Environmental Barriers Research Articles

Caregiver-reported barriers to engagement in a paediatric fresh fruit and vegetable prescription programme.

Paediatric fruit and vegetable prescription programmes hold promise in improving food security and dietary patterns among youth. However, programme success is largely dependent upon caregiver and family engagement. The current study sought to gain a better understanding of environmental barriers to engagement in a paediatric fruit and vegetable prescription programme in one low-income, urban community (Flint, Michigan, USA). Following the implementation of a paediatric fruit and vegetable prescription programme, researchers conducted thirty-two semi-structured interviews with caregivers. Researchers explored caregivers' understanding of the fruit and vegetable prescription programme, barriers to programme engagement, and recommendations for improvement. Telephone interviews were transcribed for textual analysis. Researchers used thematic analysis to examine qualitative data, determine patterns across transcripts, and develop emerging themes. Researchers concluded interviews when data saturation was reached. The majority of participants were female (94%), African American (66%), and residents of Flint (72%). Five recurrent themes emerged: (1) nutrition security; (2) prescription distribution; (3) prescription redemption; (4) educational supports; and (5) programme modifications. Although caregivers indicated that the prescription programme addressed household food insecurity, environmental barriers to engagement were apparent. Caregivers provided suggestions, such as partnering with large grocery stores and developing digital prescriptions, to address programme engagement challenges. Fundamental to the success of fruit and vegetable prescription programmes is the understanding of barriers to engagement from the perspective of participants. This study explores challenges with one paediatric fruit and vegetable prescription programme and provides actionable solutions, from the viewpoint of caregivers, to address these challenges.

Barreiras e facilitadores ambientais na participação da criança com paralisia cerebral em atividades de recreação e lazer: uma revisão integrativa

Abstract The participation of children with cerebral palsy (CP) in recreation and leisure activities can be influenced by environmental factors. The recognition and understanding of these factors as barriers or facilitators of these activities are essential to guarantee the right of these children to participate on equal terms with other people in society. In this context, the objective of this integrative review was to identify environmental barriers and facilitators in the participation of children with CP in recreation and leisure activities. The integrative review method proposed by Whittemore and Knafl (2005) was used. Studies published between 2011 and 2022 in Portuguese and/or English were selected from MEDLINE indexing sources via PubMed, EMBASE, SciELO, LILACS, SCOPUS and Web of Science. Nine studies were included in the review – most of them cross-sectional in design and qualitative in approach. The following participation facilitators were identified: support from parents, peers and teachers; interaction with adults; therapies; material conditions; activities at home, school and in the community; diversity of toys; and cultural activities. The following barriers to participation were identified: lack of access to public transport; negative attitudes; lack of choice and less parental interaction; and lack of adequacy of activities. The Classification of Functioning, Disability and Health (ICF) and the concepts of participation pyramid and family of constructs were fundamental in identifying environmental barriers and facilitators in the participation of children with CP. It is suggested that future studies be conducted to assess the quality and strength of the evidence for participants under 11 years of age.

Barriers and Facilitators during Community Reintegration of People with Spinal Cord Injury: A Qualitative Study.

Spinal cord injury (SCI) individuals face challenges in community reintegration due to various factors. This study explores the barriers and facilitators affecting their reintegration, aiming to understand and address their diverse needs and challenges in different cultural contexts. The present qualitative study was conducted between December 2021 to June 2022 among 71 SCI individuals as data saturation was achieved. Data was collected via structured in-depth interview. Participants were identified through purposive sampling method, admitted, or visited to rehabilitation center, India. Data was analyzed according to Braun and Clarke's thematic analysis method using MAXQDA 2020. Data analysis led to the emergence of four major themes and several sub-themes specific to the single problem domain. The four major themes of barriers included environmental, cultural, psychological and health-related barriers. However, four facilitators (Family support, financial stability, religious practices, friends and leisure activity) came up which may help in overcoming from the challenges faced by the SCI individuals. People with SCI face various problems in their care, management and social lives. It is important to give attention to their needs along with comprehensive health support and strengthen the patient-provider interaction. This may generate a sense of self efficacy, self-esteem and promotes the mental well-being of people with spinal cord injuries. Working on the above mentioned issues can help SCI people in low- and middle-income countries become more integrated into their communities.

