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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.

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.

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.

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.

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.

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.

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.

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.

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.

The medical profession is not a trade, it is by its nature a free profession (Federal Doctors' Ordinance). The medical practice as an institution and the medical profession are, however, subject to current social conditions, currently particularly shaped by the rules of health economics and digitization. Salomon Neumann, who, along with Rudolf Virchow, is considered the founder of social medicine in Germany, published the vision of liberating academically trained doctors from the trade regulations applicable to craftsmen and other professions in 1847. On the basis of law and reason that applies to public action, he conceived the establishment of an association, a new professional representation of the previously isolated doctors in freedom, solidarity and self-administration. The failure of the bourgeois revolution in 1849 with subsequent social restoration delayed innovative developments. The professionalization of the medical profession begins with the formation of a unified medical status in 1852, the formation of medical associations in the 1860s, the establishment of the German Association of Physicians in 1872 as an umbrella organization and the establishment of state medical associations in 1948 as public corporations.Der ärztliche Beruf ist kein Gewerbe, er ist seiner Natur nach ein freier Beruf. (Bundesärzteordnung). Die Institution Arztpraxis und der Arztberuf unterliegen jedoch jeweils aktuellen gesellschaftlichen Bedingungen, derzeit besonders geprägt von den Regeln der Gesundheitsökonomie und der Digitalisierung. Salomon Neumann, er gilt mit Rudolf Virchow als Begründer der Sozialmedizin in Deutschland, veröffentlichte 1847 die Vision der Befreiung akademisch ausgebildeter Ärzte aus der für Handwerker und andere Berufe geltenden Gewerbeordnung. Er konzipierte, auf der für öffentliches Handeln geltenden Basis von Recht und Vernunft, die Gründung einer Assoziation, einer neuen Standesvertretung der bisher isoliert tätigen Ärzte in Freiheit, solidarischer Ordnung und Selbstverwaltung. Das Scheitern der bürgerlichen Revolution 1849 mit anschließender gesellschaftlicher Restauration verzögerten innovative Entwicklungen. Die Professionalisierung der Ärzteschaft beginnt mit der Bildung eines ärztlichen Einheitsstandes 1852, der Bildung von Ärztekammern in den 1860er Jahren, der Gründung des Deutschen Ärztevereinsbundes 1872 als Dachorganisation und der Gründung von Landesärztekammern 1948 als Körperschaften öffentlichen Rechts.

This study was planned to determine the burnout levels of physicians during the COVID-19 pandemic, and to contribute to taking the necessary measures by determining the associated factors.This research was designed via Google Online Form as an online survey with questions of Sociodemographic Data Form, Maslach Burnout Inventory and Beck Anxiety Inventory and was conducted with 40 specialist physicians actively working at the Sakarya University Training and Research Hospital. The same questionnaire was re-applied online after two months, and 24 out of 40 physicians were accessed. The SPSS 25 (IBM, Armonk, NY, USA) program was used for the analysis of the data.According to the Maslach Burnout Inventory applied in the pre-test, it was found that the feeling of personal accomplishment was high, emotional burnout was normal, and depersonalization was low. Anxiety and burnout were found to be positively correlated, and there were no statistically significant differences in the average values of the pre-and post-test Maslach Burnout Inventory and Beck Anxiety Inventory scores.Detecting possible burnout in physicians working in a pandemic, identifying associated factors and taking required measures can be beneficial both for physicians and society from a biopsychosocial perspective.

To identify the factors that influence provider’s decisions on method of delivery in a country where national cesarean delivery rate (CDR) among all births increased steadily from 21 to 56% in a 16-year period. We planned nine birth scenarios, in which both delivery modes were plausible, and we used self-administered questionnaire to ask obstetricians for their preferred mode of delivery in these scenarios. If the choice was cesarean delivery (CD), the provider was asked to state the reason for choosing this method. We grouped respondents according to number of years in their occupation, working sector (state, university or private hospital) and academic degree. Four hundred and four obstetricians completed the questionnaire. Preference for CD in all scenarios was comparable between male and female obstetricians (p = 0.334) and between specialists, associate professors and professors (p = 0.812). The most frequent reason for choice of CD in all nine scenarios was fear of fetal risk and/or fear of litigation. Fear of litigation was found to be the major factor influencing CD choice. This fear not only increases the CDR but also results in loss of training in breech delivery and operative vaginal delivery, forming a vicious cycle.

Issue addressed: Australian women are less likely to participate in recommended levels of weekly physical activity compared with men. Physical activity participation rates decrease with geographical remoteness. Research suggests that a lack of social support mechanisms within the home environment may act as a barrier for rural women to engage in physical activity, along with discomfort experienced within exercise environments. The purpose of this study was to explore the social conditions that facilitate or inhibit physical activity participation amongst women from two rural South Australian communities. Methods: A qualitative descriptive approach underpinned by a phenomenological methodological orientation was applied. Participants were recruited using a purposive sampling strategy before semi-structured interviews (N = 16) were conducted and prepared for thematic analysis. Results: Four inter-related themes were identified: support from others, time, expectations and available opportunities. Further contextual analysis revealed interwoven notions of physical activity spaces, time and social context within the themes. Conclusions: Multiple types of regulators interact to shape the motivational pattern of an individual. The themes identified align with self-determination, transactional and structuration theory, suggesting a need to consider human behaviour both pragmatically and conceptually. So what?: Results provide insight into social barriers and facilitators for physical activity participation and concomitantly provide the initial development of a framework for local strategic planning of health-promoting activities, and individual reflection to increase physical activity participation amongst rural women. Refereed/Peer-reviewed

