Socio-environmental externalities of sewage waste management.

Conventional sewage management is expensive and inefficient, putting the environment and public health at risk, making access to sewage services difficult for everyone. Reusing sewage waste has agricultural and economic potential, but can contain harmful contaminants if not treated properly. This review is based on the hypothesis that the destination of sewage waste generates environmental and social externalities, which have not yet been widely compared. With the aim of identifying, from the literature, the socio-environmental externalities generated by different sewage waste management approaches, a systematic review of the literature was carried out, including 244 documents, with 50 % of these discussing impacts of conventional treatment and 37 % analyzing the reuse of waste. The main impacts and externalities were evaluated in three situations: untreated sewage, treated sewage, and reused waste. The results indicate that sewage waste has an underutilized economic value and can generate revenue, reduce operational costs and electricity expenses. Six negative externalities generated by conventional sewage treatment were identified: health costs; environmental cleaning; carbon offsetting; damage to tourism; damage to fishing and agriculture; and real estate depreciation. In reuse, there is a risk of two negative externalities: health costs and environmental cleaning, but two positive externalities were also identified: the reduction of phosphate rock mining and the neutralization of carbon credits. The complexity of the transition to sustainable sewage treatment practices is highlighted given the lack of consensus on the safe use of sewage waste, the lack of regulatory standardization, implementation costs and differences in regional parameters, highlighting the need for preliminary experimentation in a multidisciplinary and contextualized approach, considering comparative externalities among the available sewage waste management possibilities.

The effects of prenatal exposure to opioids on early childhood development: context matters most.

INTRODUCTION: The opioid crisis has brought an increasing focus on the long-term outcomes of children following prenatal opioid exposure. Evidence to date has been conflicting, which has caused confusion and concern amongst parents, caregivers, social service providers, medical providers and policy makers. METHODS: This review systematically evaluated the highest quality studies relating prenatal exposure to opioids with early childhood developmental outcomes. It focused on developmental outcomes as measured by the Bayley Scales of Infant and Toddler Development, encompassing cognitive, motor, and psychosocial domains of child development. RESULTS: Although several articles reported correlations between prenatal opioid exposure and poor early childhood developmental outcomes, these relationships were no longer statistically significant after adjusting for socio-environmental factors. CONCLUSION: Additional research is needed to determine the extent of any relationship of socio-environmental factors with early childhood development in children prenatally exposed to opioids. This review suggests that socio-environmental factors may be significantly related to poor early childhood outcomes in the presence of prenatal opioid exposure.

Molecular evolutionary characteristics of severe acute respiratory syndrome coronavirus 2 and the relatedness of epidemiological and socio-environmental factors.

After the first outbreak, SARS-CoV-2 infection continues to occur due to the emergence of new variants. There is limited information available on the comparative evaluation of evolutionary characteristics of SARS-CoV-2 among different countries over time, and its relatedness to epidemiological and socio-environmental factors within those countries. We assessed comparative Bayesian evolutionary characteristics for SARS-CoV-2 in eight countries from 2020 to 2022 using BEAST version 2.6.7. Additionally, the relatedness between virus evolution factors and both epidemiological and socio-environmental factors was analyzed using Pearson's correlation coefficient. The estimated substitution rates in the gene encoding S protein of SARS-CoV-2 exhibited a continuous increase from 2020 to 2022 and were divided into two distinct groups in 2022 (p value < 0.05). Effective population size (Ne) generally showed decreased patterns by time. Notably, the change rates of the substitution rates were negatively correlated with the cumulative vaccination rates in 2021. A strict and rapid vaccination policy in the United Arab Emirates dramatically reduced the evolution of the virus, compared to other countries. Also, the average yearly temperature in countries were negatively correlated with the substitution rates. The changes of six epitopes in SARS-CoV-2 were related to various socio-environmental factors. We figured out comparative virus evolutionary traits and the association of epidemiological and socio-environmental factors especially cumulative vaccination rates and average temperature.

Neuropsychological Profile of 25 Brazilian Patients with 22q11.2 Deletion Syndrome: Effects of Clinical and Socioeconomic Variables.

