Mortality Among Users of Anabolic Steroids.

This cohort study investigates mortality and cause of death among a large cohort of androgenic anabolic steroid users, compared with a control group, in Denmark from January 3, 2006, to March 1, 2018.

How useful do communities find the health and wellness centres? A qualitative assessment of India's new policy for primary health care.

BACKGROUND: The policy attention to primary health care has seen a global upswing in recent years, including in India. Earlier assessments had shown that a very small proportion of Indian population used the government primary health facilities. Starting in 2018, Indian government has established more than 100,000 Health and Wellness Centres (HWCs) to increase rural population's access to primary health care. It is crucial to know how useful people find the services of HWCs. METHODS: A qualitative inquiry was made to understand the perceptions, experiences and expectations of the rural communities regarding HWCs in Chhattisgarh state. Fourteen focus group discussions were conducted with community members. The study areas were chosen to include both the central and remote districts of the state. The study used accessibility, availability, acceptability and quality (AAAQ) framework to assess HWCs. RESULTS: Community members felt that the most important change brought about by HWCs was to offer a wider range of curative services than previously available. Services for noncommunicable diseases such as hypertension and diabetes were seen as a key value addition of HWCs. People felt improvements in services for acute ailments also. The services people found missing in HWCs were for injuries, dental care and mental health. In people's experience, the availability of essential medicines and point-of-care tests at HWCs was satisfactory and the treatment was effective. People appreciated the supportive behaviour of health workers in HWCs. They did not find the referrals from HWCs as excessive but often faced difficulties in receiving necessary services at higher facilities. CONCLUSIONS: The assessment based on community perceptions showed that the services of HWCs matched well with people's needs of curative primary care. It shows that people are willing to use the government facilities for primary health care if the services are relevant, adequately functional and accessible.

How staying in a gymnasium affects sleep and bed climate in children.

BACKGROUND: We investigated the relationship between sleep, ambient climate, and bed climate in school-aged children during a one-night stay in a simulated shelter in a gymnasium to demonstrate the effect of ambient climate, and bed climate on sleep. METHODS: We obtained measurements during a one-night stay in a school gymnasium (C), days before C (BC), on the day after (A1), and on the second day after C (A2) in 13 healthy school-aged children during summer. Sleep was evaluated using an actigraph, and the temperature and humidity of the bedrooms in the participants' homes and in the gymnasium were monitored for 3 days before and after C. The bed climate of the chest and foot areas was measured for two nights before and after C. The participants were asked to report on their subjective sleep estimations and thermal sensations two nights before and after C. RESULTS: The ambient temperature in C was significantly higher than that in BC at the initial 180 min, while it significantly decreased compared to A1 and A2 in the last 100 min. The ambient humidity was significantly higher in both C and BC compared to A1 and A2. The sleep efficiency index decreased significantly in C (43±4.8%) compared to other conditions. Sleep time was significantly shorter in C than in other conditions during the initial 195 min. The increase in the bed climate temperature of the chest area in C was significantly delayed compared to that in the other conditions, around the initial 30 min after the lights were off. Subjective estimation revealed that in C, 85% of the participants were out of their sleeping bag at sleep onset, and their sleep was disturbed by heat (77%). CONCLUSIONS: Our study revealed that the disturbed sleep patterns observed with children in a simulated shelter may be related to a delayed increase in bed climate temperature in the chest area. This delayed increase could be related to the children not entering the sleeping bag and a delayed chest skin temperature increase during the sleep onset period.

Physical Activity During the COVID-19 Stay-at-Home Order in Active Older Adults: A Qualitative Study.