Background: Schizophrenia spectrum disorders (SSD) are the most impairing psychiatric disorders and are a major cause of social exclusion. Despite that, there are only two studies published assessing the socioeconomic characteristics of SSD patients living in Portugal. Aims: The purpose of this study is to assess the degree of social and family support for SSD patients living in the region of ‘Tâmega e Sousa’, in northern Portugal. Method: We conducted a cross-sectional observational study using patients under home-based care provided by the Department of Psychiatry and Mental Health of Centro Hospitalar do Tâmega e Sousa. We retrieved sociodemographic data from clinical records. The study was approved by the Hospital Ethics Committee. Results: Our sample consists on 67 patients with SSD, mostly men (74.6%). Although the majority was single (69.2%) and childless (85.7%), only a minority lived alone (21.2%). In relation to their professional status, only 5.0% were employed and 78.3% got a disability pension. Among the patients that lived accompanied, 68% lived with their parents or grandparents, and a quarter lived with family members affected by psychiatric disorders. Conclusions: These findings highlight the dependence of SSD patients on their family’s support. Lack of labour market integration, economic dependence and difficulty establishing stable relationships further aggravate their social exclusion. Although our results are consistent with a previous observational study held in Portugal, our patients display a worse functional status. Even considering the possible patient selection bias, there is evidence supporting the need for more investment in psychosocial rehabilitation that should take into account the sociodemographic idiosyncrasies of this Portuguese region.

BackgroundSpatial visualization of HIV surveillance data could improve the planning of programs to address the HIV epidemic. The objectives of the study were to describe the characteristics and the spatial distribution of newly diagnosed HIV infection in Catalonia and to identify factors associated with HIV infection rates.MethodsSurveillance data from the national registry were presented in the form of descriptive and ring maps and used to study the spatial distribution of new HIV diagnoses in Catalonia (2012–2016) and associated risk factors at the small area level (ABS, acronym for “basic health area” in Catalan). Incident cases were modeled using the following as predictors: type of municipality, prevalence of young men and migrant groups, GBMSM activity indicators, and other variables at the aggregated level.ResultsNew HIV diagnoses are heterogeneously distributed across Catalonia. The predictors that proved to be significantly associated with a higher rate of new HIV diagnoses were ABS located in the city of Barcelona (IRR, 2.520;P P = 0.003), a higher proportion of GBMSM (IRR, 1.230;P = 0.030), a higher proportion of men from Western Europe (IRR, 1.281; P = 0.003), a higher proportion of men from Latin America (IRR, 1.260; P = 0.003), and a higher number of gay locations (IRR, 2.665;P ConclusionsRing maps revealed substantial spatial associations for the rate of new HIV diagnoses. New HIV diagnoses are concentrated in ABS located in urban areas. Our results show that, in the case of HIV infection, the socioeconomic deprivation index on which the Catalan government bases its budget allocation policies among the ABS should not be the only criterion used.

This study explored gender differences in mediators and moderators of the association between living alone and psychological distress among 2556 Japanese older adults aged 65 years and older. Putative mediators and moderators were physical health, income, informal networks, and social support. Living alone was significantly related to psychological distress only in men. Significant mediators were income in both genders and social support only in men. Living alone in women was related to having more informal networks, which reduced psychological distress. This contributed to mitigating the effect of living alone on psychological distress among women. Effective moderators were not discovered.

Resumen: Objetivo: Analizar si la utilización de códigos Z en la historia clínica electrónica (HCE) se correlaciona con la realidad socioeconómica de la población atendida en Atención Primaria (AP). Diseño: Estudio observacional, descriptivo, transversal, de tipo ecológico. Emplazamiento: 90 centros de salud de dos Direcciones Asistenciales de AP, Comunidad de Madrid. Participantes: El total de pacientes atendidos durante el año 2016 fue de 1.920.124 (54,33% mujeres, 45,67% hombres). El 7,15% recibió algún código Z (67,29% mujeres, 32,71% hombres). Mediciones principales: Como variable dependiente se estableció la proporción de pacientes con registros de códigos Z en su HCE. Como variables independientes se seleccionaron dos indicadores socioeconómicos que reflejan de forma objetiva las diferencias entre zonas básicas de salud: renta media disponible per cápita y proporción de inmigrantes económicos. Para evaluar la correlación entre variable dependiente e independientes se recurrió a análisis multivariante de correlación-regresión. Resultados: Se observó que a mayor renta disponible, menor proporción de registros de episodios Z en las HCE (coeficiente de correlación de Pearson: −0,56). Sin embargo, existe una gran variabilidad de registro de códigos Z y la codificación no consigue visibilizar las realidades socioeconómicas de las poblaciones atendidas (odds ratio diagnóstica: 0,12 [IC: 0,05-0,32]). Conclusiones: Resulta relevante para una orientación comunitaria de la AP la utilización de distintas herramientas que faciliten visibilizar el impacto en la salud de las desigualdades sociales, así como su evaluación a través de diversas metodologías de investigación. Los códigos Z no visibilizan en la zona estudiada los determinantes sociales de la salud de la población atendida. Abstract: Objective: Analyze whether the use of Z codes in the Electronic Health Record (EHR) correlates with the socioeconomic reality of the population attended. Design: Observational, descriptive, cross-sectional, ecological study. Location: 90 health centres of two Primary Health Care (PHC) Departments of the Community of Madrid. Participants: The total number of patients treated during 2016: 1,920,124 (54.33% women, 45.67% men). The 7.15% received some Z code (67.29% women, 32.71% men). Main measurements: As a dependent variable, the proportion of patients with Z code records in their EHRs was established. As independent variable, two socioeconomic indicators were selected that objectively reflect the differences between Basic Health Areas: Average Income Available per capita and Proportion of Economic Immigrants. To evaluate the correlation between dependent and independent variables, a multivariate correlation-regression analysis was used. Results: It was observed that the higher the disposable income, the lower the proportion of Z code records in the EHRs (Pearson correlation coefficient: −0.56). However, there is a great variability in the registration of Z codes and the coding fails to make visible the socio-economic realities of the populations covered (Diagnostic Odds Ratio: 0.12. CI: 0.05-0.32). Conclusions: The use of different tools that facilitate the visualization of the health impact of social inequalities, as well as their evaluation through various research methodologies, is relevant for a community orientation of the PHC. The Z codes do not make visible in the studied area the social determinants of health of the population attended.

