International Journal of Environmental Research and Public Health

BackgroundPatient safety culture is a key determinant of healthcare quality, yet evidence remains limited on how nurses person-centered care competence and patient safety competence relate to patient safety culture through patient safety management activities, particularly in low- and middle-income settings. ObjectiveTo describe levels of person-centered care competence, patient safety competence, patient safety management activities, and patient safety culture among nurses in central Vietnam, and to examine direct and indirect relationships among these factors using a mediation model. MethodsA multicenter cross-sectional study was conducted among 1,036 nurses from five tertiary hospitals in central Vietnam (response rate 99.6%). Person-centered care competence was measured using P-CAT, patient safety competence using H-PEPSS, patient safety management activities using PSMA, and patient safety culture using HSOPSC. Descriptive statistics, Pearson correlations, and multivariable linear regression analyses were performed. Mediation effects were tested using bias-corrected bootstrapping with 5,000 resamples. ResultsMean scores indicated moderate-to-high levels of person-centered care competence (3.77{+/-}0.36), patient safety competence (4.23{+/-}0.36), and patient safety management activities (4.44{+/-}0.35), while patient safety culture was moderate (3.93{+/-}0.35). All variables were positively correlated, with the strongest association observed between person-centered care competence and patient safety culture (r=0.49, p<0.001). In adjusted regression analyses, person-centered care competence and patient safety competence were independently associated with patient safety management activities ({beta}=0.149 and {beta}=0.274; both p<0.001). Patient safety management activities were significantly associated with patient safety culture ({beta}=0.102, p<0.001). Bootstrapped mediation analyses demonstrated significant partial mediation through patient safety management activities for both person-centered care competence (indirect {beta}=0.0265, 95% confidence interval 0.0143-0.0404) and patient safety competence (indirect {beta}=0.0497, 95% confidence interval 0.0304-0.0711). ConclusionsHigher person-centered care competence and patient safety competence were associated with stronger patient safety culture, partly through increased engagement in patient safety management activities. Interventions to strengthen patient safety culture should combine competence development with organizational supports that enable reliable frontline safety practices.

IntroductionMusculoskeletal injuries (MSKIs) are ubiquitous in the U.S. military, especially among high-performing service members such as Marines. Given that female service members only started to be assigned to ground combat roles since December 2015, evaluation of sex on MSKI risk in ground combat occupations has not been possible until there was an ample population to study. The purpose of this population-level epidemiological study was to assess (1) if female sex was a salient risk factor for MSKI in Marines serving in different military occupations, including combat arms, and (2) the effects of integration period on MSKI risk among female Marines. Materials and MethodsA population-based epidemiological retrospective cohort study of all U.S. Marines was performed assessing female sex, occupation, and integration period on the prevalence of MSKI from 2011 through 2020. The Military Health System Data Repository was utilized to identify initial healthcare encounters for diagnosed ankle-foot, knee, lumbopelvic-hip, thoracocostal, cervicothoracic, shoulder, elbow, or wrist-hand complex injuries. Prevalence was calculated for female and male Marines in each occupational category (combat, combat support, aviators, aviation support, services) during the pre-integration (2011-2015) and post-integration (2016-2020) periods. ResultsDuring the pre-integration period, 520/1,000 female Marines (n=13,985) and 299/1,000 male Marines (n=142,158) incurred MSKIs. In the post-integration period, the prevalence increased to 565/1,000 female Marines (n=17,608) and 348/1,000 male Marines (n=161,429). In the multivariable evaluation of sex, occupation, integration period, and the interaction of sex and occupation on combined MSKIs, only female sex was a significant factor for injury (prevalence ratio [PR]=1.99), with service in ground combat and aviation occupations identified as protective factors when compared with services occupations (PR=0.69). When these same factors were evaluated for specific MSKI outcomes, female sex remained a robust factor in all lower quarter (PR=1.75-2.63) and upper quarter (PR=1.38-2.36) injuries except for shoulder injuries. Service in ground combat and aviation occupations was protective for all lower quarter injuries (PR=0.46-0.71). In the upper quarter, ground combat was protective for all injuries except for elbow injuries (PR=0.67-0.77). Serving as an aviator was a risk factor for cervicothoracic (PR=1.57) and thoracocostal (PR=1.22) injuries and a protective factor for shoulder (PR = 0.73) and wrist-hand (PR = 0.46) injuries. Adjusted risk for lumbopelvic-hip (PR=1.13), ankle-foot (PR=1.53), cervicothoracic (PR=1.19), thoracocostal (PR=1.14), and elbow (PR=1.48) injuries significantly increased during the post-integration period. There was a significant sex-by-period interaction for shoulder injuries alone, with female sex in the post-integration epoch found to be salient (PR=1.26). ConclusionsFemale sex was a salient factor for MSKI, with service in ground combat and aviation occupations identified as protective factors when compared with services occupations. In the evaluation of specific MSKIs, female sex remained a robust and significant factor in all lower quarter injuries and upper quarter injuries except for shoulder injuries. There was only a significant sex-by-period interaction for shoulder conditions, with an increased risk of these injuries in female Marines in the post-integration period.

