Journal of Occupational & Environmental Medicine

Recent industry surveys have reported widespread concern about mental health, working conditions, and harassment in the UK film and television industry, but no peer-reviewed empirical study has examined the determinants of occupational burnout in this workforce. The present study tested whether physical health, mental wellbeing, perceived public stigma, intrinsic job quality, and sexual harassment exposure predict burnout in industry professionals. A cross-sectional online survey was completed by 415 individuals across more than 100 job titles, with 286 also completing an optional harassment module. Mental wellbeing sat well below population norms, with 68% scoring in the range indicative of probable depressive symptoms and 82% in the high-exhaustion range on the Maslach Burnout Inventory General Survey. Mental wellbeing and intrinsic job quality were the strongest predictors of burnout (R2 = .56), with meaningfulness accounting for most of the job-quality effect. Working hours independently predicted emotional exhaustion. Harassment exposure was associated with burnout in women but not men, approximately 30% mediated by mental wellbeing; sexist behaviour directly predicted exhaustion in women. Workers with a disability reported higher stigma. Burnout was strongly associated with intent to leave, and the findings collectively indicate an industry-wide occupational health concern requiring structural rather than individual-level intervention.

Abstract Objective To estimate the burden and patterns of multimorbidity and cardiometabolic multimorbidity among university employees undergoing a comprehensive health assessment programme, and to examine demographic and behavioural factors associated with multimorbidity. Design Cross-sectional study. Setting A public university in Maharashtra, India. Participants A total of 266 university employees who underwent a comprehensive health assessment were included. Main outcome measures Multimorbidity was defined as the presence of two or more of nine chronic conditions: hypertension, diabetes mellitus, dyslipidaemia, ischaemic heart disease, chronic kidney disease, thyroid disease, stroke, chronic obstructive pulmonary disease and cancer. Cardiometabolic multimorbidity was defined as the presence of two or more of hypertension, diabetes mellitus, dyslipidaemia, ischaemic heart disease and chronic kidney disease. Results Hypertension was identified in 119 participants (44.7%), comprising 50 participants with pre-existing hypertension and 69 newly identified during the assessment. Dyslipidaemia was present in 189 (71.1%) and diabetes mellitus in 45 (16.9%). Overall, 108 participants (40.6%) had multimorbidity and 103 (38.7%) had cardiometabolic multimorbidity. The prevalence of multimorbidity increased progressively with age, from 17.5% among participants aged <30 years to 83.3% among those aged [&ge;]60 years. The predominant exact multimorbidity patterns were hypertension with dyslipidaemia alone (49 participants) and hypertension, diabetes mellitus and dyslipidaemia (27 participants). Overall, 173 participants (65.0%) had at least one newly identified hypertension, diabetes mellitus or dyslipidaemia diagnosis. In multivariable logistic regression, age (adjusted OR [aOR] 1.058 per year, 95% CI 1.027 to 1.091), BMI (aOR 1.163 per kg/m2, 95% CI 1.076 to 1.257) and tobacco use (aOR 3.296, 95% CI 1.377 to 7.888) were independently associated with multimorbidity. The model had an area under the receiver operating characteristic curve of 0.731. Conclusion Multimorbidity affected approximately two in five university employees, with cardiometabolic conditions accounting for most of the observed disease clustering. Comprehensive health assessment identified a substantial burden of previously unrecognised chronic disease. Integrating institutional or occupational health assessment with longitudinal primary care follow-up may provide an opportunity for earlier detection, risk-factor modification and coordinated management of multimorbidity. Keywords: Multimorbidity; cardiovascular diseases; hypertension; diabetes mellitus; dyslipidaemia; occupational health; university employees; India

Background: Workplace discrimination and violence against health workers including sexual harassment is a societal problem worldwide. We aimed to assess the frequency, predictive factors, and effects of sexual harassment using a nationwide survey of physicians working in Switzerland. Materials and Methods: We conducted a self-administered questionnaire survey of physicians working in Swiss healthcare institutions. The questionnaire assessed experiences of sexual harassment at work, including frequency, types, and sources of harassment. It also asked about the impact of sexual harassment, whether incidents were reported, and what actions were taken following a report. Results: Among the 1837 physicians that participated in the survey, 575 (31.3%) had experienced sexual harassment at least once during their career. Among those reporting sexual harassment, 39.1% of women and 13.2% of men had experienced harassment at least once in their job. Women reported more verbal harassment, while men reported more physical harassment. Women were also more likely to face both forms combined. The main sources of harassment were colleagues of the same profession (46.7%), patients (42.3%), and superiors (41.0%). The most frequently reported impacts included stress (60.1%), emotional exhaustion (34.7%), reduced motivation at work (30%), and considering leaving the job (7.5%). Gender-men was associated with a lower likelihood of experiencing harassment 0.24 (0.18 to 0.31), whereas working in the German-speaking region was associated with a slightly higher likelihood of having experienced sexual harassment at least once (OR 1.35, 95% CI:1.02-1.81). Conclusions: Sexual harassment is common among physicians in Swiss healthcare institutions. It adversely affects the mental health and career trajectories of both men and women yet remains widely underreported due to fears of reprisals and inaction. Institutions should effectively intervene to ensure that reported incidents result in appropriate actions, and that those who report them receive adequate protection from reprisals.

