Environmental Determinants Research Articles

School canteens healthier for children and the planet in the Valencian Region

Abstract Issue SchoolFood4Change (SF4C), an EU Horizon 2020 project in 12 EU countries, aims at making school meals healthier for children and the planet through innovative and sustainable food procurement, promotion of planetary health diets and cooking, and a Whole School Food Approach. In the Valencian Region two subsequent market dialogues (MDs) were organised to explore a new school food procurement and feeding model. Description In our context, most children have lunch at school daily. SF4C sees schools as catalysts for a systemic change. Two intersectoral MDs were conducted with the participation of public authorities, food procurers, cooks and schools. The first one MD1, 23 attendees, used a gamification dynamic through building blocks. MD2, 58 participants, used a World Cafe methodology to analyse nutritional, environmental, educational, social and economic determinants. Results MD1 highlighted the need to increase food education in the curricula, value regional products and cuisine, improve culinary training and reduce food waste. It suggested establishing percentages of local and organic products in tenders and improving communication between the public administration and the educational community. MD2 emphasised the objective of promoting the Mediterranean diet and sustainability in canteens. To that end, participants identified the importance of establishing requirements in public tenders, annual planning of procurement, optimising logistics and integrating the canteen into the educational project. This would enhance predictability, economic sustainability, and social support for a new innovative model. Lessons Structured interaction between stakeholders was essential to devise innovative and sustainable solutions. The creation and dynamization of intersectoral working groups is an effective public health strategy to build networks for the co-creation of viable alternatives to achieve a healthier and more environmentally sustainable school feeding. Key messages • Structured interaction in intersectoral working groups is an effective public health strategy for the co-creation of viable alternatives to make school feeding healthier for children and the planet. • Tailored innovative and sustainable solutions entail a framework for structured discussions, specific context analysis, negotiations between stakeholders and locally adaptation of good practices.

Physical activity promotion in Aged care: a participatory approach

Abstract Introduction Aged care facilities (ACF) constitute an increasingly important, yet challenging setting for health promotion - given it is a highly sedentary pseudo-total institution characterized by structured daily routines within a paradigm of care for residents perceived as fragile and vulnerable. A participatory approach with residents, significant others, staff, and management might be a promising pathway to address intrapersonal, sociocultural, organizational, environmental, and political determinants of physical activity in this specific context. We will present processes and results from a research project, funded by the German Ministry of Health (2019-2023), on physical activity promotion in ACFs. Methods Our co-creation approach involved residents, significant others, staff, and management from seven nursing homes in Southern Germany. Methods included 800hrs on-site observations, semi-structured interviews (n = 31), Photovoice (n = 27 participants, n = 169 photos), as well as future workshops (n = 14) for intervention co-development (n = 14) and co-evaluation workshops (n = 7). Data analysis used reflexive thematic analysis with MaxQDA20. Results Implemented interventions (n = 57) addressed individual, social, environmental, and organizational factors. Activity promotion was integrated into care concepts and mission statements, staff work descriptions, as well as informal internal routines. Of the interventions implemented, 33% were rated as more successful, 43% as successful, and 19% as less successful than anticipated. Conclusions Participation can initiate structural and cultural change towards physical activity. However, the analyses also emphasized the critical role of staff training, along with the involvement of significant others and external service providers, as essential components for achieving sustainable change. Key messages • Participatory approaches integrate physical activity into aged care, fostering cultural shifts for resident well-being. • Success requires staff training, engaging residents’ support networks, balancing empowerment with protection.

Strategies to address common sleep disorders among middle-aged and older adults

Abstract Obstructive sleep apnea (OSA) is an underdiagnosed and prevalent condition in middle-aged and older adults, with a disproportionate burden of OSA in marginalized populations. Lack of appropriate and timely treatment puts many at risk of poor quality of life, comorbidity, motor vehicle crashes and increased health care utilization. Furthermore, social and environmental disparities were acknowledged as contributing to sleep health disparities, OSA health literacy and adherence to OSA treatment. This presentation will overview the social and environmental determinants of OSA prevalence and management. The presenter will also cover strategies to improve access and waiting time for OSA diagnosis and treatment in middle-aged and older adults, such as screening for OSA in general and marginalized populations, alternative at-home OSA detection solutions, involvement of alternative care providers in OSA care, alternative OSA targeted therapies, including accessible self-administered interventions, health equity interventions targeting OSA, and promotion of sleep-centered lifestyle approaches, including weight loss, diet and exercise.

