Sustainable Interventions Research Articles

Surveillance methods and interventions implemented in American Indian and Alaska Native communities to increase child restraint device and seat belt use in motor vehicles: a systematic review

BackgroundAmerican Indian/Alaska Native (AI/AN) children are disproportionately affected by injuries and deaths related to motor vehicle crashes. We aimed to synthesise published evidence on surveillance methods and interventions implemented in...

The effects of occupational and mental stress among home care rehabilitation professionals working during the COVID-19 pandemic: An exploratory qualitative study.

Home care rehabilitation professionals (hcRPs) provide health services for clients with a broad range of medical conditions. During the COVID-19 pandemic, home care rehabilitation professionals experienced exacerbations of pre-existing work-related stressors, increased risk of transmission of the COVID-19 virus, reduced resource availability, greater workloads, and staffing shortages. The primary aim of this study was to examine the experience and impact of occupational and mental stress on hcRPs working during the COVID-19 pandemic. Semi-structured interviews were conducted with 24 hcRPs working in Ontario, Canada during the COVID-19 pandemic. Inductive thematic analysis was used to interpret and organize the data into conceptualized themes. Interview data was organized into three themes: (a) unique challenges of a home care rehabilitation professional, (b) COVID-19 exacerbations of home care occupational and mental stress, and (c) personal and workplace coping strategies. Many participants reported reducing their hours or taking on adjunctive roles in different clinical settings outside of home care due to work-related stress exacerbated by the COVID-19 pandemic. With a focus on the effects of COVID-19 on the practice of home care, this study provides a unique perspective on the challenges experienced by hcRPs during an emergent and evolving global public health concern. The exploratory nature of this research works towards providing a framework of factors to be addressed when creating sustainable healthcare interventions, as well as recommendations to support hcRPs to benefit both the community and health-care providers.

Human Trypanosoma cruzi infection in the Argentinean Chaco: risk factors and identification of households with infected children for treatment

BackgroundChagas disease is a neglected tropical disease (NTD). Cost-effective strategies for large-scale implementation of diagnosis and etiological treatment are urgently needed to comply with NTD control goals. We determined the seroprevalence of Trypanosoma cruzi infection and associated risk factors in a well-defined rural population of Pampa del Indio municipality including creole and indigenous (Qom) households and developed two indices to identify houses harboring infected children.MethodsWe serodiagnosed and administered a questionnaire to 1337 residents (48.2% of the listed population) in two sections of the municipality (named Areas II and IV) 6–9 years after deploying sustained vector control interventions. Multiple logistic regression models were used to evaluate the relationship between human infection and a priori selected predictors. Two risk indices were constructed based on environmental and serostatus variables, and we used spatial analysis to test whether households harboring T. cruzi-seropositive children were randomly distributed.ResultsThe global seroprevalence of T. cruzi infection was 24.8%. Human infection was positively and significantly associated with exposure time to triatomines, the household number of seropositive co-inhabitants, maternal seropositivity for T. cruzi, recent residence at the current house and the presence of suitable walls for triatomine colonization in the domicile. The pre-intervention mean annual force of infection (FOI) was 1.23 per 100 person-years. Creoles from Area IV exhibited the highest seroprevalence and FOI; Qom people from both areas displayed intermediate ones and creoles from Area II the lowest. Three hotspots of infected children were spatially associated with hotspots of triatomine abundance at baseline and persistent house infestation. No child born after vector control interventions was T. cruzi seropositive except for one putative transplacental case. Two simple risk indices (based on self-reported inhabiting an infested house and suitable walls for triatomines or maternal serostatus) identified 97.3–98.6% of the households with at least one T. cruzi-seropositive child.ConclusionsWe showed strong heterogeneity in the seroprevalence of T. cruzi infection within and between ethnic groups inhabiting neighboring rural areas. Developed indices can be used for household risk stratification and to improve access of rural residents to serodiagnosis and treatment and may be easily transferred to primary healthcare personnel.Graphical

Challenges in the adoption of sustainability information systems: A study on green IS in organizations