Primary care nurse practitioner work environments and emergency department utilization among older adults with substance use disorders in rural areas

IntroductionThe prevalence of substance use disorders (SUDs) is growing among older adults, and older adults in rural areas face disparities in access to SUD care. Rural older adults with SUDs commonly have comorbid chronic conditions that puts them at risk for frequent acute healthcare utilization. In rural areas, primary care for patients with SUDs are increasingly provided by nurse practitioners (NPs), and quality primary care services may decrease ED visits in this population. Yet, NP-delivered primary care for rural older adults with SUDs may be limited by work environment barriers, which include lack of support, autonomy, and visibility. This study assessed the relationship between the NP work environment and ED utilization among rural older adults with SUDs. MethodsThis was a secondary analysis of cross-sectional data from a large survey of NPs in six U.S. states merged with Medicare claims. The study measured the NP work environment by the four subscales of the Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ), which measure 1) independent practice and support, 2) NP-physician relations, 3) NP-administration, and 4) professional visibility. Multilevel logistic regression models, adjusted for practice and patient covariates, assess the relationship between the NP work environment and all-cause ED use. ResultsThe sample included 1152 older adults with SUDs who received care at 126 rural NP primary care practices. NP independent practice and support at the practice was associated with 49 % lower odds of all-cause ED visits among older adults with SUDs. There were no relationships between the other NP-PCOCQ subscales and all-cause ED visits. ConclusionsOrganizational support for NP independent practice is associated with lower odds of all-cause ED utilization among rural older adults with SUDs. Practice administrators should ensure that NPs have access to support and resources to enhance their ability to care for rural older adults with SUDs. Ultimately, these practice changes could reduce ED utilization and health disparities in this population.

Potential of virtual reality to meaningfully engage adults living with dementia in care settings: A scoping review.

Older adults living with dementia in residential aged care homes receive physical care but may have limited access to meaningful engagement. Due to its multimodal and versatile nature, virtual reality (VR) is speculated to be an effective means of meaningfully engaging residents individually and/or in groups. However, there is little evidence regarding its efficacy as a means of meaningfully engaging older adults living with dementia. The objective of this scoping review is to identify and synthesise published research investigating the use of VR technology in promoting the meaningful engagement of older adults living with dementia in residential aged care facilities. A scoping review following Arksey and O'Malley's (2005) established process was conducted and included identifying and selecting relevant studies from seven databases (i.e., AgeLine, CINAHL, Medline, Cochrane, Embase, PsycINFO and Scopus), data charting, and collating, summarising and reporting findings. Two independent reviewers used Covidence and Excel to support data extraction and analysis. The 20 eligible studies revealed discrepancies in the classification of VR and strengths, weaknesses, opportunities and threats associated with its implementation. Findings indicate that the most influential factor in eliciting meaningful engagement is when VR use facilitates interpersonal interactions and opportunities for human connection. Although VR seems to be a promising medium in engaging older adults living with dementia, the efficacy of implementing VR technology within care facilities should be considered alongside potential environmental enablers and barriers. The apparent strength of implementing VR as a means of encouraging restoration, pleasure and productivity in older adults living with dementia lies in the fact that it creates opportunities for meaningful engagement on social and occupational levels.

Development of an Implementation Strategy Tailored to Deliver Evidence-Based and Person-Centred Nursing Care for Patients with Community-Acquired Pneumonia: An Intervention Mapping Approach.

Community-acquired pneumonia is a serious public health problem, and more so in older patients, leading to high morbidity and mortality. However, this problem can be reduced by optimising in-hospital nursing care. Accordingly, this study describes a systematic process of designing and developing a tailored theory- and research-based implementation strategy that supports registered nurses (RNs) in delivering evidence-based and person-centred care for this patient population in a hospital setting. The implementation strategy was developed by completing the six steps of the Intervention Mapping framework: (1) developing a logic model of the problem and (2) a logic model of change by defining performance and change objectives, (3) designing implementation strategy interventions by selecting theory-based change methods, (4) planning the interventions and producing materials through a co-design approach, (5) developing a structured plan for adoption, maintenance and implementation and (6) developing an evaluation plan. This method can serve as a guide to (1) target behavioural and environmental barriers hindering the delivery of nursing care in local clinical practice, (2) support evidence uptake, (3) support RNs in the delivery of nursing care according to individual patient needs and thereby (4) optimise health-related patient outcomes.