Exploring the perceived dynamic system driving inequities in the community obesogenic environment

Abstract Introduction Persons in socioeconomically disadvantaged situations (PSEDS) are more susceptible and disproportionally exposed to obesogenic environments, resulting in poorer dietary outcomes and lower levels of physical activity. This study aimed to map the complex dynamic system within the community obesogenic environment driving unhealthy eating and insufficient physical activity among PSEDS in Flanders, and to identify potential local actions. Methods Participatory group model building (GMB), a qualitative system dynamics method, was used to engage PSEDS (n = 7), local decision makers (n = 7) and local stakeholders (n = 5) in two Flemish municipalities. A two-day GMB session was held in each municipality during which a causal loop diagram (CLD) was created and potential local actions were identified by considering causal pathways and reinforcing loops in the system. Results The CLD was designed around two main variables (i) healthy eating and (ii) physical activity among PSEDS. Seven sub-systems could be identified: 1) social environment, 2) facilities and activities, 3) mobility options, 4) information, 5) affordability, 6) safety (specifically for physical activity), and 7) industry and advertisement (specifically for eating behaviour). Several actions to improve the local environment to promote eating behaviour and physical activity among PSEDS were identified. Conclusions The CLD illustrates the complex interactions between individual and environmental determinants contributing to inequalities in eating behaviour and physical activity by including multiple perspectives of community members in socioeconomically disadvantaged situations, local decision makers and local stakeholders. Both the participatory GMB approach and the final CLD visualization can provide the basis for planning local actions for promoting healthy eating behaviour and physical activity among PSEDS. Key messages • Group model building is an effective approach to explore and understand a dynamic complex system through a shared understanding among diverse stakeholders. • A systems approach is valuable to provide a more comprehensive and context-specific understanding of the perceived factors contributing to inequities in the obesogenic environment.

‘HepGenç’: A youth festival to promote health and well-being via films, photography, music, and arts

Abstract Background The ‘Lifelong Health’ framework of WHO emphasizes that investing in health during young ages fosters better health and higher quality of life in later years. When working with and for youth, using innovative and participatory approaches have become more important for effective health communication, especially in an era of increased environmental stimuli, digitalization, and decreased attention span for many young people, who are less attracted with traditional/ didactic health education and communication methods. Objectives This paper aims to share practical experiences of a multidisciplinary team of professionals with backgrounds in public health, psychiatry, communication, music, and arts, in collaboration with young people to organize a series of youth health festivals in different cities of Turkiye to promote youth health literacy and access to health care, with a special focus on mental health and well-being. Results HepGenc (ForeverYoung) Festivals are organized by academics and youth from different universities in Turkiye, in collaboration with NGOs and local municipalities of cities, where the events take place. These events encourage young people to think about health and well-being, including social and environmental determinants of health via short films, photography, music, and arts. The series of festivals use creative workshops to introduce different health and well-being topics to youth, who may not always find these issues ‘attractive.’ Social and mental health, including resilience and ability to adapt are also addressed, which help young participants to build a holistic and comprehensive look on health and its determinants. Conclusions Organizing health-focused festivals using films, photography, music, and arts encourages young people to be creative and productive, while raising their awareness on healthy lifestyles and healthy cities, and how they can be agents of positive change. Key messages • Using films, music, and arts help with greater engagement of young people and facilitates their learning, as well as their creativity and productivity. • Collaboration of health, communication, and arts professionals strengthens health communication/ education programs, with additional beneficial outcomes for all disciplines including shared learning.

Social and environmental determinants of sleep health disparities

Abstract Sleep is not equitable. Historically minoritized individuals have a high prevalence of sleep disorders and adverse sleep health. Research supports that social determinants of health are contributing to sleep health inequities. Further, sleep is socially patterned. Neighborhoods with high rates of crime, violence, disadvantage, pollution, inopportune light exposure, and noise, where historically minoritized individuals are most likely to live are associated with adverse sleep health and sleep disorders. Social determinants including discrimination, racism, socioeconomic status, lack of access to care are associated with adverse sleep health, particularly among minoritized individuals. While there is an abundance of evidence identifying risk factors for adverse sleep health, evidence also supports factors that promote healthy sleep. A small but growing literature supports that neighborhood social environment is associated with healthy sleep and may be avenue for addressing sleep disparities. Dr. Johnson will present epidemiologic data on the social and environmental determinants of adverse sleep health using a socioecological framework and discuss the mechanisms by which these factors are contributing to sleep disparities. The goal is to identify these factors, and how they can be utilized to address sleep health disparities.