To reduce the spread of COVID-19, in March of 2020, the state of Virginia issued a stay-at-home order requiring fitness center closures for 2.4 months. The purpose of this study was to explore how the fitness center closures influenced physical activity (PA) in older adults who previously participated in the centers' exercise classes. Eleven older adults (69.0 ± 6.6 years) completed semistructured interviews, which were transcribed and analyzed to identify emergent themes. Ten participants reported engaging in PA during the stay-at-home order; four participants maintained/increased PA compared to prepandemic levels. Four themes emerged regarding PA are as follows: recognition of the value of PA, high self-efficacy in regard to PA, adaptation to circumstances, and functional limitations. Findings suggest that prior exercise class participation positively influenced PA. While most participants did not maintain prepandemic PA levels, they remained active because they recognized the benefits of PA, had high self-efficacy for exercise, and adapted to their circumstances.

Protein supplement intake by non-athlete gym attendees in Jazan region: misconceptions and gender differences.

BACKGROUND: Protein supplements (PSs) have gained widespread popularity among non-athlete gym attendees, who often perceive them as essential tools for muscle growth and recovery. However, misinformation surrounding PSs may lead to inappropriate use and negative health consequences. This study aimed to assess whether non-athlete gym attendees using PSs have greater misconceptions than non-users while also examining the prevalence of PS consumption and gender differences. METHODS: A cross-sectional study of 387 participants in the Jazan region was conducted. Customers of 10 fitness centers were screened with a questionnaire comprising questions to measure PS misconceptions. Participants were divided into PS users and non-users. Data were analyzed using descriptive statistics and the Chi-square test to assess the associations between variables. An independent t-test was used to compare the PS Misconception Index Score between the two groups. RESULTS: A total of 82.4% of non-athlete gym attendees consumed at least one PS. Our findings revealed a significant association between gender and PS utilization (P<0.001), with a higher proportion of females (90.8%) consuming PS than males (77.6%). PS users had a significantly lower PS Misconception Index Score than non-users (26.8 vs. 28.3; P=0.006), indicating that PS users had a higher number of misconceptions. The internet (41.37%) and coaches (gym instructors/trainers) (34.48%) were the most common sources of information about PSs, with muscle gain being the primary reason for consumption (82.75%). CONCLUSIONS: PS consumption is highly prevalent among non-athlete gym attendees in the Jazan region, with many individuals having misconceptions about their benefits and potential risks. Targeted educational interventions are needed to promote evidence-based knowledge about PSs for gym attendees, as well as for coaches, given that they were among the primary sources of information on supplements.

A file audit of gym usage in an Australian private inpatient psychiatric hospital.

OBJECTIVE: This study aimed to determine the extent to which people admitted to a private psychiatric inpatient unit access and utilise the gymnasium and individualised coaching with an exercise physiologist (EP). METHODS: An audit of the medical record of 100 consecutive discharges and 60 individuals referred to an EP during the audit period was undertaken. Selected demographic information, physical health status, psychiatric diagnosis and routinely collected outcome data were extracted from files. RESULTS: Twenty-four percent of people discharged from the hospital had documentary evidence of having attended the gym. These people were noted to have used the gym regularly and had an exercise prescription documented on discharge. Those with substance use disorder were more likely to use the gym than those diagnosed with an affective disorder. There were no significant differences in outcomes between those who were noted to exercise and those who did not. CONCLUSION: Those who may most benefit from coaching around exercise in the context of hospital admission are not presently the individuals most likely to be referred to an EP. Standardised procedures for assessment, referral, exercise prescription and ongoing monitoring of activity and outcomes are recommended across the care continuum.

Assessment of indoor air quality in health clubs: insights into (ultra)fine and coarse particles and gaseous pollutants.