UNDERSTANDING AGE-RELATED DISPARITIES AND ENVIRONMENTAL BARRIERS IN OLDER ADULTS WITH MULTIPLE SCLEROSIS

Abstract Given the increasing life expectancy of individuals with multiple sclerosis (MS), the challenges faced by older adults with MS in terms of health changes and decreased physical function contribute to a potentially diminished quality of life. Despite this, our understanding of how this condition manifests in the context of aging remains limited. This study aims to examine age-related variations in fatigue, anxiety, depression, community engagement, and environmental barriers in older adults with MS, as well as to explore health disparities among older adults with MS. This secondary analysis involved 288 individuals with MS, divided into two age groups: below 60 years and 60 years and above. Aim 1 used T-tests and Aim 2 employed ANCOVA with disability adjustment. The results show that older adults with MS had higher levels of community engagement, disability, and behavioral-cognitive fatigue, reporting lower levels of anxiety, cognitive-motor fatigue, fatigue severity, and participation barriers than younger adults with MS. Noteworthy health disparities emerge, characterized by reduced community integration/participation (F=10.622, p=.001) and heightened environmental barriers (F=4.323, p=.039), even when adjusting for disability levels. The study highlights environmental barriers impeding social participation among older adults with MS, emphasizing the need to address these obstacles to enhance their quality of life. This underscores the imperative for customized interventions targeting reduced community disengagement and heightened environmental barriers faced by older adults with MS.

AGE-RELATED HEARING LOSS IN COMMUNITY PHARMACY: BARRIERS AND FACILITATORS TO COMMUNICATION

Abstract Pharmacists have an important role in primary care, communicating with people and ensuring safe and appropriate medication use. However, inadequate communication is a barrier to the delivery of effective care for people with hearing loss. This study sought to explore factors that facilitate and impede communication with people with age-related hearing loss (presbycusis) in the community pharmacy, in order to identify solutions to improve these interactions. Online semi-structured interviews with people with age-related hearing loss (presbycusis), older people (>50 years old) without hearing loss, and online focus groups and interviews with community pharmacists were conducted. Data were analysed using the framework method. Sixteen people with age-related hearing loss, three older people without hearing loss and eight community pharmacists took part. Participants described a multitude of environmental barriers to communication and person-centred pharmaceutical care such as heavy workload, lack of privacy, noise levels and Covid-19 safety measures. There was a perception among participants that their hearing loss is not relevant to the community pharmacy setting and that more could be done to signify that a pharmacy recognises the needs of those with hearing loss, furthermore, participants discussed their limited interaction with pharmacy personnel. There were varying perceptions about communication and levels of awareness among pharmacists about the key facilitators to communication. Greater interdisciplinary collaboration to develop and implement strategies/adaptations tailored to the needs of people with hearing loss would support the engenderment of hearing-friendly community pharmacies and the safe use of medicines.

Everyday Challenges for Individuals Aging With Vision Impairment: Technology Implications.

There are growing numbers of older adults with long-term vision impairment who are likely to experience everyday activity challenges from their impairment in conjunction with age-related changes. Technology has potential to support activity engagement. To develop effective technologies and interventions, we need to understand the context of activity challenges and identify unmet support needs. The Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) study is a mixed-method approach to explore everyday challenges of people aging with long-term disabilities. Participants included 60 adults aging with long-term vision impairment (63% female; M age = 67, SD = 4.6) who completed in-depth, structured interviews exploring the nature of everyday challenges and their unmet support needs for activity engagement. We conducted a content analysis using a deductive and inductive approach to build a detailed coding scheme of challenge codes and subcodes. The analyses provided detailed insights about the nature of challenges people aging with vision impairment experience when performing specific instrumental activities of daily living (IADLs) in the context of home maintenance, transportation, shopping/finance, and managing health. Vision-related challenges and participation restrictions were identified for several activities that require reading, navigation, and identification (e.g., shopping, medication management, public transportation). Emergent challenge themes for performing IADLs included personal limitations (e.g., physical, cognitive, financial) and environmental barriers (e.g., accessibility, technology, transportation). Contextual examples of IADL challenges among individuals aging with vision impairment highlight opportunities for technology design and innovation to support participation in everyday activities.