The 22q11.2 deletion syndrome (22q11.2DS) is associated with a heterogeneous neurocognitive phenotype, which includes psychiatric disorders. However, few studies have investigated the influence of socioeconomic variables on intellectual variability. The aim of this study was to investigate the cognitive profile of 25 patients, aged 7 to 32 years, with a typical ≈3 Mb 22q11.2 deletion, considering intellectual, adaptive, and neuropsychological functioning. Univariate linear regression analysis explored the influence of socioeconomic variables on intellectual quotient (IQ) and global adaptive behavior. Associations with relevant clinical conditions such as seizures, recurrent infections, and heart diseases were also considered. Results showed IQ scores ranging from 42 to 104. Communication, executive functions, attention, and visuoconstructive skills were the most impaired in the sample. The study found effects of access to quality education, family socioeconomic status (SES), and caregiver education level on IQ. Conversely, age at diagnosis and language delay were associated with outcomes in adaptive behavior. This characterization may be useful for better understanding the influence of social-environmental factors on the development of patients with 22q11.2 deletion syndrome, as well as for intervention processes aimed at improving their quality of life.

Socio-environmental predictors of diabetes incidence disparities in Tanzania mainland: a comparison of regression models for count data.

BACKGROUND: Diabetes is one of the top four non-communicable diseases that cause death and illness to many people around the world. This study aims to use an efficient count data model to estimate socio-environmental factors associated with diabetes incidences in Tanzania mainland, addressing lack of evidence on the efficient count data model for estimating factors associated with disease incidences disparities. METHODS: This study analyzed diabetes counts in 184 Tanzania mainland councils collected in 2020. The study applied generalized Poisson, negative binomial, and Poisson count data models and evaluated their adequacy using information criteria and Pearson chi-square values. RESULTS: The data were over-dispersed, as evidenced by the mean and variance values and the positively skewed histograms. The results revealed uneven distribution of diabetes incidence across geographical locations, with northern and urban councils having more cases. Factors like population, GDP, and hospital numbers were associated with diabetes counts. The GP model performed better than NB and Poisson models. CONCLUSION: The occurrence of diabetes can be attributed to geographical locations. To address this public health issue, environmental interventions can be implemented. Additionally, the generalized Poisson model is an effective tool for analyzing health information system count data across different population subgroups.

The influence of early life socio-environmental factors on executive performance in a healthy adult sample.

OBJECTIVE: Attempts have been made (with research efforts encouraged) to deconstruct the "race" concept into language, cultural, and life experience variables that can help explain performance differences found between ethnic groups (Romero et al., 2009). The extant empirical literature reveals that early environmental factors and life experiences (e.g., socioeconomic status) are related to cognitive test performance in adulthood (Byrd et al., 2006). This study examined the explanatory value of early life childhood resources in the relationship between ethnicity and neuropsychological test performance in adulthood. PARTICIPANTS/ METHODS: Neurologically and psychologically healthy African American (n = 40), Caucasian (n = 14), and Hispanic (n = 107) college students ranging from 19-38 years of age. On average, participants had completed around 13 years of education, indicating that the majority were in the early stages of their undergraduate studies and mostly consisted of females (72%). Each participant completed a comprehensive neuropsychological battery that included tests of executive function and an extensive background questionnaire. RESULTS: A one-way analysis of variance (ANOVA) revealed that the CA group was significantly older (F (2, 160) = 18.38, p = .045) compared to the AA and H groups, but the groups did not differ in terms of number of years of educations or gender. Also, an ANOVA revealed significant group test performance differences on the Stroop-C [F (2, 160) = 1.53, p = .047], but not on the TMT-B and COWAT. Furthermore, a Tukey post hoc revealed that there were no significant differences in test performance on Stroop-C between the groups. Hierarchical multiple regression analyses revealed that group performance differences on executive function tests were medium or non-existent and only partially explained by years of education and early life financial resources. CONCLUSION: The results are discussed in light of the existing literature, study strengths and limitations, as well as directions for future research. This research can aid in pinpointing variables crucial for interpreting differences in neuropsychological assessments among diverse populations, holding potential implications for intervention research and policy settings. It is particularly relevant in the context of the continuously evolving social, political, and economic landscapes of societies.

Research alignment in the U.S. national park system: Impact of transformative science policy on the supply and demand for scientific knowledge for protected area management.