Introduction: Exercising on regular basis provides countless health benefits. To ensure the health, well-being and performance of athletes, optimal indoor air quality, regular maintenance and ventilation in sport facilities are essential. Methods: This study assessed the levels of particulate, down to the ultrafine range (PM10, PM2.5, and particle number concentration in size range of 20-1,000 nm, i.e., - PNC20-1000 nm), gaseous pollutants (total volatile organic compounds - TVOCs, CO2, and O3) and comfort parameters (temperature - T, relative humidity - RH) in different functional spaces of health clubs (n = 8), under specific occupancy and ventilation restrictions. Results and Discussion: In all HCs human occupancy resulted in elevated particles (up to 2-3 times than those previously reported), considering mass concentrations (PM10: 1.9-988.5 µg/m3 PM2.5: 1.6-479.3 µg/m3) and number (PNC 1.23 × 103 - 9.14 × 104 #/cm3). Coarse and fine PM indicated a common origin (rs = 0.888-0.909), while PNC showed low-moderate associations with particle mass (rs = 0.264-0.629). In addition, up to twice-higher PM and PNC were detected in cardiofitness & bodybuilding (C&B) areas as these spaces were the most frequented, reinforcing the impacts of occupational activities. In all HCs, TVOCs (0.01-39.67 mg/m3) highly exceeded the existent protection thresholds (1.6-8.9 times) due to the frequent use of cleaning products and disinfectants (2-28 times higher than in previous works). On contrary to PM and PNC, TVOCs were higher (1.1-4.2 times) in studios than in C&B areas, due to the limited ventilations combined with the smaller room areas/volumes. The occupancy restrictions also led to reduced CO2 (122-6,914 mg/m3) than previously observed, with the lowest values in HCs with natural airing. Finally, the specific recommendations for RH and T in sport facilities were largely unmet thus emphasizing the need of proper ventilation procedures in these spaces.

Distance to Health Centers and Effectiveness of Azithromycin Mass Administration for Children in Niger: A Secondary Analysis of the MORDOR Cluster Randomized Trial.

Importance: The MORDOR (Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance) trial demonstrated that mass azithromycin administration reduced mortality by 18% among children aged 1 to 59 months in Niger. The identification of high-risk subgroups to target with this intervention could reduce the risk of antimicrobial resistance. Objective: To evaluate whether distance to the nearest primary health center modifies the effect of azithromycin administration to children aged 1 to 59 months on child mortality. Design, Setting, and Participants: The MORDOR cluster randomized trial was conducted from December 1, 2014, to July 31, 2017; this post hoc secondary analysis was conducted in 2023 among 594 clusters (communities or grappes) in the Boboye and Loga departments in Niger. All children aged 1 to 59 months in eligible communities were evaluated. Interventions: Biannual (twice-yearly) administration of a single dose of oral azithromycin or matching placebo over 2 years. Main Outcomes and Measures: A population-based census was used to monitor mortality and person-time at risk (trial primary outcome). Community distance to a primary health center was calculated as kilometers between the center of each community and the nearest health center. Negative binomial regression was used to evaluate the interaction between distance and the effect of azithromycin on the incidence of all-cause mortality among children aged 1 to 59 months. Results: Between December 1, 2014, and July 31, 2017, a total of 594 communities were enrolled, with 76 092 children (mean [SD] age, 31 [2] months; 39 022 [51.3%] male) included at baseline, for a mean (SD) of 128 (91) children per community. Median (IQR) distance to the nearest primary health center was 5.0 (3.2-7.1) km. Over 2 years, 145 693 person-years at risk were monitored and 3615 deaths were recorded. Overall, mortality rates were 27.5 deaths (95% CI, 26.2-28.7 deaths) per 1000 person-years at risk in the placebo arm and 22.5 deaths (95% CI, 21.4-23.5 deaths) per 1000 person-years at risk in the azithromycin arm. For each kilometer increase in distance in the placebo arm, mortality increased by 5% (adjusted incidence rate ratio, 1.05; 95% CI, 1.03-1.07; P < .001). The effect of azithromycin on mortality varied significantly by distance (interaction P = .02). Mortality reduction with azithromycin compared with placebo was 0% at 0 km from the health center (95% CI, -19% to 17%), 4% at 1 km (95% CI, -12% to 17%), 16% at 5 km (95% CI, 7% to 23%), and 28% at 10 km (95% CI, 17% to 38%). Conclusions and Relevance: In this secondary analysis of a cluster randomized trial of mass azithromycin administration for child mortality, children younger than 5 years who lived farthest from health facilities appeared to benefit the most from azithromycin administration. These findings may help guide the allocation of resources to ensure that those with the least access to existing health resources are prioritized in program implementation. Trial Registration: ClinicalTrials.gov Identifier: NCT02047981.