This longitudinal study examined outcomes of a local peace-building intervention that applied principles of intergroup contact to promote reconciliation between génocidaires and survivors whom they have directly harmed during the 1994 Genocide Against the Tutsi in Rwanda. Individual interviews were conducted with 46 génocidaires and 45 survivors whom they have directly harmed during the genocide at 7-time points over the course of their 22-month participation in three programmatic activities (workshops, cell groups, and cooperative cow raising). One thousand bootstrapped samples generated to measure changes in outcomes indicated that survivors and génocidaires regarded themselves and those who directly impacted them during the genocide more positively after 22 months. Although both survivors and génocidaires experienced significant decline in trauma symptomatology after 22 months, they responded to programmatic activities differently. Cell group interactions sustained some positive outcomes (génocidaires perceived forgiveness by others) after the workshops and further improved others (génocidaires self-forgiveness). Survivors who participated in cell groups and raised cows with génocidaires demonstrated further willingness to reconcile compared to survivors who participated in cell groups alone. Our findings empirically support the benefits of promoting different forms of intergroup interactions long after a period of intense violence and highlight the importance of considering how the trajectories of outcomes can inform program and theory development. HIGHLIGHTS: Survivors and génocidaires in Rwanda benefited from a local intergroup contact intervention (CI). However, génocidaires and survivors they directly harmed benefited differently over 22-months. Preparing survivors and génocidaires with skills to participate in communal life is critical for CI. Highlighting both CI outcomes and trajectories are essential for program and theory development.

International audience; BackgroundConstitutional thinness (CT), a non‐malnourished underweight state with no eating disorders, is characterized by weight gain resistance to high fat diet. Data issued from muscle biopsies suggested blunted anabolic mechanisms in free‐living state. Weight and metabolic responses to protein caloric supplementation has not been yet explored in CT.MethodsA 2 week overfeeding (additional 600 kcal, 30 g protein, 72 g carbohydrate, and 21 g fat) was performed to compare two groups of CTs (12 women and 11 men) to normal‐weight controls (12 women and 10 men). Bodyweight, food intake, energy expenditure, body composition, nitrogen balance, appetite hormones profiles, and urine metabolome were monitored before and after overfeeding.ResultsBefore overfeeding, positive energy gap was found in both CT genders (309 ± 370 kcal in CT‐F and 332 ± 709 kcal in CT‐M) associated with higher relative protein intake per kilo (1.74 ± 0.32 g/kg/day in CT‐F vs. 1.16 ± 0.23 in C‐F, P < 0.0001; 1.56 ± 0.36 in CT‐M vs. 1.22 ± 0.32 in C‐M, P = 0.03), lower nitrogen (7.26 ± 2.36 g/day in CT‐F vs. 11.41 ± 3.64 in C‐F, P = 0.003; 9.70 ± 3.85 in CT‐M vs. 14.14 ± 4.19 in C‐M, P = 0.02), but higher essential amino acids urinary excretion (CT/C fold change of 1.13 for leucine and 1.14 for arginine) in free‐living conditions. After overfeeding, CTs presented an accentuated positive energy gap, still higher than in controls (675 ± 540 in CTs vs. 379 ± 427 in C, P = 0.04). Increase in lean mass was induced in both controls genders but not in CTs (a trend was noticed in CT women), despite a similar nitrogen balance after overfeeding (5.06 ± 4.33 g/day in CTs vs. 4.28 ± 3.15 in controls, P = 0.49). Higher anorectic gut hormones' tone, glucagon‐like peptide 1 and peptide tyrosine tyrosine, during test meal and higher snacking frequency were noticed before and after overfeeding in CTs.ConclusionsThe blunted muscle energy mechanism, previously described in CTs in free‐living state, is associated with basal saturated protein turn over suggested by the concordance of positive nitrogen balance and an increased urine excretion of several essential amino acids. This saturation cannot be overpassed by increasing this spontaneous high‐protein intake suggesting a resistance to lean mass gain in CT phenotype.

Background: The objective of this study was to assess the safety and performance of the Omnipod® personalized model predictive control (MPC) algorithm in adults, adolescents, and children aged ≥6 years with type 1 diabetes (T1D) under free-living conditions using an investigational device. Materials and Methods: A 96-h hybrid closed-loop (HCL) study was conducted in a supervised hotel/rental home setting following a 7-day outpatient standard therapy (ST) phase. Eligible participants were aged 6–65 years with A1C

Sex and gender are not equivalent concepts, even though these 2 variables are often used interchangeably by researchers. The precise use of variables is critical to ensure that research and theoretical work is of the highest quality. This article defines sex and gender and the importance of recognizing both of these variables as being unique and then demonstrates the benefit of measuring both of these variables using the cardiovascular disease literature as an exemplar. Additionally, recommendations for scholars regarding the use of sex and gender in the research and theoretical literature are provided.