The US National Park System encompasses diverse environmental and tourism management regimes, together governed by the 1916 Organic Act and its dual mandate of conservation and provision of public enjoyment. However, with the introduction of transformative science policy in the 2000's, the mission scope has since expanded to promote overarching science-based objectives. Yet despite this paradigm shift instituting "science for parks, parks for science", there is scant research exploring the impact of the National Park Science Policy on the provision of knowledge. We address this gap by developing a spatiotemporal framework for evaluating research alignment, here operationalized via quantifiable measures of supply and demand for scientific knowledge. Specifically, we apply a machine learning algorithm (Latent Dirichlet analysis) to a comprehensive park-specific text corpus (combining official needs statements -i.e. demand- and scientific research metadata -i.e. supply-) to define a joint topic space, which thereby facilitates quantifying the direction and degree of alignment at multiple levels. Results indicate an overall robust degree of research alignment, with misaligned topics tending to be over-researched (as opposed to over-demanded), which may be favorable to many parks, but is inefficient from the park system perspective. Results further indicate that the transformative science policy exacerbated the misalignment in mandated research domains. In light of these results, we argue for improved decision support mechanisms to achieve more timely alignment of research efforts towards distinctive park needs, thereby fostering convergent knowledge co-production and leveraging the full value of National Parks as living laboratories.

Analyzing socio-environmental determinants of bone and soft tissue cancer in Indonesia.

BACKGROUND: This study is designed to explore the potential impact of individual and environmental residential factors as risk determinants for bone and soft tissue cancers, with a particular focus on the Indonesian context. While it is widely recognized that our living environment can significantly influence cancer development, there has been a notable scarcity of research into how specific living environment characteristics relate to the risk of bone and soft tissue cancers. METHODS: In a cross-sectional study, we analyzed the medical records of oncology patients treated at Prof. Suharso National Referral Orthopedic Hospital. The study aimed to assess tumor malignancy levels and explore the relationships with socio-environmental variables, including gender, distance from the sea, sunrise time, altitude, and population density. Data were gathered in 2020 from diverse sources, including medical records, Google Earth, and local statistical centers. The statistical analyses employed Chi-square and logistic regression techniques with the support of Predictive Analytics SoftWare (PASW) Statistics 18. RESULTS: Both bivariate and multivariate analyses revealed two significant factors associated with the occurrence of bone and soft tissue cancer. Age exhibited a statistically significant influence (OR of 5.345 and a p-value of 0.000 < 0.05), indicating a robust connection between cancer development and age. Additionally, residing within a distance of less than 14 km from the sea significantly affected the likelihood of bone and soft tissue cancers OR 5.604 and p-value (0.001 < 0.05). CONCLUSIONS: The study underscores the strong association between age and the development of these cancers, emphasizing the need for heightened vigilance and screening measures in older populations. Moreover, proximity to the sea emerges as another noteworthy factor influencing cancer risk, suggesting potential environmental factors at play. These results highlight the multifaceted nature of cancer causation and underscore the importance of considering socio-environmental variables when assessing cancer risk factors. Such insights can inform more targeted prevention and early detection strategies, ultimately contributing to improved cancer management and patient outcomes.

The Roles of Socio-Environmental Factors Influencing the Transmission, Prevention, and Control of COVID-19 and Tuberculosis Disease: A Review

Introduction@#Over the past two years, coronavirus disease 2019 (COVID-19) and tuberculosis (TB) have killed over 5.7 million people globally. TB and COVID-19 continue to be significant public health problems worldwide. A growing body of research supports a link between socio-environmental factors and the transmission of COVID-19 and TB disease. @*Methods@#This review article discussed the socio-environmental factors influencing the transmission, prevention, and control of COVID-19 and Tuberculosis disease. @*Result@#In this review, we highlight similarities and differences between these two infectious diseases and explore the roles of socio-environmental factors (air pollution exposure and climate change) and socioeconomic factors in disease transmission. A comprehensive, integrated TB-COVID-19 management for prevention and disease control, which includes administrative, engineering, environmental control, effective personal protective equipment, and community-based public health activities were discussed.@*Conclusion@#Understanding the similarities and differences between these two infectious diseases and the role of socio-environmental factors in disease transmission helps in planning and strengthening an integrated system for disease prevention and control strategies.