Role of community-based health clubs in promoting patients' health education for diabetes self-care management: an interventional qualitative study in a Ugandan urban setting.

BACKGROUND: Self-care management support is a core component of the Chronic Care Model that emphasises the need for empowering and preparing patients to manage their healthcare. In diabetes mellitus (DM) management, health education towards self-care empowers patients to make day-to-day decisions on their own disease and live with a healthy lifestyle. Although several strategies have been undertaken to improve the management of DM in Uganda, little has been done to empower patients to manage their own health. Community-based health clubs have been suggested as a novel way of improving diabetes management especially in settings with uneven distribution of healthcare facilities and inaccessibility to healthcare services that limit patients' awareness of the disease and self-care management. This interventional study was aimed at exploring the role of community-based health clubs in promoting patients' health education for diabetes self-care management. METHODS: A cross-sectional qualitative study was conducted among 20 participants using focus group discussions with each having six to eight members. Only patients with diabetes who seek routine diabetes healthcare services at Wakiso Health Centre IV and had participated in the 8-week community-based health clubs' health education sessions were recruited for the study. The audio-recordings were transcribed verbatim and translated into English; thematic data analysis was conducted to generate codes and themes. Similar codes were merged and a group consensus was reached on coding discrepancies. RESULTS: Three major themes on the role of health clubs in promoting patients' health education were merged from the study. These include promoting sharing of experiences among patients, improving awareness of healthy self-care practices and offering sufficient patient-health worker interaction time. CONCLUSIONS: This is the first publication reporting on the role of community-based health clubs in promoting patients' health education towards diabetes self-care management in Uganda. The ability to share experiences among patients, improve patients' awareness on healthy living practices and the increased health worker-patient interaction time contribute heavily to the capacity-building for self-care among patients.

Designing for community engagement: user-friendly refugee wellness center planning process and concept, a health design case study.

BACKGROUND: Refugee and immigrant populations have diverse cultural factors that affect their access to health care and must be considered when building a new clinical space. Health design thinking can help a clinical team evaluate and consolidate these factors while maintaining close contact with architects, patients' community leaders, and hospital or institutional leadership. A diverse group of clinicians, medical students, community leaders and architects planned a clinic devoted to refugee and immigrant health, a first-of-its-kind for South Philadelphia. METHODS: The planning process and concept design of this wellness center is presented as a design case study to demonstrate how principles and methods of human-centered design were used to create a community clinic. Design thinking begins with empathizing with the end users' experiences before moving to ideation and prototyping of a solution. These steps were accomplished through focus groups, a design workshop, and iterations of the center's plan. RESULTS: Focus groups were thematically analyzed and generated two themes of access and resources and seven subthemes that informed the design workshop. A final floor plan of the wellness center was selected, incorporating priorities of all stakeholders and addressing issues of disease prevention, social determinants of health, and lifestyle-related illness that were relevant to the patient population. CONCLUSIONS: Design thinking methods are useful for health care organizations that must adapt to the needs of diverse stakeholders and especially populations that are underserved or displaced. While much has been written on the theory and stages of design thinking, this study is novel in describing this methodology from the beginning to the end of the process of planning a clinical space with input from the patient population. This study thus serves as a proof of concept of the application of design thinking in planning clinical spaces.

First documented gymnasium cluster of COVID-19 with whole genome sequencing in Australia.