PurposeThe GIG-OSH cohort was established to investigate the impact of digital platform work on occupational safety and health (OSH), working and employment conditions, and health in seven countries in Europe. ParticipantsThe cohort comprises 3,945 digital platform workers from seven European countries. The sample includes both web-based workers (e.g., micro-tasking, freelance design) and on-location workers (e.g., delivery, transport). Participants were recruited using non-probabilistic sampling strategies tailored to national contexts, including social media advertising, recruitment through micro-task platforms, and on-site field outreach. Multidimensional data have been collected through online surveys (implemented via REDCap) covering sociodemographic characteristics, working and employment conditions, psychosocial risks, algorithmic management, and physical and mental health indicators. Findings to dateParticipants had a mean age of 32.6 years at baseline (SD 10.4), and the majority are male (58.8%), with a higher concentration of migrants in on-location tasks (62.2%) compared to web-based tasks (48.8%). Regarding educational attainment, 55.4% of the total cohort holds a tertiary degree, reaching 64.4% among web-based workers. Platform work intensity varies significantly: on-location workers averaged 85.4 hours of work in the last month, while web-based workers averaged 47.0 hours. Mean income from platform work as a percentage of the national median was 20.6% (SD 22.2). The mean WHO-5 Well-Being Index score was 58.7 (SD 20.3), which is notably lower than the European general population average (69.4), indicating poorer mental health outcomes among cohort members. Future plansThe GIG-OSH cohort represents the first large-scale, longitudinal study examining occupational safety and health among digital platform workers across multiple European countries. Future waves will prioritize developing precise tools to measure hourly earnings and unpaid waiting time. Future research should aim to include underrepresented subgroups, such as medical and domestic care workers, and explore potential linkage with administrative records to evaluate long-term health trajectories and the impact of new EU labour regulations. Strengths and limitations of this studyO_LIThis is the first large-scale longitudinal cohort to examine occupational safety and health among platform workers across multiple European countries, addressing an important evidence gap. C_LIO_LIThe inclusion of both web-based and on-location workers enables comparative analyses across diverse task types, employment conditions, and national contexts. C_LIO_LIRecruitment strategies tailored to national contexts enhanced feasibility but limited the representativeness of samples and precluded national-level weighting or benchmarking. C_LIO_LIHigh attrition between waves and the absence of harmonized classifications (e.g., education levels) across countries may constrain the generalizability and longitudinal consistency of findings. C_LIO_LIDespite relying on self-reported data, the study used stakeholder-informed instruments and captured a wide range of occupational hazards--such as psychosocial and algorithmic risks--not typically addressed in conventional labour surveys. C_LI

Objective: Improved diet quality is increasingly important for comorbidities management and healthy aging in people with HIV (PWH). Yet, limited data exist on dietary patterns and their correlates in this population. This study aimed to (1) characterize dietary patterns among adult PWH and (2) identify demographic, clinical, and HIV related factors associated with diet quality. Methods: We conducted a cross sectional analysis of PWH enrolled in the PROSPER HIV study across four U.S. academic medical centers. Dietary intake was assessed using three 24 hour dietary recalls and scored using the Healthy Eating Index 2015 (HEI2015). Participants were categorized into tertiles based on total HEI2015 scores. Between group comparisons were performed using Kruskal Wallis and chi square tests. Factors independently associated with HEI2015 scores were identified using multivariable linear regression. Results: A total of 491 PWH were included with a median age of 54 years; 76.4% were male. Overall diet quality was low with inadequate intake of dietary protein, fiber, and micronutrients. When classified by tertiles of HEI 2015 score, higher diet quality was characterized by greater intake of fiber, protein, and key micronutrients. Older age was independently associated with higher HEI 2015 scores, while Black race was associated with lower scores. Full time employment and absence of current pain were marginally associated with better diet quality. Conclusions: Diet quality among PWH varies substantially and is influenced by age, race, and social determinants. Tailored nutritional strategies are needed to support healthy aging and reduce disparities in this population.

