Long-term Negative Health Effects Research Articles

APA Calls on U.N. to Respond Urgently to Charges of Iranian Misuse of Psychiatry

APA Calls on U.N. to Respond Urgently to Charges of Iranian Misuse of Psychiatry

Abstract 13282: Towards a Decision Support Tool for Opioid Administration and Sedation Management in the Pediatric Cardiac Intensive Care Unit

Introduction: Opioids are commonly used to treat pain and agitation in the cardiac intensive care unit. However, responsiveness to opioids in pediatric patients is poorly understood, and few guidelines exist for personalized management of sedation. This leads to probable overprescription of opioids in the pediatric ICU, which can extend length of stay and have negative long-term health consequences. In this work, we build a decision support tool to predict a patient’s response to an opioid bolus measured by the state behavior scale (SBS), using available patient data at the time of administration. Methods: We built a dataset including all individual doses of morphine administered to patients admitted to the CICU between 2011-2020. Patients missing critical hemodynamic or SBS data were excluded from the analysis. The change in SBS score before and after morphine administration was converted to a binary outcome, where a decrease in SBS score was considered to be favorable (A). A LASSO regression model was trained to predict SBS response. The predictors utilized in the model included demographics, hemodynamic data, SBS score measurements before morphine, concomitant drug infusions/boluses and morphine response to prior doses. The model was trained on 80% of data and evaluated on 20%. Results: Of 197,242 intravenous boluses, 66,195 boluses administered to 6,021 patients (median age 7.2 mo) were included. The median change in SBS score was 0 (IQR -1 - 0) with 33% of administrations classified as favorable responses. The model coefficients are shown in (B). The model predicts 74% of unfavorable morphine responses with 95% confidence, AUC = 0.899 (C). Conclusions: Nearly three-quarters of ineffective responses to morphine can be predicted with 95% confidence using the prediction models developed. Such models could substantially reduce morphine over-administration for critically ill patients in the pediatric cardiac ICU.

Occurrence of Toxic Metals and Metalloids in Muscle and Liver of Italian Heavy Pigs and Potential Health Risk Associated with Dietary Exposure.

Muscle and liver tissues from Italian heavy pigs were analyzed to investigate whether the chronic consumption of these products by local consumers could represent a health risk in relation to the contamination by some toxic metals and metalloids (TMMs). The concentrations of Al, As, Cd, Cr, Cu, Fe, Ni, Pb, Sn, U, and Zn were measured with an inductively coupled plasma–mass spectrometer, while Hg analysis was performed by using a mercury analyzer. Fe, Zn, and Cu were the most abundant elements in both tissues, while U was detected only at ultra-trace levels. As, Cd, Cu, Fe, Hg, Pb, U, and Zn showed significantly higher concentrations in livers compared to muscles (p ≤ 0.01), with Cd and Cu being 60- and 9-fold more concentrated in the hepatic tissue. Despite this, concentrations of all TMMs were found to be very low in all the samples to the point that the resulting estimated dietary intakes did not suggest any food safety concern. Indeed, intakes were all below the toxicological health-based guidance values or resulted in low margins of exposure. Nevertheless, in the calculation of the worst-case exposure scenario, the children’s estimated intake of Cd, Fe, and Zn through the sole consumption of pig liver contributed to more than 23, 38, and 39% of the tolerable weekly intakes of these elements, while the combined consumption of pig liver and pig muscle to more than 24, 46, and 76%. These findings alert about the probability of exceeding the toxicological guidance values of Cd, Fe, and Zn though the whole diet, suggesting long-term negative health effects for the younger population.

Orthodontic interventions as a management option for children with residual obstructive sleep apnea: a cohort study protocol

IntroductionObstructive sleep apnoea (OSA) is a sleep-breathing disorder that seems likely to have long-term negative social and health consequences in children and adolescents. There are no established standard management approaches...

Menstrual health education in Australian schools

ABSTRACT Menstrual health literacy has a direct impact on young peoples’ quality of life, health, academic and professional performance. In Australia, the key learning area of Health and Physical Education [HPE] provides opportunities for students to develop menstrual health literacy. This paper reports on the findings of a survey of 5007 young Australian women aged 13–25 on their experiences of menstruation, dysmenorrhea and education. The discussion herein relates to the qualitative component that asked the question ‘What was the most useful information about menstruation received in HPE [Health and Physical Education] class?’ Applying a thematic analysis to the data, three key themes emerged. These include: (a) it’s all just biology; (b) the cause but not the effect, and; (c) too little, too late. The findings suggest limitations in educational approaches taken by teachers potentially resulting in poor menstrual health literacy portending long-term negative health consequences for some individuals.