Background: Transmission of coronavirus disease 2019 (COVID-19) has been demonstrated in fitness settings internationally. We report the first documented case of transmission of COVID-19 in a gymnasium in Australia in 2020. Methods: Case finding and case interviews were conducted among attendees in a Western Sydney gymnasium, Australia. Whole genome sequencing using an amplicon-based approach was performed on all SARS CoV-2 polymerase chain reaction positive samples detected through surveillance. Results: We show that five cases of COVID-19 were linked to the gymnasium, with transmission occurring on 7 July 2020, when the index case transmitted the infection to four other gymnasium attendees through the sharing of an enclosed space. Conclusions: There is an ongoing risk of transmission of COVID-19 within gymnasium environments and they are justifiably classified as a 'high-risk' venue. There may be a need to expand ventilation and space requirements to prevent transmission of COVID-19 in such settings in the context of severe COVID-19 variants or to prevent respiratory disease transmission in general.

Exploring the impact of individualized pleasure-oriented exercise sessions in a health club setting: Protocol for a randomized controlled trial.

Research on the relationship between exercise-induced affect and exercise or physical activity behavior has gained momentum in recent years, yielding several observational and longitudinal studies. However, experimental tests demonstrating a causal role of affective responses on exercise adherence are lacking. Given the need to devise exercise prescriptions that can facilitate adherence and promote regular physical activity, a Randomized Controlled Trial targeting individual pleasurable responses in a health-club setting will be conducted. The experimental protocol will compare two individualized evaluation, prescription, and supervision methods, adjusted for intensity, with the aim to explore their impact on behavioral, affective, and motivational outcomes. The planned study will be a pragmatic randomized, single-blinded, controlled superiority trial with two parallel groups and an allocation ratio of 1:1. Apparently healthy volunteer participants (N = 46) between 18 and 45 years old, who are not regularly active, will be randomly allocated to a control or experimental group. The control group will follow a general American College of Sports Medicine exercise prescription; the experimental group will follow the same prescription but with enhancements aimed at promoting pleasure: (1) individualization based on individual differences in preference for and tolerance of exercise intensity; (2) self-regulation of intensity; and (3) repeated assessments of core affect. The primary outcome will be post-intervention exercise-session attendance. Affective and motivational variables will be examined as secondary outcomes. The results are expected to advance exercise prescriptions by promoting affective regulation, thus helping to improve exercise adherence and related outcomes. TRIAL REGISTRATION: ClinicalTrials.gov; ID: NCT05416593.

Staying safe, feeling welcome, being seen: How spatio-temporal configurations affect relations of care at an inclusive health and wellness centre.

BACKGROUND: People experiencing homelessness also experience poorer health and frequently attend acute care settings when primary health care would be better equipped to meet their needs. Existing scholarship identifies a complex mix of individual and structural-level factors affecting primary health care engagement driving this pattern of health services utilisation. We build on this existing knowledge, by bringing the spatio-temporal configurations of primary health care into focus. Specifically, we interrogate how space and time inflect situated practices and relations of care. METHODS: This study took an ethnographic approach and was conducted 2021-2022 at an inclusive health and wellness centre ("the Centre") in Southeast Queensland, Australia. The data consists of 46 interviews with 48 people with lived experience of homelessness, including participants who use the services offered at the Centre (n = 26) and participants who do not (n = 19). We also interviewed 20 clinical and non-clinical service providers affiliated with the Centre and observed how service delivery took place. Interviews and observations were complemented by visual data, including participant-produced photography. All data were analysed employing a narrative framework. RESULTS: We present three interrelated themes demonstrating how space and time affect care, that is 'staying safe', 'feeling welcome' and 'being seen'. 'Staying safe' captures the perceptions and practices around safety, which sit in tension with making service users feel welcome. 'Feeling welcome' attends to the sense of being invited to use services free of judgment. 'Being seen' depicts capacities to see a health care provider as well as being understood in one's lived experience. CONCLUSION: Spatio-temporal configurations, such as attendance policies, consultation modalities and time allocated to care encounters afford differential opportunities to nurture reciprocal relations. We conclude that flexible service configurations can leverage a relational model of care. PATIENT OR PUBLIC CONTRIBUTION: Service providers were consulted during the design stage of the project and had opportunities to inform data collection instruments. Two service providers contributed to the manuscript as co-authors. People with lived experience of homelessness who use the services at the inclusive health centre contributed as research participants and provided input into the dissemination of findings. The photography they produced has been featured in an in-person exhibition, to which some have contributed as consultants or curators. It is hoped that their insights into experiences of welcomeness, safety and being seen will inform flexible and relational primary health care design, delivery, and evaluation to better cater for people experiencing housing instability and poverty.

