Efficacy of an appearance-based and a health-based sun protection intervention on summer vacationers' behaviours, PRISME cluster randomized crossover trial, France.

OBJECTIVES: Sun-seeking vacationers are particularly vulnerable to melanoma. Appearance-based interventions (ABi) showing skin damage of ultraviolet exposure may be a promising prevention tool to improve skin protection. This study aimed to measure and compare the efficacy of an ABi and a health-based intervention (HBi) on French summer vacationers' behaviours and to identify differences between subpopulations. DESIGN: A cluster randomized crossover trial with three intervention groups (control, ABi, HBi) was conducted in eight campsites on the French Mediterranean coast in summer 2019. METHODS: 1355 vacationers of both sexes and aged 12-55 years were included and followed up after 4 days (T1) and 14 months (T2). Efficacy of interventions was evaluated using multilevel mixed-effect models comparing groups on three outcomes: self-reported sun protection behaviours, sunbathing and skin colour measures. Protection behaviours were analysed according to subpopulations. RESULTS: Compared to controls, the ABi group had a higher protection and sunbathed for fewer hours at T1 and T2. In the HBi group, the skin colour was lighter than controls at T1. When comparing ABi to HBi, ABi participants had lower exposure than HBi at T1 and T2. The protection of people with a 3-years university degree was higher in the HBi group than in others groups while that of people with a secondary school certificate was higher in the ABi group. CONCLUSIONS: Our study provides further evidence of individual sun protection interventions effect in a touristic setting and highlights the relevance of ABi messages to supplement HBi messages, particularly in certain subpopulations with low to intermediate education levels.

Safety Assessment of Glucose-Lowering Drugs and Importance of Structured Education during Ramadan: A Systematic Review and Meta-Analysis.

BACKGROUND: Ramadan is the sacred month of the Islamic Hijri (lunar) calendar, and during this entire month, healthy adult Muslims abstain from eating and drinking from dawn to sunset. Muslims with Type 2 Diabetes Mellitus (T2DM) who choose to fast during Ramadan encounter major risks such as hypoglycemia, hyperglycemia, diabetic ketoacidosis, dehydration, and thrombosis. Although patients with poor glycemic control and on multiple insulin injections are at high risk and exempt from fasting, many still insist on it. Thus, healthcare professionals play a pivotal role in managing diabetes-related complications in patients who fast during Ramadan. However, there is a lack of standard guidelines to be followed in association with structured education and administration of drugs and dosage. Therefore, we performed a systematic review and meta-analysis of the literature to determine the safety and efficacy of different classes of drugs and the importance of structured education during Ramadan. METHODS: In this review, an extensive PubMed search was performed to obtain literature on T2DM patients who fast during the month of Ramadan until the year 2020. Preference was given to fully downloadable articles. The articles were extracted based on the eligibility criteria. The extracted data were analyzed using Review Manager software version 5.3. RESULTS: A total of 32 articles were included for the review and 7 studies for meta-analysis. Majority of the studies demonstrated the importance of structured education either as a group session or as a one-on-one session with the healthcare professionals in preventing diabetes-related risks during Ramadan. As far as glucose-lowering drugs are concerned, DPP-4 inhibitor combined with metformin remains the drug of choice for T2DM patients who fast during Ramadan. The newer class of glucose-lowering agents appear to lower the risk of hypoglycemia in comparison with sulphonylureas, while among sulphonylureas gliclazide is relatively safe. The meta-analysis indicates that DPP-4 inhibitors would significantly reduce the risk of hypoglycemia as compared to sulphonylurea (odds ratio = 0.38, 95% CI: 0.26 to 0.55, p < 0.00001). CONCLUSION: The results of our systematic review show that structured education and counselling by healthcare professionals can be an effective tool in preventing complications associated with fasting during Ramadan in people with T2DM. Additionally, the safest class of oral glucose-lowering drugs preferred during Ramadan fasting in T2DM patients is DPP-4 inhibitors.

Decisions to attend holiday gatherings during COVID-19 and engagement in key prevention strategies: United States, January 2021.