Health Impact Assessment (HIA): a tool to drive health in all policies?

Abstract Health Impact Assessment (HIA) is often promoted as a tool to implement ‘health in all policies’ and sustainable development approaches to improve health and equity outcomes. However, is this truly the case? Currently global HIA practice is variable. This paper shares learning from the development and implementation of HIA in Wales to date to understand how HIA has been, and can be, used to inform policies and decisions and reduce health inequalities. The research investigated if, and how, HIA can be used as a tool to mobilise HiAP in reality. It followed a mixed methodological approach and investigated the contribution of HIA to practically advancing HiAP viewed through the lens of Wales and internationally. Primary and secondary evidence and statistics were collected and analysed. A literature review, stakeholder interviews, online statistical questionnaires and case studies were conducted. Thematic and content analysis techniques used. Findings include the importance of conceptual considerations i.e. the perspective on health - social determinant an equity or environmental determinant driven - taken by those carrying out or commissioning a HIA; the importance of centres of expertise to learn from; and practical considerations such as the political and regulatory environment, workforce and organisational knowledge and capacity. Wales has a dedicated expert HIA Unit, an enabling political environment and has led to HIA influencing policies and plans over 20 years. It has transferrable learning for other nations and the research including the online survey has been replicated by others, led to collaborations with nations such as Portugal and contributed to the reviewed literature by providing case studies on a topics like climate change which have influenced decision makers. Tangible ways forward for policy makers, researchers and academics include the need to develop more cross collaboration and fill gaps in the evidence i.e. on institutionalisation of HIA. Key messages • HIA is a excellent process to drive Health in all policies approaches. • HIA needs an enabling environment and workforce support such as that in Wales to thrive.

Health promotion at local level in Portugal: is childhood obesity a concern in municipal programs?

Abstract Health promotion programs targeted at distinct health outcomes such as childhood obesity, at local level are increasingly used worldwide. There is a need to better understand the role of local governments (municipalities) as key public health promoters namely in the prevention of obesity in children. This study aims to provide some input regarding this issue in Portugal. In order to achieve this goal, health enhancing programs promoted by Portuguese municipalities in which children could participate were identified. The search of such programs was limited to the municipalities that were part of the Portuguese Network of Healthy Municipalities in 2021 (N = 57). A subsequent document analysis was conducted to describe how municipalities conceptualized children’s health by retrieving information on which topics the programs were focused on, or acted upon, and identify which socio-ecological model levels of health determinants were addressed (or not) by each program. The 77 identified programs were promoted by 30 municipalities and only 11 programs addressed childhood obesity. Most programs focused on the individual health determinants (N = 27) and provided limited information overall, which hindered a more in-depth analysis. The findings suggest that Portuguese municipalities seem to disregard their potential as public health promoters. Childhood obesity is a major public health concern at national level, as reflected in the National Health Plans, but not perceived as such locally. Municipalities are the closest government entities to the population, and it is their responsibility to ensure the population’s quality of life, by addressing the social and environmental determinants of health. Hence, municipalities should instill health concerns in all their actions/interventions, taking in consideration the most recent evidence, specifically in the case of childhood obesity. Key messages • This study findings suggest that, despite childhood obesity being a major public health concern at national level, as reflected in the National Health Plans, it is not perceived as such locally. • There is a need to better understand the role of municipalities as key public health promoters considering they are responsible to intervene on the social and environmental determinants of health.