Purpose: The internship period is a critical stage for nursing students to develop professional values. This study aimed to investigate the current status of professional identity among nursing interns, analyze the effects of social support, perceived stress, psychological resilience, and career adaptability on professional identity, and explore the mediating role of career adaptability between social support and professional identity, so as to provide empirical evidence for enhancing professional identity and optimizing nursing talent training systems. Methods: Using convenience sampling, 407 nursing interns from a tertiary hospital in Quanzhou were selected as participants from May to July 2025. Data were collected using a general information questionnaire, the Social Support Scale, the Perceived Stress Scale, the Psychological Resilience Scale, the Professional Identity Questionnaire for Nursing Students, the Career Adaptability Scale, and the Questionnaire for Nurse Intention to Retention Employed. SPSS 26.0 was used for reliability analysis, descriptive analysis, independent samples t-test, one-way ANOVA, Pearson correlation analysis, and multiple linear regression analysis. The PROCESS macro was employed to test the mediating effect. Results: The total score of professional identity among nursing interns was (61.74{+/-}11.08), with 73.5% showing moderate professional identity. Parents' attitude toward nursing, reasons for choosing the profession, personal attitude toward the major, and employment intention showed statistically significant differences in professional identity scores (p<0.05). Pearson correlation analysis revealed that professional identity was significantly positively correlated with social support (r=0.474), psychological resilience (r=0.389), and career adaptability (r=0.609) (p<0.01), and significantly negatively correlated with perceived stress (r=-0.378) (p<0.01). Multiple linear regression analysis indicated that career adaptability ({beta}=0.309, p<0.001) and social support ({beta}=0.383, p<0.001) were significant positive predictors of professional identity, whereas reasons for choosing the profession ({beta}=-3.603, p=0.001) and employment intention ({beta}=-7.116, p<0.001) were significant negative predictors. The model explained 49.2% of the variance in professional identity. Mediation effect analysis showed that career adaptability played a partial mediating role between social support and professional identity, with a mediation effect value of 0.288 (95% CI: 0.221-0.363), accounting for 40.2% of the total effect. Conclusions: Nursing interns' professional identity is at a moderately high level. Social support and career adaptability are positive influencing factors. Career adaptability plays a partial mediating role between social support and professional identity; social support indirectly enhances professional identity by strengthening career adaptability.

Background Cardiovascular disease (CVD) risk prediction is an important component of primary prevention, particularly in populations with increasing cardiometabolic risk. Several risk prediction models are available, but their estimates may differ because of differences in derivation populations, predictors, calibration, and cardiovascular outcomes. Evidence comparing these models within Indian occupational populations remains limited. This study compared 10-year CVD risk estimates generated by the World Health Organization/International Society of Hypertension (WHO/ISH) cardiovascular risk charts, the American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Equation (ASCVD-PCE), and the Framingham general cardiovascular disease risk equation among university employees in India. Methods A comparative observational study was conducted using standardized health assessment data from 266 university employees. Participants aged 40-74 years were selected to provide a common analytical age range across the three risk prediction approaches. Of 127 employees within this age range, three with documented previous ischemic heart disease were excluded because the analysis focused on primary prevention. The final analytical cohort comprised 124 participants. Blood pressure was assessed using a standardized protocol involving three readings at five-minute intervals, with repeat assessments during three subsequent weekly visits for employees with elevated initial readings. Ten-year cardiovascular risk was estimated using the 2019 WHO/ISH laboratory-based risk charts for the South Asian region, the ASCVD-PCE, and the 2008 Framingham general CVD equation. Agreement between risk categories was assessed using Cohen's kappa and linear weighted kappa. Agreement was also examined at [&ge;]10% and [&ge;]20% thresholds. Results The mean age of the 124 participants was 47.63 {+/-} 6.45 years, and 86.3% were male. Diabetes was present in 25.8%, smoking/tobacco use in 19.4%, and 29.0% were receiving antihypertensive treatment. Mean estimated risk was 5.94% for WHO/ISH, 5.95% for ASCVD-PCE, and 12.86% for Framingham. High risk ([&ge;]20%) was identified in 2.4%, 4.8%, and 20.2% of participants by WHO/ISH, ASCVD-PCE, and Framingham, respectively. Exact four-category agreement was 70.2% between WHO/ISH and ASCVD-PCE, compared with 31.5% between WHO/ISH and Framingham and 26.6% between ASCVD-PCE and Framingham. Cohen's kappa was 0.502 for WHO/ISH versus ASCVD-PCE, 0.079 for WHO/ISH versus Framingham, and 0.047 for ASCVD-PCE versus Framingham. Weighted kappa values were 0.639, 0.323, and 0.342, respectively. Conclusion WHO/ISH and ASCVD-PCE produced closely similar mean risk estimates and substantially greater categorical agreement than either model showed with the Framingham equation. Framingham generated considerably higher 10-year CVD risk estimates and classified a larger proportion of participants into higher-risk categories. These findings highlight the importance of model selection when cardiovascular risk assessment is undertaken in Indian occupational populations and support cautious interpretation of risk estimates derived from models developed in different populations and for different cardiovascular endpoints. Keywords: cardiovascular disease; risk prediction; WHO/ISH; ASCVD; Pooled Cohort Equation; Framingham; India; occupational health; university employees; risk classification