Economic, social and ecological sustainability presents one of the greatest challenges of our society. As a result, there is growing pressure on a variety of organizations to implement sustainability programs, such as inclusion training related to social sustainability, cost management programs related to economic sustainability, and perhaps most importantly, green (information) systems related to environmental sustainability. Not only is multi-faceted sustainability most beneficial to organizations at large, but also there are several categorical thresholds that organizations must meet in order to be certified. For these reasons, companies are increasingly adopting information systems (IS) for sustainability in their operations. Specifically, programs designed to influence employee motivation, attitudes, beliefs, and behaviors are gaining attention. While there is a long tradition of research on technology adoption, such sustainability systems harbor several new phenomena, both with respect to individual and organizational adoption. Therefore, in this study, we explore the challenges of adopting sustainability systems in organizational contexts. Using activity theory and innovation diffusion theory, and with technology adoption theory as the backdrop of our investigation, we conduct a qualitative field study in four small- and medium- sized companies. Using both theory-guided deductive and inductive interpretation phases, we illuminate adoption challenges through combined intersections of adoption stages (knowledge, persuasion, decision, implementation, and confirmation) and activity domains (subject, instrument, object, community, rules). We then shed light on the severity and importance of these challenges through an expert validation study with green IS experts. In discussing the challenges in light of motivational and green IS design, we posit four dilemmas in green IS adoption that arise from tensions in the specific context of sustainability in organizations. Our findings expand existing knowledge in research on green IS, motivational IS design and sustainable behavior change interventions and yield several theoretical and practical avenues for future inquiry and endeavour.

Getting Ahead of the Game: Experiential Learning for Groundwater Governance in Ethiopia

Groundwater management is highly complex, with many users sharing the same resource often with limited understanding of their interconnectedness. Behavioral experiments (games) that simulate real-life common-pool resource use have shown promise as an experiential learning tool for improving resource governance. This study pilots an experiential learning intervention in Ethiopia using a groundwater game to help raise awareness of groundwater over-extraction and improve understanding of the importance of collective action in governance. In the Meki River catchment in Ethiopia, small-scale irrigation is expanding, but overextraction and competition over groundwater have not yet reached alarming levels. The groundwater game, adapted from India and including the addition of a rule-making round, was played in 15 villages with 30 groups. The game was accompanied by subsequent community-wide debriefing in each village to reflect on the experience and lessons learned, which stimulated discussions about groundwater governance. We surveyed participants to capture individual mental models regarding groundwater use and management, as well as any immediate learning effects. Focus group discussions in each village prior to the intervention and again six months after the intervention assessed possible lasting effects. The findings indicate cognitive, normative and relational learning, including increased understanding of groundwater dynamics (such as the joint effect of diverse water uses and users), the importance of collective action in resource management, and the benefits of communication. We find gendered differences in decision-making about resource extraction in the game and development of group-level resource management, confirming the need for gender-responsive approach to sustainable groundwater management interventions. We discuss community-wide learning and institution-building, and considerations for future intervention designs. We recommend embedding experiential learning, facilitated by local extension officers and other practitioners, in intervention packages that include both technical assistance on water-conserving technologies and groundwater management approaches and support in building communities’ institutional capacity.

What contributes to the long-term implementation of an evidence-based early childhood intervention: a qualitative study from Germany.

Rigorous research trials have demonstrated that early childhood interventions can reach socially disadvantaged families and can have a lasting impact on the healthy development of their children. However, little is known about the internal and contextual factors that contribute to the long-term implementation of such interventions. In this study, we investigated the development of the home visiting program Pro Kind. The program was adapted from the evidence-based US-American Nurse-Family Partnership program and was implemented in Germany in 2006. Using an exploratory approach, we examined factors contributing to the long-term implementation of this program. Qualitative interviews with program implementers (midwives, social workers, program managers) of the Pro Kind program and key stakeholders in two cities in Germany were conducted. Interview guides were developed to assess participants' perceptions and experiences on how the program had developed over time internally and in the interaction with its environment. Data were collected between March and September 2021. Drawing on the Consolidated Framework for Implementation Research (CFIR), data was coded according to the principles of thematic analysis. A total of 25 individuals (11 program implementers, 14 key stakeholders) were interviewed. The identified factors related to three out of five domains of the CFIR model in our analysis. First, regarding the intervention characteristics, the evidence of effectiveness and the relative advantage of the implementation of the program compared to similar interventions were viewed as contributors to long-term implementation. However, the program's adaptability was discussed as a constraining factor for reaching the target group. Second, concerning the inner setting, stakeholders and program implementers perceived the implementation climate, the leadership engagement and the program's size as relevant factors for networking strategies and program visibility. Third, as part of the outer setting, the degree of networking with external stakeholders was highlighted of great importance for the program. We identified several factors of particular importance for the long-term implementation and sustainability of an early childhood intervention at the practice level, particularly in the local context in Germany. These findings should inform the design of impactful, scalable, and sustainable early childhood interventions targeting disadvantaged families.

