Personalized Lifestyle Intervention and Functional Evaluation Health Outcomes SurvEy: Presentation of the LIFEHOUSE Study Using N-of-One Tent–Umbrella–Bucket Design

The working definition of health is often the simple absence of diagnosed disease. This common standard is limiting given that changes in functional health status represent early warning signs of impending health declines. Longitudinal assessment of functional health status may foster prevention of disease occurrence and modify disease progression. The LIFEHOUSE (Lifestyle Intervention and Functional Evaluation-Health Outcomes SurvEy) longitudinal research project explores the impact of personalized lifestyle medicine approaches on functional health determinants. Utilizing an adaptive tent–umbrella–bucket design, the LIFEHOUSE study follows the functional health outcomes of adult participants recruited from a self-insured employee population. Participants were each allocated to the tent of an all-inclusive N-of-one case series. After assessing medical history, nutritional physical exam, baseline functional status (utilizing validated tools to measure metabolic, physical, cognitive, emotional and behavioral functional capacity), serum biomarkers, and genomic and microbiome markers, participants were assigned to applicable umbrellas and buckets. Personalized health programs were developed and implemented using systems biology formalism and functional medicine clinical approaches. The comprehensive database (currently 369 analyzable participants) will yield novel interdisciplinary big-health data and facilitate topological analyses focusing on the interactome among each participant’s genomics, microbiome, diet, lifestyle and environment.

Epidemiologic Trends, Social Determinants, and Brain Health: The Role of Life Course Inequalities

Brain health as expressed in our mental health and occurrence of specific disorders such as dementia and stroke is vitally important to quality of life, functional independence, and risk of institutionalization. Maintaining brain health is, therefore, a societal imperative, and public health challenge, from prevention of acquisition of brain disorders, through protection and risk reduction to supporting those with such disorders through effective societal and system approaches. To identify possible mechanisms that explain the differential effect of potentially modifiable risk factors, and factors that may mitigate risk, a life course approach is needed. This is key to understanding how poor health can accumulate from the earliest life stages. It also allows us to integrate and investigate key material, behavioral, and psychological factors that generate health inequalities within and across communities and societies. This review provides a narrative on how brain health is intimately linked to wider health determinants, thus importance for clinicians and societies alike. There is compelling evidence accumulated from research over decades that socioeconomic status, higher education, and healthy lifestyle extend life and compress major morbidities into later life. Brain health is part of this, but collective action has been limited, partly because of the separation of disciplines and focus on highly reductionist approaches in that clinicians and associated research have focused more on mitigation and early detection of specific diseases. However, clinicians could be part of the drive for better brain health for all society to support life courses that have more protection and less risk. There is evidence of change in such risks for conditions such as stroke and dementia across generations. The evidence points to the importance of starting with parental health and life course inequalities as a central focus.

Evaluation of the Implemented and Adopted Curriculum in Health Education in the Czech Republic with an Emphasis on the Drinking Regimen

According to the Framework Education Programme for Elementary Education in the Czech Republic, part of Health Education is nutrition and food intake, including the drinking regimen. This paper’s objective is to analyse that using the results of two extensive curricular studies performed at the Faculty of Education, Palacký University Olomouc. Both studies used data from representative samples of pupils in grade nine from elementary schools in the Czech Republic. The research instruments were designed according to applicable documents of the state-level implemented curriculum and showed good reliability. The results of the subjective evaluation of the implemented curriculum in health education suggest that in the area ‘healthy lifestyle and health care’, the subtopic ‘nutrition and health – healthy diet principles, drinking regimen, eating disorders’ was most dominant. The testing of the level of the adopted curriculum regarding fluid intake revealed a problematic level of pupils’ knowledge (the average percentage of task achievement was around 46%). Conclusions and recommendations for practice: nutrition and food intake (including the drinking regimen) is a very important topic in health education in elementary education in the Czech Republic, which is consistent with other research studies. However, the cognitive dimension of the pupils’ curriculum is inadequate. Qualitatively and quantitatively, the recommended drinking regimen may support natural health determinants, while an inappropriate or insufficient regimen may result in medical complications. The issue of adequate nutrition and diet and drinking regime must be taught by professionally and didactically competent teachers. Students should not only be taught cognitively, but their affective and behavioural abilities should also be formed.