Objectives To investigate the association between time spent in NHS Type 1 emergency departments (EDs, consultant led 24 hour services with full resuscitation facilities) and risk of leaving employment and hospitalisation after leaving the department alive up to two years after attendance. Methods We conducted a retrospective cohort study using linked administrative data from the NHS Emergency Care Dataset, Hospital Episode Statistics, Census 2021, and mortality records. ED length of stay was categorised from under 2 hours to 12 hours or more. Cox proportional hazards models were fitted to estimate the association between ED length of stay and subsequently leaving employment or being hospitalised over a two year follow-up period, adjusting for demographic, socioeconomic, and clinical characteristics. Results Our study population comprised 3,347,008 individuals aged 25 to 64 who attended a Type 1 ED in England between April 2021 and March 2023. For leaving employment, adjusted hazard ratios (aHRs) increased from 1.04 (95% CI 1.03 to 1.06) for stays of 2 to <4 hours to 1.21 (1.17 to 1.24) for 12 hours or more, compared with stays under 2 hours. A similar but more pronounced gradient was observed for post-discharge hospitalisation, with aHRs rising from 1.06 (1.04 to 1.07) at 2 to <4 hours to 1.95 (1.91 to 1.99) for stays of 12 hours or more. Conclusions Prolonged time spent in the ED is associated with poorer outcomes among working-age employees, including reduced labour market participation and increased hospital use. These findings suggest that long ED stays may have wider and longer-term implications beyond immediate clinical outcomes, including potentially for national labour markets and economic growth.

Introduction: Raised blood pressure is an important cardiovascular risk factor in Cambodia; however, national averages may obscure substantial local geographic heterogeneity. We assessed the spatial distribution of raised blood pressure and its demographic, metabolic, behavioural, built-environment, and environmental correlates using the 2023 Cambodia STEPwise approach to noncommunicable disease (NCD) risk factor surveillance (STEPS) survey. Methods: We analysed 289 georeferenced primary sampling units (PSUs) from the 2023 Cambodia STEPS Survey. PSU-level case counts and numbers of adults with valid blood pressure data were modelled using a frequentist binomial generalised additive model with a two-dimensional Gaussian-process smooth. An explanatory model included selected PSU-level and contextual covariates; a separate mapping model used spatially continuous predictors to generate predictions on a 5-km grid. Design-based national and residence-specific prevalence estimates were calculated separately using the survey design and Step-2 weights. Results: Among 4,225 adults with valid blood pressure data, unweighted prevalence of raised blood pressure was 28.6%, compared with 18.8% after Step-2 weighting; weighted prevalence was 17.5% in rural areas and 21.7% in urban/suburban areas. Mean observed unweighted PSU-level prevalence was 29.0%. In the adjusted spatial explanatory model, the proportion aged 60-69 years ({beta}=1.969, SE=0.327; p<0.001) and overweight/obesity prevalence ({beta}=0.996, SE=0.265; p<0.001) were positive ecological correlates. The spatial model had lower Akaike information criterion and residual deviance than its non-spatial counterpart, although Bayesian information criterion was higher. Prediction uncertainty was greater in some sparsely sampled areas. Conclusions: Raised blood pressure showed significant geographic heterogeneity across Cambodia. Older age composition and overweight/obesity prevalence were positive PSU-level correlates, not individual-level causal effects. Predicted prevalence should be interpreted alongside uncertainty and should complement, rather than replace, design-based STEPS prevalence estimates for geographically informed NCD planning.