Low-voltage electrical accidents, immediate reactions and acute health care associated with self-reported general health 4 years later

Background and aimsElectricians frequently experience low-voltage electrical accidents. Some such accidents involve long-term negative health consequences. Early identification of victims at risk for long-term injury may improve acute medical treatment and long-term follow-up. This study aimed to determine acute exposure, health effects and treatment associated with general health ≥ 2 years after low-voltage electrical accidents. MethodsIn a cross-sectional study, 89 male electricians who had experienced an electrical accident between 1994 and 2001 participated in a 2003 follow-up health examination. They were identified from a registry of low-voltage electrical accidents and included in the study. Based on exposure descriptions in the original accident reports, they were stratified into the following three groups: a current arc accident group (N = 34, mean age 38.8 years [standard deviation, SD = 12.2, range = 21–59]) and two groups with the passage of current through the body, either fixed to the current source (“no-let-go” group; N = 35, mean age 34.0 years [SD = 10.5, range = 21–57]) or not (“let-go” group; N = 20, mean age = 38.7 years [SD = 10.3, range = 21–63]). They retrospectively described acute reactions and assessed their current general health at the health examination. Multivariate linear regression, ordinal logistic regression and Fisher’s exact test were used to compare acute reactions with health at follow-up in each exposure group. ResultsThe multivariate analysis indicated that after accidents with the passage of current through the body, severe acute headache (β = − 0.56, p = 0.013), years since the accident (β = − 0.16, p = 0.017) and the accident being perceived as frightening (β = − 0.48, p = 0.040) were negatively associated with general health ≥ 2 years later (R2 = 0.25, p = 0.002). If the exposure included a no-let-go experience, then acute severe body numbness (β = − 0.53, p = 0.029) was also negatively associated with general health (R2 = 0.38, p = 0.002). Without such experience, only acute confusion (β = − 0.90, p = 0.029) was negatively associated with the health at follow-up (R2 = 0.24, p = 0.029). In univariate analyses, after the passage of current through the body, acute dizziness (p = 0.029), apathy (p = 0.028), confusion (p = 0.007) and irregular heartbeat (p ≤ 0.05) were associated with poor long-term general health. The no-let-go group, more often than the let-go group, reported panic (p = 0.001), fear of death (p = 0.029), confusion (p = 0.014), exhaustion (p = 0.009), bodily numbness (p = 0.013) and immediate unconsciousness (p = 0.019). Acute symptoms beyond the first day after a current arc accident were associated with poor long-term general health (p = 0.015). Discussion and conclusionsThe acute reactions negatively associated with general health ≥ 2 years after low-voltage electrical accidents should alert the clinician in the acute phase after an electrical accident to the risk of developing negative long-term health effects. Future studies should specify long-term health beyond the concept of general health.

Does a history of youth sport-related knee injury still impact accelerometer-measured levels of physical activity after 3–12 years?

ObjectivesTo examine accelerometer-measured physical activity (PA) in individuals with a knee injury history and controls and the association of moderate to vigorous PA (MVPA) with self-reported and performance measures of knee function. DesignHistorical cohort. ParticipantsParticipants with a 3–12 year history of youth sport-related knee injury and matched controls. Main outcome measuresMVPA (Actigraph GT3x-BT), Knee Injury and Osteoarthritis Outcome Score (KOOS), Triple Single-Leg Hop, Y-Balance and isometric knee strength was measured. Regression analyses examined differences in PA and the association between MVPA and knee function, adjusted for injury history, sex and time since injury. ResultsParticipants (42 injured, 43 controls) had a median age of 23.4 (range 16–29) years. The previously injured group spent less daily adjusted minutes in MVPA [-13.5 (95% CI -25.6, −1.4)] than controls, and females had 10.8 min (95% CI -20.2, −1.4) less MVPA than males. Higher MVPA was associated with better KOOS sport and recreation [β = 0.05, 95% CI (0.01, 0.09)] adjusted for injury history. No other associations were observed. ConclusionPreviously injured youth participated in less MVPA compared to controls 3–12 years later. Lower MVPA is associated with poorer self-reported sport and recreation knee function which may have long-term negative health consequences.