Service availability and readiness for basic emergency obstetric and newborn care: Analysis from Nepal Health Facility Survey 2021.

BACKGROUND: Although there has been a significant focus on improving maternal and newborn health and expanding services in Nepal, the expected positive impact on the health of mothers and newborns has not been achieved to the desired extent. Nepal not only needs to focus on improving access to and coverage of services but also the quality to achieve Sustainable Development Goals (SDG) by 2030. In this context, we aimed to analyze Basic Emergency Obstetric and Neonatal Care (BEmONC) service availability and readiness in Health Facilities (HFs) of Nepal. METHODS: We analyzed data from nationally representative Nepal Health Facility Survey (NHFS), 2021. BEmONC service availability and readiness in HFs was measured based on the "Service Availability and Readiness" manual of World Health Organization (WHO). We measured service availability by seven BEmONC signal functions. The readiness score was calculated for three domains- guidelines and staff training, essential equipment/supplies, and essential medicines on a scale of 100, and the average score for the three domains was the overall readiness score. We performed weighted descriptive and inferential analysis to account complex survey design of NHFS 2021. We summarized continuous variables with descriptive statistics like mean, standard deviation, median and interquartile range whereas categorical variables with percent and 95% confidence interval (CI). We applied simple, and multivariate linear regression to determine factors associated with the readiness of HFs for BEmONC services, and results were presented as beta (ß) coefficients and 95% CI. RESULTS: Of total 804 HFs offering normal vaginal delivery services, 3.1%, 89.2%, 7.7% were federal/provincial hospitals, local HFs, and private hospitals respectively. A total of 45.0% (95% CI: 34.9, 55.6) federal/provincial hospitals, 0.3% (95% CI: 0.2, 0.6), local HFs (district hospital, primary health care centers, health posts, urban health centers) and 10.5% (95% CI: 6.6, 16.4) private hospitals, had all seven BEmONC signal functions. The overall readiness of federal/provincial hospitals, local HFs, and private hospitals were 72.9±13.6, 54.2±12.8, 53.1±15.1 respectively. In multivariate linear regression, local HFs (ß = -12.64, 95% CI: -18.31, -6.96) and private hospitals had lower readiness score (ß = -18.08, 95% CI: -24.08, -12.08) compared to federal/provincial level hospitals. HFs in rural settings (ß = 2.60, 95% CI: 0.62, 4.58), mountain belts (ß = 4.18, 95% CI: 1.65, 6.71), and HFs with external supervision (ß = 2.99, 95% CI:1.08, 4.89), and quality assurance activities (ß = 3.59, 95% CI:1.64, 5.54) had better readiness scores. CONCLUSION: The availability of all seven BEmONC signal functions and readiness of HFs for BEmONC services are relatively low in local HFs and private hospitals. Accelerating capacity development through training centers at the federal/provincial level, onsite coaching, and mentoring, improving procurement and supply of medicines through federal/provincial logistic management centers, and regular supportive supervision could improve the BEmONC service availability and readiness in facilities across the country.

Improving the technical efficiency of public health centers in Cambodia: a two-stage data envelopment analysis.

