in understanding the social determination of CZS, which is embedded in a complex interaction between biological, environmental, and social factors. Salvador, the biggest city in the region, played a central role in the context of the epidemic and was a pioneer in reporting the ZIKV infection and registering a high number of cases of CZS. The aim of the study was identifying the incidence and spatial distribution pattern of children with CZS in the municipality of Salvador, according to living conditions. Methods This is an ecological study that uses the reported cases of ZIKV and CZS registered in the epidemiological surveillance database of the Municipal Secretariat of Health of the city of Salvador between August of 2015 and July of 2016. The neighborhoods formed the analysis units and the thematic maps were built based on the reported cases. Associations between CZS and living conditions were assessed using the Kernel ratio and a spatial autoregressive linear regression model. Results Seven hundred twenty-six live births were reported, of which 236 (32.5%) were confirmed for CZS. Despite the reports of ZIKV infection being widely distributed, the cases of CZS were concentrated in poor areas of the city. A positive spatial association was observed between living in places with poorer living conditions and births of children with CZS. Conclusions This study shows the role of living conditions in the occurrence of births of children with CZS and indicates the need for approaches that recognize the part played by social inequalities in determining CZS and in caring for the children affected.

Background: Previous studies have linked residential displacement as a result of the 2011 East Japan Earthquake to increases in body weight. However, no study has examined longer-term trajectories of body weight among displaced survivors. We compared body weight change between survivors relocated to temporary housing (TH) group versus other types of accommodation for up to 5 years after the Great East Japan Earthquake. Methods: Longitudinal follow-up was conducted from 2011 to 2015 in a cohort of 9,909 residents of 42,831. We compared trends in body weight in the TH group (n = 3,169) and the non-TH group (n = 6,740) using a mixed linear regression model stratified by sex (mean age, 61.0 years old; male, 38.9%). Results: In age-adjusted analysis, the body weight in the 2011 survey was not significantly different between two groups for either sex. In men, the TH group significantly increased body weight compared to the non-TH group since 2012. In women, body weight sharply increased in the TH group while body weight did not change in the non-TH group during survey time points. The interaction of living conditions and survey years was statistically significant in both sexes (men; F-value, 6.958; P < 0.001: women; F-value, 19.127; P < 0.001). Conclusion: Survivors relocated to temporary housing had an increased risk of weight gain. The weight gain in this group is a potential risk factor for metabolic syndrome in the post-disaster period.

Background and purpose — Studies regarding hip fractures in young patients are rare since the patient population is small. We assessed clinical outcomes 4 months after hip fracture in patients < 50 years of age and whether there were differences between sexes and different age groups. Patients and methods — We included adult patients < 50 years with a hip fracture between January 1, 2014 and December 31, 2018. Baseline data were extracted from the Swedish Registry for Hip Fracture Patients and Treatment (RIKSHÖFT) and mortality data was obtained from Statistics Sweden. The outcome variables were change of walking ability, pain in fractured hip, use of analgesics, living conditions, and mortality rate at 4 months. Results — Of the 905 patients included, 72% were men and femoral neck fractures were most common (58%). 4 months after surgery, 23% used a walking aid and 7% reported severe pain. Women reported slightly more pain and higher usage of analgesics. Patients aged 40–49 reported higher usage of analgesics than patients aged 15–39, although the latter group reported more pain. Nearly all of those who lived independently before fracture did so at 4 months. The mortality rate was < 1%. Interpretation — Most patients did not use any walking aid and few had severe pain at 4 months. Furthermore, a hip fracture is not a life-threatening event in a patient < 50 years. The living conditions did not change for those who lived independently before the fracture.

Health innovations are generally oriented on a techno-economic vision. In this perspective, technologies are seen as an end in themselves, and there is no arrangement between the technical and the social values of innovation. This vision prevails in sanitary crises, in which management is carried out based on the search for punctual, reactive, and technical solutions to remedy a specific problem without a systemic/holistic, sustainable, or proactive approach. This paper attempts to contribute to the literature on the epistemological orientation of innovations in the field of public health. Taking the Covid-19 and Ebola crises as examples, the primary objective is to show how innovation in health is oriented towards a techno-economic paradigm. Second, we propose a repositioning of public health innovation towards a social paradigm that will put more emphasis on the interaction between social and health dimensions in the perspective of social change. We will conclude by highlighting the roles that public health could play in allowing innovations to have more social value, especially during sanitary crises.