The effectiveness of the psychosocial empowerment program in early adjustment among adult burn survivors

BackgroundBurns constitute a major global health challenge, causing not only physical trauma, but also significant psychosocial and emotional disturbances. The complexity of these injuries requires comprehensive rehabilitation programs that address both the physical and psychosocial aspects of recovery. Despite advances in medical care, there is a lack of standardized, accessible, and sustainable psychosocial interventions for burn survivors, particularly in the transition from hospital to home. This study aimed to develop and evaluate a nurse-led psychosocial empowerment intervention for early adjustment among burn survivors after hospital discharge.MethodsThe study adopted a quasi-experimental framework. A convenient sample of 80 adult burn survivors was randomly divided into an intervention group, receiving the psychosocial empowerment program, and a control group, continuing standard care from November 2022 to May 2023. The effectiveness of the program was evaluated using various tools that measure satisfaction with appearance, coping abilities, and symptoms of post-traumatic stress disorder (PTSD). The intervention focused on enhancing resilience, self-efficacy, and adaptive coping, through targeted skill building in stress management, adaptability to coping, social reintegration, emotion regulation, and problem-solving.ResultsParticipants in the intervention group demonstrated significant improvements in body image satisfaction, coping abilities, and symptoms of PTSD compared to the control group.ConclusionsThe psychosocial empowerment program effectively addressed the psychosocial needs of burn survivors and enhanced their early adjustment after hospital discharge. The findings highlight the critical role of psychosocial support in the rehabilitation of burn survivors and underscore the need to integrate such interventions into standard post-discharge care. Future research should focus on the long-term effects of these interventions and their applicability in diverse settings.

Standardization of different doses and duration of plant derived smoke water on growth, yield and yield attributing traits of linseed (Linum usitatissimum L.)

Harnessing the potential of smoke water treatments, derived from plant combustion, this study delves into their impact on various growth and physiological parameters of linseed plants. Through a randomized controlled trial featuring 13 treatments along with control, we meticulously evaluated different concentrations and durations of smoke water application. Linseed seeds were meticulously sown under controlled conditions, enabling the comprehensive assessment of field emergence, plant height, flowering duration, branching patterns, chlorophyll content, seed yield, oil content, and protein content. Notably, Treatment 2 (1% smoke water for 16 hours) emerged as a frontrunner, showcasing superior performance across multiple parameters, including accelerated growth, enhanced flowering, increased branching, improved chlorophyll content, and higher seed yield and oil content. These findings underscore the promising role of smoke water as an environmentally sustainable and effective agricultural intervention to augment crop productivity and quality in linseed cultivation. Further research endeavors are warranted to delve deeper into the underlying mechanisms and refine application protocols, thereby unlocking the full potential of smoke water treatments in modern agricultural practices.

Seismic strengthening of isolated RC framed structures through orthogonal steel exoskeleton: Bidirectional non-linear analyses

The catastrophic effects of recent earthquakes around the world have highlighted the vulnerability of civil buildings; in Europe, most of the existing buildings were built after World War II and since they have largely exceeded their useful life, are characterized by a high vulnerability linked both to the durability of the materials and to the lack of seismic provisions in design. The current trend in constructional field is to design interventions aimed at the seismic and energy improvement of these structures jointly, in order to achieve a sustainable and integrated retrofit intervention. To this aim, the use of 2D orthogonal steel exoskeletons for the seismic strengthening represents a suitable solution, providing at the same time an enhancement in thermal insulation, through a ‘double-skin’ solution. Due to the growing interest in the design of steel exoskeleton interventions, a detailed dynamic characterization of this external strengthening solution is needed. In this framework, the present work, aims to investigate the effectiveness of the investigated strengthening solution by means of bi-directional non-linear dynamic analyses. Extensive numerical analysis was carried out. The selected case-study is an Italian existing pre-1980 s RC frame building located in Mugnano di Napoli (NA, Italy), which is a medium-high seismic hazard site in Italy (peak ground acceleration equal to 0.156 g). Two alternative strengthening solutions were numerically investigated by means of non-linear time-history and incremental dynamic analyses performed applying fifteen bidirectional ground motions on three-dimensional numerical models. The results of the dynamic non-linear analyses allow to quantify more appropriate performance indicators, both in terms of expected demand and overall collapse capacity, useful for the development of optimization strategy and design of exoskeleton system. The results highlighted that both the investigated strengthening scenarios allow to increase the stiffness of the existing building and allow it to meet the current code safety requirements reducing also the residual inter-storey drift. The obtained results are not strictly related to the investigated case study, but can be extended to all the structures retrofitted that follows the presented design procedure.

