Transforming stress program on medical students' stress mindset and coping strategies: a quasi-experimental study.

OBJECTIVE: Stress is a significant concern in medical education, and identifying effective ways to deal with stress may help with students' mental health and professional development. This study aimed to examine the effects of the Transforming Stress Program (TSP) amongst first-year medical students on their stress mindset and coping strategies when confronted with stressors. METHODS: We conducted a quasi-experimental study at the University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam. A total of 409 first-year students at the Faculty of Medicine were divided into intervention group (205 students) and control group (204 students). The 10-week TSP was delivered as an extra-curricular course. The training adopts psychoeducation based on Dialectical Behavioral Therapy with mindfulness as a fundamental practice incorporated into each component of the program. The intervention group received the training in the first semester; the control group received identical program in the second semester. Stress Mindset Measurement and Brief Coping Orientation to Problems Experienced were measured before the intervention (T0), immediately after intervention on Intervention group (T1), and six months after intervention on Intervention group (T2). RESULTS: At T1, the intervention group showed 65% improvements in stress mindset scores and increases in coping strategies scores in six domains (Problem solving, Social support, Humor, Religion, Venting, and Self-distraction) and decreases in three (Avoidance, Substance use, and Self-blame). The effect sizes were significant in all outcomes (Cohen's d > 0.2). Measurements of the control group did not change significantly in the same period. At T2, effects of the TSP were found decreased in some domains (Avoidance, Substance use, and Self-blame) compared to T1, but largely remained significantly better than T0. CONCLUSIONS: The TSP is a feasible and effective approach that significantly enhanced medical students' stress mindset and coping strategies. Some effects were still observable 6 months after the intervention. The relatively intensive intervention requires support of the school administration and staff.

Impact of physical and social living environments on pro-environmental intentions.

The living environment might play an important role in shaping the pro-environmental intentions of the people. However, there was limited research on how the living environments influenced the pro-environmental intentions of people. The objectives of this study are to evaluate the direct effects of physical and social environments on pro-environmental intentions as well as the mediating effects of environmental attitudes and life satisfaction. Structural Equation Modeling was used with data extracted from the 2020 Taiwan Social Change Survey database (n = 1671). Results showed direct positive associations of both physical and social environments with pro-environmental intentions (ß = 0.133 and ß = 0.076, respectively) as well as indirect positive associations via the life satisfaction-mediating pathway (ß = 0.031 and ß = 0.044, respectively). The physical environment negatively influenced pro-environmental intentions through the environmental attitude pathway (ß = - 0.255) with unpleasant neighborhood enhancing the pro-environmental intentions of residents. Taken together, the overall effect of the physical environment was negative (ß = - 0.093) while that of the social environment was positive (ß = 0.109). The most important factors for the physical and social environments were disturbance and livability in north, central and south Taiwan, neighborhood pollution and interestingness in east Taiwan. Accordingly, minimizing disturbance and neighborhood pollution of the physical environment could have the highest effect on pro-environmental intentions enhancement in western and eastern Taiwan, respectively. For the social environment, improving livability in the west and interestingness in the east would have an even larger impact on pro-environmental intentions. This study emphasized the importance of neighborhood environment on the environmental intentions of the people. The study also identified the important factors for policymakers to target to achieve the best effect on improving environmental intentions.

Estimating the daily average concentration variations of PCDD/Fs in Taiwan using a novel Geo-AI based ensemble mixed spatial model.

It is generally established that PCDD/Fs is harmful to human health and therefore extensive field research is necessary. This study is the first to use a novel geospatial-artificial intelligence (Geo-AI) based ensemble mixed spatial model (EMSM) that integrates multiple machine learning algorithms and geographic predictor variables selected using SHapley Additive exPlanations (SHAP) values to predict spatial-temporal fluctuations in PCDD/Fs concentrations across the entire island of Taiwan. Daily PCDD/F I-TEQ levels from 2006 to 2016 were used for model construction, while external data was used for validating model dependability. We utilized Geo-AI, incorporating kriging, five machine learning, and ensemble methods (combinations of the aforementioned five models) to develop EMSMs. The EMSMs were used to estimate long-term spatiotemporal variations in PCDD/F I-TEQ levels, considering in-situ measurements, meteorological factors, geospatial predictors, social and seasonal influences over a 10-year period. The findings demonstrated that the EMSM was superior to all other models, with an increase in explanatory power reaching 87 %. The results of spatial-temporal resolution show that the temporal fluctuation of PCDD/F concentrations can be a result of weather circumstances, while geographical variance can be the result of urbanization and industrialization. These results provide accurate estimates that support pollution control measures and epidemiological studies.

Characteristics and health impacts of PM2.5-bound PCDD/Fs in three Asian countries.