Purpose: This study aimed to examine the effects of formative and summative assessments on college students tennis performance and basic psychological needs. Methods: A total of 128 undergraduate students (64 males, 64 females; Mage = 19.22, SD = 0.91) participated in this study. Participants were cluster-randomized to either a formative assessment group (n = 64) or a summative assessment group (n = 64). The formative assessment intervention involved setting personalized learning goals and success criteria, administering periodic tests, and providing process-oriented and individualized feedback. The summative assessment intervention involved setting uniform goals for all students, offering instructor feedback only on common problems, and requiring students to practice independently after class without personalized guidance. Both interventions were implemented over 10 weeks, with one 90-minute session each week. Tennis skills and basic psychological needs (i.e., autonomy, competence, and relatedness) were assessed before and after the intervention. Tennis skills were reassessed 1 week after the intervention. Two-way mixed-effects analysis of variance (ANOVA) was used to examine the impact of group, time, and their interaction on tennis skills and basic psychological needs. Results: The results showed that the interaction between group and time was significant for all of the outcome variables. Simple effects analyses indicated that, at pre-test, the two groups did not differ significantly in tennis performance or in satisfaction of autonomy, competence, and relatedness (p > 0.05). At post-intervention, the formative assessment group demonstrated significantly better performance than the summative assessment group in tennis skills (MD = 3.50, 95% CI = [1.303, 5.697], p = 0.002), autonomy (MD = 2.44, 95% CI = [1.816, 3.059], p < 0.001), relatedness (MD = 1.33, 95% CI = [0.679, 1.977], p < 0.001), and competence (MD = 1.75, 95% CI = [1.046, 2.454], p < 0.001). At the 1-week follow-up session, the formative assessment group also showed significantly better tennis performance than the summative assessment group (MD = 6.81, 95% CI = [4.667, 8.958], p < 0.001). Conclusion: Formative assessment was more effective than summative assessment in improving college students tennis performance and satisfying their basic psychological needs. These findings suggest that incorporating personalized goals, process-oriented evaluation, and individualized feedback into tennis instruction could promote both skill development and psychological outcomes in college physical education.

BackgroundDisparities in injury and death indicate that Latinos and Hispanics are disproportionately affected by firearm violence. Understanding the factors that impact Latino and Hispanic engagement with firearm safety is integral to developing nuanced interventions, yet these factors remain largely understudied. This study explores the social ecological factors related to firearm safety engagement among Latino and Hispanic adults residing in New Mexico. MethodsThe study used a convergent mixed-methods design with quantitative and qualitative components. Data were collected from a predominantly Latino-Hispanic community experiencing high rates of firearm violence near Albuquerque, New Mexico. Quantitative data (n=303) were collected using a community-based survey with a non-random sample on firearm safety engagement, collective efficacy, and sociodemographic characteristics. Qualitative data (n=18) included semi-structured interviews from a subset of the survey population who expressed interest in participating. Quantitative data was used to explore descriptive statistics and correlations between reported levels of collective efficacy and firearm safety engagement. Qualitative data were used to explore the firearm safety experiences of Latino and Hispanic participants. AnalysesMultivariate regression analyses examined associations between collective efficacy (exposure) and engagement with firearm safety (outcome). I also explored associations across key domains: collective efficacy, neighborhood characteristics, individual characteristics, and sociodemographic factors. Interviews were analyzed using framework analysis to generate a cohesive thematic structure informed by a social ecological model. The results from the quantitative and qualitative data were then integrated to develop a robust understanding of social ecological factors related to firearm safety engagement using a mixed methods joint display. ResultsThere were 303 survey participants (40.6% male; 55.1% female; 4.3% other gender identity) and 18 interview participants in this study. 57.1% of survey participants reported engaging with at least one firearm safety practice or initiative. Results from multivariate regression indicated that higher collective efficacy ({beta} = 0.082, p = 0.002), higher informal social control ({beta} = 0.174, p = 0.001), stronger endorsement of gun safety principles ({beta} = 0.079, p < 0.001), being married vs. unmarried ({beta} = -0.334, p < 0.001), speaking Spanish in the home vs. English ({beta} = 1.048, p < 0.001), and not owning a gun ({beta} = - 0.638, p = 0.006) were significantly and positively associated with firearm safety engagement. Themes from the qualitative data included barriers (insecure environment; lack of meaningful engagement) and facilitators (location-specific contributors to safety; collective identity and pride) to firearm safety engagement, organized by social ecological domain. Mixed methods findings indicate factors associated with participants individual firearm safety engagement, while providing insights into the perceived barriers and facilitators across social ecological domains. DiscussionFindings from this mixed-methods study suggest that processes of empowerment and collective efficacy may contribute to greater firearm safety engagement within Latino and Hispanic communities. Findings expand injury prevention research by exploring the factors influencing firearm safety engagement among a marginalized and hard-to-reach population who have disproportionate experiences with firearm victimization, perpetration, and injury. ConclusionThis study offers unique methodological approaches by using concurrent mixed methods and collecting complementary data sources to understand firearm safety engagement among Latinos and Hispanics. Findings highlight the need for culturally specific and community-engaged interventions that address social ecological disparities to strengthen safety practices and reduce firearm-related harms.