Introduction The role of health problems and programs to address problems in keeping the peace has not been scientifically analyzed. We sought to mitigate this gap in knowledge. Methods We examined hundreds of conflicts in a robust international database (NAVCO 2.0) for the presence of health programs by conflict parties and were unable to demonstrate a significant statistical correlation between the presence of a health program and peace. Using this analysis and a comprehensive international database of health conditions (the Global Burden of Disease), we obtained Institutional Review Board approval and undertook a matched case-control analysis. We identified 14 countries with new-onset conflict as our cases and 52 similar countries without conflict during the same year as our controls. We calculated the association between conflict status and the prevalence of 254 different health conditions among the case and control nations. Results None of the 254 health conditions had changes in prevalence that correlated with the conflict status of that nation. None of those common health conditions is therefore a predictive “leading indicator” of conflict in this study. Conclusions Without such an association or causal link, the role of health programs in peacekeeping and “stability operations” remains ambiguous. Negative findings do not mean that there is no connection between health programs and peace, and further study should be done. Our results have implications for the value of global health engagement missions.

As the novel coronavirus (COVID-19) pandemic continues to expand, policymakers are striving to balance the combinations of nonpharmaceutical interventions (NPIs) to keep people safe and minimize social disruptions. We developed and calibrated an agent-based simulation to model COVID-19 outbreaks in the greater Seattle area. The model simulated NPIs, including social distancing, face mask use, school closure, testing, and contact tracing with variable compliance and effectiveness to identify optimal NPI combinations that can control the spread of the virus in a large urban area. Results highlight the importance of at least 75% face mask use to relax social distancing and school closure measures while keeping infections low. It is important to relax NPIs cautiously during vaccine rollout in 2021.

Child labour is a global phenomenon occurring predominantly in countries with lower socioeconomic status and resources. Societal and familial poverty, loss or incapacitation/illness of parents, lack of social security and protection, and ignorance about the value of, or limited access to, education are among the myriad reasons for the involvement of children in the workforce. Child labour is a barrier to the development of individual children and their society and economy. Global estimates indicate that 152 million children (64 million girls and 88 million boys) are working, accounting for almost one in 10 of all children worldwide. Currently the COVID-19 health pandemic and the resulting economic and labour market consequences are having a major impact on people’s lives and livelihoods. Unfortunately, impoverished families and their children are often the first to suffer, which may push many more vulnerable children into child labour situations. Child labour in India is more prevalent than in many other countries, with approximately 10 million children actively engaged in, or seeking, work. This paper focuses on the issue of child labour, its causes and its ill effects. Further, it also reviews the international legal framework relating to child labour and legislative issues in India. There is clearly an urgent need for this issue to be effectively addressed and resolved.

The objective of this study was to identify the conditions of life of patients with mental and behavioral disorders admitted to a specialized hospital in an inner city in the state of Sao Paulo, Brazil, and their possible relationship with inequities and social exclusion. The information about the conditions of life was gathered through medical records and structured interviews with the patients. The data collected were compared with the recent literature on the subject. We conclude that the conditions of health, life and social vulnerability are associated with changes in family and social relationships, stigma, discrimination and prejudice, and barriers to the exercise of citizenship for these patients. Findings confirm the need for equity in this group's access to the exercise of human rights.