Corpos-territórios e interseccionalidades: contribuições para uma vigilância popular em saúde / Bodies-territories and intersectionalities: contributions to public health surveillance

Resumo Corpos e territórios múltiplos vivenciam de diferentes formas impactos, conflitos e injustiças socioambientais. As consequências do padrão de acumulação neoextrativista recai de modo diferenciado sobre as mulheres, em especial não brancas. Esse texto traz narrativas de mulheres plurais, que vivem em diferentes territórios e que experienciam distintos impactos de grandes empreendimentos. Por meio de suas narrativas, buscamos compreender como constituem seus corpos-territórios, como são impactados e como resistem a dominação colonialista, defendem a vida e restituem a saúde. Os impactos analisados atingem os meios e modos de vida das mulheres, cerceiam suas formas de ser, poder e saber nesses territórios, tornam-nas vulnerabilizadas, sujeitas à precarização dos meios e modos de vida, imersas em intoxicações sistêmicas, chegando a situações classificadas como genocídios. Frente a tais ameaças, elas agenciam a resistência coletiva, acionam o que lhes torna subjetividade ativa, descolonizam-se como ser, saber e poder. Assim defendem a vida e restituem a saúde de si mesmas e de seus ambientes. Essas experiências apontam caminhos para o fortalecimento de perspectivas e redes de vigilância popular em saúde.

Abstract Multiple bodies and territories experience impacts, conflicts, and socioenvironmental injustices in different ways. The consequences of the neoextractivist accumulation patterns weigh differently on women, especially non-white women. This text brings narratives of a wide range of women who live in different territories and experience different impacts from major undertakings. Through their narratives, we seek to understand how they constitute their territorial bodies; how they are impacted; and how they resist colonialist domination, defend life, and restore health. These impacts affect women's means and ways of life, and restrict their ways of being, power, and knowledge in these territories, rendering them vulnerable, subject to the precariousness of life, immersed in systemic intoxication, reaching situations classified as genocide. Faced with such threats, they manage collective resistance; trigger what makes them active subjectivity; and decolonize themselves as beings, knowledge, and power. In this way they defend life and restore their health and that of their environments. These experiences indicate ways to strengthen public health surveillance perspectives and networks.

Agricultural practices and intestinal parasites: A study of socio-environmental risk factors associated with leafy vegetable production in La Plata horticultural area, Argentina.

Foodborne diseases now represent one of the most important public health problems. The objectives were to analyze the leafy vegetables and crop soil to detect parasitic species and evaluate the factors that increase the risk of parasitic contamination in the productive units in La Plata horticultural area. The study included 261 leafy vegetable and 87 crop soil samples that were processed using washing, sedimentation, and flotation techniques. Socio-environmental characteristics and agricultural practices were surveyed, and a generalized linear model was used to assess the change in parasitic prevalence with different predictor variable. The 58.6% of leafy vegetable and 31.0% of crop soil samples contained parasitic species, the most prevalent being Blastocystis sp. and oocysts of Cryptosporidium spp. Risk factors were the limited access to health, dirt roads, children and dogs circulating in crops, field cultivation, furrow irrigation and lettuce cultivation. The high prevalence of intestinal parasites in the vegetable crops was mainly associated with the conditions of structural precariousness in the production units. These results elaborated with the participation of the population, provide valuable knowledge for the planning of epidemiological programs that include environmental health as a fundamental nexus in health campaigns.

Factores socioambientales que facilitaron la propagación del dengue en Cauto Cristo, Granma

Introducción: Los arbovirus transmitidos por mosquitos y principalmente por los del género Aedes constituyen, actualmente, un reto a nivel mundial. Objetivo: Identificar los factores socioambientales que facilitaron la propagación del dengue en el municipio Cauto Cristo, durante el año 2022. Métodos: Se realizó un estudio descriptivo, retrospectivo y transversal sobre las características clínicas y epidemiológicas de los 337 pacientes diagnosticados con dengue en el municipio Cauto Cristo, provincia Granma, en el año 2022. En el análisis, se tuvieron en cuenta las variables: sexo, consejo popular, mes del año, índice de infestación y factores de riesgo. Resultados: El consejo popular con más casos de dengue fue Cauto Cristo Este (42,14 %), con una afectación del sexo femenino del 68,30 %; el mayor pico de la enfermedad se produjo período de julio a octubre, en el que hubo 78,93 % de los casos confirmados en el año. Se detectaron 286 focos positivos durante todo el período de estudio, con alto índice de infestación. El no uso de repelente (95,54 %), seguido de la presencia de criaderos en centros de trabajo (71,51 %) fueron los principales factores de riesgo. Conclusiones: Todos los consejos populares reportaron casos de dengue, principalmente el consejo popular Cauto Cristo Este, con varios focos detectados y alto índice de infestación. Entre los principales factores de riesgo, se identificaron el no uso de repelente, la presencia de criaderos en centros de trabajo y en la vivienda o sus alrededores. El mayor pico de la enfermedad ocurrió entre julio y octubre de 2022.