Resilience in vulnerable university groups: An analysis of social work intervention strategies from the perspective of social inclusion

Introduction. Resilience refers to the ability of individuals, groups or communities to adapt and recover in the face of adverse or stressful situations, such as violence, poverty, natural disasters or disease. Aim. The present research aims to analyse the impact of social work intervention in strengthening resilience in vulnerable groups served by the Faculty of Humanistic and Social Sciences of the Technical University of Manabí during the 2023-A academic period, to identify the pedagogical intervention of social work in vulnerable groups, and to evaluate the effectiveness of the intervention strategies implemented by social work professionals. Methodology and research methods. The quantitative paradigm was applied. The design corresponds to a non-experimental study. The population was 259 students of Social Work. The sample consisted of 70 students belonging to vulnerable groups. A questionnaire with 15 items was applied. Multiple regression analysis and ANOVA analysis were carried out. Results. Among the results, the pedagogical intervention strategies applied by the social work professionals were effective. There is a positive impact on strengthening resilience in vulnerable groups, as well as on socio-economic and cultural factors. Social work pedagogical intervention strategies as well as socio-economic and cultural factors are important in strengthening resilience in vulnerable groups. Scientific novelty. The scientific novelty of this study is that building resilience through inclusion stands out as a pedagogical component in social work and as a pillar that strengthens social work. Practical significance. It is important to take socio-economic and cultural factors into account when designing and implementing these pedagogical strategies, as they can influence their effectiveness. It is also important to continue research on the factors that influence the development of resilience in vulnerable groups in order to design and implement more effective and sustainable educational intervention strategies.

“It is not the end of my life”: positive identity (re)constructions among young mothers in rural South-Western Nigeria

ABSTRACT Social norms around the timing of motherhood mean that young mothers are often viewed as different and negatively stereotyped. Drawing on data from South-Western Nigeria, this paper explores unmarried young women’s identity (re)construction in the context of the negative societal representations of young motherhood. Semi-structured interviews were conducted with 24 young mothers, using photo-elicitation as a complementary method. The results revealed that despite facing social stigma, some young mothers were able to challenge negative societal stereotypes, reframe the challenges they faced as mothers and construct positive maternal identities for themselves. Our findings offer insights into the complex interplay between stigma and identity formation and provide recommendations for sustainable interventions and social support to empower young mothers in Nigeria.

Training-of-trainers program for community health workers involved in an innovative and community-based intervention against malaria among goldminers in the Guiana shield: a quality and effectiveness evaluation.