Polychlorinated dibenzo-p-dioxins/dibenzofurans (PCDD/Fs) were ubiquitous, persistent chemical compounds attached to particulate matter in the atmosphere. We aimed to study the characteristics of these pollutants in atmospheric PM2.5 of three Asian countries, including Taiwan (Taipei), Thailand (Chiang Mai), and Vietnam (Hanoi). We carried out a source apportionment analysis to determine significant PCDD/F contributors in these areas. Multiple media model was conducted to access the health impact assessment. The PM2.5 concentration in Taipei (n = 7), Chiang Mai (n = 20), and Hanoi (n = 10) were 18.4 ± 6.21 µg/m3, 133 ± 49.5 µg/m3, and 88.1 ± 12.6 µg/m3, respectively. The PCDD/Fs level in Hanoi was 92.4 ± 67.3 fg I-TEQ/m3, and in Taipei and Chiang Mai was 5.01 ± 2.39 fg I-TEQ/m3 and 14.4 ± 13.1 fg I-TEQ/m3, respectively, which showed that the higher PM2.5 concentration was not necessary to follow with higher PCDD/Fs level. In all three cities, the effect of traffic on ambient PCDD/F level was significant (23-25 %). However, we also observed the specific sources of PCDD/Fs in each city during the sampling periods, namely long-range transport (Taipei, 55 %), Biomass/open burning (Chiang Mai, 77 %), and industrial activities (Hanoi, 34 %). In the carcinogenic risk estimation, the highest median total carcinogenic risk was in Hanoi (5.87 × 10-6), followed by Chiang Mai (1.06x10-6), and Taipei (2.95 × 10-7). Although diet was the major absorption pathway, the food contributor of exposure differed among the three areas due to the difference in food consumption composition.

Characteristics of PCDD/Fs in PM2.5 from emission stacks and the nearby ambient air in Taiwan.

This study aimed to find the characteristics of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) in fine particulate matter from different stationary emission sources (coal-fired boiler, CFB; municipal waste incinerator, MWI; electric arc furnace, EAF) in Taiwan and the relationship between PM2.5 and PM2.5-bound PCDD/Fs with Taiwanese mortality risk. PM2.5 was quantified using gravimetry and corresponding chemical analyses were done for PM2.5-bound chemicals. Mortality risks of PM2.5 exposure and PCDD/Fs exposure were calculated using Poisson regression. The highest concentration of PM2.5 (0.53 ± 0.39 mg/Nm3) and PCDD/Fs (0.206 ± 0.107 ng I-TEQ/Nm3) was found in CFB and EAF, respectively. Higher proportions of PCDDs over PCDFs were observed in the flue gases of CFB and MWI whereas it was reversed in EAF. For ambient air, PCDD/F congeners around the stationary sources were dominated by PCDFs in vapor phase. Positive matrix factorization (PMF) analysis found that the sources of atmosphere PCDD/Fs were 14.6% from EAF (r = 0.81), 52.6% from CFB (r = 0.74), 18.0% from traffic (r = 0.85) and 14.8% from MWI (r = 0.76). For the dioxin congener distribution, PCDDs were dominant in flue gases of CFB and MWI, PCDFs were dominant in EAF. It may be attributed to the different formation mechanisms among wastes incineration, steel-making, and coal-burning processes.

Corrigendum to "Cytotoxicity Assessment of PM2.5 Collected from Specific Anthropogenic Activities in Taiwan".

In the Section 2 [...].

Continuous nationwide atmospheric PCDD/F monitoring network in Taiwan (2006-2016): Variation in concentrations and apportionment of emission sources.

Atmospheric polychlorinated-dibenzo-dioxins/dibenzo-furans (PCDD/Fs) remains an important environmental health concern. Although the total emission inventories of PCDD/Fs in Taiwan decreased from 320 to 52.1 g-I-TEQ/year during 2002-2016, the resulting concentrations of atmospheric PCDD/F and distributions in Taiwan are unknown. We, therefore, conducted a comprehensive investigation of spatial and seasonal variations and apportioned potential sources of ambient PCDD/F concentrations in Taiwan-based on 11-year observation data. A total of 1,008 atmospheric PCDD/F samples were collected from 25 air monitoring stations (from seven areas) and 1 background station for 2006-2016. Linear regression was used to model changes in PCDD/F concentrations. Principal component analysis (PCA) and positive matrix factorization (PMF) were used to identify potential contributors. PCDD/F concentrations in the ambient air gradually decreased during the study period, with a median concentration of 28.2 fg I-TEQ/m3 over 11 years. The highest median PCDD/F concentrations were found in the highly industrialized regions of western Taiwan (38.0-43.4 fg I-TEQ/m3). Lower concentrations were found in eastern Taiwan (∼10 fg I-TEQ/m3). Background stations reported the lowest concentrations of PCDD/Fs, with a median concentration of 1.47 fg I-TEQ/m3. Overall, the concentrations of atmospheric PCDD/Fs in Taiwan were higher in winter (13.4-86.7 fg I-TEQ/m3) than in summer (9.65-27.2 fg I-TEQ/m3). The PCA results indicated that PCDD/F profiles varied by both region (industrialized, urbanized, and background areas) and season. The PMF model for the overall data revealed that the major sources of PCDD/Fs were industrial activities (71.2%). However, in less industrialized areas, traffic activities, long-range transport, and open burning were dominant.