Rationale Several single or combined therapeutic approaches have been developed to treat addiction, however with partial efficacy in preventing relapse. Recently, the living environment has been suggested as a critical intervening factor determining the treatment outcomes. Despite accumulating evidence confirming a role of living conditions in the vulnerability to addictive behaviours, their impact on single or integrative therapeutic strategies preventing relapse is yet to be identified. Objectives Here, we explore the possible interaction between brief Environmental Enrichment (EE) exposure and acute fluoxetine administration in inhibiting sucrose-seeking behaviours, and whether this effect could be affected by living environment. Methods Social and isolated adult male C57BL/6 mice were trained to sucrose self-administration associated to a specific conditioning context (CxA), followed by a 7-day extinction in a different context (CxB). Afterwards, mice were exposed for 22 h to EE and then injected with fluoxetine (10 mg/kg, i.p.) 1 h before a CxA-induced sucrose-seeking test. Results Brief EE exposure and acute fluoxetine administration alone inhibited context-induced sucrose-seeking in both housing conditions; however, they exhibited additive properties only in social condition. Conclusions Our data show that social environment may influence the EE/fluoxetine interaction in inhibiting relapse to sucrose. These findings suggest that setting up proper living conditions to boost the efficacy of therapeutic approaches may represent a fundamental strategy to treat addiction disorders.

Background Between 1975 and 1985 a total of 91 Danish patients with moderate and severe hemophilia (PWH) was infected with HIV constituting a major scandal in the Danish health care system. This study describes the burden of HIV infection among Danish PWH by evaluating changes from 1988 to 2012 in well-being, social function, experiencing stigma and openness about disease among Danish HIV+ PWH. Methods Three anonymous surveys were conducted in 1988, 2001 and 2012 targeting all Danish patients with moderate to severe hemophilia. Survey responses were received from 53, 21 and 18 HIV+ PWH respectively. A matched comparison sample of HIV− PWH was identified for each survey-year, using propensity score matching. Differences for each survey-year and trends over time were analyzed using ordinal logistic regression. Results In 1988, HIV+ PWH had more psychosomatic symptoms than HIV− PWH, but in 2001 life satisfaction was higher among HIV+ PWH than among HIV− PWH. Tests of differences in trend over time showed larger improvements in life satisfaction among HIV+ PWH than HIV− PWH, while HIV− PWH showed an increase in educational level compared to HIV+ PWH. Analysis restricted to HIV+ PWH showed an increase in perceived stigmatization. Conclusions Differences between Danish HIV+ and HIV− PWH regarding well-being and psychosomatic symptoms seem to have evened out between 1988 and 2012. However, results suggest that HIV+ PWH still experience stigmatization and lower levels of education.

BackgroundSocioeconomic inequalities in health behaviors have been attributed to both structural and individual factors, but untangling the complex, dynamic pathways through which these factors influence inequalities requires more empirical research. This study examined whether and how two factors, material conditions and time orientation, sequentially impact socioeconomic inequalities in health behaviors.MethodsDutch adults 25 and older self-reported highest attained educational level, a measure of socioeconomic position (SEP); material conditions (financial strain, housing tenure, income); time orientation; health behaviors including smoking and sports participation; and health behavior-related outcomes including body mass index (BMI) and self-assessed health in three surveys (2004, 2011, 2014) of the longitudinal GLOBE (Dutch acronym for “Health and Living Conditions of the Population of Eindhoven and surroundings”) study. Two hypothesized pathways were investigated during a ten-year time period using sequential mediation analysis, an approach that enabled correct temporal ordering and control for confounders such as baseline health behavior.ResultsEducational level was negatively associated with BMI, positively associated with sports participation and self-assessed health, and not associated with smoking in the mediation models. For smoking, sports participation, and self-assessed health, a pathway from educational level to the outcome mediated by time orientation followed by material conditions was observed.ConclusionsTime orientation followed by material conditions may play a role in determining socioeconomic inequalities in certain health behavior-related outcomes, providing empirical support for the interplay between structural and individual factors in socioeconomic inequalities in health behavior. Smoking may be determined by prior smoking behavior regardless of SEP, potentially due to its addictive nature. While intervening on time orientation in adulthood may be challenging, the results from this study suggest that policy interventions targeted at material conditions may be more effective in reducing socioeconomic inequalities in certain health behaviors when they account for time orientation.

Since the beginning of the COVID-19 pandemic, evidence shows the negative psychological impact of lockdown measures in the general population. It is also important to identify predictors of psychological distress in vulnerable people, particularly patients with history of depressive episodes (the most prevalent psychiatric disorder), in order to adapt mental health strategies for future lockdown measures. This study aim was to (1) compare in 69 healthy controls (HC) and 346 patients with a major depressive episode in the two previous years (PP) self-reported psychological symptoms (depression, anxiety, insomnia, suicidal ideation, traumatic stress, anger) and living conditions during the first national French lockdown, and (2) identify predictors of significant psychological distress in PP. The levels of psychological symptoms were very low in HC compared with PP, independently of the living conditions. Half of PP had no psychiatric contact during the lockdown. Loneliness and boredom were independent predictors of depression, anxiety and insomnia, whereas daily physical activity was a protective factor. Virtual contacts protected against suicidal ideation. Our results highlight the need of specific strategies to target loneliness and boredom and to improve care access, including telepsychiatry. Longitudinal studies must investigate the COVID-19 pandemic psychological impact in clinical samples.