Alcohol Use and Blood Pressure Among Older Couples: The Moderating Role of Negative Marital Quality.

Spouses often have concordant drinking behaviors and important influences on one another's cardiovascular health. However, little is known about the implications of dyadic drinking patterns for blood pressure, and the marital factors that confer risk or resilience. This article examined links between alcohol use and blood pressure within individuals and opposite-sex couples over time, and whether those links vary by negative marital quality among older adults. Participants were from the nationally representative longitudinal Health and Retirement Study that included 4,619 respondents in 2,682 opposite-sex couples who participated in at least 2 of the waves from 2006 to 2016. Participants reported the number of drinks they typically consume per week, negative marital quality, and had their blood pressure measured via a cuff. Analyses revealed that greater drinking was associated with increased systolic blood pressure among both husbands and wives. Furthermore, husbands who drank more had higher blood pressure when wives drank more alcohol, whereas there was no association between husbands' drinking and blood pressure when wives drank less alcohol. Interactions with negative marital quality showed that drinking concordance may be associated with increased blood pressure over time in more negative marriages. Findings indicated that spousal drinking concordance, although often associated with positive marital quality, may have negative long-term health effects.

Home is restoration: Towards a health-based model of the importance of home for survivors of natural disasters

Something fundamental for health lies in the relationship between individuals and their homes, and it is missed by entire populations after destructive natural disasters. Although previous research has verified the importance of home to the psychological and physiological well-being of adults in normal conditions, natural disaster recovery plans still ignore the impact that recreating a sense of home in transitional and permanent relocation environments can have in the relief of stress and depression of the displaced people. This exploratory study draws upon the theory of embodied cognition to explain the interrelationship between home environments and physical and psychological restoration. Through a phenomenologically based analysis of in-depth interviews with five survivors of the 2018 Paradise Camp Fire, a review of the literature on home, and empirical evidence and theory from the cognitive sciences, an enriched definition of home is formulated on the basis that the pleasant feelings of home are a result of the activation of the parasympathetic nervous system, a physiological restorative process that is associated with environmental cues and is impaired in no-home environments. The provisional findings of this study suggest that improving access to suitable homes can be an effective non-invasive measure to prevent long-term negative health effects of relocation after a natural disaster, and that displaced individuals should always be involved in the decision-making about relocation and rebuilding. For that purpose, this study proposes a thirteen-topic survey to identify the themes that can provide a sense of home to each individual affected by displacement. • Natural disaster survivors interviewed about the meaning of home. • Hypothesized that feelings of home activate the parasympathetic nervous system. • Home is restoration from an embodied cognition perspective. • Disaster recovery policy could prevent the negative health effects of relocation.

Psychological and biological resilience modulates the effects of stress on epigenetic aging

Our society is experiencing more stress than ever before, leading to both negative psychiatric and physical outcomes. Chronic stress is linked to negative long-term health consequences, raising the possibility that stress is related to accelerated aging. In this study, we examine whether resilience factors affect stress-associated biological age acceleration. Recently developed “epigenetic clocks” such as GrimAge have shown utility in predicting biological age and mortality. Here, we assessed the impact of cumulative stress, stress physiology, and resilience on accelerated aging in a community sample (N = 444). Cumulative stress was associated with accelerated GrimAge (P = 0.0388) and stress-related physiologic measures of adrenal sensitivity (Cortisol/ACTH ratio) and insulin resistance (HOMA). After controlling for demographic and behavioral factors, HOMA correlated with accelerated GrimAge (P = 0.0186). Remarkably, psychological resilience factors of emotion regulation and self-control moderated these relationships. Emotion regulation moderated the association between stress and aging (P = 8.82e−4) such that with worse emotion regulation, there was greater stress-related age acceleration, while stronger emotion regulation prevented any significant effect of stress on GrimAge. Self-control moderated the relationship between stress and insulin resistance (P = 0.00732), with high self-control blunting this relationship. In the final model, in those with poor emotion regulation, cumulative stress continued to predict additional GrimAge Acceleration even while accounting for demographic, physiologic, and behavioral covariates. These results demonstrate that cumulative stress is associated with epigenetic aging in a healthy population, and these associations are modified by biobehavioral resilience factors.