Introduction: Arboviruses transmitted by mosquitoes, mainly by those of the Aedes genus, currently constitute a global challenge. Objective: To identify the socio-environmental factors that facilitated the spread of dengue in Cauto Cristo municipality during 2022. Methods: A descriptive, retrospective and cross-sectional study was carried out on the clinical and epidemiological characteristics of the 337 patients diagnosed with dengue in Cauto Cristo municipality, Granma province, in 2022. In the analysis, the variables taken into account were sex, people's council, month of the year, infestation rate and risk factors. Results: The people's council with the most cases of dengue was Cauto Cristo Este (42.14%), with 68.30% of the female sex affected; the highest peak of the disease occurred in the period from July to October, in which there were 78.93% of confirmed cases in the year. Two hundred eighty-six positive outbreaks were detected throughout the study period, with high infestation rate. The main risk factors were non-use of repellent (95.54%), followed by the presence of breeding sites in workplaces (71.51%). Conclusions: All popular councils reported cases of dengue, mainly in Cauto Cristo people´s council, with several outbreaks detected and high infestation rate. Among the main risk factors were the non-use of repellent, the presence of breeding sites in workplaces and in or around the home. The largest peak of the disease occurred between July and October 2022.

Effects of gender and socio-environmental factors on health-care access in oncology: a comprehensive, nationwide study in France.

Background: Gender-based disparities in health-care are common and can affect access to care. We aimed to investigate the impact of gender and socio-environmental indicators on health-care access in oncology in France. Methods: Using the national health insurance system database in France, we identified patients (aged ≥18 years) who were diagnosed with solid invasive cancers between the 1st of January 2018 and the 31st of December 2019. We ensured that only incident cases were identified by excluding patients with an existing cancer diagnosis in 2016 and 2017; skin cancers other than melanoma were also excluded. We extracted 71 socio-environmental variables related to patients' living environment and divided these into eight categories: inaccessibility to public transport, economic deprivation, unemployment, gender-related wage disparities, social isolation, educational barriers, familial hardship, and insecurity. We employed a mixed linear regression model to assess the influence of age, comorbidities, and all eight socio-environmental indices on health-care access, while evaluating the interaction with gender. Health-care access was measured using absolute and relative cancer care expertise indexes. Findings: In total, 594,372 patients were included: 290,658 (49%) women and 303,714 (51%) men. With the exception of unemployment, all socio-environmental indices, age, and comorbidities were inversely correlated with health-care access. However, notable interactions with gender were observed, with a stronger association between socio-environmental factors and health-care access in women than in men. In particular, inaccessibility to public transport (coefficient for absolute cancer care expertise index = -1.10 [-1.22, -0.99], p < 0.0001), familial hardship (-0.64 [-0.72, -0.55], p < 0.0001), social isolation (-0.38 [-0.46, -0.30], p < 0.0001), insecurity (-0.29 [-0.37, -0.21], p < 0.0001), and economic deprivation (-0.13 [-0.19, -0.07], p < 0.0001) had a strong negative impact on health-care access in women. Interpretation: Access to cancer care is determined by a complex interplay of gender and various socio-environmental factors. While gender is a significant component, it operates within the context of multiple socio-environmental influences. Future work should focus on developing targeted interventions to address these multifaceted barriers and promote equitable health-care access for both genders. Funding: None.

Unraveling complex causal processes that affect sustainability requires more integration between empirical and modeling approaches.

Scientists seek to understand the causal processes that generate sustainability problems and determine effective solutions. Yet, causal inquiry in nature-society systems is hampered by conceptual and methodological challenges that arise from nature-society interdependencies and the complex dynamics they create. Here, we demonstrate how sustainability scientists can address these challenges and make more robust causal claims through better integration between empirical analyses and process- or agent-based modeling. To illustrate how these different epistemological traditions can be integrated, we present four studies of air pollution regulation, natural resource management, and the spread of COVID-19. The studies show how integration can improve empirical estimates of causal effects, inform future research designs and data collection, enhance understanding of the complex dynamics that underlie observed temporal patterns, and elucidate causal mechanisms and the contexts in which they operate. These advances in causal understanding can help sustainability scientists develop better theories of phenomena where social and ecological processes are dynamically intertwined and prior causal knowledge and data are limited. The improved causal understanding also enhances governance by helping scientists and practitioners choose among potential interventions, decide when and how the timing of an intervention matters, and anticipate unexpected outcomes. Methodological integration, however, requires skills and efforts of all involved to learn how members of the respective other tradition think and analyze nature-society systems.