A Kano model-based demand analysis and perceived barriers of pulmonary rehabilitation interventions for patients with chronic obstructive pulmonary disease in China.

Pulmonary rehabilitation (PR) has been recognized to be an effective therapy for chronic obstructive pulmonary disease (COPD). However, in China, the application of PR interventions is still less promoted. Therefore, this cross-sectional study aimed to understand COPD patients' intention to receive PR, capture the potential personal, social and environmental barriers preventing their willingness of receiving PR, and eventually identify demanding PR services with the highest priority from patients' point of view. In total 237 COPD patients were recruited from 8 health care facilities in Zhejiang, China. A self-designed questionnaire was applied to investigate patients' intention to participate in PR and potentially associated factors, including personal dimension such as personal awareness, demographic factors, COPD status and health-related literacy/behaviors, as well as social policies and perceived environmental barriers. The demand questionnaire of PR interventions based on the Kano model was further adopted. Among the 237 COPD patients, 75.1% of COPD patients were willing to participate in PR interventions, while only 62.9% of the investigated patients had heard of PR interventions. Over 90% of patients believed that the cost of PR services and the ratio of medical insurance reimbursement were potential obstacles hindering them from accepting PR services. The multiple linear regression analysis indicated that the PR skills of medical staff, knowledge promotion and public education levels of PR in the community, patients' transportation concerns and degree of support from family and friends were significantly associated with willingness of participation in PR interventions. By using the Kano model, the top 9 most-requisite PR services (i.e., one-dimensional qualities) were identified from patients' point of view, which are mainly diet guidance, education interventions, psychological interventions and lower limb exercise interventions. Subgroup analysis also revealed that patients' demographics, such as breathlessness level, age, education and income levels, could influence their choice of priorities for PR services, especially services related to exercise interventions, respiratory muscle training, oxygen therapy and expectoration. This study suggested that PR-related knowledge education among patients and their family, as well as providing basic package of PR services with the most-requisite PR items to COPD patients, were considerable approaches to promote PR attendance in the future.

Pro-environmental practice among young population: A scoping review.

There is an inequality between pro-environmental knowledge acquisition and behavior. A change in behavior is required to solve both current and future environmental challenges since human behavior has an influence on pro-environmental practices. Of the study was to carry out a critical analysis of current literature on Pro-environmental practices among the Young population. The research question formulation on PICO served as the foundation for the search approach. Keywords were searched in different combinations from the popular databases SCOPUS, PubMed, Medline, Google Scholar, EMBASE, Google and Cochrane library Boolean operators (AND and OR) and keywords were employed in the search to avoid oversaturating the data. Fifteen full-text articles were selected for the study. Review studies confirmed that youth engagement is highly valued, with evidence from increasing usage of information and communication technologies (education and environmental consciousness among young people. Analysis of pro-environmental practices and environmental behavior has to be given greater attention considering to the adverse impacts of the existing lifestyle on the environment. This made it possible to incorporate and simultaneously explore a variety of variables and effects on environmental practices, furthering the understanding of how these are interpreted. This study pointed up and made contributions to the expanding field of environmental practices barriers. The challenges found should be taken into account in its entirety and utilized to directly inform policies and procedures in order to promote adoption for practices reduction and remove the obstacles inhibiting change.