2.X.1. Sleep Health Disparities across the life-course: from research to public health policy

Abstract Poor sleep health is a recognized common problem across the life cycle, globally. Factors that contribute to this problem include the demands of a “Western” lifestyle (urgency, productivity), economic stressors, social and environmental determinants of health, and global crises including international conflicts, political tensions, and climate change. There is a growing consensus that optimizing sleep health should be a public health priority because poor sleep patterns are a modifiable risk factor for myriad health outcomes, such as cardiovascular disease, diabetes, cancer, cognitive decline, mental illness, and early mortality. In Canada, a nationwide sleep consortium funded by the Canadian Institutes of Health Research (CIHR) was recently formed with a mandate to generate new knowledge that will inform clinical practice and support public health initiatives to deliver resources where they are most needed. The proposed workshop organized by the Chronic Disease EPH section will start with a general overview of the impact of sleep health disparities across the life-course, from childhood to older age, as well as discuss evidence-based public health approaches to promote sleep hygiene and mitigate the risk of adverse health outcomes, including chronic disease (Saverio Stranges). It will be followed by three presentations to address the root causes of sleep health disparities and their impact on chronic disease (Dayna Johnson); participatory research with families and care providers on infant sleep intervention development (Elizabeth Keys), and strategies to address common sleep disorders among middle-aged and older adults (Tetyana Kendzerska). Key messages • Sleep health disparities are a neglected public health issue. • Optimizing sleep health is both a clinical and public health priority, as sleep patterns represent a modifiable risk factor for a range of adverse health outcomes.

How are the three environmental threats challenging health systems’ resilience?

Abstract Background Known avoidable environmental risks cause about one quarter of all deaths and disease burden worldwide, amounting to at least a steady 13 million deaths each year. Indeed, diseases caused by the environment weigh heavily on health systems. These not only harm directly human health increasing the burden of disease but also potentiate other threats, by acting as drivers (e.g. pandemics, antimicrobial resistance). In addition, the increased burden due to these environmental threats also put in risk the capacity of health systems to adapt to the new healthcare needs and to provide a proper answer to the diseases caused by other health determinants. Methods Based on a review of the literature, the presentation addresses the question of potential options in public health climate action at the interface of environmental sustainability and health systems sustainability and resilience. It identifies possible priority areas in order to guarantee environmental and healthcare sustainability. Results Approaches that focus on treatment of individual diseases rather than improvement of environmental determinants of health will be insufficient to tackle the triple environmental crises of climate change, biodiversity loss and pollution. Single-determinant approaches are unlikely to achieve expected improvements, given the complex interaction of environmental factors. Conclusions Approaches that are more integrated are required to address the root causes of disease and guarantee health systems sustainability, which are often defined by policies in key sectors other than health, such as the environment. Multi-sectoral actions are needed to prevent and mitigate the threats to human health from the ongoing and interconnected environmental crises of climate change, biodiversity loss and pollution, contributing to a Planetary Health perspective on health systems’ resilience.

Environmental determinants of chronic stress in fallow deer

Environmental determinants of chronic stress in fallow deer

Comparative ecological analysis and predictive modeling of tick-borne pathogens.

Tick-borne diseases constitute the predominant vector-borne health threat in North America. Recent observations have noted a significant expansion in the range of the black-legged tick (Ixodes scapularis Say, Acari: Ixodidae), alongside a rise in the incidence of diseases caused by its transmitted pathogens: Borrelia burgdorferi Johnson (Spirochaetales: Spirochaetaceae), Babesia microti Starcovici (Piroplasmida: Babesiidae), and Anaplasma phagocytophilium Zhu (Rickettsiales: Anaplasmataceae), the causative agents of Lyme disease, babesiosis, and anaplasmosis, respectively. Prior research identified environmental features that influence the ecological dynamics of I. scapularis and B. burgdorferi that can be used to predict the distribution and abundance of these organisms, and thus Lyme disease risk. In contrast, there is a paucity of research into the environmental determinants of B. microti and A. phagocytophilium. Here, we use over a decade of surveillance data to model the impact of environmental features on the infection prevalence of these increasingly common human pathogens in ticks across New York State (NYS). Our findings reveal a consistent northward and westward expansion of B. microti in NYS from 2009 to 2019, while the range of A. phagocytophilum varied at fine spatial scales. We constructed biogeographic models using data from over 650 site-year visits and encompassing more than 250 environmental variables to accurately forecast infection prevalence for each pathogen to a future year that was not included in model training. Several environmental features were identified to have divergent effects on the pathogens, revealing potential ecological differences governing their distribution and abundance. These validated biogeographic models have applicability for disease prevention efforts.