IntroductionAtmospheric conditions under climate change increase pressure on healthcare systems. Especially, the intensive care units (ICU) are vulnerable due to low buffer capacity and high utilization rates. MethodsDaily ICU cases from 2009 to 2023 were derived from the German statutory health insurance data of eleven regional AOK insurances. Cases were stratified by age and sex. Generalized additive models were used to investigate the associations between daily ICU cases and lagged atmospheric variables. Thirteen intensive care relevant diseases were analyzed using disease-specific predictor sets. Analyses were conducted for regions derived from a human-biometeorological characterization of Germany. Model performance was assessed using (weighted) explained deviance. ResultsOver the 15-year study period, 9,970,548 ICU patients were recorded (44% women), 74.3% aged [&ge;]60 years. Trauma was the most common ICU-related disease, followed by non-ST elevation myocardial infarction (NSTEMI), pneumonia and ischemic stroke. ICU demand was most sensitive (p [&le;] 0.05) to pressure-related factors, thermo-physiological parameters and ozone concentration. In terms of sex-age differences, atmospheric factors affected men more frequently, while women were more impacted by cold weather and particulate matter (PM10). Heat was more relevant for patients aged [&ge;]60 years. The NSTEMI model in Central Eastern Germany performed best (weighted explained deviance of 49.3%). In males [&ge;]60 years, heatwaves were associated with a reduced risk of ICU cases (Relative Risk = 0.94, 95%-Confidence Interval 0.89 to 0.99). ConclusionThe study identified key atmospheric factors for ICU, enabling the German healthcare system to prepare better for short-term impacts of meteorological and air quality factors. KEY MESSAGESWhat is already known on this topic: O_LIThe atmospheric changes have a direct impact on public health and the inpatient care, particularly in intensive care units. C_LIO_LIConsequently, there is a necessity to investigate the influence of atmospheric factors on intensive care in order to prepare the healthcare system for the new circumstances. C_LI What this study adds: O_LIThe study provides evidence that atmospheric factors influence the intensive care in Germany and describes age and sex-specific aspects. C_LIO_LIThe results offer valuable insights into how different atmospheric factors affect the demand for intensive care in hospitals. C_LI How this study might affect research, practice or policy: O_LIThe study enables the German healthcare system to better prepare for short-term effects of atmospheric factors, and structural or resource-related adjustments could be made in hospitals to anticipate for short-term fluctuations in intensive care demand. C_LI