Alleviation of Cadmium Chloride-Induced Acute Genotoxicity, Mitochondrial DNA Disruption, and ROS Generation by Chocolate Coadministration in Mice Liver and Kidney Tissues.

Increased human exposure to cadmium compounds through ingesting contaminated food, water, and medications causes negative long-term health effects, which has led to the focus of recent researches on finding natural antioxidants to mitigate cadmium-induced toxicity. Therefore, the current study was undertaken to estimate the possible ameliorative effect of chocolate coadministration on acute cadmium chloride (CdCl2)-induced genomic instability and mitochondrial DNA damage in mice liver and kidney tissues. Concurrent administration of chocolate with CdCl2 dramatically decreased the DNA damage level and the number of apoptotic and necrotic cells compared to mice given CdCl2 alone. Extra-production of reactive oxygen species and increased expression of inducible nitric oxide synthase and heat shock proteins genes caused by CdCl2 administration were also highly decreased after chocolate coadministration. Conversely, chocolate coadministration restored the integrity of the mitochondrial membrane potential disrupted by CdCl2 administration, as well as the mitochondrial DNA copy number and expression level of heme oxygenase-1 gene were significantly upregulated after chocolate coadministration with CdCl2. Thus, it was concluded that the coadministration of chocolate alleviated CdCl2-induced genomic instability and mitochondrial DNA damage through its antioxidative and free radical scavenging capabilities, making chocolate a promising ameliorative product and recommended for inclusion in the daily human diet.

Üniversite öğrencilerinde alkollü araç kullanma davranışı ve ilişkili riskli davranışlar

Introduction and purpose: It has been reported that driving and non-compliance with the rules are common in young adulthood. Consequently, millions of people experience serious injuries secondary to traffic accidents and live with long-term negative health consequences. The aim of this study is to find an answer to the question of what are the alcoholic driving behavior and related socio-behavioral factors in university students. Method: In the study, 2508 students selected by the stratified cluster sampling method among the students studying at the faculties and colleges in the central district of Çanakkale Onsekiz Mart University were collected with a 41-question questionnaire prepared by the researchers. The data related to traffic safety, substance use and some violent behaviors were selected for this article. Results: Smoking in drunk drivers rate (32.7%), hookah smoking rate (61.7%), alcohol use rate (25.2%), substance use rate (2.8%), physical fight in the last year to those who do not have a mixing ratio (26.2%), a weapon carrying ratio (15.3%) was significantly higher than those who did not. Discussion and conclusion: These findings suggest that showing risky behavior also triggers risky behaviors. Family Physicians also have a preventive health service role in matters such as traffic and security and should be developed.

Fatigue in Aviation: Safety Risks, Preventive Strategies and Pharmacological Interventions.

Fatigue poses an important safety risk to civil and military aviation. In addition to decreasing performance in-flight (chronic) fatigue has negative long-term health effects. Possible causes of fatigue include sleep loss, extended time awake, circadian phase irregularities and work load. Despite regulations limiting flight time and enabling optimal rostering, fatigue cannot be prevented completely. Especially in military operations, where limits may be extended due to operational necessities, it is impossible to rely solely on regulations to prevent fatigue. Fatigue management, consisting of preventive strategies and operational countermeasures, such as pre-flight naps and pharmaceuticals that either promote adequate sleep (hypnotics or chronobiotics) or enhance performance (stimulants), may be required to mitigate fatigue in challenging (military) aviation operations. This review describes the pathophysiology, epidemiology and effects of fatigue and its impact on aviation, as well as several aspects of fatigue management and recommendations for future research in this field.