BACKGROUND: Cambodia is undergoing a series of reforms with the objective of reaching universal health coverage. Information on the causes of inefficiencies in health facilities could pave the way for a better utilization of limited resources available to ensure the best possible health care for the population. OBJECTIVES: The purpose of this study is to evaluate the technical efficiency of health centers and the determinants for inefficiencies. METHODS: This cross-sectional study used secondary data from a costing study on 43 health centers in six Cambodian provinces (2016-2017). Firstly, the Data Envelopment Analysis method with output-orientation was applied to calculate efficiency scores by selecting multiple input and output variables. Secondly, a tobit regression was performed to analyze potential explanatory variables that could influence the inefficiency of health centers. RESULTS: Study findings showed that 18 (43%) health centers were operating inefficiently with reference to the variable returns to scale efficiency frontier and had a mean pure technical efficiency score of 0.87. Overall, 22 (51%) revealed deficits in producing outputs at an optimal scale size. Distance to the next referral hospital, size and quality performance of the health centers were significantly correlated with health center inefficiencies. CONCLUSION: Differences in efficiency exist among health centers in Cambodia. Inefficient health centers can improve their technical efficiency by increasing the utilization and quality of health services, even if it involves higher costs. Technical efficiency should be continuously monitored to observe changes in health center performance over time.

The moderating role of macronutrient intake in relation to body composition and genotoxicity: A study with gym users.

In a cross-sectional study of gymnasium users (both sexes, ages = 41.9 ± 14.8 years), we examined the moderating role of macronutrient intake in relation to body composition and genotoxicity. A questionnaire was administered to evaluate characteristics of the participants. To assess macronutrient consumption, we used 24-h food recalls on three non-consecutive days. Body composition (body fat percentage and muscle mass) was evaluated with a bioimpedance scale. Genotoxicity was assessed with the buccal micronucleus cytome assay. Multiple linear regression models were applied, adjusting for age; sex; tobacco and alcohol consumption; and (with regard to exercise habits) frequency, training time, intensity, and types. Micronucleus frequency was directly associated with body fat and inversely associated with muscle mass. Our study shows that carbohydrate and fat intakes affect body fat percentage and micronucleus frequency in gymnasium users.

Association of neighborhood physical activity facilities with incident cardiovascular disease.

BACKGROUND: The availability of physical activity (PA) facilities in neighborhoods is hypothesized to influence cardiovascular disease (CVD), but evidence from individual-level long-term cohort studies is limited. We aimed to assess the association between neighborhood exposure to PA facilities and CVD incidence. METHODS: A total of 4658 participants from the Chinese Multi-provincial Cohort Study without CVD at baseline (2007-2008) were followed for the incidence of CVD, coronary heart disease (CHD), and stroke. Availability of PA facilities was defined as both the presence and the density of PA facilities within a 500-m buffer zone around the participants' residential addresses. Time-dependent Cox regression models were performed to estimate the associations between the availability of PA facilities and risks of incident CVD, CHD, and stroke. RESULTS: During a median follow-up of 12.1 years, there were 518 CVD events, 188 CHD events, and 355 stroke events. Analyses with the presence indicator revealed significantly lower risks of CVD (hazard ratio [HR] 0.80, 95% confidence interval ([CI] 0.65-0.99) and stroke (HR 0.76, 95% CI 0.60-0.97) in participants with PA facilities in the 500-m buffer zone compared with participants with no nearby facilities in fully adjusted models. In analyses with the density indicator, exposure to 2 and ≥ 3 PA facilities was associated with 35% (HR 0.65, 95% CI 0.47-0.91) and 28% (HR 0.72, 95% CI 0.56-0.92) lower risks of CVD and 40% (HR 0.60, 95% CI 0.40-0.90) and 38% (HR 0.62, 95% CI 0.46-0.84) lower risks of stroke compared with those without any PA facilities in 500-m buffer, respectively. Effect modifications between presence of PA facilities and a history of hypertension for incident stroke (P = 0.049), and a history of diabetes for incident CVD (P = 0.013) and stroke (P = 0.009) were noted. CONCLUSIONS: Residing in neighborhoods with better availability of PA facilities was associated with a lower risk of incident CVD. Urban planning intervention policies that increase the availability of PA facilities could contribute to CVD prevention.

From Apathy to Structural Competency and the Right to Health: An Institutional Ethnography of a Maternal and Child Wellness Center.