To examine differences in community mobility reduction and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outcomes across counties with differing levels of socioeconomic disadvantage.The sample included counties in the United States with at least one SARS-CoV-2 case between April 1 and May 15, 2020. Outcomes were growth in SARS-CoV-2 cases, SARS-CoV-2-related deaths, and mobility reduction across three settings: retail/recreation, grocery/pharmacy, and workplace. The main explanatory variable was the social deprivation index (SDI), a composite socioeconomic disadvantage measure.Adjusted differences in outcomes between low-, medium-, and high-SDI counties (defined by tertile) were calculated using linear regression with state-fixed effects. Workplace mobility reduction was 1.75 (95% CI, -2.36 to -1.14; P.001) and 3.48 percentage points (95% CI, -4.21 to -2.75; P.001) lower for medium- and high-SDI counties relative to low-SDI counties, respectively. Mobility reductions in the other settings were also significantly lower for higher-SDI counties. In analyses adjusted for SARS-CoV-2 prevalence on April 1, medium- and high-SDI counties had 1.39 (95% CI, 0.85 to 1.93; P.001) and 2.56 (95% CI, 1.77 to 3.34; P.001) more SARS-CoV-2 cases/1000 population on May 15 compared with low-SDI counties, respectively. Deaths per capita were also significantly higher for higher-SDI counties.Counties with higher social deprivation scores experienced greater growth in SARS-CoV-2 cases and deaths, but reduced mobility at lower rates. These findings are consistent with evidence demonstrating that economically disadvantaged communities have been disproportionately impacted by the coronavirus disease 2019 pandemic. Efforts to socially distance may be more burdensome for these communities, potentially exacerbating disparities in SARS-CoV-2-related outcomes.

Historic sites have multifaceted meanings. In the case of war-related sites, they serve as an important historical resource for present and future generations to learn about what happened there during the war. Despite their great value, it is not easy to preserve such sites properly and to make them function as historic sites-this is particularly true in the case of the preservation of sites concerning secret wartime projects. This article shows how a building from an old Japanese army laboratory overcame these difficulties to transform into a university museum: "the defunct Imperial Japanese Army Noborito Laboratory Museum for Education in Peace" on Ikuta Campus, Meiji University. This article treats the prehistory of the museum and considers the collaboration between local communities, historians, and the university in establishing the museum for peace.

Background Health care evaluation models can be useful to assign different levels of priority to interventions or policies targeting different age groups or different determinants of health. We aimed to assess early mortality in counterfactual scenarios implying reduced adverse childhood experience (ACE) and/or improved educational attainment (childhood and early life characteristics), compared with a counterfactual scenario implying reduced smoking in adulthood. Methods We used data from the 1958 National Child Development Study British birth cohort, which initially included 18 558 subjects. Applying a potential outcome approach, scenarios were simulated to estimate the expected mortality between ages 16 and 55 under a counterfactual decrease by half of the observed level of exposure to (i) ACE, (ii) low educational attainment (at age 22), (iii) ACE and low educational attainment (a combined exposure) and (iv) smoking at age 33. Estimations were obtained using g-computation, separately for men and women. Analyses were further stratified according to the parental level of education, to assess social inequalities. Results The study population included 12 164 members. The estimated decrease in mortality in the counterfactual scenarios with reduced ACE and improved educational attainment was close to the decreased mortality in the counterfactual scenario with reduced smoking, showing a relative difference in mortality of respectively −7.2% [95% CI (confidence interval) = (−12.2% to 1.2%)] versus −7.0% (−13.1% to +1.2%) for women, and −9.9% (−15.6% to −6.2%) versus −12.3% (−17.0% to −5.9%) for men. Conclusions Our results highlight the potential value of targeting early social characteristics such as ACE and education, compared with well-recognized interventions on smoking.

The aim of this paper was to describe the study design, data collection procedure and participation of the population-based study “Sámi Health on Equal Terms” (SámiHET) conducted among the Sámi in Sweden in 2021. A Sámi sample was constructed, drawing from three pre-existing-registers: the Sámi electoral roll, the reindeer mark register and the “Labour statistics based on administrative sources” register to identify reindeer herding businesses. All identified persons aged 18–84 were invited to participate during February–May 2021. Among the 9,249 invitations, 3,779 answered the survey (participation rate of 40.9%). More women than men participated, and the age group 45–64 was the most common in both sexes. Around 10% of participants were in the youngest group. A majority of participants were residents of Norrbotten (48%), while almost one fourth were living outside Sápmi (22%). SámiHET has been demonstrated to be a feasible and cost-effective way of investigating health and living conditions among the Sámi in Sweden, providing information easy to compare with Swedish data. The knowledge to be produced may be used to inform policy to guide and improve Sámi health, thus contributing to realising the equal health rights of the Indigenous Sámi in Sweden.