Work-related stress is a major public health issue affecting workers across various sectors. Individuals experiencing work-related stress are more likely to consume psychoactive substances, primarily alcohol, tobacco, and cannabis, as well as psychoactive medications, which may be used as coping mechanisms. Work-related stress is also associated with adverse outcomes such as burnout, depression, anxiety, and sleep disorders. In France, early childhood professionals, including "ATSEMs", "animateurs", and "agents dentretien", play a crucial role in the education, care, and well-being of children but are exposed to high levels of occupational stress due to the emotionally demanding nature of their work and the associated physical strain, making them vulnerable to substance use, burnout, depression, anxiety, and sleep disorders. This cross-sectional epidemiological study, conducted at a single time point, will be carried out among early childhood professionals working in schools for children in Orleans Metropole, Communaute de Communes des Terres du Val de Loire (CCTVL), and Fleury-les-Aubrais. Ethical approval for this study was obtained from the Ethics Committee of the Centre Hospitalier Universitaire dOrleans (assigned reference number is CERO 2511-02). The study aims to provide a better understanding of the relationship between work-related stress and the use of psychoactive substances and medications among early childhood professionals, as well as the association between work-related stress and burnout, depression, anxiety, and sleep disorders. Data will be collected anonymously using self-administered online questionnaires, accessed via a QR code printed on flyers distributed to participants. The same QR code will also provide access to an information sheet explaining that the study complies with ethical guidelines and that proceeding implies non-objection to participation. Based on calculations performed using BiostaTGV, a sample size of 265 participants is required. Statistical analysis will be conducted using SPSS software. Studying these associations is essential for informing the development of targeted interventions and prevention.

Limited research has examined the use of physical mock-ups and artificial intelligence (AI) to evaluate design features in adolescent mental and behavioral health environments, such as the Crisis Stabilization Unit (CSU). This mixed-methods study investigated caregiver workflows and environmental features in adolescent CSUs (e.g., furniture and open vs. enclosed nursing station designs) through physical mock-up simulations with expert and novice clinicians/designers (N = 17). Participants feedback was obtained using questionnaires and focus groups. Simulations were video-recorded, manually coded, and an AI-driven tool was developed for automatic analysis of videos. Findings revealed that experts rated the enclosed nursing station higher in visibility, whereas novice designers reported significantly higher perceived privacy in the open nursing station (P = 0.036). AI-driven video analyses demonstrated promising, high-accuracy performance in automatic detecting, tracking, and localizing individuals (>80%) when compared with manual data. This study proposed an innovative methodology to enhance safety in future adolescent CSUs.

ObjectivesTo explore the extent to which infant oral health is addressed within the family medicine residencies in Canada, and the attitudes and practices of Canadian family medicine residents towards infant oral health. MethodsTwo brief self-administered online surveys, one to 17 Canadian family medicine training program directors and another to current residents within these programs, were conducted using Research Electronic Data Capture (REDCap). Questions focused around respondents attitudes and practices towards infants oral health and infant oral health content within family medicine curricula. Results11 family medicine directors and 155 family medicine residents responded to the survey. 90% of the directors indicated that clinical oral screening was not incorporated in the curriculum. 53% of the residents reported that they did not feel their training was adequate to identify dental caries. 41% described the quality of their oral health training to be poor. While 72% reported lack of knowledge and training as the major barrier to performing oral health-related practices. ConclusionMost of the family medicine training programs in Canada do not include infant oral health screening in their curriculum. The family medicine residents reported lack of knowledge and training is preventing them from performing various oral health-related practices.

BackgroundWith the rapid ageing of Irans population, accidents among institutionalised older adults represent a major public health concern. This study aimed to determine the prevalence, characteristics, and risk factors of accidents among elderly residents of nursing homes in Shiraz, Iran, during 2024, with particular emphasis on functional limitations. MethodsA cross-sectional census-based study was conducted in all seven nursing homes in Shiraz, involving 550 residents aged [&ge;]60 years. Data were collected through structured interviews, review of medical records, caregiver reports, and an Accident Form. Accidents occurring during the previous year were analyzed using descriptive statistics, and associations between accident occurrence and participant characteristics were examined using chi-square tests. ResultsOverall, 72.0% of residents experienced at least one accident during the study period. Slipping was the leading cause, and bathrooms and toilets were the most frequent locations. Contusion or bruising was the most common outcome. Mobility limitation was the only factor significantly associated with accident occurrence (p < 0.001), whereas age, gender, marital status, and educational level showed no significant associations. ConclusionsAccidents were common among nursing home residents in Shiraz and were strongly associated with mobility limitation. These findings highlight the importance of addressing functional impairments alongside environmental hazards through targeted ergonomic modifications and mobility-support interventions.