The Implications of Informal Settlement Upgrading Programs for Access to Water, Sanitation, and Public Health

Most cities in low- and middle-income countries have substantial proportions of their population living in informal settlements—sometimes up to 60% or more. These also house much of the city’s low-income workforce; many informal settlements also concentrate informal economic activities. These settlements usually lack good provision for water, sanitation, and other essential services. The conventional government responses were to bulldoze them or ignore them. But from the 1960s, another approach became common—upgrading settlements to provide missing infrastructure (e.g., water pipes, sewers, drains). In the last 20 years, community-driven upgrading has become increasingly common. Upgrading initiatives are very diverse. At their best, they produce high-quality and healthy living conditions and services that would be expected to greatly reduce illness, injury or disablement, and premature death. But at their worst, upgrading schemes provide a limited range of improvements do nothing to reduce the inhabitants’ exclusion from public services. There is surprisingly little research on upgrading’s impact on health. One reason is the very large number of health determinants at play. Another is the lack of data on informal settlement populations. Much of the innovation in upgrading is in partnerships between local governments and organizations formed by informal settlement residents, including slum/shack dweller federations that are active in over 30 nations. Community-driven processes can deal with issues that are more difficult for professionals to resolve—including mapping and enumerations. Meanwhile, local government can provide the connections to all-weather roads, water mains, sewers, and storm drains into which communities can connect.

Crosstalk between circadian rhythms, sleep and eating habits to improve public health

Lifestyle changes in the past few decades have resulted in irregularity in sleep and meal timings. People are taking less sleep and resorting more to unhealthy food and eating habits. These factors are the most important health determinants. Sleep, food choices and eating habits are closely associated with each other. Thus, the crosstalk between circadian rhythms, sleep, and food needs urgent attention and discussion for better health management. Various research studies indicate that a healthy trend in sleep augments the regularity in meal timings and good eating habits. Healthy food and eating habits, in turn, boost sleep quality. Deterioration in the quality of anyone adversely affects the other. Several health disorders like obesity, diabetes, cancer, cardiovascular problems, and low immunity can be linked to these disturbances. The present review considers several previous studies to point out the inter-relationship between sleep and eating habits and the various health disorders arising from poor attention. Poor sleep promotes the tendency to eat junk food or eat at odd times, such as snacking late at night, leading to weight gain and other health problems. Junk food and unhealthy eating habits cause sleep disturbances. This inter-relationship of sleep and food preferences is important as it can have important treatment implications for health disorders arising due to these modifiable behavioural factors. Circadian alignment, improvements in sleep timings, and healthy eating habits have positive effects on other health behaviours as well.

Development and Assessment of a Brazilian Pilot Massive Open Online Course in Planetary Health Education: An Innovative Model for Primary Care Professionals and Community Training

Introduction: Planetary health (PH) has emerged as a leading field for raising awareness, debating, and finding solutions for the health impacts of human-caused disruptions to Earth's natural systems. PH education addresses essential questions of how humanity inhabits Earth, and how humans affect, and are affected by, natural systems. A pilot massive open online course (MOOC) in PH was created in Brazil in 2020. This MOOC capitalized on the global online pivot, to make the course accessible to a broader audience. This study describes the process of course creation and development and assesses the impact evaluation data and student outcomes of the PH MOOC.Methods: The PH MOOC pilot was launched in Brazilian Portuguese, using the TelessaúdeRS-UFRGS platform on 4/27/2020 and concluded on 7/19/2020 with a total load of 80 h. It was composed of 8 content modules, pre and post-test, 10 topics in a forum discussion, and an optional action plan. This study analyzes the course database, profile of participants, answers to questionnaires, forum interaction, and action plans submitted.Results: Two thousand seven hundred seventy-seven participants enrolled in the course, of which 1,237 (44.54%) gave informed consent for this study. Of the 1,237 participants who agreed to participate in the research, 614 (49.8%) completed the course, and 569 (92.67%) were accredited by TelessaúdeRS-UFRGS. The majority of the participants were concerned with climate change, trained in the health area, and worked in primary health care in places that lacked ongoing sustainability programs. Two hundred forty-one action plans were submitted, major topics identified were food and nutrition, infectious diseases, and garbage and recycling.Discussion: The use of the PH lens and open perspective of the course centered the need to communicate planetary health topics to individuals. The local plans reflected the motto of “think global and act local.” Brazil presents a context of an unprecedented social, political, and environmental crisis, with massive deforestation, extensive fires, and biomass burning altering the biomes, on top of an ongoing necropolitical infodemic and COVID-19 pandemic. In the face of these multiple challenges, this MOOC offers a timely resource for health professionals and communities, encouraging them to address planetary challenges as fundamental health determinants.