Shift Work, DNA methylation and Epigenetic Age

BACKGROUND AND AIM: Shift work has been associated with increased risk of age-related morbidity and mortality. Biological age, estimated using DNA methylation, may quantify the biological consequences of shift work on the risk of age-related disease. We examined whether prior employment in shift-working occupations was associated with epigenetic age acceleration. METHODS: In a sample of non-Hispanic white women ages 35-74 (n=2,574), we measured DNA methylation (DNAm) using the Illumina Infinium Human450 BeadChip and calculated DNAm age using three established epigenetic clocks. Age acceleration metrics were derived by regressing DNAm age on chronological age and predicting the residuals. Using linear regression, we estimated associations between shift work history and age acceleration. We also conducted an epigenome-wide association study (EWAS) using robust linear regression models corrected with false discovery rate (FDR) q-values. RESULTS:Approximately 7% of women reported any shift work. Higher age acceleration was observed for a one-year increase in overall (β=0.11, 95% CI: 0.02-0.21) and night-specific shift work (β=0.12, 95% CI: 0.03-0.21). The association was strongest for ≥10 years of night shift work (β=3.16, 95% CI: 1.17-5.15). From the EWAS, years of overall and night shift work were associated with DNAm at 66 and 85 CpG sites (FDR0.05), respectively. Years of night shift work was associated with lower methylation of a CpG in the gene body of ZFHX3 (cg04994202, q=0.04), a gene related to circadian rhythm. CONCLUSIONS:Shift work was associated with differential CpG site methylation and with differential DNAm patterns, measured by epigenetic age acceleration, consistent with long-term negative health effects. KEYWORDS: biomarkers of exposure, epidemiology, molecular epidemiology, socio-economic factors

Long-term health effects after conflict-related traumatic amputation among patients in Gaza

BackgroundIn the past 10–15 years, thousands of civilians in Gaza have experienced conflict-related traumatic injuries. How injuries affect survivors’ risks of negative long-term health effects and serious illness is unclear. We report follow-up findings in a group of patients with traumatic amputations. MethodsEligible patients had traumatically amputated limbs and showed signs and symptoms of possible serious illness on standardised clinical examination. The patients were all receiving rehabilitation treatment at the Artificial Limbs and Polio Centre, Gaza, which is the main provider of rehabilitation and protheses. All patients had suffered from at least one amputation during Israeli military incursions between 2006 and 2016. All were offered referral to the Al-Shifa Hospital, Gaza, for further diagnostic clinical, radiological, and laboratory tests. Each patient was examined by CT of the abdomen (or ultrasonography if CT could not be performed) and chest and MRI of the amputation stump or stumps. Laboratory analyses included ESR, complete blood count, kidney and liver function tests, serum glucose, creatine kinase, lactate dehydrogenase, and hepatitis B and hepatitis C virus infections. FindingsOf 254 traumatically amputated patients assessed, 105 had signs and symptoms of possible serious illness, among whom 94 accepted referrals. 88 (93%) of 94 were men and the median age was 31.5 years, mean age 34 years (SD 9·6). Of 90 patients who had imaging, 19 (21%) patients had fatty liver infiltration, three (<1%) had lung nodules, and ten had lung atelectasis. Shrapnel was found in the chest of 12 patients (13%), the abdomen of five patients (6%), the scrotum of one patient (<1%), in the amputation stumps of 26 patients (29%), and the non-amputated limbs of eight patients (1%). Three (<1%) of 90 patients had liver lesions. 32 (34%) of 94 patients had elevated ESR, 19 (20%) had elevated liver enzyme concentrations, and 12 (13%) were anaemic. Two patients tested positive for hepatitis C virus and three were positive for hepatitis B virus (one with fatty liver changes). Two of the 19 patients with fatty liver infiltration were diagnosed as having type 2 diabetes. A limitation of this study is that, owing to conflict-related supply-chain issues in Gaza, we were unable to collect complete data in four (5%) of patients. InterpretationAs well as residual shrapnel in more than half of patients, a notable proportion of patients had fatty liver infiltration, for which we have no clear hypothesis. We recommend close medical follow-up for trauma patients in injured by explosives. FundingThe Norwegian street-artist AFK provided €1,500 to this project, which was used to cover patients’ transportation costs.