An innovative and community-based intervention is implemented in the Guiana Shield to eliminate malaria among people involved in artisanal and small-scale gold mining. The intervention consists of the distribution of malaria self-management kits to goldminers and the presumptive treatment for individuals at risk of carrying Plasmodium vivax hypnozoites. The intervention is possible owing to community health workers (CHWs) who are previously trained to master all intervention procedures, including health education activities and goldmining training. This study aimed to evaluate the training program provided to CHWs in terms of quality and effectiveness. A training-of-trainers program for CHWs has been developed based on the CDC framework. A mixed-method case study was implemented in two steps between February and March 2023. The evaluation was based on a knowledge survey, satisfaction test, observations, and semi-structured interviews. Quantitative and qualitative data were analyzed and triangulated. A total of 20 CHWs participated in the training and the first-step evaluation. For the second step, four semi-structured interviews were conducted. The Qualitative data showed that group dynamics and adaptations were central elements of a high-quality training program. Quantitative analysis found that CHWs' satisfaction was elevated (> 4/5 overall), especially regarding format and learning results. Improvements in knowledge level demonstrated good effectiveness (pre-training vs. post-training, p < 0.05). Nevertheless, some difficulties persisted regarding tasks of the intervention procedure, such as informed consent and smartphone application procedures (with an inaccuracy rate of 29.2% and 16.7%, respectively). Further on-the-job training permitted to address these issues. The project team's previous experience and the Guiana Shield countries' commitment to the WHO-E-2025-initiative were identified as levers for the quality of the training, while the complexity of the project context was a challenge. High-quality, effective, and appropriate training programs are required for effective and sustainable interventions involving CHW profiles. Training design is a crucial point to address to accomplish quality and effectiveness. The training-of-trainers model has been shown to allow a high level of satisfaction, good learning results, and satisfactory implementation in the field. Initial and continuing training is an indispensable continuum to sustain good practices in the field and CHWs' motivation. Training evaluation permits standardizing methods and facilitates transferability.

A Decision Framework for the Regeneration Awareness of Large-Sized Public Housing Using a Building Transformability Assessment: A Test Case in Italy (Latina)

In the frame of developing sustainable, reliable, and regenerative interventions on existing buildings, namely on large-scale public housing, the implementation of functional, technological, and effective strategies is devoted to thoroughly assessing the transformability of buildings using trustworthy performance indicators. With this aim, in the present paper, an assessment framework tool is presented and tested to evaluate the potential of buildings for transformation through the detection of regeneration strategies for the reduction of energy consumption, a definition of the new apartments’ internal layout, and the implementation of sustainable systems to foster rainwater harvesting. The procedure is tested on a case study in Latina (Italy), showing its suitability to quantitatively assess the regenerative potentiality of public housing, thus resulting in an effective supporting tool for designers and policy makers.

Beyond the classroom: Influence of a sustainability intervention on university students’ environmental knowledge and behaviors

Beyond the classroom: Influence of a sustainability intervention on university students’ environmental knowledge and behaviors

Application of behavioural theories, models, and frameworks in pharmacy practice research based on published evidence: a scoping review.

Pharmacy practice research often focuses on the design, implementation and evaluation of pharmacy services and interventions. The use of behavioural theory in intervention research allows understanding of interventions' mechanisms of action and are more likely to result in effective and sustained interventions. To collate, summarise and categorise the reported behavioural frameworks, models and theories used in pharmacy practice research. PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and EBSCO (CINAHL PLUS, British Education index, ERIC) were systematically searched to capture all pharmacy practice articles that had reported the use of behavioural frameworks, theories, or models since inception of the database. Results were filtered to include articles published in English in pharmacy practice journals. Full-text screening and data extraction were independently performed by two reviewers. A narrative synthesis of the data was adopted. Studies were reviewed for alignment to the UK Medical Research Council (MRC) framework to identify in which phase(s) of the research that the theory/model/framework had been employed. Fifty articles met the inclusion criteria; a trend indicating an increasing frequency of behavioural theory/frameworks/models within pharmacy practice research was identified; the most frequently reported were Theory of Planned Behaviour and Theoretical Domains Framework. Few studies provided explicit and comprehensive justification for adopting a specific theory/model/framework and description of how it underpinned the research was lacking. The majority were investigations exploring determinants of behaviours, or facilitators and barriers to implementing or delivering a wide range of pharmacy services and initiatives within a variety of clinical settings (aligned to Phase 1 UK MRC framework). This review serves as a useful resource for future researchers to inform their investigations. Greater emphasis to adopt a systematic approach in the reporting of the use of behavioural theories/models/frameworks will benefit pharmacy practice research and will support researchers in utilizing behavioural theories/models/framework in aspects of pharmacy practice research beyond intervention development.