Gatherings where people are eating and drinking can increase the risk of getting and spreading SARS-CoV-2 among people who are not fully vaccinated; prevention strategies like wearing masks and physical distancing continue to be important for some groups. We conducted an online survey to characterise fall/winter 2020-2021 holiday gatherings, decisions to attend and prevention strategies employed during and before gatherings. We determined associations between practicing prevention strategies, demographics and COVID-19 experience. Among 502 respondents, one-third attended in person holiday gatherings; 73% wore masks and 84% practiced physical distancing, but less did so always (29% and 23%, respectively). Younger adults were 44% more likely to attend gatherings than adults ≥35 years. Younger adults (adjusted prevalence ratio (aPR) 1.53, 95% CI 1.19-1.97), persons who did not experience COVID-19 themselves or have relatives/close friends experience severe COVID-19 (aPR 1.56, 95% CI 1.18-2.07), and non-Hispanic White persons (aPR 1.57, 95% CI 1.13-2.18) were more likely to not always wear masks in public during the 2 weeks before gatherings. Public health messaging emphasizing consistent application of COVID-19 prevention strategies is important to slow the spread of COVID-19.

What is the drug of choice of young festivalgoers?

BACKGROUND: Drug and alcohol consumption are commonplace at festivals including those aimed at younger attendees. However, there is little quantitative information about the extent of this consumption. This work investigates drug use at a school-leaver festival and how it compares to non-festival weeks. METHODS: Influent wastewater was collected over three consecutive weeks from a location where a school-leaver festival occurs. Multiple liquid chromatography-mass spectrometry methods were used to analyse the use of illicit drugs, pharmaceuticals with abuse potential, new psychoactive substances (NPS), alcohol and cannabis. A method for human neurotransmitter metabolites was also utilised to show the population change and allow the drugs found to be normalised to a population. RESULTS: A total of 12 compounds were quantifiable: methamphetamine, 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxymethamphetamine (MDMA), alcohol, cannabis, cocaine, morphine, codeine, fentanyl, buprenorphine, oxycodone and nicotine. The NPS methylone was found solely over the festival weekend but at levels below the limit of quantification of the analytical method. The catecholamine metabolites vanillylmandelic acid (VMA) and homovanillic acid (HVA) were found over the entire three weeks, with identical trends - an increase over the festival weekend - indicating a population increase. HVA was used to normalise the drug mass loads to derive a population normalised mass load. Statistical differences using Hedges' g showed large changes in the use of MDMA and MDA over the festival week. Smaller increases were also seen for alcohol and cocaine. CONCLUSIONS: The drugs of choice for the attendees of this school-leaver festival were MDMA and MDA.

Efficacy of a smartphone-based intervention - "Holidaily" - promoting recovery behaviour in workers after a vacation: study protocol for a randomised controlled trial.

BACKGROUND: While work-related rumination increases the risk of acute stressors developing into chronic load reactions and adverse health, mental detachment has been suggested as a way to interrupt this chain. Despite the importance of mentally detaching from work during leisure time, workers seem to struggle to disengage and, instead, experience the constant mental representation of work-related stressors, regardless of their absence. Those who struggle with work-related rumination could benefit from an easy-access intervention that fosters mental detachment by promoting recreational activities. Especially during vacations, workers appear to naturally engage in sufficient recovery activities; however, this beneficial behaviour is not sustained. The smartphone app-based intervention "Holidaily" promotes recovery behaviour and, thus, mental detachment from work with the intension of extending the beneficial effects of workers' vacations into their daily working life. METHODS: This randomised-controlled trial (RCT) evaluates the efficacy of "Holidaily". The Holidaily app is a German stand-alone program for mobile devices with either Android/iOS operating systems. The sample includes workers, who are awaiting to go on vacation and are randomly assigned to either the intervention (IG) or a waitlist-control group (CG). The IG receives two weeks pre-vacation access to Holidaily, while the CG receives access two weeks post-vacation. On a daily basis participants in the IG are provided with three options promoting recreational activities and beneficial recovery experiences. Online questionnaires are distributed to all participants at several timepoints. The primary outcome measure assesses participants' work-related rumination (Irritation Scale). A significant difference two weeks post-vacation is expected, favouring the IG. Secondary outcomes include symptoms of depression, insomnia severity, emotional exhaustion, thinking about work, recovery experiences, vacation specifics, work and personal characteristics. To help explain the intervention's effect, explorative analyses will investigate the mediation properties of the frequency of engaging in recreational activities and the moderation properties of Holidaily users' experiences. DISCUSSION: If successful, workers will maintain their recovery behaviour beyond their vacation into daily working life. Findings could, therefore, provide evidence for low-intensity interventions that could be very valuable from a public-health perspective. App-based interventions have greater reach; hence, more workers might access preventative tools to protect themselves from developing adverse health effects linked to work-related rumination. Further studies will still be needed to investigate whether the vacation phenomenon of "lots of fun quickly gone" can be defied and long-term benefits attained. TRIAL REGISTRATION: German Clinical Trials Registration DRKS00013650 . Registered retrospectively 15.01.2018.