The aim of this study is to assess the effectiveness of Living Peace Intervention (LPint) in terms of reduction of domestic violence and a range of secondary outcomes, including violence against children, mental health wellbeing, and social/family relations. The study aims also to determine whether LPint reduces domestic violence due to mediating effects of reduction of psychopathology, improved positive masculinity attitudes, family and social life and psychological states. This study uses a Cluster Randomized Controlled Trial design, with person-level and cluster-level outcomes. The counterfactual is villages that are listed as being affected by the conflict in North and South Kivu of Democratic Republic of the Congo (DRC). Sixty villages with 1736 participants were included in the study. The primary analysis will use generalized estimating equations to compare treatments versus control groups on their mean change in domestic violence between baseline and endline one and two. The allocated group will be regarded as fixed effects whilst villages and time points are regarded as random effects in the model. This is a unique study in the context of a protracted violent humanitarian crisis notably the DRC. It uses a Cluster Randomized Controlled Trial (CRCT) to obtain hard empirical evidence to prove the scalability of the Living Peace intervention in close humanitarian contexts.

The optimal time to bolus insulin for meals is challenging for children and adolescents with type 1 diabetes (T1D). Current guidelines to control glucose excursions do not account for individual differences in glycaemic responses to meals. This study aimed to examine the within- and between-person variability in time to peak (TTP) glycaemic responses after consuming meals under controlled and free-living conditions. Participants aged 8–15 years with T1D ≥ 1 year and using a continuous glucose monitor (CGM) were recruited. Participants consumed a standardised breakfast for six controlled days and maintained their usual daily routine for 14 free-living days. CGM traces were collected after eating. Linear mixed models were used to identify within- and between-person variability in the TTP after each of the controlled breakfasts, free-living breakfasts (FLB), and free-living dinners (FLD) conditions. Thirty participants completed the study (16 females; mean age and standard deviation (SD) 10.5 (1.9)). The TTP variability was greater within a person than the variability between people for all three meal types (between-person vs. within-person SD; controlled breakfast 18.5 vs. 38.9 min; FLB 14.1 vs. 49.6 min; FLD 5.7 vs. 64.5 min). For the first time, the study showed that within-person variability in TTP glycaemic responses is even greater than between-person variability.

Background This study was part of a project funded under the Grand Challenges Explorations initiative to engage adolescent girls living in the main slums of Nairobi. This involved an innovative co-creation initiative through jointly designing and testing the feasibility of a toolkit of information, skill, and confidence-building, and coping mechanisms that can effectively shield them and their peers against the risks of mental stress during pregnancy and early motherhood. Methods Qualitative interviews and discussions from visual methodologies including Photovoice, digital storytelling, and public service announcements were conducted with 30 pregnant and adolescent mothers aged 14–19 years in four informal settlements either pregnant or having a child less than 2 years. The aims included; to generate an inventory of mental stressors during pregnancy and early motherhood; understand how mental stress affects the ability to seek care for themselves and their child, and understand individual coping strategies. Results The psychosocial challenges identified in order of importance included: chased from home by the parents; economic hardship; neglect and abandonment by the person responsible for the pregnancy; stigmatization by family, friends, and the community; feelings of shattered dreams; and daily stress related to living in poor and unhygienic conditions. During the pregnancy and early motherhood, the participants experienced feelings of embarrassment, shame, hopelessness, and to the extreme, suicidal thoughts clouded their minds. Main coping strategies included social isolation for some, socializing with other pregnant and adolescent mothers, and negative behaviors like the uptake of illicit drugs and alcohol and risky sexual relationships. Conclusion The unpreparedness for early motherhood infused with inadequate psychosocial support led to increased mental stress and risk of depression. The interconnection between the triggers to mental stress showed the need to focus on a multifaceted approach to address the wellbeing of pregnant and adolescent mothers.

Objective: To explore how medieval living conditions, occupation, and an individual's role within society impacted their risk of skeletal trauma. Materials: The skeletal remains of 314 individuals from medieval Cambridge that were buried in the parish cemetery of All Saints by the Castle (n = 84), the Augustinian friary (n = 75), and the cemetery of the Hospital of St John the Evangelist (n = 155) were analyzed. Methods: Macroscopic examination and plain radiographs were used to classify fracture type. The causative mechanisms and forces applied to a bone were inferred based on fracture morphology. Results: The skeletal trauma observed represents accidental injuries, likely sustained through occupational or everyday activities, and violence. The highest prevalence rate was observed on the individuals buried at All Saints by the Castle (44%, n = 37/84), and the lowest was seen at the Hospital of St John (27%, n = 42/155). Fractures were more prevalent in males (40%, n = 57/143) than females (26%, n = 25/95). Conclusions: Skeletal trauma was highest in All Saints parish burial ground, indicating that the poor, whether working urban or rurally, had the highest risk of injury. The pattern and types of fractures observed suggests that males experienced more severe traumatic events than females. However, females that were routinely involved in manual labor were also at increased risk of injury. Significance: This article enhances our understanding of how traumatic injuries differed by age, sex, and burial locations in the medieval period. Further research: Additional comparative studies in different geographical regions are needed to determine how representative these findings are.