The impacts of climate change, energy policy and traditional ecological practices on future firewood availability for Diné (Navajo) People.

Local-scale human-environment relationships are fundamental to energy sovereignty, and in many contexts, Indigenous ecological knowledge (IEK) is integral to such relationships. For example, Tribal leaders in southwestern USA identify firewood harvested from local woodlands as vital. For Diné people, firewood is central to cultural and physical survival and offers a reliable fuel for energy embedded in local ecological systems. However, there are two acute problems: first, climate change-induced drought will diminish local sources of firewood; second, policies aimed at reducing reliance on greenhouse-gas-emitting energy sources may limit alternatives like coal for home use, thereby increasing firewood demand to unsustainable levels. We develop an agent-based model trained with ecological and community-generated ethnographic data to assess the future of firewood availability under varying climate, demand and IEK scenarios. We find that the long-term sustainability of Indigenous firewood harvesting is maximized under low-emissions and low-to-moderate demand scenarios when harvesters adhere to IEK guidance. Results show how Indigenous ecological practices and resulting ecological legacies maintain resilient socio-environmental systems. Insights offered focus on creating energy equity for Indigenous people and broad lessons about how Indigenous knowledge is integral for adapting to climate change. This article is part of the theme issue 'Climate change adaptation needs a science of culture'.

Parental Stress in Families with Children with Early Intervention Needs linked to Socio-Environmental Vulnerability / Estrés Parental en Familias con Niños/as de Necesidades de Atención Temprana ligadas a Vulnerabilidad Socioambiental

Background and objective: Environmental risk factors are associated with a lower capacity to cope with parenting, generating greater stress in the education of children. When faced with social risk factors, mothers of children with special educational needs tend to be more vulnerable to stress. The main aim of this study was to analyse variables associated to the stress perceived by parents of children with early care needs (socio-environmental vulnerability and child’s diagnosis). Method. Four hundred and six parents (233 mothers and 173 fathers) of 239 children with early care (EC) and education needs collaborated in this research. Results. Situations of environmental vulnerability caused high levels of stress in the parents. The experience of stressful events during pregnancy conditioned the later maternal anxiety. A significant positive linear correlation was found between the results achieved in the Overprotective educational style and parental stress. Conclusions. Most interventions in Early Childhood Care and Development Centres focus on the needs of children, leaving parents out of the clinical intervention. This approach should be shifting towards a family-centred model, which will work more effectively and improve the quality of life of the family.(AU)

Antecedentes y objetivos: Factores de riesgo ambiental son asociados a una menor capacidad para afrontar la crianza, generando en la educación de los hijos/as un mayor estrés. Sumidos en factores de riesgo social, las madres de niños/as con necesidades educativas especiales tienden a mostrarse más vulnerables ante el estrés. El objetivo principal de este estudio fue analizar las variables asociadas al estrés percibido por los progenitores de niños/as con necesidades de atención temprana (vulnerabilidad socio-ambiental y diagnóstico del niño). Método. Cuatrocientos seis progenitores (233 madres y 173 padres) de 239 de niños/as con necesidades de Atención Temprana (AT) colaboraron en esta investigación. Resultados. Situaciones de vulnerabilidad ambiental provocaron en las progenitoras elevados niveles de estrés. La vivencia de acontecimientos estresantes durante el embarazo, condicionó la ansiedad materna posterior. Se halló una correlación lineal positiva significativa entre los resultados alcanzados en el estilo educativo Sobreprotector y el Estrés parental. Conclusiones. La mayoría de las intervenciones en los Centros de Atención Temprana y Desarrollo Infantil se centran en las necesidades de los niños, dejando a los padres fuera de la intervención clínica. Este enfoque debería cambiar hacia un modelo centrado en la familia, que funcionará más eficazmente y mejorará la calidad de vida de la familia.(AU)

Patients' satisfaction with heroin-assisted treatment: a qualitative study.