Given the persistence of health inequities in the United States, scholars and health professionals alike have turned to the social determinants of health (SDH) framework to understand the overlapping factors that produce and shape these inequities. However, there is scant empirical literature on how frontline health and social service workers perceive and apply the SDH framework, or related movements such as the right to health, in their daily practice. Our study seeks to bridge this gap by applying constructs from the sociological imagination and structural competency (an emerging paradigm in health professions' education) to understand the perspectives and experiences of social work case managers, community health workers, legal advocates, and mental health counselors at a maternal and child health center in a large US city. This frontline workforce displayed strong sociological imagination, elements of structural competency, and engagement with the principles of the right to health. Workers shared reflections on the SDH framework in ways that signaled promising opportunities for frontline workers to link with the global movement for the right to health. We offer a novel approach to understanding the relationships between frontline worker perspectives on and experiences with the SDH, sociological imagination, structural competency, and the right to health.

Stretching a Penny: Completing a Rapid Needs Assessment for a Nonprofit Community-Based Hospice Wellness Center in Ontario, Canada.

The literature pertaining to community-based hospice wellness centres, especially concerning program evaluation, is sparse. This article describes the development and implementation of a mixed-method, rapid needs assessment for a nonprofit community-based hospice wellness centre in Ontario, Canada. As part of the needs assessment, a survey and focus groups were performed to elicit responses from service users. Individuals registered for services and wellness centre attendees were asked about their needs, opinions, and preferences to help guide future program and service options. Findings and recommendations are presented for programming and service options, and implications for future program evaluation projects are discussed. The methodology of this time and cost-efficient evaluation provides insights that can be utilized by other hospice wellness centres facing similar challenges of time, money, and program evaluation expertise constraints. The findings and recommendations may inform program and service offerings at other Canadian hospice wellness centres.

Face Masks at the Gymnasium: Physiological Responses and Mechanical Performance Are Not Compromised by Wearing Surgical or Filtering Facepiece 2 Masks in Healthy Subjects.

ABSTRACT: Rial-Vázquez, J, Nine, I, Guerrero-Moreno, JM, Rúa-Alonso, M, Fariñas, J, Márquez, G, Giráldez-García, MA, Méndez-Bouza, KY, López-Pillado, H, Coutado-Sánchez, E, Losada-Rodríguez, A, and Iglesias-Soler, E. Face masks at the gym: physiological responses and mechanical performance are not compromised by wearing surgical or filtering facepiece 2 masks in healthy subjects. J Strength Cond Res 37(7): 1404-1410, 2023-This study explored the effects of wearing 2 types of face masks on mechanical performance and physiological responses during high-intensity resistance exercise. Twelve healthy men performed 3 workout protocols in a randomized order: wearing a surgical or filtering facepiece 2 (FFP2) mask or without a mask. Each workout consisted of 3 sets of 10 repetitions of bench press (BP) and parallel squat (SQ) with a 12 repetition maximum load, including 2 minutes of recovery between sets and exercises. Mechanical performance was evaluated through the mean propulsive velocity and the number of repetitions completed during each session. Physiological responses were the oxygen saturation (SpO2), blood lactate concentration, heart rate (HR), and HR variability. Perceived exertion was recorded after each set, and The Beck Anxiety Inventory scale was completed at the end of each workout. The number of repetitions completed and the session mean propulsive velocity {(BP [m·s-1]: surgical: 0.35 ± 0.05; FFP2: 0.36 ± 0.04; nonmask: 0.38 ± 0.06) and (SQ: surgical: 0.43 ± 0.05; FFP2: 0.40 ± 0.07; nonmask: 0.41 ± 0.05)} were similar between conditions (p > 0.05). Heart rate recorded during sessions was similar across conditions: surgical: 119 ± 14, FFP2: 117 ± 13, and nonmask: 118 ± 10 bpm (p = 0.919). Face masks had no effect on SpO2, blood lactate concentration, HR variability, perceived exertion, and anxiety values (p > 0.05). Face masks do not compromise strength performance, physiological parameters, and perceived comfort of young and healthy individuals during a high-intensity resistance training session.