Libya is a major transit and destination country for international migration. UN agencies estimates 571,464 migrants, refugees and asylum seekers in Libya in 2021; among these, 3,934 people are held in detention. We aimed to describe morbidities and water, hygiene, and sanitation (WHS) conditions in detention in Tripoli, Libya. We conducted a retrospective analysis of data collected between July 2018 and December 2019, as part of routine monitoring within an Médecins Sans Frontières (MSF) project providing healthcare and WHS support for migrants, refugees and asylum seekers in some of the official detention centres (DC) in Tripoli. MSF had access to 1,630 detainees in eight different DCs on average per month. Only one DC was accessible to MSF every single month. The size of wall openings permitting cell ventilation failed to meet minimum standards in all DCs. Minimum standards for floor space, availability of water, toilets and showers were frequently not met. The most frequent diseases were acute respiratory tract infections (26.9%; 6,775/25,135), musculoskeletal diseases (24.1%; 6,058/25,135), skin diseases (14.1%; 3,538/25,135) and heartburn and reflux (10.0%; 2,502/25,135). Additionally, MSF recorded 190 cases of violence-induced wounds and 55 cases of sexual and gender-based violence. During an exhaustive nutrition screening in one DC, linear regression showed a reduction in mid-upper arm circumference (MUAC) of 2.5mm per month in detention (95%-CI 1.3–3.7, p

Heteronormative and gender hierarchical organization of economic, legal, and family life intersect to marginalize the lesbian community in South Korea. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) and women's rights movements achieved some gains after democratic transition in the 1990s, but anti-LGBTQ activists target lesbians with harassment and violence. How do lesbians build networks and safe space under these conditions? How do they balance competing needs for visibility and safety? Drawing on 16 months of participant observation and ethnographic interviews, I analyze the relationship between lesbian community growth and safety practices. My intersectional approach examines the heterosexist context in which lesbian social spaces are maintained, and relations of power among LGBTQ, feminist, and anti-LGBTQ groups. Under threat of intersectional violence, lesbian social entrepreneurs withhold information, screen members and rely on spatial tactics to hide in plain sight, prioritizing safety over visibility. Finally, I discuss how some community members marginalized by these safety practices gain access to lesbian spaces.

Objective The overarching goal of the Swedish public health policy is to create the right societal conditions for good and equitable health throughout the population and to reduce avoidable health inequalities within a generation. The objective of this article is to highlight the main findings of the Open Comparisons in Public Health (OCPH) 2019 study. Study design The OCPH is a longitudinal indicator-based comparative study, encompassing 39 public health indicators with results from Sweden's 21 regions and 290 municipalities. Methods Descriptive statistics and 95% confidence intervals were used to compare results between municipalities, regions and time points. Correlation analysis was used to study the strength of the relationship between the results of municipalities and their socio-economic conditions. Results Across the population, levels of health are good and have, in some areas, improved over recent decades. However, some significant health disparities remain according to neighbourhood, sex, age and educational background. Health disparities related to the level of education are often larger than those between women and men, and there are larger differences within a region than between regions. Health disparities have, in some cases, increased, such as for life expectancy. Conclusion If health equity is to be achieved, leaders at all levels must collaborate and advocate for political action and local efficient public health interventions to eliminate health disparities as a result of neighbourhood and social conditions.

Loneliness can be evaluated from a 4-concept viewpoint of territory, threat, trauma and trust (4 Ts). Territory refers to an area of ownership that is controlled on a daily basis and is fundamental to one's daily life. Lonely individuals often manage boundaries by gaining greater control over their physical environment by territorial behavior. They guard personal territory well as the only area where they can exert dominance and feel safe. Perceptions of social isolation or loneliness increase vigilance for threats, decrease trust, and heighten feelings of vulnerability. Clinical teams caring for the lonely must be especially attentive to a history of prior trauma. Clinicians who ask permission, who pay attention to nonverbal cues, distance, and speed as they enter the lonely person's space, and who respect boundaries may be more successful in gaining trust. Achieving trust diminishes the risk of physical harm, while allowing lonely persons the perceived control they need to permit health care interventions. Veterans are at higher risk for loneliness. Given their military training, they may be particularly attentive to boundaries, protecting the perimeter, watching for threats, and defending their space. In this article, we discuss the successful mental health treatment of a lonely male veteran in a Veterans Affairs Medical Center, by paying attention to the 4 Ts of loneliness. We used a 4-step approach of validation, mentalization, reality testing, and socialization to decrease the sense of threat as we sought acceptance to the patient's territory, followed by building trust and working on past trauma.

OBJECTIVE The aim of the study was to investigate sex differences and the impact of social living situation on individual functional independence measure outcomes after stroke rehabilitation. DESIGN A retrospective observational study using Medicare fee-for-service beneficiaries (N = 125,548) who were discharged from inpatient rehabilitation facilities in 2013 and 2014 after a stroke. Discharge individual functional independence measure score, dichotomized as ≥5 and