BACKGROUND: Heroin-assisted treatment (HAT) involves supervised dispensing of medical heroin (diacetylmorphine) for people with opioid use disorder. Clinical evidence has demonstrated the effectiveness of HAT, but little is known about the self-reported satisfaction among the patients who receive this treatment. This study presents the first empirical findings about the patients' experiences of, and satisfaction with, HAT in the Norwegian context. METHODS: Qualitative in-depth interviews with 26 patients in HAT were carried out one to two months after their enrollment. Analysis sought to identify the main benefits and challenges that the research participants experienced with this treatment. An inductive thematic analysis was conducted to identify the main areas of benefits and challenges. The benefits were weighed against the challenges in order to assess the participants' overall level of treatment satisfaction. RESULTS: Analysis identified three different areas of experienced benefits and three areas of challenges of being in this treatment. It outlines how the participants' everyday lives are impacted by being in the treatment and how this, respectively, results from the treatment's medical, relational, or configurational dimensions. We found an overall high level of treatment satisfaction among the participants. The identification of experienced challenges reveals factors that reduce satisfaction and thus may hinder treatment retention and positive treatment outcomes. CONCLUSIONS: The study demonstrates a novel approach to qualitatively investigate patients' treatment satisfaction across different treatment dimensions. The findings have implications for clinical practice by pointing out key factors that inhibit and facilitate patients' satisfaction with HAT. The identified importance of the socio-environmental factors and relational aspect of the treatment has further implications for the provision of opioid agonist treatment in general.

COVID-19 pandemic and socio-environmental inequality: A narrative review.

Background and Aims: The COVID-19 pandemic has provided preliminary evidence of the existence of health, social, and environmental inequalities. This inequality encompasses inadequate access to safe water, clean air, and wastewater management, as well as limited socioeconomic and educational opportunities. These issues have not received sufficient attention during the pandemic. The purpose of this narrative review is to provide a comprehensive summary and analysis of the existing literature on a specific topic, ultimately leading to a conclusion based on the evidence presented. Methods: The search methodology for this study involved conducting comprehensive searches of scientific databases, including PubMed, ScienceDirect, LILACS, and Google Scholar, from 2019 to 2023. The study focused on a specific theme and its relevant aspects related to global environmental health and society. Keywords such as COVID-19, inequities, and environmental health were used for searching. Additionally, the Boolean operator "AND" was used to combine these descriptors. Results: Unequal exposure to air pollution has been reported in Africa, as well as in large parts of Asia and Latin America, according to the data that has been obtained. The pandemic has also resulted in a surge in healthcare waste generation, exacerbating the environmental impact of solid waste. Furthermore, there is evidence indicating significant disparities in the severe lack of access to sanitation services between developing nations and low-income regions. The issues related to water availability, accessibility, and quality are subject to debate. It has been reported that SARS-CoV-2 is present not only in untreated/raw water, but also in water bodies that act as reservoirs. Moreover, insufficient education, poverty, and low household income have been identified as the most significant risk factors for COVID-19 infection and mortality. Conclusion: It is evident that addressing socio-environmental inequality and striving to narrow the gap by prioritizing vulnerable populations are imperative.

Built Environment Features Obtained from Google Street View Are Associated with Coronary Artery Disease Prevalence: A Deep-Learning Framework.

Background: Built environment plays an important role in development of cardiovascular disease. Tools to evaluate the built environment using machine vision and informatic approaches has been limited. We sought to investigate the association between machine vision-based built environment and prevalence of cardiometabolic disease in urban cities. Methods: This cross-sectional study used features extracted from Google Street view (GSV) images to measure the built environment and link them with prevalence of cardiometabolic disease. Convolutional neural networks, light gradient boosting machines and activation maps were utilized to predict health outcomes and identify feature associations with coronary heart disease (CHD). The study obtained 0.53 million GSV images covering 789 census tracts in 7 cities (Cleveland, OH; Fremont, CA; Kansas City, MO; Detroit, MI; Bellevue, WA; Brownsville, TX; and Denver, CO). Analyses were conducted from February 2022 to December 2022. We used census tract-level data from the Centers for Disease Control and Prevention's PLACES dataset. Main outcomes included census tract-level estimated prevalence of CHD based on GSV built environment features. Results: Built environment features extracted from GSV using deep learning predicted 63% of the census tract variation in CHD prevalence. The ExtraTrees Regressor achieved the best result among all models with the lowest average mean absolute error of 1.11% and Root mean square of error of 1.58. The addition of GSV features outperformed and improved a model that only included census-tract level age, sex, race, income and education. Activation maps from the features revealed a set of neighborhood features represented by buildings and roads associated with CHD prevalence. Conclusions: In this cross-sectional study, a significant portion of CHD prevalence were explained by GSV-based built environment factors analyzed using deep learning, independent of census tract demographics. Machine vision enabled assessment of the built environment could help play a significant role in designing and improving heart-heathy cities.