Organizational Acceptability of Implementing SBIRT for Adolescents in Primary Care

Introduction Adolescent illicit drug, tobacco, and alcohol use can result in sudden and long-term negative health consequences. Primary care environments present the optimal opportunity for screening and brief interventions that target prevention and curtailing use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a service delivery method that could potentially be well-integrated into primary care settings and used to serve a high volume of adolescents. Methods: This qualitative analysis of clinic staff interviews (N = 20), collected during a large cluster-randomized trial to implement two models of adolescent SBIRT, examined barriers and facilitating factors to overall acceptability of SBIRT. This study was conducted in a large, urban Federally Qualified Health Center (FQHC) at 7 sites throughout Baltimore City, Maryland, USA. Participants from each clinic included a range of various roles and responsibilities including: medical assistants (n = 3), nurses (n = 3), primary care providers (n = 4), behavioral health counselors (n = 4), and administrators (n = 6). Results: Results indicate both barriers and facilitating factors for acceptability of SBIRT in terms of (1) universal screening, (2) provider time demands, (3) behavioral health collaboration, and (4) behavioral health caseloads. Discussion: Universal screening was acceptable to participants across organizational roles, but brief interventions and referrals to treatment were found substantially less acceptable.

Correlates of Housing Sustainability Among Youth Placed Into Permanent Supportive Housing and Rapid Re-Housing: A Survival Analysis

PurposeYouth experiencing homelessness (YEH) are vulnerable to multiple adverse health outcomes. Connecting YEH with housing is critical to addressing youth homelessness and to preventing long-term negative health consequences among this vulnerable population. Using administrative data, this study aims to explore correlates of YEH's sustainability in two major housing programs: permanent supportive housing (PSH) and rapid re-housing (RRH) programs. MethodsThis study used Homelessness Management Information System administrative data collected from 16 communities across the U.S. between January 1, 2015 and May 1, 2017 (n = 10,902). We conducted Cox proportional hazards survival analyses to explore correlates (e.g., demographics, homeless experiences, and overall vulnerability) of YEH's PSH (n = 577) and RRH (n = 2,883) sustainability separately. ResultsFor YEH receiving PSH, only individuals' level of vulnerability is associated with greater hazard of exiting PSH. As for RRH sustainability, YEH who were 17 years old or younger, black or Latinx (as compared to white), of higher level of vulnerability, or previously spent most nights couch surfing or in transitional living programs (as compared to on the street) are associated with higher hazard of exiting RRH. ConclusionsBoth PSH and RRH programs should incorporate comprehensive services targeting youth experiencing high vulnerability to prevent them from re-entering homelessness. Future RRH programming should also address housing sustainability disparities faced by racial and ethnic minority YEH, especially when they are disproportionately influenced by homelessness. Finally, RRH programs should incorporate services to foster independent living among younger YEH to sustain their housing status once temporary housing subsidies expire.

A Resilience-Building App to Support the Mental Health of Health Care Workers in the COVID-19 Era: Design Process, Distribution, and Evaluation.

BackgroundThe COVID-19 pandemic has resulted in increased strain on health care systems and negative psychological effects on health care workers (HCWs). This is anticipated to result in long-term negative mental health effects on the population, with HCWs representing a particularly vulnerable group. The scope of the COVID-19 pandemic necessitates the development of a scalable mental health platform to provide services to large numbers of at-risk or affected individuals. The Mount Sinai Health System in New York City was at the epicenter of the pandemic in the United States.ObjectiveThe Center for Stress, Resilience, and Personal Growth (CSRPG) was created to address the current and anticipated psychological impact of the pandemic on the HCWs in the health system. The mission of the Center is to support the resilience and mental health of employees through educational offerings, outreach, and clinical care. Our aim was to build a mobile app to support the newly founded Center in its mission.MethodsWe built the app as a standalone digital platform that hosts a suite of tools that users can interact with on a daily basis. With consideration for the Center’s aims, we determined the overall vision, initiatives, and goals for the Wellness Hub app, followed by specific milestone tasks and deliverables for development. We defined the app’s primary features based on the mental health assessment and needs of HCWs. Feature definition was informed by the results of a resilience survey widely distributed to Mount Sinai HCWs and by the resources offered at CSRPG, including workshop content.ResultsWe launched our app over the course of two phases, the first phase being a “soft” launch and the second being a broader launch to all of Mount Sinai. Of the 231 HCWs who downloaded the app, 173 (74.9%) completed our baseline assessment of all mental health screeners in the app. Results from the baseline assessment show that more than half of the users demonstrate a need for support in at least one psychological area. As of 3 months after the Phase 2 launch, approximately 55% of users re-entered the app after their first opening to explore additional features, with an average of 4 app openings per person.ConclusionsTo address the mental health needs of HCWs during the COVID-19 pandemic, the Wellness Hub app was built and deployed throughout the Mount Sinai Health System. To our knowledge, this is the first resilience app of its kind. The Wellness Hub app is a promising proof of concept, with room to grow, for those who wish to build a secure mobile health app to support their employees, communities, or others in managing and improving mental and physical well-being. It is a novel tool offering mental health support broadly.