The Effect of a School Backpack Mass Back Carried on the Features of Body Posture in the Frontal Plane of 7-year-old Students of Both Sexes

BackgroundThe lifestyle of children has a significant impact on the future health of the whole society. Therefore, health education, prevention and monitoring of health determinants is important at every stage of ontogenesis. This requires a thorough knowledge of the schoolchild's environment, perceived as a wide set of stressors, including not only genetic but also epigenetic factors. One of them is the issue of the correct and abnormal body posture at school and on the way there.MethodBody posture tests were carried out in a group of 65 students aged 7 years, using the projection moiré method in 4 positions: 1-habitual posture, 2-posture after 10-minute of asymmetric axial load, 3-a posture after one minute of the load removal, 4- a posture after two minutes of the load removal. Physical fitness was measured with the Sekita test. ResultsThe significance of differences between the 1st and 2nd measurements was analyzed to determine the impact of the backpack load and the correlation with physical fitness, and to study its influence on the value of the differences in posture features. ConclusionsCarrying school supplies on the back induces significant changes in the value of the features describing the body posture in the frontal plane. It should be assumed that the greater the weight of the container and, carrying time and intensity of physical effort is the greater the changes will be. Relatedly, it is not recommended to carry school supplies weighing more than 4 kg by first-grade students.Physical fitness has a various and sex-dependent influence on the value of changes in body posture features because of carrying school supplies. Among boys it significantly affects the asymmetry of the torso bend, shoulder height, the waist triangles height and width, whereas among girls it affects the asymmetry of the shoulders and the distance of the angles of the lower shoulder blades from the line of the spinous processes of the spine. Among boys the changes in the value of posture features are mostly influenced by endurance and speed, but strength, power and agility are of lower influence, whereas among girls only agility matters.

Rationing of Nursing Care on Example of Selected Health Care Facility

Contemporary health determinants require nurses to develop new competencies and skills while performing complex tasks in all forms of health care. The problem of rationing of care is present all over the world and usually occurs when available resources are too low to provide adequate care to all patients. The most common reasons for loss of care are shortages of nurses, use of modern treatment methods, increased demand for care by a large number of patients, and greater knowledge of patients about their rights. A questionnaire survey was conducted among 295 nurses employed in hospital wards. The survey was conducted from September to December 2020 using the standardized BERNCA (The Basel Extent of Rationing of Nursing Care) questionnaire to measure the level of rationing of nursing care. The research was hampered by the sanitation regime associated with the SARS CoV-2 pandemic. Nursing care rationing is dependent on seniority and place of work. The mean total BERNCA score of the degree of rationing of nursing care was 2.58 ± 0.96 on a scale of 0 to 4 (where 0 means “no need for it” and 4 means “often”. The median score was 2.69. The higher frequency of rationing nursing care was characteristic of those working on surgical wards. The mean score obtained by them was 2.72 ± 0.86, with the median equal to 2.88. In the case of nurses employed in non-surgical wards, the scores were 2.08 ± 1.07 and 2.28, respectively. Rationing of nursing care is dependent on seniority and work location, with a higher degree of rationing of care occurring in surgical units.

The Health Determinants of Accessibility to Clubfoot Treatment in LMICs: A Global Exploration of Barriers and Solutions

Background: Clubfoot or Congenital Talipes Equinovarus (CTEV) treatment in newborn infants involves simple, non-invasive manipulation and is primarily managed non-surgically if identified early. In low- and middle-income countries (LMICs), less than 15% of patients with CTEV access treatment. This cross-sectional questionnaire study conducted descriptive and regression analysis of institutional reasons for CTEV management in LMICs. Methods: A cross-sectional study was undertaken of 1,489 medical institutions in 62 LMICs. Data were evaluated from the “World Health Organization Situation Analysis tool” database. We analyzed characteristics of institutions that manage and did not manage CTEV. With the use of a multivariate linear regression model, we identified a set of factors linked to referral for non-management of CTEV. Results: A total of 72.7% (1,083/1,395) of institutions surveyed did not manage CTEV. The most common reason cited for not managing CTEV was a lack of sufficient skills, 92.1% (668/725, P<0.001). A total of 39.4% (286/725) of institutions also cited a lack of functioning equipment as a reason. Multivariate linear regression analysis showed lack of training, lack of supplies, and lack of functioning equipment were most closely related to non-management of CTEV. Conclusion and Global Health Implications: We identified that failure to manage CTEV may result from a lack of skills and medical equipment. Increasing the capacity of sustainable training programs may reduce the presently available skill deficit in treating CTEV in LMICs and provide improved health outcomes for those with CTEV. While considerable progress has been made in building capacity for the treatment and management of CTEV in LMICs, structured training programs that support conservative manipulative methods to manage CTEV should be initiated globally. Copyright © 2021 Sheik-Ali et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.