Social Participation and Perceived Quality of Environment of Adults with Disabilities

Background: Social participation is a fundamental right; however, restrictions often arise due to environmental barriers, both physical and social. The ‘Handicap Innovation Territoire’ (HIT) project aims to enhance social participation for individuals with disabilities living in Brittany, France. To gain insight into the desired areas of intervention and evaluate the HIT project, an initial experiment was conducted to assess the level of social participation and perceived environmental quality among people with disabilities. Methods: A cross-sectional investigation was performed, utilizing the Assessment of Life Habits (LIFE-H) and Measure of the Quality of the Environment (MQE). Results: Twenty-five individuals with disabilities, with an average age of 46.0 ± 23.6 years, were recruited. The results indicated an overall high level of social participation, while work, education, and leisure showed participation restrictions. The MQE scores revealed variations in the environmental perception across disability groups concerning work environment (p = 0.035), stores and services (p = 0.014), health care services (p = 0.006), education (p = 0.043), access to radio and television (p = 0.002), road accessibility (p = 0.003), and time allowed for tasks (p = 0.001). Conclusion: The study identified factors that influence social participation among individuals with disabilities living in Brittany, and highlighted the actions implemented within the HIT project to address the challenges related to social participation.

Assessment of functioning indicators of people with disability and impaired neuromuscular, skeletal, and movement-related functions based on the International Classification of Functioning, Disability, and Health considering environmental barriers

BACKGROUND: The need and realization of the rights to rehabilitation of people with disability is a key guideline in building a system of rehabilitation and habilitation in the Russian Federation. The need for comprehensive rehabilitation for disorders of neuromuscular, skeletal, and movement-related functions (NSMFs) has not yet been fully studied.
 AIM: To assess functioning indicators of persons with disability and impaired NSMFs based on the International Classification of Functioning, Disability, and Health (ICF) considering environmental barriers.
 MATERIALS AND METHODS: A continuous controlled medical and social study was conducted. The study enrolled 257 respondents recognized as having a disability, which were divided into two groups. The target group (n=137) consisted of patients with NSMFs receiving rehabilitation services at a rehabilitation center, and the control group included 120 respondents with NSMFs who passed the initial examination at the Bureau of Medical and Social Expertise.
 RESULTS: Despite the high need for comprehensive rehabilitation measures for people with disability and NSMFs of all age groups, patients with milder disease receive the preferential right to rehabilitation.
 CONCLUSIONS: The results show that the use of ICF determinants in the description of functional and structural disorders and the main barriers at the stages of medical and social examination allows the identification of existing barriers in people with disability and more accurately and objectively determine the need for rehabilitation measures.

Regular Physical Exercise Adherence Scale (REPEAS): a new instrument to measure environmental and personal barriers to adherence to regular physical exercise

ObjectiveTo create, develop, and validate a scale that identifies the environmental and personal barriers that make it difficult to adhere to the practice of physical exercise on a regular basis in a population of Brazilian adults.MethodsWe include adult individuals, aged 18–59 years, practitioners or former practitioners of physical exercise, with Brazilian Portuguese as their mother tongue. In the development and validation phases of the process, 6 specialists in the field of the health assessed the content validity: firstly, the specialists were asked to freely list the questions they would ask to investigate the barriers to adherence to regulating physical activity. Secondly, after compiling all the suggestions listed and eliminating suggestions with similar content, the items suggested in the first round were sent to the specialists so that an evaluation of all questions using a 5-point Likert scale and the content validity coefficient was calculated. We then evaluated the structural validity, construct validity, reliability, internal consistency, and ceiling and floor effects of the Regular Physical Exercise Adherence Scale (REPEAS).ResultsSixteen items were proposed to measure the factors that make it difficult to adhere to the regular practice of physical exercise. The internal structure of the REPEAS initially tested was based on the theoretical proposal of creating the instrument with two domains. After the structural analysis, we used the modification indices to identify the redundant items of the instrument. Consequently, the final version of the REPEAS after factor analysis had 12 items. Thus, the structure with 2 domains and 12 items presented adequate fit indices. With regard to construct validity, the REPEAS scores were compared in two distinct groups: irregular practitioners/ex-practitioners versus regular practitioners of physical exercise, in which a significant difference could be observed between groups (p < 0.001) for both the domains. Acceptable reliability was observed for the environment and personal domains, with ICC values of 0.86 and 0.94, in the same order. For internal consistency, Cronbach's alpha value was 0.908 (environmental domain) and 0.915 (personal domain), these values being adequate for the REPEAS.ConclusionThe REPEAS is a scale with a valid two-dimensional internal structure, consisting of 12 items, reliable and with a valid construct, which supports its use in the clinical, epidemiological, and research contexts in Brazil.