Introduction: Our aim was to examine the implementation of an online community-based exercise (CBE) intervention with adults living with HIV. Methods: We conducted a 12-month community-engaged intervention study with adults living with HIV in partnership with the Toronto YMCA, Canada. We conducted a two phased intervention study involving Phase 1) Intervention: participants were asked to exercise three times/week, supervised every two weeks with online personal coaching, and attend monthly online educational sessions (6-months), and Phase 2) Follow-Up: participants were asked to continue exercising thrice weekly, independently (6-months). We assessed engagement in physical activity (PA) weekly, and body composition, strength, physical function, and flexibility outcomes every two months (bimonthly) across both phases (12-months). We used segmented regression to assess the change in outcomes within and between phases to assess adoption, effect and maintenance of the intervention. Results: Of the 32 participants who initiated, 22 (69%) completed the intervention; and 18 (56%) completed the follow-up. The majority identified as men (69%), median age was 53 years (25th, 75th percentiles: 43, 60), with a median of 3 (1,7) concurrent health conditions. Median number of coaching sessions attended was 10/13 (77%). Participant engagement in [&ge;]30min of moderate or vigorous physical activity in the past week increased from 3.24 days at baseline (95%CI:2.69, 3.79) to 3.36 days (95%CI:2.83,3.89) at the end of intervention to 3.35 days (95%CI:2.81,3.89) at end of follow-up [overall mean increase of 0.11 days (95%CI: 0.02,0.20)]. During the intervention, there were significant mean decreases for weight (-1.31kg), body mass index (BMI) (-0.40kg/m2), and waist circumference (-2.92cm); and mean increases for push-ups (+7.11 in a minute), plank time (+38.13 sec), sit-to-stand (+2.86 times in 30 sec), and sit-and-reach (+3.47 cm). There were no changes in muscle mass, body fat percent and fat free mass. During the follow-up phase, there were additional significant mean decreases in body weight (-1.52 kg), BMI (-0.50 kg/m2) and sit-to-stand (+1.52 times in 30 sec). Conclusions: Participants demonstrated increases in physical activity and improvements in strength, weight, body composition, physical function, and flexibility with the online CBE intervention, some of which were sustained at the end of the study. Future research should incorporate strategies to enhance engagement in physical activity among adults with HIV.

Military aviation training noise remains understudied despite its widespread impacts across urban, rural, and wilderness areas. The predominance of low-frequency noise and repetitive training can create pervasive noise pollution, yet past research often fails to capture the full range of health and quality-of-life effects. This study analyzed two complaint datasets related to Whidbey Island Naval Air Station noise: U.S. Navy records (2017-2020) and Quiet Skies Over San Juan County data (2021-2023). We analyzed and mapped sentiment intensity from noise complaints relative to modeled annual noise exposure, developed a typology to classify impacts, and modeled the environmental and operational factors influencing complaints. Findings revealed widespread negative sentiment and anger, often beyond the bounds of estimated noise contours, suggesting that annual cumulative noise models inadequately estimate community impacts. Complaints consistently highlighted sleep disturbance, hearing and health concerns, and compromised home environments due to shaking, vibration, and disruption of daily life. Residents also reported significant social, recreational, and work disruptions, along with feelings of fear, helplessness, and concern for children's well-being. The number of complaints were strongly associated with training schedules, with late-night sessions being the strongest predictor. A delayed response pattern suggests residents reach a frustration threshold before filing complaints. Overall, our findings demonstrate persistent negative sentiment and diverse impacts from military aviation noise. Results highlight the need for improved noise metrics, modeling and operational adjustments to mitigate the most disruptive effects.

Background High body mass index (BMI) presents a serious and ongoing global health challenge. However, the difficulty of high BMI intervention has not yet been systematically evaluated. Methods We developed a Generative Artificial Intelligence Meta-Evaluation (GAME) framework, which integrated 18 indicators from 4 dimensions, including "Macro-System Level", "Socio-Cultural Level", "Community-Family Level", and "Individual Level" to evaluate the difficulty of high BMI intervention across 226 locations. The GAME framework applies 8 leading AI models to generate intervention difficulty scores (IDS) of each indicator on a scale from 1 to 5, with higher scores indicating greater difficulty. Meta-analysis was conducted to derive combined scores, evaluate the heterogeneity and sensitivity. Final intervention difficulty scores were calculated as the weighted sum of all 18 indicators. Additionally, SHapley Additive exPlanation (SHAP) values were used to evaluate the importance of each indicator in determining the intervention difficulty. Results The global difficulty of high BMI intervention shows significant imbalance. Norway (IDS = 1.48) exhibited the easiest intervention, while Yemen (IDS = 4.56) faced the greatest challenge. Regions such as Western Europe, Australasia, and High-income Asia Pacific showed lower intervention difficulty, reflecting there are mature public health frameworks, supportive social-cultural environments for healthy lifestyles, and high levels of health awareness. On the contrary, countries in North Africa and Middle East, South Asia, Oceania, and Sub-Saharan Africa faced higher intervention challenges, suggesting the need for long-term, collaborative efforts from multiple sectors. Among the 18 indicators, "Cognition and Awareness" has the most significant impact on intervention difficulty, with the SHAP value of 31.03, followed by "Family life and cognitive patterns" (18.08) and "Health Care System" (11.7). Furthermore, the IDS for high BMI was significantly correlated with Socio-Demographic Index (SDI). Higher SDI values were associated with easier interventions. Finally, the independent external empirical verification demonstrated high consistency between intervention difficulty and increase in annual prevalence of obesity, population mean BMI, and national policies. It supported the GAME framework to characterize global heterogeneity in high BMI intervention challenge. Global results were freely available at http://www.deepburden.com/high-bmi. Conclusion The difficulty of high BMI intervention varies widely across countries and regions, highlighting the need for comprehensive strategies and governance to address the growing health issue effectively.