Background: Long-term mortality data among Brazilian police officers and firefighters are scarce. This study investigated the leading causes of death in Brazilian male military police officers and firefighters over three decades, comparing their mortality and mean age at death with those of the male population. Methods: We retrospectively analyzed death records of male military police officers and firefighters from Espirito Santo (ES), Brazil, from 1988 to 2019. Mortality was analyzed across three decades and the standardized mortality ratios (SMRs) for the three leading causes were calculated using the male populations of ES and Brazil as references. Results: Overall, 2,198 deaths were identified, with a mean age at death of 59 {+/-} 18.5 years, compared with 60.5 {+/-} 23.9 years among men in ES and 63.4 {+/-} 23.7 years among Brazilian men. Mean age at death was 36 {+/-} 9 years among active-duty and 68 {+/-} 13 years among inactive personnel. Across the study population, the leading causes of death were circulatory system diseases (32%), external causes (26%) and neoplasms (15%). Circulatory disease mortality was higher in the second and third decades compared with both reference populations, whereas external-cause mortality shifted from higher, in the first two decades, to lower than expected in the last decade. Neoplasm mortality was higher relative to Brazil only in the last decade. Conclusion: Mortality patterns differed by cause and over time. The younger mean age at death among active-duty personnel, together with cause-specific excess mortality, highlights the importance of long-term occupational health surveillance and preventive strategies.

Background: Clinical decision support (CDS) systems may improve chronic pain management by providing guideline-based recommendations within clinical workflows. However, low clinician use can limit their effectiveness. Understanding the association between CDS use and guideline-recommended care may help distinguish implementation challenges from limitations in CDS functionality. Objective: To estimate the association of OneSheet, a CDS system for chronic pain management, and guideline-recommended care when the system was used during patient encounters. Methods: We conducted a per-protocol secondary data analysis of data from a pragmatic randomized clinical trial conducted from October 2020 to May 2022 across 25 primary care clinics at 2 academic health systems in Indiana and North Carolina. The parent trial enrolled 137 primary care clinicians. This analysis included 145511 eligible chronic pain encounters and 15480 long term opioid therapy (LTOT) encounters that occurred after OneSheet implementation. OneSheet use at a patient encounter was the exposure of interest. Propensity score matching was used to create comparable groups of encounters with and without OneSheet use. Outcomes included documentation of pain-related goals, documentation of pain and function using the Pain, Enjoyment of Life and General Activity (PEG) scale, prescription drug monitoring (PDMP) review, urine drug screening (UDS) orders, and naloxone orders. Results: OneSheet was used in 959 of 145511 chronic pain encounters (0.7%) and 582 of 15480 LTOT encounters (4.0%). In matched analyses, OneSheet use was associated with increased documentation of pain-related goals (relative risk (RR)=11.70 (95% CI 4.25-32.50) and PEG score documentation (RR=9.70 (95% CI 4.14-22.31). Among LTOT encounters, OneSheet use was associated with increased UDS ordering (RR=1.52 (95% CI 1.40-1.65) and PDMP review (RR=1.06 (95% CI 1.03-1.09), but decreased naloxone ordering (RR=0.13 (95% CI, 0.02-0.90). Conclusions: OneSheet use was associated with several guideline-recommended chronic pain management actions, suggesting that they system may support care quality when clinicians use it. However, use was rare, indicating that increasing routine use through better workflow integration may be necessary to achieve population-level improvements in chronic pain care.