Willingness to pay for whole turkey attributes during Thanksgiving holiday shopping in the United States.

Although whole turkeys served at Thanksgiving are the ubiquitous kickoffs to the US winter holiday season, much remains unknown about shopping behaviors for holiday food items. Given the once-a-year purchase of the whole turkey for most households, collecting data about demand and preferences necessitated the collection of data during the week before Thanksgiving, while turkey shopping was at the forefront of consumers' minds. Despite a self-reported confidence in cooking turkeys, many respondents indicated they thawed frozen meat using improper methods. Ninety-five percent of respondents indicated that they consumed meat; 89% of respondents who consumed meat or had someone in the household who did, indicated they had purchased turkey products. Positive willingness to pay (WTP) was found for all attributes of whole turkeys studied: free range, fed a vegetarian diet, hormone use not permitted, and antibiotic use not permitted. Mean estimated WTP for free range ranged from $0.37/lb for industry verified free range to $0.74/lb for USDA verified free range; although those 2 estimates were not statistically different from each other, they were both statistically different from zero. The statistically significant estimated mean WTP for hormone use not permitted ranged from $0.85/lb for industry verification to $1.35 for USDA verification but were again not statistically different from each other. Mean WTP estimates, which were statistically significant but not different from one another for antibiotic use not permitted, ranged from $0.62/lb for industry certification to $0.72 for retailer certified. Turkeys certified to be fed a vegetarian diet had a mean WTP estimate of $0.39/lb for retailer verification to $0.60/lb for USDA verification; those mean WTP estimates were not statistically different from each other but were each statistically different from zero. Social desirability bias, which can be defined as the relative over-reporting of one's own goodness, was detected with respect to self-reported holiday eating and healthfulness statements. Relationships were found between social desirability bias, gender, and age for holiday eating statements using a seemingly unrelated regression.

Did Iranians respect health measures during Nowruz holidays? A study on Iranians' knowledge, attitude and practice toward COVID-19.

INTRODUCTION: Since December 2019, the COVID-19 outbreak has affected almost every country in the world, including Iran. General awareness and commitment to recommendations made by health officials have important role in control of the outbreak. The aim of the current study was to assess the knowledge, attitude, and practice (KAP) of Iranians concerning COVID-19 after Nowruz (Persian New Year Holiday) in Iran and identifying its determining demographic and socioeconomic factors. METHOD: A cross-sectional study was designed. We translated and culturally adopted Zhong's questionnaire to Persian, which is designed to assess people's knowledge, attitude, and practice toward COVID-19. We used online Google forms to send the questionnaire via social platforms throughout the country. A total of 1015 Iranians participated in the study. RESULTS: The mean knowledge score among our participants was 10.60, with an overall correct response rate of 88.35%. Higher knowledge score was associated with higher education, being a professor, and residing in cities. Lower knowledge score was associated with being unemployed, marital status other than single or married, and living in rural areas. Almost all of our participants had favorable attitudes and practices toward COVID-19. CONCLUSION: Overall, Iranians showed a satisfactory KAP towards COVID-19. We suggest more attention to informing people living in rural areas and unemployed, as they were related to more risky behaviors and had lower knowledge scores regarding COVID-19.

Homosexual not Homogeneous: A Motivation-Based Typology of Gay Leisure Travelers Holidaying in Cape Town, South Africa.

The gay traveler, a segment of the lesbian, gay, bisexual, and transgender (LGBT) travel market, is perceived to be a homogeneous market segment as a result of the assumption that gay men have a unique "homosexual lifestyle." This assumption is problematic as it conceals many other important variables, and it may hinder effective destination marketing. A Web-based electronic survey was completed by 469 gay male travelers, and attribute-based benefit segmentation was carried out by applying a hierarchical cluster analysis using Ward's procedure with Euclidean distances. The typology is based on the push and pull framework; the motivations of travelers were assessed both in terms of their socio-psychological motivations and destination attributes of Cape Town. The typology empirically suggests that gay travelers are not homogeneous, and that sexuality influences the travel behavior of a minority of gay men. Consequently, not all gay travelers or activities by these travelers can be labeled as "gay" tourism.