BackgroundHealth behaviors established during young adulthood significantly shape the long-term risk of non-communicable diseases and mental health disorders. Although behaviors such as diet, physical activity, sleep, and substance use are often targeted individually, growing evidence suggests these behaviors function as an interconnected system. However, the organization of lifestyle behaviors at the system level, and which behaviors exert the greatest structural influence, remains poorly understood, particularly in non-Western populations. PurposeThis study aimed to model the interdependence of lifestyle behaviors among university students in China and identify key behaviors with the greatest structural influence within a lifestyle network. MethodsWe analyzed cross-sectional survey data from 5,652 university students in China, assessing seven lifestyle behaviors (diet, physical activity, sleep quality, social engagement, green and blue space exposure, alcohol use, and tobacco use) as well as symptoms of anxiety and depression. A pairwise Markov random field model was used to construct a lifestyle network and identify behavioral clusters and influential behaviors. Network stability and subgroup invariance were evaluated using bootstrap and permutation procedures. ResultsThree stable behavioral clusters were identified: (1) a positive lifestyle cluster (diet, physical activity, social engagement, and environmental exposure), (2) a distress-sleep cluster (sleep problems, anxiety, and depression), and (3) a substance-use cluster (alcohol and tobacco use). Dietary behavior consistently emerged as the most central behavior in the network, with extensive connections to both behavioral and psychological domains. Physical activity played a more peripheral role. Strong coupling between sleep problems and emotional distress was observed, consistent with systems theories of mental health. ConclusionsThese findings support a systems-based framework for understanding health behaviors in young adulthood. Identifying structurally influential behaviors, particularly dietary behavior, can provide leverage points for targeted health interventions. The study highlights implications for public health policy and intervention design, particularly in non-Western university populations.

Wildfire smoke (WFS) events are an important public health concern for communities in the Pacific Northwest of the United States. Previous studies of portable air cleaners, including high efficiency particulate air (HEPA) filtration and do-it-yourself (DIY) box fan filters built with MERV 13-rated filters, have indicated that their use in residential settings may be an effective way to reduce indoor exposures to fine particulate matter during WFS episodes. The lower-cost, easy to build instructions and availability of materials of DIY box fan filters have made their distribution by both public health agencies and community groups an attractive approach to improve community preparedness. Here, we describe a low-cost, easy-to-assemble, portable exposure chamber system that can be used to support a variety of community-engaged demonstrations of WFS removal efficiency as well as provide a mechanism to estimate the efficiency of filtration systems in a controlled environment. We conducted experiments using the portable chamber to assess the clean air delivery rate (CADR) of a MERV 13-rated DIY box fan filter, which was found to be 92.2 and 145.2 cfm at low and high fan speeds, respectively. In addition to using the chamber system to evaluate the CADR of DIY box fan filters, we also provide a case-study example, working with a tribal community in Central Washington, who used the tent system for a live demonstration of a DIY box fan filter experiment during their community gathering to promote WFS and air quality intervention knowledge and distribution of box fan filters.