Background Anxiety, depression and menstrual problems are conditions that significantly impact an individual's health and wellbeing yet, barriers to healthcare can prevent access to appropriate medical care. Trust in doctors is a notable factor as previous studies have shown that it affects engagement with healthcare services and has declined in recent years. Methods Using the Avon Longitudinal Study of Parents and Children, we investigated associations between trust in doctors and healthcare access at two timepoints, for anxiety, depression (mothers and partners) and menstrual problems (mothers only). Results Mothers reporting greater trust in doctors were more likely to access care for anxiety (n=1849, adjusted odds ratio (AOR) 1.11, 95% confidence interval (95% CI) 1.08-1.14), depression (n=2411, AOR 1.10, 95% CI 1.07-1.12), and menstrual problems (n=1723, AOR 1.04 95% CI 1.01-1.06). If mothers and partners endorsed 'the doctor is always helpful', they were more likely to access care for depression (mothers: n=2005, AOR 1.30, 95% CI 1.16-1.46; partners: n=580, AOR 1.46, 95% CI 1.05-2.03) and for anxiety (mothers: n=1892, AOR 1.35, 95% CI 1.19 to 1.54; partners: n=734, AOR 1.40, 95% CI 1.02-1.91). Implications This study supports association between trust in doctors and healthcare access for anxiety, depression and menstrual problems, particularly amongst mothers. This contributes to previous literature that suggests that trust remains an important factor in understanding treatment gaps, and that researchers and clinicians must work to improve public trust in healthcare systems.

Abstract Background Health-related quality of life (HRQoL) is an important outcome in patients with chronic kidney disease (CKD) receiving kidney replacement therapy (KRT), but the relationship between comprehensive metabolic control and the Symptoms/Problems domain of kidney diseasespecific HRQoL remains uncertain. Objective To evaluate the association between composite metabolic control and the Symptoms/Problems domain of the Kidney Disease Quality of Life-36 (KDQOL-36) in patients with stage 5 CKD receiving KRT, and to explore the relationship between individual metabolic parameters and the continuous Symptoms/Problems score. Materials and Methods We conducted an observational, cross-sectional, analytical study of 177 adults receiving hemodialysis or peritoneal dialysis at a nephrology unit in Chihuahua, Mexico. Metabolic control included blood pressure, glycated hemoglobin (HbA1c), total cholesterol, and triglycerides. Adequate control was defined as achievement of at least three of four studydefined operational thresholds. The KDQOL-36 Symptoms/Problems score was analyze as a continuous variable and categorized as low, moderate, or high according to the study protocol. Group comparisons, Spearman correlations, Pearson chi-square tests, and ordinal logistic regression were performed. Results Adequate metabolic control was present in 106 patients (59.9%). No, statistically significant association was observed between achievement of at least three of four study-defined operational thresholds and Symptoms/Problems score category (x2=3.983; p=0.137; Cramers V=0.150). None of the individual metabolic parameters differed significantly across Symptoms/Problems score categories or showed significant correlations with the continuous score. In ordinal logistic regression, adequate metabolic control yielded an odds ratio of 1.81 (95% CI: 0.98-3.35; p=0.057) after adjustment for age, sex, time receiving KRT, and KRT modality. Conclusions No, statistically significant association was identified between the operational definition of metabolic control used in this study and the KDQOL-36 Symptoms/Problems domain in patients with stage 5 CKD receiving KRT. The findings support evaluating HRQoL multidimensionally and warrant confirmation in larger longitudinal studies. Categories: Family/General Practice, Internal Medicine, Nephrology Keywords: chronic kidney disease (ckd), hemodialysis, kdqol-36, kidney replacement therapy, metabolic control, peritoneal dialysis (pd)

Background: COVID-19 vaccination uptake is influenced by various sociodemographic and psychological factors. Previous studies have suggested that the relationship between personality traits and vaccination is context-dependent. However, this association has not been investigated in Japan, a unique sociocultural context characterized by historically low vaccine confidence but exceptionally high COVID-19 vaccine uptake. We examined the association between the Big Five personality traits and completion of the primary COVID-19 vaccination series, exploring potential gender-personality interactions. Methods: A web-based, cross-sectional survey was conducted among 7,210 Japanese adults (aged 20-85 years) in December 2021. Personality was assessed using the Japanese version of the Ten-Item Personality Inventory. Multivariable Poisson generalized estimating equations were used to calculate adjusted prevalence ratios (PRs) and assess gender-personality interactions. Results: Higher extraversion and lower openness were significantly associated with vaccination completion across genders. A significant gender-agreeableness interaction was observed: agreeableness (PR = 1.016, 95% CI: 1.008-1.024) was positively associated with vaccination completion among men but not women. A similar, though only marginally significant, interaction pattern was observed for neuroticism (PR = 1.011, 95% CI: 1.004-1.019 among men). Conclusions: Personality traits act as modest but meaningful, gender-specific psychological modifiers of vaccination behavior in Japan. Public health campaigns should transition from traditional "one-size-fits-all" messages to personality-tailored and gender-responsive communication strategies to optimize vaccine uptake and bolster psychological resilience in future pandemics.