Do vacations alter the connection between stress and cardiovascular activity? The effects of a planned vacation on the relationship between weekly stress and ambulatory heart rate.

Objective: To examine how the association between psychological stress and ambulatory heart rate varies in the weeks before and after a planned vacation. We hypothesized that the impact of stress on heart rate would weaken in the weeks leading up to the vacation and return to normal levels in the weeks following the vacation.Method: Fifty-four workers eligible for paid vacation time were recruited; stress ratings obtained via weekly surveys and ambulatory heart rate readings obtained via a wrist-worn consumer device were collected before and after the vacation.Results: A statistically significant interaction was observed between weekly stress and the time period leading up to the vacation on ambulatory heart rate (b = -0.51, SE = 0.21, 95% CI = -0.91, -0.10, p = 0.01). A plot of predicted values demonstrated that the relationship between weekly stress and heart rate was stronger when the vacation was further away in the future and imparted less of an effect as the vacation approached.Conclusions: Vacations may have physical health benefits that extend beyond the vacation experience by reducing the association between stress and ambulatory heart rate in the weeks leading up to a planned vacation.

[Good Against Christmas Mood - Cultural Studies' Readings of a Festival]. / Gut gegen Weihnachtsstimmung ­ Kulturwissenschaftliche Lesarten eines Festes.

Christmas is a celebration with a strong social radiance. It is a vehicle for political positions and debates and thus shows itself to be a controversial cosmos of significance. A cosmos with history that is not as old as is often claimed - the origin of the festival as we know it today lies in the 19th century. Since then, Christmas has developed into a global festival in which many different people take part. But Christmas is not only unifying, it is also exclusive and creates cultural differences. The aim of the text is to look at the festival in its historical genesis and to critically illuminate Christmas as an ambivalent social phenomenon.

The gift of less Christmas stress.

Christmas is around the corner, and both work and life pressures may be mounting as a result. Penny Barker offers some advice on how to cope with the additional stresses the festive period can bring.

Be present this festive season.

The temptation may be to spend Christmas thinking about others non-stop. But, argues Penny Barker, it's only right to think of yourself too.

A Community-Based Participatory Approach to Promote Healthy Eating Among Marshallese.

This article describes changes made to the menu served during the 2015 Marshallese May Day celebration in Northwest Arkansas, an annual Marshallese community event. The menu changes were part of a community-based participatory collaborative to improve nutrition and health in the Marshallese community. The 2015 May Day menu significantly reduced the 2014 May Day menu amount of calories, fat, carbohydrates, sodium, and cholesterol of foods offered by incorporating healthier ingredients and reducing portion sizes. Compared to the 2014 May Day menu, the total caloric value of the revised menu was reduced by more than 63%, declining from 1369 calories to 499 calories. The menu change affected an estimated 1,800 Marshallese in attendance for the 2015 May Day celebration. The successful implementation of the menu changes, which resulted in reductions in calories, fat, carbohydrates, sodium, and cholesterol offered to participants demonstrates the effectiveness of community-based participatory approaches in the implementation of policy, systems, and environmental strategies to promote health.

Health Care Use by Muslim Patients During Ramadan.

PURPOSE: Health care utilization during Ramadan has not been examined in the United States. METHODS: A retrospective review of billing and electronic health record data for Muslims (n = 2,919) and non-Muslims (n = 184,803) in primary care practices in Eastern Massachusetts. RESULTS: Muslim patients were younger, less educated, less often commercially insured, more likely to have Medicare, and less likely to be primary English speakers (p < .0001 for all comparisons). In multivariate models, during Ramadan, Muslims, compared with non-Muslims, had a higher rate of primary care visits (incidence rate ratio [IRR], 1.06; 95% confidence interval [CI], 1.01-1.11), emergency department visits (IRR, 1.60; 95% CI, 1.34-1.91), and hospitalizations (IRR, 1.18; 95% CI, 1.03-1.34). CONCLUSIONS: Important demographic differences exist between Muslim and non-Muslim patients. Muslims, compared with non-Muslims, had higher health care utilization during Ramadan.