Cytotoxicity Assessment of PM2.5 Collected from Specific Anthropogenic Activities in Taiwan.

Fine particulate matter (PM2.5) from different sources with different components have different health impact. In this research in Taiwan, composition and cytotoxicity of PM2.5 from long-range transport event (LRT), traffic activity, and outdoor cooking at night market were studied. The PM2.5 mass concentrations were 39.0 µg/m3 during LRT, 42.9 µg/m3 at traffic area, and 28.3 µg/m3 at the night market. Traffic area had highest concentrations of PCDD/Fs (46.9 fg I-TEQ/m3) when highest PAH concentrations of 3.57 BaPeq-ng/m3 were found at night market area. One quarter of PM2.5 mass at LRT and night market was constituted by water-soluble ion (26.02-28.93%). Road dust (represented by high concentration of Al and Ca) was the main contributor for metal element at traffic station whereas presence of natural salt (Na and Cl elements) was a marker of LRT and cooking activities. Cell viability reduced 9% after exposure to organic extracts of 0.316 µg of PM2.5 from LRT and night market samples. 150% elevation of ROS production was observed after exposure with organic compound of night market samples at the dose equivalent to 10.0 µg PM2.5. Organic extracts from night market induced positive genotoxicity in umu test (at a dose of 20.0 µg PM2.5).

Sources identification of PCDD/Fs in soil and atmospheric deposition in Taiwan.

PCDD/Fs are among pollutants, which gain major concern from Taiwan government and citizens during industrialization. PCDD/Fs can be emitted into the atmosphere, soil, and water environment in either vapor or solid forms. Atmospheric deposition is the main pathways for atmospheric PCDD/Fs to precipitate on surface soil. In this study, a simultaneous analysis of both soil and deposition PCDD/Fs was done to investigate the relationship between in-soil and deposited PCDD/Fs in Taiwan. Soil samples (n = 84) and atmospheric deposition samples (n = 57) were collected within overlapped periods of time. Geometric mean of 10.4 pg WHO-TEQ/g was found in the soil samples when the geometric mean of atmospheric deposited PCDD/F concentrations was found to be 7.39 pg WHO-TEQ/m2/day. Concentration of PCDD/Fs in samples collected in industrial location were higher than those collected in other locations in all sampling areas. OCDD, OCDF, HpCDD, HpCDF, were the predominant congeners in PCDD/F profile in both soil and atmospheric deposited samples, when 1,2,3,7,8-PeCDD and 2,3,4,7,8-PeCDF were major contributors for PCDD/F fingerprint with WHO-TEQ transformation. Positive Matrix Factorization (PMF) analysis showed that 83% of soil PCDD/Fs correlate with atmospheric deposition process originated from industrial activities (44%) and long range transport activities (39%). Furthermore, the PMF analysis found long range transport, municipal solid water incinerators (MSWIs), industrial waste incinerators (IWIs), electric arc furnace, recycling process of aluminum, sintering plants to be the main sources contributing to atmospheric deposited PCDD/Fs.

Atmospheric PCDD/F concentration and source apportionment in typical rural, Agent Orange hotspots, and industrial areas in Vietnam.

Vietnam has a double burden of dioxin from both industrial sources and historical sources. To evaluate the concentration of PCDD/Fs in ambient air in different areas of Vietnam and their possible sources, atmospheric samples were collected from three areas namely Son La (rural area) and Da Nang (harbor - Agent Orange hotspot area), and Ho Chi Minh City (metropolitan - industrial city). Vapor and solid phases of PCDD/Fs were collected and analyzed following the TO-9A sampling method. Principal Component Analysis and Positive Matrix Factorization model were applied to characterize the possible source. The average concentrations of PCDD/Fs were found to be 21.3 ± 13 fg I-TEQ/m3 in Son La (n = 32), 65.2 ± 34 fg I-TEQ/m3 in Da Nang (n = 16) and 139 ± 84 fg I-TEQ/m3 in Ho Chi Minh City (n = 8). The findings of this study targeted open burning (42%) and biomass burning (51%) as the major emission sources of PCDD/Fs in ambient air of Son La, Vietnam. Major possible sources of PCDD/Fs in Da Nang could be transportation activities (64%), however, the other factor (36%) was suspected to be contaminated with 2,3,7,8-TeCDD from Agent Orange. Most of PCDD/Fs emitted in Ho Chi Minh City related to industrial activities (93%).