Background: Previous studies indicated that regional fluctuations in COVID-19 impact were associated with socioeconomic, demographic and environmental factors early in the pandemic. It is unclear whether factors associated with regional COVID-19 mortality and SARS-CoV-2 infections changed over the course of the pandemic. Methods: We evaluated the association of ecological factors with municipality-specific COVID-19 mortality in the national population of Austria between January 2020 and June 2023. Analyses were conducted separately per calendar year and pooled across years via random-effects meta-analysis. Outcomes were analysed using univariable and multivariable zero-inflated negative binomial (ZINB) regression, including annually averaged environmental exposome exposure (including air pollution and UV radiation), socioeconomic, demographic and infection dissemination predictors with significance threshold set to p<0.005. Secondary analysis modelled SARS-CoV-2 infections using of negative-binomial model (NB). Two additional approaches for smaller predictor set selection were applied as sensitivity analyses. Results: Within the entire observation period 18,430 COVID-19 deaths were reported. In univariable analyses (pooled RR (99.5% CI)), COVID-19 mortality was significantly associated with the proportion of commuters (0.79 (0.73-0.86)), residents aged 75-84 (1.18 (1.01-1.37)) and [&ge;]85 years (1.29 (1.04-1.60)), residents with at most compulsory education (1.15 (1.02-1.29)), employed residents aged 15-64 (0.89 (0.85-0.93)), and homeowners (0.91 (0.83-0.99)), as well as with precipitation (0.94 (0.89-0.99)) and the average time with a mean temperature of 5-15 C (0.95 (0.90-0.99)). In multivariable analyses the share of population aged 85 or older (1.30 (1.09-1.54)) and home ownership (0.92 (0.87-0.98)) were independently significant. Mortality predictor estimates were relatively stable across pandemic years. Across 5,963,882 documented SARS-CoV-2 infections share of employed in 15- to 64-year-olds (1.01 (1.01-1.02)), part-time employment rate (1.01 (1.00-1.02)) and district level nursing care allowance recipiency (0.97 (0.95-0.98)) were associated with detected infections. Overnight stays, population 85 or older, income, compulsory education or less and air pollution all had multiple significant estimates with opposite directionality, leading to non-significant overall associations. Sensitivity analyses outcomes mirrored main analyses outcomes. Conclusions: Throughout the pandemic in Austria, demographic and socioeconomic factors were associated with COVID-19 mortality and infections, but many associations, especially for infections, were unstable over time. These findings underscore the importance of structural vulnerabilities in epidemic impact.

OBJECTIVE: To describe (1) US emergency department-treated pickleball injury burden and the injury-to-participation measure among total players, with burden among adults aged 60 to 79 years as a descriptive subgroup, and (2) determine whether general internet search interest for 'pickleball' is also associated with total pickleball-related injuries. DESIGN: Ecological time series study, United States, 2014 to 2023. DATA SOURCES: National Electronic Injury Surveillance System (NEISS) emergency department microdata yielded 1,738 adjudicated pickleball cases, 921 of them orthopedic, weighted to an estimated 101,450 injuries nationally. Google Trends, English Wikipedia pageviews, and GDELT news volume served as general pickleball attention signals, with the Trends index for 'sourdough' as a negative control. Sports and Fitness Industry Association (SFIA) participation estimates supplied a total player denominator. MAIN OUTCOME MEASURES: Annual national injury estimates with design-based 95 percent confidence intervals; injury-to-participation measures; and correlations between total pickleball-related injuries and general pickleball attention signals before and after removing trend and seasonality. RESULTS: Estimated emergency department-treated pickleball injuries rose 17.5-fold, from 1,391 in 2014 (highly unstable) to 24,294 in 2023. 70 percent of adjudicated cases involved adults aged 60 to 79. During 2017-2023, injury estimates rose 4.0-fold and participation rose about 4.4-fold. No temporal trend was detected in the injury-to-participation measure (P=0.59). Search interest looked like an excellent proxy: in annual levels it correlated with total pickleball-related injuries at R=0.96, and Pickleball Wikipedia pageviews at R=0.98. However, so did searches for "sourdough", at R=0.76. Removing trend and seasonality left little (monthly residual R=0.084; year-on-year R=0.28 over 96 months, 2015-2023), and the seasons ran opposite, with injuries peaking in February and searches in July, such that, on 12-month mean profiles, the sourdough negative control fitted the injury season (R=0.96) while pickleball ran against it (R=-0.40). General pickleball search interest and pickleball news coverage remained correlated in year-on-year changes in 2017-2023 (R=0.64), whereas their corresponding correlations with total pickleball-related injuries in 2017-2023 were 0.25 and 0.20. CONCLUSIONS: The absolute burden of emergency department-treated pickleball injury has grown substantially, but the available surveillance data cannot resolve whether the sport has become more hazardous per participant. The observed rise is consistent with growth in exposure alone. The strong correlation between search interest and injury counts was not specific, the association was substantially attenuated after detrending, and the seasonal patterns were opposed. These descriptive results do not establish that search interest can substitute for injury surveillance, and series that rise together should not be assumed to be related.