Enabling the context for Aboriginal and Torres Strait Islander Community Controlled Birthing on Country services: Participatory action research

ProblemEstablishment of Birthing on Country services owned and governed by Aboriginal and Torres Strait Islander Community Controlled Health Services has been slow. BackgroundBirthing on Country services have demonstrated health and cost benefits and require redesign of maternity care. During the Building On Our Strengths feasibility study, use of endorsed midwives and licensing of birth centres has proven difficult. QuestionWhat prevents Community Controlled Health Services from implementing Birthing on Country services in Queensland and New South Wales? MethodsParticipatory action research identified implementation barriers. We conducted iterative document analysis of instruments to inform government lobbying through synthesis of policy, economic, social, technological, legal, and environmental factors. FindingsThrough cycles of participatory action research, we analysed 17 documents: 1) policy barriers prevent Community Controlled Health Services from employing endorsed midwives to provide intrapartum care in public hospitals; 2) economic barriers include lack of sustainable funding stream and inadequate Medicare-billing for endorsed midwives; and 3) legal barriers require a medical practitioner in a birth centre. While social barriers (e.g., colonisation, medicalisation) underpin regulations, these were beyond the scope; technological and environmental barriers were not identified. DiscussionFindings are consistent with the literature on barriers to midwifery practice. Recommendations include a national audit of barriers to Birthing on Country services including healthcare practice insurance, and development of a funding stream. Additionally, private maternity facility regulation must align with evidence on safe birth centre operation. ConclusionGovernment can address barriers to scale-up of Aboriginal and Torres Strait Islander Community Controlled Birthing on Country services.

Information needs and information-seeking behavior of visual artists: a systematic review of the literature

PurposeInformation makes an important contribution to the promotion of the creativity of visual artists. This work aims to explore relevant research through a systematic review of the literature and discuss the impact of information on visual artists' creativity.Design/methodology/approachA systematic literature review was conducted through Preferred Reporting Items for Systematic reviews and Meta-Analyses method. The authors searched and retrieved 1,320 papers from which, after evaluation, 41 papers have been analyzed.FindingsTwo thematic categories were identified for visual artists' information needs: (1) the need for professional development and (2) the need for creative techniques and materials. In terms of information sources visual artists employ, the authors have also identified seven broad categories: (1) conventional resources (galleries, museums, etc.), (2) professional scholar sources, (3) digital art websites, (4) informal information online and colleagues, (5) libraries, (6) personal collections and (7) professional scholar social networks. In addition, the study proceeded to classify the obstacles faced by visual artists in their search for visual information into two general categories: (1) environmental barriers and (2) digital literacy barriers.Originality/valueAlthough the investigation of the information needs satisfaction of visual artists as well as the evaluation of their information behavior patterns and information literacy competences is essential, it is understudied. This paper summarizes the relevant literature in a concrete and systematic way providing evidences to be considered in a variety of situations, i.e. developing lifelong learning programs, managing visual art library collections, library services development for artists, etc.

A Qualitative Assessment of Barriers and Proposed Interventions to Improve Acute Agitation Management for Children With Mental and Behavioral Health Conditions in the Emergency Department