Impact of Covid-19 Lockdown Measures on Lifestyle Behavior in Children and Adolescents With Severe Obesity

Introduction: During the COVID-19 pandemic, lockdown measures were implemented with large impact on lifestyle behaviors and well-being of children (including adolescents). The impact on children with severe obesity, who plausibly are at even larger risk, has not yet been described. Aim of this study was to investigate the impact of COVID-19 lockdown on eating behaviors, physical activity, screen time and quality of life (QoL) of children with severe obesity. Methods: In this mixed-methods study, questionnaires and semi-structured telephone interviews were used to investigate impact of COVID-19 during the first wave in the Netherlands (April 2020) on children with severe obesity (adult BMI-equivalent ≥35kg/m2) treated at our obesity center. The Dutch Eating Behavior Questionnaire - Child, Pediatric Quality of Life Inventory, and Dutch Physical Activity Questionnaire were filled out by their families pre-pandemic and during lockdown. Changes over time in percentile scores, weekly physical activity and screen time were assessed. Qualitative analyses were performed according to the Grounded Theory. Results: We included 83 families, of which 75 participated in the interviews. Their children’s characteristics were mean age 11.5years (SD 4.6), 52% female, mean BMI SD score 3.8 (SD 1.0), indicating severe obesity. On group level, no changes in scores for emotional, restrained, external eating, and QoL nor in screen time were observed (Δ scores +9.2, +3.9, +0.3; and +3.0, respectively; -0.3 hr/wk; all p>0.05). Weekly physical activity decreased (Δ -1.9 hr/wk, p=0.02). Age, pre-existent psychosocial problems and pre-pandemic questionnaire scores were associated with improved or deteriorated questionnaire scores in specific subgroups. For example, children who did not fulfill WHO physical activity criteria pre-pandemic showed a further decline from 2.8 to 0.7 h/wk (p=0.001). Children with high emotional and external eating during lockdown had the lowest QoL scores (p-values <0.01). Qualitative data showed that an increased demand for food was frequently observed (n=21), mostly in children aged <10 years (19/21). This was attributed to loss of daily structure, increased stress, or emotional eating. Families who reported no changes (n=15) or improved eating behaviors (n=11) attributed this to already existing strict eating schemes that they kept adhering to. Conclusion: This study shows differential response profiles to COVID-19 lockdown in children with severe obesity. Although on group level lifestyle scores averaged out, a substantial part of families reported deterioration in physical activity and eating behaviors. Children with pre-existent psychosocial problems, high external or emotional eating scores were most at risk. Health care professionals should target these vulnerable children to minimize short- and long-term negative physical and mental health consequences.

Assessing the Effects of Household Wood Burning on Particulate Matter in Rwanda

Considerable efforts have been made to protect people from indoor air pollutant exposure as approximately 80% of people spend time indoors where pollution is often worse than outside. Further, vulnerable populations, including elderly, children, and pregnant women, spend an excessively of time indoors, exposing them to pollutants that are responsible for both short-term and long-term negative health effects, resulting an estimated 4 million premature deaths annually. Aim of this research was to assess impressions of domestic use of solid fuels (firewood and charcoals) burning on Particulate Matter PM2.5 and PM10, which are particles that are less than or equal to 2.5 and 10 micrograms (μm) in diameter respectively within Kigali the capital city of Rwanda. A sample of 31 households using only charcoals and woods for cooking were selected for targeted 72 hours of monitoring. Portable air quality sensors AirVisual Nodes were used to measure concentration levels of PM2.5 and PM10 in microgram per cubic meter (μg/m3). Results showed that homes using wood for cooking experience moderately high concentrations level of PM2.5 and PM10, over 1000 μg/m3 and 1200 μg/m3 respectively, whereas homes using charcoals for cooking had lower concentrations. This later direct to that: Outstanding to low market prices of these solid fuels, poorer households are highly exposed to indoor air pollution. So, an alternative reasonably priced domestic energy to be used for cooking are indorsed and pollution levels survey in households using combination or different types of fuels for cooking are recommended for future research.