The rapid aging of the population in urban China has led to a significant increase in empty-nest households, necessitating a rigorous evaluation of residential environment suitability. Grounded in Person-Environment Fit theory, this study develops and validates a multidimensional Aging-Suitability Index (ASI) specifically for urban empty-nest seniors. We analyzed survey data from 753 participants across 19 provinces using Partial Least Squares Structural Equation Modeling (PLS-SEM). The comprehensive structural model demonstrated robust explanatory power (R{superscript 2} = 0.754). The results reveal a hierarchical mechanism of needs: safety features and physical design serve as the survival foundation, exerting the most substantial direct effects on overall suitability. Accessibility was found to enhance suitability primarily by fostering perceived independence, indicating a psychological mechanism of empowerment (Variance Accounted For = 67.35%). Furthermore, intelligent technology and social support function as complementary resources that improve the environment-person fit. These findings suggest that aging-in-place interventions should prioritize mandatory safety upgrades while integrating accessibility modifications to sustain functional autonomy for independent seniors.

The advent of antiretroviral therapy (ART) has led to substantial increases in life expectancy among persons with diagnosed HIV (PWDH), and in turn, an increasingly older population. This represents a public health challenge, as older PWDH are more susceptible to age-related health morbidities compared to the general population. In this study, we triangulate diverse data sources to reconstruct the Italian PWDH age structure over the past decade to better-understand recent trends, and provide demographic projections through 2035. We find that the PWDH population grew from approximately 112,000 persons in 2012, to 140,000 in 2024, and forecasted to reach 155,000 by 2035. This is primarily driven by decreased PWDH mortality, with such decreases forecast to continue. Persons over 60, estimated as 8.6% of the PWDH population in 2012, had increased to over 20% by 2020, and are projected to reach 47.2% by 2035. By 2030, over 10% of PWDH in Italy are projected to be over 75, compared to less than 1% in 2012. Our results demonstrate that the Italian HIV care infrastructure must prepare for a dramatic shift from managing a predominantly young-adult disease to caring for a majority-elderly population within the next decade, representing an unprecedented transformation in the nature and scope of required services.

BackgroundEvidence on the long-term impact of urban green and blue spaces (UGBS) interventions remains limited. This study is a 15-year evaluation of an urban greenway development in Belfast (United Kingdom), assessing the potential effects of this UGBS intervention on physical activity (PA), mental wellbeing and co-benefits. MethodsUsing quasi-experimental design, a repeated cross-sectional survey was conducted in 2010 (baseline), 2017 (post-opening) and 2023 (long-term follow-up) with about 1,200 adults participated each wave. Outcomes included PA, mental wellbeing, general health, quality of life, social capital and environmental perception. Multilevel mixed-effect regressions were performed to examine within-group changes at long-term follow-up. Difference-in-differences analysis investigated the between-group changes that might be attributed to the greenway. Additional comparative analyses included distance-decay analysis and comparison with population trends in Northern Ireland. ResultsAt six years after completion, the greenway intervention appears to buffer a decline in duration of PA - mainly from moderate-intensity activity (decline lower by 118.6 min/week, 95%CI: 3.9-232.2) but with no significant impact on the proportion of the population meeting the recommended PA level. The intervention is associated with a smaller decline in self-rated health (4.98 units; 95%CI: 0.62-9.34) relative to control group. Intervention association with mental wellbeing was positive but not significant (p=0.30). The greenway also showed positive effects on social capital and environmental perceptions, with impacts most evident in improving safety and trust in the local area. ConclusionThis study provides evidence to support the public health impact of UGBS and its long-term health and social benefits.

The widespread adoption of energy-saving bulbs like light-emitting diodes and compact fluorescent lamps in Zambia has raised significant environmental and public health issues because some of these bulbs contain dangerous materials like mercury. This study sought to evaluate households' understanding and disposal practices of used and damaged energy-saving bulbs in Lusaka, Zambia's Mtendere Compound. A cross-sectional design was used, with structured questionnaires distributed to a randomly chosen sample of households. The research showed that, although most participants were aware of the energy efficiency advantages of these bulbs, they had little understanding of their possible health risks and safe disposal procedures. The majority of households reported throwing away broken and used bulbs with their regular household trash, while only a small percentage followed the suggested disposal procedures. Environmental contamination and heightened health risks are exacerbated by a lack of awareness and inadequate municipal waste management systems for hazardous household waste. The research advocates for improved public education initiatives, the creation of specific collection sites for dangerous waste, and the formulation of explicit national regulations and policies for the handling of discarded and damaged energy-saving bulbs. In rapidly urbanizing areas like Mtendere, tackling these issues is essential for protecting public health and advancing environmental sustainability. Key Words: Knowledge, Practices, Waste Disposal, and Mercury coated bulbs