The ecology of opportunity: connecting socioecological health and school achievement in Alabama

ABSTRACT This study investigates the association between school-level achievement and the relative health of the social environment in which children are embedded, to gain a more comprehensive understanding of how behavioural, social, physical, and socio-emotional contexts may holistically impact learning. While research has recognised how specific aspects of a child’s environment can impact learning, what is less understood is how multiple facets of socioecological conditions may holistically contribute to learning advantages or disadvantages. To address this, we combine seven years and over 9,000 observations of school-level achievement scores from the U.S. state of Alabama with a comprehensive scale of “socioecological health” – a measure that includes multiple indicators such as nutrition access, housing quality, neighbourhood violence, social supports, income inequality, and mental health access. We then employ a three-level hierarchical linear modelling approach to assess the association between socioecological health and school achievement. Results suggest that (1) higher levels of socioecological health are associated with higher levels of school achievement; (2) effects are strongest for older students and rural students; and (3) healthy behaviours, social supports, and positive physical environment correspond with higher school achievement. These results highlight the breadth to which social and environmental determinants may influence learning opportunities and underscores the need for a more holistic and inclusive approach to educational leadership and social policy.

Environmental Justice and Sustainable Development: Cumulative Environmental Exposures and All-Cause Mortality in Colorado Counties

(1) Background: Colorado’s (CO) Environmental Justice mapping tool, CO EnviroScreen, quantifies environmental injustices through “EnviroScreen Scores”, highlighting areas likely affected by environmental health disparities. Identifying the specific scores most strongly associated with mortality could help prioritize interventions and allocate resources to address these issues. This study contributes to sustainable development goals by examining the relationship between environmental justice indicators and population health outcomes. By utilizing the CO EnviroScreen tool, we assess how cumulative environmental exposures and vulnerabilities impact mortality rates, providing insights for sustainable planning and public health policies. (2) Methods: We assessed the cross-sectional association between county-level all-cause mortality rates in CO, using 2019 data from the Colorado Department of Public Health and Environment, and three county-level component scores obtained from CO EnviroScreen: sensitive populations (i.e., health-related outcomes), environmental exposures (e.g., from air, water, noise), and climate vulnerability (i.e., risk of drought, flood, extreme heat, wildfire). A quasi-Poisson generalized linear model was utilized, incorporating covariates (county-level metrics for insufficient sleep, alcohol overconsumption, physical inactivity, and smoking) to explore associations adjusted for behavioral risk factors (n = 64 counties). (3) Results: The analysis revealed that a 10% increase in the “Environmental Exposures” component score was associated with a 3% higher all-cause mortality rate (95% CI: 1.00, 1.05), highlighting the importance of addressing environmental determinants for sustainable community health. No significant associations were observed for the “Sensitive Populations” or “Climate Vulnerability” component scores. (4) Conclusions: This study provides novel evidence of an association between the CO EnviroScreen score, particularly the environmental exposure component, and all-cause mortality rates at the county level in Colorado in 2019. The findings suggest that cumulative environmental exposures may contribute to geographic disparities in mortality risk, even after adjusting for key behavioral risk factors. These results underscore the importance of integrating environmental justice considerations into sustainable development strategies to promote equitable health outcomes and resilient communities. While our study demonstrates the utility of CO EnviroScreen in identifying areas at risk due to environmental factors, it does not establish a direct link to broader environmental justice outcomes. Further research is needed to explore specific environmental exposures and their direct impacts on health disparities to provide a more complete picture of environmental justice in Colorado.

Landscape and meteorological determinants of malaria vectors' presence and abundance in the rural health district of Korhogo, Côte d'Ivoire, 2016-2018, and comparison with the less anthropized area of Diébougou, Burkina Faso.