Background: Built environment characteristics have been associated with depressive symptoms, whilst active travel behaviour is linked to improved mental health. However, it remains unclear whether active travel buffers associations between increased exposure to the built environment and worse mental health. Methods: In this pre-registered study, participants were 10,310 mothers (mean age = 28.11, SD = 4.83) participating in the Avon Longitudinal Study of Parents and Children (ALSPAC). A latent built environment factor was measured at study enrolment, active travel behaviour at a 2-year follow-up, and depressive symptoms at a 4-year follow-up. Moderation was examined using adjusted linear regression models including an interaction term between the built environment factor and active travel behaviour. Results: The built environment factor was positively associated with depressive symptoms ({beta} = 0.023, p = .012). Active travel behaviour was not associated with depressive symptoms ({beta} = -0.002, p = .854) and did not moderate the association between the built environment factor and depressive symptoms ({beta} = -0.002, p = .865), after adjusting for covariates, including age, familial depressive history, socioeconomic risk factors, physical activity, baseline depressive symptoms and smoking. Conclusion: Contrary to expectations, active travel behaviour does not modify associations between the built environment and depressive symptoms. These findings provide no evidence that active travel mitigates mental health risks associated with the built environment in this population.

Introduction Low back pain (LBP) is a common leading cause of functional disability in adults worldwide, presenting with Modic changes that are visible within the endplates of the vertebral body under magnetic resonance imaging (MRI). Modic changes (MC) are not just a coincidental imaging finding; they reflect underlying pathology that needs treatment focus. This study aimed to ascertain the prevalence and patterns of Modic changes in the lumbar spine among adult patients with a history of low back pain attending the Kilimanjaro Christian Medical Centre (KCMC) Orthopedic clinic. Methods A descriptive cross-sectional study was conducted at the KCMC orthopedic clinic from 2nd October 2024 to 30th May 2025. Data from adult patients with a history of low back pain who had undergone lumbar spine MRI were collected, cleaned, and analyzed in SPSS (version 25). Categorical variables were summarized by frequency and proportion, while continuous variables were summarized using the mean and standard deviation. Frequency tables, histograms, and pie charts were used for results presentation. Results Of the 283 patients enrolled in the study, the mean age was (57.2 {+/-}15.7) years, with the majority (145; 51.2%) being aged > 59 years. Most patients, 203 (71.7%), were females, while 176 (62.2%) were married, and 142 (50.2%) were overweight. The prevalence of MC on the lumbar spine among patients with a history of low back pain was 66.4% (n=188). Among patients with lumbar spine MC, the majority, 112 (59.6%), were aged over 59 years, and 125 (66.5%) had lumbar spine MC type II, which was the most predominant compared to other types of MC. Conclusion Modic changes on the lumbar spine are prevalent in adult patients with low back pain, particularly those over 59 years, with type II being the most common. Healthcare professionals and policymakers should recognize Modic changes as clinically relevant findings that require consideration in the management of patients with a history of low back pain rather than dismissing them as mere incidental or coincidental observations.

Background: Commercial spaceflight now carries civilians on short missions, yet their stress-axis physiology is poorly described. Earlier shuttle data suggest that sympathetic responses predominate after short flights and glucocorticoid responses after long ones. The neutrophil-to-lymphocyte ratio (NLR) is a low-cost readout of both. Methods: Preregistered secondary analysis of open clinical laboratory data (NASA Open Science Data Repository OSD-569 and OSD-575) from the four Inspiration4 crew members, each sampled seven times: three draws before launch, one the day after return (R+1) and three during recovery (R+45 to R+194). Log-transformed NLR was modelled with a linear mixed model with a random intercept per crew member and Kenward-Roger inference. Lymphocyte and eosinophil counts and C-reactive protein were secondary outcomes with false discovery rate correction. Results: All 28 draws were analysed. NLR at R+1 did not differ from pre-flight (fold change 1.04; 95% CI 0.81 to 1.34; p = 0.73); two crew members increased (+25% and +46%) and two decreased (-27% and -11%). During recovery NLR was 23% lower than pre-flight (fold change 0.77; 95% CI 0.64 to 0.92; p = 0.005). No secondary outcome changed after correction; lymphocytes were 18% lower at R+1 (95% CI -35% to +4%; q = 0.31). Between-person differences explained 58% of the variance. An ordinary regression ignoring repeated measures missed the recovery effect (p = 0.08). Conclusions: A 3-day orbital flight produced no consistent leukocyte stress signature one day after return. The lower NLR during recovery suggests that pre-flight values, not recovery values, deviate from the resting state, which has implications for how baselines are defined in short-duration spaceflight studies.