Background The inadequate management of solid waste impacts populations’ health and quality of life, and disproportionately affects developing countries. This study aims to describe a protocol for epidemiological diagnosis, the purpose being to estimate the prevalence of chronic and communicable and non communicable diseases in waste pickers, and the occupational and environmental risk factors to which these are exposed. Methods This is a cross-sectional study, based on survey design in an area of extreme social vulnerability – the largest garbage dump in Latin America. Using a multidimensional research protocol, divided in three stages: 1- The identification of the subjects, and the scheduling of tests; 2- Situational diagnosis through interviews, anthropometric evaluation, measuring blood pressure, collecting hair and nail samples to detect exposure to heavy metals and undertaking laboratory tests; 3- The return of the waste pickers to receive the test results, followed by referral to the health team and to report occupational accidents. Results One thousand twenty-five waste pickers undertook tests and interviews. The majority were women (67.0%), with 36–45 years old (45.7%), and 96.0% had children. In total, 27.3% of the participants did not attend to any school and 47.7% were educated only up to primary level. The majority of waste pickers (68.70%) reported accidents and most of them (89.69%) were related to sharp objects. The mean time working in this open dump was 15 years. According the anthropometric measure, 32.6% were overweight and 21.1% were obese. The most common reported diseases were: osteomuscular disorders (78.7%); arboviruses (28.6%); episodic diarrhea (24.9%); hypertension (24.2%); bronchitis (14.3%); intestinal worms (12.6%) and diabetes (10.1%). According to the blood tests, the values outside the reference limits were: Uric acid (23.89%); creatinine (54.06%); GGT range (16.04%); SGOT - Serum Glutamic Oxaloacetic Transaminase (5.29%); SGPT - serum Glutamic-Pyruvic Transaminase (35.52%). Conclusions This study is the first to evaluate multiple risks and diseases in the majority of waste pickers working in the largest garbage dump of a continent. These findings highlight the importance to address urgently the environmental, social and health impacts related to the management of solid waste in developmental countries to protect these workers and their families. Electronic supplementary material The online version of this article (10.1186/s12889-019-6879-x) contains supplementary material, which is available to authorized users.

Background Visceral leishmaniasis (VL), a vector-borne disease caused by species of the L.donovani complex, has (re)-emerged in Ethiopia during the last two decades and is currently of increasing public health concern. However, very little is known about VL epidemiology in the Somali Region of Ethiopia. The aim of this study was to provide detailed epidemiological information on seroprevalence, associated factors and incriminated vectors of VL in Shebelle Zone and Ethiopian Somali Region in general. Methods A cross-sectional epidemiological study was conducted between March and May 2016 in Gode and Adadle districts of Shebelle Zone, Ethiopian Somali Region. Two-stage semi-random sampling was applied for selecting study participants for the field survey. The study included structured questionnaire interviews, serological assays (rK39-immunochromatographic test), ELISA and entomological surveys. Results From a total of 361 participants, 57 (15.8%) were seropositive for VL including 46 (12.7%) rK39 positive and 11 (3.0%) positive by both rK39 and ELISA. VL seroprevalence was higher (P

Background: Previous studies have identified poor dietary intake as a health risk affecting survivors of the 2011 Great East Japan Earthquake and Tsunami. We examined the association between different social factors (eg, living conditions and perceptions of community social capital) and dietary intakes among disaster-affected survivors. Methods: We studied 6,724 survivors in four municipalities of Iwate Prefecture 3 years after the disaster. Social capital was assessed via four items inquiring about respondents’ perceptions of social cohesion in their communities. Good dietary intake was defined according to the following criteria: intake of staple food ≥three times a day; intake of meat, fish and shellfish eggs, or soybean products ≥twice a day; vegetable intake ≥twice a day; and intake of fruit or dairy products ≥once a day. An individual who did not meet any of these criteria was defined as having poor dietary intake. We adjusted for covariates, including socioeconomic status, marital status, and residential area. Results: Poor dietary intake was reported by 31.6% of respondents. Poisson regression analyses revealed that the following factors were related to poor dietary intake: age

Objectives: Eudaimonic well-being (EWB), increasingly recognized as a critical component of health, typically declines in later life, and there are no existing programs to sustain or increase EWB in older adults. Lighten UP! is an 8-week program to promote EWB through facilitated group sessions in community settings and at-home practice. Building on earlier pilot research, the current study assessed the effect of the Lighten UP! Program using a longitudinal, multi-site design. Methods: Men and women (N=169) aged 60 and over were recruited from three Wisconsin communities. EWB, life satisfaction, depression, and diverse aspects of health were assessed before and after the program and at 6-month follow up. Results: Participants reported significantly increased EWB; these changes were maintained 6months later. The specific EWB domains of self-acceptance, positive relations, and personal growth showed the most robust gains. Participants also showed significant and sustained declines in depressive symptoms, anxiety, and hostility. Conclusions: Lighten UP! Program confirmed its positive effects for enhancing EWB in older adults living in multiple community settings. Clinical Implications: Programs that sustain or enhance EWB in older adults can be expected to yield improvements in diverse aspects of mental and physical health.

Aims and objectives:To gather insight in conditions important to an understanding of undocumented migrants’ life situations and more specifically to explore undocumented migrants’ quality of life and how we can understand the various domains of quality of life related to demographics, living conditions, migration history and inflicted burden. Background:Undocumented migrants suffer from economic hardship and acculturative stress, limited psychological and social support and at the same time restricted access to health care and social welfare. Design: An exploratory mixed methods design using primarily quantitative data with a qualitative component was implemented. Methods: Sociodemographic data on 90 undocumented migrants were collected, and self‐report questionnaires on quality of life and psychological distress were completed, supplemented by qualitative data obtained through interviews and additional qualitative questions. The STROBE checklist for cross‐sectional studies was used for reporting this study. Results: Quality of life in our group of undocumented migrants was poor. Leaving their home country because of war or persecution, hunger, having experienced abuse, homelessness and higher age were statistically significantly associated with poorer quality of life. Having membership in a local association and having a partner were statistically significantly associated with better quality of life. Qualitative data indicate that marginal living conditions, fear of death and suffering and conditions associated with dependency were the main components comprising the burden to our respondents, reflecting their precarious juridical status as undocumented migrants. Conclusion: Our respondents’ poor quality of life was related to the complex interplay between possible exposures to traumatic experiences before and during flight and post‐migration traumatisation in relation to our respondents’ experiences of economic, social and acculturative hardship in Norway. Relevance to Clinical Practice: Responses called for to improve undocumented migrants’ quality of life and eliminate barriers to their health care appeal more to nurses as a professional group and to those in positions of authority than each individual nurse on duty. Eckbo’s Legacy (Major og advokat Eivind Eckbos Legat). Grant Numbers: 15350 (2011), 59362 (2013)