Cartografías socioambientales. Acercamiento a las percepciones sobre la salud y la vida en territorios mineros del occidente antioqueño colombiano

Objetivo: La investigación que aquí se reporta tuvo como objetivo comprender aspectos de la percepción que tienen algunos habitantes de tres municipios del occidente del departamento de Antioquia (Colombia) sobre la minería y su relación con dimensiones vitales como la salud. Metodología: Este estudio comprensivo se fundamentó en principios de la investigación acción participativa y se llevó a cabo mediante un ejercicio cartográfico socioambiental. Se conformaron tres grupos de base comunitaria con actores locales, con quienes se realizaron entrevistas, recorridos por los territorios, definición de conceptos y símbolos, y el mapeo territorial. La información fue analizada siguiendo procesos de codificación abierta, axial y selectiva, tras lo cual se validó con la comunidad. Resultados: Se identificaron conflictos territoriales, afectaciones sobre la salud de las poblaciones involucradas y del medio ambiente, así como lógicas sociales, políticas y económicas que se tejen alrededor de la actividad minera. Conclusión: La minería de hecho se constituye en una de las principales vías de sustento de algunos participantes, no solo como tradición, sino también ante la carencia de oportunidades para el desarrollo de otros oficios; sin embargo, debido al ingreso de la gran minería en algunos territorios, se perciben amenazados los medios de vida, la seguridad y la soberanía alimentaria, la cultura, los derechos territoriales y la salud poblacional. Cabe destacar la relevancia de efectuar abordajes de la salud desde una matriz de análisis que considere los fenómenos sociales determinantes del proceso salud-enfermedad-cuidado, los sujetos en situación y las relaciones socioterritoriales que construyen en su cotidianidad.

Objective: The research reported here aimed to understand aspects of the perception that some inhabitants of three municipalities in the western department of Antioquia (Colombia) have about mining and its relationship with vital dimensions such as health. Methodology: This comprehensive study was based on principles of participatory action research and was carried out through a socio-environmental mapping exercise. Three community-based groups were formed with local actors, with whom interviews, tours of the territories, definition of concepts and symbols, and territorial mapping were carried out. The information was analyzed following open, axial and selective coding processes, after which it was validated with the community. Results: Territorial conflicts were identified, effects on the health of the populations involved and the environment, as well as social, political and economic logics that are woven around mining activity. Conclusion: Mining in fact constitutes one of the main means of livelihood for some participants, not only as a tradition, but also due to the lack of opportunities for the development of other trades; however, due to the entry of large-scale mining in some territories, livelihoods, food security and sovereignty, culture, territorial rights and population health are perceived as threatened. It is important to highlight the relevance of carrying out health approaches from an analysis matrix that considers the social phenomena that determine the health-disease-care process, the subjects in a situation, and the socio-territorial relationships that they build in their daily lives.

Objetivo: A pesquisa aqui relatada teve como objetivo compreender aspectos da percepção que alguns habitantes de três municípios do departamento ocidental de Antioquia (Colômbia) têm sobre a mineração e sua relação com dimensões vitais como a saúde. Metodologia: Este estudo abrangente foi baseado nos princípios da pesquisa-ação participativa e foi realizado por meio de um exercício de mapeamento socioambiental. Foram formados três grupos comunitários com atores locais, com os quais foram realizadas entrevistas, passeios pelos territórios, definição de conceitos e símbolos e mapeamento territorial. A informação foi analisada seguindo processos de codificação aberta, axial e seletiva, após o que foi validada com a comunidade. Resultados: Foram identificados conflitos territoriais, efeitos na saúde das populações envolvidas e no meio ambiente, bem como lógicas sociais, políticas e econômicas que se tecem em torno da atividade mineradora. Conclusão: A mineração constitui de fato um dos principais meios de subsistência para alguns participantes, não apenas por tradição, mas também pela falta de oportunidades para o desenvolvimento de outros ofícios; no entanto, devido à entrada da mineração em grande escala em alguns territórios, os meios de subsistência, a segurança e soberania alimentar, a cultura, os direitos territoriais e a saúde da população são percebidos como ameaçados. É importante destacar a relevância de realizar abordagens em saúde a partir de uma matriz de análise que considere os fenômenos sociais que determinam o processo saúde-doença-cuidado, os sujeitos em situação e as relações socioterritoriais que constroem em seu cotidiano.