Factors associated with accelerometer measured movement behaviours among White British and South Asian children aged 6-8 years during school terms and school holidays.

OBJECTIVES: To investigate factors associated with movement behaviours among White British (WB) and South Asian (SA) children aged 6-8 years during school terms and holidays. DESIGN: Cross-sectional. SETTING: Three primary schools from the Bradford area, UK. PARTICIPANTS: One hundred and sixty WB and SA children aged 6-8 years. PRIMARY AND SECONDARY OUTCOMES: Sedentary behaviour (SB), light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) measured by accelerometry during summer, winter and spring and during school terms and school holidays. Data were analysed using multivariate mixed-effects multilevel modelling with robust SEs. Factors of interest were ethnicity, holiday/term, sex, socioeconomic status (SES), weight status, weekend/weekday and season. RESULTS: One hundred and eight children (67.5%) provided 1157 valid days of data. Fifty-nine per cent of children were WB (n=64) and 41% (n=44) were SA. Boys spent more time in MVPA (11 min/day, p=0.013) compared with girls and SA children spent more time in SB (39 min, p=0.017) compared with WB children in adjusted models. Children living in higher SES areas were more sedentary (43 min, p=0.006) than children living in low SES areas. Children were more active during summer (15 min MVPA, p<0.001; 27 LPA, p<0.001) and spring (15 min MVPA, p=0.005; 38 min LPA, p<0.001) and less sedentary (-42 min and -53 min, p<0.001) compared with winter. Less time (8 min, p=0.012) was spent in LPA during school terms compared with school holidays. Children spent more time in MVPA (5 min, p=0.036) during weekend compared with weekdays. Overweight and obese children spent more time in LPA (21 min, p=0.021) than normal-weight children. CONCLUSION: The results of our study suggest that significant child level factors associated with movement behaviours are ethnicity, sex, weight-status and area SES. Significant temporal factors are weekends, school holidays and seasonality. Interventions to support health enhancing movement behaviours may need to be tailored around these factors.

Do the holidays impact weight and self-weighing behaviour among adults engaged in a behavioural weight loss intervention?

We examined the U.S. holiday period impact on weight gain, self-weighing, and treatment success among adults in a weight loss intervention (N=171). Using electronic scales, body weight and self-weighing frequency were compared by time period [i.e., pre-holiday, holiday (November 15-January 1), post-holiday]. Self-weighing was less frequent during holiday period (p<.01), and longer intervention engagement was associated with weight gain (p<.0001) during this time. Enrollment during holiday period was associated with 2.3% 12-month weight loss. Holiday period enrollment might be beneficial for preventing holiday weight gain and facilitating successful intervention outcomes.

Daily Self-Weighing to Prevent Holiday-Associated Weight Gain in Adults.

OBJECTIVE: Holiday weight gain is reported to be 0.4 to 1.5 kg and may contribute to annual weight gain. The objective of this study was to test the efficacy of daily self-weighing (DSW) using visual graphical feedback (GF) to prevent holiday weight gain. METHODS: A total of 111 adults were randomly assigned into a control or DSW + GF group and completed the preholiday visit (v1; before Thanksgiving), the postholiday visit (v2; after New Year's Day), and the follow-up visit (v3; 14 weeks after v2). The participants in the DSW + GF group performed DSW with Wi-Fi scales during the holidays and were told to try not to gain weight above baseline weight. RESULTS: There was no change in weight with DSW + GF, whereas the control group gained weight from v1 to v2 (-0.13 ± 0.27 kg vs. 2.65 ± 0.33 kg, P < 0.001, respectively). In the control group, weight change was similar between individuals with overweight or obesity (OW/OB) versus individuals with normal weight (2.71 ± 0.48 kg vs. 2.62 ± 0.43 kg, not significant, respectively). For DSW + GF, individuals with OW/OB lost weight whereas those with normal weight maintained weight during the holidays (-1.46 ± 0.62 kg vs. 0.33 ± 0.27 kg, P = 0.01, respectively). The control group lost weight during the follow-up (-1.14 ± 0.43 kg, P = 0.01; v2 to v3) but retained 57% of weight gain; therefore, weight gain from v1 to v3 was significant (1.51 ± 0.39 kg, P < 0.001). CONCLUSIONS: DSW + GF was a successful approach to prevent holiday weight gain, with those with OW/OB responding most favorably to DSW + GF.