The imperative to heed social environment and power of the situation, particularly as applied to prison settings, dates to the 1971 Stanford Prison Experiment; the widely cited study concluded that situational factors, not personality, created the damaging conditions observed. Despite critical need for research on prison climate, measurement has met stiff challenges, and little research on prison culture exists in the United States. This study applies a 17-item scale, primarily based on Essen Climate Evaluation Schema (EssenCES), an instrument validated in Australia, Germany, and the United Kingdom. It was administered to inmates and staff in three correctional facilities in the U.S. Midwest, one medium security and two maximum security. Survey results demonstrate higher levels of cohesion at the medium-security facility, but multivariate analysis suggests a much more complex relationship between facility and environment, varying particularly in response to perceived inmate threat. Qualitative data suggest that understanding these associations is vital to building socially adaptive conditions and prosocial change.

The so-called 'fatal five' behaviours (drink and drug driving, distraction and inattention, speeding, fatigue, and failure to wear a seat belt) are known to be the major behavioural contributory factors to road trauma. However, little is known about the factors that lead to drivers engaging in each behaviour. This article presents the findings from a study which collected and analysed data on the factors that lead to drivers engaging in each behaviour. The study involved a survey of drivers' perceptions of the causes of each behaviour and a subject matter expert workshop to gain the views of road safety experts. The results were mapped onto a systems ergonomics model of the road transport system in Queensland, Australia, to show where in the system the factors reside. In addition to well-known factors relating to drivers' knowledge, experience and personality, additional factors at the higher levels of the road transport system related to road safety policy, transport system design, road rules and regulations, and societal issues were identified. It is concluded that the fatal five behaviours have a web of interacting contributory factors underpinning them and are systems problems rather than driver-centric problems. The implications for road safety interventions are discussed.

Background: Although upper limb (UL) dysfunctions are quite common among people with Multiple Sclerosis (pwMS), there is a scarcity of information about actual UL usage under free-living conditions. The aim of the present study is to quantitatively assess ‘real-world’ activity time, intensity and possible asymmetry of use among dominant and non-dominant ULs in pwMS. Methods: Twenty-eight pwMS (20 women, 8 men, average EDSS 4.3) and 28 age- and sex-matched unaffected individuals were required to wear a tri-axial accelerometer on each wrist 24h/day for 2 weekdays. Raw accelerations were processed to calculate parameters associated with time and intensity of use of UL both when engaged in uni- or bilateral activities. Results: During the 2-day monitoring period, pwMS were characterized by significantly lower overall activity, they used their dominant limb for a significantly longer time and, while performing bilateral activities, their dominant limb expressed movements of superior intensity in a proportion higher than what was observed in unaffected individuals. Conclusion: The instrumental monitoring of UL activity with two wrist-worn sensors may represent an effective tool for assessing the contribution of each limb to uni- and bilateral movements. Such data can be employed to monitor the progression of UL dysfunctions and the effectiveness of pharmacologic and rehabilitative treatments.

Background Research on health-related quality of life (HRQL) has become increasingly important in recent decades. However, the impact of both living conditions and the level of autonomy impairments on HRQL in COPD patients receiving non-invasive ventilation (NIV) is still unclear. Methods The Severe Respiratory Insufficiency Questionnaire (SRI) was used to measure HRQL in a prospective cohort of COPD patients in whom home NIV was already established. Data on sociodemographics, clinical characteristics and standardized levels of autonomy impairment were evaluated. A multiple linear regression analysis was performed to identify the factors associated with a reduced HRQL. Results A total of 137 patients (67.0 ± 7.8 years, 45% female) were assessed. The mean SRI Summary Score was 54.1 ± 16.9 (95%CI: 51.1–57.1; N = 127). Regular ambulatory care was provided in 76% of patients, but only 37% underwent pulmonary rehabilitation. Overall, 69% of patients lived with family members, while 31% lived alone (family situation). Autonomy impairment levels were most serious in 3%, serious in 14%, and significant in 29% of patients, while 54% had no impairments at all. Of note, higher levels of autonomy impairment were markedly associated with lower SRI scores (regression coefficient − 6.5 ± 1.1 per level; P P = 0.959), ambulatory care by a respiratory specialist (1.7 ± 3.6; P = 0.638), and pulmonary rehabilitation (− 0.8 ± 3.1; P = 0.802) did not appear to influence HRQL. Possible subgroup effects were evident for the factors “impaired autonomy” and “living in a nursing home” (P = 0.016). Conclusion A higher level of autonomy impairment has been identified as the major determinant of reduced HRQL in COPD-patients receiving long-term NIV, particularly in those living in a nursing home. Trial Registration German Clinical Trials Register (DRKS00008759).