Financial well-being (FWB) encompasses objective and subjective financial status and may influence health. We developed and validated a parsimonious FWB index using data from 23,006 Health and Retirement Study (HRS) participants aged 50 years and older from 2006 to 2022. The FWB-5 Index was derived using correlated two-factor confirmatory factor analysis accounting for household clustering. Indicators included household wealth, household income-to-poverty ratio, monthly financial strain, satisfaction with one's financial situation, and perceived financial mastery. We assessed convergent and discriminant validity using the Consumer Financial Protection Bureau Financial Well-Being (CFPB-FWB) Scale and Satisfaction with Life Scale, respectively. Associations with pre-baseline socioeconomic factors and subsequent depressive symptoms and health conditions were examined to assess construct and predictive validity. Model fit indices supported the two-factor structure (robust comparative fit index = 0.99; robust root mean square error of approximation = 0.05). Correlations were stronger with the CFPB-FWB Scale (Spearman P = 0.80) than with life satisfaction (Spearman P = 0.43). Associations with socioeconomic factors and subsequent health outcomes were in the hypothesized directions. These findings support the FWB-5 Index as a parsimonious measure for examining financial well-being and its associations with health across HRS waves, including those predating the CFPB-FWB Scale.

Current health risk assessments from thirdhand exposure to methamphetamine (meth) to occupants of contaminated residences when no cooking or use is still occurring assume that inhalation exposure is insignificant. After Wright et al. (2021) reported substantial meth concentrations in a contaminated residence, the present study was conducted to further test the hypothesis that concentrations were high enough to contribute to total occupant dose. Air sampling was conducted in contaminated residences that had been previously sampled for surface contamination. Samples were collected on personal sampling pumps in fixed locations on treated glass fiber filters is cassettes and analyzed by gas or liquid chromatography with mass spectroscopy. Sixty-nine samples were collected from eighteen residences for the study. Meth concentrations ranged from 0.02 to 15 ug/m3. Concentrations in supply air vents were significantly higher than in return vents or in ambient air. Residences with no HVAC systems (baseboard heat) had airborne concentrations similar to residences with HVAC systems turned off, and lower than when HVAC was on. Whether a residence was occupied or not did not show differences. All data from residences with HVAC had a significant correlation with surface concentrations (R2 = 0.61) but some factors that affected results were not determined in the study. In the context of the risk assessment and regulatory standard established by California and adopted in several other states, the inhalation exposure would approximately double total occupant dose for infants, and this population would exceed the California reference dose by approximately 100%. Further studies should be conducted to refine these estimates and determine the factors that influence airborne concentrations.

Chronic pain and insomnia are common, each has serious consequences and they often coexist [1-5]. This novel study employed a phenomenological method to explore adults lived experiences of the core and meaning of comorbid insomnia and pain, here conceptualized as COMIP. The empirical data is based on 22 semi-structured interviews with adults with COMIP. Each interview was analysed, developing themes and analytical frameworks for all participants, which were then compared to construct one main analytical framework. The consolidated criteria for reporting qualitative research were used [6]. The essence of COMIP was: A vicious cycle of insomnia and pain driven by four intertwined primary factors with cross effects, which reduced sleep quality and quality of life. Four main themes emerged: Firstly, insomnia with hyperarousal like racing thoughts, and difficulties with finding comfortable sleeping positions due to pain, disturbed sleep and decreased sleep quality. Secondly, daytime symptoms like reduced energy, with reduced daytime function and reduced quality of life. Thirdly, 24-hour hyperarousal, stress and distressing experiences such as suffering. Finally, contextual factors like treatment reduced and/or increased COMIP. The main contribution of this research is three-fold; mapping of the experiences of living with COMIP, the conceptualization of COMIP, and introduction of novel concepts. Our findings indicate that, when evaluating patients with COMIP, there is value in exploring the four COMIP factors. Although, it varies between individuals which factor/s is central to their COMIP experience, we emphasize that COMIP is distressing, and patients are likely to need emotional support and validation. Keywords: COMIP, sleep, phenomenology, disability, rehabilitation, ICF.