Indian fathers are involved in nurturing healthy behaviours in adolescents: A qualitative inquiry

BackgroundIndian adolescents exhibit unhealthy food behaviours and inactive lifestyles which increase their risk of developing obesity and associated negative health consequences. The family food environment represents a vital setting to nurture healthy lifestyle behaviours in adolescents, with parents influencing their adolescents’ dietary and physical activity behaviours. Yet, much of the existing evidence exploring parental influences predominantly focuses on mothers while fathers’ engagement in instilling healthy dietary and physical activity behaviours is understudied, more so in the context of developing economies like India. Therefore, this qualitative study was designed to understand Indian fathers’ views on instilling healthy behaviours in their children.MethodsConvenience sampling along with snowball sampling techniques were employed to recruit fathers of adolescents aged 10–19 years from Kolkata city, India. Informed by the research aim and review of literature, an interview guide was developed and pre-tested. Interviews were carried out either in person or virtually (Zoom/telephone) in English/Hindi/Bengali as per the preference of the participants. All interactions were audio recorded, transcribed verbatim, and translated to English for the purpose of data analysis. The transcripts were analysed thematically using NVivo software program. Themes were identified using both inductive and deductive approaches.ResultsA total 36 fathers participated in the interviews. Seven main themes were identified: (i) Involvement of fathers in adolescent upbringing (i.e. engagement in meal preparation, food shopping, educational activities, physical activity); (ii) Family food environment (i.e. setting food rules, having meals with children, making food available); (iii) Challenges to instilling healthy behaviours in adolescents (i.e. adolescents’ sedentary lifestyle and liking for unhealthy foods); (iv) Barriers to routine involvement in adolescent upbringing (i.e. time constraints due to paid employment, poor socio-economic status); (v) Adolescent nutrition education: (vi) Dual burden of malnutrition (i.e. awareness of malnutrition, no knowledge about government-led health programs for adolescents); (vii) Paternal knowledge.ConclusionsThe emerging themes reveal that Indian fathers played a crucial role in instilling healthy dietary and physical activity behaviour in their adolescents through various parenting practices such as purchasing nutritious food, enforcing food rules, disseminating nutrition-related knowledge, and encouraging adolescents to participate in moderate-to-vigorous intensity outdoor sports. This provides strong support for the inclusion of fathers in sustainable family-focused lifestyle interventions to maximise the nurturing care required by adolescents as well as assist in normalising the representation of fathers in health and welfare policies designed for adolescents.

Burnout in early year medical students: experiences, drivers and the perceived value of a reflection-based intervention

IntroductionAccording to the 11th Revision of the International Classification of Diseases, burnout is defined as a syndrome resulting from chronic work-related stress that has not been successfully managed. Burnout is increasingly prevalent amongst medical students and has been shown to lead to worsened academic engagement, feelings of inadequacy, poor mental health and increased risk of withdrawal from the course. The aim of this study was to explore the experience of burnout amongst early year medical students and evaluate the perceived impact of a reflection-based intervention on their awareness and experience of burnout.MethodsThe reflection-based intervention comprised two tutorials covering the presentation, drivers, impact and management strategies for burnout syndrome. These were introduced into the second-year medical curriculum at Imperial College London. As part of the reflection-based intervention, students were invited to complete an anonymous Qualtrics form three times during the academic year. This included the Shirom-Melamed Burnout Measure (SMBM) and a free-text question prompting the student to consider their stressors at the time of completing the intervention. The former is composed of 14-questions measuring the extent of feelings or behaviours suggestive of burnout, divided into three categories: physical fatigue, cognitive weariness and emotional exhaustion. At the end of the academic year, students were invited to participate in an online focus group to further explore their experience of burnout and their perceived value of the reflection-based intervention. Results of the SMBM were explored descriptively; free-text questions and the focus group transcript were analysed using inductive thematic analysis.ResultsA total of 59 submissions for the reflection-based intervention were analysed: 26 students participated and consented in the first round, 8 in the second and 25 in the third round. Overall median burnout scores were 4 (IQR 3–5), 2 (IQR 1–4) and 3 (IQR 2–5) in each round of the SMBM, respectively. A total of 8 (30.8%) met the threshold for severe burnout (≥ 4.4) in round 1 of the questionnaire, zero in the second round and 4 (16%) in the third round. Physical and cognitive fatigue showed higher median scores than emotional exhaustion in every round. Four students participated in the focus group, which had two sections. The first was reflecting on burnout in medical school and the intervention, which revealed four themes: (1) indicators of burnout (often insidious, but may involve lack of energy and motivation, or changes in perceived personality); (2) perceived drivers of burnout (perceived expectation that medical school is supposed to be challenging and consistent prioritisation of work over wellbeing); (3) working habits of medical students (unachievable self-expectations and feelings of guilt when not working); (4) value of the intervention (the teaching and reflection-based intervention prompted students to identify signs of burnout in themselves and consider management strategies). The second section included considerations for implementing burnout interventions into the medical school curriculum, which revealed three themes: (1) desire to learn about burnout (students hoped to gain insight into burnout and methods of prevention as part of their curriculum); (2) importance of community (group interventions and the involvement of Faculty helped students feel less isolated in their experiences); (3) feasibility of interventions (sustainable interventions are likely to be those that are efficient, such as using multiple-choice questions, and with allocated periods in their timetable).ConclusionSecond-year medical students demonstrated symptoms and signs of burnout, including exhaustion, lack of motivation and changes in personality. They also expressed a desire to gain greater awareness of burnout and insight into preventative strategies within the medical curriculum. Whilst certain drivers of burnout can be prevented by students themselves through adequate prevention strategies, many remain systemic issues which require curriculum-level change to be effectively addressed. The students found that the reflection-based intervention was effective at improving their perception of burnout and a convenient tool to use, which could be implemented more widely and continued longer-term throughout medical school.