BackgroundMental health visits to the emergency department (ED) by children are rising in the U.S., and acute agitation during these visits presents safety risks to patients and staff. ObjectiveWe sought to assess barriers and strategies for providing high quality care to children who experience acute agitation in the ED. Study DesignWe conducted semi-structured interviews with 6 ED physicians, 6 ED nurses, 6 parents, and 6 adolescents at high risk for developing agitation. We asked participants about experiences with acute agitation care in the ED, barriers and facilitators to providing high quality care, and proposed interventions. Interviews were coded and analyzed thematically. ResultsParticipants discussed identifying risk factors for acute agitation; worrying about safety and the risk of injury; feeling moral distress; and shifting the culture towards patient-centered, trauma-informed care. Barriers and facilitators included using a standardized care pathway, identifying environmental barriers and allocating resources, partnering with the family and child, and communicating among team members. Nine interventions were proposed: opening a behavioral observation unit with dedicated staff and space, asking screening questions to identify risk of agitation, creating personalized care plans in the electronic health record, using a standardized agitation severity scale, implementing a behavioral response team, providing safe activities and environmental modifications, improving the handoff process, educating staff, and addressing bias and inequities. ConclusionUnderstanding barriers can inform solutions to improve care for children who experience acute agitation in the ED. The perspectives of families and patients should be considered when designing interventions to improve care.

Unfavorable social determinants of health and mortality risk by cardiovascular disease status: Findings from a National Study of United States Adults

The association between cumulative burden of unfavorable social determinants of health (SDoH) and all-cause mortality has not been assessed by atherosclerotic cardiovascular disease (ASCVD) status on a population level in the United States. We assessed the association between cumulative social disadvantage and all-cause mortality by ASCVD status in the National Health Interview Survey, linked to the National Death Index. In models adjusted for established clinical risk factors, individuals experiencing the highest level of social disadvantage (SDoH-Q4) had over 1.5 (aHR=1.55; 95%CI=1.22, 1.96) and 2-fold (aHR=2.21; 95% CI=1.91, 2.56) fold increased risk of mortality relative to those with the most favorable social profile (SDoH-Q1), respectively for adults with and without ASCVD; those experiencing co-occurring ASCVD and high social disadvantage had up to four-fold higher risk of mortality (aHR=3.81; 95%CI=3.36, 4.32). These findings emphasize the importance of a healthcare model that prioritizes efforts to identify and address key social and environmental barriers to health and wellbeing, particularly in individuals experiencing the double jeopardy of clinical and social risk.

Anaerobic digestion + pyrolysis integrated system for food waste treatment achieving both environmental and economic benefits

Waste-to-energy technologies for food waste (FW) and digestate treatment face environmental and economic barriers including pollutant emission and practical application concerns. This study investigated environmental impacts and economic feasibility of four scenarios to dispose 1 ton FW by life cycle assessment: Scenario A: mesophilic anaerobic digestion (AD) with digestate for biofertilizer; Scenario B: thermophilic AD with digestate for biofertilizer; Scenario C: mesophilic AD combining with digestate for 400 °C pyrolysis; and Scenario D: thermophilic AD combining with digestate for 700 °C pyrolysis. Scenario D was recommended for FW treatment especially for climate change, fine particulate matter formation, and Fossil depletion credits. Electrical recovery was identified as the most contributing and sensitive factor based on uncertainty and sensitivity analysis. Optimizing electrical generation efficiency from 39 % to 44 % benefited all 17 environmental categories through scenario analysis. Furthermore, Scenario D showed an economic advantage over the other scenarios, which was attributed to digestate post-treatment by 700 °C pyrolysis. This study provided a comprehensive reference for FW and digestate management.

Exploration and Investigation of Green Lean Six Sigma Adoption Barriers for Manufacturing Sustainability

The increased awareness about the effect of operations on sustainability dynamics and governmental pressure to cut emission rates has forced industries to adopt sustainable approaches such as Green Lean Six Sigma (GLSS). Despite increasing interest in GLSS, very limited research has focused on its implementation and no research has investigated barriers that hinder GLSS execution. This article investigates GLSS implementation barriers, their relationship, and removal of same in the manufacturing sector. In this article, 18 GLSS barriers have been recognized through literature review and formulated into logical groups using principal component analysis. This article pioneers with decision-making trial and evaluation laboratory with intuitionistic fuzzy (IF) set to prioritize barriers and handle the important and causal relationship among the same. The results of the article were validated through the IF best-worst method (BWM). The results reveal that management-related barriers are the top ranked followed by environmental and organization barriers with BWM weights 0.5283, 0.1704, and 0.1035, respectively. This provides impetus to policymakers for the induction of GLSS in business organizations to make harmony between economic development and environmental sustainability.