Understanding how weather and landscape shape the fine-scale distribution and diversity of malaria vectors is crucial for efficient and locally tailored vector control. This study examines the meteorological and landscape determinants of (i) the spatiotemporal distribution (presence and abundance) of the major malaria vectors in the rural region of Korhogo (northern Côte d'Ivoire) and (ii) the differences in vector probability of presence, abundance, and diversity observed between that area and another rural West African region located 300 km away in Diébougou, Burkina Faso. We monitored Anopheles human-biting activity in 28 villages of the Korhogo health district for 18 months (2016 to 2018), and extracted fine-scale environmental variables (meteorological and landscape) from high-resolution satellite imagery. We used a state-of-the-art statistical modeling framework to associate these data and identify environmental determinants of the presence and abundance of malaria vectors in the area. We then compared the results of this analysis with those of a similar, previously published study conducted in the Diébougou area. The spatiotemporal distribution of malaria vectors in the Korhogo area was highly heterogeneous and appeared to be strongly determined and constrained by meteorological conditions. Rice paddies, temporary sites filled by rainfall, rivers and riparian forests appeared to be the larval habitats of Anopheles mosquitoes. As in Diébougou, meteorological conditions (temperatures, rainfall) appeared to significantly affect all developmental stages of the mosquitoes. Additionally, ligneous savannas were associated with lower abundance of malaria vectors. Anopheles species diversity was lower in Korhogo compared to Diébougou, while biting rates were much higher. Our results suggest that these differences may be due to the more anthropized nature of the Korhogo region in comparison to Diébougou (less forested areas, more agricultural land), supporting the hypothesis of higher malaria vector densities and lower mosquito diversity in more anthropized landscapes in rural West Africa. This study offers valuable insights into the landscape and meteorological determinants of the spatiotemporal distribution of malaria vectors in the Korhogo region and, more broadly, in rural west-Africa. The results emphasize the adverse effects of the ongoing landscape anthropization process in the sub-region, including deforestation and agricultural development, on malaria vector control.

Importance of aerosol composition and aerosol vertical profiles in global spatial variation in the relationship between PM2.5 and aerosol optical depth

Abstract. Ambient fine particulate matter (PM2.5) is the leading global environmental determinant of mortality. However, large gaps exist in ground-based PM2.5 monitoring. Satellite remote sensing of aerosol optical depth (AOD) offers information to help fill these gaps worldwide when augmented with a modeled PM2.5–AOD relationship. This study aims to understand the spatial pattern and driving factors of this relationship by examining η (PM2.5AOD) using both observations and modeling. A global observational estimate of η for the year 2019 is inferred from 6870 ground-based PM2.5 measurement sites and satellite-retrieved AOD. The global chemical transport model GEOS-Chem, in its high-performance configuration (GCHP), is used to interpret the observed spatial pattern of annual mean η. Measurements and the GCHP simulation consistently identify a global population-weighted mean η value of 96–98 µg m−3, with regional values ranging from 59.8 µg m−3 in North America to more than 190 µg m−3 in Africa. The highest η value is found in arid regions, where aerosols are less hygroscopic due to mineral dust, followed by regions strongly influenced by surface aerosol sources. Relatively low η values are found over regions distant from strong aerosol sources. The spatial correlation of observed η values with meteorological fields, aerosol vertical profiles, and aerosol chemical composition reveals that spatial variation in η is strongly influenced by aerosol composition and aerosol vertical profiles. Sensitivity tests with globally uniform parameters quantify the effects of aerosol composition and aerosol vertical profiles on spatial variability in η, exhibiting a population-weighted mean difference in aerosol composition of 12.3 µg m−3, which reflects the determinant effects of composition on aerosol hygroscopicity and aerosol optical properties, and a population-weighted mean difference in the aerosol vertical profile of 8.4 µg m−3, which reflects spatial variation in the column–surface relationship.

Social and Environmental Determinants of Occupation and the Need for an Intersectional Approach to Culturally Meaningful Practice

Social and Environmental Determinants of Occupation and the Need for an Intersectional Approach to Culturally Meaningful Practice

Environmentally sustainable person-centred care: Occupational therapy students' attitudes, perceptions and self-perceived preparedness for practice.