Hormonal Catalysts in the Addiction Cycle of Muscle Dysmorphia: A Neuroendocrine Perspective

Abstract Muscle dysmorphia (MD) is a subtype of body dysmorphic disorder characterized by an obsessive belief that one’s body is insufficiently muscular. This review provides a comprehensive examination of the addiction cycle in MD, particularly in the context of anabolic steroid and performance-enhancing drug (PED) use. Utilizing a systematic search across databases such as PubMed, PsycINFO, Scopus, and Web of Science, the review draws on peer-reviewed literature published in the past two decades to uncover the roles of hormonal and neural alterations in perpetuating this cycle. Inclusion and exclusion criteria were meticulously applied to ensure a robust analysis of relevant studies. The article details the interaction between exogenous hormonal supplementation from steroids and PEDs and brain receptors, which significantly disrupt neurotransmitter systems and affect mood, cognition, and stress responses. The synthesis of data reveals that hormonal imbalances due to substance abuse lead to profound changes in brain plasticity and function, instigating psychiatric disorders and complicating withdrawal and treatment. Therapeutic strategies are critically assessed, with emphasis on the success of cognitive-behavioral therapy, the role of pharmacological management, and the promise of emerging treatments targeting neuroendocrine disruptions. The review suggests an integrated, holistic treatment model that includes hormonal therapy and neurological considerations, underscoring the importance of personalized and sustained interventions. In conclusion, the intricate cycle of addiction in MD, fueled by the hormonal effects of steroids and PEDs on the brain, calls for an integrated approach to treatment. Future research should focus on the neuroendocrine impact of these substances to refine therapeutic strategies for MD.

The Effect of Boko Haram Insurgency on Health and Nutrition among the Residents of Bolori 2 of Maiduguri Metropolitan Council of Borno State, Nigeria.

The Effect of Boko Haram Insurgency on Health and Nutrition among the Residents of Bolori 2 of Maiduguri Metropolitan Council of Borno State, Nigeria.

Walking the Divide: A Public Health Journey from Manhattan to Harlem.

This paper examines the striking contrasts and inequalities observation by walking from Manhattan to Harlem in New York City, highlighting the significant social and economic differences that have profound implications for public health and social policy. Through this journey, we explore various aspects including racial segregation, the composition of shops, smoking habits, street cleanliness, police presence, unemployment, real estate disparities, and the pervasive sense of insecurity. The transition from a predominantly White Manhattan to a predominantly Black and Hispanic Harlem underscores the historical and systemic inequalities that continue to shape the city's demographic and economic landscape. These disparities, rooted in discriminatory housing policies, economic disparities, and social exclusion, manifest in poorer health outcomes, higher rates of substance use, and limited economic opportunities for minority populations. By addressing these structural issues through targeted policies and sustained interventions, policymakers may work towards reducing health disparities and promoting racial equity. This paper also highlights the concept of Minorities' Diminished Returns (MDRs), where the benefits of education and income are less pronounced for minority individuals compared to their White counterparts, further perpetuating cycles of disadvantage. Comprehensive efforts to dismantle systemic inequities are essential for fostering a more equitable and healthy society.