Climate change threatens the environments in which person-centred occupational therapy occurs. Environmental sustainability is directly linked with the health and wellbeing of current and future generations, presenting occupational therapists with a unique advocacy and activist role. As practitioners of the future, there is an urgent need to understand students' attitudes, perceptions of, and self-perceived preparedness for, dealing with environmental determinants of health and intergenerational occupational and climate justice. A cross-sectional exploratory descriptive survey collected United Kingdom (UK) based allied health professional students' attitudes, perceptions, and self-perceived preparedness for advocating for environmental sustainability in the context of person-centred care. The survey was distributed to 48 gatekeepers in UK institutions with approved allied health professional training programmes (44 offered occupational therapy); 62 occupational therapy students responded. Descriptive and non-parametric inferential statistics were used to analyse quantitative data. Text and short answers were analysed qualitatively via inductive content analysis. The study was co-designed and implemented with MSc (pre-registration) occupational therapy students. Participants (94%) expressed concerns for climate change, with 84% feeling responsible for addressing environmental sustainability in health care. While 64.5% identified climate justice as a top priority, a perceived challenge emerged between person-centred care and sustainability, with only 18% of participants feeling prepared for environmental sustainability in occupational therapy practice. Participants requested education on personal and professional sustainability practices, as well as collective action. Sharing personal climate change experiences, advocating with family and friends, and facilitating connections for collective action were highlighted as potentially transformative educational tools in this area. Occupational therapy curricula should address environmental sustainability through pragmatic, critical, and ethical lenses to enhance students' preparedness for this advocacy and activist role. Reflection and continuous professional development for environmentally sustainable practices is recommended. Occupational therapists believe that it is important to support people to participate in occupations that matter to them. However, the activities that some people choose to participate in may have negative effects on the environment and the planet. It is important to ensure that when occupational therapists support people in their choices of activities, this does not lead to unequal access to healthy and meaningful occupations of others, now or in the future. That is because occupational therapists also have a responsibility to prevent occupational injustice. Occupational therapy students are the professionals of the future, so it is important to include them in research about this topic. They need to develop skills that allow them to simultaneously make sure that they are delivering person-centred care, which is not environmentally detrimental and that does not lead to occupational injustice. Making sure that occupational therapists provide person-centred care while also managing risks of occupational injustice may be seen as a profession-specific dilemma. In this study, occupational therapy students in the UK completed a survey about their feelings, views, and readiness for managing this dilemma. Results showed that most respondents are concerned about climate change, but do not feel that their occupational therapy education sufficiently prepared them to practise in an environmentally sustainable way. They were asked to propose ideas for addressing this issue, and the article discusses how occupational therapy curricula might be changed in accordance.

Investigating the determinants of homestay satisfaction on Airbnb using multiple techniques

Peer-to-peer accommodation has gained prominence in the sharing economy and e-commerce sectors, with big data playing a crucial role in understanding customer preferences and evaluating homestay satisfaction. This study proposes a novel methodology that integrates Natural Language Processing (NLP) techniques, a Random Forest model, and Geographic Information System (GIS) functionalities to quantify the complex relationship between homestay satisfaction and diverse customer preferences. Notably, this study addresses the positive bias inherent in listing scores by segmenting homestays into three categories (satisfactory, moderate, and dissatisfactory) based on sentiment analysis from online reviews. Furthermore, this study not only identifies eight key determinants of homestay satisfaction but also unveils the nonlinear relationships and interactions between them. More significantly, we identify specific threshold values for geographic determinants, offering actionable recommendations for homestay planning and layout. These findings provide valuable insights that can be leveraged to improve homestay experiences and promote the sustainable development of urban homestays.

Factors for Consideration for Hematological Cancer Patients When Planning for Place of Death: A Constructive Grounded Theory Study.

Planning for place of death is considered troublesome for patients with hematological cancer. Qualitative studies have focused on healthcare professionals and caregivers. To date, no study has been conducted from the patient's perspective of planning for place of death in the last year of life. To develop an understanding of how patients with hematological cancer experience planning for place of death in their last year of life. The study used constructivist grounded theory, semistructured interviews, a constant comparison technique, and memoing to collect and analyze data. The 21 participants were attending a cancer center, cancer unit, or hospice in the United Kingdom. This article describes one core category, factors influencing planning for death, within the incurable hematology cancer illness trajectory through the following 2 subcategories: personal factors-driving away, developing a legacy, designing a death plan, and disease determining; and environmental factors-dependent determination, displacement of the home, and discernment of services. This critical study illustrates that planning for place of death is complex and multifaceted in conjunction with an unpredictable incurable illness trajectory. Preferences for the place of death will change over time depending on the illness trajectory experienced by patients with hematological cancer and the level of physical and emotional energy and independence afforded to discuss and plan.